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LIPPINCOTT’S 
QUICK  REFERENCE  BOOK 

FOR 

MEDICINE  AND  SURGERY 


ANATOMY  OF  THE 
HUMAN  BODY 


ANATOMY  OF  THE  HUMAN  BODY 


Plates  A &:C.-THE  BONES. 

THE  MUSCLES 

N?  1 

Vertebrasoftheneckorcervical  (7)  \ 

( Continued > 

2 

Dorsal  or  thoracic  vertebras 

112) 

M 

Infraspinatus 

C 

3 

lumbar  vertebrae  (5) 

44 

Teres  minor 

C 

Sacral  vertebras  or  Sacr  um 

45 

Teres  major 

c 

Back 

5 

Coccygeal  vertebras  or  Coccy 

X 

46 

Rhomboideus  major 

c 

«. 

Clavt'cles  (2) 

The 

Trunh 

47 

Latissimus  dorsi 

c 

7 

Scapulae  (2) 

48 

Sacro-spinalis 

c 

i' 

Ribs  02) 

3 

Sternum 

49 

Biceps 

A 

JO 

ri 

Pelvis, made  up  of  thefollowing 
Ilium 

oarts : 

50 

51 

Tendon  of  biceps 
Triceps 

A 

A 

Arm 

12 

Pubis 

52 

Brachialis  anticus 

A 

53 

Ischium 

S3 

Pronator  radii  teres 

{% 

Hu  meru  s 

Arm 

54 

Supinator  longus 

A 

55 

Flexor  sublimis  digitorum 

A 

15 

Ulna 

Fore  - 

56 

Palmaris  longus 

A 

;e 

Olecranon 

-Arm 

57 

Extensor  carpi  radialis  longlor 

C 

57 

Rati  i u s 

58 

» » o brevier 

C 

i Fore- 

59 

. • communis  digitorum 

C 

/ -Arm 

le 

Carpus  ; Scaphoid 

60 

» minimi  digit! 

' C 

52i 

.>  Semilunar 

61 

» carpi  ulnaris 

C 

' 

„ Pyramidal  OP  cuneifc 

rm 

62 

Flexor  carpi  ulnaris 

A C 

21 

Pisiform 

Wrist 

63 

Extensor  brevis  pollicis 

C 

•22 

..  Unciform 

64 

» longus  pollicis 

c 

23 

» Os  magnum 

65 

Palmar  fascia- aponeurotic 

'is 

•»  Trapezoid 

/ 

expansion  of  palmaris  brevis 

25 

.1  Trapezium 

66 

Abductor  pollicis 

Wrist 

67 

Palmaris  brevis 

’ and 
Hand 

25 

Melacarpals  (5i 

68 

Flexorbrevis  minimi  digiti 

21 

First  phalanges  (5) 

. Hand 

69 

Abductor  minimi  digiti 

28 

Second  „ (4)  < 

70 

Dorsal  interossei 

2S 

Third  .1  (5) 

71 

Annular  ligament 

30 

Fe  mu  r 

72 

Tensor  of  the  fascia  lata 

^'1 

37 

» great  trochanter 

• 

Thigh 

73 

Vastus  externus 

A 

2-2 

. n small  trochanter 

74 

Rectus  femoris 

A 

75 

Vastus  internus 

A 

Pjales  A,  B £c C.  _ THE 

MUSCLES. 

76 

Sartorius 

A 

2^ 

Sterno-cleido -mastoid 

A 

77 

11  iacus 

A B 

Sterno- hyoid 

A 

Neck 

78 

Psoas 

A B 

35 

Omo- hyoid 

A 

79 

Pectin  eus 

A B 

Lower 

3i 

Scalenus  anticus 

A 

80 

Adductor  longus 

A B 

Abdomen 

Neck , 
Shoulder 

81 

Gracilis 

A B 

/ and 

5*“ 

Trapezius 

AC 

82 

Gluteus  maximus 

C 

Chest 

83 

Biceps 

C 

3t 

Becloralis  m^or 

A 

Shoulder 

84 

Semitendinosis 

C 

Deltoid 

A C 

Chest 

85 

Semimembranosis 

C 

86 

Diaphragm 

B 

Vii 

Serratus  magnus 

A 

87 

Quadralus  lumborum 

B 

mil 

External  oblique 

A 

[Abdomen 

88 

Intercostals 

B / 

Rectus  abdominis 

A 

MAURICE  DESSERTENNE  . del. 


Plate  B _ RESPIRATORY 

HEART.  CIRCULATION. KIDNEYS. 

and  VOCAL  APPARATUS. 

URETER 

1 Continued ) 

N"89 

Thyroid  muscles 

N“I22 

Mesenteric  veins 

90 

Larynx 

Neck 

123 

Common  iliac  veins 

91 

Thyroid  gland 

124 

Internal  iliac  veins 

92 

Trachea 

125 

External  iliac  veins 

/ 

126 

Cephalic  vein 

\ 

93 

Bronchi  and  bronchioles 

Thorax 

127 

Basilic  vein 

94 

Lung 

128 

Median  cephalic  vein 

129 

Median  basilic  vein 

Plate  B _ HEART, CIRCULATION, 

130 

Ulnar  vein 

Arm 

KIDNEYS.  URETER. 

131 

Radial  vein 

V Fore -Arm 

Suprarenal  glands. 

132 

Lymphatics 

Hand 

95 

Heartand  coronary  arteries  v 

133 

Brachial  artery 

96 

Auricle 

134 

Radial  artery 

97 

Pulmonary  arteryand  its  branches 

135 

Ulnar  artery 

98 

Aorta 

136 

Palmar  arch 

99 

Superior  vena  cava 

100 

External  jugular  vein 

Plate  B _ DIGESTIVE  APPARATUS, 

101 

Internal  » » 

SPLEEN  8:  BLADDER 

102 

Innominate  artery 

137 

Pharynx 

103 

Subclavian  • 

138 

Oesophagus 

104 

Common  carotid  artery 

139 

Stomach 

105 

Pulmonary  veins 

140 

Small  intestines  : 

duodenum 

106 

Inferior  vena  cava 

141 

; 

jejunum 

107 

Pericardium 

142 

» » : 

ileum 

108 

Thoracic  duct 

143 

Large  „ ; 

cecum  and  appendix 

109 

Coeliac  axis 

Thorax 

144 

» it 

ascending  , transverse 

no 

Superior  mesenteric  artery 

) and 

and  descending  colon 

111 

Renal  artery 

Abdomen 

145 

; 

rectum 

112 

Spermatic  artery 

146 

Bladder 

113 

Inferior  mesenteric  artery 

147 

Liver 

114 

Common  iliac  artery 

148 

Gail  bladder 

115 

Internal  iliac  artery 

149 

Cystic  duct 

116 

External  iliac  artery 

150 

Hepatic  duct 

117 

Kidneys 

151 

Portal  duct 

118 

Suprarenal  glands 

152 

Hepatic  artery 

119 

Ureters 

153 

Pancreas 

IZO 

Renal  veins 

154 

Spleen 

121 

Hepatic  veins 

PI.  B 


PI.  c 


LIPPINCOTT’S 

QUICK  REFERENCE  BOOK 

FOR 

MEDICINE  AND  SURGERY 


A CLINICAL,  DIAGNOSTIC  AND  THERAPEUTIC 
DIGEST  OF  GENERAL  MEDICINE,  SURGERY 
AND  THE  SPECIALTIES,  CULLED  EXTENSIVELY 
AND  INTENSIVELY  FROM  MODERN  LITERA- 
TURE, AND  SYSTEMATIZED 


BY 

GEORGE  E.  REHBERGER,  A.B.,  M.D. 

(JOHNS  HOPKINS  university) 


PHILADELPHIA  AND  LONDON 
J.  B.  LIPPINCOTT  COMPANY 


COPYRIGHT,  1920 
J.  B.  LIPPINCOTT  COMPANY 


Electrotyped  and  Printed  by  J.  B.  Lippincott  Company 
The  IVarhington  Square  Press,  Philadelphia,  U.  S.  .d. 


Cl  - 5 


PREFACE 

This  book  consists  of  eleven  parts,  dealing  respectively  with  (1)  General  Medicine 
and  Surgery,  including  Neurology  and  the  Diseases  of  Infancy  and  Childhood;  (2)  Gyne- 
cology; (3)  Genito-Urinary  Diseases;  (4)  Obstetrics;  (5)  Skin  Diseases;  (6)  Diseases 
of  the  Eye;  (7)  Diseases  of  the  Ear;  (8)  Diseases  of  the  Nose;  (9)  Diseases  of  the  Throat; 
(10)  Orthopaedics,  including  Fractures  and  Dislocations;  and  (11)  Drugs,  the  whole  field, 
indeed,  of  Practical  Medicine,  excepting  Psychiatry. 

Each  disease  or  disorder  is  treated  alphabetically.  First  is  given  a distinguishing,  or 
diagnostic,  definition,  or  description,  of  the  affection,  with  pictures  wherever  these  are 
useful.  Diagnostic  laboratory  tests  are  supplied  where  required.  Next  comes  a full  enumer- 
ation of  the  causes  of  the  Disease;  then  its  prognosis,  or  its  expected  duration  and  final 
outcome.  Finally  treatment  is  given  as  concisely,  explicitly  and  completely  as  possible 
(except,  as  a rule,  for  operative  technic)  so  as  to  obviate  the  necessity  of  referring  to  other 
works  for  elucidations,  technic,  dosage  of  drugs,  formulae,  etc.  In  addition  quarantine  and 
prophylactic  measures  are  considered  where  indicated. 

Part  Eleven  contains  an  alphabetical  list  of  all  the  drugs  mentioned  in  the  body  of  the 
work,  with  the  nature,  or  constitution,  of  each  drug;  its  solubility;  the  dosage  at  different 
ages;  mode  of  administration;  pharmacological  action,  and  toxic  effects. 

To  complete  each  part  an  appendix  is  given  containing  a scheme  for  the  history  and 
examination  of  the  patient,  the  equipment,  or  armamentarium,  required  in  the  specialty 
with  which  the  part  deals,  and  a list  of  the  drugs  mentioned  in  the  text. 

Each  affection  in  the  text  has  been  carefully  gone  over,  and  all  instruments  and  drugs, 
required  for  its  proper  treatment,  have  been  catalogued,  as  an  adequate  equipment  is,  of 
course,  a prime  requisite  to  efficiency  and  self-confidence. 

I have  undertaken  this  work  because  it  has  not  been  done  before,  and  because  I believe 
it  will  fill  a very  great  need.  I have  aimed  to  accomplish  a critical  sifting  of  the  important 
modern  literature,  a selection  of  all  that  is  useful  and  needful  in  bedside  therapeutics,  and  a 
rearrangement  of  this  mass  of  knowledge  for  purposes  of  quick  reference  and  individual  com- 
pleteness of  treatment  of  each  subject,  making  it  immediately  available  for  practical  needs. 

I claim  nothing  as  my  own  in  this  work  except  the  plan,  or  system,  the  selective  judg- 
ment employed  and  the  great  labor  involved.  It  is  a compilation,  culled  from  modern 
medical  teaching,  and  colored  by  the  varied  experience  of  one  who  has  been  an  isolated 
country  doctor,  and  feels  that  he  knows  the  needs  of  the  general  practitioner  who  is  con- 
fronted with  disease  in  all  its  manifestations,  and  should  be  of  broad  and  thorough  education. 

When  consulting  any  single  authority,  one  is  often  disappointed  by  the  lack  of  certain 
important  information,  which  may,  on  further  search,  be  found  in  another  work.  The 
physician  would  like  to  consult  many  authorities,  but  has  not  the  means,  or  the  time,  at 
his  disposal.  I have  endeavored  to  do  for  him  here,  what  he  would  like  to  do  for  himself 
had  he  the  facilities. 

In  writing  up  each  disease  I have  kept  constantly  in  mind  the  needs  of  the  practitioner, 
the  necessities  of  whose  situation  demand  that  he  should  be  well  equipped  to  meet  all 
emergencies,  and  that  he  should  be  self-reliant  and  a master  of  detail.  I have  put  myself 
in  his  place  when  he  is  actually  confronted  with  a patient  having  the  disease,  disorder,  or 
symptom  under  consideration.  A careful  history  and  examination  completed,  and  a diag- 
nosis arrived  at,  what  should  be  done  to  cure,  or  to  relieve,  the  patient,  and  if  the  disease  is 
contagious  or  mfectious,  what  should  be  done  for  the  safety  of  society? 


V 


PREFACE 


First  of  all  what  is  the  cause  of  the  ill  health?  To  assist  the  physician  in  this  inquiry 
there  are  enumerated  all  the  possible  causes  which  I could  assemble  from  many  sources  of 
information.  The  cause  removed,  if  possible,  be  it  an  operable  lesion,  or  an  injurious 
habit,  or  bad  hygiene,  etc.,  the  attention  is  directed  to  restoring  normal  conditions  of  health 
{i.e.,  normal  functioning  of  the  various  organs);  and  here  I aim  to  consider  each  measure  of 
treatment  in  the  order  in  which  it  must,  ordinarily,  be  employed,  and  to  describe  the  technic 
of  its  performance,  always  endeavoring  to  be  explicit,  thorough  and  rational,  and  sedulously 
to  avoid  vagueness,  incompleteness,  and,  if  possible,  empiricism. 

I have  devoted  serious  and  painstaking  care  to  make  this  work  as  thorough  and  reliable 
as  my  finite  capacity  for  labor  would  permit.  In  presenting  it  to  my  fellow-practitioners, 
I trust  that  it  will  be  as  useful  to  them  as  it  is  to  me. 


George  E.  Rehberger,  A.B.,  M.D. 


ABDOMEN 


The  left  lung  ishooked 
up  30  that  the  heart 
may  be  seen 


FRONT  VIEW 


Larynx 
Thyroid  Gland 
Clavicle 


Carotid  artery 
Jugular  vein 


feritoneui 


Diaphragi 


Suprarenal 

capsule 

Spleen  - 


Suspensory 
ligament 
of  the  liver 


Liver^ 


Rightkidney 

Large 

intestines 

Small 

1 Intestines 


Gall  \\ 
bladder'  \ 

Stomach 

Ascending 

colon 


Transverse 

colon 


Left  kidne; 

Large 

intestines 


|1|  Peritoneum 

Descending 
/;  1 colon 


Small 

intestine'i 


Coecum 


Pelvis 

Small 

intestines 


Rectum 


Bladder 


The  rfbs  have  been  cut 
away  and  the  lung 
hooked  up  30  as  to 
reveal  Ihe  heart. 


Thediaphragm  is  hooked 
up  1 n order  that  the 
liver  maybe  seen 

Cervical 
vertebrae  \ 


RIGHT  SIDE 


Trachea 


Intercostal 

muscle 


(Esophagus 


Perica  odium 


Sternu  m 


Heart 


Dorsal 

vertebrae 


Stomach 


Liver 


Diaphragm 


Large 

intestines 


Gall 

bladder 


Ascending 

colon 


Vertebrae 


Right  kidney — 

Lumbar 

ventebr® 


Small 
mtesti  nes 


Small 
i ntesti  nes^ 


-Peritoneum 


Rectu  m 


Ureter 


Coccyx 


Bladder 


Bladder 


LAROUSSE  MEDICAL 


Viscera  of  the  Abdomen  and  Thorax 


TABLE  OF  CONTENTS 


PART  1. 

GENERAL  MEDICINE  AND  SURGERY,  INCLUDING  NERVOUS  AND 
CHILDREN’S  DISEASES. 

PART  2. 

GYNECOLOGY. 


PART  3. 

GENITO-URINARY  DISEASES. 


PART  4. 

OBSTETRICS. 


PART  5. 

SKIN  DISEASES. 


PART  6. 

EYE  DISEASES. 


PART  7. 

EAR  DISEASES. 


PART  8. 

NOSE  DISEASES. 


PART  9. 

THROAT  DISEASES. 


PART  10. 

ORTHOPEDICS. 


PART  11. 

ALPHABETICAL  LIST  OF  DRUGS,  WITH  THEIR  DOSAGE,  METHOD  OF 
ADMINISTRATION,  PHYSIOLOGIC  AND  TOXIC  ACTION,  AND  USES. 


PHARMACOLOGIC  INDEX. 

EQUIVALENTS  OF  METRIC  AND  APOTHECARIES’  WEIGHTS  AND 
MEASURES. 


K ' 


i 


I 


' \ 


Ait 


r 'J 


/ 


* 


r 


1 


rr\  ■ • 


1 


r' 


/■l 

I 


4 

1 


MUSCLES 


SuperficLal  muscles 


LIPPINCOTT’S 

QUICK  REFERENCE  BOOK 

A CLINICAL,  DIAGNOSTIC  AND  THERAPEUTIC 
DIGEST  OF  GENERAL  MEDICINE, 
SURGERY  AND  THE  SPECIALTIES 

PART  I 

GENERAL  MEDICINE  AND  SURGERY,  INCLUDING  NERVOUS  AND 

CHILDREN’S  DISEASES. 


Abasia. — See  Astasia-Abasia. 

Abdominal  Pain. — See  Pain. 

Abducens  Nerve.— See  Motor  Nerves  of 
the  Eyeball. 

Abscess. — L.  absces'sus,  a going  apart. — 
See  Infection,  Local. 

.Alveolar. — See  Alveolar  Abscess. 
Amoebic,  of  the  Liver. — See  Liver 
Abscess. 

Brain. — See  Brain  Abscess. 

Brodie’s. — See  Osteomyelitis. 

Hand. — See  Hand  Infections. 

Hepatic. — See  Liver  Abscess. 
Ischiorectal. — See  Ischiorectal  Abscess. 
Kidney. — See  Pyelonephritis. 

Liver. — See  Liver  Abscess. 

Lung. — See  Pulmonary  Abscess. 
Mediastinal. — See  Mediastinitis. 
Muscle. — See  Myositis. 

Nephritic. — See  Pyelonephritis. 

Palmar. — See  Hand  Infections. 
Perinephric. — See  Perinephric  Abscess. 
Peritonsillar. — See  Peritonsillar  Ab- 
scess, in  Throat  Diseases,  Part  9. 
Renal. — See  Pyelonephritis. 
Retro=oesophageal. — See  Retro-oeso- 

phageal Abscess. 

Retro=peritoneal. — See  Retro -perito- 
neal Abscess. 

Retro=pharyngeal. — See  Retro-pharyn- 
geal Abscess. 

Splenic. — See  Splenic  Abscess. 
Subdiaphragmatic. — See  Subdiaphrag- 
matic  Abscess. 

Subphrenic. — See  Subdiaphragmatic 

Abscess. 

Tropical. — See  Liver  Abscess. 
Achlorhydria. — See  Anacidity. 

Acholic  Stools. — Gr.  a priv.  -f-  x»^  bile. 
See  Colorless  Stools. 


Acholuric  Jaundice. — Gr.  a priv.  -f  xokTj 
bile  + oupiio  urine.  See  Jaundice  and 
Splenomegaly. 

Achondroplasia. — Gr.  a priv.  -f-  xovr^po? 
cartilage  + nkatraeiv  to  form.  Synonyms: 
Congenital  or  Foetal  Rickets;  Chondro- 
dystrophia  Foetalis,  dvi  ill  + rpeipetv 
to  nourish;  Micromelia,  piKpos  small  -p 
peXos  limb. 

A rare  foetal  and  infantile  disease  of  un- 
known etiology,  in  which  there  is  arrest  of 
growth  and  premature  union  of  the  epiphy- 
sial cartilages  of  the  long  bones.  The  diag- 
nostic features  are : shortness  of  the  extremi- 
ties, but  normal  growth  of  the  head  and 
trunk,  which  appear  disproportionately 
large;  fingers  and  toes  respectively  of  about 
equal  length;  nose  retracted.  The  few  that 
survive  this  affection  are  dwarfs. 

Treatment — Employ  (of  course  only  in  the 
formative  stage  in  infants)  careful  feeding 
(see  Infant  Feeding),  daily  massage 
and  manipulation  of  the  distorted  parts  and 
ankylosed  joints,  and  electricity  (see  Polio- 
myelitis, Acute. 

Pituitary  extract  (q.  v.  in  Part  11)  may, 
perhaps,  be  tried  experimentally.  Thyroid 
extract  is  without  effect. 

Achylia  Qastrica. — See  Anacidity. 

Acid  Eructations. — See  Hyperacidity. 

Acidity  of  the  Stomach. — See  Hyper- 
acidity. 

Acidosis;  Hypo=alkalinity  of  the  Blood. — 

Acidosis  denotes  a diminution  in  the  alkali 
reserve  (chiefly  sod.  carbonate  and  phos- 
phate) of  the  blood,  due,  ordinarily,  to  the 
occurrence  in  the  blood  of  ^-oxybutyric  or  of 
diacetic  acid,  the  latter  being  a decomposi- 
tion product  of  the  former.  Beta-oxybutyric 
acid  arises  from  the  incomplete  oxidation  of 


ACIDOSIS,  HYPO-ALKALINITY  OF  THE  BLOOD 


fats  and  the  amino-fatty  acids  of  the  protein 
molecule.  Diacetic  acid  further  decomposes 
into  acetone  and  carbon  dioxide.  Thus,  in  a 
comparatively  mild  type  of  diabetes,  acetone 
alone  may  be  found  in  the  urine;  in  a severer 
type,  diacetic  acid;  and  in  the  severest  cases 
/9-oxy butyric  acid  and  no  acetone.  (For 
tests,  see  Urinalysis.) 

The  degree  of  acidosis  may  be  conven- 
iently ascertained  by  a determination  of  the 
carbon-dioxide  tension  in  the  alveolar  air 
(which  is  approximately  the  same  as  that 
in  the  venous  blood)  according  to  the  method 
of  W.  McKim  Marriott.  The  techniqne  of 
the  test  is  as  follows:  Close  the  neck  of  a 
hot  water  bag  (of  about  1500  c.c.  capacity) 
with  a perforated  rubber  stopper  contaming 
a short  glass  tube  three-eighths  of  an  inch 
in  internal  diameter.  To  this  tube  connect 
a short  rubber  tube  with  a glass  mouth- 
piece, one  and  a half  inches  long  and  three- 
eighths  of  an  inch  in  internal  diameter. 
Blow  into  the  bag,  by  means  of  an  atomizer 
bulb,  about  GOO  c.c.  of  air,  and  clamp  the 
rubber  tube  with  a pmch-cock. 

Instruct  the  patient  to  rest  quietly  and 
breathe  naturally,  and  at  the  end  of  a normal 
expiration  place  the  tube  in  his  mouth, 
release  the  iiinch-cock,  close  the  patient’s 
nose,  and  have  him  breathe  back  and  forth 
from  the  bag  four  (or  more)  times  m twenty 
seconds,  emptying  the  bag  at  each  inspira- 
tion. Then  close  the  stop-cock  at  the  end 
of  an  expiration  and  analyze  the  air  \vithin 
the  bag  within  three  minutes,  as  carbon 
dioxide  rapidly  escapes  through  rubber. 

The  apparatus  required  for  the  analysis 
consists  of  eight  standartlized  phosphate 
solutions,  colored  with  phenolsulphoneph- 
thalein,  sealed  in  tubes,  and  numbered  10, 
15,  20,  25,  30,  35,  40,  and  45  mm.  respect- 
ively; a standard  bicarbonate  mdicator 
solution;  a glass  pipette  drawn  out  to  a 
capillary  point;  test-tubes;  paraffined  stop- 
pers; and  a box  for  color  comparison;  the 
whole  outfit  obtainable  from  Hynson,  West- 
cott  and  Dunning,  Baltimore,  Maryland. 
Pour  about  2 or  3 c.c.  of  the  standard  bicar- 
bonate solution  into  a clean  test-tube  of  the 
same  diameter  as  the  standard  j^hosphate 
tubes.  Blow  into  this,  through  the  capillary 
pipette,  air  from  the  bag  until  no  further 
color  change  occurs,  showing  that  the  solu- 
tion is  saturated.  Stopper  the  tube,  and 
compare  its  color  at  once  with  that  in  the 
standard  tubes,  placing  it  between  the  two 
standards  which  it  most  nearly  matches. 
The  room  temperature  should  be  from 
20°  to  25°  0.  (68°  to  7 7°  F.) ; if  it  is  above  or 
below  this,  the  specimen  should  be  immersed 


in  water  of  about  25°  C.  while  being  satu- 
rated with  the  gas  being  examined.  Make 
several  determinations. 

In  acidosis  the  carbon-dioxide  tension  in 
the  alveolar  air  is  dnninished,  owing  to 
increased  ventilation  of  the  lungs,  due  to 
stimulation  of  the  respiratory  centre.  The 
normal  tension  is  about  40  nnn.;  a tension 
below  35  mm.  means  acidosis;  20  mm. 
inilicates  danger. 

Another,  but  not  conclusive,  means  of 
measuring  the  degree  of  acidosis  is  by  the 
estimation  of  the  ammonia  output  in  the 
urme  (see  Urinalysis).  The  ammonia- 
secreting  fnnction  of  the  kidneys,  may, 
however,  become  impaired. 

For  the  Fredericia  method  of  ascertaining 
the  carbon-dioxide  tension  of  the  alveolar  air, 
and  the  Van  Slyke  method  for  the  carbon- 
dioxide  capacity  of  the  blood  plasma,  obtain 
instruments  with  instructions  from  the  Emil 
Greiner  Co.,  55  Fulton  Street,  New  York. 

The  symptoms  of  acid  intoxication  are 
dyspncea  (deep  breathing  of  the  “air- 
hunger”  type,  or  acyanotic  hyperpnoea, 
due  to  increase  of  CO2  in  the  blood), 
indigestion,  burning  jiain  in  the  phai^mx  or 
epigastrium,  nausea,  vomiting,  lassitude, 
various  nervous  manifestations,  headache, 
increasing  drowsmess,  and  finally  coma. 
[Dysi)na'a  is  also  caused  by  the  excessive 
formation  of  lactic  acid  in  the  con- 
tracting muscles  in  excessive  muscular 
exertion,  due  to  the  incomplete  oxidation 
of  carbohydrates.] 

The  causes  of  acidosis  are:  diabetes 

mellitus;  starv'ation  from  any  cause,  as 
rectal  feeding,  oesophageal  stenosis,  etc.; 
non-carbohydrate  diet;  incomplete  oxy- 
genation of  the  blood,  as  in  pneumonia, 
tuberculous  pneumothorax,  mountain  sick- 
ness, CO  poisoning,  dyspnoea  from  any  cause ; 
certain  toxic  conditions  of  the  liver,  as  in 
cyclic  vomiting  of  children,  pernicions  vomit- 
ing of  pregnancy,  hepatic  cancer,  acute 
yellow  atrophy,  portal  cirrhosis,  eclampsia, 
and  j)hosphorus  and  chloroform  poisonings; 
salicylate  poisoning;  cyanide  poisoning; 
thyrotoxicosis;  ursemia;  severe  sepsis;  severe 
diarrhoeas  of  children;  severe  burns. 

Treatment. — Attend  to  the.  cause.  Open 
the  bowels  freely.  Give  alkalies  freely  until 
the  urine  is  alkaline,  and  the  alveolar  carbon- 
dioxide  tension  has  risen  above  30  mm.,  or 
the  ammonia  outjnit  is  below,  at  the  most, 
3 grams.  A fair  index  of  the  degree  of 
acidosis  is  seen  in  the  amount  of  sodium 
bicarbonate  required  to  render  the  urine 
alkaline  to  litmus;  normally  45  grams 
suffices.  (Gellards.)  If  the  urine  is  origin- 


ACROMEGALY 


ally  ammoniacal  as  a result  of  fermentation, 
it  should  be  boiled  until  all  the  ammonia  is 
driven  off,  the  original  volume  restored  by 
the  addition  of  water,  and  the  urine  then 
tested  with  litmus  for  fixed  alkali. 


Sodii  bicarbonatis oi 

Potassii  citratis gr.  xxx 

Calcii  lactatis gr.  iii 

Magnesii  carbonatis gr.  iii 

Aquam,  ad 5i 


M.  Sig. — 5i  t.i.d.;  or  in  severe  cases  every  three 
hours,  sufficient  to  render  the  urine  alkaline,  etc. 
(W.  Langdon  Brown.) 

The  above  mixture  is  “based  upon  the 
relative  proportions  of  the  metals  normally 
present  in  the  urine.”  Says  Brown:  “It 
is  not  sufficient  to  give  sodium  alone,  for 
other  metallic  bases  are  also  being  drained 
from  the  tissues,  particularly  calcium”;  and, 
too,  “If  one  metallic  salt  is  given  out  of 
proportion  to  the  others,  it  increases  the 
secretion  of  those  others.  ” Joslin  avoids  the 
use  of  alkalies. 

Administer  also  dextrose  or  levulose, 
5-10-25  per  cent,  in  aqueous  solution  per 
mouth  or  rectum,  or  intravenously.  Use 
pure  dextrose,  since  the  commercial  glucose 
may  contain,  large  amounts  of  arsenic. 
Joslin  recommends  at  least  1 gm.  of  carbo- 
hydrate per  kilogram  (2j^  lbs.)  of  body 
weight  per  24  hours.  It  may  be  given  intra- 
venously up  to  20-25  per  cent,  strength, 
introduced  by  the  gravity  method,  the  same 
as  salvarsan  (see  Intravenous  Medication). 
Enough  alkah  should  be  added  to  render  the 
solution  alkaline  to  litmus  (to  neutrafize  sul- 
phuric acid  used  in  the  manufacture  of  dex- 
trose). Sterilize  by  boiling.  Give  it  slowly 
so  as  not  to  overload  the  right  heart.  It  is 
quite  safe  to  give  250  c.c.  (one-half  pint) 
every  three  hours  to  an  adult.  One  should 
use  judgment  in  giving  more  than  tliis 
amount  at  one  time,  or  in  giving  it  oftener 
than  every  three  hours.  The  carbohydrate 
is  administered  for  the  purpose  of  engaging 
oxygen,  and  thereby  preventing  the  expos- 
ure of  the  fats  to  oxidation  or  partial  oxida- 
tion, with  the  formation  of  /3-oxybutyric 
acid.  Alcohol  or  citric  acid  (see  Part  11)  may 
be  used  as  a substitute  for  carbohydrate. 
Withdraw  fats  from  the  diet. 

In  the  presence  of  threatening  or  actual 
coma,  slowly  inject  intravenously  {q.  v.), 
at  the  body  temperature,  after  withdrawing 
200—400  c.c.  of  blood,  500  c.c.  of  4 per  cent, 
sodium  bicarbonate  solution  in  normal  salt 
solution,  previously  sterilized  by  boiling. 
Take  great  care  that  none  of  the  liquid  gets 
outside  the  vein  lest  necrosis  occur.  Repeat 
the  injection  in  a different  vein  every  four 


to  six  hours,  if  necessary,  according  to  the 
alveolar  air  findings  or  the  symptoms. 
When  the  urine  has  become  alkaline,  and 
is  kept  so  the  danger  is  past.  If  the  bicar- 
bonate solution  is  administered  subcutane- 
ously or  intramuscularly,  it  must  first  be 
saturated  with  carbon  dioxide  passed  into 
the  cold  sterile  solution  from  a cylinder,  the 
point  of  saturation  being  indicated  by  a 
change  in  color  of  a small  amount  of  added 
phenolphthalein  from  pmk  to  colorless.  This 
is  essential  in  order  to  reconvert  carbonate 
(formed  from  the  bicarbonate  in  boiling) 
into  bicarbonate,  the  former  being  very 
caustic.  For  subcutaneous  injection  use  no 
stronger  a solution  of  bicarbonate  than  3 
per  cent. 

The  following  teclmic  for  obtaining  a 
solution  of  sodium  bicarbonate  free  from 
the  caustic  carbonate  may  be  employed. 
Boil  one  litre  of  sterile  distilled  water, 
remove  it  from  the  flame,  and  add  at  once 
30  grams  of  sodium  bicarbonate  (C.  P), 
taken  directly!'(from  the  original  container 
and  weighed  in  a sterile  vessel.  Cool  to 
110°  F.,  and  use  at  once. 

Oxygen  inhalations  (sec  under  Pneu- 
monia) are  recommended. 

It  is  well  to  know  that  massage  and  baths 
increase  the  alkalinity  of  the  blood. 

Acoria. — Gr.  a priv.  -f-  Kopo'i  satiety. 
Acoria  is  absence  of  the  sensation  of  satiety. 
Consult  Bulimia. 

Acoustic  Nerve  Affections.— See  Auditory 
Nerve  Affections  in  Ear  Diseases,  Part  7. 

Acromegaly. — Gr.  axpos  extremity  -|- 
fxeydXfj  great.  A rare,  clu’onic  disease,  due 
to  an  affection  of  the  pituitary  gland  or 
hypophysis  cerebri  (hyperplasia,  adenoma, 
fibroma,  sarcoma,  neighboring  or  distant 
disease,  the  latter  acting  by  compression, 
e.g.  tumors  or  hydrocephalus),  and  char- 
acterized by  enlargement  of  the  bones  and 
soft  parts  of  the  face,  hands,  and  feet  and 
other  parts,  kyphosis,  and  perhaps  polyuria 
or  glycosuria  (hyperpituitarism) ; and,  later, 
adiposity,  mental  torpidity,  somnolence, 
slow  pulse,  subnormal  temperature,  dry 
skin,  loss  of  hair,  amenorrhoea  in  women, 
impotence  in  men,  high  sugar  tolerance 
(hypopituitarism);  also,  in  a progressively 
enlarging  lesion,  headache  and  other 
pains,  visual  disturbances  (bitemporal 
hemianopsia:  optic  atrophy),  giddiness,  par- 
sesthesia  of  the  extremities,  epistaxis,  etc., 
due  to  slow  compression  of  the  brain  and 
neighboring  structures. 

“The  anterior  lobe  of  the  pituitary  body,” 
says  Schafer,  “is  related  to  the  general 
growth  of  the  body,  and  especially  of  the 


ADDISON’S  DISEASE 


skeleton,  whilst  the  posterior  lobe,  which 
includes  the  i):irs  intermedia,  probably 
serves  to  promote  the  contractility  and 
increase  the  tone  of  plain  muscular  tissue 
generally,  as  well  as  of  the  heart,  and  to 
excite  the  activity  of  certain  glands,  viz.  the 
kidney  and  mammary  glands.” 

The  disease  usually  lasts  thirty  or 
more  years. 

To  examine  for  hypophysial  tumor,  obtain 
an  accurately  transverse  skiagram  of  the 
head  by  placing  a bullet  in  each  external 
meatus,  and  seeing  that  the  shadows  of  the 
bullets  are  accurately  superimposed. 

Treatment. — In  the  stage  of  hypopituitar- 
ism one  may  try  the  pituitary  extract,  the 
drietl  gland  of  the  ox,  gr.  ii-iv,  t.i.d.  An 
overdose  by  mouth  is  apparently  not  possi- 
ble. Arsenic,  potassinm  iodide,  quinine, 
thyroid  extract,  and  mercury  by  inunction 
(see  Part  11)  have  been  used  with  apparent 
benefit.  Tea,  coffee,  and  tobacco  should 
be  avoided. 

Have  the  changing  vision  corrected  fi’om 
time  to  time  with  glasses.  Instruct  the 
patient  in  the  u.se  of  the  fountain  syringe 
for  the  purpose  of  clearing  out  the  dis- 
charging nasal  cavities.  The  syringe,  filled 
with  warm  normal  saline  solution  (one  tea- 
spoonful of  salt  to  the  pint  of  water),  is 
suspended  beside  a chair  containing  a basin. 
The  patient  kneels  besitle  the  chair,  with  his 
head  bent  over  the  basin,  and  the  face 
turned  horizontally.  The  solution  is  now 
allowed  to  flow  into  one  nostril  and  out 
through  the  other,  the  finger  being  used  as 
a pinch-cock  to  regulate  the  flow.  During 
the  flow  the  patient  should  breathe  through 
the  mouth,  and  should  not  swallow,  in  order 
to  avoid  the  entrance  of  fluid  into  the  middle 
ear.  Every  now  and  then  the  irrigation 
should  be  interrupted,  and  the  nose  blown  to 
clear  it  out.  Cauterization  of  hypertrophied 
erectile  tissue  may  sometimes  be  advan- 
tageously performed  to  relieve  obstruction 
(.see  Simple  Chronic  Rhinitis  in  Nose 
Diseases,  Part  8).  Leonard  Mark  praises 
the  usefulness  of  menthol,  combined  in  a 
lozenge  with  eucalyptus  and  licorice,  in  re- 
lieving dryness  of  the  tongue,  and  headache 
and  faceache. 


li  Menthol gr.  xxiv 

Eiicalyptol  


Sacehari  albi  

Pulv.  ext.  ^lyeyrrhizae afiHi  gr.  x 

Ol.  sassafras gtt.  i 


Make  into  a stiff  mass  with  simple  syrup  and 
divide  into  25  lozenges. 

Sig. — One  every  5 or  4 hours. 


For  the  various  aches  and  neuralgias, 
however,  “the  greatest  relief  is  derived  from 
absolute  rest  or  immobility,”  says  Mark. 
Mark  also  highly  praises  the  daily  use  of 
the  faradic' foot-bath  for  a week  or  two,  now 
and  then,  for  the  prevention  and  cure  of 
trophic  ulcers,  and  as  a general,  a cardiac, 
and  mucous  membrane  tonic.  The  bath 
consists  of  a tub  of  warm  water  with  a 
copperplate  electrode  at  each  end.  The 
current  should  be  smooth  and  as  strong  as 
can  be  borne  with  comfort. 

The  operative  treatment  of  acromegaly  is 
in  process  of  development.  Operation  is 
indicated  in  a growing  tumor  with  com- 
pression symptoms. 

Acroparaesthesia. — Gr.  aKpov  extremity 

Trapa  beside  -p  alcjOrjaLs  sensation.  (Acro- 
parsesthesia  signifies  parsesthesia  of  the 
extremities,  usually  the  upper.) 

Etiology. — Overuse  of  the  hands;  habitual 
irritation  with  cold  water;  perhaps  alcohol, 
tobacco,  tea,  and  coffee;  sexual  disturb- 
ances; gastro-intestinal  disturbances,  par- 
ticularly constipation;  neurasthenia;  arterio- 
sclerosis ; gout ; nephritis  ; menopause ; 
oophorectomy;  tabes;  pernicious  anaemia; 
cerebrospinal  syphilis ; encephalomalacia ; 
myxoedema;  acromegaly. 

Treatment. — Attend  to  the  cause.  Tonics, 
e.g.,  iron,  quinine  (gr.  v-viiss  at  bedtime — 
Oppenheim),  stryclmine,  arsenic  (see  Drugs, 
Part  11),  and  massage  and  baths  may  be 
serviceable.  The  faradic  arm  or  foot-bath 
may  be  tried.  It  consists  of  a tub  of  warm 
water  with  a copperplate  electrode  at  each 
end.  The  current  should  be  smooth,  and 
as  strong  as  can  be  borne  with  comfort.  It 
may  be  employed  daily  for  a week  or  two, 
and  is  praised  as  a general  tonic.  Give  the 
iodides  for  arteriosclerosis.  Moffitt  recom- 
mends thyroid  extract  for  “annoying  paracs- 
thesias  in  stout  women.” 

Actinomycosis. — See  Skin  Diseases,  Part  5. 

Acute  Yellow  Atrophy  of  the  Liver. — See 
Atrophy,  Acute  Y'ellow,  of  the  Liver. 

Adams  = Stokes  Syndrome. — See  Stokes- 
Adams  Sjmdrome. 

Addison’s  Disease. — A rare  chronic  dis- 
ease of  the  adrenal  or  suprarenal  glands 
(tuberculosis,  atrophy,  sj'philis,  neoplasm, 
traumatism)  or  of  similar  bodies  situatetl 
elsewhere,  all  constituting  the  chromaffin 
system  (chromaffin  meaning  staining  affinity 
with  chromates),  characterized  by  asthenia, 
gastro-intestinal  disturbances,  pigmentation 
of  the  skin,  and  cardiac  weakness  or  lowered 
cardio-vascular  tone.  Headache  is  frequent. 

(For  other  causes  of  pigmentation  of  the 
skin,  see  Chloasma  in  Skin  Diseases,  Part  5.) 


AINHUM 


The  disease  is  usually  fatal  in  one  to  three 
years,  but  improvement,  and  even  recovery, 
is  possible. 

Treatment. — Absolute  psychical  and  physi- 
cal rest  in  bed,  fresh  air  day  and  night, 
mamtenance  of  body  warmth,  and  easily 
digestible  and  nutritious  diet,  and  tonics, 
such  as  arsenic,  stryclmine,  and  iron  (see 
Part  11),  are  imlicated. 

Should  nausea  or  vomiting  occur,  restrict 
or  stop  the  food,  apply  an  ice-bag  or  a 
mustard  plaster  (one  part  mustard  to  2-0 
parts  of  flour,  made  into  a paste  with  water, 
and  applied  between  cloths)  to  the  epigas- 
trium, and  administer  some  one  of  the  reme- 
dies enumerated  under  Vomiting.  Remove 
the  mustard  when  the  skin  has  been  well  ri'd- 
tlened.  Best  of  all,  unless  distressing  to  the 
patient,  is  gastric  lavage  with  hot  normal 
saline  solution  (a  teaspoonful  to  the  pmt). 

For  diarrhoea,  restrict  the  diet,  apply 
heat  to  the  abdomen,  wash  out  the  colon, 
unless  distressing  to  the  patient,  and 
administer  bismuth  in  large  doses,  with, 
perhaps,  opium. 

For  great  cardiac  weakness  and  s^mcope 
apply  hot  water  bags  over  the  heart,  and 
administer  tincture  of  digitalis,  i^v,  well 
diluted,  t.i.d.p.c.;  and,  when  deemed  advis- 
able, aromatic  spirits  of  ammonia,  njjxv-lx, 
well  diluted  in  water;  or  strychnine,  gr.  ^q, 
hypodermically;  or  camphorated  oil,  njxv- 
Ix,  deep  into  the  muscle;  or  ether,  ttijx-Ix, 
hypodermically.  Sudden  death  from  syn- 
cope sometimes  occurs;  therefore  the  im- 
portance of  peace  and  quiet. 

Organotherapy  should  be  tried  in  every 
case,  even  though  it  has  been  usually 
ineffectual,  for  great  improvement,  and 
even  cures,  have  been  reported  from  its  use. 
It  is  advised  that  the  adrenal  preparations 
be  used  with  extreme  caution,  especially  in 
advanced  cases,  because  of  the  possibility  of 
the  occurrence  of  dangerous  symptoms;  but 
Croftan  says:  “Too  much  can  hardly  be 
given,  as  no  untoward  effects,  excepting 
some  irritative  phenomena  about  the  stom- 
ach or  intestine,  are  ever  observed  from  the 
administration  of  these  preparations  by 
mouth.”  These  observations,  however,  do 
not  apply  to  the  hypodermic  use  of  adrena- 
lin, as  perhaps  every  practitioner  knows 
from  unpleasant  experience. 

George  Dock  says:  “No  positive  lines 
can  be  laid  down  for  dosage  and  frequency 
of  administration.” 

1.  Fresh  sheep’s  gland  (one  gland  is 
equivalent  to  about  2 mg.  adrenalin),  1 to  2 
to  3 up  to  6 glands  a day,  if  need  be.  Keep 
on  ice.  Grind  up  with  glycerine  and  normal 


saline  solution  (one  teaspoonful  of  salt  to 
the  pint  of  water) ; allow  to  stand  a half- 
hour,  filter  through  muslm,  and  take  at  once. 

2.  Powdered  suprarenal  extract,  gr.  v-xx, 
t.i.d.p.c.;  the  best  preparation,  says  Croftan. 

3.  Adrenalin,  1 : lUOU  solution,  ti^v  up  to 
iT^xxx,  according  to  the  effect,  t.i.d.p.c.,  well 
diluted  with  water  (15-20  mhihns  contains 
about  1 mg.  adrenalin). 

Discontinue  the  medication  if  it  causes 
vomiting. 

Since  tuberculosis  is  the  conmionest 
cause  of  Addison’s  disease,  a trial  of  tuber- 
culin would  suggest  itself,  but  it  is  said  to 
be  harmful. 

In  the  presence  of  syphilis,  antisyi^hilitic 
treatment  is,  of  course,  indicated. 

If  a tumor  is  recognizable,  an  exploratory 
operation  might  be  considered;  but  these 
patients  are  very  susceptible  to  shock,  and, 
besides,  Addison’s  ilisease  does  not  develop 
until  both  suprarenal  glands  are  affected. 

Adenitis. — Gr.  adrjv  gland.  See  Lympha- 
denitis. 

Adenoids. — See  Throat  Diseases,  Part  9. 

Adherent  Pericardium.— See  Pericar- 
dium, Adherent. 

Adiposis  Dolorosa;  Dercum’s  Disease. — 

(L.  adeps,  fat;  dolor,  pain.) 

A rare  disease,  occurring  chiefly  in  women 
at  or  after  the  menopause,  usually  those  with 
neuropathic  or  p.sychopathic  manifestations, 
and  characterized  by  the  presence  of  local- 
ized or  diffuse,  symmetrical,  painful,  some- 
tunes  tender,  fatty  swellings,  which  are 
never  found  on  the  face,  hands,  or  feet. 

It  should  be  distinguished  from  (1)  adi- 
posis associated  with  (listurbance  of  function 
of  the  pituitary  body  (see  Acromegaly) ; 
(2)  multiple  lipomatosis  associated  with 
general  paresis,  tabes,  sciatica,  etc.;  (3) 
symmetrical  adenolipomatosis  or  diffuse 
symmetrical  lipomatosis  of  the  neck;  (4) 
adiposis  tuberosa  simplex,  in  which  the 
tumors  disappear  under  diet,  baths,  exercise 
and  massage  (see  Obesity),  which  are  “of 
only  temporary  benefit”  m adiposis  dolo- 
rosa. (D.  J.  McCarthy.) 

The  prognosis  is  unfavorable  as  to  cure 
of  the  lipomatosis,  but  is  good  as  to  life. 

Treatment. — Thyroid  extract  may  be  tried 
cautiously  in  ascending  doses,  beginning  with 
gr.  ss  twice  a day  (see  Myxoedema) . Pitui- 
tary extract  may  also  be  tried  (see  Drugs, 
Part  11). 

Adiposity. — L.  adeps,  fat.  See  Obesity. 

Agraphia. — Gr.  a priv.  -f-  ypd4>ecv  to 
write.  See  Aphasia. 

Ague. — Fr.  aigu  sharp.  See  Malaria. 

Ainhum. — See  Skin  Diseases,  Part  5. 


ALCOHOLISM 


Akoria. — See  Acoria. 

Albuminuria. — The  various  causes  of  al- 
buminuria may  be  conveniently  classified 
as  follows: 

I.  Albuminuria  due  to  other  causes  than 
organic  kidney  disease:  so-called  constitu- 
tional or  functional  albuminuria;  practically 
always  transient. 

A temporary  or  intermittent  or  cyclic 
albuminuria,  present  only  at  certain  times 
during  the  day,  is  common  in  adolescents. 
It  may  follow  muscular  exertion,  mental  or 
bodily  strain,  violent  emotion,  sexual  excess, 
a cold  bath  or  exposure  to  cold,  a heavy  meal, 
or  the  assumption  of  the  upright  posture 
(postural  or  orthostatic  albuminuria).  This 
variety  of  albuminuria  is  generally  ascribed 
to  a temporary  loss  of  vascular  tone.  Other 
causes  of  constitutional  or  functional  albu- 
minuria are  as  follows:  pyrexia  (febrile 
albuminuria);  dyspepsia;  carcinoma  of  the 
stomach ;gastro-intestinal  intoxication  due  to 
the  ingestion  of  shell-fish,  decomposed  foods, 
etc.;  the  ingestion  of  much  raw  egg  albumen 
or  too  much  animal  food  (alimentary 
albuminuria);  jaundice;  glycosuria;  ansemia, 
purpura;  scurvy;  leukgemia;  cachexia; 
Raynaud’s  disease;  anesthesia;  toxemia 
of  pregnancy;  first  few  days  in  the  new- 
born; syphilis;  chronic  alcoholism;  chronic 
lead  or  mercury  poisoning;  obesity;  gout;  ad- 
vanced pulmonary,  cardiac,  or  hepatic  dis- 
ease, causing  chronic  passive  congestion; 
cholera;  a malarial  paroxysm;  an  epileptic 
fit;  apoplexy;  meningitis;  brain  tumor; 
mania;  tetanus;  tabes;  general  paresis;  head 
injuries;  migraine;  delirium  tremens;  exoph- 
thalmic goitre;  neurasthenia;  various  psy- 
choses; excessive  use  of  tobacco;  tuberculous 
ascites;  pregnancy,  or  compression  of  the 
inferior  vena  cava  by  a tumor;  movable 
kidney;  impeded  outflow  of  urine  due  to 
ureteral  stenosis,  ureteral  twist,  a stone, 
compression  by  a tumor,  etc.;  such  kidney 
irritants  as  cantharides,  turpentine,  car- 
bolic acid,  benzol,  mustard,  lead,  mercuiy, 
arsenic,  antimony,  phosphorus,  salicylic  acid, 
tar  compounds,  aniline  derivatives,  petro- 
leum, urotropin,  potassium  nitrate,  potas- 
sium chlorate,  ether,  chloroform;  embolism 
or  thrombosis  of  the  renal  artery,  or  throm- 
bosis of  the  renal  vein. 

II.  Albuminuria  due  to  organic  kidney 
disease,  e.g.,  nephritis,  acute  or  chronic 
amyloid  degeneration,  due  to  syphilis,  tuber- 
culosis, or  chronic  suppuration;  kidney  trau- 
matism; fatty  degeneration;  suppurative  ne- 
phritis; renal  tuberculosis;  enlarged  cystic 
kidney;  renal  neoplasms. 

For  albumin  tests,  [see  I^rinalysis.  Re- 


member that  the  presence  in  the  urine  of 
pus,  due  to  urethritis,  cystitis,  ureteritis, 
pyelitis,  or  calculus  (see  Pyuria),  of  blood 
from  below  the  kidney,  of  spermatozoa, 
of  prostatic  fluid,  or  of  a leucorrheeal 
discharge,  will  cause  a positive  albumin 
reaction.  Such  a “false  or  accidental  al- 
buminuria ’’.should  be  excluded.  The  Bence- 
Jones  proteid  occurs  in  the  urine  in  the  rare 
fatal  multiple  myelomata  of  the  bones  (see 
Urinalysis  for  its  detection). 

Treatment. — Attend  to  the  cause.  In  the 
functional  albuminuria  of  adolescents  and 
of  dyspeptics,  enjoin  fresh  air  day  and 
night,  daily  moderate  exercise,  adequate 
clothing  (flannel  underwear  in  winter),  hot 
baths  with  friction  of  the  skin,  and  a plain, 
bland  diet,  consisting  chiefly  of  vegetable 
food,  fruits  and  milk,  with  a little  fish  and 
white  meat  occasionally,  eggs  sparingly. 
Gaston  Lyon  advises  an  absolute  milk  diet 
and  rest  in  bed  for  two  or  three  weeks,  and 
a gradual  return  to  normal  diet  after  the 
albumin  has  ceased  to  appear  in  the  urine, 
the  milk  to  be  resumed  if  the  albumin 
reappears.  One  hour  before  each  meal,  the 
patient  should  drink  a glassful  of  warm 
Vichy  water,  or  water  containing  10-15 
grains  of  sodium  or  potassium  bicarbonate, 
to  which  may  be  added  a teaspoonful  of  lemon 
juice.  For  constipation  employ  sodium 
phosphate  or  Rochelle  salt  (see  Drugs 
Part  11). 

Such  tonics  as  iron,  quinine,  and  strychnine 
may  render  service  in  cases  associated  with 
anaemia  and  loss  of  vascular  tone. 

If  the  condition  is  due,  according  to  Sir 
Almroth  Wright’s  view,  to  diminished  vis- 
cosity of  the  blood,  then  calcium  lactate,  gr. 
XV,  t.i.d.  (see  Part  11),  should  be  of  service. 

Yeo  says : “Albuminuria  in  a child  having 
an  elongated  prepuce  has  been  relieved  by 
circumcision.”  A focus  of  infection,  such 
as  a diseasedTonsil,  may  cause  albuminuria, 
which  disappears  after  the  infection  has 
been  eradicated. 

Alcaptonuria. — See  Alkaptonuria. 

Alcoholic  Cirrhosis  of  the  Liver. — See 
Cirrhosis,  Portal,  of  the  Liver. 

Neuritis. — See  Neuritis,  IMultiple. 

Alcoholism. — Arabic,  Al-kohl,  some- 
thing subtle. 

Alcoholism  may  conveniently  be  consid- 
ered under  three  headings,  (1)  acute  alco- 
holism, (2)  chronic  alcoholism,  and  (3) 
delirium  tremens,  or  mania-a-potu. 

The  latter  occurs  in  chronic  alcoholism, 
often  as  a consequence  of  such  exciting 
causes  as  a sudden  excess  of  alcohol,  a sudden 
withdrawal,  trauma,  mental  shock,  hemor- 


ALCOHOLISM 


Alcoholic 

liver 

( Cirrhosis) 


Normal  brain 


Alcoholic  brain 

( Meningitis ) 


Hypertrophied 

qlards 


Normal  liver  Pylorus 


White, star-like 
Fibrous  ulcers 


White  spot 
Vascular  patches 
Glandular  cysts 

Alcoholic  stomach 


Pigmented  patches 


Alcoholic  liver 

( Steatosis ) 


Normal  stomach 

( Opened ) 


l^wAlcohoIic 
^ heart 
(Fatty  deposit ) 


Normal 

heart 


LAROUSSE  MEDICAI. 


Action  of  alcoholism  on  different  organs. 

From  wax  models  made  from  life  by  M.  Jumelin  (Tramond  Rouppert  edit.) 


ALCOHOLISM 


rhage,  an  acute  infection,  particularly  pneu- 
monia, an  epileptic  attack,  etc;  It  is  char- 
acterized by  restlessness,  muscular  tremor, 
insomnia,  hallucinations,  chiefly  optic  and 
tactile,  disorientation,  delirium,  and  often 
anxiety  and  terror.  The  condition  may  last 
from  two  to  ten  days.  Sometimes  the  psy- 
chosis is  one  of  acute  hallucinosis  (acute 
paranoia,  acute  persecutory  insanity),  in 
which  there  are  intense  hallucinations, 
chiefly  auditory,  delusions  of  persecution, 
and  a tendency  to  suicide,  while  orientation 
is  retained.  This  condition  may  last  for 
several  days  to  several  weeks.  Rarely 
semi-coma  or  coma  (wet  brain  or  cerebral 
oedema)  follows  delirium  tremens,  and  lasts 
from  two  to  twelve  weeks,  with  a mortality 
of  nearly  75  per  cent. 

In  chronic  alcoholism  there  sometimes 
develops  a sympbmi-complex  characterized 
by  the  association  of  polyneuidtis  with 
delusions  of  time,  place,  and  persons,  and  a 
tendency  to  indulge  in  “pseudo-reminis- 
cences,”— the  so-called  Korsakow’s  syn- 
drome. This  condition  may  last  for  months, 
the  neuritis  clearing  up  before  the  psychosis. 
The  neuritis  may,  however,  end  in  atrophy 
(see  Neuritis,  Multiple). 

Treatment. — (1)  Acute  Alcoholism  (mus- 
cular tremor,  nervousness,  coated  tongue, 
gastritis,  etc.,  following  a spree;  dipsomania, 
or  an  uncontrollable  thirst  for  alcohol,  is 
here  included). 

Withdraw  alcohol  at  once,  and  put  the 
patient  to  bed.  Unless  the  patient  is  old  or 
arteriosclerotic,  evacuate  the  stomach,  either 
by  lavage  or  an  emetic,  such  as  copper  sul- 
phate, gr.  V,  in  solution,  every  fifteen  min- 
utes until  effectual;  or  zinc  sulphate,  3ss, 
in  solution,  repeated  in  fifteen  minutes 
if  necessary;  or  powdered  ipecac,  3ss.  If 
he  is  violent,  or  “fighting-drunk,”  or  even 
restless,  administer  a hypodermic  injection 
of  apomorphine,  gr.  Ms-  This  is  followed 
by  vomiting  and  sleep,  and  the  latter  may 
last  a number  of  hours. 

It  is  well  to  give  calomel  and  soda  in 
divided  doses,  or  in  a single  dose  of  calomel, 
gr.  V,  and  sodium  bicarbonate,  gr.  xv.  An 
enema  may  be  given.  Promote  free  per- 
spiration and  diuresis. 

R Potassii  citrati.s SH 

Liq.  ammonia  acetatis.  . . 5vi 

M.  Sig. — One  tablespoonful  (pot.  cit.  gr.  x)  with 
lots  of  water  every  three  hours  for  a few  days. 

For  insomnia,  one  may  give  paraldehyde 
in  water,  5ss-i,  repeated  in  an  hour  if 
necessary;  or  trional,  gr.  xv-xxx,  in  hot 
liquid;  or,  perhaps  best,  chloral,  gr.  xv-xxx, 
well  diluted,  best  per  rectum. 


For  nervousness,  antipyrin,  gr.  v,  t.i.d., 
or  sodium  or  ammonium  bromide,  gr. 
xx-xxx,  well  diluted,  t.i.d.,  may  be  of  service. 

For  collapse,  apply  heat  to  the  body, 
rub  the  limbs,  administer  hypodermically 
strychnine,  gr.  Mo?  or  camphor,  gr.  i-ii  in 
olive  oil,  Tijxv-xxx,  and  give  aromatic 
spirits  of  ammonia,  3ss-i,  in  a tumbler  of 
water,  by  mouth. 

For  alcoholic  gastritis,  prescribe  a light, 
highly  seasoned  diet:  concentrated  broths, 
meat  juices,  bovinine,  milk,  eggs. 

Tinctura;  capsici,  vel 

F.  ext.  zingiberis..  oh-vi  ( iiex-xxx  per  dose) 

Extract!  nucis  vom- 
ica?   gr.  vi  (gr.ss  per  dose) 

Infusi  quassisB,  q.s.  ad  3 vi 

M.  Sig. — One  tablcspoonful  in  hot  water,  t.i.d. 


(for  alcoholic  gastritis). 

R Ammonii  carbonatis gr.  v-x 

Tinctura;  capsici npx 

Infusi  quassia? 5 i 


M.  Sig. — Take  in  one  dose,  (for  sinking  sensa- 
tions and  craving  for  stimulants.)  S.  O.  L.  Potter. 

Ammonium  chloride,  3ss,  is  recom- 
mended to  straighten  a drunken  man  up. 

(2)  Chronic  Alcoholism. — One  or  two 
years  of  institutional  treatment  is  best,  but 
six  weeks  of  treatment  may  suffice.  Having 
first  determined  the  patient’s  degree  of 
tolerance,  by  ascertaining  how  much  alcohol 
is  required  each  day  to  prevent  the  occur- 
rence of  abstinence  symptoms— e.gf.,  nervous- 
ness, irritability,  restlessness,  insomnia,  and 
muscular  tremor — gradually  withdraw  the 
alcohol  entirely,  by  about  2 fl.  oz.  per  diem. 
(F.  E.  Hare).  For  undue  restlessness  dur- 
ing the  withdrawal,  administer  bromide, 
3 ss-i,  well  diluted,  t.i.d.  An  occasional  hyp- 
notic may  also  be  required : paraldehyde,  or 
trional,  or  chloral  (see  Part  11).  The  diet 
should  be  nutritious:  milk,  two  quarts 

daily,  meat  juice,  eggs,  carbohydrates.  Pre- 
scribe a stomachic: 

R Extract!  nucis  vomica?.  . . gr.  M-H 
Extract!  gcntiana? gr.  v-x 

Mitte  talis  pilula-,  no.  xxx.  Sig. — One  pill  t.i.d. 

Daily  massage  and  outdoor  exercises, 
including  Swedish  movements  or  the  army 
setting  up  exercises,  should  be  practiced. 

McBride’s  treatment  is  well  recommended. 
Atropine  and  strychnine,  aa  gr.  Moo?  are 
given  hypodermically  three  times  a day, 
and  the  doses  are  gradually  increased  until 
the  mouth  is  continually  dry  and  the  pupils 
dilated,  and  the  patient  is  receiving  gr. 

Mo  of  strychnine  t.i.d.  These  drugs  should 
then  be  continued  at  a slightly  reduced 
dose  for  four  or  five  days,  and  then  grad- 
ually reduced  until  none  is  taken.  “The 


ALKALINURIA 


length  of  time  required  for  this  treatment 
is  about  a month  or  six  weeks.”  It  destroys 
the  craving  for  alcohol  usually  in  a few  days. 

Ergot  is  recommended  by  Lambert  (see 
next  column). 

During  convalescence,  implant  reiterat- 
ingly  upon  the  patient’s  mind  the  advice  and 
suggestion  that  permanent  total  abstinence 
is  “for  him”  essential.  (F.  E.  Hare.) 

(3)  Delirium  Tremens. — Put  the  patient 
to  bed,  and  if  necessary  restrain  him  with 
sheets.  He  should  be  kept  under  constant 
surveillance.  Many  believe  that  alcohol 
should  not  be  suddenly  withdrawn ; but 
Lambert,  who  has  hail  a large  experience, 
believes  “that  alcohol  should  be  absolutely 
withdrawn  in  all  cases,”  and  strychnine, 
gf.  or  camphor,  gr.  i-ii,  in  olive 

oil,  i^xv-xxx,  given  hypodermically,  every 
four  hours  or  oftener,  if  stimulation  is 
required.  Caffeine  is  a good  stimu- 
lant, but  it  causes  wakefulness.  Digitalis 
is  lately  not  so  well  recommended.  A calo- 
mel purge,  calomel,  gr.  v,  and  sodium  bicar- 
bonate, gr.  XV,  should  be  given  in  the  begin- 
ning. Some  also  advise  an  emetic  dose  of 
ipecac,  5ss. 

In  the  milder  cases,  paraldehyde,  3ij 
diluted,  repeated  every  hour  if  necessary, 
for  three  doses;  or  trional,  gr.  xv-xx,  every 
four  hours,  may  be  tried.  But  these  nar- 
cotics, as  well  as  the  bromides,  are  usually 
insufficient.  Hyoscine,  gr.  Koo“/^o>  hypO" 
dermically,  every  six  hours,  or  until  the 
pupils  become  dilated,  is  better  recom- 
mended, although  it  is  said  sometimes  to 
increase  the  delirium. 

In  severe  cases,  chloral  hydrate,  in  doses 
of  gr.  xxx-lx,  well  diluted,  per  rectum,  is 
required;  or,  more  effectual  still: 


Morphinse gr-  K 

Chlorali  hydrati gr.  xv-xxx 

Tincturae  hyo.scyaini 5ss 

Tincturse  zingiberis iijx 

Tincturae  capsici T^iii 

Aquae,  q.s.,  ad 5ss 


M.  Sig. — Administer  in  one  dose.  Repeat  in  one 
hour  if  necessary.  (LaiTibert.) 

In  the  severest  cases  Lambert  injects 
hyoscine,  gr.  Hoo,  apomorphine,  gr.  }fo, 
and  strychnine,  gr.  Ko-  If  must  be  remem- 
bered that  chloral  and  morphine  are  dan- 
gerous drugs,  the  former  poisoning  the  heart, 
and  the  latter  tending  to  produce  urinary 
suppression.  Morphine,  indeed,  should  be 
used  only  as  a last  resort.  Apomorphine,  in 
the  dose  of  gr.  Ko,  sometimes  causes  col- 
lapse. The  hot  bath  and  the  cold  pack  are 
useful  sedative  measures. 


Lambert  recommends  the  intramuscular 
injection  of  ergot: 


II  Extract!  Ergotaj  (solid ) . . . 5 i 

Chloroformi gtt.  iii 

Chloretoni gr.  iii 

Aqua?  sterili 5i 

Misce,  fiat  solut.,  et  filtra. 

Sig. — Inject  into  the  gluteal  or  deltoid  muscle 


30  drops  (about  4 gr.  of  ergot)  every  2-4  hours. 

Says  Lambert:  “It  reduces  the  dilated 
blood-vessels,  lessens  the  various  conges- 
tions, and  brings  about  a better  equilibrium 
of  the  circulation.  After  it,  there  is  a dis- 
tinct tendency  to  a quieter  delirium,  and 
less  need  of  restraint;  it  reduces  the  tremor, 
less  hyimotic  is  required,  and  it  tliminishes 
the  temlency  to  ‘wet  brain.’” 

Except  when  asleep,  the  patient  should  be 
fed  regularly,  every  two  or  three  hours, 
with  highly  seasoned,  concentrated  broths, 
meat  juice,  bovinine,  milk,  and  eggs. 
This  is  important. 

Should  cerebral  oedema  or  “wet  brain” 
occur,  manifested  by  semi-coma,  rapid, 
feeble  pulse,  hypersesthesia  or  supersensi- 
tiveness to  pressure  of  the  skin  and  muscles, 
muscular  rigidity,  contracted  pupils,  give 
stimulants — strychnine,  gr.  3^o“Moj  hypo- 
dermically every  two  hours;  camphor,  gr.  ii, 
in  olive  oil,  njjxxx,  hypodermically,  ever>' 
two  hours;  caffeine  sodiosalicylate,  gi’.  3^, 
hypodermically  every  two  hours.  Sceleth 
and  Beifeld  “have  found  ergot  harmful  as 
compared  with  its  usefulness  in  the  asthenic 
type  of  delirium  tremens.”  Lumbar  punc- 
ture was  also  of  no  service  in  their  hands. 
The  patient  should  be  thoroughly  purged; 
and  milk,  eggs,  and  broth  should  be  admin- 
istered every  two  or  three  hours,  through 
the  nasal  tube,  if  need  be. 

During  the  period  of  convalescence  pre- 
scribe stomachics. 

Aleppo  Boil. — See  Oriental  Sore,  in  Skin 
Diseases,  Part  5. 

Alexia. — Gr.  a neg.  -f  word.  See 
Aphasia. 

Alkalinuria. — Causes.— Gastric  digestion : 
the  urine  is  sometimes  alkaline  for  a period 
of  two  to  four  hours  following  a meal ; gastric 
hypersecretion  with  motor  insufficiency  and 
vomiting  or  lavage;  ingestion  of  alkalies  be- 
tween meals,  or  of  organic  acids  of  the  fattj' 
series,  such  as  citric  acid,  etc.,  contamed  in 
vegetable  food ; rajiid  absorption  of  a transu- 
date or  exudate,  increasing  the  amount  of 
alkaline  salts  in  the  blood;  intestinal  hemor- 
rhage; clironic  nephritis;  neurasthenia’ 
mental  depression;  sexual  excesses:  typhoid 
fever;  sometimes  iineumonia;  sometimes 


ANACIDITY;  ACHLORHYDRIA;  ACHYLIA  GASTRICA 


anaemia;  admixture  of  exudates  from  the 
urinary  tract. 

The  alkalinity  m the  above  cases  is 
“fixed”;  that  is,  red  litmus  paper  is  per- 
manently blued  by  the  urine.  If,  however, 
the  blue  color  disappears  when  the  litmus 
paper  is  dried,  the  alkalinity  is  termed 
“volatile,”  and  is  due  to  the  bacterial 
decomposition  of  urea  into  ammonium  car- 
bamate and  carbonate  (ammoniacal  decom- 
position), the  result  of  local  inflammation 
in  the  urinary  tract,  usually  the  bladder. 
(R.  W.  Webster.) 

Alkaptonuria. — The  rare,  harmless  occur- 
rence in  the  urine  of  homogentisic  acid, 
and,  perhaps,  uroleucic  acid.  Homogentisic 
acitl  is  possibly  derived  from  the  tyrosin 
of  the  protein  molecule.  It  reduces  Fehl- 
ing’s  solution,  and  turns  the  urine  brown 
on  standing,  or  on  the  addition  of  an  alkali 
(see  Ochronosis). 

Alternation  of  Heart=beats. — 8ee  Arrhyth- 
mia, Cardiac. 

Alveolar  Abscess. — If  the  tooth  is  savable, 
incise  and  drain  the  abscess,  and  have  the 
tooth  treated  by  a dentist;  if  not  savable, 
extract  the  tooth.  The  so-called  “blind” 
abscess  may  sometimes  be  detected  only^by 
expert  rontgenography.  (q.v.). 

Amaurotic  Family  Idiocy. — L.  from  Gr. 
atiavpotcv,  to  darken;  idLwrrjs,  private. 

A Hebrew  family  disease  of  infancy, 
characterized  by  idiocy,  progressive  general 
muscular  weakness  and  paralysis,  rapid 
blindness  (in  cases  seen  early  a cherry-red 
spot  may  be  seen  in  the  region  of  the  macula 
lutea;  later,  optic  atrophy  occurs),  and 
usually  marasmus  and  death  before  the  end 
of  the  second  year. 

The  anatomical  cause  of  the  disease  is  a 
progressive  degeneration  of  the  ganglion 
cells  of  the  central  nervous  system. 

There  is  a juvenile  form  of  amau- 
rotic family  idiocy  not  restricted  to  the 
Jewish  race. 

There  is  no  treatment. 

Amoebic  Abscess  of  the  Liver. — See 
Liver  Abscess. 

Dysentery. — See  Dysentery,  Amoebic. 

Amyotonia  Congenita. — Gr.  a neg.  -\- 
ixvs,  muscle  -f-  zbvo'i,  tone.  L.  congenitus 
born  with.  (See  Dystrophy,  Progres- 
sive Muscular. 

Amyotrophic  Lateral  Sclerosis. — Gr.  a 

neg.  4-  fjLvs,  muscle  -f-  Tpo</»j,  nourishment; 
mXripojai?,  hardness.  See  Atrophies,  the 
Progressive  Muscular. 

Anacidity;  Achlorhydria;  Achylia  Qas= 
trica. — Anacidity  and  achlorhydria  denote 
persistent  lack  of  hydrochloric  acid  in  the 


gastric  secretion;  achylia,  Gr.  a priv.  -F 
xvXos  chyle,  denotes  lack  of  both  hydro- 
chloric acid  and  enzymes  (see  Dyspepsia; 
Gastric  Indigestion,  for  the  manner  of  ob- 
taining and  testing  the  gastric  secretion). 
Repeated  exammations  should  be  made. 

There  may  be  no  symptoms,  or  the  symp- 
toms of  gastric  indigestion,  or  only  intes- 
tinal symptoms,  that  is  diarrhoea,  due  to  the 
presence  in  the  intestine  of  putrefymg  undi- 
gested food.  Diarrhoea  somethnes  alter- 
nates with  constipation. 

Etiology  (Hypoacidity  included). — Neu- 
rasthenia, hyst(‘ria;  tabes;  anjemia;  tubercu- 
losis; nephritis;  diabetes;  alcoholism;  lead 
poisoning;  severe  febrile  disease;  chronic  gas- 
tritis; gastric  cancer;  amyloid  degenera- 
tion of  the  stomach;  cirrhosis  or  sclerosis  of 
the  stomach. 

Treatment.^ — ^Consider  the  cause.  The  diet 
should  be  liquid  or  soft,  and  served  in  small 
amounts  at  three-hour  intervals:  vegetables 
in  puree  form — potato,  spinach,  peas,  lentils, 
beams — steamed  or  boiled  fish,  raw  oysters, 
scraped  raw  meat,  well-boiled  meat,  plainly 
cooked  minced  meat,  sweetbreads,  brains, 
milk,  buttermilk,  bonnyclabber,  cottage 
cheese,  well-cooked  gruels — rice,  oats,  sago 
tapioca — stale  bread,  crackers,  rusks,  cocoa, 
olive  oil,  cream,  and  butter  in  moderation, 
predigested  foods,  such  as  somatose,  which 
consists  of  meat  albumoses  and  peptones, 
also  meat  extracts,  to  stimulate  the  flow  of 
gastric  juice.  Meat  extract  is  prepared  as 
follows:  Thoroughly  mix  one  pound  of 

finely  minced  beef  with  one  pint  of  cold 
water,  and  set  aside  for  ten  minutes.  Place 
in  a double  boiler — e.g.,  an  oatmeal  boiler — 
and  gradually  heat  the  surrounding  water 
to  the  boiling  point.  Now  decant  off  the 
liquid,  and,  after  cooling,  skim  off  the  fat. 

In  the  presence  of  diarrhoea,  due  to  the 
putrefaction  in  the  intestine  of  undigested 
proteins,  exclude  meat,  eggs,  and  beans. 
Oil  is  said  to  relieve  diarrhoea  by  promoting 
the  secretion  of  bile  and  pancreatic  juice. 

Prescribe  strychnine  and  bitter  tonics 
(see  Anorexia)  before  meals,  and  dilute 
hydrochloric  acid,  15-20  drops,  well  diluted 
in  sweetened  albumen  water,  and  sucked 
through  a tube  to  avoid  injury  to  the 
teeth,  during  and  one-half  to  one  hour 
after  meals.  Croftan  thinks  that  the  acid 
and  stomachics  should  both  be  given  before 
meals.  Pepsin,  gr.  vi-viii  (active  only  in 
an  acid  medium),  or  papain,  gr.  iv-vii 
(active  in  both  acid  and  alkaline  media), 
or  pancreatin  (active  only  in  an  alkaline 
medium),  administered  dissolved  in  water 
after  meals,  may  or  may  not  be  of  service. 


ANEMIA 


Pancreatini 

Sodii  bicarbonatis aa  gr.  vii 

M.  fiat  caps.  No.  1 Dent.  tal.  caps.  No.  x.xx. 

Sig. — One  capsule  15  minutes  after  meals.  (Boas.) 

Atony  or  motor  insufficiency,  or  the 
presence  of  excessive  mucus,  calls  for  syste- 
matic lavage. 

In  neurotic  cases  employ  local  galvanism, 
etc.,  as  directed  under  Dyspepsia,  Nervous. 

Ansemia. — See  Anemia. 

Anal  Fissure. — See  Fissure  in  Ano. 

Fistula. — See  Fistula  in  Ano. 

Prolapse. — See  Prolapse  of  the  Rec- 
tum and  Anus. 

Pruritus. — See  Pruritus,  in  Sldn  Dis- 
eases, Part  5. 

Stricture. — See  under  Rectal  Stricture. 

Tumors. — See  Rectal  and  Anal  Tumors. 

Analysis,  Gastric. — See  Dyspepsia. 

Analysis,  Urinary. — See  Urinalysis. 

Anaphylactic  Shock. — Gr.  av  neg.  -f 
protection. 

The  occurrence  of  such  s>anptoms  as 
urticaria  or  an  exanthematous  rash,  cedema- 
tous  swelling  of  the  mucous  membranes, 
vomiting,  dyspnoea,  rapid  pulse,  cyanosis, 
swelling  of  the  lymph  glands,  joint  pains 
and  swelling,  general  malaise,  subnormal 
temperature  or  fever,  perhaps  convulsions, 
collapse,  and  prolonged  prostration,  very 
rarely  death,  when  the  injection  of  a serum 
from  another  species  of  animal  (a  foreign 
protein)  is  followed,  after  the  lapse  of 
six  to  twelve  or  more  days,  by  a second 
injection.  These  symptoms  do  not  occur 
if  the  second  dose  of  serum  is  given  before 
the  sixth  day  (safer:  third  or  fourth 

day).  In  other  words,  repeated  injections 
of  a foreign  protein  at  short  intervals  is  not 
followed  by  anaphylactic  phenomena,  be- 
cause of  the  fact  that  immunity  is  estab- 
lished before  the  incubation  period  has 
expired.  This  immunity  is  only  temporary. 

Anaphylaxis  is  a state  of  supersensitive- 
ness or  hypensusceptibility  (“sensitization”) 
to  the  action  of  a foreign  protein,  brought 
about  in  the  manner  above  described.  To 
avoid  possible  anaphylactic  s.>nnptoms  when 
administering  a serum,  give  a preliminary 
injection  of  a small  trial  dose  of  0.1  (about 
2 drops)  to  0.2  to  1.0  c.c.,  and  if  after  the 
lapse  of  34-2-6-12  hours  no  untoward 
result  has  occurred,  give  the  full  dose  very 
slowly.  Asthmatic  and  hay  fever  subjects, 
and  those  closely  associated  with  horses, 
are  particularly  liable  to  anaphylactic  shock. 

For  anaphylactic  shock  are  recommended 
epinephrine,  calcium  lactate  or  chloride, 
gr.  xv-xxx,  t.i.d.,  sodium  salicylate,  ami 
morj)hine  and  atropine  (see  Part  11),  the 
latter  in  full  doses  in  urgent  cases,  com- 


bined, if  necessary,  with  artificial  respir- 
ation iq.v.). 

Serum  disease  or  sickness  designates  the 
occurrence  of  pyrexia,  a rash,  and  occasion- 
ally arthritis,  following  a latent  period  of  a 
few  days  to  one  or  two  weeks  after  the  in- 
jection of  the  serum. 

Anasarca. — Gr.  avd.  throughout  + adp^ 
flesh. — See  (Edema. 

Anchylostomiasis. — See  Ankylostomiasis. 

Anemia. — Gr.  dv  neg.  4-  aipa  blood. — 
For  diagnostic  tests,  see  Blood  Examination. 

Etiology. — Intestinal  parasites : ankylos- 

toma  duodenale  or  old-world  hookworm, 
uncinaria  Americana  or  new-world  hook- 
worm (see  Ankylostomiasis;  the  anaemia  is 
of  the  pernicious  type),  bothriocephalus 
latus  (see  Tapeworm  Infection;  the  anaemia 
is  of  the  pernicious  D’pe),  taenia  solium  (see 
Tapeworm  Infection),  oxymris  vermicularis 
(see  Oxyuriasis),  strongyloides  intestinalis 
(see  Strongyloidosis),  trichocephalus  dispar 
or  whipworm,  ascaris  lumbricoides  (see 
Ascariasis),  flukeworm  (see  Distomiasis) , 
amoeba  dysenteriae  (see  Dysentery,  Amoe- 
bic) ; pernicious  or  cryptogenetic  anaemia 
(q.v.);  chlorosis  (q.v.);  bad  hygiene — poor 
or  insufficient  food,  poor  ventilation,  lack 
of  sunlight,  overheating,  excessive  fatigue, 
overstudy,  homesickness,  anxiety  (Cabot 
denies  that  bad  hygiene  or  insufficient  food 
causes  anaemia) ; enlarged  tonsils,  and 
adenoids;  prolonged  milk  feeding;  sojourn 
in  hot  countries;  malignant  neoplasms; 
blood  parasites:  plasmodium  malariae  (see 
Malaria),  filaria  sanguinis  (see  Filariasis), 
distoma  haematobium  (see  Distomiasis;) 
chronic  gastro-intestinal  affections:  chronic 
gastritis,  chronic  gastric  dilatation,  atrophy 
of  the  stomach,  gastric  cancer,  intestinal 
intoxication  (q.v.),  constipation,  ulcerative 
colitis,  dysenteiyy  etc. ; hemorrhage : trauma, 
epistaxis,  hemorrhoids,  phthisis,  gastric 
and  duodenal  ulcer,  gastric  or  intestinal 
cancer,  intestinal  ulcer,  intestinal  para- 
sites, hepatic  cirrhosis,  splenic  fibrosis, 
hemorrhagic  pancreatitis,  dysentery, 
tyj:)hoid  fever,  nephrolithiasis,  kidney  tumor, 
bladder  tumor,  nejjhritis,  aneurysm,  leu- 
kajinia,  purpura,  scurvy,  ha?mophilia,  haemo- 
globinuria,  abortion  or  miscarriage,  extra- 
uterine  in’egnancy,  post-partum  hemorrhage, 
uterine  fibroids,  uterine  iiolxy,  uterine  can- 
cer, etc.;  imperfect  mastication;  oesophageal 
obstruction;  bodily  and  mental  injuries; 
pregnancy;  prolonged  lactation;  chronic 
nephritis;  chronic  suppuration;  prolonged 
fever  (the  latter  four  causing  an  albuminous 
drain);  toxajinia  of  pregnancy;  uraemia; 
jaundice  or  cholaemia;  rickets;  myxoedema; 
arteriosclerosis;  Addison’s  disease;  asthma; 


ANEMIA 


obesity;  neurasthenia;  trichiniasis ; kidney 
abscess;  leukaemia;  Hodgkin’s  disease;  pur- 
pura; scurvy;  splenic  anaemia  (see  Anemia, 
Splenic);  Kala-azar  {q.v.)]  anaemia  infantum 
pseudoleukaemia  of  Von  Jaksch  {q.v.)\ 
thymus  enlargement;  aortic  insufficiency; 
mitral  stenosis;  neoplasms  or, osteosclerosis 
involving  the  bone-marrow ; aplastic  anaemia, 
in  which  there  is  aplasia  instead  of,  as  in 
p>ernicious  anaemia,  hyperplasia  of  the  ery- 
throblastic tissue  in  the  bone  marrow  (the 
disease  is  acute  and  fatal  within  a few 
months;  it  occurs  chiefly  in  young  females; 
the  color  index  is  low;  there  is  a relative 
lymphocytosis,  no  nucleated  red  blood  cells, 
hemorrhages  are  common);  infections:  ma- 
laria, syphilis,  tuberculosis,  gonorrhoea,  lep- 
rosy, rheumatic  fever,  typhoid  fever,  diph- 
theria, oral  sepsis  (pyorrhoea  alveolaris,  etc.), 
chorea,  septico-pysemia,  and  malignant  endo- 
carditis; chemical  poisons;  mercury,  arsenic, 
lead,  potassium  chlorate,  nitrobenzol,  ricin, 
guaiacol,  male  fern,  pyrogallic  acid,  pheno- 
coll,  lactophenin,  phenacetin,  acetanilid, 
cocaine,  opium,  alcohol,  nitroglycerin,  poi- 
sonous mushrooms,  iodides,  carbon  mon- 
oxide, etc. 

Treatment  of  AnsemJa  as  Such. — A. 

Acute  Anaemia. — Rest,  fresh  air,  and  sun- 
light, and  a concentrated,  nutritious,  easily 
digestible  diet,  administered  every  three  or 
four  hours,  are  the  chief  requisites;  fresh 
beef  juice,  finely  minced  meat,  bovinine, 
vinsip,  ferroglidine,  ironsomatose, blood,  fish, 
raw  oysters,  bone-marrow,  eggs,  milk,  car- 
bohydrates (oatmeal  or  wheat  gruel),  vege- 
tables in  puree  form  (spinach,  lentils,  beans, 
peas,  asparagus),  apple  sauce,  strawberries. 
If  the  stomach  is  in  good  condition,  and 
fever  and  tuberculosis  are  absent,  iron  (see 
Part  11  for  doses  at  various  ages)  may  be 
prescribed.  It  may  be  given  by  mouth  or 
hypodermically.  Arsenic  {q-v.)  may  also 
be  of  value  (except  in  nephritis). 

Pil.  ferri  carbonatis  (Blaudii) ...  gr.  v 
Recent  praeparat.  pulv.  in  caps.  No.  c. 

Sig. — ^Ono  pill  t.i.d.p.c.,  increased  by  one  pill  each 
week  until  3 or  4 or  5 pills  are  taken  t.i.d. 

To  prevent  gastric  solution  and  irritation, 
the  powder  may  be  dispensed  in  gelatin 
capsules  hardened  with  formalin;  e.g.,  Sahli’s 
glutoid  capsules,  grade  II  of  hardness. 

R Ferri  carbonatis  saccha- 

rati gr.  X (gr.  ss  per  dose) 

Olei  menthse  piperitae.  . . ^t.  ii 
Pulveris  cacao 

Misce  et  fiat  pulvis.  Div.  in  chart,  cerat.  No.  xx. 

Sig. — One  powder  three  or  four  times  a day, 
after  meals. 


R Tincturae  ferri  chloridi  % '\  ( ttexv-x.xx  per  dose) 

Glycerini 5i 

Syrupi  aurantii,  q.s.  ad  5iv 

M.  Sig. — One  or  two  drams  in  water,  t.i.d.p.c.,  to 
be  taken  through  a glass  tube,  followed  by  rinsing 
and  brushing  of  the  teeth. 

R Pil.  aloes  et  ferri  U.S.P.  (gel.  coat.).  No.  i 
Dent.  tal.  pil.  No.  xxx 

Sig. — 3-5  pills  daily. 

R Ferri  et  potassii  tartratis,  vel  ferri  et  ammonii 

citratis 3iss  (about  gr.  iii  per  dose) 

Syrupi  hmonis .... 

Aquae  distillatae,  aa  5ii 

M.  Sig. — One  dram  3 or  4 times  a day,  after 
meals,  in  sherry  wine. 

R Syrupi  ferri  iodidi.  §ii 

Sig.— Vine-half  to  one  dram,  well  diluted,  t.i.d.p.c., 
to  be  taken  through  a glass  tube. 

R Liquoris  ferri  et  ammonii  acetatis  (mist. 
Bashami)  recent,  praeparat 5viii 

Sig. — One  ounce,  t.i.d.,  in  water  (used  in  nephritis 
because  of  its  diuretic  and  diaphoretic  properties). 

If  indigestion,  vertigo,  and  insomnia  are 
produced  by  the  above  inorganic  prepara- 
tions, try  the  organic  preparations  or  chaly- 
beate mineral  waters  given  below.  The 
organic  preparations  are,  however,  inferior 
in  hsematinic  value  to  the  inorganic  salts. 

R Ovoferrin 5 xii 

Sig. — One  tablespoonful  in  water,  t.i.d.a.c. 

R Ferratini  (acid  albuminate  of  iron),  gr.  viii 
Dent.  tal.  caps.  No.  xx 

Sig. — One  capsule  t.i.d. 


R Ferri  albuminatis gr.  x-xxx-^ii 

Dent.  tal.  caps.  No.  xx 
Sig. — One  cap.sule  t.i.d.p.c. 

R Hajmol gr.  ii-viii 

Dent.  tal.  pulv.  in  chart,  cerat.  No.  xxx 
Sig. — One  powder  one-half  hour  before  meals. 

R Haemogallol gr.  v-x 

Saccharini gr.  ss-i 

Pulveris  cacao q.s. 


Misce  talis  tabellae  sive  pulveres  in  chart,  cerat. 
No.  lx.  ^ 

Sig. — One  tablet  or  powder  one-half  hour  before 
meals. 

R Ferri  peptonati  gr.  v-x 

Dent.  tal.  caps.  No.  xx 
Sig. — One  capsule,  t.i.d. 

Ferruginous  Waters. — Saratoga  and 
Sweet  Chalybeate  in  Virginia,  in  America; 
Pyrmont,  Franzenbad,  Kissingen,  and 
Langenschwalbach,  in  Germany  and  Austria; 
Spa  in  Belgium;  St.  Moritz,  Levico,  and 
Roncegno,  in  Switzerland. 

For  hypodermic  use: 

R Ferri  et  ammonii  citratis,  solut.  aq.  neutral. 

steril.,  10%,  1.0  c.c. 

Dispense  in  sterile  ampoules. 

Sig. — Inject  one  c.c.  (‘gr.  iss  per  dose)  daily  or 
every  other  day  deep  into  the  skin  of  the  back 
or  thigh,  using  a platinum  hypodermic  needle. 
(Forchheimer.) 


ANEMIA,  PERNICIOUS 


For  infants,  the  albuminate  bitter  wine, 
sweet  wine,  and  wine  of  the  citrate  (see 
Part  11)  preparations  of  iron  are  appropriate; 
for  older  children,  reduced  iron,  and  Blaud’s 
pills.— Holt.  Codliver  oil,  and  malt  e.xtract 
are  often  useful  (see  Malnutrition). 

Blood  transfusion  {q.v.)  is  of  value. 

For  the  treatment  of  severe  post-hemor- 
rhagic  anaemia,  see  Hemorrhage. 

B.  Chronic  Anemia. — Mental  and  phys- 
ical rest,  fresh  air  day  and  night,  hot  baths, 
warm  clothing,  especially  warm  footwear 
(wool  in  winter,  flannel  and  silk  in  summer), 
and  an  abundance  of  nutritious,  easily  di- 
gestible food,  are  the  chief  requisites.  Pre- 
scribe particularly  foods  rich  in  iron — e.g., 
meat,  fresh  meat  juice,  blood,  bovdnine, 
vinsip,  ferroglydine,  iron  soinatose,  bone- 
marrow,  spleen,  liver,  oysters,  fish,  eggs, 
oatmeal,  lentils,  beans,  peas,  spinach, 
asparagus,  apples,  and  strawberries.  Milk 
is  also  valuable. 

Iron  (see  under  Acute  Aniemia  for  formu- 
lae) and  arsenic  may  be  given  if  the  stomach 
is  in  good  condition.  The  elixir  ferri, 
quininae,  et  strychninae  phosphatum,  one  tea- 
spoonful  well  diluted,  t.  i.  d.p.c.,  is  a 
good  preparation. 

Iron  should  not  be  given  in  pulmonary  tu- 
berculosis, or  arsenic  in  nephritis.  (Croftan.) 

For  the  treatment  of  anorexia, 
see  Anorexia. 

Anaemia  Infantum  Pseudoleukaemia  of 
Von  Jaksch. — This  affection  of  doubtful 
identity  is  characterized  by  enlargement  of 
the  liver,  lymph-nodes,  and  spleen  (the 
last  is  greatly  enlarged),  and  the  following 
blood  picture : marked  reduction  in  red 
blood  cells  and  hiemoglobin,  numerous  nu- 
cleated red  cells,  marked  leucocytosis  (see 
Blood  Examination  for  laboratory  technic. 
Most  authorities  believe  the  condition  to 
be  a severe  secondary  anaiinia,  or  pernicious 
anaemia,  or  leukaemia. 

Prescribe  both  arsenic  and  iron  (the  sac- 
charated  carbonate,  and  the  diet  recom- 
mended for  rickets  (q.v.).  Give  of  Fowler’s 
solution  one  drop  four  or  five  times  a day, 
well  diluted,  after  meals,  for  a long  period. 

Anaemia,  Pernicious  (idiopathic,  crypto- 
genetic). — Gr.  t'5ios  own  -f-  irados  disease; 
KpvwTOs  hidden  -)-  yhecn^  origin. 

A fairly  common  chronic,  remittent, 
usually  fatal  disease  of  unknown  origin,  oc- 
curring usually  after  the  thirty-fifth  year  of 
age,  characterized  by  a severe  anaemia  of 
slow  and  insidious  onset,  general  weakness, 
breathlessness,  palpitations,  gastro-intes- 
tinal  crises,  and  often  degenerative  spinal- 
cord  symptoms.  The  blood  shows  a great 


reduction  in  the  number  of  red  blood  cells, 
which  are  deformed  (poikilocytes),  abnor- 
mally large  (macrocytes),  and  often  stain 
abnormally  (polychromatophilic  degenera- 
tion), a high-color  index,  the  presence  of 
normoblasts  and  megaloblasts  (small  and 
large  nucleated  red  cells),  and  a normal 
or  diminished  leucocyte  count  (poly- 
morphonuclear leucopaenia).  The  prepon- 
derance of  megaloblasts  in  the  blood 
picture  is  considered  pathognomonic  (see 
Blood  Examination). 


Fig.  1. — Blood  picture  of  pernicious  ansmia,  showing  a,  poi- 
kilocytes; 6,  macrocyte;  c,  normoblast,  and  d,  megaloblasts. 

The  skin  has  a lemon-yellow  tint,  and  the 
subcutaneous  fat  is  well  preserved.  From 
two  to  six  or  more  spontaneous  remissions, 
lasting  from  three  months  to  four  years,  or 
longer  may  occur.  These  remissions  are 
characteristic  of  the  disease. 

Death  usually  occurs  in  from  one  to  three 
or  four  or  more  years.  Recovery  has  pos- 
sibly occurred,  but  is  rare. 

Treatment. — Of  first  importance  are  pro- 
longed rest  in  bed,  fresh  air  daj^  and  night, 
and  an  abundance  of  nutritious  food  served 
in  small  amounts  everj'-  three  hours.  General 
massage  is  helpful.  All  carious  teeth  should 
be  removed  or  treated,  the  teeth  scaled,  if 
need  be,  and  the  mouth  kept  clean  with 
castile  soap  and  water  and  antiseptic  mouth- 
washes (see  Pyorrhoea  Alveolaris).  Gastric 
and  intestinal  lavage  is  recommended. 
Since  improvement  often  follows  a severe 
diarrhoea,  laxatives  may  be  tried,  e.g., 
the  fluid  extract  of  cascara  sagrada 
(average  dose,  npxxx)  in  sufficient  dosage  to 


ANEURYSM 


produce  at  least  two  watery  stools  a day,  as 
suggested  by  Cabot.  Croftan  believes  that 
anthehnintics  (see  Ankylostomiasis)  should 
be  given  a full  trial  in  every  case.  A patient 
of  the  writer’s,  in  her  third  relapse,  with 
marked  ataxia  and  feebleness,  apparently 
almost  completely  recovered  following  a 
course  of  large  doses  of  thymol,  which  acted 
as  a hydragogue  cathartic.  She  died,  how- 
ever, with  pneumonia,  about  two  years  later. 

Hydrochloric  acid  and  pepsin  are  usually 
indicated  (see  Anacidity). 

Diarrhoea,  unless  excessive,  should  prob- 
ably not  be  combated. 

Arsenic  is  of  great  value; 

Liquoris  potas.sii  arsenitis  (Fowler’s 
solution) §i 

Sig. — ^Two  drops,  well  diluted,  t.i.d.p.c.,  gradually 
increased  by  3 to  5 drops  every  five  or  six  days,  up 
to  10-15-20-25  drops  t.i.d. 

The  maximum  dose  may  be  taken  for 
weeks  or  months,  but  the  arsenic  should  be 
stopped  should  any  of  the  following  symp- 
toms occur,  viz. — belching  and  epigastric 
pain  and  soreness,  nausea,  vomiting,  thirst, 
diarrhoea,  odor  of  garlic  in  the  breath,  burn- 
ing in  the  mouth,  salivation,  conjunctival 
congestion,  itching,  burning,  or  swelling  of 
the  eyelids,  brownish  pigmentation  of  the 
eyes,  skin  eruptions,  pcrij)heral  neuritis. 
After  these  symptoms  have  subsided,  the 
arsenic  may  be  resumed,  but  in  much 
smaller  doses. 

Other  eligible  arsenic  preparations  are: 
arsenous  acid,  gr.  Moo,  in  pih  form,  one  pill 
t.i.d.p.c.,  gradually  increased  to  three  and 
five  pills  t.i.d.;  and  salvarsan  or  neosal- 
varsan  intramuscularly  or  intravenously 
(see  Syphili.s). 

Splenectomy  is  lately  advocated,  pre- 
ceded, if  need  l)e,  and  followed  by  blood 
transfusion  (q.if.).  Says  H.Florcken:  “The 
most  convenient  access  to  the  spleen  is 
afforded  by  an  incision  parallel  to  the  left 
costal  arch  with  a continuation  backward 
quite  to  the  spinal  column.” 

No  permanent  cure  of  pernicious  anajmia 
has  as  yet  been  discovered. 

Anaemia,  Splenic. — “Among  the  condi- 
tions which  may  give  rise  to  the  splenic  type 
of  anajinia  we  find  gummata  of  the  spleen, 
large  round-cell  sarcoma  of  the  spleen, 
chronic  splenitis  of  the  malarial  type,  and 
splenomegaly  associated  with  cirrhosis  of 
the  liver.”  (R.  W.  Webster.) 

Primary  splenomegaly  with  anaemia  is  a 
rare,  very  chronic  disease  of  the  spleen,  of 
unknown  cau.se,  characterized  by  progre.ssive 
enlargement  of  the  spleen  (fibrosis),  no  lym- 


phatic enlargement,  often  pigmentation  of 
the  skin,  a tendency  to  hemorrhage  from  the 
mucous  membranes,  with,  eventually,  the 
occurrence  of  anaemia  of  a secondary  type, 
and  cirrhosis  of  the  liver,  ascites  and  jaundice 
(Banti’s  syndrome).  The  following  blood 
picture  is  presented : only  slight  reduction  in 
the  red-cell  count,  marked  reduction  in  the 
percentage  of  haemoglobin,  consequently  a 
low-color  index,  very  rarely  poikilocytes  or 
nucleaited  reds,  leucocytes  usually  dimin- 
isheil  with  a relative  (not  absolute)  lympho- 
cytosis (see  Blood  Examination  for  laboratory 
technic;  see  also  Splenomegaly  and  Jaundice 
for  the  many  causes  of  these  conditions). 

Treatment. — Treat  the  anaemia  by  rest, 
fresh  air,  and  abundance  of  good  food  (see 
Anemia,),  and  ar.senic.  Careful  X-ray  (g-v.) 
applications  to  the  spleen  may  prove  effect- 
ual. Spleitectomy  is  curative.  It  should  be 
done  before  the  liver  has  become  involved 
and  ascites  has  developed.  In  the  presence 
of  hepatic  cirrhosis  the  operative  mortality 
is  19  per  cent.  Says  H.  Florcken:  “ The 
most  convenient  access  to  the  spleen  is 
afforded  by  an  incision  parallel  to  the  left 
costal  arch  with  a continuation  backward 
quite  to  the  spinal  column.”  In  the  separa- 
tion of  perisplenic  adhesions  there  is  great 
risk  of  fatal  hemorrhage.  In  the  i^resencc  of 
ascites  epiplopexy  may  be  performed. 

It  should  be  borne  in  mind  that  .splenec- 
tomy is  contraindicated  in  leuksemia,  poly- 
cythemia, malaria,  aplastic  anaemia,  atrophic 
cirrhosis  of  the  liver,  and  usually  tubercu- 
losis and  syphilis. 

Aneurysm. — Gr.  avthpvatxa  a widening. 
The  general  diagnostic  signs  of  aneurysm 
are:  a visible  pulsating  tumor,  the  pulsa- 
tions of  which  are  expansile,  punctate,  and 
heaving;  a palpable  thrill;  dulne.ss  on  per- 
cussion; a systolic  bruit  on  auscultation,  and 
a diastolic  shock.  An  arterio-venous  aneu- 
rysm is  manifested  by  great  venous  disten- 
tion and  the  presence  of  a humming-top 
murmur  on  auscultation.  An  X-ray  {q.v.) 
examination  should  be  made. 

Following  is  an  enumeration  of  the  possi- 
ble signs  and  symjitoms  of  a thoracic 
aneurysm:  tracheal  tugging,  felt  during 

expiration  as  well  as  during  insjiiration  (the 
latter  association  is  frequently  normal) ; in- 
equalityof  theradial  pulsesand  of  the  carotid 
pulses,  compre.ssion  of  the  cervical  sympa- 
thetic, causing  at  fir.st  dilatation  of  the 
pupil  due  to  nerve  irritation,  and,  later, 
contraction  of  the  pupil,  due  to  nerve  paral- 
ysis, rarely  flushing,  sweating,  and  drooping 
of  theeyelid  on  the  affected  sifle; compression 
of  the  left  recurrent  laryngeal  nerve,  causing 


ANEURYSM 


spasm  of  the  laryngeal  adductors  with  urgent 
symptoms,  or  paralysis  with  a cracked  voice 
and  a brassy  or  goose  cough ; compression  of 
the  trachea  or  bronchus,  causing  stridor  or 
dyspnoea,  cough,  tracheitis,  bronchitis,  hae- 
moptysis from  leaking  of  the  aineurysm,  per- 
haps bronchiectasis;  compression  of  the 
superior  vena  cava,  causing  congestion  of 
the  veins  of  the  head,  neck,  and  arm;  com- 
pression of  the  oesophagus,  causing  dys- 
phagia; pain,  sometimes  attacks  of  angina 
pectoris.  Always  examine  the  back. 

Remember  that  the  preternatural  throb- 
bing or  pulsation  which  is  present  in  the 
following  conditions  may  simulate  aneurysm, 
e.g.,  aortic  insufficiency,  antemia,  neuras- 
thenia, hysteria,  exophthalmic  goitre,  dila- 
tation of  the  heart,  pulsating  pleurisy,  a 
pulsating  solid  tumor,  especially  a medias- 
tinal tumor,  retraction  of  the  right  lung  in 
fibroid  phthisis  uncovering  the  heart,  diffuse 
dilatation  of  the  aortic  arch  following  long- 
standing hypertension  associated  with  ne- 
phritis or  arteriosclerosis,  dislocation  of  the 
heart  in  curvature  of  the  spine.  Also,  in 
pulmonary  tuberculosis  or  cancer  of  the 
CESophagus,  the  occurrence  of  substernal 
pain,  cough  and  aphonia  may  wrongly  sug- 
gest the  presence  of  aneurysm. 

Osier  says:  “ It  is  to  be  remembered  that 
no  pulsation,  however  forcible,  or  the  pres- 
ence of  a thrill  or  a systolic  murmur, 
justifies  the  diagnosis  of  abdominal 
aneurysm  unless  there  is  a definite  tumor 
which  can  be  grasped  and  which  has  an 
expansile  pulsation.” 

Prognosis. — The  prognosis  is  grave,  but 
cure  is  possible. 

Etiology.^ — Syphilitic  mesarteritis  is  un- 
doubtedly the  most  important  cause.  Other 
acute  infections — e.g.,  typhoid  fever,  influ- 
enza, pneumonia,  rheumatic  fever,  scarlet 
fever,  erysipelas,  septicaemia,  and  possibly 
malaria  and  tuberculosis — may  j)redispose. 
Hard  work  and  alcohol  are  factors;  also 
lead,  tobacco,  auto-intoxication  (gout, 
Bright’s  disease),  senile  arteriosclerosis,  em- 
bolism, external  trauma. 

Treatment. — The  aims  of  medical  treat- 
ment are  the  reduction  of  arterial  tension  to 
a minimum  and  the  promotion  of  clotting. 
These  ends  are  sought  by  absolute  rest  in 
bed,  including  the  use  of  a bed-pan,  for 
from  two  to  six  months,  restriction  of  the 
diet,  esjiecially  liquids,  to  a minimum,  and 
the  administration  of  potassium  iodide,  be- 
ginning with  gr.  V,  well  diluted,  t.i.d.p.c., 
and  gradually  increasing  to  gr.  xx-xxx  t.i.d. 
Osier  says  that  doses  larger  than  gr.  xx  t.i.d. 
are  unnecessary. 


R iSolut.  potassii  iodidi  concentrati . . . . ^ i 

Sig. — Five  drops  t.i.d.p.c.  in  a half  or  full  glass  of 
milk,  increased  by  one  drop  each  day  up  to  twenty 
drops  t.i.d. 

The  bowels  should  be  regulated ; constipa- 
tion and  straining  should  be  avoided.  Cas- 
cara  sagrada  (see  Part  11)  should  be  useful 
for  this  purpose. 

The  diet  should  consist  principally  of 
milk  and  vegetables.  Meat,  fish,  preserves, 
cheese,  and  spices  should  be  avoided ; coffee, 
tea,  alcohol,  and  tobacco  should  be  pro- 
hibited. Tufnell’s  starvation  diet  is  un- 
necessary. Indeed,  Gaston  Lyon  declares 
that  it  is  less  important  to  regulate 
the  quantity  than  the  quality  of  the  food 
and  drink. 

Adjuvant  measures  are:  the  withdrawal 
from  the  veins  of  six  to  ten  ounces  of  blood 
every  week  for  five  or  six  weeks;  the  appli- 
catioir  of  the  ice-bag  or  Leiter’s  coil  for 
several  hours  at  a time  with  several  hours’ 
intermission;  the  administration  of  calcium 
lactate,  gr.  x-xv-xl,  three  or  four  times  a 
day,  regulating  the  dose  according  to  the 
pulse-rate,  i.e.,  diminishing  the  dose  if  the 
pulse-rate  rises  (Yeo) : 

Calcii  hictatis  (Merck’s  or  Squibb’s 
.soluble  salt) gr.  x-xl 

Fiat  jnilvis  una  et  dispense  in  chart,  cerat.  Mitte 
tabs  xvi. 

Sig. — One  powder  in  water  three  or  four  times  a 
day  for  one  or  two  days  every  week. 

(if  continued  longer  than  three  days  it  is 
said  to  diminish  the  coagulability  of  the 
blood);  the  subcutaneous  injection,  every 
other  day,  of  200-250  c.c.  of  a 2 per  cent, 
solution  of  sterile  gelatin  (Merck’s)  in  0.7 
per  cent,  sodium  chloride  solution,  for  the 
purpose  of  increasing  the  coagulability  of 
the  blood  (gelatin,  however,  quickens  the 
pulse-rate). 

This  regimen  demands  a great  deal  of 
patience  and  fortitude  on  the  part  of  the 
patient,  and  is,  perhaps,  scarcely  feasible 
if  the  sac,  as  shown  by  the  X-ray,  is  large, 
or  the  dilatation  diffuse.  In  any  case, 
the  possibility  of  a cure  by  these  means 
is  uncertain. 

In  early  aneurysm  active  antisyphilitic 
treatment  should  be  employed. 

Phenacetin,  antipyrine,  pyramidon,  and 
morphine  are  indicated  for  distressing  pain ; 
nitro-glycerine  for  anginal  attacks  (see  Part 
11  for  formulie).  ^'enesection  is  valuable 
for  the  relief  of  urgent  dyspnoea  and  cyano- 
sis. In  lar^mgeal  spasm,  if  relaxation  is  not 
effected  by  the  inhalation  of  chloroform,  it 
may  be  necessary  to  perform  tracheotomy 
{q.v.).  Tracheotomy  and  the  passage  of  a 


ANGINA  PECTORIS;  BREAST  PANG 


long  soft  cannula  beyond  the  point  of  com- 
pression is  rarely  demanded. 

The  operative  treatment  of  thoracic  and 
abdominal  aneurysms  (only  the  sacciform, 
not  the  fusiform)  is  sometimes  successful. 
It  mcludes  (a)  wiring  the  sac  combined  with 
electrolysis,  or  the  passage  of  a constant 
current  through  the  blood  l)y  the  means  of 
two  fine  electrodes  introduced  within  the 
sac ; and  (b)  needling  or  scarifying  the  inner 
sac-wall.  The  patient  should  be  at  absolute 
rest  and  on  the  medical  treatment  described 
above  for  at  least  a month  before  the  opera- 
tion, and  for  at  least  a month  after  the  last 
trace  of  exj^ansile  pulsation  has  disappeared ; 
or,  altogether,  from  three  to  five  months. 

Peripheral  aneurysms  may  be  cured  by 
the  use  of  Halstead’s  metal  band  applied 
above  the  sac,  or  by  suture  of  the  endothe- 
lial wall. 

Angina  Ludovici;  Cellulitis  of  the  Neck. — 

See  Ludwig’s  Angina. 

Angina  Pectoris;  Breast  Pang. — A not  un- 
common cardio-vascular  disease,  character- 
ized by  paroxysmal  attacks  of  agonizing 
pain  and  a sense  of  constriction  in  the  region 
of  the  heart,  the  jjain  e.xtending  into  the 
arms  (usually  the  left)  and  neck,  and  some- 
times present  in  other  ami  distant  parts. 
The  cause  of  the  attack  is  presumably  a 
myocardial  ischaemia,  due  to  sclerosis  and 
{perhaps  spasm  of  the  coronary  artery,  and 
excited  by  muscular  effort,  mental  emotion, 
flatulent  distension  of  the  stomach,  cold,  etc. 

Syphilis,  arteriosclerosis,  excess  in  eating, 
drinking,  and  smoking,  and  habitual  worry 
and  mental  stress  are  predisposing  causes. 

Anginal  attacks  not  due  to  organic  coro- 
nary disease  may  occur  as  a result  of  the 
excessive  use  of  tobacco,  tea  or  coffee,  die- 
tetic errors,  constipation,  hysteria,  neuras- 
thenia, hyperthyroidism,  valvular  heart  dis- 
ease, especially  aortic  insufficiency,  thoracic 
aneurysm,  adherent  pericardium,  and  acute 
cardiac-  overstrain  (angina  nervosa;  angina 
vasomotoria;  pseudo  angina;  toxic  angina; 
reflex  angina). 

Prognosis. — This  is  serious  in  true  angina 
due  to  coronary  sclerosis.  Sudden  death 
during  a paroxysm  sometimes  occurs.  The 
prognosis  in  other  anginas  is  usually  good, 
depending  upon  the  cause. 

Treatment. — Enjoin  a quiet  life,  physically 
and  mentally,  and  the  avoidance  of  tea, 
coffee,  alcohol,  tobacco,  and  constipation. 
The  diet  should  be  bland  and  easily  digesti- 
ble: milk,  buttermilk,  eggs  boiled  three 
minutes,  well-cooked  cereals,  vegetable  pu- 
rees, fruit;  no  tea,  coffee,  alcohol,  hot 
breads,  pastry,  soups,  spices,  excess  of  meat. 


of  salt,  or  of  fluids.  A glass  of  warm  water 
one  hour  before  each  meal  may  be  bene- 
ficial. Frequent  warm  baths  with  friction 
of  the  skin  are  advised  (no  cold  baths,  no 
cold  sheets  at  night).  Flannel  should  be 
worn  next  the  skin. 

To  prevent  attacks  the  following  drugs 
are  prescribed: 

B Sodii  vel  potassii  iodidi,  solutionis  con- 

centrati 5ss 

Sig. — Five  droi)S  (or  less),  well  diluted  in  milk, 
three  or  four  times  a day,  p.c. 

Give  the  iodide  continuously,  unless  symp- 
toms of  iodism  occur  (q.v.  in  Part  11),  fora 
year  or  longer.  It  is  well,  perhaps,  to  omit 
it  for  about  ten  days  in  each  month. 
(Osier.)  At  the  same  time  nitroglycerin  may 
be  given. 

B Spiritus  glonoini  ( I % alcoholic  solution 

of  nitroglycerine) gss 

Sig. — One  drop  in  water  t.i.d.,  increased  by  one 
drop  every  four  or  five  days  until  flushing  and 
headache  occur,  then  reduced  several  drops,  and 
occasionally  increased  tentatively. 

irpviii-x  may  have  to  be  given  to  p-  oduce 
the  desired  physiological  effect.  It  should  be 
given  intermittently  for  two  or  three  weeks 
at  a time.  Instead  of  the  drops,  tablets  may 
be  prescribed  (tabellaei  trinitrini,  gr.  bioo> 
beginning  with  gr.  J-f  00  three  or  four  times 
daily,  and  gradually  increasing,  if  need  be, 
to  gr.  }/20  or  even  Nitroglycerin 

acts  quicker  dissolved  in  the  mouth  than 
when  swallowed. 

In  place  of  nitroglycerin  one  may  use 
erythrol  tetranitrate,  drop  doses  of  the 
concentrated  solution,  or  tablets,  gr. 
every  four  hours,  increasing  to  gr.  or 

until  flushing,  throbbing,  or  slight  transient 
faintness  indicates  that  the  physiological 
limit  has  been  reached.  Intermit  the  drug 
for  several  days  every  two  weeks. 

Sodium  or  potassium  nitrite  is  another 
eligible  preparation,  gr.  i-iii  t.i.d.  in  milk 
or  water,  the  dose  being  regulated  according 
to  the  ])roduction  of  flushing  and  headache. 

Theobromine,  gr.  xv-xlv  pi'o  die,  or 
diuretin,  gr.  xv-xlv  pro  die,  is  also  well 
recommended  as  a preventive  of  attacks. 

Syphilitic  cases  require,  of  course,  anti- 
syphilitic treatment. 

For  the  attacks  themselves  employ  nitrite 
of  amyl  in  perles;  a perle  is  broken  in  a 
handkerchief  from  which  the  contents  are 
inhaled;  one,  two,  three,  or  four  perles  may 
be  inhaled  at  inteiwals.  Or,  one  drop  of  a 
one  per  cent,  solution  of  nitroglycerin  may 
be  placed  upon  the  tongue  every  minute 
until  the  arterial  tension  is  lowered  or  flush- 


ANKYLOSTOMIASIS;  UNCINARIASIS;  HOOKWORM  DISEASE 


ing  and  headache  occur;  sometimes  10-20 
drops  being  required.  (Hoover.)  Phenace- 
tin,  antipyrine  (see  Fart  11),  or  pyramidon 
may  prove  to  be  the  best  for  securing  relief. 
Morphine,  gr.  hypodermically, 

or  chloroform  inhalation,  may  be  recjuired. 
It  may  be  well  to  apply  heat  or  a mustard 
plaster  to  the  precordium,  and  aflminister 
hot  drinks.  The  galvanic  current,  with 
the  anode  over  the  vagus  in  the  neck, 
ami  the  kathode  over  the  heart,  and  a cur- 
rent of  20  milliamperes  for  five  minutes  to 
each  side  of  the  neck,  is  well  recommended 
by  J.  O.  Hirschfelder.  After  an  attack,  the 
patient  shoukl  rest  for  several  hours  or  days. 

In  the  neurotic  cases  tonics  and  sedatives 
are  of  service.  Liq.  potassii  arsenitis  (Fow- 
ler’s solution),  gtt.  iii-v,  well  diluted, 
t.i.d.p.c.;  elixir  ferri,  quininje,  et  strychninaj 
phosphati,  one  teaspoonful  in  water  t.i.d.; 
zinc  valerianate,  gr.  ii-iv,  with  phosphorus, 
gr.  3^(50  in  pill,  t.i.d.;  the  Weir  Mitchell 
treatment  and  hydrotherapy;  sodium  or 
strontium  or  ammonium  bromide,  gr. 
x-xv-xx,  well  diluted  in  water,  t.i.d.,  for 
nervousness  and  anxiety;  the  nitrites 
for  high  tension;  ergotin,  gr.  ii,  t.i.d., 
for  vasomotor  instal)ility;  phenacetin, 
antipyrine,  or  pyramidon  for  anginal 
attacks.  Correct  air  swallowing  by  keeping 
the  mouth  open. 

Angina,  Pseudo. — Gr.  \pev8r]s  false.  See 
Angina  Pectoris. 

Vincent’s. — See  Stomatis,  Ulcerative. 

Angiocholitis. — See  Cholangitis. 

Angioneurosisof  the  Kidney. — Gr.  ayye7,ov 
ves.sel  d-  vevpov  nerve.  See  under  Hema- 
turia. 

Angioneurotic  CEdema. — See  Skin  Dis- 
eases, Part  5. 

Ankylostomiasis;  Uncinariasis;  Hook= 
worm  Disease. — Gr.  ayKvXos  bent  -f  aropa 
mouth.  L.  unciudtus,  hooked. 

Other  names  that  have  been  given  to  this 
disease  are  tropical  chlorosis,  Egyptian 
chlorosis,  brickmaker’s  ana?mia,  tunnel  anae- 
mia, miner’s  cachexia,  dirt-eater’s  disease, 
mountain  anaemia. 

Ankylostomiasis  is  a common  parasitic 
disease  caused  by  the  hookworm  (ankylo- 
stoma  duodenale,  or  old-world  hookworm; 
uncinaria  Americana,  or  necator  Ameri- 
canus,  new-world  hookwmrm),  which  lives  in 
the  intestine,  and  gives  rise  to  a chronic 
anaemia  of  the  pernicious  type  with  eosini- 
philia.  The  hookworm  embiyos  or  larvae, 
which  live  in  mud  or  muddy  water  in  an 
encysted  state,  gain  entrance  to  the  body 
either  through  the  skin  (ground-itch)  or  the 
mouth.  Ground-itch  is  an  itching  vesiculo- 


pustular  dermatitis  occurring  usually  be- 
tween the  toes.  The  larvae  travel  from  the 
skin  through  the  blood  and  lymph  to  the 
lungs,  where  they  enter  the  air  passages,  and 
finally  reach  the  mouth  in  the  bronchial 
mucus,  and  are  swallowed. 


Fig.  2. — Hookworm  ova. 


The  diagnosis  of  ankylostomiasis  is  made 
by  finding  the  ova  in  the  stools  (washed 
through  cheesecloth),  see  under  Worms. 
The  ova  are  distinguished  from  those  of 
ascaris  lumbricoides  chiefly  by  the  presence 
of  segmentation  in  the  ova  of  the  hookworm. 

Treatment. — The  following  prophylactic 
instructions  should  be  given:  Wear  shoes 
and  stockings,  keep  the  hands  clean,  boil 
the  drinking  water,  thoroughly  wash  raw 
vegetable  food,  do  not  defecate  upon  the 
surface  of  the  ground,  bul  in  privies  or 
latrines.  Fteces  is  disinfected  by  burying 
eighteen  niches  deep,  by  freezing,  burning 
or  mixhig  with  an  equal  amount  of  bichloride 
solution,  1:200. 

The  followmg  treatment  is  curative:  In 
the  evening  purge  the  patient  with  Epsom 
salt  or  Glauber’s  salt,  3v-x,  and  allow  no 
supper.  At  6 A.M.  the  following  morning,  or 
after  the  bowels  have  moved  freely,  give 
thymol,  gr.  xxx,  in  capsule,  or  in  an  emulsion 
with  mucilage  of  acacia  and  syrup;  at  8 a.m. 
repeat  the  dose  (or  20  grains  may  be  given 
at  6,  7,  and  8 o’clock) ; :uid  at  10  a.m.  give 
an  ounce  of  sodium  or  magnesium  sulphate, 
or  senna,  or  calomel  (see  Part  11).  Keep 
the  patient  in  bed  on  the  right  side  to  hasten 
the  passage  of  thymol  thi’ough  the  stomach; 
and  allow  no  food  and  ver}"  little  water  on 
the  day  of  treatment.  No  alcohol,  oil,  fat, 
alkali,  or  other  drug  should  be  allowed  on 
the  day  before  or  during  the  thjTnol  admin- 
istration, as  alcohol  and  oils  dissolve  thymol, 
and  other  drug  may  be  incompatible  with  it. 

The  thymol  treatment  should  be  repeated 
one  day  each  week  until  no  ova  are  found  in 
the  stools.  If  this  treatment  fails,  Riesman 
suggests  that  ammonium  chloride  (see  Part 
11)  be  first  given  for  the  purpose  of  expel- 
ling a possible  accumulation  of  mucus  from 
the  bowel. 

The  dose  of  thymol  at  different  ages  or 


ANOREXIA;  LOSS  OF  APPETITE 


sizes  is  as  follows:  under  5 years  in  age  or 
size,  about  grains;  5 to  10  years,  15 
grains;  10  to  15  years,  30  grains;  15  to  20 
years,  45  grains;  20  to  00  years,  00  grains; 
above  00  years,  45-30  grains. 

Conditions  unfavorable  to  the  adminis- 
tration of  thymol  are:  great  tlebility, 

very  old  age,  very  low  temperature,  preg- 
nancy, advanced  cardiac  or  other  organic 
disease  (fatty  heart,  nej)hritis,  anasarca), 
chronic  tliarrhoea,  dysentery,  tendency  to 
vomit.  (Stiles.) 

Beta-naphthol  is  also  well  recommended: 
Give  one  ounce  of  sodium  sulphate  or  a half- 
ounce of  magnesium  sulphate  in  the  evening, 
and  no  food.  Keep  the  patient  in  bed  the 
next  day,  and  give  15-30  grains  (women, 
25  grains)  of  beta-naphthol  at  6 a.m.,  another 
dose  at  8 a.m.,  and  another  at  10  a.m.;  at 
12  noon  give  1 ounce  of  sodium  sulphate  or 
6 drams  of  magnesium  sulphate. 

Oil  of  chenopodium  (American  wormseed 
oil)  is  also  efficient.  Cleanse  the  bowels  the 
evening  before,  then  give  one  drop  of  the  oil 
for  every  year  of  age  up  to  15,  in  a teaspoon- 
ful of  granulated  sugar,  every  two  hours  for 
three  doses,  followed  two  hours  later  by  a 
good  dose  of  castor  oil.  Repeat  this  treat- 
ment weekly  until  no  ova  are  found  in  the 
stools.  “ Subminhnal  doses  repeated  at  inter- 
vals of  several  days  become  to.xic.”  (Epitome 
of  the  U.  S.  P.and  N.  F.)  Alessandrini  praises 
chloroform,  3-4  gm.  dissolved  in  castor  or 
ohve  oil  in  a single  dose;  not  to  be  repeated 
in  less  than  a week. 

Ground-itch  should  be  treated  as  follows: 
If  seen  in  the  very  beginning  stage  of  red 
spots,  apply  turpentine  for  the  purpose  of 
destroying  the  larvae.  In  the  later  stages, 
open  vesicles,  blebs,  and  pustules,  and  soak 
the  parts  in  hot  bichloride  solution,  1 : 2000, 
or  boric  acid  solution.  The  lesion  is  thereby 
healed  in  ten  to  twelve  days. 

Anoci=Association. — See  under  Shock. 

Anorexia;  Loss  of  Appetite. — Gr.  dr  with- 
out -f  Spells  appetite. 

Anorexia  in  Adults.^ — Lack  of  appetite  is 
particularly  pronounced  in  chronic  gastric 
disease,  e.g.,  cancer,  chronic  gastritis,  gastro- 
ptosis,  gastrectasia,  cirrhosis  of  the  stomach, 
in  febrile  conditions,  anaemia,  tuberculosis, 
chronic  nephritis,  morphinism,  tobacco  ad- 
diction, the  u.se  of  belladonna,  anorexia 
nervosa  (hysteria,  neurasthenia,  emotion, 
insanity),  etc.  In  anorexia  nervosa  the  loss 
of  appetite  may  be  extreme  and  persistent, 
and  death  may  even  result. 

Treatment. — Consider  the  cause.  The  fol- 
lowing bitter  tonics  are  recommended  as 
useful  appetizers: 

2 


Tinctura;  gentianaj  compositae,  5ss-i-iv  in 
water  t.i.d.,  about  15-30  minutes  a.c. 

II  Tincturse  calumbae,  oi-u-iv  in  water  t.i.d., 
about  15-30  minutes  a.c. 

II  Tincturse  quassiae,  tijj.xv-Lx  in  water  t.i.d.,  about 
15-30  minutes  a.c. 

II  Fluidextracti  chiratae,  njjv-xv  in  water  t.i.d., 
about  15-30  minutes  a.c. 

II  Tincturse  cardamomi  compositae,  3ss-i-iss  in 
water  t.i.d.,  about  15-30  minutes  a.c. 

II  Tincturae  cinchonse,  vel.  Tr.  cinchona;  comp., 
3ss-i-ii,  t.i.d.,  about  15-30  minutes  a.c. 

II  Fluidextracti  condurango,  3ss-i  in  water,  t.i.d., 
about  15-30  minutes  a.c. 

II  Tincturae  nucis  vomicae,  Ttpv-xx,  in  water,  t.i.d., 
about  15-30  minutes  a.c. 

Several  bitters  may  be  combined  in  one 
prescription : 

II  Tincturae  nucis  vomicae. . . 3v  ( i^x  per  dose) 

Tinct.  gentianae  comp q.s.  ad  3iv 

M.  Sig. — A teaspoonfui  in  a quarter  glass  of  water, 
t.i.d.  a.c. 

II  Tincturse  nucis  vomicae ...  Si  ( "Ex  per  dose) 
Tinct.  cinchonae  comj) ....  3 xi 
M.  Sig. — Two  teaspoonfuls  t.i.d.  (S.  Theobald.) 

II  Tincturae  rhei  aromatici.. . 3iiss  (irgx  per  dose) 
Tincturae  nucis  vomicae . . . 3iii-iv 

( itExii-xvi  per  dose) 
Tincturae  gentianae  comp. . Siss 
Tincturse  aui'antii  amarae. . q.s.  ad  S iv 
M . Sig. — Two  tcaspoonfuls  in  water  shortly  before 
'meals.  For  anorexia  in  atonic  dyspepsia.  (Modi- 
fication of  Huchard’s  formula). 

II  Acidi  hydrochloric!  diluti.  . 5! 

Sig. — Twenty  drops  in  water,  15  minutes  before 
meals,  as  a stomachic.  (Ortner.)  Strychnine  sul- 
phate, gr.  ho,  or  tr.  nucis  vomicae,  Trjjx,  may  be 
added  to  each  dose. 

II  Orexini  basic! gr.  v 

Fiat  capsula  una;  mitte  talis.  v. 

Sig. — Take  one  capsule  in  the  middle  of  the 
afternoon,  followed  by  a fuU  glass  of  water  or 
milk.  (Croftan.) 

Penzoldt  gives  it  at  10  a.m.,  followed  by 
a cup  of  soup.  Says  Croftan:  “After  the 
fourth  or  fifth  day  the  further  administra- 
tion of  the  remedy  is  generally  superfluous, 
especially  as  its  effect  wears  off.  It  is  often 
good  practice  to  stop  the  administration  of 
orexine  for  a week  and  then  to  resume  the 
use  of  the  medicine  for  four  or  five  days 
again.”  He  says  that  “ basic  orexine  is 
better  than  orexine.”  The  dose  of  the  latter 
is  given  as  gr.  v in  capsule  t.i.d. 

Alcohol  (a  whiskey  cocktail  before  eating) 
is  efficacious;  also  liquids  during  meals. 

It  may  be  well  to  advise,  on  rising,  and 
also  one-half  to  one  hour  before  meals,  a 
glassful  of  hot  water  containing  one-third 
of  a teaspoonful  of  sodium  bicarbonate. 
Gastric  lavage  with  warm  normal  saline 


APOPLEXY 


solution  (one  teaspoonful  to  the  pint)  may 
be  useful  in  gastric  disorders. 

For  anfBinia  prescribe  Blaud’s  pills,  iron 
albuminate,  the  elixir  ferri,  quininse,  et 
strychninae  phosphati,  one  teaspoonful  in 
water  t.i.d.,  or  arsenic  (sec  Part  11). 

P''or  anorexia  nervosa  employ  absolute 
rest  in  bed,  fresh  air  day  and  night,  isola- 
tion, massage,  hydrotherapy,  electricity,  and 
gavage  or  rectal  feedmg  (q.v.),  if  necessary. 
In  employing  cutaneous  faradization  or  gal- 
vanization, apply  two  large  plate  electrodes, 
well  moistened,  over  the  stomach,  or  the 
anode  to  the  epigastrium  and  the  cathode 
to  the  spine,  and  use  a current  strong  enough 
to  produce  visible  twitchings  of  the  abdom- 
inal muscles  for  no  longer  than  ten  minutes. 

Anorexia  in  Infants — Causes:  Wrong  feeding, 
overfeeding,  limited  digestive  capacity, 
feebleness,  acute  disease. 

Treatment. — See  under  Inanition. 

Anorexia  Nervosa. — See  Anorexia. 

Anosmia. — See  Nose  Diseases,  Part  8. 

Anterior  Crural  Nerve. — See  Lumbar 
Plexus. 

Anterior  Poliomyelitis,  Acute. — See  Poli- 
omyelitis, Acute. 

Poliomyelitis,  Chronic. — See  Atrophies, 
the  Progressive  Muscular. 

Tibia!  Nerve. — See  Sacral  Plexus. 

Anthracosis;  CoaLminer’s  Lung. — Gr. 
avdpa^  coal.  See  Pneumokoniosis. 

Anthrax. — See  Skin  Diseases,  Part  5. 

Antidotes. — L.  antidotum,  from  Gr.  avrl 
against  -|-  hihbvai  to  give.  See  Poisonmg. 

Anuria;  Ischuria;  Oliguria. — Gr.  d^neg.  + 
o7jpov  urine;  Lax^i-v  to  check;  dXtyos  scanty. 

Anuria  (arrest  or  suppression  or  abnormal 
scantiness  of  the  urinary  secretion)  should 
be  distinguished  from  retention  (q.v.  in 
Genito-Urinary  Diseases,  Part  3,).  Oliguria 
refers  to  a twenty-four-hour  secretion  below 
about  800  c.c. 

Etiology.— Blocking  of  the  ureters  with  cal- 
culi, fibrin,  pus,  mucus,  bits  of  tissue  or 
new-growths;  stone  in  one  ureter  or  kidney, 
with  reflex  inhibition  of  the  other  kidney; 
traumatism  or  infection  of  one  kidney,  with 
reflex  inhibition  of  the  other  kidney; 
one  ureter  blocked  and  the  other  kiilney 
functionally  inactive;  blocking  of  a single 
ureter  of  fused  kidneys,  or  of  the  common 
stem  of  the  two  ureters;  removal  of  the  only 
kidney;  removal  of  the  only  sound  kidney; 
thrombosis  of  both  renal  arteries;  collapse 
after  severe  injuries,  operations,  the  passage 
of  a catheter,  cholera,  and  yellow  fever; 
anaesthesia;  acute  nephritis;  acute  poisoning 
with  phosphorus,  lead,  or  turpentine;  acute 
yellow  atroi)hy  of  the  liver;  eclampsia;  con- 


vulsions; hysteria;  hepatic  cirrhosis;  fevers; 
cachectic  states;  chilling  of  the  skin  surface; 
large  ascitic  accumulation ; pressure  upon  the 
vena  cava  by  tumors;  acute  cardiac  dropsy; 
digitalis  in  toxic  doses;  blackwater  or  hsemo- 
globinuric  fever;  chronic  parenchymatous 
nephritis;  profuse  sweating,  vomiting,  diar- 
rhoea, or  hemorrhage;  scant  water  drinking. 

In  the  new-born  the  causes  are : malforma- 
tion of  the  genital  tract,  or,  usually,  uric  acid 
infarctions  in  the  renal  tubules,  or  unknown 
causes.  The  newly  born  baby  may  normally 
not  pass  urine  for  twenty-four  hours. 

Osier  says:  “ A patient  may  live  for  from 
ten  days  to  two  weeks  with  complete  sup- 
pression of  urine.”  I 

Treatment. — Obstructive  cases  require  sur- 
gical intervention.  Gaston  Lyon  advises,  in 
calculous  anuria,  prolonged  hot  baths,  elec- 
tricity, and  a milk  diet;  and,  if  uraemia 
appears,  or  the  anuria  is  not  relieved  before 
the  fifth  day,  nephrostomy. 

In  non-obstructive  cases  employ  hot  ap- 
plications and  cupping  over  the  kidneys,  hot 
colonic  irrigation  with  normal  saline  solu- 
tion (a  teaspoonful  to  the  pint),  or  irriga- 
tions by  means  of  Kemp’s  double  current 
rectal  tubes,  free  sweating  with  hot  air 
and  perhaps  pilocarpine,  gr.  3^,  hypodermic- 
ally, and  free  purging.  A dry  cup  is  applied 
as  follows:  a tumbler  is  swabbed  quickly 
with  alcohol,  the  edges  wiped  dry,  the 
alcohol  ignited  and  allowed  to  burn  for  a few 
moments,  and  the  cup  then  quickly  applied. 
Diuretics  are  not  advised.  The  treatment 
of  acidosis  (q.v.)  may  reestablish  diuresis. 

Intravenous  (q.v.)  or  subcutaneous  infu- 
sions of  sterile  normal  saline  solution  are 
indicated  in  collapse. 

In  the  newly  born  one  may  prescribe  the 
following: 

B Spiritus  aetheris  nitrosi. . . niiviii  ( irgi  per  dose) 
Potassii  citratis  vel  ace- 

tatis gr.  viii  (gr.  i per  dose) 

Aquae o i 

M.  Sig. — One  dram  every  hour  or  two,  together 
with  plenty  of  water,  until  the  urinary  secretion  is 
established.  (Holt.) 

In  uric  acid  infarction,  the  uric  acid,  when 
washed  out,  appears  as  reddish  stains. 

Anus. — See  Anal. 

Aortitis. — See  Arteriosclerosis  and 
Arteritis. 

Aphasia. — Gr.  a priv.  4>a(ns  speech.  See 

under  Brain  liocalization. 

Aphonia. — See  Throat  Diseases,  Part  9. 

Aphthee. — See  Stomatitis,  Aphthous. 
Bednar’s. — See  Ulcer  of  the  hlouth. 

Apoplexy. — Gr.  6.TroTr'Kr]l;ia.  Apoplexy  de- 
notes a more  or  less  sudden  loss  or  dis- 


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APERIENT  PLANTS 


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Aperient  .astringent,  laxative  and  refreshing  plants. 


LAROUSSE  MEDICAL 


APOPLEXY 


turbance  of  consciousness  associated  with  a 
flaccid  paralysis,  due  to  cerebral  hemor- 
rhage, embolism,  or  thrombosis.  A dif- 
ferential diagnosis  between  hemorrhage, 
embolism,  and  thrombosis  can  never  be 
certain,  therefore  I have  included  all  three 
under  the  designation  Apoplexy,  for  thera- 
peutic reasons. 

Causes  of  Cerebral  Hemorrhage. — ^Arterio- 
sclerosis iq.v.),  rupture  of  a miliary  aneu- 
rysm, trauma,  vascular  tumor,  sudden  mus- 
cular or  mental  stress,  whooping-cough,  gen- 
eral i^aresis,  sudden  arrest  of  menstruation, 
pregnancy  and  the  puerperal  state,  obesity, 
chronic  nephritis,  infectious  diseases,  leu- 
kaemia, pernicious  anaemia,  purpura. 

Causes  of  Cerebral  Hmbolism. — Endocar- 
ditis, septico-pyemia,  atheroma,  piece  of 
clot  from  the  auricular  appendix  or  from  an 
aneurysmal  sac. 

Causes  of  Cerebral  Thrombosis. — Syphilis, 
infectious  diseases,  atheroma,  abnormal 
blood  states — e.g.,  anaemia,  chlorosis,  leu- 
kaemia, pregnancy,  and  diabetes — obstruction 
to  the  flow  of  blood  by  tiunors,  gumma 
or  abscess,  ligation  of  the  carotid  artery, 
very  rarely  cardiac  or  general  circula- 
tory enfeeblement. 

For  other  causes  of  unconsciousness,  see 
Coma. 

Prognosis. — Most  apoplectic  attacks  are 
recovered  from,  but  the  ultimate  outlook  in 
elderly  patients  is  serious. 

Treatment. — With  great  gentleness,  place 
the  patient  in  bed,  in  a quiet,  darkened  room, 
with  the  head  slightly  raised  without  bend- 
ing the  neck,  and  the  body  turned  upon  its 
side  to  avoid  falling  back  of  the  tongue. 
See  that  the  clothing  is  loose.  Place  an  ice- 
cap to  the  head,  and  hot  bottles  covered  with 
flannel  near  the  feet.  If  the  arterial  tension 
is  high  (cerebral  hemorrhage),  purge  the 
patient  actively  by  means  of  croton  oil, 
gtt.  i-ii,  in  four  or  five  drops  of  glycerine, 
olive  oil,  or  butter,  placed  upon  the  back  of 
the  tongue,  or  elaterium,  gr. 
elaterin,  gr.  /4o~M.o>  or  calomel,  gr.  v-x, 
aided  by  an  enema  consisting  of  oil  of  tur- 
pentine, 5ss-i-iv,  and  olive  oil,  in  a large 
amount  of  warm  soapsuds. 

For  restlessness  administer  sodium  bro- 
mide, gr.  XXX,  well  diluted,  every  4-6  hours. 

For  sleeplessness  administer  trional,  gr.  xv. 

For  convulsions  administer  chloroform  by 
inhalation,  and  hyoscin,  gr.  3'{oO;  bypo- 
dermically,  or  chloral,  gr.  xx,  with  sodium 
bromide,  gr.  xxx,  well  diluted,  per  rectum. 

For  feeble  heart  action  administer,  when 
necessary,  camphor,  gr.  ii,  in  olive  oil,  i^xxx, 
hypodermically;  or  ether,  ngxxx-lx,  hypo- 


dermically; or  caffein,  gr.  iss  to  hi,  dissolved 
in  sterile  water  by  the  addition  of  benzoate 
or  salicylate  of  sodium,  gr.  iv-x. 

For  hiccough,  retching,  and  vomiting, 
administer  mori)hine,  gr.  with  atropine, 
gr-  K20,  hypodermically. 

When  no  positive  diagnosis  between 
hemorrhage,  embolism,  and  thrombosis  can 
be  made,  blood-letting  is  perhaps  inadvis- 
able, since  it  favors  clotting.  Cushing  says 
it  is  “ unphysiological  and  hazardous.” 
Good  authorities,  however,  advise  the  with- 
drawal of  8-16  ounces  of  blood,  when  the 
face  is  congested,  the  pulse  full  and  hard, 
and  the  second  aortic  sound  accentuated. 
Small  doses  of  aconite  (see  Part  11)  are 
recommended  for  the  same  purpose. 

Cushing  advocates  simple  decompression 
or  removal  of  the  clot  in  those  cases  in  which 
the  blood  pressure  and  temperature  con- 
tinue to  rise  and  Cheyne-Stokes  respiration 
occurs,  or  in  which  the  blood-pressure  is 
250  (Riva-Rocci)  and  the  pulse  as  low  as  50 
per  minute. 

If  syphilitic  thrombosis  is  suspected,  ad- 
minister mercury  by  injection  or  inunction, 
and  add  potassium  iodide,  gr.  xx-xxx  -j- 
t.i.d.,  as  soon  as  the  patient  can  swallow 
(see  Syphilis). 

Feed  the  patient  only  per  rectum  (see 
Rectal  Feeding),  until  he  is  able  to  swal- 
low, then  feed  him  with  a spoon — milk, 
eggs,  and  broth,  every  three  or  four  hours. 
Keep  the  mouth  clean  with  an  alkaline  anti- 
septic solution  (see  Pyorrheea  Alveolaris), 
using  for  tho.  purpose  a cotton  or  gauze 
swab  attached  to  haemostatic  forceps. 
Bathe  the  body  daily  with  tepid  water  and 
alcohol,  and  guard  against  bed-sores  (q.v.). 
Relieve  urinary  retention  with  the  catheter. 

Keep  the  patient  in  bed  for  at  least  two 
weeks  after  recovery  from  the  stroke.  At 
least  ten  days  after  recovery,  begin  to  treat 
the  paralyzed  muscles  by  means  of  massage 
toward  the  heart,  for  no  longer  than  fifteen 
minutes,  once  or  twice  daily,  and  passive 
movements.  “After  the  lapse  of  a fort- 
night, or,  in  severe  cases,  a month”  (Osier), 
employ  the  faradic  current  for  a half-hour, 
alternately  with  massage,  of  a strength  not 
sufficient  to  cause  pain  or  muscular  con- 
traction . T o keep  the  shoulder  from  sagging, 
support  the  arm  at  the  elbow.  No  further 
improvement  can  be  expected  in  the  paraly- 
sis after  it  has  persisted  over  three  months. 
If  contractures  begin  to  develop,  see  that  the 
limbs  are  placed  in  convenient  positions. 
Tendon  and  even  nerve  transplantations 
may  be  of  service  in  alleviating  the  effects 
of  residual  paralyses. 


APPENDICITIS 


Prophylaxis. — This  is  the  same  as  the  treat- 
ment of  arteriosclerosis  (q-v.),  viz.,  mod- 
erate exercise,  the  avoidance  of  excessive 
physical  or  mental  work  and  of  sexual  inter- 
course, free  bowel  action,  a bland,  light  diet, 
and  the  avoidance  of  tea,  coffee,  alcohol,  and 
tobacco.  Should  such  premonitoiy  symp- 
toms of  hemorrhage  as  vertigo,  jiarajsthesia, 
muscular  twitching,  etc.,  occur,  the  patient 
should  keep  very  quiet,  open  his  bowels, 
restrict  his  diet,  and  take  about  fifteen 
grains  of  sodium  bromide  every  four 
hours.  (Forchheimer). 

Appendicitis. — The  characteristic  symp- 
toms of  appendicitis  are:  sudden  pain  with 
nausea  and  vomiting,  elevation  of  tempera- 
ture and  rapid  pulse,  usually  constipation, 
sometimes  diarrhoea,  some  flexion  of  the 
right  thigh,  tenderness  and  muscle  sj:)asm  m 
the  right  iliac  region,  pain  on  turning  on 
the  left  side,  and  sometimes  tumor.  Re- 
current attacks  are  common. 

Other  conditions  that  may  sometimes  sim- 
ulate the  commoner  appendicitis  are:  men- 
strual ]:>ain,  tubo-ovarian  disease,  pelvic 
peritonitis,  biliary  colic,  renal  colic,  Dietl’s 
crises  in  floating  kidney,  perinephric  abscess, 
psoas  abscess,  early  sj^inal  caries,  sacro-iliac 
disease,  pleurisy,  typhoid  fever,  mucous 
colitis  with  enteralgia,  acute  hemorrhagic 
pancreatitis,  intussusception  m infants,  acute 
indigestion,  hysteria. 

Treatment. — Most  cases  of  acute  appendi- 
citis recover  without  operation,  but  subse- 
quent attacks  are  prone  to  occur.  All  cases 
seen  within  the  first  thirty-six  to  forty-eight 
hours  of  an  attack  should  be  operated  ujion 
at  once,  unless  adventitious  contraindica- 
tions exist.  Operation  in  these  early  hours 
is  very  safe.  But  if  the  case  is  seen,  while 
still  j)rogressing,  after  the  first  forty-eight 
hours,  what  should  be  done?  This  is  a per- 
plexing problem.  The  inflammatory  jjroc- 
es.ses  are  at  their  height,  the  defensive 
forces  of  the  body  have  not  yet  gained  the 
ascendancy,  ami  premature  surgical  inter- 
ference may  be  a detriment  instead  of  a help. 
Many  surgeons  operate  at  once  at  whatever 
time  the  case  is  seen;  others  are  inclined  to 
employ  the  following  ])lan  of  Ochsner’s: 
absolute  rest  in  bed,  with  the  head  and 
chest  elevated,  and  a pillow  under  the  knee, 
and  strict  injunction  against  turning  over  or 
sitting  up  (the  jiatient  should  be  lifted  on 
the  bed-pan  when  the  latter  is  used,  and 
shoidd  be  warned  against  exertion) ; the  with- 
drawal of  all  food  and  water,  for  the  jmrpose 
of  preventing  peristalsis;  the  administration 
of  an  enema  consisting  of  two  ounces  of  olive 
oil;  the  mouth  kept  clean  and  moist;  warm 


or  cold  applications  to  the  affected  region 
(50  per  cent,  alcohol  compresses,  changed 
every  twelve  hours,  are  strongly  recom- 
mended by  Ortner);  for  vomiting,  warm 
api)lications  to  the  epigastrium,  gastric 
lavage,  or  some  one  of  the  remedies  enumer- 
ated under  Vomiting;  for  excessive  thirst, 
small  pieces  of  ice  to  suck,  or,  better, 
j)roctoclysis,  with  the  metal  reservoir  ele- 
vated only  about  six  or  seven  inches  above 
the  buttocks,  no  tube  clamps  being  used,  and 
the  water  or  saline  solution  (pi  ad  Oi)  bemg 
kept  warm  (115°  F.)  by  means  of  hot  water 
bottles  immersed  in  the  metal  reservoir.  If 
progres.sive  improvement  does  not  follow  this 
line  of  treatment,  operate.  The  result  of  this 
rest  treatment  usually  is  rapid  localization  of 
the  inflanmiatory  processes,  and  either  en- 
tire resolution  or  local  abscess  formation. 
Operation  with  drainage  at  this  stage  is  very 
safe.  After  48  hours  of  the  above  treatment, 
provided  that  all  symptoms  have  subsided, 
return  cautiously  to  a liquid  diet,  e.g.,  milk, 
one  to  two  tablespoonfuls  every  2-3  hours, 
or  broth  with  an  egg  stirred  in  it,  or  strained 
barley  gruel;  later,  well-cooked  cereals,  such 
as  sago,  tapioca,  arrowroot,  wheat,  or  oat- 
meal, with  a gradual  return,  after  seven  to 
ten  days,  to  soft-boiled  eggs,  mashed  pota- 
toes, vegetable  purees,  finely  chopped  sweet- 
breads, chicken,  or  mutton,  etc.  After  the 
symptoms  have  disappeared,  give  calomel 
(see  Part  11).  Absolute  rest  should  be 
continued  for  at  least  five  to  ten  days  after 
the  symptoms  have  disappeared. 

Should  fever,  nausea,  or  local  sjunptoms 
return,  operate  at  once. 

When  operation  is  iwrformed  at  the  height 
of  an  attack,  remove  the  appendix  only  if  it 
is  accessible  and  easily  amputated,  and  the 
constitutional  intoxication  is  not  severe,  but 
remove  it  if  at  all  feasible.  Do  not  invag- 
inate  the  stump.  Irrigation,  sponging,  and 
manipulation  of  the  tissues  should  be 
strictly  avoided.  It  may  be  best  merely  to 
open  any  existing  abscess  and  insert  a large 
split  drainage  tube  with  many  side  openings 
at  its  lower  end,  especially  where  the  intoxi- 
cation is  great.  The  abdomen  should  be 
opened  median  ward  and  the  intestines  coffer- 
dammed  before  incising  the  abscess. 

Should  fever  and  pain  recur  after  the 
evacuation  of  the  abscess,  make  hot  applica- 
tions in  order  to  promote  freer  drainage. 
Give  enemas  whenever  required  for  dis- 
tressing distention. 

To  remove  the  risk  of  operation  between 
about  the  fifth  to  tenth  day,  when  the  con- 
tents of  the  abscess  are  apt  to  be  extremely 
virulent.  Page  advocates  a conservative 


APTYALISM ; HYPOPTYALISM  ; XEROSTOMIA 


operation:  “ If  on  opening  the  abdomen  the 
abscess  is  found  not  to  be  shut  off  from  the 
general  peritoneal  cavity,  no  attempt  is 
made  to  open  the  cavity  or  do  anything 
further;  a cigaret  drain  of  medium  size  is 
put  down  to  the  outer  sitle  of  the  inflamma- 
tory mass  and  the  wound  sutured.  Hot 
abdominal  fomentations  are  then  applied. 
Spontaneous  discharge  of  the  abscess  occa- 
sionally occurs  along  the  tube;  in  a sur- 
prising number  of  ca.ses,  however,  the  in- 
flammatory swelling  subsides  without  any 
pus  appearing.  If  the  temperature  keeps 
up  and  the  pain  persi.sts  after  the  second  or 
third  day,  the  tube  is  removed  and  a finger 
inserted  along  its  track  under  gas,  and  in 
this  way  the  abscess  can  usually  be  broken 
into.  At  this  stage  adhesions  around  the 
line  of  the  drainage  tube  remove  the  risk  of 
infecting  the  peritoneum.”  {The  Practical 
Medicine  Series  of  1915.) 

After  operation  for  general  peritonitis 
following  perforative  appendicitis,  place  the 
patient  in  a semi-sitting  posture  (Fowler’s 
po.sition),  and  administer  hot  normal  saline 
solution  (5i  of  NaCl  ad  Oi)  containing  cal- 
cium chloride,  pi  to  each  pint,  or  just  plain 
water,  per  rectum.  Keep  the  rectal  tube  con- 
stantly in  place,  and  give  6-15  quarts  during 
each  twenty-four  hours,  or  pints  every 
two  hours.  Continue  this  for  three  or  four 
or  more  days.  Give  no  water  by  mouth. 
Eight  hours  after  the  operation  promote  a 
mild  catharsis  by  means  of  small  doses  of 
calomel,  or  give  an  enema  as  often  as  is 
necessary  to  correct  distention  and  distress. 

In  performing  proctoclysis  employ  a metal 
fountain  syringe  and  a rectal  tube  with 
many  openings,  bent  at  an  obtuse  angle  two 
inches  from  its  tip,  so  that  it  can  be  fa.stenetl 
to  the  thighs  with  adhesive  strips.  Suspend 
the  can  so  that  its  base  is  six  inches  above 
the  level  of  the  buttocks.  Keep  the  solution 
at  a temperature  of  100°  by  means  of  hot 
water  bags,  thermolytes,  an  incasing  can  of 
hot  water,  or  hot  water  bottles  immersed  in 
the  reservoir.  Do  not  employ  clamps  or 
knots  in  the  tube  to  control  the  flow.  The 
multiple  openings  are  intended  “ to  provide 
for  a sudden  return  of  the  flow  into  the  can 
when  the  patient  strains,  wishes  to  expel  the 
fluid,  or  void  gas.”  “ It  should  require  not 
le.ss  than  forty  nor  more  than  sixty  minutes 
for  the  pint  and  a half  of  solution  to  perco- 
late into  the  bowel,  being  uniformly  absorbed 
in  this  period  of  time;  but  if  administered 
more  rapidly,  it  will  be  expelled.”  (John 
B.  Murphy.) 

Appendectomy  Operation. — Make  a longitu- 
dinal incision,  about  two  inches  in  length, 


just  to  the  median  side  of  the  semilunar 
line,  and  bisected  by  a line  drawn  from 
the  anterior  superior  spine  of  the  ilium  to 
the  umbilicus. 

Incise  the  skin  and  two  layers  of  apon- 
eurosis and  thus  expose  the  rectus  muscle. 
Loosen  the  latter  in  its  sheath,  and  retract 
it  toward  the  middle  line.  Divide  the  pos- 
terior sheath  and  peritcjneum  transversely, 
bearing  in  mind  the  proximity  of  the  deep 
epigastric  artery. 

Hook  up  the  meso-ilium  into  the  wound, 
and  follow  and  free  the  appendix  from  its 
ba.se  to  its  tip. 

Clamp  the  mesentery  of  the  appendix 
about  half  an  inch  from  its  appendiceal 
margin  with  compression  forceps;  place  a 
catgut  ligature  in  the  groove;  and  divide  the 
mesentery  close  to  the  appendix  up  to  the 
caput  coli  with  scissors. 

Clamp  the  appendix  one-half  an  inch  from 
the  caput  coli;  place  a catgut  ligature  in  the 
groove;  and  amputate  the  appendix  one- 
eighth  of  an  inch  distal  to  the  ligature. 

If  adhesions  cannot  be  separated  with 
.safety,  divide  the  peritoneal  and  fibrous 
coats  of  the  appendix  from  base  to  tip, 
shell  out  the  mucosa,  close  with  a whipstitch 
of  catgut,  and  amputate  the  appendix. 
Ligate  the  niesentery  as  before,  if  it  can  be 
freed.  (Partly  from  Keen’s  Surgery.) 

Appetite,  Excessive. — See  Bulimia. 

Loss  of. — See  Anorexia. 

Apraxia. — Gr.  a neg.  -|-  irpacaeLv  to  do. 
Apraxia  or  dyspraxia  (Gr.  6ds  ill)  signifies  the 
inability  to  perform  certain  voluntary  move- 
ments, although  there  exists  no  motor  or 
sensory  paralysis  or  ataxia.  The  cause  is 
usually  a lesion  of  the  corpus  callosum  or 
posterior  part  of  the  frontal  lobe. 

The  treatment  consists  in  the  retraining 
of  the  limb  for  such  acts  as  are  lost  or 
defective.  (S.  A.  Kinnier  Wilson.) 

Aptyalism;  Hypoptyalism;  Xerostomia. — 
Gr.  a priv.  + xruaXIfeu'  to  spit;  virb  under; 
^Tjpos  dry  + aroixa  mouth. 

Causes  of  Dry  Mouth. — Fevers;  fright  and 
excitement;  neurasthenia;  tumor  of  the  tem- 
poral lobe;  convalescence  from  typhoid  fever; 
atrophy  of  the  salivary  glands,  as  after 
mumps ; arteriosclerosis ; polyuria  iq.v.) ; atro- 
pine; diarrhoea;  occurrence  of  ascites. 

Treatment. — Consider  the  cause.  Employ 
a glycerine  or  albolene  spray,  or  a mouth- 
wash containing  lemon  juice,  e.g.  glycerine 
and  peppermint  water,  aa5i,  to  which  is 
added  the  juice  of  a lemon.  Pilocarpine 
may  be  employed;  five  drops  of  a 2}/2  per 
cent,  solution  (gr.  %),  by  mouth,  two  or 
three  times  daily,  gradually  increased  by 


ARRHYTHMIA,  CARDIAC 


one  drop  at  a time,  until  a moderate  increase 
of  perspiration  and  saliva  follows  each  dose. 
Warn  the  patient  to  avoid  draughts  for  one 
and  a half  hours  after  each  dose.  The  drug 
may  be  continued  for  a long  time  if 
desired.  Faradism  may  be  applied  to  the 
salivary  glands. 

Arm  Pain. — See  Pain. 

Arrhythmia,  Cardiac. — Gr.‘  a priv.  + 
pv9/j.6s  rhythm;  Kapb'ux  heart. 

1.  Extrasystoles  or  Premature  Beats. — This 
is  probably  a harmless  form  of  arrhythmia 
due  to  excessive  irritability  of  the  heart 
resulting  from  some  toxic  action.  It  is 
revealed  in  the  arteriogram  by  the  occur- 
rence of  a weak  premature  beat  followed  by 
a compensatory  pause,  and  this  in  turn  by 
an  unusually  strong  beat.  On  auscultation 
the  second  sound  is  often  absent,  the  first 
sound  alone  being  heard.  These  extrasys- 
toles usually  originate  in  the  ventricle;  less 
often  in  the  auricle. 


Says  Thomas  Lewis,  quoted  by  R.  C.  Cabot : 
“ The  mechanism  of  the  heart  may  be  identi- 
fied in  the  majority  of  cases  in  which  it  is 
irregular  by  a careful  examination  of  the 
radial  pulse-tracing  alone.” 


The  electrocardiagram  is  a magnified 
photographic  tracing  of  the  oscillations  of  a 
fine,  gold-covered,  quartz  string  galvanom- 
eter placed  between  the  poles  of  a powerful 
electric  magnet  and  coimected  with  three 
finely  spun  German  silver  wire  leads  applied 
to  the  surface  of  the  body,  through  which 
leads  the  galvanometer  receives  the  action 
currents  of  the  heart.  The  leads  are  applied 
to  each  forearm  and  to  the  left  leg,  forming  a 
triangle,  lead  I constituting  the  base,  lead  II 
the  right  side,  and  lead  HI  the  left  side.  The 
electrodes  are  curved  to  fit  the  limb,  and 
held  in  place  with  bandages  soaked  in  hot 
solution,  and  insulated  wres  carry  the  cur- 
rent to  the  string  galvanometer.  The  string 
in  its  oscillations  registers  the  electric  poten- 
tial of  the  heart  in  the  form  of  a curve  (figures 
5 and  6).  Lead  II  registers  the  greatest  value 
of  the  heart’s  contraction-waves,  because  it  is 
more  nearly  parallel  with  the  electric  axis 
of  the  heart,  and  thus  reflects  more  of  the 
heart’s  surface. 

The  vertical  unit  of  measure- 
ment in  the  electrocardiogram 
represents  104  millivolts;  the 
horizontal  unit,  0.04  seconds. 

The  “P”  wave  represents  auricular  con- 
traction; Q,  R,  S,  T represent  the  ventricu- 
lar complex.  The  “P”  wave  is  a “small 
blunt-pointed  or  rounded  elevation,  not 
normally  over  2 mm.  high,  nor  over 
0.02  sec.  wide,  and  is  directed  upward.” 
“The  time  taken  for  the  passage  of  the 
impulse  from  auricle  to  ventricle  is  called 
the  ‘P,  R’  interval;  it  is  measured  from 
where  P leaves  the  base  line  to  where  R 
begins,  and  normally  occupies  from  0.12 
to  0.18  second;  over  0.2  second  indi- 
cates a delay  m conduction.”  “The 
‘P,  R’  interval  is  the  expression  of  the 
conductivity  of  the  bundle  of  His.”  “The 
Q,  R,  S,  T denote  ventricular  contrac- 
tion.” “Q  is  the  first  evidence  of  activity 
at  the  apex  of  the  ventricle;  it  is  directed 
downward,  usually  not  over  2 mm.,  and 
may  be  entirely  lacking,  being  submerged 
by  stronger  contraction  waves.”  “The 
R wave  is  due  to  the  action  of  the  basal 
portions  of  both  ventricles;  it  is  directed 
sharply  upward  in  all  three  leads,  and 
in  lead  II  registers  its  greatest  normal 
amplitude  of  from  10  to  20  mm.  (nor- 
mally, the  values  of  all  waves  of  lead  II 
equal  the  combined  values  of  leads  I and 
III).”  “ The  first  sound  of  the  heart 
l)egins  as  R approaches  the  zenith.” 
“The  S wave  is  a sharp  peak  directed 
(knmward  5 or  6 mm.,  and  is  due  to 
activity  at  the  apical  portions  of  the 


Fio.  4. — Electrocardiogram  in  Auricular  Fibrillation.  The  P 
wave,  the  representative  of  auricular  contraction,  is  absent  in  all 
throe  leads.  Fine  fibrillary  (f)  waves  fill  diastole  in  Lead  ill. 
Note  the  absolute  irregularity  of  ventricular  coiitra^ion.  as 
expresse<l  in  the  uneven  spacing  of  the  It  wave.  Oourtesy 
practical  Medicmc  Series. 


Fto.  3. — 'Arteriogram  showing  extrasystoles.  ^ 


ARRHYTHMIA,  CARDIAC 


Fig.  7. — Arteriogram  in  auricular  fibrillation  (R.  C.  Cabot). 


3.  Auricular  Flutter. — A condition  in 
which  tliere  occur  very  rapid  (above  200  per 
minute),  but  regular,  auricular  contractions, 
with  consequently  a rapid  ventricular  rate, 
which,  however,  is  slower  than  the  auricular 
rate  (usually  one-half),  due  to  heart-block. 
Sudden  transient  attacks  are  designated 
paroxysmal  tachycardia.  The  condition  is 
due  to  excessive  stimulation  of  the  auricle. 

Says  R.  C.  Cabot  : “We  now  know, 
through  electrocardiographic  investigations, 
that  while  in  the  vast  majority  of  these 
tachycardias  the  cardiac  impulse  comes  down 
from  the  auricle  in  the  ordinary  way,  it  does 
not  arise  at  the  ordinary  place,  i.e.,  at  the 
pace-maker  (sino-auricular  node),  but  starts 
up  like  an  insurrection  at  some  other  ])oint 
in  the  auricular  muscle  (‘heterogeneous  im- 
pulses’). Rarely  does  such  a tachycardia 


ventricles;  it,  too,  may  also  lie  lacking, 
also  less  often  than  Q.”  “The  slowly  rising 
T wave  represents  the  final  activity  of  the 
ventricle,  and  has  its  origin,  it  is  believed, 
at  the  basal  portion  of  the  ventricles,  nearer 
the  great  vessels.”  “T,  as  will  be  noticed. 


located  at  the  junction  of  the  superior  vena 
cava  with  the  right  auricle,  whence  it 
spreads  through  the  bundle  of  Flack  to  the 
node  of  Tawara,  locatedjn  the  right  auriculo- 
ventricular  septum,  thence  to  the  bundle  of 
His,  one  branch  of  which  passes  to  the  right 
ventricle  ami  the  other  to  the  left  ven- 
tricle through  the  interventricular  sep- 
tum, the  terminal  arborizations  of  these 
branches,  called  the  “ filires  of  Purkinje,” 
spreading  out  in  all  directions  in  the 
V(mtricular  muscle. 

2.  Auricular  Fibrillation. — This  is  a 
state  of  myocardi;il  insufficiency  in 
which  the  auricle  is  distended  and 
fibrillating,  i.e.,  “the  seat  of  imiumer- 
able,  incoordinate  contractions,”  which 
project  along  the  bundle  of  His  a 
“rapid  and  haphazard  succession  of 
waves”  into  the  ventricle,  which  conse- 
quently beats  absolutely  irregularly 
(delirium  cordis).  The  condition  is 
ordinarily  diagnosed  by  the  absolutely 
irregular  pulse.  In  the  polygraphic 
tracing  of  the  jugular  vein,  the  A wave 
is  absent,  owing  to  the  absence  of  auricu- 
lar contraction,  and  is  perhaps  replaced 
by  multiple  undulations.  In  mitral 
stenosis  the  presystolic  bruit  disappears 
on  the  onset  of  auricular  fibrillation. 
The  arrhythmia  of  the  failing  or  uncom- 
pensated heart  is  practically  always  due  to 
auricular  fibrillation.  The  latter  may  occur 
in  any  form  of  heart  disease,  in  poison- 
ing with  digitalis,  caffeine,  and  chloroform, 
and  in  sudden  interruption  of  the 
coronary  circulation. 


Fig.  5. — Normal  ElectrocardioRram.  P represents  auricular 
contraction.  Q,  R,  S,  T represent  tlie  ventricular  complex. 
Courtesy  Uraciical  Medicine  Series. 

returns  to  the  base  line  much  more  sharjily 
than  it  left  it.”  “It  is  normally  directed 
upward  (‘positive’)  in  all  three  leads,  al- 
though it  may  occasionally  be  directed  down- 
ward (‘negative’)  in  lead  III,  in  which  lead 
it  is  often  quite  small.”  “Exercise  increases 


Pro.  G. — Normal  EIoctrorardioKram  (enlarged  and  sche- 
matic). From  article  by  J.  S.  Goodall,  The  Practitioner ^ 
April,  1917. 


the  size  of  the  T wave;  the  second  heart- 
sound  occurs  synchronously  with  the  end  of 
T.”  “ From  T to  P is  the  diastolic  period  of 
the  heart.”  (S.  Calvin  Smith.) 

The  impulse  of  contraction  arises  in  the 
sino-auricular  node,  called  the  “pace-maker,” 


ARRHYTHMIA,  CARDIAC 


originate  in  the  ventricle  or  in  the  bundle 
of  His.” 

4.  Heart-Block. — A condition  in  which  («) 
the  interval  between  auricular  systole  anil 
ventricular  systole  is  prolonged;  or  (6),  in 
more  advanced  cases,  the  ventricle  occa- 


Fiq.  8. — Arteriogram  in  paroxysmal  tachycardia  (R.  C.  Cabot.) 

sionally  drops  a beat,  or  is  “silent” 
following  an  auricular  systole  ; or  (c) 
“dropped  beats”  recur  regularly;  or  (d) 
the  ventricle  beats  each  time  only  after 
two  or  more  auricular  beats;  or  (e)  no 
impulses  at  all  pass  tlown  from  the 
auricle  to  the  ventricle,  and  the  latter 
either  stops  altogether,  or  establishes  a 
slow  rhythm  of  its  own  (“approximately 
32  per  minute”).  “If  the  ventricular 
silence  lasts  three  to  five  seconds  the 
patient  usually  loses  consciousness  for  a 
moment.  Silence  of  ten  to  twenty  second.^ 
usually  results  in  epileptiform  convul- 
sions. When  these  cerebral  ])henomena 
are  associated  with  more  or  less  heart- 
block,  we  have  the  Stokes-Adams  syn- 
drome {q.v.).  Silence  over  ninety  seconds 
means  death.”  (R.  C.  Cabot,  quoting 
Thomas  Lewis.) 


The  cause  of  heart-block  is  impaired  con- 
ductivity in  the  auriculo-ventricular  con- 
ducting bundle  of  His,  due  to  a variety  of 
factors  (gumma,  calcification,  fibrosis,  neo- 
plasms, infarction,  simple  round-celled  in- 
filtration, ulceration,  fatty  degeneration, 
sclerosis  of  the  nutritive  ar- 
tery, acute  infections,  as- 
phyxia, acute  gastro-intestinal 
disturbance,  poisoning  with 
digitalis,  strophanthus,  aconite,  etc.). 

Heart-block  is  usually  accompanied  by 


Fig.  9. — Auricular  Flutter.  The  auricles  are  contracting  at  an 
average  rate  of  270  times  per  minute.  The  ventricular  rate  aver- 
ages 00  times  per  minute.  'I’he  impossibility  of  arriving  at  a 
clinical  diagnosis  under  such  circumstances  is  quite  apparent. 
Graphic  records  such  as  this,  however,  clearly  establish  the  diag- 
nosis and  thus  point  the  way  to  efficient  treatment.  Courtesy 
Practical  Medicine  Series. 

The  polygraph  and  the  electrocardiograph 
give  accurate  information.  Sometimes  more 
than  two  jnilsations  may  be  counted  in  the 
external  jugular  vein  to  one  in  the  arteries, 
or  the  auricular  contractions  may  be  heard 
near  the  left  sternal  margin  like  the 
ticking  of  a watch.  The  fluoroscope  may 
show  the  auricles  and  ventricles  contract- 
ing independently. 


Fig.  10. — Delayed  Conduction.  The  impulse  for  contractloix 
is  transmitted  from  the  auricle  to  the  ventricle  over  the  node  of 
Tawara  and  the  bundle  of  His.  In  the  normal  heart  this  trans- 
nussion  occupies  0.18  second.  In  the  lower  figure  conduction  is 
delayed  to  0.3  second.  Delayed  conduction  may  often  be  the 
forerunner  of  eventual  heart-block;  hence,  such  patients  require 
frequent  graphic  study  and  appropriate  treatment.  Courtesy 
Practical  Medicine  Series. 

bradycardia,  but  it  may  also  be  present 
in  an  extremely  rapid  heart,  as  in  auricu- 
lar flutter.  The  latter  may  also  be 
associated  with  syncopal  attacks, 
due  to  cerebral  ana;mia  (see  Stokes - 
Adam.S  sjmdrome). 

.5.  Coiipling  of  the  Veritricular  Beats, 
or  the  occurrence  of  beats  in  “close- 
knit  pairs  with  pauses  of  varying 
lengths  between  the  iRiirs,”  occurs  often 
in  auricular  fibrillation  following  the  ad- 
ministration "of  digitalis.  (R.  C.  Cabot.) 

0.  Pulsus  Altcrnans  is  revealed  bj' 
the  radial  arteriogram,  which  shows  a 
regular  alternation  of  strong  and  weak 
beats,  with  or  without  a tlisturbance  of 
rhythm.  When  constant  it  is  a sign  of 
great  myocardial  exhaustion. 

7.  Sinus  Arrhythmia. — An  irregu- 
larity in  the  discharge  of  stimuli  from 
the  sinoauricular  node,  caused  nor- 
mally by  the  respiratory  movements, 
and  manifested  by  rapid  action  of  the 
heart  at  the  beginning  of  inspiration,  and 
a much  slower  action  for  several  beats 
during  expiration.  It  is  of  no  significance. 

Palpitation  is  “irregular  or  forcible  action 
of  the  heart,  perce))tible  to  the  individual” 
(Osier) ; it  is  usually  produced  by  exTra- 
sy.st()les.  It  is  considered  in  its  alpha- 
betical order;  as  are  also  tachycardia 
and  bradycardia. 


ARRHYTHMIA,  CARDIAC 


Some  of  the  Causes  of  Arrhythmia. — 
Neurasthenia  ; hysteria ; hypoclioiidri- 
asis;  prolonged  severe  mental  distress; 
traumatic  neurosis;  nervousness  in  chil- 
dren; debility;  toxic  agents,  e.g.,  coffee, 
tea,  tobacco,  digitalis,  belladonna,  aco- 
nite, opium,  lead,  alcohol,  intestinal 
poisons,  metabolic  poisons,  as  in  exoph- 
thalmic goitre,  gout,  and  kidney  disease ; 
infectious  diseases;  high  blood-pressure; 
flatulent  dyspepsia;  overfull  stomach; 
change  in  posture;  overstrain  due  to 
overexertion,  intense  emotion,  sexual 
excess  (see  Heart  Strain) ; organic  heart 
disease,  valvular  or  myocardial ; thoracic, 
abdominal,  or  pelvic  disorders  (uterine 
cervical  polyp,  etc.)  giving  rise  to  reflex 
sympathetic  irritation;  cardiac  syi^hilis; 
arteriosclerosis;  anaemia;  chorea;  mi- 
graine ; organic  central  nervous  disease ; 
vomiting  from  any  cause,  producing 
reflex  vagus  irritation ; pain. 


Treatment. — Search  for  and  remove  the 
cause,  if  possible.  Treat  palpitation 
iq.v.)  if  present;  also  heart  strain  {q.v.). 

Persistent  tachycardia  due  to  auric- 
ular flutter  or  auricular  fibrillation,  calls 
specifically  for  digitalis  {q.v.  in  Part  11). 
Digitalis  impedes  conduction  in  the 
bundle  of  His.  In  cases,  however,  of 
cardiosclerosis,  with  marked  myocardial 
degeneration,  and  in  fever,  the  action 
of  digitalis,  whether  auricular  fibrilla- 
tion is  present  or  not,  is  not  marked. 
Digitalis  is  contraindicated,  as  a rule, 
says  Billings,  when  auricular  fibrillation 
is  associated  with  mitral  stenosis.  After 
the  pulse  has  been  slowed  to  normal,  it 


Fig.  13. — High-Grade  Heart-Block.  There  is  complete  dissociation  of  the  auricles  and  ventricles,  each  contracting  regularly,  while  ab- 
solutely independent  of  the  other.  The  auricular  rate  is  ^K),  the  ventricular  5U  per  minute,  (-ourteay  Practical  Medicine  5eriea. 


Fig.  11. — Dropped  Beat.  In  the  second  curve  it  will  be  noticed 
that  P-3  is  not  followed  by  a ventricular  contraction.  Dropped 
beat  is  in  reality  a low-grade  heart-block,  not  to  be  confused  with 
ventricular  premature  contractions  which  fail  to  reach  the  wrist. 
Courtesy  Practical  Medicine  Series. 


Fig.  12. — Right  Bundle  Branch  Block.  The  time  which  elapses 
from  the  point  where  H leaves  the  base  line  in  Lead  I until  it 
returns  to  the  base  line,  plus  the  width  of  the  R-S  deflection  in 
Lead  III  are  the  characteristics  of  block  in  the  right  branch  of 
the  bundle  of  His.  Practical  Medicine  Series. 


ARTERIOSCLEROSIS 


may  be  necessary  to  continue  the  digitalis 
in  smaller  but  sufficient  doses  indefinitely. 

W.  M.  Barton  states  that  caffeine  tends 
to  counteract  digitalis  arrhythmias. 

For  paroxysmal  tachycardia  the  following 
measures  are  recommended:  Inversion, 


poisoning  may  be  caused  by  medicines,  wall- 
paper,  and  other  colored  papers,  carpets, 
fabrics,  furs,  rugs,  paint,  crayons,  beer. 

It  is  characterized  l)y  puffiness  of  the  eye- 
lids, nausea,  vomiting,  diarrhoea,  salivation, 
flushing  of  the  skin,  herpes,  paraj.sthesiae  and 
^ pains,  ])igmentation,  keratosis, 
and  polyneuritis.  The  prognosis 
is  usually  good. 

Treatment. — Remove  the  cause. 
Administer  pota.ssium  iodide  {q.v. 

Fig.  14. — Aiiriculo-Ventricular  Heart-Block  (Stokes-Adams’ diseased.  Note  in  Part  11)  gr.  V Well  diluted 

at.  tlifi  anriflps  boat  tvvioft  to  tlia  vpntrirloi?  rinop.  Krorn  article  by  - . ^ ^ ^ ^ 


PT  P ^ I i P P T P P T ' p 

It 


that  the  auricles  beat  twice  to  the  ventricles  once 
J.  S.  Goodall  ill  The  Practitioner^  April,  1917. 


which  drains  the  splanchnic  region  and  stim- 
ulates the  vagus  centres ; the  drinking  of  ice- 
water  or  strong  coffee;  compression  of  the 
abdomen  with  a tight  towel;  with  the  head 
low,  taking  a deep  breath,  closing  the  glottis, 

Fia.  15. — Arteriogram  showing  pulsus  alternans  (R.  C.  Cabot). 

and  making  a strong  expiratory  effort ; com- 
pression of  the  vagus  just  to  the  left  of 
the  thyroid  cartilage;  galvanic  stimulation 
of  the  vagus;  stimulation  of  the  vagus 
centres  by  spraying  the  nape  of  the 
neck  with  ether  or  ethyl  chloride;  ice- 
bag  to  the  precordium;  spray  of  ether 
or  ethyl  chloride  over  the  heart;  the 
production  of  belching,  facilitated  by 
sitting  down,  filling  the  mouth  4\ith 
water,  bending  the  head  back  as  far  as 
possible,  and  swallowing ; tincture  of 
aconite,  1-3  droj^s,  in  water,  every  one 
to  three  hours;  a nerve  sedative:  liro- 
mide  or  morphine  (see  also  Tachycardia). 

The  treatment  of  pulsus  alternans  is 
rest,  both  mental  and  physical.  Digitalis 
is  contraindicated. 

Arsenical  Poisoning. — I.  Acxde  Poisoning. 
See  Poisoning. 

II.  Chronic  Poisoning. — Chronic  arsenical 


after  meals,  as  an  eliminant.  For 
pain,  employ  hot  applications 
and  hot  baths;  protect  the  skin  from  the 
pressure  of  the  bed-clothes  by  means  of 
supporting  cradles,  and  prescribe  phen- 
acetin  or  morphine  if  necessary  (no  alco- 
hol). Treat  paralysis  as  described  mrder 
Neuritis,  Multiple. 

Arterial  Thrombosis. — See  Gangrene  of 
the  Skm. 

Arteriosclerosis. — Gr.  apr-gpia  artery  + 
(TKXgpos  hard.  The  characteristic  signs  of 
arteriosclerosis  are:  mcreased  blood- 

pressure  (the  normal  is  120-160  mm.  of 


Fig.  17. -^Paroxysmal  Tachycardia.  The  ventricles  respond 
to  each  auricular  impulse,  both  chambers  contracting  at  the  rate 
of  210  per  minute.  Courtesy  Practical  Medicine  Series. 

mercuiy;  it  becomes  normally  higher  as  one 
grows  older;  a maximum  pressure  of  over 
160  mm.  in  one  over  forty  is  moderately 


Normal  electrocartiiogram 


Fig.  10. — Sinus  .\rrhythmia.  This  curve  strikinglv  illustrates  the  variations  in  rate  which  characterize  the  "youthful  t.vpe"  of  cardiac 
irregularity.  The  seiiuence  of  events  is  a normal  P It  S-T  complex,  but  the  rate  varies  with  each  contraction.  Courtesy  Practical 
Medicine  Series. 


ARTERITIS 


high),  hypertrophy  of  the  left  ventricle,  a 
ringing  second  aortic  sound,  and  palpably 
thickened  and  tortuous  arteries.  Calci- 
fied plaques  occurrmg  along  the  course 
of  the  deep  vessels  are  revealed  by  the 
X-ray  {q.v.). 

The  facies  may  be  pallid,  but  is  oftener 
fiorid.  There  occurs  a gradual  diminution 
of  the  physical  and  mental  powers. 

In  cerebral  arteriosclerosis,  the  oblitera- 
tion or  rupture  of  the  capillary  vessels  gives 
rise  to  impairment  of  the  blood  supply  and 
focal  areas  of  necrosis,  with  resulting  neu- 
rasthenia, perhaps  headache,  relieved  by 
reducing  the  blood-pressure,  dizziness  or 
vertigo,  insomnia,  apoplectic  or  apoplecti- 
form attacks  with  transitory  or  permanent 
paralyses  or  aphasia,  due  to  spasm  or  obliter- 
ation or  rupture  of  a vessel,  convulsions, 
mental  failure,  and  perhaps  Stokes-Adams 
syndrome  {q.v.).  The  condition  of  the 
retinal  vessels  (imeven  calibre  and  tortuous- 
ness, pallid  arteries,  white  stripes  in  the 
vessel  walls,  gray  opacity  around  the 
optic  disc  indicating  oedema,  hemorrhages) 
is  an  important  aid  in  the  diagnosis  of 
cerebral  arteriosclerosis. 

Muscle  cramps,  neuritic  pains,  erythro- 
melalgia,  intermittent  claudication,  coldness 
and  gangrene  are  evidences  of  sclerosis  of 
the  arteries  of  the  lower  extremities. 

Angina  pectoris,  paroxysmal  dyspnoea, 
paroxysmal  tachycardia,  and  Stokes-Adam 
syndrome  are  possible  cardiacmanifestations. 

Dilatation  of  the  heart  may  occur.  Dys- 
peptic symptoms  may  be  present.  Slight 
albuminuria  is  common.  Aneurysm  is  a 
possible  sequela. 

Etiology. — ^Advancing  age,  aided  by  the 
“wear  and  tear  of  life”  (Osier);  persistent 
physical  or  mental  stre.ss  and  strain;  habitual 
overeating;  heredity;  syphilis;  the  acute 
infectious  diseases;  chronic  intoxications, 
e.g.,  lead,  tea  (?),  coffee  (?),  alcohol  (?), 
tobacco  (?),  adrenalin  (?) ; gout,  rheumatism, 
chronic  nephritis,  diabetes,  obesity. 

Treatment. — Enjoin  a quiet  life,  regular 
moderate  exercise  in  the  open  air,  a daily 
warm  full  bath,  regulation  of  the  bowels, 
and  a plain,  bland,  light  diet — milk,  butter- 
milk, eggs  boiled  three  minutes,  bread  and 
butter,  vegetables,  fruit,  fish,  oysters,  meat 
sparingly,  at  the  most  only  once  a day,  best 
boiled  to  remove  the  extractives.  Proteids, 
salt,  and  fluids  should  be  restricted.  For- 
bid alcohol,  tea,  and  coffee,  and  forbid,  or 
enjoin  moderation  in,  smoking.  Manual  or 
vibratory  ma.ssage  is  beneficial.  A periodic 
calomel  purge,  gr.  ii-viii,  is  helpful. 


R Sodii  vel  potassii  iodidi  5 i (gr.  iii-v-x  per  dose) 
Aquaj  destillatse,  q.s.  ad.  3 i 

M.  Sig. — Drops  3-5-10  t.i.d.p.c.,  well  diluted 
in  milk,  to  which  may  be  added  about  a quarter 
of  a teaspoonful,  or  gr.  v-x,  of  sodium  or 
potassium  bicarbonate. 

Give  the  iodide  continuously  for  years, 
with  about  ten  days’  intermission  each 
month.  For  the  symptoms  of  iodism  see 
Part  11.  The  iodides  reduce  the  blood- 
pressure,  and  act  as  an  eliminant.  They 
relieve  neurasthenia,  angina,  dyspnoea  and 
cardiac  asthma.  Sajodin  and  iodipin  (see 
Part  1 1)  are  less  likely  to  produce  gastric  and 
cutaneous  disturbances  than  the  iodide. 

Klemperer  gives  arsenic  {q.v.)  alter- 
nately with  the  iodides;  he  says  it  relieves 
headache,  dizziness,  sensations  of  fear,  and 
subjective  cardiac  symptoms,  and  reduces 
blood-pressure. 

For  very  high  blood-tension  and  its 
accompanying  micomfortable  symptoms,  the 
nitrites  may  be  employed: 

R Spiritu.s  glonoini  (1  per  cent,  .alcoholic 

solution  of  nitroglycerin) gss 

Sig. — Drops  1-3-5  in  water,  three  or  four  times  a 
day,  beginning  with  one  drop  and  increasing  by  one 
drop  at  a time,  until  the  tension  is  lowered,  or 
flushing,  headache,  palpitation,  or  buzzing  in  the 
ears  occurs. 

R Sodii  nitritis ........  (gr.  i-ii,  up  to  iv,  per  dose) 

Sodii  bicarbonatis, 

Potassii  nitratis. . .iia  gr.  xxxii 
Aqua;  destillata;,q.s.ad  § Li 

M.  Sig. — 5ss-i,  up  to  3ii,  in  water,  every  three 
or  four  hours,  as  required. 

R ErythroUs  tetranitratis  gr. 

Mitte  talis  tabella;  No.  100. 

Sig. — One  tablet  every  3-4-G  hours,  gradually 
increased  to  four  or  nine  tablets,  or  until  flushing, 
throbbing,  or  slight  transient  faintness  are  experi- 
enced. Intennit  the  drug  for  several  days  every 
two  weeks. 

The  effect  of  nitroglycerin  lasts  about 
twenty  minutes;  of  .sodium  nitrite,  about 
thirty  minutes;  of  er3dhrol  tetr.anitrate, 
three  to  four  hours. 

Ergot  {q.v.  in  Part  11)  is  recommended  for 
vertigo  due  to  vasomotor  instability. 

Arteriosclerotic  Kidney. — See  Bright’s 
Disease. 

Arteritis. — ^Acute  arteritis  occurs  very 
rarely  as  a primary  affection  in  the  course 
of  the  acute  infectious  diseases,  particularly 
typhoid  fever.  It  is  oftener  caused  by  an 
infected  embolus,  or  an  infected  marantic 
thrombus,  or  by  the  extension  of  an  inflam- 
matory process  from  without. 

Syphilis  is  a familiar  cause  of  arteritis, 
which,  in  the  aorta,  may  eventuate  into 
aortic  regurgitation  or  aneury.sm. 

Chronic  arteritis  is  arteriosclerosis  {q.v.). 


ASCARIASIS 


Arthritis. — Gr.  apdpov  joint  + -trts  inflain- 
nuition.  See  Orthoptedics,  Part  10. 

Arthritis  Deformans. — See  Ortliopajdics, 
Part  10. 

Arthropathies. — ( !r.  apOpov  joint  + 7ra0os 
disease.  For  a consitleration  of  secondary 
hypertroj:)hic  osteo-arthrojiathy,  see  Osteo- 
artiiropathy.  The  neuropathic  arthritides 
are  those  occurring  in  such  organic  central 
nervous  diseases  as  syringomyelia,  locomo- 
tor ataxia,  dementia  paralytica,  hemiplegia, 
and  acute  myelitis. 

Treatment  of  the  Neuropathic  Arthritides. — In 
the  early  stages,  with  much  effusion  mto 
the  joint,  employ  weight  extension  and 
fixation  (see  Buck’s  extension,  in  Ortho- 
paedics, Part  10).  A.spirate  the  joint, 
if  need  be.  Later  employ  immobilization 
and  relief  from  the  body-weight  by  means 
of  ambulatory  splints.  In  trophic  ulcera- 
tion, sequestra  may  have  to  be  removed,  or 
even  amputation  performed.  To  prevent 
ulceration,  etc.,  all  traumatism  due  to  ill- 
fitting  shoes,  etc.,  should  be  avoided. 

(See  Gangrene  of  the  Skin,  for  other 
causes  of  apparently  spontaneous  necrosis.) 

Articular  Rheumatism,  Acute. — See  Rheu- 
matic Fever. 

Chronic. — ^See  Arthritis  Deformans,  in 
Orthopaedics,  Part  10. 

Artificial  Pneumothorax. — See  Pneumo- 
thorax, Artificial. 

Respiration. — See  Asphyxia. 

Ascariasis. — Infection  with  the  round-  or 
eel-worm  (Ascaris  lumbricoides : Gr.  aaKapis 
ascaris,  L.  lumhricfus  earthworm  -t~  Gr.  el5os 
form),  which  occupies  the  upper  portion 
of  the  small  intestine.  The  worms  some- 
times wander  into  the  bile-ducts,  mouth, 
ear,  respiratoiy  tract,  through  the  bowel 
walls,  etc.  They  may  cause  intestinal 
obstruction.  Often  no  symj)toms  are  pres- 
ent, or  the  symptoms  may  be  many  and 
various.  The  diagnosis  is  made  by  fmding 
the  worms  and  eggs  in  the  faeces  (see 
under  Worms). 

The  ova  may  be  conveyed  from  the  faeces 
to  the  mouth  by  the  drinking  water,  fruits, 
vegetables,  flies,  aiul  dirty  hands.  Boiling 
destroys  the  eggs. 

Treatment.^ — Santonin  is  of  s])eeial  efficacy 
against  the  round-worm.  It  may  be  given 
with  calomel  in  powder  form,  mixed  with  a 
little  pulverized  suga.r,  in  the  morning,  after 
having  first  emptic'd  the  bowels  the  night 
before,  and  repeateil  each  morning  for  two 
or  three  successive  days.  The  treatment  is 
rep(>ated  at  intervals  of  about  four  days  as 
long  as  worms  or  eggs  are  found  in  the  faeces. 
Since  it  takes  one  month  for  the  adult  worm 


to  develop  from  the  egg,  the  stools  should  be 
examined  for  eggs  after  the  lapse  of  a month. 

The  various  writers  are  not  agreed  as  to 
the  proper  dose  of  santonin.  Holt  gives, 
to  a child  of  five  years,  1 grain  every  four 
hours  for  three  doses,  soon  followed  by 
calomel,  or  ca.stor  oil  (see  Part  11);  or  1-2 
grains  of  santonin  with  |/^-l  grain  of  calomel 
every  other  night  for  three  or  four  nights. 


a h 


Fig.  18. — Eggs  of  ascaris  lumbricoides.  a.  Round  to  oval. 
Within  tlie  outer  hull  a clear  nucleus  is  usually  visible  in  the 
finely  granular  yolk.  6.  Elongated  oval.  Its  contents  con^ 
sist  chiefly  of  different-sized,  powerfully  refractive  images, 
resembling  fat  droplets.  These  eggs  are  sterile,  according 
to  Lutz. 

Kerley  gives  castor  oil,  2-4  teaspoonfuls, 
at  bedtime,  and  the  next  mornhig,  two 
hours  before  breakfast,  santonin,  gr.  i,  under 
2 years  of  age;  gr.  iss,  from  2 to  4 years; 
gr.  ii,  after  4 years.  The  santonin  is  mixed 
with  an  equal  Jimount  of  milk  sugar. 

Riesman  gives  santonm,  gr.  ss,  with 
calomel,  gr.  i,  t.i.d.,  for  three  days. 

G.  C.  Low  gives  “the  adult  dose  as  5 gr., 
that  for  a child  of  2 to  4,  2 gr. ; 6 to  10,  3 gr.; 
12  to  18,  4 gr.”;  the  dose  being  “generally 
repeated  three  times,  either  on  successive 
nights  or  on  alternate  days.”  “An  emulsion 
of  castor  oil  and  santonin  may  be  given,  or 
the  santonm  may  be  given  at  night  and  the 
castor  oil  the  following  morning.” 

Forchheimer,  m view  of  the  fact  that  2 
grains  may  cause  death  in  a child,  advises 
caution.  He  gives  to  a child  not  more  than 
gr.  3^:3  in  a tlose,  and  no  more  than  gr.  i in 
twenty-four  hours;  to  adults  not  more  than 
gr.  V in  twenty-four  hours.  He  combines  it 
with  calomel. 

The  dose,  according  to  Ortner,  is  ^:4-l3^ 
grs.  for  adults,  3^-^  gT.  for  children,  twn 
or  three  times  daily  for  several  days.  He 
says:  “To  be  sure  of  avoiding  toxic  effects, 
santonin  should  never  be  given  on  an 
emj)ty  stomach.” 

According  to  Stiles,  the  dose  should  be 
grain  for  each  year  of  the  child’s  age.” 
According  to  “Useful  Drugs”  of  the  A. M. A., 
“Santonin  is  seldom  absorbe<l  to  a sufficient 
extent  to  produce  symptoms.”  “In  proper 
doses  it  is  a reasonably  safe  drug.” 

Hare  recommends  a lai-ge  enema  of  salt 
water  immediately  after  the  action  of 
the  purge. 


ASCITES 


The  symptoms  of  santonin  poisoning  are 
xanthopsia  or  yellow  vision,  mental  con- 
fusion, nausea,  vomiting,  diarrhoea,  slow 
pulse,  feeble  respiration,  cramps,  muscular 
twitching,  grinding  of  the  teeth,  stupor, 
convulsions,  paralysis.  When  such  occur 
administer  emetics  (ipecac)  and  purga- 
tives, and  wash  out  the  stomach  and  colon. 
Give  chloral  for  convulsions  (see  Drugs, 
Part  11). 

Other  less  efficient  vermicides  are: 

1.  Olei  chenopodii  (American  wormsced) 
n]jii-x,  in  emulsion,  or  on  a lump  of  sugar, 
t.i.d.a.c.,  for  tw^o  days,  followed  by  a cal- 
omel purge.  (The  dose  of  the  powder  is 
20-30  grains.  See  also  Part  11.) 

2.  Flext.  senna)  et  flext.  spigeliae,  aa  3ss-i, 
in  water,  t.i.d.,  until  purgation  occurs;  or 
three  doses  of  one  teaspoonful  every  two 
hours  for  a child;  two  teaspoonfuls  for 
an  adult. 

3.  Thjrmol.  See  Ankylostomiasis. 

Ascending  (Landry’s)  Paralysis,  Acute. — 

See  Landry’s  Acute  Ascending  Paralysis. 

Ascites. — Gr.  aaKLrtjs,  from  aaKos  bag. 
Ascites  denotes  a peritoneal  effusion.  It  is 
usually  serous.  It  may  be  chylous  (fatty), 
or  chyliform  (non-fatty,  milky  ascites). 

The  diagnostic  characters  are:  uniform 
abdominal  enlargement  (rarely  is  the  ascitic 
fluid  encysted  by  adhesions) ; percussion  dul- 
ness  in  the  flanks,  with  tympany  in  the 
epigastric  and  umbilical  area;  movable  dul- 
ness  (if  the  amount  of  fluid  is  small,  percuss 
the  abdomen  in  the  knee-chest  posture); 
“ fluctuation  shock,”  obtained  by  placing  the 
fingers  of  one  hand  on  one  side  of  the  abdo- 
men and  tapping  the  opposite  side  sharply, 
w'hile  an  assistant  presses  ^vith  the  edge  of 
his  hand  along  the  linea  alba,  in  order  to 
exclude  waves  caused  by  tjunpanitic  dis- 
tention or  a large  panniculus  adiposus. 

Consider,  in  the  diagnosis,  ovarian  tumor, 
distended  bladder,  large  pancreatic  or  hyda- 
tid cysts,  dilated  stomach,  and  a large  hydro- 
nephrosis. The  presence  of  jaundice  suggests 
hepatic  cirrhosis  or  malignant  disease. 

Etiology. — A.  General  Causes  of  Serovs 
Ascites. — Cardiac  incompetency;  Bright’s 
disease;  chronic  emphysema;  sclerosis  of 
the  lung;  adherent  pericardium  {q.v.)', 
erythremia;  cachectic  states,  e.q.,  advancecl 
nephritis,  amyloid  disease,  anemia,  leu- 
kemia, convalescence  from  typhoid  fever 
and  other  infections  (the  ascites  in  these 
affections  is  usually  slight). 

B.  Local  Causes  of  Serous  Ascites. — Peri- 
tonitis, simple,  tuberculous,  or  cancerous; 
abdominal  tumors,  viz.,  carcinoma,  lympha- 
denoma,  ovarian  tumor,  uterine  fibromyoma. 


papillomatous  disease  of  the  ovary  with 
peritoneal  implantations;  cirrhosis  (proba- 
bly carcinomatous)  of  the  stomach ; enlarged 
spleen  (see  Splenomegaly);  compression  of 
the  portal  vein  in  the  gastro-hepatic  omen- 
tum by  peritoneal  adhesions,  proliferative 
peritonitis,  large  lymphatic  glands,  or  aneu- 
rysm; com])ression  of  the  hepatic  veins  by 
proliferative  peritonitis,  tiunors,  or  aneu- 
rysm; cirrhosis  of  the  liver;  syphilis  of  the 
liver;  lardaceous  liver;  malignant  disease  of 
the  liver;  thrombosis  of  the  inferior  vena 
cava;  rupture  of  a hydatid  or  ovarian  cyst; 
ileus  (ascitic  fluid  blood-stained). 

C.  Causes  of  Chylous  Ascites. — Rupture 
or  obstruction  of  lymphatic  vessels,  lacteals, 
the  receptaculum  chyli,  or  the  thoracic  duct, 
due  to  tumors,  inflammation,  tuberculosis, 
aneurysm,  e,xostoses,  adhesions,  filariasis, 
thrombosis  of  the  subclavian  or  innominate 
vein,  high  venous  pressure  in  tricuspid 
insufficiency,  etc.,  whooping-cough,  vomit- 
ing, muscular  exertion,  trauma. 

D.  Causes  of  Chyliform  Ascites. — Any  of 
the  causes  of  serous  ascites;  also  puerperal 
sepsis;  and  filaria.sis. 

Treatment. — The  treatment  depends  upon 
the  cause  (q.v.).  The  fluid  accumulation 
may  be  removed  to  some  extent  by  means 
of  saline  cathartics,  especially  Rochelle  salt, 
one  tablespoonful  dis.solved  in  very  little 
water,  one  hour  before  breakfast;  comix)und 
jalap  pow'der,  gr.  xxx,  in  a little  water,  once 
or  twdce  a day;  or  calomel,  gr.  iss,  t.i.d., 
with  ext.  opii,  gr.  ss;  or  elaterium,  gr.  y'\2~ 
}/2  in  pill  form,  tw'ice  or  thrice  a day;  and 
sweating  {q.v.  under  Urteinia) ; but  tapping 
is  the  best  method.  In  hepatic  cirrhosis 
early  and  repeated  tapping  has  resulted  in 
cures.  Tapping  is  certainly  demanded  in  the 
presence  of  pain  due  to  distention,  dyspncea, 
moist  rales  over  the  bases  of  the  lungs,  di- 
minished urine,  hemoptysis  or  hsematemesis, 
and,  in  alcoholic  cirrhosis,  the  onset  of  de- 
liriiun  tremens. 

Before  tapping,  always  have  the  patient 
urinate,  or  catheterize  him.  Place  the 
patient  on  his  back,  with  the  head  and 
shoulders  raised.  Give  a diffusible  stimu- 
lant of  brandy  or  whiskey.  Tap  i^referably 
in  the  midline  betw^een  the  umbilicus  and 
pubes,  or  on  a line  between  the  umbilicus 
and  the  anterior  superior  spine  of  the  ilium 
on  the  left  side  (the  deep  epigastric  artery, 
if  wounded,  should  be  ligated).  Percuss  to 
see  that  the  site  selected  is  dull.  The  skin 
may  first  be  anaesthetized  with  the  ethyl 
chloride  spray,  or  an  injection  of  a few'  drops 
of  cocaine  solution,  about  gr.  Y\o  to  the 
dram.  If  deemed  advantageous,  a small 


ASPHYXIA 


incision  may  first  be  made  tlirough  the  skin. 
Use  a small  cannula,  and  remove  the  fluid 
slowly.  During  the  withdrawal  of  the  fluid 
apply  firm  pressure  with  a flannel  binder 
or  a three-  or  four-tailed  flaimel  bandage, 
in  order  to  prevent  syncope.  After  with- 
drawing the  caimula,  seal  the  puncture  with 
cotton-wool  saturated  with  collodion,  and 
strap  the  abdomen  tightly  with  adhesive 
plaster  or  a bandage,  to  prevent  syncope. 
Adrenalin  chloride  solution,  1 : 1000,  3 i in 
water,  5 i,  may  be  injected  into  the  peritoneal 
cavity  after  tapping.  In  tuberculous  peri- 
tonitis oxygen  may  be  injected  (see  Peri- 
tonitis, Tufjerculous). 

After  tapping  (not  very  useful  before), 
diuretics  may  be  of  service  for  the  purpose 
of  retarding  the  return  of  the  ascitic  fluid: 
digitalis,  caffeine  citrate,  diuretin,  theocin, 
theobromine,  potassium  acetate,  bitartrate, 
or  citrate,  urea,  spirits  of  jimiper,  oil  of 
copaiba  (see  Drugs,  Part  11). 


Pulveris  digitalis gr.  i 

Pulveris  scillae gr.  i 


Hydrargyri  cliloridi  niitis. . gr.  H 

Mitte  talis  pilula;  No.  xv. 

Sig. — One  pill  twice  a day.  (Addison’s  i)ill.) 

"'7 

The  dietary  should  consist  of  bread, 
butter,  milk,  buttermilk,  junket,  cream,  eggs 
boiled  three  minutes,  fish,  chicken,  mutton; 
avoiding  salt,  starchy  and  vegetable  foods 
(producing  flatulence),  pickles,  spices,  alco- 
hol. Fluids  should  be  restricted  to  no  more 
than  one  or  one  and  a half  pints  a day. 

An  abdominal  supporting  binder  may  be 
worn  for  comfort. 

In  hepatic  cirrhosis  one  may  consider  the 
pros  and  cons  of  the  operation  which  aims 
at  the  production  of  vascular  adhesions 
between  the  liver  and  spleen  and  the  parie- 
tal peritoneum,  and  between  the  omentum 
and  the  anterior  abdominal  wall,  the  adhe- 
sions being  brought  about  by  excoriating 
large  opposing  surfaces,  and  vmiting  them 
with  catgut.  About  37  per  cent,  have  thus 
been  cured,  while  about  33  per  cent,  have 
tlied  as  a result  of  the  operation.  But  early 
o])eration  should  reduce  this  high  mortality. 
Untreated  cases  present  a bad  prognosis, 
although  early  and  repeated  tapping  has 
resulted  in  cures. 

In  chylous  ascites  do  not  repeat  tapping 
unless  necessary,  since  it  drains  the  patient’s 
vitality.  The  food  should  be  concentrated 
and  easily  digestible,  and  fluids  should  be 
restricted.  Operation  should  be  considered. 

Asiatic  Cholera. — See  Cholera  Asiatica. 

Asphyxia. — Gr.  a priv.  -f  pulse. 

(A.)  Causes  of  Sudden  Asphyxia. — For- 
eign body  in  the  jfliarynx  or  larynx  (see 


Foreign  Bodies  in  the  Air  Passages); 
constriction  of  the  trachea,  or  strangula- 
tion; spasm  of  the  glottis;  embolism  or 
thrombosis  of  the  pulmonary  artery;  large 
hemorrhage  into  the  bronchi;  “unilateral 
pneumothorax  suddenly  complicated  by 
pneumothorax  on  the  other  side”;  “sudden 
bending  of  the  trachea  in  patients  with 
goitre”;  sudden  paralysis  of  the  respiratory 
muscles;  convulsions;  enlarged  thymus; 
ulceration  of  tuberculous  lymph  nodes  into 
the  trachea  or  bronchi;  rupture  of  a retro- 
pharyngeal abscess;  overlying. 

Asphyxia  in  the  newly  born  is  caused  by: 
maternal  convulsions;  hemorrhage;  pro- 
longed second  stage  of  labor;  tetanic  con- 
traction of  the  uterus;  the  use  of  ergot  in 
the  second  stage;  grave  systemic  disease  in 
the  mother;  death  of  the  mother;  com- 
pression of  the  cord;  syphilitic  periphlebitis 
of  the  cord;  multiple  coils  of  cord  about  the 
neck;  premature  separation  of  the  placenta; 
birth  with  unruptured  membranes;  precipi- 
tate labor;  prenatal  respiration;  brain  com- 
pression; congenital  respiratory,  circulatory, 
or  brain  malformation  or  disease;  laying  the 
infant  in  an  improper  position.  (Cerebral 
hemorrhage  is  diagnosed  by  the  presence  of 
a bulging  fontanelle,  coma,  and  possibly 
paralysis;  see  Hemorrhage,  intracranial,  in 
the  New  Born). 

(B.)  Causes  of  Gradual  Asphyxia. — 
Asthma;  pneumonia;  bronchitis;  emphy- 
sema; pulmonary  tuberculosis;  pleural  effu- 
sion; carcinoma  of  the  lung;  oedema  of  the 
lungs;  traumatic  compression  of  the  trunk; 
trichinosis;  oedema  of  the  glottis;  laryngeal 
diphtheria;  tracheo-bronchial  tuberculous 
adenitis;  retropharyngeal  abscess;  retro- 
oesophageal  abscess;  pressure  of  tuberculous 
bronchial  nodes  upon  the  pneumogastric 
nerve;  post-mediastinal  abscess  in  Pott’s 
disease;  acute  cardiac  insufficiency;  excessive 
hemorrhage;  smoke;  illuminating  or  coal  gas 
or  carbon  monoxide;  sewer-gas  and  hydrogen 
sulphide;  dromiing. 

Treatment. — This  depends  upon  the  cause 
{q.v.,  in  its  alphabetical  place).  If  the  right 
heart  is  dilated,  perform  venesection,  or 
apply  dry  cups.  A dry  cup  is  applied  as 
follows:  A tumbler  is  swabbed  quickly  with 
alcohol,  the  edges  wiped  dry,  the  alcohol 
ignited  and  allowed  to  burn  for  a few 
moments,  and  the  cup  then  quickly  applied. 
If  the  heart’s  action  is  weak,  administer 
strychnine,  gr.  or  caffeine  sodio- 

salicylate,  gr.  ss,  hjqwdermically;  or  cam- 
phor, gr.  ii,  in  ether,  nijxv,  hypodermically; 
or  aromatic  spirits  of  ammonia,  one  tea- 
spoonful in  a tumbler  of  water. 


ASPHYXIA 


In  suffocation  by  smoke,  dry  the  face, 
rub  the  hands,  give  hot  water  to  drink 
freely  for  the  purpose  of  inducing  vomiting, 
and  also  to  stimulate  the  kidneys;  a hot 
bath  is  effectual;  or  an  enema  of  warm 
normal  saline  solution  (3i  ad  Oi),  to  which 
black  coffee  may  be  added.  Give  strych- 
nine hyijodermically  if  the  pulse  is  weak, 
and  apply  a mustard  plaster  over  the  heart. 
If  the  patient  is  overcome,  resort  to  oxygen 
inhalations  and  artificial  respiration,  cover 
him  with  blankets  and  surround  him  with 
hot  water  bottles. 

To  administer  oxygen  in  smoke  or  gas 
poisoning  or  drownmg,  insert  in  one  nostril 
a rigid  tube  connected  to  an  oxygen  cylinder 
by  a length  of  “pressure”  tubing,  turn  on 
a “fairly  forcible”  current  of  oxygen,  then 
pinch  the  nostrils,  close  the  mouth,  and 
allow  the  oxygen  to  inflate  the  lungs;  then 
allow  it  to  escape  by  releasing  the  nose. 
Repeat  this  fifteen  times  to  the  minute,  thus 
producmg  artificial  respiration.  (L.  E. 
Hill.)  The  Hill  and  Davis  artificial  oxygen 
breathing  apparatus  should  be  of  great 
service  in  asphyxia  (made  by  Messrs. 
Liebe  Gorman,  Ltd.,  187  Westminster  Bridge 
Road,  S.  E.,  London). 

In  asphyxia  from  drowning,  invert  the 
patient  in  order  to  expel  water  from  the 
respiratory  passages,  and  then  perform  arti- 
ficial respiration. 

Artificial  respiration  is  performed  as  fol- 
lows: With  the  patient  either  prone  or 
supine,  and  the  clothing  loosened,  grasp  the 
lower  thorax  with  both  hands,  one  on  each 
side,  and,  with  the  weight  of  the  body, 
compress  the  thorax,  and  so  produce  expira- 
tion; then  remove  the  compression,  and  so 
permit  inspiration.  Repeat  this  procedure 
about  twelve  to  fifteen  times  to  the  minute. 
If  the  patient  is  on  his  back,  an  assistant 
may  carry  the  arms  above  the  head  during 
inspiration,  and  back  across  the  chest  during 
expiration.  Another  assistant  may  employ 
rhythmic  traction  on  the  tongue,  drawing  it 
forward  at  each  inspiration.  The  patient 
should  be  kept  warm. 

Breathing  may  be  reestablished  even  after 
two  hours  of  artificial  respiration.  After 
breathing  is  established,  the  patient  should 
be  watched  for  some  time,  and  artificial 
respiration  repeated,  if  necessary. 

In  poisoning  with  illuminating  gas  (coal 
gas,  carbon  monoxide)  allow  the  patient 
plenty  of  fresh  air.  If  he  is  conscious,  have 
him,  at  intervals,  inhale  deeply  and  then 
blow  out  forcibly  through  a goose-quill  or 
other  narrow  tube.  If  he  is  unconscious, 
wash  out  the  stomach  repeatedly  with  water 


at  a temperature  of  105°  F.;  then  introduce 
two  to  four  ounces  of  castor  oil;  withdraw 
about  eight  ounces  of  blood  from  a vein, 
and  give  subcutaneously  and  rectally  warm 
normal  saline  solution  (3i  ad  Oi),  at  least 
one  quart.  Human  blood  may  be  infused 
(see  Blood  Transfusion,).  Oxygen  in- 
halation and  artificial  respiration  (see 
above)  may  be  required.  If  the  temperature 
becomes  high,  place  an  ice-bag  over  the 
heart,  and  sponge  the  body  with  ice-water. 

In  sewer-gas  and  hydrogen  sulphide  poi- 
soning, surround  the  patient  with  hot  water 
bottles  and  warm  blankets;  give  saline 
infusions  and  oxygen  inhalations,  and  re- 


Fig.  19.— Schultze’s  Method  of  Artificial  Respiration:  Ex- 
piration (Jewett).  Courtesy  Lea  & Febiger. 


sort  to  artificial  respiration,  if  required 
(see  above). 

In  suffocation  Avith  ammonia  vapor,  have 
the  patient  inhale  vinegar. 

If  chlorine  or  hydrochloric  acid  is 
the  offending  agent,  have  the  patient 
inhale  steam. 

In  asphyxia  neonatorum,  first  clear  the 
throat  of  mucus  by  means  of  the  little 
fing('r  covered  with  absorbent  cotton,  the 
child  being  suspended  by  the  feet;  then 
slap  the  buttocks  and  back  with  the  head 
downward.  “Simply  swinging  the  child  in 
the  air  is  a powerful  stimulus  to  respiration,” 
says  Holt.  The  child  may  be  immersed  in 


ASPHYXIA 


warm  water,  the  back  and  chest  rubbed 
vigorously,  and  ice-water  poured  on  the 
epigastrium.  Or,  completely  immerse  (ex- 
cepting the  face)  in  hot  water  at  a tempera- 
ture of  104°-108°  F.  for  several  minutes, 
then  plunge  in  ice-cold  water  for  a few 
seconds,  then  at  once  in  hot  water  again, 
and  persevere  in  this  treatment  if  the  respira- 
tions show  signs  of  returning.  Rhythmic 
traction  upon  the  tongue,  ten  to  twelve  to 


Fig.  20. — ;^Schultze’s  Method  of  Artificial  Respiration:  In- 
spiration (Jewett).  Courtesy  Lea  & Febiger. 

the  minute,  with  the  child  well  wrapped  in 
flannels,  and  the  head  hanging  over  the  edge 
of  a table,  or  with  the  chikl  in  a hot  bath,  is, 
according  to  Williams,  “generally  speaking, 
the  most  effective  measure  at  our  disposal.” 
Schultzc’s  method:  Wrap  the  child  in  a 
towel  and  grasp  it  as  shown  in  the  figures 
19  and  20. 

Swing  the  child  from  between  the  knees 
over  the  shoulder,  as  showm,  four  or  five 
times  a minute. 


Byrd’s  method  is  shown  in  figures  21  and 
22.  This  method  may  be  carried  on  while 
the  child  is  in  the  hot  bath. 


Fig.  22. — Byrd’s  Method  of  .\rtificial  Respiration:  Inspira- 
tion (Jewett).  Courtesy  Lea  & Febiger. 

In  all  methods  of  artificial  respiration  the 
first  movement  should  be  that  of  expiration. 

Mucus  may  be  sucked  from  the  trachea 
and  bronchi,  and  the  lungs  inflated  by  means 


ASTHMA,  BRONCHIAL 


of  a soft  rubber  catheter  containing  a wire 
stylet  passed  into  the  larynx. 

Another  measure  is  the  employment  of 
t)ie  faradic  current;  one  pole  on  the  epi- 
gastrium, and  the  other  on  the  sternum, 
flanks,  and  thighs. 

Persist  in  efforts  at  resuscitation  as  long 
as  the  heart  beats:  for  an  hour  or  longer. 
After  establishing  respirations,  swathe  the 
baby  in  cotton-wool,  and,  if  necessary,  sur- 
round with  hot  water  bottles.  One  may 
give  5 drops  of  brandy  and  1 drop  of  digi- 
talis tincture  in  hot  water  every  two  or  four 
hours  if  required,  or  strychnine,  gr.  J^oo- 
Watch  the  child,  in  severe  cases,  for  twenty- 
four  or  thirty-six  hours,  so  as  to  repeat 
artificial  respiration  if  necessary. 

Asphyxia  Neonatorum. — Gr.  veos  new;  L. 
ndtus,  born.  See  Asphyxia. 

Traumatic. — Gr.  Tpavfxa  wound.  See 
Cyanosis. 

Astasia=Abasia. — Gr.  a priv.  -f-  (jracrts 
stand;  /3do-tj  step.  Inability  to  stand  or 
walk,  unassociated  with  any  disturbance  of 
muscular  strength,  sensation,  or  coordina- 
tion, as  tested  with  the  patient  recumbent. 

Etiology. — Hysteria;  neurasthenia;  emo- 
tion; mtention  psychosis;  exhaustion;  trau- 
matism, epilepsy;  chorea. 

Treatment. — The  Weir  Mitchell  rest  treat- 
ment and  static  electricity  (see  under  Med. 
Elect.)  are  advised.  (See  Hysteria, 
and  Neurasthenia.) 

Asthenia. — Gr.  a priv.  -f  aOkvos  strength. 
See  Debility. 

Asthma  Bronchial  — Gr.  aadpa  panting; 
Ppoyxos  windpipe  or  bronchus.  Bronchial 
asthma  is  a neurosis  (an  effect  of  vagus 
excitation),  characterized  by  paroxys- 
mal attacks  of  a wheezy  dppnoea,  chiefly 
expiratory,  lasting  several  minutes  to  several 
hours  (or  even  days),  and  associated  with 
spasm,  hypersmia  and  turgescence  of  the 
smaller  bronchial  tubes,  and  hypersecretion 
from  the  entire  respiratory  tract.  The 
presence  in  the  sputum  of  rounded  gelatinous 
pellets  or  “perles,”  Curschmann’s  spirals, 
elongated  diamond-shaped  Charcot-Leyden 
crystals,  and  eosinophile  cells,  is  character- 
istic of  the  affection.  Eosinophilia  is  an 
important  diagnostic  sign,  especially  in  chil- 
dren, where  it  is  sometimes  necessary  to 
distinguish  asthma  from  simple  bronchitis 
or  tuberculosis. 

Dyspnoeic  conditions  which  may  resemble 
asthma  are:  hay  fever,  emphysema,  acute 
bronchitis,  laryngeal,  tracheal,  or  bronchial 
obstruction  (q.v.),  renal  or  uraemic  paroxysms 
of  dyspnoea,  paroxysmal  cardiac  dyspnoea, 

3 


hysterical  dyspnoea,  onset  of  influenza. 
(See  Dyspnoea.) 

Etiology. — A.  Predisposing  Causes. — 

Neurotic  disposition;  heredity — asthma,  mi- 
graine, epilepsy,  gout,  etc.,  in  the  forbears; 
disease  of  the  respiratory  mucous  mem- 
brane— e.g.,  chronic  rhinitis,  nasal  polypi, 
adenoids,  enlarged  tonsils,  chronic  bron- 
chitis, whooping-cough;  gout;  eczema  in 
children;  sensitization  or  anaphylactization 


II. 


Fiq.  23. — Curschmann’s  Spirals  (Tyson  after  Curschmann). 
I,  Natural  size;  II  and  III  enlarged.  a,  central  thread. 
Webster's  Diagnostic  Methods^  P.  Blakiston’s  Son  & Co. 

(q.v.)  to  a foreign  protein,  e.g.,  bacteria  (in 
focal  infection),  animal  dander,  feathers, 
various  powders,  dust,  perfumes,  pollen, 
flour,  casein,  egg  albumen,  flaxseed,  etc. 
True  asthma  rarely  occurs  in  cardiac  or 
renal  disease. 

(B.)  Exciting  Causes. — Dust;  vapors; 
odors;  pollen;  animal  emanations;  emotion; 
climate;  season;  atmosphere;  locality  (ca- 
pricious as  to  locality);  a “cold”;  preg- 
nancy (due  possibly  to  toxaemia);  th3unus 
enlargement  (q.v.)  ; reflex  irritation  from 
the  nose,  throat,  teeth,  ear,  skin,  gastro- 
intestinal tract,  genital  tract,  etc.,  e.g., 
elongated  uvula,  nasal  polypi,  indigestion, 
flatulence,  overeating,  constipation,  intes- 
tinal worms,  dentition. 


ASTHMA,  BRONCHIAL 


Prognosis. — The  prognosis  as  to  cure  is 
more  favorable  before  than  after  middle 
life.  Chronic  bronchitis  and  emphysema 
follow  recurrent  attacks.  “Death  during 
the  attack  is  unknown.”  (Osier.) 

Treatment. — (A.)  Treatment  of  the  Par- 
oxysm.— A hypodermic  of  morphine,  gr.  3-^, 
with  atropine,  gr.  ^{20>  or  with  strychnine, 
gr.  is  usually  the  most  promptly 

effective  remedy.  It  should  be  used  with 
caution,  if  used  at  all,  in  the  aged,  and  in 
cases  of  bronchitis  with  much  secretion. 
(It  should  not  be  used  in  renal  or  uraemic 
paroxysms  of  dyspnoea.)  Other  sedative 
remedies,  to  be  used  with  the  same  caution, 
are  heroin,  gr.  34o>  hypodermically,  re- 
peated in  one  hour  if  necessary;  chloral 
hydrate  and  potassium  bromide,  aa  gr.  x, 
well  diluted,  every  hour  for  several  doses, 
then  gr.  v until  relieved,  or  gr.  xv-xxx,  aa, 
in  one  dose,  per  rectum  (do  not  give  chloral 
if  the  heart  is  weak;  it  sometimes  induces 
delirium  instead  of  giving  relief);  hyoscine 
hydrobromide,  gr.  )^oo  or  Mo, 
atropine,  gr.  M20,  ^ire  of  value  where  there 
is  a large  accumulation  of  secretion  in  the 
bronchial  tubes. 

R Potassii  iodidi, 

Potassii  bromidi. . . aa  5iiss  (gr.  614  aa  per  dose) 
Aquae  mentha?  pip- 

eritae,  q.s aid  5iii 

M.  Sig. — A teaspoonful,  well  diluted,  two  or 
three  times  at  half-hour  intervals,  then  every  four 
hours.  (Forchheimer.) 

The  following  remedies  are  variously 
recommended: 

Spiritus  chloroform!,  3ss-i,  in  hot  whiskey, 
well  diluted. 

Pilocarpinae,  gr.  hypodermically,  to  produce 

sweating  and  relaxation . 

Adrenalin,  1 : 1000  solution,  0.1  to  0.5  to  1.0  c.c. 
(2-714“15  minims),  hypodermically.  Fifteen  drops 
in  water  may  be  sprayed  into  the  nose  and  throat, 
or  taken  daily  by  mouth. 

Flext.  grindeliae  robirstae,  in  doses  of  t^x-qi 
(highly  praised). 

Pulv.  ipecacuanlue,  gr.  x,  or  syr.  vel  vin.  ipecac., 
3ii,  as  an  emetic,  for  children. 

Hot  waiter  vapor,  to  which  may  be  aidded  creosote, 
about  10  drops,  or  menthol,  about  gr.  x,  eucalyptol 
about  n\^x,  .and  benzoin  tinct.,  3ii~iv,  adOi  of  steam- 
ing water. 

Fumes  of  burning  nitre  (potassium  nitrate)  p.apcr. 

Nitrites  (see  Pairt  11). 

Ergot,  hypodermicailly  (see  Part  11). 

Tobacco  smoke. 

Hoffmann’s  anodyne,  3i-ii)  well  diluted. 

Inh.akitions  of  chloroform,  ether,  ammonia,  tur- 
pentine, oxygen  (^.y.),  ethyl  iodide,  nt^x-xw  on  lint, 
or  amyl  nitrite,  3-5  drops. 

AntipyrinaCj  gr.  xii,  with  caffeinae  sodiosailicyl.atis, 
gr.  iii,  to  be  given  at  the  very  onset  of  the  attack. 

C.affeiriffi  vel  caffeinae  citratis,  gr.  ii-iii,  saicchari 
lactis  (sugar  of  milk)  (g.s.).  Give  one  powder  about 


one  hour  before  bedtime,  and  again  during  the 
night,  if  necessary,  both  to  prevent  and  to  amehorate. 

Compressed  air  in  the  pneumatic  cabinet. 

Faradic  electricity,  each  pole  being  placed  “just 
below  the  angle  of  the  jaw  and  in  front  of  the  sterncv 
mastoid,”  along  the  hne  of  the  vagus  nerve.  (“Very 
effectual,”  says  Yeo.) 

Hot  hand-and-foot  bath. 

Cocaine,  5-10  per  cent,  solution,  applied  to  “sen- 
sitive areas”  in  the  nose.  X-ray  (g.v.)  (Shilhng.) 


Pulveris  stramonii  foliorum . . . 3ii 

Pulveris  anisi 3i 

Tabaci gr.  iii 

Pot.assii  nitratis 3 * 


M.  Sig. — -Ignite  a teaspoonful  and  inhale  the  fumes. 

R Potassii  nitratis. 

Aqua;  destillatae, 

Pulveris  lobeliae, 

Pulveris  foliorum  stramonii. 


Pulveris  thea;  nigrie aa  3iv 

Olei  anisi i^i 


M.  Sig. — Ignite  half  a teaspoonful  and  inhale  the 
fumes  six  or  eight  times  a day,  and  fumigate  the  bed- 
room with  the  same. 


Potassii  nitratis, 

Stramonii aa  3v 

Belladonna;  folia;. 

Cannabis  indica; aa  3 iiss 


M.  fiat  mist.  Sig. — To  be  burned  and  the  fumes 
inhaled.  (Ortner.) 

I^  Potassii  nitratis, 

Pulveris  lobelia;, 

Pulveris  stramonii  foliorum, 

Pulveris  anisi aa  Si 

Dissolve  the  potassium  nitrate  in  one  fluid  dram 
of  w.ater,  mix  thoroughly  with  the  powder,  and  dry. 

Sig. — -Ignite  one  dram  and  inhale  the  fumes  at 
frequent  intervals.  (H.  Pritchard.) 


E Extract!  cannabis  indica; gr.  xv 

Extract!  opii gr.  iss 

Aqua;  amygdala;  amara; q.s. 

Belladonna;  folise, 

Stramonii aa  gr.  xxx 

Fcenicuh gr.  viiss 


Minutim  dissecta  et  contusa.  M.  fiant  cigaretae 
No.  X. 

Sig. — Smoke  one  or  two  a day.  (Ortner.) 

The  inhalations  usually  afford  but  tem- 
porary relief. 

Atropime  sulphatis gr.  iss 

Sodii  nitritis gr.  ix 

Glycerini 3ss 

Aqua?  destillata?  q.s ad  5ss 

M.  Sig. — -Use  as  a spray  in  asthma  and  ha}'  fever. 

“To  prevent  the  recurrence  of  night 
attacks,”  says  Holt,  “nothing  in  my  experi- 
ence has  been  so  valuable  as  a full  dose  of 
antipyrine  at  bedtime — gr.  iv  at  5 years  of 
age,  and  gr.  vi  at  10  years.”  He  also  says: 
“In  the  severe  acute  attacks  nothing  gives 
so  much  immediate  relief  as  the  use  of 
adrenalin,  hypodermically;  dose,  njv  to  a 
child  of  3 years.” 


ASTHMA,  BRONCHIAL 


6 mos.  1 yr.  2-3  yrs. 
Syrupi  ipecacuanhae  gtt.  xviii  gtt.  xxiv  gtt.  xxxvi 

Antipyrinae gr.  vi  gr.  xii  gr.  xviii 

Sodii  bromidi gr.  xviii  gr.  xxiv  gr.  xxxvi 

Syrupi  rubi  idaei .. . 3v  3v  3y 
Aquae,  q.s.  ad 5u  5u 

M.  Sig. — One  dram  in  water  every  two  hours — 
6 doses  in  24  hours.  (Kerley.) 

For  children  of  five  to  ten  years,  antipy- 
rine,  gr.  iii,  with  sodium  bromide,  gr.  vi-x, 
repeated  in  two  hours.  (Kerley.)  Ker- 
ley attributes  the  greater  number  of  cases  of 
asthma  to  the  gouty  or  rhemnatic  diathesis, 
and  treats  them  as  he  does  recurrent  bron- 
chitis (q.v.).  In  bottle-fed  infants  he  reduces 
the  sugar  one-half,  and  adds  one  grain  of 
sodium  bicarbonate  to  each  ounce  of  milk. 

Sometimes  the  remedy  given  for  an  asth- 
matic attack  aggravates  instead  of  relieves 
the  symptoms.  Different  remedies  are 
required  for  different  individuals.  The 
affection,  indeed,  is  very  capricious. 
Asthma  occurring  only  during  pregnancy 
may  possibly  yield  to  a milk  diet  and 
eliminative  measures. 

(B.)  Preventive  Treatment. — Search 
for  and  correct  any  possible  causal  factor. 
Cauterize  “sensitive  areas”  in  the  nose,  etc. 
Build  up  the  general  health  by  means  of 
fresh  air  day  and  night;  a simple,  nutritious 
diet  (no  late  meals) ; a cold  morning  sponge, 
in  a warm  room,  with  the  feet  in  warm 
water;  deep  breathiug  exercises;  gymnastics. 
The  carbohydrates  should  be  restricted  in 
flatulency.  Brief  periods  of  starvation 
(5-6 -t-  days),  cleansing  of  the  bowels,  and 
copious  water  drinking — in  other  words, 
eliminative  treatment — has  been  very  effi- 
cacious. Codliver  oil,  given  in  winter,  is 
often  valuable,  especially  in  children.  For 
anaemia  give  iron  (see  Part  11,  for  drugs). 

A dry  climate  is  usually  best,  but  indi- 
vidual experience  must  decide  as  to  which 
climate  is  most  suitable.  Florida,  Southern 
California,  and  Egypt  have  a good  reputa- 
tion. The  patient  should  remain  where  he 
enjoys  freedom  from  attacks  long  enough 
(several  years)  to  break  up  the  tendency 
to  recurrence. 

Potassium  iodide,  taken  over  long 
periods  of  time  (two  years  or  more),  is  a 
valuable  prophylactic: 

Potassii  iodidi,  solutionis  concentrati  ...  5ss 

Sig. — Five  drops  well  diluted  in  milk,  t.i.d.p.c., 
gradually  increased  to  15-20  drops  t.i.d.  (see 
Part  11  for  toxic  sjnnptoms).  Omit  the  medicine 
for  a day  every  8-10  days,  or  for  a week  every  3-4 
months. 

For  children  of  five  years  give  drops  (^ains)  ii-iv, 
t.i.d.;  or.syrupiacidihydriodici,iTgv-x,  t.i.d.  (Holt.) 

Next  in  value  to  potassium  iodide  is  arsenic: 


B Liquoris  potassii  arsenitis  (Fowler’s 

solution) §ss 

Sig. — ^Tt\^v,  well  diluted,  t.i.d.p.c.,  gradually  in- 
creased even  to  irg  .\v  t.i.d.,  with  intermissions  of 
about  ten  days  each  month  (see  Part  11  for  toxic 
symptoms). 

Atropine,  gr.  H2O)  t.i.d.,  increased,  if 
necessary,  to  gr.  K2O)  six  tunes  a day,  is 
also  recommended  (see  Part  11  for  toxic 
symptoms).  It  is  a preventive  of  anaphy- 
laxis. Calcium  chloride  (gr.  xv  four  times 
a day  in  aqueous  solution)  is  also  a pre- 
ventive of  anaphylaxis. 

Tincture  of  nux  vomica  is  praised : 

Tincturaj  nucis  vomicae,  §ss. 

Sig.— Drops  20  in  water,  t.i.d.,  increased  by  5 
drops  every  three  days  until  45-60-70-100  drops  are 
being  taken,  or  until  there  occurs  muscular  twitch- 
ing, stiffness  of  the  neck,  slight  vertigo,  ^ or  slight 
disturbance  of  the  vision,  when  the  dose  should 
be  reduced  10-20  drops,  and  continued  at  the 
reduced  dosage. 

Asthma  may  in  some  instances  be  an 
expression  of  anaphylaxis  or  sensitization  to 
a foreign  protein.  To  discover  the  offending 
protein,  one  may  try  the  skin  test  described 
by  I.  C.  Walker  as  follows:  Incise  the  skin 
to  the  length  of  about  one-eighth  of  an  inch, 
but  not  deep  enough  to  draw  blood,  in  at 
least  two  places.  Into  one  cut  place  the 
protein  to  be  tested  and  add  a drop  of 
tenth-normal  hydro.xide  solution  to  dissolve 
the  protein.  In  the  other  cut  drop  the 
hydroxide  solution  alone,  as  a control.  At 
the  end  of  half  an  hour  wash  off  the  cuts. 
A positive  reaction  is  indicated  by  the 
presence  of  a raised  white  elevation  or  urti- 
carial wheal  surrounding  the  cut.  Any  reac- 
tion measuring  less  than  0.5  cm.  in  diameter 
is  considered  doubtful.  Walker  considers  the 
intradermal  test  too  sensitive. 

According  to  Walker,  the  older  the  patient 
at  the  time  of  onset  of  asthma  the  less 
frequently  is  he  found  to  be  sensitive  to 
protein;  and  he  found  none  sensitive  to  pro- 
tein when  the  onset  occurred  after  the  age 
of  fifty  years. 

If  the  patient  is  sensitive  to  certain  food 
proteins,  these  should  be  omitted  from  the 
diet  for  at  least  a month,  says  Walker,  who 
declares  that  attempts  to  desensitize  the 
patient  by  subcutaneous  injection  of  the 
protein  or  by  feeding  gradually  increasing 
amounts  have  failed.  He  believes  that  pro- 
longed abstinence  from  an  offending  food 
protein  automatically  desensitizes  the  pa- 
tient for  that  protein.  Patients  sensitive  to 
other  proteins,  however,  may  be  desensitized 
by  gradually  increasing  doses  given  twice 
weekly,  beginning,  for  instance,  with  no  more 


ATAXIA,  LOCOMOTOR;  TABES  DORSALIS 


than  100  million  bacteria,  and  increasing 
each  time  by  no  more  than  50  million,  up  to 
doses  of  2000-3000+millions  (12  to  20 
injections  in  all). 

In  obtaining  vaccine  (see  Part  II)  from 
raised  sputum,  the  latter  must  first  be 
washed  repeatedly  with  sterile  normal  saline 
solution  (0.85  per  cent.). 

Asthma,  Cardiac.- — See  Cardiac  Insuf- 
' ficiency. 

Goitre. — See  Goitre,  Simple. 

Renal. — See  Chronic  Interstitial  Ne- 
phritis. 

Thymic. — See  Thymus  Enlargement. 

Ataxia. — Gr.  ara^La  lack  of  order.  Ataxia 
signifies  disturbance  of  muscular  coordi- 
nation. 

Etiology  and  Classification. — 1.  Cerebellar 
ataxia. — Characteristics ; reeling,  drunken 
gait,  inability  to  pronate  and  supinate  the 
wrist  rapidly,  disordered  phonation  and 
articulation,  nystagmus,  perhaps  vertigo; 
the  incoordination,  while  the  patient  is  lying 
in  lyed,  is  not  marked  as  in  tabes  (see  also 
Cerebellar  Lesions).  There  is  an  hereditary 
cerebellar  ataxia  associated  with  optic 
atrophy.  Prescribe  coordinated  exercises  for 
both  the  hands  and  legs. 

2.  Multiple  sclerosis  (q.v.).  The  ataxia 
is  usually  of  the  cerebellar  tyi^e. 

3.  Friedreich’s  hereditary  ataxia  (q.v.). 

4.  Lesions  of  the  midbrain  or  quadri- 
geminal bodies.  The  ataxia  resembles  the 
cerebellar  type,  and  is  associated  with 
ocular  palsies. 

5.  Alcoholic  intoxication. 

6.  Ear  disease. 

7.  Lesions  of  the  basal  ganglia  of 
the  cerebrum. 

8.  Tabes  dorsalis  (q.v.). — Characteristics: 
excursions  of  voluntary  movements  exag- 
gerated, gait  stamping,  the  feet  held  -wide 
apart,  and  the  patient  beuig  compelled  to 
supervise  his  movements  closely;  swaying 
increased  on  closing  the  eyes. 

9.  Multiple  neuritis  (q.v.).  The  ataxia 
re,sembles  that  of  tabes. 

10.  Dementia  paralytica  (q.v.) 

11.  Ataxic  paraplegia  (Gr.  7:apd  across  -fi 
stroke) : ataxia  combined  with  spastic 

paraplegia  (paralysis  of  the  legs),  occurring 
commonly  m middle-aged  males,  and  due  to 
sclerosis  of  the  dorsal  and  lateral  columns  of 
the  cord;  pains  and  eye  sjunptoms  common 
in  tabes  are  usually  absent.  Traumatism 
and  exposure  to  cold  are  causal  factors. 

12.  Any  affection  of  the  posterior  columns 
of  the  cord,  e.q.,  multiple  sclerosis,  post- 
meningeal  tumors,  tumors  ynthin  the  cord, 
syringomyelia  when  invohdng  the  posterior 


columns,  general  myelitis,  syphilis,  perni- 
cious anaemia. 

13.  Interstitial  hypertrophic  progressive 
neuritis  of  childhood  (q.v.),  with  secondary 
involvementof  thedorsal  columnsof  the  cord. 

14.  An  acute  ataxia  sometimes  follows 
measles,  smallpox,  malaria,  and  other  in- 
fectious diseases. 

15.  Hysterical  ataxia. 

16.  Ataxia  due  to  a destructive  lesion  of 
the  parietal  area  of  the  cerebral  cortex.- — It 
differs  from  cei’ebellar  ataxia  in  the  persist- 
ence of  ataxia  in  the  recumbent  posture  and 
in  the  absence  of  nystagmus. , (Consult  Brain 
Localization,  and  Spinal  Cord  Localization). 

Ataxia,  Friedreich’s  Hereditary. — A slowly 
progressive  ataxia,  occurring  [in  early  life, 
usually  in  several  members  of  a family, 
associated  with  nystagmus,  disturbances  of 
speech,  which  is  usually  slow  and  scanning, 
loss  of  knee-jerks,  presence  of  the  Babinski 
reflex,  and,  in  many  cases,  oscillatory  move- 
ments of  the  body  and  head,  soon  followed 
by  paralysis  and  contractures  (talipes  equi- 
nus  and  scoliosis).  The  imderlying  patho- 
logical condition  is  a sclerosis  of  the  dorsal 
and  lateral  cohunns  of  the  cord. 

Alcoholism,  syphilis,  tuberculosis,  and 
consanguinity  in  the  parents  are  all 
causal  influences. 

The  disease  lasts  many  years,  and 
is  incurable. 

Measures  for  the  prevention  of  con- 
tractures may  be  taken  by  splinting  the 
limb  against  the  action  of  the  intact  antag- 
onistic muscles  (see  Orthopaedics,  Part  10, 
Talipes  Equinus,  and  Scoliosis).  Massage 
and  active  and  passive  movements  should 
be  employed.  The  ataxia  may  be  treated 
by  coordinated  exercises,  as  described  under 
Locomotor  Ata.xia.  The  patient  should 
avoid  fatigue. 

(Marie’s  cerebellar  heredo-ataxia  begins 
after  the  age  of  twenty,  the  knee-jerks  are 
retained  or  exaggerated;  there  is  spastic 
paralysis  wfithout  scoliosis  or  club-feet.) 

Ataxia,  Locomotor;  Tabes  Dorsalis. — Gr. 
ara^La  lack  of  order;  L.  locus,  place  -f- 
movere,  to  move;  L.  tabescere,  to  waste; 
dorsum,  back'.  A not  imcommon  chronic 
cUsease  of  adult  life,  of  slow  course,  prac- 
tically always  a remote  consequence  of 
syphilis,  characterized  by  (a)  an  incipient 
stage  of  lightning  ]:>ains,  hjqierJBsthesiae  and 
parsesthesi®,  girdle  sensation,  \fisceral  crises, 
Argjil-Robertson  pupil,  in  which  the  latter 
contracts  durmg  accoimnodation  but  not  to 
light,  sex\ial  impotence,  often  retention  of 
urine,  loss  of  the  deep  reflexes,  often  ptosis 
and  paralysis  of  the  external  eye-muscles. 


ATELECTASIS  IN  INFANTS  AND  CHILDREN 


with  resulting  strabismus,  and  sometimes 
optic  atrophy;  followed  sooner  or  later  by 
(6)  an  ataxic  stage,  in  which  the  body  sways 
when  the  eyes  are  closed  and  feet  held  to- 
gether (Romberg’s  sign),  the  excursions  of 
the  voluntary  movements  are  exaggerated, 
the  gait  stamping,  the  feet  being  held  wide 
apart,  and  the  patient  compelled  to  super- 
vise his  movements  closely;  the  muscles  are 
hypotonic,  permitting  excessive  passive 
movements;  trophic  disorders  (perforating 
ulcer,  arthropathies)  are  apt  to  appear; 
finally  (c),  the  stage  of  paralysis  occurs. 
In  cases  with  optic  atrophy  ataxia 
rarely  develops. 

Etiology. — Syphilis  is  the  cause  in  the  great 
majority  of  cases,  i^erhaps  in  all  cases. 
Other  possible  causes  are:  traumatism, 

severe  exposure  to  cold  and  wet,  sexual 
excess,  'excessive  exertion  and  fatigue.  Leatl 
poisoning,  ergot  poisoning,  and  pernicious 
antemia  may  produce  a similar  affection. 

Prognosis. — The  disease  is  perhaps  incur- 
able, but  it  may  become  arrested,  and  often 
shows  marked  remissions. 

Treatment. — Antisyphilitic  treatment  with 
mercury,  iodide,  and  salvarsan  or  neosal- 
varsan  (see  Syphilis,)  should  always  be 
employed  in  the  pre-ataxic  stage,  and  in 
all  cases  in  which  the  treatment  was  pre- 
viously imperfectly  carried  out;  perhaps  in 
all  cases,  without  exception. 

Enjoin  a quiet,  temperate,  orderly  life,  at 
the  patient’s  customary  vocation.  Fatigue 
should  be  avoided,  since  Edinger  seems  to 
show  that  fatigue  is  one  of  the  causes  of 
tabetic  degeneration.  Alcohol  and  tobacco 
should  be  avoided.  Tepid  full  baths  fol- 
lowed by  slightly  cooler  douching,  general 
massage  and  galvanism  of  the  spine,  given 
daily  or  every  other  day,  are  useful  invigor- 
ating measures.  The  galvanic  current  (see 
Med.  Elect.)  should  be  no  greater  than 
6-10-20  milliamperes,  applied  for  from 
three  to  ten  minutes.  One  electrode  is 
placed  on  the  neck  or  between  the  shoulders, 
and  the  other  in  the  lumbar  region.  The 
electrodes  should  be  broad,  measuring  about 
3x5  inches. 

The  tabetic  is  very  susceptible  to  climatic 
changes.  A warm,  dry  climate  is  best. 

The  following  drugs  are  reputed  to  be  of 
some  value: 

Acidi  arsenosi,  tabellai,  gr.  Xo,  t.i.cl.p.c. 

Sodii  cacodylatis,  gr.  t.i.d.p.c. 

R Sodii  et  auri  chloridi,  pilulae,  gr.  M0-K2,  t.i.d. 

R Argenti  nitratis,  pilula;  kaolini,  gr.  t.i.d.; 
continued  for  periods  of  one  or  two  months,  with 
intervals  of  six  to  eight  weeks.  (Forchheimer.) 
Discontinue  the  drug  if  argyria  appears. 


Glycerophosphates  (for  drug  formulae,  etc., 
see  Part  11)  are  valuable. 

For  lightning  pains:  Rest  in  bed;  applica- 
tion to  the  spine  of  the  thermocautery;  pyra- 
midon,  or  phenacetin,  or  antipyrine,  or 
aspirin,  with  codeine,  or  sodium  salicylate; 
morphine,  gr.  only  as  a last  resort. 

For  gastric  crises:  Rest  of  the  stomach 
and  bowels;  hot  applications  to  the  abdo- 
men ; anaesthesin,  or  cocaine,  or  cerium 
oxalate,  gr.  v,  with  codeine,  gr.  }/i,  or 
phenacetin,  or  antipyrin  or  hyoscine  hydro- 
bromide; morphine,  gr.  only  as 

a last  resort. 

For  laryngeal  crises:  Inhalations  of  amyl 
nitrite  or  of  chloroform;  local  application  of 
cocaine,  2-4  per  cent. 

For  rectal  crises:  Morphine  suppository, 

gi-.  34- 

Osier  recommends,  for  the  purpose  of 
allaying  neuralgic  pains  and  diminishing  the 
frequency  of  crises,  in  cases  of  increased 
arterial  tension,  the  prolonged  used  of  nitro- 
glycerin, given  in  increasing  doses  until 
the  occurrence  of  flushing  indicates  that  the 
physiological  limit  has  been  reached  (see 
Part  11). 

Provide  against  rectal  retention  by  means 
of  laxatives  and  enemas,  and  against  vesical 
retention  by  regular  catheterization,  boric 
acid  irrigations,  the  passage  of  sounds,  and 
galvanization  over  the  perineal  and  supra- 
pubic regions. 

In  incontinence  the  patient  should  empty 
the  bladder  regularly  every  three  or  four 
hours  during  the  day. 

Rest  is  the  best  treatment  of  trophic 
ulceration.  To  prevent  it,  all  trauma 
caused  by  ill-fitting  shoes,  etc.,  should  be 
avoided  (see  Arthropathies). 

In  suitable  cases  one  may  employ  Frenk- 
el’s systematic  exercises  for  the  purpose  of 
reeducating  the  ataxic  muscles.  These  exer- 
cises comprise  efforts  at  following  on  the 
floor,  with  the  tip  of  the  toe,  straight  and 
curved  lines  and  triangles,  taking  steps  of 
definite  lengths,  going  up  stairs,  placing  the 
head  in  various  holes  in  a board,  placing  the 
heel  of  one  foot  on  various  parts  of  the 
other  limb,  placing  cribbage  pegs,  type- 
writing, piano-playing,  etc. 

The  exercises  should  last  at  first  no  longer 
than  five  minutes,  with  five  minutes’  rest, 
and  should  be  practiced  two  or  three  or 
four  times  a day.  The  time  may  be  slowly 
and  gradually  increased.  Fatigue  should 
be  avoided. 

Ataxic  Paraplegia. — See  Ataxia,  No.  11. 

Atelectasis  in  Infants  and  Children. — Gr. 

cLTeXrjs  imperfect  -f-  eKracns  expansion.  The 


ATROPHIES,  THE  PROGRESSIVE  MUSCULAR 


manifestations  are:  cyanosis,  with  or  with- 
out rapid  superficial  breathing  or  convul- 
sions, and  the  absence  of  breath-sounds 
over  the  affected  area,  chiefly  the  lower 
lobes  posteriorly. 

Etiology. — Asphyxiation  due  to  labor  (see 
Asphyxia;  inematurity,  marasmus,  or  other 
form  of  weakness;  compression  of  the  lung  l^y 
a pleuritic  effusion,  pericardial  effusion,  pneu- 
mothorax, cardiac  enlargement,  tumor,  or 
chest  deformity  due  to  rickets  or  Pott’s  dis- 
ease; obstruction  of  a bronchus  with  mucus 
or  a foreign  Ixjdy. 

Treatment. — Attend  to  the  cause  {q.v.,  in 
its  prop(‘r  alphabetical  order).  Induce  cry- 
ing, by  s])anking;  or  by  alternately  dipping 
the  child  in  hot  (110°  F.)  and  cold  (00°  F.) 
water;  or  Ijy  brief  immersion  in  water  at  a 
temperature  of  95°  F.,  and  i)Ourmg  one  pint 
of  cokl  water  over  tlie  chest,  back,  and  head, 
from  four  to  six  times,  repeating  this  every 
two  hours.  (Heulmer).  The  mustard  poul- 
tice may  be  of  some  service. 

Mouth  to  mouth  insufflation  may  be  prac- 
ticed, but  the  lungmotor  (or  pulmotor) 
is  preferable. 

Atelectasis,  Post=operative. — See  Pul- 
monary Collapse,  Post-operative. 

Atheroma. — Gr.  adi}pri  porridge.  See  Ar- 
teriosclerosis. 

Athetosis. — Gr.  adrjTos  not  fixed.  An  in- 
voluntary, slow,  sinuous  or  twisting,  mobile 
spasm,  occurring  in  certain  muscular  groups 
which  are  spastically  paralyzed.  It  is 
always  secondary  to  some  organic  cerebral 
lesion.  According  to  J.  Ramsay  Hunt,  it  is 
a combination  of  rigidity  with  chorea,  the 
rigidity  l)eing  due  to  atrophy  of  the  efferent 
or  motor  extrapyramidal  or  pallidal  system 
of  the  corpus  striatum,  the  function  of  which 
is  to  control  automatic  and  associated  move- 
ment, and  the  chorea  being  tlue  to  degener- 
ation of  the  small  ganglion  cells  of  the  neos- 
triatal  system  (caudate  nucleus),  releasing 
the  pallidal  (or'automatic)  motor  mechanism 
from  control,  with  resulting  choreiform, 
movements.  It  is  incurable. 

Atonic  Dyspepsia. — Gr.  a neg.  + 
Tovos  tone.  See  Dyspepsia,  Nervous 
and  Enteroptosis. 

Atony,  Gastric. — See  Dyspepsia,  Ner- 
vous, and  Enterojitosis. 

Atony,  Intestinal. — See  Constipation. 

Atrophic  Cirrhosis  of  the  Liver. — See 
Cirrhosis,  Portal,  of  the  Liver. 

Atrophies,  the  Progressive  Muscular. — 
Gr.  a neg.  -fi  Tpo4>i]  nourishment.  “ A 
chronic  atrophica  jiaralj^sis  characterized  by 
a slowly  ])rogressing  muscular  weakness  and 
atrophy,  beginning  in  one  part  of  the  body 


and  advancing  to  another  part,  may  occur 
under  the  following  conditions”  (Author?) : 
fibrillary  tremor  of  the  tongue  are  absent). 

1.  Progressive  (central)  muscular  atrophy ; 
synonyms:  chronic  anterior  poliomyelitis; 
amyotrophic  lateral  sclerosis;  progressive 
bulbar  or  glosso-labio-laryngeal  paralysis. 
(Gr.  TToXtos  gray  fiveXos  marrow;  a neg. 
pvs  muscle  rpo^i)  nourishment;  yXAacxa 
tongue;  L.  labium,  lip;  Gr.  Xdpvy^  larynx.) 

2.  Progressive  (neural)  muscular  atrophy. 

3.  Interstitial  hypertrophic  progressive 
neuritis  of  childhood  (q.v.). 

4.  Multiple  neuritis  (q.v.). 

5.  Muscular  Dystrophy  (q.v.). 

Here  are  considered  only  progressive 
(central)  and  progressive  (neural)  mus- 
cular atrophy. 

(A.)  Progressive  (Central)  Muscular 
Atrophy. — ^A  rare,  slowly  progressive,  mus- 
cular wasting  and  paralysis,  beginning  usu- 
ally in  'midtile  life,  not  usually  hereditary  or 
familial,  the  result  of  degeneration  of  the 
motor  tract,  and  characterized  by  muscular 
weakness,  atrophy,  and  usually  spasticity, 
fibrillary  tremors,  usually  exaggerated  tendon 
reflexes,  the  Babinski  reflex,  contractures, 
and  bulbar  or  glosso-labio-lar3mgeal  dis- 
turbances, e.g.,  difficult  speech,  dribbling  of 
saliva,  difficulty  in  chewing  and  swallowing, 
inability  to  whistle,  atrophy  and  fibrillary 
tremor  of  the  tongue;  in  palatal  paralysis — 
regurgitation  of  fluids  through  the  nose,  and 
immobility  of  the  palate  when  the  patient 
says  “Ab” — due  to  bilateral  degeneration 
in  the  medulla  and  pons  of  the  motor  cells 
of  the  hypoglossal,  facial,  pneumogastric, 
glosso-pharyngeal,  vago-accessorial,  and  tri- 
geminal nerves.  The  various  symptoms 
characteristic  respectively  of  upper  (spas- 
ticity: amyotrophic  lateral  sclerosis,  includ- 
ing bulbar  palsy)  and  lower  (flaccidity: 
chronic  anterior  poliomyelitis)  segment 
paralysis  may  “coexist  in  every  degree 
and  combination.” 

Exclude  syringomyelia  (q.v.),  and  the 
pseudo-bulbar  palsy  of  cerebral  origin  (le- 
sions of  the  cortex  of  the  lower  part  of  the 
ascending  frontal  convolution,  and  of  the 
knee  of  the  internal  capsule;  atrophy  and 
fibrillary  tremor  of  the  tongue  are  absent). 
There  are  acute  tJ^Ies  of  bulbar  paral3^sis 
due  to  hemorrhage,  embolism,  thrombosis, 
or  inflammation  (acute  poliomyelitis,  diph- 
theria, electric  shock)  in  the  pons  or  medulla. 
Mj'asthenia  gra\fis  (q.v.)  is  a transient  bulbar 
paresis.  The  sjunjitoms  of  bulbar  palsy 
maj’-  also  result  from  giunmata  or  tumors 
involving  the  vagus,  accessory  and  hypo- 
glossal nerves  at  the  base  of  the  skull. 


BACKACHE 


Etiology.- — The  chief  cause  is  probably  an 
inherent  tendency  to  early  degeneration  of 
the  motor  nervous  system  and  muscles. 
Cold,  wet,  traumatism,  fright,  and  worry  are 
favoring  influences.  Lead  is  a possible  cause. 

Prognosis.^ — The  disease  is  fatal  in  one  to 
four  or  more  years. 

Treatment. — Fresh  air  day  and  night,  an 
abundance  of  plain,  easily  digestible  food; 
very  moderate  exercise,  strictly  avoiding 
fatigue;  moderate  massage,  passive  move- 
ments, galvanism  (the  last  for  no  more  than 
five  minutes  daily);  iron  arsenic,  codliver 
oil,  and  malt  extract  are  useful  invigorating 
agents.  (See  Drugs,  Part  11.) 

Strychnine  nitrate  should  be  tried,  begin- 
ning with  a dose  of  gr.  Moo~Ho)  hypo- 
dermically, every  day,  and  gradually  in- 
creasing the  dose  until  muscular  twitching 
occurs,  and  then  continuing  the  drug  at  a 
smaller  dose  for  three  or  four  months,  or 
until  the  disease  is  arrested,  and  then  con- 
tinuing it  with  an  intermission  of  one  week 
out  of  every  three  or  four  weeks.  (Gowers.) 

Silver  nitrate,  zinc  phosphide,  and  ergot 
are  reputed  to  be  of  some  value.  If  a pos- 
itive Wassermann  reaction  is  obtained, 
employ  antiluetic  treatment. 

In  bulbar  paralysis  there  is  danger  of 
choking,  or  of  aspiration  pneumonia.  The 
food  should  be  liquid  or  soft  or  semi-solid. 
Feeding  by  the  stomach-tube  is  eventually 
required.  For  dyspncea  administer  the 
bromides;  tracheotomy  (q.v.)  is  sometimes 
required.  For  s}mcope  administer  camphor, 
gr.  i-ii,  in  ether,  ttrxv,  hypodermically,  or 
aromatic  spirits  of  ammonia,  one  teaspoon- 
ful in  a glass  of  water. 

(B.)  Progressive  (Neural)  Muscular 
Atrophy  (“  Charcot-Marie-Tooth”). — A rare 
slowly  progressive,  hereditary  or  familial 
muscular  atrophy,  begiiming  in  youth,  and 
exhibiting,  as  an  essential  feature,  involve- 
ment of  the  distal  portions  of  the  limbs,  with 
little  or  no  involvement  of  the  proximal  por- 
tions. The  reaction  of  degeneration,  fibril- 
lary tremors,  and  perhaps  slight  sensory 
disturbances,  together  with  loss  of  the 
reflexes,  are  present.  Club-foot  occurs.  The 
subject  of  the  disease  may  live  many  years. 

The  treatment  is  that  of  the  preceding  disease. 

Atrophy,  Acute  Yellow,  of  the  Liver. — A 
very  rare,  acute,  general  hepatic  necrosis, 
characterized  clinically  by  jaundice,  fol- 
lowed after  several  days  or  weeks  by  head- 
ache, vomiting,  trembling  of  the  muscles, 
delirium,  hemorrhages  from  the  skin  and 
mucous  membranes,  diminution  of  the  liver 
volume,  sometimes  convulsions,  coma,  and 
usually  death. 


Leucin  and  tyrosin  are  often  present  in 
the  urine.  The  urea  of  the  urine  is  much 
diminished,  and  the  ammonia  correspond- 
ingly increased  (see  Urinalysis). 

Etiology.— Over  50  per  cent,  of  the  cases 
occur  in  pregnancy,  sometimes  during  the 
puerperium.  Other  causes  are:  chloroform, 
ptomaines;  alcohol;  infectious  diseases,  e.g., 
syphilis,  septico-pyemia,  typhoid  fever,  diph- 
theria; profound  mental  emotion.  Similar 
symptoms  may  occur  in  phosphorus  poison- 
ing, hypertrophic  cirrhosis  of  the  liver, 
advanced  passive  congestion,  cholangitis,  etc. 

Treatment. — The  treatment  is  eliminative. 
In  pregnancy,  terminate  the  latter  promptly. 
Purge  freely  with  calomel,  gr.  v-viii,  fol- 
lowed by  Rochelle  salt,  a tablespoonful  dis- 
solved in  water,  or  a teaspoonful  every  hour 
until  free  purgation  is  established.  Atlmin- 
ister  large  amounts  of  water  and  alkaline 
diuretics,  dextrose,  and  sodium  bicarbonate 
to  counteract  acid  intoxication  (see  Acidosis). 
Hot  normal  saline  solution  (0.9  per  cent.) 
should  be  administered  subcutaneously,  in- 
travenously, or  per  rectum — about  three 
pints,  at  the  rate  of  a pint  an  hour. 

The  diet  should  consist  of  milk  diluted 
with  soda  water  or  Vichy,  and  dextrose  and 
other  carbohydrates  (well-cooked  cereals)  in 
abundance,  since  carbohydrates  are,  in  this 
condition,  the  food  most  easily  metabolized. 

Otherwise,  treat  the  case  symptomatically. 
For  vomiting,  see  Vomiting.  For  convulsions 
and  delirium  give  morphme,  no  chloroform, 
because  of  its  toxic  action  upon  the  liver. 

Atrophy,  Infantile. — See  Marasmus. 

Lingual. — See  Hypoglossal  Paralysis. 

Muscular. — See  Atrophies,  the  Pro- 
gressive Muscular. 

Of  the  Tongue  . — See  Hypoglossal 
Paralysis. 

Auditory  Nerve  Affections. — See  Ear  Dis- 
eases, Part  7. 

Auricular  Fibrillation. — See  Arrhythmia, 
Cardiac. 

Flutter. — See  Arrhythmia,  Cardiac. 

Autumnal  Catarrh. — See  Hay  Fever. 

Axillary  Pain. — See  Pain. 

Bacillary  Dysentery. — See  Dysentery, 

Bacillary. 

Bacilluria. — See  Typhoid  Fever. 

Backache. — Causes. — Fatigue;  debility; 

neurasthenia;  sacro-iliac  strain  (see  Ortho- 
paedics, Part  10 ; sprain  of  the  back 
(see  Orthopaedics);  flat-foot;  inequality  of 
the  limbs;  lumliago;  parturition;  post- 
operative pain;  herpes  zoster;  splanchnopto- 
sis; displaced  kidney;  loaded  colon;  renal 
disease  (stone,  tuberculosis,  nephritis,  tu- 
mors, infarction,  hydronephrosis,  pyelone- 


BERI-BERI;  KAKKE 


phritis,  cystic  degeneration);  perinephritic 
abscess;  thoracic  or  abdominal  aneurysm; 
spondylitis  deformans;  infectious  spondy- 
litis (see  Arthritis  m Orthopaedics);  verte- 
bral exostosis;  Pott’s  disease  (see  Ortho- 
paedics) ; sacro-iliac  disease  i (see  Orthopae- 
dics); cancer  of  the  spine;  retroperitoneal 
tumor;  ulcer  or  cancer  of  the  stomach ; pel- 
vic disease  (uterine  displacement,  uterine  or 
ovarian  tumor;  subinvolution  and  inflam- 
mation; see  Gynaecology,  Part  2;  chole- 
lithiasis; lead  colic;  internal  hemorrhoids; 
prostatitis  and  enlarged  prostate  (see  Genito- 
urinary Diseases);  varicocele  or  relaxed 
scrotmn  (see  Genito-Urinary  Diseases);  in- 
fectious diseases  (influenza,  smallpox,  ty- 
phoid fever,  etc.);  locomotor  ataxia;  tumor 
of  the  cord  (see  Spastic  Paralysis);  diabetes; 
impingement  of  the  transverse  process  of  the 
fifth  hunbar  vertebra  on  the  ilimn;  fracture 
of  a transverse  process  of  a lumbar  vertebra; 
spondylolisthesis  (see  Obstetrics). 

Bad  Breath. — See  Breath,  Bad. 

Banti’s  Disease. — See  Antemia,  Splenic. 

Barlow’s  Disease. — See  Scurvy,  Infantile. 

Basedow’s  Disease. — See  Exophthalmic 
Goitre. 

Basilar  Meningitis. — See  Tuberculosis, 
Acute  Miliary. 

Bednar’s  Aphthae. — See  Ulcer  of  the 
Mouth. 

Bed=Sore;  Decubitus. — L.  decubitus,  a 
lying  down.  To  prevent  bed-sores,  the  bed 
sheets  should  be  kept  clean  and  smooth,  the 
skin  should  be  bathed  frequently  (at  least 
twice  a day)  with  soap  and  warm  water,  or 
preferably  with  equal  parts  of  alcohol  and 
water,  dried,  and  dusted  with  powder,  and 
the  position  should  be  changed  frequently 
(every  half-hour  in  spinal  cases).  Over 
points  of  pressure  should  be  placed  air 
cushions  or  rings  of  cotton-wool.  The  air- 
bed or  water-bed  (water  mattress)  is  best. 
The  evacuations  should  be  at  once  removed, 
the  skin  cleansed  with  soap  and  water,  then 
plain  water,  carefully  dried,  andfpowdered 
with  equal  parts  of  zinc  oxide,  and  starch ; 
or  the  skin  about  the  genitals  and  buttocks 
may  be  protected  with  an  ointment,  e.g., 
boric  omtment,  10  per  cent. 

As  soon  as  any  redness  is  noticed,  the 
parts  should  be  batlu'd  with  alcohol  or  com- 
pomid  tincture  of  benzoin,  thoroughly  dried, 
dusted  with  talcum  powder  or  starch  and 
oxide  of  zinc,  equal  parts,  and  a protecting 
rubber  ring  or  cushion  employed.  The  skin 
should  be  pinched  up  with  the  fingers  in 
order  to  increase  the  circulation. 

Sores  should  be  treated  with  bismuth, 
aristol,  or  iodol  powders,  or  peroxide  of 


hydrogen,  or  balsam  of  Peru  and  castor  oil, 
equal  parts. 

Bed=Wetting  . — See  Enuresis. 

Belching,  Acid. — See  Hyperacidity. 

Air. — See  Eructations,  Nervous. 

Nervous. — See  Eructations,  Nervous. 

Bell’s  Palsy  . — See  Facial  Paralysis. 

Bends. — See  Caisson  Disease. 

Beri=beri;  Kakke. — (Beri-beri  is  Cing- 
alese, meaning  “sheep,”  so  named  from  the 
resemblance  of  the  gait  of  this  disease  to  the 
trembling  walk  of  sheep;  Kakke  is  Japanese). 
A chronic  endemic  and  epidemic,  chiefly 
tropical,  peripheral  neuritis,  associated 
sometimes  Avith  cardiac  degeneration  and 
anasarca,  and  caused  by  the  lack  of  certain 
elements  (vitamines)  in  the  food  (mostly 
the  use  of  polished  or  milled  rice  from  which 
the  pericarp  has  been  removed,  but  also 
the  use  of  dried,  turned,  pickled,  or 
sterilized  foods). 

There  are  acute  and  subacute  phases  of 
the  disease. 

The  prognosis  is  not  J necessarily  bad,  but 
the  disease  is  very  chronic. 

Treatment. — Confine  the  patient  to  bed, 
because  of  the  cardiac  weakness.  Prescribe 
a nutritious,  easily  digestible  diet  of  fresh 
food  containing  vitamines — raw  milk,  fresh 
meat,  meat  extracts,  fresh  eggs,  fresh  vege- 
tables, especially  beans  and  peas,  yeast, 
potatoes,  Katjang  idjo  beans,  extract  of 
rice  bran,  pineapple. 

In  the  early  stages  of  the  disease  saline 
cathartics  are  recommended: 

Magnesii  seu  soclii  sul- 

phatis 5i-iss  ( Z per  dose) 

Acidi  hydrochlorici 

diluti iiEXX-xxx 

TincturiE  aurantii  am- 
ara5 3 i 

Aquce,  q.s.  ad 5vi 

M.  Sig. — Two  tablespoonfuls,  t.i.d.  for  5-7  days, 
repeated  after  an  intermission  of  several  days. 
(A  Japanese  prescription,  quoted  in  Osier’s 
Modern  Medicine.) 

Cardiac  dilatation  and  oedema  are  to 
be  treated  as  described  under  Cardiac 
Insufficiency;  but  do  not  carry  depletive 
measures  to  excess,  and  thereby  cause  seri- 
ous weakness. 

For  vomiting,  for  dyspnoea,  and  for  local 
hypersesthesia  are  recommended  small  doses 
of  morphine.  The  bromides,  gr.  xv-xx,  well 
diluted  in  water,  from  two  to  four  times  a 
day,  and  chloroform  liniment  are  also  use- 
ful for  the  latter  complaint. 

For  the  paralysis  employ,  as  soon  as  the 
oedema  has  disappeared,  massage,  passive 
movements,  and  galvanism,  as  described 


BLOOD  EXAMINATION 


under  Multiple  Neuritis.  Moderate  exer- 
cise should  be  resorted  to  as  soon  as  prac- 
ticable; but  it  should  be  stopped  if  it 
increases  the  heart-rate  unduly. 

Bier’s  Hypersemia. — See  under  Inflam- 
mation. 

Bile  Ducts,  Cancer  of  the. — See  Cancer 
of  the  Gall  Bladder  and  Bihary  Ducts. 

Catarrh,  Acute  and  Chronic,  of  the. — 
See  Jaundice,  Catarrhal. 

Suppurative  Inflammation  of  the. — 
See  Cholangitis,  Suppurative. 

Biiharziasis. — See  Distomiasis. 

Biliary  Calculus. — L.  hil'is,  bile.  See 
Cholelithiasis. 

Cancer. — See  Cancer  of  the  Gall 
Bladder  and  Bile  Ducts. 

Catarrh. — See  Jaundice,  Catarrhal. 

Cirrhosis  of  the  Liver. — See  Cirrhosis, 
Biliary,  of  the  Liver. 

Biliary  Colic. — See  Cholelithiasis. 

Biliousness. — See  Liver,  Active  Conges- 
tion of  the. 

Birth  Palsies. — (See  Hemorrhage,  Menin- 
geal, in  the  New  Born;  and  Upper  Arm  Type 
of  Paralysis,  under  Brachial  Plexus. 

Black  Tongue. — See  Sldn  Diseases,  Part  5. 

Black=water  or  Haemoglobinuric  Fever. — 
This  serious  condition  is  probably  the  result 
of  the  combined  haemolytic  action  of  chronic 
aestivo-autumnal  malaria  and  quinine. 
Sandwith  attributes  it  to  want  of  regular- 
ity in  taking  the  quinine  rather  than  to 
excessive  dosage. 

Spontaneous  recovery  often  occurs,  but 
about  10-12  per  cent,  of  the  patients  die. 

Treatment.— Remove  the  patient  from  the 
malarial  region  and  confine  him  to  bed. 
Withhold  quinine,  imless  parasites  other 
than  crescents,  which  are  not  affected  by 
quinine,  are  present  in  the  blood,  when 
doses  of  gr.  i-ii,  t.i.d.,  may,  perhaps,  be  cau- 
tiously tried,  the  urine  being  watched  closely 
and  measured.  If  well  borne,  the  quinine 
may  be  cautiously  increased  to  five  or 
more  grains. 

Treat  the  kidney  condition:  keep  the 
bowels  open  with  calomel  {q.v.  in  Part  11), 
give  copioas  warm  drinks,  e.  g.,  barley  water, 
albumen  water,  weak  chicken  broth,  and  pre- 
scribe diuretics  and  diaphoretics: 

Spiritas  setheris  nitrosi.  . . §i  (i^xl  per  dose) 

Pota.ssii  acetatLs 5 i (gr.  xl  per  do.se) 

Liquoris  ammonii  acetatis  5iv(3ii  3 ii  per  dose) 

Syrup i simp licis gss 

Aquas  camphor®,  q.s.,  ad. . 3 vi 

M.  Sig. — One  tablespoonful,  after  shaking,  dis- 
solved in  a gla.ss  of  water,  three  or  four  times  daily. 
Keep  the  patient  well  covered  with  woolen  blankets 
and  guard  against  chilling  draughts.  Hot  normal 


saline  ( 3 i ad  Oi)  subcutaneous  infusions  and  ene- 
mata  are  advised ; also  oxygen  inhalations  (see 
Pneumonia,  Lobar).  Sweating  (see  Ur®mia)  may 
be  required. 

Hearsey  recommends  the  foUowing : 

H Hydrargyri  perchloridi  . . gr.  ss  (gr.  per  dose) 

Sodii  bicarbonatis 5ii  9i  (gr.  x per  dose) 

Aquae,  q.s.,  ad 3d 

M.  Sig. — One  dram  every  two  hours  for  one  day, 
then  every  three  hours  until  the  urine  improves  m 
color.  Take  no  acid  drinks.  (Hearsey.) 

For  vomiting,  see  Vomiting;  nutrient  ene- 
mata  (see  Rectal  Feeding)  may  be  neces.sary. 

For  restlessness,  backache,  or  in.somnia, 
or  vomiting,  morplune  may  be  demanded. 

For  heart-failure,  see  Cardiac  Insuf- 
ficiency; for  anuria.  Anuria. 

During  convalescence,  iron  and  arsenic 
may  be  required  (see  Part  11). 

Rest  in  bed  and  a milk  diet  should  be  con- 
tinued until  all  evidences  of  nephritis  have 
disappeared.  P.  W.  Plehn  insists  that  in 
severe  cases  of  black-water  fever,  nothing 
should  be  done  aside  from  keeping  the  pa- 
tient in  bed.  He  should  not  be  moved,  or 
violently  purged,  or  sweated,  and  heart 
stimulants  should  be  scrupulously  avoided. 
{Practical  Medicine  Series,  vol.  vi,  1915.) 

Blastomycosis. — See  Skin  Di.seases,  Part  5. 

Bleeder. — See  Hiemophilia. 

Blindness. — See  Eye  Diseases,  Part  6. 

Blood  Examination. — A.  Enumeration  of 
the  Red  and  White  Blood=CeIls. — The  normal 
erydhrocyte  count  is  5,000,000  per  c.mm. 
for  men,  and  4,500,000  for  women.  The 
normal  leucoc3d.e  count  is  5,000-10,000, 
average  7500  per  c.mm.  See  Leucocytosis ; 
Lymphocytosis;  Eosinophilia;  Mast-Cell 
Leucocytosis;  Leucopenia. 

1.  To  Count  the  Red  Blood-Cells. — 
The  diluents  used  are: 

Hayem’s  solution: 

Mercuric  chloride 0.5  gram 

Sodium  sulphate 5.0  grams 

Sodium  chloride  1.0  gram 

Distilled  water 200.0  c.c. 

Toisson’s  fluid  (colors  leucocytes  blue) : 

Sodium  chloride 1.000  gram 

Sodium  sulphate 8.000  grams 

Neutral  glycerine .30.000  c.c. 

Distilled  water  160.000  c.c. 

Methyl  violet  5B  0.025  gram 

Filter  before  using,  to  remove  yea.st  cells. 

Technique. — Obtain,  by  puncture,  avoid- 
ing compression  or  manipulation,  a large 
drop  of  blood  from  the  lobe  of  the  ear  or  tip 
of  the  finger.  Insert  the  tip  of  the  eryth- 
rocyte pipette  (erythrocytometer)  in  the 
drop,  and  draw  the  blood  by  suction  exactly 
to  the  mark  0.5.  If  the  blood  is  drawn  too 
far,  it  may  be  brought  down  by  rubbing  the 


BLOOD  EXAMINATION 


tip  of  the  pipette  with  the  finger.  Now  wipe 
away  any  excess  of  blood,  and  dip  the  pipette 
into  the  diluent,  at  the  same  time  apjdying 
immecUate  suction  and  drawing  the  fluid  up 
to  the  101  mark.  Now  close  both  ends  of 
the  pipette  with  thumb  and  finger  and 
shake  vigorously  so  as  to  mix  the  contents 
thoroughly.  Now  blow  the  three  or  four 
drops  of  unmixed  fluid  from  the  capillary, 
and  place  one  drop  of  the  remaining  fluid 
on  the  centre  of  the  ruled  area  of  the  counting 
chamber.  Cover  with  the  cover-glass  so  as 
not  to  include  an  air-bubble.  If  Newton’s 
color  rings  are  not  brought  out  by  pressm’e, 
make  another  preparation.  Examine  now 
with  the  low  jjower  to  make  sure  that  the 
cells  to  be  counted  are  uniformly  distributed. 
Put  on  the  higher  power,  and  count  all  the 
I'ed  cells  in  each  unit  of  25  small  squares,  IG 
units  or  large  squares  in  all.  C’ount  from 
left  to  right,  beginnmg  at  the  upper  left 
corner  of  the  IG  large  squares.  In  counting, 
disregard  cells  touching  the  right  and  lower 
boundaries  of  the  small  squares,  but  include 
those  touching  the  upper  and  left  boundaries. 

Each  small  square  has  an  area  of  Mooo 
c.mm.;  the  whole  field  of  400  squares,  3d!o 
c.mm.  The  number  of  cells  counted  in  the 
whole  field  multiplied  by  ten  equals  the 
number  of  cells  in  one  c.mm.  Multiply 
this  by  200,  the  degree  of  dilution  (it  would 
be  100,  if  the  blood  were  originally  drawn 
to  the  mark  1 in  the  pipette),  to  obtain 
the  number  of  cells  in  one  c.imn.  of 
undiluteil  blood. 

2.  To  Count  the  White  Cells  Alone. 
— Use  the  leucocyte  pipette  (leucocytom- 
eter)  and  a diluent  consisting  of  0.5  or  1 
per  cent,  solution  of  glacial  acetic  acid  in 
water  (to  destroy  the  red  cells),  and  con- 
taining, perhaps,  gentian  violet.  It  should 
be  made  fresh,  to  avoid  contamination  with 
yeast  cells.  Draw  blood  to  the  mark  1,  and 
diluent  to  the  mark  11;  making  a dilution 
of  1 to  10  (blood  drawn  to  0.5  equals  a dilu- 
tion of  1 to  20).  Count  the  cells  in  the  whole 
ruled  spa(^e  and  multiply  the  result  by  100 
(200  if  the  dilution  were  1 to  20)  ; thus  ob- 
taining the  number  of  white  cells  in  1 c.mm. 
of  blood. 

Wash  the  counting  chamber  with  distilled 
water  and  dry  before  and  after  using.  Never 
use  alcohol  or  ether.  Wash  out  the  pipettes, 
after  using,  with  distilled  water,  then  with 
alcohol  and  ether,  and  blow  dry  with  dry 
air  until  the  glass  bead  in  the  ampulla  is 
freely  movable. 

B.  HfEmoglobin  Estimation. — 1.  Tallqiiist’s 
Method  (not  accurate  within  ten  degrees). 
— Saturate  a strip  of  the  filter  paper  (which 


comes  with  the  Tallquist  scale)  with  the 
blood  to  be  tested;  let  the  latter  dry  until 
the  humid  gloss  has  disappeared ; then  place 
it  at  once  beside,  not  behind,  the  scale,  with 
the  light  (always  daylight)  behind  or  at 
one  side. 

2.  Sahli’s  Method. — The  standard  of 
comparison  in  Sahli’s  hsemometer  is  an  acid 
haimatin  solution  with  a color  tone  corre- 
sponding to  a one  per  cent,  solution  of  normal 
blood.  Before  u.sing,  invert  the  tube  so  as 
to  allow  the  haemin  (or  hsematin  hydroclilo- 
ride)  precipitate  to  diffuse  uniformly. 

Dilute  the  blood  with  ten  tunes  its  volume 
of  N/10  normal  HCl  (made  by  diluting  15 
c.c.  of  c.p.  concentrated  HCl  to  1000  c.c.) 
by  taking  the  blood  with  the  20  c.mm.  pi- 
pette (drawn  up  to  the  mark  1)  and  blowing 
it  mto  the  graduated  tube,  which  already 
contains  the  N/10  normal  HCl  up  to  the 
mark  10.  Mix  the  blood  and  acid,  and  as 
soon  as  a clear  dark  brown  color  is  visible 
(caused  by  a fine  suspension  of  haemin),  add 
water  carefully  with  a dropping  pipette  and 
mix,  until  the  color  tone  corresponds,  by 
transmitted  light,  to  that  of  the  standard 
solution,  when  the  percentage  of  haemoglobin 
may  be  read  off.  For  women  add  one-eighth 
to  the  percentage  values  as  read,  as  female 
blood  is  said  to  run  from  12}/^  to  20  per 
cent,  less  in  haemoglobin  than  the  blood  of 
man;  for  a child  one-seventh  should  be 
added  to  the  percentage.  Calculate  the 
absolute  value  per  100  c.c.  of  blood  by  mul- 
tiplying the  percentage  obtained  by  0.1377 
(the  normal  number  of  grams  of  haemoglo- 
bin per  100  grams  of  blood  is  80  = 100  per 
cent,  haemoglobin). 

The  Sahli  test  is  said  to  be  accurate 
within  two  per  cent. 

3.  The  Fleischl-Miescher  Method. — 
First  see  that  the  chambers  do  not  leak,  b}’ 
placing  in  one  compartment  the  diluting 
fluid  (0.1  per  cent,  sodium  carbonate  solu- 
tion; it  should  be  clear  and  contain  no  bicar- 
bonate). Now  draw  blood  into  the  diluting 
pipette,  to  the  mark  3^  or  ^3  or  1,  accord- 
ing to  the  supposed  degree  of  anaemia,  and 
dilute  to  the  mark  above  the  ampulla  (blood 
to  1 = dilution  of  200;  blood  to  ^3  = dilu- 
tion of  300;  blood  to  = dilution  of  400; 
the  two  marks  above  and  below  the  main 
divisions  correspond  to  l^oo  of  fho  contents 
of  the  capillary  tube).  Shake  and  mix 
thoroughly  the  blood  and  diluent,  blow  out 
the  unmixed  contents  of  the  capillary  tube, 
and  blow  the  diluted  blood  into  one  com- 
partment of  the  15  mm.  cell,  so  that  a convex 
meniscus  ajipears  above  the  top  of  the  cham- 
ber. Fill  the  other  compartment  with  the 


BLOOD  EXAMINATION 


diluent.  Slide  the  grooved  cover-glass  over 
the  compartments,  place  the  cap  over  the 
cover-glass  with  its  opening  at  right  angles 
with  the  vertical  partition  between  the 
chambers,  place  the  cell  in  the  central  open- 
ing of  the  stand,  and  adjust  the  light.  Work 
in  a dark  room  with  a candle  about  eighteen 
inches  from  the  stand  and  to  the  side,  look 
into  the  cell  from  the  side,  with  the  eyes 
about  one  foot  above  the  cell.  Contrast  the 
color  tones  by  quick  movements  of  the  slide, 
and  rest  the  eyes  at  short  intervals.  When 
the  color  of  the  tliluted  blood  is  matched, 
take  the  reading  of  the  instrument. 

Now  transfer  the  diluted  blood  from  the 
15  mm.  cell  to  onecompartmentof  the  12mm. 
chamber,  by  means  of  the  pipette,  and  make 
readings  again.  These  latter  readings  should 
be  four-fifths  of  those  obtained  with  the  15 
mm.  cell.  This  latter  test  is  a control  over 
the  former. 

Now  turn  to  the  “ table  of  calibrations” 
for  the  number  of  mg.  of  hsemoglobin  in 
1000  c.c,  of  the  diluted  blood  corresponding 
to  the  color  scale  reading.  Multiply  this 
by  the  degree  of  dilution  to  obtain  the  mg. 
in  1000  c.c.  of  undiluted  blood.  Divide  this 
by  10  to  obtain  the  amount  in  100  c.c. 

The  percentage  of  normal  is  obtained  by 
dividing  this  latter  figure  by  14  (the  amount 
of  hemoglobin  corresponding  to  the  100 
division  of  the  scale) . 

The  color  index  is  the  hemoglobin  per- 
centage of  normal  divided  by  the  percentage 
of  normal  (5,000,000)  of  red  cells.  It  is 
normally  1. 

Secondary  anemia,  as  distinguished  from 
primary  anemia,  presents  the  following  blood 
picture:  ordinarily  there  is  only  slight  re- 
duction in  the  number  of  red  blood  cells,  a 
greater  reduction  in  hemoglobin,  so  that  the 
color  index  is  below  one.  Normoblasts, 
polychromatophilia,  stippling,  and  poikilo- 
cydosis  may  be  present,  but  megaloblasts 
are  exceedingly  rare.  Says  Cabot:  “Achro- 
mia or  abnormally  great  pallor  of  the  cen- 
tres of  the  cells  is  the  most  important  point 
in  the  recognition  of  secondary  anemia  and 
the  exclusion  of  pernicious  anemia.” 

C.  The  Coagulation  Time.  — Rudolph’s 
Method. — Apparatus:  glass  tubes,  about  18 
cm.  or  7 inches  long,  and  1.5  mm.  in  diam- 
eter; a pint  thermos  bottle,  with  the  ordinary 
cork  replaced  by  a triply  perforated  rubber 
stopper,  two  of  these  perforations  containing 
brass  tubes,  7 inches  in  lengt,h,  and  of  suffi- 
cient calibre  to  hold  easily  the  glass  blood 
tubes,  and  the  other  perforation  contain- 
ing a thermometer. 

Fill  the  thermos  bottle  with  water  at  a 


temperature  of  20°  C.  and  insert  the  stopper. 
Puncture  the  ear  lobe  or  finger,  noting  the 
exact  time  of  puncture,  and  almost  fill  two 
of  the  glass  tubes  from  the  same  drop.  Place 
the  tubes  in  the  brasstubes  of  the  stopper,  and 
seal  their  protruding  ends  (where  the  blood 
entered)  with  a Bunsen  or  alcohol  flame.  At 
the  end  of  about  five  minutes,  and  at  inter- 
vals thereafter  of  fifty  to  thirty  seconds,  with- 
draw with  gloved  fingers  the  first  tube  filled, 
scrape  it  with  a sharp  file,  break  it  across, 
and  slowly  separate  the  broken  ends.  As 
soon  as  a thread  of  fibrin  is  observed  to 
appear  between  the  broken  ends,  note  the 
time.  The  interval  between  the  puncture 
and  the  appearance  of  fibrin  is  the  coagula- 
tion time  of  the  blood.  The  tube  No.  2 may 
be  used  as  a control.  By  this  method  the 
coagulation  time  averages  normally  eight 
and  a half  minutes. 

The  coagulation  time  is  delayed  in  haemo- 
philia, purpura,  jaundice,  haemoglobinaemia, 
asphyxia,  general  dropsy,  cobra  poisoning. 

D.  The  Fresh  Blood  may  be  examined  for 
malarial  parasites,  the  spirochete  of  re- 
lapsing fever,  filaria,  and  trypanosomes. 

Puncture  the  ear  and  wipe  away  the  first 
few  drops  of  blood.  To  the  top  of  a drop  of 
blood  about  the  size  of  a large  pinhead 
touch  the  centre  of  a cover-glass  held  with 
pinch  forceps.  Drop  the  cover  on  a pre- 
viously warmed  slide.  Do  not  press.  In 
examining  for  malarial  parasites,  look  par- 
ticularly for  brassy  red  cells. 

E.  Technique  of  Preparing  and  Staining 
Smears. — (a)  Collect  the  blood  on  one  end  of 
a clean  dry  slide,  and  with  another  slide 
evenly  touching  the  blootl  at  an  angle  of  45° 
with  the  first  slide,  draw  the  blood  along 
the  first  slide  with  little  pressure,  maintaining 
the  angle  of  45°.  Dry  the  smear  in  the  air. 

(b)  Fix  the  smear  by  immersing  it  in 
absolutely  pure  methyl  alcohol  for  three  to 
five  minutes,  or  even  longer.  Then  drain 
it  off,  and  allow  it  to  dry  in  the  air;  or 
wash  with  water  and  dry  between  sheets 
of  filter  paper. 

(c)  Stain  in  0.5  per  cent,  alcoholic  (70 
per  cent.)  solution  of  Griibler’s  “French 
pure”  eosin  for  three  to  five  minutes. 

(d)  Wash  in  distilled  water  and  dry  be- 
tween filter  paper. 

(e)  Stain  in  a well-mixed  solution  of  20 
drops  of  0.25  per  cent,  aqueous  solution  of 
methylene  blue  (B.  pat.)  and  ten  drops  of  the 
aboveeosinsolutionforone-halftooneminute. 

(f)  Wash  quickly  and  briefly  with  dis- 
tilled water  and  dry  at  once  between  filter 
paper  or  over  the  flame. 

(g)  Mount  in  Canada  balsam. 


BLOOD  EXAMINATION 


The  above  is  the  eosin-methylene  blue 
stain.  Red  cells  and  eosinophile  granules 
are  stained  bright  red;  neutrophile  granules, 
pink  to  bright  red  (smaller  than  eosinophile 
granules);  nuclei,  mast-cell  granules,  bodies 
of  the  lymphocytes,  platelets,  malarial  organ- 
isms, trypanosomes,  and  filaria,  varying 
shades  of  blue. 

R.  C.  Cabot  prefers  Wright’s  stain,  which 
may  be  had  from  the  medical  supply  houses. 

Technique. — Flood  the  surface  of  the 
the  smear  with  the  stain,  and  allow  it  to  act 
for  one  minute.  Then  add  distilled  water 
until  a greenish  metallic  lustre  appears  like 
a scum.  After  about  two  minutes  wash  off 
cautiously  with  water,  and  keep  the  film  in 
clean  water  for  about  a minute  more,  or 
until  it  takes  on  a light  pink  color.  Dry 
gently  with  blotting  paper,  and  mount  in 
Canada  balsam. 

Red  cells  are  stained  orange  or  pink, 
eosinojihile  granules  red  or  pink,  neutrophile 
granules  lilac,  nuclei  blue  or  dark  lilac,  large 
mast-cell  granules  purple,  fine  basojihile 
granules  deep  blue,  bodies  of  the  Ijmipho- 
cytes  robin’s  egg  blue,  platelets  deep  blue  or 
purple,  bacteria  blue,  malarial  and  other  par- 
asites blue,  the  chromatin  element  varying 
from  lilac  to  ruby-red  to  black.  (Webster.) 

A special  stain  for  malarial  organisms,  by 
which  little  else  is  stained  but  the  organisms, 
is  the  thionin  stain  of  Futcher  and  Lazear: 

Carbolic  acid  2% 100.0  c.c. 

Thionin  (Lauth’s  Violet),  saturated 

solution  in  50%  alcohol 20.0  c.c. 

Allow  to  ripen  for  a few  days. 

Fix  the  smear  with  a 0.25  per  cent,  solu- 
tion of  formalin  in  95  per  cent,  alcohol  for  one 
minute.  Wash  in  water  and  dry  between 
filter  paper.  Then  stain  for  ten  to  fifteen 
minutes.  Wash  in  water,  dry,  and  mount 
in  Canada  balsam. 

The  plasmodia  appear  as  deep  purple 
irregular  masses  within  the  faint  green  eryth- 
rocytes; the  hyaline  forms  appear  as  red- 
dish violet  ring-like  bodies. 

James’suncthod  of  thick  film  staining  is  as 
follows;  spread  a drop  of  blood  in  the  form 
of  a cirede  % inch  in  diameter  and  allow  it  to 
dry.  Immerse  it  in  ethyl  alcohol,  50  c.c., 
containing  10  drops  of  hydrochloric  acid, 
until  the  haemoglobin  is  dissolved.  Now 
wash  in  running  tap  water  for  ten  to  twent}^ 
minutes,  and  stain  with  a Romanowski  stain 
for  two  or  three  minutes;  then  add 
water  from  time  to  time,  and  after  eight 
minutes  wash  and  examine. 

F.  The  Differential  Count.— Count  in  the 
stained  smear  from  250  to  500  leucocytes,  un- 


less the  smear  is  even  and  the  leucocytes 
well  distributed,  when  100  may  suffice. 

(a)  Polymorphonuclear  Neutrophiles: 
about  10  microns  in  size,  containing  an 
irregularly  shaped  nucleus  and  fine  neutro- 
phile granules;  the  ordinary  pus  cells,  65 
to  75  per  cent,  of  the  white  blood-cells,  or 
5000  per  c.mm.  (lower  than  this  before  the 
age  of  fifteen). 

(b)  Polymorphonuclear  Eosinophiles: 
about  10  microns  in  size,  containing  an  irreg- 
ularly shaped  nucleus  and  coarse  acido- 
philic granules;  2 to  4 per  cent,  of  the  white 
blood  cells,  or  100  to  200  per  c.mm. 

(c)  Polymorphonuclear  Basophiles  or 
Mast  Cells  : about  10  microns  in  size,  con- 
taining an  irregularly  shaped  nucleus  and 
irregular  basophilic  granules;  about  0.5  per 
cent,  of  the  white  blood  cells,  or  0 to  50 
per  c.mm. 

(d)  Lymphocytes  or  Small  Mononu- 
clears: Any  non-granular  mononu- 

cleated  cell  smaller  than  a polymorphonu- 
clear neutrophile;  the  nucleus  nearly  fills 
the  cell,  which  shows  a narrow  rim  of 
homogeneous  basophilic  cytoplasm;  20  to 
25  per  cent,  of  the  white  blood  cells,  or  1200 
to  2000  per  c.mm.  (higher  than  this  before 
the  age  of  fifteen). 

(e)  Large  Mononuclears:  large  cell, 
containing  a large  round  or  oval,  usually 
eccentrically  placed  nucleus,  and  abundant 
non-granular  cytoplasm  (including  the  tran- 
sitional forms  with  indented  nucleus);  a 
large  mononuclear  is  any  non-granular 
mononucleated  cell  larger  than  a polymor- 
phonuclear neutrophile;  3 to  5 per  cent,  of 
the  white  blood-cells,  or  200  to  400  per  c.mm. 

(f)  Myelocy'Tes:  mononuclear  cells  with 
a large  round,  oval,  or  kidney-shaped,  pale, 
eccentric  nucleus,  and  neutrophile,  eosino- 
phile or  basophile  granules  in  the  cytoplasm. 

Q.  Fragility  of  the  Red  Blood=Cells. — Place  in 
a very  small  test-tube,  50  drops  of  a 0.5  per 
cent,  sodium  chloride  solution;  in  a second 
tube,  48  drops;  in  a third,  46  drops,  and  so 
on;  and  add  distilled  water  sufficient  to  make 
50  drops  in  each  tube.  Introduce  20  c.mm. 
of  blootl  into  each  tube  from  a capillary 
measuring  jiipctte,  e.g.,  a Gower’s  hsemo- 
globinometer  pijiette.  Stand  at  room  tem- 
perature for  two  hours.  H;emolysis  normally 
begins  in  a tube  containing  44  drops  of  salt 
solution  and  6 drops  of  distilled  water,  and 
is  complete  in  the  fifth  or  sixth  following 
tube.  The  percentage  of  saline  concentra- 
tion in  the  44-drop  tube  is  of  0.5  = 
0.44  per  cent. 

If  the  blood-cells  are  veiy  fragile,  begin 
with,  say,  0.7  per  cent,  salt  solution,  and 


BLOOD  TRANSFUSION 


put  in  the  first  tube  70  drops;  in  the  second 
68;  etc.,  and  add  distilled  water  up  to  70 
drops  in  each  case.  If  haiinolysis  begins  in 
the  tube  containing  04  drops,  the  saline 
concentration  is  of  0-7  = 0.64  per 

cent.  (P.  Ribierre’s  method.) 

Diminished  resistance  of  the  erythrocytes 
to  hyposmotic  solutions  occurs  in  fever, 
chlorosis,  pernicious  anaemia,  and  cyanosis. 
Increased  resistance  occurs  in  carcinoma  and 
obstructive  jaundice  (Hamburger).  In  ob- 
structive jaundice  the  resistance  of  the 
corpuscles  is  raised,  while  in  haemolytic 
jaundice  it  is  lowered. 

Blood  Fluke  Diseases.— See  Distomiasis. 

Blood=  Pressure. — Method  of  Taking  the  Blood= 
Pressure. — Fit  closely  around  the  upper  arm 
the  inflatable  rubber  armlet  of  a Riva-Rocci 
sphygmomanometer  of  the  Mercer  or  Nichol- 
son type.  With  the  stethoscope  over  the 
brachial  artery  just  distal  to  the  cuff,  pump 
in  air  until  the  pulse  is  quite  obliterated, 
then  let  the  mercuiy  column  slowly  fall, 
and  note  the  point  on  the  scale  at  which  the 
tapping  systolic  sound  first  reappears.  This 
point  represents  the  systolic  or  maximum 
pressure  in  the  brachial  artery  or  the  total 
energy  of  the  heart  at  that  instant.  Allow 
the  mercury  column  gradually  to  descend: 
“about  30  to  90  mm.  below  the  systolic 
reading  the  sound  suddenly  changes  from 
a sharp  tap  to  a dull,  feeble  thud.”  The 
height  of  the  mercury  column  at  this 
point  represents  the  tliastolic  or  minimum 
blood-pressure.  (R.  C.  Cabot.)  It  measures 
peripheral  resistance  (vasomotor  tonus;  it 
is  low  too  in  aortic  insufficiency). 

The  normal  systolic  blood-pressure  is  110 
to  150  to  160  mm.  of  mercury.  It  varies 
with  the  age,  becoming  normally  higher  as 
one  grows  older.  A systolic  pressure  above 
160  in  one  over  forty  is  undoubtedly  above 
normal;  a systolic  pressure  below  90  is  un- 
doubtedly below  normal.  Says  Cabot: 
“With  any  of  the  various  types  of  Riva- 
Rocci  instrument,  the  readings  in  healthy 
adults  at  rest  are  approximately  as  follows: 
systolic,  110  to  135  mm.  of  mercury;  dias- 
tolic, 60  to  90  mm.  Hg.”  “The  ‘pulse  pres- 
sure,’ i.  e.  the  difference  between  the  systolic 
and  diastolic  pressure,  averages  30  to  60 
mm.  Hg. ; children  under  two  years,  75  to  90 
mm.;  in  older  children,  90  to  110  mm.  Ex- 
citement or  exercise  raises  the  pressure 
temporarily  but  considerably.  It  is  5 to 
10  mm.  lower  in  recumbency  than  in  the 
sitting  position.”  It  measures  the  effective 
energy  of  the  heart. 

A.  Causes  of  Increased  Systolic  Blood- 
Pressure.  — Advancing  age ; mental  and 


muscular  exertion;  excitement;  over-indul- 
gence in  eating  and  drinking;  sedentary  life; 
cold  temperature;  acute  pain;  arteriosclerosis 
{q.v.))  toxaemias  of  pregnancy;  parturition; 
obesity;  alcohol;  tobacco,  gout;  diabetes; 
plumbism;  migraine;  convulsions;  eryth- 
rsemia;  hysteria;  intestinal  intoxication;  per- 
foration in  typhoid  fever;  chronic  nephritis; 
uraemia;  syphilitis  aortitis,  with  or  without 
aneurism;  hyperthyroidism;  increase  of  in- 
tracranial pressure,  as  in  apoplexy  due  to 
hemorrhage,  skull  fracture,  meningitis,  hy- 
drocephalus; tumor,  abscess;  certain  drugs 
in  therapeutic  doses,  e.g.,  adrenalin,  pituitary 
extract,  thyi’oid  extract,  ergot,  physostig- 
mine,  strychnine,  digitalis,  strophanthus, 
adonis  vernalis,  convallaria  majalis,  atro- 
pine, ammonia,  alcohol,  ether,  nitrous  oxide, 
etc.;  asphyxia;  emphysema;  asthma;  laryn- 
geal or  tracheal  stenosis;  myocardial  insuffi- 
ciency; uterine  fibromata. 

Treatment  of  High  Blood-Pressure. — 
(See  Arteriosclerosis.)  Consider,  of  course, 
the  cause.  A brief  course  of  starvation  from 
five  to  six  days,  with  or  without  the  free 
drinking  of  purgative  waters  (see  under 
Constipation),  may  be  of  value. 

B.  Causes  of  Lowered  Systolic  Blood- 
Pressure. — Following  exercise;  warmth; 
massage;  purgation  or  diarrhoea;  emesis; 
hemorrhage;  debility;  exhaustion;  feeble 
heart  action;  shock  {q.  v.);  hypoth3rroidism; 
acute  infections,  except  epidemic  cerebro- 
spinal meningitis;  chronic  wasting  diseases 
or  cachexias,  e.g.,  tuberculosis,  carcinoma, 
Addison’s  disease;  acute  adrenal  insuffi- 
ciency; ana?mia;  polycythemia  with  spleno- 
megaly ; amyloid  disease  of  the  kidney; 
sometimes  nephritis ; cyclic  albuminuria; 
tachycardia;  cardiac  dilatation;  mitral  steno- 
sis; sometunes  arteriosclerosis;  neurasthenia; 
general  paralysis  of  the  insane;  following 
a convulsion;  following  lumbar  puncture; 
sometimes  exophthalmic  goitre ; osteo-arthri- 
tis;  intestinal  toxa?mia;  anaphylactic  shock; 
just  preceding  death;  bromism ; certain  drugs, 
e.g.,  aconite,  veratrine,  tobacco,  alcohol, 
bromides,  chloroform,  ethyl  chloride,  anti- 
mony, nitroglycerine,  amyl  nitrite,  sodium 
nitrite,  erythrol  tetranitrate,  etc. 

Treatment  of  Low  Blood-Pressure. — 
Attend  to  the  cause.  See  above  for  drugs 
which  raise  the  blood-pressure. 

Blood  Transfusion. — Indications:  hem- 

orrhage, shock,  prolonged  infection,  anaemia, 
subnormal  blood-pressure  from  any  cause. 

A donor  should  be  chosen  who  is  healthy, 
who  is  free  from  any  blood  communicable 
disease,  such  as  syphilis,  malaria,  trench 
fever,  etc.,  whose  plasma  does  not  agglutin- 


BLOOD  TRANSFUSION 


ate  or  hajmolyze  the  patient’s  red  cells,  and 
whose  red  cells  are  not  agglutinated  or 
hseinolyzed  by  the  patient’s  plasma.  The 
blood  is  best  taken  over  two  hours  after  a 
meal.  About  one-third  of  cases  that  are 
transfused  without  a precautionary  test 
show  some  reaction,  sometimes  even  death, 
due  to  agglutination  or  hjemolysis  of  red 
blood-cells  (caused  by  isoagglutinins  and 
isohtemolysins).  The  latter  is  the  more 
dangerous.  In  agglutination,  thrombi  may 
be  produced;  but  in  haiinolysis,  foreign  pro- 
tein floods  the  blood.  Agglutination  may  be 
present  without  hsemolysis,  but  haemolysis  is 
always  preceded  by  agglutination. 

If  an  ideal  donor  can  not  be  obtained,  it 
is  safer  to  use  a person  whose  plasma  agglu- 
tinates the  patient’s  cells  than  one  whose 
cells  are  agglutinated  by  the  patient’s 
plasma,  because  the  recipient’s  cells  are 
protected  by  his  own  plasma. 

Immediate  members  of  the  patient’s 
family  should  be  obtained,  if  possible,  since 
they  offer  the  least  risk,  but  their  blood 
ought  nevertheless  to  be  tested. 

If  a test  in  vitro  can  not  be  m;ide,  one 
should  draw  up  a few  drops  of  sodium  citrate 
solution,  0.2  per  cent.,  and  eight  drops  of  the 
prospective  donor’s  blood  into  a syringe, 
shake  thoroughly,  and  inject  into  a vein  of 
the  patient.  Within  fifteen  minutes,  if  the 
blood  is  incompatible,  there  will  occur 
inspiratory  dyspnnea,  precordial  pain  and 
distress,  and,  possibly,  lumbar  j)ain  and 
urticaria,  and,  if  more  blood  is  injected, 
vomiting  or  purging,  pupillary  dilatation 
and  sweating,  indicative  of  shock. 

Selection  of  a Donor. — The  simplest 
and  a “fairly  reliable”  test,  says  J.  L.  Miller, 
is  to  mi.N  a few  drops  of  defibrinated  blood 
from  the  donor  with  about  an  equal  amount 
of  blood  from  the  recipient,  allow  the  mix- 
ture to  stand  for  half  an  hour,  or  until  the 
serum  separates,  and  note  whether  the  latter 
is  blood-tinged. 

A test  of  iso-agglutination  as  well  as 
hiemolysis  is  that  of  Rous  and  Turner. 
Using  a leucocjde-counting  pipet  which  has 
been  rinsed  with  a 10  per  cent,  aqueous 
solution  of  sodium  citrate,  draw  the  citrate 
solution  up  to  the  mark,  1 ; then  fill  it  rapidly 
to  the  mark,  11,  with  lilood  from  an  ear  or 
finger  puncture,  and  expel  it  at  once  into  a 
small  test-tube.  Should  it  hapjien  that 
there  is  not  enough  blood  to  fill  the  pipet, 
empty  the  pipet  at  once  into  the  test-tube, 
in  oi'der  to  mix  the  blood  and  citrate  solu- 
tion and  prevent  clotting;  then  draw  up  the 
mixture  again  into  the  pipet,  and  completely 
(or  approximately)  fill  it  from  another 


puncture.  One  pipetful  of  citrated  blood 
should  be  obtained  from  each  prospective 
donor,  and  two  from  the  recipient  if  several 
donors  are  to  be  tested.  The  pipet  should 
be  rinsed  each  time  before  obtaining  fresh 
blood,  first  with  citrate,  then  with  distilled 
water,  and  again  with  citrate. 

After  obtaining  the  citrated  specimens  of 
blood  in  separate  test-tubes,  make  the  follow- 
ing mixtures  by  means  of  a capillary  pipet 
(Fig.  24) : 9 parts  of  patient’s 
citrated  blood  with  1 of  donor’s; 

1 part  of  patient’s  blood  with  1 of 
donor’s;  1 part  of  patient’s  blood 
with  9 of  donor’s.  Draw  up  the 
blood  to  an  arbitrary  mark  on  the 
capillary  pipet,  then  draw  up  one 
air-bubble,  and  so  on,  alternately. 

After  standing  for  about  fifteen 
minutes,  examine  a drop  of  the 
mixture  (mixed  with  a drop  of 
salt  solution  to  separate  the 
red  cells  more)  microscopically 
for  clumping. 

The  presence  of  greater  clump- 
ing in  the  first  than  in  the  second 
mixture  indicates  agglutination  of 
the  patient’s  corpuscles  by  the 
donor’s  plasma.  The  presence  of 
clumping  in  the  second  mixture, 
with  little  or  none  in  the  first,  in- 
dicates agglutination  of  the  donor’s 
corpuscles  by  the  recipient’s  plasma. 

It  has  been  learned  that  there 
are  just  four  types  of  human  blood: 
type  or  group  I,  found  in  5 per 
cent,  of  all  individuals,  whose 
plasma  agglutinates  no  corpuscles, 
but  whose  corpuscles  are  aggluti- 
nated by  the  plasma  of  all  three 
other  types;  group  II,  40  per  cent., 
whose  plasma  agglutinates  cor- 
puscles of  groups  I and  III,  and 
whose  corpuscles  are  agglutinated 
by  plasma  of  groups  III  and  IV; 
group  III,  10  per  cent.,  whose 
plasma  agglutinates  corpuscles  of  groups  I 
and  II,  and  whose  corpuscles  are  agglutin- 
ated by  plasma  of  groups  II  and  IV;  and 
group  IV,  45  per  cent.,  whose  plasma  agglu- 
tinates corpuscles  of  groups  I,  II,  and  III, 
but  whose  corpuscles  are  agglutinated  by 
no  plasma. 

The  inter-relations  of  these  four  types  is 
graphically  shown  on  the  follomng  page. 
(Fig.  25). 

The  -b  sign  means  corpuscles  agglutin- 
ated; the  O sign,  corpuscles  not  agglutinated; 
thus,  the  corpuscles  of  type  I,  reading  trans- 
versely, are  not  agglutinated  by  the  plasma 


Fig.  24. 
—A  capil- 
lary pipet. 


METHODS  OF  BLOOD  TRANSFUSION 


of  type  I,  but  by  the  plasma  of  types  II,  III, 
and  IV ; and  the  plasma  of  type  I,  reading 
vertically,  agglutinates  no  corpuscles. 

The  group  to  which  any  individual  belongs 
may  be  determined  by  testing  the  blood  with 
only  groups  II  and  III  sera,  as  follows,  the 
sera  being  obtainable  from  the  U.  S.  Army 
Medical  School,  Wash.,  D.  C.,  or  the  Rocke- 
feller Institute,  N.  Y.: 

On  a clean,  dry  glass  slide,  place  on  the 
left  end  a drop  of  group  II  serum,  and  on  the 

Plasma  of  Types. 

I II  nr  lY 


I 

oi 

O 

+ 

+ 

+ 

o 

a 

^ n 

m 

a; 

o 

o 

+ 

+ 

I 

1 m 

o 

+ 

o 

+ 

lY 

o 

o 

o 

o 

Fig.  25. — Diagram  illustrating  the  interrelations  of  the 
four  types  of  human  blood. 

right  end  a drop  of  group  III  serum.  From 
an  ear  lobe  of  the  individual  to  be  grouped 
obtain  by  puncture  a drop  of  l)lood  about 
half  the  size  of  the  drop  of  serum  on  the  slide 
and  mix  it  thoroughly  with  the  serum,  one 
drop  of  blood  with  each  drop  of  serum,  using 
separate  droppers  or  glass  rods  for  each. 
The  occurrence  of  a brickdust-like  appear- 
ance in  the  mixture  denotes  agglutination. 
When  agglutination  occurs  in  both  sera,  the 
individual  belongs  to  group  I;  when  agglu- 
tination occurs  only  in  III  serum,  the  indi- 
vidual belongs  to  group  II;  when  agglutin- 
ation occurs  only  in  II  serum,  the  individual 
belongs  to  group  III;  and  when  no  agglutina- 
tion occurs  in  either  serum,  the  individual 
belongs  to  group  IV. 

Use  a donor  of  the  same  group  to  which 
the  recipient  belongs,  if  possible;  otherwise 
use  a group  IV,  or  universal,  donor.  It  is 
stated,  however,  that  one  can  receive  the 
blood  of  any  other  individual  whose  red  cells 
are  not  agglutinated  by  the  recipient’s 
plasma,  because  the  cells  of  the  recipient  are 
protected  by  his  own  plasma. 

A simple  and  accurate  test  is  as  follows: 
Mix  one  drop  of  recipient’s  and  one  drop  of 
donor’s  blood  in  separate  receptacles  with 
2 c.c.  of  a 2 per  cent,  aqueous  solution  of 
sodium  citrate.  Draw  out  two  tubes  to  a 


capillary  point;  draw  up  into  one  tube  the 
recipient’s  citrated  blood,  and  in  the  other 
the  donor’s  blrx)d;  seal  one  end,  and  centri- 
fuge. On  one  end  of  a clean,  dry  glass  slide, 
place,  with  a loop,  one  drop  of  donor’s  cells 
with  one  drop  of  recipient’s  serum,  and  on 
the  other  end  of  the  slide  one  drop  of  recipi- 
ent’s cells  with  one  drop  of  donor’s  serum. 
After  five  to  fifteen  (to  thirty)  minutes  look 
for  agglutination  in  the  first  mixture. 

Methods  of  Blood  Transfusion. — The 
K empton-B  ro wn  M etii  od  . — Eq  uipmen  t . — 
Kempton-Brown  glass  cylimlers,  2 sizes, 
100  c.c.  and  250  c.c.;  sharp  scalpels  or  cata- 
ract knives;  scissors;  small  htemostats;  mos- 
quito hajinostats;  tissue  forceps;  medicine 
droppers;  hypodermic  syringes;  tourniquet 
or  blood-pressure  instrument;  alcohol  lamp; 
alcohol;  ether;  tr.  iodi;  cocaine  or  novocaine; 
paraffin,  or  “Vincent’s  mixture”  (stearin, 
1 part;  paraffin,  2 parts;  vaseline  2 parts); 
sterile  towels;  sterile  cotton;  autoclave. 

The  tubes  are  thoroughly  cleansed,  first 
with  water,  then  alcohol,  then  ether,  and 
dried.  A small  lump  of  paraffin  or  of  “Vin- 
cent’s mixture”  is  placed  in  the  tube,  the 
latter  corked,  wraj^ped  in  a towel,  and  steril- 
ized in  an  autoclave.  The  tube  is  removed 
while  hot,  and  rapidly  rotated  until  the 
inner  surface  is  coated  with  the  paraffin, 
the  excess  being  poured  out.  Obstructing 
solidifications  of  paraffin  are  removed  by 
heating  over  an  alcohol  lamp.  The  tubes 
are  kept  in  sterile  towels  surrounded  with 
sterile  cotton. 

Technique. — Under  strict  asepsis  and  local 
anaesthesia,  e.xpose  a vein  of  both  donor  and 
recipient  for  a distance  of  one  inch,  and 
ligate  the  donor’s  vein  distalward  and  the 
recipient’s  vein  proximalward.  Wash  the 
wound  in  normal  saline  solution  (0.9  per 
cent.)  dry  rapidly,  and  drop  liquid  paraffin 
over  the  vein.  Strip  off  the  adventitia  from 
the  anterior  aspect  of  the  vein.  Apply  a 
Crile  artery  clamp  and  open  the  vein  between 
clamp  and  ligature  with  a cataract  knife. 
Wash  out  at  once  with  salt  solution  and  drop 
on  liquid  paraffin.  Grasp  the  edges  of  the 
incised  vein  with  mosquito  ha}mostats,  which 
are  allowed  to  lie  on  the  arm. 

After  constricting  the  upper  arm  of  the 
donoi'  with  a tourniquet  or  blood-pressure 
apparatus,  gently  introduce  the  cannula  tip 
of  the  Kempton  tube  into  the  vein  toward 
the  hand  and  release  the  Crile  clamp.  Have 
the  donor  open  and  close  the  hand  slowly 
in  order  to  facilitate  the  flow  of  blood.  When 
the  tube  is  full,  withdraw  it  quickly  and 
turn  it  obliquely  on  its  side  with  the  cannula 
and  side  tube  uppermost.  Reclamp  the 


BRACHIAL  PLEXUS 


donor’s  vein.  Now  introduce  the  cannula 
tip  into  the  recipient’s  vein,  toward  the 
heart,  remove  the  Crile  clamp,  and  attach  the 
cautery  bulb  to  the  side  tube.  If  more  than 
250  c.c.  of  blood  is  removed,  use  fresh  tubes 
for  each  transfer  of  blood.  After  each  tulx) 
has  been  used  it  must  be  immediately  rinsed 
in  very  hot  water  so  as  to  soften  the  paraffin 
and  remove  blood-clots. 

Vincent’s  tubes,  which  are  similar  to  the 
Kempton-Brown  tubes,  have  a cannula  tip 
that  is  ground  so  as  to  fit  into  a hollow 
needle  which  is  thrust  into  the  vein  directly 
through  the  skin. 

Percy’s  tubes  are  designed  to  suck  in 
sterile  liquid  paraffin,  which  is  lifted  up  by 
the  blood  as  the  latter  enters  the  tube,  thus 
protecting  the  blood  from  the  air. 

The  Citrate  Method. — Apply  a toiumi- 
quet  to  the  donor’s  arm,  and,  under  aseptic 
precautions,  puncture  one  of  the  larger  veins 
in  the  flexure  of  the  elbow  Mth  a cannula  or 
aspirating  needle  of  large  calibre  (a  Schreiber 
sharp-pointed  needle  may  be  used).  The 
needle  should  be  introduced  parallel  with  the 
surface  of  the  skin,  and  after  introduction 
should  lie  flat  on  the  skin,  shomng  that  its 
pioint  is  free  in  the  lumen  of  the  vein.  To 
make  the  veins  more  prominent  have  the 
patient  slowly  open  and  close  the  hand. 
Collect  the  blood  in  a graduated  glass  jar 
jwhich  contains  a 2 per  cent,  solution  of 
sodium  citrate.  Stir  constantly  \vith  a glass 
rod.  To  tranfuse  450  c.c.  of  blood,  use  50  c.c. 
of  the  citrate  solution,  thus  making  a 2 per 
thousand  mixture.  One  might  add  a few 
more  c.c.  of  citrate  solution  in  order  to  make 
sure  that  the  proportion  is  no  less  than  2 per 
thousand.  For  every  50  c.c.  of  blood  trans- 
fused use  about  6 c.c.  of  citrate  solution. 
Indeed,  a dilution  of  0.5  per  cent,  in  1000  c.c. 
of  blood  is  said  to  non-toxic  in  adults 
(limit  of  safety  is  75  grains),  and  prevents 
clotting  better  than  a dilution  of  0.2  per  cent. 
The  citratcd  blood  may  be  preserved  for 
two  or  three  Aveeks  or  longer  in  a refrigerator. 

As  a rule,  the  recipient’s  vein,  because  of 
the  ansemia  present,  must  be  expo.sed  by  a 
small  incision.  A cannula  or  needle  is  in- 
serted which  is  attached  to  a glass  funnel  by 
means  of  rubber  tubing  (the  whole  contain- 
ing about  20  or  30  c.c.  of  normal  saline  solu- 
tion [0.85  jAcrcent.]  free  fromairbubbles).  The 
citrated  blood  is  then  poured  into  the  glass 
funnel  and  allowed  to  run  into  the  vein  by 
gravitation  (chiefly  after  Lewisohn).  The 
blood  should  be  introduced  at  the  rate  of 
two  ounces  per  minute  so  as  not  to  overloatl 
the  heart. 

For  infants,  about  GO  to  75  c.c.  of  mother’s 


blood  is  approximately  sufficient  (Cherry 
and  Langrock).  The  transfusion  should  be 
repeated  as  required  to  keep  the  blood- 
pressure  normal. 

Bloody  Stools. — See  Hemorrhage,  Intes- 
tinal. 

Bone  Diseases. — Achondroplasia,  Acro- 
megaly, Fragilitas  Ossium,  Leontiasis  Ossea, 
Neurotrophic  Atrophy,  Osteitis  Deformans, 
Osteo-Arthropathy,  Secondary  Hypertro- 
phic, Osteomalacia,  Osteomyelitis,  Oxy- 
cephaly, Recklinghausen’s  Disease:  fibrous 
degeneration  of  bone.  Rickets,  Scurvy,  Tu- 
berculosis, see  Orthopedics,  Part  10,  Tumors. 

Bothriocephalus. — See  Tapeworm  Infec- 
tion. 

Botulism. — (L.  hot'ulus,  sausage.)  Sau- 
sage or  other  food  poisoning  due  to  the 
anierobic  bacillus  botulinus.  The  charac- 
teristic symtoms  are  the  expression  of  a cen- 
tral motor  paralysis:  strabismus,  diplopia, 
ptosis,  mydriasis,  paralysis  of  accommoda- 
tion, hoarseness,  aphonia,  or  a barking  cough, 
diminished  secretion — buccal,  pharyngeal, 
urinary — difficulty  in  swallowing;  there  is 
usually  constipation,  and  often  slight  colicky 
pains  and  headache. 

Treatment. — Treat  the  affection  by  early 
and  complete  evacuation,  lavage,  emesis, 
stimulation,  etc.,  as  described  under  “Poison- 
ing,” The  specific  antitoxic  sermn  should 
be  employed  if  procurable. 

Boulimia. — See  Bulimia. 

Brachial  Neuralgia. — See  Neuralgia. 

Brachial  Plexus. — (L.  hrach'ium,  from 
Gr.  /3paxicov  arm;  L.  plex'us,  braid.) 

See  the  chart,  under  Nerves,  Peripheral, 
showing  the  distribution  of  sensory  nerves 
in  the  skin. 

Causes  of  Brachial  Plexus  Paralysis. — Obstet- 
rical or  birth  traumatism  to  the  new-born; 
other  forms  of  tramnatism;  compression  by 
tumors,  abscess,  or  by  a cervical  rib; 
neuritis  (q.v.). 

The  upper  arm  type  of  paralysis,  affecting 
the  deltoid,  biceps,  brachialis  anticus,  and 
supinator  longus  muscles,  is  characterized  by 
feebleness  or  loss  of  the  poAver  of  abduction 
and  outAvard  rotation  of  the  ann,  of  flexion 
at  the  elboAv,  and  of  supination  of  the  fore- 
arm, Avhile  electrical  stimulation  at  a point 
in  the  neck  “three  centimetres  lateral  to  the 
sternomastoid  and  the  same  distance  above 
the  clavicle,”  causes  contraction  of  the  par- 
alyzed muscles.  The  upper  arm  hangs 
lifeless,  and  rotated  inAvard,  the  forearm 
pronated,  the  palm  looking  outward;  the 
forearm  and  hand  are  not  paralyzed.  This 
is  the  usual  form  of  peripheral  birth  palsy. 

In  the  loAver  arm  type  of  paralysis  the 


BRACHIAL  PLEXUS 


intrinsic  muscles  of  the  hand,  and  perhaps 
some  of  the  muscles  of  the  forearm,  are 
affected,  and  there  is  some  loss  of  sensa- 
tion in  the  ring  and  little  fingers  and  the 
ulnar  side  of  the  hand  and  forearm.  If  the 
sympathetic  nerve  is  paralyzed  there  results 
a narrowing  of  the  palpebral  fissure  and 
contraction  of  the  pupil. 

The  presence  of  a cervical  rib  produces, 
in  5 to  10  per  cent,  of  the  cases,  the  following 
symptoms : pain  and  weakness  in  the 

shoulder  and  arm  increased  by  use,  some- 
tunes  swelling,  redness,  heat,  and  numb- 
ness of  the  arm  on  exertion,  sunulating 
erythromelalgia,  perhaps  numbness,  tin- 
gling, coldness,  and  loss  of  sensation  on  the 
ulnar  border  of  the  forearm  and  hand,  and 
in  the  two  ulnar  fingers,  perhaps  paralysis, 
perhaps  inequality  of  the  radial  pulses  due 
to  compression  of  the  subclavian  artery. 


The  Musculo-Spiral  or  Radial  Nerve* 
— Paralysis  of  this  nerve  .is  manifested  by 
wrist  drop,  and,  perhaps,  inability  to  supi- 
nate  the  forearm  when  extended. 

Causes  of  Musculo-Spiral  or  Radial 
Nerve  Paralysis. — Dislocation  or  fracture 
of  the  upper  end  of  the  humerus;  callus  in- 
carceration; sleeping  upon  the  arm,  or  com- 
pression of  the  nerve  during  anaesthesia,  or 
compression  by  an  Esmarch’s  bandage,  or  by 
a crutch;  injection  of  ether  into  the  nerve; 
sudden  violent  contraction  of  the  triceps 
muscle,  as  in  an  epileptic  fit;  multiple 
neuritis  {q.v.)]  local  neuritis  {q.v.). 

The  Ulnar  Nerve. — A lesion  at  or  above 
the  elbow  is  characterized  by  feeble  flexion 
of  the  hand,  with  radial  deflection,  hyper- 
extension  of  the  wrist  when  the  fingers  are 
extended,  and  loss  of  the  movements  of  the 
little  finger  and  of  adduction  and  abduction 
of  the  fingers. 

4 


The  presence  of  a cervical  rib  is  revealed 
by  the  X-ray;  but  syringomyelia  and  other 
nervous  diseases  should  be  excluded.  The 
offending  rib  should  be  removed  with  great 
care  so  as  not  to  injure  further  the  bra- 
chial plexus. 

The  Long  Thoracic  Nerve. — This  nerve 
supplies  the  serratus  magnus  muscle,  paraly- 
sis of  which  is  revealed  by  the  occurrence 
of  winged  scapula  on  moving  the  arm  for- 
ward, and  by  difficulty  in  raising  the  arm 
above  the  horizontal. 

Causes  of  Paralysis  of  the  Long 
Thoracic  Nerve. — Traumatism,  including 
the  carrying  of  heavy  weights  on  the  shoulder, 
forcible  reaching  of  the  arm  over  the  head, 
and  forcible  contraction’of  the  scalenus  medius 
muscle;  neuritis,  due  to  exposure,  or  to 
infectious  diseases,  or  to  acute  arthritis  of 
the  shoulder  joint;  progressive  muscular 
atrophy;  muscular  dystrophy. 


The  Circumflex  Nerve. — This  nerve 
supplies  the  deltoid  muscle.  Its  paralysis 
results  in  relaxation  of  the  shoulder  joint, 
wasting  of  the  muscle,  and  inability  to 
abduct  and  raise  the  arm. 

Causes  of  Paralysis  of  the  Circumflex 
Nerve. — Blow  or  fall  on  the  shoulder;  long 
lying  upon  the  shoulder;  pressure  of  a 
crutch;  dislocation  or  fracture  of  the  hum- 
erus; neuritis,  due  to  exposure,  infectious 
diseases,  plumbism,  diabetes,  arthritis,  axil- 
lary disease. 


BRADYCARDIA,  SLOW  HEART 


A lesion  in  the  lower  forearm  is  char- 
acterized by  paralysis  alone  of  the  interos- 
sei  and  thumb  muscles,  resulting  in  a claw- 
like hand  or  main  en  griffe. 

Causes  op  Ulnar  Nerve  Paralysis. — 
Dislocation  or  fracture  of  the  humerus  at 
the  shoulder  or  elbow;  callus  incarceration; 
compression  by  a crutch;  dislocation  of  the 
nerve  at  the  elbow;  pressure  on  the  elbow 
during  sleep;  other  forms  of  traumatism; 
traumatic  or  S3movial  elbow  cysts;  neu- 
ritis due  to  cold,  syphilis,  leprosy,  etc. 
(See  Neuritis.) 

The  Median  Nerve.- — A lesion  above  the 
elbow  is  characterized  by  difficulty  in  firmly 
grasping  objects,  inability  to  pronate  the 
forearm,  and  feelile  flexion  of  the  wrist  and 
interphalangeal  joints. 

A lesion  in  the  lower  forearm  results  in 
loss  of  the  thumb  movements. 

The  Suprascapular  Nerve. — This  nerve 
supplies  the  infraspinatus  muscle.  Its 
paralysis  is  characterized  by  flattening  of 
the  infraspinous  fossa,  weakness  of  outward 
rotation  of  the  humerus,  and  inability  to 
carry  weights  upon  the  shoulder. 

Causes  of  Suprascapular  Paralysis. — 
Traumatism,  including  a fall  on  the  shoulder, 
or  upon  the  outstretched  arm;  local  neuritis 
due  to  cold. 

The  Musculocutaneous  Nerve. — This 
nerve  supplies  the  biceps,  coracobraclualis, 
and  brachialis  anticus  muscles,  and  its 
paralysis  is  characterized  by  inability  to  flex 
the  forearm  when  supinated. 

The  chief  causes  of  musculocutaneous 
paralysis  are:  a blow  on  or  compression  of 
the  arm;  and  fracture  or  dislocation  of 
the  humerus. 

Treatment  of  Nerve  Lesio?is. — Consider  the 
the  cause.  In  open  wounds,  accurately 
approximate  and  suture  divided  nerves. 

During  acute  symptoms  keep  the  arm  at 
rest.  After  all  acute  symptoms  have  sub- 
sided (about  a month)  practice  energetic 
massage  of  the  affected  muscles  at  least  twice 
daily,  passive  and  active  movements  of  the 
joints,  and  electrical  stimulation  of  the 
paralyzed  muscles,  using  a mild  faradic 
current  for  ten  minutes  daily,  if  effectual 
in  exciting  a resjx)nse  (prognosis  then 
good),  otherwise  the  mild  galvanic  current 
(see  Med.  Elect.). 

Guard  against  contractures  by  means  of 
splints.  Einjiloy  a dorsal  splint,  with  full 
extension  of  the  wrist  and  fingers,  in  paraly- 
sis of  the  extensor  muscles.  In  paralysis  of 
the  flexors  of  the  forearm  support  the  fore- 
arm in  flexion  in  a sling. 

In  birth  palsy,  examine  also  for  disloca- 


tion of  the  shoulder.  As  long  as  pain  per- 
sists (about  a month)  keep  the  hmb  at  rest, 
with  the  fingers  extended  upon  the  chest, 
beneath  the  clothing.  Thereafter  massage 
the  muscles  several  times  daily  and  employ 
passive  movements  of  the  shoulder,  elbow, 
wrist  and  fingers  to  the  hmit  of  their  mobil- 
ity, in  the  intervals  keeping  the  arm  slung 
as  before.  It  is  essential  that  the  head  of 
the  hmnerus  be  kept  in  place  (see  Congenital 
Dislocation  of  the  Shoulder,  in  Whitman’s 
Orthopedic  Surgery).  If  no  marked  un- 
provement  in  the  paralysis  apjiears  within 
nine  months,  diasect  out  the  injured  nerves, 
excise  the  injured  parts,  and  suture  the  cut 
ends  (see  Whitman’s  Orthopedic  Surgery). 

Bradycardia,  Slow  Heart.^ — Gr.  ^pabvs 
slow  -|-  Kapbia  heart. 

Etiology. — Hunger;  rest  after  athletic  exer- 
cise; pain;  vomiting;  puerperiiun;  exhaus- 
tion; excessive  sexual  indulgence;  senility; 
convalescence  from  acute  fevers,  especially 
typhoid  fever,  pneumonia,  rheumatic  fever, 
and  diphtheria;  toxic  agents:  alcohol,  to- 
bacco, coffee,  digitalis,  lead,  muscarin,  pic- 
ric acid,  physostigmine,  ursemic  poisons, 
gastro-intestinal  toxines;  anaemia;  jaundice; 
diabetes;  nephritis;  hypothyroidism;  coro- 
nary sclerosis  and  chronic  myocarditis; 
increased  intracardiac  pressure  in  dilata- 
tion of  the  heart;  emphysema;  pericarditis; 
gastro-intestinal  diseases — chronic  dyspep- 
sia, gastric  ulcer,  gastric  cancer;  increased 
intracranial  pressure — apoplexy,  brain 
tumor,  brain  abscess,  concussion  of  the 
brain,  meningitis;  diseases  and  injuries  of 
the  cervical  cord  or  medulla — syringomyelia, 
tabes  dorsalis,  combined  system  disease, 
timiors,  hemorrhage,  vertebral  disease  caus- 
ing compression  of  the  cord;  epilepsy;  gen- 
eral paresis;  melancholia;  mania;  sunstroke; 
hysteria;  neurasthenia;  pressure  of  tubercu- 
lous mediastinal  glands  upon  the  vagus, 
reflex  vagus  stimulation  through  the  abdom- 
inal sjanpathetic  system;  hemorrhage  or 
tumoi-s  in  the  vagus  sheath;  vagus  neuritis 
in  multiple  neuritis  (plumbism,  diabetes, 
acute  infections,  particularly  diphtheria  and 
influenza);  affections  of  the  skin  and  sexual 
organs;  heart  block  {q.v.). 

A slow  pulse — 50  to  the  minute — may  be 
normal  to  the  indirtdual.  Extracardiac 
bradycardia  (nervous — due  to  vagus  irrita- 
tion) may  be  distinguished  from  intra- 
cardiac  bradycardia  by  means  of  atropine, 
amyl  nitrite,  and  pressure  on  the  eyeball. 
If  the  bradycardia  is  nervmus  in  origin,  the 
administration  of  atropine  in  physiological 
doses  will  quicken  the  heart..  In  heart 
block  atropine  increases  only  the  auricular 


BRAIN  arvcL  NERVK S 


nternal  popliteal  nerve 
External  popliteal  nerve 


tiblal  nerve 
emii 


plantar  nerve 
Internal  plantar  nerve 


Brain 


Cerebellum 
Sympathebc  ganglion 
Bulb 


Spinal  cord 


Sympathetic 

ganglion 


Sciatic 

nerve 


usculo-spinal 

nerve 


..Ulnar  nerve 


Sacral 

plexus 


ranch 

radial 


Lumbar  plexus 


LAROUSSE  MEDICAL 


Brain  , spinal  cord,  and  nerves 


BRAIN  LOCALIZATION 


rate,  not  the  ventricular.  Pressure  on  the 
eyeball,  especially  the  right,  slows  the  heart 
only  when  the  bradycardia  is  of  nervous 
origin.  “The  test  is  po.sitive  when  the 
lowering  of  the  pulse  is  five  pulsations  a 
minute  or  more.”  (Petzetakis.) 

The  Treatment  of  bradycardia  is  causal. 

Brain  Abscess. — Symptomatology. — Head- 
ache, dizziness,  drowsiness,  torpor,  nausea 
and  vomiting,  slowing  of  the  pulse  and 
respirations,  slightly  elevated,  normal,  or 
subnormal  temperature,  sometimes  chills, 
choked  optic  discs,  stupor,  paralysis,  con- 
vulsions. A long  latent  period  of  weeks  or 
months  may  precede  the  appearance  of 
frank  symptoms.  (See  Brain  Localization.) 


Achninister  hexamethylenamine  (uro- 
tropin),  gr.  x-xv,  t.i.d.,  for  the  prevention 
of  diffuse  meningitis,  since  the  drug  liberates 
formaldehyde  in  the  cerebrospinal  fluid. 

Operate;  expose,  evacuate,  and  drain  the 
abscess  freely. 

Brain  Concussion,  Contusion,  and  Com- 
pression.— See  Concussion,  Contusion,  and 
Compression  of  the  Brain. 

Brain  Localization. — The  Motor  Tract.— The 
motor  tract  arises  from  cerebral  cortical  cells 
in  the  posterior  part  of  the  third  frontal  con- 
volution, the  anterior  central  convolution 
and  the  paracentral  lobule  (Fig.  27). 
Beneath  the  cortex,  in  the  centrum  ovale, 
the  axone  fibres  converge  in  the  shape  of  a 


Superior  FronTal 
Conuolut'ion 


Anrenor  Central  Conuolofion 
Fiftiure  of  Kolando 
Posrerior  Central  Conuolution 


.Superior  Parietal  Lobe 


Inferior  Parietal 
Lobe 

AngularSyrus 


3upr«\ 

’Marginal 

G^vus 


Inferior 
frontbl 
conuolufiOn 


Fissure  of  S^iulus 
first  Temporal  Conuolonort- 
Second  Temporal  Conuolution 
Thirel  Temporal  Convolution 


Fig.  27. — The  functional  areas  of  the  left  cerebral  cortex. 


Etiology. — Otitis  media  and  mastoiditis 
(abscess  extradural  or  in  the  temporal  lobe 
or  cerebellum) ; sinusitis  (abscess  extra- 
dural or  in  the  frontal  lobe) ; trauma  to  the 
head;  pulmonary  purulent  processes,  e.g., — 
bronchiectasis,  putrid  bronchitis,  abscess, 
gangrene,  empyema;  a purulent  focus 
anywhere  in  the  body,  e.g. — phlegmon,  ery- 
sipelas, septico-pyemia,  ulcerative  endocar- 
ditis, osteomyelitis,  liver  abscess,  etc.; 
infectious  fevers. 

Treatment.— Enjoin  absolute  rest  and  quiet. 
Open  the  bowels  thoroughly.  Apply  an 
ice-cap  to  the  head.  For  restlessness  and 
pain  prescribe  the  bromides,  gr.  xx-xxx, 
well  diluted,  3 or  4 times  a day;  or  phe- 
nacetine,  gr.  x,  once  or  twice,  as  required, 
or  morphine,  gr.  3^-34- 


fan  and  collect  together  to  enter  the  internal 
capsule  (Fig.  28).  Hence  they  traverse  the 
middle  third  of  each  crus  cerebri,  then  the 
pons,  and  thence  the  medulla,  where,  in  the 
pyramids,  they  decussate  for  the  most  part 
and  enter  the  crossed  pyramidal  tracts  of  the 
spinal  cord,  while  some  fibres  continue 
directly  into  the  anterior  median  columns  of 
the  cord  (Fig.  28).  At  various  levels  in  the 
cord  the  fibres  and  their  collaterals  given  off 
at  right  angles  to  their  course  terminate 
about  the  cells  of  the  anterior  horns,  whence 
axones  issue  into  the  anterior  roots  and 
thence  to  the  body  musculature.  In  the 
base  of  the  brain  fibres  are  given  off 
in  like  manner  to  the  motor  nuclei  of  the 
cranial  nerves. 

Irritative  lesions  in  the  motor  areas  pro- 


BRAIN  LOCALIZATION 


duce  muscular  twitchingjs,  spasms  or  convul- 
sions (called  Jacksonian  epilepsy  when 
localized) ; and  the  part  first  involved  in  the 
spasm  points  to  the  location  of  the  lesion  in 


Fjg.  2S. — Scheme  of  the  motor  tract  to  show  the  effect  of  lesions  at 
different  positions.  1,  Cortical  or  subcortical  lesion,  causing  mono* 

f)legia  of  left  arm;  2,  capsular  lesion,  causing  left  hemiplegia;  3,  cruS 
esion,  causing  left  hemiplegia  and  right  third  nerve  palsy;  4,  pons 
lesion,  causing  alternating  paralysis  of  right  face  and  left  arm  and  leg; 
s,  sylvian  fissure;  O.T.,  optio  thalamus;  N.L.,  lenticular  nucleus;  C, 
crus;  N.C.,  candate  nucleus;  VII,  facial  nerve;  M,  medulla.  Starr's 
Nervous  Diseases,  Lea  & Febiger. 

the  brain.  Sometimes  an  irritation  starting 
outside  the  motor  area  may  extend  to  the 
latter  and  set  up  a spasm;  and  this  should 
be  borne  in  mind  in  the  localization  of  the 
source  of  irritation.  In  such  cases  other 
localizing  signs  (sensory,  hallucinatory, 
aphasic,  etc.)  may  be  present.  A spasmodic, 
jerky  movement  of  the  head  and  eyes  or  of 
the  eyes  alone  to  the  right  indicates  irrita- 
tion of  the  posterior  part  of  the  second  left 
frontal  convolution;  such  movements  to  the 
left  indicate  irritation  in  the  same  region  on 
the  right  side.  (Starr.) 

Destructive  lesions  in  the  motor  areas 
produce  pai’alysis.  In  cortical  and  subcorti- 
cal lesions  the  paralysis  is  usually  of  limited 
extent — a monoplegia,  i.e.,  j^aralysis  of  the 
face  alone  (on  the  opposite  side),  or  arm 
alone,  or  face  and  arm,  or  leg  alone,  or  arm 
and  leg  together.  If  both  ])aracentral 
lobules  at  the  toj)  of  the  brain  are  affected, 

{IS  in  w{ir  wounds,  there  results  a double 
crural  monoplegia  (a  true  cortical  para- 
plegi{i).  A lesion  in  the  internal  capsule 
produces  hemiplegia  on  the  op{)osite  side. 


A lesion  in  the  crus  cerebri  produces  hemi- 
plegia on  the  opposite  side  and  oculomotor 
palsy  on  the  same  side.  A lesion  in  the  pons 
causes  jiaralysis  of  the  fifth,  sixth,  seventh, 
or  eighth  nerves  on  the  side  of  the 
lesion  and  hemiplegia  on  the  opposite 
side.  A le,sion  in  the  medulla  causes 
paraly.sis  of  the  ninth,  tenth,  eleventh, 
or  twelfth  nerves  on  the  side  of  the 
lesion  and  hemiplegia  on  the  opposite 
side.  Tumors  of  the  jwns  usually  pro- 
duce loss  of  knee-jerk  and  often  weak- 
ened control  of  the  bladder  and  rectiun. 
Lnmediately  following  a cerebral  wound 
involving  the  motor  area  the  resulting 
paralysis  is  flaccid,  \vith  diminished  or 
absent  reflexes,  and  spasticity  and  con- 
tracture do  not  appear  for  several  weeks. 

The  SensoryTract. — The  sensory  axones 
of  the  posterior  columns  of  the  spinal 
cord  terminate  in  arborizations  about 
the  dendrites  of  cells  situated  in  the 
nuclei  gracilis  and  cuneatus  of  the 
medulla,  whence  a second  set  of  axones 
decussate  and  pass  upward  in  the  oppo- 
site interolivary  tract  which  lies  inter- 
nal to  the 
hypoglossal 
nerve.  The 
interolivary 
tract  passes 
over  into 
the  lem- 
n i s cu  s 
which 
traverses  the 
pons  behind 
the  motor  or 
pyramidal 
tracts  and 
deep  t r a n s - 
verse  fibres, 
aiul  then  as- 
cends through 
the  crus  cere- 
bri, thence  the 
lower  part  of 
the  internal 
capsule,  and 
terminates 
largely  in  the 
outer  nucleus 
of  the  optic 
thalamus  and 
partly  in  the 
posterior  cen- 
tiuil  convolu- 
tion {ind  adja- 
cent  parietal 
region  of 


Fig. 


29. — Diagram  of  visual  paths 
(From  Vialet,  modified.)  OP.  N.,  optic 
nerve.  OP.  C.,  optic  tchiasm.  OP.  T., 
optic  tract.  OP.  R.,  optic  radiations. 
Ext.  GE.  N.,  external  geniculate  body. 
TH.  O.,  optic  thalamus.  C.  QLL,  cor- 
pora quadrigemina.  C.  C.,  corpus  cal- 
losum. V.  8„  visual  speech  ^center. 

S.,  auditory  speech  center.  M.  8., 
motor  speech  center.  A lesion  at  1 
causes  blindness  of  that  eye;  at  2,  bi- 
temporal hemianopia;  at  3,  nasal  hem- 
ianopia.  Symmetrical  lesions  at  3 and 
3'  would  cause  bi-nasal  hemianopia;  at 
4.  hemianopia  of  both  eyes,  with  hem- 
ianopic  pupillary  inaction;  at  o and  6, 
hemianopia  of  both  eyes,  pupillary  re- 
flexes normal;  at  7,  amblyopia,  espec- 
ially of  opposite  eye;  at  8,  on  left  side* 
word-blindness. 


BRAIN  LOCALIZATION 


the  cortex.  In  the  pons  many  axones  enter 
the  gray  matter  and  terminate  about  neu- 
rones on  the  floor  of  the  ventricle,  in  the 
formatio  reticularis,  and  in  the  deej)  gray 
matter,  whence  second  axones  again  enter  the 
lemniscus  to  ascend.  In  the  crus  cerebri 
many  of  the  lemniscus  axones  enter  the  ante- 
rior and  posterior  coi'pora  quadrigemina. 

The  lenmiscus  is  the  tract  of  muscular 
sense,  and  when  it  is  diseased,  hemiataxia 
results.  Hemiataxia  associated  with  oculo- 
motor palsy  indicates  a lesion  in  the  crus. 
Hemiataxia  associated  with  trigeminal  anjes- 
thesia  or  facial  palsy  indicates  a lesion  in  the 
pons.  Hemiataxia  associated  with  auditory 
or  hypoglossal  paralysis  indicates  a lesion  in 
the  medulla. 

The  antero-latcral  columns  of  the  spinal 
cord,  which  transmit  tactile,  pain  and  tem- 
perature sensations,  pass  directly  over  into 
the  formatio  reticularis  of  the  medulla,  pons 
and  crus,  and  thence  into  the  internal  cap- 
sule (behind  the  motor  tract)  or  the  optic 
thalamus  to  the  sensory  corte.x,  except  the 
ascending  tract  of  Gowers,  which  ends  in  the 
vermis  of  the  cerebellmn.  The  formatio 
reticularis  contains,  beside  the  sensory  tract, 
transverse  commissural  fibres  of  the  medulla, 
pons  and  cerebellum,  cranial  nerve  fibres, 
and  the  nucleus  ambiguus,  sui^erior  olive, 
nuclei  of  the  lemniscus,  and  the  red  nucleus, 
which  are  collections  of  neurone  bodies. 

A lesion  in  the  formatio  reticularis  in  the 
upper  third  of  the  pons,  or  in  the  crus 
cerebri,  or  in  the  internal  capsule,  produces 
a hemianaesthesia.  A lesion  lower  in  the 
pons  or  in  the  medulla  produces  an  alter- 
nating anaesthesia,  i.e.,  facial  anaesthesia  on 
the  side  of  the  lesion  and  anaesthesia  of  the 
opposite  side  of  the  body. 

A lesion  of  the  red  nucleus  produces  inco- 
ordination and  paralysis  of  the  third  nerve. 

The  direct  cerebellar  tract  of  the  spinal 
cord,  which  transmits  muscular  sensations 
whereby  equilibrium  is  maintained,  enters, 
in  the  medulla,  the  restiform  body,  and 
thence  turns  outward  into  the  cerebellum. 
It  is  joined  in  the  corpus  restiforme  by  some 
fibres  from  the  nuclei  gracilis  and  cuneatus 
of  each  side  and  also  by  fibres  from  the 
opposite  olivary  body.  A lesion  in  this 
tract  results  in  vertigo  and  staggering. 

Irritative  lesions  in  the  sensory  areas 
produce  paraesthesiae,  hallucinations,  or  pain; 
destructive  lesions  produce  anaesthesia. 

A lesion  in  the  superior  parietal  convolu- 
tion causes  astereognosis  or  loss  of  the  power 
of  recognizing  objects  by  touch. 

The  Visual  Tract. — The  optic  nerves  (Fig.  29) 
meet  at  the  optic  chiasm  where  a partial 


decussation  occurs.  The  optic  tracts  end 
each  in  the  pulvinar  of  the  optic  thalamus, 
in  the  external  geniculate  'l)ody,  and  in  the 
anterior  qiuulrigeminal  body,  from  which 
ganglia  new  axones  pass  out  into  the  pos- 
terior fifth  of  the  internal  capsule,  and  thence 
through  the  centrum  ovale,  outside  of  the 
posterior  horn  of  the  lateral  ventricle,  to  the 
cortex  of  the  occipital  lobe  about  the  cal- 
carine fissure  and  in  the  cuneus. 

As  is  evident  from  Fig.  29,  cerebral  blind- 
ness is  always  a bilateral  hemianopsia. 

The  memory  of  the  meaning  of  things 
seen,  or,  in  other  words,  the  recognition  of 
objects  seen,  is  stored  in  the  occipital  cortex; 
and  the  loss  of  this  memory  is  called  psychi- 
cal blindne.ss.  It  is  attended  by  hemianoj^sia 
when  the  cuneus  is  involved. 

The  memory  of  the  meaning  of  words  seen, 
or  the  power  of  understanding  written 
language,  is  stored  in  the  angular  gyi’us,  and 
its  loss  is  called  word  blindness. 

Visual  hallucinations  or  aur®  have  their 
seat  in  the  occipital  cortex. 

In  cortical  hemianopsia  the  inner  limiting 
line  of  blindness  is  usually  vertical  and  very 
near  the  point  of  central  vision;  whereas,  in 
subcortical  or  basal  ganglia  hemianopsia  the 
latter  is  usually  less  extensive  and  less  sym- 
metrical in  the  two  eyes  and  extends  farther 
outside  the  point  of  central  vision. 

A lesion  of  the  visual  tract  just  beneath 
the  cortex  usually  produces  word  blindness 
as  well  as  hemianopsia. 

A lesion  in  the  region  of  the  internal  cap- 
sule or  optic  thalamus  generally  produces 
hemiataxia,  or  hemiantesthesia,  or  hemi- 
plegia, as  well  as  hemianopsia. 

A lesion  in  the  external  geniculate  body 
involves  the  fibres  of  the  corpora  quadri- 
gemina with  the  residting  association  of 
Wernicke’s  hemiopic  pupillary  reflex  with 
hemianopsia.  Wernicke’s  reflex  is  elicited 
as  follows;  In  a dark  room,  with  the  eyes 
only  faintly  illuminated  in  order  to  obtain 
dilatation  of  the  i^upils,  throw  a ray  of  light, 
by  means  of  a mirror,  only  upon  the  blind 
side  of  the  retina.  If  no  pupillary  contrac- 
tion results,  the  lesion  is  in  the  optic  tract 
or  basal  ganglia  (the  reflex  arc  of  pupillary 
response  to  light). 

A lesion  limited  to  the  corpora  quadri- 
gemina produces  strabismus,  double  vision 
(oculomotor  palsy),  nystagmus  and  loss  of 
the  pupillary  reflex,  dizziness  and  staggering 
(from  involvement  of  the  underlying  red 
nuclei),  but  no  hemianopsia. 

A lesion  of  the  optic  ti-act  produces  hemi- 
anopsia associated  with  Wernicke’s  hemiopic 
pupillary  reflex,  and,  owing  to  the  pro.ximity 


BRAIN  LOCALIZATION 


of  the  crus,  also,  often,  hemiplegia  and  oculo- 
motor palsy  (ptosis,  diplopia,  etc.):  see  Ocu- 
lomotor Paralysis. 

A lesion  in  the  optic  chiasm  causes  partial 
or  total  bliiulness  accoi'ding  to  the  situation 
and  extent  of  the  lesion,  as  may  he  seen  by 
the  diagram  (Fig.  29).  Consult  Part  6,  on 
Eye  Diseases,  for  tests,  etc. 

The  Auditory  Tract. — The  centre  of  hearing  is 
located  in  the  middle  part  of  the  first  and 
second  tempoi'al  convolutions.  Since,  how- 
ever, each  ear  is  connected  with  both  tem- 
jxtral  loltes  through  both  lemnisci,  cortical 
deafness  does  not  occur  unless  both  lobes  or 
lemnisci  are  destroyed.  Irritative  lesions 
produce  auditory  hallucinations. 

A lesion  of  tlie  left  temporal  cortex  (in 
right-handed  persons)  causes  loss  of  memory 
of  the  meaning  of  words  heard  (word  deaf- 
ness) and  of  things  heard  (psychical  deafness). 

Smell. — The  centre  of  smell  is  located  in  the 
uncinate  gyrus  and  nucleus  amygdalus  which 
are  situated  in  the  apex  of  the  temporal  lobe. 

The  Frontal  Lobes — A lesion  of  the  frontal 
cortex  aiul  subjacent  white  mattei'  is  mani- 
fested by  mental  inertia,  stupidity,  loss  of 
memory,  lack  of  judgment,  inattention,  lack 
of  self-control,  and  a tendency  to  somno- 
lence. Emotional  disturbances  are  produced 
by  lesions  in  the  frontal  convolutions  and  in 
the  anterior  portion  of  the  corpus  callosum 
which  unites  the  two  frontal  lobes.  A lesion 
in  the  thalamus  sometimes  results  in  inabil- 
ity to  smile  on  the  side  opposite  to  the  lesion, 
although  the  risorii  muscles  are  not  paralyzed 
(Nothnagel).  The  thalamus  is  connected 
with  the  frontal  lobe  by  means  of  a large 
association  tract  which  traverses  the  anterior 
limb  of  the  internal  capsule  and  ends  in  the 
external  nucleus  of  the  thalamus. 

The  Mechanism  of  Language.— Aphasia 
(Or.  a priv.  + <t>aais  speech)  is  of  two  kinds, 
motor  or  expressive,  and  sensory  or  pei'cep- 
tive.  Motor  aphasia,  in  which  the  emissive 
speech  faculty,  concerned  with  articulation, 
writing,  and  iiantomime,  is  deranged,  may 
be  cortical,  subcortical,  or  intercortical. 
Cortical  motor  ai)hasia  or  Broca’s  aphasia 
has  l)cen  thought  to  be  due  to  a lesion  in  the 
lK)sterior  part  of  the  third  frontal  convolu- 
tion (Broca’s  coTitre)  on  the  left  side  in  right- 
handed  persons,  and  vice  versa.  It  is  mani- 
fested by  loss  of  the  power  of  s))occh  and 
usually  of  writing,  but  unaccompanied  by  a 
loss  of  understanding  of  spoken  or  written 
language.  Subcortical  motor  aphasia  is 
distinguished  from  cortical  motor  aphasia 
by  th(^  patient’s  ability  to  write  and  read, 
and  to  indicate  by  signs  the  number  of 
syllables  and  letters  in  words  seen  and  hoard 


(Prout-Lichtheim  test).  He  is  incapable  of 
articulate  speech,  but  the  memory  pictures 
are  not  lost,  as  in  cortical  aphasia.  Inter- 
cortical motor  ajihasia  (paraphasia),  involv- 
ing the  association  tracts  between  Broca’s 
centre  and  the  sensory  speech  centres,  is 
characterized  by  the  inability  to  repeat 
words  heard  or  seen,  while  understanding 
their  meaning,  and  retaining,  too,  the  pow'er 
of  enunciation.  The  patient  can  talk, 
becau.se  the  motor  centre  and  efferent  tract 
are  intact,  but  he  continually  misplaces 
words  an<l  talks  jargon.  “There  are  as 
many  forms  of  paraphasia  as  there  are 
association  tracts.’’  (Starr.)  The  temporo- 
brocal  intercortical  tract  lies  beneath  the 
island  of  Reil. 

Sensory  aphasia,  in  which  the  receptive 
speech  faculty,  concerned  with  the  compre- 
hension of  the  meaning  of  words,  is  deranged, 
may  be  cortical,  subcortical,  or  intercortical. 
The  auditory  si^eech  centre  is  located  in  the 
middle  jiart  of  the  cortex  of  the  first  anti 
second  temporal  gyri,  on  the  left  side  in 
right-handed  persons,  and  vice  versa,  and  a 
disturbance  here  causes  auditory  ajihasia, 
or  word-deafness,  or  loss  of  memory  of  the 
meaning  of  words  heard.  The  visual  speech 
centre  is  located  in  the  angular  g>Tus,  and 
a disturbance  here  causes  visual  aphasia,  or 
wortl-blindness,  or  loss  of  memory  of  the 
meaning  of  woi’ds  seen,  or,  in  other  words, 
loss  of  the  jx)wer  of  understanding  wTitten 
language.  A tlisturbance  in  the  neighboring 
supramarginal  gyrus  causes  mind-blindness, 
or  loss  of  memory  of  t’..e  meaning  of  things 
or  objects  seen.  In  subcortical  as  distin- 
guished from  critical  aphasia,  the  memory 
picture  is  not  lost,  as  it  is  in  cortical  aphasia, 
but  is  merely  cut  off  from  its  ordinary  con- 
nections with  other  memory  pictures,  anti 
may  be  recalled  by  a roundabout  path. 
Intercortical  sensory  aphasia,  due  to  a lesion 
of  the  long  association  tract  between  the 
temporal  and  occipital  lobes,  is  character- 
ized by  an  inability  to  recall  the  name  of  an 
object  seen  and  the  appearance  of  an  object 
named,  while  the  name  is  recognized  when 
heard  ami  the  object  is  recognized  when  seen. 

In  any  given  case  of  aj;)hasia,  the  latter 
may,  of  course,  be  only  partial,  deix'iiding 
upon  the  extent  of  the  local  disturbance. 

To  test  the  motor  S{x?ech  centre  and  its 
association  tracts,  ascertain  the  patient’s 
power  of  speaking  voluntarily,  and  of  reix'at- 
ing  words  seen  or  h('ard.  To  test  the  audi- 
tory speech  ccTitre  and  its  association  tracts, 
ascertain  the  jmtient’s  power  of  understand- 
ing the  meaning  of  words  spt)ken,  and  of 
naming  things  seen,  heard,  handled,  tasted, 


BRAIN  LOCALIZATION 


or  smelled.  To  test  the  visual  speech  centre 
and  its  association  tracts,  ascertain  the 
patient’s  power  of  understanding;  the  mean- 
ing of  words  seen,  of  reading  aloud,  and 
of  understanding  what  is  read,  of  writing 
the  names  of  things  seen,  heard,  tasted, 
smelled,  and  handled,  of  copying  and  writing 
from  dictation. 

The  above  has  been  the  accepted  concep- 
tion of  the  mechanism  of  speech,  but  Pierre 
Marie  denies  that  the  third  frontal  convolu- 
tion is  a speech  centre,  and  contends  that 
Broca’s  aphasia  is  so-called  sensory  aphasia 
(Wernicke’s  aphasia)  plus  anarthria  or 
dysarthria,  the  latter  being  due  to  a lesion 
of  the  lenticular  area  of  the  brain,  which 
includes  the  central  gray  nuclei,  the  internal 
and  external  capsules,  the  insula,  the  motor 
cortex,  and  some  important  fibres  of  the 
white  matter,  while  the  third  frontal  con- 
volution is  not  included. 

Other  kinds  of  dysarthria  besides  the 
aphasic  are  (1)  cerebellar  dysarthria  char- 
acterized by  a “very  deliberate,  explosive, 
sometimes  wandering  or  drawling  method  of 
speaking”;  (2)  bulbar  dysarthria,  due  to 
nuclear  paralysis,  and  “marked  by  amyo- 
trophia and  fibrillar  tremors  of  the  muscles 
innervated  by  the  7th  and  12th  pairs  of 
nerves”;  and  (3)  pseudo-bulbar  dysarthria, 
occurring  in  lesions  of  the  central  gray  nuclei 
or  of  the  pons,  and  characterized  by  a 
“breathless,  choking,  nasal,  muffled  speech” 
(Chatelin  and  De  Martel).  A slow,  difficult 
and  indistinct  speech  occurs  in  Huntington’s 
and  in  tetanoid  chorea. 

Etiology  of  Aphasia. — Transient  aphasia 
may  occur  in  epilepsy,  migraine,  arterio- 
sclerosis (due  probably  to  angiospasm), 
general  paresis,  chronic  interstitial  nephritis 
(due  to  local  cerebral  oedema),  Raynaud’s 
disease  (due  to  angio-spasm),  mental  strain 
or  shock,  eye-strain,  intestinal  intoxication, 
poisoning  by  snake-bite,  opium,  cannabis 
indica,  belladonna,  etc. 

More  or  less  persistent  aphasia  may  occur 
in  infantile  hemiplegia,  cerebral  tuberculosis, 
syphilis,  abscess,  hemorrhage,  embolism, 
thrombosis,  cyst,  or  tumor. 

Treatment  of  Aphasia. — Consider  the 
cause.  Children  can  be  reeducated  much 
more  easily  than  adults.  Teach  the  aphasic 
language  by  means  of  the  grammar  and 
dictionary,  taking  him  through  the  conju- 
gation of  verbs,  the  declension  of  nouns  and 
pronouns,  etc.,  just  as  one  would  teach 
language  to  a child,  and  using  objects  to 
illustrate  names. 

Apraxia  or  Dyspraxia  (Gr.  a neg.,  bvs-  ill 
-j-  wpaffaeiv  to  do)  signifies  the  inability  to 


perform  certain  voluntary  movements,  al- 
though there  exists  no  motor  or  sensory 
paralysis  or  ataxia.  The  cause  is  possibly  a 
lesion  of  the  corpus  callosum  or  posterior 
part  of  the  frontal  lobe,  or  possibly  a lesion 
of  the  left  parietal  lobe.  The  treatment  con- 
sists in  the  retraining  of  the  limb  for  such 
acts  as  are  lost  or  defective. 

The  Cerebellum. — The  following  phenom- 
ena characterize  lesions  of  the  cerebellum  or 
its  peduncles: 

(1)  Hypermetria  (Gr.  over  -1-  pirpov 
measure),  or  e.xaggerated  movements.  With 
the  finger  or  foot  of  the  same  side  as  the 
lesion  the  patient  can  not  rapidly  touch 
designated  points  on  the  body  correctly,  but 
over-reaches  the  mark.  Closing  the  eyes 
does  not  increase  this  disorder,  thus  dis- 
tinguishing it  from  ataxia.  When  told  to 
make  a dot  on  paper  he  over-shoots  the 
mark,  and  finally  makes  a dash  instead  of  a 
dot.  When  told  to  make  a circle,  he  makes 
a polygon  of  broken  outline  (asynergia  with 
hypermetria).  An  intentional  oscillatory 
tremor  of  large  amplitude,  extending  the 
full  length  of  the  limb,  accompanies  volun- 
tary movements. 

(2)  Asynergia  (Gr.  a neg.  awepyta  co- 
operation), or  loss  of  the  power  to  synchron- 
ize or  coordinate  movements.  When  the 
patient  is  told  to  bend  the  trunk  backwards 
as  far  as  possible,  he  does  not  flex  the  knee 
and  thigh  as  a normal  subject  does,  and 
consequently  loses  his  balance.  When 
placed  upon  his  back,  with  arms  crossed  on 
the  chest,  and  told  to  raise  the  trunk,  he 
can  not  do  so,  but  raises  only  the  leg  a little 
on  the  affected  side.  (This  phenomenon 
occurs  also  in  hemiplegia.) 

(3)  Adiadococcinesia  (Gr.  a neg.  habo- 
xos  succeeding  -|-  Kivycns  motion),  or  the 
inability  to  rapidly  alternate  certain  volun- 
tary movements,  such  as  pronation  and 
supination,  on  the  same  side  as  the  lesion. 
Compare  the  two  sides. 

(4)  Diminished  tonicity  (hypotonia)  of 
certain  gi-oups  of  muscles  which  cause  by 
their  action  movement  in  a certain  direction, 
together  with  exaggerated  tonicity  of  the 
opposing  group  of  muscles,  is  produced  by 
a localized  lesion  of  the  cerebellar  cortex. 
If  the  whole  cortex  of  one  side  is  involved 
there  results  general  hypotonia  or  asthenia 
on  the  side  of  the  lesion,  with  loss  of  knee- 
jerk.  The  “rebound  phenomenon”  illus- 
trates this  defect.  With  the  patient’s 
elbows  resting  on  the  table,  he  is  told  to  pull 
each  hand  in  succession  toward  his  mouth 
against  resistance  offered  by  the  physician 
who  holds  his  wrist.  When  the  wrist  is 


BRAIN  TUMOR 


suddenly  let  go,  the  hand  of  the  affected  side 
is  jerked  toward  the  mouth,  while  the  hand 
on  the  unaffected  side  is  restrained  by  con- 
traction of  the  antagonist  (triceps)  muscle 
and  may  even  rebound  by  the  action  of  this 
muscle.  With  both  arms  extended  horizon- 
tally in  front,  and  the  eyes  then  closed,  the 
arm  of  the  affected  side  moves  away  from 
the  symmetrical  jiosition. 

(5)  Inclination  of  the  head  and  trunk  to 
the  injured  side  on  standing. 

(6)  Gait  like  that  of  a drunken  man. 

(7)  Speech  jerky,  deliberate,  explosive; 
sometimes  slow  and  drawling. 

(8)  Vertigo. 

(9)  Sometimes  nystagmus  on  fixing  an 
object. 

Lesions  of  the  Vermis  or  median  lobe 
give  rise  to  vertigo,  the  cerebellar  or 
drunken  gait,  abnormal  positions  of  the 
head,  slowness  in  the  movements  of  the  head 
and  face,  speech  disturbance,  and  asynergia 
in  the  trunk  and  possibly  the  lower  limbs. 

Lesions  of  one  hemisphere  produce  hemi- 
asynergia,  hemiadiadococcinesia,  and  hemi- 
hypermetria  on  the  same  side  as  the  lesion. 

Lesions  localized  in  the  cortex  produce 
localized  phenomena  confined  to  one  limb 
or  one  joint. 

Lesions  of  the  central  gray  cerebellar 
nuclei  produce  vertigo,  lateropulsion,  abnor- 
mal positions  of  the  head  and  trunk,  cata- 
lepsy, perhaps  nystagmus. 

A lesion  in  the  middle  cerebellar  peduncle 
(crura  cerebelli  ad  pontem)  causes  a ten- 
dency to  turn  or  fall  toward  one  side  in  walk- 
ing and  a tendency  to  a turning  of  the  head, 
eyes,  or  body  toward  one  side. 

Labyrinthine  lesions  produce  symptoms 
similar  to  those  of  cerebellar  disease,  e.g., 
vertigo,  lateropulsion  (toward  the  affected 
side);  but  see  Ear  Diseases,  Part  7,  for 
diagnostic  labyrinthine  tests. 

A lesion  confined  to  a hemisphere  of  the 
cerebellum  may  jn-oduce  no  symptoms  un- 
less neighboring  parts  are  pressed  upon. 
Cerebellar  disease  is  usually  associated  with 
pons  and  medulla  symptoms.  Tumors  of  the 
cerebello-pontine  angle,  which  are  not  un- 
common, may  produce  compression  of  the 
5th,  0th,  7th,  8th,  9th,  10th,  and  11th  cranial 
nerves,  compression  of  the  cerebellar  pedun- 
cles, or  compression  of  the  pons. 

It  should  be  remembered  in  connection 
with  brain  tumors,  (1)  that  no  focal  symp- 
toms may  be  present  in  tumors  of  the  frontal 
and  temporal  lobes,  especially  on  the  right 
side,  ami  (2)  that  focal  symptoms  may  be 
protluced  indirectly  by  pressure  exerted  by 
a tumor  at  a distanca 


Organic  versus  Functional  (nysterical)  Paralysis. 
— In  hysterical  paralysis,  the  latter  is  gen- 
erally partial,  the  reflexes  are  normal  and 
equal  on  both  sides,  there  is  frequently 
ana'sthesia  of  the  paralyzed  limb,  and,  if  it 
is  the  leg  that  is  paralyzed,  the  patient 
drags  the  limb,  instead  of  scraping  the 
ground  with  it.  In  organic  paralysis,  the 
latter  is  complete,  the  reflexes  are  diminished 
or  exaggerated  on  the  paralyzed  side, 
Babinski’s  reflex  and  ankle  clonus  are  present 
in  upper-segment  paralysis,  in  flaccid  paraly- 
sis the  paralyzed  limb  can  be  passively 
flexed  to  a greater  degree  than  in  functional 
paralysis,  and  the  paralyzed  hand  placed  in 
supination  involuntarily  assumes  the  posi- 
tion of  pronation.  In  organic  hemiplegia, 
if  the  patient  is  extended  supine  on  a rigid 
couch,  and  told  to  cross  the  arms  and 
attempt  to  sit  up,  the  lower  paralyzed  limb 
will  be  seen  to  rise  from  the  couch. 

Brain  Tumor.  — Varieties.  Glioma  (com- 
monest) ; endothelioma  or  fibro-sarcoma 
(next  commonest — usually  meningeal  and 
enucleable,  and  owing  to  its  usual  occur- 
rence in  the  cerebello-pontine  recess,  often 
associated  with  the  early  onset  of  auditory 
symptoms);  sarcoma;  carcinoma  (both  usu- 
ally metastatic);  tubercle;  syphiloma;  cho- 
lesteatoma; cysts.  Dermoid,  teratoma,  lipo- 
ma, fibroma,  psammoma,  osteoma,  enchon- 
droma,  neuroma,  and  angioma  are  all  rare. 

Symptomatology. — A.  GENERAL  PRESSURE 
Symptoms. — Headache;  dizziness;  drowsi- 
ness; torpor;  nausea  and  vomiting;  slowing 
of  the  pulse  and  respirations;  psychic  dis- 
turbances; choked  disc  (not  an  early  sign; 
it  usually  appears  first  on  the  same  side  as 
the  brain  lesion,  with  “tortuosity  of  the 
retinal  veins,  injection  of  the  disc  and  more 
or  less  haziness  of  its  outlines,  the  Uasal 
margins  usually  being  the  first  to  become 
obscured”;  it  is  not  associated  in  the 
beginning  with  diminution  of  vision;  the 
latter  usually  indicates  optic  atrophy) ; 
dyschromatopsia  (Gr.  hvs  ill  -t-  color 

-b  oy'as  vision.:  “interlacing  and  inversion  of 
the  color  fields.” — Cushing) ; dilated  veins 
and  venules  of  the  eyelids  and  scalp;  con- 
vulsions; coma;  paralyses. 

B.  Focal  Symptoms.- — These  are  irrita- 
tive (convulsive),  or  destructive  (paral>dic), 
or  are  absent.  So-called  “distant  symp- 
toms,” due  to  distant  oedema  or  to  com- 
pression of  one  lobe  by  a tumor  in  another, 
may  give  false  information  regarding  the 
location  of  the  tumor.  Auscultatory  per- 
cussion of  the  shaved  scalp  may  be  of 
assistance,  the  “audibility  of  transmitted 
sound  of  a tuning  fork  being  lessened  over 


BREAST  ENLARGEMENTS 


the  tumor”  (Cushing).  If  psammomatous 
bodies  or  calcification  are  present,  or  if  bone 
is  eroded,  the  tinnor  may  be  localized  by 
means  of  the  X-ray  (see  Brain  Localization). 

Brain  tumor  should  be  distinguishetl  from 
hysteria,  general  paresis,  multiple  sclerosis, 
cerebral  arteriosclerosis,  cerebral  hemor- 
rhage, embolism  or  thrombosis,  cerebral 
aneurysms,  brain  abscess,  nephritis,  serous 
meningitis  or  ependymitis,  hydrocephalus, 
hsematoma  of  the  dura  mater,  traumatic 
cysts,  lead  encephalopathy. 

Prognosis. — Unless  the  tumor  can  be  re- 
moved, it  is  usually  fatal  in  six  to  twelve 
months  after  the  appearance  of  pressure  symp- 
toms; but  sometimes  spontaneous  cure  occurs. 

Treatment.— Eliminate  syphilis  by  means 
of  the  Wassermann  or  Noguhi  test.  Cush- 
ing says:  “In  the  presence  or  absence  of  a 
positive  serum  reaction  or  a definite  history 
of  lues,  antisyphilitic  treatment  deserves 
only  a brief  vigorous  trial;  if  pressure 
symptoms  have  been  outspoken  and  do  not 
become  distinctly  ameliorated  (as  shown 
chiefly  by  the  appearance  of  the  eye- 
grounds)  in  the  course  of  a few  days,  a 
palliative  depompression  should  be  per- 
formed and  the  treatment  subsequently 
resumed  should  the  diagnosis  remain  in 
doubt.”  Mercury  and  potassium  iodide, 
especially  the  latter  in  ascending  large  doses 
over  an  extended  period,  are  sometimes  very 
beneficial  even  in  non-syphilitic  tumors. 
Arsenic  may  also  be  of  some  value  (for  drugs 
see  Part  11). 

Keep  the  head  elevated,  and  an  ice-cap 
applied,  and  give  daily  morning  salines, 
e.g.,  Rochelle  salt,  3i~iv,  or  sodium  phos- 
phate 3ss-iv,  or  liquor  magnesii  citratis, 
5vi-xx,  or  Epsom  salt,  3ii-viii,  one  hour 
before  breakfast. 

Give  easily  digestible  food  in  frequent 
small  amounts — about  every  three  hours. 

For  severe  headache,  insomnia,  convul- 
sions, and  vomiting,  see  these  captions. 

The  tinnor  should  be  removed,  if  practic- 
able; otherwise  a decompressive  operation 
should  be  done  to  relieve  symptoms  and 
prevent  blindness. 

Brain,  Wet. — See  Alcoholism. 

Break=Bone  Fever. — See  Dengue. 

Breast  Cancer. — See  Breast  Enlargements. 

Breast  Enlargements. — Benign  tumors  are 
distinguished  from  malignant  ones  by  the 
following  opposite  characteristics,  i.e.,  oc- 
currence in  the  young,  encapsulation,  free 
movability,  non-adherence  to  surrounding 
tissues,  absence  of  retraction  or  dimpling 
of  the  skin,  absence  of  atrophy  of  the  over- 
lying  fat,  absence  of  lymphatic  involvement. 


The  removal  of  tissue  for  microscopic  diag- 
nosis is  condemned  by  Ochsner.  The  deci- 
sion to  operate  or  not  should  rest  upon  the 
clinical  diagnosis. 

Classification. — ^1.  MASTITIS,  pyogenic, 
tuberculous,  syphilitic,  antinoniycotic. 
See  Mastitis. 

2.  Simple  Hypertrophy,  a.  Virginal — 
gradually  progressive  and  eventually  requir- 
ing removal,  b.  Gestational — usually  disap- 
pearing at  the  termination  of  pregnancy. 

3.  Galactocele  or  Milk  Retention 
Cyst. — Excise  the  cyst. 

4.  Senile  Cyst. — Usually  multiple  and 
bilateral,  occurring  usually  between  the 
ages  of  forty  and  fifty,  and  possessing  a ten- 
dency to  malignant  degeneration,  there- 
fore the  advisability  of  removing  the 
whole  breast. 

5.  Cyst  with  Intracystic  Papilloma. 
— Characterized  by  a discharge  from  the 
nipple  and  showing  a tendency  toward  ma- 
lignancy. Remove  the  entire  breast.  If 
the  base  of  the  papilloma  is  indurated,  and 
the  surrounding  tissues  infiltrated,  do  the 
radical  cancer  operation. 

6.  Intracanalicular  Myxoma. — Occurs 
in  young  women;  is  elastic,  nodulated,  often 
multiple,  and  of  slow  growth.  Excision  of 
the  tumor  is  advised  by  some. 

7.  Angioma. — Excise  the  growth. 

8.  Lipoma. — Circumscribed,  soft,  lobu- 
lated;  very  rare.  Excise  the  tumor. 

9.  Fibroadenoma  or  Adenofibroma. — 
Occurs  in  young  women,  is  smooth,  firm, 
elastic;  usually  single.  Excise  the  tumor. 

10.  Cystic  Adenoma.  — Rare,  occurs 
in  young  women,  is  hard  and  lobulated, 
no  discharge  from  nipple.  Excise  the  tumor. 

11.  Dermoid  Cyst. — Very  rare.  Excise 
the  growth. 

12.  Sarcoma. — Rare,  clinically  benign  at 
first,  the  axillary  glands  are  rarely  involved. 
Remove  the  breast;  but  if  there  is  the 
slightest  doubt  as  to  involvement  of  the 
lymph  glands,  do  the  radical  operation. 

13.  Carcinoma. — Common,  occurs  usu- 
ally between  the  ages  of  40  and  60;  signs 
of  malignancy:  diffuse  growth,  adherence  to 
the  surrounding  tissues,  dimpling  of  the 
skin,  retraction  of  the  nipple,  atrophy  of 
the  overlying  fat,  enlargement  of  the  axil- 
lary lymphatic  glands,  age  of  the  patient. 
As  a result  of  compression  of  the  blood 
vessels  in  cancer,  if  the  overlying  skin  is 
rubbed  with  alcohol  and  ether,  it  shows 
irregular  pale  areas,  whereas  in  non-cancer- 
ous  growths  the  rubbed  skin  is  uniformly 
red  (Moszkowicz).  Do  the  radical  opera- 
tion. In  recurrent  or  inoperable  cases  employ 


BRIGHT’S  DISEASE;  NEPHRITIS 


radium  {q.v.)  or  the  X-rays  {q.v.)  or  both. 
Radium  tubes  may  be  inserted  directly  into 
the  substance  of  tlie  giowth.  Remember 
that  Paget’s  disease  of  the  nipple,  mani- 
fested Ijy  a yellow  secretion  from  the 
nipple,  followed  by  eczema  and  ulcera- 
tion, is  malignant  cancer  beginning  in  the 
milk  duct. 

Breast  Inflammation. — See  Mastitis. 

Neuralgia.  — See  Mastodynia  under 
Neuralgia. 

Pang. — See  Angina  Pectoris. 

Tumors. — See  Breast  Enlargements. 

Breath,  Bad  or  Offensive;  Fetor  Oris. — 
(L.  Fet'or,  stench;  os,  gen.  o'ris,  mouth). 

Causes.— Unclcanliness;  pyorrhoea  alveol- 
aris;  dental  caries;  poorly  fitting  artificial 
devices;  mouth  breathing;  adenoids;  sto- 
matitis; indigestion;  constipation;  putrid 
plugs  in  the  tonsillar  crypts;  tonsillitis;  naso- 
pharyngitis ; ozmna;  antral  empyema;  scur\y ; 
chlorosis;  diabetes;  acidosis  (fruity  odor  of 
acetone);  ammoniacal  cystitis;  men.strual 
disonlers;  acute  febrile  diseases;  diphtheria; 
.septiciemia;  hepatic  cirrhosis;  uriemia;  oeso- 
phageal diverticulum;  dilatation  of  the 
stomach;  carcinoma  of  the  larynx;  putrid 
bronchitis;  bronchiectasis;  pulmonary  ab- 
scess; pulmonary  gangrene;  tuberculous 
pulmonary  cavities;  hiemoptysis;  alcohol- 
ism; arsenic;  phosporus;  bromitles;  iodides. 

Treatment.— Correct  the  cause. 


R Beta-naplithol gr.  iii 

Sodii  biboratis 3i 

A(1uu3  nientlue  jiiperita^ § v 

Aqua;  destillabe,  q..s.  ad Oii 

Sig. — Mouth-wash. — Ortner;  Croftan. 

l\  Formalini 3 iiss 

Mentholis gr.  xv 

Ti  net  lira;  Kraincriae pintxv 

Alcolioli.s,  ([.s.  ad Jni  oii 

M.  Sig. — ()ne-lialf  to  one  teaspoonful  in  a quarter 
of  a glass  of  water,  as  a mouth-wash.  (Ortner.) 

R Thymol gr.  vss 

Aeidi  benzoici gr  xlv 

Olei  menthm  piperitm njxx 

Olei  eucalypti tt^xIv 

Alcoholis 5iii  pii 


M.  Sig. — \ des.scrt.spoonfid  in  half  a wineglass- 
ful of  water,  as  a mouth-wash. 

Breathlessness. — See  Dyspnoea. 

Bright’s  Disease;  Nephritis. — Gr.  ve^pds 
kidney  -| — ins  inflammation. 

I.  Acute  Briglit’s  Disease;  Acute  Diffu.se 
Nephritis. — .Acute  diffuse  nephritis  is  char- 
actt'rized  usually  by  the  sudden  appearance 
of  oedema,  jtallor,  scanty  urine  of  high 
s|X'cific  gravity,  containing  blood,  tube 
ciusts  and  albumen,  and,  pi'rhaps,  headache, 
mental  apathy,  lumbar  pains,  slight  fever, 
nausea  and  vomiting.  In  some  cases,  how- 


ever, the  urinary  changes  are  the  most 
prominent  feature.  See  Urinalysis. 

Differentiate  acute  nephritis  from  albu- 
minuria due  to  other  causes  (see  Albumi- 
nuria), from  an  acute  exacerbation  of  a 
chronic  nephritis  and  from  chronic  paren- 
chymatous or  chronic  diffuse  nephritis. 

PiioGNOSis.-Recoveryusuallyoccurs,  even, 
sometimes,  after  a year’s  illness,  but  the 
disease  is  nevertheless  serious. 

Etiology.— Overeating;  highly  seasoned 
food;  traumatism,  including  operations  on 
the  kidney;  exposure  to  cold  and  wet;  pro- 
longed X-ray  exposures;  extensive  burns 
and  skin  diseases;  pregnancy;  chemical 
poisons,  e.g.,  cantharides,  turpentine,  balsam 
of  pine,  carbolic  acid,  potassium  chlorate, 
salicylates,  cubebs,  copaiba,  antimony,  potas- 
sium nitrate,  hydrochloric  acid,  nitric  acid, 
sulphuric  acid,  oxalic  acid,  potassium  bichro- 
mate, alcohol,  chloroform,  pho.sphorus,  ura- 
nium salts,  arsenic,  mercury,  lead,  oil  of 
mustard,  morphine,  vinylamin,  cobra  venom, 
jDoisonous  mushrooms,  tartrates,  ptomaines, 
sodium  chloride  in  large  doses,  skin  applica- 
tions of  iodoform,  pyrogallic  acid,  naphthol, 
tar  preparations,  and  the  other  drugs  enume- 
rated; infectious  diseases  and  focal  infec- 
tions, e.g.,  scarlet  fever,  diphtheria,  syphilis, 
acute  tuberculosis,  influenza,  septico-pyemia, 
smallpox,  malaria,  typhus  fever,  tonsillitis, 
sinusitis,  jrurpura,  rarely  measles,  German 
measles,  varicella,  whooping-cough,  mumps, 
meningitis,  typhoid  fever,  vaccinia,  pneu- 
monia, empyema,  acute  diarrhoeal  dis- 
eases, cholera,  yellow  fever,  relapsing  fever, 
rheumatic  fever,  chorea,  erysipelas;  acute 
yellow  atrophy  of  the  liver. 

Treatment.— Put  the  patient  to  bed,  and 
keep  him  there  until  the  heart  is  normal 
and  the  urine  free  from  albumin.  Should 
the  confinement  eventually  become  too 
irksome,  allow  him  up  occasionally.  Von 
Noorden  allows  the  patient  up  after  two 
weeks  of  absence  of  red  cells  and  kidney 
epithelium  from  the  urine,  whether  albumi- 
nuria is  presentor  not, providing,  of  coui’se,  no 
other  s>mi])toms  of  nephritis  are  present.  The 
room  should  be  warm  but  well  ventilated; 
draughts  should  be  avoided.  A flannel 
gown  should  be  worn  next  the  skin,  and  the 
patient  should  sleeji  between  flannel  or 
woolen  blankets.  The  diet  should  be  light, 
bland,  and  easily  digestible,  and  low  in 
protein,  in  order  to  lessen  the  work  of  the 
kidneys  (moreover  nitrogen  retention  exists 
with  its  consequent  dangers).  Salt  should 
also  be  reduced  to  a minimum,  especially 
in  the  presence  of  mdema,  since  its  retention 
in  the  tissues  (the  retention  being  due  to 


BRIGHT’S  DISEASE;  NEPHRITIS 


renal  insufficiency)  promotes  cedema  by 
raising  the  osmotic  pressure.  In  the 
beginning,  give  barley  water  with  a little 
milk,  fruit  juices,  and  Sugar,  later  increa.sing 
the  proportion  of  milk  as  the  patient 
improves,  until  he  is  taking  one  and  a half 
quarts  (if  taken  alone)  or  less  a day,  diluted 
if  need  be.  Yeo  adds  one  to  two  tablespoon- 
fuls of  the  following  alkaline  solution  to 
each  cup  of  milk  and  water: 


R Sodii  bioarbonatis, 

Pota.s.sii  citratis aa  gr.  x 

Aquam  de.stillatain,  ad 5* 


Ortner  gives  1}/^  to  2 ilrams  of  sodium 
bicarbonate  a day,  to  render  the  urine  less 
acid,  and  therefore  less  irritating. 

Other  allowable  foods  are:  buttermilk, 
in  small  amounts  at  a time,  4 to  6 pints  in 
twenty-four  hom-s,  kumyss  (see  Part  11), 
kefir  whey,  well-cooked  cereals — oatmeal, 
barley,  rice,  farina,  arrowroot,  sago,  tapioca, 
macaroni,  apple  sauce,  baked  apple,  orange, 
grape  fruit,  prunes.  Prohibit  meat,  eggs, 
broths,  meat  extracts,  alcohol. 

After  the  acute  stage  of  the  disease  is 
pas.sed,  and  urine  is  secreting  freely,  add  to 
the  dietary  junket,  custard,  cream,  let- 
tuce, celery,  water  cress,  mashed  potatoes. 


as  the  albuminuria  diminishes,  eggs  boiled 
three  minutes,  fish,  vegetables,  and  meat  in 
small  quantities  only  if  it  is  craved. 

Some  advise  only  moderate  amounts  of 
water,  according  to  the  patient’s  thirst; 
Osier,  Yeo,  and  Holt  favor,  except  in  the 
presence  of  oliguria  and  oedema,  an  abun- 
dance of  water  for  the  purpose  of  flushing 
the  kidneys:  cream  of  tartar  lemonade, 
one  teaspoonful  of  cream  of  tartar  to  the 
pint  of  boiling  water,  cooled  and  flavored 
I with  lemon  and  sugar  (both  diuretic  and 
laxative);  alkaline  mineral  waters,  e.g., 
Waukesha  (Wis.)  and  Poland,  (Me.). 

The  following  prescription  is  a useful 
diaphoretic  fever  mixture : 


R Spiritus  tetheris  nitrosi ttpxxx 

Liquoris  ammonii  acetatis ...  3 ii-iv 
Syrupi  simpliois, 

Aquai  camjjhonn,  cps.  ad  ....  3 i 


M.  Sig.-^ne  ounce  (two  tablespoonfiils)  in 
water  three  or  four  times  a day. 

The  free  use  of  diuretics  is  condemned; 
but  digitalis,  diuretin,  theophyllin,  an(l 
caffeine  (no  more  than  gr.  ix  daily)  may  be 
of  service  in  moderate  doses  when  the  heart 
is  weak  and  the  blood-pressure  low,  if  not 
continued  over  a day  or  two  at  a time  (for 
drug  formulae,  etc.,  see  Part  11). 


There  should  be  one  or  two  loose  bowel 
movements  daily.  To  this  end  employ 
Rochelle  salt,  Epsom  salt,  or  sodium  phos- 
l)hate,  5i~iv  of  anyone  dissolved  in  water, 
one  hour  before  breakfast;  or  the  laxative 
mineral  waters — Hunjadi,  Rubinat,  Carls- 
bad, etc.,  before  meals.  P'luid  magnesia 
is  useful  for  children.  If  necessary,  calomel, 
cas(!ara,  s(uina,  or  the  compound  laxative 
pill  may  be  given  at  bedtime. 

For  lumbar  pain  and  for  ha'inaturia 
employ  the  hot  water  bag,  or  the  Paquelin 
cautery,  or  a mustartl  pcniltice,  or  hot  lin- 
seed poultices  frequently  changed,  or  dry 
cu{)ping,  or  wet  cupping.  A dry  cup  is 
applied  as  follows:  a tumbler  is  swabbed 
quickly  with  alcohol,  the  edges  wiped  dry 
the  alcohol  ignited  and  allowed  to  burn 
for  a few  moments,  and  the  cup  then 
quickly  applied. 

For  vomiting,  withhold  all  footl,  give 
small  pieces  of  ice  to  suck,  apply  an  ice- 
bag  or  mustard  poultice  to  the  ei^igastrium, 
ancl,  if  need  be,  administer  some  one  of 
the  remedies  enumerated  umler  Vomiting. 
Rectal  feeding  (q.v.)  may  be  instituted. 

For  dysj^noea,  tap  serous  transudations,  if 
causative;  give  digitalis,  or  stroidianthin  for 
cardiac  dyspnoea.  Morj)hine  is  very  usefid. 

For  dropsy  and  scanty  urine,  restrict 
fluids  to  a minimum,  apply  dry  cups  over 
the  loins,  and  administer  cathartics,  viz., 
comj)ound  jalap  powder,  gr.  xx^oEii,  in  a 
little  water,  once  or  twdce  a day,  followed 
by  salines;  or  elaterium,  gr.  3^-)^,  two  to 
three  times  a day;  or  elaterin,  gr. 
two  to  three  times  a day;  or  croton  oil,  gtt. 
i-ii,  in  olive  oil.  If  the  purgative  causes 
griping,  give  extract  of  hyoscyamus,  gr. 

Hi  the  presence  of  acidosis  give 
alkalies  intravenously  {q.v.). 

Diaphoresis  may  be  jii'omoted  once  or 
twice  daily,  or  less  often,  as  required,  by 
means  of  hot  air  conducted  beneath  the 
elevated  blankets  through  a stove  pijie,  or 
by  means  of  electric  light  bulbs  placed 
beneath  the  blankets,  or  hot  wet  packs,  or 
hot  bricks  covered  with  wet  towels  sprinkled 
with  alcohol,  or  hot  or  lukewarm  tub  baths 
with  cold  cloths  to  the  head,  followed  liy  a 
rubdown  and  a warm  bed.  Be  careful  in 
employing  the  hot  tub  bath,  as  it  may 
weaken  the  patient.  The  sweating  should 
be  continued  for  from  twenty  minutes  to 
one  hour,  during  which  copious  hot  drinks 
should  be  given,  and,  perhaps  a diaphoretic 
(see  above  prescription).  An  ice-cap  should 
be  kept  to  the  head.  If  the  patient  does 
not  sweat,  give  pilocarpine,  gr.  to 

adults,  gr.  to  children  of  from  two  to 


BRIGHT’S  DISEASE;  NEPHRITIS 


ten  years,  hypodermically,  unless  the  heart 
is  weak.  Watch  the  pulse  closely  during  the 
sweat,  and  give  stimulants  if  recjuired,  e.g., 
camjihor,  gr.  i-ii,  in  olive  oil,  rjjxv-xxx  hypo- 
dermically; or  caffeine  sodiosalicylatc,  gr. 

hypodermically;  or  digitalin  (Ger- 
man), gr.  hy{X)dcrmically.  After 

the  sweat,  rub  the  patient  dry  and  cover 
with  woolen  blankets. 

Hot  rectal  urigations  with  normal  saline 
solution  (one  teaspoonful  to  the  pint),  for 
ten  to  fifteen  minutes,  tlu’ough  a two-way 
tube,  such  as  Kemp’s,  or  Tuttle’s,  or  Mar- 
tin’s, with  the  buttocks  slightly  elevated, 
are  of  value. 

Treat  intractable  ascites  and  pleural 
effusions  by  paracentesis,  as  described  under 
Ascites  and  Pleurisy.  If  the  legs  are  exces- 
sively oedematous,  they  may  be  drained  by 
means  of  a fine  aspirator  needle  connected 
with  rubber  tubing. 

Scarification  by  means  of  the  muTor  and 
laryngeal  lancet,  or  tracheotomy  ((/.w.)  is 
sometimes  required  for  cedema  of  the  larynx. 

See  Pulmonary  (Edema  for  its  treatment. 

Should  urajinic  sjmiptoms  (headache, 
drowsiness,  muscular  twitching,  convulsions, 
etc.,  see  Urjemia)  occur,  purge  and  sweat  the 
patient,  apply  dry  cups  followed  by  hot, 
frequently  changed  linseed  poultices  to  the 
loins,  give  rectal  irrigations  of  hot  normal 
saline  solution,  and,  if  the  patient  is  a 
robust  man,  withdraw  twenty  ounces  of 
blood  (three  to  six  ounces  in  a five-year-old 
child),  and  replace  it  with  twice  the  amount 
of  normal  saline  solution  (0.9  per  cent). 

Nitroglycerine,  gr.  }{oo-Ho,  every 
fifteen  to  thirty  minutes  until  effectual 
(gr-  Yoo  every  hour  for  five  or  six  doses, 
or  until  effectual,  for  a child  of  five  years, 
see  Part  11);  or  tincture  of  aconite,  iriji-ii, 
every  hour  until  effectual,  is  also  recom- 
mended where  the  arterial  tension  is  high. 
In  children  with  a temperature  of  102°  or 
more,  with  a hot  dry  skin,  aconite  is  very 
useful:  three  years — gtt.  ss  every  two  hours; 
older  children,  gtt.  i. 

For  restlessness,  insomnia,  and  headache, 
employ,  as  required,  the  bromides  or  chloral 
or  paraldehyde  or  trional  or  even  morphine. 
(See  Part  11.) 

Forconvulsions  give,  perrectum,  chloral,  gr. 
XX,  and  bromide,  gr.  xl  well  diluted;  and  chlo- 
roforminhalations  (under  threeyeai-s,  chloral, 
gr.  ii-iii,  sod.  bromide,  gr.  viii,  everyfour  to  six 
hours;  after  three  years,  chloral  gr.  iii,  sod. 
bromide,  gr.  viii-xv.  (Kerley.) 

In  impending  uriemia,  restrict  the  diet  to 
nothingelsethanonequart  orlitre  of  milkcon- 
taining  one-quarter  part  of  lime  water  a day. 


As  the  kidney  function  improves,  more 
and  more  water  may  be  allowed,  with,  per- 
haps, diuretics — potassium  citrate  or  ace- 
tate, gr.  x-xxx  every  tw(j  hours  or  so;  or 
cream  of  tartar  lemonade  freely  until  loose- 
ness of  the  bowels  results. 

Kiigelgen  advocates,  in  anuria  or  uraemia, 
decapsulation  of  the  kidney,  or  nephrotomy, 
for  the  purpo.se  of  relieving  congestion 
and  tension. 

During  convalescence  keep  the  patient 
warmly  clad  and  protected  against  cold. 
For  anaemia  give  Basham’s  mixture,  freshly 
prepared,  5 ii-iv,  well  diluted  in  water,  three 
or  four  times  daily  after  meals;  or  Blaud’s 
mass;  for  children,  the  syrup  or  the  iodide 
or  phosphate  of  iron.  Iron  should  not  be 
prescribed  until  after  the  acute  symptoms 
have  subsided. 

At  this  stage,  if  the  appetite  is  poor, 
tincture  of  mix  vomica,  and  dilute  hydro- 
chloric acid,  maybe  prescribed  before  meals. 

Caution  the  patient  against  chill,  and 
advise  him  to  wear  a flannel  protector 
about  the  loins. 

The  malarial  and  syphilitic  nephritiiles 
require  specific  treatment. 

II.  Chronic  Bright’s  Diseases.  A.  Chronic 
Parenchymatous  or  Chronic  Diffuse  Nephritis. 
— This  type  of  clironic  nephritis  is  charac- 
terized by  a slow,  imsidious  onset  (unless 
it  follows  acute  nephritis)  and  the  following 
manifestations:  marked  dropsy,  anaemia, 
indigestion,  frequently  diarrhoea,  commonly 
uraemic  .symptoms  (malaise,  headache,  sleep- 
lessness, vomiting,  etc.,  see  Uraemia),  and  the 
following  urinary  changes,  xdz.— climinished 
quantity,  normal  or  high  specific  graGty, 
acidity,  dark  color,  often  turbidity,  abundant 
sediment  on  standing,  abundance  of  albumin 
and  casts.  (See  Urinalysis.) 

Prognos-2's.— Death  usually  occurs  in  “from 
six  to  eighteen  months,”  unless  the  secon- 
dary contracted  kidney  (chronic  interstitial 
nephritis)  should  develop,  in  which  event 
life  may  be  prolonged  sometimes  for  several 
years.  Recovery  occasionally  occurs  in 
children  even  after  the  disease  has  persisted 
for  two  years.  (Osier.) 

Etiology. — Acute  nephritis  (q.v.);  habitual 
exposure  to  cold  and  damp;  acute  infectious 
diseases ; chronic  infection  through  the  tonsils, 
teeth,  simises,  gall-bladder,  etc.;  syphilis;  tu- 
berculosis; suppuration;  malaria;  alcoholism; 
diabetes;  chronic  passive  congestion  in  heart 
disease;  plumbism;  mercury  jx)isoning. 

TreatnmU.— Acute  exacerbations  should 
be  treated  the  same  as  acute  nephritis,  with 
rest  in  bed,  etc.;  otherwise,  except  in  the 
presence  of  ura'inia  or  marked  dropsy,  the 


BRIGHT’S  DISEASE;  NEPHRITIS 


patient  is  allowed  up.  The  diet  should  con- 
sist of  milk  with  lime  water,  one-fourth  part, 
or  Yeo’s  alkaline  solution  (see  under  Bright’s 
Disease,  Acute)  added,  buttermilk,  well- 
cooked  cereals,  fresh  bland  vegetables — peas, 
beans,  potatoes,  carrots,  tm’nips,  cauliflower, 
squash,  lettuce,  celery;  ohve  oil,  cream,  but- 
ter, bread,  fruit,  oysters,  fresh  fish,  eggs, 
and  meat  sparingly.  Interdict  liver,  kidney, 
sweatbread,  rumpsteak,  meat  extracts, 
soups,  broths,  tea,  coffee,  alcohol.  Reduce 
salt  to  a minunum.  Reduce  j^roteins  when- 
ever the  albuminuria  is  hicreased,  and 
dyspnoea,  headache,  and  general  discomfort 
occm-.  Allow  water  freely  only  when  it  is 
excreted  freely  and  there  is  no  dropsy.  The 
patient  should  be  warmly  clad,  wear  wool- 
en underclothing  and  a flannel  band  over 
the  loins,  keep  his  feet  dry  and  warm,  and 
should  reside,  if  practicable,  in  a warm,  thy, 
equable  climate,  such  as  that  of  Southern 
California,  Northern  Florida,  Egypt,  or 
Algiers.  The  bowels  should  be  kept  active. 
A hot  bath  followed  by  a rubdown  should 
be  taken  three  or  four  times  a week.  For 
anjBinia,  give  iron  as  in  acute  neplnitis. 

For  oliguria  and  dropsy,  employ  catharsis 
and  diaphoresis  as  in  acute  nephritis  {q.v.). 
In  the  absence  of  acute  inflammation 
diuretics  are  commonly  prescribed:  tligi- 
talis  (infusion,  5h-iv;  tincture,  Ttpv-xx; 
fluid  extract,  i^Mv),  well  diluted,  three  or 
four  times  a day,  for  one  or  two  days;  tinc- 
ture of  strophanthus,  npy-x,  in  water,  t.i.d.; 
caffeine,  gr.  ss-v,  not  over  gr.  ix  a day; 
theobromine,  gr.  .xv-xxii  a day;  theocin,  gr. 
hi,  well  diluted,  twice  or  thrice  daily  for  one 
day;  diuretin,  gr.  xx-lx  a day;  potassium  acet- 
ate or  citrate,  gr.  x-xxx,  t.i.d.;  infusum 
scoparii  (broom  tops), — 5ss  of  broom  tops 
in  water  Oiss,  boiled  down  to  a pint — 2 
oz.  frequently  until  the  whole  pint  is  taken 
in  tw’enty-f our  hours;  triticum  repens  (couch 
grass),  5 i ici  water  Oiss,  boiled  down  to  a pint, 
and  taken  in  the  same  way; juniper  berries,  §i, 
steeped  in  boding  water,  Oi,  for  one  hour, 
then  strained  and  given  as  the  preceding; 
cream  of  tartar,  5i,  may  be  added  to  the 
latter.  But  these  drugs  shoukl  be  used  with 
discretion;  they  may  do  no  good  and  may 
do  harm.  They  should  be  used  for  no  longer 
than  one  or  two  days  at  a time.  W.  Langdon 
Brown  advises  that  the  urine  be  tested 
daily  for  blood  (see  Urinalysis),  and  the 
drug  discontinued  at  once  if  the  slightest 
trace  is  found . He  regards  Basham’s  mixture 
as  the  best  diuretic. 

Kiigelgen  advocates  decapsulation  or 
nephrotomy  in  chronic  nephritis  with  uncon- 
trollable ura?mic  symptoms. 


B.  Chronic  Interstitial  or  Chronic  Vascular 
Nephritis  (Granular  Kidney). — This  type  of 
chi’onic  nephritis  is  characterized  by  a slow, 
insidious  onset,  with  anorexia,  dyspepsia, 
anajnua,  dizziness,  headaches,  shortness  of 
breath  on  exertion,  liigh  blood-pressure 
{q.v.),  usually  general  arteriosclerosis, 
hypertrophy  of  the  heart  with  the  second 
sound  accentuated,  and  the  following  urin- 
ary changes,  viz. — increase  in  amount  and 
frequency,  low  specific  gravity,  a trace  of 
albumin  and  a few  casts;  in  the  arterio- 
sclerotic kidney  the  amount  is  normal  or 
reduced,  and  the  specific  gravity  is  nor- 
mal or  increased  (see  Urinalysis).  Nose- 
bleed is  common.  Other  hemorrhages, 
including  renal  epistaxis,  cerebral  hemor- 
rhage, and  reti:ial  hemorrhage  may  occur. 
Other  occasional  manifestations  are; 
cramps  in  the  muscles,  especially  the  calf 
muscles,  neuralgias,  attacks  of  spasmodic 
dyspnoea  resembling  asthma,  transient  pa- 
ralyses and  amaiu'o.sis,  sudden  oedema  of  the 
glottis  or  hmgs,  persistent  vomiting  or  diar- 
rhoea, cardiac  incompetence,  uraemia  {q.v.). 
Acute  pleurisy,  pneumonia,  and  bronchitis 
are  common  comjfiications. 

The  affection,  however,  is  often  latent. 

Prognosis. — The  disease  is  practically  in- 
curable, but  the  patient  may  live  a long  useful 
life.  Says  Osier:  “ The  phenolsulphoneph- 
thalein  test  (see  Urinalysis)  gives  valuable  in- 
formation as  to  the  functional  capacity  of  the 
kidneys  and  is  a material  aid  in  prognosis.” 
“ If  the  elimination  of  phthalein,  on  the 
administration  of  phenolsulphonephthalein, 
is  below  10  per  cent,  in  two  houi’s,  there  is 
grave  danger  of  ursemia.” 

Etiology.— Acute  nephritis  (q.v.);  chronic 
parenchymatous  nephritis  {q.v.);  overeating 
and  overdrinking;  mental  and  nervous 
strain;  chronic  gastro-intestinal  indigestion 
with  protein  putrefaction  and  resulting 
diamine  intoxication;  heredity;  gout;  dia- 
betes, syphilis;  alcohol;  lead;  chronic  con- 
gestion due  to  heart  disease;  tramnatisrn; 
chronic  obstruction  to  the  outflow  of 
urine;  arteriosclerosis  (^.v.) ; chronic  infection 
through  the  tonsils,  teeth,  sinuses,  gall- 
bladder, etc. 

Treatment. — Enjoin  a quiet,  orderly  mode 
of  life,  with  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals,  woolen 
underclothing,  a daily  tepid  bath  with 
friction  (no  cold  baths),  daily  gentle  exer- 
cise in  the  open  air,  ancl  a daily  movement 
of  the  bowels,  preferably  by  means  of 
sodium  sulphate,  5i~viii,  in  hot  water,  one 
hour  before  breakfast.  A weekly  calomel 
purge  followed  by  a saline,  is  advised  (see 


BRIGHT’S  DISEASE;  NEPHRITIS 


Part  11).  A dry,  warm,  equable  climate  i.s 
best,  such  as  that  of  Southern  California, 
Northern  Florida,  Egypt,  or  Algiers.  The 
diet  .should  consist  of  milk,  Ij^  quarts  or 
less  a day;  buttermilk,  1)4  quarts  or  less 
a day,  well-cooked  cereals — oatmeal,  wheat, 
farina,  rice,  barley,  sago,  tapioca,  noodles, 
matvaroni — vegetables — green  peas,  string 
beans,  potatoes,  carrots,  tmaiijis,  cauli- 
flower (restrict  the  use  of  lettuce,  celery, 
radishes,  sorrel,  onions,  garlic,  tomatoes, 
asparagus,  mushrooms) — puddings,  cream, 
ice  cream,  bread,  butter,  an  occasional  egg, 
boiled  three  minutes,  sweets  and  meat  very 
sparingly.  Reduce  last  to  a minimum. 
.Allow  no  meat  soujis  or  extracts,  internal 
organs,  sauces,  condiments,  pastries,  alco- 
hol; tea,  coffee,  and  tobacco  in  moderation, 
or  not  at  all. 

Some  advocate  restricted,  some  copious 
water  drinking,  some  a “ flushing  out  ” 
once  a week.  Fluids  should  certainly  be 
restricted  when  the  blood  tension  is  high. 

When  the  blood-pressure  is  persistently 
high,  with  resulting  headache,  dizziness,  and 
dyspnoea,  enjoin  rest  and  curtail  the  diet, 
keep  the  bowels  active,  encourage  diaphore- 
sis by  means  of  hot  baths,  and  prescribe 
nitroglycerin  or  sodium  nitrite,  or  erythrol 
tetranitrite.  Says  Osier;  nitroglycerin  may 
be  given  “for  six  to  seven  weeks,  then  stopped 
for  a week  and  resumed.”  Potassium  iodide, 
gr.  V,  t.i.d.,  may  also  be  given  for  long 
periods  (see  Arteriosclerosis). 


R Sodii  iiitritis gr.  ss 

Erythrol  tetranitritis gr.  )4 

Mannitol  nitritis gr.  M 

Aininonii  hippuratis gr.  i 


(Called  tabloids,  Sodii  Nitrit.  Co.,  Oliver,  Bur- 
roughs and  Wellcome.) 

Sig. — One  tabloid  twice  or  thrice  a day,  with  a few 
days  or  a week’s  intermission  in  each  month.  (( )livcr.) 

For  cardiac  incomj^etency,  manifested  by 
a gallop  or  fetal  rhjThm,  dyspnoea,  tlropsy, 
and  scanty,  albuminous  urine,  put  the 
))atient  to  bed  on  a reduced  diet  consisting 
of  such  concentrated,  easily  digestible  foods 
tusmilk,  cream,  crackers, toast, zweil)ack,  eggs 
boiled  three  minutes,  and  well-cooked  cer- 
eals; open  the  bowels  with  calomel,  gr.  ii-v, 
at  night,  followed  I)y  Rochelle  salt,  5iv  in 
hot  water,  one  hour  before  breakhist,  and 
administer  digitalis:  U Tinctune  digitalis, 
ii^x,  w'ell  diluted,  three  or  four  times  a day; 
or  li  Infusi  i-ecenti  digitalis  foliorum,  5>-iv, 
diluted,  three  or  four  times  a day;  or  R Dig- 
italini  (Merck’s  German),  gr. 
t.i.d.  hypo(lermically.  Reduce  the  dose 
when  the  full  effects  of  the  drug  are  ol> 


tained,  or  shoukl  untoward  symptoms 
occur,  such  as  a slow,  bigeminal  pulse, 
nausea,  restlessness,  delirium,  etc.  (see 
Part  11).  When  prompt  stimulation  is 
demanded,  inject  camphor,  gr.  i-iii,  in 
olive  oil,  gtt.  x-xx  several  times  a day. 
If  the  patient  is  robust,  300-700  c.c.  of 
blood  may  be  withth’awn.  Apply  ice  to 
the  precordium  for  the  relief  of  palpitation. 
Give  morphine  for  pain,  restlessness,  and 
insomnia  (see  also  Insomnia). 

For  acitl  eructations,  prescribe  mistura 
rhei  et  sodae,  5ss-i-iv,  once  to  thrice  daily; 
or  magnesia  (Part  11),  or  sodimn  bicarbon- 
ate, a teaspoonful  to  a tumbler  of  water, 
to  be  sipped  as  required. 

For  distressing  gaseous  distension,  restrict 
nitrogenous  foocl,  cleanse  the  bowels,  and 
prescribe,  perhaps,  resorcin;  R Resorcino- 
lis,  gr.  XX,  Aquae,  5h.  M.  Sig. — One  drachm 
in  water,  t.i.d.  (resorcin  gr.  per  dose). 

For  vomiting,  withhold  all  food,  give 
small  pieces  of  ice  to  suck,  apply  an  ice- 
bag,  or  mustard  poultice,  or  heat  to  the 
epigastrium,  and,  if  need  be,  administer 
small  doses  of  morphine  hypodermically,  or 
some  one  of  the  remedies  enumerated 
under  Vomiting.  Rectal  feeding  (q-v.) 
may  be  instituted. 

For  persistent  diarrheea,  prescribe  a 
calomel  or  castor  oil  purge,  followed  by 
tannigen,  gr.  v,  in  powder  or  capsule,  three 
or  four  times  daily;  or  Tinct.  luno,  5ss, 
three  or  four  times  daily.  A moderate 
diarrhoea  should  not  be  checked. 

For  anaemia,  prescribe  fresh  air  day  and 
night,  nourishing  food,  bitter  tonics  (tr. 
nucis  vomicae,  and  dilute  hydrochloric 
acid,  before  meals),  and  iron  (Bland’s  mass, 
Basham’s  mixture,  tinct.  ferri  perchloridi, 
5ss-i,  t.i.d.)  (Weir  Mitchell.) 

For  the  treatment  of  uraemia  (manifested 
by  a coated  tongue,  vomiting,  dyspnoea, 
perhaps  headache,  irritable  heart,  high 
blood-pressure,  diminished  urinary  secretion, 
muscular  twitching,  restlessness  or  drowsi- 
ness, delirium,  etc.)  see  Uraemia. 

Diuretics  are  jiermissible  only  when 
the  urinary  secretion  is  deficient  (cardiac 
oliguria;  see  under  Chronic  Parenchj'- 
matous  Nephritis.) 


R Diurotin gr- x 

Potasii  tartrati.s gr.  xx 

Spiritus  junipori mjxxx 

Infu.si  .scopari,  acl 5i 

M.  Sig. — One  ounce  everx-  four  hours  with 


plenty  of  water.  (W.  Langdon  Brown.) 

Decapsulation  and  fixation  of  the  kidnet'^ 
is  to  be  considered  only  as  a last  resort  of 


BRONCHITIS 


doubtful  utility  in  cases  which  are  growing 
progressively  worse  under  medical  treatment. 

Brill’s  Disease, — See  Typhus  Fever. 

Brodie’s  Abscess.— See  under  Osteo- 
myelitis. 

Broken  Cardiac  Compensation. — See 

Cardiac  Insufficiency. 

Bronchial  Catarrh. — See  Bronchitis. 

Dilatation. — See  Bronchiectasis. 

Obstruction. — See  Bronchostenosis. 

Stenosis.- — See  Bronchostenosis. 

Str  ictu  re. — See  B ronchostenosis . 

Bronchiectasis. — Gr.  fipdyxos  bronchus  + 
tKTacns  dilatation. 

Bronchial  dilatation,  either  localized  or 
diffuse,  manifested  clinically  by  a paroxys- 
mal cough,  occurring  especially  on  rising 
in  the  morning  and  on  lying  down  at  night, 
and  a copious  muco-purulent,  eventually 
offensive,  fluid  expectoration,  which  on 
standing  separates  into  layers.  Clubbing 
of  the  fingers  frequently  occurs. 

The  Prognosis  is  usually  good  in  cases  fol- 
lowing measles,  whooping  cough,  and  influ- 
enza. In  other  cases  the  condition  is  apt 
to  persist  until  death  occurs  from  broncho- 
pneumonia, tuberculous  infection,  hismopty- 
sis,  gangrene,  pyemia  (particularly  cerebral 
abscess),  amyloid  degeneration  of  the  vis- 
cera, or  acute  dilatation  of  the  heart.  With 
care,  however,  in  keeping  the  cavities 
aseptic,  the  patient  may  live  many  years. 

Etiology.— Bronchitis,  acute  and  chronic; 
pneumonia,  lobar  and  lobular,  especially 
bronchopneumonia  following  influenza,  less 
often  measles  or  whooping-cough;  pleurisy 
with  effusion;  adhesive  pleuritis;  interlobar 
empyema;  pulmonary  collapse;  fibrosis  of 
the  lung;  emphysema;  pneunionokoniosis ; 
pulmonary  neoplasm;  tuberculosis;  bronchial 
stricture  or  stenosis  (see  Bronchostenosis, 
for  causes) ; chronic  cough  associated  with 
poor  health. 

Treatment. — Fresh,  clean  air  is  of  the  first 
unportance.  The  bronchial  cavities  should 
be  emptied  regularly,  at  least  every  morn- 
ing and  evening,  by  lowering  the  head  and 
body,  and  inclining  them  toward  the  sound 
side,  after  which,  once  daily,  creosote  vapor 
should  be  inhaled  within  an  enclosed  space, 
e.g.,  a small,  air-tight  room.  About  thirty 
drops  of  creosote  are  placed  in  water  or 
sand,  in  a flat  metal  dish,  on  a tripod,  over 
an  alcohol  lamp.  The  vapor  is  inhaled  at 
first  for  fifteen  minutes  every  other  day; 
then  the  time  is  gradually  increased  up  to 
one-half  to  one  to  two  hours  daily,  and  con- 
tinued for  three  months.  The  eyes  should 
be  protected  with  watch-glasses  sealed  with 
adhesive  plaster,  the  nose  with  cotton  wool. 


the  hair  with  a towel  or  cap,  and  the  cloth- 
ing with  a gown.  The  inliafations  produce, 
after  about  twenty  minutes  or  so,  violent 
coughing  and  expectoration,  and  are  usually 
very  efficacious. 

The  intratracheal  injection  twice  daily  of 
one  dram  of  one  of  the  following  emulsions 
is  also  recommended: 


1}  Menthol 10.0 

Guaiacol 2.0 

Olei  ofivai  stcrilisati 88.0 


R Emulsio  iodoformi  in  oleo  oliva?,  2-10  per 
cent,  (less  irritating  than  the  above). 

The  emulsion  may  be  nijected  through  a 
nozzle  whose  tip  is  introduced  beyond  the 
vocal  cords  (the  larynx  may  first  have  to  be 
aniesthetized  with  a 4 jx3r  cent,  solution  of 
cocaine);  or  Musser’s  or  Mendel’s  recom- 
mendation may  be  followed:  “A  simple 

methotl  is  to  have  the  patient  stick  out  the 
tongue  and  then  gently  inject  on  the  lateral 
pharynx  the  drug,  which  then  trickles  down 
into  the  trachea  and  bronchi.  The  patient 
should  be  told  not  to  swallow  during  the 
tieatment,  and  the  tongue  should  be  kept 
out  for  some  seconds  after  the  drug  has 
been  injected.” 

The  following  drugs  may  serve  as  dis- 
infectants and  deodorizers  of  the  bronchial 
secretions,  viz.,  R Olei  terebinthina?  rectifi- 
cati,  TTgxv  in  water,  t.i.d.;  R terebini, 
TTjv-xv,  in  cajjsule  or  on  sugar,  t.i.d.;  R C're- 
osoti,  tTijii-v,  well  diluted  in  water,  t.i.d.; 
R Eucalyptol,  njv-xv,  in  capsule,  t.i.d., 
R myrtol,  n^i-ii,  in  capsiffe,  t.i.d.;  R Thy- 
mol, gr.  i-ii,  in  capsule,  t.i.d.  R Cam- 
phorsD,  gr.  i-iii,  in  capsule,  three  or  four 
times  a day.  As  little  fluid  as  possible 
should  be  drunk,  in  order  to  reduce  the 
bronchial  secretions  to  a minimum. 

If  the  opening  into  the  dilated  bronchus 
is  large,  the  artificial  production  of  pneu- 
mothorax by  the  injection  of  sterile  nitrogen 
gas  (Murphy)  is  saitl  to  be  the  most  effectual 
treatment  (see  Pneinnothorax,  Artificial). 

Of  the  two  operative  procedures  at  oiu* 
disposal,  (1)  pneumotomy  or  rib  resection, 
for  the  purpose  of  making  the  lung  collapse, 
is  without  much  danger,  but  is  not  apt  to 
be  altogether  curative;  (2)  Pneumectomy, 
or  excision  of  the  lobe  to  which  the  cavity 
is  confined,  is  apt  to  be  curative  if  success- 
ful, but  the  mortality  of  the  operation  is 
about  fifty  per  cent. 

Bronchitis. — Gr.  Pp6jx<-(x  air-tubes  + -itls 
inflammation. 

A.  Acute  Bronchitis. — A common  acute 
catarrhal  inflammation  of  the  bronchial 
mucous  membrane,  usually  bilateral,  char- 


BRONCHITIS 


acterized  by  a substernal  sense  of  rawness 
and  compression,  some  fever,  malaise,  and  a 
cough  wliich  is  at  first  dry  and  racking  and 
accompanied  by  musical  rales  and  a scanty 
viscid  expectoration,  the  latter  in  a few 
days  becoming  mucopurulent  and  abundant 
with  bubbling  rales,  and  later  purulent. 
When  the  infiammation  is  confined,  however, 
to  the  trachea  and  larger  bronchi,  no  rales 
are  hearth 

Tubci'culous  bronchitis  is  usually,  and 
influenzal  bronchitis  often,  unilateral  instead 
of  bilateral. 

There  is  a benign  bronchitis,  usually  last- 
ing about  a month,  which  occurs  in  India 
and  has  been  introduced  into  various  other 
countries,  and  which  is  accompanied  by  a 
uniformly  rosy,  viscid  expectoration,  resem- 
bling currant-juice.  It  is  due  to  the  spiro- 
chaeta  bronchialis. 

Recovery  from  acute  bronchitis  usually 
occurs  in  from  ten  to  fourteen  days;  longer 
in  severe  cases.  The  danger  is  extension  of 
the  inflammation  to  the  capillary  bronchi 
(capillary  bronchitis  or  bronchopneumonia), 
when  the  symptoms  become  severe, 
with  diverse  rales  throughout  the  chest 
unaltered  by  coughing,  dyspnoea,  perhaps 
cyanosis,  and  perhaps  some  dullness  and 
blowing  breathing. 

Etiology.— Exp osAire  to  inclement 
weather;  an  ordinary  “ cold,”  or  catarrhal 
fever;  irritating  inhalations  such  as  dust, 
fumes,  or  gases ; foreign  bodies ; irritating  pul- 
monary excretions  such  as  iodme,  bromine, 
etc.;  infection  of  the  upper  air  passages; 
asthma;  hay  fever;  influenza;  whooping 
cough;  measles;  scarlet  fever;  typhoid  fever; 
diphtheria;  malaria;  smallpox;  syphilis; 
tuberculosis;  the  plague;  glanders;  anthrax; 
pemphigus;  trichiniasis;  pneumonia;  aden- 
oids and  enlarged  tonsils;  adynamic  states, 
e.g.,  heart  disease,  chronic  nephritis,  diabetes, 
alcoholism,  carcinoma,  scurvy,  rickets,  mal- 
nutrition, tuberculosis,  syphilis,  cholera, 
infective  endocarditis. 

Causative  bacteria  are  the  pneumococcus, 
streptococcus,  influenza  bacillus,  micrococ- 
cus catarrhal’s,  Friedlander’s  diplobacillus, 
staphylococci,  bacillus  coli,  typhoid  bacillus, 
micrococcus  tetragenus,  saprophytes,  spiro- 
clueta  bronchialis  of  India. 

Treatment. — Keep  the  patient  in  bed  dur- 
ing the  acute  stage  (three  or  four  days  or 
longer).  The  room  should  be  warm — G5°- 
72°  F. — but  well  ventilated  and  free  from 
draughts.  A woolen  undervest  should  be 
worn.  The  patient  should  be  almost  sitting, 
and  should  not  lie  too  long  on  one  side  for 
fear  of  hypostatic  congestion.  The  diet 


should  be  liquid  during  the  acute  stage. 
Open  the  bowels  with  castor  oil,  5ss-i,  or 
calomel,  gr.  ii-v,  followed  by  a saline  (see 
Part  11). 

A full  hot  bath  of  about  fifteen  minutes’ 
duration,  taken  at  the  onset  at  home,  and 
followed  instantly  by  blanketing,  hot  water 
bottles,  and  copious  hot  drinks,  such  as  hot 
lemonade  containing  whiskey  or  brandy,  a 
tablespoonful  to  the  tumbler,  or  hot  milk 
and  Seltzer  or  Apollinaris,  or  Vichy 
water,  with  or  without  a dessertspoonful 
of  brandy  or  whiskey,  every  three  or  four 
hours,  is  often  abortive.  The  hot  pack, 
however,  is  perhaps  in  most  cases  pre- 
ferable to  the  hot  bath,  because  more 
practicable.  A hot  mustard  foot  bath, 
13^  to  3 ounces  of  mustard  to  the  bath, 
is  also  beneficial. 

As  diaphoretics,  may  be  given — Dover’s 
powder,  gr.  v-vii ; or  liquor  ammonii  acetatis, 
one  tablespoonful,  with  spiritus  setheris 
nitrosi,  one  teaspoonful,  well  diluted;  or 
pilocarpine,  gr.  3^o“Ko-  Sodium  bicarbon- 
ate, gr.  x-xx,  well  diluted  in  hot  water,  every 
one  or  two  hours  for  twenty-four  hours,  or 
potassium  citrate,  acetate,  or  carbonate, 
gr.  x-xxx,  well  diluted,  every  four  or  five 
hours,  is  recommended.  (See  Part  11  for 
dnig  formulge,  etc.). 

Quinine  sulphate,  gr.  iii  (7  to  10  grains  a 
day  for  the  first  three  or  four  days)  is  sup- 
posed to  be  of  some  abortive  value,  and 
may  be  useful  in  severe  cases. 

Tincture  of  aconite,  gtt.  i every  hour  for 
five  or  six  doses,  is  of  value  if  the  pulse 
is  full  and  rapid.  It  is  especially  useful 
in  children. 

The  application  of  a mustard  paste  (1.2 
of  flour  at  first;  later  as  the  skin  becomes 
sensitive,  1:5  or  6;  kept  on  for  five  to  fifteen 
minutes,  or  until  a flush  is  produced)  two 
to  five  times  a day,  followed  by  camphorated 
oil,  or  lard  and  turpentine,  equal  parts,  is 
very  valuable.  Cold  wet  compresses,  cov- 
ered with  dry  flannel,  and  kept  on  until 
dr>q  or  changed  every  two  to  four  or  five 
hours,  are  also  well  recommended. 

The  air  of  the  room  should  be  kept  moist 
during  the  dry  stage  by  means  of  the  steam 
kettle.  Every  two  or  three  hours  the 
patient  may  inhale  under  a sheet,  for  about 
fifteen  or  thirty  minutes,  the  vapor  from  a 
vessel  of  boiling  normal  saline  solution; 'or 
sodium  bicarbonate,  2-3  per  cent,  solution; 
or  lime  water;  or  plain  water;  or  water 
containing  compound  tincture  of  benzoin, 
pi,  and  light  magnesium  carbonate,  5i  + to 
the  pint;  or  creosote,  njx-xv  to  the  pint;  or 
the  following: 


BRONCHITIS 


R Olei  pini  sylvestris, 

Olei  eucalypti aa  njjxv 

Mentliolis,  seu  acidi  carbolici . gr.  v 
Magnesii  carbonatis  Icvis ....  gr.  x 

Creosoti njx 

Tincturaj  benzoiiii  coinpo.sitac . § i 
M.  Sig. — One  teaspoonful  in  a pint  of  steaming 


water  as  an  inhalant.  Add  glycerine  Sd  to  the 
above,  if  used  in  a nebulizer.  (McPhedran.) 

The  solution  may  be  heated  in  a Holt 
croup  kettle,  or  in  a vessel  on  a tripotl  over 
an  alcohol  lamp.  With  infants  the  sheet 
may  be  placed  over  an  umbrella.  Every 
ten  minutes  the  sheet  should  be  lifted  and 
fresh  air  wafted  in.  Holt  and  Kerley  regard 
creosote  as  the  best  inhalant. 

Yeo  heartily  recommends  for  children  the 
following  warm  spray,  which  is  “ allowed  to 
play  freely  before  the  child’s  mouth 
and  nose,  by  means  of  a Seigle’s  steam- 
spray  producer 


R Sodii  bicarbonatis gr.  x 

Glycerini  acidi  carbolici 5i 

Aqua}  destillata; 5i 


M.  Sig. — -To  be  used  warm  as  a sj^ray.  (Yeo.) 

The  following  preparations  are  employed 
for  the  relief  of  a dry,  harassing  cough: 

Dover’s  powder,  gr.  v-vii;  gr.  Ko  every  two  hours 
for  a one-year-old  child  (see  also  Part  11). 

Dover’s  powder,  gr.  ss,  and  phenacetin,  gr.  ii 
every  three  to  six  hours  for  a five-year-old  child 
(see  also  Part  11). 

Paregoric,  one  month,  ngi;  three  months,  t^ii; 
one  year,  trjv-x;  five  years,  Tgjxxx-xl  (see  also  Part  1 1). 

Codein,  gr.  Ks-bf  (see  Part  11). 

Heroin,  gr.  Mo-He  (see  Part  11). 

Morphine,  gr.  Jh-’b  (see  Part  11). 

Sedatives  should  be  used  only  for  a use- 
less cough  not  associated  with  an  accumu- 
lation of  secretion  in  the  tubes.  They 
should  not  be  given,  as  a rule,  to  children, 
or  to  the  aged. 

R Syrupi  sanguinaria}, 

Syrupi  ipecacuanha}, 

Syrupi  scillce aajss  (irp_  per  dose) 

Syrupi  pruni  Vir- 
ginian®, q.s.  ad.  5 in 

M.  Sig. — One-half  to  one  dram  every  two  to 
three  hours  until  relief  is  obtained.  (For  dry, 
hara.ssing  cough  and  chest  oppression,  J.  H. 
Musser.)  Sjrrup  of  ipecac  may  be  given  alone, 
several  drops  every  hour. 

B Vini  antimonialis . . 

Vini  ipecacuanh®. . aanglxxx  (ttjx  per  dose) 
Mistur®  glycjurhi- 

z®  com  posit®.  . . 3i  (3i  per  dose.) 

Liquoris  ammonii 
acetatis,  q.s.  ad.  3iv 

M.  Sig. — One-half  ounce  every  four  hours,  for 
dry  cough.  (McPhedran.) 

5 


R Vini  antimonialis  . . irjxxx  (itjvii  per  dose) 
Spiritus  ®theris  ni- 

trosi i^lxxx  (ttjxx  per  dose) 

Liquoris  ammonii 

acetatis §i  (3ii  per  dose) 

Syrupi  tolutani 3iv  (3i  per  dose) 

Aqu®  camphor®,  ad  5iv 

M.  Sig. — One  ounce  every  four  hours,  for  the 
dry  stage.  (H.  Pritchard.) 

Infants  Adults 

R Fluidextracti  ipeca- 
cuanh®  njv-xx  (heK-IK  per  dose) 

Ammonii  chloridi . . gr.  iii-xw  (gr.  %-!  per  dose) 

Syrupi  tolutani oss  (iry-xvi  per  dose) 

Aqu® 5 iss 

M.  Sig. — One  tcaspoonful  every  two  hours, 
according  to  age,  for  the  dry  stage.  (P’orchheimer.) 

R Infu.si  ipecacuanh®,  gr.  ss-x  ad  5 iss  (gr. 
per  do.se). 

Ammonii  chloridi,  gr.  iii-xv  (gr.  %-l  per  dose). 
Syrupi 5 ss 

M.  Sig. — One  teaspoonful  every  two  hours, 
according  to  age — for  the  dry  stage  (the  infu- 
sion of  ipecac  is  better  than  the  fluid  extract). 
— (Forchheimer). 

R Ammonii  chloridi . . gr.  xl  (gr.  v per  dose) 
Mistur®  glycyrrhi- 
z®  composit® ...  o >v 

M.  Sig. — Tablespoonful  every  three  or  four 
hours,  as  required,  for  cough. 

R Potassii  seu  am- 
monii iodidi,  so- 
lutionis concen- 
trati 3 ii 

Sig. — -Three  to  five  drops,  well  diluted,  every  two 
or  three  hours,  for  the  dry  stage. 

R Codein®  sulphatis.  gr.  iv  (gr.  % per  dose) 
Ammonii  chloridi. . 3iss  (gr.  3%  per  dose) 
Syrupi  acidi  citrici 
vel  Syrupi  tolu- 


tani   5 i 

Aqu®,  q.s.  ad giv 


M.  Sig. — Teaspoonful  in  water,  every  two  or 
three  hours.  {Ilandbooh  of  Therapy  of  the  A.  M.  A.) 

“ Carbonate  of  ammonium,”  says  Pritch- 
ard, “ should  not  be  used  in  the  acute  stage 
of  acute  bronchitis.”  Ipecac  is  especially 
indicated.  Ammonium  chloride  is  an  effi- 
cient expectorant  in  the  second  stage. 

Should  suffocation  threaten,  aclminister 
a prompt  emetic, — ipecac  gr.  xx;  or  better, 
apomorphine,  gr.  hypodermically,  gr. 

by  mouth;  for  children,  wine  of  ipecac, 
one  tablespoonful,  repeated  if  necessary. 
For  attacks  of  suffocation  in  infants,  employ 
spanking,  alternate  hot  and  cold  douches 
to  the  chest,  the  hot  mustard  bath- — one 
tablespoonful  to  six  gallons, — a mustard 
pack,  of  the  same  strength,  to  the  entire 
body,  oxygen  inhalations  (g.v.),  and  dry 
cupping  (g.v.)  to  the  front  and  back  of 
the  chest  for  five  to  ten  minutes  every  few 
hours.  The  air  of  the  room  should  be  kept 
warm  70°-72°  F.  (Holt.) 


BRONCHITIS 


Strychnine,  gr.  }4o~Ho}  administereil 
hypodermically,  is  a respiratory  and  circu- 
latory stimulant.  Given  at  bedtime  it  may 
prevent  nocturnal  dyspnoea.  For  a weak  heart 
administer  digitalis,  or  caffeine  or  alcohol 
every  three  hours  (see  Part  11.) 

For  severe  dyspnoea  and  cyanosis  apply 
dry  cups  to  the  back  and  mustard  ixniltices 
to  the  front. 

Discontinue  the  use  of  antimony,  opium, 
and  aconite,  just  as  soon  as  the  cough,  dry- 
ness, and  fever  are  relieved. 

During  the  Wet  Stage  the  following  expec- 
torants, etc.,  may  be  used  if  deemed  proper: 

R Terpini  hydratis  vel  Olei  picis  liquidse,  et 
Ammonii  chloridi;  aa  gr.  v,  in  capsule,  every 
three  hours. 

R Terebeni,  5 to  10  drops,  on  sugar,  or  in  capsule, 
t.i.d. 

R Ammonii  chloridi.  . . 3ss-i  (gr.  iiss-v  per  dose) 
Fluidextracti  senegue  qh-iv  (r^x-xx  per  dose) 

Aquaj,  q.s.  ad 5vi 

M.  Sig. — -Tablespoonful  every  two  hours. 

R Olei  terebinthaj  rectificati,  gtt.  x-xx,  in  a 
tablespoonful  of  milk,  followed  immediately  by  half 
a glass  of  milk,  t.i.d.  Discontinue  at  once  should 
signs  of  renal  irritation  appear. 


R Sodii  benzoatis gr.  xl-5iv 

Aquffi o iv 


M.  Sig. — Tablespoonful  (gr.  v-xxx)  in  water, 
twice  or  thrice  daily. 

R Balsami  tolutani  vel 

Peruvianae 5i-iii  (gr.  v-xv  per  dose) 

Mucilaginis  acacia; . . 5 u 

M.  Sig. — One  teaspoonful  several  times  a day. 
(The  balsams  contain  benzoin  or  its  derivatives.) 

R Olei  cupebae,  copaiba;,  vel  santali,  t^x-xv  in 
cap.sule,  several  times  a day.  Discontinue  should 
gastric  irritation  occur. 

R Infusi  senegae giv 

Ammonii  carbonatis gr.  xxxii 

Tincturae  scillae njclx 

Spiritus  chloroformi oii 

Aquam,  ad §viii  B.  P. 

M.  Sig. — Two  tablcspoonfuls  every  four  or  five 
hours.  (Yeo.) 

R Tincturae  belladonna;,  itbv-x,  in  water,  every 
three  or  four  hours,  or  Atropinae,  gr.  1/200-1/50, 
as  required,  for  bronchorrhoca. 

B Fhiidextracti  hydrastis  Canadensis,  gtt.  xx- 
XXV,  well  diluted  in  milk  or  water,  t.i.d.  (N.  Sa;nger.) 

B Hexamethylenaminae,  gr.  viiss,  in  capsule  or 
powder,  t.i.d.  (Mikhailoff.) 

Medicated  steam  inlialations  are  also 
useful  in  the  Wet  Stage. 

During  convalescence  tonics  may  be  indi- 
cated, e.g.,  elixir  ferri,  quininae,  et  strych- 
ninai  phosphati,  one  teaspoonful  well  diluted, 
t.i.d.;  or  arsenic  or  codliver  oil.  A warm 
dry  climate  is  best,  such  as  that  of 


Southern  Arizona,  New  Mexico,  Western 
Kansas,  Colorado,  Wyoming,  Georgia,  Upper 
Egypt,  Algiers. 

B.  Chkonic  Bronchitis. — A common 
chronic  inflammation  of  the  bronchial  mu- 
cous membrane,  always  associated  in  old 
men  with  emphysema  and  cardiac  weak- 
ness, and  often,  at  any  age,  with  bronchial 
dilatations;  characterized  by  a chronic,  vari- 
able cough,  especially  marked  in  winter, 
shortness  of  breath  on  exertion,  usually 
abundant  expectoration,  and  the  following 
physical  signs — chest  usually  deep,  per- 
cussion note  clear  or  hyperresonant,  sibi- 
lant, rhonchi  on  expiration,  which  is  pro- 
longed, or,  in  children,  coarse  mucous  rales, 
often,  in  the  elderly,  crepitant  rales  at  the 
bases.  If  the  trachea  and  larger  bronchi 
are  alone  affected,  no  physical  signs  may  be 
evident.  Occasionally  there  is  little  or  no 
expectoration  (dry  catarrh);  very  rarely  the 
expectoration  is  fetid  (putrid  bronchitis: 
exclude  bronchiectasis,  gangrene,  abscess, 
tuberculous  cavities,  perforation  of  the 
lung  by  an  empyema,  and  foreign  body). 

The  Prognosis  in  the  young  is  favorable; 
in  those  beyond  middle  life  it  is  unfavorable 
as  regards  cure. 

Etiology. — Acute  bronchitis ; a cold,  change- 
able climate;  gout;  obesity;  alcoholism; 
arteriosclerosis;  chronic  nephritis;  chronic 
dyspepsia  giving  rise  to  auto-intoxication; 
severe  anaemia;  rickets;  malnutrition;  tuber- 
culosis; syphilis;  mouth-breathing  due  to 
nasal  obstruction,  adenoids,  etc.  (see  Nose 
Diseases,  Part  8) ; chronic  naso-pharjmgeal 
catarrh  (see  Nose  Diseases);  irritating  inhal- 
ations, e.g.,  dust,  fumes,  gases,  tobacco  smoke; 
certain  drugs  excreted  by  the  bronchial  muco- 
sa, such  as  iodine  and  bromine;  chest  deformi- 
ties due  to  rickets  or  Pott’s  disease;  protracted 
whooping-cough;  measles;  asthma;  emphy- 
sema; pleural  adhesions;  enlarged  bronchial 
glands;  chronic  interstitial  pneumonia;  bron- 
chiectasis; pulmonaiy  neoplasm;  pneumo- 
nokoniosis;  aortic  aneurA'sm;  chronic  passive 
congestion  of  the  lungs  due  to  heart  disease. 

Treatment.— Xtiend  to  any  possible  causal 
factor.  Enjoin  an  outdoor  life,  with  light 
but  warm  clothing  and  woolen  under- 
garments, deep-breathing  exercises  ever}’- 
morning  before  breakfast,  and  regular  bowel 
activity.  A coiu’se  of  calomel,  gr.  ii-v  a day 
for  three  days,  is  often  valuable.  Sulphur, 
gr.  v-x,  t.i.d.,  may  be  of  service.  Pro- 
longed wami  full  baths,  ameliorate  cough. 
Such  tonics  as  codliver  oil,  to  which  creosote, 
or  terebene  may  be  added,  elixir  calcii  et 
sodii  glycero-phosphati,  two  teaspoonfuls 
t.i.d.,  and  the  elixir  ferri,  quininae,  et  strych- 


BRONCHITIS 


ninae  phosphati,  one  teaspoonful  in  water 
t.i.d.,  are  often  useful  (see  Drugs,  Part  11). 

The  alkalies  are  well  recomniencled,  and 
are  especially  indicated,  if  the  urine  is 
highly  acid  (gouty  diathesis).  Five  or  six 
ounces  of  Apollinaris,  or  Enis  water  may  be 
taken  in  a little  boiling  hot  milk  four  or 
five  times  a day  (Yeo);  or  about  a half- 
teaspoonful of  sodium  bicarbonate  may 
be  added  to  the  milk.  The  iodides  are 
very  useful. 

For  troublesome  cough  try  the  following: 

Sodii  bicarbonatis . oiss  (gr.  xv  per  do.se) 

Sodii  chloridi 3ss  (gr.  v per  dose) 

Ammonii  carbonatis  3ss  (gr.  v per  dose) 

Potassii  iodidi gr.  xx  (gr.  iii-1/3  per  dose) 

Spiritus  chloroformi  3ss-ii  (njv-xx  per  dose) 
Aquseanisi,  q.s.  ad.  5vi 

M.  Sig. — -Two  tablespoonfuls,  with  two  of  hot 
water,  or  hot  milk,  every  four  to  six  hours,  as 
required  for  cough  (usually  in  the  morning). 

Bromide,  3is9  (gr*  xv  per  dose)  may  be 
added  to  the  above  if  the  cough  is  chiefly  an 
irritative  one.  Whiskey  is  useful  at  bed- 
time for  the  aged.  Codeine  heroin,  and 
paregoric  should  be  used,  if  at  all, 
with  caution. 

An  oronasal  respirator  containing  a dry, 
volatile  antiseptic,  such  as  ammonium 
chloride,  or  menthol,  or  a sponge  saturated 
with  terebene,  spirits  of  tmpentine,  or 
eucalyptol,  may  be  worn  for  several  hours 
at  a time. 

Medicated  steam  inhalations  are  very 
valuable:  creosote,  ti^x-xv,  to  the  pint  of 
steaming  water,  over  an  alcohol  lamp;  or 
ol.  terebinthse,  gtt.  xx-xxx,  to  the  pint,  or 
terebene,  oil  of  eucalyptus,  menthol,  ol. 
picks  liquidse,  or  compound  tincture  of 
; benzoin,  3i  of  any  of  the  former  to  the  pint; 

1 or  comp.  tr.  benzoin  and  paregoric,  aa  one 
' tablespoonful  to  the  pint.  The  inhalations 
are  taken  under  a sheet,  for  fifteen  to  thirty 
minutes,  several  times  a day. 

' A mustard  paste  {q.v.  in  Part  11)  applied 
I to  the  whole  chest  at  bedtime  is  of  great 
service.  Another  useful  counter-irritant  is 
' turpentine  liniment  containing  tincture  of 
iodine,  39s-i  to  the  ounce. 

Forchheimer  warmly  recommends  eleva- 
tion of  the  foot  of  the  bed  at  night,  for 
' pm-poses  of  drainage,  in  cases  in  w^hich 
. there  is  much  secretion.  Manual  com- 
' pression  of  the  thorax  during  expiration, 
with  the  patient  prone,  the  hands  being 
, applied  over  the  axillary  regions,  is  useful 
; as  an  aid  in  expelling  the  secretions 
' in  emphysema. 

The  following  drugs  are  sometimes 
I of  service: 


a.  In  cases  of  scanty  and  viscid  secretion, 

Potassii  iodidi.  . . gr.  Lxxx 
Ajmnonii  carbon- 
atis   gr.  Lxxx  (aa  gr.  v per  dose) 

Aquam,  ad 5iv 

M.  Sig. — Two  teaspoonfuls  in  hot  water  or 
milk,  every  four  hours. 

II  Ammonii  chloridi  vel  carbonatis,  gr.  v every 
four  hours. 

R Syrupi  picis  liquidse,  3ss-i-ii,  every  three  or 
four  hours. 

R Syrupi  vel  vini  ipecacuanha;,  tijx-xv-xx,  in 
water,  every  three  or  four  hours. 

R Apomorphina;,  gr.  every  two  hours; 

or  better,  the  following : 

^ Euporphina;,  gr.  }io,  every  two  hours,  up 
to  gr.  'A-Ys  a day.  (Ortner.) 

R Pilocarpime,  2)4  per  cent,  solut.,  gtt.  v {gx-%), 
two  or  three  tunes  daily  by  mouth,  increased  by 
one  drop  at  a time  until  a moderate  increase  of 
perspiration  and  saliva  follows  each  dose. 

b.  In  cases  of  profuse  secretion, 

R Creosoti  (Beech wood) ...  3i  (gr.  hi  per  dose) 
Tinctura;  gentianse  com- 

posita; 3 ii 

Alcohohs 5ii  3ss 

Vini  xerici,  q.s.,  ad Oss 

M.  Sig. — Tablespoonful  in  a glass  of  water, 
t.i.d.  (Bouchardat  and  Gimbert.) 

I^  Creosotalis,  drops  v-xx,  gradually  increased 
to  one  teaspoonful  three  to  four  times  a day,  in 
milk.  (Ortner.) 

R Guaiacolis,  ttjv,  in  capsule,  or  in  W'ell-chluted 
whiskey,  two  or  three  times  daily. 

I|  Olei  terebinthina;  rectificati,  ttjx  in  a table- 
spoonful of  milk,  followed  immediately  by  half  a 
glass  of  milk.  Caution,  turpentine  is  a renal  irritant. 

B Terpeni  hydratis,  gr.  i-u-v,  in  capsule,  every 
three  or  four  hours  (see  Part  11). 

R Terebini,  i^v-vih-xx,  on  sugar  or  in  capsule, 
t.i.d.  (see  Part  11). 

R Ammon  h chlor- 
idi  3i  (about  gr.  iv  per  dose) 

Fluidextracti 

senegse 3iiss  (about  tijx  per  dose) 

Aquae,  q.s.  ad . . 5 ii 

M.  Sig. — One  teaspoonful  every  two  hours. 

R Sodh  benzoatis  gr.  xl-.;^  iv  (gr.  v-xxx  per  dose) 
Aquae 5 iv 

M.  Sig. — Tablespoonful  in  water  twice  or  thrice 
daily.  (See  Part  11.) 

B Balsami  tolutani  vel  Peruvianas,  gr.  Ixxx- 
3iv  (about  gr.  v-xv  per  dose) 

Mucilaginis  acacias,  ad 5h 

M.  Sig. — Teaspoonful  several  times  a day. 
(These  balsams  contain  benzoin  or  its  derivatives.) 

R Oleorisinae  cubebrae,  vel  copaibae,  vel  santali, 
n]jv-x-xv>  in  capsule,  several  times  a day.  Discon- 
tinue if  gastric  irritation  ensues. 

B Olei  picis  liquidse, 

Olei  copaibae aa  irjiv 

Fiat  capsula.  Sig. — One  capsule  four  to  eight 
times  a day. 

B Tinctura;  belladonnae,  gtt.  x in  a wineglassful 
of  water,  every  three  or  four  hours  as  required,  to 
produce  a physiological  effect.  (See  Part  11.) 


BRONCHITIS,  FIBRINOUS,  PLASTIC,  CROUPOUS 


For  excessive  dyspnoea,  especially  at 
night,  administer  strychnine  hypodermi- 
cally, gr.  34o~Mo-  U is  both  a respira- 
tory and  a circulatory  stimulant.  Digi- 
talis {q.v.  in  Part  11)  and  strychnine  in  com- 
bination are  valuable  when  the  heart  is  feeble. 
Moderate  exercise  in  the  open  air  is  a good 
heart  tonic. 

In  the  bronchitis  of  heart  and  kidney 
disease,  enjoin  rest,  a comparatively  dry 
and  salt-free  diet,  anti  free  bowel  activity. 
Employ  digitalis  when  required.  Potassium 
iocUtle  {q.v.)  is  often  valuable  for  the  pur- 
pose of  easing  and  loosening  the  cough,  and 
also  “ for  its  action  on  the  myocardium.” 
Morpliine  hypodermically  is  recoimnended 
for  a “ weak,  u’regular  heart  with  sleepless- 
ness.” Give  diuretin  {q.v.)  for  oedema.  Dry 
cupping  (see  Cupping)  of  the  chest  two  or 
three  times  a day  may  be  of  service.  For 
asthmatic  attacks  morphine  may  be  given 
if  there  is  not  much  secretion,  otherwise 
the  following: 

Potassii  iodidi . . . 3i-ii  (gr.  viii-xv  per  dose) 
Ammonia  carbon- 

atis gr.  xxiv-.xl  (gr.  iii-v  per  dose) 

Aquam,  ad 3i 

M.  Sig. — One  teaspoonful,  t.i.d.,  well  diluted. 

The  subjects  of  chronic  bronchitis  do  best 
in  a warm,  equable  climate.  For  the  dry 
variety  select  a moist  climate,  such  as  that 
of  Southern  California,  Florida,  Southern 
France,  the  Riviera,  Corsica;  for  the  moist 
variety,  a dry  climate  such  as  that  of 
Southern  Arizona,  New  Mexico,  Western 
Kansas,  Colorado,  Wyoming,  Georgia, 
Upper  Egypt. 

Kerley  regards  recurrent  bronchitis  as 
probably  a manifestation  of  a gouty  or 
rheumatic  tendency,  and  he  prescribes  an 
outdoor  life  in  a dry  climate,  a daily  warm 
tub  bath  followed  by  a cool  douche  and  a 
brisk  rubdown,  a daily  bowel  movement, 
the  restriction  of  meat  and  sugar,  and  the 
administration  of  sodium  bicarbonate  in 
large  doses,  together  with  the  salicylates: 

Sodii  salicylatis gr.  xxxvi  (gr.  iii  per  dose 

vSodii  bicarbonatis. . . gr.  Ixxii  (gr.  vi  per  dose) 
Elixiris  simplicis.  . . . 3v  « 

Aqiuo,  q.s.  ad 5ii 

M.  Sig. — One  tcaspoonful,  well  diluted,  twice 
daily  after  meals  (for  a child  of  four  years).  (Kerley.) 

The  salicylates  may  be  given  for  five  days 
at  a time,  at  intervals  of  fit'e  days,  for  many 
months. 

Shilling  praises  the  X-ray  {q.v.). 

C.  Foetid  or  Putrid  Bronchitis  (L /rtor,  stench; 
pxit'ridus,  rotten). 


Besides  those  drugs  recommended  for  the 
wet  variety  of  chronic  bronchitis.  The  follow- 
ing are  useful: 

Myrtol,  i^ii,  in  capsule.  Two  capsules  every 
two  hours. 

II  Olei  santali,  gtt.  v,  in  capsule.  One  capsule 
three  to  five  times  a day. 

II  Fluidextracti  eucalypti,  gtt.  xv-xx,  in  water 
t.i.d. 

A spray  of  a 2-4  per  cent,  solution  of 
carbolic  acid  may  be  inhaled;  or  the  follow- 
ing medicated  steam  inhalations  may  be 
employed,  viz.,  thymol,  ol.  eucalypti,  or 
ol.  picis  Uquidse,  3i  to  the  pint  of  steaming 
water;  or  ol.  terebinthinse,  gtt.  xx-xxx  to 
the  pint;  or  creosote  or  carbolic  acid,  gtt.  xv 
to  tbe  pint. 

Equal  parts  of  alcohol  and  carbolic  acid, 
or  of  alcohol,  spirits  of  chloroform,  and 
creosote,  may  be  inhaled  from  a mask  or 
respirator,  worn  during  the  day. 


II  Olei  cinnamomi i^v 

Mentholis gr.  x 

Olei  pini  sylvestris 5ss 

Spiritus  chloroformi 3s.s 

Creosoti 3 ii 


M.  Sig. — Ten  drops  on  the  sponge  or  cotton  of 
a respirator  or  inhaler,  renewed  every  hour.  (Dun- 
das  Grant.) 

To  mitigate  the  offensive  odor,  one  may 
hang  about  the  room  muslin  strips  dipped 
in  Platt’s  chlorides,  or  in  a mixttire  of  one 
part  of  oil  of  eucalyptus  and  six  parts  of 
rectified  spirit;  or  the  latter  may  be  sprayed 
into  the  air. 

In  inveterate  cases  one  maytrj^  the  intratra- 
cheal injections  used  in  bronchiectasis  {q.v.). 

The  diet  should  be  nutritious.  Codliver  oil 
and  creosote  (see  Part  11)  are  valuable. 

II  Ammonii  carbonatis ...  gr.  xl  (gr.  v per  dose) 
Tincturac  nucis  vomica? . 3 iiss  (i^xviii  per  dose) 
Tincturse  cinchona;  com- 

positsc 3iv  (3ss  per  dose) 

Spiritus  chloroformi ....  3ii  (rtxv  per  dose) 
Infusi  senega-,  q.s.  ad.  . oviii  (o?i  per  dose) 

M.  Sig. — Two  tablespoonfuls  t.i.d.  Tonic  and 
expectorant  in  foetid  bronchitis.  (Yeo.) 

Bronchitis,  Capillary. — See  Broncho- 

pneumonia. 

Foetid. — See  C.  under  Bronchitis. 

Bronchitis,  Fibrinous,  Plastic,  Croupous 
or  Pseudo=membranous. — ^A  very  rare,  acute, 
or  chronic  recurrent,  affection  of  the  bron- 
chial tubes,  characterized  by  the  formation 
of  fibrinous  casts,  “which  are  expelled  in 
paroxysms  of  dyspnoea  and  cough.”  (Osier.) 

The  acute  cases  occur  often  in  connection 
with  infectious  diseases  and  are  usually  fatal. 


BRONCHOPNEUMONIA 


Treatment.— The  general  treatment  is  that 
of  acute  bronciiitis  {q.v.).  To  loosen  the 
exudate,  employ,  under  a sheet,  inlrala- 
tions  of  steaming  hme  water,  or  creosote, 
TTjxv  to  the  pint;  or  apply  these  jn-eparations 
with  a nebulizer. 

Potassium  iodide  in  full  doses  and  pilo- 
carpine are  employed  for  the  same  purpose. 
Intratracheal  injections,  of  olive  oil,  plain,  or 
mcchcated  with  creosote,  1 : 20,  may  be  given 
(see  Bronchiectasis).  An  emetic  may  some- 
times be  required,  viz.,  apomorphine,  or 
euporphine,  hypodermically. 

Atropine  may  be  tried  (see  Part  11  for 
drug  formulae,  etc.). 

Bronchitis,  Foetid. — See  C.  under  Bron- 
chitis. 

Putrid. — See  C.  under  Bronchitis. 

Bronchopneumonia. — Gr.  /Spoyxta  air- 
tubes  -b  irvevixoiV  lung. 

An  acute  inflammation  of  the  bronchioles 
and  their  related  lobules  (lobar  pneumonia), 
with  the  signs  of  bronchitis  of  the  smaller 
tubes  (subcrepitant,  musical,  and  diverse 
rales  throughout  the  chest),  but  with  more 
severe  symptoms,  e.g.,  high  fever,  rapid 
pulse,  dyspnoea,  and  perhaps  cyanosis. 
Some  dulness  and  blowing  breathing  may 
sometunes  be  detected. 

Abscess  and  gangrene  sometimes  occur, 
especially  in  aspiration  pneumonia.  Otitis 
is  frequent. 

The  Prognosis  is  serious,  but  desperate 
cases  often  recover.  The  duration  varies 
from  seven  days  or  less  to  twenty-one  days 
or  longer  (Holt).  Resolution  is  sometimes 
long  delayed.  Relapse  may  occur. 

Etiology.— Acute  infectious  diseases,  espe- 
cially bronchitis,  measles,  whooping  cough, 
diphtheria,  scarlet  fever,  and  influenza,  less 
often  typhoid  fever,  erysipelas,  smallpox, 
general  sepsis,  etc. ; the  aspiration  of  foreign 
material;  debihtating  diseases,  e.g.,  rickets, 
diarrhoea,  cancer,  nephritis,  diabetes,  heart 
disease,  tuberculosis,  etc.;  cold,  damp,  and 
changeable  weather;  Bad  hygiene;  infancy; 
old  age. 

Causal  bacteria  are  the  pneumococcus, 
streptococcus,  influenza  bacillus,  staphylo- 
cocci aiu-eus  and  albus,  Friedliinder’s 
bacillus  pneumonise,  sometimes  the 
tubercle  bacillus,  rarely  the  bacilli  typhosus 
and  cUphtheriae.  The  infection  is  almost 
always  mixed. 

Treatment.- Put  the  patient  to  bed  in  a 
comfortably  warm  (not  over  70°-72°  F.) 
but  well -ventilated  room,  with  the  windows 
wide  open,  and  the  patient  screened  against 
draughts.  The  bed  clothing  should  not  be 
heavy.  Open  the  bowels  with  calomel. 


or  castor  oil  (see  Part  11  for  di’ugs).  Feed 
the  patient  every  three  hours  with  concen- 
trated hquid  nourishment,  e.g.,  milk,  diluted 
if  necessaiy,  buttermilk,  eggs  boiled  three 
mmutes  or  raw,  beef  juice,  broths,  cocoa, 
well-cooked  cereal  gruels,  ice-cream.  Water 
should  be  given  freely,  best  in  the  form  of 
lemonade.  In  bottle-fed  infants  dilute  the 
milk  one-third  or  one-half;  in  the  breast- 
fed, given  water  before  and  between  nursings. 

Yeo  recommends  for  c-hildren  the  follow- 
ing warm  spray,  which  is  “ allowed  to  play 
freely  before  the  child’s  mouth  and  nose, 
by  means  of  a Seigle’s  steam  sjn-ay  producer” : 


B Sodii  bicarboiiatis gr-  x 

Glycerini  acidi  carbolici 3i 

Aquae  destillatae 5 i 


M.  Sig. — Use  as  a warm  spray.  (Yeo.) 

A kettle  of  water  may  be  kept  uix»n  the 
stove,  containing  tinctiu'e  of  benzoin, 
or  a few  grains  of  menthol. 

A mustard  paste  applied  to  the  whole 
chest  front  and  back,  three  to  six  times 
daily,  or  as  requirecl,  is  very  valuable, 
especially  for  dyspnoea,  circulatory  failure, 
and  cough.  Employ  at  first  a strength  of 
one  part  mustard  to  two  of  flour,  later 
reducing  this  strength  as  the  skin  becomes 
sensitive.  Keep  the  paste  on  for  five  to 
fifteen  minutes,  or  until  flushing  is  produced, 
then  anoint  the  chest  with  camphorated  oil, 
or  equal  parts  of  lard  and  turpentine,  ancl 
cover  with  a light  piece  of  flannel.  Many 
advise  the  application  of  a cold  linen  com- 
press, wrung  out  of  water  at  a temperature 
of  60°-70°  F.,  covered  with  flannel,  and 
changed  every  half  to  one  to  two  hours. 
Frequent  dry  cups  {q.v.)  are  reconunended 
by  some. 

I The  patient  should  be  raised  slightly  with 
pillows  and  the  position  changed  frequently 
in  order  to  prevent  hypostasis. 

I Creosote  carbonate  is  well  recommended 
by  some:  B Creosotalis  gtt.  v-xx,  gradually 
increased  to  one  teaspoonful,  three  to  four 
times  a day,  in  milk  (Ortner).  Forchheimer 
always  gave  quinine  which  is  believed  to  be 
of  special  value  in  influenza.  Expectorants, 
when  required,  for  the  facilitation  of  expec- 
toration and  coughing,  should  be  used  with 
care,  so  as  to  avoid  disturbing  the  digestion. 

B Ammonii  chlor- 
idi  vel  carbon- 


atis gr.  xxxii-lxxx  (gr.  ii-v  per  dose) 

Vini  ipecacuan- 
ha!  3iiss-v  (npx-xx  per  dose) 

Glycerini 3i  (3ss  per  do.se) 

Aquam,  ad § ii 


M.  Sig. — One  dram  in  water  every  four  to  six 
to  eight  hours. 


BRONCHOSTENOSIS;  BRONCHIAL  OBSTRUCTION 


If  the  cough  is  very  distressing,  add  pare- 
goric, or  codeine,  or  Dover’s  powder,  or 
heroin,  or  morphine.  (See  Part  11  for  drugs). 

Medicated  steam  inhalations  are  advo- 
cated by  some,  but  are  condemned  by  Abt. 
They  “ should  be  stopped  if  the  patient  be- 
comes cyanosedor  the  expectoration  copious,” 
says  Jex-Blake.  Use  ten  drops  of  creosote  in 
a pint  of  steaming  water  over  an  alcohol  lamp 
under  a sheet;  continue  the  inhalation  for 
thirty  minutes  at  a time,  but  raise  the  sheet 
for  fresh  air  eveiy  ten  minutes.  Repeat  the 
inlialation  every  two  or  tlwee  hoiu’s. 

For  hyperpyrexia  (a  temperature  of  105° 
F.  or  over)  employ  hych’otherapy:  (1)  cool 
sponging  of  the  whole  body;  an  ice-cap  to 
the  top  of  the  head;  (2)  cold  packs  covered 
with  a woolen  blanket,  an  ice-cap  to  the 
head,  the  packs  to  be  repeated  at  short 
intervals  until  the  temperature  is  lowered 
several  degrees;  (3)  the  full  bath  at  a tem- 
perature of  90°-06°,  gradually  lowered  to 
75°-60°,  with  friction  of  the  skin,  for  five 
to  ten  minutes,  two  or  three  times  a day, 
an  ice-cap  being  placed  to  the  top  of  the 
head.  Says  Osier:  “ Hydrotherapy  is 

especially  indicated  for  patients  with  high 
fever,  delirium,  or  stupor,  severe  toxaemia, 
or  circulatory  failure.”  Holt  says:  “ When 
with  hyperpyrexia  (105°  F.  or  over)  we  have 
general  cyanosis,  cold  surface,  feeble  pulse, 
shallow  respiration,  and  stupor,  cold  is  con- 
traindicated and  a hot  mustard  bath  should 
be  used — 1 to  2 tablespoonfuls  of  mustard  to 
4 gallons  of  water  at  a temperature  of  10G°- 
108°  F.;  keep  the  patient  in  the  bath  for 
one  or  two  minutes,  at  the  same  time 
splashing  cold  water  on  the  face,  then  take 
out,  chy  rapidly,  and  put  back  to  bed 
(Jex-Blake).  Phenacetin  may  be  given  only 
for  the  purpose  of  allajdng  restlessness  when 
cold  or  tepid  sponging  has  failed. 

Early  cardiac  stimulation,  before  dilata- 
tion occurs,  is  advised.  Alcohol  (whiskey  or 
brandy)  is  considered  an  excellent  heart 
stimulant  in  pneumonia  by  some;  con- 
demned by  others.  Other  excellent  stimu- 
lants are  caffeine,  digitalis,  strychnine, 
strophanthus,  atropine,  belladonna.  For  a 
quick  effect  employ,  hypodermically,  adren- 
alin, or  camphor.  Hoffman’s  anodyne,  aro- 
matic spirits  of  ammonia,  and  ammonium 
carbonate  (both  stimulant  and  expectorant) 
are  also  well  recommended  for  dyspnoea  and 
cyanosis.  (See  Part  11). 

If  the  bronchi  fi  1 rapidly  with  mucus,  an 
emetic  may  be  given  if  the  patient  is  robust: 
wine  of  ipecac,  or  cojiper  sulphate,  or  apo- 
morphine.  followed  by  atropine  or  strychnine. 
(See  Part  11). 


For  collap,se  employ  the  hot  mus 
bath,  dry  cups,  adrenalin,  caffeine,  or  cam- 
phor hypodermically,  and  oxygen  continu- 
ously, or  for  one  or  two  minutes  out  of 
every  seven  or  ten  (Kerley).  Oxygen  is 
administered  through  a funnel,  draped  with 
a cm-tain,  held  over  the  mouth  and  nose. 
According  to  L.  E.  Hill,  pure  oxygen  may 
be  breathed  for  two  to  four  hours  con- 
tinuously, without  harm;  and  an  atmos- 
phere of  50  per  cent,  oxygen  can  be  breathed 
indefinitely.  He  says:  “ The  cyhnder  valve 
must  be  opened  wide  enough  to  give  a 
pleasant  cool  current  (as  tested  upon  the 
lips),  and  drive  the  exhaled  CO2  out  of  the 
mask.”  Hill’s  mask  (made  by  Messrs. 
Davis  Bros.,  St.  Thomas’s  Street,  S.E., 
London)  should  be  of  service. 

In  the  aged,  stimulation,  especially  with 
alcohol  and  strychnine,  and  concentrated 
nutriment,  are  the  main  requisites. 

During  convalescence,  fresh  air  and  tonics 
are  indicated:  codliver  oil,  syrup  of  the 
iodide  of  iron,  arsenic,  nux  voinica  (see  Part 
11,  for  drugs). 

Bronchostenosis;  Bronchial  Obstruction. 

— Gr.  l3p6yxos  bronchus  -)-  (rrevcoaLi  stricture. 

Bronchial  obstruction  is  manifested  by 
cough,  which  is  usually  dry,  dyspnoea  asso- 
ciated with  noisy  stridulous  breathing  and 
inspiratory  retraction  of  the  chest,  retro- 
sternal distress,  a hoarse  broken  voice,  and 
feeble  vesicular  murmur  over  the  part  sup- 
plied by  the  obstructed  tube.  Larjmgeal 
and  tracheal  obstruction  (q.v.)  are  to 
be  excluded. 

Etiologj'.— Foreign  bodies  (q-v.);  aneurj'sm; 
mediastinal  tmnors,  e.g.,  tuberculous,  sjq)h- 
ilitic,  or  malignant  bronchial  glands, 
leukemia,  Hodgkin’s  disease;  mediastinal 
abscess,  secondaiy  to  disease  of  the  bron- 
chial glands,  sternum,  vertebrae,  clavi- 
cles, or  oesophagus;  pericardial  effusion; 
dilatation  of  the  left  auricle;  cardiac  hyper- 
trophy; perforation  of  a bronchus  by  neo- 
plasms or  diseased  glands;  bronchial  dis- 
ease, e.g.,  fibrinous  bronchitis,  syphilitic 
peri-bronchitis,  gunmiata,  neoplasms,  peri- 
chondritis, ulceration  due  to  burns,  foreign 
bodies,  or  syphilis,  spasm  as  in  asthma. 

Treatment. — For  the  removal  of  foreign 
bodies,  see  Foreign  Bodies  in  the  Air  Passages. 

The  administration  of  morphine,  atropine, 
and  chlorofonn,  and  venesection  may 
afford  relief  in  cases  of  aneurj^sm  (see  Part 
11  for  drugs). 

Potassium  iochde  may  be  tried  in  all 
cases,  of  whatever  cause,  except,  of  course, 
obstruction  due  to  foreign  bodies. 

In  cicatricial  stenosis  the  tube  may  be 


CANCER  OF  THE  GALL-BLADDER  AND  BILIARY  DUCTS 


dilated  through  a tracheotomy  wound  by 
means  of  graduated  sounds. 

Bronzed  Diabetes. — See  Hsemochroma- 
tosis. 

Brown=Sequard’s  Paralysis. — See  Hajma- 
tomyelia. 

Bruise. — See  Contusion. 

Bubonic  Plague. — Gr.  jSov^wy  groin.  See 
Plague. 

Bulbar  Paralysis,  Acute. — An  acute  form 
of  glosso-labio-laryngeal  paralysis,  charac- 
terized by  the  following  symptoms;  diffi- 
cult speech,  dribbling  of  saliva,  difficulty 
in  chewing  and  swallowing,  inability  to 
whistle,  and,  in  palatal  paralysis,  regurgita- 
tion of  fluids  through  the  nose  and  hnmo- 
bility  of  the  palate  when  the  patient 
says,  “ Ab.” 

Etiology.— Hemorrhage,  embolism,  throm- 
bosis, or  inflammation  (acute  poliomyelitis, 
diphtheria,  electric  shock)  in  the  pons  or 
medulla.  Myasthenia  gravis  (q.v.)  is  a 
transient  bulbar  paralysis.  The  symptoms 
of  bulbar  palsy  may  also  result  from  giun- 
mata  or  tumors  involving  the  vagus,  acces- 
sory and  hypoglossal  nerves  at  the  base  of 
the  skull. 

Treatment.— Treat  the  cause.  See  Pro- 
gressive (Central)  Muscular  Atrophy,  under 
Atrophies,  the  Progressive  Muscular. 

Bulbar  Paralysis,  Chronic. — See  Atro- 
phies, the  Progressive  Muscular. 

Bulimia;  Polyphagia. — Gr.  jSovs  ox  + Xi/uos 
hunger;  ttoXvs  much  -|-  <t>ay€i.v  to  eat. 

Bulimia  means  excessive  hunger.  Acoria 
or  akoria  (Gr.  a priv.  -t-  Kopos  satiety)  means 
absence  of  the  sensation  of  satiety.  The 
two  are  not  necessarily  associated. 

Etiology.— Neurasthenia;  hysteria;  various 
psychoses,  including  shock,  sorrow,  and 
mental  excitement;  disorders  of  the  male 
sexual  organs;  exophthalmic  goitre;  epilepsy; 
cerebral  ttmior;  syphilis;  diabetes;  preg- 
nancy; pulmonary  tuberculosis;  intestinal 
worms;  gastric  ulcer;  gastric  carcinoma; 
gastric  dilatation  (especially  those  gastric 
disorders  associated  with  hypersecretion 
and  hyperacidity). 

Atony  and  dilatation  of  the  stomach 
may  result  from  the  large  amounts  of 
food  ingested. 

Treatment.— Attend  to  the  underlying  con- 
dition. Strontium  bromide,  gr.  xv,  well 
diluted,  three  or  four  times  a day,  codeine, 
opium  and  arsenic  are  recommended.  (See 
Part  11).  It  is  advised  that  the  patient 
eat  slowly,  every  two  hours,  masticating 
the  food  thoroughly. 

For  acoria  is  recommended  strychnine 
in  ascending  doses. 


Burns. — See  Skin  Diseases,  Part  5. 

Cachexial  Fever. — Gr.  KaKos  iU  -j-  e^ts 
habit.  See  Ka.a-Azar. 

Cacosmia.^ — See  Nose  Diseases,  Part  8. 

Caisson  Disease;  Diver’s  Paralysis. — 
An  affection  appearing  in  divers  or  workers 
in  caissons  or  deep  mines  shortly  after  their 
return  to  the  surface,  characterized  by 
severe  pains,  headache,  giddiness,  etc., 
(“  bends  ”),  followed  in  severe  cases  by 
paraplegia,  rarely  monoplegia  or  hemiplegia, 
resembling  that  of  myelitis,  and  due  to  too 
rapid  decompression,  whereby  the  nitrogen, 
with  which  the  tissues  have  become  satur- 
ated during  the  increased  air  pressure,  sud- 
denly escapes  as  bubbles  into  the  blood  and 
tissue  spaces,  giving  rise  to  air  embolism 
and  laceration  of  the  tissues,  especially  of 
the  spinal  cord. 

In  mild  cases,  as  stated,  there  occur  only 
severe  pains  (the  “bends”);  in  severe 
cases  unconsciousness  and  cyanosis,  as  well 
as  paralysis. 

The  condition  is  serious,  both  as  to  life 
and  persistence  of  paralysis,  but  many 
cases  recover,  often  rapidly. 

Treatment. — Immediate  r e c o m p ression 
should  be  resorted  to  as  soon  as  untoward 
symptoms,  such  as  headache,  giddiness, 
pains,  etc.,  appear.  The  severe  pains 
may  require  morphine,  hot  fomentations, 
and  massage. 

The  preventive  treatment  is  gradual  de- 
compression. The  workers  should  remain 
under  compression  no  longer  than  two  hours 
in  each  shift;  for  the  first  exposure  only  one 
hour.  They  should  be  men  of  good  health 
and  habits,  not  obese,  and  not  hungiy. 

Calculus,  Biliary. — L.  Calc'ulns,  pebble; 
bUis,  bile.  See  Cholelithiasis. 

Pancreatic.— See  Pancreatic  Calculus. 

Renal  and  Ureteral. — See  Nephrolith- 
iasis. 

Salivary. — See  Salivary  Calculus. 

Ureteral. — See  Cholelithiasis. 

Urinary. — See  Nephrolithiasis. 

Vesical.^ — See  Genito-Urinary  Di.seases; 
and  Gynaecology. 

Caloric  Food  Values. — See  Food  Values. 

Cancer. — See  Malignant  Neoplasms. 

Cancer  of  the  Breast. — L.  Canc'er,  crab. 
See  Breast  Enlargements. 

Cancer  of  the  Qal=Bladder  and  Biliary 
Ducts. — Cancer  of  these  structures  is  seen 
usually  in  elderly  women.  Cholelithiasis  is 
evidently  a causal  factor. 

The  onset  is  with  vague  gastric  symptoms, 
local  tenderness,  and  pain,  which  is  some- 
times colicky.  Soon  there  follow  enlarge- 
ment of  the  gall-bladder,  jaundice,  and 


CANCER  OF  THE  (ESOPHAGUS 


cachexia.  The  disease  is  usually  fatal 
within  six  months. 

The  Treatment  is  surgical. 

Cancer  of  the  Intestines. — Cachexia 
occurs,  and  a tumor  may  usually  be  pal- 
pated. If  the  growth  occurs  in  the  duo- 
denum, above  the  papilla,  the  resulting 
symptoms  resemble  those  of  cancer  of  the 
pylorus  (g.f.);  if  it  occurs  about  the 
papilla,  the  sym2Dtoms  are  those  of  pyloric 
obstruction  and  obstructive  jaundice;  if 
below  the  papilla,  there  are  gastric  obstruc- 
tion and  vomiting  of  bUe  and  pancreatic 
juice,  the  latter  being  demonstrable  by  its 
lipolytic  and  proteolytic  action  in  an  alka- 
line medimn.  If  the  growth  occurs  in  the 
jejunum  or  ilimn,  the  following  synij^toms 
arise;  some  obstruction  and  constipation 
which  may  alternate  with  diarrhoea,  pain, 
which  is  frequently  colicky,  and  occult 
bleeding  revealed  by  microscopic  examina- 
tion of  the  faeces  and  the  Benzidin  test 
(see  under  Gastric  Ulcer). 

If  the  growth  occurs  in  the  colon,  the  fol- 
lowing s3uni3toms  present  themselves;  col- 
icky pains,  constii^ation,  which  may  alter- 
nate with  diarrhoea;  tmnor,  distention,  the 
occurrence  of  visible  {Deristaltic  waves  above 
the  tumor,  possibly  narrow,  circular,  ribbon- 
shaped, or  rectangular  faeces,  due  to  stenosis. 

For  cancer  of  the  rectmn,  see  Rectal  and 
Anal  Tumors. 

Treatment. — Early  oiDeration  is,  of  course, 
the  only  curative  treatment.  If  the  case  is 
inoperable,  feed  the  patient  as  in  cancer  of 
the  stomach,  with  easily  digestible  food  con- 
taining little  residue.  Give  frequent  small 
doses  of  laxative  and  oil  enemata.  For 
meteorism  give  intestinal  antiseptics  (see 
Tympanites).  Finally,  when  an  analgesic 
is  required,  employ  Schlesinger’s  solution 
{q.v.  in  Part  11). 

Cancer  of  the  Liver. — Cancer  of  the  liver 
is  usually  secondary  to  cancer  of  the  stom- 
ach or  intestines.  It  is  characterized  by 
progressive  enlargment  of  the  liver,  wliich 
is  of  particular  diagnostic  significance  if 
nodular;  cachexia,  dysjDepsia,  conuuonly 
jaundice,  sometimes  ascites. 

It  is  usually  fatal  in  from  three  to 
fifteen  months. 

The  Treatment  is  only  palliative  The 
diagnosis  of  tumor  of  the  liver,  however, 
calls  for  an  exploratory  operation,  as  some 
tumors  may  be  successfully  removed.  For 
other  causes  of  enlargement  of  the  liver, 
see  Liver  Enlargement.  Tentative  anti  luetic 
treatment  should  be  emiiloyed. 

Cancer  of  the  Lung. — See  under  Pulmon- 
ary Tumors. 


Cancer  of  the  (Esophagus. — Cancer  of  the 
oesophagus  is  manifested  by  the  appearance, 
usually  in  one  past  forty,  of  difficulty  in 
swallowing,  obstruction  to  the  passage  of  a 
tube,  local  discomfort  or  pain,  and  rapid 
loss  of  flesh  and  strength.  Dysphagia  is  not 
always  present.  Vomiting  immediately  fol- 
lowing deglutition  occurs  when  the  oeso- 
phagus has  become  dilated. 

Exclude  other  causes  of  (Esophageal 
Stenosis  {q.v.).  Always  make  an  oesojjha- 
goscopic  examination. 

The  disease  is  fatal  usually  in  from  six 
months  to  two  years. 

Treatment.— This  is  only  palliative.  Feed 
the  patient  by  mouth  as  long  as  possible, 
with  a diet  of  milk,  buttermilk,  koumyss, 
cream,  ice-cream,  soups  thickened  with 
flour,  cream,  eggs,  and  butter,  well-cooked 
cereals,  fine  puree  of  potato,  carrots  and 
spinach,  minced  tripe,  eggs,  custards,  fruit 
juices  diluted  with  mineral  water,  wine. 
Olive  oil  may  be  swallowed  before  taking 
food.  A ten  per  cent,  solution  of  sodium 
bicarbonate  (48  grains  to  the  ounce)  is 
recommended  as  a mouth-wash  and  to 
swallow  for  the  purpose  of  dissolving  the 
accumulation  of  stringy  mucus.  Papayotin, 
gr.  i-v,  may  be  added  to  the  soda  solution. 

The  oesophagus  may  be  irrigated  daily  or 
less  often  by  means  of  Boas’s  recurrent  silk 
catheter  or  the  stomach  tube,  followed  by 
the  introduction  of  30  c.c.  of  warm  olive  oil. 
One  hour  later  the  jratient  may  take  food. 

For  the  relief  of  pain  and  spasm  are 
recommended  the  following; 

Silver  nitrate,  gr.  iii,  in  water,  5viiss. 
One  tablespoonful,  t.i.d.a.c. 

Eucain,  3-4  per  cent,  solution,  10-15 
drops,  t.i.d. 

Tincture  of  belladonna,  10-15  drops  in 
water,  t.i.d. 

Hoffman’s  anodyne,  5i~ih  'veil  diluted. 

Chloroform,  tijjv-x,  in  ice. 

Tincture  of  nux  vomica,  10-20  drops,  in 
water,  t.i.d. 

Heroin,  1 per  cent,  solution,  10  drops,  t.i.d. 

Codeine,  gr.  3^4-1,  t.i.d. 

Morphine  hypodermically,  gr. 

Schlesinger’s  solution  (see  Part  11). 

Gastrostomy,  if  irermitted  by  the  patient, 
should  be  performed  only  when  swallowing 
is  impracticable.  If  deemed  feasible,  an 
cesoirhageal  tube  may  be  passed  over  a silk 
thread  or  piano  wbe  as  a guide,  as  described 
by  Sijipy  under  (Esophageal  Stenosis  and 
Stricture,  and  the  upper  end  of  the 
tube  fixed  in  the  mouth  by  cords  attached 
to  the  ear  or  elsewhere.  Hill’s  styletted 
orooesophago-gastric  intubation  tube  is  use- 


CANCER  OF  THE  STOMACH 


ful.  It  is  inserted  through  the  oesophagus 
after  dilating  the  stricture,  and  is  fastened 
to  the  teeth.  At  first  liquids  are  fetl 
through  the  tube  from  a funnel,  but  later 
food  may  be  swallowed  beside  the  tube, 
“ owing  to  the  continuous  bougie  effect  on 
the  stricture.” 

Recently  the  use  of  radium  {q.v.)  has 
proved  to  be  of  great  palliative  value.  One 
may  use  50  to  200  mg.  of  radium  salt 
screened  in  platinum,  2 mm.  thick,  and 
enclosed  in  a rubber  tube,  2 mm.  thick.  The 
rubber  tube,  attached  to  a flexible  silver 
style,  is  inserted  into  the  stricture  by  means 
of  the  cesophagoscope  aided  by  radiography 
anti  the  bismuth  meal  (2  to  4 ounces  of  bis- 
muth sulphate  suspended  in  mucilage  of 
acacia  or  in  milk). 

It  may  be  necessary  first  to  dilate  the 
stricture  to  permit  of  the  entrance  of  the 
radium  tube.  A general  antesthetic  is  tlesu- 
able.  Hill  and  Finzie,  using  100  mg.  in  a 
platinum  screen  2 mm.  thick,  allow  the  tube 
to  remain  in  for  twelve  hours.  If  the 
stricture  is  long,  the  tube  may  be  pulled  up 
from  its  primary  low  position  for  2 to  3 cm., 
and  allowed  to  remain  for  another  twelve 
hours,  if  tolerated.  Morphine  and  atropine 
should  be  given  while  the  tube  is  in 
place.  After  six  weeks  another  airplication  is 
usually  required,  preceded  by  an  cesophago- 
scopic  examination. 

Radium  therapy  is  applicable  only  to 
patients  of  fair  general  health,  with  the 
growth  limited  to  the  oesophagus,  and  no 
greater  than  5 to  6 cm.  in  ertent. 

Cohnheim  says  that  potassium  iochde 
should  be  given  in  every  case,  because  of  the 
possibility  of  syphilis. 

Cancer  of  the  Pancreas. — Cancer  of  the 
pancreas  is  manifested  by  epigastric  pain, 
dilatation  of  rhe  gall-bladder  and  progressive 
jaundice,  unless  the  body  or  tail  of  the  pan- 
creas is  alone  involved,  cachexia,  gastro- 
intestinal disturbances,  and  sometimes  ghi- 
cosuria.  A tumor  is  not  often  evident.  [In 
gall-stone  obstruction  of  the  common  duct, 
the  gall-bladder  is  usually  contracted.] 

The  disease  is  fatal  in  from  two  months 
to  two  years,  very  rarely  four  years. 

Treatment — If  the  stools  are  fatty,  showing 
that  the  pancreatic  duct  is  obstructed,  pre- 
scribe an  emulsion  of  fresh  pig’s  pancreas, 
or  pancreatin. 

R Pancreatini, 

Soclii  bicarbonati.s aa  gr.  vii 

Make  thirty  such  pills  coated  with  keratin  or 
salol-shellac  (to  prevent  destruction  of  the  pan- 
creatin by  the  acid  ga.stric  juice). 

Sig. — One  pill  t.i.d.p.c. 


Surgery  may  be  attempted,  either  for  the 
removal  of  the  growth,  or  for  the  relief  of 
certain  symptoms,  e.g.,  cholecystenterostomy 
for  jaundice;  gastroenterostomy  for  com- 
pression of  the  pylorus,  with  resulting  gas- 
trectasis  and  persistent  vomiting. 

Cancer  of  the  Rectum. — See  Rectal  and 
Anal  Tumors. 

Cancer  of  the  Skin. — See  Skin  Diseases, 
Part  5. 

Cancer  of  the  Stomach.— Cancer  of  the 
stomach  appears  usually  after  the  age  of 
forty  years,  with  symptoms  of  dyspepsia, 
viz.,  anorexia,  coated  tongue,  flatulence  and 
eructation  of  gas,  the  sensation  of  fullne.ss 
after  eating,  ami  pain;  later  vomiting  and 
sometimes  haematemesis  occur,  together 
with  anaemia  and  progressive  loss  of  weight 
and  strength.  A tumor  may  sometimes  be 
detected  on  inspection,  palpation,  and 
inflation  of  the  stomach  (see  under  Dilatation 
of  the  Stomach).  The  stomach  contents 
early  show  the  presence  of  lactic  acid 
and  the  long,  thread-like  Boas-Oppler 
ba(ullus,  and  usually  persi.stent  diminution 
of  hydrochloric  acid  (many  tests  should 
be  made)  except  when  the  cancer  is 
engrafted  upon  ulcer.  The  vomitus  has  the 
appearance  of  coffee-grounds  when  blood 
has  been  retained  in  the  stomach  for  some 
time.  Both  the  stomach  contents  and  the 
stools  should  be  examined  microscopically 
and  by  means  of  the  Benzidin  test  (see  under 
Gastric  Ulcer)  for  occult  bleeding  (see  Dys- 
pepsia for  gastric  technique  and  analysis). 
Ascites  and  oedema  of  the  extremities 
sometimes  occur. 

A bismuth  X-ray  examination  gives 
important  information.  Two  to  four  ounces 
of  bismuth  sulphate  suspended  in  mucilage 
of  acacia  or  milk  are  given  on  an  empty 
stomach,  say  at  5 a.  m.,  and  six  hours  later 
the  patient  is  radiogi-aphed  in  the  upright 
position.  The  stomach  should  then  nor- 
mally be  empty.  If  bismuth  is  still  present, 
it  indicates  pyloric  obstruction.  A seconcl 
bismuth  meal  is  now  given  and  frequent 
radiographs  taken  with  the  tube  focussed 
upon  the  third  lumbar  vertel)ra,  taking 
care  to  exert  no  pressure  upon  the 
stomach.  (Cabot.) 

The  signs  of  Carcinoma,  according  to 
Epplen,  are:  (1)  filling  defect,  the  result  of 
an  excess  of  tissue  which  diminishes  the 
cavity  of  the  stomach;  (2)  diminished  size 
of  the  stomach;  (3)  absence  of  peri.stalsis  in 
the  diseased  portions;  (4)  residue  in  an 
acid  stomach  that  shows  normal  shape  and 
tonicity;  (5)  assumption  of  the  steer-horn 
shape  of  stomach;  (6)  an  incisura  on  the 


CANCER  OF  THE  STOMACH 


lesser  curvature;  (7)  a large  stomach  plus 
filling  defects;  (8)  a stiffened  gaping  pylorus; 
(9)  with  a gaping  pylorus,  achylia  plus  well- 
advanced  movement  of  the  six-hour  meal. 

Treatment. — An  exploratory  operation 

should  be  performed  at  once  if  cancer  is 
suspected.  An  early  partial  or  complete 
gastrectomy  may  possibly  be  curative. 
Palliative  operations  are  gastro-enterostomy, 
gastrostomy,  and  jejunostomy. 

The  chet  in  gastric  cancer  should  not  be 
restricted  in  the  daily  amount,  but  small 
quantities  of  soft,  easily  digestible  food  leav- 
ing no  residue  should  be  allowed  at  short 
intervals,  e.g.,  vegetable  pm-ees,  well  cooked, 
mashed,  and  freed  from  fibres,  skins,  shells, 
seeds,  etc.,  especially  potatoes,  carrots, 
turnips,  spinach,  cauliflower,  artichoke, 
asparagus  tops,  beans  and  peas;  also  vege- 
table soups,  well-cooked  cereals,  such  as 
rice,  barley,  oatmeal,  wheat,  arrowroot, 
sago  tapioca,  noodles,  macaroni;  milk, 
buttermilk,  koumyss  (see  Part  11),  cream, 
junket,  custards,  eggs,  cocoa,  coffee,  tea,  stale 
bread,  butter,  olive  oil,  mayonnaise  salad 
dressing,  scraped  meat,  minced  chicken  or 
other  finely  divided  meats  freed  from  con- 
nective tissue  and  cartilage,  stewed  tripe, 
and  wines,  diluted  and  in  small  amounts. 
Where  the  digestion  is  very  poor  the  follow- 
ing foods  are  serviceable,  namely,  bovinine, 
beef  tea,  meat  extracts,  somatose  (3  to  4 tea- 
spoonfuls daily,  cooked  in  milk  or  soups),  the 
vegetable  albumoses,  neutrose  and  tropon, 
and  various  other  peptones  and  infant  foods 
(Mellin’s,  Liebig’s,  Bonger’s,  Allenbury’s). 

Prescribe,  one  hour  before  each  meal, 
some  alkaline  mineral  water,  or  a cup  of 
hot  water  containing  a quarter  teaspoonful 
of  sodium  bicarbonate,  and  immediately 
before  the  meal,  a stomachic  (see  Anor- 
exia), for  the  purpose  of  stimulating  the 
gastric  secretions  and  the  appetite.  For 
anacidity,  which  is  usually  present,  pre- 
scribe dilute  hydrochloric  acitl  (or  dilute 
phosphoric  acid — Eichhorst),  gtt.  x-xx,  in 
three  ounces  of  water,  after  meals,  with  or 
without  pepsin,  gr.  viiss,  and  maltine,  gr. 
iss.  The  hydrochloric  acid  may  be  repeated 
three  or  four  times  at  hourly  intervals 
(Croftan).  If  acids  increase  discomfort, 
subst  tute  the  following  mixture; 

Bismuth  subcarhonatis, 

Sodii  hicarbonatis, 

Magnesii  carbonatis,  aagr.  Ixxx  (gr.  x per  dose) 
Tinctura;  belladonnas  t^xI-Ixxx  (ii^v-x  per  dose) 
Tincturse  nucis  vomi- 

c;e T^lxxx  (i^x  per  dose) 

A(pia>,  q.s.,  ad 3iv 

M.  Sig. — Shake  well  and  take  one  tablespoonful 
t.i.d.p.c. 


The  following  drugs  are  well  recommended ; 

Condurango  corticis  pulveris gr.  xxx 

Mitte  talis  pulveres No.  xxx 

8ig. — One  powder  four  or  five  times  a day,  before 
meals. 

Fluidextracti  condurango. 

Sig. — One-half  to  one  teaspoonful  four  or  five 
times  a day,  before  meals. 

Fluidextracti  condu- 
rango  oxii  (ttexIv  per  dose) 

Stiychninaj  sulphatis  gr.  ]i  (gr.  li,  per  dose) 

Acidi  hydrochlorici 

dduti 3iii  (>IRxi  per  dose) 

Infusi  gentiana;  com- 
positi,  ad 3vui 

M.  Sig. — Tablespoonful  in  a wineglass  of  water 
after  meals,  to  be  taken  through  a tube.  (Modified 
from  a prescription  of  Hemmeter’s.) 

Methyl  tliioninje  hydrochloridi  (methylene 
blue),  gr.  iii. 

Mitte  talis  caps,  gelat.  No.  xxx. 

Sig. — One  capsule  t.i.d.  (Einhorn.) 

R Trypsini gr.  viss-xx 

Mitte  talis  caps,  gelat.  No.  xxx. 

Sig.— One  capsule  t.i.d.  (To  dissolve  the  tumor 
cells.) 

For  flatulence,  due  to  the  decomposition 
of  retained  food: 

B Chlorali  hydrati 3iss  (gr.  xi  per  dose) 

Aquai 5 iv 

M.  Sig. — Tablespoonful  in  water  every  two  or 
three  hours.  (Ewald.) 

Creosoti,  tiji,  in  water,  t.i.d.p.c.  (Yeo.) 

II  Thymolis,  gr.  i,  in  capsula,  t.i.d.p.c. 

For  vomiting,  withdraw  food  by  mouth, 
and  substitute  rectal  feeding  if  necessary. 
Wash  out  the  stomach,  apply  heat  or  cold 
to  the  epigastrium,  and  achninister  some  one 
of  the  remedies  enumerated  under  Vomiting. 
Morphine  is  of  value. 

For  hsematemesis,  withdraw’  food  by 
mouth,  keep  the  patient  absolutely  quiet, 
elevate  the  foot  of  the  bed,  apply  a suspended 
ice-bag  to  the  epigastrium,  giv’e  ice  to 
suck  but  not  to  sw’allow’,  and  administer 
adrenalin  chloride,  1 : 1000  solution,  lQ-20-30 
drops  in  a little  water,  every  hom  or  two 
for  about  three  or  four  doses.  Give  mor- 
phine if  there  is  much  peristalsis.  To  av'oid 
thirst  and  peristalsis,  normal  saline  solution 
may  be  given  per  rectum  by  the  Murphy 
drop  method;  one-half  to  one  pint  may  be 
given  night  and  morning. 

For  pain  employ  lavage,  hot  wet  com- 
presses, anti  the  following  analgesics : Spirits 
of  chloroform,  methjdene  blue,  clxloral  hy- 
tlrate,  orthoform,  ana?sthesin,  bismuth, 
cotleine,  morphine,  Schlesinger’s  solution. 
(See  Part  11  for  dmg  formulte,  etc.). 


II  Morphinie gr.  ’g 

Sodii  bicarbonatis gr.  v 


Bismuthi  subnitratis gr.  v-x  (Osier) 


CARDIAC  INSUFFICIENCY  OR  FAILURE 


For  constipation  employ  laxatives 
and  enemas. 

For  diarrhoea  employ  rest  in  bed,  lavage, 
hot  abdominal  apphcations,  and  astringents. 

Thorough  lavage  of  the  stomach,  once  or 
twice  daily  in  the  morning  on  arising  and 
before  the  last  meal,  is  of  great  value.  The 
patient  may  improve  wonderfully  after 
lavage  is  begun.  After  each  lavage,  two  or 
three  ounces  of  warm  oil  may  be  introduced 
into  the  stomach.  (Cohnlieim.) 

Cancrum  Oris.  — See  under  Stomati- 
tis, Gangrenous. 

Canker  Sores. — See  Stomatitis  Herpetica. 

Capillary  Bronchitis. — See  under  Broncho- 
pneumonia. 

Carbon  Monoxide  Poisoning.— See 

Asphyxia  and  Poisoning. 

Carbuncle. — See  Skin  Diseases,  Part  5. 

Cardiac  Arrhythmia. — See  Arrhythmia, 
Cardiac. 

Asthma. — See  Cardiac  Insufficiency. 

Degeneration. — See  Myocarditis. 

Dilatation. — See  Cardiac  Insufficiency 
or  Failure. 

Extrasy  stoles. — See  Arrhythmia, Cardiac . 

Failure. — See  under  Cardiac  Insuffi- 
ciency or  Faihu-e. 

Fibrillation. — See  Arrhythmia,  Cardiac. 

Flutter. — See  Arrhythmia,  Cardiac. 

Cardiac  Insufficiency  or  Failure. — The 
symptoms  of  chronic  cardiac  insufficiency 
vary  in  severity  from  an  undue  proneness 
to  mental  or  physical  fatigue,  or  shortness 
of  breath  or  a sense  of  oppression  on  slight 
exertion,  to  the  following  more  persistent, 
although  variable  symptoms,  e.g.,  anorexia, 
indigestion,  perhaps  even  nausea  and  vomit- 
ing, abdominal  and  thoracic  pain  and  oppres- 
sion, pain  down  the  arms,  sometimes  throb- 
bing, rarely  palpitations,  the  heart’s  action 
rapid,  sometimes  slow,  perhaps  feeble,  some- 
times irregular,  perhaps  diill  headache  or 
dizziness,  perhaps  cough,  sometimes  haemop- 
tysis, especially  in  mitral  disease,  dyspnoea, 
especially  orthopnoea,  sometimes  paroxys- 
mal dyspnoea  or  cardiac  asthma,  signs  of 
congestion  at  the  bases  of  the  lungs,  per- 
haps enlargement  and  pulsation  of  the  liver, 
sometimes  jaundice,  nervous  symptoms, 
(restlessness,  insomnia,  fainting,  melan- 
cholia, delusions,  hallucinations,  mania), 
usually  constipation,  perhaps  hemorrhoids, 
cyanosis,  pallor,  dropsy,  and  diminished 
excretion  of  urine  which  shows  albumin, 
casts,  and  increase  of  acidity,  color,  and 
specific  gravity.  Sudden  death  may  be  the 
first  symptom. 

Percussion  reveals  an  enlarged  area  of 
cardiac  dulness,  and  fluoroscopy  a dilated 


heart.  The  entire  or  deep  area  of  cardiac 
dulness  may  be  mapped  out  best  by  means 
of  auscultatory  percussion,  with  the  tip  of 
the  stethoscope  placed  above  and  within 
the  apex  beat.  The  right  border  of  the 
heart  normally  extends  just  beyond  the 
sternum  at  the  fourth  interspace  on  the 
right;  and  on  the  left  it  extends  from  the 
left  sternal  margin  in  the  second  interspace 
diagonally  outward  and  downward  to  just 
outside  of  the  apex  beat,  which  normally 
lies  in  the  fifth  interspace,  about  three 
inches  to  the  left  of  the  midsternal  fine,  and 
one-half  inch  inside  the  mammillary  line. 
The  size  of  the  heart  is  best  ascertained, 
however,  by  fluoroscopy.  As  determined 
by  fluoroscopy,  at  a distance  of  seven  feet, 
with  the  patient  in  an  upright  position,  the 
normal  male  adult  heart  extends  7-11  cm. 
to  the  left  of  the  median  line.  Women’s 
hearts  average  about  1 cm.  less  in  each 
direction.  The  most  generally  useful  way 
of  ascertaining  the  size  of  the  heart  is  by 
noting  the  position  of  the  maxhnum  cardiac 
impulse  (by  inspection  or  auscultation), 
then  finding,  by  palpation,  the  “ point 
farthest  out  and  farthest  down  at  which 
any  rise  and  fall  synchronous  with  the 
heart-beat  can  be  felt.”  The  latter  point 
corresponds  to  the  apex  of  the  heart. 
(R.  C.  Cabot.) 

Etiology. — (Osier) . 

A.  Causes  op  Acute  or  Sudden  Cardiac 
Failure. — Wounds  of  the  heart,  spontan- 
eous rupture  of  the  heart;  rupture  of  a 
valve;  rapid  effusion  of  blood  or  serum  into 
the  pericardium,  due  to  rupture  of  an 
aneurysm,  or  of  a hydatid  cyst,  or  to  acute 
inflammation;  overexertion;  entrance  of  air 
into  the  heart,  from  the  uterine  veins  fol- 
lowing parturition,  or  from  operation  open- 
ing of  the  veins  of  the  neck,  or  in  caisson 
disease;  very  rarely  sudden  thrombosis 
within  one  of  the  heart  cavities;  embolism 
or  thrombosis  of  the  pulmonary  artery; 
sudden  interference  with  the  coronary  cir- 
culation, due  to  embolism,  thrombosis, 
sclerosis,  or  spasm;  sudden  asphyxia  due  to 
strangulation,  a foreign  body  in  the  pharynx 
or  larynx,  oedema  of  the  larynx,  oedema  of 
the  lungs,  or  bronchial  spasm;  infectious  dis- 
eases, particularly  diphtheria,  tjqihoid  fever, 
acute  endocarditis,  and  septicopyemia;  poi- 
sons, e.g.,  phosphorus,  cocaine,  chloroform, 
pilocarpine,  muscarine,  etc.,  too  rapid  ascent 
into  high  altitudes ; nervous,  probably  vagus, 
influences,  e.g.,  sudden  strong  emotion,  a 
tumor  contiguous  to  the  vagus  or  its  centre 
in  the  medulla,  abdominal  and  laryngeal 
injuries,  thoracic  paracentesis. 


CARDIAC  INSUFFICIENCY  OR  FAILURE 


B.  Causes  of  Chronic  Cardiac  Insuf- 
ficiency.— Myocardial  disease  (parenchy- 
matous, fatty,  amyloid,  or  hyaline  degenera- 
tion, or  brown  atrophy,  or  fibrous  myocar- 
ditis), due  to  malnutrition  from  improper  or 
insulficient  food,  niahgnant  disease,  severe 
anaemia,  leukiemia,  diabetes,  gout,  obesity, 
gastro-intestinal  intoxication  (chronic  dys- 
pepsia, chronic  dysentery),  poisoning  with 
arsenic,  lead,  phosphorus,  alcohol,  especially 
beer,  tobacco,  tea  and  coffee,  infectious  dis- 
eases, especially  streptococcic  rheumatism, 
prolonged  high  fever,  chronic  infection  (cho- 
lecystitis, appendicitLs,  tonsillitis,  naso- 
pharyngitis, suppuration,  etc.),  neoplasm, 
gumma,  or  parasitic  disease  of  the  myo- 
caixlium,  disease  of  the  coronary  arteries, 
exophthalmic  goitre,  chronic  worry. 

Overwork  of  the  heart,  due  to  valvular 
heart  disease,  mental  or  jihysical  over- 
exertion, excessive  veneiy,  atlherent  peri- 
cardium, and  peripheral  lesions  obstructing 
the  aortic  or  pulmonary  circulation,  e.g., 
atheroma  of  the  aorta,  syphilitic  aortitis 
with  or  without  aneurysm,  arteriosclerosis, 
renal  disease,  emphysema,  chronic  bron- 
chitis, bronchiectasis,  pulmonary  sclerosis, 
asthma,  chest  deformity  (kypho-scoliosis), 
compression  of  the  trachea  by  a goitre,  ery- 
thnemia,  obesity. 

Treatment  of  Chronic  Cardiac  Insufficiency  (so- 
called  failure  of  compensation,  tlecompensa- 
tion,  or  broken  compensation). — Remember 
first  and  always  that,  in  heart  failure,  it  is 
the  myocarthum,  the  heart  muscle,  which  is 
incapacitated,  and  which  we  are  to  treat. 
The  first  essential  is  rest  in  bed — in  a sitting 
posture  if  there  is  orthopneea.  Changes  of 
po.sture  should  be  made  slowly.  The  diet 
should  be  light  and  bland  and  administered 
in  small  amounts  every  three  hours:  egg 
albumen,  beef-juice,  milk  tliluted  with  lime 
water  or  soda  water;  later — custards,  well- 
cooked  cereals,  eggs  boiled  three  minutes, 
stale  bread,  toast,  crackers,  zwieback,  green 
vegetables,  tender  meats,  fish,  clam  and 
oyster  soups,  cooked  fruit.  Liquids  should 
be  restricted  unless  the  urine  is  very  scanty 
and  the  skin  dry.  Salt  should  be  restricted. 
If  nausea  ami  vomiting  are  troublesome 
symptoms,  withdraw  all  food,  except  per- 
haps milk  and  lime  water,  and  give  small 
bits  of  ice  to  suck,  or  Apollinaris  water,  or 
iced  champagne,  and  place  a large  mustard 
poultice  over  the  epigastrium.  Give 
required  medicines  hypodermically  under 
these  circumstances. 

Administer  in  the  beginning  a brisk 
calomel  purge,  gr.  ii-iii-v-x,  in  a single 
dose  or  divided  doses,  with  a little  sodium 


bicarbonate  to  avoid  digestive  disturbance 
at  night,  followed  by  a saline — Rochelle 
salt,  or  Epsom  salt,  5ss~i,  or  compound 
jalap  powder,  5ss,  in  the  morning,  at  least 
one  hour  before  the  first  meal.  Hirschfelder 
prefers  rhubarb  and  calomel,  aa  gr.  v,  at 
night,  as  being  more  certain  in  its  action. 

As  soon  as  the  bowels  have  been  emptied, 
a cardiac  stimulant  or  tonic  may  be  given. 

II  Tinctura!  digitalis 5 i 

Sig. — Minims  1.5-20,  well  diluted,  every  three 
hours,  after  eating,  for  about  two  days,  or  until 
diuresis  is  established  and  the  heart  slowed;  then 
minims  x-v,  t.i.d.,  until  compensation  is  restored. 
The  drug  may  have  to  be  continued,  in  api)iopiiate 
dosage,  indefinitely.  (See  Part  11.)  (To  lessen 
ndusea,  Hirschfelder  administers  the  drug  in  half  a 
glass  of  water  flavored  with  tr.  aurantii  amara',  3i, 
or  in  lemon  and  albumen  water,  or  a bitter,  such 
as  comp.  tr.  of  gentian  or  cardamom,  or  tr.  of 
(luassia  or  calumba,  3ss  of  either.) 

II  Infusi  digitalis  recentis Sviii 

Sig. — One-half  ounce  every  three  hours  for  two 
days,  then,  3iiss  t.i.d. 

II  Fluidextracti  digitalis 3ss 

Sig. — Five  minnns  t.i.d.  until  the  pulse  rate 
reaches  eighty;  then  discontinue.  (Hirschfelder.) 

R Digipurati,  tabellse  xxxii  (one  tablet  O gr. 
iss  of  digitalis  leaves;  it  contains  digi toxin,  and 
chgitalin,  but  no  digitonin. 

Sig. — 3 or  4 tablets  a day,  gradually  reduced. 

R Digitalini  veri  (a  mixture  of  pure  digitalin, 
digitalein,  and  digitonin),  gr.  }io,  hj'poderinically, 
every  three  or  four  hours. 

II  Digitalini  Germanici  (Merck),  gr. 
t.i.d.,  by  mouth  or  hypodermically.  The  best  of 
the  digitahns,  says  Forchheiiner. 

II  Digitalini  (Homolle’s  and  Nativelle’s  gran- 
ules; French  digitalin;  consists  almost  of  pure 
digitalin).  Begin  with  one-half  a granule;  the  next 
day  give,  perhaps,  a whole  granule,  (0.25  mg.)  watch- 
ing the  effects  carefully.  Intennit  the  drug  every 
third  or  fourth  day.  Very  effectual.  (Allbutt.) 

II  Digitalone  (tested  pharmacologically),  dose 
gtt.  v-xx. 

Digitalis  may  be  given  by  rectum  in 
normal  saline  solution  (qi  acl  Oi)  or  in 
starch  solution.  Given  by  mouth  the  effects 
arc  not  manifested  before  twenty-four  to 
seventy-two  hours.  Small  doses  may,  if 
required,  be  continued  for  months  and 
even  years. 

Digitalis  is  particularly  indicated  in  dila- 
tation of  the  heart,  accompanied  by  dysp- 
noea, cyanosis,  dropsy,  and  a rapid  irregular 
pulse,  (auricular  fibrillation,  g.v.).  It  is, 
as  a rule,  contraindicated  when  the  pulse 
is  slow,  when  extra-systoles  are  present, 
and  according  to  F.  W.  Price,  when  there 


CARDIAC  INSUFFICIENCY  OR  FAILURE 


is  a forcible  apex-beat  and  bounding  arteries. 
It  is  also  contraindicated  in  pulsus  alternans 
{q.v.),  and  in  conditions  in  which  the  heart- 
muscle  is  acutely  poisoned,  e.gr.,  in  acute 
infectious  disease,  acute  fatty  degeneration, 
and  other  intoxications.  It  is  not  contra- 
indicated, says  Osier,  in  high  arterial  tension. 

Toxic  effects  of  digitalis  are  as  follows: 
slowing,  (sometimes  quickening),  irregularity 
(especially  the  occurrence  of  extra-systoles 
and  coupling  of  the  beats),  and  weakness  of 
the  pulse,  falling  blood-pressure,  faintness, 
nausea  and  vomiting,  headache,  diarrhoea, 
diminished  urinaiy  excretion,  bad  dreams. 
When  these  occur,  discontinue  the  drug 
until  the  pulse-rate  begins  to  increase 
again  (usually  several  days).  The  urine 
should  be  measm’ed  each  day  while  admin- 
istering digitalis.  The  drug  should  be  given 
until  diuresis  is  established  and  the  heart 
slowed.  If  digitalis  fails,  it  should  not  be 
continued,  but  some  other  remedy  should 
be  tried. 

R PulverLs  digitalis  recenti.s, 

Pulveris  scillae, 

Mass®  hydrargyri,  vcl  hydrargyri 


subchloridi aa  gr.  i 

Confectionis  ros® c[.s. 


Fiat  pilula  una,  mitte  talis  x. 

Sig. — One  pill  every  eight  hours.  Guy’s  Pill, 
highly  recoininended ; both  digitalis  and  squills  are 
cardiac  stimulants,  mercury  is  both  laxative 
and  diuretic. 

R Strychnin®,  gr.  KoUio,  hypodermically  or 
by  mouth,  in  combination  with  digitalis.  Or  gr. 
%o  may  be  given  every  three  or  four  hours,  until 
facial  twitching  occurs. 

Strychnine  is  of  particular  value  as  a 
respiratory  stimulant  in  cardiac  dyspnoea 
and  Cheyne-Stokes  breathing. 

Much  less  useful  drugs  than  the  preceding 
are  the  following: 

Tinctur®  strophanthi 5ss 

Sig. — Minims  ten  in  water  or  cocoa  every  three 
or  four  hours. 

Osier  says  it  should  be  given  intramus- 
cularly or  intravenously  since  its  effect  by 
mouth  is  uncertain:  tr.  strophanthi,  rtpx  or 
strophanthin,  gr.  j-fooi  every  twenty-four 
hours  for  two  or  three  days.  Strophanthus 
is  said  to  be  more  effectual  than  digitalis  in 
the  presence  of  fever.  It  causes  much  less 
vaso-constriction.  It  should  not  be  given 
twenty-four  to  thirty-six  hours  following 
digitalis;  but  it  may  be  given  at  the  time 
digitalis  is  administered  by  mouth. 

R Infusi  adonis  vernalis  recenti.s Sviii 

Sig. — 3i-iv  every  two  to  four  hours. 


R Fluidextracti  convallari®  majalis. . 3ss 

Sig.— njv-x  four  times  a day.  A better  vaso- 
constrictor than  strophanthus. 

R Caffein® gr.  i 

Fiat  pulvis  una;  mitte  talis  xv. 

Sig. — One  powder  every  hour.  (Allbutt.) 

R Caffeine gr.  i-v 

Sodii  benzoatLs  vel  salicylatLs ....  gr.  iv-x 

Tinctur®  aurantii njxx 

Aquam  chloroformi,  ad 5i 

M.  Sig. — t)ne  ounce  three  or  four  times  daily. 

Caffeine  is  often  advantageously  given 
with  digitalis.  It  tends  to  counteract  (hgi- 
talis  arrhythmias  (W.  M.  Barton).  But  it 
is  apt  to  produce  restlessness  and  insomnia. 


R Potassu  acetatis gr.  xv 

Aceti  scill® nj.xv 

Syrupi  pruni  virginiana' tqjxI 

Aqu®  piment® 5i 


M.  Sig. — One  ounce  three  or  four  times 
daily.  (Allbutt.) 

To  tide  the  patient  over  emergencies, 
inject  hy]Dodermically  one  of  the  following 
rapid  stimulants: 

Ether,  Si- 

Camphor,  gr.  i-ii,  in  olive  oil  tt^xv, 
sterilized  by  heat,  every  two  to  three  hours; 
or  spirits  of  camphor,  itpxv.  Camphor  shoukl 
be  given  deep  into  the  muscles. 

Strychnine,  gr.  (contraindicated 

if  the  arterial  tension  is  high). 

Digitalin,  German,  (Merck)  gr. 
every  three  to  foiu'  hours. 

Strophanthin,  Amorphous,  gr.  H2O)  ii^“ 
travenously,  repeated  if  necessary,  in  twelve 
hours  (contraincUcated  if  the  patient  has 
been  taking  digitalis;  but  it  may  be  given 
when  digitalis  is  first  begun  by  mouth). 

Nitroglycerin,  gr.  HoO)  injected  with 
strophanthin,  is  very  effectual. 

Caffeine  sodium  salicylate  or  caffeine 
sodium  benzoate,  gr.  iss-iii,  two  to  three 
times  daily. 

Also,  by  mouth — Hoffman’s  anodyne, 
one  teaspoonful  on  sugar;  or  aromatic  spirits 
of  ammonia,  one-half  to  one  teaspoonful, 
well  diluted,  every  two  to  three  hours. 

Or,  oxygen  inhalations  (see  Pneumonia). 
The  oxygen  maybe  generated  from  a gasogen 
containing  oxylith  (Na-O,,)  or  sodium  per- 
borate, brought  in  contact  with  water  and 
a fountain  syringe  used  as  an  inhaler,  as 
described  by  Hirschfelder.  The  oxygen  may 
be  stored  in  a fifteen-litre  gas  bag.  (Fig.  30). 

Osier  highly  recommends  the  extraction 
of  6-10-20-30  ounces  of  blood  in  cases  with 
venous  engorgement,  cyanosis,  and  or- 
thopnoea.  Venesection  is  especially  in- 
dicated in  pulmonary  oedema,  along  with 


CARDIAC  INSUFFICIENCY  OR  FAILURE 


dry  cupping  {q.v.)  and  mustard  poultices. 
It  is  not  indicated,  however,  in  aortic  incom- 
petency.  Six  to  twelve  leeches  placed  over 
the  right  ventricle  or  the  liver,  may  be  sub- 
stituted for  venesection. 

For  anaemia  prescribe  iron  (the  ammonio- 
citrate,  phosphate,  or  tartrate)  and  arsenic 


(Fowler’s  solution),  as  soon  as  the  acute 
cardiac  symptoms  have  subsided. 


R Ferri  et  ammonii  citratis gr.  v-x 

Tincturai  nucis  vomica; rojviiss 

Tinctura;  calumba; 3i 

Aquae  pimeiitae,  q.s.,  ad Si 


M.  Sig. — One  ounce  t.i.d.  (Allbutt.) 

For  Throbbing,  Palpitation,  and  Pain. — 
Causal  influences  are  flatulence,  coffee,  tea, 
tobacco,  high  blood-pressure,  anjemia,  neu- 
rasthenia, hysteria.  See  Tympanites,  for  the 
correction  of  flatulency.  For  high  blood- 
pressure  prescribe  nitroglycerin,  or  sodium 
nitrite,  or  erythrol  tetranitrate  (see  Part  11). 
An  ice-bag  over  the  precordium,  tied  around 
the  chest  and  shoulders  with  an  elastic  four- 
tailed bandage,  and  changed  every  hour  or 
two,  may  afford  relief.  The  application  of  cold 
slows  the  heart  and  raises  the  blood-pres- 
sure, and  may  be  used  as  a routine  except 
in  cases  of  marked  fibrous  or  fatty  myocardial 
degeneration  (Hirschf elder).  Other  reflex 
measures  are  the  application  of  a belladonna 
plaster,  a blister  (see  Cantharides  in  Part 
11),  and  the  faradic  and  sinusoidal  currents 
to  the  precordium. 

Drugs  recommended  are:  Quinine  or 

quinine  valerianate,  gr.  i-iii  in  capsule; 
sodium  bromide,  gr.  xv-xxx,  t.i.d.,  in  milk 
or  soda  water;  morphine,  gr.  M;  potassium 
iodide,  gr.  x,  well  diluted,  t.i.d.,  (for  pain; 
see  Part  11). 

For  Flatulence. — See  Tjunpanites. 

For  Sleeplessness,  Irritability,  and  Psychi- 
cal Disturbances.— See  Insomnia.  Osier 
higlily  praises  morplhne  (gr.  hypodermic- 
ally, say  every  other  night)  for  its  calmative 
influence  in  cardiac  insufficiency.  For  the 
nocturnal  dyspnoea  and  restlessness  he  says 
it  is  invaluable. 

For  Dyspnoea.' — As  aggravating  factors 


think  of  flatulence,  ascites,  hydrothorax, 
and  congestion  or  oedema  of  the  Ixmgs. 
Morphine,  gr.  3^,  and  strychnine  in  full 
doses  (gr.  2]  stryclmine  is  a respira- 

tory stimulant)  are  weU  recommended. 

For  Eyilarged  and  Painful  Liver.— Fvo- 
Ihbit  meat.  Purge  the  patient.  Guy’s  pill  {q.v. 
in  Part  11)  is  well  recommended.  A mustard 
poultice,  ice-bag,  hot  water  bag,  dry  or  wet 
cups,  or  six  to  ten  leeches,  may  be  applied. 
In  applying  a wet  cup,  first  disinfect  the 
skin  by  means  of  tincture  of  iodine,  then 
apply  a dry  cup  as  described  under  Cupping; 
now  scarify  the  congested  skin  with  an 
instrument  consisting  of  lancet  blades  on 
a spring,  and  reapply  the  dry  cup. 

For  Bronchitis. — Syrup  of  squiUs,  mxxx- 
xl,  three  or  four  times  daily,  is  both  an 
expectorant  and  cardiac  stimulant.  Mus- 
tard poultices,  turpentine  embrocations, 
(see  Part  11)  dry  cupping,  and  inhalations 
of  steam  medicated  with  compound  tincture 
of  benzoin,  5i  ad  Oi,  or  creosote,  gtt.  x-xv 
ad  Oi,  are  useful  measures.  All  butt  says: 
“ Urgent  bronchitis  is  best  treated  by  large 
doses  of  ammonium  carbonate  ”: 

II  Ammonii  carbonatis gr.  xv-xx 

Sodii  iodidi gr.  ii 

Tincturae  scillae iijxv 

Aquae  camphorae  vel  infusi  sene- 
ga;, q.s.  ad gi 

M.  Sig. — One  ounce  3 or  4 times  daily.  (Allbutt.) 

Ammonium  chloride,  up  to  75  grains  a 
day  (Ortner),  is  also  of  value.  Codeine  or 
heroin  is  of  service  when  the  cough  is  a dry, 
reflex,  irritating  cough. 

For  Pulmonary  (Edema. — Dry  cupping, 
mustard  poultices,  venesection. 

For  Persistent  Dropsy.- — Salt  should,  of 
course,  be  withdrawn,  and  fluids  restricted. 
Purgation  should  be  resorted  to:  Epsom 
ralts,  5ss-i,  in  concentrated  solution,  one 
hour  before  breakfast;  or  5ss,  in  one  ounce 
of  water,  everj'  hour  until  effectual;  or  com- 
pound jalap  powder,  3ss,  once  or  twice  a 
day;  or  calomel,  gr.  iii,  every  six  hours  for 
three  or  four  days;  or  elaterium,  gr. 

}'2,  twice  or  thrice  a day.  Useful  diuretics 
are  caffeine  sodium-salicylate  or  caffeine 
sodium-benzoate,  dissolved  in  water,  gr. 
xx-xxx  daily;  theobromin,  gr.  viiss,  every 
three  hours  for  sbc  daj’s  (Tyson);  diuretin, 
gr.  x-xx,  dissolved  in  hot  water  on  using, 
three  or  four  times  a day;  theophyllin  or 
theocin,  gr.  iii,  well  diluted,  t.i.d.,  for  one 
day  (the  best,  says  Rowntree);  agurin,  gr. 
xv-xlv  a day;  potassium  acetate,  citrate, 
or  bitartrate,  not  more  than  one  ounce  a 
day;  Guys  or  Niemayer’s  pill  (calomel, 
digitalis,  and  squills,  aa  gr.  i).  Diuretics 


CARDIAC  INSUFFICIENCY  OR  FAILURE 


should  be  admini  tered  for  only  one  or  two 
days  at  a time. 

A marked  hydrothorax  or  ascites  shoidd, 
perhaps,  be  tapped  before  digitalis  is  achnin- 
istered  (see  Ascites,  and  Pleurisy.) 

The  legs  may  have  to  be  punctured.  After 
thoroughly  washing  the  legs  with  soap  and 
hot  water,  rinsing,  drying  with  sterile 
gauze,  and  painting  the  site  of  puncture 
with  tincture  of  iodine,  make  an  incision 
one  or  two  inches  long  completely  through 
the  skin,  perhaps  best  on  the  dorsum  or 
external  margin  of  the  foot  below  the 
malleolus  (Croftan).  Anoint  the  skin  with 
sterile  oil  to  shed  the  fluid.  Cover  the  wound 
with  sterile  gauze  and  cotton.  The  patient 
should  be  in  a sitting  posture.  Bier’s  suction 
cups  may  be  used  to  assist  the  flow.  Instead 
of  the  incision  one  may  employ  Southey’s 
or  Curschmann’s  tubes,  or  aspirating  needles 
with  boiled  rubber  tubing  attached,  leading 
to  a basin  of  boiled  water  on  the  floor,  thus 
establishing  siphonage  (Romberg).  The 
needles  may  be  inserted  on  either  side  of  the 
tendo  Achillis,  and  allowed  to  remain 
twenty-four  to  forty-eight  hours. 

After  acute  symptoms  have  subsitled,  and 
the  patient  can  sit  up  in  bed  without  dis- 
comfort, the  employment  of  non-fatiguing 
exercises  is  of  great  benefit  as  an  after- 
treatment  in  restoring  tone  to  a convalescent 
heart  that  is  not  devoid  of  reserve  j^ower. 

First,  passive  movements  in  betl  are 
employed  for  five  or  ten  minutes,  two  or 
three  tunes  a day,  and  these  are  gradually 
increased  in  number  and  intensity.  Then, 
after  several  days  of  rest  out  of  bed,  slow 
active  movements,  assisted  by  an  attendant, 
are  begun,  no  movement  to  be  repeated 
twice  in  succession.  The  movements  em- 
ployed are  all  the  natural  joint  movements 
in  all  directions;  but  the  arms  should  not  be 
raised  high  above  the  head,  because  of  the 
increased  hydrostatic  pressure  in  the  vena 
cava  thereby  induced.  Schott’s  regulations 
governing  resistance  exercises  are  as  follows: 

1.  “ Resistance  movements  include 
abduction,  adduction,  flexion,  extension, 
and  rotation  in  a vertical,  horizontal,  or 
lateral  direction.” 

2.  “ These  movements  should  so  alternate 
that  new  groups  of  muscles  are  continu- 
ously made  to  act  in  sequence,  thus  avoid- 
ing fatigue.” 

3.  “ The  resistance  should  be  made  by 
the  operator  as  slowly  and  gently  as  possi- 
ble but  with  as  much  firmness  and  muscu- 
lar power  as  the  patient’s  phys’eal  condition 
will  warrant.” 

4.  “ The  operator  should  nevel*  grasp  the 
patient’s  limb  tightly,  but  should  oppose  its 


movement  by  firm  counter-pressure  against 
the  advancing  side,  thus  retarding  the  move- 
ment but  always  permitting  the  patient  to 
retain  the  ‘ balance  of  power  ’.” 

5.  “ The  operator  should  change  his 
resistance  whenever  the  direction  of  the 
physical  force  is  changed.” 

6.  “ To  gain  a well-balanced  and  uniform 
effect,  these  exercises  should  always 
be  bilateral.” 

7.  “ The  operator  should  closely  watch 
the  j)atient’s  breathing  and  circulation  and 
at  the  slightest  sign  of  embarrassment  should 
stop  the  exercises.  The  patient  should 
never  be  allowed  to  hold  his  breath 
while  exercising.” 

8.  “A  pause  of  one  or  two  minutes  should 
be  allowed  between  each  exercise  in  order  to 
avoid  any  fatigue.  The  patient  may  sit 
down  during  the  pause,  especially  during  the 
latter  half  of  the  seance.” 

9.  “ The  length  of  time  devoted  to  each 
seance  shoukl  be  about  a half-hour.  At  the 
end  of  that  period  it  will  frequently  be 
found  that  the  number  of  heart-beats  has 
been  reduced  from  ten  to  fifteen  per  minute 
and  that  the  area  of  cardiac  dulness  has 
been  made  to  contract  an  inch,  more  or  less.” 

10.  “ After  the  seance  is  finished  the 
patient  should  rest  quietly  on  a couch  for 
at  least  fifteen  minutes.” 

In  place  of  the  resisted  movements  the 
patient  may  practice  resistance  himself  by 
the  slow  simultaneous  contraction  of  antag- 
onistic muscles. 

Shortly  after  the  use  of  resisted  exer- 
cises the  employment  of  stimulating  salt 
and  carbon  dioxide  (Nauheim)  baths  may 
be  instituted: 


Sodium  chloride 8 pounds 

Calcium  or  magnesium  chloride 2 pounds 

Sodium  bicarbonate pounds 

Sodium  bisulphate  (yielding  CO2) 21^  pounds 

Bath  water  at  90°  to  95°  F 40  to  45  gallons 


Protect  the  tub  against  the  bisulphate  by 
means  of  a large  rubber  cloth.  Add  the 
salts  to  the  bath  in  the  order  given.  Begin 
wdth  half-strength,  or  less,  of  the  salts,  and 
allow  the  patient  to  remain  in  the  bath  only 
fifteen  minutes,  watching  him  closely  for  an 
increase  of  cyanosis,  faintness,  or  excite- 
ment. After  the  bath,  rub  the  body  vigor- 
ously with  hot  towels  until  the  skin  glows. 
The  patient  should  then  rest  recumbent 
for  at  least  an  hour.  The  bath  should  not 
be  given  less  than  one  or  two  hours  after  a 
light  meal,  or  four  or  five  hours  after  a 
heavy  meal.  It  should  be  preceded  by  a 
cup  of  warm  milk,  cocoa,  or  broth.  The 
skin  should  take  on  a healthy  glow  within 
a few  minutes  after  the  bath;  and  if  this 


CARDIOSPASM  AND  (ESOPHAGISMUS 


does  not  occur  after  several  trials,  the  baths 
should  be  discontinued. 

In  place  of  the  carbon  dioxide  baths  one 
maj^  employ  electric  baths,  using  either 
alternating  or  sinusoidal  cm-rents  and  large 
copper  or  zinc  electrodes,  and  a current 
strong  enough  to  produce  prickly  sensations 
but  no  discomfort. 

Massage  is  also  beneficial. 

Finally,  before  the  patient  returns  to  his 
vocation  (which  should  be  changed  if  it  is 
too  strenuous),  he  should  take  daily  grad- 
uated walks  or  climbs,  interrupted  by  fre- 
quent rests. 

Days  of  rest  must  be  occasionally  inter- 
posed in  the  treatment.  The  latter  lasts 
from  three  to  sLx  weeks  in  mild  cases  to 
several  months  in  severe  cases.  Both  the 
exercises  and  the  baths  increase  the  tone  of 
the  heart,  raise  the  blood-pressure,  and  slow 
the  pulse  rate.  It  should  be  remembered 
that  they  arc  to  be  employed  only  as  an 
after-treatment,  to  strengthen  a convales- 
cent heart,  and  that  the  slightest  fatigue  or 
increased  breathing  should  be  avoided. 
(Schott-Hirschfelder.) 

In  the  stage  of  compensation  the  patient 
should  lead  a quiet,  temperate  life,  observe 
regular  hours  of  eating  anti  sleeping,  sleep 
at  least  ten  or  eleven  hours  at  night,  keep  the 
bowels  regular  (emj)loying  if  necessary  mild 
laxatives,  such  as  compound  licorice  powder, 
or  aromatic  cascara  sagrada,  or  compound 
laxative  pills  (see  Part  11);  take  daily 
moderate  exercise  short  of  fatigue,  breath- 
lessness, or  distress,  take  a daily  tepid 
bath  of  about  ten  or  fifteen  minutes  dura- 
tion, breathe  fresh  air  day  and  night,  and 
eat  a fair  abundance  of  simple,  bland, 
and  nourishing  food,  such  as  milk,  butter- 
milk, eggs,  raw  or  boiled  three  minutes, 
stale  bread  and  fresh  butter,  well-cooked 
farinaceous  gruels,  potatoes  in  motleration, 
fresh  vegetables,  meat,  and  stewed  fruits,  if 
he  is  feeble;  whereas  the  diet  should  be 
restricted,  especially  as  to  carbohydrates,  if 
the  patient  is  stout.  Fluids  and  salt  should 
be  restricted.  Foods  that  are  likely  to 
cause  flatulency  should  be  forbidden,  e.g., 
cabbage,  peas,  beans,  lentils,  sauerkraut, 
starchy  foods,  such  as  potatoes,  in  excess, 
and  ai'rated  beverages,  meat  extractives, 
liver,  Iddney,  sweetbreads,  raw  and  smoked 
meats,  condiments,  spices,  tea,  coffee,  and 
tobacco  should  also  be  avoided.  They  irri- 
tate the  heart  and  raise  the  blood  pressure. 
Brandy  or  whiskey  may,  perhaj^s,  be  allowed 
in  moderation.  The  patient  should  rest  for 
one  hour  before  and  after  meals. 

Any  focus  of  infection,  such  as  diseased 
tonsils,  pyorrhoea,  sinusitis,  pelvic  disease. 


bronchitis,  etc.,  should  be  eradicated,  in 
order  to  diminish  the  risk  of  acute  endo- 
carditis. High  altitudes  are  best  avoided. 

Cardiac  Intermittency. — See  Arrhythmia, 
Cardiac. 

Irritability. — See  Arrhjdlnnia,  Heart- 
Strain,  and  Palpitation. 

Neurasthenia. — See  Neurasthenia,  and 
Heart-Strain. 

Overstrain. — See  Heart-Strain. 

Palpitation. — See  Palpitation. 

Strain. — See  Heart-Strain. 

Cardialgia;  Heartburn. — Gr.  Kapbla  heart 
-}-  aXyos  ]iain.  See  Hyperacidity. 

Cardiospasm  and  CEsophagismus. — Gr. 
Kapbla  heart:  cardiac  end  of  the  stomach; 
olao(f>ajos  oesophagus:  oesophageal  spasm. 

Functional  spasmodic  contraction  of  the 
oesophagus  or  cardia,  causing  dysphagia, 
may  be  acute,  i.e.,  of  sudden  onset  and 
transient,  or  it  may  be  chronic.  Chronic 
spasm  may  be  followed  by  oesophageal  dila- 
tation, q.v.  The  cardia  is  oftenest  affected. 

The  stomach  tube  and  oesophageal  bougies 
may  be  passed  without  difficulty,  the  larger 
bougies  even  more  easily  than  the  small 
ones.  It  may  sometimes  be  necessary,  on 
introilucing  the  bougie  up  toThe  obstruction, 
to  wait  a moment  until  the  spasm  relaxes. 
If  a sound  cannot  be  passed,  ana'sthetize 
the  patient.  Exclude  inflammatory  or 
malignant  stricture,  an  impacted  foreign 
body,  pressure  from  a goitre  or  aneurysm, 
etc.  See  CEsophageal  Stenosis  and  Stricture. 

Etiology. — Hysteria;  neurasthenia;  hypo- 
chondriasis; epilepsy;  chorea;  excitement  or 
strong  emotion;  central  nervous  disease; 
such  reflex  influences  as  tonsillar  disease, 
foreign  body  in  the  ear,  intestinal  parasites, 
tuberculous  laryngitis,  gastric,  uterine,  and 
peritoneal  disease,  gall-stones,  renal  calculus, 
chronic  pancreatitis,  pregnancy,  oesophageal 
disease,  tumors  and  aneurysm;  gouty  dia- 
thesis; arteriosclero.sis;  plumbism;  uraemia; 
tobacco  and  alcohol  addiction;  hard  food; 
highly  seasoned  food;  too  rapid  swallowing; 
habitual  air  swallowing  with  resulting 
gaseous  distention  of  the  stomach;  dr}'- 
ness  of  the  throat  caused  by  atropine; 
strychnine  poisoning;  hydrophobia;  tetanus. 
According  to  William  Hill,  an  ocsophago- 
scopic  examination  will  reveal,  in  practi- 
cally all  cases  of  suspected  primary  card- 
iospasm, kinking  or  angulation,  tumefactive 
oesophagitis,  paresis — due  to  diphtheritic 
or  influenzal  neuritis  or  to  lesions  in 
the  pons  and  medulla,  e.g.,  hemorrhages, 
tumors,  bulbar  paralysis,  multiple  sclerosis, 
tabes,  dementia  paralydica,  or  an  organic 
stricture,  all  relieved  by  bougieing.  Ro{)ke, 
however,  affirms  that  most  examples  of 


CEPHALODYNIA 


cardiospasm  or  dilatation  of  the  cesophagus 
are  of  nervous  origin. 

Treatment. — Attend  to  the  underlying 
cause.  In  acute  cases  try  “ having  the 
patient  take  deep  inspirations  and  restrain 
expiration,”  also  “ pressure  upon  the  lower 
end  of  the  sternum  ” (Eorchheimer),  and 
sedative  drugs,  e.g.,  bromide,  antipyrine, 
ammonium  or  zinc  valerianate,  validol, 
camphor  or  camphor  monobromate,  atropine 
in  ascending  doses  until  flushing  is  produced, 
codeine,  morphine  (see  Part  11  for  drug 
formulae,  etc.).  The  passage  of  an  oeso- 
phageal bougie  is  effectual. 

Chronic  cases  are  treated  as  follows:  The 
diet  should  be  soft  or  liquid,  and  olive  oil 
may  be  taken  as  a lubricant  before  meals. 
Feeding  through  a tube  may  be  required. 
A dilated  oesophagus  may  have  to  be  irri- 
gated before  each  feeding.  The  systematic 
passage  of  a sound  may  be  eventually 
effectual;  but  the  use  of  Sippy’s  inflatable 
rubber  bag  or  balloon  to  paralyze  the  con- 
tracted muscles  of  the  cardia  is  preferable. 

Connected  with  the  bag  is  a blood-pressure 
apparatus,  100-150  mm.  pressure  being  suf- 
ficient and  perhaps  safe.  Air  pressure,  or 
water  pressure  by  means  of  a fountain- 
syringe  suspended  no  higher  than  five  to 
seven  feet  above  the  cardia  (to  avoid  rup- 
ture) is  used.  The  circumference  of  the 
limiting  silk  cover  on  the  rubber  balloon 
should  not  ordinarily  exceed  4 to  41^  inches 
in  adults.  Before  inserting  the  balloon  the 
stricture  should  be  examined  with  an  oeso- 
phagoscope.  In  difficult  cases,  the  spiral 
introducer  described  under  Qilsophageal 
Stenosis  and  Stricture,  may  be  passed  over 
the  silk  thread  as  a guide,  first  cocainizing 
the  pharynx  to  prevent  vomiting.  (Sippy.) 

T.  A.  Johnson  has  introduced  the  follow- 
ing improvement: 


Fig.  31. — Diagram  of  complete  apparatus  for  dilating  the  card: 
(Johnson),  a,  Hand-bulb  of  mercury  manometer;  b,  water  i 
pressure  bottle;  c,  mercury  manomete^;  d,  glass  capillary  tub 
e,  emergency  valve;  f,  Sippy  cardiospasm  dilator;  compressic 
chamber  above  water.  Courtesy  Practical  Medicine  Series. 

6 


Sippy  says:  “ One  good  stretching  may 
suffice  for  years.” 

The  cardia  has  been  dilated  through  a 
gastrostomy  opening  by  means  of  the  finger 
or  the  rubber-covered  blades  of  a pair  of 
dressing  forceps.  In  a rebellious  case  of 
Ropke’s,  complete  cure  was  obtained  by 
drawing  down  the  lower  end  of  the  o?so- 
phagus  through  an  abdominal  incision, 
and  freeing  it  from  all  the  surrounding 
tissues. 

In  persistently  recurring  cases,  it  may  be 
necessary  to  feed  the  patient  by  rectum 
for  a time  (see  Rectal  feeding). 

Carpo= Pedal  Spasm. — L.  carpus,  wrist; 
Gr.  Kap-iros;  L.  pes,  foot.  See  Tetany. 

Carrel’s  Treatment  of  War  Wounds. — 
See  Wounds. 

Cataphoresis. — See  under  Inflammation. 
Catarrhal  Cholangitis. — L.  catar'rhus, 

from  Gr.  Karappeiv  to  flow  down;  Gr.  yoXi) 
bile  + a.'yjtiov  vessel  -|-  -trts  inflammation. 
See  Jaundice,  Catarrhal. 

Catarrhal  Fever;  Cold. — See  Nose  Dis- 
eases, Part  8. 

Jaundice. — See  Jaundice,  Catarrhal. 
Epidemic. — See  Jaundice,  Infections. 

Stomatitis. — See  Stomatitis,  Catarrhal. 
Catarrh,  Autumnal. — See  Hay  Fever. 

Biliary. — See  Jaundice,  Catarrhal. 

Gastric. — See  Gastritis. 

Intestinal. — See  Enteritis. 

Nasal. — See  Nose  Diseases,  Part  8. 

Pharyngeal. — See  Throat  Diseases, 
Part  9. 

Post=nasal. — ^See  Throat  Diseases, 
Part  9. 

Cecum  Mobile. — See  under  Constipation, 

Chronic. 

Cellulitis  of  the  Neck. — L.  ceVlula,  cell. 
See  Ludwig’s  Angina. 

Cellulitis  of  the  Pharynx. — See  Lud- 
wig’s Angina. 

Cephalhaematoma. — Gr.  Ke(t>a\ij  head; 
aifjia  blood. 

A subperiosteal  blood-tumor  occurring 
during  or  shortly  after  parturition,  usually 
over  the  right  parietal  bone  and  circum- 
^ scribed  by  the  suture  boundaries  of  the 
bone,  unless  the  hemorrhage  happens  by 
chance  to  be  subaponeurotic.  The  tumor 
is  first  tense,  and  later  fluctuates.  It 
differs  from  a meningocele  in  that  the 
latter  may  be  emptied  by  pressure  and 
swells  when  the  child  cries. 

Treatment. — If  small,  protect  the  part 
with  cotton  pads  and  a hood.  If  large,  or 
infected,  incise,  and  evacuate  the  blood. 

Cephalodynia. — Gr.  K€4>a\i] ; head  -1- 
bbuvr)  pain.  See  Myalgia. 


CEREBROSPINAL  FEVER;  EPIDEMIC  CEREBROSPINAL  MENINGITIS 


Cerebellar  Ataxia.^ — L.  diminutive  of  cer'e- 
brum,  brain.  See  Ataxia. 

Lesions. — See  Brain  Localization. 

Cerebral  Abscess. — L.  cer'ebrum,  brain. 
See  Brain  Abscess. 

Arteriosclerosis. — See  Arteriosclerosis. 

Compression. — See  Concussion,  Con- 
tusion, and  Compression  of  the  Brain. 

Concussion. — See  Concussion,  Contu- 
sion, and  Compression  of  the  Brain. 

Contusion. — See  Concussion,  Contu- 
sion, and  Compression  of  the  Brain. 

Diplegia. — Gr.  twice  -f  TrXriyr]  stroke : 

bilateral  paralysis.  See  Spastic 
Paralysis. 

Embolism. — See  Apoplexy. 

Hemorrhage. — See  Apoplexy,  Concus- 
sion, Contusion,  and  Compression 
of  the  Brain,  and  Hemorrhage, 
Meningeal,  in  the  New  Born. 

Localization. — See  Brain  Localiza- 
tion. 

Nerve  Affections. — See  Cranial  Nerve 
Affections. 

Paralysis  of  Children. — See  Part  10, 
on  Orthopfedics. 

Peduncle  Lesions. — See  Brain  Local- 
ization. 

Softening. — See  Apoplexy. 

Thrombosis. — See  Apoplexy. 

Tumor. — See  Brain  Tumor. 

Cerebrospinal  Fever;  Epidemic  Cerebro= 
spinal  Meningitis. — An  acute  infectious  epi- 
demic and  sporadic  disease  of  young  people, 
caused  by  the  diplococcus  intracelhilaris  or 
meningococcus  (of  which  there  are  at  least 
4 types  not  serologically  related),  character- 
ized by  inflammation  of  the  cerebrospinal 
meninges,  and  the  following  variable  sjanp- 
toms,  viz.,  abrupt  onset  with  severe  head- 
ache, tender  eyeballs,  chills,  fever,  vomiting, 
increased  reflexes,  perhaps  convulsions;  pulse 
rapid,  sometimes  slow  and  irregular,  fever 
irregular,  rigidity  of  the  neck  and  extremities, 
sometimes  opisthotonous  (Gr.  omadtv  back- 
ward -|-  roVos  stretching),  flexures,  commonly 
strabismus,  muscular  tremors,  general  pains 
and  hyperiBsthesia,  great  irritability,  grind- 
ing of  the  teeth,  delirium,  stupor,  and  coma. 
Herpes  commonly  occurs.  An  erjdhematous 
roseolar,  and  petechial  or  purj^uric  rash  is 
common.  There  is  a marked  leucocytosis. 
Kernig’s  sign,  or  the  inability  to  exdend  the 
leg  on  the  thigh,  when  the  latter  is  placed  at 
right  angles  to  the  trunk,  is  present  in  other 
conditions  besides  cerebrospinal  meningitis. 

Lumbar  puncture  should  be  performed 
for  diagnostic  reasons.  The  procedure  is  as 
follows:  Turn  the  patient  on  the  side  with 
the  back  bowed  and  the  knees  drawn  up. 


Sterilize  the  skin  over  the  third  to  fifth 
Imnbar  vertebrae  with  soap  and  hot  water 
followed,  after  drying,  by  tincture  of  iodine. 
Then  cocainize  the  skin  endermally  (see 
Cocaine  inPart  11),  or  freeze  it  with  the  ethyl 
chloride  spray.  Insert  a sterile  aspirator 
needle,  5 to  10  cm. long  and  a lumen  of  1 to  2 
mm.  diameter,  with  stylet  (Kerley  uses 
Quincke’s  needle),  into  the  third  or  fourth 
lumbar  interspace  (in  children  on  a line  par- 
allel with  the  Iliac  crests),  slightly  to  one  side 
of  the  median  line,  and  direct  it  a little  up- 
ward and  inward.  The  depth  of  tissue  to  be 
penetrated  is  about  2)^  cm.  in  infants  and 
4 to  6 cm.  in  adults.  The  fluid  obtained  is 
apt  to  be  under  increased  pressure  (the 
normal  pressure  is  between  5 and  7.5  mm.  of 
mercury — Webster).  Never  aspirate,  as  it  is 
extremely  dangerous.  To  measure  the  pres- 
sure, connect  the  aspirating  needle,  as  soon 
as  it  enters  the  dura,  with  a mercury  man- 
ometer (filled  with  mercury  to  the  zero  point) 
by  means  of  a rubber  tube  containing  a one 
per  cent,  carbolic  acid  solution,  which  also 
fills  the  limb  of  the  manometer  connecting 
with  the  rubber  tube.  Hold  the  zero  point 
on  a level  with  the  aspirating  needle.  The 
spinal  fluid  in  epidemic  meningitis  is  usually 
turbid,  and,  in  the  acute  stage,  contains  a 
predominance  of  polymorphonuclear  leu- 
cocytes (lymphocytes  predominate  in  tuber- 
culous meningitis).  Stained  smears  from 
the  centrifuged  sediment,  and  cultures 
should  be  made.  The  technique  of  prepar- 
ing and  staining  smears  is  as  follows: 

(a)  Collect  the  sediment  on  one  end  of  a 
clean  dry  slide,  and  with  another  shde 
evenly  touching  the  fluid  at  an  angle  of  45° 
with  the  first  slide,  draw  the  fluid  along  the 
first  slide  with  little  pressure,  maintain- 
ing the  angle  of  45°.  Dry  the  smear  in 
the  air. 

(b)  Fix  the  smear  by  immersing  it  in 
absolutely  pure  methyl  alcohol  for  three  to 
five  minutes.  Then  drain  it  off,  and  allow 
it  to  dry  in  the  air;  or  wash  with  water  and 
dry  between  sheets  of  filter  paper. 

(c)  Stain  for  one-half  minute  in  0.5  per 
cent,  alcoholic  ("0  per  cent.)  solution  of 
Ginibler’s  blood  eosin  or  his  “French  pure” 
eosin.  Wash  in  water. 

(d)  Without  dr>dng,  stain  for  one  to  three 
minutes  in  Dclafield’s  ha'matoxylin,  made 
as  follows: 


Hsematoxj-lin  crA-stals 4 grams 

Absolute  alcohol 25  c.c. 

Ammonium-alum  crj’'stals,  C.P ....  52  grams 

Distilled  water 400  c.c. 

Glycerine,  C.P 100  c.c. 

Methyl  alcohol,  C.P 100  c.c. 


CEREBROSPINAL  FEVER;  EPIDEMIC  CEREBROSPINAL  MENINGITIS 


“ Rub  up  the  hsematoxyliu  crystals  with 
the  alcohol  until  they  are  dissolved  and 
place  the  solution  in  a loosely  corked  glass 
bottle,  allowing  it  to  stand  exposed  to  the 
light  for  four  days.  Dissolve  the  ammon- 
ium alum  in  the  water,  and  allow  it  to  stand 
exposed  in  the  same  way  for  four  days.  At 
the  end  of  this  time  mix  the  two  solutions, 
shake  thoroughly,  and  filter  at  the  eiul  of 
three  hours.  Add  the  glycerine  and  methyl 
alcohol  to  the  filtrate  and  allow  this  to 
stand  over  night.  Filter  the  mixture,  place 
it  in  a clear  bottle,  and  allow  it  to  ripen, 
exposed  to  the  light,  for  six  weeks,  when  it 
is  ready  for  use.” 

(e)  Wash  with  water,  chy  between  sheets 
of  filter  paper,  and  mount  in  Canada  balsam, 
(R.  W.  Webster).  (This  is  the  eosin-hfema- 
toxylin  stain,  and  is  ordinarily  employed 
especially  as  a nuclear  and  basophile  stain. 
The  meningococcus  is  found  mostly  within 
the  leucocytes. 

The  following  test  of  Collignon  and  Pilod 
may  be  tried:  To  50  drops  of  the  centri- 
fuged spinal  fluid  add  1 to  4 drops  of  anti- 
meningococcus  serum  and  incubate  along 
with  a control  tube  containing  only  spinal 
fluid,  at  56°  C.  for  twelve  hours.  The  occur- 
rence of  precipitation  is  positive  for  menin- 
gococcus meningitis. 

If  the  cerebrospinal  fluid  is  cloudy,  with- 
draw as  much  of  it  as  possible,  and  inject 
at  least  30  c.c.  of  Flexner’s  serum  at  once. 
The  serum  need  not  be  repeated  if  no 
meningococci  are  found. 

Other  bacterial  causes  of  acute  meningitis 
are,  pneumococci,  bacillus  tuberculosis, 
streptococci,  staphylococci,  bacillus  influ- 
enzae, and  rarely  the  following:  Friedlander’s 
bacillus  pneumoniae,  bacillus  typhosus,  bacil- 
lus coli,  gonococcus,  bacillus  mallei,  bacillus 
pestis.  (See  Meningitis,  AcuteCerebrospinal). 

In  meningococcic  meningitis  it  is  probable 
that  infection  takes  place  through  the  nose 
and  mouth. 

Prognosis. — Some  cases  are  mild  and  recover 
quickly;  some  are  malignant  and  rapidly 
fatal.  The  use  of  Flexner’s  serum  has 
reduced  the  mortality  from  about  50- 
80  per  cent,  to  about  25-31.4  per  cent. 
The  duration  of  the  disease  is  from  one  to 
six  weeks  or  longer  in  cases  not  treated  with 
serum.  Convalescence  is  usually  protracted. 
The  following  complications  and  sequelae 
may  occur;  bronchopneumonia,  pleuritis, 
parotitis,  endocarditis  and  pericarditis,  ar- 
thritis, inflammation  of  the  eye  structures, 
blindness,  deafness  due  to  otitis  or  nerve 
degeneration,  deaf-mutism,  hydrocephalus, 
mental  deficiency,aphasia,paralyses,epilepsy. 


Treatment.— Gentleness  in  handling  the 
patient,  and  quiet  should  beobserved,  and  the 
sick-room  should  be  darkened.  The  bowels 
should  be  opened  with  calomel  followed  by 
a saline  (see  Part  11),  and  a daily  move- 
ment should  be  thereafter  secured.  A con- 
centrated liquid  diet  should  be  administered 
every  two  or  three  hours;  water  should  be 
given  freely  (see  the  diet  in  Bronchopneu- 
monia. Gavage  {q-v.)  is  sometimes  required. 
The  hair  should  be  cliiDped  and  an  ice-cap 
kept  to  the  head.  A spinal  ice-bag  may 
also  be  used  if  not  chsagreeable.  The  skin 
should  be  daily  cleansed  with  equal  parts 
of  alcohol  and  water,  etc.,  to  avoid  bed- 
sores {q.v.).  The  nasal,  buccal,  and  urinary 
discharges  should  be  destroyed  (see  Disin- 
fection) . A nose  and  throat  spray  of  Dobell ’s 
solution  (see  Part  11)  is  advisable  both  for 
the  patient  and  attendants. 

Flexner’s  and  Jobling’s  antimeningococcic 
serum  should  be  administered  at  once,  since 
delay  in  its  use  diminishes  the  chances  of 
its  efficacy.  The  serum  should  be  kept  in 
the  refrigerator,  and,  before  using,  should 
be  warmed  together  with  the  syringe  with 
which  it  is  injected,  to  the  body  temperature. 
Twenty  to  forty-five  to  even  sixty  c.c. 
(according  to  the  clinical  requirements; 
three  to  twenty  c.c.  for  infants  and  children, 
but  see  Part.  11)  are  injected  very  slowly, 
to  avoid  pressure  symptoms,  into  the 
subarachnoid  space,  following  a lumbar 
puncture  and  the  withdrawal  of  as  much 
cerebrospinal  fluid  as  possible.  The  foot 
of  the  bed  should  be  elevated,  so  that  the 
serum  may  gravitate  toward  the  brain.  L. 
F.  Barker  directs  that  20  to  40  c.c.  of  cerebro- 
spinal fluid  be  withdrawn,  according  to  the 
age  and  size  of  the  patient,  and  5 c.c.  less  of 
antimeningococcic  serum  than  the  amount 
of  cerebrospinal  fluid  withdrawn  be  rapidly 
injected.  The  injection  should  be  given 
every  day  (twice  daily  in  very  severe  cases) 
for  four  days  or  longer,  until  the  meningo- 
cocci disappear  from  the  cerebrospinal  fluid 
and  the  symptoms  disappear.  If  the  cerebro- 
spinal fluid  is  so  purulent  that  it  does  not 
flow,  irrigate  the  canal  by  means  of  a number 
of  syringefuls  ofsterile  normal  saline  solution, 
and  then  inject  the  serum.  Dubois  and 
Neal  regard  the  syringe  as  dangerous,  and 
use  Koplik’s  gravity  method  instead.  The 
pulse  and  respiration  should  be  watched  for 
signs  of  compression  while  introducing 
the  serum. 

Lumbar  puncture  in  itself  is  valuable  as 
a therapeutic  measure,  for  the  relief  of 
pressure  symptoms  and  for  drainage,  and 
should  be  performed  as  often  as  necessary 


CHICKEN  POX;  VARICELLA 


under  the  following  circumstances,  viz., 
sudden  onset  with  collapse,  excessive  head- 
ache and  delirium;  marked  cervical  opis- 
thotonous  indicative  of  posterior  basic 
meningitis,  where  repeated  puncture  may 
possibly  prevent  hydrocephalus;  sudden 
development  of  symptoms  of  hydrocephalus 
during  convalescence,  i.  e.,  slight  rise  of 
temperature,  increased  pulse  rate,  mydri- 
asis, stupor,  convulsions,  and  a hollow 
tympanitic  percussion  note  over  the  site 
of  the  horn  of  the  lateral  ventricle  (2.5  to 
3 cm.  lateralward  from  the  junction  between 
the  sagittal  and  coronal  sutures.  The  punc- 
tures should  be  repeated  until  the  symptoms 
disappear.  If,  however,  the  ventricle  is 
obstructed  by  adhesions  in  the  passage 
between  the  third  and  fourth  ventricles  or 
about  the  fourth  ventricle,  one  or  more 
ventricular  punctures  will  be  necessary,  and 
should  be  done  early  (see  Cushing,  in  Keen’s 
Surgery).  In  persistent  obstruction  a con- 
nection may  be  established  between  the 
posterior  horn  of  the  lateral  ventricle  and  the 
subarachnoid  space  by  means  of  strands  of 
silk.  Lumbar  puncture  in  these  cases  is 
not  without  danger,  for  the  medulla  may 
crowd  down  into  the  foramen  magnum  and 
cause  sudden  death. 

For  the  relief  of  pain  and  restlessness 
employ  every  two,  three,  or  four  hours,  hot 
baths  or  hot  packs,  at  a temperature  of 
100°  to  110°  F.,  for  five  to  twenty-five 
minutes  at  a time,  with  an  ice-cap  to  the 
head  during  the  bath  or  pack.  Morphine, 
trional,  veronal,  pyramidon,  chloral,  and 
bromicle,  may  be  used  with  discretion  when 
deemed  advisable.  Ergot  is  said  to  pro- 
long the  action  of  a narcotic  (see  Part  1 1 for 
drug  formul®,  etc.). 

“ The  fever,”  says  Koplik,  “ requires  very 
little  treatment.” 

Since  hexamethylenamine  (urotropin)  lib- 
erates formaldehyde  in  the  spinal  fluid,  it 
may  be  tried;  gr.  lx  a day;  but  helmitol 
would  seem  more  appropriate  (see  Part  11). 
Corrosive  sublimate,  gr.  to  hypo- 
dermically, every  day,  for  adults,  and 
unguentum  Cred6  for  children,  are,  no  doubt, 
of  some  value  as  bactericidal  agents. 

For  pain  and  stiffness  during  convales- 
cence employ  hot  baths,  warm  packs,  and 
gentle  massage,  once  daily.  Potassium 
iodide  and  sweating  cures  are  recommended 
in  chronic  cases  to  hasten  the  absorption 
of  exudate. 

Cerebrospinal  Meningitis. — See  Menin- 
gitis, and  Cerebrosjiinal  Fever. 

Cervical  Enlargements. — L.  cer'vix,  neck. 

See  Neck  Enlargements. 


Cervical  Hypertrophic  Pachymeningitis. — 

Gr.  vTrep  over  -|-  Tpo<t>ri  nutrition;  Traxvs 
thick  -f  membrane  -|-  -tns  in- 

flammation ; inflammation  of  the  dura 
mater.  See  Meningitis,  Chronic. 

Rib. — See  Brachial  Plexus. 

Cervico=Brachial  Neuralgia. — See  Neu- 
ralgia. 

Cervico=Occipital  Neuralgia. — See  Neu- 
ralgia. 

Cestode  Infection,  Intestinal. — See  Tape- 
worm Infection. 

Chagas’  Disease. — See  American  Tiy- 
panosomiasis. 

Charcot’s  Joints. — See  Arthropathies. 

Cheese  Poisoning. — See  Poisoning. 

Chicken  Pox;  Varicella. — A common, 
trivial,  acute  infectious,  contagious  and 
epidemic  children’s  disease,  characterized  by 
an  incubation  period  of  fourteen  to  sixteen 
days,  followed  by  some  slight  indisposition 
and  the  appearance  of  a discrete  papulo- 
vesicular rash,  which  comes  out  slowly  in 
successive  crops,  and  is  most  marked  upon 
the  trunk.  There  is  very  little  fever.  The 
rash  lasts  about  a week  or  longer. 

Varicella  differs  from  variola  in  that  the 
pocks  are  single-chambered  and  can  be 
emptied  by  a single  needle-prick;  they  occur 
mostly  upon  the  trunk,  and  often  in  the 
mouth;  they  are  not  hard  and  shotty  to 
the  feel;  they  may  be  seen  at  one  time 
in  all  stages  of  development  — papules, 
vesicles,  crusts. 

Treatment.— If  isolation  is  decided  upon, 
it  should  be  continued  until  the  skin  is 
clear.  The  child  should  be  restrained  from 
scratching.  For  this  purpose  celluloid  mit- 
tens may  be  worn.  To  relieve  itching, 
sponge  the  skin  with  tepid  boric  acid  solu- 
tion, two  heaping  tablespoonfuls  to  the 
half  gallon;  or  apply  ten  per  cent,  boric 
acid  in  cold  cream;  or  menthol  ointment, 
5 to  10  per  cent.;  or  a solution  of  menthol 
in  equal  parts  of  alcohol  and  water;  or 
calamine  lotion  on  lint. 


B CalaminaB, 

Zinci  oxidi aa  5ii-iv 

Acidi  borici 3h 

Glyccrini irjxxx 

Acidi  carbolici gr.  xv-lx 

Aquic  calcis 5ii 

Aqusp,  q.s.,  ad Sviii 


M.  Sig. — .tpply  locally,  on  lint,  for  the  relief 
of  itching. 

Some  advise  painting  the  lesions  with 
equal  parts  of  tincture  of  iodine  and  alcohol. 
Distended  pustules  may  be  opened  and 
cleansed  with  boric  acid  solution  or  tincture 
of  iodine. 


CHLOROSIS 


Child=Crowing. — Sec  Laryngismus  Strid- 
ulus. 

Chills.  — Causes.  — Nervousness  ; severe 
pain;  parturition  (nervous  chill);  infusion 
of  saline  solution;  urethral  catheterization; 
movable  kidney;  cholelithiasis;  paroxysmal 
haemoglobinuria;  gastric  cancer;  acute  con- 
gestion of  the  lungs;  pneumonia,  tubercu- 
losis; malaria;  pyogenic  sepsis;  typhoid 
fever;  typhus  fever;  acute  nephritis;  rheu- 
matic fever;  relapsing  fever;  acute  diffuse 
myelitis;  acute  febrile  polyneuritis,  and 
other  infectious  diseases  at  the  onset. 

Chioroma.  — Gr.  x^wpos  green  -w/xa 
tumor. — Chioroma  is  a name  given  to  a 
rare,  fatal  affection,  characterized  by  the 
occurrence  of  “ greenish,  subperiosteal, 
lymphoid  masses  and  the  blood  picture  of 
lymphatic  leukemia.”  (A.  E.  Stansfeld.) 
See  Leukaemia. 

Chlorosis. — Gr.  xXwpos  green;  green-sick- 
ness.— An  anaemia  of  unknown  cause,  occur- 
ring almost  exclusively  in  young  girls, 
usually  between  fourteen  and  twenty-five 
years  of  age,  characterized  by  a slight 
diminution  in  the  number  of  red  corpuscles, 
ordinarily  a diminution  in  their  size,  and  a 
marked  reduction  in  the  coloring  matter  per 
corpuscle  (achromia  or  pallor  of  the  centres 
of  the  cells  is  noticeable),  with  consequently 
a low  color  index.  See  Blood  Examination. 


The  skin  has  a wax-like  appearance, 
changing  to  a greenish  tone;  the  cornea  are, 
in  typical  cases,  sky-blue.  Secondary  symp- 
toms are  breathlessness  on  exertion,  palpi- 
tations, syncope,  functional  systolic  mur- 
murs, slight  oedema,  muscular  weakness  and 
lassitude,  perverted  appetite  (for  pickles, 
chalk,  etc.),  dyspepsia,  constipation,  amen- 
orrhoea,  etc.  Thrombosis  {q.v.)  sometimes 


occurs.  Exclude  early  pulmonary  tubercu- 
losis and  gastric  or  duodenal  ulcer. 

Etiological  factors  of  importance  are  bad 
hygiene,  care  and  worry,  mental  or  physical 
strain,  masturbation,  insufficient  food,  lack 
of  fresh  air  and  exercise. 

Prognosis. — Under  treament  recovery  usu- 
ally occurs  in  from  tlu’ee  to  six  months. 
Recurrences,  however,  are  common. 

Treatment. — Enjoin  mental  and  physical 
rest,  sufficient  sleep,  fresh  air  day  and  night, 
sunshine,  nutritious  digestible  food,  and 
frequent  warm  bathing  followed  by  a sprink- 
ling of  cool  water  and  friction  with  a coarse 
towel.  Carbon  dioxide  baths  {q.v.  in  Part  11), 
taken  thrice  weekly,  are  very  stunulating. 
General  massage  is  useful.  Prescribe  iron. 

R Pil  ferri  carbonatis  (Blaudii) gr.  v 

Recent.  Praeparat.  pulv.  in  caps.  no.  c. 

Sig. — One  pill  t.i.d.p.c.,  increased  by  one  pill  each 
week  until  three  or  four  or  five  pills  are  taken  t.i.d. 
(To  prevent  gastric  solution  and  irritation  the 
powder  may  be  dispensed  in  gelatine  capsules 
hardened  with  formalin:  Sahli’s  glutoid  capsules, 
grade  II  of  hardness.)  Continue  the  iron  for  six 
months  after  recovery,  in  order  to  prevent  relapse, 
and  withdraw  it  gradually. 

Kerley  prefers  the  following : 

R Tincturae  nucis  vomi- 
cae  gtt.  cxx  (gtt.  iv  per  dose) 

Extract)  cascarae  sa- 

gradac gr.  x (gr.  K per  dose) 

Extract)  ferri  pomati.  gr.  xv  (gr.  per  dose) 
Liquoris  potassii  ar- 

senitis gtt.  cxx  (gtt.  iv  per  dose) 

Quininaj  bisulphatis. . 5i  (gr.  h per  dose) 

M. — Div.  et  fiant  capsulae  no.  xxx. 

Sig. — One  after  each  meal.  Take  for  periods  of 
ten  days,  with  five  days  intermission.  (Kerley). 

Yeo  prefers  the  following  two  formulae: 

R Ferri  sulphatis  exsic- 

cati gr.  l.xxii  (gr.  iii  per  dose) 

Potassii  carbonatis ...  gr.  xii  (gr.  ss  per  dose) 
Pulveris  nucis  vomi- 
cae   gr.  xxiv  (gr.  i per  dose) 

Saponis ■ • ■ ; gr.  vi 

Misce  et  chv.  in  pil.  xxiv. 

Sig. — One  to  three  pills  after  each  meal.  (Yeo.) 

R Ferri  sulphatis gr.  xvi  (gr.  ii  per  dose) 

Acidi  .sulphurici  diluti  irgxl  (n^v  per  dose) 
Liquoris  strychninae, 

1 per  cent iigxlviii  (iTEvi  per  dose) 

Magnesii  sulphatis.  . . 5i  (oi  per  dose) 

Aquam  chloroform),  ad  5viii 

M.  Sig. — Two  tablespoonfuls  twice  or  thrice  a 
day,  an  hour  before  meals.  (Yeo.) 

Forchheimer  gave  gr.  v-x  of  beta-naph- 
thol,  salol,  or  benzosalin,  t.i.d.a.c.,  as  an 
intestinal  antiseptic,  and  Blaud’s  pills  after 
meals.  To  children  he  gave  chocolate  or 
saccharin  flavored  tablets  of  ha;mogallol. 


CHOLECYSTITIS 


or  ferratin  (see  Part  11  for  drug  formulae, 
etc;  for  other  preparations  of  iron, 
see  Anaemia.) 

For  constipation,  a saline  may  be  given 
each  morning,  one  hour  before  breakfast; 
or  cascara  sagrada;  or  compound  laxative 
pill;  or  aloes;  or  aloes,  gr.  ii-iv,  with  ext. 
nuc.  vom.,  gr.  or  ext.  cas.  sag.,  gr.  ii, 
with  ext.  nuc.  vom.,  gr.  3^;  may  be  given 
once  or  twice  daily  or  at  night,  to  ensure  a 
daily  bowel  movement.  The  officinal  pilula 
aloes  et  ferri  may  be  of  service. 

For  anorexia  prescribe  bitter  tonics  before 
meals  (see  Anorexia). 

For  hyperchlorhydria,  see  Hyperacidity. 

For  hypochlorhydria,  prescribe  dilute  hy- 
drochloric acid,  10  to  20  drops,  well  diluted, 
one-half  hour  after  meals,  sucked  through 
a tube,  and  nux  vomica  before  meals. 

In  severe  cases,  keep  the  patient  in  bed 
for  several  weeks,  and  give,  besides  iron, 
Fowler’s  solution,  gtt.  ii,  well  diluted,  p.c., 
very  gradually  increased  even  up  to 
15  or  20  drops  t.i.d.  The  iron  may  be 
given  hypodermically. 

Ferri  et  ammonii  citratis,  solut.  aq.  neutral, 
steril.,  10  per  cent.  1.0  c.c. 

Dispense  in  sterile  ampoules. 

Sig. — Inject  1 c.c.  (gr.  iss  per  dose)  daily  or  every 
other  day  deep  into  the  skin  of  the  back  or  thigh, 
using  a platinum  hypodermic  needle.  (Forchheimer). 

For  the  treatment  of  thrombosis,  see 
under  Thrombosis. 

Chlorosis  may  be  accompanied  by,  or 
possibly  caused  by,  hypothyroidism  (q.v.). 

Cholangitis,  Acute  and  Chronic  Catarrhal. 
— Gr.  xoki)  bile  -f-  ayyaov  vessel  -| — trts  in- 
flammation. See  Jaundice,  Catarrhal. 

Cholangitis,  Suppurative.  — Suppurative 
inflammation  of  the  bile  ducts. 

Symptomatology. — Repeated  chills  and 

sweats,  leucocytosis,  and  a septic  fever,  a 
variable  degree  of  jaundice,  enlargement  and 
tenderness  of  the  liver,  usually  cholecystitis, 
nau.sea  and  vomiting,  and  progressive  emaci- 
ation and  weakness.  The  prognosis  is  bad. 

Etiology.— Gall  stones;  chronic  catarrhal 
cholangitis  (catarrhal  jaundice);  a tumor 
obstructing  the  bile  ducts;  infectious  dis- 
eases; suppurative  pylephlebitis;  rarely  the 
following:  liver  abscess;  compression  of  or 
rupture  into  the  biliary  ducts  of  a hydatid 
cyst;  comi)ression  of  the  duets  by  an 
aneurysm  of  the  hepatic  artery;  the  presence 
in  the  ducts  of  round  worms,  or  liver  flukes, 
or  of  a foreign  body,  such  as  a fish  bone. 

Treatment.— Establish  free  and  prolonged 
drainage  by  means  of  a cholecystostom5^ 

Cholecystitis.  — Gr.  xoXi)  bile  Kvans 
bladder  -t-  -irts  inflammation. 


A.  Acute  Cholecystitis. — Acute  cholecystitis 
may  be  catarrhal,  suppurative,  or  gangren- 
ous. Typical  symptoms  are  nausea,  vomit- 
ing, elevation  of  temperature,  rapid  pulse 
and  local  pain,  tenderness,  enlargement,  and 
muscle  spasm.  Local  signs,  however,  may 
be  absent.  If  jaundice  occurs,  it  may  be 
due  to  cholangitis,  spasm  of  the  bile  ducts, 
or  gall  stones.  Sometimes  the  symptoms  are 
those  of  acute  intestinal  obstruction;  some- 
times apjjendicitis  is  diagnosed. 

The  condition  is  serious.  While  the 
inflammation  usually  subsides  in  from  ten 
to  fourteen  days,  chronic  cystitis  and  gall 
stones  are  apt  to  follow.  Perforation 
is  a danger. 

Etiology.— Gall  stones;  traumatism;  infect- 
ious diseases;  typhoid  fever,  pneumonia, 
bronchitis;  tonsillitis;  local  intestinal  disease; 
Bright’s  disease;  obstruction  of  the  drainage 
ducts  due  to  tumors,  round  or  fluke  worms, 
a foreign  body,  such  as  a fish  bone,  gall  stones, 
kinking  or  cicatricial  constriction  of  the  ducts. 

Bacterial  agents  are  the  bacillus  coli, 
streptococci,  staphylococci,  bacillus  influ- 
enzae, bacillus  typhosus,  pneumococci, 
bacillus  mucosus. 

Treatment. — Because  of  the  vomiting,  with- 
draw all  food  for  a day  or  two,  or  allow 
small  amounts  of  broth,  raw  egg  albumen, 
and  equal  parts  of  milk  and  Vichy  or  Apolli- 
naris  or  lime  w'ater.  For  persistent  vomit- 
ing, try  gastric  lavage  with  hot  soda  w’ater 
or  the  remedies  enumerated  under  Vomiting. 

Apply  hot  fomentations  locally  for  the 
relief  of  pain  and  to  promote  the  reaction 
of  inflammation.  Administer  morphine 
hypodermically,  say  gr.  3>f6,only  if  necessary. 

Clean  out  the  bowels  with  hot  normal 
saline  (5i  ad  Oi)  enemas  for  the  first  one  or 
two  days;  or  give  calomel,  followed  by  a 
saline,  e.g.,  sodium  phosphate,  or  some  other 
saline,  together  with  hot  enemas.  The  free 
drinking  of  alkaline  mineral  waters  is 
advised.  Urotroj^in  or  helmitol  (helmitol  can 
act  in  an  alkaline  medium)  and  the  salicylates 
are  recommended  as  biliaiy  antiseptics. 
(See  Part  1 1 for  Drugs) . 

Operate  if  the  sjnnptoms  grow  worse 
instead  of  subsiding.  Do  a cholecystectomy, 
if  feasible,  but  if  there  is  the  slightest  evi- 
dence of  involvement  of  the  hepatic  ducts, 
do  a cholecystostomy  and  drain  the  ducts 
for  a w'eek  or  tw'o.  Cholecystostom}'  is  also 
indicated  in  the  presence  of  pancreatitis, 
pregnancy,  old  age,  and  stenosis  of  the 
common  duct.  The  IMayos  advise  that 
the  gall  bladder  be  sutured  “to  the  apo- 
neurosis e.xternal  to  the  muscle,  just  beneath 
the  skin,”  so  that,  in  case  of  relapse,  “ spon- 


CHOLELITHIASIS;  GALLSTONES 


taneous  reestablishment  of  the  fistula  ” 
can  occur. 

B.  Chronic  Cholecystitis.— Gall  stones  are 
usually  present ; indeed,  the  symptoms,  prog- 
nosis and  treatment  are  the  same  as  for 
cholelithiasis  (q.v.).  Jaundice  and  colicky 
pains,  however,  may  occur  as  a result  of 
spasm  of  the  ducts,  or  cholangitis,  or  con- 
stricting peritoneal  adhesions,  and  not  neces- 
sarily as  a result  of  gall  stones. 

The  Treatment  is  cholecystectomy,  or,  if  the 
hepatic  ducts  are  infected,  cholecystostomy 
and  drainage. 

In  operating  for  chronic  non-calculous 
cholecystitis,  the  Mayos  advise,  for  diag- 
nostic reasons,  that  the  appendix,  right  kid- 
ney, pylorus  of  the  stomach,  and  the  duo- 
denum be  explored  before  opening  the 
gall  bladder. 

Cholelithiasis;  Gall  Stones.— Gr.  yoXi? 
bile  -}-  \Ldos  a stone.  Chronic  indigestion — 
usually  pylorospasm,  hyperchlorhydria,  and 
intestinal  flatulence — may  be  the  only 
symptom.  There  is  usually,  however,  a 
history  of  gall-stone  colic.  An  attack  of 
colic  may  last  from  several  hours  to  a week 
or  longer,  and  is  characterized  by  severe 
paroxysmal  pain  in  the  epigastric  or  right 
hypochondriac  region,  radiating  to  the 
right  scapular  region,  associated  with  eleva- 
tion of  temperature,  sometimes  chilliness, 
nausea,  vomiting,  and  usually  the  local 
signs  of  acute  cholecystitis  (q.v.).  Search 
the  stools  for  gall-stones  by  means  of  a 
fine  sieve.  Before  diagnosing  biliary  colic, 
exclude  renal  colic,  Dietl’s  crisis,  gastric  or 
duodenal  ulcer,  hyperchlorhydria,  lead  colic, 
and  gastric  tabetic  crisis. 

Jaundice  is  a common  symptom  of  chole- 
lithiasis, and  may  be  due  to  stone  in  the 
common  duct  or  in  the  hepatic  ducts,  to 
compression  of  the  ducts  by  a stone  in  the 
cystic  duct,  to  spasm  of  the  ducts,  to 
inflammatory  swelling  of  the  ducts,  or  to 
constricting  peritoneal  adhesions  (for  all 
possible  causes  of  jaundice,  see  Jaundice.) 
Stone  in  the  common  bile  duct  may 
cause  complete  obstruction  and  persistent 
jaundice,  or  incomplete  obstruction  (“ball 
valve  stone  ”),  with  a jaundice  of  varying 
intensity,  associated  with  intermittent  chills, 
fever,  and  sweats,  pain  in  the  right  hypo- 
chondriac and  epigastric  regions,  nausea 
etc.,  due  to  biliarj^  infection  (cholangitis). 

Stone  in  the  cystic  duct  may  cause  com- 
plete obstruction,  distention  of  the  gall- 
bladder with  mucus,  and  acute  cholecystitis; 
or  it  may  cause  incomplete  obstruction, 
with  contraction  and  fibrosis  of  the  gall- 
bladder, and  a resulting  chronic  dyspepsia. 


The  occurrence  of  peritoneal  adhesions 
may,  in  themselves,  give  rise  to  symptoms 
of  indigestion  and  even  jaundice.  Biliaiy 
fistulse — cutaneous,  gastro-intestinal,  bron- 
chial, rarely  others — may  occur.  Perfora- 
tion into  the  peritoneum  and  intestinal 
obstruction  are  other  possible  consequences 
of  gall-stones.  “ Involvement  of  the  pan- 
creas in  gall-stone  disease  is  exceedingly 
common.”  (Mayo.) 

Etiology.— In  Naunyn’s  belief,  a mild 
catarrh  of  the  bile  passages  is  the  starting 
point  of  gall-stone  formation,  but  Boysen 
and  Rovsing  hold  that  gall-stones  are  the 
result  of  transient  thickening  or  inspissation 
of  the  bile,  during  which  precipitation  is 
liable  to  occur. 

Contributory  cau.ses  are : a sedentary  life, 
constipation,  insufficient  fluid  ingestion, 
overeating,  alcohol,  obesity,  pregnancy, 
tight-lacing,  enteroptosis,  nephroptosis,  de- 
pressing mental  emotions,  and  an  habitual 
“ leaning  forward  ” posture,  all  causing 
concentration  of  the  bile  or  obstruction  to 
its  free  flow.  Typhoid  fever  is  often  followed 
by  cholelithiasis.  The  colon  bacillus, 
typhoid  bacillus,  streptococcus,  staphylo- 
coccus, pneumococcus,  and  influenza  bacil- 
lus may  act  as  causal  agents.  The  great 
majority  of  stones  have  their  origin  in  the 
gall-bladder  and  not  in  the  liver  itself. 

Treatment. — (a)  Gall-stone  colic.  Admin- 
ister a hypodermic  of  morphine,  gr.  34> 
with  atropine,  gr.  Hoo>  both  to  relieve 
pain  and  relax  spasm,  and  repeat  the  dose 
if  necessary.  A few  whiffs  of  chloroform  or 
ether  may  be  given  while  waiting  for  the 
morphine  and  atropine  to  act.  Atropine, 
gr.  or  tincture  of  belladonna, 

Tijxv-xxx,  may  be  given  alone  for  the  pur- 
pose of  relaxing  muscular  spasm  of  the  ducts; 
TTpx  of  the  tincture  may  be  given  every  four 
hours  until  the  throat  becomes  dry  and  a 
red  flush  appears  on  the  face  and  neck. 
Tincture  of  hyoscyamus,  npxv-xxx;  spirits 
of  chloroform,  5i,  well  diluted;  and  spirits 
of  ether,  30  drops  in  two  drams  of  chloro- 
form water  every  fifteen  minutes;  are  also 
severally  recommended.  Hot  local  fomenta- 
tions, hot  antiphlogistine  or  cataplasma 
kaolini,  mustard  packs,  hot  lavage  of  the 
stomach,  hot  foot-baths,  and  the  hot  full 
bath  lasting  an  hour  or  so,  arc  all  useful  for 
the  purpose  of  relaxing  spasm  of  the  bile 
ducts.  Osier,  Croftan,  and  others  advise 
the  administration  of  laxatives;  Yeo  does 
not.  The  patient  should  drink  large  quanti- 
ties of  hot  water  containing  sodium  bicar- 
bonate, 5i  to  the  pint;  to  which  sodium 
salicylate,  gr.  x-xx  every  four  hours,  may 


CHOLERA  ASIATICA 


also  bo  added,  for  flic  j)urpose  of  diluting 
the  bile  (Yeo;  Langdoii  Brown).  If  collapse 
threatens,  give  hot  alcoholic  drinks,  cham- 
pagne, aromatic  sj)irits  of  ammonia,  5i 
well  diluted;  or  sterile  camphorated  oil, 
3ss,  or  ether,  i^x-pi,  hypodermically,  deep 
into  the  muscle,  every  one  or  two  hours,  as 
required.  For  the  relief  of  persistent  vomit- 
ing, employ  gastric  lavage,  or  the  remedies 
enumerated  under  Vomiting.  Give  no  food 
as  long  as  the  vomiting  persists. 

(b)  After  the  attack  has  sub.sided,  enjoin 
the  following  prophylactic  rules,  viz.,  a 
plain,  moderate,  bland  diet;  the  drinking  of 
large  amounts  of  alkaline  mineral  waters, 
such  as  Vichy  or  Apollinaris,  or  soda  water — 
sotlium  bicarbonate,  gr.  xx  to  the  tumbler- 
ful, preferably  hot;  laxatives — Carlsbad 
water,  or  sodium  sulphate  or  phosphate, 
3i,  in  a glass  of  hot  water,  once  to  thrice 
daily,  as  required,  one  hour  before  meals; 
daily  exercise  in  the  open  air;  and  deep, 
diaphragmatic  breathing.  The.se  measures 
are  designed  to  promote  the  flow  of  bile  and 
to  prevent  its  concentration. 

Sodium  glycocholate,  gr.  x-xv  daily, 
ammonium  chloride,  gr.  x t.i.d.,  and  sodium 
salicylate,  gr.  x-xv,  well  diluted,  t.i.d.,  are 
the  most  effectual  cholagogues.  The  latter 
is  also  a biliary  antiseptic.  Hexamethy- 
lenamine  or  urotropine,  and  helmitol  (see 
Part  11)  liberate  formaldehyde  in  the  bile 
passages,  and  may  therefore  be  used  as 
biliary  antiseptics,  if  deemed  advisable.  The 
use  of  olive  oil  is  of  doubtful  value. 

For  the  relief  of  itching,  emjdoy  hot  alka- 
line baths,  or  a dusting  powder  consisting 
of  starch,  5 i,  camphor,  3 iss,  and  zinc  oxide, 
3ss,  or  some  one  of  the  remedies  given 
under  Pruritis,  in  Skin  Di.seasos,  Part  5. 
W.  Langdon  Brown  says  he  has  found 
thyroid  extracd,,  gr.  v,  two  or  three  times 
a day,  the  best  remedy,  “as  it  diminishes 
the  production  of  bile  salts  to  the  presence  of 
which  in  the  circulation  the  itching  is  due.” 

(c)  Operation  is  indicated  in: 

1.  Acute  cholecystitis  which  increases  in 
spite  of  conservative  treatment. 

2.  Persistent  enlargement  of  the  gall 
bladder. 

3.  Two  or  more  attacks  of  gall-stone  colic. 

4.  Chronic  jaundice  (operate  early). 

5.  Intestinal  obstruction,  due  to  gall  stones 
or  to  fistula}. 

6.  Peritonitis. 

7.  Chronic  pain  and  dyspncea  due  to 
{X'ritoneal  adhesion. 

For  stones  in  the  gall-bladder  or  cystic 
duct,  perform  a cholecystectomy,  unless 
there  is  evidence  of  infection  of  the  hepatic 


ducts,  when  a cholecysto.stomy  .should  be 
performed,  the  stones  removed,  and  drain- 
age* established.  For  stones  in  the  com- 
mon duct,  perform  a choledochotomy  fol- 
lowed by  temj)orary  drainage  to  the  surface. 

In  the  presence  of  jaundice,  give  calcium 
lactate,  gr.  xv,  t.i.d.,  for  three  days  before 
operation,  in  order  to  diminish  the  tendency 
to  hemorrhage. 

Cholera  Asiatica. — Gr.  xoXepa,  from  xo^ij 
bile.  A very  fatal,  epidemic,  acute  intestinal 
infection,  caused  by  the  ingestion  of  the 
cholera  vibrio  or  spirillum,  or  coma 
bacillus  of  Koch,  and  characterized  by  an 
incubation  period  of  about  two  to  six  days, 
followed  by  a profuse  diarrhoea  (rice-water 
stools),  nausea,  vomiting,  flatulency,  colic, 
coated  tongue,  thirst,  muscular  cramps,  and 
often  collapse.  The  cases  vary  in  severity 
from  mild  ones  which  recover  in  a few  days, 
to  very  severe  cases  with  delirium,  coma, 
shrunken  facies,  circulatory  failure,  anuria, 
and  rapid  death. 

The  diagnosis  is  made  by  the  demonstra- 
tion of  the  cholera  vibrios  in  the  dejecta, 
ami  by  the  agglutination  test.  The  latter  is 
performed  as  follows:  Place  in  a small  test 
tube  fifteen  drops  of  an  actively  motile 
twelve  to  twenty-four  hour  bouillon  culture 
of  cholera  vibrios,  and  add  to  this  one 
equally  sized  drop  of  the  patient’s  blood. 
Examine  the  mixture  under  a cover  glass 
with  a high-power  dry  lens.  The  occurrence 
of  clumping  within  five  to  twenty  minutes 
indicates  a positive  reaction. 

H.  K.  Mulford  Co.,  Philadelphia,  furnish 
a cholera  agglutinating  serum  which  con- 
sists of  the  dried  blood-serum  of  horses 
which  have  been  injected  with  killed  cul- 
tures of  the  cholera  vibrio.  “ For  use  the 
serum  is  dissolved  in  salt  solution  so  as  to 
make  a definite  dilution,  commonly  1 :100. 
A drop  of  this  is  mixed  with  the  suspected 
culture  and  the  mixture  is  observed  untler 
the  microscope  for  evidences  of  agglutina- 
tion.” (N.  N.  R.) 

Treatment.— Put  the  patient  to  bed,  cover 
warmly,  and  administer  frequently  and 
abundantly  a mixture  of  equal  parts  of 
kaolin  or  bolus  alba  and  water  (Stumpf). 
Charcoal  may  also  be  added  to  this  mixture 
in  any  amount.  Both  the  kaolin  and  char- 
coal jirobably  act  by  aI)sorbing  the  toxins 
and  mechanically  carrying  the  bacteria 
away  with  them.  Leonard  Rogers  extols  the 
virtues  of  permanganates,  which,  he  declares, 
“ have  the  power  of  rapidly  oxidizing  cholera 
toxins  into  harmless  bodies.”  He  gives  in 
.severe  cases  two  keratin  or  salol  coated  pills, 
each  containing  two  grains  of  potassium  per- 


SUDORIFIC  PLANTS 


Bitter-Sweet 
>1 X Berry 


Bitter-Sweet 


Burdock 


[uniper  tree 


Elder  tree 


Enlarged  blooms 


DIURIETIC 


PLANTS 


Chervil 


Parietary 


Enlarged  bloom 


fS  i 'A  Asparagi 


Milkwort 


Flower 


Spihelet 


Do0S  grass] 


yV'  7)frrtt)ul-n  Sc 


LAR0U3SE  MEDICAL 


Sudorific  and  diuretic  plants 


CHONDRODYSTROPHIA  FCETALIS 


manganate,  every  fifteen  minutes  for  two 
to  four  hours,  and  then  every  half-hour, 
“ until  the  stools  become  less  copious  and 
of  a greenish  or  3"ellow  color.”  “ In  milder 
cases  and  in  children  smaller  quantities  are 
given.”  “ In  addition,  a solution  of  calcium 
permanganate,  gr.  ii-vi  to  the  pint,  is  given 
to  drink  in  large  quantities.”  “ Commonly, 
in  about  si.x  to  eight  hours,  the  stools  change 
color,  when  the  permanganates  are  omitted, 
but  a further  course  of  sixteen  grains  is 
given  twenty-four  hours  after  admission  to 
guard  against  relapses,  or  whenever  rice- 
water  stools  are  again  passed.” 

Formerly  it  was  the  custom  to  administer 
calomel,  gr.  3^  to  every  two  hours  for  one 
or  two  days  (gr.  ix-xv  altogether  for  an 
adult) ; followed  by  Bismuth  subnitrate 
in  large  doses,  e.g.,  3^s-i,  every  two  or 
three  hours: 


II  Bismuthi  subnitratis, 

Bismuthi  salicylatis aa  gr.  xxx 

Mucilaginis  acacisD o ii 

Aquam  chloroformi,  ad 5i 


M.  Sig. — To  be  taken,  after  shaking,  every  two 
or  three  liours.  (Yeo.) 

The  bismuth  is  supposed  to  form  a pro- 
tective antiseptic  coating  to  the  intestinal 
wall,  and  it  gives  off  slowly,  in  contact  with 
water,  nitric  acid  (the  cholera  vibrios  do  not 
grow  in  an  acid  medium).  Rogers  does  not 
sanction  the  administration  of  astringents  or 
of  opium. 

For  the  first  three  days  it  is  well  to  give 
no  food  by  mouth,  excepting  only  hot 
barley  water  or  hot  weak  tea  in  small 
amounts  frequently.  On  about  the  fourth 
day,  if  feasible,  try  the  addition  of  whey 
1 and  arrowroot,  and  later  boiled  milk  diluted 
with  Apollinaris  or  Seltzer  water,  broths, 

I cocoa,  and  raw  eggs.  Water  should  be 
: given  freely. 

To  help  control  the  vomiting,  one  may 
I wash  out  the  stomach  with  a warm  solution 
I of  sodium  bicarbonate,  3i  ad  Oi,  or  give 
I cracked  ice  to  suck,  or  tincture  of  iodine 
i one  drop  in  a teaspoonful  of  water,  every 
I fifteen  minutes  for  three  or  four  hours,  and 
at  the  same  time  apply  a mustard  plaster 
(g.  V.  in  Part  11)  to  the  epigastrium. 

I Apply  hot  flaxseed  poultices  or  hot  tur- 
pentine .stupes  to  the  abdomen,  the  latter 
as  follows:  Wring  out  a flannel  from  steam- 
ing hot  water  containing  a teaspoonful  of 
turpentine  to  the  quart,  apply  it  to  the 
abdomen,  and  cover  with  dry  flannel;  alter- 
nate these  with  plain  hot  stupes. 

If  the  fever  exceeds  104°  F.,  employ  ice 
to  the  head,  cold  packs  or  cold  sponging, 
and  cold  water  enemata,  at  once,  for,  says 


Rogers,  “if  the  patient  once  becomes  uncon- 
scious from  hyperpyrexia,  I have  never  seen 
recovery  take  place,  although  a temperature 
of  100°  is  harmle.ss  if  detected  and  reduced 
without  dela>'.” 

I"or  collapse,  employ  warmth  and  stimu- 
lation : camphorated  oil,  .stiychnine,  caffeine, 
strophanthin,  digitalin,  pituitrin,  epine- 
phrine (see  Part  11). 

The  subcutaneous,  intravenous,  or  colonic 
infusion  of  normal  (gr.  lx.x  ad  Oi)  or  better, 
gum-salt  solution,  should  be  employed 
from  the  beginning  to  replace  water  loss  and 
maintain  the  circulatory  and  renal  functions. 
Leonard  Rogers’  hypertonic  solution  con- 
sists of  sodimn  chloride,  gr.  exx,  potassium 
chloride,  gr.  vi,  and  calcium  chloride,  gr.  iv, 
to  the  pint  of  water.  It  is  best  given  intra- 
venously iq.v.):  3 to  4 pints,  slowly,  to 
adults;  1)^  pints  to  children  of  ten  years; 
less  for  younger  children.  From  twenty  to 
even  thirty-four  pints  may  be  injected  in 
the  course  of  three  or  four  days;  but  only  in 
the  presence  of  lowered  arterial  tension.  If 
the  fever  is  high,  the  temperature  of  the 
infusion  should  be  correspondingly  lowered. 

Soloids  containing  the  above  salts  may 
be  obtained  from  Burroughs,  Wellcome  & 
Company;  4 to  one  pint  makes  a h3^pertonic 
solution,  3 to  one  pint  an  isotonic  solution. 

Treat  suppression  of  the  urine  by  early 
and  repeated  infusions  of  alkalies,  as 
described  under  Acidosis. 

The  bland  liquid  diet  should  be  continued 
for  some  time  cluring  convalescence  in  order 
to  guard  against  relapse. 

Prophylaxis.— Isolate  the  sick,  cholera  car- 
riers and  all  contacts  (the  latter  for  six  days), 
and  carry  out  the  sanitary  measures  des- 
cribed under  Disinfection.  The  excreta  and 
soiled  objects  should  be  disinfected;  crosol 
water,  2)-^  per  cent.,  milk  of  lime,  1:5, 
and  chloride  of  lime,  1 : 50,  are  efficient 
disinfectants.  Clean  out  dirty  dwellings. 
Boil  the  drinking  and  washing  water  and 
cook  all  food;  and  exclude  flies.  Keep  the 
hands  clean.  Preventive  vaccination  with 
living  or  dead  vibrios  is  successfully  carried 
out  (see  Vaccines  in  Part  11). 

Convalescent  patients  should  be  released 
from  quarantine  only  when  examination  of 
the  stools  for  vibrios  is  negative  on  three 
alternate  days. 

Cholera  Infantum. — See  under  Diarrhma 
in  Bottle-fed  Infants  and  in  Early 
Childhood. 

Morbus  or  Nostras. — See  under  Ente- 
ritis Acuta. 

Chondrodystrophia  Fcetalis. — See  Achon- 
droplasia. 


CHOREA,  ACUTE 


Chorea,  Acute. — Gr.  xop^'iot  dance.  Syn. 
Sydenham’s  Chorea;  St.  Vitus  Dance.  A 
common  affection,  mostly  of  children  and 
adolescents,  characterized  by  the  occurrence 
of  irregular,  jerky,  bizarre,  involuntary 
clonic  contractions  of  various  groups  of 
muscles  (the  fidgets),  a.ssociated  with  an 
irritable  and  emotional  cUsposition,  mental 
dulness,  muscular  weakness  or  paresis,  and 
sometimes  mutism.  Endocarditis  often 
occurs.  There  are  mild  and  severe  cases, 
and  rare  malignant  or  maniacal  cases 
(chorea  insaniens,  which  usually  ends  fat- 
ally). The  cUsease  usually  terminates  in 
recovery  in  from  about  six  to  twelve  weeks, 
more  or  less;  but  it  may  recur.  It  rarely 
becomes  chronic. 

Indoubtful  cases  exclude  multiple  sclerosis, 
Friedreich’s  ataxia,  hysteria,  chronic  polio- 
myelitis or  spinal  paraplegia,etc.  (seeTremor.) 

Etiology. — The  cUsease  is  possibly  related  to 
rheumatic  fever.  Antemia  and  poor  nutri- 
tion predispose.  Worry,  anxiety,  grief, 
fright,  shock,  and  mental  strain  in  school 
are  causal  factors.  Pregnancy  is  a factor  in 
cases  occurring  in  adults. 

Treatment. — Enjoin  mental  and  physical 
tranquility.  Keep  the  patient  in  bed  dur- 
ing the  acute  stage,  surround  the  bed  with 
a screen,  and  exclude  visitors  and  other 
children  of  the  family.  Prescribe  an 
abundant,  simple,  nourishing  diet — milk, 
milk  foods,  eggs,  vegetables,  cereals — and 
prohibit  tea,  coffee,  and  alcohol.  Bitter 
tonics  may  be  given  to  aid  digestion  (see 
Anorexia).  Attend  to  the  bowels.  Warm 
or  cold  wet  packs,  a daily  hot  bath  lasting 
ten  to  fifteen  minutes,  followed  by  a cool 
douche,  and  gentle  massage  of  the  entire  body 
for  fifteen  to  twenty  minutes  daily,  are  useful 
sedative  and  rejuvenating  measures.  After 
being  allowed  up,  the  child  should  rest 
recumbent  for  two  hours  after  the  noon  meal. 

Arsenic  is  universally  praised.  Give 
Fowler’s  solution,  two  drops,  well  diluted, 
t.i.d.p.c.,  to  a child  of  six  years,  gradually 
increased  by  one  drop  every  one,  two,  or 
three  days,  up  to  10  or  15  or  even  25  drops 
t.i.d.  Should  symptoms  of  poisoning  occur, 
e.g.,  puffiness  below  the  eyes,  abdominal 
pain,  coated  tongue,  foul  breath,  vomiting 
and  diarrhoea,  stop  the  drug  for  three  or 
four  days,  and  then  begin  it  again  in  the 
same  or  smaller  doses. 

Yeo  praises  the  following,  where  arsenic 
seems  ineffectual: 

Zinci  valeratis  vel  bromo-valeratis  gr.  i-iii 
Extract!  hyoscyami . gr.  i-ii 

Fiat  pilula  una;  initte  talis  xx. 

Sig. — One  pill  t.i.d.  (Yeo.) 


Antipyrine,  gr.  xv-xx  a day,  in  divided 
doses,  to  a child  of  eight  years,  with  strych- 
nine, gr.  3"^0)  gradually  increased  to  gr. 

t.i.d.,  is  recommended  as  a substitute 
for  arsenic  by  Holt  and  Forchheuner.  Early 
symptoms  of  antipyrine  poisoning  are  an 
exanthem,  vertigo,  faintness,  and  vomiting; 
of  strychnine  poisoning,  muscular  twitching. 

Other  drugs  of  service  in  procuring  rest- 
fulness and  sleep  are : hyoscine  hydro- 

bromide, gr,  3^00)  several  times  daily; 
trional,  gr.  ii,  every  two  to  four  hours,  for 
a child  of  six  to  eight  years  (praised  by 
Sachs);  chloramid,  gr.  x;  monobromate  of 
camphor,  gr.  i-iii;  phenacetin  (see  Part  11); 
chloral  and  bromide,  aa  gr.  v,  up  to  gr. 
xv-xx,  if  necessary,  three  or  four  tunes 
a day,  well  diluted,  in  grave  forms  of 
the  disease,  for  the  purpose  of  keeping 
the  patient  asleep  until  the  choreic  move- 
ments have  ceased  for  about  twelve  hours 
(Forchheimer);  or  apomorphine,  gr. 
increased  if  necessary  (see  Part  II  for 
methods  of  administering  the  above  drugs, 
etc.). 

If  rheumatic  manifestations  have  pre- 
ceded or  attend  the  chorea,  prescribe  sali- 
cylates (see  Rheumatic  Fever) . Kerley  advo- 
cates antirheumatic  treatment  in  all  cases: 

R Sodii  salicylatis  (Merck’s  or  Squibb’s) 

Sodii  bicar- 

bonatis . . aa  gr.  Lxxx  (gr.  v of  each  per  dose) 
Aquae 5 iv 

M.  Big.- — Two  drams,  well  diluted,  t.i.d.,  for 
five  days  at  a time  with  five  days  intermission  (to 
avoid  anorexia  and  indigestion) ; restrict  sugar,  and 
allow  meat  only  every  other  day.  (Kerley.) 

Kinnier  Wilson  says  that  the  most  effi- 
cacious remedy  (“  practically  a specific  ”)  is 
aspirin,  gr.  x-xv,  four  times  or  oftener 
in  twenty-four  hours,  the  dose  to  be 
reduced  after  a week  if  the  case  is  pro- 
gressing favorably. 

II  Acidi  acetylsalicylici . . . 5 iiss  (gr.  xii  per  dose) 

Syrupi  aurantii 5 i 

Aquae  chloroformi,  q.s., 
ad 5iv 

M.  Sig. — Shake  well  and  give  a dessertspoonful 
in  water  every  4 hours  (for  a child  6 to  8 years  of 
age).  Handbook  of  Therapy  of  the  A.  M.  A. 

Starr  says,  if  periodical  rises  of  tempera- 
ture occur,  suggesting  malaria  as  a cause, 
give  a calomel  purge,  followed  by  quinine 
“ for  at  least  a week.”  He  adds:  “ Tins 
often  cuts  short  an  attack  of  chorea.” 

Prescribe  iron  for  anaemia  (see  Anaemia). 

In  pregnancy  cases  the  uterus  may  have 
to  be  emptied  (see  Obstetrics,  Part  4). 

Correct  any  nasal  or  ocular  defects,  otitis 


CIRRHOSIS,  BILIARY,  OF  THE  LIVER 


media,  carious  teeth,  diseased  tonsils,  ade- 
noids, worms,  phimosis,  etc. 

In  chronic  cases  employ  massage,  passive 
movements,  and  voluntary  movements 
under  control. 

Chorea,  Huntington’s. — A chronic,  pro- 
gressive, often  hereditary  chorea,  with 
irregular,  chsorderly  movements,  appearing 
in  adult  life,  of  hopeless  prognosis,  tending 
to  dementia  and  insanity,  and  due  to  a 
chronic  diffuse  cortical  encephalitis.  In 
well-developed  cases  the  gait  is  irregular 
and  swaying,  and  the  speech  slow,  difficult, 
and  indistinct. 

Try  helmitol  see  (Part  11),  which  liberates 
formaldehyde  in  an  alkaline  medium.  Uro- 
tropine  liberates  formaldehyde  only  in  an 
acid  medium. 

Chorea,  Post=Hemiplegic. — See  Athetosis. 

Sydenham’s.- — See  Chorea,  Acute. 

Chorea,  Tetanoid;  Progressive  Lenticular 
Degeneration. — Gr.  xopda  dance;  rkravos 
tetanus  + eidos  form.  A rare,  often  familial 
disease,  characterized  anatomically  by  bilat- 
eral degeneration  of  the  lenticular  nucleus 
of  the  corpus  striatum,  and  hepatic  cirrhosis, 
and  chnically  by  bilateral  tremors,  increased 
on  voluntary  motion,  choreo-athetoid  move- 
ments, spasticity,  contractures,  dysarthria, 
dysphagia,  and  emotionalism,  without  ankle 
clonus  or  the  Babinski  reflex  (the  pyramidal 
tracts  are  not  affected),  fever,  emaciation, 
and  a rapid  course.  The  affection  resembles 
paralysis  agitans. 

No  effectual  treatment  is  known. 

Chyliform  Ascites. — See  Ascites. 

Chylothorax. — Gr.  chyle  -\-  d(I>pa^ 

chest.  The  milky  effusion  may  be  chylous, 
due  to  distention  or  rupture  of  the  lym- 
phatics in  obstructive  lesions  of  the  thoracic 
duct  (tumors,  inflammation,  tuberculosis, 
aneurysm,  exostoses,  adhesions,  trauma, 
whooping-cough,  vomiting,  muscular  exer- 
tion, high  venous  pressure  in  tricuspid  insuf- 
ficiency, thrombosis  of  the  left  subclavian  or 
innominate  vein,  filariasis,  q.v.,  etc.),  or  it 
may  be  chyliform,  due  to  fatty  degeneration 
of  a tumor  (the  fat  droplets  are  larger  and 
less  numerous  than  in  chyle),  carcinoma  of 
the  pleura,  tuberculous  and  non-tuberculous 
pleuritis,  pulmonary  abscess  (?),  pus  cells, 
epithelial  cells,  lipsemia  (?),  etc. 

(Fat  stains  black  with  osmic  acid,  red 
with  Sudan  III,  and  is  removed  on  shaking 
with  ether,  after  alkalinizing  with 
sodium  hydrate.) 

Treatment. — Enjoin  quiet,  and  strap  the 
chest  from  spine  to  sternum  (as  described 
under  Pleurisy,  in  order  to  restrict  its 
movements.  Evacuate  chylous  fluid  (see 


Ascites),  only  if  the  heart  is  much  displaced, 
or  pressure  symptoms  arise,  viz.,  dyspnoea, 
cyanosis,  and  feeble  heart  action,  and  then 
remove  only  small  amounts  at  a time. 
Cure  has  often  followed  repeated  aspiration. 

Small  wounds  of  the  thoracic  duct  may 
be  expected  to  close  spontaneously. 

Chylous  Ascites. — See  Ascites. 

Chyluria. — Gr.  xeXos  chyle  -f-  ohpov  urine. 
Chyluria  is  the  result  of  rupture  of  a lym- 
phatic varix  in  the  kidney  or  bladder,  due 
to  lymphatic  obstruction  caused  usually  by 
the  filaria  sanguinis  hominis  Bancrofti  (see 
Filariasis)  and  sometimes  by  unknown 
conditions.  Rare  causes  are  obstruction 
of  the  thoracic  duct,  due  to  aneurysm, 
exostoses,  tumors,  pregnancy,  adhesions, 
trauma,  thrombosis,  etc.,  and  chronic 
lymphangitis  due  to  gonorrhea,  syphilis, 
tuberculosis,  bubonic  plague,  neighboring 
abscesses  or  ulcers,  etc. 

The  chyluria  is  usually  intermittent, 
and  may  be  provoked  by  violent  exercise, 
child-birth,  eating,  recumbency,  etc.  Re- 
tention of  urine  sometimes  occurs  as  the 
result  of  clotting  of  the  chylous  urine  in 
the  bladder. 

Treatment. — Enjoin  absolute  rest  in  bed 
with  the  hips  elevated,  and  restriction  of 
the  diet,  especially  fats  and  fluids,  until  the 
rupture  has  healed,  as  ascertained  by  giving 
the  patient  a glass  of  milk.  Administer 
saline  aperients,  azid  irrigate  the  bladder. 

Should  retention  occur,  inject  repeatedly, 
through  as  large  a catheter  as  possible,  a 
warm  sterile  solution  of  sodium  bicarbonate, 
in  order  to  break  up  the  coagulum. 

Adult  filaria  may  be  removed  from  the 
enlarged  lymph  glands. 

Circumflex  Nerve. — L.  circumflex' us,  bent 
about.  See  under  Brachial  Plexus. 

Cirrhosis,  Alcoholic,  of  the  Liver. — Gr. 
/appos  orange-yellow ; but  cirrhosis  has  come 
to  mean  a chronic  interstitial  inflammation. 
See  Cirrhosis,  Portal,  of  the  Liver. 

Cirrhosis,  Biliary,  of  the  Liver. — Syn. 
Hypertrophic  Biliary  (Intralobular)  Cirrho- 
sis of  Hanot.  A rare  disease,  occurring 
mostly  in  the  young,  characterized  by  a per- 
sistent, smooth  enlargement  of  the  liver 
and  spleen,  associated  with  chronic  jaundice, 
usually  slight,  and  due  to  a radicular 
angiocolitis  of  unknown  cause.  Bile  is 
present  in  the  faeces.  Periodic  attacks  of 
abdominal  pain,  with  fever,  leucocytosis, 
and  increased  jaundice,  occur,  lasting  sev- 
eral days  or  weeks. 

The  disease  is  fatal  in  from  four  to  ten 
years  or  longer. 

For  other  causes  of  liver  enlargement,  see 


CIRRHOSIS,  PORTAL,  OF  THE  LIVER 


Liver  Enlargement,  For  otlier  causes  of 
jaundice,  see  Jaundice. 

Treatment. — Enjoin  moderate  e.xercise  in 
the  fresh  air,  adequate  protection  against 
cold  and  damp,  and  a plain,  blaml,  nourish- 
ing diet,  excluding  alcohol  and  all  foods 
difficult  of  digestion.  Keep  the  bowels  regu- 
lar by  means  of  an  occasional  dose  of  calomel 
at  night,  and  salts,  such  as  sodium  phos- 
phate in  the  morning,  one  hour  before 
breakfast.  Prescribe,  one  hour  before  meals, 
a full  glass  of  warm  water  containing  about 
a quarter-teaspoonful  of  sodium  bicarbonate, 
and  the  iodides  after  meals  (see  Part  11 
for  drug  formulae,  etc.). 

Sodium  glycocholate,  gr.  x-xv  daily, 
ammonium  chloride,  gr.  x,  t.i.d.,  and  sodium 
salicylate,  gr.  x-xv,  well  diluted,  t.i.d.,  are 
the  most  effectual  cholagogues.  The  latter 
is  also  a biliary  antiseptic.  Hexamethy- 
lenamin  or  urotropin,  and  helmitol  liberate 
formaldehyde  in  the  bile  passages,  and 
may  therefore  be  tried  as  biliary  antiseptics. 

Potassium  or  sodium  hyposulphite  is 
praised  by  Semmola.  (Forchheimer.) 

Cirrhosis,  Gastric. — See  Cirrhosis  of  the 
Stomach. 

Cirrhosis,  Portal,  of  the  Liver. — Syn. — 
Alcoholic,  Ati'ophic,  Interlobular  Cirrhosis; 
Hobnail  or  Granular  Liver.  A disease 
mostly  of  adults,  characterized  by  a tender, 
enlarged  liver,  the  enlargement  being  often 
intermittent  (see  Liver  Congestion,  Active), 
and  later  followed,  perhaps,  by  a re- 
duction in  size,  associated  with  gastro- 
intestinal catarrh  and  portal  obstruction, 
with,  perhaps,  ascites,  haematemesis,  melena, 
hemorrhoids,  distention  of  the  superior 
abdominal  veins,  enlargement  of  the  spleen, 
and  sometimes  slight  jaundice.  Toxic  symp- 
toms— delirium,  stuj^or,  coma,  convulsions, 
may  appear. 

For  other  causes  of  liver  enlargement,  see 
Liver  Enlargement.  For  other  causes  of 
ascites,  see  Ascites. 

The  Prognosis  is  bad,  unless  early  treatment 
is  instituted.  Death  often  occurs  within 
three  years  of  the  onset  of  ascites.  Tuber- 
culosis of  the  lungs  and  peritoneum  often 
supervenes.  Nephritis  is  common. 

Etiology.— Chronic  alcoholism  is  the  chief 
cause.  Other  causes  are  the  habitual  use 
of  spices,  poisons  elaborated  in  chronic 
gastro-intestinal  catarrh,  infections,  the 
fluke-worm  (see  Distomiasis),,  etc. 

Treatment.— On  the  first  appearance  of 
symptoms  of  the  disease,  it  is  advised  that 
tile  patient  be  placed  upon  an  almost 
exclusive  milk  diet  for  from  four  to  six 
weeks:  two  to  three  quarts  of  milk  daily, 


diluted  with  an  equal  quantity  of  thin  oat- 
meal gruel,  Vichy,  or  Apolhnaris  water,  or, 
instead  of  the  alkaline  mineral  waters,  one 
may  atld  sodium  bicarbonate,  gr.  x-xv,  to 
each  glassful  of  warm  milk  and  water;  butter- 
milk, chocolate,  or  cocoa  may  also  be 
allowed;  the  milk  may  be  peptonized  (see 
Part  11).  At  the  expiration  of  the  four  or  six 
weeks,  add  to  the  diet  eggs,  raw  or  boiled 
three  minutes,  custards,  well-cooked  cereal 
gruels, vermicelli, macaroni  cooked  with  milk, 
green  vegetables,  stewed  fruits,  and  fish; 
lots  of  water  should  be  drunk;  salt 
should  be  restricted.  After  a month  or 
longer  return  to  the  milk  diet  for  several 
weeks,  and  so  on  indefinitely  (A.  O.  J. 
Kelly).  Alcohol,  including  medicines  con- 
taining alcohol,  spices  and  condiments, 
meat  soups,  extracts  and  broths,  fatty  and 
saccharine  foods,  and  foods  that  are  prone 
to  ferment  in  the  intestinal  tract,  such  as 
beans,  should,  of  course,  be  interdicted. 

1 The  bowels  should  be  kept  active  by 
means  of  an  occasional  dose  of  calomel, 
gr.  ii-vii  at  night,  and  sodium  phosphate  or 
sulphate,  5ss-ii-iv,  in  hot  water,  one  hour 
before  breakfast;  and  it  is  well  to  prescribe, 
for  the  gastric  catarrh,  a glassful  of  hot 
water  containing  about  fifteen  grains  of 
sodium  bicarbonate  one  hour  before  each 
meal.  Ammonium  chloride  is  recommended 
for  the  gastric  catarrh,  also  the  following: 

R Acidi  nitro-hydrochlo- 

rici  diluti oss  (njx'per  dose) 

Strj'chninae  nitratis.  . gr.  ss  (gr.  Ks  per  dose) 
Infusi  chiratae,  ad  3xii 

M.  Sig. — Tablespoonfiil  in  a wineglassful  of  water 
before  meals. 

R Sodii  bicarbonatis ...  o iss  (gr.  xxii  per  dose) 
Bismuthis  subcarbon- 

atis gr.  Kxx  (gr.  xx  per  dose) 

Mucilaginis  acacioe. . . 5ss 
Aquaj  inenthai  piper- 
itse,  g.s.,  ad ovi 

M.  Sig. — ^Three  tablespoonfuls  (after  shaking)  as 
required,  for  pyrosis  and  morning  vomiting. 

For  the  relief  of  flatulent  distention  em- 
ploy the  remedies  given  under  Tynipanites. 

For  local  pain  employ  hot  or  cold  com- 
presses, abdominal  massage,  purgatives  and 
ammonium  chloride. 

The  iodides  (see  Part  11)  are  well  recom- 
mended for  the  cirrhotic  condition.  A 
history  of  syphilis  or  a positive  Wassermann 
reaction  calls  for  specific  treatment. 

For  htematemesis  or  melaena  employ 
absolute  rest  in  bed,  with  an  ice-bag  sus- 
pended from  a bed-cradle  over  the  epi- 
gastrium, and  morpliine  hypodermically  if 
necessary  to  allay  restlessness.  Allow  no 


CLAU I )lCATION,  INTERMITTENT 


food  or  drink  by  mouth  until  several  days 
after  the  hemorrhage  has  ceased,  then  insti- 
tute a gastric  ulcer  regimen  {q.v.).  For 
continuous  bleeding  one  may  try  atlren- 
alin  chloride,  1;  1000,  thirty  drops  iira  tea- 
spoonful of  water  every  hour  for  two  or 
three  doses;  or  gallic  acid,  or  turpentine, 
highly  praised;  or  aromatic  sulphuric  acid, 
and  free  purgation  with  sodium  phosphate 
mixed  with  dilute  sulphuric  acid,  see 
also  Haematcmesis. 

For  toxic  manifestations  (noisy  delirium, 
stupor,  coma,  convulsions)  purge  the  patient 
with  calomel,  gr.  v-viii,  and  compouml 
jalap  powder,  3ss-i,  make  hot  applications 
to  the  liver,  encourage  copious  water  drink- 
ing and  administer  alkalies  as  described 
under  Acidosis. 

For  ascites,  early  and  repeated  tapping 
should  be  resorted  to,  for  it  has  sometimes 
resulted  in  cure.  The  use  of  purgatives  and 
diuretics  (calomel,  elaterium,  compound 
jalap  powder,  Rochelle  salt)  is  usually  of 
little  avail,  but  saline  cathartics  and  diure- 
tics are  usefid  after  tapping. 


Pulveris  digitalis, 

Pulvcris  scillsB aa  gr.  i 

Hydrargyri  chloridi  mitis gr. 


Fiat  pilula  iina;  mitte  talis  xii. 

Sig. — One  pill  twice  daily.  (Addison’s  Pill.) 

Potassii  acetatis, 

Spiritus  a3theris  nitrosi, 

Spiritus  juniperi ....  aa  5i  (oss  per  dose) 

Infusi  digitalis 3viii  (5ss  per  dose) 

Aquae,  q.s.,  ad oi 

M.  Sig. — Two  tablespoonfuls  t.i.d.  (^'eo.) 

Olei  copaiba; iiyxv 

Fiat  capsula  una;  initte  talis  xv. 

Sig. — One  capsule  2 or  3 times  a day,  after  meals- 

Tinctura;  apocyni  cannabini  (Lloyd’s)  qii 
S g. — Two  or  three  minims  every  three  or 
four  hours.  (Said  to  be  very  effectual  but  not  free 
from  danger.) 

Tapping  is  certainly  demanded  in  the 
presence  of  pain  due  to  distention,  dyspnoea, 
moist  rales  over  the  bases  of  the  lungs, 
haimatemesis,  oliguria,  and  beginning  delir- 
ium tremens. 

Before  tapping,  always  have  the  patient 
urinate,  or  catheterize  him.  Place  him  on 
his  back  with  the  head  and  shoulders 
raised.  Administer  a diffusible  stimulant 
of  brandy  or  whiskey.  Tap  preferably  in 
the  midiine  between  the  umbilicus  and 
pubes,  or  on  a line  between  the  umbilicus 
and  the  anterior  superior  spine  of  the  ilium 
on  the  left  side,  (the  deep  epigastric  artery, 
if  wounded,  should  be  ligated).  Percuss  to 
see  that  the  site  selected  is  dull.  The  skin 
may  first  be  anaesthetized  with  the  ethyl 


chloride  spray,  or  an  injection  of  a few 
drops  of  cocaine  solution,  about  gr.  to 
the  dram.  If  deemed  advantageous,  a small 
incision  may  first  be  made  through  the  skin, 
for  the  latter  is  sometimes  quite  tough.  Use 
a small  cannula  and  remove  the  fluid  slowly. 
During  the  withdrawal  of  the  fluid  apply 
firm  pre.ssure  with  a flannel  binder  or  a three- 
or  four-tailed  flannel  bandage,  in  order  to 
prevent  syncope.  After  withdrawing  the 
cannula,  seal  the  i)uncture  with  cotton-wool 
saturated  with  collodion,  and  strap  the 
abdomen  tightly  with  adhesive  plaster  or  a 
bandage,  to  j^revent  syncope. 

An  abdominal  supporting  binder  may  be 
worn  for  comfort. 

One  may  consider  the  pros  and  cons  of 
the  operation  which  aims  at  the  production 
of  vascular  adhesions  between  the  liver  and 
spleen  and  the  parietal  peritoneum,  and 
between  the  omentum  and  the  anterior 
abdominal  wall,  the  adhesions  being  brought 
about  by  excoriating  large  opposing  sur- 
faces, and  uniting  them  with  catgut.  About 
37  per  cent,  have  thus  been  cured,  while 
about  33  per  cent,  have  died  as  a result  of 
the  operation.  But  early  operation  should 
reduce  this  high  mortality.  Untreated  cases 
present  a bad  prognosis,  although  early  and 
repeated  tapping  has  resulted  in  cures. 

Cirrhosis,  Pulmonary. — See  Pulmonary 
Cirrhosis. 

Cirrhosis  of  the  Stomach. — A very  rare, 
non-malignant  or-  malignant,  slowly  j>ro- 
gressive,  diffuse  or  circumscribed  sclerosis 
and  thickening  of  the  walls  of  the  stomach, 
with  reduction  of  its  lumen,  manifested  by 
indigestion,  a slowly  increasing  intolerance 
of  much  food  at  one  time,  pain,  a slow 
cachexia,  a transverse  epigastric  mass  or 
tumor,  the  absence  usually  of  haematcmesis 
or  melaena,  sometimes  ascites.  It  is  rarely 
diagnosed  during  life. 

Treatment.— Where  the  process  is  localized 
about  the  pylorus,  do  a pylorectomy;  where 
it  is  diffuse,  do  a total  resection.  Gastro- 
enterostomy is  merely  palliative. 

Claudication,  Intermittent. — L.  claudicd- 
tio,  limping  or  lameness.  The  occurrence 
of  sudden  painful  muscular  cramp,  numb- 
ness, prickling  and  inability  to  proceed, 
after  walking  a certain  distance,  the  pulse 
in  the  dorsalis  pedis  artery  at  the  same  time 
diminishing;  all  of  which  phenomena  disap- 
pear on  resting  a while. 

Etiology. — Sclerosis  of  the  posterior  tibial 
artery;  aneurysm  of  the  iliac  artery;  syphilis; 
alcohol;  tobacco.  There  is  said  to  be  a 
spinal  form  of  the  disease.  Gangrene  some- 
times occurs. 


COLIC,  INTESTINAL 


Treatment. — See  arteriosclerosis.  Employ 
potassium  iodide  in  large  doses  over 
a prolonged  period.  Locally  employ  syste- 
matic massage,  galvanization,  and  frequent 
hot  bathing. 

Clay=colored  Stools;  Acholic  Stools;  Fatty 
Stools. — Gr.  a priv.  + X0X57  bile.  See  Color- 
less Stools. 

Cleft  Palate See  Harelip  and  Cleft  Palate. 

Coal  Gas  Poisoning. — See  Asphyxia, 

and  Poisoning. 

Cocainism. — Cocaine  addictees  exhibit  an 
exalted  bouyancy  of  spirits,  sometimes  alter- 
nating with  periods  of  depression,  and  event- 
ually delusional  insanity. 

Treatment.— Withdraw  the  cocaine  at  once 
or  gradually,  as  deemed  advisable;  and  if 
necessary  replace  it  for  a time  with  valerian; 
the  bromides,  or  hyoscyamus.  (See  Drugs, 
Part  11.)  Give  stimulants  when  required. 
For  insomnia,  employ  prolonged  warm 
baths.  Prescribe  full  diet.  The  patient 
is  best  treated  in  a sanitarium. 

Coccydynia  or  Coccygodynia. — Gr.  kokkv^ 
coccyx  “h  68ov7]  pain.  An  intractable  neu- 
ralgia of  the  coccygeal  nerves,  aggravated 
by  sitting. 

Etiology. — Traumatism  (external  violence, 
horseback  riding,  childbirth,  fracture,  dis- 
location); caries  of  the  bone;  rheumatism; 
anal  fissure;  constipation;  proctitis;  utero- 
ovarian  disease;  rarely  neurasthenia. 

Treatment.— Remove  the  coccyx  if  the 
cause  resides  within  the  bone  itself;  other- 
wise correct  any  possible  etiological  factor. 

The  galvanic,  or  perhaps  better,  the 
faradic  current,  (see  Med.  Elect.)  one 
pole  to  the  sacrum  or  within  the  vagina 
and  the  other  pole  to  the  coccyx  and  sur- 
rounding tissues,  may  prove  curative  after 
a number  of  sittings.  Massage  may  also 
be  employed. 

For  the  relief  of  pain  one  may  employ  the 
injection  of  sterile  water  over  the  seat  of 
pain;  or  belladonna  (gr.  ss)  or  iodoform 
(gr.  v-x)  suppositories;  or  inunction  with 
ung.  veratri  (U.  S.  P.)  et  lanolin,  aa,  avoid- 
ing the  anus,  as  the  ointment  is  irritating; 
or  inunction  with  tr.  aconiti,  5ss,  et.  ung. 
belladonnse,  5i;or  fly  blisters  one-half  inch 
wide,  over  the  posterior  sacral  foramina  on 
each  side  (Ashton),  Fig.  33. 

Ashton  highly  recommends,  as  often  cura- 
tive, the  deep  burning,  by  means  of  the 
actual  cautery,  of  a narrow  strip  from  the 
base  of  the  cocc>oc,  on  each  side  upward 
along  the  course  of  the  sacral  foramina.  See 
Fig.  33. 

Yeomans  has  had  success  with  injections 
of  alcohol:  “The  patient,  with  rectum 

empty,  assumes  the  left  lateral  (Sims’)  posi- 


tion on  a firm  table,  with  the  thighs  well 
flexed  on  the  abdomen,  and  the  region  of 
the  coccyx  is  painted  with  iocUne.  An  all- 
glass Luer  or  similar  sterile  syringe  of  two 
c.c.  capacity  is  filled  with  80  per  cent, 
alcohol  and  armed  with  a two-inch  needle 
of  fine  gauge.  The  right  index  finger  is 
then  inserted  into  the  rectum  and  the  point 
of  maximum  tenderness  is  determined  by 
counter-pressure  with  the  thumb  outside. 
With  the  finger  still  in  the  rectum  to  guard 
against  puncture  and  to  act  as  a guide,  the 
needle  is  next  introduced  through  the  mid- 
line directly  to  the  painful  spot.  When  this 
is  reached,  the  patient  exclaims  from  pain 


that  is  exquisite  but  tolerable,  and  the 
injection  of  from  10  to  20  minims  is  made 
slowly.  The  needle  is  withdrawn  and  its 
puncture  sealed  with  collodion  after  neu- 
tralizing the  iodine  on  the  skin  with  alcohol. 
The  pain  from  the  injected  alcohol  lasts  a 
few  minutes  only  and  may  be  followed  by  a 
dull  ache  for  a day  or  two.  As  a rule,  three 
and  at  the  mo.st  five  injections  should  suffice. 
The  interval  between  the  injections  should 
vary  from  five  to  ten  days — one  w’eek  on  the 
average — and  they  are  to  be  made  always 
at  the  joint  which  is  found  most  tender  at 
the  time  of  injection.” — Quoted  from  the 
Practical  Medicine  Series,  1915,  Vol.  ^TIL 

If  conservative  measures  fail,  remove  the 
coccj"x.  This  is  “ almost  always  curative,” 
says  H.  A.  Kelly. 

Cold;  Catarrhal  Fever.  — See  Nose  Dis- 
eases, Part  8. 

Colic,  Biliary. — See  Cholelithiasis. 

Colic,  Intestinal. — Paroxj'^smal  attacks  of 
intestinal  pain,  caused  by  spasmodic  con- 
tractions of  the  gut. 

Etiology.— A.  In  Adults. — The  presence  of 
undigested  and  irritating  food;  the  drinking 


COLITIS,  MUCOUS 


of  cold  liquids;  overeating;  idiosyncrasy  in 
regard  to  certain  foods;  constipation;  for- 
eign bodies,  including  round  worms;  expos- 
ure to  cold;  fatigue;  emotion;  certain  laxa- 
tive drugs,  for  instance,  senna;  lead  (lead 
colic  may  be  an  angiospasm  phenomenon: 
the  blood-pressure  is  high);  arsenic;  angio- 
neurotic oedema;  enteritis  and  enterocolitis; 
intestinal  ulceration;  appendicitis;  intestinal 
obstruction;  mucous  colitis;  mesenteric  cysts. 

B.  In  Infants. — Cold  feet;  improper 
feeding  of  either  the  child  or  the  mother; 
constipation  in  the  child  or  mother;  nervous 
disturbance  in  the  child  or  mother;  lack  of 
exercise  of  the  mother. 

For  other  causes  of  abdominal  pain, 
see  Pain. 

Treatment  of  simple  intestinal  colic. — A. 
In  Adults. — If  deemed  advisable,  morphine, 
gr.  }4  to  with  atropine,  gr.  tfao  to 
1-^0)  he  administered  hypodermically, 
for  the  relief  of  spasm  and  pain.  Give  one 
or  two  tablespoonfuls  of  castor  oil,  or 
two  to  five  grains  of  calomel,  the  latter 
to  be  followed  later  by  a saline;  and, 
while  waiting  for  the  purgative  to  act  from 
above,  give  a large  warm  soapsuds  enema, 
to  which  may  be  added,  if  deemed  necessary, 
one  or  two  tablespoonfuls  of  ca.stor  oil  or 
sweet  oil,  with,  perhaps,  a tablespoonful 
of  turpentine. 

It  is  a common  practice  to  give  to  chil- 
dren, by  mouth,  a mixture  of  castor  oil 
and  paregoric  (see  Part  11  for  drugs). 

Hot  applications  to  the  abdomen  and 
massage  along  the  course  of  the  large  bowel 
are  useful  adjuvant  measures.  (Massage 
and  purgatives  are  contraindicated  in 
spastic  constipation.) 

Useful  carminative  and  antispasmodic 
preparations  are  the  following: 

Soda-mint  tablets,  one  or  two. 

Oil  of  peppermint,  rrgi-v,  well  diluted,  in  hot  water. 

Tincture  of  ginger,  3ss-i,  well  diluted,  in 
hot  water. 

Spirits  of  chloroform,  3ss-i,  well  diluted,  in  hot 
water. 

Hoffmann’s  anodyne,  3ss-i,  well  diluted,  in  hot 
water. 

Aromatic  spirits  of  ammonia,  3ss-i,  well  diluted, 
in  hot  water. 

Compound  tincture  of  cardamom,  3ss-iss,  well 
diluted,  in  hot  water. 

Valerian,  peppermint,  fennel,  and  caraway,  one 
tablespoonful  of  a mixture  of  equal  parts,  steeped 
in  a cupful  of  hot  water. 

Tinct.  belladonnaj  fob,  gtt.  Ixxx-3hss  (gtt.  v 
to  ix  per  dose) 

Spt.  menthse  piperitae,  gtt.  Ixxx  (gtt.  v to  vi 
per  dose) 

Tinct.  Valerianae,  3iv-v,  (gtt.  xv-xx  per  dose) 

M.  Sig. — Thirty  drops  in  a cup  of  hot  pepper- 
mint or  fennel  tea,  t.i.d.  (Cohnheim.) 


Tincturae  hyoscyami.  . . 3ss  (a  large  dose) 
Tincturae  belladonnae . . . ngvi 

Sodii  bicarbonatis gr.  xx 

Tincturae  zingiberis. . . . irgxv 
Spiritus  chloroformi ....  ngxx 
Aquam  menthae  piperitae, 
ad 51 

M.  Sig.' — One  ounce  in  water,  t.i.d.  (Mummery.) 

II  Spiritus  ammoniae  aromatici, 

Spiritus  chloroformi, 

Syrupi  zingiberis, 

Tincturae  lavandulae  compositae ....  aa  5 ss 

M.  Sig. — One  or  two  teaspoonfuls  in  a cupful  of 
hot  water. 

Enjoin  rest  and  a light  diet  for  several 
days  after  the  bowels  have  been  emptied. 
A flannel  abdominal  binder  aids  in  the  pre- 
vention of  colic. 

B.  In  Infants. — Clear  out  the  intestinal 
tract  by  means  of  castor  oil,  5i-h;  or 
calomel,  gr.  i,  in  divided  doses  (gr.  hlo 
every  half  to  one  hour,  until  effectual,  or 
until  the  stools  turn  green) ; or  milk  of 
magnesia,  to  1 teaspoonful;  or  aromatic 
cascara  sagrada,  10  to  30  drops;  or  spt. 
ajtheris  comp.,  5ss,  et  tr.  rhei,  3iii, — 7 drops 
in  a teaspoonful  of  sweetened  water,  four 
times  a clay;  and  enemata  of  warm  water 
and  massage  the  abdomen  along  the  course 
of  the  colon.  Hot  flannel  or  hot  water  bags 
may  be  applied  to  the  abdomen,  or  hot  tur- 
pentine stupes  (turpentine,  gtt.  x to  water, 
one  quart),  repeated  every  ten  to  fifteen 
minutes.  The  feet  should  be  well  warmed. 

Hoffmann’s  anodyne,  gtt.  iii,  in  two  tea- 
spoonfuls of  hot  water,  every  ten  minutes, 
or  one  soda-mint  tablet  in  one  ounce  of 
hot  water — one  teaspoonful  every  five 
minutes,  may  be  given  as  a carminative. 

Attend  to  the  diet,  etc.,  as  described 
under  Infant  Feeding.  If  the  mother’s 
milk  is  too  strong,  give  to  1)^  ounces 
of  plain  water  or  barley  water  before 
each  nursing. 

Colic,  Renal. — See  Nephrolithiasis. 

Colitis. — Gr.  Kokbv  colon  -in%  inflamma- 

tion. See  Enteritis. 

Colitis,  Mucous. — A chronic  affection, 
characterized  by  the  periodic  passage  of 
mucus  in  the  form  of  shreds,  membranes, 
and  casts,  which  is  sometimes,  but  rarely, 
preceded  by  severe  abdominal  pain.  Some- 
times the  colon  may  be  felt  spastically 
contracted.  Dyspepsia  and  usually  consti- 
pation (spastic  constipation:  q.v^  are 

associated  conditions. 

While  an  ultimate  cure  may  not  be 
obtained,  much  relief  is  afforded  by  treat- 
ment. Cohnheim  regards  membranous 
enteritis  and  spastic  constipation  as  reme- 
diable conditions,  the  result  of  a catarrhal 


COLITIS,  MUCOUS 


enteritis  induced  by  a long  continued 
atonic  constipation. 

Etiology. — The  disease  occurs  mostly  in 
women.  Neurasthenia,  hypochondriasis, 
melancholia,  and  hysteria  are  frequently 
assocuited  with  it.  Possible  causal  influ- 
ences are  splanchnoptosis  (including  movable 
kidney,  uterine  displacement,  etc.),  chronic 
appen(licitis,  cholelithiasis,  aneurysm  of  the 
aoida,  tubo-ovarian  disease,  partial  intestinal 
obstruction  due  to  adhesions,  strictures, 
diverticula,  tumors,  etc.,  long-standing  con- 
stipation, the  abuse  of  purgative  drugs, 
especially  mercury  and  podophyllin,  intes- 
tinal catarrh,  dysentery,  infectious  diseases. 
It  may,  however,  be  primary. 

Treatment. — Correct  any  possible  causal  in- 
fluence. Enjoin  fresh  air  day  and  night,  regu- 
lar hoursof  eating  andsleeping,andamorning 
warm  bath  (the  bath  being  preceded  by  a 
cup  of  warm  cocoa).  Arsenic  (see  Part  11) 
may  perhaps  be  prescribed  as  a tonic. 

Some  (Edwards;  Roberts)  prescribe,  in 
the  absence  of  indigestion  or  diarrhoea,  a 
coarse,  bulky  and  fatty  diet,  such  as  is 
recommended  for  atonic  constipation;  while 
others  (Cohnheim;  A.  F.  Hertz)  consider  a 
too  coarse  diet  improper.  The  following 
dietary  is  perhaps  admissible,  viz.,  well- 
boiled  green  vegetables,  passed  through  a 
sieve  and  served  as  purees,  other  vegetable 
purees,  olive  oil,  butter,  cream,  bacon,  stale 
bread,  buttermilk,  well-cooked  cereals,  bread 
pudding  with  fruit  sauce,  fresh  or  cooked 
juicy  fruits,  freed  from  skins  and  pips, 
jams,  an  orange  for  breakfast,  fresh  meats 
in  moderation.  The  food  should  be  thor- 
oughly masticated.  Avoid  coffee,  tea,  con- 
diments, salads,  pickles,  acids,  alcohol,  car- 
bonated drinks,  pork,  goose  liver,  salt  meats, 
salt  fish,  hard-boiled  eggs,  new  bread, 
pastry,  cakes,  peas,  beans,  cabbage,  cucum- 
bers, celery,  radishes,  cheese,  nuts.  Water 
should  be  drunk  freely.  A glassful  of  hot 
water,  containing,  perhaps,  about  fifteen 
grains  of  sodium  bicarbonate,  may  be  taken 
one  hour  before  each  meal. 

An  occasional  laxative  should  bo  employed 
when  required.  Hertz  considers  castor  oil 
best  in  most  cases;  one  or  two  tablespoonfuls 
may  be  given  at  night;  White  proscribes 
small  doses  several  times  daily,  to  keep  the 
colon  empty.  Cascara  sagrada,  compound 
liquorice  powder,  colocynth,  rhubarb,  and 
aloes  are  mentioned  as  eligible  laxatives. 
Liquid  paraffin  and  agar-agar,  may  be 
used  after  the  bowels  have  once  been  emp- 
ti(‘d  of  accumulated  fa'ces.  Forchheimer 
says,  “ Saline  cathartics  are  the  best.” 
(See  Part  11  for  drug  formuhe,  etc.). 


The  following  plan  of  treatment,  “ has 
done  more  for  me,”  says  Edwards,  “ than 
any  other  method  that  I have  used  for  more 
than  twenty  years.”  Edwards  irrigates  the 
colon  daily  for  about  a week  with  warm 
normal  saline  solution  (oi  ad  Oi)  containing 
a teaspoonful  of  sodium  bicarbonate  to  the 
quart  (avoid  irritants,  such  as  soap,  glycer- 
ine, etc.).  Thereafter,  every  night  at  bed- 
time he  passes  slowly  into  the  colon,  to  be 
retained  overnight,  about  250  to  500  c.c., 
or  8 to  16  ounces,  according  to  the  amount 
retained,  of  warm  olive  or  cottonseed  oil, 
which  has  first  been  shaken  with  water  in 
ortler  to  remove  irritating  fatty  acids.  This 
is  continued  for  about  six  months,  the 
injections  being  given  at  first  daily  for 
two  or  three  weeks,  then  every  other  day 
for  about  a month,  and  then  three  times 
a week. 

Hot  sitz-baths  for  five  to  fifteen  minutes 
about  one  hour  before  supper  are  recom- 
mended. 

The  daily  administration  of  bella- 
donna is  recommended  for  aggravated 
spastic  constipation. 

For  painful  attacks  of  enterospasm, 
employ  hot  abdominal  applications  or  hot 
sitz-baths,  and  administer  codeine,  heroin, 
or  dionin,  together  with  belladonna,  either 
by  mouth  or  in  a suppository;  or,  if  necessary, 
give  a hypodermic  of  morphine  and  atropine. 
At  the  same  time  give  cascara  sagrada 
and  warm  alkaline  saline  enemata,  followed, 
perhaps,  by  a high  warm  injection  of  one- 
half  to  one  pint  of  bland  olive  or  cottonseed 
oil,  to  be  retained  all  night  (no  soap,  glyc- 
erine, or  other  irritating  enemata). 

R Tincturce  hyoscyami oss  (a  large  dose) 

Tinctura3  belladonnaj njivi 

Sodii  bicarbonatis gr.  xx 

Tincturse  zingiberis iiExv 

Spiritus  chlorofornii i^xx 

AquammenthiE  piperitse,  ad  5 i 

M.  Sig. — One  ounce  t.i.d.,  for  painful  entero- 
spasm. (Mummery,  quoted  by  Edwards.) 

Ionization  with  zinc  sulphate,  4 per  cent., 
is  advocated  (see  Enteritis).  Append- 
icostomy  is  sometimes  performed  for  the 
purpose  of  irrigating  the  colon  (every  morn- 
ing, after  normal  defecation)  and  keeping  it 
at  rest.  Says  IMummery:  “Although  it 

must  be  admitted  that  in  many  of  the  cases 
in  which  appendicostomy  is  performed,  a 
comjtlete  cure  docs  not  result,  yet  very 
great  improvement  is  the  rule,  and  in  many 
instances  it  is  possible  to  close  the  opening 
at  the  end  of  a few  months.”  It  is  perhaps 
best  to  maintain  the  artificial  opening  for 
at  least  a year. 


COMBINED  SYSTEM  DISEASES 


Moynihan  advocates  partial  or  complete 
resection  of  the  colon  in  intractable  cases, 
especially  the  last  part  of  the  ilium,  the 
caecum,  and  the  ascending  colon. 

Collapse. — See  Shock. 

Colon,  Dilatation  of  the. — Idiopathic  dila- 
tation of  the  colon  (congenital  or  acquired) 
is  characterized  by  the  association  of  obsti- 
nate constipation  with  increasing  abdominal 
distention  and  attacks  of  pain,  temporarily 
relieved  by  the  evacuation  of  a large  amount 
of  faeces.  The  diagnosis  may  be  aided  by 
giving  an  enema  of  bismuth  sulphate  and  oil 
in  the  knee-chest  posture,  and  then  taking 
an  X-ray  picture. 

Treatment. — To  keep  the  colon  from  becom- 
ing overfilled,  employ  olive  oil,  and  liquid 
paraffin  (see  Part  11)  by  mouth,  together 
with  copious  high  enemata.  Faradization 
and  massage  may  be  practiced,  but  no! 
massage  if  there  is  pain  indicating  the 
presence  of  ulcer. 

In  the  presence  of  acute  obstruction  do 
not  perform  colostomy,  unless  done  above 
the  affected  bowel,  for  the  heavy  gut  is 
apt  to  tear  away,  with  resulting  peritonitis. 

Resection  of  the  enlarged  colon,  or  anas- 
tomosis of  the  ilium  with  the  lower  sigmoid 
or  upper  part  of  the  rectum,  is  said  to  be 
curative,  although  a recurrence  has  even 
followed  resection.  Mummery  suggests  ap- 
pendicostomy  or  caecostomy  and  daily  irriga- 
tion of  the  colon  through  the  appendix  in 
cases  in  which  the  formidable  operation  of 
resection  does  not  seem  feasible  or  desirable. 

Colon,  Inflammation  of  the. — See  Enteritis. 

Spasm. — See  Enterospasm. 

Ulceration  of  the. — See  Enteritis. 

Coloptosis. — Gr.  k6\ov  colon  -f-  tttuctls  fall. 
See  Enteroptosis. 

Colorless  Stools. — Causes. — Complete  bil- 
iary obstruction;  conversion  of  the  bile  pig- 
ments into  colorless  substances  (leuko- 
urobilin);  milk  diet;  large  amount  of  mucus 
in  the  faeces,  as  in  membranous  colitis;  large 
amount  of  pus  in  the  faeces,  as  in  syphilis, 
carcinomatous  ulceration,  or  rupture  of  an 
appendiceal  abscess;  excess  of  fat  in  the 
stools,  due  to  any  one  of  the  following 
causes,  viz.,  excessive  ingestion  of  fat, 
biliary  obstruction,  deficiency  of  pancreatic 
juice  due  to  pancreatic  obstruction  or  dis- 
ease, and  interference  with  fat  absorption 
due  to  bowel  disease  or  increased  peristalsis, 
as  in  catarrhal  enteritis,  tuberculous  enter- 
itis, tabes  mesenterica,  chronic  tuberculous 
peritonitis,  dysentery,  cholera,  carcinoma 
of  the  stomach  or  intestine,  amyloid 
disea.se  of  the  intestine,  atrophy  of  the 
mucosa,  leukaemia. 

7 


Coma;  Stupor;  Unconsciousness. — L;Gr. 

k^^/xa;  L.  stupor.  Coma  means  total  uncon- 
sciousness; stupor  means  partial  uncon- 
sciousness, from  which  the  individual  may 
be  to  some  extent  aroused. 

Causes. — ^Natural  or  artifically  induced 
sleep;  general  anaesthesia;  syncope  or  simple 
fainting;  hysteria;  hypnotism;  overdose  of  a 
sedative  drug  (alcohol,  opium,  veronal,  etc.); 
epilepsy;  apoplexy;  uraemia;  trauma;  aci- 
dosis; (causes:  diabetes  mellitus,  eclampsia, 
acute  yellow  atrophy  of  the  liver,  portal  cir- 
rhosis, hepatic  cancer,  phosphorus  and 
chloroform  poisoning,  etc.);  sunstroke  and 
heat  exhaustion;  pernicious  malaria;  con- 
cussion, contusion  and  compression  of 
the  brain;  brain  tiunor;  brain  abscess; 
brain  syphilis;  hemorrhagic  internal  pachy- 
meningitis; meningitis;  hydrocephalus,  ac- 
quired chronic;  dementia  paralytica;  poi- 
soning with  carbon-monoxide,  carbolic  acid, 
lead,  strychnine;  infections  (typhoid  fever, 
typhus  fever,  pneumonia,  malaria,  mumps, 
rheumatic  fever,  smallpox,  pyogenic  sepsis, 
acute  endocarditis,  meningitis,  acute  miliary 
tuberculosis,  tetanus,  trypanosomiasis,  etc.); 
hemorrhage;  leukaemia;  pernicious  anaemia; 
cachexia  of  cancer;  valvular  or  myocardial 
disease;  Stokes-Adams  disease;  pericarditis 
'with  effusion;  rupture  of  an  aneurysm;  cor- 
onary occlusion  due  to  acute  syphilitic 
aortitis;  pleural  irritation,  as  during  irriga- 
tion; withdrawal  of  a large  ascitic  accumu- 
lation; Addison’s  disease;  digestive  and 
infectious  diseases  of  infancy ; congeni- 
tal defects,  including  birth  accidents, 
with  or  without  hydrocephalus,  haemi- 
plegia,  or  idiocy;  prolonged  muscular  exer- 
tion; malingering. 

!'  R.  C.  Cabot  says  that  conjugate  devia- 
tion of  the  head  and  eyes,  stertorous  breath- 
ing, albmnen  or  sugar  in  the  urine,  with  or 
without  casts,  hemorrhage  from  the  ear, 
haemiplegia,  aphasia,  and  Jacksonian  epi- 
lepsy are  not  necessarily  pathognomonic  of 
the  diseases  which  they  commonly  suggest. 

Combined  System  Diseases. — Diseases 
involving  both,  the  afferent  (dorsal)  and 
efferent  (lateral  and  perhaps  anterior)  col- 
umns of  the  cord,  and  characterized  by  the 
association  of  spastic  (or  perhaps  flaccid) 
and  sensory  paralyses  with  ataxia: 

1.  Myelitis. 

2.  Multiple  sclerosis. 

3.  Dementia  paralytica  (often). 

4.  Tabes  dorsalis  (occasionally). 

5.  Toxic  combined  sclerosis  of  the  cord, 
due  to  profound  anemia,  wasting  diseases, 
prolonged  suppuration,  chronic  indigestion 
and  diarrhoea,  acute  or  chronic  infections, 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


pellagra,  and  poisoning  with  ergot,  and  with 
lathyrus  or  vetch  (lathyrism) . 

6.  Friedreich’s  hereditary  ataxia. 

7.  Interstitial  hypertrophic  progressive 
neuritis  of  childhood. 

Compensated  Heart  Disease. — See  under 
Cardiac  Insufficiency. 

Compression  of  the  Brain. — See  Con- 
cussion, Contusion,  and  Compression  of 
the  Brain. 

Compression  of  the  Spinal  Cord. — (See 
under  Myelitis. 

Concussion,  Contusion,  and  Compression 
of  the  Brain. — Simple  concussion  is  indi- 
cated by  temporary  loss  of  consciousness, 
followed  by  headache,  dizziness,  perhaps 
nausea  and  vomiting,  possibly  convulsions, 
weakness,  mental  disturbance,  and  even, 
perhaps,  a slow  pulse,  these  symptoms  being 
of  variable  severity  and  duration. 

In  contusion  the  symptoms  are  more 
severe,  and  hunbar  puncture  usually  reveals 
blood.  Fever  follows  recovery  from 
the  initial  shock  in  contusion,  but  not  in 
simple  concus.sion. 

Compression  (due  to  hemorrhage  or 
oedema)  is  indicated  by  continued  uncon- 
sciousness, slow  pulse,  cyanosis  of  the  face, 
dilatation  of  the  venules  of  the  eyelids, 
distention  and  tortuosity  of  the  veins  of 
the  fundus  oculi,  later  a rise  of  blood  pres- 
sure, bounding  pulse,  choked  optic  discs,  and 
Cheyne-Stokes  respiration.  An  interval  of 
consciousness  following  an  injury,  preceded 
or  not  by  unconsciousness,  and  followed  by 
unconsciousness,  indicates  intracranial  hem- 
orrhage. (For  Cerebral  Hemorrhage  in  the 
New-born,  see  Hemorrhage,  Meningeal,  in 
the  New-born.) 

Treatment. — ^Examine  the  head  carefully  for 
evidences  of  fracture.  Keep  the  patient 
quiet,  with  the  head  low,  and  an  ice-cap 
applied.  Atropine  {q.v.  in  Part  11)  is  recom- 
mended. Lumbar  puncture  {q-v.)  is  recom- 
mended for  the  relief  of  cerebral  hyperten- 
sion. Keep  the  bowels  active.  The  patient 
should  be  kept  in  bed  on  a light  diet  for  at 
least  two  or  three  weeks,  or  until  all  headache 
has  disappeared  and  the  pulse  has  returned 
to  normal.  The  bowels  should  be  moved 
daily.  Remember  that  ■ meningeal  hemor- 
rhage or  brain  abscess  may  occur  months 
after  apparent  recovery  from  fracture  of 
the  skull.  The  onset  of  symptoms  of  com- 
pression demands  an  immediate  decom- 
pressive craniotomy. 

Treatment  of  Fractures  of  the  Skull. — 
A.  Closed  Fracture.  Enjoin  absolute 
rest  and  quiet,  with  an  ice-cap  to  the  head. 
Open  the  bowels  with  salines.  Give  phe- 


nacetin  or  morphine  (see  Part  11)  for 
headache  and  restlessness.  Operate  if  symp- 
toms of  compression  occur.  The  latter  may 
be  due  to  hemorrhage  or  to  depression  of 
the  inner  table  of  the  skull.  Spoon-shaped 
depression  of  the  new-born  skull  should 
be  reduced,  if  not  by  antero-posterior 
compression  of  the  skull,  then  by  opera- 
tion and  elevation  of  the  depression  by  a 
blunt  steel  sound. 

B.  Open  or  Compound  Fracture. — 
Cleanse  the  wound  carefully;  elevate 
depressed  fragments  of  bone,  even  if  no 
symptoms  are  present,  trephining  if  neces- 
sary (it  is  not  necessary  to  remove  all 
detached  pieces) ; remove  clots ; suture  a 
wounded  dura  with  catgut;  drain,  if  deemed 
advisable,  to  avoid  infection. 

Trephine  in  all  penetrating  wounds  of 
the  skull. 

C.  Basal  Fracture. — If  there  is  a dis- 
charge of  blood  or  cerebrospinal  fluid  from 
the  nose  or  ears,  wipe  out  these  passages 
with  a sterile  cotton  swab  moistened  in 
boric  acid  solution,  and  insert  very  loose 
absorbent  cotton  or  iodoform  gauze,  and 
change  frequently. 

If  symptoms  of  compression  occur,  one 
may  do  Cushing’s  intermusculotemporal 
craniotomy,  and  insert  a rubber  drain  if 
there  is  continuous  bleeding.  A bilateral 
craniotomy  may  be  requiretl.  F.  Albert 
says  that  lumbar  rupture  (?.  v.)  is 
the  “ only  efficient  treatment  of  basal 
fracture.” 

Congenital  Dilatation  of  the  Colon. — L. 

conge'nitus,  born  together.  See  Colon, 
Dilatation  of  the. 

Congenital  Heart  Disease. — The  Treatment 

is  that  of  compensated  valvular  heart 
disease  (see  under  Cardiac  Insufficiency). 
Keep  the  child  warm  and  guard  very  care- 
fully against  bronchitis. 

Treat  cardiac  failure  as  described  under 
Cardiac  Insufficiency. 

Congenital  Hydrocephalus. — See  Hydro- 
cephalus. 

Hypertrophic  Pyloric  Stenosis. — See 

Dilatation  of  the  Stomach,  Chronic. 

Myatonia. — Gr.  jucs  muscle  + a neg.  -f 
Tovos  tone.  See  Dystrophy,  Pro- 
gressive Muscular. 

Congestion  of  the  Lungs. — See  Pulmon- 
ary Congestion. 

Constipation,  Habitual  or  Chronic. — L. 

constipat'io,  a crowding  together.  I.  Consti- 
pation in  Adults. — Chronic  constipation  is 
either  atonic  or  spastic,  nearly  always  the 
former.  In  spastic  constipation,  the  small 
or  large  bowel  is  tonically  contracted,  with 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


resulting  abdominal  discomfort,  amounting 
sometimes  to  colic,  often  an  associated 
spasm  of  the  sphincter  ani,  and  perhaps 
band-shaped,  narrow  cylindi’ical,  or  sheep- 
dung-like  faeces.  Palpation  may  sometimes 
reveal  a contracted  gut.  It  may  be  distin- 
guished from  atonic  constipation  by  the  relief 
afforded  by  morphine  or  belladonna,  per- 
haps also  by  the  presence  of  mucus  sur- 
roun(kng  the  stool.  Cohnheim  regards 
spastic  constipation  as  a sequel  of  atonic 
constipation,  in  which  the  hardened  faeces 
have  set  up  a catarrhal  inflammation  of  the 
intestinal  mucosa.  The  bismuth  or  barium 
X-ray  examination  gives  important  informa- 
tion (see  under  Dyspepsia  for  technique). 

(a)  Etiology  of  Atonic  Constipation. 
— Habitual  neglect  of  the  calls  of  nature; 
sedentary  life;  habitual  use  of  purgatives  or 
enemata;  insufficient  food;  food  deficient  in 
residue,  e.g.,  milk,  eggs,  and  meat;  some- 
times too  much  residue;  insufficient  water 
drinking;  oyerdigestion  and  absorption  of 
food;  chronic  gastric  disease;  chronic  inva- 
lidism; debility;  obesity;  anaemia;  cachexia; 
acute  infectious  diseases;  convalescence  from 
exhausting  fevers;  senility;  neurasthenia; 
hypochondriasis;  cerebrospinal  disease 
(tabes,  etc.);  diphtheritic  paralysis;  plumb- 
ism;  insanity;  melancholia;  hysteria;  worry 
or  grief,  etc.;  chronic  passive  congestion  of 
of  the  bowels  due  to  lung,  heart,  liver,  or 
kidney  disease;  weakness  of  the  diaphragm 
caused  by  emphysema,  pleural  adhesions, 
and  other  chronic  thoracic  diseases;  weak 
abdominal  walls  caused  by  pregnancy, 
ascites,  tumors,  obesity,  or  spinal  paralysis; 
rheumatism  of  the  abdominal  muscles; 
idiopathic  dilatation  of  the  colon;  senile 
atrophy  of  the  intestinal  mucosa;  reflex 
inhibition  due  to  painful  inflammation  or 
traumatism  of  the  abdominal  or  pelvic 
viscera;  constricting  corsets;  enteroptosis; 
elongated  ptosed  colon;  mobile  cecum; 
inflammatory  pericolitis;  redundant  ami 
angulated  sigmoid;  relaxed  vaginal  outlet; 
strictures,  stenoses,  and  tumefactions  due  to 
adhesions,  tumors,  enlarged  organs  (enlarged 
prostate,  fibromyoma  uteri),  displaced 
uterus,  and  inflammation  (tuberculous,  lue- 
tic, malignant,  traumatic,  chancroidal,  gon- 
orrheal, catarrhal,  dysenteric,  hemorrhoiflal 
ulceration);  morphinism;  astringent  ingesta, 
e.g.,  tea,  red  wines,  chestnuts,  hard  water 
(lime  salts),  alum,  copper,  iron,  lead,  bis- 
muth, tannic  acid  preparations;  obstruction 
to  the  flow  of  bile;  too  short  or  too  long 
mesentery;  diverticula;  congenital  narrow- 
ing of  the  anus;  deviated  coccyx;  torpor 
recti  or  dyschezia;  heredity. 


(b)  Etiology  of  Spastic  Constipation. 
— Neurasthenia;  hypochondriasis;  melan- 
cholia; hysteria;  cerebrospinal  disease;  sen- 
ility; overuse  of  purgative  drugs;  irritating 
foods;  gastric  and  intestinal  indigestion 
(hyperacidity);  mucous  colitis;  intestinal 
ulceration;  chronic  plumbism;  neighboring 
inflammation;  chronic  colitis,  sigmoiditis, 
ami  proctitis;  hypertrophied  rectal  valves 
due  to  chronic  interstitial  inflammation 
(uncommon);  spasm  or  hypertrophy  of  the 
sphincter  ani  due  to  fissure,  blind  fistula,  a 
fish  bone,  neighboring  disease,  inflamma- 
tion, ulceration  (traumatic,  dysenteric, 
tuberculous,  syphilitic,  cancerous,  chan- 
croidal, gonorrhceal,  hemorrhoidal);  hyper- 
trophied levator  ani  muscles  due  to  chronic 
uterine,  vesical,  or  rectal  disease;  hyper- 
trophy of  O’Beirne’s  sphincter,  the  conse- 
quence of  spasmodic  contraction  caused  by 
the  irritation  of  a foreign  body,  inflamma- 
tion or  ulceration  (very  rare);  chronic  invag- 
ination due  to  an  abnormally  long  sigmoid 
or  mesentery,  or  to  straining  excited  by 
the  presence  of  a polyp,  of  stricture,  cancer, 
etc.;  rectal  prolapse;  rectal  polypi. 

Treatment. — Question  and  examine  the 
patient  carefully  in  order  to  ascertain,  if 
possible,  the  cause  or  causes  of  the  constipa- 
tion. In  making  a proctoscopic  and  sig- 
moidoscopic  examination,  one  may  choose 
between  the  left  lateral  or  Sims’  position, 
the  knee-chest  position,  Mathew’s  and 
Hanes’s  inverted  position,  using  their  special 
table,  and  the  exaggerated  lithotomy  posi- 
tion. The  bladder  and  bowels  should  first 
be  emptied.  Gant  describes  the  procedure, 
with  the  patient  in  the  knee-chest  posture, 
as  follows;  “ The  proctoscope  or  sigmoido- 
scope is  oiled  and  introduced  into  the  rectum 
and  directed  downward  and  forward  until  it 
passes  through  the  anal  canal,  about  two 
inches.  It  is  then  pointed  upward  and 
backward  until  the  promontory  of  the 
sacrum  is  reached,  when  it  is  again  directed 
downward  and  forward  over  the  upjxir 
rectal  valve  and  into  the  sigmoid  flexure. 
The  obturator  is  then  removed  and  the  air 
permitted  to  rush  in  and  dilate  the  bowel. 
When  this  has  been  accomplished,  the  sig- 
moid is  examined;  and  as  the  instrument  is 
slowly  withdrawn,  a perfect  view  of  every 
part  of  the  rectum  can  be  obtained.  When 
the  air  does  not  dilate  the  sigmoid  flexure,  a 
pneumatic  sigmoidoscope  should  be  intro- 
duced, with  the  obturator  in  place,  until 
the  middle  valve  has  been  passed.  The 
obturator  is  then  removed,  and  the  rectum 
and  bowel  higher  up  is  inflated  and  studied 
step  by  step,  by  pressing  the  bulb  from  time 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


to  time  as  the  instrument  is  passed  higher 
up.”  A great  aid  to  diagnosis  is  obtained 
by  giving  an  enema  of  bismuth  and  oil  in 
the  knee-chest  posture,  and  then  taking  an 
X-ray  picture. 

For  the  treatment  of  rectal  polypi,  hem- 
orrhoids, fissure  in  ano,  fistula  in  ano,  ulcera- 
tion, colonic  dilatation,  mucous  colitis,  vis- 
ceroptosis, etc.,  etc.,  consult  the  appropriate 
heading  or  caption. 

Simple  spastic  constipation  is  treated  the 
same  as  mucous  colitis  {q.v.).  Massage, 
electricity,  cold  baths,  and  exercises  are 
contraindicated  in  this  affection  and  in  dis- 
ease or  inflammation  of  the  abdominal  or 
pelvic  viscera.  Hot  applications  and  pro- 
longed tepid  sitz-baths  are  useful.  Pro- 
longed rest  of  mind  and  body  is  essential. 

^ Tincturaj  belladonnse  foliorum,  gtt.  lxxx-3iiss 
(gtt.  v-f-  to  ix-t-  per  dose) 

Spiritus  menthiB  piperita),  gtt.  Ixxx  (gtt.  v + 
to  vi  per  dose) 

Tinctura)  Valerianae,  3iv-v  (gtt.  xv-xx  per 
dose) 

M.  Sig. — Thirty  drops  in  a cup  of  hot  fennel  or 
peppermint  tea,  t.i.d.  Sedative  for  spastic  consti- 
pation. (Cohnheim.) 

“ Constipation  due  to  acute  proctitis,” 
says  Gant,  “ can  be  relieved  in  short  order 
by  alternating  cold  (60°  F.)  and  hot  (110°  F.) 
enemata;  the  former  to  be  retained  for  five, 
the  latter  for  ten,  minutes.”  For  spasm  of 
O’Beune’s  sphincter  due  to  inflammation, 
apply  hot  fomentations  to  the  lower  abdo- 
men, and  give  daily  injections  of  hot  oil  and 
bismuth,  or  a mild  antiseptic  solution,  such 
as  boric  acid,  one  teaspoonful  to  the  pint. 
Belladonna,  with  or  without  morphine,  may 
be  useful  for  the  purpose  of  relaxing  spasm. 

When  the  bowel  is  much  occluded  by 
hypertrophy  of  the  sphincter,  its  divulsion 
may  be  attempted  with  extreme  care,  to 
avoid  rupture,  of  which  there  is  great  danger. 
Gant  says:  “ It  can  be  easily  and  quickly 
dilated  by  introducing  a large  proctoscope 
up  to  the  obstructed  point  and  then  passing 
a Wales  bougie  of  proper  size  through  it. 
Divulsion  can  also  be  satisfactorily  accom- 
plished by  tamponing  with  a rubber  bag 
distended  with  air  or  water  left  inside  as 
long  as  may  be  required,  or  with  the  Hirsch- 
mann  dilator.  The  treatment  may  be 
applied  daily  or  two  or  three  times  weekly, 
according  to  the  exigencies  of  the  case.” 
“ When  the  treatment  outlined  fails,  surgi- 
cal intervention  is  imperative,  and  the 
obstruction  should  be  relieved  by  colostomy, 
resection  of  the  sphincter,  or  by  making  an 
anastomosis  between  the  sigmoid  above  and 
the  rectum  below.” 


For  hypertrophied  rectal  valves,  discov- 
ered by  their  resistance  to  being  drawn  down 
by  a blunt  hook,  apply  Gant’s  clamps,  or 
Pennington’s  clips,  or  employ  Lynch’s  elec- 
tric angiotribe. 

In  hypertrophy  of  the  levatores  ani 
muscles,  hot  applications  may  relax  the 
spasm,  but  great  hypertrophy  may  require 
the  division  of  the  coccygeal  attachment  of 
the  muscles,  either  by  a subcutaneous 
tenotomy  or  an  open  incision. 

For  hypertrophy  of  the  sphincter  ani, 
divulse  or  divide  the  muscle  under  local  co- 
caine ansesthesia(see  Fissure  in  Ano).  (Gant.) 

For  redundant  and  angulated  sigmoid, 
perform  sigmoidopexy,  or  short  circuiting 
lateral  anastomosis,  or  resection. 

In  operating  for  chronic  invagination,- 
withdraw  the  slack  and  anchor  it  to  the 
inner  abdominal  parietes.  (Gant.) 

Cecum  mobile  is  a possible  cause  of 
chronic  constipation.  In  itself  the  condition 
is  not  pathological  unless  a kink  is  formed, 
with  resulting  chronic  distention  and  atony 
of  the  cecum,  which  becomes  palpable,  associ- 
ated with  local  pain,  tenderness,  and  sense 
of  fulness,  attach  of  colic,  and  chronic  con- 
stipation. The  symptoms  resemble  those  of 
chronic  appendicitis.  A correct  diagnosis  is 
facilitated  by  means  of  the  bismuth  or  barium 
meal  (see  under  Dyspepsia)  and  rontgen- 
oscopy (q.v.).  Two  pictures  are  taken  about 
eighteen  hours  after  the  meal,  one  with  the 
patient  on  his  back  and  the  other  upon  his 
left  side.  If  the  cecum  is  abnormally  mov- 
able there  is  quite  a difference  in  its  position 
in  the  two  pictures.  The  treatment  consists 
in  the  use  of  an  abdominal  binder  with  an 
accessor>^  pad  placed  just  to  the  right  of  the 
median  line  (see  Splanchnoptosis),  the  use, 
for  a while,  of  daily  or  less  frequent  enemata 
of  neutral  cottonseed  oil,  one-half  to  one-pint, 
alternately  wdth  sodium  bicarbonate,  three 
per  cent.,  to  dissolve  mucus,  paraffin  oil,  or 
cascara  (see  Part  11)  by  mouth,  and  a gen- 
eral invigorating  regimen.  Anchoring  of 
the  cecum  is  sometimes  but  not  usually 
of  benefit. 

Excluding  simple,  v'agotonic  spastic  con- 
stipation, and  the  various  gross  pathological 
conditions  that  may  act  as  more  or  less 
potent  factors  in  the  causation  of  constipa- 
tion, there  remain  a majority  of  cases  with- 
out any  other  apparent  cause  than  atony  or 
torpor  or  sluggishness  of  the  bowel  with 
diminished  secretion.  These  cases  are 
treated  as  follows,  from  six  to  ten  weeks 
being  required  to  effect  a cure : 

Enjoin  fresh  air  day  and  night,  regular 
hours  of  eating  and  sleeping,  a morning 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


tepid  sponge  bath,  standing  in  warm  water, 
followed  by  a cool  or  cold  douche  and  a 
vigorous  rubdown  (the  bath  being  preceded 
by  a cup  of  warm  cocoa),  and  lots  of  out- 
door exercise,  but  rest  before  and  after 
meals  (at  least  one  hour’s  rest  after  meals). 
In  lieu  of  the  preferable  outdoor  sports — 
tennis,  golf,  surf  bathing,  swimming,  rowing, 
horseback  riding,  mountain  climbing — the 
following  exercises  recommended  by  Gant 
may  be  practiced  once  or  twice  daily,  each 
exercise  being  repeated  five  to  ten  times: 

1.  Standing  erect,  with  the  legs  together, 
slowly  bend  the  trunk  at  the  hips  as  far  as 
possible  to  the  right  and  left,  and  forward 
and  backward. 

2.  Lying  supine,  raise  the  trunk  to  a right 
angle  with  the  legs. 

3.  Reverse  the  procedure  by  raising  the 
legs  to  a right  angle  with  the  trunk. 

4.  Lying  supine,  flex  the  knees  and  draw 
the  thighs  close  against  the  abdomen. 

5.  Standing  erect,  with  hands  crossed  be- 
hind, quickly  change  to  the  squatting  posture. 

6.  Leaning  forward,  draw  up  the  abdom- 
inal muscles  and  diaphragm  repeatedly,  at 
the  same  time  taking  deep  respirations. 

7.  With  both  arms  extended  at  a right 
angle  from  the  body,  walk  on  tip  toes. 

Abdominal  massage  may  be  practiced  for 
fifteen  or  twenty  minutes  twice  daily  (before 
arising  and  on  retiring,  or  several  hours 
after  meals),  with  the  hand  (bhnanual 
kneading),  or  with  a leather  or  felt-covered 
two  to  ten  pound  cannon  ball  or  bowling 
ball,  the  patient’s  head  being  raised  and  the 
legs  and  thighs  slightly  flexed  in  order  to 
relax  the  abdominal  muscles.  The  bladder 
should  be  empty.  Begin  the  massage  over 
the  descending  colon  in  order  to  empty  this 
first.  Vibrasage  is  of  value.  “Active  stimu- 
lation over  the  head  of  the  colon  and  sig- 
moid, and  a continuous  treatment  along  the 
line  of  the  large  intestine  will  give  the 
best  results.”  (Author?). 

Electricity  may  be  employed  in  daily  five- 
minute  sittings.  If  galvanism  is  employed, 
one  electrode  may  be  placed  within  the 
rectum  (best  in  ineffii  cient  defecation  or 
dyschezia),  the  other  moved  about  con- 
stantly over  the  colon  from  right  to  left.  A 
roller  electrode  may  be  used.  The  sinu- 
soidal current  of  slow  periodicity  is  especially 
recommended.  If  faradism  is  used,  the 
anode  is  placed  over  the  spine,  and  the 
kathode  moved  with  deep  pressure  over  the 
colon.  •'  The  current  should  be  interrupted 
from  two  to  six  times  a second.”  {Hand- 
book of  Therapy  of  the  A.  M.  A.) 

The  head  should  be  raised  and  the  knees 


drawn  up  during  the  treatments,  and  the 
bladder  should  be  empty.  Thirty  or  forty 
daily  sittings  are  sometimes  required. 

The  ethyl  ether  spray  to  the  abdomen  for 
five  to  fifteen  minutes  thrice  daily;  douches 
of  cold  water;  large  linen  compress  wrung 
out  of  cold  water,  covered  with  flannel  and 
worn  all  night;  and  the  cold  sitz-bath 
for  no  longer  than  five  or  six  minutes, 
taken  about  one  hour  before  supper,  are 
also  recommended. 

Treatment  by  suggestion  is  often  effectual,  * 
the  suggestion  being  made  that  the  bowels 
will  act  at  a specified  hour.  Interesting  and 
absorbing  intellectual  activity  is  effectual 
in  certain  cases. 

The  diet  should  be  coarse  and  bulky,  con- 
sisting chiefly  of  vegetables  rich  in  insoluble 
cellulose,  carbohydrates,  fats,  and  plenty  of 
water,  and  a modicum  of  meat,  viz.,  well- 
boiled  vegetables : Brussels  sprouts,  spinach, 
cabbage,  sauerkraut,  cauliflower,  onions, 
carrots,  turnips,  beets,  salsify,  asparagus, 
tomatoes,  corn,  string  beans,  lima  beans, 
peas,  lentils,  cucumbers,  cress,  radishes,  let- 
tuce, celery,  rhubarb,  mushrooms,  olives, 
oatmeal,  cornmeal,  hominy;  brown,  whole 
meal,  ginger,  graham,  corn,  raisin,  rye,  and 
bran  breads;  pumpernickel,  bran  pudding, 
bread  pudding  with  fruit  sauce,  preserves, 
honey,  molasses,  grape  juice,  cider,  lemon- 
ade, carbonated  waters,  malted  milk,  butter- 
milk, koumyss,  matzoon  (see  Part  11). 
beer,  butter,  cream,  olive  oil,  salads  with 
oil,  sardines,  anchovies,  fresh  or  cooked 
juicy  fruits  after  each  meal:  orange  (for 
breakfast),  baked  apples,  prunes,  tamarinds, 
grapes,  raisins,  melons,  pears,  peaches, 
plums,  cranberries,  currants,  figs,  dates. 

Musser  and  Piersol  give  the  following 
recipe  for  making  bran  muffins : 

Bran  flour 2 cups 

Wheat  flour 2 cups 

Sour  milk 1 cup 

Molasses 4 tablespoonfuls 

Soda 2 teaspoonfuls 

A little  salt. 

Bake  in  muffin  pans,  one  to  be  taken  at  each  meal . 

Avoid  tea,  cocoa,  chocolate,  thick  broths, 
sago,  rice,  farina,  potatoes,  liver,  pork, 
salted,  potted,  or  smoked  fish  and  meats, 
cheese,  excess  of  eggs  or  milk,  nuts,  huckle- 
berries, red  wines. 

The  patient  should  eat  slowly  and  not 
oV'Oreat.  A glass  of  cold  water  should  be 
taken  on  rising,  and  a carbonated  mineral 
water,  such  as  Vichy  or  Apollinaris  or  a 
glassful  of  cold  or  hot  water  to  which  may 
be  added  about  fifteen  grains  of  sodium 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


bicarbonate,  sJioukl  be  taken  one  hour 
before  each  meal.  Water  may  be  drunk 
freely  between  meals. 

About  one-half  to  one  hour  after  break- 
fast, the  patient  should  repair  regularly  to 
the  toilet. 

The  occasional  employment  of  laxative 
drugs  may  be  of  service  in  the  beginning  of 
the  treatment.  Cascara  sagratla,  aloes, 
podophyllin,  and  senna  are  perhaps  the 
best,  as  requiring  no  increase  in  dosage.  On 
the  contrary,  the  dose  may  be  gradually 
reduced  week  by  week,  until  the  drug  is  no 
longer  required.  For  preparations  and 
dosage  consult  Part  11.  Compound  liquor- 
ice powder  is  useful  in  flatulency  because 
of  the  containetl  fennel,  and  in  hemor- 
rhoids,— Ortner. 

Laxative  mineral  waters  are: 

(a)  Saline,^ — Hunjadi,  Apenta,  Friedrich- 
shall,  Piillna,  Birmenstorf,  Rubinat,  Marien- 
bad,  Carlsbad,  Bedford,  Saratoga  (Hathorn), 
C'ondal,  Carabana,  Congress,  Kissingen, 
Homburg,  Rakoczy,  Crab  Orchard,  Ky. 

(b)  Sulphur,  — Aix-les-Bains,  Neudorf, 
Adenau,  West  Baden,  French  Lick,  Rich- 
field, Sharon  Springs,  Harrogate,  Schinznach. 

A daily  colonic  enema,  consisting  of  from 
one  to  three  pints  of  cool  or  cold  water  may 
be  injected,  if  three  days  of  regular  repair- 
ing to  the  toilet,  etc.,  fail.  It  is  best  given 
immediately  after  breakfast.  The  fre- 
quency of  administration  should  be  grad- 
ually reduced  as  the  constipation  improves. 

Selected  formula; 

Sulphuris  praecipitati, 

PiilverLs  rhei, 

Sacohari  lacti.s, 

Magnesia,  aa 

M.  Sig. — A teaspoonful  with  a glass  of  water 
every  morning  and  evening.  (Croftan.) 


Aloini gv.% 

Strychnin® gX-Vm 


Extracti  belladonna  foliorum . . . gr.  % 
Extract!  rhainni  purschiana.  ...  gr.  ss 
Fiat  pilula.  Sig. — 1 to  2 to  3 pills  at  bedtime. 

Extracti  aloes  soco- 

trina gr.  xv  (gr.  1 % per  dose) 

I’ulveris  ipecacuan- 
ha   gr-  vi  (gr.  ss  per  dose) 

Pulveris  zingibcris,  gr.  xxiv  (gr.  ii  per  do.se) 
Syrupi,  q.s. 

Mtsce  et  div.  in  pil.  No.  xii. 

Sig. — A pill  to  be  taken  before  dinner.  (Dr. 
Baillie’s  dinner  pills.) 

k Pulveris  rhei gr.  Ixxx  (gr.  x per  dose) 

Sodii  bicarbonatis . 5ii  (gr.  xv  per  dose) 
Tinctura  zingiberis  t^xl  (iti;v  per  dose) 

Spiritus  ammonia 

aromatici 5 ii  (g^xv  per  dose) 

Aquam  mentha  pi- 
perita, ad 5viii 

M.  Sig. — Two  tablespoonfuls  half  an  hour  before 
food,  twice  daily  (aperient  and  stomachic).  (Yeo.) 


II  Ferri  sulphatis . . . . gr  xvi  (gr.  ii  per  dose) 
Magnesii  sulphatis.  Si  (3i  per  dose) 

Quiniiia  sulphatis. . gr.  xii  (gr.  iss  per  dose) 
Liquoris  strychnina 

1 per  cent itr.xI  (njv  gr.  Ho  per  dose) 

Acidi  sulphuric!  di- 

luti T5jl  (i^v  per  dose) 

Aqua,  q.s.,  ad Sviii 

M.  Sig.- — Two  tablespoonfuls  twice  a day,  an 
hour  before  breakfast  and  dinner.  (For  constipa- 
tion in  anaraic  women).  (Yeo.) 

II  Pulveris  magnesii, 

Pulveris  rhei,  aa. . . 3 ii 
Sodii  bicarbonatis, 

Sodii  carbonatis, 

Pulveris  sacchari,  aa  qiv 
Olei  mentha  piperita,  q.s. 

Misce  et  fiat  pulvis. 

Sig. — One-half  to  one  teaspoonful  in  water,  two 
hours  after  each  meal.  (I’or  constipation  with 
hyperacidity.)  (Allen.) 


The  correction  of  gastric  hyperacidity 
with  antacids  (see  Hyperacidity)  and  of 
anacidity  with  dilute  hydrochloric  acid  with 
meals,  and  ascending  doses  of  nux  vomica 
before  meals  (see  Anacidity),  often  cures 
constipation.  (Musser  and  Piersol.) 


II  Extract!  nucis  vomica 

exsicatti gr.  vi  (gr.  H per  dose) 

Sodii  bicarbonatis gr.  c (gr.  4 % per  dose) 

Extracti  pancreatic!. . 3i  (gr.  2 % per  dose) 

M.  et  ft.  caps.  No.  xxiv. 

Sig. — One  capsule  before  each  meal.  (For  “ con- 
stipation associated  with  gastric  sluggishness  or 
chronic  gastritis”;  a little  ext.  belladonna,  adult 
dose  gr.  Ho  to  Yi,  or  physostigniin,  gr.  Xoo  to  Ho,  may 
be  added  to  aid  intestinal  peristalsis.)  (Stengel.) 


Says  Stengel,  nux  vomica,  belladonna 
(1  to  3 drops  of  the  tincture  at  night), 
physostigmine,  the  thgestive  ferments  (full 
doses  of  pepsin  after  meals),  the  cinchona 
derivatives,  and  strophanthus  “ correct 
digestion  and  stimulate  peristalsis  with- 
out irritating.” 

Gant  recommends  physostigmine  and 
nux  vomica  for  constipation,  digestive  dis- 
turbances, vertigo,  etc.,  occurring  during 
the  change  of  life. 

In  intractable  cases  of  intestinal  stasis, 
Moynihan  advocates  partial  or  complete 
resection  of  the  colon,  especially  the  last 
part  of  the  ilium,  the  caecum,  and  the 
ascending  colon. 

II.  Constipation  in  Infants.  — ETIOLOGY. — 
Habit;  irregularity  in  nursing;  too  frequent 
nursing;  food  insufficient  in  quantity  or 
strength;  too  little  fat;  too  much  fat;  too 
little  sugar ; too  much  non-fermentable 
carbohydrate,  e.g.,  dextrins;  boiled  or  ster- 
ilized milk;  gastric  indigestion:  anorexia; 
excessive  vomiting ; muscular  atony  (rickets, 
malnutrition,  abuse  of  purgative  drugs,  sup- 
positories, and  enemata) ; constipation,  lack 


CONSTIPATION,  HABITUAL  OR  CHRONIC 


of  exercise,  and  tea-drinking  in  the  mother; 
small  anus ; tonic  spasm  of  the  anal  sphincter 
due  to  fissure,  hemorrhoids,  or  polypus;  con- 
genital narrowing  or  twisting  of  the  large 
intestine;  dilatation  of  the  colon  {q.v.). 

Treatment.— Attend  to  the  patient’s 
dietary,  as  directed  under  Infant  Feeding. 
If  the  infant  is  nur.sing  at  the  breast, 
direct  the  mother  to  engage  in  ade- 
quate exercise,  to  keep  the  bowels  regular, 
preferably  with  salines,  and  to  eat  more 
carbohydrate  and  fat  and  less  nitrogenous 
food.  If  there  are  curds  in  the  baby’s 
stools,  the  baby  should  receive  several  tea- 
spoonfuls of  warm  boiled  water,  plain  or 
sweetened,  or  bai'ley  or  oatmeal  water, 
before  each  nursing.  Barley  ami  oatmeal 
waters  are  laxative,  lime  water  is  con.sti- 
pating.  Cream,  to  1 teaspoonful,  may,  in 
cases  of  fat  deficiency,  be  given  before  each 
or  every  other  nursing,  or  olive  oil,  or  cod- 
liver  oil  (see  Part  11);  but  usually,  perhaps, 
more  fermentable  carlx)hydrate  is  required, 
e.g.,  after  each  nursing,  an  ounce  or  more  of 
cereal  water  containing  5 to  10  per  cent,  lac- 
tose, or  else  Yi  to  1 ounce  of  10  per  cent, 
aqueous  solution  of  malt  soup  extract  (see 
Infant  Feeding),  together  with  fruit  juices 
(orange  or  prune)  and  after  the  third  or 
fourth  month,  a little  apple  sauce  (Gerstley). 
Anointing  the  anus  and  buttocks  with  sweet 
oil  is  sometimes  effectual. 

If  need  be,  one  or  two  ounces  of  warm 
sweet  oil  may  be  injected  nightly  for  a time, 
or  once  or  twice  a week,  to  be  retained  over 
night,  or  an  oiled  glass  rod  or  gluten 
suppository  may  be  used. 

Stretch  an  abnormally  small  anus  with 
the  finger  every  two  or  three  days.  In 
tonic  spasm  of  the  sphincter,  the  latter  may 
have  to  be  stretched  under  ether.  Heal 
fissure  in  ano  by  the  application  of  the  silver 
nitrate  stick  every  three  or  four  days. 

In  bottle-fed  infants  the  fat  may  possibly 
need  to  be  increased,  but  it  should  not  be 
increased  beyond  4 per  cent.  The  sugar  may 
be  increased  to  at  least  7 per  cent.;  or 
malt  sugar  may  be  used  in  place  of  milk 
sugar,  and  in  the  same  quantity;  or  one  or 
two  drams  of  sweet  manna  may  be  dissolved 
in  the  day’s  feeding.  Do  not  reduce  the 
proteid  below  1.5  per  cent,  for  fear  of  rickets. 
The  milk  may  be  given  raw. 

If  the  baby’s  stools  are  diy,  crumbly,  and 
soap-like  (the  baby  being  flabby,  somewhat 
anaemic,  and  not  thriving),  the  constipation 
is  due  to  a disproportionate  amount  of  fat 
over  carbohydrate  in  the  diet.  High  fat 
in  an  alkaline  intestine  (the  alkalinity  caused 
by  high  protein)  forms  insoluble  soaps  with 


calcium  and  magnesium;  in  an  acid  intestine 
(the  acidity  caused  by  high  fermentable 
carbohydrate,  e.q.,  lacto.se  or  saccharose)  it 
forms  irritating  fatty  acids.  To  correct  this 
type  of  constipation,  more  fermentable  carbo- 
hydrate should  be  added  to  the  food,  both 
to  burn  up  the  fat  and  to  favor  acid  fer- 
mentation in  the  intestine.  Gerstley  directs 
that  the  milk  be  diluted  by  adcUng  two- 
thirds  water  (see  Infant  Feeding),  and 
malt  soup  extract  added  and  gradually  in- 
creased until  the  patient  improves  and  the 
stools  return  to  normal.  Then  the  amount 
of  milk  should  be  gradually  increased,  and 
if  constipation  recurs,  due  to  the  increased 
protein,  more  carbohydrate  should  be  added. 
Malt  soup  extract  instead  of  cane  sugar  is 
used  because  the  latter  might  be  too  sweet 
in  the  quantities  required.  If  no  more  than 
six  to  eight  teaspoonfuls  of  carbohydrate 
are  needed,  cane  sugar  may  be  used.  The 
milk  is  diluted  to  prevent  trouble  from  the 
high  carbohydrate. 

Tr.  nucis  vomicae  is  indicated  for  atony, 
and  iron  (eisenzucker  or  the  saccharated 
oxide;  see  Part  11)  for  anaemia. 

Where  dietetic  measures  fail,  Dennet 
recommends  milk  of  magnesia,  f^a- 
spoonful,  in  one,  two,  three,  or  four  of  the 
bottles  a day,  as  required.  After  the  age  of 
six  or  seven  months,  substitute  orange 
juice,  1 to  2 teaspoonfuls  twice  daily,  before 
or  between  meals,  gradually  increased  by 
one  teaspoonful  at  a time  to  the  juice  of 
half  an  orange  twice  daily;  or  scraped  raw 
apple  may  be  useful;  or  prune  juice;  or 
vegetable  purees  (see  Chicago  Methods  of 
Infant  Feeding). 


Mannae  optimi 5i 

Syrupi  simplicis 5ss 

Aqua;  cinn.amomi,  q.s.  ad 5* 

M.  Sig. — A teaspoonful  three  times  a day. 
(Kerley.) 

Lactis  magnesia;, 

Syrupi  rhei  aromatici,  aa 5i 

M.  Sig.— A)ne  to  three  teaspoonfuls  daily. 
(Kerley.) 

Fluidextracti  cascara;  sagrada;  aromat- 
ici (Parke,  Davis  & Co.) §ii 

Sig. — (For  dosage  at  different  ages,  see  Part  II). 

II  Lactis  magnesia; § ii 

Sig.^ — One-quarter  teaspoonful  one  to  four  times 
daily. 


II  Olei  ricini:  See  Part  II  (only  for  emergencies.) 

II  Ilydrar^ri  chloridi  mitis gr.  i 

Sacchari  albi,  q.s. 

Misce  et  div.  in  chart.  No.  x-xii. 

Sig. — One  powder  every  hour  until  the  bowels  open : 
(only  for  emergencies). 

In  obstinate  constipation  in  older  chil- 
dren, Kerley  injects  high  into  the  colon 


CONVULSIONS 


every  night,  four  ounces  (or  less  if  immedi- 
ately evacuated)  of  olive  oil,  using  a four- 
ounce  bulb  syringe  and  a No.  18  American 
catheter  or  a small  adult  rectal  tube.  The 
oil  is  to  be  retained  during  the  night.  The 
next  morning,  after  breakfast,  the  child  is 
placed  on  a stool  until  the  bowels  move,  or 
until  fifteen  minutes  have  elapsed,  when  a 
glycerine  suppository  is  used.  After  two 
weeks  of  such  treatment,  the  oil  injections 
are  tentatively  gradually  withdrawn.  Two 
months  or  longer  are  required  for  a cure. 

Consumption. — (See  Tuberculosis,  Pul- 
monary.) 

Contusion;  Bruise. — L.  contu'sio,  from 
contun'dere,  to  bruise.  Employ  at  once, 
with  a degree  of  gentleness  coimnensurate 
with  the  amount  of  pain  present,  centripetal 
stroking,  kneading,  hacking,  and  gentle 
exercises,  the  skin  being  fii'st  anointed,  per- 
haps, with  an  oleaginous  substance,  such  as 
olive  or  cottonseed  oil,  lard,  butter,  goose- 
grease,  camj^horated  oil,  larfl  and  turpentine 
equal  parts,  turpentine  liniment,  etc. 

Where  there  is  much  extravasated  blood, 
leeches  may  be  applied,  or  small  incisions  or 
punctures  made  and  the  blood  pressed  out. 
Hot  compresses  are  serviceable. 

Contusion  of  the  Brain. — (See  Concussion, 
Contusion,  and  Compression  of  the  Brain.) 

Convulsions. — L.  conml'sio,  from  con- 
vell'ere,  to  pull  together.  A.  Convulsions  in 
Adults.  — Causes.  — Epilepsy;  urtemia;  hys- 
teria; apoplexy  (cerebral  hemorrhage,  embol- 
ism, or  thrombosis);  trauma;  fracture  of  the 
skull;  Stokes-Adams  disease;  meningitis, 
acute  or  chronic;  encephalitis;  brain  tumor; 
brain  abscess;  sclerosis  cerebri;  general  pare- 
sis; cerebral  syphilis;  cerebral  tuberculosis; 
cerebral  arteriosclerosis,  and  other  cerebral 
affections;  chronic  alcoholism;  pernicious 
malaria;  plumbism;  hepatic  toxaemia  (acute 
yellow  atrophy,  eclampsia,  portal  cirrhosis, 
etc.);  poisoning  with  strychnine,  picrotoxin, 
camphor,  phosphorus,  nitrobenzol,  ergot, 
etc.;  profound  post-hemorrhagic  anaemia; 
Addison’s  disease;  passage  of  a gall  stone; 
tapping  of  a pleuritic  effusion;  exaggerated 
nervous  irrital>ility  in  pregnancy,  in  which 
“ an  overdisteiuled  bladder  or  bowel,  pres- 
sure of  the  head  on  the  perineum,  the  intro- 
duction of  a hand  to  jicrform  version, 
or  excessive  after-pains  ” may  bring  on 
a convulsion. 

Treatment. — Attend  to  the  cause.  For 
repeated  convulsions  inject,  per  rectum,  a 
well-diluted  aqueous  solution  of  chloral, 
gr.  xlv,  with  or  without  sodium  or  potassium 
bromide,  gr.  xxx-xlv.  Administer  chloro- 
form, if  necessary,  until  the  enema  acts. 


Repeat  the  enema  after  two  hours,  if  neces- 
sary. Hyoscin  hydrobromide,  gr.  3^100  fo 
3^0)  hypodermically,  is  also  recommended. 
Sustain  the  heart.  Control  fever  by  means 
of  cool  or  cold  sponging,  wet  packs,  and  an 
ice-cap  to  the  head.  Feed  the  patient  per 
rectum,  (see  Rectal  Feeding). 

B.  Convulsions  of  Infancy  and  Childhood. — 
Causes. — Birth  traumatism;  neurotic  or 
hyperexcitable  disposition ; gastrointestinal 
disturbance,  e.g.,  overeating,  indigestible 
food,  catarrh,  worms,  colic;  malnutrition 
and  debility;  anaemia,  rickets,  dentition; 
adenoids  and  enlarged  tonsils;  phimosis; 
elongated  prepuce;  pressure  on  the  testicles; 
herpes  vaginalis;  erosion  of  the  genitals 
caused  by  irritating  urine,  etc.;  severe 
injury  or  pain;  excessively  hot  bath;  sudden 
violent  variation  in  the  surrounding  tem- 
perature; renal  colic;  kidney  and  bladder 
stones;  acute  infectious  fevers — at  the  onset 
or  during  the  course;  high  fever;  syphilis; 
tuberculosis;  status  lymphaticus;  foreign 
bodies  in  the  nose  or  ear;  aural  ulcer;  otitis 
media;  mastoiditis;  congenital  kidney  dis- 
ease; uraemia;  organic  disease  of  the  nervous 
system,  e.g.,  meningitis,  encephalitis,  cere- 
bral hemorrhage,  embolism,  thrombosis, 
abscess  or  tumor,  hydrocephalus;  certain 
drugs,  viz.,  alcohol,  opium,  atropine,  strych- 
nine, santonin,  etc. ; strong  emotion  in 
mother  or  child,  e.g.,  fright,  etc.;  congenital 
heart  disease;  atelectasis;  asphjoda;  per- 
tussis; laryngismus  stridulus;  enlarged  thy- 
mus; tetany;  liver  disease;  congenital  ano- 
malies; epilepsy. 

Treatment. — To  control  the  convulsions, 
produce  a very  light  chloroform  anaesthesia, 
and  at  once  inject  copibus  warm  enemata 
until  the  bowels  move  thoroughly.  As  soon 
as  consciousness  returns,  administer  a dose  of 
castor  oil,  or  divided  doses  of  calomel  (gr.  }/[o 
every  fifteen  minutes  until  effectual).  Place 
the  child  in  a quiet,  darkened  room. 

Should  the  convulsions  continue,  place  an 
ice-cap  to  the  head,  give  a hot  foot  bath, 
and  surround  the  body  with  a sheet  wrung 
out  of  hot  mustard  water  (one  tablespoonful 
of  mu.stard  to  two  quarts  of  water) ; keep  the 
mustard  pack  on  until  the  skin  is  reddened. 
At  the  same  time,  inject  a solution  of  chloral 
hydrate  and  sodium  or  potassium  bromide 
in  one  or  two  ounces  of  warm  milk  or  muci- 
lage of  acacia  high  up  into  the  bowel 
through  a catheter:  at  one  month,  chloral, 
gr.  i;  three  months,  chloral,  gr.  ii;  six  months; 
chloral  gr.  iii-v,  potassium  bromide  gr.  v-x; 
one  year,  chloral,  gr.  iii-vi,  sodium  bromide, 
gr.  x-xx;  two  years,  chloral,  gr.  viii.  After 
removing  the  tube,  close  the  anus  by  press- 


CRANIAL  NERVE  AFFECTIONS 


ing  the  buttocks  together  with  the  fingers. 
Repeat  the  injection  in  an  hour  if  necessary, 
every  two  to  four  hours.  By  the  mouth, 
one-half  the  dose  is  given,  but  give  nothing 
by  mouth  while  the  child  is  in  convulsions. 
Batten  advises  lumbar  puncture  (q-v.), 
both  for  diagnostic  purposes  and  to  relieve 
intracranial  pressure. 

The  inhalation  of  oxygen  (see  under  Pneu- 
monia) is  sometimes  effectual. 

Hot  baths  or  hot  packs  are  contraindicated 
when  the  pulse  is  weak.  Cold  tub  baths 
should  be  given  if  there  is  hyperpyrexia. 

Keep  the  patient  quiet  and  on  light  diet 
for  several  days  after  the  convulsions  have 
ceased,  and  administer  sodium  bromiile, 
gr.  v-viii  a day,  to  a child  of  one  year  (see 
Part  11),  with  or  without  antipyrin,  or 
phenacetin  for  about  a week,  when  the 
drug  may  be  gradually  withdrawn. 

Correct  any  possible  etiological  factor. 

Convulsive  Tic. — See  Habit  Spasm. 

Cord,  Spinal. — See  Spinal  Cord  Localiza- 
tion. 

Corpulence. — L.  corpulent' ia.  See  Obesity. 

Coryza. — L.;  Gr.  Kopv^a.  See  Nose  Dis- 
eases, Part  8. 

Costiveness.— See  Constipation. 

Cough. — Causes. — Pharyngitis ; tonsillitis ; 
elongated  uvula;  adenoids;  nasal,  aural, 
pharyngeal,  gastric,  hepatic,  and  uterine 
reflex  influences;  pressure  upon  the  vagus 
caused  by  mediastinal  tumors,  posterior 
mediastinal  abscess  due  to  Pott’s  disease, 
and  enlarged  tracheo-bronchial  glands ; aneu- 
rysm or  tumors  pressing  upon  the  trachea  or 
bronchi;  heart  disease,  valvular,  myocardial 
or  congenital;  pericardial  effusion;  pleurisy; 
adherent  pleura;  laryngitis;  tracheitis; 

bronchitis;  foreign  bodies  in  the  air  pass- 
ages; acute  pulmonary  congestion;  pneu- 
monia; phthisis;  influenza;  pertussis;  asthma; 
hay  fever;  emphysema;  bronchiectasis;  pul- 
monary abscess;  pulmonary  gangrene; 

pulmonary  oedema;  pulmonary  cirrhosis;  pul- 
monary actinomycosis;  pulmonary  tumors; 
pulmonary  distomiasis;  echinococcus  cyst  of 
the  lung;  pneumokoniosis;  pulmonary  infarc- 
tion; habit  (see  Habit  Spasm);  nervous- 
ness; hysteria. 

Kerley  says:  “An  immense  majority 

of  obscure  coughs  in  children  are  due 
to  adenoids.” 

Coupling  of  the  Heart  Beats. — See  Ar- 
rhythmia. 

Cow  Pox. — See  Vaccinia. 

Craft  Palsies. — See  Cramps,  Profession. 

Cramps,  Heat. — See  Sunstroke. 

Cramps,  Professional. — P rofessional 

cramp  is  “ a spasm  of  a group  of  muscles. 


due  to  excessive  use  in  one’s  daily  occupa- 
tion ” (Borland),  such  as  writing,  type- 
writing, type-setting,  sewing,  telegraphy, 
hammering,  weaving,  letter  sorting,  cigar- 
ette rolling,  watch-making,  music  playing, 
milking,  ball  throwing,  etc. 

Etiology.— Overwork  of  the  function  affected 
is  the  immediate  cause.  Contributing 
causes  are  a faulty  cramped  position  of  the 
acting  parts,  including  droop  shoulder  in 
writing,  traumatism,  poor  health,  neuras- 
thenia, worry,  etc. 

The  Prognosis  is  uncertain. 

Treatment.— The  affection  is  a neurosis  and 
should  be  treated  as  such.  Rest  of  the  func- 
tion involved  is  the  first  essential.  Starr 
advises  a rest  of  two  years;  a change  of  occu- 
pation is  best.  Besides,  a general  tonic 
regimen  is  indicated;  change  of  scene,  rest 
of  mind  and  body,  adequate  healthful  exer- 
cise, fresh  air  day  and  night,  regular  hours 
of  eating  and  sleeping,  an  abundance  of 
good  food,  abstention  from  tea,  coffee,  alco- 
hol, tobacco,  and  excessive  venery,  and  per- 
haps a tonic,  such  as  iron,  strychnine,  ansenic, 
the  hypophosphytes,  and  codliver  oil.  (See 
Part  11.) 

Massage,  manual  or  vibratory,  and  mild 
galvanization,  practiced  for  five  to  ten  min- 
utes daily  for  a number  of  months,  is  of 
value.  Local  cold  or  hot  compresses,  kept 
on  for  about  twenty-four  hours  at  a time, 
are  useful  for  the  relief  of  pain.  The  prac- 
ticing of  movements  opposed  to  the  cramp 
movements  is  advised. 

In  writer’s  cramp,  various  devices  may 
be  resorted  to  with  more  or  less  success, 
such  as,  the  use  of  a large  penholder;  of  a 
stub  pen;  of  a penholder  thrust  through  a 
cork  and  the  latter  held  in  the  palm  of  the 
hand;  the  use  of  a bracelet  (Nussbaum’s) 
for  holding  the  pen;  holding  the  pen  between 
the  index  and  second  fingers;  the  use  of  the 
wrist,  or  the  entire  forearm,  or  the  shoulder 
in  writing,  instead  of  the  fingers;  changing 
the  slant  of  writing;  using  the  unaffected 
hand;  or  the  employment  of  a typewriter. 

Cramp,  Tailor’s  or  Shoemaker’s. — See 
under  Tetany. 

Cranial  Nerve  Affections.  — i.  Olfactory 
Nerves.  (See  Nose  Diseases,  Part  8,  Anos- 
mia, Cacosmia,  Hyperosmia,  and  Parosmia.) 

2.  Optic  Nerve.  — See  in  Eye  Diseases, 
Part  6,  Amblyopia  and  Amaurosis  without 
Ophthalmoscopic  Change;  Optic  Chiasma, 
Tract,  and  Centres;  Optic  Atrophy;  Optic 
Neuritis;  and  Retinitis. 

3.  Motor  Nerves  of  the  Eyeball. — (q.v.) 

4.  Hypoglossal  Nerve. — (q.v.) 

5.  Trigeminal  Nerve. — (q.V.) 


CYANOSIS 


6.  Vagus  Nerve. — (q.v.) 

7.  Facial  Nerve. — (See  q.V.) 

8.  Auditory  Nerve. — See  Ear  Diseases,  Part  7. 

9.  Glossopharyngeal  Nerve. 

10.  Spinal  Accessory  Nerve. 

Craw=Craw. — See  Skin  Diseases,  Part  5. 

Cretinism. — An  uncommon  constitutional 

disease  of  infancy  and  childhood,  due  to  a 
deficiency  of  the  thyroid  secretion  (hypo- 
thyroidism) and  characterized  by  the  follow- 
ing sym])toms:  body  short  and  broad;  face 
large  and  bloated  looking;  forehead  low  and 
broad,  nose  Hat,  nostrils  large,  lips  thick, 
tongue  large,  pads  of  fat  in  the  supra- 
clavicular ami  other  regions;  skin  pale, 
thick,  inelastic,  dry,  scaly,  and  cold;  hair 
thin,  teeth  brittle  and  carious;  pudgy,  paw- 
like hands,  large  abdomen,  low  bocly  tem- 
perature, imbecility  or  idiocy.  The  disease 
is  clinically  the  same  as  the  myxcedema  of 
adults  and  cachexia  strumipriva  or  opera- 
tive myxcedema  (q.v.) 

There  arc  two  varieties  of  cretinism,  an 
endemic  variety  which  occurs  in  goitrous 
districts,  and  a sporadic  variety  with  the 
following  etiology:  congenital  absence  of 

the  thyroid  gland;  inflammation  and  atrophy 
of  the  gland  following  typhoid  fever,  influ- 
enza, measles,  enteritis,  tuberculosis,  trau- 
matism; bad  hygiene;  parental  hypothy- 
roidism; alcoholism,  etc. 

The  symptoms  may  not  appear  until  after 
the  child  has  been  weaned,  or  much  later. 

Cretinism  should  be  distinguished  from 
rickets,  dwarfism,  mongolian  idiocy,  achon- 
droplasia, congenital  adiposity,  sclerema 
neonatorum,  and  hydrocephalus. 

Treatment. — ■ 

Glaiulula^  thyroide®  siccas,  gr.  ?,  tabclUe  No.  ? 
vel  d'liyroidei  sicci. 

Begin  with  a small  dose,  gr.  at  3 
months  of  age,  gr.  }-g  at  6 months,  gr 
at  9 months,  gr.  }i  at  12  months,  gr.  % 
at  18  months — once  to  thrice  daily,  and 
gradually  increase  the  dose  ujt  to  5 to  6 to 
10  to  15  grains  a day,  or  until  the  child  is 
normal,  or  sym])toms  of  thyroidism  appear; 
then  reduce  the  dose  until  the  proper 
amount  required  to  maintain  the  mental 
and  bodily  integrity  is  found.  The  latter 
dose  must  be  continued  indefinitely. 

The  symptoms  of  thyroidism  which 
demand  a temporary  withdrawal  of  the 
thyroid  medication  are  as  follows:  tachy- 
cardia, palpitations,  restlessness  or  nervou.s- 
ness,  insomnia,  tremor,  pallor,  sweating, 
fever,  sometimes  coryza,  anorexia,  nausea, 
vomiting,  diarrhoea,  raj)id  emaciation. 

Leonard  Williams  says:  “ The  recumbent 


pulse  should  never  be  allowed  to  go  above 
95,  and  when  the  temperature  rises  to  normal 
the  drug  should  be  suspended  for  a time.” 
It  should  be  suspended  too  “ if  the  weight 
begins  to  fall.”  It  is  “ a safe  plan,”  he 
says,  “ to  intermit  the  treatment  for  one 
week  in  every  four.”  He  says  also  that  the 
effect  of  the  thyroid  extract  is  “ consider- 
ably enhanced  if  it  is  exhibited  in  combina- 
tion with  three  other  drugs,  namely,  iodine, 
arsenic,  and  calcium: 

Calcii  iodidi gr.  v 

Liquoris  arsenicalis  (Fowler’s  solu- 
tion)   ig^ii 

Aquara  cldoroformi,  ad 5ss 

M.  Sig. — One-half  ounce  t.i.d.p.c.  Suspend  every 
fourth  week  coincidentally  with  the  thyroid  extract. 
(Leonard  Wilhams.) 

The  diet  which  has  been  found  best  for 
cretins  consists  of  milk,  eggs,  butter,  vege- 
tables, cereals,  fruit,  and  little  or  no  meat, 
no  alcohol,  and  the  least  possible  amount 
of  salt. 

Rest,  fresh  air  day  and  night,  warm  cloth- 
ing, a warm  climate  in  winter,  and  frequent 
warm  baths  are  of  important  consideration. 
General  massage  is  very  beneficial. 

In  endemic  cretinism,  the  boiling  of  the 
drinking  water  may  be  a possible  preventive. 

If  thyroid  treatment  proves  ineffectual, 
pituitary  extract  (consult  Part  11)  may  be 
tried  experimentally. 

Crile’s  Anoci=Association. — Gr.  a neg. ; L. 
nocer'e  to  injure.  See  under  Shock. 

Croup,  Membranous;  Laryngeal  Diph= 
theria.-^ee  Diphtheria. 

Croup,  Non=Membranous,  or  False,  or 
Spasmodic. — An  old  name  for  acute  catar- 
rhal laryngitis  and  also  for  laryngismus  strid- 
ulus; called  spasmodic  as  distinguished  from 
continuous  croup  or  laryngeal  diphtheria. 

Croupous  Bronchitis.—  See  Bronchitis, 
Fibrinous. 

Pneumonia. — See  Pneumonia,  Lobar. 

Cryptogenetic  Anaemia.  — See  Anaemia, 
Pernicious. 

Cupping. — A dry  cup  is  applied  as  fol- 
lows: A tumbler  is  swabbed  quickly  with 
alcohol,  the  edges  wiped  dry,  the  alcohol 
ignited  and  allowed  to  burn  for  a few 
moments,  and  the  cup  then  quickly  applied. 

In  applying  a wet  cup,  first  disinfect  the 
skin  by  means  of  tincture  of  iodine,  then 
apply  a dry  cup  as  described  above;  now 
scarify  the  congested  skin  with  an  instru- 
ment consisting  of  lancet  blades  on  a spring, 
and  rea{)ply  the  dry  cup. 

Cutaneous  Ulcers.— See  Ulcers,  Cutaneous. 

Cyanosis. — Gr.  Kvavos  blue.  Causes.— 
Simple  “ weathering  ” in  healthy  persons; 


DENGUE;  BREAK-BONE  FEVER 


exertion  in  high  altitudes;  cardiac  disease, 
especially  mitral  and  congenital  disease; 
pericardial  effusion;  pulmonary  disease,  espe- 
cially emphysema  and  pneumonia;  ana;s- 
thesia  in  excess;  erythnemia;  convulsions; 
hysteria;  laryngeal  obstruction  or  spasm; 
apoplexy;  cholera;  intestinal  anthrax; 
methjEinoglobinaemia,  due  to  potassium 
chlorate,  carbon  monoxide,  acetanelid,  phe- 
nacetin,  antipyrin,  intestinal  disturbance 
(see  Intestinal  Intoxication),  and  microbic 
infection;  sulphaemoglobintemia  (see  Intes- 
tinal Intoxication);  tetany;  mediastinal 
tumors  obstructing  the  superior  vena  cava; 
traumatic  asphyxia  (extreme  cyanosii^  of  the 
head,  face,  and  neck  due  to  severe  injury  of 
the  thorax  and  abdomen);  paralysis;  local 
pressure;  arteriovenous  aneurysm;  Ray- 
naud’s disease;  scleroderma. 

Cyclic  Albuminuria. — Gr.  k6k\os  circle. 
See  Albuminuria. 

Cystic  Degeneration  of  the  Kidney.— See 

Male  Genito- Urinary  Diseases,  Part  3. 

Cysticercosis. — Gr.  ku<jti.s  bladder  + KepKos 
tail.  See  Echinococcus  Disease,  and  Tsenia 
Solium,  under  Tapeworm  Infection. 

Cystinuria. — See  Nephrolithiasis. 

Cystitis. — See  Gynaecology,  Part  2,  or 
Male  Genito-Urinary  Diseases,  Part  3. 

Cysts  of  the  Pancreas. — See  Pancreas, 
Cysts  of  the. 

Dakin’s  Solution. — See  Part  11. 

Dandy  Fever. — See  Dengue. 

Deafness. — See  Ear  Diseases,  Part  7. 

Decomposition.  See  Marasmus. 

Debility;  Asthenia. — L.  de'bilis,  weak; 
Gr.  a priv.  d-  adevos  strength.  Causes.— Over 
work;  bad  hygiene;  anaemia;  neurasthenia; 
tuberculosis;  nephritis;  cardiac  disease;  obes- 
ity; diabetes;  Addison’s  Disease;  exophthal- 
mic goitre;  my^c oedema  and  cretinism;  malig- 
nant disease;  influenza;  typhoid  fever; 
toxaemia  in  general. 

Treat  the  cause. 

Decompensation  of  the  Heart. — See  Car- 
diac Insufficiency. 

Decubitus. — See  Bed-Sore. 

Delicate  Infants. — See  Premature  and 
Delicate  Infants. 

Delirium  Tremens. — L.  delir'iurn  -f  tre- 
m'ere,  to  shake;  delirium  with  trembling. 
(See  Alcoholism.) 

Dementia  Paralytica;  General  Paresis. — 

L.  de,  neg.  -f-  mens,  mind;  Gr.  -irapa  beside 
+ \veLv  to  loosen;  Trdpeo-ts  relaxation.  A 
chronic  progressive  meningo-encephalitis, 
characterized  by  the  following  symptoma- 
tology: perhaps  neurasthenic  symptoms  at 
the  onset,  change  in  character,  forgetfulness, 
indifference,  irritability,  unseemly  conduct. 


delusions  of  grandeur,  slow  hesitating  speech 
and  syllable  stumbling  (get  the  patient  to 
say  “ truly  rural,”  “ artillery  cavalry  bri- 
gade,” “ around  the  rugged  rock  the  ragged 
ruffian  ran  ”),  blank  facial  expression,  some- 
times restlessness  and  expansive  delirium, 
sometmies  hypochondriasis,  tremor  of  the 
facial  muscles,  tongue  and  hands,  writing 
tremulous  and  letters  and  syllables  omitted, 
reflex  immobility  of  the  pupils  to  light  ami 
sometimes  also  to  accommodation,  deep 
reflexes  diminished  or  exaggerated,  epilepti- 
form and  apoplectiform  attacks,  progressive 
denumtia,  pareses  and  paralyses,  lympho- 
cytosis and  albumin  in  the  cerebrospinal 
fluid,  Wassermann  test  u.sually  positive.  The 
spirochteta  pallida  has  been  demonstrated  in 
the  cerebral  cortex. 

General  paresis  and  tabes  evidently  repre- 
sent but  different  localizations  of  the  same 
underlying  affection. 

Prognosis.— General  paresis  is  fatal  usually 
within  two  to  five  years;  but  life  is  occasion- 
ally prolonged  ten  or  fifteen  years.  Re- 
missions may  occur. 

Etiology.— Syphilis  is  the  most  important 
cause.  Other  causal  influences  arc  mental 
strain,  worry  and  anxiety,  physical  strain, 
excesses  in  alcohol  and  venery,  heat  stroke, 
cerebral  traumatism. 

Treatment.  — Administer  a course  of  sal- 
varsan  or  neosalvarsan,  followed  by  mer- 
cury and  iotlides  intermittently,  with 
tonics  in  the  intermissions  (see  Syphilis). 
Enjoin  physical  and  mental  rest,  and 
prohibit  alcohol  and  sexual  indulgence. 
A daily  hot  bath  and  daily  massage  are 
very  beneficial. 

For  restlessness  and  insomnia  employ  cold 
to  the  head,  hot  baths,  wet  packs,  massage, 
and  the  sedative  drugs  given  under  Insom- 
nia. Starr  recommends  active  purgation 
for  great  restlessness,  with  the  object 
of  producing  anaemia  of  the  brain. 

The  subarachnoid  injection  of  serum  sal- 
varsanized  in  vivo,  (Swift-Ellis)  or  salvar- 
sanized  in  vitro  (Ogilvie)  or  mercurialized 
(Byrnes)  is  probably  of  no  material  value. 
Some  one  ha«  suggested  lumbar  puncture  one 
hour  after  the  intravenous  injection  of  arsenic 
with  the  idea  of  drawing  .serum  into  the 
central  nervous  system. 

Dengue;  Break=Bone  Fever. — Spanish 
dan'gwa.  Syn. — Dandy  Fever,  Sun  Fever, 
Solar  Fever.  An  acute,  infectious,  epidemic, 
tropical  and  subtropical  di.sease,  causc(l 
probably  by  an  ultramicroscopic  organism 
transmitted  by  the  culex  fatigans  mosquito, 
and  characterized  by  an  incubation  periocl 
of  one  to  four  to  five  days,  followed  abruptly 


DIABETES  INSIPIDUS 


by  chills,  coryza,  severe  headache,  pains 
and  inflammation  in  the  muscles  and  joints, 
fever,  and  an  erythematous  rash;  these 
symptoms  lasting  from  two  to  five  days, 
followed  by  a remission  of  twelve  hours  to 
three  or  four  days  with  sweating  and  pros- 
tration, and  a second,  less  severe,  paroxysm 
lasting  twenty-four  to  thirty-six  hours,  and 
followed  by  a tardy  convalescence  and 
recovery.  The  disease  is  very  rarely  fatal. 

Hemorrhages  from  the  mucous  surfaces 
and  vomiting  may  occur,  and  give  rise  to 
the  suspicion  of  yellow  fever. 

Treatment. — Put  the  patient  to  bed  on 
liquid  diet,  and  open  the  bowels  with  calomel 
in  divided  doses,  followed  by  a saline. 
Employ  cold  sponging,  cold  packs,  and  cold 
applications  to  the  head  and  joints  for  the 
fever  and  pain.  Phenacetin,  antipyrin,  as- 
pirin, codeine  and  belladonna  are  of  service; 
but  morphine,  gr.  hypodermically,  is 

occasionally  required.  Oil  of  wintergreen 

and  spirits  of  camphor,  equal  parts,  is  recom- 
mended for  rubbing  the  back  and  joints 
(see  Part  11  for  drug  formulae,  etc.) 

During  convalescence  prescribe  tonics  (see 
Anorexia,  and  Anaemia,  for  formulae).  Po- 
tassium iodide  is  recommended  at  this 
time  for  the  joint  pains. 

Isolate  the  patient  until  desquamation  has 
ceased,  and  screen  him  against  mosquitoes. 

Dercum’s  Disease. — See  Adiposis  Dolo- 
rosa. 

Dermato=Myositis. — Gr.  b'epua  skin;  juOs 
muscle  -h  -tns  inflammation.  See  Myositis. 

Diabetes,  Bronzed. — Gr.  ha  through  + 
^ai'veiv  to  go.  See  Haemochromatosis. 

Diabetes  Insipidus. — A rare  chronic  affec- 
tion, characterized  by  great  thirst  and  the 
continued  excretion  of  a large  amount  of 
pale  urine  of  low  specific  gravity,  containing 
no  sugar,  albumin,  or  casts. 

Etiology.— Diabetes  insipidus  or  mellitus, 
albuminuria,  tuberculosis,  syphilis,  or  gout 
in  the  parents;  exposure;  the  drinking  of 
large  amounts  of  cold  water  or  alcohol; 
hysteria;  lesions  involving  parts  of  the 
middle  lobe  of  the  cerebellum,  medulla,  pons, 
or  pituitary  body,  e.g.,  traumatism,  tumors, 
hemorrhage,  arteriosclerosis,  hydrocephalus, 
general  paresis,  tuberculosis,  syphilis,  basilar 
meningitis,  injury  of  the  floor  of  the  fourth 
ventricle  just  in  front  of  the  glycosuric 
centre,  otitis  media;  rarely  spinal  cord  dis- 
ease; abdominal  affections  involving  the 
solar  plexus,  e.g.,  tumors,  tuberculosis, 
aneurysm ; section  of  the  greater  splanchnic 
nerve;  inability  on  the  part  of  the  kidneys 
to  secrete  a concentrated  urine,  especially 
the  salts  and  urea.  Dyspituitarism  (stimu- 


lation of  the  pars  intermedia)  may  possibly 
be  the  most  common  cause. 

Transitory  bitemporal  hsemianopsia  and 
headache  often  occur  in  syphilitic  basilar 
meningitis.  Persistent  bitemporal  hsemi- 
anopsia  with  headaches  succeeded  by  optic 
atrophy  indicates  tumor  of  the  hypophysis 
(see  Acromegaly).  To  examine  for  hypo- 
physial tumor,  obtain  an  accurately  trans- 
verse skiagram  of  the  head  by  placing  a 
bullet  in  each  external  meatus  and  seeing 
that  the  shadows  of  the  bullets  are  accur- 
ately superimposed  (see  Rontgenology.) 

The  renal  type  of  the  disease  may  be 
diagnosed  by  administering  five  drams  of 
sodiiun  chloride:  the  normal  kidney  will 
excrete  this  amount  within  twenty-four 
hours,  whereas  in  renal  insufficiency,  sev- 
eral clays  may  be  required  (see  Urinalysis). 

For  other  causes  of  polyuria,  see  Polyuria. 

Prognosis. — This  depencls  upon  the  cause. 
It  is  usually  not  good  as  to  cure,  except  in 
so-called  idiopathic  cases  (cases  showing  no 
tangible  cause),  in  which  a spontaneous  cure 
sometimes  occurs. 

Treatment.— Fluids  should  not  be  restricted, 
say  Osier  and  W.  Langdon  Brown;  but 
Futcher,  Forchheimer,  and  Ralfe  favor  the 
gradual  reduction  of  fluids,  say  by  a pint  a 
clay  or  every  other  clay,  stopping  when  the 
corresponding  reduction  in  the  polyuria 
ceases.  Where  the  output  of  water  is 
greater  than  the  intake,  and  in  the  renal 
type  of  the  disease,  it  is  obvious  that  fluids 
should  not  be  restricted.  Acidulated  waters 
tend  to  diminish  the  thirst.  Meat  and  pro- 
tein food  in  general  and  salt  should  be 
restricted  in  order  to  diminish  the  concen- 
tration of  the  urine.  Meat  extracts,  tea, 
coffee,  and  alcohol  should  be  forbidden. 
Vegetables,  cereals,  carbohydrates  (rice, 
tapioca,  sago,  etc.)  and  fresh  butter  and 
other  fats  are  aj:)propriate.  Constipation 
should  be  corrected.  A general  tonic  regime 
— rest,  adequate  exercise,  fresh  air  day  and 
night,  baths,  galvanization,  arsenic  and 
iron — is  indicated  (see  Part  11  for  drugs). 

In  the  presence  of  a positive  Wassermann 
reaction  or  a jiositive  history  of  syphilis, 
specific  treatment  should,  of  course,  be 
applied  (see  Syphilis). 

Drugs  are  of  no  great  permanent  benefit. 

1.  Fluidextracti  ergotse,  ngx,  t.i.d.  Be 
on  the  lookout  for  ergotism. 

2.  Theocin  sodio-acetatis,  gr.  ii-v,  twice 
or  thrice  daily,  p.c.  This  drug  increases  the 
permeability  of  the  kidneys  to  solids,  and 
thus  removes  the  necessity  for  polydipsia. 

3.  Pulveris  radicis  valerians,  gr.  v,  t.i.d., 
gradually  increased  to  oh  a day.  Zinci 


DIABETES  MELLITUS 


valeratis,  gr.  iv-xv,  gradually  increased  to 
gr.  XXX,  t.i.d.  Tincturae  valerianse, 
three  or  four  times  a day,  even  up  to  3 iv 
four  times  a day. 

4.  Sodii  vel  potassii  bromidi,  gr.  v-x,  t.i.d. 

5.  Antipyrinse,  gr.  v-x,  t.i.d. 

6.  Tincturae  belladonnae,  ttjjv-x  in  water, 
t.i.d.,  gradually  increasecl  until  the  skin 
flushes,  the  throat  becomes  dry,  and  the 
pupils  dilate. 

7.  Codeinae,  gr.  ss,  t.i.d.,  up  to  4 to  6 
grains  daily. 

8.  Extract!  opii,  gr.  ss,  t.i.d.,  gradually 
increased  up  to  4 to  6 grains  daily. 

Prompt  relief  of  polyuria  and  thirst  follows 
the  intramuscular  or  intravenous  injection 
of  a solution  of  extract  of  the  posterior 
lobe  of  the  pituitary  body,  due,  possibly, 
to  vaso-constriction  of  the  renal  vessels. 
Good  results  are  reported  from  the  hypo- 
dermic achninistration  of  strychnine  nitrate 
in  large  doses.  Lumbar  puncture  may 
be  tried. 

Diabetes  Mellitus. — Gr.  5ta  through  -|- 
^alvtiv  to  go;  yiieXt  honey;  L.  mel.  A chronic 
disorder  of  carbohydrate  metabolism  in 
which  the  ability  of  the  body  economy  to 
assimilate  carbohydrates  is  diminished,  the 
latter  consequently  accumulating  in  the 
blood  as  glucose  (hyperglycsemia),  which  is 
excreted  in  the  urine  (glycosuria).  The  chief 
symptoms  are  polyuria,  increased  thirst  and 
appetite;  debility;  often  emaciation,  espe- 
cially in  the  acute  rapid  cases  in  young 
people,  whereas,  in  chronic  mild  cases  in  the 
middle-aged  the  patient  is  apt  to  be  obese; 
the  urine  pale,  of  high  specific  gravity,  and 
containing  glucose  (always  test  the  urine 
from  a mixed  twenty-four  hour  sample,  see 
Urinalysis).  Other  common  symptoms 
are  sexual  impotence;  a tendency  to  morose- 
ness; various  neuralgias;  lumbar  pain; 
cramps  in  the  calves  of  the  legs;  peripheral 
neuritis;  a tendency  to  furuncles,  carbuncles, 
otitis  media,  eczema,  gangrene,  and  per- 
forating ulcer  of  the  foot;  pruritis,  general 
or  local;  a “ deep  red  color  ” of  the  face; 
constipation;  failure  of  vision  due  to  cata- 
ract or  retinitis;  acidosis  (acid  intoxication 
with  /3-oxybutyric  and  diacetic  acids),  with 
resulting  lassitude,  breathlessness  or  deep 
breathing,  pharyngeal  or  epigastric  pain, 
nausea,  vomiting,  various  nervous  mani- 
festations, increasing  drowsiness,  and  finally 
coma  (see  Acidosis).  The  occurrence  of 
diabetic  coma  is  favored  by  constipation, 
too  sudden  changes  in  the  diet,  a pro- 
longed carbohydrate-free  diet,  excessive 
fatigue,  anxiety,  carbuncle,  an  operation, 
and  pneumonia. 


Causes  of  Glycosuria  (a  permanent  glyco- 
suria means  diabetes  mellitus). — The  exces- 
sive consumption  of  sugar  (alimentary  or 
dietetic  glycosuria,  common  in  children  and 
of  no  significance;  the  ingestion  of  over 
150  to  300  grams  of  glucose  by  a normal 
individual  causes  a temporary  glycosuria); 
convulsions;  asphyxiation;  certain  poisons, 
e.g.,  phosphoric  acid,  hydrochloric  acid,  lactic 
acid, chloroform,  ether,  amyl  nitrite,  adrenalin, 
strychnine,  alcohol  (especially  champagne), 
chloral,  morphine,  veronal,  cocaine,  mer- 
cury bichloride,  phosphorus,  arsenic,  can- 
tharidin,  chromates,  uraniiun,  curare, 
methyldelphinin,  caffeine,  carbon  monoxide, 
carbon  dioxide;  obesity;  gout;  rarely  syphilis; 
pregnancy;  sometimes  the  infectious  dis- 
eases; cachexias;  severe  anaemia;  exophthal- 
mic goitre  or  hyperthyroidism;  extirpation 
of  the  thyroid  gland;  diseases  of  the  liver 
causing  a disturbance  of  its  glycogenic  func- 
tion; general  anaesthesia;  heredity  (the 
Jewish  race) ; diseases  of  the  central  nervous 
system,  functional  or  organic,  e.g.,  trauma- 
tism, cerebral  hemorrhage,  tumor,  general 
paresis,  tabes,  multiple  sclerosis,  meningitis, 
traumatic  neurosis,  nervous  shock  or  strain 
or  worry,  mania,  melancholia,  hysteria, 
pituitary  disease  (irritative  lesions  of  the 
hypophysis  increase  its  internal  secretion 
and  cause  hyperglycsemia;  removal  of  the 
hypophysis,  on  the  other  hand,  increases  the 
toleration  for  carbohydrates);  multiple  neu- 
ritis; tumor  or  inflammation  of  the  vagus; 
disease  of  the  abdominal  sympathetic  gan- 
glia; pancreatic  disease  causing  interference 
with  the  internal  secretion  of  the  islands  of 
Langerhans  (hemorrhagic  pancreatitis,  can- 
cer, hepatic  or  pancreatic  calculi,  catarrh 
of  the  ducts,  chronic  interstitial  pancreatitis, 
hsemochromatosis) ; the  administration  of 
phloridzin,  and  the  intravenous  injection  of 
large  amounts  of  physiologic  salt  solution, 
producing  a glycosuria  of  renal  origin,  not 
associated  with  hyperglycsemia. 

Prognosis. — The  prognosis  depends  upon 
the  cause  of  the  glycosuria.  It  is  good  in 
those  cases  in  which  the  cause  is  removable, 
that  is,  in  alimentary  glycosuria  and  that 
due  to  mental  strain  and  worry,  etc.  It  is 
usually  good,  as  to  life,  in  middle-aged 
obese  patients,  although  a cure  is  rare.  It  is 
bad  in  the  young;  in  children  death  usually 
occurs  within  six  months.  The  prognosis  is 
relatively  good  when  no  sugar  is  excreted 
on  a non-carbohydrate  diet.  The  occurrence 
of  diabetic  coma  is  practically  invariably 
fatal.  The  occurrence  in  the  urine  of 
/3-oxybutyric  acid,  or  of  its  derivatives, 
diacetic  acid  and  acetone,  is  a warning  of 


DIABETES  MELLITUS 


impending  acid  intoxication,  which,  if  un- 
checked, leads  to  coma  (see  Acidosis 
and  Urinalysis). 

A case  may  be  consitlered  mild  if  glyco- 
suria is  not  produced  by  less  than  50  gms. 
of  carbohydrate  daily;  moderate,  if  glyco- 
suria is  produced  by  10  to  50  gms.  of  carbo- 
hydrate; severe,  if  glycosuria  is  produced  by 
not  over  10  gms.  of  carbohydrate  daily. 

Treatment. — The  basic  aim  of  treatment, 
as  formulated  l)y  Dr.  Frederick  hL  Allen,  is 
to  avoid  overtaxing  the  weakened  pan- 
creatic function,  just  as  in  dyspepsia  the 
aim  is  to  avoid  overtaxing  the  weakened 
gastric  function,  and  so  allow  of  its  recupera- 
tion as  far  as  possible.  By  this  course,  the 
hyperglycjEinia  and  glycosuria  will  lessen  or 
disappear,  the  power  of  assimilating  carbo- 
hydrates will  increase,  and  the  danger  of 
acid  intoxication  will  diminish. 

Enjoin,  to  begin  with,  correct  living — a 
calm  mental  life  (a  vacation  and  change  of 
scene  once  or  twice  a year),  active  daily 
exercise  in  the  fresh  air,  short  of  undue 
fatigue  (massage  if  exercise  cannot  be  taken) ; 
light  woolen  underwear  and  adequate  outer 
clothing  to  preserve  the  body  heat;  a daily 
bath,  lukewarm  for  thin  and  weak  patients, 
an  occasional  Turkish  bath  for  obese 
patients;  regular  hours  of  eating  and  sleep- 
ing; at  least  nine  hours  of  sleep;  sleeping 
with  the  windows  open;  daily  cleansing  be- 
fore breakfast  of  the  mouth  and  teeth  Avith 
brush,  castile  soap,  and  warm  water;  care 
of  the  bowels.  One  hour  before  each  meal 
the  patient  should  drink  a glassful  of  hot 
water,  to  which  may  perhaps  be  added  a 
quarter  to  half  a teaspoonful  of  sodium 
bicarbonate;  or  Apollinaris  or  Vichy  may  be 
taken  instead. 

The  Allen-Joslin  method  of  treatment  is 
as  follows:  Begin  treatment  by  omitting  fat 
(butter,  lard,  oil,  cream,  etc.)  from  the  cu.s- 
tomary  diet.  After  two  days  of  a fat-free 
diet,  omit  protein  (meat,  fish,  egg  albumen, 
curd  of  milk),  and  then  reduce  the  carbo- 
hydrate (cereals,  vegetables,  fruits,  sugar) 
by  one-half  each  day  until  only  10  grams  is 
taken  daily.  Then  fast  for  four  days  or  less, 
as  required  to  render  the  urine  sugar-free, 
allowing  timing  the  fast  water  and  clear, 
thin,  meat  broths  freely,  and  plain  tea  or 
coffee  in  moderation,  sw^eetened  if  desired 
with  saccharin  (about  3^-1  gr.  to  8 fl.  oz.). 
Whiskey,  one  ounce  three  times  a day,  may 
be  taken  if  desired.  Weak  patients  should 
be  in  bed  during  the  fast;  stronger  patients 
may  exercise,  in  order,  thereby,  to  shorten 
the  duration  of  the  fast.  Examine  the 
mixed  twenty-four-hour  urine  each  morn- 


ing before  breakfast  for  sugar  and  acetones 
(see  Urinalysis). 

Fat  is  completely  omitted  prior  to  the 
withdrawal  of  protein  and  carbohydrate  in 
order  to  avoid  the  occurrence  or  an  increase 
of  acidosis.  Joslin  says  that  acidosis  may 
be  produced  in  normal  individuals  within 
three  days  by  the  omission  of  carbohydrate 
from  the  diet;  and  this  acidosis  may  reach 
dangerous  proportions  if  the  quantity  of  fat 
is  at  the  same  time  increased. 

If  glycosuria  is  still  present  at  the  end  of 
four  days  of  fasting,  allow  a little  protein  or 
carbohydrate  for  several  days,  and  then 
fast  again. 

When  the  urine  has  been  free  from  sugar 
for  twenty-four  hours,  give,  on  the  first 
day,  from  150  to  200  grams  (containing 
approximately  5 grams  of  available  carbo- 
hydrate) of  mixed  green  vegetables  of  the 
“5  per  cent,  group”  (see  Table),  best  cooked 
by  steaming  in  a double  boiler  so  that 
nothing  may  be  lost. 

If  no  glycosuria  occurs,  add,  on  the  second 
day,  vegetables  equivalent  to  five  more 
grams  of  carbohydrate;  and  add  this  amount 
each  day  until  twenty  grams  of  carbohydrate 
are  given.  Then  add  five  grams  every  other 
day  until  glycosuria  occurs,  or  the  patient  is 
receiving  as  much  as  three  grams  of  carbo- 
hydrate per  kilogram  (2.2  lbs.)  of  body 
weight  in  twenty-fom-  hours.  After  the  first 
day  or  two,  one  may  give  vegetables  of  the 
10  per  cent,  group  (75  grams  equals  about  5 
gms.  carbohydrate),  and  later  those  of  the  15 
and  20  per  cent,  groups,  followed  by  the  addi- 
tion of  fruits,  and  finally,  if  glycosuria  has 
not  appeared,  oatmeal  and  bread  (see  Table). 

The  amount  of  carbohydrate  that  just 
falls  short  of  producing  glycosuria  represents 
the  patient’s  tolerance  for  carbohydrate. 
This  tolerance  usually  increases  by  treat- 
ment. The  patient  should,  however,  be 
kept  w'ell  wdthin  the  limit  of  tolerance  for  a 
considerable  period  of  time. 

When  the  urine  has  been  sugar-free  for 
three  days  (and,  as  a rule,  wUile  still  testing 
the  carbohydrate  tolerance),  add  protein 
(egg  albumen,  non-fatty  fish  or  lean  meat) 
at  the  rate  of  15  grams  daily  (see  Table), 
until  1 gram  of  protein  per  kilogram  (2.2  lbs.) 
of  l.)ody  w'eight  is  reached  in  adults,  unless 
this  much  provokes  glycosuria  even  in  the 
absence  of  carbohydrate  from  the  diet. 
Children  require  2 or  even  3 grams  of  pro- 
tein jrer  kilogram  of  body  weight.  Some 
adults  may  later  require  1.5  grams  per  kilo- 
gram. The  patient  should,  if  possible, 
receive  at  least  1 gram  of  protein  daily  per 
kilogram  of  body  w^eight,  the  carbohydrate 


DIABETES  MELLITUS 


being  restricted,  if  necessary,  to  ensure  a 
sugar-free  urine,  and  not  the  protein. 

When  the  daily  amount  of  protein  fed  has 
reached  1 gram  per  kilogram  of  body  weight, 
add  gradually  increasing  amounts  of  fat  (by 
25  grams  a day,  or,  in  severe  or  obese  or 
elderly  or  acidosis  cases,  only  5 to  10  grams), 
until  the  total  daily  diet  provides  about  30 
calories  per  kilogram  of  body  weight,  unless 
glycosuria  or  acidosis  supervenes.  Should 
glycosuria  occur,  fast  the  patient  for  twenty- 
four  hours,  or  until  the  glycosuria  disappears, 
and  begin  again  slowly,  aiming  to  avoid  a 
second  appearance  of  sugar. 

The  diabetic  should  fast  one  day  out  of 
every  seven,  say  on  Sunday,  or  else  restrict 
the  calories  by  about  one-half. 

Divide  the  carbohydrate  in  the  diet  be- 
tween the  three  meals,  and  always  include 
vegetables  of  the  5 per  cent,  group.  For  a 
given  quantity  of  5 per  cent,  vegetables,  one 
may  substitute  one-half  as  much  10  per  cent., 
one-quarter  as  much  15  per  cent.,  and  one- 
sixth  as  much  20  per  cent.  By  cooking 
vegetables  in  three  changes  of  water,  most 
of  the  starch  and  sugar  is  removed. 

The  normal  adult  requires,  at  rest,  about 
25  calories  per  kilogram  (2.2  lbs.)  of  body 
weight;  at  light  work,  30  calories.  Children 
of  two  years  require  80  calories  per  kilogram; 
six  years,  70  calories;  twelve  years,  50  calo- 
ries. In  old  age  less  calories  are  required 
than  for  adults. 

The  normal  adult  (of  about  70  kilograms, 
or  154  lbs.),  at  moderate  physical  wwk,  con- 
sumes' per  day  about  400  gms.  of  carbohy- 
drate, 100  gms.  of  protein,  and  100  gms.  of 
fat,  or  2900  calories;  but  smaller  amounts 
are  usually  sufficient,  e.g.,  70  gms.  of  protein, 
300  gms.  of  carbohydrate,  and  100  gms.  of 
fat.  The  diabetic  should  confine  his  diet  to 
the  minimum  normal  caloric  requirements. 
The  daily  carbohydrate  allowance  in  the 
diabetic  diet  seldom  exceeds  25  per  cent,  of 
normal,  or  100  grams,  but  there  is  a com- 
pensatory increase  of  fat  (no  more,  however, 
than  is  necessary  to  maintain  the  body 
weight).  (Joslin.)  Joslin  believes  that 
diabetes  is  usually  due  to  overeating  (especi- 
ally of  sugar)  and  lack  of  exercise.  Strenu- 
out  mental  work  also  plays  a part.  He  says 
the  diabetic  should  be  10  to  20  per  cent, 
below  the  average  weight  for  his  height  and 
age  (see  Weight),  so  as  to  obviate  the  neces- 
sity for  a superabundance  of  food  to  supply 
an  overly  large  body.  He  needa  25  to  30 
calories  per  kilogram  of  body  weight,  or  12 
to  14  calories  per  pound,  which  is  a little  less 
than  that  for  the  normal  individual. 

Joslin’s  Treatment  of  Acidosis  (see  also 


Acidosis). — Put  the  patient  to  bed  and  keep 
warm.  Open  the  bowels  with  enemata. 
Administer  one  quart  of  hot  liquids  (water, 
very  weak  tea  or  coffee,  consomme)  slowly 
within  six  hours  (a  glassful  every  one  to  one 
and  one-half  hours).  If  the  patient  is 
nauseated,  administer  the  same  amount  of 
normal  saline  solution  (3i  ad  Oi)  per  rectum, 
subcutaneously,  or  intravenously.  Omit  fat 
from  the  diet,  and  give  at  least  one  gram  of 
carbohydrate  per  kilogram  of  body  weight 
per  twenty-four  hours  (as  orange  juice,  or 
strained  oatmeal  gruel,  or  skimmed  milk, 
or  bread,  see  Table).  Wash  out  the  stomach 
if  food  is  present  or  the  stomach  dilated  (see 
under  Dyspepsia  for  technique).  Sustain  the 
heart  with  digitalis  or  caffeine  (see  Part  11). 
Avoid  alkalies.  Less  fluids  are  required  if 
alkali  is  omitted. 

Joslin’s  Diet  Table. 

Foods  arranged  approximately  according 
to  percentage  of  carljohydrates.  The  foods 
in  each  group  are  listed  according  to  their 
carbohydrate  content,  lettuce,  for  instance, 
containing  about  2 per  cent.,  and  string 
beans  about  6 per  cent. 

5 per  cent. 

Vegetables,  fresh  or  canned  (actually  avail- 
able carbohydrates,  3 per  cent.). — Lettuce, 
cucumbers,  spinach,  asparagus,  rhubarb, 
endive,  vegetable  marrow,  sorrel,  sauer 
kraut,  beet  greens,  dandelion  greens,  Swiss 
chard,  celery,  tomatoes,  Brussels  sprouts, 
water  cress,  sea  kale,  olcra,  cauliflower, 
eggplant,  cabbage,  radishes,  leeks,  string 
beans,  broccoli. 

Fruits. — Ripe  olives  (20  per  cent,  fat); 
grapefruits;  lemons. 

iVa/s.— Butternuts,  pignolias. 

Miscellaneous. — Unsweetened  and  un- 
spiced pickles,  clams,  oysters,  scallops,  liver, 
fish  roe. 

10  per  cent. 

Vegetables  (actually  available  carbohy- 
drate 6 per  cent.). — Pumpkin,  turnip.  Kohl- 
rabi, squash,  beets,  carrots,  onions,  mush- 
rooms. 

Fruits. — Oranges,  cranberries,  straw- 
berries, blackberries,  gooseberries,  peaches, 
pineapples,  watermelons. 

Nuts. — Brazil  nuts,  black  walnuts,  hick- 
ory nuts,  pecans,  filberts. 

15  per  cent. 

Vegetables. — Green  peas,  artichokes,  pars- 
nips, canned  lima  beans. 


DIABETES  MELLITUS 


Fruits. — Apples,  pears,  apricots,  blue- 
berries, cherries,  currants,  raspberries, 
huckleberries. 

Nuts. — Almonds,  English  walnuts.  Beech 
nuts,  pistachios,  pine  nuts. 

20  per  cent. 

Vegetables. — Potatoes,  shell  beans,  baked 
beans,  green  corn,  boiledrice,  boiledmacaroni. 

Fruits. — Plums,  bananas,  prunes. 

Nuts. — Peanuts. 

Chestnuts. — 40  per  cent. 


Thirty  Grams,  or  Cubic  Centimetres,  or  One 
Ounce,  of  Each  of  the  Following  Contain 
Approximately 


Protein 

grains 

Fat 

grams 

Car- 

bohy- 

drate 

grams 

Calo- 

ries 

Broth 

0.7 

0 

0 

3 

Meat  (uncooked,  lean) . 

6 

3 

0 

50 

Meat  (cooked,  lean) . . . 

8 

5 

0 

75 

Bacon  (cooked) 

5 

15 

0 

155 

Fish  (cooked  cod,  had- 
dock)   

6 

0 

0 

25 

Oysters,  six 

6 

1 

4 

50 

Egg,  one 

6 

6 

0 

75 

Egg  albumen,  one 

3 

0 

0 

12 

Egg  yolk,  one 

3 

6 

0 

66 

Milk 

1 

1 

1.5 

20 

Cream,  20  per  cent .... 

1 

6 

1 

60 

Cream,  40  per  cent .... 

1 

12 

1 

120 

Cheese 

8 

11 

0 

130 

Butter 

0 

25 

0 

225 

Oatmeal,  dry  weight.  . . 

5 

2 

20 

120 

Potato 

1 

0 

6 

30 

Bread 

3 

0 

18 

90 

Vegetables,  5 per  cent, 
group 

0.5 

0 

1 

6 

Vegetables,  10  per  cent, 
group 

0.5 

0 

2 

10 

Orange,  one  small 

0 

0 

10 

40 

Grapefruit,  one 

0 

0 

20 

80 

Brazil  nuts 

5 

20 

2 

210 

Olive  oil  (shake  in  water 
to  remove  fatty  acids) 

0 

30 

0 

270 

1 gram  protein=4  calories;  1 gram  fat  = 9 calories;  1 gram 
carbohydrate =4  calories;  1 gram  alcohol  = 7 calories  (i.25 
grams  of  protein  contain  1 gram  of  nitrogen. 


In  the  place  of  bread,  w'hich  is  usually 
better  excluded  from  the  routine  dietary 
of  the  diabetic,  the  following  substitutes 
are  serviceable. 

Bran  Biscuits  (contain  no  carbohydrate, 
and  serve  as  a useful  vehicle  for  the  admin- 
istration of  butter  and  fats  and  for  the  pre- 
vention of  constipation: 

Bran 60  grams  or  2 oz. 

Salt }/i  teaspoonful 

Agar-Agar,  powdered 6 grams  or  oz. 

Cold  water 100  c.c.  CA  glass) 

Tie  the  bran  in  a cheesecloth  bag  and  wash 
under  a cold  water  tap  until  the  wash  water  is  clear 
(1  hr.,  to  remove  starch).  Mix  the  agar  in  cold 


water  and  bring  to  the  point  of  boiling.  Add  to 
the  washed  bran  the  salt  and  the  hot  agar  solu- 
tion. Mold  into  three  cakes.  Place  in  pan,  and 
when  firm  and  cold,  bake  in  moderate  oven  from  45 
to  50  minutes. — Rockefeller  Institute  Hospital 
recipe,  copied  from  the  Journal  of  the  A.  M.  A., 
October  7,  1916.  The  addition  of  eggs  and  butter 
or  bacon  giease  render  them  more  palatable. 

Akoll  Biscuit  (Huntley  and  Palmer),  2.7  per  cent, 
carbohydrate;  0.41  g.  nit.  in  each  biscuit;  20  oz. 
equivalent  to  one  ounce  of  white  bread. 

Gluten  Meal  Biscuit,  about  4 per  cent,  carbo- 
hydrate; 13  per  cent,  nitrogen;  14  oz.  equivalent  to 
one  ounce  of  white  bread ; made  as  fo  Uows : 

“To  one  egg  add  one  heaping  saltspoonful  of  salt 
and  beat;  then  add  six  tablespoonfuls  of  cold  water 
and  beat  until  quite  thick,  or  until  it  becomes  in 
quantity  from  1 to  1)4  pints,  and  into  this  beat 
one  tablespoonful  of  thin  cream;  add  two  heaping 
tablespoonfuls  of  dry  Barker’s  Gluten  Food  A (to 
be  had  of  Herman  B.  Barker,  Somerville,  Mass.); 
stir  this  into  the  previous  mixture;  stir  occasionally 
during  one-half  hour,  until  of  the  consistency  of 
thick  gruel;  bake  35  minutes  in  well-buttered  muffin 
pans  in  a hot  oven.”  (Janeway.) 

Casoid  Biscuit  (Thomas  Leeming  and  Co.,  New 
York  City),  8 per  cent,  carbohydrate;  10  per 
cent,  nitrogen;  7 oz.  equivalent  to  one  ounce  of 
white  bread. 

Pure  Gluten  Biscuit  and  Potato  Gluten  Biscuit 
(Battle  Creek  Sanitarium  Food  Co.),  10  per  cent, 
carbohydrate;  13  per  cent,  nitrogen;  5)4  oz.  equi- 
valent to  one  ounce  of  white  bread. 

No.  1 Protopuff  (Health  Food  Co.,  New  York), 
10  per  cent,  carbohydrate;  12  per  cent,  nitrogen; 
5)4  oz.  equivalent  to  one  ounce  of  white  bread. 

Diabetic  flours  are  Barker’s  Gluten  Food  A (not 
more  than  4 per  cent,  carbohydrate  and  87  per  cent, 
protein;  500  grams=o2200  calories);  casoid  flour, 
soja-bean  meal  (Thomas  Metcalf  Co.,  Boston, 
Mass.);  Roborat  (protein  84.5  per  cent.,  fat  1.4 
per  cent.;  500  grams O2095  calories;  imported 
by  Lehn  and  Fink,  120  Wilham  Street,  New  York 
City);  Hepco  flour  (soy  bean);  Lister’s  diabetic 
flour  (casein.) 

The  above  substitutes  for  bread,  except- 
ing bran  biscuits,  are  expensive,  and  soon 
become  distasteful.  They  are  useful  for  a 
change. 

Recipe  for  baked  custard — 

1 egg 

3 tablespoonfuls  cream 

5 tablespoonfuls  water 

2 or  3 saccharine  tablets 

8 drops  vanilla  essence. 

Beat  up  well.  Bake  in  buttered  dish  twenty  min- 
utes, with  a httle  nutmeg  grated  on  top.  (Janeway.) 

Recipe  for  coffee  ice  cream — 

3 tablespoonfuls  cream 

3 tablespoonfuls  water 

2 tablespoonfuls  coffee  with  2 or  3 saccharine 
tablets  dissolved  in  it 
1 egg- 

Mix  in  saucepan  and  beat  gradually  until  it 
thickens;  then  cool  and  freeze.  (Janeway.) 

Artificial,  sugar-free  milk — 

To  about  a pint  of  water  add  3 to  4 tablespoon- 
fuls of  cream,  mix  well,  and  allow  to  stand  for  12  to 


DIARRHCEA 


24  hours.  Skim  off  the  floating  fat,  pour  in  a glass, 
add  the  white  of  an  egg  and  stir;  then  add  water 
and  flavor  with  a little  salt  and  a trace  of  saccha- 
rin (Williamson.) 

Gelatin  sweetened  with  saccharin  {q.v.  in 
Part  11)  and  favored  with  lemon,  rhubarb, 
cracked  cocoa,  or  coffee,  is  a useful  dia- 
betic food. 

For  pruritus,  says  Futcher,  “ the  best 
remedy  is  a solution  of  boric  acid  or  of 
hyposulphite  of  soda,  one  ounce  to  the 
quart  of  water,  applied  as  a lotion.”  Crof- 
tan  says  that  soclium  salicylate,  gr.  xxx, 
internally,  several  times  a day,  is  “ almost 
a specific.”  The  genitals  should  be  bathed 
after  each  urination. 

As  a more  or  less  preventive  measure,  one 
should  enjoin  the  restriction  of  starchy  and 
saccharine  foods,  and  of  overeating  in  gen- 
eral, in  families  showing  a marked  predis- 
position to  diabetes,  for  in  these  instances 
the  pancreas  may  be  inherently  weak,  but 
may  continuously  function  well  enough  if 
not  overtaxed.  This  advice  is,  of  course, 
good  for  the  conservation  of  other  mechan- 
isms besides  the  pancreatic. 

(For  the  Lewis  and  Benedict  blood-sugar 
test,  obtain  the  Epstein  instrument  with 
instructions  from  Ernst  Leitz,  30  East  18th 
Street,  New  York  City.) 

Diaphragmatic  Neuralgia.— See  Neuralgia. 

Diarrhoea. — Gr.  bla  through  -f-  puv  to 
flow.  A diarrhsea  may  be  the  expression  of 
either  a functional  disturbance  or  of  organic 
changes.  The  so-called  functional  diar- 
rhoeas, however,  are  often  catarrhal. 

A.  Diarrhoea  in  Adults. — EtioloGY.  — (1) 
Functional:  Weather  changes,  either  to 

cold  or  to  hot;  exposure  to  cold  and  wet; 
cold  drinks;  excessive  drinking  of  water  or 
other  fluids;  purgative  drugs  and  certain 
other  drugs  in  overdose;  nervous  influences, 
e.g.,  fear,  apprehension,  nervousness,  shock, 
neurasthenia,  hysteria;  hyperthyroidism; 
tabes  dorsalis;  gastric  hyperacidity;  gastric 
hypoacidity,  anacidity,  and  achylia,  with 
the  entrance  into  the  intestines  of  undigested 
proteins  and  microorganisms,  and  resulting 
putrefaction;  pyloric  incontinence;  overeat- 
ing, the  undigested  excess  of  food  under- 
going fermentation  or  putrefaction;  excessive 
fermentation  of  carbohydrates  (fermenta- 
tive diarrhoea) ; excessive  putrefaction  of 
proteins  (putrefactive  diarrhoea) ; bulky 
foods  containing  much  indigestible  residue, 
such  as  raw  fruits  and  vegetables;  an 
excessively  fatty  diet,  or  fat  intolerance; 
ab.sence  or  diminution  of  the  pancreatic 
secretion,  causing  a fatty  diarrhoea;  decom- 
8 


posing  and  poisonous  foods,  especially  fish, 
shell-fish,  milk,  and  cheese;  reflex  influ- 
ences arising  from  the  generative  organs, 
nose,  skin,  enteroptosis,  hernia;  chronic 
passive  congestion  due  to  heart,  liver,  lung, 
or  kidney  disease;  urmmia  (irritation  caused 
by  ammonia  arising  from  the  urea  which  is 
vicariously  excreted  into  the  bowel);  retro- 
cedent gout;  cachexia;  cancer;  antemia; 
Addison’s  disease;  Bright’s  disease;  infec- 
tious diseases,  viz.,  malaria,  pneumonia,  diph- 
theria, the  exanthemata,  tuberculosis,  an- 
thrax, erysipelas,  septicopyemia,  etc. 

(2)  Organic:  Typhoid  fever;  dysentery, 
amoebic  or  bacillary;  cholera;  intestinal 
tuberculosis;  intestinal  anthrax;  distomiasis; 
tropical  sprue  or  psilosis;  infectious  diseases, 
e.g.,  pneumonia,  tuberculosis,  septico- 
pyemia, diphtheria,  erysipelas,  the  exanthe- 
mata, etc.;  intestinal  ulceration,  due  to 
stercoral  accumulations,  tuberculosis  (spe- 
cific ulceration  or  not),  syphilis  (specific 
ulceration  or  not),  gout,  scurvy,  leukaemia, 
Hodgkin’s  disease,  cutaneous  burns,  arsenic, 
mercury,  antimony,  alcoholism,  ura?mia, 
cancer,  amyloid  disease,  embolism  and 
thrombosis  (occurring  in  ulcerative  endo- 
carditis or  septico-pyemia,  chronic  valvu- 
lar disease,  arteriosclerosis,  local  abscess, 
multiple  neuritis,  erysipelas),  diphtheria, 
varioloid,  leprosy,  pellagra,  typhoid  fever, 
dysentery,  anthrax,  and  chronic  passive 
congestion  due  to  heart,  liver,  lung,  or  kid- 
ney disease;  amyloid  disease  of  the  intestines 
due  to  chronic  suppuration,  tuberculosis, 
syphilis,  or  cachexia;  poisonous  foods,  such 
as  toadstools  and  decomposing  foods;  min- 
eral poisons,  e.g.,  arsenic,  mercury,  copper, 
lead,  etc.;  intestinal  worms  (see  Worms); 
cancer  of  the  stomach  or  bowels;  gastritis; 
extensive  cutaneous  burns;  peritonitis;  in- 
testinal obstruction;  hernia;  diverticulitis. 
(See  Enteritis.) 

(a)  Treatment  of  Simple  Acute  Diar- 
RHoeA  OR  Acute  Intestinal  Indigestion. — 
(Symptoms:  diarrhoea,  flatulence,  meteor- 
ism,  perhaps  pain,  perhaps  nausea  and 
vomiting.)  Put  the  patient  to  bed,  and 
clean  out  the  digestive  tract  by  means  of 
castor  oil,  to  which  may  bo  added,  if  there  is 
much  pain,  laudanum  or  paregoric;  or, 
instead  of  castor  oil,  prescribe  calomel  in  a 
single  dose  or  in  divided  doses,  followed  by  a 
saline.  While  waiting  for  the  purgative  to 
act,  a copious  colonic  irrigation  is  of  service. 
(See  Part  11  for  drug  formulae,  etc.) 

For  the  relief  of  colic,  other  useful  reme- 
dies besides  opium  are  spirits  of  chloroform, 
spirits  of  ginger,  compound  tincture  of  carda- 
mom, chlorodyne,  and  the  following: 


DIARRHCEA 


R Spiritus  ammonii  aromatici, 

Spiritus  chloroformi, 

Syrupi  zingiberis, 

Tinctura;  lavanduloe  compositae,  aa  gss 

M.  Sig. — One  or  two  teaspoonfuls  in  a cupful  of 
hot  water  (diffusible  stimulant). 

R Tincturai  liyoscyami 3ss  (large  dose) 

Tincturae  belladonnae njjvi 

Sodii  bicarbonatis gr.  xx 

Tinctura;  zingiberis njxv 

Spiritus  chloroformi i^xx 

Aquam  mentha^  piperitae,  ad  . . 5* 

M.  Sig. — One  ounce  t.i.d.  (Mummery;  for  intes- 
tinal colic.) 

Apply  a hot  water  bag  to  the  abdomen. 
Morphine  may  be  required  hypodermically. 

Withdraw  all  food  for  twenty-four  hours, 
then  allow  only  small  quantities  of  albumen 
water,  barley  water,  sweetened  arrowroot 
water,  beef  tea,  or  hot  broth  free  from  fat; 
no  milk  or  carbonated  beverages.  Later,  as 
the  condition  improves,  add  broths  contain- 
ing the  yolk  of  an  egg,  meat  juice,  meat 
jellies,  rice  gruel,  boiled  milk,  milk  puddings, 
junket,  zwieback  or  crackers,  blueberry 
wine.  Restrict  the  diet  to  liquids  and  soft 
foods  for  several  days  after  the  disturbance 
has  been  allayed.  Forbid  cold  drinks,  coarse 
vegetables  such  as  cabbage  and  potatoes, 
legumes,  cheese,  goose,  duck,  salmon,  animal 
fats,  gravies,  raw  fruits,  acids,  cakes, 
coffee,  etc. 

Should  the  diarrhoea  persist  after  thor- 
ough evacuation  of  the  bowels,  prescribe  an 
astringent,  such  as  bismuth  in  large  doses, 
compound  chalk  powder,  lead  acetate,  tinc- 
ture of  kino,  compound  tincture  of  catechu, 
tannigen,  or  tannalbin;  with  or  without 
paregoric  or  laudanum. 

R Bismuthi  subnitratis 5iv  (5ss-i  per  dose) 

Mucilagini.s  acaciae 5 ii 

Aquw,  q.s.,  ad 5iv 

M.  Sig. — Shake  well,  and  take  one  to  two  table- 
spoonfuls every  four  hours. 

(b)  Treatment  of  Simple  Chronic 
Diarrhcea  or  Chronic  Intestinal  Indi- 
gestion.— (Symptoms : diarrhoea,  flatu- 

lence, meteorism,  perhaps  pain.)  Ascertain 
and  correct  the  cause.  If  an  excessive, 
coarse  vegetable  ami  fruit  diet  is  at  fault, 
correct  this.  If  the  diarrhoea  is  due  to  exces- 
sive fermentation  of  carbohydrates,  as 
shown  by  the  acid,  odorless  character  of  the 
stools,  after  standing  twenty-four  hours, 
exclude  starchy  foods  from  the  dietary  for 
several  weeks. 

If  the  diarrhoea  is  due  to  the  excessive 
putrefaction  of  proteins,  as  shown  by  the 
alkaline,  ammoniacal,  offensive  character  of 
the  stools  after  standing  twenty-four  hours 


(the  normal  stool  is  almost  neutral),  exclude 
meat  for  a period  continued  at  least  two 
weeks  after  the  diarrhoea  has  ceased,  and 
give  milk,  butter  milk,  sour  milk  (koumyss 
or  matzoon,  see  Part  11),  vegetables  and 
carbohydrates  instead. 

In  achylia  gastrica,  give  milk,  sour  milk, 
vegetables  and  carbohydrates,  exclude  meat 
and  eggs,  and  prescribe  dilute  hydrochloric 
acid,  15  to  20  drops,  well  diluted  in  sweetened 
albumen  water,  during  and  for  one-half  to 
one  hour  after  meals. 

In  nervous  diarrhoea,  prescribe  sodium  or 
potassium  bromide,  gr.  v,  or  more,  and 
tincture  of  belladonna,  iijv,  more  or  less, 
half  an  hour  before  meals,  with,  in  severe 
cases,  a small  dose  of  codeine.  After  the 
condition  has  been  corrected,  graduallj' 
withdraw  these  drugs.  (A.  F.  Hertz.) 

Hysterical  diarrhoea  is  said  to  be  extremely 
intractable,  the  rest  cure  and  a change  of 
scene  being  required. 

In  fatty  diarrhoea,  due  to  deficiency  of 
the  pancreatic  secretion,  try  pancreatin, 

or  pancreon. 

A brief  course  of  starvation  of  from  five 
to  six  or  more  days,  with  or  without  the 
free  drinking  of  purgative  waters,  may  be 
of  value  in  both  gastric  and  intestinal 
disorders. 

Ortner  recommends  menthol  as  the  best 
intestinal  antiseptic : 

R Mentholis gr.  iss-iiiss 

Olei  olivsB  vel  olei  symgdala) 
expressivsD i^ivss 

M.  fiat  caps.  No.  1 Dent,  tab  caps,  molles 

No.  XXX. 

Sig. — One  capsule  3 to  5 times  a day  after  meals. 
(If  it  is  desired  that  the  drug  be  liberated  in  the 
intestine,  enclose  it  in  glutoid  capsules,  grade  II, 
gelatin  capsules  hardened  wdth  formalin.)  (Ortner.) 

B.  Diarrhoea  in  Bottle=Fed  Infants  and  in  Early 
Childhood. — The  affection  may  be  simple 
intestinal  indigestion,  of  the  irritative,  the 
fermentative,  or  the  putrefactive  type,  or 
it  may  be  an  inflammatory  or  infectious 
diarrhoea,  i.e.,  an  enterocolitis  or  dysentery; 
or  it  may  be  the  grave  fulminating  choleraic 
diarrhoea  or  cholera  infantum. 

Prophylaxis. — Fresh  air  in  abundance 
day  and  night,  preferably  in  the  countrj"  or 
in  the  city  parks;  very  light  clothing  in 
warm  weather,  and  a light  flannel  abdominal 
binder;  frequent  spongings  on  hot  da.ys, 
strict  cleanliness;  cleanliness  of  the  mouth 
and  hands,  boiling  of  the  nursing  bottles 
and  nipples,  pasteurization  or  boiling  of  the 
milk,  boiling  of  the  drinking  water,  exclusion 
of  flies;  weaker  milk  diet  and  less  frequent 
feeding,  and  an  abundance  of  boiled  water 


DIAllRHCEA 


in  hot  weather;  breast  feeding* if  possible 
(see  Infant  Feeding  for  details). 

I,  Simple  Intestinal  Indigestion  or  Dyspepsia. — 
The  onset  in  simple  dyspepsia  is  gradual, 
except  when  the  disturbance  is  caused  by  a 
parenteral  infection,  such  as  a “cold,”  cysti- 
tis, otitis,  etc.,  the  weight  becomes  stationary 
or  increases  but  slightly,  or  declines  (norm- 
ally there  should  be  a gain  of  6 to  8 oz.  a 
week  under  six  months  of  age,  and  3 to  4 oz. 
a week  thereafter).  The  stools  are  usually 
increased  (more  than  3 or  4 a day  after  the 
fu’st  month  constitutes  a diarrhoea),  and 
usually  show  the  presence  of  mucus,  per- 
haps curds  if  raw  milk  is  being  given.  The 
reaction  is  usually  acid  and  the  odor  usu- 
ally sour. 

The  physiology  of  digestion  is  briefly  as 
follows:  Protein  is  broken  up  in  the  intestine 
into  amino-acids  and  ammonia,  the  amino- 
acids  being  absorbed  as  salts  and  the  am- 
monia serving  to  render  the  intestinal  con- 
tents alkaline.  Fat  in  the  intestine  is  split 
by  the  action  of  lipase  into  glycerine  and  a 
fatty  acid.  The  fatty  acids  in  an  alkaline 
medium  form  soaps,  which  are  emulsified 
by  the  action  of  the  bile  and  then  absorbed. 
The  disaccharide  sugars  (lactose,  saccharose, 
and  maltose)  are  split  in  the  intestine  into 
the  monosaccharides  and  are  absorbed  as 
such.  An  excess  may  be  acted  upon  by 
bacteria  and  converted  into  formic,  acetic, 
butyric,  and  other  acids.  Fat  may  also  be 
thus  acted  upon. 

High  fermentable  sugar  (lactose  and  sac- 
charose) feeding  plus  concentrated  whey 
(salts)  produces  watery,  greenish,  sour- 
smelling, acid,  mucous  stools,  associated 
with  colic,  vomiting,  scalding  of  the  but- 
tocks, perhaps  slight  elevation  of  tempera- 
ture, and  malnutrition;  in  acute  cases,  high 
fever,  apathy,  prostration,  air  hunger,  and 
rapid  loss  of  weight  (acid  intoxication; 
cholera  infantum),  due  to  incomplete  break- 
ing down  of  the  fats  into  acids  which  are 
absorbed  through  the  weakened  intestine. 
High  sugar  plus  well  diluted  whey  is  better 
borne;  and  concentrated  whey  without  car- 
bohydrate is  well  borne.  Fat  in  an  acitl 
intestine  is  converted  into  fatty  acids,  which 
cause  additional  irritation.  Fat  in  an  alka- 
line intestine  (rendered  alkaline  by  protein) 
favors  constipation.  High  fat  plus  relatively 
low  protein  produces,  in  the  order  of  their 
appearance,  anorexia,  lack  of  gain  or  loss 
in  weight,  sour  regurgitation,  acid  vomit- 
ing (due  to  fatty  acids)  diarrhoea  with  soft 
curds  and  mucus  in  the  stools,  scalding 
of  the  buttocks,  acidosis  (q.v.)  with  rapid 
breathing,  restlessness,  cherry  red  lips,  coma; 


in  less  severe,  chronic  cases,  malnutrition 
and  atrojjhy. 

High  fat  and  protein  with  insufficient 
carbohydrato  feeding  produces  flabby,  pasty, 
constipated,  non-thriving  babies.  High  fat 
plus  high  protein,  low  whey,  and  sufficient 
non-fermentable  carbohydrate,  e.g.,  albu- 
men milk  (see  under  Diarrhoea  in  Bottle- 
Fed  Infants),  is  well  borne.  The  fat  is 
thereby  renclered  harmless.  High  unboiled 
casein  feeding  cau.ses  vomiting  of  lai’ge 
curds,  flatulence,  colic,  frequent  alkaline 
putrefactive  stools  containing  mucus  and 
large  tough  curds,  possibly  fever  and  con- 
vulsions. High  starch  feeding  produces 
emaciateol,  weak  infants. 

Etiology. — Other  factors  in  the  cairsation 
of  dyspepsia  besides  improper  feeoling  are 
heat,  lack  of  fresh  air,  overclothing,  insuffi- 
cient clothing,  uncleanliness,  insufficient 
bathing,  parenteral  infection  and  ner- 
vous influences. 

Treatment. — In  acid,  fermentative  diar- 
rhoea, reduce  the  fat  and  sugar,  dilute  the 
whey,  and  sulistitute  for  fermentable  sugar 
non-fermentable  carbohydrate.  The  middle- 
Western  method  of  treatment  is  as  follows: 
Allow  only  water  or  weak  tea  sweetened 
with  a little  saccharine  for  twelve  to  twenty- 
four  hours.  Then  begin  feeding  with  1 part 
milk  and  2 parts  water  (to  dilute  the  whey) 
plus  1 or  2 per  cent,  nonfermentable  carbo- 
hydrate, e.g.,  dextri-maltose,  boiled  for  one 
to  three  minutes.  Give  6 to  10  oz.  in  twenty- 
four  hours,  divided  into  sLx  bottles.  Add 
about  3 oz  to  the  total  every  day  or  every 
other  day  until  a sufficient  amount  for  the 
baby’s  age  is  reached  (see  Infant  Feeding), 
then  gradually  increase  the  carbohydrate  to 
5 per  cent.,  using  the  weight  curve  as  a guide. 

If  the  cause  of  the  dyspepsia  is  a parenteral 
infection,  etc.,  and  the  weight  is  rising  or 
stationary,  do  not  change  the  food;  but  if  the 
weight  is  falling,  treat  as  above. 

In  the  presence  of  intoxication  (cholera 
infantum),  allow  nothing  but  water  or  tea 
for  twenty-four  hours,  excepting  stimulants, 
e.g.,  whiskey  or  brandy,  10  to  15  drops,  well 
diluted,  every  few  hours;  or  caffeine  citrate, 
gr.  34)  or  camphor  in  oil,  10  per  cent.,  10 
to  15  mins,  hypodermically;  or  adrenalin, 
2 to  3 mins,  hypodermically  every  two  to 
three  hours.  The  alkaline  chalk  mixture 
{q.v.  in  Part  11),  several  teaspoonfuls  every 
few  hours,  may  be  of  value.  At  the  end  of 
twenty-four  hours,  begin  feeding  with  breast 
milk  or  albumen  milk,  10  feedings  of  about 
34  oz.  each;  the  next  day  10  feedings  of 

oz.  each;  the  next  day  10  feedings  of  134 
or  134  oz.  each.  Hold  to  the  10x134  oz. 


DIARRHCEA 


schedule  until  the  weight  curve  becomes 
horizontal  (do  not  change  under  any  circum- 
stances). Then  gradually  increase  the 
daily  total  to  about  3 oz.  for  every  pound 
of  the  baby’s  weight.  Then  cautiously 
increase  the  carbohydrate  to  5 per  cent. 
After  a few  weeks  return  to  the  ordinary 
milk  mixture  (see  Infant  Feeding). 

Albumen  or  Eiweiss  milk  may  be  made  as 
follows;  MLx  together  one  quart  each  of 
buttermilk  and  water,  boil  three  or  four 
minutes,  and  allow  to  stand  at  least  half  an 
hour.  Poiu-  off  the  supernatant  whey- 
water.  Add  to  the  casein  sediment  4 oz. 
of  boiled  cream,  3 per  cent,  of  dextrin- 
maltose  (or  Mellin’s  Food  or  Horlick’s  Malt 
Food)  and  sufficient  whey-water  to  make 
one  quart.  Sweeten,  if  need  be,  with  a little 
saccharine,  1 gr.  to  the  quart  (Langstein  and 
Meyer).  The  composition  is  protein,  3.5; 
fat,  2.5;  sugar,  1.5. 

Instead  of  albumen  milk  one  may  use  a 
mixture  of  high  protein,  low  whey,  and  non- 
fermentable  carbohydrate,  and  begin  with 
small  doses. 

In  the  treatment  of  older  children  (one  to 
three  years  of  age)  with  acid  intoxication, 
allow  only  water  or  tea  the  first  day,  then 
begin  feeding  tiny  doses,  gradually  increased, 
of  proteins,  e.g.,  egg,  scraped  meat,  cottage 
cheese,  and  milk  diluted  one-third  or  one- 
half  (or  no  milk),  and  non-fermentable  carbo- 
hydrate, e.g.,  zwieljack,  potato,  cornstarch, 
arrowroot.  Cream  of  Wheat,  and  salts  in  the 
form  of  vegetable  purges. 

Putrefactive  diarrhoea,  which  is  rare,  is 
treated  by  the  reduction  of  protein  and  the 
increase  of  carbohydrate,  and,  perhaps,  the 
administration  of  lactic  acid  cultures  (see 
Part  II)  to  inliibit  putrefaction. 

Dyspepsia  caused  by  the  ingestion  of 
grossly  indigestible  articles,  such  as  bananas, 
watermelon,  cucumbers,  etc.,  calls  for  pur- 
gation by  means  of  castor  oil,  3 Hi  to  a baby 
of  six  months,  3iii~iv  to  a child  of  three  to 
five  years;  or  calomel,  gr.  ^{q,  every  fifteen 
to  thirty  minutes  (gr.  3^  every  fifteen  to 
twenty  minutes,  up  to  6 or  8 doses — Holt). 
While  waiting  for  the  pmgative  to  act,  the 
colon  may  be  irrigated  with  a large  quantity 
of  water,  which  may  be  used  cool  where 
there  is  much  fever.  Food  should  be  with- 
held for  twenty-four  hours,  and  feeding  then 
cautiously  resumed. 

II.  Infectious  Diarrhoeas. — In  the  infectious 
diarrhoeas,  as  distinguished  from  the  nutri- 
tional diarrhoeas,  the  onset  is  sudden,  with 
high  temperature,  vomiting,  prostration,  and 
frequent  loose  stools  (alkaline  in  dysentery), 
containing  mucus  and  blood  or  mucus  and 


serum,  with  pus,  and  little  or  no  solid 
material,  and  there  is  no  response  to  twenty- 
four  hours  of  starvation.  In  nutritional 
diarrhoea,  the  onset  is  usually  gradual, 
following  improper  feeding,  the  stools  are 
green,  usually  acid  and  watery,  contain 
increased  osolid  material  and  mucus,  but 
rarely  blood  or  pus,  and  there  is  a favorable 
response  to  twelve  to  twenty-four  hours  of 
starvation.  To  obtain  the  stool  free  from 
urine,  insert  into  the  rectum  a narrow  test- 
tube  with  a hole  blowm  in  the  side. 

The  bacillus  dysenterise  is  a common  cause 
of  infectious  diarrhoea.  The  gas  bacillus  and 
streptococcus  are  occasional  causes.  Flies 
and  dirt  are  important  factors.  Boiling  the 
milk  is  preventive.  To  demonstrate  the  gas 
bacillus,  inoculate  a test-tube  of  milk  with 
a pea-sized  amount  of  stool,  heat  to  180°  F. 
for  half  an  hour,  or  boil  for  three  minutes,  to 
destroy  all  bacteria  except  spores,  then  incu- 
bate at  body  temperature  for  twenty-four 
hours.  If  the  gas  bacillus  is  present,  the 
sugar  of  the  milk  wall  be  split  into  acetic 
and  butyric  acids  (smelling  of  rancid  butter) 
which  precipitates  the  casein,  and  the  latter 
is  shot  full  of  holes  by  the  gas  formation. 
The  microscope  reveals  the  large  Gram — 
positive  gas  bacillus. 

Treatment. — Since  the  gas  bacillus  grows 
w^ell  in  sugar,  but  not  in  protein  or  lactic 
acid,  the  treatment  is  buttermilk  or  lactic 
acid  cultures  or  albumen  milk  (see  under 
Diarrhoea  in  Bottle-Fed  Infants).  (Kendall.) 

In  dysenteric  and  streptococcus  infection, 
on  the  other  hand,  no  bacterial  poison  is 
produced  in  a carbohydrate  medium,  but  is 
in  a protein  medium,  so  that  a high  carbo- 
hydrate diet  is  indicated.  Employ  breast 
feeding,  if  possible,  otherwise  the  Frank 
artificial  feeding,  as  follows:  weak  tea  for 

twenty-four  hours,  e.xcept  in  cases  of  maras- 
mus or  decomposition;  on  the  second  day, 
five  feedings,  each  of  2 oz.  of  W'hey  plus  2 oz. 
of  gruel,  made  of  barley  flour,  rice  flour, 
browm  Hour,  cornstarch,  arrowTOot  or  farina 
(made  bj^  boiling  one  even  tablespoonful  of 
the  Hour  in  12  oz.  of  water  for  twenty  min- 
utes; if  the  grains  are  used,  2 tablespoonfuls, 
wath  a pinch  of  salt,  are  boiled  in  one  quart 
of  water  for  six  hours,  the  amount  being  kept 
up  to  one  quart  by  the  addition  of  w'ater; 
after  boiling  strain  through  coarse  muslin); 
the  W’hey  and  gruel  mixture  to  be  gradually 
increased  by  the  fourth  or  fifth  day  to  five 
feedings  of  2}^  oz.  each  of  w’hey  and  gruel; 
on  the  fifth  to  eighth  day,  gradual  replace- 
ment of  the  whey  by  milk  in  teaspoonful 
doses;  on  the  twelfth  to  fourteenth  day,  dis- 
regarding the  stools,  a diet  consisting  of  a 


QUIETING  PLANTS 


pectoral ) 


Eucalyptus 

/pectoral) 


" "'Thyme 
enlarged  flower) 


floweri 


Wood  pine 

' . /pectoral  I 


Oats  ™ 
spiUelet 


Venus’s  hair  /pectoral. 


Linden 

quieting , 


'iolel  ipectorah 


Linden  ^ 
(Section  ^-2,5- 


Violet 

(Seed) 


Warshmallow 

/ emollient ) 


^ u i 1 e I n L 
section  of  flower 


IViullein 

Ipectorah 


Round  l^mallow 


Mullei  n 
< seed ) 


ipectorah 


Round-leaf  mallow 

! pectoral  i 


LAROUSSE  MEDICAL 


Quieting, emollient, and  pectoral  plants. 


DIARRHCEA 


daily  total  of  13  to  14  oz.  of  gruel,  13  to  14 
oz.  of  milk,  and  6 to  7 oz.  of  broth. 

For  high  fever,  apply  an  ice-cap  to  the 
head,  and  employ  tepid  sponging,  the  cold 
pack,  or  perhaps  better,  the  tub  bath  at  a 
temperature  of  100°  F.,  gradually  reduced  by 
means  of  ice  to  80°  or  85°  F.,  and  continued 
for  five  to  twenty  minutes.  Repeat  the  bath 
every  two  to  four  hours.  If  the  skin  is  cold 
and  the  temperature  subnormal,  employ 
hot  mustard  baths  or  packs  (1  to  2 table- 
spoonfuls of  mustard  to  four  gallons  of 
water),  until  a cutaneous  reaction  is  pro- 
duced, and  apply  hot  water  bottles.  To 
combat  the  associated  prostration  and 
feeble  pulse,  administer  whiskey  or  brandy, 
together  with  tincture  of  strophanthus;  or 
strychnine  hypodermically;  or  digitalin;  or 
camphorated  oil  or  spirits  (see  Part  11).  For 
persistent  vomiting,  wash  out  the  stomach 
once  with  a warm  one  per  cent,  solution  of 
sodium  bicarbonate  (see  Inanition  for  tech- 
nique); or,  in  older  children,  give  a large 
quantity  of  boiled  water  to  drink,  which  is 
usually  soon  vomited  and  thus  washes  out 
the  stomach.  Dennett  gives  sodium  bicar- 
bonate, 1 level  teaspoonful  in  a glass  of 
water — one  tablespoonful  every  15  to  30 
minutes,  up  to  4 or  6 tablespoonfuls  every 
hour.  In  severe  vomiting,  purging,  and 
threatening  collapse,  give  a hypodermic 
injection  of  morphine,  gr.  3d^oo  to  to 
3^  0^  with  atropine  gr.  i^oo,  to  an  infant 
of  six  months  to  one  year.  Do  not  give 
morphine,  however,  if  there  is  stupor  or 
coma,  or  if  the  stomach  and  bowels  have  not 
been  thoroughly  emptied  by  repeated  vom- 
iting and  purging. 

To  replace  great  loss  of  fluid,  administer 
water  by  mouth  and  normal  saline  solution 
by  bowel  or  subcutaneously,  at  least  one 
pint  every  twelve  hours. 

In  cases  in  which,  after  the  bowels  have 
been  thoroughly  evacuated  and  the  tem- 
perature is  falling,  the  diarrhoea  still  con- 
tinues and  the  stools  are  not  foul,  prescribe 
bismuth  subnitrate,  subcarbonate,  or  sub- 
gallate  in  big  doses — gr.  v-x  (see  Part  11) 
every  hour  until  the  stools  are  blackened. 
To  hasten  blackening  of  the  stools,  which 
is  essential,  lac  sulphur  may  be  added  to  the 
bismuth  mixture  in  grain  doses.  Holt  says 
subcarbonate  of  bismuth  is  the  safest:  gr. 
v-xv  every  two  hours,  to  a child  of  one  year: 
R Bismuth!  subcarbo- 

natis gr.  Ixxx  fgr.  x per  dose) 

Sulphurus  praccipitatis  gr.  viii  (gr.  i per  dose) 
Mucilaginis  acacise ....  .^iii 
Aquae,  q.s.,  ad 5h 

M . Sig. — Shake  well,  and  give  two  drams  every 
two  hours. 


Other  astringent  preparations  are  pre- 
pared chalk,  tannalbin,  tannigen,  quinine 
tannate  (see  Part  11).  Deodorized  tincture 
of  opium,  or  Dover’s  powder,  or  paregoric, 
should  only  be  employed  to  check  frequent, 
excessive  movements,  and  to  relieve  pain  and 
tenesmus.  Remember  that  elevation  of  tem- 
perature and  foul  stools  call  for  purgation. 

In  cases  in  which  a slight  diarrhoea  with 
much  mucus  persists  (chronic  ileocolitis), 
employ,  once  or  twice  daily,  colonic  irriga- 
tions of  warm  normal  saline  solution  (3i 
ad  Oi);  or  fluid  extract  of  hamamelis  in 
warm  normal  salt  solution,  1:65;  or  tannic 
acid,  3i  to  the  pint  of  hot  water;  or  silver 
nitrate,  1:8000,  followed  by  normal  salt 
solution.  For  distressing  tenesmus  inject 
into  the  rectum  two  ounces  of  a thin 
starch  solution  containing  laudanum.  In 
chronic  ileo-colitis  in  infants  under  one  year, 
says  Kerley,  “ breast  milk  is  practically  the 
only  hope,”  with  plain  boiled  water  before 
each  nursing. 

See  that  the  baby  is  not  overclad,  and 
has  plenty  of  fresh  air,  preferably  in  the 
country  or  in  the  parks. 

C.  Diarrhoea  in  Breast=fed  Infants  (more  than 
four  stools  a day,  associated  with  vomiting,  regurgi= 
tation,  anorexia,  flatulence,  colic,  stationary  or 
falling  weight,  pallid  inelastic  skin,  slight  elevation 
of  temperature,  fretfulness.)  — CAUSES.  — Too 
frequent  feeding;  too  long  feeding  or  over- 
feeding (to  ascertain  which,  weigh  the  baby 
before  and  after  nursing);  maternal  illness, 
nervous  strain,  or  the  ingestion  of  certain 
articles  of  diet;  maternal  overfeeding  pro- 
ducing an  over-rich  milk;  accessory  feeding; 
enteric  infection;  parenteral  infection 
(“cold,”  cystitis,  otitis,  etc.;  of  sudden  onset 
and  temporary);  overclothing;  overheating; 
overcooling;  bad  hygiene. 

Treatment. — In  alimentary  cases  discon- 
tinue the  breast  milk  for  twelve  to  twenty- 
four  hours,  and  give  plain  unsweetened  water 
or  albumen  water  instead.  Albumen  water 
is  made  by  adding  the  white  of  one  egg  to  a 
pint  of  boiled  water,  with  or  without  salt. 
It  may  be  warmed  slightly.  To  render  the 
intestine  alkaline,  one  may  limit  the  nursing 
to,  say,  about  five  minutes,  and  give  albumen 
milk  (see  Infant  Feeding)  without  sugar. 
If  it  is  suspected  that  the  baby  has  received 
some  food  other  than  the  breast,  give  a dose 
of  castor  oil. 

Unless  very  much  undernourished,  the 
infant  should  be  nursed  every  three  hours — 
at  6,  9,  and  12  a.  m.,  3,  6,  and  9 p.  m.,  and 
up  to  the  fifth  or  sixth  month,  at  2 a.  m. — 
seven  or  six  nursings  in  twenty-four  hours. 
Each  nursing  should  be  continued  until  the 


DILATATION  OF  THE  STOMACH,  CHRONIC 


baby  is  satisfied  or  goes  to  sleep,  but  no 
longer  than  twenty  minutes. 

Diarrhoea,  Inflammatory. — (In  Adults, 
see  Enteritis.)  (In  Infancy  and  Early 
Cliiklhood,  see  under  Diarrhoea.) 

Diathermy. — Gr.  5ta  through  -|-  OepfiaLveiv 
to  heat.  Diathermy  means  the  destruc- 
tion of  tissue  by  means  of  the  intense  heat 
that  is  generatetl  by  a powerful  high- 
frequency  current  (.see  Medical  Electricity). 

The  cm’rent  is  produced  by  a motor,  and 
is  applied  by  means  of  two  electrodes,  a 
large  one  wrapped  in  wet  towels,  and  laid 
upon  the  abdomen  or  chest,  and  a small  one 
with  a metal  point,  which  is  plunged  into 
the  tissue  to  be  desti-oyed.  The  great  heat 
produced  at  the  small  electrode,  and  the 
little  heat  i)roduced  at  the  large  electrode  is 
due  to  the  respective  size  of  the  electrodes. 

General  anaesthesia  is  required. 

The  jiart  to  be  treated  is  carefully  wiped 
dry  (atropine,  see  Part  11,  may  be  given 
internally),  the  small  needle  electrode  is 
buried  completely  in  the  tissues,  and  the  cur- 
rent is  turned  on.  As  soon  as  the  part  turns 
white,  or  bubbles  appear  (five  to  ten  seconds), 
the  current  is  turned  off,  the  needle  removed, 
and  another  part  punctured  and  treated  in  a 
similar  manner  until  the  whole  is  destroyed. 
But  too  much  should  not  be  de.stroyed 
at  one  sitting,  for  fear  of  the  production  of 
too  large  a slough,  with  resulting  septic 
absorjjtion. 

Diathermy  is  employed  in  the  removal  of 
tumors,  naevi,  lupus,  enlarged  or  septic 
tonsils,  etc. 

Dibothriocephalus  Latus. — Gr.  jSoOpLov  pit 
+ Ke4>a\ri  head;  L.  lat'us,  broad.  (See  Tape- 
worm Infection.) 

Dietetics. — See  Food  Values. 

Dietl’s  Crisis. — See  Movable  Kidney, 
under  Enteroptosis.) 

Dilatation  of  the  Bronchi. — See  Bronchi- 
ectasis. 

Colon. — See  Colon,  Dilatation  of  the. 

Heart. — See  Cardiac  Insufficiency  or 
Failure. 

(Esophagus. — See  (Esophageal  Dilata- 
tion. 

Dilatation  of  the  Stomach,  Acute;  Acute 
Qastrectasis. — Gr.  yaariip  stomach  + 

eKTaais  stretching.  This  is  an  imj)ortant 
])athological  condition  to  keep  in  miiul,  and 
is  not  very  uncommon.  It  is  characterized 
by  an  onset  which  is  usually  siuhlen  and 
severe,  resembling  acute  intestinal  obstruc- 
tion. There  is  acute  abdominal  pain  and 
distention,  copious  vomiting  of  a bilious 
fluid,  dyspnoea,  great  thirst,  scanty  urine, 
and  collapse;  no  fever.  An  imi)ortant  diag- 


nostic sign  is  the  replacement  of  gastric 
tympany  by  dulness,  the  latter  extending 
from  below  the  navel  on  the  left  side  to  the 
right  costal  margin.  Gastric  lavage  and 
the  prone  or  knee-chest  po.sture  usually 
reduce  the  swelling  anil  stop  the  vomiting. 
Unless  properly  treated,  the  condition  is 
fatal.  Properly  treated  it  is  usually  cured 
within  five  days. 

Etiology.— Paralysis  of  the  gastric  muscula- 
ture secondary  to  a surgical  operation,  gen- 
eral anaesthesia,  traumatism  of  any  part  of 
the  body  producing  nervous  shock,  infec- 
tious diseases  (typhoid  fever,  pneumonia), 
debility  resulting  from  infectious  diseases, 
anaemia,  cachexia,  heart  disease,  rickets, 
etc.,  gastric  disease,  compression  exerted  by 
a plaster  jacket,  spinal  deformity,  over- 
eating causing  sharp  flexion  of  the  pylorus, 
incarceration  of  a gall  stone.  The  immediate 
cause  is  often  a kinking  or  constriction  of 
the  duodenum  due  to  traction  on  the  mesen- 
teric root  caused  by  gravitation  of  the 
intestines  into  the  pelvis,  the  patient  lying 
upon  his  back. 

Treatment.— Turn  the  patient  face  down, 
with  the  head  low  and  the  pelvis  high,  or 
get  him  in  the  knee-chest  posture.  Wash 
out  the  stomach  thoroughly  at  once.  Cohn- 
heim  leaves  in  a saline  cathartic  or  elaterin, 
gr.  ss,  and  gives  a high  enema  of  saturated 
magnesium  sulphate  solution,  4 to  6 ounces. 
Repeat  the  stomach  lavage  every  two  or 
three  hours  for  three  or  four  tunes,  then 
every  four  to  six  hours. 

Allow  no  food  or  drink  by  mouth. 

For  the  thirst  employ  normal  saline 
enemata  (pi  ad  Oi)  or  subcutaneous  infu- 
sions. Administer  stimulants  as  required, 
viz.,  camphorated  oil,  strychnine,  or  digi- 
talin, hypodermically  (see  Drugs,  Part  11.) 
Eserine,  or  j^ituitrin,  may  be  given  hypoder- 
mically for  the  purpose  of  stimulating  the 
gastro-intestinal  musculature.  Atropine  is 
recommended  for  the  purpose  of  lessening 
pylorospasm  and  secretion  (but  is  there  any 
spasm  present?). 

If  lavage  and  the  knee-chest  or  prone 
posture  are  unsuccessful,  do  an  exploratory 
operation.  Look  for  intestinal  obstruction 
and  explore  the  duodenum  for  constriction. 
If  the  .stomach  alone  is  involved,  do  a 
gastrostomy  or  a gastrojejunostomy  or  the 
Finney  gastroduodenostomy.  If  the  duo- 
denum is  involved  with  the  stomach  do  a 
duodenojejunostomy. 

Dilatation  of  the  Stomach,  Chronic; 
Chronic  Qastrectasis. — Chronic  dilatation 
of  the  stomach  is  the  result  of  pyloric 
obstruction.  Says  Cohnheim,  “ The  assump- 


DILATATION  OF  THE  STOMACH,  CHRONIC 


tion  of  the  existence  of  primary  muscular 
weakness  (or  atony)  of  the  stomach,  as  a 
cause  of  chronic  dilatation,  has  now  been 
quite  generally  abandoned. 

Causes  of  Pyloric  Obstruction. — Pylorospasm 
due  to  ulcer,  to  a neurosis,  or  to  gallstones, 
or  possibl}'  to  irritating  ingesta,  etc. ; cicatriz- 
ation of  an  ulcer;  constricting  or  displacing 
adhesions  due  to  cholelithiasis,  appendicitis, 
or  gastric  ulcer;  inflammatory  swelling  due 
to  ulcer;  benign  pyloric  hypertrophy;  cancer 
of  the  pylorus;  compression  by  an  adjacent 
tumor,  floating  kidney  or  spleen;  benign 
adenomata  and  polypi;  foreign  bodies; 
cicatricial  narrowing  caused  by  caustic 
alkalies,  acids,  and  corrosives;  kinking  of 
the  duodenum  due  to  enteroptosis; 
epigastric  traumatism  giving  rise  to 
pyloric  spasm  or  organic  changes;  epigastric 
hernia;  congenital  hypertrophic  pyloric  ste- 
nosis; congenital  stricture. 

The  symptoms  of  pyloric  obstruction 
vary  all  the  way  from  no  symptoms  what- 
ever, on  through  a variety  of  dyspeptic 
manifestations,  such  as  sensations  of  full- 
ness, flatulence,  heartburn,  colicky  pains, 
palpitations,  headache,  dizziness,  anaemia, 
depression,  etc.,  to  the  symptoms  of  frank 
obstruction,  viz.,  the  copious  periodic  vomit- 
ing of  sour-smelling  food  retained  beyond 
the  usual  time,  followed  by  relief  of  symp- 
toms. Associated  symptoms  in  advanced 
cases  are  thirst,  dryness  of  the  skin,  oliguria, 
constipation,  and  perhaps  emaciation,  rarely 
tetany,  which  is  a serious  sign.  “Gastrec- 
tasis  clue  to  spasm  of  the  pylorus,”  says 
Cohnheim,  “should  always  be  thought  of, 
if  colicky  pains  occur  regularly  at  certain 
periods  of  the  day,  especially  four  to  six 
hours  after  meals,  at  five  or  six  o’clock  in 
the  afternoon  and  from  one  to  three  o’clock 
at  night.” 

The  stomach  is  enlarged,  as  may  be 
demonstrated  by  rapid  inflation  with  a 
Davidson  double-bulb  s}Tinge  attached  to 
a stomach-tube,  or  with  carbonic  acid  gas, 
formed  in  the  stomach  by  the  administra- 
tion of  a small  teaspoonful  of  tartaric  acid 
dissolved  in  an  ounce  of  water,  followed  by 
a rather  larger  quantity  of  sodium  bicar- 
bonate (Osier).  The  lower  border  of  the 
normal  stomach,  under  air  inflation,  rarely 
descends  lower  than  the  umbilicus,  when 
the  upper  border  is  in  its  normal  position. 
Look  and  feel  for  peristaltic  waves  and  for 
the  presence  of  a tumor. 

A bismuth  X-ray  examination  gives 
important  information.  Two  to  four  ounces 
of  bismuth  sulphate  suspended  in  mucilage 
of  acacia  or  in  milk  is  given  on  an  empty 


stomach,  say  at  5 a.  m.,  and  six  hours 
later  the  patient  is  rachographed  in  the 
upright  position.  The  stomach  should  then 
be  empty.  If  bismuth  is  still  present, 
pyloric  obstruction  is  indicated.  A second 
bismuth  meal  is  now  given  and  frequent 
radiographs  taken  with  the  tube  focussed 
upon  the  third  lumbar  vertebra,  taking  care 
to  exert  no  pressure  upon  the  stomach. 
(R.  C.  Cabot.) 

The  retention  of  food  overnight  indicates 
pyloric  obstruction.  “ If  the  physician 
gives  the  test  supper  (at  8 p.  m.,  porridge 
containing  rice  and  raisins,  and  one  or  two 
slices  of  bread  and  butter),  and  finds  the 
stomach  empty  in  the  morning  before  break- 
fast (12  hours  later),  gastrectasis  may  be 
eliminated  from  the  diagnosis.”  (Cohnheim. ) 

“In  benign  stenosis  of  the  pylorus,  hydro- 
chloric acid  is  always  present;  and  in  almost 
all  cases,  there  are  both  hyperchlorhydria 
and  hypersecretion;  occasionally  the  gastric 
juice  is  normal  or  subacid.”  (Cohnheim.) 

(See  Dyspepsia,  for  gastric  analysis 
and  technique.) 

Congenital  hypertrophic  stenosis  of  the 
pylorus  is  a very  serious  affection,  with  a 
mortality  of  about  50  per  cent.  (Holt), 
characterized  by  the  appearance  usually 
during  the  first  month  of  life,  of  persistent 
bile-free  projectile  vomiting,  gastric  dis- 
tension, visible  peristalsis,  a palpable,  small 
olive-sized  tumor,  the  absence  of  milky 
stools,  usually  constipation,  no  fever,  and 
progressive  emaciation  due  to  starvation. 
Pylorospasm  is  an  important  factor  in 
this  affection. 

Prognosis.— In  non-malignant  cases  the 
prognosis  under  appropriate  treatment,  med- 
ical or  surgical,  as  required,  is  usually  good. 

Treatment.— Where  food  remains  in  the 
stomach  overnight,  the  stomach  should  be 
thoroughly  washed  each  day  at  bedtime  until 
the  overnight  retention  ceases  (see  under 
Dypepsia  for  technique).  If  fermentation  is 
present,  employ  lukewarm  boric  acid  solu- 
tion, a teaspoonful  to  the  pint,  or  salicylic 
acid,  15  grains  to  the  pint,  or  thymol,  4 
grains  to  the  pint.  Sodium  bicarbonate,  a 
tablespoonful  or  more  to  the  pint,  is  used  to 
remove  mucus.  As  soon  as  the  fermentative 
processes  have  been  checked,  use  only  luke- 
warm water.  The  washing  should  be  con- 
tinued each  time  until  the  fluid  returns 
clear.  Lavage  in  the  early  morning  may 
sometimes  be  advisable.  Cohnheim  follows 
lavage  with  the  introduction  into  the  stom- 
ach of  50  to  100  c.c.  (or  even  150  c.c.;  30  c.c. 
= 1 oz.)  of  warm  olive  oil,  which  may  first 
be  shaken  with  warm  water  in  order  to 


DIPHTHERIA 


remove  any  irritating  fatty  acids  that  may 
be  present.  Large  doses  of  olive  oil  (50  c.c. 
or  1 34  oz.)  may  be  taken  one-half  hour 
before  meals,  t.i.d. 

To  prevent  decomposition  of  the  stomach 
contents,  one  may  employ,  if  deemed  advis- 
able, creosote,  iijji,  in  a tablespoonful  of  water, 
t.i.d.;  or  thymol,  gr.  i in  pill,  3 or  4 times  a 
day;  or  chloroform  water,  one  tablespoonful 
3 or  4 times  a day;  or  bismuth  salicylate 
and  magnesium  carbonate,  aa  gr.  v,  in 
powder  form,  after  meals;  or  sodimn  sali- 
cylate, gr.  V,  several  times  a day. 

The  diet  should  consist  of  soft  or  finely 
chvided  or  well-masticated,  easily  digestible, 
concentrated,  non-irritatingfood,leaving  little 
residue,  e.g.,  panopepton,  liquid  peptonoids, 
somatose,  Leube’s  beef  solution,  scraped 
beef,  meat  juices  and  jellies,  thick  meat 
soups,  boiled  tender  meats  (fish,  chicken, 
etc.),  eggs  boiled  three  minutes,  milk,  cream, 
custards,  junket,  toasted  bread,  rusks,  and 
the  less  coarse  vegetables  in  puree  form: 
potatoes,  rice,  grits,  arrowroot,  peas,  car- 
rots, asparagus  tips,  spinach,  ajiple  and 
orange  sauces.  Some  interdict  fats.  Cohn- 
heim  says  the  diet  “ should  be  as  rich  in 
fats  as  possible,”  and  records  remarkable 
success  with  his  lavage  and  oil  treatment. 
Liquids  should  be  restricted.  Avoid  tea, 
coffee,  cocoa,  alcohol,  beans,  whole  potatoes, 
green  and  coarse  vegetables,  raw  fruit, 
sweets,  salads,  sjhces,  condiments,  cheese, 
old  butter,  black  bread,  smoked  meats. 

Some  advise  four  or  five  small  meals  a 
day,  at  least  tlu-ee  hours  apart,  others 
(Hemmeter)  allow  but  two  meals,  at 
8 A.  M.  and  3 p.  m.  Rectal  feeding,  for  the 
purpose  of  resting  the  stomach,  may  be 
advantageous  in  some  cases. 

Attend  to  the  mouth  and  teeth.  The 
latter  should  be  cleansed  with  brush,  warm 
water,  and  castile  soap  at  least  once  a day, 
before  breakfast.  It  is  best  for  the  patient 
to  lie  down  for  at  least  an  hour  after  every 
meal. 

For  the  consideration  of  hyperacidity, 
hypersecretion,  and  sub-acidity,  see  the 
proper  caption.  Employ  saline  enemata 
(5i  ad  Oi)  for  the  relief  of  great  thirst. 

Cases  that  do  not  respond,  say  in  three 
or  four  weeks,  to  medical  treatment,  should 
be  submitted  to  operation,  viz.,  pyloro- 
j)lasty  (Finney’s  operation,  etc.),  gastro- 
enterostomy, pylorectomy,  gastroplication. 
The  occurrence  of  tetany  demands  opera- 
tive interference. 

A.  Bernheim  has  used  fibrolysin  (see  Part 
11)  with  success  in  the  treatment  of  be- 
nign stenosis. 


Treatment  of  Congenital  Hypertrophic  Stenosis 
of  the  Pylorus. — Allow  the  baby  to  nurse  for 
only  three  to  eight  minutes  at  three  to  four 
hourly  intervals  (some  feed  small  amounts 
eveiy  hour  or  two);  or  remove  the  milk 
with  a breast-pump  and  feed  no  more  than 
two  ounces  to  a child  of  one  month.  With 
bottle-fed  children  it  is  advised  that  the  fat 
be  reduced.  Twice  daily,  about  2 34  hours 
after  feeding,  wash  out  the  stomach  with 
warm  one  per  cent,  sodium  bicarbonate 
solution  (about  a teaspoonful  to  the  pint). 
The  lavage  may  have  to  be  continued  for 
several  months.  Wachenheim  considers 
lavage  irrational,  but  not  with  good  reason. 
Hot  applications  to  the  epigastrium  (also 
atropine,  q.v.,  and  alkalies)  may  aid  in 
relaxing  spasm.  See  that  the  mother  is  not 
eating  irritating  foods,  and  that  her  bowels, 
etc.,  are  functioning  properly. 

If  the  patient  grows  worse  under  several 
days  of  medical  treatment,  operate.  Per- 
form pylorodiosis  (chvulsion),  pyloroplasty, 
gastroenterostomy,  or  perhaps  best,  merely 
splitting  of  the  circular  muscle  fibres  of  the 
pylorus.  Following  the  operation  employ 
Murphy’s  drop  method  of  proctoclysis,  with 
the  patient  in  a semi-erect  posture.  After 
twenty-four  hours  the  patient  may  be  verj’’ 
cautiously  fed,  beginning  with  breast  milk, 
one  part,  and  water,  two  parts,  one  teaspoon- 
ful every  hour.  The  operative  mortality  is 
high,  unless  simple  measures  are  employed. 

Diphtheria. — Gr.  Siepdepa  membrane.  An 
acute  endemic  and  epidemic  contagious  local 
mucous  membrane  infection  with  general 
toxsemia,  caused  by  the  Klebs-Lotller  bacil- 
lus, and  characterized  by  an  incubation 
period  of  one  to  three  to  eight  days,  followed 
by  the  appearance  in  the  throat  of  a dirty- 
white  membrane  which  gradually  extends 
from  the  tonsils  to  the  u\ada  and  soft  and 
hard  palate,  and  sometimes  to  the  larjmx. 
The  disease  may  begin  in  the  larynx  with  a 
brassy  cough,  dyspnoea,  cyanosis,  and  rigid- 
ity of  the  sterno-cleido-mastoid  muscles;  or 
it  may  begin  in  the  nose.  The  eye,  middle 
ear,  vulva,  penis,  skin,  etc.,  may  become 
infected.  An  erj’thematous  rash  sometimes 
occurs.  The  fever  is  usually  low  as  com- 
pared with  simple  tonsillitis.  Bronchopneu- 
monia, ne{)hritis,  myocarditis,  and  cervical 
adenetis  are  common  complications.  Com- 
mon sequelae  are,  paralysis  of  the  palatal 
muscles,  manifested  by  nasal  voice,  regurgi- 
tation of  food  through  the  nose,  inability  to 
pronounce  “ wrong.”  or  to  blow  out  the 
cheeks,  and  immobility  of  the  palate  on  one 
or  both  sides  when  the  patient  says  “ Ah 
paralysis  of  the  muscles  of  the  eye,  both 


DIPHTHERIA 


intrinsic  (ciliary:  muscles  of  accommoda- 
tion) and  extrinsic;  paralysis  of  the  trapezii, 
causing  the  head  to  fall  forward;  and  paraly- 
sis of  the  extremities,  etc.  Recovery  from 
paralyses  always  occurs  within  a few  months. 

A positive  diagnosis  of  diphtheria  is  made 
by  the  demonstration  of  the  bacillus  diph- 
therise  in  cultures  obtained  from  the  affected 
parts,  the  Schick  reaction,  of  course,  being 
positive.  A portion  of  the  exudate  is 
removed  on  a sterile  swab  of  cotton  and 
spread  over  the  surface  of  Loffler’s  blood 
serum  and  incubated  at  37°  C.  for  no  longer 
than  six  to  eight  hours.  The  colonies  found 
are  then  stained  on  cover-glass  preparations 
in  Lbffler’s  alkaline  methylene  blue  solution 
for  one  to  five  minutes,  washed,  chied,  and 
examined  with  the  oil-unmersion  lens. 

If  "the  Schick  test  is  followed  by  no  local 
reaction,  the  incUvidual  has  not  got  diph- 
theria, even  though  chphtheria  bacilli  are 
present.  The  Schick  test  is  performed  as 
follows  (Webster):  Dilute  the  minimum 

fatal  dose  of  diphtheria  antitoxin  for  a 
guinea  pig  of  250  grams  weight  with  sterile 
physiological  salt  solution  (0.  9 per  cent.) 
so  that  each  c.c.  of  the  dilution  contains 
0.2  of  the  minimmn  fatal  dose.  Prepare 
fresh;  the  toxin  may  be  obtained  from  the 
health  officers  in  the  larger  cities  or  from 
the  larger  laboratories  handling  biological 
products,  e.g.,  the  H.  K.  Mulford  Co., 
Philadelphia;  keep  in  a cool  place  to  prevent 
deterioration.  Inject  0.1  c.c.  (f^o  of  the 
minimum  fatal  dose)  with  a 1 c.c.  record 
tuberculin  syringe  intracutaneously  into  the 
outer  side  of  the  upper  portion  of  the  arm. 
Make  a control  injection  into  the  other 
arm  of  0.  1 c.c.  of  bouillon  diluted  l.TO  or 
1:1000.  A positive  reaction  (indicating 
susceptibility  to  diphtheria)  is  manifested 
by  a gradually  increasing  redness  and  infil- 
tration at  the  site  of  the  white  wheal  origin- 
ally produced,  measuring  about  1 to  2.5  cm. 
within  twenty-four  to  forty-eight  hours, 
which  persists  for  several  days,  and  gradually 
fades,  leaving  a brownish  pigmentation  and 
shght  scaling.  If  the  reaction  is  negative,  the 
original  wheal  produced  usually  disappears 
within  an  hour.  If  a so-called  pseudo  reac- 
tion appears  in  both  arms,  differentiated  by 
its  earUer  appearance  and  disappearance,  less 
circmnscription,  and  absence  of  subsequent 
pigmentation,  it  is  merely  an  indication  of 
an  extreme  sensitiveness  of  the  skin.  A 
negative  reaction  indicates  the  presence  of 
diphtheria  antitoxin  in  the  blood,  and  con- 
sequently immunity  against  diphtheria;  a 
positive  reaction  indicates  the  reverse. 
Therefore,  protective  inmiunization  is  re- 


quh’ed  only  for  those  showing  a positive 
reaction.  If  there  is  a question  of  diagnosis 
between  orchnary  tonsilitis  and  diphtheria, 
a positive  reaction  would  point  to  the  latter, 
as  patients  with  true  diphtheria  have  little 
antitoxin  in  the  blood.  If  a patient  with 
tonsilitis  shows  chphtheria  bacilli  in  cultures 
from  the  throat,  and  a negative  reaction,  he 
is  merely  a diphtheria  carrier  and  not  an 
actual  cUphtheritic. 

Prognosis. — The  prognosis  should  always 
be  guarded. 

Treatment. — Isolate  the  patient  (see  Disin- 
fection), and  put  liirn  to  bed.  Prescribe,  in 
the  acute  stage,  a nutritious  liquid  diet: 
milk,  eggs,  broths,  meat  juice  well  salted, 
meat  jellies,  rice,  oatmeal  and  barley  gruels, 
buttered  toast,  ice-cream,  orange  juice,  and 
plenty  of  water.  Give  at  the  onset  calomel 
in  small  repeated  doses,  followed  by  a saline 
(see  Drugs,  Part  11.) 

Administer  antitoxin  at  once;  do  not 
delay  for  even  one  day,  for  the  later  it  is 
given,  the  less  potent  is  its  action.  Inject 
the  antitoxin  aseptically  (Kerley  recom- 
mends the  “ Record  ” antitoxin  syringe) 
into  the  cellular  subcutaneous  tissue,  best 
in  the  back  near  the  angle  of  the  scapula. 
First  cleanse  the  sldn  with  alcohol  or  tinc- 
ture of  iodine,  lift  it  with  thmnb  and  fore- 
finger, and  insert  the  needle  quickly.  Do  not 
rub  the  part.  Seal  the  puncture  with  a thin 
wisp  of  sterile  absorbent  cotton  saturated 
with  collodion.  It  may  best  be  adminis- 
tered intramuscularly  or  intravenously,  (q.v.) 

Inject  at  least  4000  to  5000  units,  or  to 
those  under  one  or  two  years  of  age,  1500  to 
2000  units.  If  the  membrane  is  very  exten- 
sive, or  there  is  laryngeal  stenosis,  inject 
8000  to  12,000  to  15,000  to  30,000  units. 
A single  large  dose  is  preferable  to  repeated 
smaller  doses.  Repeat  the  initial  dose  every 
four  to  six  hours  until  the  membrane  shrivels, 
the  nasal  discharge  and  fetor  duninish,  the 
fever  subsides,  and  the  general  condition  im- 
proves. The  worse  the  case,  the  bigger  the 
doses  of  antitoxin  required,  and  the  shorter 
the  intervals  of  its  administration;  in 
other  words,  give  enough  antitoxin  to  neu- 
tralize the  toxin.  (McCollom.)  Schick 
recommends  100  units  of  antitoxin  per  kilo- 
gram (2.2  pounds)  of  weight  in  ordinary 
cases,  and  500  units  per  kilogram  in  severe 
cases.  (For  anaphylactic  phenomena— 
“serum  reaction”^ — see  Anaphylactic  Shock.) 
If  there  is  reason  to  fear  hypersusceptibility 
to  horse  serum,  one  may  inject  0.1  c.c.  of 
the  serum  and  double  the  dose  hourly  until 
the  full  dose  is  given. 

Other  remedies  of  more  or  less  value  are 


DIPHTHERIA 


(I)  corrosive  Buhlimate,  given  cautiously  in 
very  small  doses,  and  continued  no  Uniger, 
says  Yeo,  than  three  or  four  days;  (2)  daily 
inunctions  of  unguentuin  hydrargyri,  gr.  xv- 
XXX,  or  unguentuni  Crede,  gr.  xv-xlv;  (3) 
tinctura  ferri  chloridi,  TTjjii  for  a child  of  one 
year,  in  a teaspoonful  of  syrup  and  water 
(best  flavored  with  orange  or  lemon)  every 
hour;  njv-x  for  a child  of  three  years;  rr^xii 
to  the  tables])oonful  for  children  over  ten 
years  and  for  adults;  and  (4)  fresh  garlic  juice 
(succus  alii  sativi),  5i  every  four  to  six  hours, 
or,  for  a child  under  twelve  years,  5ss,  best 
in  syrup;  a bulb  may  be  held  in  the  mouth 
and  occasionally  scored  with  the  teeth; 
the  fresh  juice  with  an  equal  amount  of 
water  used  as  an  antiseptic  nose  and  throat 
wash  (highly  praised  by  Minchin). 

If  practicable,  the  affected  parts  should 
be  very  gently  swabbed,  sprayed,  or  irri- 
gated every  three  hours  with  warm  mild 
antiseptic  preparations,  e.g.,  bichloride  solu- 
tion, 1:4000;  boric  acid  solution,  two  tea- 
spoonfuls  to  the  pint;  hydrogen  peroxide, 
3 per  cent.;  sodium  bicarbonate,  2)4 
spoonfuls  to  the  pint ; or,  ])erhaps  best, 
normal  saline  solution,  one  teaspoonful  of  salt 
to  the  pint.  In  giving  irrigations,  use  a foun- 
tain syringe,  and  place  the  child  on  its  side 
with  the  head  low. 


R MentholLs 10.0  gm. 

Toluol,  ad 36.0  c.c. 

Liquori.s  ferri  se.squichlorati 4.0  c.c. 

Alcoliolis  absoluti 60.0  c.c. 

M.  Sig. — Swab  the -throat  very  gently  every  two 
hours.  (Loffler’s  solution.) 

R Acidi  carbolici gr.  xiv 

Alcoholis,  30% oi 

M.  Sig. — Swab  the  throat,  very  gently  every 
two  hours. 

R Tinctune  ferri  chloridi oiss 

Glycerin! 5i 

Acidi  carbolici irgxv-xx 

Aqua} 5 i 

M.  Sig. — Swab  the  throat  very  gently  every 
two  hours. 


A formalin  lozenge  (gr.  )^)  may  be 
sucked.  The  teeth  and  mouth  should  be 
kept  clean. 

For  nasal  discharge,  swal)  the  nose  with 
absorbent  cotton  soaked  in  boric  acid  solu- 
tion, and  spray  or  irrigate  with  an  alkaline 
antiseptic  solution,  viz.. 


R Phenolis  cryst gr.  xxiv 

Sodii  boratis, 

Sodii  bicarbonatis,  aa oi* 

Glycerini 5ss 

Aqiue  destillata},  q.s.,  ad Oi 


M.  Sig. — Nasal  antiseptic  solution.  (Dobell.) 


or 

R Extract!  hamamelis. 

Aqua}  cinnamomi. 

Hydrogen!  peroxidi,  aa 

M.  Sig. — Na.sal  antiseptic  solution.  (Kyle.) 

Calomel  may  then  be  insufflated,  if 
desired;  or  liquid  albolene  instilled.  Inhala- 
tions of  medicated  steam  are  deemed  useful 
for  the  purpose  of  loosening  the  membrane, 
especially  in  laryngeal  diphtheria: 

R Olei  eucalypti, 

Alcoholis,  aa 

M.  Sig. — Add  20  or  30  drops  to  the  pint  of 
steaming  water. 


R Olei  eucalypti 5 i 

Acidi  carbolici  liquid! 5 i 

Olei  terebinthina} Sviii 


M.  Sig. — Add  one  ounce  to  the  pint  of  steaming 
water.  (McCollom.) 

Do  not  continue  the  steam  inhalations 
any  longer  than  about  thirty  minutes  at  a 
time,  because  of  their  debilitating  effect. 
Every  ten  minutes  the  inhalation  should 
be  interrupted  and  the  lungs  filled  with 
fresh  air.  St.  Clau’  Thompson  does  not 
advocate  steam  inhalations. 

For  very  septic  putrid  throats  Thompson 
recommends  the  following  acid  chlorate  of 
potash  solution,  which  contains  free  chlor- 
ine: To  nine  grains  of  powdered  chlorate 
of  potash  add  five  minims  of  pure  hydro- 
chloric acid;  then  add  gradually  one  ounce 
of  water  and  shake;  add  to  this  an  equal 
amount  of  hot  water.  Syringe  the  throat 
every  two  to  four  hours. 

Ice  may  be  sucked  and  ice-bags  applied 
to  the  neck. 

For  ophthalmia,  instil  atropine,  gr.  i-ii 
to  the  ounce,  t.i.d.,  and  irrigate  the  con- 
junctival sac  every  two  hours  with  a warm 
solution  of  boric  acid  2 to  4 per  cent.  Ever}' 
eight  hours  introduce,  by  means  of  a wooden 
toothpick,  ung.  hydrargjTi  iodidi  rubri,  gr. 
i ad  3i-  Protect  the  sound  eye  with  a 
watch  glass.  In  otitis  media  {q.v.  in  Ear 
Diseases,  Part  7),  perform  paracentesis  of 
the  drum  membrane  at  the  first  sign  of 
bulging.  IMastoiditis  rarely  occurs. 

Should  swallowing  become  difficult,  feed 
the  jiatient  through  the  stomach  tube  in 
order  to  avoid  aspiration  pneumonia. 

Myocarditis  is  a complication  greatly  to 
be  feared.  Should  the  pulse  become  feeble, 
or  embrocardia,  galloj^  rhj-thm,  or  arrj’tlinua 
occur,  keej)  the  jjatient  very  quiet,  using 
morphine  if  necessaiy,  employ  the  bed- 
pan,  and  do  not  allow  him  even  to  feed 
himself.  Some  advise  and  some  condemn 
the  administration  of  brandy  or  whiskey  in 


DIPHTHERIA 


liberal  doses  together  with  strychnine  (see 
Paid  11).  Kerley  gives,  under  three  years, 
tr.  strophanthi,  gtt.  i-ii,  with  codeine, 
gr.  Ms  to  Ho)  every  two  hours;  over 
three  years,  tr.  stroplianthi,  gtt.  iss-iii,  with 
codeine,  gr.  to.  H every  two  houi-s. 
Normal  saline  infusions  (0.  9 per  cent.)  may 
also  be  given  to  restore  tension;  but  the 
physician  must  use  chscretion  and  common 
sense  in  the  treatment  of  such  cases.  Rest 
is  the  most  unportant  remechal  agent. 

The  occm’rence  of  urgent  laiyngeal  dys- 
pnoea demands  the  performance  of  intuba- 
tion or  tracheotomy  the  former  to  be 
ordinarily  preferred. 

Intubation  is  performed  as  follows:  The 
child  may  either  be  held  upright  with  its 
legs  between  the  knees  of  the  nurse,  or  it 
may  be  placed  on  its  back  on  a table.  The 
head  is  steacUed  by  an  assistant  and  the 
arms  pinioned  to  the  sides  by  a sheet.  Having 
selected  a tube  of  O’Dwyer’s  Intubation  Set 
suitable  for  the  age  of  the  patient,  attach 
it  to  the  introductor.  Insert  the  gag  into 
the  left  angle  of  the  mouth  and  open  it 
widely.  Pass  the  left  index  finger  in  back 
of  the  epiglottis  and  draw  the  latter  for- 
ward, at  the  same  time  passing  the  tube, 
which  has  first  been  lubricated  with  glycerine 
or  mentholized  oil  (gr.  v ad  §i  of  licjuid 
albolene),  along  the  palmar  surface  of  the 
finger  as  a guide  into  the  larynx,  at  the  same 
time  giving  the  handle  of  the  introductor 
an  abrupt  turn  upward.  Then  push  the 
tube  home  with  the  finger  and  withdraw 
the  introductor.  Hold  the  tube  in  place 
with  the  finger  for  a few  seconds  until  sure 
that  it  is  in  the  larynx,  as  evidenced  by  the 
hissing  breathing  sounds,  severe  coughing, 
and  relief  of  dysi^noea,  then  cut  and  remove 
the  silk  thread.  Some  leave  the  thread  in 
and  strap  it  to  the  cheek.  In  introducing 
the  tube  be  quick  and  gentle  and  keep  in 
the  median  line.  Several  short  attempts 
are  better  than  one  prolonged  effort.  The 
physician  should  always  be  within  call  while 
the  tube  is  being  worn.  Sometimes  it  is 
necessary  to  feed  the  patient  through  the 
stomach  tube  following  intul^ation,  unless 
the  plan  of  Casselbury,  of  feeding  with  the 
patient  on  his  back  and  the  head  lowered  so 
as  to  bring  the  pharynx  lower  than  the 
larynx,  is  successful.  Atropine  (see  Part  11) 
is  recommended  when  mucus  accumulates  in 
the  intubation  tube,  but  it  should  not  be 
repeated  “until  the  effect  of  the  first  dose 
has  passed  away.”  If  the  presence  of  the 
tube  causes  a persistent  cough,  give  sodium 
bromide,  to  a child  of  four  years,  gr.  iv,  every 
half  hour  for  two  or  three  hours.  (Kerley.) 


The  intubation  tube  should  be  removed 
at  the  end  of  three  or  four  days,  and  not 
reinserted  unless  necessary. 

Extubation  is  more  tlifhcult  than  intuba- 
tion. It  is  accomphshed  by  a reverse  of  the 
movement  in  mtubation.  The  French  “enu- 
cleate ” the  tube  by  extending  the  head  with 
the  left  hand  and  placing  the  fingers  of  the 
right  hand  over  the  laiynx  beneath  the  tube, 
then  suddenly  pusliing  the  head  forward  and 
at  the  same  time  pressing  iq^ward  upon  the 
intubation  tube.  Food  should  not  be  given 
for  two  hom’s  before  performing  extubation 
to  avoid  vomiting  and  the  aspu’ation  of 
food  particles. 

In  rare  cases  the  tube  cannot  be  discarded, 
because  of  the  occurrence  of  dangerous 
dyspnoea  on  its  removal.  In  such  instances 
tubes  of  progressively  increasing  calibre 
should  be  insertetl  eveiy  few  weeks;  but, 
says  Holt,  “ not  until  long  after  all  acute 
symptoms  have  subsided.”  Holt  says, 
“ True  cicatricial  stenosis  may  best  be 
relieved  by  opening  the  trachea  and  dilating 
from  below,  and  afterward  inserting  an 
intubation  tube.” 

If  intubation  is  hnpracticable  or  unsuc- 
cessful, tracheotomy  is  required.  Indeed, 
tracheotomy  instruments  should  be  on  hand 
while  attempting  intubation.  They  are: 
a scalpel,  probe-pointed  bistoury  for  enlarg- 
ing the  tracheal  wound,  small-toothed  dis- 
secting forceps,  haemostatic  forceps,  retract- 
ors, a sharp  hook,  horsehair  or  silkworm-gut 
sutures,  tape.  Trousseau’s  dilator  with 
three  blades,  and  the  tracheotomy  tube. 

Tracheotomy  is  performed  as  follows: 
Under  very  light  general  or  local  anaesthesia, 
or,  in  urgent  cases,  under  no  anaesthesia  at 
all,  and  with  the  neck  over-extended,  the 
chin  exactly  in  the  midline  of  the  body,  and 
the  left  thumb  and  third  finger  grasping 
and  .steadying  the  larynx,  make  an  incision 
about  two  inches  long  exactly  in  the  mid- 
line, from  the  crico-thyroid  membrane  to 
below  the  level  of  the  thyroid  isthmus,  cut- 
ting through  skin,  platysma,  superficial 
fascia,  intermuscular  line,  and  deep  fascia. 
Expose  the  trachea  by  retracting  the  tis- 
sues, and  secure  aU  bleeding  vessels.  Raise 
and  steady  the  trachea  by  means  of  a sharp 
hook  inserted  in  the  midline  under  tlie  cri- 
coid cartilage  or  between  the  first  and  second 
tracheal  rings.  Then  incise  two  or  three 
rings  from  below  upwards.  Seize  the  right 
edge  of  the  wounfl  with  small-toothed  dis- 
secting forceps,  introduce  Trousseau’s  dila- 
tor, open  the  blades,  and  insert  the  cannula. 
Reduce  the  size  of  the  skin  wound  by  horse- 
hair or  silkworm-gut  sutures,  and  fasten  the 


DISINFECTION 


cannula  to  the  neck  with  tapes.  Dress  the 
wound  under  the  collar  of  the  tube  with 
sterile  gauze  and  place  moist  gauze  over  the 
tube.  Remove  and  cleanse  the  inner  tube 
every  two  or  three  hours.  The  tracheotomy 
t ube  should  be  removed  at  the  end  of  three 
or  four  days,  and  not  reinserted  unless  neces- 
saiy.  J.  Biernacki  says  the  patient  must  be 
fed  nasally  with  peptonized  milk  (see  Part 
11)  for  at  least  two  weeks. 

During  convalescence  from  diphtheria, 
watch  the  heart  carefully  and  keep  the 
patient  quiet  for  several  weeks.  For  post- 
chphtheritic  paralysis,  confine  the  patient  to 
bed  on  a nutritious  diet,  and  administer 
strychnine,  iron,  and  codliver  oil  and  also 
antitoxin,  3000  units  daily,  less  for  young 
cliilch-en.  Employ  also  massage  and  farachsm. 
Gavage  may  be  recjuired  in  paralysis  of  the 
pharynx.  The  paralysis  tends  to  disappear 
spontaneously  in  four  to  eight  weeks. 

Attendants  upon  diphtheria  patients  may 
protect  themselves  by  tying  a chloroform 
mask  over  the  nose  and  mouth  wliile  treat- 
ing the  patients.  The  immunizing  dose  of 
antitoxin  is  500  units  for  infants  and  1500  to 
2000  units  for  children  over  two  years. 
Kerley  says  at  least  1000  units  regardless  of 
the  age  of  the  child.  Immunity  lasts  about 
three  weeks.  Adults  need  not  be  immunized, 
and  children  only  when  there  is  overcrowd- 
ing, as  in  institutions. 

The  patient  should  not  be  released  from 
quarantine  until  two  or  four  bacterial  exam- 
inations of  the  fauces,  made  on  consecutive 
or  alternate  days  have  proved  negative. 
The  cultures  are  not  to  be  begun  until 
“ seven  days  after  the  disappearance  of  the 
membrane  and  the  cessation  of  the  discharge 
from  the  nose”  (McC'ollom).  Bacilli  may, 
however,  be  harbored  indefinitely  in  the 
depths  of  the  tonsils.  The  latter  should,  of 
course,  be  removed  in  such  cases. 

Diplegia. — Gr.  81s  twice  -|-  irXrjyr,  stroke. 
Diplegia  denotes  the  paralysis  of  both 
arm  and  leg;  paraplegia,  paralysis  of  the 
legs  alone.  (See  Spastic  Paralysis,  and 
Brain  and  Cord  Localization.) 

Diplopia. — Gr.  8ur\6os  double  + 6\pis  vis- 
ion. See  IMotor  Nerves  of  the  Eyeball, 
and  also  Eye  Diseases,  Part  6. 

Dipsomania.— Gr.  8i\pa  thirst  -b  (xavLa 
madness.  Uncontrollable  desire  for  alcohol. 
(See  Alcoholism.) 

Disinfection. — L.  dis-  apart  -f-  infi'cere,  to 
corrupt.  Patients  suffering  with  commun- 
icable infectious  diseases  should  be  isolated. 
The  sickroom  should  be  screened  against 
flies.  It  may  be  screened  from  the  rest  of 
the  house  by  means  of  a sheet,  wet  with 


carbolic  solution  1:20.  No  dry  sweeping 
should  be  permitted.  The  broom  should  be 
covered  with  a cloth  w^et  with  carbolic 
solution,  1:20.  A mackintosh  should  be 
placed  under  the  sheet  and  piUows  to  protect 
the  mattress. 

Stools  and  vomitus  may  be  disinfected  by 
breaking  them  up  in  carbolic  acid  solution, 
1 : 20,  thrice  the  volume  of  the  stool,  or  lysol, 
5 per  cent.,  twice  the  volume  of  the  .stool, 
and  allowing  it  to  stand  at  least  two  hours 
before  emptying.  Urine  may  be  disinfected 
by  emptying  it  in  a vessel  containing  200 
c.c.  of  bichloride  solution,  1 : 1000,  or  thi-ee 
litres  of  carbolic  solution  1 : 20,  or  5 per  cent, 
lysol,  1.5  litres.  Three  litres  of  urine  are 
thereby  sterilized  in  two  hours.  Empty  the 
vessel  each  day.  Keep  the  urinal  and  bed- 
pan  in  a similar  solution.  In  typhoid  fever 
these  mea.sures  should  be  continued  for  at 
least  three  weeks  after  the  bacilli  have  disap- 
peared from  the  urine. 

Soak  infected  bed  linen  in  bichloride  solu- 
tion 1:1000,  or  lysol,  3 per  cent.,  for  tw’o 
horn’s,  before  senchng  it  out  to  be  boded  (for 
one-half  hour) . 

Disinfect  dishes  by  boiling,  sputum  by 
burning;  bath  water  by  the  addition  of 
chloride  of  lime,  one-half  pound  to  the  50- 
gallon  bath,  allowed  to  stand  one  hour. 

After  each  stool  and  urination,  cleanse 
the  parts  with  bichloride  solution  1 : 1000 
and  tlust  with  powder.  Wipe  away  nasal 
and  buccal  discharges  with  a piece  of  cloth 
wliich  should  be  burned. 

The  mouth  (tongue,  cheeks,  teeth  and 
gums)  may  be  swabbed  evei’j’  four  hours  with 
a mixture  of  glycerine,  oiv,  boric  acid,  5i, 
carbolic  acid,  tijxx,  and  water  to  5iv;  or  with 
glycerine  and  peppermint  w’ater,  of  each  5 i, 
with  the  juice  of  a lemon  added.  Use  for 
cleansing  purposes  a cotton  stick  or  cotton 
or  gauze  sponge  held  bj"  haemostatic  forceps. 
Anoint  ch-y  lips  with  vaseline  or  cocoa  butter. 

The  nurse  should  wear  a rubber  apron, 
which  should  be  washed  frequently  with 
bichloride  solution  1:1000;  and  she  should 
cleanse  her  liands  in  this  solution,  or  in  5 per 
cent.  lysol,  after  handling  the  patient.  Keep 
the  thermometer  in  70  per  cent,  alcohol. 

The  doctor  should  don  a gown  before 
entering  the  sickroom. 

If  the  skin  desquamates,  as  in  scarlet 
fever,  anoint  it  lightly  with  a bland  oil, 
such  as  sweet  oil,  cold  cream,  lanolin  soft- 
ened with  oil  and  i-)erfumed,  or  cocoa  butter, 
to  prevent  the  dissemination  of  infec- 
tious scales. 

Attendants  upon  diphtheria  patients  may 
protect  themselves  by  tying  a chloroforir 


DISTOMIASIS  OR  DISTOMATOSIS 


mask  over  the  mouth  and  nose  while  treat- 
ing the  patient. 

. Before  releasing  the  patient  from  quaran- 
tine, he  should  be  bathed  and  shampooed 
and  dressed  in  clean  clothes. 

Dead  bodies  should  be  wrapped  in  cloths 
soaked  with  cresol  water. 

At  the  termination  of  quarantine,  seal  all 
windows  and  door  cracks  by  means  of 
strips  of  newspaper  pasted  on  with  flour  and 
water,  spread  or  suspcntl  clothing  about  so 
as  to  expose  all  sm-faces  to  the  disinfecting 
fumes  (formaldehyde  gas  is  but  a surface 
disinfectant),  then  j)lace  on  the  floor,  in 
the  centre  of  the  room,  a wide  bowl,  such 
as  a large  wash  bowl,  and  within  this  a 
second  smaller  bowl  containing  commercial 
potassium  permanganate,  6 3^  ounces  for 
500  cubic  feet  of  air  space.  Pour  over  the 
permanganate  commercial  formalin  (40  per 
cent.)  one  pint  for  500  cubic  feet  of  air 
space.  Then  leave  the  room  at  once  and 
seal  the  door  and  keyhole. 

After  from  twelve  to  twenty-four  hours, 
open  wide  all  windows,  and  when  the  room 
can  be  entered,  wash  the  walls  with  damp 
bread  and  other  parts  with  bichloride  1 ; 1000, 
or  washing  soda,  1 pound  to  3 gallons  of  hot 
water,  or  carbolic  solution,  1 : 20.  It  is  best 
to  repaint  and  repaper  the  sickroom. 

S.  G.  Dixon  recommends  the  following  for 
fumigating  purposes: 


Sodium  dichromate 10  oz. 

Formaldehyde  saturated  solution.  1 pt. 
Sulphuric  acid,  commercial 1)4  A-  oz. 


Mix  the  formalin  and  sulphuric  acid,  and 
after  cooling  add  to  the  bichromate  in  a 
vessel  of  ten  times  the  capacity  of  the 
volimie  of  ingredients  used. 

If  it  is  desirable  to  destroy  insects,  sul- 
phur should  be  burned  in  each  room,  3 to  5 
pounds  to  each  1000  cubic  feet  of  air  space 
(all  surfaces  and  articles  should  be  wet,  if 
disinfection  is  aimed  at).  To  destroy  mos- 
quitoes, use  2 pounds  per  1000  cubic  feet; 
or  pyrethrum,  at  least  one  quarter  pound 
per  1000  cubic  feet. 

Dislocations. — See  Ortbopaedics,  Part  10. 

Disseminated  Sclerosis. — See  Multiple 
Sclerosis. 

Distomiasis  or  Distomatosis;  Trematode 
or  Fluke  (Flat=worm)  Infections. — Gr.  5ls 

two  4-  aro'fxa  mouth;  TprjuaTOjSrjs  pierced. 

I.  Pulmonary  Distomiasis. — A mild  chronic 
Oriental  disease  of  the  lungs  simulating 
phthisis,  caused  by  the  Distoma  Wester- 
manii,  rarely  by  the  giant  liver  fluke,  and 
characterized  by  a chronic  cough,  occasional 
haemoptysis,  and  the  presence  of  the  oval 


ova  in  the  sputum.  The  brain  (with  result- 
ing epilepsy),  liver,  eyelid,  etc.,  may  become 
secondarily  infected. 

Treatment. — Remove  the  patient  to  an 
uninfected  district,  with  the  hope  that  the 
worm  may  die  and  be  coughed  up  or  assimi- 
lated. The  sputum  should  be  destroyed. 
Preventive  measures  are  the  destruction  of 
infected  cats,  dogs,  and  swine,  and  the  boil- 
ing, cooking  and  thorough  cleansing  of  the 
drinking  water  and  foods,  especially  crabs. 
The  embryo  lives  in  fresh  water,  and  the 
encysted  cercariae  in  molluscs  and  crabs. 

II.  Hepatic  Distomiasis. — A chronic  disease  of 
the  liver  occurring  in  the  Orient,  in  Prussia 
and  Siberia,  and  occasionally  in  other  coun- 
tries, caused  by  at  least  two  species  of 
fluke-worm,  and  characterized  by  an  en- 
larged tender  liver,  an  intermittent  diar- 
rhoea, with  the  presence  of  the  oval  eggs  in 
the  faeces,  and,  after  several  years,  hepatic 
cirrhosis  with  ascites  and  anasarca.  The 
worms  live  in  the  portal  and  mesenteric 
veins,  or  in  the  bile  ducts  and  gall-bladder. 
They  sometimes  invade  the  spleen  and 
intestine.  The  disease  is  eventually  fatal. 

Treatment. — Remove  the  patient  to  an 
uninfected  district,  and  prescribe  male  fern 
(see  Part  11).  Destroy  the  stools  by  heat  or 
drying.  The  fluke  usually  dies  and  is  dis- 
charged within  a year.  Preventive  measures 
are  the  thorough  cleansing,  boiling  or  cook- 
ing of  the  drinking  water  and  food,  and  the 
wearing  of  leggings  to  guard  against  possible 
infection  through  the  skin  from  manure, 
particularly  sheep’s  dung.  The  ova  develop 
in  the  bodies  of  small  molluscs,  usually 
gasteropods,  into  a swimming  form  which 
lives  in  fresh  water.  The  fi.sh  is  an  inter- 
mediate host. 

III.  Intestinal  Distomiasis. — This  affection 
occurs  in  Asia  and  Africa,  and  is  character- 
ized by  a chronic  diarrhoea,  with  perhaps 
blood  in  the  stools,  and  the  presence  in  the 
stools  of  the  oval  eggs. 

Treatment. — The  same  as  described 
above.  Try  thymol  (see  Ankylostomiasis), 
calomel,  eucalyptus,  or  male  fern  (see  Part  11). 

IV.  Hsemic  or  Venal  Distomiasis;  Blood-Fluke 
Disease;  Bilharziasis. — A common  chronic  dis- 
ease, chiefly  of  tropical  and  subtropical 
countries,  caused  by  the  distomum  or 
schistosomum  (Gr.  o-xto-ro's  cleft  + awpa 
body)  hsemotobium,  which,  starting  from 
the  portal  vein  and  its  radicles,  migrates  to 
the  veins  of  the  bladder  and  rectum,  where 
the  female,  cariying  the  male  (see  Fig.  34), 
deposits  her  eggs  in  the  tissues.  The  eggs 
eventually  appear  in  the  urine  and  faeces. 

In  vesical  bilharziasis  there  occur  haema- 


DIVEimCULUM  OF  THE  (ESOPHAGUS 


tiiria,  irremediable  chronic  cystitis,  and  {)er- 
haps  urinary  fistula?  and  vaginal  tumors; 
commonly  renal  and  vesical  calculi. 

In  rectal  bilharziasis  there  occur  a bloody 
discharge,  straining  and  tenesmus,  ]?ro- 
lapse  and  perhaps  papilliform  growths  and 
a chronic  ulcerative  proctitis. 


Fig.  34. — Distonium  hsematobium:  female  carrying  male 

(Emerson). 

There  is  an  intestinal  hiemic  distomiasis 
occurring  in  China,  Japan,  and  the  Philijv 
pines  (Katayama  disease),  due  to  a different 
fluke-worm,  the  schi.sto.soma  japonicum  vel 
eattoi,  and  characterized  by  hepatic  cirrhosis, 
splenomegaly,  ascites,  dysentery,  and 
progressive  ana?mia,  sometimes  focalized 
epilepsy. 

Treatment. — The  treatment  is  s>u:ipto- 
matic.  Have  the  patient  drink  freely  of 
boiled  water,  and  avoid  ingesta  that  irritate 
the  urinary  tract,  e.g.,  alcohol,  spices,  condi- 
ments, salted  and  preseiA'ed  foods,  red 
meats,  cheese,  radishes,  asparagus,  tea, 
coffee,  lemons,  and  tobacco;  as  enjoined 
under  Cystitis  (Part  3)  and  Pyelitis.  Iho- 
tropin  (see  Part  11)  may  be  of  service.  Cal- 
culi may  require  removal.  Local  treatment 
of  the  bladder  is  not  recommended.  In  re- 
tention of  urine  due  to  the  filling  of  the 
bladder  with  blood-clots,  do  a perineal  sec- 
tion, break  up  the  clots  with  the  finger,  arid 


wash  them  out.  If  the  bleeding  continues, 
wash  the  bladder  with  hot  creolin  solution, 
1 : lO(X)  to  500,  or  hot  silver  nitrate  solution, 
1 ; 1000  to  500.  A double  tube  may  be  kept 
in  for  about  ten  days  (see  Part  3).  Excise 
urethral  fistula?  freely,  scrape  perineal  fistula? 
with  a sharp  sjxion  and  pack  with  gauze  so 
as  to  keep  the  wound  open  to  granulate. 

Rectal  or  vaginal  tmnors  should  be 
removed.  Copper  sulphate  solution,  1:000, 
and  iodoform  or  ichthyol  suppositories  are 
of  service  in  rectal  cases.  For  the  relief  of 
tenesmus  and  frequent  mucous  passages, 
inject  about  two  ounces  of  a thin  solution 
of  starch  containing  ten  to  twenty  drops  of 
laudanum.  The  stools  should  be  de.stroyed 
by  heat  or  thying. 

It  is  saitl  that  spontaneous  cure  often 
occurs. 

Preventive  measures  embrace  the  boiling 
of  the  drinking  water,  thorough  cleansing  of 
foods,  and  the  avoidance  of  infection  through 
the  skin,  contracted  by  bathing  in  in- 
fected water. 

Diver’s  Paralysis.— See  Caisson  Disease. 

Diverticula  of  the  (Esophagus.— See  (Eso- 
phageal Diverticula. 

Diverticulitis. — L.  diverticula' re,  to  turn 
aside.  Diverticula  of  the  intestine  are 
either  congenital  or  acquired.  Acquired 
diverticula  occirr  in  almost  any  part  of  the 
intestinal  tract,  and  are  due  to  constipation, 
ulceration  (see  Intestinal  Ulcers),  coproliths, 
foreign  bodies,  torsion,  trauma.  Sigmoid 
diverticulitis  is  commonest.  It  is  probably 
the  result  of  chronic  constipation.  The  acute 
form  of  the  affection  simulates  left-sided 
appendicitis,  adnexal  disease  in  the  female, 
and  intestinal  obstruction;  the  chronic  form 
simulates  cancer  (X-ray  shows  filling  defect 
in  cancer),  chronic  sigmoiditis,  tuberculous 
peritonitis,  and  actinomycosis. 

Possible  complications  and  sequela?  are 
abscess,  gangrene,  perforation,  peritonitis, 
intestinal  obstruction,  vesico-colic  fistula, 
metastatic  abscesses,  cicatricial  stenosis  of 
the  bowel,  and  cancer. 

Treatment.— The  treatment  of  acute  diver- 
ticulitis is  (a)  in  early  mild  cases,  the  use  of 
laxatives  and  enemas;  (b)  in  intractable  cases, 
resection  of  the  diseased  portion  of  the  bowel 
or  extrai>eritoneal  drainage,  or  intra-abdomi- 
nal gauze  packing  for  forty-eight  to  seventy- 
two  hours,  or  until  firm  adhesions  have 
formed  al)out  the  gauze,  then  removal  of  the 
gauze,  incision  of  the  abscess,  and  drainage. 

Chronic  diverticulitis  calls  for  resection 
or  short-circuiting. 

Diverticulum  of  the  (Esophagus. — See 
(Esophageal  Diverticula. 


DYSENTERY,  AMCEBIC 


Dizziness. — See  Vertigo. 

Dorsodynia.  L.  do'rsum,  back+Gr.  66w'r? 
pain.  See  Myalgia. 

Double  Vision. — See  Motor  Nerves  of 
the  Eyeball,  and  also  Eye  Diseases,  under 
Part  6. 

Dracontiasis. — See  Skin  Diseases,  Part  5. 

Dropsy. — L.  hyd'rops,  from  Gr.  v5wp 
water.  See  (Edema,. 

Drowning. — See  Asphyxia. 

Dry  Mouth. — See  Aptyalism. 

Dum-Dum  Fever — See  Kala-Azar. 

Duodenal  Ulcer. — See  Gastric  and  Duo- 
denal Ulcer. 

Duodenitis. — See  Gastric  and  Duodenal 
Ulcer,  and  Jaundice,  Catarrhal. 

Dysarthria.- — ^Gr.  6vs-  difficult  + apdpov 
joint.  See  under  Aphasia. 

Dysentery. — L.  dysenter'ia,  from  Gr.  dvs 
— ill  + evTepov  intestine.  The  term  dysentery 
signifies  a colitis  or  entero-colitis  associated 
with  abdominal  pain,  perhaps  tenesmus,  and 
frequent  scanty  stools  consisting  largely  of 
mucus  and  blood.  The  presence  of  tenes- 
mus indicates  involvement  of  the  sigmoid 
or  rectum. 

Four  varieties  of  dysentery  may  be  con- 
veniently cUstinguished,  namely: 

1.  Colitis  or  enterocolitis  caused  by 
improper  food,  great  heat,  chilling,  metallic 
poisons,  mushrooms,  m-semia,  plant  poison- 
ing, etc.  See  Enteritis. 

2.  Bacillary  dysentery,  caused  by  various 
types  of  the  bacillus  dysenteria),  and  possi- 
bly the  bacillus  pyocyaneus,  paratyphoid 
bacillus,  and  other  bacteria.  See  Dysen- 
tery, Bacillary. 

3.  Protozoal  Dysentery,  caused  by  the 
amoeba  hystolitica  (see  Dysentery,  Amoebic, 
and  balantidium  coli,  Kalazoa  of  India,  and 
the  malarial  protozoon  (pernicious  malaria). 

4.  Colitis  and  enterocolitis  caused  by 
worms,  e.g.,  flukes,  nematodes,  etc.  See 
Worms. 

Other  causes  of  tenesmus  with  bloody, 
mucous  stools  are  rectal  polypi,  hemorrhoids, 
neoplasms,  uterine  retroflexion,  retro-uterine 
phlegmon,  cystitis. 

Dysentery,  Amoebic. — Gr.  apoL^y  change. 
An  acute  or  chronic  ulcerative  oedematous 
colitis,  occurring  endemically  in  tropical  and 
subtropical  countries,  and  sporadically  in 
temperate  countries,  and  caused  by  the 
amoeba  or  entamoeba,  dysenterijE  (amoeba 
histolytica),  which  enters  the  body  in  the 
cystic  state  in  drinking  water,  and  uncooked 
vegetables  and  fruits.  Active  amoebae  are 
destroyed  by  the  acid  gastric  juice;  the  cysts 
are  not. 

The  characteristic  symptoms  are  abdom- 


inal pain,  diarrhoea,  which  is  usually  inter- 
mittent, mucus  and  sometimes  blood  in  the 
stools,  loss  of  weight  and  strength,  and 
anaemia.  The  symj)toms  may  be  acute  or 
chronic.  In  mild  cases  there  may  be  only 
lassitude,  dyspepsia,  abdominal  discomfort, 
perhaps  constipation,  or  perhaps  an  occa- 
sional diarrhoea. 

Abscess  of  the  liver  is  prone  to  occur,  and 
it  may  j)erforate  into  neighboring  parts, 
such  as  the  lung,  in  which  event  there  is 
coughed  up  a sputum  resembling  anchovy 
sauce  and  containing  amoebae  and  liver  cells. 

The  disease  is  diagnosed  by  tlie  tliscovery 
of  motile  amoebae  in  the  stools.  The  latter 
should  be  passed  into  a warm  vessel  follow- 
ing the  administration  of  magnesium  sul- 
phate. They  should  be  examined  while  still 
warm,  on  a warm  slide,  with  a high  power 
dry  lens.  Select  a bit  of  blood-stained  mucus 
for  examination,  mixing  it  with  a drop  of 
water.  A small  drop  of  aqueous  methylene 
blue  solution,  1 per  cent.,  a])plied  to  the  edge 
of  the  cover-glass,  colors  all  elements  except- 
ing the  amoebae  until  the  latter  are  killed. 
Motile  amoebae  are  found  only  during  a 
diarrhoeal  crisis,  but  cysts  may  be  found  at 
any  time.  The  amoeba  dysenteriae  is  actively 
motile,  its  nucleus  is  not  visible  when  the 
amoeba  is  active,  endoplasm  and  ectoplasm 
are  well  marked,  and  red  blood-cells  are 
enclosed.  The  nonpathogenic  amoeba  coli  is 
sluggish,  the  nucleus  is  visible,  endoplasm 
and  ectoplasm  are  poorly  differentiated,  and 
there  are  no  enclosed  red  corpuscles.  Cysts 
of  the  dysenteric  amoeba  are  10  to  14 
microns  in  diameter  at  the  most,  and  contain 
1 to  4 nuclei,  no  more.  Cysts  of  the  non- 
pathogenic amoeba  are  IG  to  25  microns  and 
contain  1 to  8 nuclei. 

Prognosis. — Many  cases  are  cured,  especially 
in  children,  some  even  recovering  spontan- 
eously; but  when  untreated  the  disease  is 
usually  very  serious.  In  rare  cases  a chronic 
colitis  remains  after  the  amoeb®  have 
been  eradicated. 

Treatment. — Put  the  patient  to  bed  on  a 
very  restricted  diet  consisting  of  milk 
diluted  with  lime  water,  diluted  buttermilk, 
whey,  albumen  water,  broths,  and  rice,  bar- 
ley, or  oatmeal  water.  Peptonize  (see  Part  11) 
or  boil  the  milk  if  curds  appear  in  the  stools. 
The  food  should  bo  neither  hot  nor  cold,  so 
as  not  to  excite  peristalsis.  Soft  foods — 
gruels,  potato  puree,  eggs,  custards,  minced 
fish  or  chicken,  etc.,  may  be  added  as  the 
intestinal  symptoms  subside.  Solid  food 
should  be  withheld  until  the  patient  is  well. 
Keep  the  abdomen  warm  by  means  of  a 
flannel  binder.  Disinfect  the  stools  by 


DYSENTERY,  AMCEBIC 


breaking  them  up  in  a solution  of  carbolic 
acid,  1 : 20,  thrice  the  volume  of  the  stool, 
and  allow  this  mixture  to  stand  at  least  two 
hours  before  emptying. 

Purge  the  patient  at  the  start  with  castor 
oil,  calomel  or  magnesium  sulphate,  1 oz. 
(see  Part  11).  Then  give  each  night  at  bed- 
time, at  least  three  hours,  better  six,  after 
eating  or  drinking,  at  first  GO  to  90  grains  of 
ipecac  (the  powdered  Brazilian  root  is  best, 
being  richest  in  emetine),  in  pill  form,  thickly 
coated  with  salol,  or  in  keratin  capsules,  to 
avoid  dissolution  in  the  stomach.  To  pre- 
vent vomiting  the  patient  must  lie  motion- 
less; laudanum  is  perhaps  necessary,  nyx-xv, 
thirty  minutes  before  the  ipecac.  The  dose 
is  reduced  by  5 grains  each  night  until  a dose 
of  10  grains  is  reached.  The  latter  may  be 
continued  for  two  weeks,  or  the  first  course 
may  be  repeated  after  the  expiration  of  a 
week,  if  amoebae  are  still  present  in  the 
stools.  (Rogers.) 

Emetine  hydrochloride  is  to  be  preferred 
to  ipecac.  It  may  be  administered  by  mouth 
in  keratin-coated  capsules,  with  a bowl  of 
milk  or  gruel,  on  an  empty  stomach;  or  it 
may  be  administered  hypodermically.  Give 
gr.  iss-ii  on  alternate  days  for  five  doses, 
followed  by  three  or  four  weeks  rest,  and  a 
repetition  of  the  course,  if  necessary.  R. 
Lyons  advises  at  least  three  courses.  The 
dose  for  children  of  two  years  is  gr.  every 
twelve  hours  for  3 doses;  under  one  year, 
gr.  for  2 or  3 doses.  (IMartin.) 

Emetine  hydrochloride  acts  upon  amoebae 
in  the  tissues,  but  not  within  the  lumen  of  the 
bowel,  so  that,  while  administering  the 
hydrochloride  hypodermically,  emetine  bis- 
muth iodide  should  be  given  by  mouth,  gr. 
iii,  in  salol-coated  pills,  or,  perhaps  better, 
in  powder  in  cachets,  nightly  for  twelve 
nights.  (Vincent  and  Muratet.) 

The  combined  administration  of  emetine 
and  salvarsan  is  recommended. 

Owing  to  the  long  incubation  period, 
averaging  sixty-four  days,  a permanent  cure 
is  not  certain  until  this  period  has  elapsed 
without  recurrence. 

In  suspected  hepatitis  (enlargement  anti 
tenderness  of  the  liver,  intermittent  fever, 
leucocytosis),  administer  ipecac,  gr.  xxx, 
daily,  or  emetine,  gr.  ss-i  daily,  the  latter 
hypodermically,  and  continue  the  drug  for 
perhaps  two  weeks  after  the  temperature 
has  returned  to  normal  (Rogers). 

If,  however,  the  liver  abscess  does  not 
promjitly  subside,  it  shoidtl  be  oj^ened  and 
drained,  and  the  cavity  irrigated  frequently 
with  quinine  solution,  1 : 1000. 

Should  the  lung  become  perforated,  and 


the  liver  abscess  discharge  freely  through 
this  channel,  one  may  try  postural  drainage 
by  having  the  patient  hang  head  downward 
over  a table,  five  or  six  times  a day,  and 
cough  and  compress  the  chest.  If  such  treats 
ment  is  ineffectual,  rib  resection  is  required. 

For  abdominal  pain,  apply  hot  turpentine 
stupes  (flannel  wrung  out  of  steaming  hot 
water  containing  a teaspoonful  of  turpentine 
to  the  quart,  and  covered  with  dry  flannel; 
these  alternating  with  plain  hot  stupes); 
give  morphine,  or  opium  if  the  pain  is  severe. 

For  vomiting,  see  Vomiting. 

For  hemorrhage,  employ  morphine  and 
the  abdominal  ice-bag,  and  raise  the  foot  of 
the  bed;  allow  nothing  by  mouth  excepting 
ice  to  suck,  for  eight  to  twenty-four  hours. 

For  tenesmus,  inject  into  the  rectum  one 
or  two  ounces  of  thin  starch  solution  con- 
taining 10  to  20  drops  of  laudanum,  followed, 
if  desired,  by  the  application  of  silver 
nitrate  solution  to  the  rectal  ulcers  through 
a speculum  (see  under  Enteritis,  Chronic 
for  technique). 

In  the  chronic  stage  of  the  disease  (con- 
traindicated during  acute  symptoms),  em- 
ploy large  colonic  injections  (two  litres)  of 
quinine  sulphate  or  neutral  quinine  hydro- 
chloride solution,  1 : 5000,  increased  grad- 
ually, in  the  course  of  a few  days,  to  1 : 500 
(for  children,  1 : 10,000).  Give  the  injec- 
tions once  or  twice  daily  through  a three 
to  four  foot  colon  tube  smeared  with  vase- 
line. Have  the  hips  and  the  foot  of  the 
bed  elevated,  and  allow  the  fluid  to  enter 
slowly.  The  patient  should  try  to  retain 
the  solution  for  fifteen  to  twenty  minutes 
at  the  same  time  rolling  his  abdomen  about 
so  as  to  bring  the  fluid  into  all  parts  of 
the  colon.  The  injections  cause  pain,  and 
sometimes  vomiting.  An  occasional  injec- 
tion of  silver  nitrate,  1 : 2000,  increased  to 
1 : 500,  washed  out  with  saline  solution,  may 
be  of  benefit;  also  argyrol,  1 : 1000,  and  cop- 
per sulphate,  1 : 10,000;  and  Labarraque’s 
solution,  1 : 100  (see  Part  11).  If  the  rectum 
is  very  irritable,  it  may  be  necessary  to 
insert  a cocaine  (gr.  i),  or  morphine  (gr. 
suppository  one-half  hour  before  introducing 
the  colon  tube. 

An  occasional  dose  of  castor  oil  or  salts 
should  be  given;  indeed,  it  is  stated  that  the 
daily  administration  of  magnesium  sulphate, 
oi,  is  an  effectual  mode  of  treatment. 

Irrigation  of  the  large  bowel  through  a 
crecal  or  appendicular  fistula  is  a valuable 
mode  of  treatment. 

Too  prolonged  local  treatment  (continued 
for  several  months)  should  be  avoided,  for  it 
may  produce  a permanent  catarrhal  colitis. 


DYSENTERY,  BACILLARY 


Bolus  alba  or  kaolin  (see  Cholera  Asiatica 
and  Part  11)  has  recently  come  to  the  front  as 
a promising  remedy  for  diarrhoeal  affections. 

For  antemia  employ  iron;  for  anorexia  and 
debility,  tincture  of  nux  vomica  before  meals 
(see  Anorexia). 

Prophylaxis  embraces  the  boiling  of  the 
drinking  water  and  milk,  the  cooking  or 
thorough  cleansing  of  foods,  personal  clean- 
liness, the  avoidance  of  dust,  and  screening 
against  flies.  To  disinfect  carriers,  give 
emetine  bismuth  iodide,  gr.  iii,  in  powder 
form  in  cachets  (not  in  pill  or  tablet  form), 
with  a hot  drink,  at  9 p.  M.,  after  retiring, 
daily,  until  at  least  36  grs.  have  been  given. 
(Jepps  and  Meakins.) 

Dysentery,  Bacillary. — An  acute,  or  some- 
times chronic  ulcerative  colitis,  extending 
at  times  to  the  lower  ileum,  occurring  endem- 
ically,  epidemically,  and  sporadically,  caused 
by  various  strains  of  the  bacillus  dysenteriae, 
and  possibly  the  bacillus  pyocyaneus, 
paratyphoid  bacillus,  and  other  bacteria,  and 
characterized  by  an  incubation  period  of 
about  two  days  (two  to  seven  days) , followed 
by  a colicky  diarrhoea  and  fever,  al:)dominal 
pain  and  tenderness,  nausea,  vomiting,  fre- 
quent small  mucous  and  bloody  stools,  tenes- 
mus, anorexia,  and  weakness.  In  the  United 
States  the  disease  is  usually  caused  by  the 
mannite-fermenting  or  Flexner  type  of 
organism;  whereas  in  Japan  the  Shiga  type 
predominates.  Other  strains  or  types  are 
those  of  His,  Strong,  etc. 

In  marked  cases  (not  in  brief,  mild  cases), 
the  serum  of  the  patient  agglutinates  the 
dysentery  bacillus  causing  the  infection  (and 
no  other  bacillus)  at  about  the  eighth  to 
tenth  day  of  the  disease. 

The  disease  is  transmitted  by  fomites, 
contaminated  water  and  milk,  dust  and  flies, 
and  is  favored  by  overcrowding,  as  in  institu- 
tions and  camps.  Summer  diarrhoea  in 
infants  is  commonly  caused  by  the  bacillus 
dysenteriae  (see  Diarrhoea  in  Bottle-fed 
Infants  and  in  Early  Childhood). 

Prognosis.— Under  appropriate  treatment 
the  disease  is  usually  cured  in  about  a 
month.  The  prognosis  becomes  more  seri- 
ous the  higher  in  the  bowel  the  disease 
extends,  being  very  serious  in  enteric  ca-ses. 

Treatment.— Acute  Dysentery:  Put  the 
patient  to  bed  and  keep  him  warmly 
covered;  place  hot  water  bottles  to  the  feet, 
and  protect  tile  abdomen  with  a flannel 
binder.  Apply  frequently  renewed  hot 
poultices  or  turpentine  stupes  (a  teaspoon- 
ful to  the  quart)  to  the  abdomen. 

The  diet  should  be  liquid,  and  admin- 
istered in  small  quantities  every  three  or 
9 


four  hours:  broths,  albumen  water,  rice  or 
barley  water,  strained  cereal  gruels,  Mellin’s, 
or  Liebig’s,  or  Benger’s  food,  water  as 
required  for  thirst.  It  is  advised  that  milk 
be  deferred  until  the  tongue  clears,  when  it 
may  be  given  boiled,  and  diluted  with  lime 
water  or  barley  or  arrowroot  water.  The 
ingesta  should  be  “ neither  hot  nor  cold,” 
so  as  not  to  excite  peristalsis.  All  food  and 
water  should  be  withheld  in  the  presence 
of  vomiting. 

At  the  outset  the  bowels  should  be  thor- 
oughly evacuated,  best,  says  Osier,  by 
means  of  (1)  sodium  sulphate  or  Rochelle 
salt,  oii  of  either  for  two  doses  an  hour 
apart,  then  pi  every  three  hours  until  the 
bowels  have  been  thoroughly  moved.  Yeo 
and  W.  J.  Buchanan  give  (2)  sodium  sul- 
phate or  magnesium  sulphate,  5i  in  5ss 
of  water,  every  hour  until  the  stools  become 
yellow  and  free  from  mucus  and  blood 
(usually  two  or  three  days).  Dickie  gives 
(3)  5^s  of  saturated  magnesium  sulphate 
and  TrjJX  of  dilute  sulphuric  acid  in  water 
every  two  hours  until  the  stools  are  free 
from  mucus  and  blood;  the  acid  being  given 
to  destroy  the  bacilli.  Other  methods  of 
purgation  recommended  are  (4)  calomel, 
gr.  viii-xii,  once  or  twice,  followed  after  two 
hours  by  a dose  of  castor  oil  (Shiga);  (5) 
castor  oil  3iv-vi,  once,  or  in  divided  doses; 
(6)  castor  oil,  5ss,  followed  the  next  morn- 
ing by  calomel,  gr.  ss,  every  hour  for  twelve 
hours,  this  course  to  be  repeated  twice  or 
thrice,  at  the  same  time  watching  for  saliva- 
tion. The  stools  should  be  mixed  with  boil- 
ing water;  or  with  sawdust  and  burned. 

After  the  bowels  have  been  thoroughly 
purged,  prescribe  bismuth  in  large  doses  and 
opium  for  the  diarrhoea  that  remains : 

R Bismuth!  subnitratis  ....  5iv  (3ss-iperdose) 

Mucilaginis  acacise 5 ii 

Aquae,  q.s.,  ad giv 

M.  Sig. — Shake  well,  and  take  one  to  two  table- 
spoonfuls every  one  to  four  hours. 

Dover’s  powder  or  morphine,  hypodermi- 
cally, may  be  given  as  required  (for  drug 
formulte,  etc.,  see  Part  11). 

For  tenesmus  give  a rectal  enema  of  thin 
starch  solution,  5i~iij  containing  15  to  20 
drops  of  laudanum,  followed,  if  desired,  by 
the  application  of  silver  nitrate  solution  to 
rectal  ulcers  through  a speculum  (see 
under  Enteritis,  for  technique). 

For  hemorrhage,  employ  morphine  and. 
the  abdominal  ice-bag;  raise  the  foot  of  the 
bed,  and  allow  nothing  by  mouth,  except 
ice  to  suck,  for  eight  to  twenty-four  hours. 

Bolus  alba,  or  kaolin  (see  Part  11;  and 


DYSPEPSIA  OR  GASTRIC  INDIGESTION 


Cholera  Asiatica)  has  recently  come  to 
the  front  as  a promising  remedy  for  diar- 
rhceal  affections. 

Serum  therapy  is  employed;  the  sooner, 
the  better  the  results.  C.  F.  Martin  says 
that  the  polyvalent  serum  (actively  im- 
munized horse  serum:  antibacterial)  should 
be  administered  in  as  large  doses  and  as 
frequently  as  necessary  to  produce  results, 
beginning  with  “ 40  to  60  c.c.  hypodermi- 
cally in  mild  cases,  80  c.c.  in  severe  cases, 
and  100  to  120  c.c.  in  desperate  cases, 
repeated  as  required.”  He  says  the  patient’s 
general  condition  should  improve  in  four  to 
twelve  hours,  while  the  character  of  the 
stools  may  even  become  apparently  worse. 

Vincent  and  Muratet  advise,  for  adults, 
in  cases  of  average  severity,  20  c.c.,  repeated 
in  twenty-four  hours,  if  necessary,  and  again, 
if  necessary;  in  serious  cases,  40  to  60  c.c., 
repeated  daily,  if  neces.sary;  in  bad  cases,  as 
much  as  50  c.c.  twice  daily;  for  children, 
34  to  % to  the  adult  dose,  according  to 
age.  The  serum  should  be  continued  in 
diminishing  doses  until  the  stools  are  reduced 
to  several  a day. 

Osier  says  the  Pasteur  Institute  and  Lister 
Institute  serums  “ should  be  given  in  doses 
of  20  c.c.  two  or  three  times  a day,”  (for 
about  two  or  three  consecutive  days). 

The  serum  employed  against  the  Shiga 
type  of  dysentery  (antitoxic  and  anti- 
bacterial) is  given  as  follows,  according  to 
Thomas  and  Ivy — in  mild  cases,  one  sub- 
cutaneous injection  of  10  c.c.;  in  severe 
cases,  two  injections  of  10  c.c.,  at  an  interval 
of  6 to  10  hours;  never  more  than  20  c.c.  in 
one  day  (see  also  Serum  Antidysenter- 
icurn,  in  Part  11;  and  Anaph}dactic  Shock). 

As  the  patient  convalesces,  the  diet  may 
be  gradually  increased,  but  no  solid  food 
should  be  given  for  a number  of  days  after 
the  stools  have  become  normal. 

B.  Chronic  Dysentery. — Rest  in  bed, 
fresh  air  day  and  night,  and  a simple  diet 
consisting  of  boiled  milk,  diluted  if  necessary 
with  lime  water  or  barley  water,  eggs,  beef 
juice,  and  well-cooked  strained  gruels,  are 
important.  A change  of  climate  is  bene- 
ficial. An  occasional  purge  of  castor  oil, 
5ss-i  should  be  given.  Hillier  gives  castor 
oil,  3i~5ii,  with  tr.  opii,  njiv-x,  t.i.d.  Ort- 
ner  favors  repeated  doses  of  castor  oil 
together  with  tannin  irrigations.  Olive  oil 
is  also  used.  Bismuth  subnitrate,  3ss-i 
every  three  hours  during  the  day;  tannalbin, 
in  ten -grain  doses,  gr.  xxx-1  per  day;  and 
tannigen  in  the  same  dosage  is  also 
recommended. 

Once  or  twice  every  day  the  colon  should 


be  irrigated,  very  gently  and  slowly,  the 
hips  being  elevated  (or  the  knee-chest 
posture  assumed),  with  about  two  quarts  of 
a warm  solution  of  silver  nitrate,  1 : 5000, 
increased  to  1 : 500,  the  silver  being  subse- 
quently washed  out  and  precipitated  by 
means  of  salt  solution;  or  instead  of  |the 
silver,  tannin,  0.5  per  cent. ; or  alum,  0.5  to  1 
per  cent. ; or  salicylic  acid,  1 per  cent. ; or  cre- 
olin,  0.5  to  1 per  cent.;  or  boric  acid  solution, 
two  teaspoonfuls  to  the  quart;  or  normal 
saline  solution,  3i  ad  Oi.  The  colon  tube 
should  be  well  smeared  with  vaseline.  If  the 
rectum  is  irritable  it  may  be  necessary  to 
insert  a cocaine  (gr.  i)  or  morphine  supposi- 
tory one-half  hour  before  introducing  the 
colon  tube.  The  solution  should  be  retained 
for  twenty  minutes,  if  possible. 

The  rectum  and  sigmoid  should  be  exam- 
ined and  treated  through  specula  (see 
under  Enteritis,  for  technique). 

Irrigation  of  the  colon  through  a csecal  or 
appendiceal  fistula  is  a valuable  mode  of 
treatment  in  protracted  cases. 

It  should  be  remembered,  however,  that 
prolonged  local  treatment,  continued  for 
several  months,  may  in  itself  produce  a 
permanent  catarrhal  colitis.  See  also  the 
Treatment  of  Chronic  Intestinal  Catarrh, 
for  fuller  details. 

Dyspepsia  or  Gastric  Indigestion. — Gr. 

8vs  ill  -|-  TrewTeiv  to  concoct;  L.  in,  neg. 
digestio,  from  dis,  apart  ger'cre,  to  carry. 
When  a patient  presents  himself  with  the 
symptoms  of  gastric  indigestion,  e.g.,  gas- 
tric discomfort,  sense  of  fulness  or  pressure 
after  eating,  flatulent  distention  of  the 
stomach,  eructations,  heartburn,  gastralgia, 
nausea,  vomiting,  anorexia  or  capricious 
appetite,  perhaps  a coated  tongue  and  fetid 
breath,  perhaps  constipation,  perhaps  head- 
aches, dizziness,  palpitations,  lassitude,  men- 
tal depression,  insomnia,  etc.,  the  physician 
should  first  endeavor  to  ascertain  whether 
the  disturbance  is  functional  or  organic, 
while  bearing  in  mind  the  fact  that  the  large 
majority  of  cases  are  functional. 

The  Causes  of  these  two  kinds  of  dyspepsia 
may  be  conveniently  classified  as  follows : 

I.  Function.vl  Dyspepsia. — a.  Irritating 
Ingesta. — Fried  foods,  sweets,  tarts,  pastry, 
hot  breads,  pancakes,  sandwiches,  nuts, 
pickles,  spices,  condiments,  tea,  coffee, 
alcohol,  too  much  fat,  too  much  carbohj"- 
drate,  coarse  vegetables,  etc.,  tobacco,  drugs 
(mercury,  lead,  copaiba,  cubebs,  sandal- 
wood, male  fern,  purgatives,  etc.),  infectious 
material  from  the  nose,  pharjmx,  teeth, 
gums,  and  mouth;  food  that  is  too  hot  or 
too  cold,  imperfectly  masticated  food,  the 


DIGESTANTS  PLAi\TS 


Ground  Ivy 


Roman  camomile 


Fever-few 
Outside  of  flower 


Fever -few  4ft 
Center 
of  flower 


Balm-mintl 

Flower  x 


Fever -few  ^ 
Section  of  flower 


I Flower i 


f Anise 

Enlarged  seed 


Small  centaury 


Coriander 


Coriander 
I Seed 


f Coriander 
Enlarged  flower 


Anise 

^ Enlarged  flower 


Small  centaury 
Fh  wer  enlarged 


Small 

centaury' 

Seed 


Amser^d/ 


Aniseed  < 

Fruii.called  anise-star* 


Peppermint  (st) 


Fennel  g 
Enlarged  flower 


Fennel 
¥ Seed 


U Peppermint 
’Enlarged  flower 


Vervai n 
Enlarged  flower 


K.D£:SS^»5TC/^/r/e 


LAROUSSE  MEDICAL 


Plants  that  are  digestants  and  stimulants 


GASTRIC  ANALYSIS  AND  TECHNIQUE 


result  of  hasty  eating  or  bad  teeth,  excessive 
amounts  of  food,  too  frequent  eating,  the 
too  frequent  use  of  bitters  and  appetizers. 

b.  Unhygienic  and  Debilitating  Influences. 
— Lack  of  sufficient  rest  before  and  after 
eating,  bathing  immediately  after  eating, 
irregular  hours  of  eating,  self-starvation, 
poor  general  health  and  debility  due  to  lack 
of  fresh  air  and  adequate  exercise,  overwork 
and  worry,  loss  of  sleep,  excessive  venery, 
anaemia,  tuberculosis,  gout,  diabetes,  rickets, 
Addison’s  disease,  plumbism,  malaria,  syphi- 
lis, infectious  diseases,  arteriosclerosis  (aorti- 
tis and  para-aortitis  abdominis — Stockton), 
chronic  cardiac,  hepatic,  pulmonary,  or 
renal  disease,  etc. 

c.  Nervous  Influences. — (1)  Central  ner- 
vous influences,  occurring  in  overwork  and 
worry,  anxiety,  loss  of  sleep,  excess!  v^e 
venery,  the  abuse  of  alcohol,  morphine, 
cocaine,  tea,  coffee,  and  tobacco,  plumbism, 
neurasthenia,  hysteria,  insanity,  excitement, 
depression,  locomotor  ataxia  (gastric  crises), 
general  paresis,  myelitis,  brain  abscess, 
brain  tumor,  meningitis,  etc. 

(2)  Reflex  influences,  due  to  enteroptosis, 
movable  kidney,  uterine  displacement,  ne- 
phrolithiasis, cholelithiasis,  cholecystitis,  ap- 
p>endicitis,  peritonitis,  herniae,  pancreatic 
disease,  utero-ovarian  disease,  constipation, 
angina  pectoris,  nasal,  pharyngeal,  larjm- 
geal,  and  aural  disease,  eye-strain,  male 
genital  disease,  pregnancy,  perigastric  ad- 
hesions (following  gastric  or  duodenal  ulcer, 
gall-bladder  disease,  pancreatic  disease, 
syphilitic  hepatitis,  chronic  peritonitis, 
chronic  tuberculosis),  intestinal  parasites 
and  other  intestinal  diseases,  intestinal 
obstruction,  etc. 

II.  Organic  Dyspepsia. — Dilatation  of 
the  stomach,  chronic ; gastric ; and  duo- 
denal ulcer;  gastritis,  acute  and  chronic; 
cirrrhosis  or  sclerosis  of  the  stomach;  cancer 
of  the  stomach. 

Consider  first  the  organic  derangements: 
Dilatation  of  the  stomach  due  to  pyloric 
obstruction  is  characterized,  in  frank  cases, 
by  the  copious  periodic  vomiting  of  sour- 
smelling food  retained  beyond  the  usual  time 
(six  or  seven  hours)  followed  by  relief  of 
symptoms,  together  with  more  or  less  thirst, 
dryness  of  the  skin,  oliguria  and  constipa- 
tion, and  demonstrable  enlargement  of  the 
stomach  (see  Dilatation  of  the  Stomach, 
Chronic).  Gastric  and  duodenal  ulcer  is 
characterized  by  pain  after  eating,  relieved 
by  food  or  alkalies,  the  pain  being  localized, 
and  often  radiating  to  the  back,  epigastric 
tenderness  commonly  localized,  sometimes 
tenderness  to  the  left  of  the  spine  opposite 


the  ninth  and  tenth  dorsal  vertebrae,  hsema- 
temesis  or  occult  bleeding  detected  by  exam- 
ination of  the  faeces  (see  Gastric  and  Duo- 
denal Ulcer). 

Acute  gastritis  is  characterized  by  the 
sudden  onset  of  acute  symptoms:  pain, 

nausea,  vomiting,  salivation,  pyrosis,  thirst, 
coated  tongue,  and  foul  breath.  Chronic 
gastritis  is  characterized  by  chronic  gastric 
indigestion,  coated  tongue,  fetid  breath, 
perhaps  vomiting  of  mucus  containing  many 
leucocytes,  etc.  (see  Gastritis,  Acute  and 
Gastritis,  Chronic) . 

Cancer  of  the  stomach  is  suggested  by  the 
age  of  the  patient  (usually  beyond  forty 
years),  anorexia  and  the  progressive  loss  of 
weight  and  strength,  the  presence  of  lactic 
acid  after  Boas  test  meal,  and  of  the  Boas- 
Oppler  bacillus  and  blood  in  the  stomach 
contents,  and  usually  persistent  diminution 
of  the  hydrochloric  acid  (see  Cancer  of  the 
Stomach).  Hydrochloric  acid  may  also  be 
absent  in  chronic  gastritis,  in  atrophy  of  the 
gastric  mucosa,  and  in  nervous  dyspepsia). 

Cirrhosis  or  Sclerosis  of  the  Stomach  {q.v.) 
is  very  rare. 

Gastric  Analysis  and  Technique. — Use  of 
the  Stomach  Tube. — First  boil  the  tube,  and 
place  it  in  a basin  of  hot  water  or  ice  water. 
Have  the  patient  sit  with  the  head  slightly 
forward  and  the  chin  raised,  and  instruct 
him  to  take  full  deep  breaths  during  the 
passage  of  the  tube.  Refrain,  if  possible, 
from  putting  the  fingers  in  the  patient’s 
mouth.  If  the  reflexes  are  excessively 
active,  the  pharynx  may  be  carefully 
swabbed  with  a 4 to  10  per  cent,  solution  of 
cocaine.  The  passage  of  the  tube  may  be 
facilitated  by  having  the  patient  swallow  a 
mouthful  of  water  at  the  moment  of  intro- 
ducing the  tube.  Keep  the  latter  in  the 
median  line. 

In  washing  out  the  stomach,  use  each 
time  ordinarily  about  a pint  of  fluid,  and 
hold  the  funnel  a little  bit  above  the  patient’s 
mouth.  To  empty  the  stomach,  lower  and 
invert  the  funnel  before  all  the  fluid  has 
left  it,  so  as  to  insure  a return  siphonage. 
While  withdrawing  the  tube,  compress  it 
with  the  fingers. 

Contraindications  to  the  use  of  the  tube 
are:  aneurysm,  advanced  heart  disease, 

marked  emphysema,  advanced  pulmonary 
disease,  advanced  arteriosclerosis,  advanced 
cirrhosis  of  the  liver  with  suspected  ceso- 
phageal  varices,  recent  ulcer,  recent  hemor- 
rhage, recent  corrosion,  acute  oesophagitis, 
acute  febrile  diseases. 

Examination  of  the  Stomach  Contents. — The 
old  method  of  procedure  is  as  follows: 


GASTRIC  ANALYSIS  AND  TECHNIQUE 


Give  to  the  patient  in  the  morning,  fasting, 
about  two  ounces  of  stale  wheat  bread, 
which  should  be  well  masticated,  and  eight 
to  ten  to  twelve  ounces  of  water  (Ewald  test 
breakfast).  An  hour  later,  withdraw  the 
stomach  contents,  either  by  aspiration  into 
a rubber  bulb  (Boas  bulb  or  a Politzer  bag) 
attached  to  the  outer  end  of  the  tube,  or, 
better,  by  expression  through  the  stomach 
tube,  accomplished  by  the  patient  taking  a 
deep  inspiration  and  then  compressing  his 
abdominal  walls  as  in  the  act  of  defecation. 
As  suggested  by  Aaron,  if  a bulb  is  at- 
tached to  the  end  of  the  stomach  tube,  and 
the  bulb  is  kept  compressed  in  the  left  hand 
during  the  introduction  of  the  tube,  at  the 
instant  the  patient  begins  to  retch,  the  tube 
not  yet  having  entered  the  stomach,  the 
latter’s  contents  can  be  aspirated  by  allowing 
the  bulb  to  expand  and  then  immediately 
■withdrawing  the  tube.  The  normal  amount 
withdrawn  is  about  20  to  30  to  50  c.c. 

The  Ewald  test-meal  removed  in  one  hour 
is,  however,  not  reliable,  because  the  curve 
of  acid  secretion  is  quite  variable,  even  in 
normal  individuals,  and  does  not  uniformly 
reach  its  crest  an  hour  after  the  meal.  There- 
fore Rehfuss’s  fractional  method  of  analysis, 
using  Rehfuss’s  tube,  is  jDreferable.  The 
bulb  attached  to  the  capillary  tube  is  swal- 
lowed at  the  time  of  taking  the  test-meal, 
and  portions  of  the  stomach  contents  are 
aspirated  every  fifteen  to  twenty  minutes 
until  the  stomach  is  empty.  The  protruding 
end  of  the  tube  is  closed  by  a stop-cock.  To 
secure  a sample  of  contents  for  analysis, 
the  stop-cock  is  opened,  a 5 to  10  c.c.Luer 
syringe  is  inserted,  and  1 to  3 c.c.  of  fluid 
withdrawn.  The  bibe  may  be  kept  in  the 
stomach  (or  duodenmn)  for  a period  of 
weeks,  if  desired. 

To  pass  the  Einhorn  duodenal  tube,  the 
patient,  after  swallowing  the  metal  capsule, 
is  made  to  lie  on  the  right  side  with  the  hips 
elevated  about  ten  inches.  The  capsule 
passes  into  the  duodenum  in  fifteen  to  sixty 
minutes.  Siphonage  is  started  by  the  injec- 
tion of  a few  c.c.  of  warm  water.  Gastric 
contents  siphon  out  first.  Pure  duodenal 
fluid  is  clear  Idle,  viscid  and  alkaline,  and  the 
foam  is  golden.  Should  the  flow  of  bile 
become  interrupted,  inject  a little  warm 
water  into  the  tube,  and  have  the  patient 
take  deep  breaths. 

The  reddening'  of  litmus  paper  indicates 
acidity.  The  turning  blue  (weak  blue-black 
— ^ hypochlorhydria;  sky-blue  -»•  normal 
acidity  or  hyperchlorhydria)  of  Congo 
paper  indicates  the  presence  of  free'  acids 
(always  free  hydrochloric  acid  with  the 


above  test  breakfast).  Tropeolm  paper 
turns  brown  in  the  presence  of  free  HCl, 
and  on  drying  at  a gentle  heat  the  color 
changes  to  violet.  Another  test  for  free 
HCl  is  made  by  thoroughly  mixing  one  drop 
of  the  stomach  contents  with  one  drop  of 
Giinzberg’s  solution  (phloroglucin,  gr.  xxx, 
vanillin,  gr.  xv,  alcohol,  5 i)  ^ white  por- 
celain dish,  and  heating:  the 
appearance  of  a cherry-red 
color  indicates  the  presence 
of  free  HCl.  According  to 
Einhorn,  if  the  gastric  con- 
tents still  give  the  reaction 
for  free  HCl  when  diluted  8 
to  10  times,  the  acidity  is 
probably  normal;  if  the  reac- 
tion is  still  obtained  on  chlut- 
ing  the  gastric  contents  over 
12  times,  the  acidity  is  above 
normal;  and  if  a cUlution  of 
5 times  or  less  fails  to  give 
the  reaction,  the  acidity  is 
subnormal. 

To  test  for  lactic  acid,  give 
the  Boas  test  meal,  consist- 
ing of  a tablespoonful  of 
oatmeal  flour  boiled  in  a litre 
or  quart  of  water  down  to 
the  consistency  of  a thin 
gruel,  or  to  500  c.c.  (one  pint). 

This  meal  contains  no  lactic 
acid,  which  is  present  in  bread 
in  small  amounts. 

Using  the  separating  fun- 
nel shown  in  Figure  35,  pour 
in  the  filtered  stomach-con- 
tents to  the  5 c.c.  mark,  then 
add  ether  to  the  25  c.c.  mark. 

Shake  thoroughly  for 
three  minutes,  and  then 
allow  the  ether  to  sep- 
arate. Now  run  out  the 
contents  of  the  tube 
until  the  5 c.c.  mark  is 
reached ; add  distilled 
water  to  the  25  c.c. 
mark,  then  two  drops 
of  a 10  per  cent,  solu- 
tion of  ferric  chloride, 
and  shake  gently,  ihe  ^cid.  (Strauss's.) 
appearance  of  an  in- 
tense yellow-green  color  indicates  the  pres- 
ence of  0.1  per  cent,  lactic,  acid  ; a slight 
green  color,  0.  05  per  cent.  (Strauss’  Test.) 

Ufflelmann’s  less  accurate  test  is  as.  fol- 
lows; To  8 to  10  c.c.  of  water  containing  one 
drop  of  ferric  chloride  solution,  10  per  cenk. 
add  the  gastric  filtrate  drop  b'y  drop.  ■ The 


Fiq.  35.- 


-Separating 
apparatus  suitable  for 
making  test  for  lactic 


GASTRIC  ANALYSIS  AND  TECHNIQUE 


appearance  of  a yellowish-green  color  indi- 
cates the  presence  of  lactic  acid. 

The  presence  of  lactic  acid  means 
anacidity  associated  with  stagnation.  An- 
acidity  without  stagnation  precludes  the 
presence  of  lactic  acid. 

If  the  stomach  still  contains  food  in  the 
morning,  twelve  hours  after  a substantial 
supper  of  porridge  containing  rice  and 
raisins  and  one  or  two  slices  of  buttered 
bread,  taken  at  8 p.  m.,  there  exists  pyloric 
obstruction.  Examine  the  abdomen  by 
sight  and  touch  for  the  presence  of  tumor 
and  of  peristaltic  waves,  and  for  points  of 
tenderness.  Examine  the  gastric  contents 
microscopically,  and  by  means  of  the  benzidin 
test,  for  blood,  for  pus  cells,  the  long  Boas- 
Oppler  bacillus,  sarcinae,  and  yeast  cells. 

■ A bismuth  X-ray  examination  gives  im- 
portant information.  Two  to  four  ounces 
of  bismuth  sulphate  suspended  in  muci- 
lage of  acacia  or  in  milk  are  given  on  an 
empty  stomach,  say  at  5 a.  m.,  and  six 
hours  later  the  patient  is  radiographed  in 
the  upright  position.  The  stomach  should 
then,  normally,  be  empty.  If  bismuth  is 
still  present,  it  indicates  pyloric  obstruction. 
A second  bismuth  meal  is  now  given  and 
frequent  radiographs  taken  with  the  tube 
focussed  upon  the  third  lumbar  vertebra, 
taking  care  to  exert  no  pressure  upon  the 
stomach.  (R.  C.  Cabot.)  If  it  is  desired  to 
study  the  passage  of  the  bismuth  through 
the  intestines,  examinations  may  be  made 
at  six  and  twelve  hour  intervals  for  two  or 
three  days. 

E.  Price  employs  the  following  technique: 
The  day  before  the  examination  is  nrade, 
the  bowels  are  thoroughly  emptied.  At 
9 A.  M.,  before  breakfast,  a meal  is  given 
consisting  of  oz.  of  bismuth  oxychlo- 
ride or  Merck’s  barium  sulphate,  2)/^  oz. 
of  bread  crumbs,  about  6 oz.  of  hot  milk, 
and  a little  sugar.  The  patient  then  un- 
dresses. With  the  patient  in  an  upright 
position,  an  opaque  disc  is  placed  on  the 
umbilicus,  and  a screen  examination  made, 
with  the  tube  centred  over  the  anatomic 
position  of  the  pylorus.  A plate  is  now 
exposed,  the  patient  remaining  in  the 
upright  position.  A second  e.xamination  is 
made  at  1 o’clock,  no  food  or  drink  being 
taken  in  the  interval.  After  this  examina- 
tion the  patient  is  allowed  to  eat  as  usual. 
Examinations  are  made  at  intervals  of  three 
and  one-half,  eight,  twelve,  and  twenty-four 
hours  after  the  first  one,  occasionally  thirty- 
six  and  forty-eight  hours  or  even  longer. 
“ From  the  .skiagrams  thus  obtained  the 
examiner  is  able  to  determine  the  following 


important  points:  (1)  the  position  of  the 
various  organs;  (2)  the  shapes;  (3)  the  rate 
of  progress  of  the  contents  through  the  ali- 
mentary canal;  (4)  the  condition  of  the 
muscular  walls.”  Barium  sulphate  may  be 
used  instead  of  bismuth  (see  Part  11).  “ It 

may  safely  be  assumed  that  in  cases  in 
which  the  bismuth  meal  is  not  completely 
voided  within  forty-eight  hours,  a patho- 
logical stasis  is  present.”  (Watson.) 

Quantitative  Analysis  of  the  Gastric  Juice. — 
Equipment:  Beakers;  medicine  droppers  or 
pipettes;  water  bath;  bath  thermometer; 
separating  funnel  graduated  up  to  25  c.c.; 
cylinder  graduated  up  to  100  c.c.;  burette 
of  50  c.c.  capacity;  phenolphthalein,  alco- 
holic .solution,  1 pt'r  cent. ; dimethylamidoazo- 
benzol,  alcoholic  solution,  0.5  per  cent. ; 
alizarin  (sodium  alizarin  sulphonate)  aqueous 
solution,  1 per  cent.;  ether;  ferric  chloride, 
10  per  cent,  solution;  calcium  chloride, 
aqueous  solution,  1 per  cent.;  distilled  water; 
decinormal  sodium  hydrate  solution.  Nor- 
mal sodium  hydrate  solution  = Na  (23)  -|-  O 
(16)  -|-  H (1),  or  40  (molecular  weight)  gins, 
of  sodium  hydrate  to  one  litre  of  thstilled 
water.  Decinormal  sodium  hydrate  solu- 
tion = 10  c.c.  of  normal  sodium  hydrate 
solution  -|-  90  c.c.  of  distilled  water,  1 c.c. 
of  which  contains  0.004  gm.  NaOH,  which 
exactly  neutralizes  1 c.c.  of  decinormal  HCl 
solution,  or  0.00365  gm.  HCl. 

Topfer  Method  of  Analysis. — 1.  Fill  the  bur- 
ette up  to  50  c.c.  with  the  decmormal  sod- 
ium hydrate  solution.  Place  in  a beaker 
5 c.c.  of  the  filtered  (unfiltered,  says  Webster, 
filtering  causing  the  absorption  of  free  HCl) 
stomach  contents,  obtained  one  hour  after 
the  Ewald  test-breakfast,  and  add  two  or 
three  drops  of  the  phenolphthalein  solution. 
Now  add  the  decinormal  sodium  hydrate 
solution  drop  by  drop  (avoiding  shaking, 
which  would  introduce  acid  CO2  from  the 
air),  until  a permanent  red  color  is  produced. 
Then  read  off,  at  the  lowest  point  of  the 
concavity  of  the  fluid,  the  number  of  c.c.  of 
decinormal  solution  used.  If  x c.c.  were 
used,  then  20x  c.c.  of  decinormal  solution 
would  be  required  to  neutralize  100  c.c.  of 
gastric  juice;  or, 

Total  acidity  (free  HCl  4-  combined  HCl  -f  acid 
phosphates  + organic  acids,  or  lactic,  acetic,  buty- 
ric, carbonic  acids,  etc.)  = 20x. 

40  - 6.5  = normal  acidity  (varies  with  the  indi- 
vidual and  the  diet). 

Below  40  = subacidity. 

5 - 8 = atrophy  of  the  gastric  glands. 

Above  65  = hyperacidity.  (Paul  Cohnheim.) 

2.  Place  5 more  c.c.  of  the  filtered  (un- 
filtered, says  Webster)  stomach  contents  in 


DYSPEPSIA,  NERVOUS 


another  beaker;  add  2 or  3 drops  of  the 
diinethylamidoazobenzol  solution;  and  add 
decinormal  sodium  hydrate  solution,  drop 
by  drop,  until  the  solution  in  the  beaker  is 
permanently  yellow.  If  y c.c.  were  used, 
then  20  y c.c.  of  decinormal  solution  would 
be  required  to  neutralize  the  free  HCl  of 
100  c.c.  of  the  gastric  juice;  or. 

Free  HCl  = 2Qy. 

3.  Repeat  the  same  procedure,  using 
another  5 c.c.  of  filtered  stomach  contents 
and  2 or  3 drops  of  the  ahzarm  solution  as 
an  indicator,  and  add  the  decinormal  solu- 
tion until  a permanent  yellow  color  is  pro- 
duced. The  number  of  c.c.  used  (z)  x 20  = 
the  number  of  c.c.  required  to  neutralize  all 
the  acid  factors  in  100  c.c.  of  the  gastric 
juice  except  the  combined  HCl;  or. 

Combined  HCl  = total  acidity  (20x)  - 20z. 

a.  Total  acidity  = 20x. 

b.  Free  HCl  = 20y. 

c.  Combined  HCl  = 20x  - 20z. 

d.  Sum  of  free  and  combined  HCl  = 2Qy  + 
(20X-20Z). 

e.  Organic  acids  and  acid  phosphates  = 20x  - 
(20y  + 2Qx-20z). 

f.  Sum  of  free  and  combined  HCl  x 0.00365  = 
percentage  of  HCl  (normal  = 0.2  per  cent.). 

If  free  HCl  is  absent,  and  the  total  acidity 
is  20  or  less,  make  a quantitative  test  of  the 
ferments.  Diminution  of  the  rennin  secre- 
tion usually  indicates  gastritis  as  opposed 
to  a neurosis;  a very  great  diminution  indi- 
cates glandular  atrophy. 

With  a pipette  or  medicine  dropper,  intro- 
duce one  c.c.  of  the  filtered  gastric  contents 
into  a graduated  cylinder  of  10  c.c.  capacity. 
Then  add  tap  water  up  to  10  c.c.;  shake  b}’’ 
inverting  several  times,  and  pour  5 c.c.  into 
a test-tube,  marked  “ 1 to  10.” 

Add  water  again  up  to  10  c.c.  in  the 
graduated  cyhnder,  invert  several  times, 
and  pour  5 c.c.  into  a second  test-tube, 
marked  “ 1 to  20.”  Continue  the  dilutions 
in  the  same  manner  to  “ 1 to  40,”  “ 1 to  80,” 
“ 1 to  160,”  “ 1 to  320,”  etc.  Then  add  to 
each  test-tube  5 c.o.  of  boiled  milk  and 
2]/2  c.c.  of  a one  per  cent,  calcium  chlo- 
ride solution,  shake,  and  place  in  a water- 
bath  which  has  been  heated  to  102°  F.,  or 
40°  C.  Use  a control  test-tube  containing 
only  milk  and  calcium  chloride,  which  should 
not  coagulate. 

Normally  the  test-tube,  “1  to  160,” 
should  show  a “ firm,  cake-like  coagulation”; 
“ 1 to  320,”  a “ fine,  flaky  coagulation”;  and 
the  preceding  dilutions,  a “ solid,  cake-like 
coagulation.”  In  higher  dilutions  than 
“1  to  320,”  no  coagulation  occurs  except 
in  hypersecretion. 


Atro- 

phy 

Inter- 

stitial 

gastritis 

Simple 

catarrh 

Subacid- 

ity 

Hyper- 

chlor- 

hydria 

Total 

acidity 

Rennin 

5-6 

1-1 

to 

1-10 

6-12 

1-10 

to 

1-40 

14-20 

1-80 

to 

1-160 

25-40 

1-200 

70-100 

1-200 

to 

1-800 

(After  Paul  Cohnheim). 


To  examine  the  stomach  contents  for 
peptolytic  ferments  by  means  of  silk  pep- 
tone, proceed  as  follows:  Neutralize  5 c.c. 
of  the  stomach  contents  with  magnesimn 
oxide  and  filter.  To  the  filtrate  add  0.2  gm. 
of  silk  peptone  incubate  the  mixture  and 
examine  every  thirty  minutes  for  a possible 
separation  of  crystals  (tyrosin),  the  occur- 
rence of  which  indicates  the  presence  of 
peptolytic  ferments.  A test  for  tyrosin 
should  be  applied  in  order  to  make  sure  that 
the  crystals  are  those  of  tyrosin. 

Organic  disease  having  been  excluded, 
next  turn  the  attention  to  the  functional 
gastric  disorders,  bearing  in  mind  the  various 
dietetic,  unhygienic,  and  nervous  causes  of 
functional  dyspepsia  hereinbefore  enumer- 
ated. 

The  principles  of  treatment  of  the  dyspep)- 
sias  due  to  dietetic  errors  and  unhygienic  and 
debilitating  influences  are  described  in  the 
treatment  of  chronic  gastritis.  The  dyspep- 
sias ascribed  to  nervous  (also  debilitating) 
influences  are  considered  imder  Nervous 
Dyspepsia.  The  treatment  of  the  reflex 
dyspepsias  consists  primarily  in  the  removal 
of  the  cause.  Reflex  dyspepsia  is  usually 
characterized  by  hyperchlorhydria  and  hyper- 
secretion, due  to  reflex  excitation  of  the 
gastric  secretion  (see  Hyperacidity). 

Acute  and  clironic  gastric  indigestion  in 
infants  is  considered  under  acute  and  chronic 
gastritis  respectively. 

Dyspepsia,  Atonic. — See  Dyspepsia,  Ner- 
vous, and  Splanchnoptosis. 

Dyspepsia,  Nervous. — Nervous  dyspepsia 
is  a functional  gastric  disorder  caused  by 
both  direct  and  reflex  nervous  influences. 
Vagus  stimulation  dilates  the  cardia,  stimu- 
lates gastric  peristalsis  and  secretion,  and 
probably  relaxes  the  pylorus.  Sjunpathetic 
or  splanchnic  stimulation  diminishes  gastric 
tonus  and  peristalsis,  but  probably  in- 
creases the  tone  of  the  pylorus. 

Etiology.— (1)  Central  or  direct  nervous 
influences:  Neurasthenia;  hysteria;  mental 
disturbance  or  insanity;  overwork,  worry, 
and  anxiety,  etc.;  excessive  venery;  plumb- 
ism;  the  abuse  of  alcohol,  morphine,  cocaine, 
tea,  coffee,  and  tobacco;  locomotor  ataxia 


DYSPEPSIA,  NERVOUS 


(gastric  crises);  general  paresis;  myelitis; 
brain  tumor,  brain  abscess,  etc.;  debilitating 
diseases:  pulmonary"  tuberculosis,  syphilis, 
malaria,  anjemia,  diabetes,  gout,  rickets, 
nephritis,  Addison’s  disease,  arteriosclerosis 
(aortitis  and  para-aorititis  abdominis — Stock- 
ton),  etc. 

(2)  Reflex  nervous  mfluences:  Enterop- 
tosis;  movable  kidney;  nephrolithiasis;  chole- 
lithiasis; cholecystitis;  appendicitis;  utero- 
ovarian  disease;  displaced  uterus;  preg- 
nancy; male  genital  disease;  intestinal  dis- 
ease— chronic  constipation,  worms,  intes- 
tinal obstruction,  etc.;  pancreatic  disease; 
hernia;  perigastric  adhesions  (following  gas- 
tric or  duodenal  ulcer,  gall-bladder  disease, 
pancreatic  disease,  syphilitic  hepatitis, 
chronic  peritonitis,  tuberculosis);  nasal,  pha- 
ryngeal, laryngeal,  and  aural  disease;  eye- 
strain,  etc. 

Symptomatology. — The  symptomatology  is 
variable.  It  embraces:  noisy  eructations  of 
swallowed  air  (see  Eructatio  Nervosa); 
audible  borborygmi  and  gurgling  due  to 
peristaltic  unrest;  vomiting,  which  is  in 
rare  instances  serious  (see  Vomiting);  card- 
iospasm (q.v.);  sense  of  weight  and  pressure 
and  burning,  and  usually  acid  eructations, 
occurring  usually  at  the  height  of  digestion, 
or  from  one-half  to  three  or  four  hours 
after  eating,  and  relieved  by  vomiting,  by 
food,  and  by  alkalies  (hyperacidity,  q.v.); 
continuous,  or  rarely  intermittent  or  per- 
iodic supersecretion  of  usually  a hyper- 
acid gastric  juice,  associated  with  pain,  acid 
eructations,  perhaps  vomiting  of  a clear, 
watery,  highly  acid  fluid,  and  eventuating 
in  gastric  dilatation  due  to  pylorospasm 
(hypersecretion  or  gastrosuccorrhcea,  q.v.); 
subacidity,  or  anacidity,  possibly  even  achylia 
{q.v.);  gastric  distress  appearing  soon  after 
eating  and  lasting  until  the  stomach  is  empty 
(hyperaesthesia  gastrica,  q.v.);  possibly  sud- 
den attacks  of  severe  epigastric  pain  radi- 
ating toward  the  back,  and  usually 
independent  of  the  taking  of  food  (gastralgia, 
q.v.);  attacks  of  excessive  hunger  (bulimia, 
q.v.);  anorexia  {q.v.);  capricious  appetite; 
regurgitation;  salivation;  usually  constipa- 
tion; perhaps  anaemia,  headaches,  dizziness, 
insomnia,  palpitations,  lassitude,  depres- 
sion, and  other  neurasthenic  or  hysterical 
symptoms.  Periods  of  illness  often  alter- 
nate with  periods  of  well-being.  Cohnheim 
says,  “ actual  pain  never  occurs  in  nervous 
dyspepsia”;  nor  achylia.  As  distinguished 
from  chronic  gastritis,  says  Webster,  the 
acidity  is  variable  in  different  examinations 
in  nervous  dyspepsia,  whereas  it  remains 
constant  in  gastritis;  the  ferments  are  nor- 


mal in  nervous  dyspepsia,  diminished  in 
gastritis;  little  or  no  mucus  is  present  in 
nervous  dyspepsia,  whereas  it  is  abundant 
in  gastritis.  (See  Dyspepsia  or  Gastric 
Indigestion  for  diagnostic  information  re- 
garding the  dyspepsias.) 

Prognosis.— This  depends  upon  the  ability 
to  discover  and  eradicate  the  cause.  In 
mild,  purely  neurasthenic  cases  the  prog- 
nosis is  good  under  appropriate  treatment; 
but  relapses  may  occur.  Some  cases  are 
very  intractable. 

Treatment. — Search  for  and  endeavor  to 
remove  all  possible  causal  factors.  In  neur- 
asthenic and  myasthenic  states,  enjoin, 
where  practicable,  adequate  exercise  in  the 
open  air,  adequate  rest,  psychical  and 
physical  (perhaps  rest  in  bed  for  about  a 
month  in  severe  cases:  see  Neurasthenia), 
perhaps  change  of  scene  and  climate,  a 
daily  tepid  bath  followed  by  a cool  douche 
and  friction  with  a coarse  towel,  especially 
the  circular  cold  and  warm  douche  over  the 
stomach  and  the  spinal  douche,  daily  brush- 
ing of  the  teeth  before  breakfast  with  cas- 
tile  soap  and  warm  water,  fresh  air  day 
and  night,  regular  hours  of  eating,  rest  for 
one-half  to  one  to  two  hours  both  before 
and  after  eating,  preferably  reclining  on  a 
couch  on  the  right  side,  slow  and  thorough 
mastication  of  the  food. 

Gentle  massage,  practiced  no  earlier  than 
one  and  a half  hours  after  a meal,  is  useful 
for  both  gastric  and  intestinal  atony;  as  is  also 
galvanization  or  faradization,  (see  Medical 
Electricity),  a large  well-moistened  sponge 
electrode  being  placed  over  the  stomach,  and 
a smaller  sponge  electrode  over  the  seventh 
or  eighth  dorsal  vertebra.  The  current 
should  be  strong  enough  to  produce  visible 
twitchings  of  the  abdominal  muscles,  but 
should  be  applied  for  no  longer  than  ten 
minutes.  The  electrical  abdominal  roller 
combines  massage  with  electricity.  Says 
Cohnheim,  employ  the  galvanic  current  with 
irritable  patients,  the  faradic  current  with 
relaxed  patients. 

A supporting  abdominal  binder  should  be 
worn  if  enteroptosis  is  evident  (see  Enter- 
optosis). 

Iron,  arsenic,  and  strychnine  or  nux  vomica 
are  indicated  for  anaemia  and  debiUty,  (see 
Part  11  for  drugs). 

Says  Cohnheim,  the  diet  should  be  adapted 
to  the  physical  constitution  of  the  patient, 
e.g.,  full  diet  for  the  undernourished;  a diet 
restricted  in  carbohydrates  and  fats  for  the 
obese;  laxative  diet  for  the  constipated; 
bland  soft  diet  for  organic  disease. 

In  atonic,  asthenic,  or  myasthenic  states. 


DYSTROPHY,  PROGRESSIVE  MUSCULAR 


in  which  the  stomach  is  presumed  to  share, 
it  is  recommended  that  the  cUet  be  bland, 
nutritious,  soft  or  finely  tUvided,  and  taken 
in  small  amounts  at  three-hour  mtervals 
(four  or  five  small  meals  a day),  fluids  with 
meals  being  restricted,  but  not  between 
meals:  finely  minced  beef,  mutton,  chicken, 
stewed  tripe,  stewed  whitefish,  eggs,  raw 
or  boiled  three  minutes,  custards,  well- 
cooked  cereals,  vegetables  in  puree  form, 
well-masticatecl  toast,  rusks,  or  zwieback. 
Each  morning,  about  one  hour  before 
breakfast,  the  patient  should  take  a glassful 
of  hot  water. 

A digestive,  such  as  taka-diastase,  or  pep- 
sin, or  pancreatin,  or  papain  (see  Part  11), 
may  be  of  service  in  suitable  cases.  Strych- 
nine, or  nux  vomica  is  advised  as  a general 
and  local  stimulant  and  tonic. 

For  the  treatment  of  nervous  anorexia, 
nervous  vomiting,  hyperacidity,  hypersecre- 
tion, subacidity,  hyperoesthesia,  gastralgia, 
nervous  belching,  cardiospasm,  bulimia, 
and  pylorospasm,  consult  the  appropriate 
heading. 

Dysphagia. — Gr.  8vs-  ill  -f  (payeLv  to  eat: 
difficulty  in  swallowing.  Causes. — Dental, 
gingival,  lingual,  palatal,  tonsillar,  peritonsil- 
lar, post-nasal,  pharyngeal,  laryngeal,  or 
cesophageal  inflammation  or  new  growth; 
retropharyngeal  abscess;  cervical  caries; 
syphilis;  mediastinal  tumors;  pericarchtis 
with  effusion;  fracture  of  the  hyoid  bone  or 
larynx;  aneurysm;  cardiospasm  and  ceso- 
phagismus;  oesophageal  steno.sis  (q.v.,  for 
causes) ; oesophageal  paresis  due  to  lesions 
in  the  pons  and  medulla,  e.g.,  hemorrhage, 
tumors,  multiple  sclerosis,  tabes,  general 
paresis,  bulbar  palsy;  or  to  diphtheritic  or 
influenzal  neuritis;  or  to  progressive  lenticu- 
lar degeneration. 

Before  passing  an  oesophageal  bougie, 
exclude  aneurysm  of  the  tlescending  aorta 
by  means  of  bismuth  and  the  X-rays  (see 
under  Dyspepsia).  For  the  manner  of 
introducing  an  oesophageal  tube  and  the 
contraindications,  see  Dyspepsia;  see  also 
(Esophageal  Affections. 

Dyspnoea. — Gr.  8vs-  ill  -f  irvoia  breath. 
Difficult  or  laboretl  or  rapitl  breathing  or 
breathlessness.  The  normal  frecpiency  is 
18  per  minute. 

Causes. — Exertion;  excitement;  slight  exer- 
tion in  high  altitudes;  cardiac  disease;  peri- 
cardial effusion;  angina  pectoris;  pulmonary 
disease:  emphysema,  bronchitis,  acute  pul- 
monary congestion,  pneumonia,  phthisis, 
pulmonary  fibrosis,  atelectasis,  post-opera- 
tive collapse  of  the  lungs,  pulmonary  oedema, 
asthma,  hay  fever,  pleurisy,  pneumothorax. 


pneumatosis;  laryngeal  obstruction:  acute 
laryngitis,  spasm  of  the  glottis,  oedema  of 
the  glottis,  laryngeal  diphtheria,  pertussis, 
foreign  bodies,  tumors,  fracture  of  the  hyoid 
bone  or  larynx;  tracheal  obstruction  {q.v., 
for  causes);  bronchial  obstruction  (q.v.,  for 
causes) ; retropharyngeal  abscess  ; Ludwig’s 
angina;  pushing  up  of  the  diaphragm  by  gas, 
fluid  or  timior;  mediastinal  tumors  or 
abscess;  aneurysm;  paralysis  of  the  dia- 
phragm, as  in  acute  anterior  poliomyelitis 
and  transverse  cervical  myelitis;  eryth- 
raeinia;  acidosis:  diabetes,  starvation, 

eclampsia,  unemia,  thyrotoxicosis,  toxic 
liver  conditions;  lactic  acid  acidosis  due  to 
long  hard  muscular  exertion;  debility;  anae- 
mia; obesity;  gout;  plumbism;  infectious 
diseases;  hysteria. 

Dystrophy,  Progressive  Muscular. — Gr. 

8vs-  ill  + Tpo<p-q  nourishment.  A rare,  usu- 
ally hereditary  and  familial  myopathy, 
appearing  as  a rule  in  early  childhood, 
characterized  by  a slowly  progressive,  pri- 
mary muscular  atrophy,  which  begins 
almost  always  hi  the  proximal  muscles  of 
the  limbs  and  in  the  trunk,  and  is  asso- 
ciated with  a pseudo-hypertrophy  of  some 
of  the  muscles,  especially  those  of  the 
calves,  and  diminished  or  lost  tendon 
reflexes. 

When  the  muscles  of  the  shoulder-girdle 
are  affected,  the  scapulie  appear  “ winged,” 
and  when  the  patient  is  lifted  by  the  axillae 
the  shoulders  are  carried  away  upward 
(“  loose  shoulders  ”). 

When  the  muscles  of  the  back,  gluteal 
region,  thigh  and  calf  are  affected,  the 
patient,  on  rising  from  a sitting  posture  on 
the  floor,  climbs  uji  his  lower  limhs  with  his 
hands.  Lordosis  is  also  present  when  the 
back  muscles  are  involved.  Paralysis  of 
the  glutaei  muscles  results  in  a waddling, 
duck-like  gait. 

The  facial  muscles  are  rarely  involved. 
Contractures  eventually  occur. 

The  amyotonia  congenita  of  Oppenheim 
is  a very  rare  congenital,  but  not  herechtary, 
usually  fatal,  general  or  local  muscular 
flaccidity  of  infants,  with  diminished  or 
absent  tendon  reflexes.  It  is  a type  of 
muscular  dystrophy. 

Hypogh'caemia  is  present  in  all  cases  of 
progressive  muscular  dystrophy.  It  may 
l)e  the  result  of  adrenal  or  other  endo- 
crine disease. 

Prognosis.— This  is  unfavorable  as  to  cure, 
but  not  as  to  life.  The  degenerative  process 
may  possibly  be  brought  to  a standstill, 
however,  by  means  of  systematic  mas- 
sage, etc. 


ECHINOCOCCUS  OR  HYDATID  DISEASE 


Treatment. — Massage  practiced  for  about 
an  hour  each  day,  mild  galvanism,  passive 
movements,  moderate  gymnastic  exercise  of 
the  affected  muscles,  carefully  avoiding 
overexertion,  these  measures  being  con- 
tinued for  years  with  the  hope  of  bringing 
the  disease  to  a standstill,  may  be  of  some 
benefit,  but  much  is  not  to  be  expected. 
Good  nutrition  and  a healthful  open-air  life 
are  important  adjuvants. 

Light  splints  may  be  applied  at  night  for 
the  prevention  of  contractures.  Trouble- 
some contractures  may  require  tenotomy 
(see  Orthopedics). 

Dysuria. — Gr.  8vs-  ill  -f  ovpov  urine:  pain- 
ful or  difficult  urination.  See  Gynecology, 
Part  2,  and  Male  Genito-Urinary  Dis- 
eases, Part  3. 

Ecchymosis,  Traumatic. — Gr.  k out  + 

X'Vo;  a flow;  rpowna  a wound.  See  Con- 
tusion. 

Echinococcus  or  Hydatid  Disease. — Gr. 

txTvos  hedge-hog  -|-  kokkos  berry;  L.  hy'datis; 
Gr.  oSarh  vesicle.  The  Echinococcus  or 
hydatid  cyst  which  occurs  in  the  various 
organs  in  man  is  caused  by  the  ingestion  of 
the  eggs  of  the  tenia  echinococcus,  a minute 


Fio.  36. — Echinococcus  compositus  hydatitosus  (endo- 
genus).  Bk,  the  connective-tissue  capsule.  C,  the  cuticular 
layer  of  the  mother-cell,  or  cyst.  P',  the  parenchymatous 
layer  of  the  mother-cell.  C',  the  cuticular  layer  of  the  daugh- 
ter-cell. P',  the  parenchymatous  layer  of  the  daughter-cell. 
FI,  the  fluid  contents.  I,  II,  III,  IVy  stages  of  development 
of  the  head  of  the  echinococcus  (k)  and  the  breeding- 
capsule  (IV). 


tapeworm  which  lives  in  the  intestine  of  the 
dog,  by  whom  it  is  contracted  by  the  eating 
of  infected  hogs,  cattle,  and  sheep.  In  the 
human  stomach  the  six-hooked  embryo, 
freed  from  its  egg-shell  by  digestion,  bores 
through  the  stomach  or  intestinal  wall,  and 
eventually  reaches  various  organs,  particu- 


Fig. 37.  — Echinococcus 
ectogenus.  C,  the  cuticular 
layer  of  the  mother-cyst. 
P,  the  parenchymatous 
layer  of  the  mother-cyst. 
C',  the  cuticle  of  the 
daughter-cyst.  P',  the 
parenchymatous  layer  of 
the  daughter-cyst,  k,  the 
echinococcus  head.  Br, 
the  breeding-chamber. 


larly  the  liver,  where  it  develops  into  a cyst 
of  gradually  increasing  size,  which  consists 
of  an  inner,  proper  capsule,  containing  a 
transparent  fluid,  and  an  outer  connective 
tissue  capsule.  From  the  inner  capsule, 
daughter  cysts,  and  within  the  latter,  grand- 
daughter cysts,  may  develop  and  be  set  free 
in  the  cavity  of  the 
original  cyst.  Later  the 
parent  cyst  develops 
buds  which  become  scol- 
eces  or  heads  provided 
with  suckers  and  book- 
lets, and  these,  if  they 
should  reach  the  intes- 
tine of  the  dog,  are  cai> 
able  of  growing  into 
atlult  tienije.  (Figs.  3G, 

37,  and  38.) 

A positive  diagnosis 
of  hydatid  disease  is 
made  only  by  finding 
the  “hooks”  or  “heads” 

(see  the  pictures)  in  the 
chscharged  or  aspirated 
cyst  fluid.  If  the  cyst  content  is  purulent 
or  the  walls  calcified,  a diagnosis  may  pos- 
sibly be  made  by  means  of  the  X-ray. 

Small  cysts  often  undergo  spontaneous 
cure;  but  the  cyst  may  rupture  into  neigh- 
boring parts,  or  it  may  suppurate.  If  it 
ruptures  into  a bronchus,  spontaneous  cure 
may  occur. 

Treatment.— This  is  surgical.  The  inner  or 
parasitic  capsule  is  cautiously  removed  from 
the  outer,  connec- 
tive tissue  capsule, 
by  first  incising  the 
latter  and  stitching 
it  to  the  parietes  of 
the  body,  and  then 
raising  it  from  the 
inner  capsule  with 
great  care  to  avoid 
rupture.  After  the 
inner  sac  has  been 
removed,  the  re- 
sulting cavity  is  allowed  to  drain  externally. 

When  operating  within  the  abdominal 
cavity,  do  not  allow  any  of  the  fluid  con- 
tents of  the  cyst  to  escape  and  thereby  cause 
a general  di.ssemination  of  daughter  cysts. 

The  thoracic  route  is  required  in  sub- 
phrenic  and  pulmonary  hydatids. 

If  the  cyst  suppurates  it  should  be 
treated  as  an  abscess. 

Preventive  measures  embrace  thorough 
cleansing  of  vegetables  and  fruits,  boiling 
the  drinking  water,  and  the  avoidance  of 
contact  with  dogs. 


Fiq.  38. — Echinococcus  hooks. 
(J.  C.  Wilson). 


EMPHYSEMA,  PULMONARY 


Eclampsia. — Gr.  Ik  out  + XaiJLiretp  to 
flash.  See  Convulsions. 

Edema. — See  (Edema. 

Eel  Worm. — See  Ascariasis. 

Eighth  Nerve. — See  Ear  Diseases,  Part  7. 

Electricity,  Medical. — See  Medical  Elec- 
tricity. 

Elephantiasis.' — See  Skin  Diseases,  Part  5 

Elevation  of  Temperature. — See  Fever. 

Eleventh  Nerve. — See  Spinal  Accessory 
Nerve. 

Embolism.  — L.  embolismus,  from  Gr. 
in  + ^aWeLv  to  throw.  The  occurrence 
of  embolism  is  usually  manifested  by  sud- 
den severe  pain.  If  in  an  extremity,  the 
limb  is  at  &st  usually  pale  and  cold  and 
slightly  cedematous,  and  pulsation  is  absent 
in  the  affected  artery  below  the  embolus. 
Unless  a collateral  circulation  is  established, 
cyanosis  and  eventually  gangrene  supervene. 
Hemorrhage  may  follow  pulmonary,  mesen- 
teric (see  Intestinal  Obstruction)  and  renal 
embolism.  Apoplexy  (q.v.)  occurs  in  cerebral 
embolism;  sudden  death  in  embolism  of 
the  heart. 

Pulmonary  embolism  is  characterized  by 
sudden  pain  in  the  side  and  dyspnoea,  sub- 
sequently cough  and  perhaps  (not  always) 
the  spitting  of  blood,  with,  if  the  infarct  is 
very  large,  the  local  signs  of  consolidation, 
e.g.,  dulness,  increased  vocal  fremitus,  dimin- 
ished breath  sounds,  crepitant  rales,  and 
perhaps  bronchial  breathing.  If  a large 
blood-vessel  is  occluded,  the  dyspnoea  is 
intense  and  unconsciousness  and  rapid 
death  from  heart-failure  ensue.  Pleurisy, 
abscess,  gangrene,  or  pneumonia  may  result 
from  an  infected  pulmonary  embolus. 

For  splenic  embolism  see  Splenic  Infarction. 

Etiology  of  Embolism.— Thrombosis,  occur- 
ring in  the  veins  of  the  leg,  brain,  uterus 
(following  childbirth  or  even  menstruation), 
right  heart,  pulmonary  artery,  (the  latter 
two  the  result  of  feeble  circulation  in  chronic 
heart  disease);  arteriosclerotic  or  atheroma- 
tous abscesses  or  ulcers;  aneurysm,  from 
which  particles  of  clot  may  become  de- 
tached; entrance  of  fat  into  the  circulation, 
occurring  in  bone  fracture,  concussion  of 
the  body,  atheroma  of  an  artery,  diabetes 
rnellitus,  inflammation  or  laceration  of  sub- 
cutaneous fatty  tissue,  fatty  degeneration 
of  the  internal  organs,  subcutaneous  injec- 
tions of  oil;  subcutaneous  injection  of  paraf- 
fine or  of  insoluble  mercury  preparations; 
entrance  of  gas  into  a vein  occurring  during 
an  operation,  or  in  childbirth,  or  as  a 
result  of  infection  with  the  bacillus  sero- 
genes  capsulatus;  parasites  and  other  bod- 
ies, e.g.,  the  malarial  plasmodium,  bacteria. 


cells  of  the  bone  marrow,  liver,  placenta, 
and  tumors,  and  destroyed  blood  cor- 
puscles; septico-pyemia  and  endocarditis; 
appendicitis;  chlorosis. 

Treatment  of  Embolism  of  a Limb. — Lower  the 
limb  and  apply  moist  heat,  and  administer 
morphine,  if  necessary,  for  pain.  Surgical 
removal  of  the  embolus  may  be  considered 
(see  Alexis  Carrel’s  work  on  vascular  sur- 
gery). F.  Bauer  has  successfully  removed 
an  embolus  from  the  abdominal  aorta. 
While  an  assistant  compressed  the  aorta, 
the  latter  was  incised,  the  clot  extracted, 
and  the  opening  closed  with  fine  silk. 

If  gangrene  sets  in,  keep  the  parts 
aseptic  by  means  of  tincture  of  iodine  and  a 
sterile  cotton  dressing,  and  when  a well- 
marked  line  of  demarcation  has  formed,  and 
the  inflammation  m the  sound  tissue  has 
subsided,  amputate.  The  lower  limit  of 
sound  tissue  may  be  ascertained  by  rubbing 
the  skm  vigorously  with  alcohol  and  ether, 
when  a well-outlined  hypersemia  will  ensue 
m the  soimd  skin  (W.  Sandrock). 

Treatment  of  Pulmonary  Infarction.  — Enjoin 
absolute  rest  propped  up  in  bed  for  eight 
or  ten  days,  including  feeding  with  a spoon, 
the  use  of  a bed-pan,  the  administration  of 
morphine  for  cough,  pain,  and  restlessness, 
and  of  laxatives  to  avoid  straining  at  stool. 
Oxygen  may  be  administered  per  inhalation 
if  practicable  (see  Pneumonia,  Lobar) . Apply 
counter-irritation  to  the  chest  in  the  form  of 
hot  compresses,  a large  mustard  poultice, 
and  dry  or  wet  cups  (see  Cupping).  Give 
heart  stimulants  hypodermically,  if  needed, 
e.g.,  camphor,  ether,  brandy,  whiskey,  strych- 
nine, digitalin,  strophanthin,  atropine,  adren- 
alin, caffeine,  or  whiffs  of  ammonia  vapour, 
or  aromatic  spirits  of  ammonia  by  mouth, 
and  hot  fomentations  over  the  heart  ( see 
Part  11  for  drug  formulae,  etc.) 

For  pain,  the  side  may  be  strapped  from 
below  upward  with  overlapping  strips  of 
adhesive  plaster  extending  from  spine  to 
sternum. 

For  hemorrhage,  see  Haemoptysis. 

The  diet  should  be  light.  The  patient 
should  remain  in  bed  for  four  to  six  weeks 
and  should  keep  quiet  for  months.  The 
prognosis  is  usually  good. 

Embolism,  Cerebral. — See  Apoplexy. 

Pulmonary. — See  Embolism. 

Emesis.— ^r.  k/inv  to  vomit.  See  Vomiting. 

Emphysema,  Pulmonary. — Gr.  en4>vtr]fia 
inflation;  L.  pul'mo,  lung.  General  pul- 
monary emphysema  is  a general  dilatation 
of  the  pulmonarj'  air  cells  due  to  atrophy  of 
their  walls,  and  is  manifested  by  the  following 
signs  and  symptoms,  viz.:  shortness  of 


ENDOCARDITIS,  ACUTE 


breath  present  sometimes  only  on  exertion 
and  increased  during  exacerbations  of  bron- 
chitis to  which  the  patient  is  subject;  cyano- 
sis; increased  antero-posterior  diameter  of 
the  chest  (barrel-shaped  chest)  and  round 
shoulders;  increased  resonance  on  percussion 
and  enlarged  area  of  resonance  overlapping 
the  heart,  liver,  and  spleen;  diminished 
fremitus;  breath  and  voice  sounds  weak, 
inspiration  short  and  expiration  prolonged 
and  accompanied  by  rales  and  ronchi  if 
bronchitis  is  present.  The  heart  gradually 
hypertrophies,  and  breaks  in  compensation 
are  prone  to  occur. 

Etiology. — Congenitally  weak  lung  tissue 
due  to  heredity,  e.g.,  emphysema  and  gout 
in  the  forebears  (the  disease  is  not  rare 
in  children);  old  age,  chronic  alcoholism; 
habitually  high  intravesicular  pressure  due 
to  coughing  in  chronic  bronchitis  and 
in  whooping-cough,  to  asthma,  laryngeal 
stenosis,  heavy  lifting,  and  glass  and 
wind  instrument  (?)  blowing;  adhesive 
pleuritis;  dust;  premature  ossification  of  the 
costal  cartilages  (?). 

Treatment. — Treatment  aims  only  to  check 
the  progress  of  the  disease  and  to  reUeve 
s3Tnptoms.  Residence  in  a warm  equable 
climate,  such  as  that  of  Southern  California, 
Florida,  and  Egypt,  is  best.  The  patient 
should  lead  a quiet  life,  should  dress  warmly, 
and  should  avoid  exposure  to  inclement 
weather,  dust,  and  other  irritating  inhala- 
tions. The  bowels  should  be  kept  regular, 
employing,  if  required,  an  occasional  saline 
before  breakfast.  The  diet  should  be  simple 
and  easily  digestible;  in  obese  patients  it 
should  be  restricted  (see  Obesity).  Deep 
breathing  exercises  are  beneficial.  The 
inspiration  of  compressed  air  and  its  expira- 
tion into  rarified  air  by  means  of  a portable 
apparatus,  such  as  that  of  Waldenburg,  gives 
great  relief  to  the  dyspnoea.  Practiced  for 
one  hour  a day  for  months  it  may  produce 
permanent  rehef  (Musser.) 

Bronchitis  and  asthmatic  attacks  should 
be  treated  as  described  under  their  respective 
headings.  Sodium  iodide,  gr.  v,  t.i.d.p.c., 
well  diluted  in  water  or  milk,  or  the  syrup  of 
hydriodic  acid,  if  the  former  causes  indiges- 
tion, is  recommended  (see  Part  11).  Manual 
compression  of  the  thorax  during  expiration, 
with  the  patient  prone  and  the  hands  applied 
over  the  axillary  regions,  is  useful  as  an  aid 
in  expelling  the  secretions. 

If  the  heart  becomes  weak,  prescribe 
tincture  of  digitalis,  about  five  drops,  well 
diluted,  t.i.d.,  or  strj’-chnine,  gr.  three 
or  four  times  a day.  In  severe  dyspncea  and 
cyanosis,  remove  from  200  to  300  c.c.  of 


blood.  Oxygen  inhalations  (see  under  Pneu- 
monia) are  also  of  value  here.  Give  mor- 
phine and  atropine  for  restlessness. 

Empyema. — Gr.  tv  within  -f-  irvov  pus.  See 
under  Pleurisy.) 

Encephalitis  Acuta. — Gr.  eyKe<t>a\os  brain 

-irts  inflammation.  The  symptoms  of 
acute  inflammation  of  the  brain  are  head- 
ache, nausea  and  vomiting,  fever,  rapid 
pulse,  somnolence,  vertigo,  delirium,  per- 
haps paralyses  or  convulsions,  sometimes, 
when  compression  becomes  marked,  slowing 
of  the  pulse  and  respirations,  choked  discs, 
and  coma.  The  prognosis  is  not  hopeless. 

The  diagnosis  is  seldom  made.  The  con- 
dition is  to  be  distinguished  from  meningitis, 
sinus  thrombosis,  brain  tumor,  abscess, 
hemorrhage  and  softening,  brain  syphilis, 
acute  poisoning,  uraemia,  acidosis,  hysteria. 

Etiology. — Poisoning  with  gas,  alcohol,  per- 
haps gasohne  fumes,  etc.;  tramnatism;  acute 
infectious  diseases  and  septico-pyemia;  oti- 
tis media;  sinusitis;  rabies;  sleeping  sickness; 
general  paresis;  syphilitic  meningitis;  tuber- 
culous meningitis;  trichinosis. 

There  has  recently  appeared  a so-called 
epidemic  encephalitis  (lethargic  encepha- 
litis; nona),  a diffuse  encephalitis  affecting 
chiefly  the  gray  matter  of  the  midbrain,  and 
manifested  by  somnolence  or  stupor  of 
gradual  onset,  accompanied  by  bilateral 
oculomotor  palsy  and  sometimes  other 
paralyses,  with  slight  pyrexia,  lasting  sev- 
eral days  or  weeks  or  months,  and  terminat- 
ing fatally  in  from  4.5  to  about  25  per 
cent,  of  the  cases.  The  blood  and  spinal 
fluid  show  no  material  changes.  The  disease 
may  be  a new  affection  or  a cerebral  form  of 
poliomyelitis  or  influenza. 

Treatment. — Enjoin  absolute  rest  in  bed  in 
a quiet,  darkened  room  with  the  head  high 
and  an  ice-cap  applied.  Place  leeches  to  the 
temples  and  mastoids.  Bleed  the  patient 
unless  anaemic.  Give  a daily  purge.  Avoid 
heart  stimulants  so  as  to  avoid  hemorrhage. 
Prescribe  liquid  diet.  Lumbar  puncture 
(q.v.)  may  be  of  value. 

Encephalitis  Epidemica  vel  Lethargica. — 
See  under  Encephalitis  Acuta. 

Encephalocele. — Gr.  (rfKt<j>a\os  brain  -f- 
/C17X17  hernia.  See  Meningocele. 

Endocarditis,  Acute.— ^r.  evSov  within  + 
Kaphia  heart  -f-  -ms  inflammation.  Acute 
endocarditis  presents  usually  no  distinctive 
sign  or  symptom.  Fever,  or  augmentation 
of  an  existing  fever,  leucocytosis,  palpita- 
tions, and  an  increase  in  the  force  and 
rapidity  of  the  heart’s  action  are  usually 
present,  together  with  a mitral  systolic 
murmur,  and  later  an  increase  in  the  area  of 


ENDOCARDITIS,  ACUTE 


cardiac  dulness.  Myocarditis  is  commonly 
j)resent,  as  shown  by  irregularity  in  the 
heart’s  action,  feeble  pulse,  dyspnoea,  and 
precordial  distress.  Pericarditis  sometimes 
occurs,  and  renders  the  prognosis  serious. 

Osier  describes  a serious  chronic  septic 
endocarditis,  characterized  anatomically  by 
chronic  vegetative  changes  superimposed 
upon  old  valvular  lesions,  and  clinically  by 
a prolonged  septic  fever  lasting  for 
months  and  unassociated  with  any  special 
disturbance  of  the  heart’s  action.  The  con- 
dition simulates  typhoid  fever,  tuberculosis, 
or  malaria.  It  is  due,  says  Billings,  to  the 
streptococcus  viridans,  and  is  usually  the 
result  of  chronic  pyorrhoea  alveolaris. 

Embolism  is  apt  to  occur  in  endocarditis — 
in  the  kidney,  sj)lcen,  brain,  eye,  peripheral 
arteries  and  subcutaneous  tissues.  The 
tender  finger  tips  which  occur  in  septic  endo- 
carditis are  probably  embolic. 

Aniemia  is  at  times  a prominent  symptom. 

Valvular  insufficiency  due  to  sclerosis  is 
prone  to  follow. 

Etiology.— Rheumatic  fever,  even  torticollis 
(rheumatism  is  probably  the  cause  in  95  per 
cent,  of  the  cases,  says  Kerley);  chorea; 
influenza;  scarlet  fever;  pneumonia;  tuber- 
culosis; typhoid  fever;  measles;  diphtheria; 
cerebrospinal  meningitis;  smallpox;  chicken- 
pox;  dysentery;  gonorrhoea;  syphilis;  septico- 
pyemia, occurring  as  a result  of  puerperal 
infection,  erysipelas,  skin  infection,  paro- 
nychia, tonsillitis  or  chronic  tonsillar  dis- 
ease, pyorrhoea  alveolaris,  dental  caries, 
alveolar  abscess,  bone  and  joint  infection, 
appendicitis,  cholecystitis,  cholangitis; 
gastro-intestinal  ulceration,  jirostatic  ab- 
scess, ischiorectal  abscess,  Iddney  abscess, 
cystitis,  nasal  and  sinus  suppuration,  otitis, 
laryngeal  and  tracheal  disease,  bronchi- 
ectasis, etc.;  also  debilitating  constitutional 
diseases,  such  as  gout,  cUabetes,  Bright’s 
disease,  and  cancer;  and  chronic  vahailar 
sclei’osis,  in  which  the  valves  are  liable  to 
recurrent  attacks  of  acute  inflammation. 

Treatment.— Absolute  rest  in  bed  in  a well- 
ventilated  room  is  of  the  first  importance. 
'The  slightest  exertion  on  the  part  of  the 
patient,  even  raising  the  head  from  the 
pillow,  should  be  prohibited . The  bed-pan 
and  urinal  should,  of  course,  be  employed, 
and  the  patient  should  be  fed  with  a spoon. 
Recumbency  .should  be  continued  for  at  least 
a month  after  the  fever  has  subsided,  and 
longer  if  any  cardiac  disturbance  is  jiresent. 
Rest  and  quiet  should  be  observed  for  at  least 
three  months  from  the  beginning  of  the  fever 
(Caton;  Osier).  Codeine  may  be  given  for  rest- 
lessness. The  bowels  shoukl  be  movetl  daily; 


calomel  is  recommended  both  as  a laxative 
and  antiphlogistic.  A concentrated  liquid  or 
soft  diet  should  be  achninistered  in  small 
amounts  every  three  hours  during  the 
period  of  pyrexia  (milk,  at  least  3 pints 
in  twenty-four  hours,  3 or  more  eggs, 
meat  juice)  and  cream  of  tartar  lemonade 
(see  Part  11)  should  be  given  freely.  After 
the  fever  has  subsided,  however,  fluids  should 
be  restricted  to  two  pints  a day.  The  mouth 
should  be  kept  clean.  An  ice-bag  should  be 
applied  over  a thin  piece  of  flannel  more  or 
less  continuously,  for  the  purpose  of  quieting 
the  heart,  relieving  palpitation  and  cardiac 
distress,  and  preventing  pericarditis.  Coun- 
ter-irritants may  be  employed  in  the  form  of 
mustard  poultices,  belladonna  plaster,  or 
tincture  of  iodine.  In  early  cases  “when 
the  heart  beats  fast  and  strong,”  tincture 
of  aconite  may  be  of  service  for  the  purpose 
of  quieting  the  heart  and  reducing  the  blood 
pressure.  Strychnine  is  advised,  gr. 
to  3^0  t.i.d.  Tepid  sponging  should  be 
employetl  for  fever.  For  heart-failure  admin- 
ister hypodermically  brandy,  whiskey,  cam- 
phor, ether,  or  strychnine  (for  drug  formulae, 
etc.,  see  Part  11. 

In  rheumatic  fever  and  chorea  prescribe 
salicylates  and  alkalies  (see  Rheumatic 
Fever).  Search  for  a possible  portal  or  focus 
of  infection. 

During  convalescence  it  is  advised  that 
potassium  iodide  be  administered  in  mod- 
erate dosage — gr.  v,  well  diluted,  t.i.d. 
— for  many  months  with  the  object  of  pre- 
ventmg  or  lessening  sclerosis.  For  anaemia 
and  cardiac  asthenia  during  convalescence, 
employ  iron  or  arsenic  (see  Anaemia),  and 
strychnine,  and  a nutritious  diet  composed 
largely  of  milk,  eggs,  and  green  vegetables. 


R Ferri  et  ammon  ii  citratis gr.  v-x 

Tinctura;  nueis  vomicse trijviiss 

Tincturae  calumboe 5i 

Aquas  pimentte,  q.s.,  ad 5i 

M.  Sig. — Ounce  t.i.d.  (Allbutt.) 


After  a prolonged  period  of  recumbency, 
gradually  get  the  patient  up,  first  allowing 
extra  pillows,  and  so  on,  until  the  patient  is 
up  in  a chair,  and  later  walking.  Rapitl 
pulse,  jtrecortlial  pain  or  distress,  fatigue, 
jialpitation,  or  breathlessness  should  be 
strictly  avoided. 

The  malignant  (ulcerative)  or  septico- 
pyemic cases  should  be  treated  as  such  (see 
Septico-Pyemia).  Search  for  the  portal  of 
entry  of  the  infection,  make  a blood  culture, 
and  employ  an  antibacterial  serum  corre- 
sponding to  the  organism  found.  Of  antistrep- 
tococcic serum  (univalent  or  polyvalent), 


ENTERITIS 


administer  10  c.c,  subcutaneously  or  15  c.c. 
per  rectum,  daily,  for  three  or  four  days, 
(smaller  doses,  e.g.,  2 c.c.,  if  an  increase  of 
the  symptoms  and  fever  are  produced),  then' 
wait  several  days  before  resuming  the  serum 
(F.  W.  Price).  Employ  antipneumococcus 
serum  in  full  doses  for  pneumococcus  septi- 
csemia  (see  Part  11). 

The  injection  of  vaccines  or  dead  micro- 
organisms in  cases  in  which  the  blood  is 
already  teeming  with  living  organisms,  docs 
not  seem  altogether  rational.  If  vaccines 
are  given,  start  with  a small  dose  and  pro- 
ceed cautiously  according  to  the  tempera- 
ture and  symptoms;  for  instance,  according 
to  F.  W.  Price,  begin  with  2 to  5 millions  of 
streptococci,  or  50  to  100  millions  of  staphy- 
lococci, and  repeat  the  dose  after  three  to  five 
days,  at  the  same  tune  closely  watching  the 
effects  to  see  that  the  patient  is  not  made 
worse.  Says  Billings,  however,  “ Vaccines, 
even  autogenous,  are  of  no  value  in  malig- 
nant endocarditis;  based  upon  personal 
experience  (my)  opinion  is  that  vaccines  are 
harmful  agents  in  the  management  of  malig- 
nant endocarditis.” 

The  following  antibacterial  agents  may 
possibly  be  of  some  aid  in  combating  the 
infection,  namely,  collargol,  unguentum 
Crede,  nuclein,  quinine  hydrochloride  (gr. 
viiss,  in  capsule,  twice  daily),  arsenic,  and 
antipyrine.  Malignant  endocarditis,  however, 
is  almost  invariably  fatal. 

Endocarditis,  Chronic;  Chronic  Valvular 
Heart  Disease. — See  Stage  of  Compensation 
under  Cardiac  Insufficiency. 

Enlargement  of  the  QalFBladder. — See 
Gall-Bladder  Enlargement. 

Enlargement  of  the  Head. — See  Head 
Enlargement. 

Enlargement  of  the  Thyroid  Gland. — See 

Thyroid  Enlargement. 

Enteralgia;  Intestinal  Neuralgia. — Gr. 

evTepov  intestine  -j-  aXyos  pain.  Causes. — 
Constipation;  excessive  eating;  un proper 
food;  excessive  drinking  of  iced  beverages; 
urticaria  or  angioneurotic  oedema;  plumb- 
ism;  anaemia;  neurasthenia;  hysteria;  multi- 
ple neuritis;  neuralgia;  tabes,  and  other 
organic  spinal  diseases;  displacement  of 
the  coccyx.  ■ i 

For  other  causesof  abdominal  pain,seePain. 

Enteric  Fever. — See  Typhoid 'Fe'ror; 

Enteritis. — Gr.  ivTepov  intfestine  + -tm  in- 
flammation'. Enteritis,  or  intestinal  inflam- 
mation, here  includes  simple  ileitis,  • enter-o- 
or-  ilio-colitis,  colitis,-  sigmoiditis,  jlrootitis, 
intestinal  • ulcer,  and  cholera  ‘ nostras  or. 
morbus.  .Membranous  enteritis  is  considered- 
under  'the  caption.  Colitis,  Mucus.  Chol- 


era infantum  and  inflammatory  diarrhoea 
in  young  children  are  considered  under 
Diarrhoea  in  Bottle-Fed  Infants  and  in 
Early  Childhood.  The  dysenteries,  Asiatic 
cholera,  typhoid  fever,  etc.,  are  considered 
under  their  respective  headings  (see  Diar- 
rhoea, for  all  its  causes).  Here  are  con- 
sidered only  the  simple  mflammatory  diar- 
rhoeas of  adults. 

A.  Enteritis  Acuta. — The  onset  is  usually 
acute,  with  vomiting.  Soon  there  follow 
gurgling  noises  or  borborygmi,  coheky  pains, 
abclominal  distention  and  tenderness,  diar- 
rhoea, thirst,  coated  tongue,  and  anorexia, 
perhaps  fever,  rarely  constipation.  In 
colitis,  mucus  and  often  blood  are  present 
in  the  stools.  The  occurrence  of  tenesmus 
indicates  involvement  of  the  sigmoid  or 
rectum.  Cholera  morbus  or  nostras  is  an 
old  name  given  to  a very  severe  acute 
enteritis  of  sudden  onset  with  severe  abdom- 
inal pam,  vomiting,  and  prostration. 

Causes  of  Acute  Enteritis. — Tainted 
and  poisonous  foods,  especially  milk,  butter- 
milk, fish,  shellfish,  cheese,  sour  potatoes, 
and  fresh  cucumbers;  irritating  .foods,  espe- 
cially raw  fruits  and  coarse  vegetables;  toad- 
stool poisoning;  mineral  poisons:  lead,  mer- 
cury, copper,  arsenic,  etc.;  chilling  of  the 
body;  cold  drinks;  septic  conditions  of  the 
nose,  mouth,  or  pharynx;  intestinal  worms 
iq-v.))  uraemia;  extensive  cutaneous  burns; 
portal  obstruction  due  to  hepatic,  cardiac,  or 
pulmonary  disease;  infectious  diseases: 
tyjihoid  fever,  cholera,  dysenteiy,  tuber- 
culosis, pneumonia,  the  exanthemata,  diph- 
theria, erysipelas,  septico-pyiemia,  varioloid, 
anthrax,  etc.  (see  Diarrhoea,  for  its  vari- 
ous causes). 

The  Prognosis  in  shnple  acute  catarrhal 
enteritis  is  usually  favorable.  , Ordinarily 
the  attack  lasts  from  two  to  ten  days. 

Treatment  of  Acute  Intestinal  Ca- 
tarrh.— Put  the  patient  to  bed,  and  admin- 
ister a dose  of  castor  oil,  one  or  two  table- 
spoonfuls, or  calomel,  gr.  ii-v  in  a single 
dose,  or  in  divided  doses,  followed  by  a 
saline.  For  vomiting  let  the  patient  sip 
ice--cold  soda  water  (see  also  Vomiting) . 
Apply  heat  to  the  abdomen  to  relieve  pain, 
quiet  peristalsis,  and  promote  healing.  For 
the  relief  of  distention  apply  hot  turpentine 
stupes,  i.e.,  flannel  wrung  out  of  steaming 
hot  water  containing  a te&spoonful  of  tur- 
pentine to  the,  .quart,  . covered  ■ wi,th’  dry 
flanriel,  these  alternating  with  plain  hot 
stupes.  For  severe  pain,  morphine- may  be 
required,  gr.  to  3-^  hypodermically;  or 
laudanum,  ^t.  x-xv,  oy  mouth, .or, rectum; 
or  one  of  the  following. formulae:  > • 


ENTERITIS 


Chloroformi 3i  per  dose) 

Morphin®  acetatis . . gr.  iss  (gr.  So  per  dose) 

Olei  anisi (gt.  S per  dose) 

Olei  menth®  pip>eri- 

t®,  aa gtt.  X (gt.  S per  dose) 

Syrupi  acaci® 5ii 

Aqu®  camphor® , q.s., 
ad 

M.  Sig. — Teaspoonful  in  ice-water,  p.  r.  n. 
(Edwards.) 

Cohnheim  strictly  forbids  opium  because 
it  paralyzes  peristalsis,  and  gives  bella- 
donna instead: 

Spiritus  menth®  p i- 

perit® i^tlxxx  (about  njiv  per  dose) 

Tinctur®  be  lladon- 

n®  foliorum 3iiss  (about  njx  per  dose) 

Tinctur®  valerian®  3iv  (about  iqjxvi  per  dose) 

M.  Sig. — Thirty  drops  in  a cup  of  hot  water  or 
fennel  tea,  t.i.d.  (Cohnheim.) 

Should  symptoms  of  collapse  occur,  ad- 
minister morphine  hypodermically,  together 
with  strychnine,  gr.  }4o,  or  camphor, 
gr.  i-ii,  in  sterile  oil  or  ether,  n^xv,  give  hot 
drinks  containing  brandy  or  whiskey,  and 
make  hot  applications  to  the  abdomen. 

Withhold  all  food  for  from  twenty -four  to 
forty-eight  hours  (unless  the  patient  is  very 
delicate,  when  broths  and  albumen  or  barley 
water  may  be  given) ; then  allow  small 
quantities  of  albumen  water,  barley  water, 
sweetened  arrowroot  water,  beef  tea  or  hot 
broth  free  from  fat;  no  milk  or  carbonated 
beverages.  As  the  condition  improves,  add 
broths  containing  the  yolk  of  an  egg,  meat 
juice,  meat  jellies,  rice  gruel,  boiled  milk, 
milk  puddings,  junket,  zwieback  or  crackers, 
blueberry  or  blackberry  wine.  Restrict  the 
diet  to  liquids  and  soft  foods  for  several 
days  after  the  diarrhoea  has  ceased. 

If  the  diarrhoea  shows  no  tendency  to 
abate  following  the  initial  cleansing  of  the 
bowels,  give  large  doses  of  bismuth  sub- 
nitrate, or  tincture  of  kino,  or  tincture  of 
catechu,  or  tannalbin,  or  tannigen,  or  tan- 
noform,  or  silver  nitrate,  or  lead  subacetate, 
or  copper  sulphate;  with  or  without  pare- 
goric, laudanum,  or  Dover’s  powder  (for 
drug  formulae  see  Part  11.) 

Bismuth!  subnitratis.  5iv  (3  ss-i  per  dose) 
Sulphuris  precipitati . gr.  viij  (gr.  i-ii  per  dose) 
Mucilagitus  acaci®. . . 5|i 
Aqu®,  q.s.,  ad 5iv 

M.  Sig. — Shake  well,  and  take  one  or  two  table- 
spoonfuls every  four  hours. 

R Tannigen  . . . 4.00  gm.  or  3 i (gr-  v per  dose) 
Bismuthi  sub- 

§allatis  . . . 8.00  gm.  or  3ii  (8T-  x per  dose) 

alol 1.55  gnj.  or  gr.  xxiv  (gr.  ii  per  dose) 

Extract!  opii 
(denarcotT 

ized) 0.20  gm-  or  gr.  iii  (gr.  K per  dose 

M.  et  div.  in  caps.  xii. 

Sig.— One  capsule  t.i.d.  (Hemmeter.) 


For  the  troublesome  tenesmus  that  accom- 
panies sigmoid  and  rectal  involvement, 
inject  cool  water,  followed,  if  necessary,  by 
an  enema  of  thin  starch  solution,  2 or  3 
ounces,  containing  laudanum,  15  to  20  drops, 
which  may  be  repeated  every  six  horns, 
if  required. 

In  protracted  cases  one  may  employ 
colonic  enemas  of  normal  saline  solution, 
3i  to  the  pint,  or  ichthyol,  5i  to  the  quart; 
or  creolin,  5i  to  the  quart;  or  argyrol,  5i  to 
the  quart;  or  tannic  acid,  gr.  xv  to  the  quart; 
or  a saturated  aqueous  solution  of  thymol. 

Employ  olive  oil  enemata  for  subse- 
quent constipation. 

B.  Enteritis  Chronica. — Diarrhoea,  either  con- 
tinuous or  intermittent,  is  the  chief  sjmp- 
tom.  Sometimes  constipation  alternates 
with  diarrhoea.  The  stools  usually  contain 
mucus;  always,  if  the  large  bowel  is  involved, 
when  the  stools  are  also  often  blood-tinged. 
Abdominal  distention  is  usually  present, 
with  abdominal  discomfort  and  tenderness, 
perhaps  colic.  The  tenderness  may  be 
localized  in  ulcer.  Blood  in  the  stools  sug- 
gests ulceration  or  the  presence  of  polypi. 
Tenesmus  indicates  involvement  of  the  sig- 
moid or  rectum. 

Causes  of  Chronic  Enteritis. — Acute 
enteritis;  dysentery  (q.v.);  amyloid  dis- 
ease of  the  intestines  due  to  chronic  suppura- 
tion, tuberculosis,  syphilis,  or  cachexia; 
intestinal  worms  (q-v.);  cancer  iq-i'-): 
distomiasis  (q-v.);  intestinal  tuberculosis 
(q.v.);  intestinal  obstruction;  diverticu- 
litis (q.v.);  tropical  sprue  or  psilosis  (q.v.); 
chronic  gastritis;  septic  conditions  of  the 
nose,  mouth,  or  pharynx  (pyorrhoea, 
etc.);  chronic  nephritis;  Addison’s  disease; 
anaemia;  intestinal  ulceration,  due  to  the 
following  causes,  viz.,  stercoral  accumula- 
tions, tuberculosis  (ulcers  specific  or  not), 
sj’philis  (ulcers  specific  or  not),  gout,  scurvy, 
leukaemia,  Hodgkin’s  disease,  cutaneous 
bums,  uraemia,  mercury,  arsenic,  antimonj^ 
alcoholism,  cancer,  amyloid  disease,  diph- 
theria, varioloid,  leprosy,  pellagra,  dj'sen- 
tery,  typhoid  fever,  anthrax,  chronic  passive 
congestion  due  to  heart,  liver,  lung,  or  kid- 
ney disease,  and  embolism  or  thrombosis 
(occurring  in  ulcerative  endocarditis  or 
septico-pyaemia,  erj-siiielas,  chronic  valvular 
heart  disease,  arteriosclerosis,  local  abscess, 
multiple  neuritis). 

Treatment  of  Chronic  Intesttn.vl 
Catarrh. — Several  years  may  be  required 
for  a cure.  Enjoin  rest  in  the  reclining 
posture,  especially  for  an  hour  or  longer 
after  meals,  with,  in  mild  cases,  occasional 
moderate  exercise.  Chilling  of  the  body 


ENTERITIS 


surface  should  be  guarded  against;  woolen 
xmderwear  should  be  worn,  warm  stockings, 
and  a flannel  abdominal  band.  An 
abundance  of  fresh  air  day  and  night 
is  of  importance. 

The  diet  should  consist  of  Uquid,  soft,  or 
finely  divided  food  leaving  as  little  residue 
as  possible,  and  served  in  small  amounts  at 
regular  intervals — every  three  or  four  hours: 
beef  juice,  bovinine,  somatose,  peptonoids, 
scraped  beef  or  mutton,  chopped  raw  beef, 
calves’  brains,  sweetbreads,  meat  jellies, 
non-ofly  fish,  egg  albumen,  milk  (boiled  or 
peptonized,  see  Part  11,  or  diluted  with 
lime  water),  kovunyss,  milk  soup,  bouillon 
with  eggs  and  rice,  thoroughly  cooked  and 
strained  cereal  gruels,  e.g.,  farina,  rice,  bar- 
ley, and  arrowroot,  sago,  tapioca,  macaroni, 
potato  puree,  stale  bread,  toast,  crackers, 
zweiback.  Avoid  ice-cold  drinks,  carbon- 
ated beverages,  sweet  drinks,  lemonade, 
acids,  coffee,  frmts,  coarse  vegetables, 
legumes,  dark  breads,  oatmeal,  fried  foods, 
nuts,  salted  meats,  fat,  sausage,  pork,  veal, 
goose,  duck,  shellfish,  salmon,  mackerel, 
herring,  gravies,  cheese,  pastry. 

Diastase  or  taka-diastase  may  be  pre- 
scribed as  an  aid  to  carbohydrate  digestion. 
Watch  the  stools  for  undigested  curds  when 
milk  is  being  taken. 

An  occasional  dose  of  castor  oil,  one  or 
two  tablespoonfuls,  or  calomel,  gr.  ii-v,  or 
liquid  paraffin,  3^^  to  3 ounces  a day,  or 
effervescent  citrate  of  magnesia,  5 vi-xx, 
may  be  of  service. 

Drugs  are  of  secondary  value,  and  shoifid 
be  used  with  discrimination:  bismuth  sub- 
salicylate or  sub  nitrate;  betanaphthol;  tan- 
nalbin  (preferred  by  Ortner  to  all  other 
astringents);  tannopin;  tannigen;  tannoform; 
salol;  calomel  (see  Part  11).  These  drugs 
are  best  administered  in  gelatin  capsifies 
hardened  with  formalin  (glutoid  capsules. 
No.  2 or  3 of  hardness)  to  prevent  liberation 
in  the  stomach.  Blackberry  brandy  and 
huckleberry  wine  are  good  astringents. 
Opium  preparations  should  be  avoided. 

When  the  large  bowel  is  involved,  give 
daily  high  injections  of  warm  normal 
saline  solution  (3i  ad  Oi)  and  astringents, 
e.g.,  silver  nitrate,  1 : 5000  to  1 : 1000,  washed 
out  by  normal  saline  solution;  quinine, 
1:5000;  fluid  extract  of  hamamelis,  1:125  of 
normal  saline  solution;  ichthyol,  3i  to  the 
quart;  creolin,  3i  to  the  quart;  salicylic  acid, 
1 per  cent.;  lead  acetate,  1 per  cent.;  copper 
sulphate,  1 per  cent.;  zinc  sulphate,  1 per 
cent.;  tannin,  gr.  xv~3i  to  the  quart;  tannin, 
one  teaspoonful,  and  starch,  one  tablespoon- 
ful to  the  quart  of  hot  water  (Cohnheim); 


saturated  aqueous  solution  of  thymol;  boric 
acid,  3i  to  the  pint.  The  fluid  should  be 
introduced  slowly  (about  two  quarts  at  each 
injection),  with  the  hips  elevated,  and  should 
be  allowed  to  remain  in  the  bowel  as  long 
as  possible,  gradually  up  to  half  an  hour, 
if  possible.  The  silver  nitrate  injections  are 
very  painful. 

Ionic  medication  (q.v.)  is  recommended. 
The  bowel  is  first  washed  out,  following 
which,  13^  pints  of  a 0.1  per  cent,  solution  of 
silver  nitrate  or  4 per  cent,  zinc  sulphate  are 
introduced  through  a rectal  tube  containing  a 
copper  wire  which  is  attached  to  the  positive 
pole  of  a galvanic  battery.  Large  negative 
electrodes  are  placed  on  the  back  and  abdo- 
men. A current  of  15  to  20  milliamperes 
is  very  gradually  (to  avoid  shock)  appUed, 
and  allowed  to  act  for  ten  to  fifteen  minutes. 
This  is  repeated,  at  first  twice  a week,  and 
later  once  a week.  The  solution  should  be 
washed  out  after  each  treatment. 

For  distressing  tenesmus,  inject  thin 
starch  solution,  5ii,  containing  laudanum, 
gtt.  xv-xxx. 

Ulcers  which  can  be  reached  through  a 
proctoscope  or  sigmoidoscope  should  be 
touched  with  a strong  solution  of  silver 
nitrate.  The  enteroscope  should  be  used 
with  caution  for  fear  of  causing  a perfora- 
tion. In  making  an  enteroscopic  examina- 
tion, one  may  choose  between  the  left 
lateral  or  Sim’s  position,  the  knee-chest 
position,  Mathew’s  and  Hanes’  inverted 
position,  using  their  special  table,  and  the 
exaggerated  lithotomy  position.  The  blad- 
der and  bowels  should  first  be  emptied. 
Gant  describes  the  procedure  with  the 
patient  in  the  knee-chest  posture,  as  follows: 
“ The  proctoscope  or  sigmoidoscope  is  oiled 
and  introduced  into  the  rectum,  and  directed 
downward  and  forward  until  it  passes 
through  the  anal  canal — about  two  inches. 
It  is  then  pointed  upward  and  backward  imtil 
the  promonotory  of  the  sacrum  is  reached,! 
when  it  is  again  directed  downward  and  for- 
ward over  the  upper  rectal  valve  and  into  the 
sigmoid  flexure.  The  obturator  is  then  re- 
moved and  the  air  permitted  to  rush  in  and 
dilate  the  bowel.  When  this  has  been 
accomplished,  the  sigmoid  is  examined; 
and  as  the  instrument  is  slowly  withdrawn  a 
perfect  view  of  every  part  of  the  rectum  can 
be  obtained.  When  the  air  does  not  dilate 
the  sigmoid  flexure,  a pneumatic  sigmoido- 
scope should  be  introduced,  with  the  obtu- 
rator in  place,  until  the  middle  valve  has 
been  passed.  The  obturator  is  then  re- 
moved, and  the  rectum  and  bowel  higher 
up  are  inflated  and  studied  step  by  step. 


EPILEPSY 


by  pressing  the  bulb  from  time  to  time,  as 
the  instrument  is  passed  higher  up.” 

In  obstinate  cases  of  colitis,  the  large 
bowel  may  be  irrigated  daily,  or  even  twice 
daily,  through  a csecal  or  appendicular 
fistula,  until  all  traces  of  pus  or  blood  have 
disappeared  from  the  stools;  or,  according 
to  A.  F.  Herz,  untU  two  or  three  months 
after  a sigmoidoscopic  examination  has 
shown  that  all  ulceration  has  disappeared. 
Use  warm  water  for  the  irrigations  and 
argyrol  or  protargol,  0.5  per  cent.,  only  if 
need  be.  Remember  that  prolonged  local 
treatment,  continued  for  several  months, 
with  irritating  astringents,  may  in  itself 
produce  a permanent  catarrhal  colitis.  To 
prevent  recurrence,  keep  the  patient  in  bed 
for  four  weeks  after  the  disappearance  of 
blood  from  the  stools;  continue  the  soft 
diet,  which  leaves  no  residue,  for  three 
months  after  no  ulceration  can  be  seen  with 
the  sigmoidoscope,  and  keep  the  bowels 
soft  for  six  months,  using  liquid  paraffin 
(Part  11),  if  need  be  (A.  F.  Hertz). 

Mummery  urges  early  operative  treat- 
ment of  ulcerative  colitis.  He  says:  “ There 
is  only  one  satisfactory  way  of  treating 
cases  of  ulcerative  colitis,  and  that  is  by 
immediate  operation.”  He  advises  leaving 
the  fistula  open  for  a full  year  after  all  symp- 
toms have  disappeared,  so  that  a possible 
relapse  may  be  easily  dealt  with.  Where 
hard  scybala  are  passed  frequently,  give 
olive  oil  per  mouth  and  colon. 

Enterocolitis. — See  Enteritis. 

Enterogenous  Cyanosis. — Gr.  evrepov  in- 
testine d-  yevvav  to  produce.  See  Cyanosis. 

Enteroptosis. — See  Splanchnoptosis. 

Enterospasm. — Gr.  evrepov  bowel  d-o-Trao-juos 
spasm.  Spasm  of  the  small  or  large  bowel 
is  either  acute  or  chronic.  Acute  entero- 
spasm is  characterized  by  a sudden  attack 
of  intense  pain,  which  may  last  a few  hours 
or  even  days,  and  then  suddenly  disappear. 
Vomiting  is  often  associated  with  the 
attack;  and  a tumor  may  possibly  be  felt 
at  the  site  of  the  contracted  gut.  The 
symptoms  suggest  acute  intestinal  obstruc- 
tion, renal  colic,  appcmlicitis,  peritonitis. 

The  caecum  or  the  sigmoid  is  the  part 
usually  affeeded,  and  there  is  often  an  asso- 
ciated si^asm  of  the  sphincter  ani.  Consti- 
pation is  present. 

Chronic  enterospasm  is  the  same  as 
spastic  constipation  (q .a.)  • 

Causes  of  Acute  Enterospasm. — Ulceration  (see 
Enteritis,'  for  causes)-;  foreign  body ; ■ fa'cal  • 
iinpaction,  irritating  foods,  poisons,  or 
purgative  drugs;-  plumbism;.  neighboring 
inflammation;  gastric  and  intestinal'  indi- 


gestion (hyperacidity,  etc.);  mucous  colitis; 
organic  disease  of  the  cerebrospinal  axis. 

Treatment  of  Acute  Enterospasm. — Employ  hy- 
podermic injections  of  morphine  and  atropine, 
hot  abdominal  compresses,  hot  baths,  and 
hot  normal  sahne  (3i  ad  Oi)  enemata,  for 
the  purpose  of  relaxing  the  spasm. 

Enuresis;  Incontinence  of  Urine;  Bed= 
wetting. — Gr.  evovpeTv  to  void  urine.  See 
Male  Genito-Urinary  Diseases,  Part  3, 
and  Gynaecology,  Part  2. 

Eosinophilia. — Eosin,  from  Gr.  ijcos  dawn, 
d-  (fiCkeTv  to  love.  The  normal  number  of 
eosmophiles  per  cmm.  of  blood  is  100  to  200 
(up{3er  limit  of  normal,  500). 

Causes  of  Eosinophilia. — Childhood;  spleno- 
myelogenous  leukaemia;  sarcoma  of  bone- 
marrow;  osteomyelitis;  osteomalacia;  perhaps 
chlorosis;  secondary  anaemias,  especially 
those  due  to  parasites;  splenectomy; 
chronic  splenic  tumor;  bronchial  asthma; 
emphysema;  many  skin  diseases  (pemphigus, 
eczema,  psoriasis,  urticaria,  purpura,  sclero- 
derma, lupus,  leprosy,  herpes  zoster,  etc.); 
gout;  scarlet  fever;  malaria;  acute  rhemna- 
tism;  ovarian  disease,  excepting  cancer; 
syphilis;  parasitic  infections  (trichinosis, 
uncinariasis,  oxyuriasis,  filariasis,  hydaticl 
ilisease,  Bilharziasis,  trypanosomiasis,  most 
of  the  intestinal  worms,  etc.) 

For  the  technique  of  preparing  and  stain- 
ing smears,  and  of  making  a differential 
count,  see  under  Blood  Examination. 

Ephemeral  Fever.- — Gr.  e-wl  for  -|-  tp^pa 
day.  See  Febricula. 

Epidemic  Catarrhal  Jaundice. — See  Jaun- 
dice, Infectious. 

Cerebrospinal  Meningitis. — See  Cerebro- 
spinal Fever. 

Encephalitis.  — See  under  Encephalitis 
Acuta. 

Haemoglobinuria. — See  Haemoglobiniuia. 

Parotitis. — See  IMumps. 

Epigastric  Pain. — See  Pain. 

Epilepsy. — Gr.  em\r]\pLa  seizure.  Essential 
or  idiopathic  epilepsy  is  a functional  nervous 
affection,  characterized  by  irregularl}^  recur- 
ring, sudden,  transient  attacl-cs  of  uncon- 
sciousness with  or  without  convulsions. 

Sometimes  a rapid  succession  of  con\ml- 
sions  occurs,  with  continuous  loss  of  con- 
sciousness, elevation  of  temperature,  rapid 
pulse  and  respiration,  and  often  a fatal 
termination  due  to  heart  exhaustion  and 
pulmonary  oedema  (status  epilepticus). 
Some  epileptics  are  subject  to  periods  of 
mental  disturbance  or  insanity. 

■ Etiology. — An  important  cause  of.  epilepsy 
is  infancy,  during  which  the  nervous  system 
is  particularly  susceptible  to  permanent 


EPILEPSY 


damage  as  a result  of  adverse  influences, 
such  as  improper  feeding,  bad  hygiene, 
rickets,  infectious  fevers,  trauma,  etc. 

Congenital  weakness  or  nervous  instability, 
due  to  hereditary  causes,  e.g.,  syphilis,  alco- 
holism,hysteria,  epilepsy, insanity,  neuralgia, 
etc.,  in  the  forebears,  predisposes  to  epilepsy. 

The  disease  is  rarely  caused  by  reflex  irri- 
tation, e.g.,  eyestrain,  phimosis,  adenoids, 
polypi,  foreign  body  in  ear  or  nose,  intestinal 
woi’ms,  dentition,  irritation  of  a cicatrix, 
undescended  testis,  menstruation,  shock,  etc. 

Epilepsy  beginning  in  adult  life  is  usually 
due  to  a local  lesion,  particularly  syphilis. 
See  Convulsions,  for  all  the  latter’s  causes. 

Epileptic  seizures  which  bear  a time  rela- 
tion to  puberty,  menstruation,  or  the  meno- 
pause, may  be  due  to  hypothyroidism  {q.v.) 

Prognosis. — This  is  usually  unfavorable  as 
to  cure,  but  judicious  treatment  is  often 
followed  by  lessening  of  the  seizures.  The 
latter  sometmies  cease  spontaneously. 

Treatment. — While  the  fundamental  cause 
of  idiopathic  epilepsy  is  altogether  unknown, 
stiU  it  is  well  known  that  the  tendency  to 
seizures  is  much  duninished  if  all  possible 
sources  of  irritation  are  removed,  and  the 
patient  is  made  to  lead  a well-regulated 
hygienic  hfe.  Therefore,  when  an  epileptic 
presents  himself  for  treatment,  explain  to 
him  that  while  you  cannot  promise  a cure, 
nevertheless,  by  the  correction  of  all  exist- 
ing remecUable  defects,  and  by  correct  liv- 
ing, he  may  hope  .so  to  strengthen  his  nervous 
stability  (an  inherited  or  acquu’ed  nervous 
instability  may,  after  all,  be  the  real  pri- 
mary cause  of  epilepsy),  as  to  diminish 
materially  the  frequency  of  his  seizirres,  with 
even  the  possibility  of  a cure. 

Make  a thorough  physical  examination  of 
every  organ  and  function  of  the  body,  and 
correct,  if  possible,  all  defects  or  deficiencies. 
Then  give  the  patient  the  following  instruc- 
tions: Lead  as  sane  and  normal  a life  as 
possible,  refrain  from  mental  and  phy.sical 
overwork  and  worry;  observe  regular  hours 
of  sleeping  and  eating;  breathe  fresh  pure  air 
day  and  night;  bathe  the  whole  body  regu- 
larly, always  an  hour  before  taking  food, 
with  warm  water  followed  by  a cool  douche; 
cleanse  the  teeth  with  castile  soap,  brush, 
and  warm  water,  before  meals,  or  before 
breakfast;  keep  the  bowels  regular;  take 
daily  exercise  in  the  open  air,  preferably  in 
the  form  of  some  agreeable  manual  employ- 
ment, such  as  gardening;  eat  light  and  sim- 
ple, but  nutritious  food,  chiefly  vegetables, 
with  a glass  of  water  at  least  a half  hour 
before  each  meal;  do  not  work  or  bathe 
immediately  before  or  after  eating;  do  not 
10 


eat  before  retiring;  abstain  from  alcohol, 
tea,  coffee,  and  tobacco.  In  other  words, 
forcibly  impress  upon  him,  if  you  will,  that 
it  seems  quite  evident  that  his  affliction  is 
primarily  an  inherited  or  acquired  nervous 
instability,  and  that  he  should  emleavor, 
with  unyielding  purpose  and  cheerful  indiffer- 
ence as  to  results,  to  earn  the  great  credit  of 
overcoming  or  of  rishig  above  this  hanilicap 
by  a rigid  adherence  to  correct  living. 

I do  not  advocate  the  routine  administra- 
tion of  bromides  in  all  cases.  Where  an 
epileptic  has  but  one  fit  a month,  it  is 
obviously  irrational  to  keep  his  nervous 
system  continuously  depressed  for  the  pur- 
pose of  preventing  this  occasional  seizure. 
Where  the  seizure  can  be  foretold,  then  a 
dose  of  20  to  30  grs.  of  socUum  or  potassium 
bromitle,  well  tliluted  and  administered  one 
or  two  hours  before  the  expected  fit,  may 
be  of  real  service. 

Those  who  advocate  the  bromide  treat- 
ment give  it  continuously,  and  for  two  or 
three  years  after  the  fits  have  ceased.  It 
shoukl  be  withdrawn  extremely  gradually, 
otherwise  there  is  great  danger  of  the  occur- 
ence of  status  ejjilepticus.  Begin  with  gr.  v 
of  sodium  bromide,  t.i.d.,  well  diluted  in 
water,  milk,  or  best  an  alkaline  carbonated 
water,  and  increase  the  dose  to  10  to  15  to 
30  grains,  t.i.d.  (no  more  than  30  gra.). 

Sodii  broniidi 3v  (gr.  v per  teaspoonful) 

Aquse Sviii 

M.  Sig. — One  teaspoonful  (up  to  six  teaspoon- 
fuls), well  diluted,  t.i.d. 

Bromism  should  be  avoided.  Its  symp- 
toms are  mental  torpor,  dyspepsia,  and 
acne.  Aisenic,  in  the  form  of  Fowler’s  solu- 
tion, gtt.  ii-vi,  well  diluted,  twice  a day, 
after  meals,  may  be  used  both  as  a tonic 
and  to  lessen  the  tendency  to  bromide  rash. 
Belladonna,  TTpiirtvii  of  the  tincture,  t.i.d., 
is  recommended  as  an  adjuvant  to  the 
bromides.  Restrict  salt  m the  food  while 
achnin  ister ing  bromides . 

Luminal  {q.v.)  is  recently  highly  praised. 

For  epilepsj^  associated  with  menstrua- 
tion, prescribe  thyroid  extract  (see  Part  11) 
ill  the  intermen.strual  period  or  for  two  weeks 
preceding  menstruation. 

For  serial  convulsions,  give  chloral,  gr. 
xlv,  well  diluti'd,  per  rectum,  with  or  with- 
out sodium  bromide,  gr.  xxx-xlv,  and  repeat 
the  dose  after  two  hours,  if  necessary. 
Hyoscine  hydrobromate  is  also  of  service, 
SI’-  Hoo  }io  hypodermically.  Sustain 
the  heart.,  control  the  fever  by  means  of 
cool  sponging,  wet  packs,  and  an  ice-bag  to 
the  head,  and  feed  the  patient  per  rectum 
(see  Rectal  Feeding). 


EXOPHTHALMIC  GOITRE  ; HYPERTHYROIDISM 


Owing  to  the  common  mental  deficiency 
of  the  epileptic,  and  also  for  humane  and 
economic  reasons  with  many  intelligent 
patients,  institutional  care  and  treatment  is 
often  desirable. 

Epiphysitis. — Gr.  ext  upon  + 4>ueiv  to  grow 
+ -ms  inflammation.  See  Osteomyelitis. 

Epistaxis.- — Gr.  iTrLara^is  nosebleed.  See 
Nose  Diseases,  Part  8. 

Epulis. — Gr.  iirL  on  -p  ouXof  gum.  A gen- 
eral term  applied  to  various  soft  tumors 
(sarcoma,  fibroma,  granuloma,  angioma) 
arising  in  the  mouth  from  the  jawbone 
or  gmn. 

Equinia. — L.  equus,  horse.  See  Skin 
Diseases,  Part  5. 

Eructations,  Acid. — L.  eructdre,  to  belch. 
See  Hyperacidity. 

Eructations,  Nervous;  Eructatio  Nervosa. 

— The  noisy  belching  of  swallowed  air. 

Etiology.— Overwork;  worry;  neurasthenia; 
hysteria;  gastritis;  gastroptosis;  reflex  influ- 
ences from  the  genito-urinary  system,  intes- 
tines, heart,  etc.  See  Dyspepsia,  Nervous. 

Treatment.— Attend  to  the  cause.  The 
bromides,  valerian,  and  belladonna  may  be 
of  service  (see  Part  11).  Penzoldt  advises 
breathing  through  the  open  mouth  for  one- 
half  hour  two  or  three  times  a day;  a cork 
may  be  placed  between  the  teeth  (Mathieu). 
Try  sharp  pressure  against  the  epigastrium 
(Cohnheim).  Ortner  praises  sulphur  iodid, 
gr.  M to  1 }/2)  in  capsules,  after  meals,  for 
hysterical  eructations. 

Erysipelas. — Gr.  tpvdpSs  red  xeXXa  skin. 
See  Skin  Deseases,  part  5. 

Erythraemia. — See  Polycythremia  Vera. 

Erythromelalgia. — Gr.  ^pvdpos  red  + peXos 
limb  + d'Xyos  pain.  See  Skin  Diseases, 
Part  5. 

Esophagus. — See  CEsophagus. 

Exophthalmic  Goitre;  Hyperthyroidism. — 

Gr.  out  -f-  64>6a\p6s  eye;  F.  goitre;  Gr. 
virep  over.  A usually  chronic  affection, 
occurring  mostly  in  women,  characterized 
by  tachycardia,  palpitations,  shortness  of 
breath,  forcible  throbbing  of  the  arteries, 
flushings,  usually  increased  perspiration, 
nervousness,  irritability,  insomnia,  a fine 
tremor,  muscular  weakness,  usually  some 
enlargement  of  the  thyroid  gland,  usually 
exophthalmos,  anajmia,  emaciation,  and 
often  attacks  of  diarrhoea  with  or  without 
vomiting. 

Spontaneous  remissions  and  intermissions 
occur,  and  the  patient  may  live  many  years. 
Dock  says,  “ About  30  per  cent,  recover 
almost  completely.”  Forchheimer,  Mayo, 
and  Kocher  affirm  that  70  to  90  per  cent,  of 
all  cases  are  cured  by  medical  treatment. 


Mental  and  physical  rest,  and  suggestion, 
such  as  prescribing  a medicine  and  declaring 
that  it  will  cure,  may  even  effect  a cure. 

Etiology. — Provocative  causes  are  emo- 
tional shock,  nervous  strain,  worry,  over- 
exertion, and  acute  or  chronic  infections. 

Treatment. — Mental  and  physical  rest  are 
of  the  very  first  importance;  at  first  rest  in 
bed,  and  later,  as  improvement  occurs,  very 
moderate  exercise.  In  very  nervous  cases 
with  a bad  heart,  the  rest  must  be  absolute; 
the  Weir  Mitchell  treatment  being  here 
indicated  (see  Neurasthenia).  There  should 
be  plenty  of  fresh  air  day  and  night.  The 
diet  should  be  plain,  bland,  and  wholesome; 
no  condiments,  spices,  tea,  coffee,  chocolate, 
alcohol,  or  tobacco. 

To  quiet  the  heart,  apply  the  ice-bag 
intermittently,  and  administer,  if  necessary, 
tincture  of  strophanthus,  or  fluid  extract  of 
veratrum  viride,  or  tincture  of  aconite  (for 
drugs  see  Part  11).  The  latter,  says  Croftan, 
is  the  “best  remedy  for  palpitation  and 
tachycardia  ” ; with  care  it  may  be  continued 
indefinitely.  It  is  also  well  recommended 
by  Sequin. 

Where  the  nervous  symptoms  are  marked, 
one  may  prescribe  sodium  bromide,  or  cam- 
phor monobromate,  or  zinc  valerianate.  For 
insomnia  employ  the  warm  bath  and  perhaps 
a hot  drink  at  bedtime,  with  perhaps  a single 
large  dose  of  sodium  bromide  (see  also 
Insomnia).  For  great  cerebral  excitement 
give  hyoscine  hydrobromide,  gr.  Hoo>  hjqjo- 
dermically,  together  with  sodium  bromide 
or  valerian. 

For  gastro-intestinal  disturbances  pre- 
scribe sodium  phosphate  and  restricted  diet, 
followed,  if  required,  by  bismuth.  Give 
no  morphine. 

For  ana?mia  prescribe  iron  and  arsenic 
(see  Ana?mia). 

Search  for  and  eradicate  any  possible 
source  of  infection  or  intoxication  (in  the 
pelvis,  gastro-intestinal  tract,  gall-bladder, 
appendix,  mouth,  throat,  tonsils,  nose, 
sinuses,  ears,  joints,  etc.). 

The  following  measures  are  well  recom- 
mended for  curative  purposes: 

1.  Sodium  phosphate,  5ss-i,  in  aqueous 
solution,  two  or  three  times  a day. 

2.  Belladonna. 

3.  Quinine  hydrobromate  (vasoconstric- 
tor), gr.  V in  gelatin-coated  pills,  four  times 
a dajq  If,  after  48  hours,  the  tachycardia 
does  not  disappear,  add  to  each  pill,  ergotin, 
gr.  i.  Continue  this  medication  daily  until 
all  symptoms  have  disappeared.  It  may 
be  continued  for  years  without  harm. 
Forchheimer  has  employed  this  mode  of 


FACIAL  PARALYSIS;  BELL’S  PALSY 


treatment  for  over  twenty-five  years,  with 
almost  uniform  success.  He  says,  “ If  symp- 
toms do  not  return  in  two  weeks  after  the 
withdrawal  of  the  qiurfine  the  patient  may 
be  considered  cured.” 

4.  Galvanism  (see  Medical  Electricity)  the 
anode  placed  at  the  sternal  notch  and  the 
cathode  at  the  angle  of  the  jaw,  no  more  than 
three  milliamperes  for  three  to  five  minutes 
daily,  “often  acts  favorably  by  diminishing 
the  vascularity.”  (Kocher.) 

5.  Rontgentherapy  (q.v.).  “The  entire 
area  is  covered  with  a chamois  skin  to  pro- 
tect from  the  secondary  rays  given  out  by  the 
filters.  Over  this  a heavy  lead  protector, 
3 mm.  thick,  is  placed  with  a hole  cut  in  it 
large  enough  to  allow  the  tumor  to  be  pal- 
pated and  located.  Brass  discs  inches 
thick  surmounted  by  an  aluminum  filter 
1 mm.  thick,  are  placed  on  this  plate  and  as 
the  filter  is  1 inch  below  the  wall  of  a 7-inch 
tube,  there  is  a distance  of  5 inches  from  the 
wall  and  inches  from  the  anode  to  the 
patient.  Between  three  and  four  points 
on  Hampson’s  radiometer  are  given  with  a 
moderately  soft  tube  to  avoid  too  great  pene- 
tration. From  four  to  six  exposures  are 
usually  required  to  show  marked  improve- 
ment.”— Simpson.  From  six  weeks  to  sLx 
months  treatment  is  required  (Sielmann). 
Knox  advocates  one-third  pastille  dose, 
estimated  by  the  use  of  a Lovibond  tinto- 
meter, through  3 mm.  of  ahuninum  and  one 
or  more  layers  of  chamois  leather  or  loofah 
sponge  to  protect  the  skin  from  the  second- 
ary rays  given  out  by  the  filter,  three  times  a 
week  for  a long  period.  The  dose  is  given  to 
three  areas,  right  side  of  thyroid,  left  side, 
and  centre  of  the  root  of  the  neck  to  include 
the  thymus  gland. 

Pancoast  advises  a full  dose  of  20-X  units 
through  3 mm.  of  aluminum  and  leather  to 
each  lobe,  exposing  only  a part  of  the  lobe 
every  few  days,  with  cross-firing  if  the  gland 
is  large,  together  with  treatment  of  the 
thymus  in  the  same  way,  the  series  of  expos- 
ures to  be  repeated  several  times  every  three 
or  four  weeks,  according  to  the  .symptoms 
of  hyperthyroidism. 

6.  Radium  Therapy  (g.t^.).  Says  Knox: 
“Using  100  mgrms.  with  3 mm.  of  lead  filter, 
twelve  hours  to  each  side  of  the  enlarged 
thyroid  gland  should  suffice  to  produce 
marked  improvement.  The  exposures  may 
be  repeated  in  from  three  to  four  weeks. 
Several  exposures  at  long  intervals  should 
be  given  after  the  symptoms  have  improved. 

7.  “ Early  operation  ” (partial  thyroi- 
dectomy), says  Kocher,  “ is  the  best  treat- 
ment of  thyrotoxicosis.”  “ The  operation 


is  indicated  in  all  cases  that  do  not  present 
degeneration  [of  the  heart-muscle  with 
irregular  pulse,  low  blood-pressure  ($.t^.),  or 
periodical  attacks  of  delirium  cordis.”  In 
any  severe  case  it  is  advisable  to  perform  one 
or  two  preliminary  ligations  of  the  superior 
thyroid  artery,”  under  local  anjEsthesia  (see 
Part  11:  cocaine  or  novocaine).  The  danger 
in  operating  is  from  heart-failure,  and  this 
danger  increases  with  the  duration  of  the 
disease.  Therefore,  before  operating,  the  heart 
should  be  strengthened  by  rest,  the  applica- 
tion of  the  ice-bag,  and  tonics,  etc.  Dock 
says:  “ C.  H.  Mayo  does  not  operate  if  the 
pulse  is  above  130,  or  varying  in  force  and  fre- 
quency, or  if  there  is  anamia  or  oedema.  In 
such  cases  he  has  treatment  with  X-rays  and 
belladoima  carried  out.”  Adrenahn  com- 
presses over  the  thyroid  are  recommended. 

External  Cutaneous  Nerve. — See  Meral- 
gia  ParjEsthetica. 

Popliteal  Nerve. — See  Sacral  Plexus. 

Extrasystole. — See  Arrhythmia,  Cardiac. 

Eyeball,  Motor  Nerves  of  the.— ^ee  Motor 
Nerves  of  the  Eyeball. 

Eyelids,  CEdema  of  the. — See  Skin  Dis- 
eases, Part  5. 

Facial  Hemiatrophy. — L.  facies,  face;  Gr. 
r}/xL  half  + a.Tpo4>La  atrophy.  A rare  incur- 
able affection,  characterized  by  atrophy  of 
all  the  tissues  of  one  side  of  the  face,  and 
doubtless  due  to  disease  of  the  fifth  nerve. 

Other  causes  of  facial  asymmetry  are 
congenital  wryneck,  anterior  poliomyelitis, 
hemiplegia,  lesions  of  the  Gasserian  ganglion, 
sympathetic  nerve  paralysis,  scleroderma, 
and  facial  hemihypertrophy.  (Osier.) 

Treatment. — A plate  may  be  fastened  to  the 
teeth,  in  order  to  round  out  the  affected  side. 

Facial  Nerve. — See  Facial  Paralysis,  and 
Habit  Spasm. 

Neuralgia. — See  Neuralgia. 

Facial  Paralysis;  Bell’s  Palsy. — Paralysis 
of  the  facial  nerve  is  usually  due  to  exposure 
to  cold  or  draughts,  and  is  then  of  sudden 
onset,  with  herpes  often  associated  with  it. 
The  prognosis  is  usually  good.  Recovery 
occurs  in  one  or  more  weeks  or  months,  even 
up  to  fifteen  months,  or  else  the  paralysis 
is  permanent. 

Test  the  facial  muscles  by  getting  the 
patient  to  laugh,  wrinkle  the  forehead 
horizontally  and  vertically,  whistle,  and 
close  the  eyes  tightly. 

The  location  of  the  lesion  may  be  ascer- 
tained as  follows: 

1.  Below  the  stylomastoid  foramen;  taste 
not  affected. 

2.  Stylomastoid  foramen  to  geniculate 
ganglion  within  the  Fallopian  canal;  loss 


FEBRICULA 


of  taste  in  the  anterior  two-thirds  of 
the  tonj^ue. 

3.  Geniculate  ganglion  to  pons:  no  loss 
of  taste;  often  deafness. 

4.  Within  the  pons:  no  loss  of  taste  or 
hearing;  other  nerve  lesions,  particularly  of 
the  sixth  or  abducens  nerve. 

5.  Above  the  pons:  no  changes  in  the 
nerve  or  muscle  electrical  reactions;  upper 
branch  of  the  nerve  supplying  the  orbicu- 
laris pali:)ebraruni,  frontalis,  and  corrugator 
muscles  much  less  involved  than  the  two 
lower  branches;  usually  hemiplegia. 

Etiology. — Exposure  to  cokl  or  draughts; 
otitis  media;  caries  of  the  petrous  bone; 
diphtheria;  anterior  poliomyelitis;  multiple 
neuritis;  traumatism  (l>asal  fracture,  com- 
pression of  the  head  during  parturition, 
mastoid  operation);  basal  meningitis;  affec- 
tions of  the  medulla,  jxjns,  or  higher  struc- 
tures (neoplasms,  abscess,  softening);  tabes; 
puerperium;  emotional  shock;  parotid  gland 
disease;  govit;  diabetes;  leuka'inia;  syphilis. 

Treatment. — During  the  first  day,  api:)ly  hot 
fomentations  or  hot  linseed  poultices  to  the 
mastoid  region,  and  open  the  bowels  thor- 
oughly by  means  of  castor  oil  or  calomel. 
On  subsequent  days,  apply  the  thermocau- 
tery lightly,  or  small  blisters  (see  Part  11: 
cantharides),  or  rub  in  the  following  oint- 


ment : 

B Potassii  iodidi 3ss 

lodi  piiri gr.  iii 

Adipis  lame  hydros!, 

Petrolati  mollis,  aa 5ss 


Sodium  salicylate  or  aspirin  is  recom- 
mended in  the  early  stages.  Potassium,  gr. 
X,  t.i.d.,  is  also  commonly  used  (for  drugs 
see  Part  11).  Syphilitic  cases  call,  of  course, 
for  specific  medication.  Bandage  the  eye  in 
order  to  prevent  conjunctivitis  ami  keratitis 
e lagophthalmo. 

After  the  lapse  of  ten  or  fourteen  days,  or 
when  the  acute  inflammatory  process  has 
altogether  subsided,  employ  galvanism — not 
more  than  3 to  4 to  5 milliamperes  for  five 
to  ten  minutes  at  intervals  of  one  or  two 
days;  the  positive  pole  being  jilaced  behind 
the  ear  or  over  the  sternum,  while  the  nega- 
tive pole  is  used  to  stroke  the  muscles.  Sub- 
stitute faradism  as  the  faradic  irritability 
returns.  More  useful  still  than  electricity 
to  maintain  the  nutrition  of  the  muscles 
until  the  nerve  regenerates  is  massage, 
manual  or  vibratory.  Voluntary  muscle 
exercises  are  also  to  be  employed.  Strych- 
nine, gr.  gradually  increased  to  gr.  }4o, 
t.i.d.,  may  be  given  after  the  secoml  week. 

Much  improvement  is  not  to  be  exj^ected 
before  the  fourth  month.  If  none  has 


occurred  at  the  end  of  six  months,  it  prob- 
ably will  not  occur  at  all. 

In  incurable  cases  one  may  consider  the 
transplantation  of  the  hypoglossal  nerve 
into  the  facial  nerve,  close  to  its  exit  from 
the  skull. 

Ionic  medication  (q-v.)  is  recommended 
for  facial  paralysis.  The  active  electrode  is 
applied  to  the  parotid  region  and  below 
and  behind  the  ear.  The  electrolytes  used 
are  quinine  hydrochlorate,  1 per  cent,  solu- 
tion, and  socUum  salicylate,  1 to  2 per 
cent,  solution.  The  quinine,  being  kath- 
ionic,  is  placed  at  the  anode;  the  salicylate, 
being  anionic,  at  the  kathode.  A gi'adually 
increasing  current  up  to  20  to  40  milli- 
amperes is  employed  for  thirty  minutes, 
thrice  or  twice  a week. 

Facial  Spasm. — See  Habit  Spasm. 

Fainting. — See  Coma. 

Family  Amaurotic  Idiocy. — See  Amaurotic 
Family  Idiocy. 

Family  Periodic  Paralysis. — A rare  famil- 
ial affection,  characterized  by  recurrent 
attacks  of  a flaccid  paralysis  involving  the 
muscles  of  the  triuik  and  extremities,  some- 
times other  muscles,  beginning  suddenly  and 
lasting  several  hours  or  days,  and  exliibitmg 
a tendency  to  amelioration  after  middle  life. 

Treatment. — Enjoin  the  avoidance  of  all 
possible  exciting  causes,  as  oveiavork,  over- 
feeding, exposure  to  cold,  etc.  Keep  the 
bowels,  skin,  and  kidneys  active.  Try 
potassium  citrate  in  full  doses  (Part  11), 
together  with  copious  water  drinking. 

Malaria  is  a cause  of  a non-familial 
periodic  paralysis. 

Family  Spastic  Paraplegia. — See  Spastic 
Paralysis. 

Famine  Fever. — See  Relapsing  Fever. 

Farcy. — See  Equinia  in  Skin  Diseases, 
Part  5. 

Fatty  Heart. — -See  Myocarditis,  and 

Obesity. 

Liver. — See  Liver  Enlargement. 

Stools. — See  Colorless  Stools. 

Febricula. — L.  a slight,  temporary'  fever. 
Febricula  or  ephemeral  fever  is  merely  a 
convenient  term  by  which  to  designate  a 
simple  acute  continued  fever  of  doubtful 
nature  but  of  good  prognosis,  which  lasts 
from  a day  to  several  weeks,  and  occui's 
chiefly  in  the  young.  Labial  herpes  is  com- 
monly associated  with  it  (febris  herpetica). 

Possible  causes  are  sudden  marked  changes 
of  temperature,  dietary  indiscretions,  gastro- 
intestinal disturbances,  sewer  gas  or  other 
noxious  vapors,  mental  excitement,  fatigue, 
and  abortive  or  larval  forms  of  the  acute 
infectious  diseases,  e.g.,  tonsillitis,  diphthei'ia. 


FEVER 


measles,  scarlet  fever,  malaria,  typhoid 
fever,  paratyphoid  or  paracolon  infection, 
central  pneumonia. 

Treatment. — Put  the  patient  to  bed  and 
clean  out  the  bowels  with  calomel  in  divided 
doses  followed  by  a saline  (see  Part  11). 

Prescribe  liquid  diet  and  water  in  abun- 
dance, preferably  in  the  form  of  cream  of 
tartar  lemonade  until  the  temperature  has 
returned  to  normal. 

For  a fever  of  103°  F.  and  over,  place  an 
ice-cap  to  the  head,  and  sponge  the  body, 
or  employ  the  cool  pack  or  grailually 
cooled  bath. 

Give  salol  or  aspirin  and  phenacetin  for 
pain  and  headache. 

A mild  fever  mixture  may  be  prescribed. 

Spiritus  SDtheris  nitrosi . . pii  (rciv  per  dose) 

Potassii  citratis 3 i (gr.  ii  per  dose) 

Liqiioris  aminonii  aceta- 

tis 5iss  (njjxxiv  per  dose) 

Syrupi  simplicis 

Aquaj  campliora;,  q.s.,  ad  5 iv 

M Sig. — A teaspoonful  every  three  hours. 

Fecal  Impaction. — L.  fasces,  feces;  im- 
pac'iio,  firmly  wedged.  See  Intestinal 
Obstruction. 

Feeding,  Infant. — See  Infant  Feeding. 

Rectal. — See  Rectal  Feeding. 

Feet,  Pain  in  the. — See  Pain. 

Felon;  Whitlow. — Subperiosteal  suppura- 
tion localized  m the  terminal  phalanx  of 
a finger. 

Make  an  immetliate  free  longitudinal 
incision,  somewhat  lateral  to  the  median 
line,  down  to  the  bone.  Do  not  wait  for 
fluctuation.  Sometimes  necrotic  bone  must 
be  removed. 

Pack  the  wound  lightly  with  dry  gauze 
or  gauze  soaked  in  hot  boric  acid  solution. 
Renew  the  dressing  every  day  or  less  often 
until  healing  occurs. 

Fetal  Rickets. — See  Achondroplasia. 

Fetid  Breath. — See  Breath,  Bad  or  Of- 
fensive. 

Bronchitis. — See  Fetid  or  Putrid 
Bronchitis. 

Stomatitis. — Sec  Stomatitis. 

Fetor  Oris. — See  Breath,  Bad  or  Offensive. 

Fever. — L.  fe'bris.  According  to  R.  C., 
Cabot,  90  per  cent,  of  long  continued  fevers 
lasting  two  weeks  or  longer,  occurring  in  the 
temperate  zone,  are  due  to  typhoid  fever, 
tuberculosis  (pulmonary,  renal,  etc.),  and 
pyogenic  sepsis  (puerperal  infection,  cervical 
laceration,  endocarditis,  erysipelas,  lym- 
phangitis, phlebitis,  phlegmonous  inflamma- 
tion, empyema,  dental  sepsis,  deep-seated 
abscesses:  hepatic,  cholecystic,  subphrenic. 


mediastinal,  renal,  perirenal,  appendicular, 
gastroduodenal,  genito-urinary,  ischio-rectal, 
etc.).  The  remaining  10  per  cent,  arc 
due  to  influenza,  infectious  arthritis,  rheu- 
matic fever,  acute  chorea,  syphilis, 
gonorrhoea,  cirrhosis,  meningitis,  trichinosis, 
leukaemia,  cancer. 

Long  continued  fevers  occurring  in  hot 
countries  include  malaria,  Indian  Kala-azar, 
Malta  fever,  and  typhus  fever. 

The  short  fevers  embrace  the  above 
named,  and  also  the  exanthemata,  chph- 
theria,  catarrhal  fever,  tonsillitis,  pharyn- 
gitis, mumps,  influenza,  plemisy,  bronchitis, 
pneumonia,  appendicitis,  salpingitis,  arthri- 
tis, sinusitis,  lymphangitis,  purpura,  relaps- 
ing fever,  yellow  fever,  herpes  zoster, 
miliary  fever,  milk  sickness,  erysipelas, 
poliomyelitis,  acute  diffuse  myelitis, 
acute  febrile  polyneuritis,  acute  gastro- 
enteritis, acute  pancreatitis,  anthrax, 
dengue,  hsemoglobinuria. 

Non-infectious  fevers  occur  in  gastro- 
intestinal disturbances,  brain  injuries  and 
diseases,  malignant  tumors,  cholelitliiasis, 
severe  anaemia,  leuka?mia,  Hodgkin’s  dis- 
ease, scurvy,  rickets,  belladonna  and  coal 
gas  poisoning,  movable  kidney,  uraemia, 
eclampsia,  hepatic  toxaemia,  coma  from  any 
cause  (see  Coma),  sunstroke,  gout,  exoph- 
thalmic goitre,  thyroid  extract  in  toxic 
doses,  hysteria,  nervousness,  fatigue,  starva- 
tion (as  in  the  inanition  or  starvation  fever 
of  infants).  (Chiefly  from  R.  C.  Cabot.) 

In  any  case  of  obscure  fever,  make  a 
searching  examination  for  some  focus  of  in- 
fection, not  omitting  the  rectum  and  vagina. 

Treatment  of  Fever  as  Such. — For  the  reduc- 
tion of  high  fever  (103°  F.  and  over)  the 
following  measures  are  appropriate: 

1.  Ice-cap  to  the  toj)  of  the  head. 

2.  Cold  siionging  of  the  body  with  water 
at  a temperature  of  about  80°  F.,  or  with 
equal  parts  of  water  and  alcohol,  or  water 
and  vinegar,  to  be  continued  for  from  ten 
to  twenty  minutes,  and  repeated  frequently. 

3.  The  cold  pack,  consisting  of  a sheet, 
wrung  from  water  at  a temperature  of  100° 
F.,  over  which  ice  is  rubbed,  a hot-water 
bottle  being  kept  to  the  feet,  if  necessary. 

4.  The  cold  bath,  at  a temperature  of 
100°  F.,  p-adually  lowered  to  about  80°  F., 
and  continued  for  from  five  to  ten  minutes. 

.5.  Fanning  the  body,  after  moistening  the 
skin  with  hot  water. 

G.  Rectal  irrigation  with  cool  water 
(70°  F.). 

The  Fever  Diet. — A Daily  Ration,  according 
to  Tibbies,  representing  about  2426  to 
2836  calories: 


FISH  POISONING 


Fresh  milk 3-4  pints 

Fresh  raw  eggs 2 

Well-cooked  fine  oatmeal ....  1 ounce 

Well-cooked  arrowroot 1 ounce 

Stale  bread 3 ounces 

Fresh  butter 1 ounce 

Sugar 2 J/2  ounces 

Barley  water 20  ounces 

Beef  tea 20  ounces 


Milk  may  be  boiled  or  peptonized  if  curds 
appear.  It  may  be  diluted  one-third  with 
barley,  lime,  or  soda-water.  Milk  puddings, 
custards,  jelly,  milk  toast,  junket,  are  appro- 
priate foods.  Water  is  usually  allowed  ad 
libitum,  often  in  the  form  of  cream  of  tartar 
lemonade  (Part  11). 

During  convalescence  add  gradually  to 
the  diet,  milk  puddings  containing  eggs, 
eggs  boiled  three  minutes,  well-cooked  cer- 
eals, vegetable  purees,  cauliflower,  squash, 
spinach,  potatoes,  tender  string  beans,  green 
peas,  steamed  fish  (whiting,  haddock,  sole, 
plaice,  cod),  boiled  meats,  oysters,  etc. 

Fibrillation,  Cardiac.— ^ee  Arrhythmia, 
Cardiac. 

Fibrinous  Bronchitis. — See  Bronchitis, 
Fibrinous. 

Pleurisy. — See  Pleurisy. 

Fibroid  Heart. — L.  fib'ra,  fibre;  Gr.  eidos 
form.  See  Myocarditis. 

Fibroid  Phthisis. — Gr.  4>91€lv  to 

consume.  See  Pulmonary  Cirrhosis. 

Fibrosis  of  the  Lung. — See  Pulmonary 
Cirrhosis. 

Fibrositis. — L.  fib'ra,  fibre  -f  -ins  inflamma- 
tion. See  Myalgia. 

Fifth  Nerve. — See  Trigeminal  Nerve. 

Filariasis. — L.  filamcn'tum,  fine  thread. 
Infection  with  the  filaria  sanguinis  hominis, 
a tropical  and  subtropical  menatode  worm, 
comprising  at  least  three  species,  the  filaria 
Bancrofti  or  nocturna,  the  filaria  loa  or 
diurna,  and  the  filaria  perstans. 

A.  Of  these  the  first  is  the  most  important. 
It  is  a cause  of  elephantiasis,  including 
lymph  scrotum  (see  Part  5,  Skin  Diseases), 
and  of  chylothorax  (q.v.),  chylous  ascites 
iq.v.),  chylous  diarrhoea,  lymphatic  varices, 
chylocele  (see  Hydrocele,  in  Male  Genito- 
urinary Diseases,  Part  3),  orchitis,  abscess, 
and  hemato-chyluria  (see  Chyluria).  The 
symptoms  in  all  these  affections  are  due  to 
obstruction  of  the  lymphatics  by  the  embiyo 
worms,  ova,  or  adult  worms.  The  embryos 
are  also  found  in  the  peripheral  blood,  in 
greatest  numbers  at  night  or  diuing  sleep 
(they  reach  the  general  circulation  only 
through  the  thoracic  duct).  They  may  be 
found,  possibly,  in  the  urine  and  chylous 
accumulations. 

The  disease  is  transmitted  by  the  mos- 


quito, both  the  culex  and  anopheles  varieties. 
(Fig.  39.) 

To  make  a fresh  blood  examination,  punc- 
ture the  ear,  and  wipe  away  the  first  few 
drops  of  blood.  To  the  top  of  a drop  of 
blood  about  the  size  of  a large  pinhead, 
touch  the  centre  of  a perfectly  clean  cover- 
glass  held  with  pinch-forceps,  and  drop  the 
cover  on  to  a previously  warmed  slide.  Do 
not  press.  For  the  technique  of  preparing 
and  staining  smears,  see  Blood  Examination. 


© 


Fia.  39. — Filaria  bancrofti;  Webster's  Diagnostic  Methods, 
P.  Blakiston  Son  & Co. 

Treatment.— This  is  considered  under  Ele- 
phantiasis(  Skin  Diseases,  Part  5),  Chyluria, 
Ascites,  Chylothorax,  and  Hydrocele  (Male 
Genito-Urinary  Diseases,  Part  3). 

Prophylaxis  embraces  boiling  the  drink- 
ing water  and  protection  against  mosquitoes. 

B.  The  filaria  loa  occurs  chiefly  on  the  west 
coast  of  Africa.  Its  larva  is  like  that  of  the 
filaria  Bancrofti;  but  it  is  found  in  the  blood 
in  the  dajdime.  It  is  transmitted  by  biting 
flies  of  the  genus  chrj'sops.  The  adult  worm 
travels  abhut  in  the  connective  tissue  all  over 
the  body,  producing  wandering  swellings  or 
irritation  (in  the  eyelid,  conjimctiva,  nose, 
fingers,  penis,  etc.). 

To  remove  the  worm,  grasp  the  tissues 
with  forceps  and  incise  down  to  the  worm; 
or  inject  bichloride  of  mercmy,  1 : 1000 
(M?  gX-  of  bichloride  in  1 c.c.). 

Schultz  recommends  collargol,  1 per  cent., 
a dessertspoonful  t.i.d.  for  over  a year;  for 
subconjunctival  filariae,a  few  drops  instilled 
into  the  eye. 

First  Nerve. — See  Olfactory  Affections. 

Fish  Poisoning. — See  Poisoning. 


FISTULA  IN  ANO 


Fissure  in  Ano. — This  painful  condition 
is  commonly  the  result  of  scratching  of  the 
anal  mucous  membrane  by  hard  scybala. 

Treatment.— There  are  three  methods  of 
treatment,  but  the  two  operative  methods 
are  the  quickest  and  surest.  Some  (Abbe) 
favor  divulsion  of  the  sphincter  ani;  others 
(Gant,  Earle)  favor  cUvision  of  this  muscle. 

1.  Non-operative  Treatment. — Keep 
the  parts  clean  with  castile  soap  and  warm 
water,  followed  by  warm  boric  acid  solution. 
For  pain,  employ  hot  applications,  or  inject 
hot  oil,  or  insert  a suppository  containing 
Morphine,  gr.  % ; or  cocaine,  gr.  ss-i;  or 
eucaine,  gr.  3"^-i;  or  powdered  stramonium; 
or  extract  of  belladonna,  gr.  to 


Morphinae  sulphatis gr.  hf 

Extract!  belladonna) gr.  ss 

Adipis  lana)  hydros! 3! 


M.  S!g. — Apply  after  each  movement,  by  means  of 
a pile  ointment  pipe,  and  repeat  if  necessary.  (Gant.) 


Hydrar^r!  chlorid!  mitls, 

Extract!  belladonnie,  aa 3! 

Unguent!  stramon!!,  q.s.,  ad §! 


M.  S!g. — Apply  by  means  of  a pile  pipe  as  often 
as  required.  (Gant.) 

Keep  the  stools  soft  by  means  of  a nightly 
mild  pill  of  cascara  sagrada  or  aloin,  aided, 
if  necessary,  by  ohve  oil,  or  liquid  paraffin 
by  mouth,  once  or  twice  daily  (see  Part  11 
for  drugs). 

Twice  or  thrice  weekly  anaesthetize  the 
fissure  by  the  local  apphcation  of  cocaine, 
4 per  cent.,  or  eucaine,  6 per  cent.,  ancl 
apply  on  gauze,  which  is  to  be  left  in  place, 
silver  nitrate,  gr.  xx  to  the  ounce,  or  ich- 
thyol,  20  per  cent,  or  pure,  or  balsam  of 
Peru.  Cohnheim  has  ichthyol  apphed  on  a 
cotton-woimd  applicator  twice  a day.  The 
anal  canal  may  be  dilated  by  the  greased 
finger  of  the  patient  for  fifteen  minutes 
morning  and  night.  (Chiefly  from  Gant.) 

Ionic  mechcation  (q.v.)  is  recommended. 
Use  a zinc  rod  wrapped  with  hnt  soaked  m 
zinc  chloride  solution.  Employ  15  milham- 
pieres  for  twelve  minutes,  and  repeat  at  the 
end  of  a week. 

2.  Divuesion  of  the  Sphincter  Ani. — 
Under  general  ether  anaesthesia,  dilate  the 
anus,  using  first  one  finger,  then  two  fingers, 
then  both  thmnbs,  and  gently  stretch  the 
sphincter  until  the  thumbs  press  upon 
the  tubera  ischii  on  each  side.  The  base 
of  the  ulcer  may  be  cauterized.  Then  insert 
an  opium  suppository  containing  extractum 
opii,  gr.  ss. 

3.  Division  of  the  Sphincter  Ani. — 
First  anaesthetize  the  tissues  by  means  of 
the  local  apphcation  of  cocaine,  4 per  cent.. 


and  the  hypodermic  injection  of  eucaine, 
per  cent.,  or  cocaine  0.1  per  cent.,  or 
sterile  water.  Gant  injects  the  anaesthetic 
beneath  the  skin  at  a point  one-half  an 
inch  directly  behind  the  posterior  anal  com- 
missure, and  then  pushes  the  needle  forward 
and  injects  the  sphincter  muscle  and  lower 
posterior  rectum.  He  then  inserts  the 
sharp-pointed  blade  of  a pair  of  scissors 
through  the  skin  and  tissues  posterior  to 
the  external  spliincter  for  a distance  of  one 
inch,  while  the  probeqxiinted  blade  of  the 
scissors  is  inserted  into  the  rectmn  for  the 
same  distance.  With  one  cut  the  skin 
and  external  sphincter  are  then  divided. 
The  resulting  triangular-shaped  wound  is 
drained  by  a small  piece  of  gauze  until 
it  heals.  (Gant.) 

Fistula  in  Ano. — L.  fistula,  a pipe;  anus, 
anus.  Fistula  in  ano  is  the  sequel  of  an 
abscess  situated  about  the  rectum  or  anus. 
It  is  often  tuberculous. 

Treatment. — Before  operating  for  fistula, 
open  the  bowels  thoroughly  for  three  days. 
For  from  five  to  ten  days  after  the  opera- 
tion, keep  the  bowels  completely  consti- 
pated by  means  of  an  occasional  opiate  and 
light  diet  consisting  of  broth,  eggs,  some 
meat,  and  very  little  bread. 

A.  Complete  or  Externo=internal  Fistula. — First 
dilate  the  sphincter  ani  as  described  above 
under  Fissure  in  Ano.  Then,  with  the 
index  finger  in  the  rectum,  pass  a grooved 
director  through  the  outer  opening  of  the 
fistula  into  the  bowel,  and  hook  up  the  end 
of  the  director  with  the  finger  m the  rectum 
and  bring  it  outside  and  across  the  anus. 
Then  divide  aU  the  overlying  tissues,  at 
right-angles  to  the  external  sphincter  muscle, 
with  a sharp-pointed  curved  bistoury.  If 
the  tract  of  the  fistula  runs  obliquely  in 
reference  to  the  external  sphincter  muscle, 
first  divide  the  tissues  overlying  the  external 
portion  of  the  tract  down  to  the  margin  of 
the  external  sphincter,  then  change  the 
course  of  the  director  to  a right  angle  with 
the  sphincter  muscle,  and  then  divide  the 
latter.  Instead  of  the  director,  one  may 
use  probe-pointed  scissors.  All  lateral  or 
tributary  tracts  should  be  opened.  Granu- 
lations should  be  gently  curetted  away, 
taking  care  not  to  penetrate  the  delimiting 
fibrous  wall  of  the  tract,  and  the  wound 
then  cauterized  and  packed  with  gauze. 

The  operation  may  sometimes  be  done 
under  local  anaesthesia,  using  per  cent, 
eucaine,  but  general  anaesthesia  is,  no  doubt, 
usually  preferable. 

B.  Blind  Internal  Fistula. — Pass  a director  into 
the  opening  of  the  fistula,  and  then  upward 


FOOD  VALUES 


or  downward  beneath  the  mucosa,  according 
to  the  direction  of  the  sinus,  until  the  end 
of  the  sinus  is  reached.  Then  sever  the 
overlying  mucous  membrane.  Where  the 
sinus  is  directed  downward  from  its  internal 
opening,  and  under  the  sphmeter  or  skin, 
use  Gant’s  angular  director,  and  draw  it 
downward  through  the  sinus  until  it  causes 
the  skin  to  bulge.  Bring  this  lower  end  of 
the  director  out  tlrrough  the  skin  by  means 
of  a small  incision  in  the  latter,  and  then 
hook  the  upper  end  out  of  the  rectum  by 
means  of  the  finger,  and  sever  the  over- 
lying  tissues  as  in  the  operation  for 
complete  fistula. 

The  sphincter  ani  should  be  cut  at  a right 
angle  to  the  course  of  its  fibres,  and  the  skin 
and  mucous  membrane  should  be  prevented 
from  growing  into  the  gutter-like  wound  by 
packing  the  latter  with  a little  strip  of  iodo- 
form gauze  for  a week.  Insert  the  dress- 
ings lightly  and  change  as  soon  as  they 
become  soaked. 

Should  both  sphincters  be  cut,  a per- 
manent incontinence  is  apt  to  follow,  requir- 
ing a tlifficult  plastic  operation. 

Excision  of  the  fistulous  tract  is  sometimes, 
but  rarely,  the  oi^eration  of  choice. 
(From  Gant.) 

Tuberculous  fistulae  should  be  cauterized 


Fits. — See  Convulsions. 

Flat=Foot. — See  Orthopaidics,  Part  10. 

Flatulence. — L.  flatulentia,  distention  with 
gas.  (See  Tympanites.) 

Floating  Kidney. — See  Enteroptosis. 

Fluke=Worm  Disease. — See  Distomiasis. 

Follicular  Stomatitis. — See  Stomatitis. 

Fontanels. — Fr.  fontanelle,  a little  foun- 
tain. The  larger  anterior  fontanel  closes 
about  the  twentieth  month;  the  posterior 
about  the  sixth  week. 

Causes  of  Delayed  Closure  of  Fontanels  and 
Sutures. — Rickets,  hydrocephalus;  hereefitary 
syphilis;  cretinism. 

Causes  of  Bulging  Fontanels. — Increased  in- 
tracranial pressure  (hemorrhage,  meningitis, 
hydrocephalus,  any  acute  febrile  disease  not 
accompanied  by  dyspnoea). 

Causes  of  Depressed  Fontanels. — Severe  diar- 
rhoea; wasting  diseases;  collapse;  acute 
dyspnoea.  (R.  C.  Cabot.) 

Food  Poisoning. — See  Poisoning. 

Food  Values. — One  gram  of  protein  yields 
on  combustion  4.1  calories;  one  gram  of 
carbohydrate  yields  4.1  calories;  one  gram  of 
fat  yields  9.3  calories;  and  one  gram  of 
alcohol  yields  7 calories.  A calorie  repre- 
sents the  amount  of  heat  required  to  raise 
the  temperature  of  one  kilogram  of  water 
one  degree  Centigrade. 


THE  CALORIC  REQUIREMENTS  DURING  T\\T2NTY-FOUR  HOURS 


Age 

Weight 
kg.  lbs. 

Calories  per 
kilogram, 
body  weight 

Calories  per 
pound,  body 
weight 

Total  calories 

Two  years 

12 

20 

80 

36 

960 

Six  years 

20 

44 

70 

31 

1400 

Twelve  years 

36 

80 

50 

23 

1800 

Adult  at  rest 

70 

154 

25-30 

11-14 

1750-2100 

Adult  at  light  work 

70 

154 

35-40 

16-18 

24.50-2800 

Adult  at  moderate  work 

70 

1.54 

40-45 

18-20 

2800-3150 

Adult  at  hard  woi'k 

70 

1.54 

4.5-60 

20-27 

31.50-4200 

with  the  thernro-cautcry  after  the  tract  has 
been  laid  open. 

Ionic  medication  has  its  advocates. 
Use  a zinc  positive  electrode  with  its 
point  insulated  by  a covering  of  melted 
wax.  Employ  a current  of  about  3 milli- 
amperes,  for  three  minutes  every  four  days. 

Fistula,  Salivary. — See  Salivary  Fistula. 


In  old  ago  less  calories  are  required. 

At  moderate  physical  work  the  average 
man  of  154  pounds  consumes  per  day  about 
100  grams  of  protein,  100  grams  of  fat,  and 
400  grams  of  carbohydrate,  or  2900  calories; 
but  smaller  amounts  are  usually  sufficient, 
e.g.,  70  grams  of  protein,  100  grams  of  fat,  and 
300  grams  of  carbohydrate,  or  2400  calories. 


DISEASED  MEATS. 


BEEF-FROIVl  AN  AN  IIMAL  WITH  FEVER 


PSOROSPERMIASIS-  PORK- 


MEASLES  IN  PORK 


ginning  vesicle 
Completely  developed 

APHTHOUS  vesicle 

Vesicle  intact  ) 

* ^ Ulcerated  vesicles 

(Vesicles  ruptured  i 
Vesicles  in  the . . . _ . 


APHTHOUS 

FEVER 

ulcerated 
I Vesicles ruplured  i 


LAROUSSE  MEDICAL 


Diseased  Meats 


FOOD  VALUES 


WEIGHT  TABLE  (Male) 


(Showing  average  weight  for  each  height  and  age.  Based  on  “Nylic  Graphic  Table.’*  Correct  to  one  pound.) 


Age 

57 

Ins. 

58 

Ins. 

59 

Ins. 

00 

Ins. 

61 

Ins. 

62 

Ins. 

6.3 

Ins. 

04 

Ins. 

65 

Ins. 

GO 

Ins. 

07 

Ins. 

08 

Ins. 

69 

Ins. 

70 

Ins. 

71 

Ins. 

72 

Ins. 

73 

Ins. 

20 

104 

108 

Ill 

114 

117 

121 

125 

128 

132 

136 

140 

144 

149 

153 

158 

163 

167 

21 

105 

108 

111 

115 

118 

122 

125 

129 

133 

137 

141 

145 

150 

154 

159 

164 

168 

22 

106 

109 

112 

116 

119 

123 

126 

130 

134 

138 

142 

146 

151 

155 

160 

165 

169 

23 

105 

109 

113 

116 

119 

123 

127 

130 

135 

138 

143 

147 

152 

156 

161 

166 

170 

24 

107 

no 

114 

117 

120 

124 

128 

131 

136 

139 

144 

148 

153 

157 

162 

167 

171 

25 

108 

111 

114 

118 

121 

125 

128 

132 

136 

140 

144 

149 

154 

158 

163 

168 

172 

26 

108 

111 

115 

118 

122 

126 

129 

133 

137 

141 

145 

150 

154 

159 

164 

169 

173 

27 

109 

112 

116 

119 

122 

127 

130 

134 

138 

142 

146 

150 

155 

160 

165 

170 

174 

28 

109 

112 

116 

120 

123 

127 

130 

134 

138 

142 

147 

151 

156 

161 

166 

170 

175 

29 

no 

113 

117 

120 

124 

127 

131 

135 

139 

143 

148 

152 

157 

162 

167 

171 

176 

30 

no 

114 

117 

121 

124 

128 

132 

136 

140 

144 

148 

152 

157 

162 

167 

172 

177 

31 

111 

114 

118 

121 

125 

129 

132 

136 

140 

145 

149 

153 

158 

163 

168 

173 

178 

32 

111 

115 

118 

122 

125 

129 

133 

137 

141 

145 

150 

154 

159 

164 

169 

173 

179 

33 

112 

115 

119 

122 

126 

130 

133 

138 

142 

146 

150 

155 

159 

164 

170 

174 

179 

34 

112 

116 

119 

123 

126 

130 

134 

138 

142 

147 

151 

155 

160 

165 

170 

175 

180 

35 

112 

116 

120 

123 

127 

131 

134 

139 

143 

147 

152 

156 

161 

166 

171 

175 

181 

36 

113 

117 

120 

124 

127 

131 

135 

139 

143 

148 

152 

156 

161 

166 

172 

176 

181 

37 

113 

117 

120 

124 

128 

131 

135 

140 

144 

148 

153 

157 

162 

167 

172 

177 

182 

38 

113 

117 

121 

124 

128 

132 

136 

140 

144 

149 

153 

158 

162 

167 

173 

177 

183 

39 

114 

118 

121 

125 

129 

132 

136 

141 

145 

149 

154 

158 

163 

168 

173 

178 

183 

40 

114 

118 

122 

125 

129 

133 

136 

141 

145 

149 

154 

158 

163 

168 

173 

178 

184 

41 

114 

118 

122 

125 

129 

133 

137 

141 

146 

150 

154 

159 

164 

168 

174 

179 

184 

42 

115 

118 

122 

126 

130 

133 

137 

142 

146 

150 

155 

159 

164 

169 

174 

179 

185 

43 

115 

119 

123 

126 

130 

134 

138 

142 

146 

151 

155 

161 

165 

170 

175 

180 

185 

44 

115 

119 

123 

126 

130 

134 

138 

143 

147 

151 

155 

160 

165 

170 

175 

180 

186 

45 

116 

119 

123 

126 

131 

134 

138 

143 

147 

151 

156 

161 

165 

170 

176 

181 

186 

46 

116 

119 

123 

127 

131 

135 

139 

143 

147 

152 

156 

161 

166 

170 

176 

181 

186 

47 

116 

120 

124 

127 

131 

135 

139 

144 

148 

152 

157 

161 

166 

171 

176 

181 

187 

48 

116 

120 

124 

127 

131 

135 

139 

144 

148 

152 

157 

161 

166 

171 

177 

182 

187 

49 

117 

120 

124 

127 

131 

135 

139 

144 

148 

153 

157 

162 

167 

171 

177 

182 

187 

50 

117 

120 

124 

127 

132 

136 

140 

144 

148 

153 

157 

162 

167 

172 

177 

182 

188 

51 

117 

120 

124 

128 

132 

136 

140 

145 

149 

153 

158 

162 

167 

172 

178 

182 

188 

52 

117 

121 

125 

128 

132 

136 

140 

145 

149 

153 

158 

162 

167 

172 

178 

183 

188 

53 

117 

121 

125 

128 

132 

136 

140 

145 

149 

154 

158 

163 

168 

172 

178 

183 

188 

54 

118 

121 

125 

128 

132 

136 

140 

145 

149 

154 

158 

163 

168 

173 

178 

183 

188 

55 

118 

121 

125 

128 

132 

136 

140 

145 

149 

154 

158 

163 

168 

173 

178 

183 

188 

WEIGHT  TABLE  (Female) 


(Showing  average  weight  for  each  height  and  age.  Based  on  “Nylic  Graphic  Table.”) 


Age 

57 

Ins. 

58 

Ins. 

59 

Ins. 

60 

Ins. 

01 

Ins. 

02 

Ins. 

03 

Ins. 

64 

Ins. 

05 

Ins. 

00 

Ins. 

07 

Ins. 

68 

Ins. 

09 

Ins. 

70 

Ins. 

71 

Ins. 

72 

Ins. 

73 

Ins. 

20 

100 

103 

106 

109 

113 

116 

120 

123 

127 

130 

134 

138 

142 

147 

152 

156 

161 

21 

101 

104 

107 

no 

114 

117 

120 

124 

127 

131 

135 

139 

143 

148 

152 

157 

162 

22 

101 

105 

107 

no 

114 

118 

121 

124 

128 

132 

136 

140 

144 

149 

153 

158 

162 

23 

102 

105 

108 

111 

115 

118 

122 

125 

128 

132 

137 

140 

145 

149 

154 

158 

163 

24 

102 

106 

108 

111 

115 

119 

122 

126 

129 

133 

137 

141 

145 

150 

155 

159 

164 

25 

103 

106 

109 

112 

116 

119 

123 

126 

130 

134 

138 

142 

146 

151 

155 

160 

165 

26 

103 

107 

no 

113 

117 

120 

124 

127 

131 

134 

139 

143 

147 

151 

156 

161 

166 

27 

104 

107 

no 

113 

117 

121 

124 

128 

131 

135 

139 

144 

148 

152 

157 

162 

166 

28 

104 

108 

111 

114 

118 

121 

125 

128 

132 

136 

140 

144 

149 

153 

158 

162 

167 

29 

105 

108 

111 

114 

118 

122 

126 

129 

133 

136 

141 

145 

149 

154 

158 

163 

168 

30 

105 

109 

112 

115 

119 

123 

126 

129 

133 

137 

141 

146 

150 

154 

159 

164 

1()9 

31 

106 

109 

112 

116 

119 

123 

127 

130 

134 

138 

142 

146 

151 

155 

160 

165 

170 

32 

106 

no 

113 

116 

120 

124 

127 

131 

135 

138 

143 

147 

151 

15() 

161 

166 

170 

33 

107 

no 

113 

117 

120 

124 

128 

131 

135 

139 

143 

148 

152 

156 

162 

166 

171 

FOOD  VALUES 


WEIGHT  TABLE  (Female). — Continued 


(Showing  average  weight  for  height  and  age.  Based  on  “Nylic  Graphic  Table.”) 


■\ge 

57 

Ids. 

58 

Ins. 

59 

Ins. 

CO 

Ins. 

61 

Ins. 

G2 

Ins. 

63 

Ins. 

64 

Ins. 

65 

Ids. 

06 

Ins. 

67 

Ins. 

68 

Ins. 

69 

Ins. 

70 

Ins. 

71 

Ins. 

72 

Ins. 

73 

Ins. 

34 

107 

no 

114 

117 

121 

125 

128 

132 

136 

140 

144 

149 

153 

157 

162 

167 

172 

35 

108 

111 

115 

118 

122 

125 

129 

133 

137 

140 

145 

150 

154 

158 

163 

168 

173 

36 

108 

112 

115 

119 

122 

126 

130 

133 

137 

141 

146 

150 

154 

159 

164 

169 

174 

37 

109 

112 

116 

119 

123 

126 

130 

134 

138 

142 

146 

151 

155 

160 

165 

170 

175 

38 

109 

113 

116 

120 

123 

127 

131 

135 

139 

142 

147 

152 

156 

161 

166 

170 

175 

39 

110 

113 

117 

120 

124 

128 

131 

135 

139 

143 

148 

153 

157 

161 

166 

171 

176 

40 

110 

114 

117 

121 

124 

128 

132 

135 

140 

144 

148 

153 

157 

162 

167 

172 

177 

41 

111 

114 

118 

121 

125 

129 

132 

136 

140 

145 

149 

154 

158 

163 

168 

173 

178 

42 

111 

115 

118 

122 

125 

129 

133 

137 

141 

145 

150 

155 

159 

163 

169 

173 

179 

43 

112 

115 

119 

122 

126 

130 

134 

138 

142 

146 

150 

156 

159 

164 

169 

174 

179 

44 

112 

116 

119 

123 

127 

130 

134 

138 

142 

147 

151 

156 

160 

165 

170 

175 

180 

45 

113 

116 

120 

123 

127 

131 

135 

139 

143 

147 

152 

157 

161 

166 

171 

175 

181 

46 

113 

117 

120 

124 

128 

131 

136 

139 

143 

148 

152 

157 

162 

166 

171 

176 

182 

47 

114 

117 

121 

124 

128 

132 

136 

140 

144 

149 

153 

158 

162 

167 

172 

177 

182 

48 

114 

118 

121 

125 

129 

133 

137 

141 

144 

149 

154 

159 

163 

168 

173 

178 

183 

49 

115 

118 

122 

125 

129 

133 

138 

141 

145 

150 

154 

159 

164 

168 

174 

179 

184 

50 

115 

119 

122 

126 

130 

131 

138 

142 

146 

150 

155 

160 

164 

169 

174 

179 

185 

51 

116 

119 

123 

126 

130 

134 

139 

143 

147 

151 

156 

161 

165 

170 

175 

180 

186 

52 

116 

120 

123 

127 

131 

135 

139 

143 

147 

152 

156 

161 

166 

170 

176 

181 

186 

53 

117 

120 

124 

127 

131 

135 

140 

144 

148 

153 

157 

162 

166 

171 

177 

182 

187 

54 

117 

120 

124 

128 

132 

136 

140 

144 

148 

153 

158 

162 

167 

172 

177 

182 

188 

55 

118 

121 

125 

128 

132 

136 

140 

145 

149 

154 

158 

163 

168 

173 

178 

183 

188 

WEIGHT  TABLE 


(Showing  average  or  normal  height  and  weight  according  to  age.) 


MALES 

FEMALES 

•Age  in 

Height  in 

Weight  in 

Weight  in 

Age  in 

Height  in 

Weight  in 

Weight  in 

years 

feet 

inches 

kilos. 

pounds 

years 

feet 

inches 

kilos. 

pounds 

0 

1 

1V2 

3.20 

7.0 

0 

1 

7 

2.91 

6.4 

1 

2 

3 

9.45 

20.7 

1 

2 

2H 

8.79 

19.2 

2 

2 

6 

11.34 

24.8 

2 

2 

6H 

10.67 

22.3 

3 

2 

10 

12.47 

27.2 

3 

2 

9H 

11.79 

25.8 

4 

3 

1 

14.23 

31.2 

4 

3 

1 

13.00 

28.6 

5 

3 

3 

15.77 

34.5 

5 

3 

2M 

14.36 

31.5 

6 

3 

5 

17.24 

37.8 

6 

3 

7 

16.01 

35.2 

7 

3 

73^ 

19.10 

42.0 

7 

3 

9 

17.54 

38.5 

8 

3 

9M 

20.76 

48.5 

8 

3 

10 

19.08 

41.8 

9 

4 

0 

22.65 

49.7 

9 

3 

lOH 

21.36 

46.9 

10 

4 

2 

24.52 

52.8 

10 

4 

1 

23.52 

51.7 

11 

4 

43^ 

27.10 

59.6 

11 

4 

3 

25.70 

56.5 

12 

4 

&V2 

29.80 

65.5 

12 

4 

5 

29.80 

65.5 

13 

4 

83^ 

34.40 

75.6 

13 

4 

7 

32.90 

72.3 

14 

4 

103^ 

38.80 

85.3 

14 

4 

9 

36.70 

80.7 

15 

5 

1 

43.60 

95.9 

15 

4 

lOM 

40.40 

88.9 

16 

5 

23^ 

49.70 

109.3 

16 

5 

34 

43.60 

95.9 

17 

5 

4 

52.90 

116.3 

17 

5 

134 

47.30 

104.0 

18 

5 

5 

57.90 

127.3 

18 

5 

134 

51.00 

112.2 

20 

5 

5H 

60.10 

132.3 

20 

5 

2 

52.30 

115.0 

25 

5 

6 

62.90 

138.3 

25 

5 

234 

53.30 

117.2 

30 

5 

6 

63.70 

140.1 

30 

5 

234 

54.30 

119.4 

40 

5 

6 

63.70 

140.1 

40 

5 

234 

55.20 

121.4 

50 

5 

63.50 

139.7 

50 

5 

34 

56.20 

123.6 

60 

5 

4 

62.90 

138.3 

60 

5 

0 

54.30 

119.4 

70 

5 

33^ 

59.50 

138.9 

70 

5 

0 

51.30 

112.8 

FOOD  VALUES 


TABLE  OF  FOOD  VALUES 
A.  Animal  Foods 


(a)  Meats  and  Meat  Products 

Bacon,  smoked 

Beef,  canned: 

Boiled  beef 

Chili-con-carne 

Corned  beef ‘ 

Dried  beef 

Kidneys,  stewed 

Luncheon  beef 

Ox-tails 

Roast  beef 

Rump  steak 

Sweetbreads 

Tongue,  ground 

Tongue,  whole 

Tripe 

Beef,  cooked: 


Protein,  Fat, 

per  cent.  per  cent. 


10.5 


64.8 


25.5 

13.3 

15.6 

39.2 

18.4 

27.6 

18.5 
25.9 

24.3 

20.2 

21.4 

19.5 
16.8 


22.5 

4.6 

26.2 

5.4 
5.1 

15.9 

4.5 
14.8 
18.7 

9.5 

25.1 

23.2 

8.5 


Carbohydrates, 
per  cent. 


Calories  per 
100  grams 


645 


4.0 


314 

114 

307 

211 

123 

261 

118 

244 

273 

171 

321 

296 

148 


Roast  beef 

Round  steak  (without  fat) 

Sirloin  steak,  baked 

Tenderloin  steak 

Beef  juice 

Calf’s  foot  jelly 

Capon,  cookeci 

Chicken,  broiler,  fresh 

Chicken,  fricasseed 

Fowls,  fresh 

Gelatin 

Goose,  young,  fresh 

Ham,  deviled 

Ham,  luncheon,  cooked 

Ham,  smoked,  boiled 

Ham,  smoked,  fried 

Ham,  smoked,  lean 

Kidneys,  stewed 

Lamb  chops,  broiled 

Lamb,  leg,  roast 

Liver,  fresh  or  raw: 


22.3 
27.6 
23.9 

23.5 
4.9 
4.3 

27.0 

21.5 

17.6 

19.3 

91.4 

16.3 

19.0 

22.5 
20.2 
22.2 
19.8 

18.4 

21.7 

19.7 


28.6 

7.7 

10.2 

20.4 
0.6 

11.5 
2.5 

11.5 

16.3 
0.1 

36.2 

34.1 
21.0 

22.4 

33.2 

20.8 

5.1 

29.9 

12.7 


17.4 


2.4 


356 

185 

193 

286 

26 

89 

118 

111 

189 

230 

375 

403 

395 

112 

291 

400 

274 

123 

367 

199 


Beef 

Chicken 

Goose 

Mutton 

Pork 

Turkey 

Veal 

Mutton,  corned  (canned) 

Mutton,  leg  roast 

Mutton  tongue  (canned). 

Pigs  feet,  pickled 

Pork  ribs,  cooked 

Pork  steak,  cooked 

Sausage,  canned: 


21.0 

22.4 

16.6 

23.1 

21.3 
22.9 

19.0 
28.8 

25.0 

24.4 
16.3 

24.8 

19.9 


4.5 

4.2 
15.9 

9.0 

4.5 

5.2 

5.3 
22.8 
22.6 
24.0 
14.8 
37.6 
45.4 


1.7 

2.4 

3.7 
5.0 

1.4 
0.6 


133 

141 

231 

199 

135 

144 

127 

330 

312 

323 

204 

451 

504 


Beef 

Bologna,  Italian 

Frankfort 

Oxford 

Pork 

Sausage,  cooked  (Deerfoot  Farm) 
Sausage,  raw: 

Bologna 

Frankfort 

Pork ; 

Summer 

Wienerwurst 

Turkey,  roast 


17.9 

24.9 

14.9 
9.9 

16.6 

19.93 

18.7 
19.6 

13.0 

26.0 
28.0 

27.8 


20.6 

27.8 
9.9 

58.5 

24.8 
54.21 


0.6 

6.34 


17.6 

18.6 
44.2 
44.5 
22.1 
18.4 


0.6  (0.2-3. 1) 
1.1  (0.0-6.6) 
1.1  (0.0-8.6) 


1.6 


265 

361 

153 

587 

299 

587 

243 

258 

468 

520 

327 

285 


FOOD  VALUES 


A.  Animal  Foods. — Continued. 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

(b)  Fish 

Fish,  fre.sh  or  raw; 

Bass,  black 

20.0 

1.7 

100 

Bass,  red 

16.9 

0.5 

74 

Bass,  sea 

19.8 

0.5 

86 

Ba.ss,  strijjod 

8.8 

2.2 

56 

Blue  fish  

19.4 

1.2 

91 

Blue  fish  (cooked) 

2.5.9 

4.5 

• 

148 

Butter  fish 

18.0 

11.0 

176 

Cat  fish 

14.4 

20.6 

251 

Cod 

16.7 

0.3 

72 

Eels 

18.6 

9.1 

161 

Flounder 

14.2 

0.6 

64 

Haddock 

17.2 

0.3 

74 

Halibut 

18.6 

5.2 

124 

Herring 

19.5 

7.1 

146 

Mackerel 

18.7 

7.1 

142 

Mullet . 

19.5 

4.0 

123 

Pereh^  white 

19.3 

4.0 

116 

Perch,  yellow 

18.7 

0.8 

84 

Pike,  iirav 

17.9 

0.8 

81 

Salmon 

22.0 

12.8 

209 

Shad 

18.8 

9.5 

165 

Shad  roe 

20.9 

3.8 

2.6 

132 

Smelt  ...  

17.6 

1.8 

89 

Stiirpeon 

18.1 

1.9 

92 

Trout,  brook  . ... 

19.2 

2.1 

98 

17.8 

10.3 

169 

Tiirhnt, 

14.8 

14.4 

195 

17.8 

2.4 

95 

Whitefish.  

22.9 

6.5 

154 

Fish,  preserved; 

27.3 

0.3 

108 

TTerrinpj  smokerl  

36.9 

15.8 

298 

Mnekerel,  snlt.  

21.1 

22.6 

297 

23.7 

6.5 

158 

21.8 

12.1 

202 

23.0 

19.7 

277 

Shad  roc . . 

20.9 

3.8 

2.6 

121 

Sturgeon  caviare 

30.0 

19.7 

8.0 

198 

(r)  Shiil-Fish,  Raw 

Clams,  long 

8.6 

1.0 

2.0 

53 

Clams,  round 

6.5 

0.4 

4.2 

48 

Crabs,  hardsliell 

16.6 

2.0 

1.2 

91 

CJrawfish 

16.0 

0.5 

1.0 

74 

Lobster  . . 

16.4 

1.8 

0.4 

86 

Mussels  . . 

8.7 

1.1 

4.1 

63 

Oysters  

0.2 

1.2 

3.7 

52 

Scallops 

14.8 

0.1 

3.4 

76 

21.2 

3.5 

120 

19.8 

0.5 

86 

((/)  Eggs,  Hens’ 

14.0 

12.0 

169 

14.8 

10.5 

158 

13.0 

0.2 

55 

16.1 

33.3 

376 

(c)  Dairg  Products 

1.0 

85.0 

793 

Hutteriuilk  

3.0 

0.5 

4.8 

36 

Cheese ; 

28.8 

35.9 

0.3 

452 

29.6 

38.3 

476 

21.0 

21.7 

2(X) 

Cottage  

20.9 

1.0 

4.3 

112 

Cream,  full 

25.9 

33.7 

2.4 

429 

37.1 

17.7 

316 

Tiim!>nrp^er 

23.0 

29.4 

0.4 

369 

FOOD  VALUES 


A.  Animal  Foods. — Continued. 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

(e)  Dairy  Products  (Cont’d.) 

Cheese  (cont’d.); 

Neufchatel 

18.7 

27.4 

1.5 

337 

Pineapple 

29.9 

38.9 

2.6 

494 

Roquefort 

22.0 

29.5 

1.8 

374 

Skimmed  milk 

31. .5 

10.4 

2.2 

290 

Swiss 

27.6 

34.9 

1.3 

442 

Cream,  appro.ximately  20  per  cent,  fat 

2.5 

18.5 

4.5 

194 

Cream,  40  per  cent,  fat 

1.5 

40.0 

3.0 

378 

Kephir 

3.1 

2.0 

1.0 

38 

Koumiss 

2.8 

2.1 

5.4 

53 

Milk,  condensed,  sweetened 

8.8 

8.3 

.54.1 

334 

Milk,  condensed,  unsweetened  (evai>oratcd) . 

9.0 

9.3 

11.2 

172 

Milk,  skimmed 

3.4 

0.3 

5.1 

37 

Milk,  whole 

3.3 

4.0 

5.0 

72 

Whey 

1.0 

0.3 

5.0 

27 

(/)  Fats 

Beef  fat,  clear 

4.1 

82.1 

780 

Cottolene 

100.0 

930 

Lard,  refined ...  .... 

100.0 

930 

Lard,  unrefined 

2.2 

94.0 

883 

Oleomargarine ...  . . 

1.2 

83.0 

777 

Pork  fat,  back. . . 

3.6 

89.9 

851 

Pork  fat,  belly ... 

5.2 

81.9 

783 

Pork  fat,  ham 

3.5 

88.0 

833 

Pork  fat,  jowl 

5.9 

78.8 

757 

Pork,  salt,  clear  fat 

1.9 

80.2 

809 

Pork,  salt,  lean  ends. 

8.4 

07.1 

658 

B.  Vegetable  Foods 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbf)hydrates, 
per  cent. 

Calories,  per 
100  grams 

(a)  Vegetables,  Raw 

Artichokes 

2.6 

0.2 

10.7 

78 

Asparagus 

1.8 

0.2 

3.3 

23 

Beans,  butter,  green 

9.4 

0.6 

29.1 

163 

Beans,  dried 

22.5 

1.8 

59.6 

353 

Beans,  Uma,  dried 

18.1 

1.5 

65.9 

358 

Beans,  lima,  fresh 

7.1 

0.7 

22.0 

126 

Beans,  string 

2.3 

0.3 

7.4 

43 

Beets 

1.0 

0.1 

9.7  (6-10) 

44 

Bru.s.sels  sprouts 

1.5 

0.1 

3.4 

21 

Cabbage 

1.6 

0.3 

4.7  (3-6.5) 

29 

Cabbage,  curly 

4.1 

0.6 

6.2 

48 

Cabbage  sprouts 

4.7 

1.1 

4.3 

47 

Carrots 

1.1 

0.4 

9.3  (5.9-11.5) 

45 

Cauliflower 

1.8 

0.5 

4.7 

30 

Celery 

1.1 

0.1 

3.3 

18 

Celery  root 

6.3 

26 

Chicory 

15.0 

62 

Corn,  green 

3.1 

i.i 

19.7 

101 

Cucumbers 

0.8 

0.2 

3.1 

48 

Dandelion  greens 

2.4 

1.0 

10.6 

62 

Eggplant 

1.2 

0.3 

5.1 

29 

Endive 

1.0 

2.6 

15 

Kohl-rabi 

2.0 

0.1 

7.0  (3..5-14) 

38 

Leeks 

1.0 

0.4 

6.0 

32 

Lentils,  dried 

25.7 

1.0 

59.2 

357 

Lettuce 

1.2 

0.3 

2.2 

17 

Lima  beans,  dried 

18.1 

1.5 

05.9 

358 

Lima  beans,  fresh 

7.1 

0.7 

22.0 

126 

Mushrooms 

3.5 

0.4 

6.0  (2-18;  largely 

43 

Okra 

1.6 

0.2 

unassimilable) 

4.0 

25 

Onions 

1.6 

0.3 

9.9  (4-14) 

46 

FOOD  VALUES 


B.  Vegetable  Foods. — Continued. 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

(a)  Vegetables,  Raw  (Cant’d.) 

Onions,  green 

Oyster  plant 

1.0 

0.1 

11.2 

50 

1.2 

0.1 

7.0 

35 

Parsnips 

1.6 

0.5 

11.0  (6-14) 

56 

Peas,  dried 

24.6 

1.0 

62.0 

364 

Peas,  green 

7.0 

0.5 

15.0 

95 

Peas,  sugar,  green 

Potatoes,  Irish 

3.4 

0.4 

13.7 

74 

2.2 

0.1 

20.0  (13-27) 

101 

Potatoes,  sweet 

1.8 

0.7 

27.4 

126 

Pumpkins 

1.0 

0.1 

6.0  (3-14) 

30 

Radishes 

1.3 

0.1 

5.0  (2.7-7.5) 

27 

Rhubarb 

0.6 

0.7 

2.5 

19 

Rutabagas 

1.3 

0.2 

7.0  (3-12) 

36 

Sauerkraut 

1.7 

0.5 

3.0 

24 

Sea-kale 

1.4 

3.8 

21 

Sorrel 

3.0 

12 

Soy  beans 

20.0 

43.0 

28.0  (19.3-39;  un- 
assimilable) 

467 

Spinach 

2.1 

0.3 

2.3 

21 

Squash 

1.4 

0.5 

8.0  (3-15) 

43 

String  beans 

2.3 

0.3 

6.0  (3.9-10) 

37 

Sweet  potatoes 

1.8 

0.7 

26.0  (16.5-44.5) 

120 

Tomatoes .■ 

0.9 

0.4 

3.3 

21 

Truffles 

9.1 

0.5 

7.0 

71 

Turnips 

1.3 

0.2 

6.0 

32 

Vegetable  marrow 

0.1 

0.2 

2.6 

13 

Watercress 

0.7 

0.5 

3.7 

23 

Yams 

16.0 

66 

(6)  Vegetables,  Cooked 

Asparagus 

2.1 

3.3 

2.2 

48 

Beans,  string 

0.8 

1.1 

1.9 

21 

Beet  greens 

2.2 

3.4 

3.2 

54 

Beets 

2.3 

0.1 

7.4 

41 

Onions 

1.2 

1.8 

4.9 

42 

Peas,  green 

6.7 

3.4 

14.6 

119 

Potatoes,  Irish,  boiled 

2.5 

0.1 

20.9 

97 

Potatoes,  sweet 

3.0 

2.1 

42.1 

204 

(c)  Vegetables,  Canned 

Artichokes 

0.8 

4.4  (3.2-6.1) 

21 

Asparagus 

1.5 

1.1 

2.3  (1.6-3.3) 

26 

Beans 

22.5 

1.8 

55.0 

334 

Beans,  baked 

6.9 

2.5 

17.0 

121 

Beans,  haricot-flageolets 

4.6 

0.1 

11.0  (9.8-12.4) 

65 

Beans,  haricot-verts 

1.1 

0.1 

2.0 

14 

Beans,  lima 

4.0 

0.3 

13.0  (9.6-16.5) 

72 

Beans,  red  kidney 

7.0 

0.2 

17.0 

100 

Beans,  string 

1.1 

0.1 

3.3  (1.5-4.5) 

19 

Beans,  wax 

1.0 

0.1 

3.1 

18 

Brussels  sprouts 

1.5 

0.1 

2.9 

19 

Corn,  green 

2.8 

1.2 

18.0  (11.7-25.1) 

97 

Cow  peas 

21.4 

1.4 

55.0 

326 

Lentils 

25.7 

1.0 

59.0 

357 

Lima  beans 

4.0 

0.3 

13.0  (9.6-16.5) 

72 

Macedoine,  mixed  vegetables 

1.4 

3.9  (1.9-5) 

22 

Okra 

0.7 

0.1 

2.9 

16 

Peas,  green 

3.6 

0.2 

10.0  (4.3-17.2) 

58 

Pumpkins 

0.8 

0.2 

6.0  (3.6-7.3) 

30 

Squash 

0.9 

0.5 

10.0  (3.6-12.8) 

49 

String  beans 

1.1 

0.1 

3.3  (1. 5-4.5) 

19 

Succotash 

3.6 

1.0 

18.0  (13.9-21.3) 

98 

Tomatoes 

1.2 

0.2 

3.0  (1-4.5) 

19 

(d)  Fruits  and  Berries,  Raw 

Alligator  pears 

7.0 

29 

Apples 

0.4 

0.5 

11.0 

71 

FOOD  VALUES 

B.  Vegetable  Foods. — Continued. 


(d)  Fruits  and  Berries,  Raw  (Cont’d) 

Apricots 

Bananas,  yellow 

Blackberries 

Cherries 

Cranberries 

Currants 

Dates 

Figs 

Gooseberries 

Grape  fruit,  California 

Grape  fruit,  Florida 

Grape  fruit,  Porto  Rico 

Grapes 

Huckleberries 

Lemons 

Mangoes 

Mulberries 

Muskmelons 

Nectarines 

Oranges,  California 

Oranges,  Florida 

Peaches 

Pears 

Persimmons 

Pineapples 

Plums 

Pomegranates 

Prunes 

Raisins 

Raspberries,  black 

Raspberries,  red 

Strawberries 

Watermelons 

Whortleberries 

(e)  Fruits  and  Berries,  Canned 

Apricots 

Blackberries 

Blueberries 

Cherries 

Crab-apples 

Peaches 

Pears 

Pineapples 

Strawberries 

Dried  fruits 

Jams,  jellies,  preserves,  and  marmalades . . . . 

(/)  Nuts 

Almonds 

Brazil  nuts 

Butternuts 

Chestnuts,  dried 

Chestnuts,  fresh 

Cocoanuts 

Filberts 

Hickory  nuts 

Peanut  butter 

Peanuts 

Pecans 

Pine  nuts;  pignolias 

Pistachios 

Walnuts,  California 

Walnuts,  California,  black 

Walnuts,  California,  soft  shell 

‘Malted  nuts” 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

1.1 

12.0 

54 

1.3 

0.6 

22.0 

101 

0.9 

2.1 

8.0 

56 

0.8 

0.8 

17.0 

80 

0.5 

0.7 

8.0 

41 

0.4 

13.0 

55 

1.9 

trace 

54.0 

229 

1.5 

17.0 

76 

0.4 

12.0 

51 

6.9 

28 

6.6 

27 

8.2 

34 

1.3 

1.6 

19.2 

99 

0.0 

0.6 

17.0 

78 

1.0 

0.9 

7.0 

31 

13.0 

53 

0.3 

12.0 

48 

0.7 

0.3 

10.0 

47 

0.6 

15.0 

64 

8.3 

34 

8.0 

33 

0.5 

0.2 

9.0 

41 

0.4 

0.6 

11.0 

72 

0.8 

0.7 

32.0 

141 

0.4 

0.3 

12.0 

54 

1.0 

17.0 

74 

1.5 

1.6 

17.0 

91 

0.8 

19.0 

81 

2.6 

3.3 

76.1 

353 

1.7 

1.0 

12.6 

68 

1.0 

12.6 

56 

1.0 

0.6 

7.4 

40 

0.4 

0.2 

6.7 

31 

0.7 

3.0 

10.0 

72 

0.9 

17.0 

73 

0.8 

2.1 

56.0 

252 

0.6 

0.6 

13.0 

61 

1.1 

0.1 

21.0 

92 

0.3 

2.4 

54.0 

245 

0.7 

0.1 

11.0 

49 

0.3 

0.3 

18.0 

78 

0.4 

0.7 

15.0  (6-25) 

70 

0.7 

24.0 

63.0- b 

47.0- h 

101 

21.0 

54.9 

17.3 

667 

17.0 

66.8 

7.0 

364 

27.9 

61.2 

3.5 

95 

10.7 

7.0 

74.2 

413 

6.2 

.5.4 

42.1 

248 

5.7 

.50.6 

27.9 

607 

15.6 

65.3 

13.0 

724 

15.4 

67.4 

11.4 

736 

29.3 

46.5 

17.1 

623 

25.8 

38.6 

24.4 

563 

11.0 

71.2 

13.3 

760 

33.9 

49.4 

6.9 

626 

22.3 

54.0 

16.3 

659 

18.4 

64.4 

13.0 

726 

27.6 

56.3 

11.7 

683 

16.6 

63.4 

16.1 

723 

23.7 

27.6 

43.9 

534 

FOOD  VALUES 


B.  Vegetables  Foods. — Continued. 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

{g)  Flours,  Meals,  Etc. 

Acorn  meal 

7.3 

4.9 

64.0 

Arrowroot  (tapioca) 

0.1 

0.1 

84.0 

Banana  flour 

3.9 

1.0 

85.0 

Barley  flour  and  meal 

10.5 

2.2 

72.8 

Buckwheat 

10.1 

2.5 

61.0 

Buckwheat  flour 

6.4 

1.2 

77.9 

Cassava  meal 

1.3 

1.2 

81.0 

Cornmeal,  unbolted 

8.4 

4.7 

74.0 

Corn  flakes,  toasted 

81.0 

Corn  starch 

1.2 

85.0 

Cotton-seed  flour:  Schulcnburg  Oil  Mill, 

iSchulcnburg,  Texas 

50.4 

11.2 

1.1 

Cracked  wheat 

11.1 

1.7 

74.0 

Cream  of  Wheat 

11.5 

0.9 

75.0 

Farina 

11.0 

1.4 

75.0 

Force 

10.6 

1.1 

74.0 

Glidinc:  Menley  James,  N.  Y 

91.4 

0.8 

1.0 

Graham  flour 

13.3 

2.2 

70.0 

Grape  nuts 

11.5 

0.6 

75.0 

Hominy 

7.6 

0.2 

78.0 

Hominy,  cooked 

2.2 

0.2 

17.8 

Hominy  flour 

8.3 

0.6 

79.0 

Macaroni 

13.4 

0.9 

74.1 

Macaroni,  cooked 

3.0 

1.5 

15.8 

Malt  Breakfast  Food 

13.8 

1.5 

75.0 

Mapl-Flake 

11.0 

1.4 

76.0 

Oatmeal 

16.1 

7.2 

67.5 

Oatmeal,  boiled 

2.8 

0.5 

11.5 

Oatmeal  water 

0.7 

0.1 

2.9 

Oats,  rolled 

16.7 

7.3 

66.2 

Pea  flour 

25.7 

1.8 

57.0 

Pettijohn’s  Breakfast  Food 

9.1 

2.Q 

74.0 

Plasmon:  Plasmon  Co.,  London 

78.7 

2.7 

Pop  corn,  popped 

10.7 

5.0 

77.0 

Potato  starch 

0.9 

0.1 

81.0 

Puffed  rice 

6.7 

0.4 

80.0 

(Quaker  Wheat  Berries 

13.8 

1.9 

72.0 

Ralston  Health  Food 

11.9 

1.7 

72.0 

Rice 

8.0 

0.3 

79.0 

Rice,  boiled 

2.8 

0.1 

24.4 

Rye 

10.2 

1.7 

72.0 

Rye  flour 

6.8 

0.9 

78.7 

Sago  starch 

2.2 

81.0 

Shredded  Wheat  Biscuit 

8.3 

0.6 

76.0 

Soy  bean  meal 

42.5 

19.9 

34.0  (assimilable 

Tapioca  (arrowroot) 

0.1 

0.1 

carb.  is  3%  or  less) 
84.0 

Triscuit 

11.0 

1.4 

75.0 

Wheatena 

11.3 

2.8 

76.0 

Wheat  flour,  California  fine 

7.9 

1.4 

76.4 

Wheat  flour,  entire  wheat 

13.8 

1.9 

71.9 

Wheat  flour,  patent  roller  j)roccss 

11.4 

1.0 

75.1 

Wheatlet,  patent  roller  process 

12.8 

1.6 

74.0 

(h)  Breads,  Cakes,  Fastrij,  Etc. 

Bread : 

Acorn  bread 

27.0 

Alfalfa  bread 

10.6 

i.3 

64.0 

Biscuit,  homemade 

8.7 

2.6 

55.3 

Brown  bread 

5.4 

1.8 

47.1 

Buns,  hot  cro.ss 

7.9 

4.8 

49.7 

Cassava  bread 

27.0 

Corn  bread  (Johnny  cake) 

7.9 

4.7 

46.3 

Gluten  bread 

9.3 

1.4 

49.8 

Graham  bread 

8.9 

1.8 

52.1 

Peanut  bread 

33.6 

12.8 

20.0 

Rolls,  all  analyses 

8.9 

4.1 

56.7 

Calories,  per 
100  grams 


338 
346 
375 

361 
315 
356 
348 
381 
332 
353 

348 

365 
353 
367 

358 

377 

362 
360 

353 
84 

363 

366 
91 

378 

369 
409 

63 

16 

407 

354 

359 

339 
586 
337 

359 

370 

360 
359 
112 
353 
359 
341 
351 
499 

346 

365 

384 

358 

369 

363 

371 


111 

318 

277 

231 

281 

111 

265 
255 

266 
339 
307 


FOOD  VALUES 


B.  Vegetables  Foods — Continued. 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

(h)  Breads,  Cakes,  Pastry,  Etc.  {Cont’d.) 
Bread : — Continued. 

Rolls,  French 

8.5 

2.5 

55.7 

286 

Rolls,  Vienna 

8.5 

2.2 

56.5 

287 

Rye  bread 

9.0 

0.6 

53.2 

260 

Rye  bread,  whole 

11.9 

0.6 

35.0 

198 

Toasted  bread 

11.5 

1.6 

61.2 

312 

Wheat  bread,  home  made 

9.1 

1.6 

53.3 

270 

Wheat  bread,  miscellaneous 

9.3 

1.2 

52.7 

266 

Wheat  bread,  whole 

9.7 

0.9 

49.0 

249 

Cake  (all  analyses,  except  fruit  cake) 

6.3 

9.0 

63.0  (53-78) 

368 

Cake,  fruit 

5.0 

10.9 

64.0 

384 

Cookies  (all  analyses) 

7.0 

9.7 

73.7 

420 

Cracker  meal 

Crackers : 

10.9 

6.0 

72.9 

399 

Boston  (split) 

11.0 

8.5 

71.1 

415 

Graham 

10.0 

9.4 

73.8 

430 

Oatmeal 

11.8 

11.1 

69.0 

434 

Oyster 

11.3 

10.5 

70.5 

433 

PUot  bread 

11.1 

5.0 

74.2 

396 

Saltines 

10.6 

12.7 

68.5 

441 

Soda 

9.8 

9.1 

73.1 

424 

Uneeda  biscuit 

10.1 

8.8 

70.0 

399 

Water 

11.7 

5.0 

75.7 

405 

Doughnuts 

6.7 

21.0 

52.0  (45-63) 

436 

Ginger  snaps 

6.5 

8.6 

76.0 

418 

Jumbles 

7.4 

13.5 

63.0  (52-71) 

418 

Macaroons 

6.5 

15.2 

64.0  (57-70) 

430 

Noodles 

Pie: 

13.3 

0.8 

72.0 

357 

Apple 

3.1 

9.8 

42.8 

279 

Custard 

4.2 

6.3 

26.1 

183 

Lemon 

3.6 

10.1 

37.4 

262 

Mince 

5.8 

12.3 

38.0  (30-44) 

194 

Raisin 

3.0 

11.3 

47.2 

311 

Squash 

4.4 

8.4 

21.7 

185 

Pretzels 

9.7 

3.9 

72.8 

374 

Pudding,  rice  custard 

4.0 

4.6 

31.4 

188 

Pudding,  tapioca 

3.3 

3.2 

28.2 

159 

Spaghetti 

12.1 

0.4 

74.0 

353 

Vermicelli 

10.9 

2.0 

72.0 

358 

Zwieback 

9.8  ■ 

9.9 

73.5 

433 

Zwieback,  peanut 

23.2 

8.0 

28.0 

284 

(i)  Pickles  and  Condiments 

Capers 

3.2 

0.5 

5.0 

41 

Chili  sauce 

20.0  (14-28) 

82 

Horseradish 

1.4 

0.2 

11.0 

53 

Ketchup 

1.8 

0.2 

10.0  (3-26) 

50 

Mustard,  prepared 

4.7 

4.1 

5.0 

78 

Mustard,  prepared,  plus  cereal 

3.5 

1.9 

7.0  (4-15) 

61 

Olives,  green 

2.1 

12.9 

1.8 

137 

Ohves,  ripe 

2.0 

21.0 

4.0 

220 

Peppers  (paprika),  green,  dried 

15.5 

8.5 

63.0 

400 

Peppers,  red  chili 

9.4 

7.7 

70.0 

397 

Pickles,  cucumber 

0.5 

0.3 

2.7 

16 

Pickles,  mixed 

1.1 

0.4 

4.0 

25 

Pickles,  spiced 

0.4 

0.1 

21.0 

89 

Vinegar,  cider 

Vinegar,  distilled 

0.25  (-1.52) 

1 

0 

Vinegar,  spiced  salad 

10.0 

41 

(j)  Beverages,  Non-Alcoholic 

Birch  beer 

Cereal  cofJee  infusion  (1  part  boiled  in  20 

8.0 

33 

parts  water) 

0.2 

1.4 

7 

Cider 

4.5  (0-13.5) 

18 

11 


FRAGILITAS  OSSIUM 


B.  Veoetable  Foods. — Continued. 


Protein, 
per  cent. 

F^t, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

ij)  Beverages,  Non-Alcoholic.  {Coni’ d.) 

Cocoa  (0.5  oz.  to  1 pt.  milk) 

6.0 

25 

Cocoa  (0.5  oz.  to  1 pt.  water) 

1.1 

5 

Coffee  (1  oz.  to  1 pt.  water) 

0.7 

3 

Cream  or  lemon  soda 

7.0 

29 

Ginger  ale 

8.0 

33 

Root  beer 

9.0 

37 

Sarsaparilla 

7.0 

29 

Tea  (0.5  oz.  to  1 pt.  water) 

0.6 

2 

{k)  Miscellaneous  Vegetable  Foods 

Baking  powder 

32.0  (Q-51.5) 

131 

Chocolate 

12.9 

48.7 

30.3 

629 

Cocoa 

21.6 

28.9 

37.7 

510 

Yeast,  compressed 

11.7 

0.4 

21.0 

138 

C.  Miscellaneous  Foods 


Protein, 
per  cent. 

Fat, 

per  cent. 

Carbohydrates, 
per  cent. 

Calories,  per 
100  grams 

(o)  Soups,  Canned 

Bouillon 

2.2 

0.1 

0.2 

11 

Chicken  gumbo 

3.8 

0.9 

4.7 

43 

Chicken  soup 

3.6 

0.1 

1.5 

22 

Consomm6 

2.5 

0.4 

12 

Julienne 

2.7 

0.5 

13 

Mock  turtle 

5.2 

0.9 

2.8 

41 

Mulligatawny 

3.7 

0.1 

5.7 

40 

Oxtail 

4.0 

1.3 

4.3 

46 

Pea  soup 

3.6 

0.7 

7.6 

52 

Tomato  soup 

1.8 

1.1 

5.6 

41 

Vegetable  soup 

2.9 

0.5 

14 

(6)  Soups,  Home-Made 

Bean 

3.2 

1.4 

.9.4 

65 

Beef 

4.4 

0.4 

1.1 

26 

Chicken 

10.5 

0.8 

2.4 

61 

Clam  chowder 

1.8 

0.8 

6.7 

43 

Meat  stew 

4.6 

4.3 

5.5 

81 

Soup  stock  . . 

5.8 

1.5 

38 

Foot=and=Mouth  Disease. — A usually 
mild  acute  infectious  disease,  contracted 
from  infected  cattle  and  other  domestic  ani- 
mals, through  milk,  butter,  or  cheese,  or  by 
cutaneous  inoculation,  and  characterized  by 
fever  and  stomatitis,  followed  in  about  two 
or  three  days  by  subsidence  of  the  fever 
and  the  appearance  of  vesicles  in  and  about 
the  mouth  and  fingers,  somethnes  over  the 
whole  body,  with  swelling  of  the  buccal 
mucous  membrane  and  marked  salivation. 
The  disease  lasts  about  two  weeks,  more  or  less. 

Treatment.— Isolate  the  patient  (see  Dis- 
infection), and  treat  the  lesions  antiseptically 
(see  Stomatitis). 

Infected  animals  should  be  isolated  and 
all  milk  boiled. 

Foot  Pain. — See  Pain. 

Foreign  Bodies  in  the  Air  Passages. — 
See  Throat  Diseases,  Part  9. 


Foreign  Bodies  in  the  (Esophagus. — See 

Throat  Diseases,  Part  9. 

Foul  Breath. — See  Breath,  Bad  or  Of- 
fensive. 

Fourth  Nerve. — See  Motor  Nerves  of 
the  Eyeball. 

Fractures.^ — See  Orthopaedics,  Part  10. 

Idiopathic. — L.  fractur'a,  from  fran'gere, 
to  break;  Or.  'idios  own  Tados  dis- 
ease. (See  Fragi litas  Ossium.) 

Pathological. — See  Fragilitas  Ossium. 

Skull. — See  Concussion,  Contusion, 

and  Compression  of  the  Brain. 

Spontaneous. — See  Fragilitas  Ossium. 

Fragilitas  Ossium. — L.  fmgil'itas,  brittle- 
ness; os',  pi.  os'sa,  bone;  Or.  otreov  bone  -t- 
\padvp6s  friable.  The  various  causes  of 
abnormal  brittleness  of  the  bones,  whereby 
they  tend  to  fracture  from  slight  cause,  are 
as  follows:  Congenital  fragility  of  all  the 


GASTRALGIA 


bones  in  the  new-born  (fcetal  osteogenesis 
imperfecta);  hereditary  fragility  occurring 
in  families,  associated  with  blue  sclerotics 
and  small  stature,  and  due  to  a deficiency 
in  fibrous  tissue;  senile  osteoporosis  (Gr. 
TTopos  passage);  atrophy  due  to  disuse; 
chronic  wasting  diseases  and  cachexia; 
rickets,  scurvy;  phosphorus  poisoning;  in- 
sanity; general  paresis;  locomotor  ataxia; 
syringo-myelia;  paralysis;  anterior  polio- 
myelitis; aneurysm  causing  erosion;  osteo- 
malacia; osteomyelitis,  pyogenic  or 
tuberculous;  tumors,  e.g.,  osteosarcoma, 
metastatic  sarcoma,  metastatic  carcinoma, 
multiple  myeloma,  hypernephroma,  benign 
osseous  cysts,  eclnnococcus  cyst,  enchon- 
droma,  gumma. 

Treatment.— This  depends  upon  the  cause. 
In  appropriate  cases  one  may  try  experi- 
mentally phosphorus,  or  pituitary  extract 
(see  Part  11):  the  anterior  lobe,  which  is 
related  to  the  general  growth  of  the  body, 
especially  the  skeleton;  obtainable  from 
Parke  Davis  Co.,  and  from  Burroughs 
and  Welcome.) 

Frambesia. — ~L.  framba:' sia,  raspberry.  See 
Skin  Diseases,  Part  5. 

Frequent  Micturition. — See  Polyuria. 

Friedreich’s  Ataxia. — See  Ataxia,  Fried- 
reich’s Hereditary. 

Frost=Bite. — See  Skin  Diseases,  Part  5. 

Fumigation. — L.  funiiga'tio.  See  Disin- 

fection. 

Functional  Albuminuria. — See  Albumi- 
nuria. 

Furrowed  Tongue. — See  Skin  Diseases, 
Part  5. 

Gait. — I . — Ataxic=cerebellar. — In  one  form 
of  cerebellar  ataxia,  in  which  there  is  dis- 
turbance of  equilibrium  and  often  vertigo, 
the  gait  is  irregular  and  swaying  or  stagger- 
ing, like  that  of  a drunken  man.  In  another 
form,  the  gait  resembles  that  of  spinal 
ataxia,  a stamping  gait  with  the  feet  far 
apart  (see  Ataxia,  and  Cerebellar  Lesions, 
under  Brain  Localization. ) 

Acoustic  nerve  and  labyrinthine  irritation 
are  accompanied  by  a staggering  gait; 
indeed,  vertigo  from  any  cause  is  apt  to  be 
associated  with  a staggering  gait. 

2.  Ataxic=spinal.— This  is  the  tabetic  gait, 
an  irregular  stamping  gait  with  the  feet  far 
apart,  the  hip  overflexed,  the  excursions  of 
the  movements  exaggerated,  and  the  patient 
closely  watching  his  movements  to  make  sure 
of  the  position  of  his  limbs  (see  Ataxia). 

3.  Paralytic=flaccid. — Steppage  gait  due  to 
toe-drop,  the  foot  being  raised  high  and 
slapped  down  with  a flail-like  motion; 
joints  flaccid. 


4.  Paralytic=spastic. — Muscles  stiff,  joints 
more  or  less  rigid,  tendency  of  the  legs  to 
cross  on  walking,  tendency  to  ankle  clonus, 
steps  .short,  and  difficulty  in  lifting  the 
feet,  “ the  patient  scuffs  along,  usually  with 
bent  knees,  and  as  if  his  feet  were  fastened 
to  the  ground.”  (R.  C.  Cabot.) 

5.  Tremor. — Occurring  in  multiple  sclerosis, 
hysteria,  and  paralysis  agitans.  The  gait 
of  the  latter  is  characterized  by  a stooped 
rigid  attitude,  and  propulsion  or  festination 
and  retropulsion  (sometimes  lateropulsion), 
producing  the  appearance  of  the  patient 
running  after  his  centre  of  gravity. 

6.  Wobbly  Gait. — Occurring  in  paralysis  of 
the  gluteus  mechus  et  mmimus  muscle  (see 
Dystrophy,  Progressive  Muscular),  and  in 
dislocation  of  the  hip. 

7.  Intermittent  Claudication. — Inability  to 

walk,  except  for  a short  distance,  because 
of  the  occurrence  of  pain,  fatigue  and  numb- 
ness in  the  legs,  these  symptoms  disappear- 
ing with  rest  (see  Claudication,  Intermittent) . 

8.  Gait  of  Simple  Weakness. 

QalLBladder  Cancer. — (See  Cancer  of  the 

Gall-Bladder  and  Biliary  Ducts. 

QalLBladder  Enlargement.  — Causes.— 
Cholecystitis;  stone  at  the  neck  of  the  gall- 
bladder; compression  of  the  common  duct 
by  a tiunor  growth,  as  cancer  of  the  pancreas. 

Gall  = Bladder  Inflammation. — See  under 
Cholecystitis. 

GalLDucts,  Cancer  of  the.— See  Cancer  of 
the  Gall-Bladder  and  Biliaiy  Ducts. 

Inflammation,  Catarrhal,  of  the. — See 
Jaundice,  Catarrhal. 

Inflammation,  Suppurative,  of  the. — 
See  Cholangitis,  Suppurative. 

GalLStones. — See  Cholelithiasis. 

Gangrene,  Cutaneous. — Gr.  yayypmpa; 
L.  cu'tis,  skin.  See  Skin  Diseases,  Part  5. 

Gangrene,  Hospital. — See  Inflammation. 

Gangrene,  Pulmonary. — See  Puhnonary 
Gangrene. 

Gangrenous  Stomatitis. — See  Stomatitis. 

Gas  Bacillus  Infection. — See  Inflammation. 

Gas  = Poisoning.— See  Asphyxia,  and 
Poisoning. 

Gastralgia. — Gr.  yaar-qp  stomach  -p  d'Xyos 
pain.  Gastralgia  signifies  a sudden  attack 
of  severe  epigastric  pain,  radiating  toward 
the  back,  and  usually  independent  of  the 
taking  of  food.  It  is  merely  a symptom, 
induced  by  many  different  causes,  e.g., 
gastric  ulcer;  gastric  cancer;  hyperchlor- 
hydria;  gastritis;  empty  .stomach;  iX)isoning; 
perigastric  adhesions;  exposure  to  cold;  wet- 
ting of  the  feet;  drinking  of  ice-water; 
tobacco;  genito-urinary  disease;  uterine  dis- 
placement; enteroptosis ; appendicitis;  her- 


GASTRIC  AND  DUODENAL  ULCER 


niffi  (inguinal,  femoral,  abdominal,  occult); 
aortic  insufficiency;  aneurism  of  the  abdom- 
inal aorta;  central  nervous  disease:  tabes 
(gastric  crLses),  myelitis,  multiple  sclerosis, 
brain  tumor,  neurasthenia,  hysteria;  mucous 
colitis;  constitutional  disease:  plumbism, 

gout,  anaemia,  malaria,  tuberculosis,  Addison’s 
disease,  etc.;  dorsal  Pott’s  disease. 

Exclude  renal  and  gall-stone  colic,  angina 
pectoris,  diaphragmatic  pleurisy,  etc.  (See 
also  Hypersesthesia  Gastrica.) 

Treatment. — Consider  the  cause.  For  the 
relief  of  pain,  apply  a hot  water  bag,  a hot 
turpentine  stupe,  or  a mustard  poultice 
(see  Part  11),  or  galvanization,  with  the 
anode  to  the  epigastrimn  and  the  cathode 
to  the  spinal  column.  Some  recommend  a 
weak  ciuTent,  of  no  more  than  ten  minutes’ 
duration,  others  a strong  ciurent.  Ortner 
says  the  current  should  be  strong  enough  to 
produce  visible  abdommal  contractions  with- 
out substantial  pain.  The  taking  of  food 
sometunes  gives  relief.  The  writer  was  once 
instantly  relieved  by  a large  draught  of 
blackberry  wine,  taken  in  desperation  for 
lack  of  anything  else  at  hand. 

Useful  analgesic  drugs  are:  Hoffman’s 

anodyne,  validol,  chloroform  water,  tincture 
of  valerian,  bromoform,  phenacetin,  anti- 
pyrin,  lactophenin,  pyramidon,  cocaine, 
codeine,  and  morphine  (see  Part  11).  I 

The  coal-tar  analgesics  are  of  especial 
value  in  nervous  cases. 

Arsenic  in  small  doses  over  a prolonged 
period  is  recommended  (Fowler’s  solution). 

Gastrectasis. — See  Dilatation  of  the 
Stomach,  Acute,  and  Chronic. 

Gastric  Acidity. — See  Hyperclilorhydria. 

Anacidity.— ^ee  Anacidity. 

Analysis  and  Technique. — See  under 
Dyspepsia. 

Atony. — ^ee  Dyspepsia,  Nervous,  and 
Enteroptosis. 

Atrophy.— See  Gastritis,  Chronic. 

Cancer. — See  Cancer  of  the  Stomach. 

Catarrh. — See  Gastritis  Acuta,  and 
Gastritis  Chronica. 

Cirrhosis.— See  Cirrhosis  of  the  Stomach. 

Dilatation. — See  Dilatation  of  the 
Stomach,  Acute,  and  Chronic. 

Gastric  and  Duodenal  Ulcer. — Gr.  yatjTijp 
stomach;  L.  duode'ni,  twelve  (twelve  finger- 
breadths  in  length);  L.  ul'cus,  ulcer.  Ulcer 
may  exist  without  symaptoms;  or  backache 
may  be  the  only  symptom;  or  chi-onic  dys- 
pepsia may  be  present  for  months,  and  a 
prrfuse  hemoirhage  or  an  acute  perforative 
peritonitis  suddenly  appear. 

The  characteristic  symiptoms  are  as  fol- 
lows: pain,  occurring  sooner  or  later  after 


eating,  at  a definite  time  in  each  case,  com- 
monly localized,  and  often  radiating  to  the 
back,  and  relieved  by  food  or  alkalies; 
epigastric  tenderness,  commonly  localized; 
sometunes  tenderness  to  the  left  of  the  spine, 
opposite  the  ninth  and  tenth  dorsal  vertebra, 
or  elsewhere  along  the  spine;  vomiting, 
usually  following  pain;  hamatemesis  (see 
for  other  causes  of  hamatemesis) ; occult 
bleechng,  detected  by  examination  of  the 
faces  by  means  of  the  benzidin  test, 
described  below;  dyspepsia;  conmionly 
hyperclilorhydria  (q.v.) 

According  to  IMayo’s  statistics,  consider- 
ably over  half  the  ulcers  are  duodenal. 

Benzidin  Test  for  Occult  Blood. — For  three 
days  before  making  the  test,  exclude  from 
the  diet  blood,  blood  sausage,  raw  or  rare 
beef,  or  meat  of  any  kind,  iron,  and  chloro- 
phyl  containing  foods.  Extract  the  fat  from 
a portion  of  the  faces  by  shaking  it  with  an 
equal  amount  of  a mixture  of  ether  and  alco- 
hol; then  add  to  the  fat-free  stool  one-third 
its  volume  of  glacial  acetic  acid  and  10  c.c. 
of  ether,  and  shake  thoroughly.  To  the 
resulting  acid  ethereal  extract,  which  con- 
tains the  hamatin,  add  2 c.c.  of  a saturated 
alcoholic  solution  of  benzicUn  and  2 c.c. 
of  3 per  cent,  hycfiogen  peroxide.  The 
appearance  of  a greenish-blue  color  indi- 
cates the  presence  of  blood. 

Wagner’s  shnple  and  reliable  modifica- 
tion of  the  benzidin  test  is  as  follows:  mix 
a knife-point  of  benzicUn  with  2 c.c.  of 
glacial  acetic  acid  and  20  di’ops  of  a 3 
per  cent,  solution  of  hydrogen  peroxide. 
Pom-  a few  drops  of  this  mixture  over  a 
little  of  the  solid  feces  spread  on  a clean 
glass  slide;  when,  in  the  presence  of  blood, 
a greenish-blue  color  will  appear  almost 
immediately. — Webster.  If  the  color  aj> 

pears  later  than  two  minutes,  the  test 
is  negative. 

Occult  bleechng  may  occur  in  the  follow- 
ing conditions  besides  gastric  and  duo- 
denal ulcer,  viz.,  those  conditions  produc- 
ing hjEinatemesis  (q.v.);  typhoid  fever; 
intestinal  ulceration  (see  under  Enteritis 
Chronica,  for  all  causes) ; malignant  tumors 
of  the  pancreas  or  liver  with  ulceration; 
hemorrhagic  pancreatitis;  intestinal  para- 
sites; hemorrhoids;  fissure  in  ano;  fistula 
in  ano. 

For  gastric  analysis  and  technique,  see 
under  Dyspepsia. 

Etiology.— External  trauma;  epigastric  com- 
pression, occurring  in  tight  lacing,  tailors, 
cobblers,  locksmiths,  bookkeepers,  basket- 
makers,  masons,  street-cleaners;  irritating 
ingesta,  e.g.,  cold  or  hot  foods,  chemical 


GASTRIC  AND  DUODENAL  ULCER 


irritants,  excesses  in  eating,  drinking,  and 
smoking,  foreign  bodies;  hyperacidity;  anae- 
mia; arteriosclerosis;  chronic  endocarditis; 
gastric  cancer;  tuberculosis;  syphilis;  typhoid 
fever;  diphtheria;  sepsis;  focal  infection; 
skin  burns.  The  presence  of  hydrochloric 
acid  tends  to  prevent  healing.  Ulcers  exist 
only  where  the  acid  gastric  juice  is  present. 

Prognosis. — The  great  majority,  perhaps 
97  per  cent,  of  acute  cases,  those  cases  of 
acute  onset  with  copious  hemorrhage,  get 
well  in  a few  months  with  rest  and  a 
restricted  diet,  or  even  without  treatment. 
W.  J.  Mayo  says  in  this  connection,  how- 
ever, “ It  should  be  borne  in  mind  that  a 
single  hemorrhage  which  is  not  preceded 
and  followed  by  the  usual  signs  and  symp- 
toms of  ulcer  is  seldom  due  to  ulcer,  but 
usually  to  some  toxic  cause  ” (see  Hsemate- 
mesis). 

Chronic  recurrent  cases  are  perhaps  not 
completely  curable  except  by  surgery. 

The  prognosis  in  all  cases  of  ulcer  is 
good,  about  90  to  95  to  98  per  cent.  (Mayo) 
recovering  imder  mecUcal  or  surgical  treat- 
ment, as  required.  The  tendency  to  cancer 
should  be  borne  in  mind. 

Treatment.— The  following  regime  is  for 
severe  cases.  It  may  be  modified  for 
mild  cases. 

Enjoin  rest  in  bed  for  a period  of  from 
three  to  six  weeks  (eight  to  ten  weeks  in 
ulcers  of  long  standing).  Thereafter  allow 
the  patient  up  gradually  for  one  adcUtional 
hour  or  half-hour  each  (lay,  until  he  is  up  all 
day;  but  do  not  allow  him  to  go  to  work  for 
some  weeks  after  leaving  his  bed.  He  should 
rest  for  at  least  an  hour  after  each  meal. 
Have  him  understand  that  it  requires  from 
three  to  six  months  to  a year  or  longer  of 
careful  dieting  to  effect  a cure. 

For  the  first  three  to  six  days,  if  there  is 
hemorrhage  or  severe  pain  or  vomiting  after 
eating,  one  may,  if  deemed  advisable,  allow 
nothing  at  all  by  mouth,  not  even  water,  but 
feed  the  patient  per  colon  twice  daily  with 
warm  milk,  3 to  4 ounces,  two  well-beaten 
raw  eggs,  or  only  the  yolks,  one  tablespoonful 
of  white  flour,  30  grains  of  salt  (15  grs.  to 
each  egg),  20  grains  of  sodiiun  bicarbonate, 
a dessertspoonful  of  liquor  pancreaticus, 
and  a tablespoonful  of  grape  sugar  (to 
obviate  acidosis),  to  which  may  be  added,  if 
desired,  one-hajf  to  one  ounce  of  claret  or 
brandy.  Laudanum,  5 to  15  drops,  may  be 
added  if  the  enema  is  not  well  retained. 
One  hour  before  each  feeding  the  bowel 
should  be  cleansed  with  normal  saline  solu- 
tion, one  pint  of  which  should  be  allowed  to 
remain,  in  order  to  prevent  or  relieve  thirst. 


The  mouth,  gums,  and  teeth  should  be 
cleansed  frequently.  Hot  or  cold  applica- 
tions to  the  epigastrium  are  well  recom- 
mended. Instead  of  nutrient  enemata, 
Fulton  gives  normal  saline  solution  by  the 
Murphy  drop  method. 

The  following  is  Sippy’s  method  of  treat- 
ment (evidently  the  best) : 

First  day. — Milk  and  cream,  aa^ss,  or 
one  tablespoonful,  every  hour  from  ? a.  m. 
to  7 P.  M.  Midway  between  feedings  admin- 
ister heavy  calcined  magnesia  and  sodium 
bicarbonate,  aa  gr.  x,  in  one  to  three  ounces 
of  water,  alternately  with  bismuth  subcar- 
bonate, gr.  X.  and  sodium  bicarbonate,  gr. 
XXX.  After  the  last  feeding  give  the  powders 
every  half  hour  for  3 or  4 doses,  or  until  the 
stomach  is  empty.  This  medication  is  to 
be  continued  throughout  the  treatment,  the 
bismuth  and  the  magnesia  being  substituted, 
the  one  for  the  other,  according  to  the  pres- 
ence of  diarrhoea  or  constipation.  Some 
give,  instead  of  the  bismuth,  silver  nitrate, 
0.1  per  cent,  solution,  one  tablespoonful 
(about  gr.  34)  ^ -wineglass  of  water, 

before  meals. 

To  see  that  sufficient  alkali  is  being  given 
to  remove  gastric  acidity,  aspirate  (see  under 
Dyspepsia)  and  test  the  stomach  contents 
late  in  the  afternoon,  just  before  a feeding  or 
powder,  and,  if  acidity  is  still  present,  add 
soda,  10  grs.  at  a time,  to  each  powder,  until 
the  acidity  is  controlled. 

Second  day. — The  same  as  the  first  day, 
if  the  diet  has  caused  no  discomfort. 

Third,  fom-th,  and  fifth  days. — Milk  and 
cream,  aaSiss,  every  hour. 

Sixth  and  seventh  days. — One  soft  egg 
added  to  the  milk  and  cream  mixture  in 
the  forenoon,  and  another  in  the  afternoon, 
if  desired. 

Eighth,  ninth,  and  tenth  days. — If  no 
discomfort  has  been  experienced  from  the 
preceding  diet,  add  at  noon,  if  desired,  3 
ounces  of  a well-cooked  cereal — rice,  oat- 
meal, farina,  or  cream  of  wheat,  measured 
after  it  is  prepared. 

Eleventh  and  twelfth  days. — Add  another 

3 ounces  of  cereal  or  a soft  egg;  but  not  to 
the  noon  meal. 

Thirteenth  day. — The  same  as  before;  or 
add  another  soft  egg  or  3 ounces  of  cereal. 
The  patient,  at  about  this  time,  is  receiving 
between  7 A.  m.  and  7 p.  m.,  1)4  ounces 
each  of  milk  and  cream  every  hour,  2 to 

4 eggs,  and  2 to  4 feedings  of  3 ounces  of 
cereal.  “ The  total  bulk  at  any  one  feeding 
should  not  exceed  six  ounces  when  feeding 
every  hour”;  and  no  more  than  four  eggs 
and  four  feedings  of  3 ounces  of  cereal 


GASTRIC  AND  DUODENAL  ULCER 


should  be  given  in  adtlition  to  the  milk  ami 
cream  in  one  day. 

At  about  the  eml  of  the  third  week. — Add 
if  desired,  stewed  fruits,  jellies,  and  gelatin 
preparations,  and  seedless  marmalade  in 
small  quantity.  Substitute  for  any  one  or 
two  feedings,  if  tlesired,  cream  soups  of  all 
kinds.  Allow  toasted  cracker,  milk  toast, 
and  puree  of  j:>otato. 

Increase  the  interval  between  feedings  at 
about  the  end  of  the  tenth  week  to  two  hours. 
No  more  than  eight  ounces  at  a 'feeding 
should  th(;n  be  given.  Milk  and  cream  may 
now  be  increa.sed  to  23^2  ounces  each,  and 
various  vegetable  purees  and  stale  breatl 
with  butter  may  be  allowed.  Two  j:>owders 
are  now  taken  midway  between  feeding. 

At  the  end  of  twenty  weeks,  increase  the 
interval  between  feedings  to  three  hours, 
five  meals  daily,  three  small  meals  at  the 
regular  hours,  and  a glass  of  equal  parts 
milk  and  cream  midway  between  meals. 
Two  powders  are  now  taken  midway  between 
feedings  and  one,  two,  and  three  houi-s  after 
the  evening  meal,  with  a week’s  interruption 
every  five  to  six  weeks.  Continue  this  regi- 
men for  a period  of  four  or  five  months  or 
longer,  depending  on  the  age  of  the  ulcer 
(Lc.,  the  duration  of  the  symptoms)  prev- 
ious to  treatment.  The  meals  are  given 
frequently  in  small  amounts,  together 
witli  alkalies,  in  order  to  keep  the  free, 
corrosive  HCl  down  to  a minimum, 
and  to  reduce  mechanical  irritation  and 
peristalsis. 

In  cases  of  pyloric  obstruction,  which  con- 
stitute, according  to  Sippy,  about  70  per 
cent,  of  the  cases  definitely  diagnosed  as 
ulcer,  Sippy  advises  the  use  of  more  alkali 
than  in  non-obstructive  cases  (usually  10  to 
30  grs.  more  of  soda),  and  also  aspiration  of 
the  stomach  contents  every  night,  one-half 
hour  after  the  last  powder  is  taken.  The 
alkali  should  be  increased  gradually  until 
aspiration  late  in  the  afternoon  just  prior  to 
a feetling  or  a powder,  and  at  night  one-half 
hour  after  the  last  powder,  shows  no  free 
acidity  (see  tests  under  Dysixqxsia) . 

In  cases  of  excessive  continued  secretion 
asjjiration  should  be  rc'peated  at  twelve  or 
one  o’clock  at  night,  and  if  3(K)  to  400  c.c. 
of  gastric  juice  is  found,  another  aspiration 
shovdd  be  jx'rformed  at  4 or  5 A.  m.,  and  if  at 
fhis  time  1(K)  to  2(K1  c.c.  of  fluid  is  present, 
aspiration  should  be  repeated  before  the 
first  meal.  This  is  continued  until  no  more 
than  the  normal  10  or  15  c.c.  of  secretion  is 
found  at  midnight  or  thereafter,  which  is 
usually  for  three  or  four  nights. 

When  the  evening  aspiration  shows  very 


little  or  no  food,  it  may  be  discontinued 
(usually  at  the  end  of  one  or  two  weeks). 

About  90  per  cent,  of  obstructive  cases 
(due  to  pylorospasm  or  acute  inflammatory 
swelling),  says  Sippy,  yield  to  the  above 
treatment  in  two  to  three  weeks;  the  remain- 
ing 10  per  cent,  (due  to  indurated  tissue 
narrowing)  yield  after  three  or  more  weeks. 

The  presence  of  pyloric  obstruction  means 
that  the  ulcer  is  almost  always  duodenal  and 
therefore  not  prone  to  cancerous  degeneration. 

The  occuri’ence  of  pain  not  relieved  by 
food  or  alkali  is  due  to  local  peritonitis,  per- 
foration, perigastric  abscess,  carcinoma,  gall- 
bladder (lisease,  or  a colon  iri’itatetl  by  too 
much  magnesia.  (Sippy.)  “During  a 
period  of  a year  or  more,  milk,  cream,  cer- 
eals, soft  eggs,  vegetable  purees,  cream 
soups,  bread  and  butter,  and  lean  meats, 
finely  divided,  when  desired,  should  form 
the  basis  of  the  diet.”  If  plain  milk  is  dis- 
tasteful, it  may  be  flavored  with  grape  juice, 
coffee,  tea,  or  cocoa,  or  a small  quantity  of 
cereal  added;  or  buttermilk,  egg  albumen,  or 
cream  soups  may  be  substituted.  Frozen 
balls  of  butter  may  be  substituted  for  the 
cream.  Boil  or  peptonize  the  milk  (see  Part 
11),  should  curds  appear  in  the  stools.  Some- 
times ohve  oil,  13^  ounces  t.i.d.,  one  hour 
before  meals,  or  5 ounces  in  the  morning  on 
an  empty  stomach,  is  of  benefit,  especially 
in  old  cases  with  pylorospasm  due  to  hyper- 
acicUty.  For  hyperchlorhydria  and  hyper- 
secretion, tincture  of  belladonna  in  5t^ 
doses,  one-half  hour  before  meals,  t.i.d., 
is  of  value. 

Extract!  belladonna; . . gr.  iiss-iv-viiss 

(gr-  per  dose) 

Bismuthi  subnitratis, 

Magnesii  oxidi, 

Sodli  bicarbonatis,  aa  oiiss  (gr.  xaa  per  dose) 

M.  et  div.  in  pulveres  xw. 

Sig. — One  powder  t.i.d.p.c.  (Ortner).  (Watch  for 
to.xic  symptoms,  q.  v.  in  Part  11). 

Regime  used  in  the  IMassachusetts  Gen- 
eral Hospital  (R.  C.  Cabot); 

“A.  Rest  in  bed.” 

“ B.  Diet  as  follows: 

1.  “ For  fii-st  three  days  give  every  two 
hours  (when  awake) — milk,  2 ounces, 
with  two  pow tiered  soda  crackei's  (23^ 
inches  square)  and  cane  sugar,  1 teaspoon- 
ful (if  relished).” 

2.  “ For  next  two  or  three  weeks  every 
two  hours— milk,  0 to  8 ounces,  with  four 
jwwdered  soda  crackers,  and  cane  sugar, 
1 to  2 teaspoonfuls  (if  desired).” 

3.  “ For  next  two  months  (more  or  less) 
a diet  consisting  of  average  portions  of  the 
following  articles — milk  and  crackers,  as 


GASTRIC  AND  DUODENAL  ULCER 


above;  cornmeal  mush  with  cream  and  sugar 
or  salt;  potato  pmee;  milk  with  whites 
of  two  eggs;  soft  custard;  chocolate;  pea 
puree.  Water  is  given  according  to  the 
patient’s  desire.” 

C.  “ For  pain  or  sour  burning  eructation 
a saucer  of  sodium  bicarbonate  and  a spoon 
are  put  at  the  bedside  and  the  patient  is  told 
to  take  the  soda  in  amounts  sufficient  to 
relieve  him.” 

For  hemorrhage,  enjoin  absolute  rest, 
including  the  use  of  the  bedpan  and  urinal; 
lower  the  head  and  elevate  the  foot  of  the 
bed,  to  prevent  fainting;  morphine  hypo- 
dermically is  generally  advised,  but  Lind- 
berg  believes  that  it  promotes  bleeding  by 
relaxing  the  gastric  muscles;  apply  an  ice- 
bag  to  the  epigastrium,  suspended  from  a 
bed  cradle;  give  ice  to  suck  but  not  to 
swallow;  administer  one  of  the  following 
haemostatics:  (1)  adrenalin  chloride,  1 : 1000, 
30  drops  in  a tablespoonful  of  water  every 
hour  for  two  or  three  doses,  or  10  to  20  to 
30  drops  every  three  or  four  hours;  (2)  ol. 
terebinthinae  rectificati,  1 tablespoonful 
beaten  into  a fine  emulsion  with  the  white 
of  an  egg — 1 teaspoonful  every  hour  (F.  C. 
Moore,  highly  praised);  (3)  bismuth  sub- 
nitrate; (4)  sterile  10  per  cent,  gelatine — 
40  C.C.,  at  104°  F.,  subcutaneously,  repeated 
at  least  once  a day;  (5)  antidiphtheritic 
serum,  2000  units,  or  normal  horse  serum, 
15  C.C.,  repeated  in  3 to  12  hours  (Fulton). 
Allow  no  food  by  mouth  or  rectum  for  four 
or  five  days;  but  administer  normal  saline 
solution  (5i  ad  Oi)  per  rectum,  by  the 
Murphy  drop  method  (about  2 quarts  in 
24  hours;  dextrose,  2 to  5 per  cent.,  may  be 
added,  to  prevent  acidosis),  in  order  to 


relieve  thirst  and  avoid  gastric  peristalsis. 
If  the  hemorrhage  is  continuous  and  danger- 
ous, or  persistently  recurs,  it  is  generally 
advised  that  the  stomach  be  opened  and  the 
bleeding  point  ligated  from  the  mucous  side, 
or  excised,  and  the  peritoneum  sutured  over 
its  base,  to  prevent  perforation.  Lindberg 
and  Eiselsberg,  however,  declare  that  sta- 
tistics show  expectant  treatment  to  be  safer 
than  operation  (see  also  Hemorrhage). 

For  perigastritis  and  threatened  perfora- 
tion, suggested  by  continuous  discomfort, 
aggravated  by  breathing,  local  tenderness, 
elevation  of  temperature  and  leucocytosis : 
absolute  rest;  no  food  or  drink;  after  24 
hours,  rectal  saline  enemata,  continued  until 
the  acute  symptoms  have  subsided.  It  is 
perhaps  best,  however,  to  operate  at  once. 

The  sudden  occurrence  of  violent  pain 
with  abdominal  rigidity  means  perforation, 
which  calls  for  immediate  operation.  After 
closing  the  perforation,  flushing  out  the 
abdomen  with  hot  normal  saline  solution 
(0.9  per  cent.),  and  clo.sing  the  abdominal 
wound,  introduce  a glass  tube  just  above  the 
symphysis  into  the  pelvis,  for  drainage,  and 
place  the  patient  in  the  semi-sitting  posture. 
Subdiaphragmatic  abscess  calls  for  subdia- 
phragmatic  or  transpleural  evacuation. 

For  severe  pain,  apply  hot  poultices  to 
the  epigastrium,  and  administer  orthoform, 
or  ansesthesin,  or  codeine,  or  morphine.  For 
burning  pain,  due  to  h}q)eracidity,  prescribe 
calcined  magnesia,  or  sodium  bicarbonate, 
with  bismuth;  or  belladonna  (see  Part  11 
for  formulae,  etc.). 

For  vomiting,  see  Vomiting. 

For  constipation,  calcined  magnesia,  or 
Carlsbad  salts,  or  enemata. 


Lenhartz  Schedule 


Days  after  last 
hemorrhage 

1 

2 

3 

4 

5 

G 

7 

8 

9 

10 

11 

12 

13 

14 

Egg.s,  beaten  up 
and  served  cold 

2 

3 

4 

5 

6 

7 

8 

8 

8 

8 

8 

8 

8 

8 

Sugar,  grams.  . . 

20 

20 

30 

30 

40 

40 

50 

50 

50 

50 

50 

50 

Cold  milk,  c.c.. . 

200 

300 

400 

500 

600 

700 

800 

900 

1000 

1000 

1000 

1000 

1000 

1000 

Raw  chopped 
meat,  grams.  . . 
Boiled  rice,  gms. 

35 

70 

70 

70 

70 

70 

70 

70 

70 

100 

100 

200 

200 

300 

300 

300 

300 

Zwieback,  grams 

20 

40 

40 

60 

60 

80 

100 

Raw  shaved 

50 

50 

50 

50 

ham,  grams .... 
Butter,  in  frozen 
pills,  grams .... 

20 

40 

40 

40 

Calories 

280 

420 

637 

777 

955 

1135 

1588 

1721 

2138 

2478 

2941 

2941 

3007 

3073 

1 gm.  = 15  grs. ; 100  c.c.  =3}^oz. ; 4 c.c.  = 1 dr. 

Salt  should  be  avoided. 

Feed  every  2 hours;  eggs  and  milk  alternately. 

Absolute  rest  in  bed  for  at  least  four  weeks;  an  ice-bag  to  the  stomach  for  two  weeks,  almost  continuously;  bismuth, 
gr.  XXX,  twice  or  thrice  a day;  no  attention  to  the  bowels  for  one  or  two  weeks,  then  a daily  enema,  if  necessary  of  warm  water 
and  glycerine. 


GASTRITIS,  ACUTE 


For  anaemia,  Blaud’s  pills  with  a laxative; 
or  preferably,  says  Forclilieirner,  the  organic 
preparations-bovinine,  ha;inogallol,  ha^inol, 
iron  peptonate,  or  ferratin  (see  Anaemia). 

Inchcations  for  Operaition;  (1)  Failure  of 
medical  treatment  to  bring  about  material 
improvement  after  a trial  of  about  four  to 
eight  weeks.  (2)  Hemorrhage  following  upon 
a prolonged  dyspepsia.  (3)  Chronic  recur- 
rent symptoms.  (4)  Perigastritis  with  adhe- 
sions or  abscess  (suggestive  symptoms:  con- 
tinuous discomfort,  aggravated  by  breathing, 
local  tenderness,  elevation  of  temperature, 
and  leucocytosis) . (5)  Pyloric  stenosis  and 

gastric  dilatation  (?).  (6)  Hourglass  stomach. 
(7)  Perforation.  (8)  Uncontrollable  hemor- 
rhage (?).  (9)  Suspected  carcinoma. 

The  operation  of  choice  is  posterior 
gastro-jej unostomy,  combined  wdth  excision 
of  the  ulcer,  if  possible,  because  of  the 
danger  of  malignancy.  Small  gastric  ulcers 
may  be  destroyed  with  the  cautery.  Trans- 
gastric  e.xcision  is  of  service  for  posterior 
adherent  ulcers  of  the  body  of  the  stomach. 
Pylorectomy  may  be  best  for  ulcers  occupy- 
ing the  pyloric  end  of  the  stomach.  For 
hour-glass  stomach:  gastro-gastrostomy,  or 
resection  in  continuity,  or  gastro-jej  unos- 
tomy. For  ulcer  in  which  excision  or  gastro- 
jejunostomy cannot  be  performed,  do  a 
temporary  jej unostomy  and  feed  per  jeju- 
num for  several  months  in  order  to  rest  the 
stomach  (Mayo).  For  duodenal  ulcers: 
gastro-jej  unostomy  plus  enfolding  of  the 
ulcer  by  a few  mattress  sutures  of  linen 
(Mayo).  Cover  the  ulcer  with  omentum. 
Following  operation  the  patient  should  be 
dieted  and  rested  for  weeks  or  months. 

Gastric  Hemorrhage. — See  Htematemesis. 

Hyperacidity. — See  Hyperacidity. 

Hypersesthesia. — See  Hyperjesthesia 
Gastrica. 

Hypersecretion. — See  Hypersecretion. 

Hypoacidity. — See  Anaciclity. 

Indigestion. — See  Dyspepsia. 

Inflammation. — See  Gastritis. 

Neuroses. — See  Dyspepsia,  Nervous. 

Pain. — See  Gastralgia. 

Prolapse. — See  Splanchnoptosis. 

Sclerosis SeeCirrhosisof  the  Stomach. 

Subacidity. — See  AnacicUty. 

Ulcer. — See  Gastric  and  Duodenal  Ulcer. 

Gastritis,  Acute. — Gr.  yaar-qp  stomach  -f 
-LTis  inflammation.  Under  this  caption  are 
included  both  acute  inflammatory  gastritis, 
and  simple  acute  gastric  indigestion. 

The  onset  is  usually  acute,  with  pain, 
eructations,  salivation,  nausea,  vomiting, 
thirst,  coated  tongue,  foul  breath,  anorexia, 
and  perhaps  distension  and  tenderness  of 


the  epigastrium.  The  ' vomitus  contains 
undigested  food,  mucus,  bile,  and  sometimes 
blood.  In  infants,  fever,  nervous  disturb- 
ances, and  prostration  occur.  Diarrhoea  is 
apt  to  follow. 

In  formulating  a diagnosis,  consider 
particularly  the  history  of  the  case,  and 
remember  that  the  symptoms  may  be  the 
prelude  of  some  acute  infectious  disease, 
especially  in  children. 

The  Prognosis  in  simple  acute  gastritis  is 
usually  good,  the  disturbance  usually  sub- 
siding in  from  one  to  three  or  more  days. 

Etiology. — Irritating,  indigestible,  or  decom- 
posed foods;  food  that  is  too  cold  or  too 
hot;  overeating;  alcohol;  poisons,  e.g.,  acids, 
alkahes,  metallic  salts,  copaiba,  male  fern, 
etc.,  (toxic  or  corrosive  gastritis : see  Poison- 
ing); swallotved  pus;  animal  parasites;  acute 
infectious  diseases;  toxalbumins  secreted  in 
the  stomach  in  Asiatic  cholera,  uraemia,  dia- 
betes, gout,  and  extensive  skin  burns.  Poor 
health,  hot  water,  chilling  of  the  body  sur- 
face, dentition,  chronic  gastritis,  and  indi- 
vidual susceptibility  are  predisposing  factors. 

In  infants,  the  important  causes  are: 
milk  too  rich  in  fat  or  in  sugar,  overeating, 
sudden  change  of  diet,  indigestible  food, 
nervous  influences,  infections  (enteral  or 
parenteral).  See  also  Vomiting. 

(There  is  a rare,  fatal,  suppurative  or 
phlegmonous  gastritis,  which  is  usually  not 
diagnosed  until  after  death.  Early  incision 
and  drainage  would,  of  course,  be  the  proper 
treatment.) 

A.  Treatment  in  Adults. — The  first  indication 
is  to  empty  the  stomach,  and  this  is  usually 
accomplished  by  vomiting,  which  is  effect- 
ually induced  by  the  drinking  of  large 
amounts  of  warm  water,  aided  by  the  finger 
in  the  throat.  Gastric  lavage,  (see  under 
Dypepsia.),  preferably  with  a solution  of 
sodium  bicarbonate,  one  teaspoonful  to  the 
quart,  is  better  still,  if  practicable.  It  is 
well  to  give  calomel,  gr.  ii-iii-v,  in  divided 
doses  (gr.  3^^  every  fifteen  minutes;  or  gr.  i 
every  hour),  followed  by  a saline.  IMorphine 
with  atropine,  given  hypodermically,  is  of 
great  value  for  the  Telief  of  severe  pain 
and  vomiting.  Hot  applications  or  a mustard 
poultice  to  the  epigastrium  are  grateful.  It 
is  well  also  to  flush  the  colon  with  normal 
saline  solution  (3i  ad  Oi). 

For  persistent  vomiting,  and  for  thirst, 
give  the  patient  bits  of  ice  to  swallow,  or 
iced  effervescent  soda  water  (for  instance,  a 
Seidlitz  powder);  and  dilute  hydrochloric 
acid,  gtts.,  XXX,  well  diluted  (Cohnheim) ; or 
bismuth  subcarbonate,  gr.  x,  and  sodium 
bicarbonate,  gr.  xv,  in  water;  or  some  one  of 


GASTRITIS,  CHRONIC;  CHRONIC  GASTRIC  CATARRH 


the  remedies  enimierated  under  Vomiting. 
To  supply  water,  introduce  slowly  per 
rectum  about  one  pint  of  warm  normal 
saline  solution  every  four  to  six  hours. 

R Pulveris  rhei, 


Magnesii  oxidi, 

Soclii  bicarbonatis,  aa gr.  v-x 

Aquaa)  menthse  piperitas,  ad §i 


M.  Sig. — Shake  well,  and  take  one  ounce 
every  two  or  three  hours,  for  acid  eructa- 
tions. (Forchheimer.) 

Keep  the  mouth,  gums,  and  teeth  clean 
with  an  alkaline  antiseptic  solution  (for 
instance,  Dobell’s  solution.  Part  11);  and 
allow  no  food  for  at  least  twenty-four  hours 
(five  days,  if  necessary).  The  return  to 
food  should  be  gradual — albumen  water, 
cold  boiled  skiimned  milk  chluted  with  lime 
water,  bouillon,  fat-free  broths,  beef  tea, 
Mellin’s  or  Benger’s  food,  soups  thickened 
with  sago  or  tapioca,  well-cooked  gruels  of 
barley,  rice,  or  farina,  eggs  boiled  three 
minutes,  toast,  crackers,  zwieback,  meat 
jelly,  custards,  up  to  steamed  or  boiled  non- 
oily  fish,  and  finally  orcUnary  diet.  In  the 
beginning  of  convalescence,  particularly  if 
there  is  distress  after  eating,  it  is  recom- 
mended that  dilute  hydrochloric  acid,  8 to 
15  drops  in  a wineglassful  of  water,  be  sipped 
before,  during,  or  after  meals. 

B.  Treatment  in  Infants.— Give  the  child  a 
large  amount  of  lukewarm  water  to  drink, 
which  is  usually  vomited  and  thus  serves  to 
wash  out  the  stomach.  Dennett  gives  sod- 
ium bicarbonate,  one  level  teaspoonful  to  a 
glass  of  water — one  tablespoonful  every  fif- 
teen to  thirty  minutes,  up  to  4 or  6 table- 
spoonfuls every  hour;  or,  perform  gastric 
lavage  once,  using  warm  boiled  water,  or  a 
warm  1 per  cent,  solution  of  sodium  bicar- 
bonate (say  a teaspoonful  to  the  pint).  In 
washing  out  the  infant’s  stomach,  have  the 
child  held  upright  and  inclined  slightly  for- 
ward with  its  arms  held  to  its  sides  by  means 
of  a towel  or  sheet  about  the  body.  The 
stomach  tube  consists  of  a No.  12  to  16 
(American  scale)  or  24  (French  scale)  rub- 
ber catheter,  connected  by  a piece  of  glass 
tubing  to  rubber  tubing  and  a funnel. 
Depress  the  base  of  the  tongue  with  the 
left  forefinger,  and  pass  at  least  ten  inches 
of  the  catheter  rapidly  into  the  oesophagus 
and  stomach.  Then  raise  the  funnel  high 
so  as  to  allow  the  escape  of  gas,  and  then 
lower  it  to  empty  the  stomach  of  its 
contents.  Wash  the  stomach  repeatedly 
with  warm  boiled  water,  using  about  2 
to  6 ounces  at  a time,  according  to  the 
child’s  age  and  capacity,  until  the  water 
returns,  clear. 


Apply  hot  flannels  to  the  epigastrium. 
Calomel,  gr.  ^iq,  every  hour,  until  effectual, 
may  be  of  service. 

Withhold  all  food  for  about  eight  hours, 
then  give  thin  barley,  rice,  or  albumen  water, 
one-half  to  one  ounce  every  hour.  After 
twenty-four  hours,  addbeef  juiceor  broth,  but 
give  no  milk  for  about  three  days  (Holt) ; or 
twelve  to  eighteen  hours  (Dennett).  Then  it 
should  be  skimmed  and  diluted  with  five  or 
six  parts  of  water  (Holt);  or,  according  to 
Dennett,  one  part  milk  and  two  parts 
water,  without  sugar,  boiled  three  minutes, 
etc.  (see  Infant  Feeding.) 

If  the  baby  is  mu'sing,  the  breast  should 
be  withheld  for  twenty-four  hours,  “ and 
then  nursing  allowed  for  two  minutes  every 
three  hours,  the  time  of  nursing  being 
gradually  increased  to  three,  five,  and  ten 
minutes,  as  improvement  occurs.”  (Holt.) 

If  vomiting  persists  after  thirty-six  hoiu’s, 
give  nutrient  enemata— to  a child  of  one 
year,  3 to  4 ounces  of  skimmed  milk,  pep- 
tonized for  one  hours  (see  Part  11),  every 
four  hours,  five  enemata  daily. 

Gastritis,  Chronic;  Chronic  Gastric  Ca= 
tarrh;  Chronic  Dyspepsia. — Gr.  yaariip 
stomach  H — trts  inflammation.  The  symp- 
toms of  chronic  gastritis  are  variable.  They 
occur  during  the  digestive  period : epigastric 
discomfort,  fulness  and  tenderness;  eructa- 
tions of  gas;  heartburn  or  cardialgia;  coated 
tongue;  fetid  breath;  bad  taste  in  the  mouth; 
presence  in  the  stomach,  four  to  eight  hours 
after  eating,  of  undigested  food,  which  is 
apt  to  decompose  and  cause  gaseous  dis- 
tension, perhaps  nausea  and  vomiting,  the 
vomitus  containing  mucus  and  perhaps  leu- 
cocytes. The  appetite  is  capricious.  Neu- 
rasthenia, headaches,  lassitude,  palpitations, 
and  vertigo  commonly  occur.  Exacerba- 
tions and  remissions  occur  as  the  result  of 
dietetic  errors.  Subacidity  (q.v.)  is  much 
commoner  than  hyperacidity  (g.f.).  Achylia 
(q.v.)  due  to  atrophy  may  eventually  super- 
vene. Diarrhoea  is  then  apt  to  ensue.  The 
course  of  a progressive  chronic  gastritis  is 
— hyperacidity,  subacidity,  anacidity,  and 
finally  achylia.  (For  Gastric  Diagnosis, 
Analysis,  and  Technique,  see  Dyspepsia). 

Prognosis. — This  depends  upon  the  stage  to 
which  the  disease  has  advanced.  Much  may 
be  accomplished  by  proper  treatment. 

Etiology.— The  habitual  use  of  alcohol,  tea, 
coffee,  tobacco,  bitters  and  appetizers,  purga- 
tives (especially  salines)  or  other  irritating 
drugs,  too  much  water  with  meals,  ice- 
water,  hot  foods,  too  much  fat  or  carbo- 
hydrate, and  foods  difficult  of  digestion, 
such  as  hot  breads,  pastry,  pies,  tarts,  pan- 


GASTRITIS,  CHRONIC;  CHRONIC  GASTRIC  CATARRH 


cakes,  fried  foods,  spices,  nuts,  candies,  etc.; 
overeating,  too  frecpient  eating,  irregular 
hours  of  eating,  hasty  and  insufficient  mas- 
tication, bad  teeth,  and  infectious  material 
from  the  nose,  jrharynx,  mouth,  teeth,  and 
gums,  are  the  common  causes. 

Other  causes  are:  oft-recurring  acute 

gastritis;  other  forms  of  gastric  disease,  i.e., 
ulcer,  cancer,  and  gastrectasia;  chronic  pas- 
sive congestion  due  to  heart,  liver,  lung,  and 
kidney  disease;  cUsease  of  the  gall  bladder, 
pancreas,  or  appenchx;  constitutional  dis- 
eases, e.g.,  nephritis,  gout,  tUabetes,  anaemia, 
leukaemia,  AdcUson’s  disease,  tuberculosis, 
syphffis,  general  carcinosis,  infectious  cUs- 
eases,  rickets,  malnutrition,  marasmus,  etc. 

A.  Treatment  in  Adults  and  Children  past  Infancy. 
• — First  iiKpiirc!  into  and  correct  the  cause. 
Consider  each  possible  etiological  factor 
in  detail. 

Place  the  patient  upon  a liquid,  soft,  or 
finely  cUvided,  bland,  easily  digestible  diet, 
preferably  a mixed  chet:  fresh,  clean  milk, 
in  sensitive  cases  skimmed  milk,  cUluted  at 
least  one-third  with  lime  water,  Vichy,  or 
ApoUinaris  water,  or  with  water  containing 
sochum  bicarbonate  (gr.  v-x  to  the  tumbler- 
ful of  milk  and  water);  perhaps,  if  well 
borne,  diluted  buttermilk,  or  kumyss,  kefir, 
or  matzoon  (see  Part  11)  may  be  tried.  If  it 
is  deemed  advisable  to  employ  an  exclusive 
milk  diet  for  a time,  one  or  two  quarts  may 
be  allowed  daily,  or  6 to  8 ounces  every 
three  hours.  The  milk  may  be  peptonized 
in  severe  cases;  or  it  may  be  boiled. 
Usually  it  is  better  to  replace  some  of  the 
milk  with  milk  soups  containing  cracker; 
well-cooked,  tlfin,  strained  gruels  made  of 
rice,  barley,  farina,  arrowroot,  or  oatmeal; 
gelatin  prej^arations ; and  dry  toast,  crack- 
ers, rusks,  or  zwieback.  Later,  as  improve- 
ment occurs,  one  may  gradually  add  to  the 
dietary  light  custards,  junket,  eggs  boiled 
three  minutes ; boiled  minced  meat  free  from 
fat,  sldn  and  connective  tissue  (calves’ 
brains,  sweetbreads,  stewed  tripe,  chicken, 
beef),  boiled  or  steamed  non-fatty  fish  (pike, 
perch,  flounder,  trout,  cod,  weakfish,  fresh 
haddock,  sole,  plaice,  whiting,  turbot,  brill), 
vegetables  in  puree  form,  stale  bread  and 
fresh  butter,  stewed  sweet  fruits  (apple 
sauce,  plum  sauce). 

In  flatulence,  carbohydrates  should  be 
restricted.  Little  or  no  water  should  be 
t aken  during  meals.  Three  meals  a day  are 
ordinarily  sufficient.  The  patient  should  rest 
for  o!ie  hour  before  and  after  eating.  He 
should  nevei-  baflie  immediately  after  eating. 
He  should,  of  course,  observe  the  ordinary 
rules  of  hygiene:  fresh  air  day  and  night. 


adequate  rest  anti  exercise,  regular  hours  of 
eating  and  sleeping,  a daily  morning  warm 
bath,  if  practicable,  followed  by  a cool 
douche  wliile  standing  in  warm  water  in  a 
warm  room,  and  cleanliness  of  the  mouth, 
gums,  and  teeth.  A flannel  abdominal 
binder  should  be  worn. 

Each  patient  must  be  dieted  individually, 
accortUng  to  Iris  digestive  powers.  A brief 
course  of  starvation  (5  to  6 days),  with  or 
without  the  free  drinking  of  purgative 
water,  may  be  of  value  in  some  cases. 

The  following  foods  are  strictly  forbidden, 
e.g.,  black  breads,  pastries,  hot  bread,  hot 
buttered  toast,  doughnuts,  pancakes,  muf- 
fins, crumpets,  or  other  hot  cakes,  new  bread, 
rich  cakes,  boiled  pudchngs,  sweetened  dishes, 
jam,  candy,  condiments,  spices,  sauces, 
pickles,  ices,  cold  chunks,  nuts,  coarse  vege- 
tables, cabbage,  fried  potatoes,  legmnes,  raw 
fruit,  stewed  acid  fruits,  such  as  currants 
and  gooseberries,  fruits  containing  seeds, 
cheese,  fat  ham,  veal,  mutton,  pork,  bacon, 
goose,  duck,  salted  meats,  tinned  meats, 
smoked  meats,  smoked  fish,  salmon  and  other 
oilyfish,  sausage,  forcemeat,  liver,  kidneys, 
shellfish,  fats,  except  butter,  hard-boilecl 
eggs,  rich  soups,  gravies,  fried  foods,  etc. 

At  first,  it  is  often  advisable  to  wash  out 
the  stomach  every  day  or  every  other  day 
for  a few  weeks.  This  may  be  done  in  the 
morning  before  breakfast,  or  about  six 
hours  after  the  midday  meal  (a  very  light 
supper  being  taken  afterward),  or  on  retir- 
ing. Plain  warm  water  may  be  used,  or 
normal  sahne  solution  (qi  ad  Oi),  or  a solu- 
tion of  sochmn  bicarbonate,  1 to  5 teaspoon- 
fuls to  the  quart  (useful  where  there  is  much 
mucus),  or  boric  acid  solution,  one  tea- 
spoonful to  the  pint  (where  there  is  much 
fermentation).  The  washing  should  be  con- 
tinued each  tune  until  the  fluid  retm’ns  clear. 
(See  under  Djqjepsia  for  technique,  etc.). 

If  lavage  is  contraindicated  or  is  imprac- 
ticable, prescribe  an  alkahne  saline  water, 
such  as  Carlsbatl  water,  or  sochum  phos- 
phate, or  sulphate  (Part  11),  one  hour 
before  meals,  for  a time;  followed  by  non- 
purgative alkaline  water,  such  as  Vichy, 
Ems,  or  \"als,  or  hot  water  containing  sodium 
bicarbonate  and  common  salt,  aa  gr.  ii-iii 
to  the  ounce.  Two  or  three  tumblerfuls  may 
be  taken  one  hour  before  breakfast,  and  a 
tumblerful  one  hour  before  each  meal  and 
at  bedtime.  This  treatment  is  very  Ifiglily 
recommended  by  Niemeyer. 

For  hyperacidity,  see  flyj^eracidity. 

For  svd)acidity,  tmacichty,  and  achylia, 
see  Anacidity. 

For  })ain,  see  Gastralgia. 


GINGIVITIS 


For  vomiting,  see  Vomiting. 

For  constipation,  see  Constipation,  (select 
what  is  appropriate) . 

For  fermentation  (pyrosis),  with  the  for- 
mation of  lactic,  butyric  and  acetic  acids, 
employ  lavage,  or  prescribe  the  following: 

Mentholis gr.  iss-iiiss 

Olei  olivai i^iivss 

M.  Ft.  caps.  No.  i.  Dent.  tal.  caps.  moUes 
No.  XXX. 

Sig. — One  capsule  3 to  5 times  a day  after 
meals.  (Ortner.) 

Thymol gr.  i 

Mitte  talis  capsular  molles  No.  xxx. 

Sig. — One  capsule  3 to  5 times  a day,  after  meals. 

Acidi  carbolic!, 

Aquaj,  aa 3ii 

M.  Sig. — One  minim  in  water,  p.c. 

Creosoti, 

Alcoholis,  aa oi 

M.  Sig. — One  minim  in  water,  p.c. 

Carbonis  ligni, 

Pulveris  ciimamomi  comp. 


BLsmuthi  subcarbonatis gr.  x-xv 

Magnesii  oxidi gr.  iii-v 

Sodii  bicarbonatis gr.  v-x 

Mucilaginis  tragacantha; oi 

Aqua}  menth®  piperit®,  ad. . . 5 i 


M.  Sig. — Shake  well  and  take  one  ovmce,  t.i.d., 
half  an  hour  before  eating. 

Digestives  may  be  prescribed,  if  desired: 
pepsin  (the  powder  or  scales,  not  the  essence 
or  wine  of  pepsin);  pancreatin;  papain  or 
papayotin;  malt  diastase  or  taka-chastase 
(see  Part  11  for  all  drugs).  These  digestives 
are  said  by  some  to  be  of  doubtful  utility. 
The  intestines  are  capable  of  carrying  on 
digestion  vicariously. 

B.  Treatment  in  Infants. — See  Infant  Feeding, 
for  the  proper  feecUng  of  these  cases. 
If  Holt’s  methods  are  followed,  the  fat 
should  be  reduced,  as  a rule,  to  1.5  per  cent., 
the  sugar  to  3 to  4 per  cent.  The  interval 
between  feechngs  in  infants  over  three 
months  should  be  three  or  four  hours. 

Gastric  lavage  (see  under  Inanition  for 
technique),  practiced  at  first  daily,  and  later 
less  often,  is  of  value.  Plain  warm  boiled 
water,  or  a solution  of  sodium  bicarbonate, 
one  teaspoonful  to  the  pint,  may  be  used. 
The  lavage  is  best  performed  three  hours  after 
feeding,  and  is  continued  each  time  until 
the  return  flow  is  clear.  The  stomach 
capacity  of  an  infant  of  one  week  is  one 
ounce;  six  weeks,  two  ounces;  six  months, 
four  to  six  ounces. 

Gastritis,  Phlegmonous.^ — Gr.  4>\ey^vh 
heat,  inflammation:  suppurative  con- 
nective tissue  inflammation.  See 
under  Gastritis,  Acute. 


Gastritis,  Suppurative. — See  Gastritis, 
Acute. 

Gastrodynia. — Gr.  yacTTijp  stomach  + 
odvuri  pain.  See  Gastralgia. 

Gastro=Enteritis.^ — See  Gastritis,  Diar- 
rhoea, and  Enteritis. 

Gastroptosis. — Gr.  yaar-qp  stomach  -\- 
iTTwais  falling.  See  Enteroptosis. 

Gastrorrhoea ; Gastrosuccorrhoea. — Gr. 

yaoTqp  stomach  poia  flow;  L.  sue' cits, 
juice.  See  Hypersecretion. 

Gavage. — Fr.  See  under  Inanition,  Sim- 
ple Acute. 

General  Paralysis  of  the  Insane. — See 

Dementia  Paralytica. 

Geographic  Tongue. — See  Skin  Diseases, 
Part  5. 

Gerlier’s  Disease. — See  Kubisagari. 

German  Measles;  Rubella;  Rubeola; 
Rbtheln. — L.  ru'ber,  red.  A common  epi- 
demic, contagious,  acute  infectious  disease 
of  children,  characterized  by  an  incubation 
period  of  fourteen  to  twenty-one  days 
(limits  five  to  ten  to  twenty-two  days),  fol- 
lowed by  very  few  symptoms  other  than 
enlargement  of  the  post-cervical  lymph- 
glands  and  a polymorphous,  rose-red  rash, 
sometimes  scarletiniform  and  sometimes 
morbilliform,  but  consisting,  typically,  of 
pinhead  to  pea-sized  maculo-papules,  often 
becoming  confluent,  and  facUng  after  one 
to  three  days.  They  are  most  marked  on 
the  face. 

Treatment. — The  disease  is  usually  very 
mild.  The  treatment  is  symptomatic. 
Quarantine  the  patient  two  weeks  from  the 
first  appearance  of  the  rash  (see  Disinfection). 

G ibraltar  Fever.— See  Mediterranean  Fever. 

Giddiness. — See  Vertigo. 

Gigantism. — Gr.  yiyas  giant.  See  Acro- 
megaly. 

Gingivitis. — L.  gingi'va,  gum.  The  gums 
are  red,  swollen,  spongy,  and  tender. 

Etiology. — Stomatitis ; pyorrhoea  alveolaris ; 
dental  caries;  calcareous  dental  deposits; 
overlapping  fillings;  mechanical  appliances; 
impacted  food;  the  local  use  of  arsenious 
acid,  sulphuric  acid,  carbolic  acid,  etc.; 
tobacco;  mercury;  lead;  phosphorus;  scurvy; 
pregnancy;  rickets;  syphilis;  diabetes;  gout; 
febrile  diseases. 

Treatment. — Attend  to  the  cause.  The 
services  of  a dentist  may  be  required.  The 
teeth  .should  be  kept  clean  with  water, 
castile  soap,  and  a soft  brush  or  cloth,  and 
an  alkaline  antiseptic  mouth -wash,  such  as 
Dobell’s  solution  (see  Part  11),  should  be  used 
frequently.  A good  astringent  mouth-wash 
consists  of  tincture  of  myrrh,  5i  iit  water  Oi. 

Once  daily  the  gums  may  be  painted  with 


GLOSSODYNIA 


tincture  of  iodine;  or  a strong  solution  of 
silver  nitrate;  or  one  of  the  following: 


Tincturae  krameriae, 

Tincturse  iodi,  aa 3v 

Tincturae  myrrhae 3iiss 

Tincturae  krameriae, 

Tincturae  myrrhae,  aa gss 


See  also  Scurvy. 

Glanders. — See  Equinia  in  Skin  Diseases, 
Part  5. 

Glandular  Fever. — A mild,  contagious  and 
infectious,  endemic  and  epidemic  disease 
of  chOdren,  characterized  by  an  acute  onset 
with  fever,  tonsillar  and  pharyngeal 
congestion,  and  later  cervical  adenitis, 
the  latter  lasting  from  one  to  four 
weeks.  Sometimes  other  glands  than  those 
of  the  neck  are  involved.  Suppuration 
rarely  occurs. 

Treatment. — Isolate  the  patient  (see  Disin- 
fection) . Put  him  to  bed  in  a well-ventilated 
room  free  from  draughts.  Open  the  bowels 
with  cUvided  doses  of  calomel.  The  cUet 
should  be  liquid  until  the  fever  subsides. 
Employ  antiseptic  sprays  and  gargles 
(Dobell’s  solution),  and  hot  or  cold  appli- 
cations to  the  neck.  Freely  incise  suppur- 
ating glands.  Remember  the  possibility  of 
nephritis,  otitis  mecha,  and  retropharyngeal 
abscess  occurring  as  complications.  Give 
tonics  of  iron  and  strychnine  during  con- 
valescence (for  drugs  see  Part  11). 

Glenard’s  Disease. — See  Splanchnoptosis. 

Glossitis. — Gr.  yXcoacra  tongue  -ltls 
inflammation.  Inflammation  of  the  tongue 
may  be  acute  or  chronic,  superficial  or 
parenchymatous.  The  latter  is  sometimes 
unilateral  (hemiglossitis) . The  term  linguo- 
papillitis  designates  an  affection  of  the  fungi- 
form papillae  of  the  tip  and  margin  of  the 
tongue,  characterized  by  pain  and  the  pres- 
ence of  minute  ulcers  revealed  only  by  the 
magnifying  glass.  Glossitis  papillaris,  so- 
called,  is  limited  to  the  circiunvallate 
papillae,  and  causes  a sticking  sensation  in 
the  throat,  slight  difficulty  in  swallowing, 
and  cough.  Geographic  tongue,  Leuko- 
plalda,  and  Glossodynia  Exfoliativa,  are  con- 
sidered in  Part  5,  Skin  Diseases. 

Etiology.— Dental  caries;  sharp-edged  teeth; 
stomatitis;  burns;  insect  bites;  biting  of  the 
tongue  in  epileptic  seizures,  etc.;  wliooping 
cough,  producing  ulcer  of  the  frenum; 
tobacco;  alcohol;  mercury;  iodine;  lead; 
spices;  tuberculosis;  syphilis;  actinomycosis; 
cancer;  diphtheria;  foot-and-mouth  dis- 
eases; herpes;  thrush;  constitutional  dis- 
eases— fevers,  gastro-intestinal  disorders, 
gout,  pernicious  anaemia,  etc. 


Treatment. — Attend  to  the  cause.  Flush 
out  the  bowels  by  means  of  calomel  or  cas- 
tor oil,  followed  by  a saline  (Part  11).  Keep 
the  mouth,  teeth,  and  gums  clean  with 
brush,  castile  soap  and  warm  water,  and  an 
astringent  mouth-wash,  such  as  potassium 
permanganate,  1 : 300;  or  the  following: 

II  Acidi  borici,  vel  sodii  biboratis,  vel 


sodii  bicarbonatis 3ii 

Tinctura;  myrrha; gss 

Aquffi,  q.s.,  ad gvlii 


M.  Sig. — Mouth-wash,  to  be  mi.xed  with  an 
equal  amount  of  warm  water. 

Paint  the  inflamed  surface  night  and 
morning  with  a solution  of  chromic  acid, 
gr.  v-x  ad  5i-  Swab  cracks,  fissures,  and 
ulcers,  once  daily,  with  silver  nitrate  solu- 
tion, almn,  gr.  xv  ad  5i,  or  chromic  acid 
solution.  Ionic  medication  (q.v.)  has  its 
advocates. 

In  acute  parenchymatous  glossitis,  with 
great  pain,  swelling,  and  fever,  incise  the 
tongue  with  a sharp  knife  on  each  side, 
about  two-tliirds  of  an  inch  from  the  median 
raphe,  and  to  the  depth  of  one-thu-d  of  an 
inch,  in  order  to  reduce  the  swelling. 
Abscesses  should  be  freely  opened.  Should 
a portion  of  the  tongue  become  gangrenous, 
cut  away  the  dead  parts,  and  apply  pure 
carbolic  acid,  followed  by  the  frequent 
application  of  iodoform. 

Forbid  alcohol,  tobacco,  and  v'ery  hot  or 
cold  or  otherwise  irritating  foods. 

Touch  the  minute  ulcers  of  linguopapilli- 
tis  with  the  galvano-cautery  aided  by  a 
magnifying  lens. 

Tuberculous  nodules,  even  though  ulcer- 
ated or  fissured,  should  be  excised  by  ellip- 
tical incisions,  and  the  glands  beneath  the 
jaw  removed.  If  the  ulcers  are  secondary 
to  pulmonary  tuberculosis,  and  operation  is 
not  feasible,  employ  antiseptic  astringent 
nrouth-washes,  and  rub  into  the  ulcers, 
three  or  four  times  daily,  a mixture  of 
iodoform,  gr.  i,  with  borax,  gr.  iii.  Incise 
and  curette  tuberculous  abscesses. 

A chronic  ulcer  with  tluckened  and 
indurated  edges  should  be  freely  excised  by 
means  of  an  elliptical  incision,  which  should 
include  a wide  margin  of  healthy  tissue  and 
the  underlying  muscle.  Bring  the  cut 
edges  together  with  silk. 

Glossodynia. — Gr.  yXwcrcra  tongue  68vvr} 

pain.  Causes.  — Rheumatism;  trigeminal 
neuralgia;  hysteria;  tabes;  insanity;  dental 
caries;  artificial  teeth;  granular  pharyn- 
gitis with  hypertrophy'  of  the  lingual  tonsil 
and  the  posterior  pillars;  lingual  varices; 
glossitis;  glossodynia  exfoliativa. 


GONOCOCCUS  INFECTION 


Qlossodynia  Exfoliativa. — See  Skin  Dis- 
eases, Part  5. 

Qlosso=Labio=Laryngeal  Paralysis. — Gr. 

yXuaaa  tongue;  L.  la'bium,  lip;  Gr.  Xapvy^ 
larynx.  See  Bulbar  Paralysis,  Acute  and 
Chronic. 

Qlosso=Pharyngeal  Nerve. — Gr.  yXuada 
tongue;  4>apvy^  pharynx.  The  ninth  cranial, 
or  glosso-pharyngeal  nerve,  transmits  taste 
impulses,  especially  from  the  posterior  part 
of  the  tongue,  and  is  concerned  also  with 
deglutition,  supplying  the  middle  con- 
strictor of  the  pharynx  and  the  stylo- 
pharyngeus  muscles.  It  is  involved  in 
bulbar  paralysis  (q.v.),  and  may  be  involved 
in  meningitis,  syphilis,  and  new  growths  at 
the  base  of  the  skull. 

Test  the  sense  of  taste  for  bitter,  sweet, 
sour,  and  salt,  using  strips  of  filter  paper 
moistened  with  solutions  of  quinine,  sugar, 
vinegar,  and  common  salt,  with  which  the 
protruded  tongue  is  touched. 

Glottis,  (Edema  of  the. — See  Tlrroat  Dis- 
eases, Part  9. 

Spasm  of  the. — See  Throat  Diseases, 
Part  9. 

Glycosuria. — Gr.  yXvKvs  sweet  -f-  ovpov 
mine.  See  Causes  of  Glycosuria  under 
Diabetes  Mellitus;  see  Urinalysis. 

Goitre,  Exophthalmic. — See  Exophthal- 
mic Goitre. 

Goitre,  Simple. — Fr.  goitre.  Simple  goitre 
is  a chronic  enlargement  of  the  thyroid 
gland,  of  unknown  cause,  occurring  sporad- 
ically, endemically,  and  even  epidemically 
in  certain  regions  of  the  earth  called 
“ goitrous  districts.”  A goitrous  thyroid 
contains  much  less  iodine  than  the  normal 
thyroid,  and  therefore  probably  represents 
a compensatory  hypertrophy  due  to 
thyroid  insufficiency.  Focal  infection  is 
cited  as  a possible  cause. 

The  enlargement  sometimes  produces 
pressure  symptoms.  Dyspnoea  is  caused 
by  pressure  upon  the  trachea,  veins,  or 
recurrent  laryngeal  nerves.  In  the  latter 
case,  severe  attacks  of  dyspnoea  occur 
(goitre  asthma). 

A sudden  increase  in  the  size  of  a 
goitre  may  be  due  to  traumatism,  strain, 
an  infectious  disease,  inflammation,  or  a 
new  growth. 

(For  other  causes  of  enlargement  of  the 
thyroid,  see  Thyroid  Enlargement). 

Treatment.— In  endemic  cases,  leaving  the 
goitrous  district,  or  boiling  the  drinking 
water,  may  possibly  cause  the  enlargement 
to  disappear.  Iodine  used  internally  or 
externally,  and  thyroid  extract,  are  often 
cmative.  Small  recent,  diffuse,  paren- 


chymatous goitres  in  the  young,  and  also 
nodular  (adenomatous)  goitres  without  de- 
generation, usually  disappear  under  iodine 
treatment  in  about  two  weeks.  Colloid 
goitres  are  reduced  only  after  prolonged 
treatment.  Cysts  are  not  affected. 


Sodii  vel  potassii  iodidi (gr.  v per  dose) 

Aquae  destillatae,  aa gss 


M.  Sig. — Five  drops,  well  diluted  in  milk  or 
water,  t.i.d.p.c.,  gradually  increased,  if  need  be,  to 
three  or  four  times  this  amount. 

1^  Tincturaj  iodi §i 

Sig. — Five  drops  well  diluted  t.i.d.p.c.  gradu- 
ally increased  if  need  be  to  15  to  20  drops  t.i.d. 

Liquoris  iodi  compositi 5 ss 

Sig. — Drops  one  to  three,  well  diluted,  gradually 
increased  to  gtt.  x-xx,  t.i.d.,  every  other  day. 

During  the  administration  of  iodine  or 
thyroid  extract,  watch  the  patient  closely 
for  symptoms  of  hyperthyroidism, 
p.g.,  irritability,  insomnia,  tremor,  palpita- 
tions and  tachycardia,  sweating,  asth- 
matic attacks,  voiniting,  diarrhoea,  weak- 
ness, emaciation. 

Local  applications  of  iodine,  in  the  form 
of  tincture  of  iodine,  unguentum  iodi,  or 
iochne-vasogen  or  iodine-petrogen  (see  Part 
11)  are  often  effectual.  The  ointment  should 
be  well  rubbed  in  each  day.  Adrenalin  com- 
presses worn  at  night  are  recommended. 
The  X-ray  may  be  tried.  Do  not  neglect 
rest  and  proper  hygiene. 

The  following  forms  of  goitre  require 
operative  removal,  viz.,  cystic,  fibroid, 
degenerated  nodular,  hemorrhagic,  and  cal- 
cified goitres;  goitres  which  are  painful  or 
sensitive  on  pressm’e;  goitres  with  marked 
cardiac  or  pressure  symptoms;  goitres  of 
sudden  and  rapid  growth  (probably  malig- 
nant) ; old  goitres  generally;  and  those  wliich 
resist  iodine  medication. 

Before  operating  for  goitre,  see  that  the 
heart,  lungs,  and  kidneys  (see  Urinalysis) 
are  functioning  properly.  lodothyrin  and 
arsenic  are  recommended  for  inoperable 
mahgnant  cases. 

Gonococcus  Infection. — Besides  uretfiritis, 
the  gonococcus  may  cause  perim-ethral 
abscess,  cowperitis,  prostatis,  epididymitis, 
cystitis,  pyelitis,  rectitis,  vulvo-vaginitis, 
bartholinitis,  endocervicitis,  metritis,  salpin- 
gitis, ovaritis,  peritonitis,  arthritis,  syno- 
vitis, bursitis,  periostitis,  iritis,  ophthalmia, 
stomatitis,  pleurisy,  pericarditis,  meningitis, 
endocarditis,  septico-pyaemia. 

Treatment.— Attend  to  the  primary  infec- 
tion, q.v.,  in  its  appropriate  Part,  as  well  as 
to  the  complications,  q.v.  Open  the  bowels. 


GOUT 


and  prescribe  rest,  fresh  air,  and  a bland, 
nutritious  diet. 

The  antigonococcus  serum  and  vaccine 
may  possibly  be  of  some  benefit.  Anti- 
gonococcus serum  is  antibacterial  in  its 
action.  Inject  deeply,  but  not  necessarily 
into  the  muscle,  2 to  4 c.c.  every  one,  two, 
or  three  days,  gradually  increased  to  6 to 
8 c.c.  (See  Anaphylactic  Shock).  Say 
Thomas  and  Ivy:  Antigonococcus  serum 
“is  of  little  or  no  value  in  acute  and  chronic 
urethritis,  prostatis,  and  conjunctivitis,  but 
has  beneficial  effects  in  cases  of  gonor- 
rhoeal arthritis,  endocarcUtis,  peritonitis, 
and  septicaemia.” 

If  a vaccine  is  used,  it  may  be  sensitized 
(see  vaccines  in  Part  11),  in  order  to  avoid 
toxic  symptoms.  Give  three  subcutaneous 
or  intramuscular  injections  on  successive 
days,  of  20,  50,  and  100  million  dead  organ- 
isms. If  no  reaction  occurs,  give  200,  500, 
and  1000  million  on  the  fourth,  fifth,  and 
sixth  days.  Should  a reaction  appear  after 
any  one  of  these  injections,  wait  fourteen  to 
twenty-one  days  before  beginning  another 
series  (McDonagh).  McDonagh  says : “The 
sensitized  vaccines  are  most  useful  in  acute 
cases  treated  early,  and  speedily  effect  a 
cure.”  “ Chronic  cases  may  often  be 
improved  enormously  by  vaccines,  but  after 
they  are  stopped  the  tlisease  remains  latent 
for  a time,  only  to  break  out  again;  there- 
fore a cure  should  not  be  guaranteed.”  He 
says  that  a vaccine  to  be  potent  should  be 
no  older  than  ten  days.  Similar  remedial 
effects  have  been  obtained  by  the  injection 
of  antityphoid  vaccine  (Bloch),  so  that  it  is 
possible  that  vaccines  are  not  specific  in 
their  action. 

Qout. — A disorder  of  proteid  metabolism 
(possibly  of  purin  catabolism,  due  to  failure 
of  the  liver  to  destroy  uric  acid),  character- 
ized by  an  excessive  accumulation  of  uric 
acid  in  the  blood  (miciemia),  and  its 
occasional  deposition,  in  the  form  of 
sodium  biurate,  in  the  articular  cartilages 
and  periarticular  tissues,  the  subcutane- 
ous tissues,  tendons,  and  the  aponeuroses, 
with  resulting  constitutional  and  arthritic 
S3unptoms. 

The  subcutaneous  deposits,  called  tophi, 
are  especially  common  in  the  ears.  When 
occurring  elsewhere,  they  resemble  rheu- 
matic fibroid  nodules.  They  contain  the 
characteristic  needle-shaped  sodium  biu- 
rate crj'stals. 

Cdinically,  three  types  of  gout  are  recog- 
nized, acute,  chronic,  and  irregular. 

Acute  gout  is  characterized  bj"  the  peri- 
odic occurrence,  at  interv'als  of  months  or 


3"ears,  of  acute  articular  pain,  swelling,  and 
a shiny  redness,  usually  affecting  the  meta- 
tarso-phalangeal  and  tarsal  joints,  especially 
of  the  big  toe,  often  preceded  by  indigestion, 
irritability  of  temper,  etc.,  and  lasting  about 
five  to  ten  days.  The  patient  suffers  worse 
at  night.  During  the  attack,  the  urinary 
output  of  uric  and  phosphoric  acids  is 
increased.  The  urine  is  scanty,  dark- 
colored,  and  acid,  and  deposits  red  urates 
on  cooling.  Albuminuria  and  glycosuria 
may  be  present  (see  Urinalysis.) 

In  rare  in.stances,  coincidentally  with  a 
sudden  chsappearance  of  the  articular  symp- 
toms, serious  internal  s^unptoms  may  occur, 
e.g.,  vomiting,  diarrhoea,  and  abdominal 
pain;  or  dj'spnoea,  precorclial  pain,  irregular 
heart  action,  palpitations,  and  sjmcopal  or 
anginal  attacks;  or  headache;  or  delirium, 
muscular  twitchings,  and  coma  (retro- 
cedent gout). 

Chronic  gout  is  characterized  by  the  fre- 
quent recurrence  of  acute  attacks,  affecting 
many  joints,  and  the  appearance  of  tophi 
and  persistent  thickening  of  the  joints,  due 
to  the  repeated  deposition  of  sodium  and 
calcium  biurate  (“  chalk  stones  ”).  Diges- 
tive chsturbances  and  muscular  cramps 
are  common.  Eventually  arteriosclerosis, 
mjmcartlitis,  cardiac  hj-pertrophy,  chronic 
interstitial  nephritis,  and  perhaps  emphj"- 
sema,  supervene. 

Irregular  gout,  or  masked  gout,  or  lith- 
semia,  or  the  gouty  or  uric  acid  diathesis, 
as  it  is  variously  called,  designates  a gouty 
state  without  articular  sjTnptoms,  the  com- 
monest manifestations  of  which  are  reputed 
to  be  the  following:  eczema,  recurrent 

pharyngitis,  conjunctivitis,  episcleritis,  “ hot 
or  itching  ej'eballs,”  iritis,  glaucoma,  bilious- 
ness, headaches,  neuralgias,  migraine,  “ hot 
or  itcliing  feet  at  night,”  muscular  cramps, 
paroxj'smal  tachj'cardia,  angina  pectoris, 
mjmearditis,  arteriosclerosis,  phlebitis, 
asthma,  chronic  bronchitis  and  emphj’sema, 
nephrolithiasis,  chronic  interstitial  nephritis, 
pm’ulent  urethritis,  phosphaturia,  albu- 
minmia,  intermittent  glycosuria,  obesity. 

Etiology.— Heredity;  alcohol,  particularly 
the  fermented  liquors  (beer,  ale,  and  wines), 
not  so  much  the  distilled  liquors  (whiskey, 
branch",  rum,  gin);  overeating,  especiallj'  of 
nitrogenous  foods;  insufficient  exercise;  lead. 
Woriy  or  mental  shock  maj-  precipitate 
an  attack. 

Prognosis.— With  proper  care  much  may 
be  accomplished. 

Treatment.— In  an  acute  attack,  put  the 
patient  to  bed  in  a warm  but  well-ventilated 
room,  open  the  bowels  thoroughly  with 


GOUT 


calomel,  gr.  ii-viii,  followed  by  a saline, 
elevate  the  affected  joint  and  wrap  it  up 
thickly  in  cotton-wool  covered  with  oiled 
silk,  and  prescribe  wine  or  tincture  of  col- 
chicum,  TTjjxv-xxx  in  water,  every  two  hours 
for  eight  or  ten  doses,  then  every  four 
hours  for  three  or  four  days,  or  until  the 
pain  is  relieved  or  symptoms  of  poisoning 
occur,  e.g.,  nausea,  vomiting,  diarrhoea,  and 
canliac  depression. 

Colchicine  or  colchicine  salicylate, gr. 
every  four  horn’s,  may  be  used  instead,  if 
desired. 

If  colchicum  affords  no  relief,  sodium 
salicylate  or  asphin,  gr.  x-xx,  every  two  to 
four  hom’s,  until  relieved,  may  be  tried;  or 
phenacetin,  antipyrine,  or  morphine  (see 
Part  11.) 

Alkaline  waters  should  be  drunk  freely; 
citrate,  acetate,  or  bicarbonate  of  potassium, 
gr.  xx-xxx,  in  a glass  of  water,  every  four 
hours,  until  the  urine  is  rendered  alkaline. 

In  the  presence  of  fever,  the  diet  should 
consist  of  milk  and  barley  water;  later,  as 
the  fever  subsides,  junket,  custards,  well- 
cooked  rice  or  sago,  with  cream,  stale  white 
bread  and  fresh  butter,  soft  eggs  boiled 
three  minutes,  fresh  boiled  or  steamed  fish, 
chicken,  crisp  bacon,  and  oysters. 

For  very  severe  pain,  apply  lead  and 
opium  wash  {q-v.)]  or  alcohol  covered 
with  oiled  silk;  or  menthol,  5iv,  in  spirits  of 
camphor,  5vi;  or  camphor-menthol  (three 
parts  of  menthol  rubbed  up  with  two  parts 
of  camphor);  or  ichthyol,  gr.  x,  ext.  opii, 
gr.  v-xv,  ext.  belladonnse,  gr.  xlv,  ad  lanolin 
5i,  applied  once  or  twice  daily;  or  titict. 
opii  3v,  ol.  gaultherise  5i,  chloroform  5iss — 
shake  and  paint  on  several  times  a day. 
Bier’s  passive  hyperemia  (see  Inflamma- 
tion), employed  for  five  minutes  several 
times  a day  is  also  recommended. 

One  may  try  ionic  mechcation  {q.v.). 
Employ  a hot  solution  of  sodium  salicylate, 

1 to  3 per  cent.,  at  the  cathode,  and  a cur- 
rent of  30  to  40  milliamperes  for  twenty  min- 
utes, every  other  day.  Guilloz  (quoted  by 
Lewis  Jones)  recommends  that  the  affected 
limb  be  immersed  in  a porcelain  basin  contain- 
ing a 2 per  cent,  solution  of  lithium  chloride, 
with  just  enough  lithium  hydrate  to  render 
the  solution  alkaline.  The  positive  electrode 
is  placed  in  the  solution,  and  a large  nega- 
tive electrode  over  the  lumbar  region.  The 
current  is  very  slowly  increased  to  150  to 
200  milhamperes,  and  continued  for  twenty 
to  thirty  minutes.  The  treatment  is  repeated 
once  or  twice  every  day. 

In  the  intervals  between  attacks,  and  in 
chronic  and  irregular  gout,  enjoin  the  follow- 


ing regunen : Fresh  air  day  and  night,  regu- 
lar hoiu’s  (jf  eating  and  sleeping,  moderate 
daily  exercise  m the  open  air,  a daily  warm 
or  hot  bath,  an  occasional  Tiu’kish  bath  if 
the  heart  is  good,  warm  clothing,  free  bowel 
activity- — a morning  saline,  if  need  be,  such 
as  sotlium  phosphate,  or  Carlsbad  salts — 
copious  water  drinking,  temperance  in  eat- 
ing, and  avoidance  of  worry.  The  following 
foods  are  interdicted  (the  most  of  them 
because  of  their  rich  purin  content,  some 
because  of  indigestibility  or  of  acidity) : 
alcohol,  game,  sweetbreads,  liver,  kidney, 
brain,  sausages,  smoked  meats,  meat  ex- 
tracts, meat  soups,  broths,  gravies,  salt  fish, 
fish  roe,  caviar,  crabs,  lobsters,  sharp  cheese, 
mushrooms,  peas,  beans,  lentils,  oatmeal, 
celery,  onions,  garlic,  radishes,  asparagus, 
cuciunbers,  sorrel,  tomatoes,  cabbage,  hot 
breads,  corn  breads,  pastries,  canches,  pre- 
serves, much  salt,  vinegar,  condiments  and 
spices,  tea,  coffee,  cocoa,  bananas,  straw- 
berries, cherries,  dates. 

The  following  foods  are  allowed:  milk, 
buttermilk,  koumyss,  junket,  cream,  butter 
(23^-^  to  3^  ounces  a day — Ebstein),  eggs, 
custard,  mild  cheese,  olive  oil,  white  bread, 
rice,  macaroni,  tapioca,  sago,  potatoes,  spin- 
ach, sprouts,  beet  tops,  cauliflower,  lettuce, 
chicken,  crisp  bacon,  fresh  fish,  oysters, 
white  and  red  meat  in  moderation,  pears, 
green  figs,  mild  oranges.  A bitter  tonic  (see 
Anorexia),  may  be  given  before  meals  if  the 
patient  is  debilitated. 

No  more  nor  less  than  1)^  quarts  of 
water  should  be  drunk  daily,  before  and 
between  meals,  says  Croftan.  To  the  water 
may  be  added  effervescent  lithium  carbon- 
ate or  citrate,  gr.  v-x,  in  tablet  form,  three 
or  four  times  a day;  or  potassium  citrate, 
acetate,  or  bicarbonate,  gr.  x-xx,  three  or 
foiu’  times  a day;  or  calcium  carbonate, 
gr.  xv-xx,  t.i.d.,  the  latter  being  highly 
recommended  by  Croftan  for  its  power  to 
keep  uric  acid  in  solution. 

A brief  course  of  starvation  (five  to  six 
days),  with  or  without  the  free  drink- 
ing of  purgative  waters,  may  be  of  great 
value. 

Atophan  causes  an  increased  excretion  of 
uric  acid,  and  is  for  this  reason  used: 
I^  Atophan,  tabellsc,  gr.  viiss,  4 to  6 
tablets  a day,  with  plenty  of  water  (see 
Appendix),  and  perhaps  with  potassium 
bicarbonate,  3iss  daily.  Atophan  is  said 
to  remove  pain  in  acute  gout  more  promptly 
than  colchicum  and  without  undesirable 
by-effects. 

For  chronic  gout,  Garrod  very  highly 
extols  guaiacum  (Part  11.) 


H.EMATEMESIS 


Pulveris  guaiaci.  5i  (about  gr.  1 per  dose) 
Pulveris  rhei ...  3 ii  (about  gr.  iiss  per  dose) 
Potassii  bitartra- 

tis 5 i (about  gr.  x per  dose) 

Sulphuris  prajcip- 

itati 5 ii  (about  gr.  xx  per  dose) 

Mellis (ti 

Pulveris  myris- 
ticae i 

M.  Sig. — Shake  well  and  take  two  large  tea- 
spoonfuls night  and  morning. — “ T/ie  Chelsea 
Pensioner.”  (Yeo.) 

Yeo  prai.ses  the  intermittent  use  of  sod- 
ium iodide,  gr.  v-x,  well  diluted,  t.i.d.p.c. 
(see  Part  11),  “in  cases  wdth  albuminuria 
and  well-marked  vascular  and  renal 
changes,”  and  “ in  chronic  and  subacute 
arthritic  affections.”  Small  doses  of  thyroid 
extract  {q.v.)  given  over  a prolonged  period, 
are  said  to  be  of  considerable  benefit. 

A sojourn  of  several  weeks  at  one  of  the 
following  mineral  springs  is  of  the  greatest 
benefit:  Saratoga,  Bedford,  and  Wlrite 

Sulphur  in  the  United  States;  Buxdon, 
Bath,  Strathpeffer,  and  Llandrindod  in 
Britain;  Aix-les-Bains,  Contrexeville  and 
Vichy  in  France;  and  Carlsbad,  Wildbad, 
Badenweiler,  Homburg,  Schlangenbad,  and 
Marienbad,  etc.,  in  Germany. 

Grain  Poisoning. — See  Poisoning. 

Graves’s  Disease.  — See  Exophthalmic 
Goitre. 

Grippe. — See  Influenza. 

Ground  Itch. — See  Anklylostomiasis. 

Guinea=Worm  Disease. — See  Dracon- 
tiasis  in  Skin  Diseases,  Part  5. 

Gums,  Inflammation  of  the. — See  Gingi- 
vitis. 

Habit  Chorea. — See  Habit  Spasm. 

Habit  Spasm;  Habit  Chorea;  Tic;  Tic 
Convulsif. — ^The  habitual  occm-rence  of  a 
sudden,  quick,  purposive,  involuntary,  local- 
ized muscular  action  resembling  an  “ auto- 
matic gesture,”  e.g.,  blinking  of  the  eyes, 
elevation  of  the  eyebrows,  frowning,  shrug- 
ging of  the  shoulder,  protrusion  of  the 
tongue,  jerking  of  the  head  or  hands,  bow- 
ing, nodding,  sniffling,  sighing,  grimacing, 
laryngeal  cough,  echolalia,  coprolalia,  etc. 

Etiology.— Neurotic  temperament;  mental 
strain,  worry,  or  shock;  pyschogenic  habit; 
debility;  reflex  irritation,  due  to  dental 
caries,  adenoids,  nasal  obstruction,  am-al  dis- 
ease, eyestrain,  pliunosis,  worms,  skin  irri- 
tation (caused  by  woolen  underwear,  sus- 
pension of  the  clothing  from  the  shoulders 
causing  shoulder  shrugging,  etc.),  etc. 

Facial  spasm  may  also  be  due  to  nerve 
irritation  caused  by  a new-growth,  a brain 
lesion,  etc. 

The  Prognosis  is  uncertain. 


Treatment. — Enjoin  correct  hygiene,  regu- 
lar hours  of  eating  and  sleeping,  adequate 
rest  and  exerci.se,  rest  before  and  after  meals, 
frequent  bathing,  fresh  air  day  and  night, 
regulation  of  the  bowels,  and  a bland, 
nutritious  diet,  together  with  such  tonics 
as  iron,  arsenic,  strychnine,  and  quinine  (see 
Part  11).  Interdict  tea  and  coffee.  Remove  all 
possible  sources  of  reflex  irritation.  Encour- 
age the  patient  to  inhibit  the  movements. 

In  intractable  cases,  one  may  try  the 
injection  of  alcohol  into  the  trunk  of  the 
facial  nerve  near  the  stylomastoid  foramen, 
with  the  hope  that,  following  recovery  from 
the  resulting  paralysis,  the  spasm  may  not 
return.  Or,  one  may  divide  the  nerve  near 
its  exit  from  the  skull,  and  anastomose  the 
peripheral  end  with  the  spinal  accessory,  or 
better,  the  hypoglossal  nerve. 

Haemarthrosis. — Gr.  atga  blood  fl-  apSpov 
joint.  Spontaneous  blood  extravasation  into 
a joint  ocemrs  in  haemophilia,  pm-pura,  and 
scurvy.  See  Haemophilia. _ 

Hsematemesis. — Gr.  aipa  blood  -f  eg0o-ts 
vomiting.  The  blood  in  haematemesis  is 
apt  to  be  dark  in  color,  acid  and  clotted; 
whereas  in  haemoptysis  it  is  bright  red  in 
color,  frothy,  alkaline,  and  usually  asso- 
ciated with  muco-pus. 

Etiology.— Gastric  and  duodenal  ulcer;  gas- 
tric cancer;  gastritis;  gastric  traumatism, 
due  to  the  strain  of  vomiting,  the  passage 
of  a stomach  tube,  artificial  distension  with 
carbon-dioxide  gas,  corrosive  poisons,  ab- 
dominal operations;  passive  congestion, 
due  to  hepatic  cirrhosis,  sjqjhilitic  hepa- 
titis, portal  thrombosis,  very  rarely 
thrombosis  of  the  hepatic  veins,  compres- 
sion of  the  portal  vein,  heart  disease,  lung 
disease;  rarely  gastric  or  oesophageal  varices; 
neighboring  abscesses,  ulcers,  or  fistulse 
opening  into  the  stomach;  cancer  of  the 
gall  bladder;  pancreatic  inflammation  or 
tiunor;  miliary  aneurj'sms,  associated  per- 
haps with  arteriosclerosis;  leaking  or  rup- 
ture of  an  aortic  or  abdominal  aneurj’-sm; 
splenic  enlargement  (see  Splenomegaly,  for 
causes);  vicarious  menstruation;  vicarious 
blood  states:  profound  amemia,  leuka?mia, 
purpura,  scm•^y,  haemophilia,  cholemia, 
phosphorus  poisoning,  acute  yellow  atro- 
phy, yellow  fever,  malaria,  uraemia,  septico- 
pyaemia,  hemorrhagic  form  of  the  exanthe- 
mata, typhoid  fever,  typhus  fever,  relapsing 
fever,  etc.,  haematemesis  neonatorum; 
epilepsy;  general  paresis;  tabes;  meningitis; 
hysteria;  swallowed  blood  arising  from  the 
nose,  pharjmx,  mouth,  msophagus,  or  the 
mother’s  breast. 

Exclude  fruit,  wine,  fruit  juices,  red 


H^MATOMYELIA  AND  HiEMATORRHACHIS 


vegetables,  red  sausage,  coffee,  cinnamon, 
iron,  bismuth,  haemoptysis.  If  the  blood 
has  remained  in  the  stomach  for  some  time 
before  being  vomited,  it  may  resemble 
coffee  grounds.  In  doubtful  cases  examine 
the  vomitus  microscopically,  spectroscopi- 
cally, or  chemically  (see  the  benzidin  test 
under  Gastric  and  Duodenal  Ulcer.) 

Treatment  of  the  Hemorrhage  Itself. — Enjoin 
absolute  rest  in  bed,  including  feeding  with 
a spoon  and  the  use  of  the  bed  pan.  Lower 
the  head  and  elevate  the  foot  of  the  bed, 
to  prevent  syncope.  Morphine  hypodermi- 
cally is  advised.  Apply  an  ice-bag  to  the 
epigastrium,  suspended  from  a bed-cradle. 
Give  ice  to  suck  but  not  to  swallow.  Admin- 
ister one  of  the  following  hemostatics: 

1.  Adrenalin  chloride,  1 : 1000,  30  drops 
in  a teaspoonful  or  tablespoonful  of  water 
every  hour  for  two  or  three  doses;  or  10  to 
20  to  30  drops  every  three  or  four  hours 
(see  Part  11). 

2.  01.  terebinthine  rectificati,  one  table- 
spoonful beaten  into  a fine  emulsion  with 
the  white  of  an  egg,  one  teaspoonful  every 
hour  (F,  C.  Moore:  highly  praised). 

3.  Sterile  10  per  cent.,  gelatin  (Merck) 
5x,  hypodermically,  repeated  at  least  once 
a day. 

4.  Antidiphtheritic  serum,  2000  units,  or 
normal  horse  serum,  15  c.c.,  repeated  in 
3 to  12  hours.  (Fulton.) 

5.  Ergot  subcutaneously. 

6.  Calcium  chloride,  3i-ii,  per  rectum, 
daily. 

7.  Hot  rectal  injections. 

Allow  no  food  by  mouth  or  rectum  for 
four  or  five  days  (in  infants  for  twenty-four 
hours  after  the  hemorrhage  has  ceased) ; but 
administer  normal  sahne  solution  (3i  ad  Oi) 
per  rectum,  by  the  Murphy  drop  method 
(about  two  quarts  in  twenty-four  hours; 
dextrose,  2 to  5 per  cent.,  may  be  added  to 
prevent  acidosis),  in  order  to  relieve  thirst 
and  avoid  gastric  peristalsis.  Keep  the 
mouth  clean. 

For  faintness,  sprinkle  the  face  with  cold 
water,  apply  smelhng  salts  to  the  nostrils, 
and  hot  bottles  to  the  feet.  If  the  heart  is 
very  weak,  inject,  hypodermically,  ether, 
njxx-xxx;  or  camphor,  gr.  i-ii,  in  ohve  oil, 
Ttjjxv;  give  gum-salt  solution  (see  Part  11); 
and  bandage  the  limbs. 

For  subsequent  anaemia,  prescribe  rest, 
fresh  air,  nutritious  food,  and  iron,  if  well 
borne  (see  Anaemia). 

Hsematochyluria. — Gr.  aina  blood  -fxi^Xos 
chyle  -b  ovpov  urine.  See  Chyluria. 

Haematoma  of  the  Sternocleidomastoid. — 
See  Sternocleidomastoid  Haematoma,. 

12 


Haematomyelia  and  Hamatorrhachis. — 

Spinal  Hemorrhage. — Gr.  aiixa  blood;  fxve\6s 
marrow,  paxts  spine.  I.  Haematorrhachis 
(Spinal  Meningeal  Apoplexy;  Hemorrhage 
into  the  Spinal  Membranes). — The  onset  is 
usually  sudden.  In  traumatic  cases  there  is 
severe  pain  in  the  back,  tenderness  along  the 
whole  length  of  the  spine,  and  shock.  Symp- 
toms of  meningeal  irritation  supervene,  e.g., 
spinal  rigidity,  involuntary  spasmodic  mus- 
cular contractions,  and  root  pains  and 
parsesthesise  in  the  distribution  of  the  spinal 
nerves  involved  (see  Spinal  Nerves;  and 
Spinal  Cord  Localization.)  In  severe  cases 
meningeal  pressure  symptoms  occur,  e.g., 
atrophic  paralysis  and  anaesthesia  of  the 
arms  and  trunk  or  the  legs,  depending 
upon  the  site  of  the  hemorrhage,  with  re- 
tention or  incontinence  of  urine  and  faeces. 
The  cerebrospinal  fluid  is  blood-stained. 
Haematomyelia  may,  of  course,  also  be 
present. 

“ The  disease  reaches  its  height  in  the 
course  of  a few  hours  or  a day  or  two,”  and 
death  may  occvu*.  If  the  patient  survives 
this  period,  he  usually  recovers  within  two 
or  more  months. 

Etiology. — Traumatism,  due  to  verte- 
bral fracture  or  dislocation,  concussion  pro- 
duced by  falls  on  the  head,  feet,  or  sacrum, 
great  muscular  exertion,  excessive  coitus, 
convulsions,  urgent  dyspncea,  difficult  par- 
turition, obstetrical  injuries  to  the  child; 
septic  meningitis;  acute  infectious  fevers; 
hEemophilia,  purpura,  scurvy;  rupture  of  an 
aneurysm  of  the  vertebral  or  basilar  artery. 

II.  Haematomyelia  (Hemorrhage  into  the 
Spinal  Cord). — Characterized  by  the  sudden 
occurrence  of  flaccid  paralysis  and  anaes- 
thesia below  the  level  of  the  hemorrhage 
(see  Spinal  Cord  Localization),  with  or  with- 
out pain,  and  with  complete  retention  of  urine 
and  faeces,  followed,  after  a few  days,  by  spas- 
ticity of  the  lower  limbs,  when  the  cervical 
or  dorsal  region  is  affected,  and  inconti- 
nence of  urine,  and  perhaps  alternating 
fecal  incontinence  and  constipation. 

In  a unilateral  lesion  a Brown-Sequard 
paralysis  results,  i.e.,  flaccid  paralysis  and 
anaesthesia  at  the  level  of  and  on  the  same 
side  as  the  lesion;  spastic  paralysis  and  loss 
of  muscle  sense  (“  ability  to  appreciate  the 
size,  consistency,  weight,  and  shape  of  an 
object  ”),  but  retention  of  the  senses  of 
pain,  temperature,  and  touch,  on  the  side  of 
and  below  the  level  of  the  lesion;  and  loss 
of  the  perception  of  pain  and  temperature 
below  the  level  of  the  lesion  on  the  oppo- 
site side. 

If  the  patient  survives  the  first  few  days, 


HiEMOGLOBINURIA 


he  usually  recovers,  with  perhaps  more  or 
less  of  residual  paralysis. 

Etiology.— The  same  as  that  of  hsemator- 
rhachis,  including  also  cold  or  exposure, 
tumors,  myelitis,  and  syringomyelia. 
Trauma  is  the  commonest  cause.  The 
cervico-dorsal  enlargement  is  most  com- 
monly affected. 

Treatment  of  Spinal  Hemorrhage. — The  prone 
position  is  perhaps  preferable.  If  not  intol- 
erable, an  ice-bag  may  be  applied  to  the 
spine  for  the  purix)se  of  arresting  the  hem- 
orrhage. Enjoin  absolute  rest,  including 
feeding  with  a sjxion  and  the  use  of  the  bed- 
pan  and  urinal.  Give  morphine  hypoderm- 
ically. Guard  agaimst  bed-sores  (q.v.,)]  and 
also  against  cystitis  by  means  of  the 
administration  of  urotropin,  gr.  vii,  t.i.d., 
regular  aseptic  catheterization,  and  irriga- 
tion of  the  bladder  with  warm  sterile  boric 
acid  solution,  a heaping  teaspoonful  to  the 
pint.  Employ  aperients  and  enemata  for 
the  bowels.  The  diet  should  be  bland  and 
nutritious.  T.  G.  Stewart  advises  the  use 
of  potassium  iodide,  gr.  x,  well  diluted,  t.i.d. 
(see  Part  11),  and  Fowler’s  solution,  Tfiii, 
well  diluted,  t.i.d.,  for  a period  of  six  weeks. 

In  traumatic  cases,  an  X-ray  picture 
should  be  taken,  and  if  it  shows  compression 
of  the  cord  by  chsplaced  bone,  an  operation 
should  be  performed,  otherwise  not.  In 
fracture  the  spine  may  be  immobilized  by 
means  of  sand-bags,  extension  apparatus, 
plaster  jacket,  or  braces  (see  Pott’s  Dis- 
ease, in  Orthopajdics,  Part  10).  In  applying 
a plaster  jacket,  the  patient  is  suspended 
prone  in  a hammock,  or  between  two  tables, 
so  as  to  produce  extension  and  correct  defor- 
mity (see  Pott’s  Disease).  An  amesthetic 
may  be  required. 

Six  to  eight  weeks  after  all  acute  symp- 
toms have  subsided,  employ  electricity, 
gentle  massage,  and  passive  movements 
to  restore  tone  to  the  flaccid  muscles  (see 
Poliomyelitis);,  for  the  spastic  muscles, 
only  massage  and  warm  applications.  As 
long  as  a muscle  retains  its  faradic  irrita- 
bility, there  is  hope  of  its  recovery;  but  if 
it  tloes  not  resjiond  at  all  to  either  galvanic 
or  faradic  stimulation,  it  can  not  recover. 
In  lumbosacral  hemorrhage,  the  paralysis  of 
the  anal  and  vesical  sphincters  is  likely  to 
be  permanent. 

Haematoporphyrinuria. — Gr.  alfia  blood  + 
wop4>vpeos  purple  -f-  ovpov  urine.  See  Ha'ino- 
globinuria. 

Haematorrhachis. — See  Hiematomyelia 
and  Iliematorrhachis. 

Haematuria. — See  Part  3,  Genito-Urinary 
Diseases. 


Haemochromatosis;  Bronzed  Diabetes. — 

Gr.  alpa  blood  -f-  xpw^ua  color.  A very  rare 
affection,  characterized  by  pigmentation  of 
the  skin  and  viscera  with  hsemosiderin  and 
hsemofuscin,  cirrhosis  of  the  liver,  chi’onic 
interstitial  pancreatitis,  and  enlargement  of 
the  spleen.  When  the  pancreatic  islands  of 
Langerhans  become  involved,  diabetes  en- 
sues. The  patient  usually  dies  “ within  a 
year  after  the  appearance  of  glycosuria.” 
(A.  O.  J.  Kelly.) 

Treatment. — In  the  early  stages  of  the  dis- 
ease, the  treatment  is  that  of  cirrhosis  of  the 
liver;  in  the  later  stages  it  is  that  of  diabetes. 

Haemoglobinuria. — Gr.  aipa  blood  -f  glo- 
bin  + ovpov  urine.  Haemoglobinuria  denotes 
the  presence  of  blood  coloring  matter  in  the 
freshly  voided  urine  (haemoglobin,  methae- 
moglobin,  haematoporphyrin).  It  is  dis- 
tinguished from  haematuria  by  the  absence 
of  red  corpuscles  in  the  secUment  of  the 
centrifuged  urine. 

Etiology. — Transfusion  of  blood  from  a dif- 
ferent species  of  animal;  certain  haemolytic 
poisons;  potassium  chlorate,  carbolic  acid, 
sulphuric  acid,  hydrochloric  acid,  pjTogallic 
acid,  arseniuretted  hydrogen,  aniline,  acetan- 
ehd,  antipyrine,  phenacetin,  lactophenin, 
sulphonal,  trional  tetronal,  pyTidine,  toluy- 
lendiamine,  solanine,  saponin,  muscarine, 
naphthol,  phosphorus,  lead,  snake-venom, 
ether,  chloroform,  nitrites,  bile  salts,  car- 
bon monoxide,  tuberculin;  fevers:  malaria, 
black-water  fever,  syphilis,  scarlet  fever, 
yellow  fever,  typhoid  fever,  erysipelas,  acute 
rheumatism,  croupous  pneumonia,  puhno- 
nary  tuberculosis;  pleurisy  with  effusion; 
pericarditis;  Addison’s  disease;  exophthal- 
mic goitre;  Raynaud’s  disease;  angioneurotic 
oedema;  hepatic  curhosis;  hydroa  aestivale; 
intestinal  hemorrhage;  extensive  burns;  ex- 
posure to  cold;  traumatism;  muscular  and 
mental  overexertion;  Winckle’s,  usually 
fatal,  epidemic  ha?moglobinuria  of  the  new- 
born, with  jaundice  and  cyanosis. 

Treatment.— Put  the  patient  to  bed,  open 
the  bowels,  restrict  the  thet,  and  give  large 
quantities  of  water  to  dilute  the  blood  and 
wash  out  the  kidneys.  Oxygen  inhalations 
(see  under  Pneumonia)  may  be  given. 

As  a preventive  against  paroxysmal  ha?mo- 
globinuria  the  patient  should  be  kept 
warmly  clad,  and  should  avoid  causal  influ- 
ences. Residence  in  a warm  climate  is  best. 
Amyl  nitrite  (Part  11)  is  recommended  for 
the  purpose  of  aborting  an  attack. 

In  sulphonal  or  trional  ha'inatoporphyri- 
nuria  the  prognosis  is  grave.  Sodium  bicar- 
bonate should  be  given  m large  doses  (see 
Acidosis). 


HAEMOPTYSIS 


Haemoglobinuria,  Epidemic. — See  under 
Haenioglobinuria,  above. 

Haemoglobinuric  Fever.  — See  Black 
Water  Fever. 

Haemopericardium. — Gr.  al^a  blood  + 
Trept  around  + KapdLa  heart.  A non-inflam- 
inatory  effusion  of  blood  into  the  pericardial 
cavity,  due  to  (1)  penetrating  wounds 
caused  by  a foreign  body  or  a fractured 
sternum  or  rib;  (2)  crushing  wounds;  (3) 
traumatic  rupture  of  the  heart;  (4)  spon- 
taneous rupture  of  the  heart,  due  to  strain; 
(5)  rupture  of  an  aneurysm  of  the  aorta  or 
of  a coronary  artery;  (6)  malignant  erosion 
of  a blood-vessel. 

In  the  pericarditis  of  tuberculosis,  cancer, 
nephritis,  scurvy,  alcoholism,  grave  fevers,  and 
senility,  the  exudate  may  be  blood-stained. 

The  diagnosis  of  haemopericardium  is 
made  from  the  combination  of  sudden 
symptoms  of  internal  hemorrhage  (in- 
creased pulse-rate,  faintness — collapse)  with 
signs  of  pericardial  effusion. 

See  Hemon-hage.  A ruptured  heart  may 
be  successfully  sutured.  _ 

Haemophilia. — Gr.  al/jM  blood  + <jn\eLv  to 
love.  An  hereditary  hemorrhagic  disposi- 
tion, usually  transmitted  to  the  males 
through  the  females,  characterized  by  a 
tendency  to  marked  bleeding,  either  spon- 
taneous or  traumatic,  due  to  deficient  blood 
coagulability.  The  bleeding  may  occur,  ap- 
parently, in  or  from  any  part  of  the  body. 
The  joints,  especially  the  knee,  are  frequently 
affected  (hsemartlirosis).  Following  repeated 
hemorrhages  into  the  joint  there  results 
a chronic  arthritis,  followed  by  ankylosis 
and  deformity. 

There  is  also  an  acquired  hemor- 
rhagic disposition. 

Treatment.— The  slightest  traumatism  (even 
violent  exertion),  and  surgical  operations 
should  be  strictly  avoided.  The  mouth, 
gums,  and  teeth  should  be  kept  clean  with 
castile  soap,  warm  water,  and  brush,  and  a 
dentist  consulted  on  the  first  signs  of  dental 
caries,  in  order  to  avoid  the  need  of  having 
a tooth  extracted.  With  painful  teeth,  the 
nerve  may  be  destroyed.  Abscesses  should 
be  opened  through  the  tooth. 

A daily  cold  douche,  taken  standing  in 
warm  water,  and  sea-bathing  are  of  prophy- 
lactic value.  A warm  climate  is  recom- 
mended because  the  disease  is  rare  in  warm 
climates.  Milk  is  recommended  as  a food  for 
increasing  the  coagulability  of  the  blood. 
Calcium  lactate  may  be  prescribed,  but  for 
not  more  than  three  days  in  succession,  since 
its  continued  administration  is  said  to 
diminish  the  coagulability  of  the  blood. 


Calcii  lactatis  (Marck’s  or  Squibb’s 

soluble) gr.  x-xx 

Fiat  pulvis  una,  et  dispense  in  charta  cerata. 
Mitte  tabs  100. 

Sig. — One  powder  three  to  six  times  a day,  “for 
a day  or  two  every  week.” 

Sodium  sulphate  and  thyroid  extract  are 
also  recormnended  (see  Part  11.) 

The  tendency  to  bleed  may  disappear  in 
later  life. 

To  check  bleeding,  exert  compression 
with  tampons  of  gauze,  either  dry  or  soaked 
with  adrenalin  solution,  1 : 1000;  or  cocaine, 

1 to  2 per  cent.;  or  sterile  gelatine  solution, 
5 per  cent.(?);  or  fresh  blood  serum  from 
another  animal,  or  even  antidiphtheritic  or 
antistreptococcic  serum;  or  a normal  saline 
extract  of  a highly  cellular  organ,  such  as 
the  thymus,  testis,  or , brain  (kephalin,  a 
brain  phosphatid).  The  actual  cautery  may 
be  tried. 

The  subcutaneous  or  intravenous  (q.  v.) 
injection  of  fresh  rabbit,  horse,  or  human 
serum  (not  beef  serum,  as  it  is  toxic), 
is  highly  recommended.  Intravenously  the 
dose  is  10  to  20  c.c.  for  adults,  and  half  tliis 
for  children;  subcutaneously  it  is  20  to  30  c.c. 
for  adults,  and  half  this  amount  for  children. 
The  dose  may  be  repeated,  if  necessary,  on 
the  .same  or  the  second  day.  Ortner  mentions 
doses  of  2 to  4 oz.  Moss,  quoted  by  Osier, 
says  that  “ as  much  as  100  or  even  200  c.  c. 
in  fom  or  five  days  ” may  be  given. 
Antidiphtheritic  (horse)  sermn  may  be  used. 
Blood  transfusion  (q.v.)  may  be  practiced. 
Calcimn  lactate,  pss-i,  may  be  given  three 
times,  if  necessary,  during  the  day. 

In  severe  uterine  hemorrhage,  atmocausis 
(Gr.  arpos  steam  -}-  Kauats  burning)  may  be 
employed  for  two  or  three  minutes  at  a 
temperature  of  115°  C. 

In  hjemarthrosis  employ  absolute  quiet, 
iimnobilization,  and  gentle  compression  with 
the  limb  elevated,  followed,  after  a few  days, 
by  gentle  massage,  proximal  to  the  joint, 
but  not  to  the  joint  itself.  If  contracture 
occurs,  bring  about  gi-adual  extension  by 
means  of  an  adjustable  splint,  or  a plaster 
splint  frequently  appUed. 

Haemoptysis. — Gr.  alpa  blood  -f-  irTveiv  to 
spit.  Haemoptysis  denotes  hemorrhage 
through  the  mouth  from  the  respiratory 
tract  below  the  epiglottis.  The  blood  in 
haemoptysis  is  bright  red  in  color,  frothy, 
alkaline,  and  usually  associated  with  muco- 
pus;  whereas  in  haematemesis  it  is  apt  to  be 
dark  in  color,  acid,  and  clotted. 

Etiology.— Pulmonary  tuberculosis;  bron- 
chitis, especially  influenzal;  pneumonia  in 
the  initial  congestive  stage;  bronchiectasis; 


HEMOTHORAX 


fibrinous  bronchitis  following  the  expectora- 
tion of  the  cast;  pulmonary  abscess;  pul- 
monary gangrene;  pulmonary  infarction; 
pulmonary  chrhosis;  emphysema;  asthma; 
pleurisy;  pulmonary  syphilis;  pulmonary 
neoplasm;  pulmonary  distomiasis ; pulmon- 
ary actinomycosis;  pulmonary  leprosy; 
passive  pulmonary  congestion  clue  to  heart 
disease;  trauma  to  the  chest;  heavy  lifting, 
violent  exercise ; aortic  aneuiysm ; ulceration 
of  the  larynx,  trachea,  or  bronchi;  chronic 
arthritis  (artlu’itic  chathesis) ; severe  an- 
aemia, leukaemia,  purpura  scrnyy,  haemo- 
philia; vicarious  menstruation;  mediastinal 
dermoid  cyst;  severe  acute  infections; 
infectious  jaunchce  or  Weil’s  disease;  nervous 
influences:  injury  of  the  central  nervous 
system,  epilepsy,  hysteria  insanity,  adol- 
escence, pregnancy  (due  to  “cardiac  nerve 
storms”  in  neurotic  women,  and  controlled 
by  rest,  bromides  and  chloral — Hirst) ; 
inhalation  of  irritating  fumes. 

Treatment.—"  The  incUcations,”  says  Osier, 
“ are  to  reduce  the  frequency  of  the  heart- 
beats and  to  lower  the  blood-pressure.”  To 
tills  end  employ  rest  and  quiet  in  bed,  on 
the  affected  side,  or  in  a sitting  or  semi- 
recumbent  posture,  in  a well-ventilated,  cool 
room.  Place  an  ice-bag  to  the  precorcUiun, 
suspended  from  a bed-cradle,  and  give  ice 
to  swallow.  Enjoin  the  patient  not  to 
speak,  but  to  write  down  requests.  Exclude 
visitors.  To  allay  restlessness  and  cough, 
give  a hypodermic  of  morpliine,  gr.  but 
do  not  give  morphine  unless  actually 
required.  Administer  a piugative. 

The  diet  should  be  restricted,  liquid  (to 
obviate  chewmg),  and  bland:  iced  milk,  ice 
cream,  albumen  water,  gelatine  preparations, 
raw  eggs;  no  alcohol,  tea,  coffee,  chocolate, 
spices,  hot  foods,  or  carbonated  beverages. 
In  tuberculosis,  however,  a solid  but 
restricted  diet  should  be  resumed  as  soon 
as  feasible. 

For  tumultuous  heart  action,  prescribe 
nitroglycerin,  or  sodimn  nitrite,  or  amyl 
nitrite,  or  aconite  (see  Part  11)  until  the 
heart  is  quieted  and  the  blood-prcssiire 
lowered,  as  shown  by  a blood-pressure 
instrument  (q.v.).  Ligatures  may  be  applied 
to  the  lower  extremities.  Do  not  obliterate 
the  pulse,  and  do  not  leave  them  on  too 
long.  Loosen  the  ligatures  gradually.  Apply 
dry  cups  (q.  v.)  for  pulmonary  congestion. 

To  Ihnit  the  mobility  of  the  chest,  one 
may,  if  deemed  advisable,  apply  a broad 
adhesive  band  around  it,  just  below 
the  nipples. 

Artificial  pneumothrorax  (q.v.)  is  of  value 
in  persistent  hemorrhage. 


The  following  haemostatics  are  of  service: 

FI.  ext.  hydrastic,  njjxv-xlv,  in  milk,  every 
hour  for  four  or  five  doses. 

Hydrastinin,  gr.ss-ii,  hypodermically,  t.i.d. 
(the  most  rehable  haemostatic,  says  Croftan). 

Cotarnine  or  Stypticin,  gr.  i-v  by  mouth, 
or  gr.  to  3^  hypodermically,  4 to  5 
times  daily. 

FI.  ext.  hamamehdis,  30  to  60  drops, 
five  times  a day.  (Ortner.) 

Aromatic  sulphuric  acid,  20  drops  in 
water,  every  three  or  four  hours. 

01.  terebinthinae  rectificati,  5 drops  in 
milk  or  on  bread  or  in  capsule,  every  two 
to  three  hours  (every  half  hour  for  six 
doses,  says  Yeo.) 

FI.  ext.  ergot,  5ss-i-iv,  in  water. 

Gelatine,  3h~iv  of  the  dry  gelatine  made 
into  a 10  per  cent,  flavored  jelly,  3 to  4 times 
daily;  or  10  per  cent,  sterile  (Merck),  3x 
hypodermically,  repeated  at  least  once  a day. 

Salt,  one  tablespoonful  in  a little  water. 

Calcium  lactate,  3ss-i,  t.i.d.,  for  a day 
or  two. 

Atropine,  gr.  hypodermically,  in 

severe  cases. 

Pituitary  extract,  gr.  ii-iv,  t.i.d.  (the  best, 
says  Wiggers). 

Emetine  hydrochloride,  0.5  gm.  in  dis- 
tilled water,  3i;  ^®iv  (Mo  gn^-)  hypodermi- 
cally (Raeburn).  It  may  be  repeated  in 
about  twelve  hours. 

For  other  remedies,  see  Hemorrhage. 

Haemorrhage,  see  Hemorrhage. 

The  bleeding  usually  ceases  spontaneously, 
except  in  rupture  of  an  aneurysm  or  erosion 
of  a blood-veSsel.  In  heart  disease,  the 
hemorrhage  acts  beneficially  by  reheving 
the  arterial  tension. 

The  patient  should  remain  in  bed  until 
every  trace  of  blood  has  disappeared  from  the 
sputum;  perhaps  a w'eek  or  ten  days  longer. 

Haemothorax. — Gr.  al/ia  blood  + ecopa^ 
chest.  The  presence  of  blood  in  the 
pleural  cavity. 

Etiology.— Pleuritis,  especially  tuberculous; 
hydrothorax;  cancer;  traumatism;  erosion  of 
an  intrathoracic  vessel,  usually  non-tubercu- 
lous;  rupture  of  an  aneurj'sm. 

If  the  hemorrhage  is  large,  there  soon 
appear  dyspnoea,  rapid  pulse,  and  pallor; 
and  if  the  lung  is  injured,  haemoptysis.  Fever 
follows  in  a day  or  so.  Possible  sequelae 
are  empyema,  pneumothorax,  pulmonary 
abscess,  pulmonary  gangrene,  pneumonia. 

Treatment.- Enjoin  absolute  rest  in  bed, 
including  feeding  with  a spoon  and  the  use 
of  the  bed-pan.  Give  morphine,  or  codeine, 
to  prevent  cough  (see  Part  11).  Immo- 
bilize the  chest  by  the  application,  during 


HAND  INFECTIONS 


expiration,  from  below  upward,  of  several 
well-warmed  overlapping  strips  of  zinc-oxide 
adhesive  plaster,  about  three  inches  wide, 
and  extending  from  the  spine  to  well  over 
the  sternum.  Apply  an  ice-bag.  (See 
Haemoptysis,  for  haemostatic  drugs.) 

If  there  is  urgent  dyspnoea,  perform 
aracentesis  {q.  v.,  under  Pleurisy),  followed 
y the  injection  of  25  to  30  drops  of  adrenalin 
solution,  1 : 1000. 

In  traumatic  cases  with  continuous  hem- 
orrhage, resect  one  or  more  ribs,  and  secure 
the  bleeding  vessel  by  means  of  catgut,  cau- 
terization, or  gauze  packing  (see  also  Hemor- 
rhage). In  suturing  wounds  of  the  lung,  use 
round  needles  and  catgut,  or  perform  large 
mass  Ugation.  Treat  shock  (q.v.) 

H and  1 nfections.— Varieties.— Lymphangitis 
iq.v.) ; tenosynovitis  (see  Orthopaedics,  Part 
10) ; fascial-space  abscesses  (considered  here) ; 
felon  iq.v.);  carbuncle  (see  Skin  Diseases, 
Part  5) ; paronychia  (Skin  Diseases) ; subepi- 
thelial  abscesses  (considered  here);  ery- 
sipelas (see  Skin  Diseases) ; erysipeloid  (see 
Skin  Diseases) ; gas-bacillus  infection  (see  In- 
flammation); anthrax  (see  Skin  Diseases); 
sporotrichosis  (see  Skin  Diseases);  tuber- 
culosis (see  Skin  Diseases);  syphilis  iq.v.); 
oidiomycosis  or  blastomycosis  (see  Skin  Dis- 
eases); chronic  staphylococcus  dermatitis. 

Localized  subcutaneous  abscesses  require 
simple  incision  and  drainage  with  gauze. 
In  the  superficial  subepithelial  infec- 
tions, remove  with  sharp  scissors  all  of  the 
raised  epithelium,  and  soak  the  part  in 
an  antiseptic  solution  or  apply  a dry 
antiseptic  powder. 

Fascial  Space  Abscesses. — I.  Middle 
Palmar  Space. — This  space  lies  beneath  the 
palmar  aponeurosis  and  tendons,  and  extends 
from  the  middle  metacarpal  bone  to  the 
radial  side  of  the  metacarpal  bone  of  the 
little  finger.  Infection  here  is  shown  by 
the  presence  of  localized  tenderness,  bulg- 
ing of  the  palm,  and  flexion  of  all  the  fingers. 
Pus  is  located  at  the  site  of  greatest  tender- 
ness. Its  presence  is  indicated  by  a brawny 
induration,  not  by  a soft  oedema  which 
pits  on  pressure. 

For  the  proper  incision  in  middle  palmar 
abscess,  see  Fig.  40. 

II.  Thenar  Space. — This  space  extends 
from  the  middle  metacarpal  bone  to  the 
radial  side  of  the  hand.  Its  involvement  is 
shown  by  a great  balloon-like  swelling  over 
the  ball  of  the  thumb,  and  flexion  of  the 
distal  phalanx  of  the  thumb,  but  no  oblitera- 
tion of  the  concavity  of  the  palm. 

The  proper  incision  in  thenar  abscess  is  a 
dorsal  one  on  the  radial  side  of  the  index 


metacarpale,  opposite  its  middle,  on  a level 
with  its  flexor  surface. 

III.  Hypothenar  Space. — ^Abscess  occur- 
ring here  is  subcutaneous.  It  requires 
merely  simple  incision  and  drainage 
with  gauze. 

IV.  Web  or  Lumbrical  Spaces  between  the 
bases  of  the  fingers  at  the  distal  edge  of  the 
palm.  A dumb-bell-shaped  accumulation  of 
pus  may  occur  here  beneath  both  the  epi- 
dermis and  derma  (collar-button  or  shirt- 
stud  abscess  or  frog  felon).  In  making  an 
incision  between  the  fingers,  see  that  both 
pockets  of  pus  are  opened,  using  a probe,  if 
necessary,  to  find  the  second  pocket. 

V.  Dorsal  Subcutaneous  Space. — Abscess 
here  calls  for  simple  incision  and  drainage. 


Pig.  40. — Line  of  incision  in  middle  palmar  abscess  (Kanavel) 

VT.  Dorsal  Subaponeurotic  Space. — In  ab- 
scess here,  make  the  incision  over  an  inter- 
osseous space  in  order  to  avoid  the  tendons. 

If  a palmar  abscess  should  extend  into  the 
forearm,  it  is  always  found  beneath  the 
flexor  profundus  and  upon  the  pronator 
quadratus  and  interosseous  septum,  and  fol- 
lowing the  ulnar  artery.  Such  an  extension, 
however,  usually  has  its  origin  in  a radial  or 
ulnar  bursitis  (see  Tenosynovitis,  Part  10, 
for  its  proper  treatment). 

Should  a fascial  space  become  infected 
secondarily  to  a tendon-sheath  infection, 
the  two  conditions  must  be  treated  indi- 
vidually, since  an  incision  in  one  will  not 
drain  the  other. 

General  Considerations. — Open  the  bowels 
prescribe  local  and  systemic  rest,  a light, 
nutritious  diet,  and  plenty  of  water.  Before 
operating,  soak  the  part  in  a hot  anti- 
septic solution  frequently,  for  about  an 
hour  at  a time,  until  the  infection  is  walled 
off.  After  the  operation,  drain  the  abscess 
cavity  with  gauze  saturated  with  vaseline, 
or  with  gutta  percha,  for  a day  or  longer. 
The  soaking  may  be  continued  after  the 
pus  has  been  evacuated.  After  the  inflam- 
mation has  subsided  (about  three  days), 


HAY  FEVER 


begin  passive  and  active  movements.  (All 
after  Allen  B.  Kanavel.) 

Hanot’s  Cirrhosis.— See  Cirrhosis,  Bil- 
iary, of  the  Liver. 

Harelip  and  Cleft  Palate. — The  best  time 
to  operate  for  harelip  is  between  the  end  of 
the  first  and  fourth  months;  for  cleft 
palate,  during  the  second  year. 

If  nursing  is  hnpossible,  feed  the  infant 
with  a spoon  or  metlicine  dropper,  or  by 
gavage,  or  by  means  of  a flap  of  thin  sheet 
rubber  attached  to  the  rubber  nipple  of  the 
nursing  bottle  in  such  a way  as  to  close 
the  cleft.  (Holt.) 

In  performing  gavage,  the  infant  should 
be  recumbent,  with  the  arms  held  to  the 
sides  by  means  of  a towel  or  sheet  about 
the  body.  The  stomach-tube  consists  of  a 
No.  12  to  16  (American  scale)  or  24  (French) 
rubber  catheter,  connected  by  a piece  of 
glass  tubing  to  rubber  tubing  and  a funnel. 
Depress  the  base  of  the  tongue  with  the  left 
forefinger,  and  pass  at  least  ten  inches  of 
the  catlieter  rapidly  into  the  oesophagus  and 
stomach.  Then  raise  the  funnel  high,  to 
allow  the  escape  of  gas,  before  pouring  in  the 
food.  In  removing  the  catheter,  fii'st  pinch 
the  tubing  to  prevent  a retiun  of  the  fluid. 

Harvest  Bug. — See  Part  5,  Skin  Diseases. 

Hay  Fever. — A recurrent  spring  or  au- 
tumnal catarrh  of  the  nasal,  conjunctival, 
and  pharyngeal  mucosae,  manifested  by  con- 
gestion, tickling,  itclung,  burning,  sneezing, 
cough,  increased  secretion,  etc.,  sometimes 
leading  to  asthmatic  symptoms,  and  lasting 
from  four  to  six  weeks,  due  to  a special  indi- 
vidual susceptibility  (sensitization  or  ana- 
phylactization — (q-v.)  to  the  pollen  protein 
of  certain  plants,  e.q.,  the  maples,  oaks,  the 
willow, birch,  poplar,  the  grasses,  (rye,  wheat, 
timothy,  foxtail,  red-top,  blue-grass,  beech 
grass,  etc.),  the  ragweeds,  rose,  field  daisy, 
golden-rod,  aster  or  starwort,  colt’s-foot, 
privet,  swamp  pink,  lily  of  the  valley,  .sweet 
pea,  hyacinth,  lilac,  hairy  Solomon’s  seal, 
rape,  green  cabbage,  thistle,  spinach,  yellow 
dock,  amaranth,  goose-foot,  sage  wormwood, 
chrysanthemum,  marigold,  xanthium,  blue 
bottle,  (Enothera  biennis,  Baccharis  hal- 
irnifolia,  Parthenium  hysterophorus.  Am- 
brosia trifida. 

Treatment.— The  best  treatment  is  removal 
to  an  immune  locality:  Adirondacks,  White 
Mountains,  Michigan,  the  ocean,  or  for 
those  with  autumnal  catarrh,  Europe. 

All  local  abnormalities  .should  be  remedied. 
p.g.,  septal  deviations,  spurs,  adhesions, 
polypi,  sinu.sitis,  turgescent  or  hypertrophic 
rhinitis  and  nasopharyngitis,  adenoids,  and 
sensitive  areas.  Sensitive  spots  should  be 


cauterized  with  chromic  acid  fused  on  the 
end  of  a probe  (first  warm  the  probe,  dip  it 
in  the  chromic  acid  crystals,  then  warm  the 
part  of  the  probe  next  beyond  the  crystals 
until  the  latter  melt),  or  with  trichloracetic 
acid  on  the  end  of  the  probe,  or  “ with  a flat 
electrode  at  white  heat  without  the  use  of  a 
local  anse.sthetic.”  First  tiun  on  the  current 
until  the  electrode  is  brought  almost 
instantly  to  a white  heat.  Introduce  it 
cold,  find  a sensitive  area  with  it  (the  sensi- 
tive areas  are  reddened  and  slightly  ele- 
vated, and  are  usually  found  “ just  above  the 
tuberculum  septi  on  each  side,  and  on  the 
anterior  part  of  each  inferior  turbinal  ”),  and 
turn  on  the  current.  As  soon  as  a white  heat 
is  observed,  turn  off  the  current  and  remove 
the  electrode.  “ From  four  to  five  sensitive 
areas  may  be  cauterized  at  a sitting,”  and 
the  treatment  may  be  repeated  in  five  to 
seven  days.  (Ballenger.) 

The  following  palliative  measures  are  of 
variable  benefit: 

(a)  Inhalations  of  steam  medicated  with 
compound  tincture  of  benzoin,  menthol, 
camphor,  or  cliloroform ; or  dry  inhalations  of 
menthol , eucalyptus,  or  sanitas  oil . (Thomson) . 

(b)  Insufflation  of  powdered  quinine  sul- 
phate; or  a spray  of  quinine,  gr.  i ad  5i;  or 
ointment,  gr.  xxx,  ad  vaseline  5 i- 

(c)  A spray  of  the  following : 


II  Mentholis, 

Camphor®,  aa gr-  iv 

Petrolati  liquidi 5 i 


(d)  Adrenalin  hydrocliloride,  1 : 20,000  to 
10,000  to  1000,  freslily  made  from  tablets, 
used  every  one  or  two  hours  as  a nasal 
spray;  or  adrenalin,  1 : 10,000,  in  lanolin 
and  vaseline,  dispensed  in  collapsible  tubes: 
a piece  about  the  size  of  a pea  is  inserted 
into  each  nostril  every  two  hours,  by  means 
of  a brush  or  the  little  finger,  the  head  being 
tlu-own  back  luitil  the  ointment  melts  and 
flows  over  the  mucous  membrane.  St.  Clair 
Thomson,  however,  condemns  the  use  of 
adrenalin  and  also  cocaine.  He  says:  “ The 
temporary  ischemia  is  followed  by  increased 
irritation,  tUscharge,  and  obstruction.” 

(e)  Irrigation  of  the  nose  (see  Part  8)  with 
normal  saline  solution  (5i  ad  Oi). 

(f)  Irrigation  of  the  conjunctival  sacs 
with  normal  saline  or  boric  acid  solution 
(oi  atl  Oi);  and  protection  of  the  eyes 
by  goggles. 

(g)  Application  over  the  closed  eyes,  at  a 
distance  of  12  to  18  inches,  of  the  500  candle- 
power  incandescent  lamp,  for  ten  to  twenty- 
five  minutes,  once  to  four  times  daily. 
(Ballenger.) 

(h)  To  check  secretion: 


HEADACHE 


Quininjc  bromidi gr-  ii 

Atropinse gr.  Koo 

Codeinae Sr-  34  _ 

Misce  et  fiat  pilula  una.  Mitte  tabs  vi. 

Sig. — One  pill  t.i.d.  (Do  not  continue  long.)  (Kyle.) 

Extract!  belladonnse gr.  )4o  to  Yu 

Arsenii  iodidi gr.  3i6 

Quinin®  sulphatis gr.  i 

Misce  et  fiat  pilula  una.  Mitte  tabs  ix. 

Sig. — One  pill  t.i.d.  (Thomson.) 

(i)  Active  purgation;  abundance  of  water; 
free  action  of  the  skin. 

(j)  Bromides,  phenacetin,  antipyi-ine,  pyi’a- 
midon,  etc.,  for  the  relief  of  malaise  (see 
Part  11  for  drugs.) 

(k)  To  limit  the  production  of  uric  acid, 
freshly  prepared  concentrated  nitromuriatic 
acid,  5 to  10  drops,  diluted  with  one-half  a 
tumblerful  of  water,  after  meals,  and  “ some- 
times also  at  night  ” (Gleason).  “ The 
results  of  the  remedy  are  apparent  within 
forty-eight  hours,”  says  Gleason. 

It  may  be  possible  to  desensitize  the 
patient  against  the  particular  pollen  protein 
to  which  he  is  suceptible  by  the  injection  of 
gradually  increasing  doses  of  the  protein 
extract,  which  is  obtained  by  treating  1 
gram  of  pollen  for  twenty-four  hours  with 
500  c.c.  of  normal  salt  solution  (0-85  per 
cent.)  containing  15  per  cent,  by  volume  of 
alcohol,  which  is  added  as  a preservative. 
To  ascertain  the  type  of  plant  toward  whose 
pollen  the  patient  is  sensitive,  make  a num- 
ber of  scratches  on  the  skin  of  the  upper 
arm  and  gently  rub  in  a drop  of  the  pollen 
extract  to  be  tested  (after  first  shaking  the 
extract  to  distribute  the  albuminous  pre- 
cipitate). In  positive  cases  an  urticarial  or 
wheal-like  reaction  appears  in  from  five  to 
fifteen  minutes.  In  making  the  tests,  says 
Goodale,  one  grass  pollen  will  suffice  for  all 
grasses,  one  rose  pollen  for  all  members  of 
the  rose  family,  and  ragweed  pollen  for  all 
of  the  compositse. 

Immunizing  injections  of  pollen  extract 
should  be  begun  about  ten  to  six  weeks  prior 
to  the  hay-fever  season.  Goodale  begins  the 
injections  ordinarily  with  1-3  minims  of  a 
1:  50,000  chlution,  which  nearly  always  pro- 
duces a subcutaneous  swelling  measuring 
1-3  cm.  in  diameter  and  lasting  from  one  to 
three  days.  After  this  reaction  subsides, 
he  doubles  the  dose,  and  a few  days  later 
quadruples  it.  He  next  gives  three  injections 
of  a 1 : 5,000  dilution,  from  3-8  minims  at 
an  injection;  then  three  injections  of  a 
1 : 2,000  dilution ; and  finally  the  full  strength 
of  1 : 500  in  doses  ranging  from  5-10  minims. 
Injections  are  given  about  twice  weekly. 

These  immunizing  injections  should  be 


repeated  each  season,  and  are  said  to  be 
increasingly  efficacious.  Goodale  reports 
123  cases  treated  for  two  or  more  years  with 
“very  definite  improvement”  in  59  cases. 

In  the  interval  between  attacks  the 
patient  should  aim  to  increase  his  nervous 
and  physical  stamina  by  the  observance  of 
correct  hygiene : regular  hours  of  eating  and 
sleeping,  fresh  air  day  and  night,  bland,  non- 
poisonous,  nutritious  diet,  (no  alcohol  nor 
too  much  nitrogenous  food),  abundant  water 
drinking,  a daily  warm  bath  followed  by  a 
cool  spinal  douche  and  friction,  adequate 
rest  and  exercise,  regulation  of  the  bowels 
(sodium  phosphate,  when  required),  tonics  if 
indicated,  e.g.,  arsenic,  strychnine,  phos- 
phorus, iron,  (see  Part  11 , and  the  correction 
of  eyestrain. 

All  nasal  and  pharyngeal  abnormalities 
should  be  corrected,  e.g.,  septal  deviations, 
spurs,  adhesions,  polypi,  sinusitis,  turgescent 
or  hypertrophic  rhinitis  and  naso-pharyn- 
gitis,  adenoids,  and  sensitive  areas  (see 
Parts  8 and  9 on  Nose  and  Throat  Diseases). 

Calcium  chloride,  taken  indefinitely,  may 
possibly  act  as  an  efficient  prophylactic,  as 
claimed  by  Emmerich  and  Loew  in  five 
cases  reported  (dosage  recommended:  tea- 
spoonful of  a 20  per  cent,  solution  of  the 
crystals  in  distilled  water,  in  a quarter  of  a 
glass  of  water,  t.i.d.,  during  meals).  White 
petrolatum  should  be  liberally  used  in  the 
nostrils  and  eyes. 

Headache. — Causes. — Fatigue;  hunger; 

overeating;  unhappiness;  constant  weeping; 
menstruation  ; bad  air  ; psychoneuroses  : 
neurasthenia,  psychasthenia,  hysteria;  eye- 
strain;  spotted  veils;  gastro-intestinal  intoxi- 
cation : dyspepsia,  hyperacidity,  constipation, 
etc. ; insufficient  aeration  due  to  tuberculosis, 
pleurisy  with  effusion,  emphysema,  asthma, 
etc.;  heavy  hats  or  heavy  masses  of  hair; 
toxemia  of  pregnancy;  acute  yellow  atrophy 
of  the  liver;  diabetes;  gout;  plumbism; 
malaria;  infectious  diseases,  particularly  the 
onset;  Addison’s  disease;  anaemia;  leukaemia; 
polycythaemia  ; low  blood-pressure  (q.v.); 
high  blood-pressure  (q.v.);  arteriosclerosis; 
nephritis;  alcohol,  tobacco,  tea,  coffee,  ether, 
chlorofonn,  opium,  etc.;  eye  diseases,  viz., 
conjunctivitis,  keratitis,  iritis,  glaucoma;  den- 
tal caries;  nasal  ohstruction,  due  to  turges- 
cence  of  the  erectile  tissue  over  the  middle 
turbinate  and  a deviated  septum,  causing 
pressure  on  the  sphenopalatine  ganglion, 
hypertrophies,  adhesions,  polypi,  adenoids, 
etc.;  sinusitis;  otitis  media;  nasopharyngeal 
disease;  aortic  incompetency;  cardiac  hyper- 
trophy; venous  hypersemia  due  to  chronic 
cardiac  insufficiency,  emphysema,  coughing. 


HEART  DILATATION 


obstruction  to  the  venous  return  in  the 
neck;  general  paresis;  trigeminal  neuralgia; 
supra-orbital  neuralgia;  migraine  (hemi- 
crania,  sick  headache,  or  periodic  headache) ; 
vasomotor  paralj^sis  and  dilatation,  char- 
acterized by  a very  flushed  face;  menin- 
gitis; acquh’ed  chi’onic  hydrocephalus;  brain 
tumor;  brain  abscess;  acromegaly;  trauma 
to  the  head;  concussion  of  the  brain; 
epilepsy  (following  a seizure);  syphilis; 
insolation;  herecUty;  female  pelvic  dis- 
ease; indurative  myalgia,  characterized 
by  the  presence  of  painful  indurations 
near  the  insertions  of  the  muscles  at  the 
occiput,  and  cm’ed  by  massaging  away 
these  indurations. 

Treatment. — First  ascertain  and  correct  the 
cause,  if  possible.  Good  hygiene  is  unpor- 
tant  in  all  cases : regular  hours  of  eating  and 
sleeping,  fresh  au  day  and  night,  adequate 
rest  and  exercise,  a daily  warm  bath  followed 
by  a cool  douche;  a bland,  non-poisonous 
diet,  in  some  cases  a nutritious  cUet,  in 
others,  especially  migraine  {q.v.,)  a re- 
stricted diet,  with  much  water  drinking  and 
plenty  of  exercise;  and  Anally,  tonics,  c.g., 
glycerophosphates  {q.v.  in  Part  11),  or  strych- 
nine, gr.  t.i.d.,  gradually  increased  to 
gr.  bio  t.i.d.;  or  tincture  of  nux  vomica, 
10  drops  in  water,  t.i.d.p.c.,  gradually 
increased  to  20  to  25  drops  t.i.d. 

For  high  blood-pressure  {q.v.),  prescribe 
ammonium  bromide,  gr.  x-xx  well  diluted, 
every  hour  until  relieved;  or  sotUum  nitrite, 
gr.  ss,  t.i.d.;  or  nitroglycerine,  gr.  Koo, 
every  few  hours,  as  required. 

For  low-blood  pressure,  prescribe  ergotin, 
gr.  }/i,  t.i.d.,  increased,  if  necessary,  to 
gr.  i,  t.i.d. 

For  cardiac  headaches,  employ  digitalis, 
which  may  be  taken  in  appropriate  doses 
for  months  or  years;  or  caffeine  citrate, 
gr.  ii,  in  a teaspoonful  of  aromatic  elixir, 
every  fifteen  to  thirty  minutes,  until  relief  is 
afforded.  (Kolipinski.) 

Analgesic  Remedies. — Phenacetin,  gr.  V— x, 
with  or  without  salol,  gr.  x,  repeated,  if 
necessary.  Phenacetin,  caffeine,  and 
aspirin,  aa  gr.  v.  Aspirin,  gr.  vui-x,  every 
two  to  three  hours. 

Phcnacetini,  vel  anti- 
pjTina;,  vel  aceta- 


nelidi gr.  iii-v 

Caffeinm gr.  i 

Sodii  bicarbonatis, 

Acidi  tartarici,  aa . . . gr.  xv 
M.  ct.  ft.  chart,  i. 


Sig. — One  powder  in  lialf  a glass  of  water, 
repeated  if  necessary  (be  very  cautious,  however, 
if  using  acetanelid). 


p Acetanelidi gr.  xxxvi  (gr.  iii  per  dose) 

Caffeinaj  citratis, 

Camphorse  monobro- 

matse,  aa gr.  vi  (gr.  ss  per  dose) 

Sodii  bicarbonatis, 

Acidi  tartarici,  aa . . . gr.  xxiv  (gr.  ii  per  dose) 
M.  et.  ft.  chartulas.  No.  xii. 

Sig. — One  powder  in  half  a glass  of  water, 
every  half-hour  imtil  reheved  (be  very  careful 
with  acetanelid). 

Ammonium  bromide,  gr.  x-xx,  well  diluted,  every 
hour  until  relieved. 

II  Spiritus  ammonii  aro- 

matici 5iv  (iiExx  per  dose) 

Ammonii  bromidi.  . . 3 hi  (gr.  xv  per  dose) 
Elixiris  simpheis,  q.s. 
ad 3 ih 

M.  Sig. — ^Two  teaspoonfuls  in  water  everj"  two 
hours.  (Fussell.) 

Sodium  bromide,  gr.  xx-xl,  with  chloral 
hydrate,  gr.  x-xx,  well  diluted,  repeated 
after  one  or  two  hours,  if  necessary.  Aro- 
matic spirits  of  ammonia,  5ss,  in  a cupful  of 
hot  water  or  hot  lemonade,  repeated  if 
necessary,  every  three  hours  for  three  or 
four  tunes.  Hoffman’s  anodyne,  one  tea- 
spoonful, well  diluted.  Fluid  extract  of 
cannabis  iudica,  gtt.  i,  every  half  to  one 
hour,  until  relieved  (2  to  10  to  even  60  drops 
may  be  required;  see  Part  11).  Morphine, 
gr.  M- 


II  Aqua?  ammonia? 5h 

Sodii  chloridi oh 

Spiriti  camphora? 5 hi 

Aqua?,  q.s.,  ad Oi 


M.  Sig. — For  local  application  to  the  forehead. 
(Respah’s  Eau  Sedative.) 

Hot  or  cold  applications,  electricity,  or 
massage  may  be  of  service.  The  hot  foot- 
bath lasting  ten  minutes,  or  the  cold  foot- 
bath lasting  half  a minute  to  three  or  four 
minutes,  may  be  tried.  Counter-irritation 
over  the  upper  certdcal  spine  in  the  form  of 
mustard  poultices  {q.v.),  the  Paquehn 
cautery,  chloroform  liniment  {q.v.),  tinc- 
ture of  iodine,  or  hot  followed  by  cold  douch- 
ing, is  also  recommended. 

Headache,  Periodic. — See  Migraine. 

Head  Enlargement. — Causes.— Hydroceph- 
alus; rickets;  osteitis  deformans;  bone 
tumoi-s  (myeloma,  hypernephroma,  sj'phihs, 
etc.) ; acromegaly. 

Heart  Asthenia. — See  Heart-Strain  and 
Neurasthenia. 

Heart=Block.  — (See  imder  Arrhythmia. 

Heartburn;  Cardialgia. — Gr.  Kapdia  heart 
aXyos  pain.  A burning  sensation  in  the 
cardia  and  oesophagus  due  to  acid  untation. 
(See  Hj-peracidlty.) 

Heart  Dilatation. — See  Cardiac  Insuflfi- 
ciency  or  Failure. 


HEART 


CIRCULATION  OF  THE  BLOOD  . 


I.Vn\phal.ic 
'^channel 
of  the  hand 


CIRCULATION  OF  THE  LYMPH, 


Veniole 


' Valves 


Lvinpltatics  of  the  forearm 

Radial  vein  / 


Temporal  artery 


Vein 


Inside 


Carotid  artery 

Internal  jugular  vein 
Externaljugularvein 
Arch  of  the  Aorta 
Subclavian  vein 
Superior  vena  cava_  J-- 

Pulmonary  vein  7^ 

Axillary  artery  ■ ' 

Axillary  vein  — ^ 

Inferiorvenacava  ‘ 

Portal  vein 


. , Brachial  artery 

of  artery 


Division 

of 

artery 


Artery 


Valves 


Arteries 

and  veins 
ofthe  hand 


Open 

lymphatics 


srent 
gland 

Lymphatic  ducts  and 
ganglia  or  glands 


Renal  artery  and  vein 
Mesenteric  artery 

Ulnar  artery 
Radial  artery 
Radial  vein 


Radial  artery^ 


Anterior  tibial  arter; 
Anterior  tibial  vein 


Plantar  artery^ 


^ • Left 
ventricle 

Section  of  the  heart 


I PiPt  V -u  '^Dorsal  venous 

Mi  )areh  of  the  foot 


of  the  foot 


LAROUSSE  MEDICAL 


Heart  and  circulation,  (arteries,  veins  , lymphatics  . ) 


HEMORRHAGE 


Heart  Disease,  Acute  Valvular. — See 

Endocarditis,  Acute. 

Chronic  Valvular. — See  Stage  of 
Compensation,  under  Cardiac  In- 
sufficiency. 

Compensated  Valvular. — See  Stage 
of  Compensation,  under  Cardiac 
Insufficiency. 

Congenital. — See  Congenital  Heart 
Disease. 

Failure. — See  Cardiac  Insufficiency  or 
Failme. 

Irritable.- — See  Arrhythmia,  Palpitation, 
Heart-Strain,  and  Neurasthenia. 

Rapid. — See  Tachycardia. 

Slow. — See  Bradycardia. 

Soldier’s. — See  Heart-Strain,  and 
Neurasthenia. 

Heart=Strain.^ — Heart-strain  is  the  result 
of  overwork  or  stress  brought  to  the  break- 
ing point,  with  a subsequent  cUminished 
capacity  of  the  strained  organ  for  exertion, 
and  a diminished  adaptability  to  changes 
of  blood-pressure  (loss  of  tone). 

The  symptoms  are:  unduly  rapid  action 
of  the  heart,  perhaps  extra  systoles  and  pal- 
pitation, perhaps  breathlessness  and  cyano- 
sis, perhaps  nausea,  perhaps  thoracic  dis- 
tress, coming  on  after  comparatively  slight 
exertion;  inability  on  the  part  of  the  heart 
to  adapt  itself  promptly  either  to  sudden 
exertion  or  to  sudden  cessation  from  exer- 
tion (in  the  latter  instance  the  heart  may 
suddenly  almost  stop  beating,  due  to  the 
sudden  release  of  tension  which  was  keep- 
ing it  steady). 

Treatment.— Confine  the  patient  to  bed  for 
a number  of  days  on  a light  diet,  and  keep 
the  bowels  free.  Later,  allow  him  grad- 
ually to  sit  up,  first  propping  him  up  with 
pillows;  then  allow  him  out  of  bed,  keeping 
close  watch  upon  the  heart  for  increased 
rate  or  irregularity.  After  several  days 
of  rest  out  of  bed,  graduated  exercises  may 
be  tmdertaken,  always  strictly  avoiding 
fatigue  or  distress.  The  general  hygienic 
rules  given  under  Compensated  Heart  Dis- 
ease, (under  Cardiac  Insufficiency),  should 
be  observed  for  an  indefinite  period. 

Heat  Cramps. — See  Sunstroke. 

Exhaustion. — See  Sunstroke. 

Helminthiasis. — Gr.  'iXnivs  worm.  See 
Worms. 

Hematuria. — See  under  Genito-Urinary 
Diseases. 

Hemeralopia.— See  Part  6. 

Hemiansesthesia. — See  Brain  Localization. 

Hemianopia. — See  Part  6,  Eye  Diseases. 

Hemiatrophy,  Facial.— See  Facial  Hemi- 
atrophy. 


Hemicrania. — Gr.  jjyut-  half  -j-  Kpavia  skull. 
See  Migraine. 

Hemiopia. — See  Part  6,  Eye  Diseases. 

Hemiplegia. — See  Brain’  Localization. 

Hemorrhage. — Gr.  alpa  blood  -f-  prjyv'vi'ai 
to  burst  forth.  External  hemorrhage  is  self- 
evident.  Increased  pulse  rate  and  faintness 
or  syncope  are  the  most  important  signs  of 
internal  hemorrhage.  Excessive  bleeding  is 
followed  by  collapse. 

Treatment.— Arrest  surgical  hemorrhage  by 
ligature;  firigation  with  hot  liquid  at  a 
temperature  of  110°  to  115°  F. ; pressure  with 
gauze,  either  dry,  or  soaked  with  adrenalin 
solution,  1 : 1000;  or  cocaine,  1 to  2 per 
cent. ; or  sterile  gelatine  solution,  5 per  cent. ; 
or  fresh  blood  serum  from  another  animal,  or 
even  chphtheritic  or  antistreptococcic  serum ; 
or  a normal  saline  extract  of  a highly  cellular 
organ,  such  as  the  thymus,  testis,  or  brain 
(cephalin,  a brain  phosphatid) ; or  a 5 to  10 
per  cent,  solution  of  coagulene  (see  Part  11); 
or  pressure  with  living  muscle;  or  the 
actual  cautery. 

Internal  Haemostatic  Remedies. — 1.  Fresh  rab- 
bit, horse,  or  human  serum  (not  beef  serum, 
as  it  is  toxic).  Intravenously  the  dose  is 
10  to  20  c.c.  for  adults,  half  this  amount  for 
children;  subcutaneously  it  is  20  to  30  c.c. 
for  adults,  and  half  this  for  children.  The 
dose  may  be  repeated  if  necessary  on  the 
second  day  (Weil).  Ortner  mentions  doses 
of  2 to  4 oz.  Moss,  quoted  by  Osier,  says 
that  “ as  much  as  100  or  even  200  c.c.  in 
four  or  five  ” days  may  be  given. 

2.  Blood  transfusion  (q.v). 

3.  Coagulene,  5 to  10  per  cent,  solution 
in  normal  saline  solution  (0.  6 per  cent.), 
internally  or  intravenously  (q.v). 

4.  Gelatine  (Merck’s  sterilized),  1 to  2 
per  cent,  in  normal  saline  solution  100  to 
200  c.c.  intravenously,  at  37°  C.,  daily, 
until  effectual  (probably  of  no  value). 

5.  Other  haemostatics  enumerated  under 
Haemoptysis. 

If  much  blood  has  been  lost,  lower  the 
head,  apply  heat  to  the  extremities,  pre- 
cordium,  and  head,  and  administer  hot 
normal  saline  solution  (0.6  to  0.7  per  cent., 
gr.  xlvi  to  the  pint,  temperature  102°  F.) 
per  rectum,  subcutaneously,  or  intraven- 
ously, according  to  the  urgency  of  the  case; 
or,  much  to  be  preferred,  gum-salt  or  gum- 
bicarbonate  solution  (Part  11.)  Give,  ac- 
cording to  Crile,  not  more  than  a pint  at 
a time  (to  avoid  pulmonary  oedema),  and 
repeat  every  hour  until  the  pulse  and  blood- 
pressure  are  restored.  Give  the  infusion 
very  slowly.  Should  the  pulse  become 
markedly  slow  and  soft,  stop  the  infusion, 


HEMORRHAGE,  INTRACRANIAL,  IN  THE  NEW-BORN 


proj^  the  patient  up,  resort  to  artificial  res- 
piration, and  massage  tlie  heart  by  “ rapid 
rliythniic  compression  over  the  precordium 
and  epigastrium.”  (Matas.)  Blood  trans- 
fusion iq.v.)  is  best  of  all. 

In  order  to  confine  the  blood  to  the  vital 
centres,  elevate  the  foot  of  the  bed,  and 
Ijandage  the  extremities  and  abdomen  evenly 
and  tightly  over  thick  layers  of  non-absorb- 
ent cotton,  for  one  or  two  hours;  or  use 
Crile’s  rubber  pneumatic  suit. 

The  following  heart  stimulants  may  be 
enii)loyed,  if  required,  after  the  hemor- 
rhage has  been  arrested : strychnine,  gr.  to 

tligifalin  (Merck’sGerman),gr.  3 lofoHi 
atroifine,  gr.  ^oo  to  Kqo;  camphor,  gr.i-ii, 
in  sterile  oil,  npx-xv,  frequently  repeated; 
ether,  ttjjx-xx-1x;  acLenalin,  1:1000,  nyv-xx, 
very  slowly  in  normal  saline  infusion,  not 
suddenly  at  one  shot;  caffeine  benzoate  or 
citrate,  gr.  i;  morphine,  gr.  to  yi  (in 
p.sychic  shock) ; oxygen  inhalation  (see  under 
Pneumonia).  The  above  stimulants  may 
be  used  alternately.  Water  should  be 
given  by  mouth  or  rectum.  Matas  injects 
slowly  into  the  rectum,  black  coffee,  8 oz., 
panopepton,  1 oz.,  brandy  or  whiskey,  1 oz., 
tincture  of  digitalis,  15  minims,  and  lauda- 
num, 10  minuns,  which  may  be  repeated 
after  two  hours  if  necessary. 

After  the  patient  is  out  of  danger,  pre- 
scribe, for  the  restoration  of  the  blood, 
rest,  fresh  air,  a liberal  diet,  and  iron  (see 
Antemia) . 

Hemorrhage,  Cerebral. — See  Apoplexy; 
Concussion,  Contusion,  and  Compression  of 
the  Brain;  and  Hemorrhage,  Meningeal,  in 
the  New  Born. 

Hemorrhage,  Cutaneous. — See  Purpura. 

Hemorrhage,  Gastric. — See  Haemateniesis. 

Hemorrhage,  Intestinal. — The  presence  of 
retl  blood  in  the  stools  indicates  bleeding 
from  the  lower  bowel.  In  bleeding  from  the 
upper  bowel  the  stools  are  usually  dark  or 
tarry  (melaena,  from  Gr.  neXaiva  black  bile), 
and  very  offensive.  The  blood  may  be 
“ occult,”  as  in  gastric  or  duodenal  ulcer,  or 
in  cancer,  and  revealed  only  by  microscopic 
or  chemical  examination  (see  Gastric  and 
Duodenal  Ulcer). 

raiology. — a.  Local  Dlsease.— Anal  fis- 
sure; hemorrhoids;  enteritis  (q.v.,  for  its 
many  causes);  intestinal  neoplasms,  rarely 
mul1i])le  polyposis;  j)arasites:  ama'ba,  ankyl- 
ostoma,  fluke-worm,  etc.  (see  Worms); 
end)olism  or  thrombosis  of  the  mesenteric 
vessels;  intussusception;  strangulation  of  the 
bowel;  hernia;  rupture  into  the  l)ile  pas.sages 
of  an  aneurysm  of  the  hepatic  artery;  rui)ture 
of  an  aneurysm  of  the  intestinal  vessels; 


amyloid  degeneration  of  the  intestinal  vessels; 
gastric  and  duodenal  ulcer;  gastric  cancer. 

b.  Constitutional  Disease. — Severe 

anajmia;  purpura;  scurvy;  leukaemia;  haemo- 
philia; splenic  anaemia;  severe  nose-bleed; 
severe  infections:  yellow  fever,  smallpox, 
malaria,  septico-pyaemia,  melaena  neona- 
torum (probably  infectious  in  origin;  the 
bleeding  may  occur  anywhere  in  the  body, 
not  alone  in  the  intestines);  heart  disease; 
chronic  interstitial  nephritis;  hepatic  ch'rho- 
sis;  vicarious  menstruation. 

Treatment. — Attend  to  the  cause.  In 
obscure  cases  make  an  anal,  rectal,  and  sig- 
moidoscopic  examination  (see  Enteritis,  for 
technique).  Appropriate  measures  in  appro- 
priate cases  are  the  application  of  an  ice-bag 
or  Leiter’s  coil  to  the  abdomen,  elevation  of 
the  foot  of  the  bed,  the  hypodermic  admin- 
istration of  morphine  to  allay  restlessness 
and  quiet  peristalsis,  and  perhaps  the  admin- 
istration of  astringents,  e.g.,  bismuth,  tannic 
acid  preparations,  silver  nitrate,  lead  acetate, 
etc.  (See  Part  11).  For  a fist  of  haemostatic 
drugs,  etc.,  see  under  Hemorrhage. 

In  melaena  neonatorum,  one  may  try 
calcium  lactate,  gr.  ii,  every  five  hours,  or, 
according  to  Holt,  as  much  as  20  to  30  grs.  a 
day ; or  suprarenal  extract,  gr . ii,  -|- , by  mouth, 
every  two  hours.  Attempt  to  check  access- 
ible bleeding  points  by  means  of  compresses 
soaked  with  adrenalin,  1 : 1000.  In  intract- 
able cases  resort  to  blood  transfusion  (q.v.). 

Hemorrhage,  Intracranial,  in  the  New= 
Born. — The  chief  symptoms  of  cerebral  hem- 
orrhage are  stupor,  bulging  fontanelle  (not 
invariable),  slow  pulse,  paralysis  with  rigid- 
ity ami  increased  reflexes,  muscular  twitch- 
ing and  convulsions. 

Hemorrhage  above  the  tentorium  is  indi- 
cated by  cortical  sjnnptoms,  chiefly  involv- 
ing the  facial,  oculo-niotor,  and  accessorius 
neiwe  tracts,  and  the  extremities.  The 
infant  is  restless,  and  the  greater  fontanelle 
bulges.  Hemorrhage  below  the  tentorium 
is  imhcated  by  spinal  nerve  sjTnptoms,  e.g., 
rigid  extremities,  erection  of  the  penis, 
wrinkling  of  the  scrotal  skin.  The  infant  is 
quiet  ami  somnolent,  the  fontanelles  do  no1 
bulge,  and  lumbar  puncture  (q.v.)  usually 
shows  blood. 

Treatment.— If  it  is  possible  to  locate  the 
hemoi-rhage  from  the  paralysis  or  con- 
vulsions, an  operation  should  be  performed 
as  soon  as  possible.  The  risk  is  not  small, 
but  is  justifiable  in  view  of  the  hopeless 
idiocy  which  may  otherwise  ensue.  (For 
the  treatment  of  the  paralysis,  see  Part 
10,  Orthoiia'dics).  Marked  s>nnptoms 
of  cranial  iiressure  call  for  deconqiression. 


HEMORRHOIDS 


The  latter  is  performed  over  the  parietal 
region  if  the  hemorrhage  is  supratentorial; 
over  the  occipital  region  if  the  hemorrhage 
is  infratentorial. 

Hemorrhage,  Meningeal. — See  Apoplexy; 
Concussion,  etc.,  of  the  Brain;  flema- 
torrachis;  and  Hemorrhage,  Intra- 
cranial, in  the  New  Born. 

Nasal. — See  Epistaxis,  in  Nose  Dis- 
eases, Part  8. 

(Esophageal. — See  Htematemesis. 

Pulmonary. — See  Haemoptysis. 

Spinal. — See  Haematomyelia  and  Haem- 
atorrhachis. 

Hemorrhagic  Diathesis. — Gr.  to 

dispose.  See  Haemophilia. 

Diseases  of  the  Newly  Born. — See 
under  Hemorrhage,  Intestinal. 

Pancreatitis,  Acute. — See  Pancreatitis, 
Acute  Hemorrhagic. 

Polymyositis. — See  Myositis. 

Hemorrhoids. — Gr.  aliMppoLs;  from  alpa 
blood  -|-  poid  flow.  Etiology. — Constipation; 
diarrhcea;  tenesmus  due  to  fissure  in  ano, 
proctitis,  or  sigmoiditis;  overuse  of  cathar- 
tics; long  straining  at  stool ; overeating;  sed- 
entary habits;  excessive  smoking  and  drink- 
ing; cardiac  insufficiency;  hepatic  cirrhosis; 
abdominal  or  pelvic  tmnors;  pregnancy; 
uterine  chsplacements;  heredity;  hyperchlor- 
hydria  (E.  Palier). 

Treatment. — Attend  to  any  possible  causal 
influence.  Prescribe  moderate  exercise,  a 
bland  diet,  alkalies  for  hyperacidity  (Palier); 
a mild  laxative  as  required  (cascara,  rhubarb, 
licorice  powder,  magnesia,  or  a morning 
saline,  see  Part  11),  strychnine  as  a tonic, 
local  cleanliness  with  castile  soap  and  water, 
and  perhaps  a cool  cleansing  enema  after  each 
bowel  movement.  The  following  astringent 
ointment  may  be  applied  by  means  of  a pile 
pipe,  night  and  morning,  and  after  each 
bowel  movement,  ' the  parts  being  first 
cleansed  with  castile  soap  and  water: 


B Acidi  tannici gr.  x 

Pulveris  camphoraj gr.  v 

Ichthyoli 3 iss 

Unguenti  zinci  oxidi,  q.s.,  ad gi 

(Kerley.) 


For  painful,  oedematous,  irreducible  piles, 
cleanse  the  parts  with  castile  soap  ancl 
water,  rinse,  and  bathe  with  boric  acid  solu- 
tion, 5i~iv  ad  Oi.  and  apply  either  (1)  hot 
fomentations  or  hot  poultices  (or  a hot 
sitz  bath  for  about  half  an  hour),  or  (2) 
compresses  wet  with  lead  and  opium  lotion 
(q.v.),  or  aluminum  acetate,  one  table- 
spoonful to  a cup  of  water,  and  covered  with 
an  ice-bag.  A suppository  containing 


opium,  aq.  ext.,  gr.  i,  may  be  inserted,  if 
necessary.  Other  soothing  applications  are 
the  following: 


1^  Unguenti  galluj  et  opii 3 i 

Sig. — Apply  several  times  daily,  as  required. 

B Unguenti  gall®, 

Unguenti  stramonii,  aa 3ss 

Sig. — Apply  several  times  daily,  as  required. 

Pulveris  opii gr.  x 

Extraoti  hyoscyami gr.  xii 

Extracti  hamamelidis 5ii 

Petrolati  mollis,  q.s.,  ad gi 

M.  Sig. — ^Apply  every  3 to  4 hours  about  one- 
twelfth  of  the  above.  (Earle.) 

B Chrysarobini gr.  xii 

lodoformi gr.  ivss 

Extracti  belladonnae  foliorum ....  gr.  viiiss 

Petrolati  mollis 3iv 

M.  Sig. — Apply  several  times  daily.  (Cohnheim.) 

B Chrysarobini gr.  iss 

Acidi  tannici gr.  iss 

lodoformi gr.  iii 

Extracti  belladonme  foliorum ....  gr.  % 

Olei  theobromatis gr.  x.xx 

M.  ft.  suppos.  i.  No.  xii. 


Sig. — Use  two  or  three  daily.  (Cohnheim.) 

A hard,  painful,  tlu’ombotic  hemorrhoid 
should  be  incised,  under  cocaine,  or  novo- 
caine  anaesthesia,  (see  Part  11),  and  the 
clot  turned  out. 

Chronic  hemorrhoids  are  curable  by 
surgery,  the  best  methods  being  (1)  ligation 
and  excision;  and  (2)  the  clamp  ancl  cautery 
method.  The  bowels  should  first  be  thor- 
oughly moved,  and  the  rectum  cleansed  by 
an  enema  and  soap  and  water  just  before 
the  operation. 

The  first  method  is  as  follows:  If  general 
anaesthesia  is  employed,  the  sphincter  is 
divulsed,  using  first  one  finger,  then  two 
fingers,  then  both  thumbs,  and  gently 
stretching  the  sphincter  until  the  thumbs 
press  upon  the  tubera  ischii  on  each  side; 
or  Kelly’s  conical  dilator  may  be  used. 
Under  local  anaesthesia  the  procedure  is  as 
follows:  Insert  a fenestrated  speculum,  and 
bring  down  each  pile  by  tilting  the  specu- 
lum, assisted  by  the  patient  straining.  In- 
ject the  pile  with  sterile  water  or  eucain, 
}y-s  per  cent.,  until  it  turns  white.  Then 
sever  it  at  the  muco-cutaneous  junction 
(Hilton’s  white  line)  with  scissors,  the 
artery  being  above.  Ligate  the  pedicle  with 
fine  linen,  and  excise  the  pile,  leaving  a long 
pedicle.  The  cut  edges  need  not  be  suturecl. 
After  the  operation  is  completed,  apply  a 
thick  wedge-shaped  gauze  pressure  pad  over 
the  anus  and  a snug  T-binder  to  prevent 
bleeding.  (Gant.) 


HERNIA 


In  the  clamp  and  cautery  method,  the 
clamp  is  applied  after  the  pile  has  been 
severed  at  the  muco-cutaneous  junction;  the 
pile  is  then  removed  with  scissors  and  the 
stump  thoroughly  burned  with  a Paquelin 
cautery  at  a dull  red  heat.  After  being 
cauterized  it  should  not  be  handled,  for 
fear  of  causing  hemorrhage.  After  all  the 
piles  have  been  removed,  the  stumps  are 
smeared  with  sterile  carbolized  vaseline,  and 
the  same  dressing  applied  as  in  the  ligature 
operation.  (Gant.)  Before  attacking  the 
piles,  see  that  the  anus  is  very  thoroughly 
chlated.  Draw  each  pile  down  and  outside 
the  anus. 

Some  in.sert,  after  either  operation,  a sup- 
pository of  opium  (aq.  ext.  gr.  i,  with  iodo- 
form, gr.  iii),  and  a small  gauze-wound  tube, 
to  be  left  in  for  thirty-six  hours.  The  bowels 
should  not  be  moved  until  after  the  fourth  or 
fifth  day,  when  castor  oil  may  be  given. 

Bokenham  recommends  ionization.  A 
zinc  needle  attached  to  the  positive  pole  of 
a galvanic  battery  (the  negative  electrode 
may  be  placed  on  the  back)  is  plunged  into 
the  pile,  which  may  first  be  injected  with 
adrenahn  and  novocain  (see  Part  11),  and  a 
current  of  10  to  25  milhamperes  is  gradually 
turned  on  and  allowed  to  act  for  ten  minutes 
or  longer,  or  until  coagulation  is  produced. 
If  the  pile  is  as  large  as  a pigeon’s  egg,  treat 
it  in  two  or  three  instalments  at  intervals 
of  ten  days. 

Henoch’s  Purpura. — See„Purpura. 

Hepatic  Abscess. — Gr.  rjirap  liver.  See 
Liver  Abscess. 

Cancer. — See  Cancer  of  the  Liver. 

Cirrhosis. — See  Cirrhosis  of  the  Liver, 
Biliary,  and  Portal. 

Congestion. — See  Liver,  Active  Con- 
gestion of  the. 

Distomiasis. — See  Distomiasis. 

Enlargement. — See  Liver  Enlargement. 

Hepatoptosis. — Gr.  fiirap  liver  + wruais, 
falling.  See  Enteroptosis. 

Hereditary  Ataxia. — See  Ataxia,  Fried- 
reich’s Hereditary. 

Spastic  Paraplegia. — See  Spastic  Para- 
plegia. 

(Edema  of  the  Legs,  or  Milroy’s  Dis= 
ease. — See  (Edema. 

Heredo= Ataxia. — See  Ataxia,  Friedreich’s 
Hereditary. 

Hernia. — L.  hernia.  The  protrusion  of 
the  contents  of  a cavity  through  an  abnor- 
mal opening.  Here  are  considered,  how- 
ever, only  abdominal  hernije. 

Etiology  .—a.  Exciting  Causes. — Local 
trauma,  a fall,  lifting,  straining,  coughing, 
sneezing,  etc. 


b.  Predisposing  Causes. — Heredity,  a 
congenital  sac,  defective  muscular  and  tendi- 
nous development,  loss  of  weight  and  muscle 
atrophy  due  to  constitutional  diseases, 
obesity,  pregnancy. 

A hernia  is  liable  to  serious  complications, 
e.g.,  irreducibility,  obstruction,  inflamma- 
tion, and  strangulation. 

An  irreducible  hernia  is  apt  to  give  rise 
to  indigestion,  flatulency,  coheky  pains, 
irregular  action  of  the  bowels,  and  perhaps 
attacks  of  local  peritonitis,  and  it  is  in  con- 
stant danger  of  strangulation. 

An  obstructed  hernia  is  manifested  by 
local  discomfort,  tenderness,  increase  in 
size,  indigestion,  nausea,  incomplete  con- 
stipation, and  perhaps  acute  colicky  pains. 
The  impulse  on  coughing  is  usually  retained. 
Strangulation  may  follow  obstruction. 

An  inflammed  hernia  is  characterized  by 
local  tenderness  and  increase  in  size,  and 
fever.  The  impiflse  is  retained. 

Strangulation  is  manifested  by  the  sudden 
occurrence  of  sharp,  colicky  pain,  accom- 
panied by  more  or  less  shock,  and  soon 
followed  by  nausea  and  vomiting  and 
complete  constipation.  The  hernia  is 
irreducible,  tender,  shows  an  increase  in  size 
and  tenseness,  and  is  dull  on  percussion. 

1.  Treatment  of  Complications. — a.  IRREDUCI- 
BLE Hernia. — If  the  condition  is  recent, 
an  attempt  may  be  made  to  reduce  the 
hernia  by  rest  in  bed  with  the  hips  elevated 
and  thighs  and  legs  flexed,  a pressure  pad 
applied  by  means  of  adhesive  straps,  an 
ice-bag  over  this,  reduced  diet,  and  careful 
taxis,  practiced  every  two  or  three  days. 
The  knee-chest  posture  may  be  tried.  But 
it  is  better  to  operate,  if  no  contra-indi- 
cations exist  (see  below). 

b.  Obstructed  Hernia. — Flex  the  thighs 
and  legs,  apply  heat,  elevate  the  foot  of 
the  bed,  and  give,  every  two  or  three  hours, 
high  enemata  of  oil  followed  by  warm  water. 
When  these  are  successful,  calomel  in  small 
doses  may  be  given,  followed  by  a saline. 
(Part  11). 

If  the  above  measures  are  unsuccess- 
ful, operate. 

c.  Inflamed  Hernia. — Apply  ice  or 
heat  locally,  always  the  latter  in  elderly 
persons,  and  give  high  enemata  as  in 
obstruction. 

d.  Strangulated  Hernia. — Taxis  may 
be  tried  for  about  five  minutes,  with  the 
hips  elevated  and  thighs  and  legs  flexed,  but 
there  is  danger  of  contusion  or  rupture  of 
the  bowel  or  sac,  or  of  reduction  of  the  still 
strangulated  hernia.  If  reduction  is  success- 
ful, fasten  a pad  over  the  hernial  opening. 


HILL  DIARRHCEA 


and  keep  the  patient  in  bed  until  all  symp- 
toms have  disappeared. 

If  taxis  fails,  or  is  deemed  inadvisable, 
operate  at  once.  If  the  incarcerated  gut  is 
gangrenous,  it  should  be  resected.  If  in 
doubt  as  to  the  presence  of  gangrene,  apply 
towels  wet  in  hot  normal  sahne  solution  for 
ten  or  fifteen  minutes.  If  then  the  purplish 
color  has  turned  to  bright  red  and  the 
peritoneum  is  still  glossy,  resection  is 
not  required. 

II.  Treatment  of  Uncomplicated  Hernia. — Since 
about  95  per  cent,  of  herniEe  are  cured  by 
operation,  and  in  view  of  the  dangers  to 
which  one  with  hernia  is  exposed,  operation 
is  the  treatment  of  choice,  except  in  children 
under  three  or  four  years  of  age,  in  whom 
the  defect  is  often  ctirable  by  a truss,  and 
in  the  following  cases:  senility,  grave  con- 
stitutional disease,  and  very  large  irreduci- 
ble hernia,  especially  in  the  obese. 

In  these  exceptional  cases  a truss  or  belt 
should  be  employed,  the  latter  for  umbilical 
hernia.  Coley  recommends,  for  hospital 
patients,  the  Knight  (cross-body)  truss, 
for  both  inguinal  and  femoral  herniEe;  and, 
for  private  patients,  the  Hood  or  frame 
truss.  (Pomeroy.) 

The  truss  should  be  applied  with  the 
patient  prone  and  the  hernia  completely 
reduced,  and  the  pad  should  rest  over  the 
internal  ring;  a perineal  strap  may  be. 
required  for  large  scrotal  hernise. 

For  inoperable,  irreducible  inguinal  her- 
nise, employ  a canvas  or  other  unyielding 
scrotal  bag  supported  from  the  pelvis 
and  shoulders. 

For  inoperable  umbilical  hernise  employ  a 
linen  duck  or  canvas  belt  with  elastic  straps, 
or  a woven  silk  elastic  belt  with  non-elastic 
straps,  to  which  may  be  fastened  a cir- 
cular pad  of  hard  rubber  or  wood  covered 
with  chamois  skin,  convex  in  reducible  and 
concave  in  irreducible  hernise,  and  double 
the  size  of  the  hernial  ring,  or  at  least  two 
inches  larger  than  the  latter  in  diameter. 
In  large  hernise  the  belt  may  be  supported 
from  the  shoulders  if  necessary.  (Coley.) 

The  French  spring-truss  is  reconunended 
during  pregnancy  for  inguinal  and  fem- 
oral hernise. 

Infantile  umbihcal  hernia  usually  disap- 
pears spontaneously;  but  one  may  employ  a 
wooden  pad,  1)4  inches  in  diameter,  fastened 
on  with  adhesive  plaster,  which  should 
encircle  the  entire  abdomen.  Or,  draw 
together  over  the  navel  two  parallel  linear 
folds  of  the  skin  so  that  they  meet  in  the 
median  line,  and  hold  in  place  with  a strip 
of  zinc  oxide  adhesive  plaster,  1 to  2 inches 


wide  and  4 to  6 inches  long.  Change  every 
fifth  day.  If  the  plaster  causes  excoriation, 
fold  the  skin  horizontally  for  a time.  A 
cure  may  be  effected  by  this  means  in  from 
three  to  six  months  (Authorf). 

Ventral  hernia  in  children  is  usually 
cured  in  several  months  by  placing  zinc 
oxide  adhesive  plaster  “ flat  on  the  skin 
over  the  hernia.”  (Kerley). 

In  children,  if  no  cure  is  accomphshed 
with  the  truss  in  two  years,  operate. 

Herpes. — Gr.  sp-jrris.  See  Part  5,  Skin 
Diseases. 

Buccal. — See  Stomatitis. 

Zoster. — See  Part  5,  Skin  Diseases. 

Herpetic  Stomatitis.— See  Stomatitis. 

Hiccough. — Hiccough,  hiccup,  or  singul- 
tus (L.)  is  an  intermittent  sudden  chronic 
contraction  or  spasm  of  the  diaphragm  fol- 
lowed immediately  by  sudden  closure  of  the 
glottis  as  the  air  is  rapidly  inspired.  It  is  a 
phrenic  nerve  reflex. 

Etiology.— Various  inflammatory  and  irri- 
tative conditions  of  the  abdominal  viscera; 
certain  constitutional  diseases,  e.g.,  gout, 
diabetes,  and  chronic  nephritis;  nervous 
diseases,  e.g.,  hysteria,  epilepsy,  brain  tumor, 
cerebral  hemorrhage,  shock. 

Remedial  Measures. — 1.  Drinking  of  ice-cold 
w'ater;  or  a teaspoonful  of  salt  and  lemon 
juice;  or  salt  and  vinegar;  or  whiskey;  or 
turpentine;  or  musk;  or  cocaine,  gr.  )4o  to 
34o  (see  Part  11  for  all  drugs.) 

2.  Inhalation  of  amyl  nitrite  or  chloroform. 

3.  Strong  traction  upon  the  tongue. 

4.  Ether  spray  or  mustard  leaves  on 
the  epigastrium. 

5.  Galvanism,  or  mustard  leaves,  or  mas- 
sage, or  pressure  over  the  phrenic  nerve 
between  the  sternomastoid  and  scalenus 
anticus  muscles  and  above  the  omohyoid. 

6.  Gastric  lavage  (see  imder  Dyspepsia 
for  technique.) 

7.  Rhubarb  and  soda  (q.v.)  and  an  enema. 

8.  Sneezing. 

9.  Hypodermic  injection  of  nitroglycerin, 
or  pilocarpine,  or  apomorphine,  or  best,  mor- 
phine, gr.  34,  with  atropine,  gr.  ^20- 

10.  Bilateral  compression  of  the  eyeballs. 

Hill  Diarrhoea. — ^A  tropical  affection  oc- 
curring chiefly  in  Europeans  who  ascend  to 
an  elevation  of  about  six  thousand  feet  or 
more,  especially  dm-ing  the  rainy  season, 
and  characterized  by  an  acute  morning 
diarrhoea  accompanied  by  flatulence,  the 
stools  being  large,  usually  liquid,  pale  and 
frothy.  Early  recovery  is  the  rule. 

Treatment.— A deficiency  in  the  digestive 
ferments  is  presumably  at  fault,  therefore 
pepsin  or  pancreatin  is  prescribed,  gr.  x-xv, 


HYDROCEPHALUS 


about  two  hours  after  eating.  Bichloride  of 
mercury,  gr.  to  3^0;  well  cUluted,  before 
meals,  is  said  to  be  “an  important  aid  in 
the  treatment.”  (Author.?)  A strict  milk 
tliet,  perhaps  preferably  boiled,  is  advis- 
able. A flannel  band  should  be  worn  about 
the  abdomen. 

Hirschsprung’s  Disease. — See  Colon, 
Dilatation  of  the. 

Hodgkin’s  Disease;  Pseudo=Leuksemia. — 

Cr.  xpevdrjs  false.  An  uncommon,  fatal  dis- 
ease, caused  probably  by  the  so-called 
bacillus  Hodgkiiii,  characterized  by  pro- 
gressive painless  enlargement  of  the  lym- 
j:)hatic  glands,  usually  enlargement  of  the 
spleen,  sometimes  of  the  liver,  usually  fever, 
and  a progressive  ana?mia  of  secondary 
type.  The  red  cells  and  hajinoglobin  are 
diminished  to  about  the  same  extent; 
nucleated  reds  and  degenerated  reds  are 
unconnnon  except  in  the  late  stages;  the 
leucocytes  are  only  slightly  increased,  aver- 
aging about  12,000,  with  a relative  increase 
of  lymphocytes  (see  Blood  Examination.) 

Pressure  symptoms,  depending  upon  the 
parts  compressed,  eventually  occur.  Pres- 
sure upon  the  trachea  produces  cough  and 
dyspnoea;  upon  the  veins,  cyanosis  ami 
mdema;  upon  the  recurrent  laryngeal  nerve, 
alteration  of  the  voice;  upon  the  oesophagus, 
dysphagia;  within  the  mediastinmn,  dysj> 
noea,  cough,  cyanosis,  dysphagia;  upon  the 
bile  ducts,  jaundice;  within  the  abdomen, 
pain,  ascites,  pain  and  oedema  in  the  lower 
extremities,  etc. 

Osier  describes  six  clinical  types  of  the 
(hsease,  (1)  acute;  (2)  localized;  (3)  with 
relapsing  pyrexia;  (4)  latent;  (5)  splenome- 
galic;  and  (6)  Ij^unphadenia  ossium;  the 
last  of  doubtful  identity. 

From  lymphosarcoma,  ljunphatic  leuk- 
a'lnia,  gummatous  Ijunphoma,  tuberculous 
lymphadenitis,  and  simple  acute  inflamma- 
tory lymphatlenitis,  the  affection  is  dis- 
tinguished by  the  characteristic  histological 
appearance  of  an  excised  gland,  winch  shows 
a uniform  proliferation  of  the  endothelial 
and  reticular  cells,  mononuclear  and  multi- 
nuclear  giant  cells,  eosinophiles,  and  fibrosis 
due  to  proliferation  and  thickening  of  the 
fibrous  stroma.  (Dorothy  Reed).  The  tuber- 
culin (see  Tuberculosis,  Pulmonary)  and 
Wassermann  tests  may  be  of  assistance. 

Prognosis. — The  disease  is  usually  fatal 
within  three  years. 

Treatment. --When  the  case  is  seen  early, 
with  only  a few  accessible  glands  involved, 
these  should  be  thoroughly  removed,  and 
an  exhaustive  search  made  for  a possible 
atrium  of  infection  in  the  nose,  mouth,  or 
throat.  Later  operation  is  futile. 


X-ray  therapy,  (q.v.)  if  resorted  to  early,  is 
of  great  benefit,  and  even  possibly  curative. 
Large  areas  of  the  body  surface  as  well  as 
the  enlarged  glands  should  be  treated.  Knox 
recommends  a dose  once  a week,  over  sev- 
eral large  areas  at  a time,  using,  in  most 
cases,  a .5  to  1 mm.  filter  and  changing  the 
areas  treated  as  frequently  as  possible. 
Later,  a dose  should  be  given  every  two 
weeks  for  several  months.  In  very  acute 
cases,  a daily  dose  may  be  given  to  chffer- 
ent  areas. 

Fowler’s  solution  (Part  11)  in  increasing 
doses  causes  the  glands  to  dwindle,  but  they 
enlarge  again  when  the  arsenic  is  withdrawn. 
Some  report  cm-es  with  arsenic.  Phosphorus 
is  also  recommended:  Zinci  phosphidi, 

gr.  }i2  in  piil  form,  t.i.d. 

Vaccines  have  recently  been  tried  with 
variable  results. 

HookwormDisease.— See  Ankylostomiasis. 

Hour=Qlass  Contraction  of  the  Stomach. — 
See  Gastric  and  Duodenal  Ulcer. 

Huntingdon’s  Chorea. — See  Chorea, 

Huntingdon’s. 

Hydatid  Disease. — See  Echinococcus 

Disease. 

Hydrencephalocele. — Gr.  vbu>p  water  fl- 
ey/ce^aXos  brain  koTKos  hollow.  See  Men- 
ingocele. 

Hydrocephalus. — Gr.  vbup  water  -f-  Kt4>a.\rt. 
Hydrocephalus  is  acute  or  chronic,  congeni- 
tal or  acquired,  internal  or  external  (rarely 
the  latter).  Internal  hydrocephalus  is  a 
chstension  of  the  ventricles  of  the  brain  wdth 
fluid.  The  rare  and  relatively  unimportant 
external  hych’ocephalus  is.  a collection  of 
fluid  external  to  the  brain  cortex,  occurring 
as  a result  of  atrophy  of  the  brain  due  to 
old  age,  sclerosis,  softening,  hemorrhage, 
rickets,  and  the  cachexias  of  cancer,  alco- 
holism, nephritis,  etc.;  or  sometimes  occur- 
ring in  the  form  of  a meningeal  cyst. 

Congenital  internal  hydrocephalus  is  man- 
ifested by  an  enormous  enlargement  and 
thinning  of  the  cranium,  the  presence  of 
large  open  areas  uncovered  by  bone,  down- 
ward inclination  of  the  eyes,  and  usually 
imbecility.  It  is  usually  fatal  within  fom-  or 
five  years.  The  cause  is  unknown. 

Acquired  internal  hydrocephalus  is  either 
acute  or  chronic.  The  sjunptoms  are  those 
f)f  brain  compression,  i.e.,  headache,  slow 
j)ulse,  drowsiness,  stupor  or  coma  (wliich 
may  clear  up  and  recur),  choked  discs,  and 
perhaps  retraction  of  the  neck  and  muscular 
rigidit}',  suggesting  meningitis.  The  head 
need  not  be  enlarged.  It  maj"  be  idiopathic 
(serous  meningitis  or  ependjunitis  of 
Quincke),  or  secondary  tumor,  abscess, 
cysts,  parasites,  syphilis,  tubercle,  sinus 


HYDROPHOBIA;  RABIES 


thrombosis,  meningitis,  rickets,  nephritis, 
heart  chsease,  profound  anaemia,  etc.  It  is 
difficult  of  diagnosis.  Two  types  are  recog- 
nized, (1)  obstructive,  due  to  closure  of  the 
foramina  of  Lushka  and  Majendie,  through 
which  the  ventricles  communicate  with  the 
subarachnoid  space;  and  (2)  non-obstructive 
or  communicating,  due  to  closure  of  the 
subarachnoid  space  by  adhesions.  Cerebro- 
spinal fluid  is  secreted  by  the  chorioid  plexus, 
and  is  absorbed  almost  entirely  in  the  sub- 
arachnoid space.  The  two  types  are  differ- 
entiated by  introducing  1 c.c.  of  a specially 
prepared  neutral  solution  of  phenolsulpho- 
nephthalein  into  either  lateral  ventricle  and 
performing  lumbar  puncture  one-half  hour 
later.  Colorlessgpinal  fluid  indicates  the  ob- 
structive variety  of  hydrocephalus.  (Dandy.) 

Treatment. — In  congenital  hydrocephalus 
one  may  occasionally  withdraw  the  accumu- 
lation of  fluid  by  lumbar  or  ventricular 
puncture,  in  the  hope  that  the  process  may 
come  to  a standstill.  The  ventricular  punc- 
ture may  be  made  anywhere  on  the  cranium 
(but  see  Cushing  in  Keen’s  Surgery  for  his 
method  of  treatment  by  permanent  sub- 
peritoneal  drainage) . 

Acquired  hytlrocephalus  should  be  treated 
accorcUng  to  the  cause.  A decompression 
operation  with  puncture  of  the  ventricle  has 
resulted  in  ciu'e.  An  artificial  opening  may 
be  made  between  the  ventricle  and  the  sub- 
arachnoid space.  When  a tumor  is  causa- 
tive, it  should  be  removed,  if  possible,  or  a 
decompression  done.  In  inflammatory  cases 
(see  Meningitis)  repeated  puncture  of  the 
ventricles  may  protect  the  patient  from  the 
effects  of  compression  until  a sirontaneous 
cure  of  the  inflammation  occurs. 

Hydronephrosis. — See  Part  3,  Male 
Genito-Urinary  Diseases. 

Hydropericardium. — Gr.  Uwp  water  + 
TTcpi  around  Kapdia  heart.  A serous,  non- 
inflammatory transudation  into  the  peri- 
cardial cavity,  usually  cccm’ring  unnoticed 
as  a terminal  event. 

Etiology.— Passive  congestion  due  to  carthac 
or  pulmonary  disease,  or  to  obstruction  of 
the  pericardial  or  cardiac  veins  by  cancer, 
tubercle,  aneurysm,  thrombosis,  or  cardiac, 
pericardial,  or  mecliastinal  adhesions;  scle- 
rosis of  the  coronary  arteries;  neplndtis; 
cachexia  (due  to  nephritis,  tuberculosis, 
carcinoma,  malaria,  leukaemia,  etc.). 

The  Treatment  is  that  of  pericarditis  with 
effusion  (q.v.). 

Hydrophobia ; Rabies. — Gr.  iJ5cop  water  + 
4>60os  fear;  L.  ra'bere,  to  rage.  An  acute 
infectious  disease,  transmitted  to  man  by 
the  bite  of  infected  (rabid)  animals,  particu- 
larly the  dog,  and  probably  caused  by  Negri’s 


protozoon,  which  is  found  in  the  nerve  cells 
of  the  central  nervous  system.  The  virus 
slowly  accunuflates  in  the  central  nervous 
system,  where,  after  an  incubation  period  of 
from  five  days  to  six  months  (average  about 
forty  days)  from  the  time  of  the  bite,  it 
gives  rise  to  the  following  symptoms:  at 
first,  irritation  at  the  seat  of  the  bite, 
depression,  anxiety,  headache,  irritability, 
restlessness,  hypersensitiveness  to  external 
stimuli,  slight  difficulty  in  swallowing  liquids, 
and  huskiness  of  the  voice,  these  symptoms 
continuing  from  one  or  two  days  to  a week, 
when  they  become  more  severe;  attempts  to 
swallow  water,  and  even  other  slight  external 
stimuli,  precipitate  distressful  spasm  of  the 
muscles  of  deglutition  and  respiration,  so 
that  the  sufferer  dreads  the  sight  or  thought 
of  water;  these  spasms  soon  become  general 
and  associated  with  excitement  or  delirium, 
and  after  from  one  and  a half  to  three  days, 
paralysis  sets  in,  followed  by  death  in  six  to 
eighteen  hom-s.  The  symptoms  are  rarely 
paralytic  from  the  start  (dumb  rabies) . 

Wounds  about  the  face  are  more  rapidly 
and  severely  fatal  than  wounds  lower  down. 

The  offending  (.log  may  be  kept  under 
observation  for  fourteen  (.lays,  and  if  it  is 
then  well,  it  was  not  rabid.  Or,  the  dog 
may  be  killed,  and  a small  portion  of  its 
medulla  oblongata  inociflated  beneath  the 
dura  of  several  rabbits.  If  the  rabbits 
become  paralyzed  in  from  fifteen  to  twenty 
days,  the  condition  is  rabies.  The  demon- 
stration of  the  presence  of  the  Negri  bodies, 
however,  is  diagnostic,  for  they  have  never 
been  found  except  in  rabies.  Obtain  sections 
of  the  gray  matter  from  the  cerebral  cortex 
in  the  region  of  the  fissure  of  Rolando,  from 
Ammon’s  horn,  and  from  the  cerebellum 
(the  Negri  botlies  are  best  found  in  these 
locations),  at  right  angles  to  the  surface. 
Place  the  sections  upon  slides,  cover  with 
coverglasses,  and  gently  press  while  moving 
the  coverglass  over  the  slide,  in  order  to 
spread  out  the  section  moderately  thin.  Dry 
in  the  air.  Fix  in  pure  methyl  alcohol  for 
five  minutes,  and  pour  on  the  following 
stain:  distilled  water,  10  c.c.,  made  alkaline 
by  the  addition  of  one  drop  of  one  per  cent, 
potassium  carbonate  solution,  to  wliich  is 
added  ten  drops  of  Giemsa’s  stain.  Allow 
to  stand  for  three  hours;  pour  off  the  stain; 
wash  in  running  tai>water  for  one  to  three 
minutes;  and  dry  with  filter  paper.  If  the 
smear  is  thick,  dip  it  in  50  per  cent,  methyl 
alcohol  before  washing  in  water.  The  Negri 
bodies  appear  as  round,  oval,  triangular,  pear- 
shaped,  spindle  or  sausage-shaped  bodices, 
usually  within  the  nerve-cells  or  their 
branches  varying  in  size  from  0.5/x  to  20m 


HYPERACIDITY;  HYPERCHLORHYDRIA 


in  diameter,  with  a hyaline  cytoplasm,  and 
chromatoid  granules  surrounding  the  nu- 
cleus. The  cytoplasm  is  stained  blue,  the 
central  bodies  and  chromatoid  granules  a 
blue  red  or  azure;  while  the  cytoplasm  of 
the  nerve-cells  is  blue,  their  nuclei  red, 
nucleoli  dull  blue,  and  the  red  blood-cells  a 
pink  yellow  (method  of  Williams  and  Low- 
den,  described  by  Webster).  Van  Giesen’s 
method  is  as  follows : After  fixing  the  smears 
in  methyl  alcohol,  pour  upon  them  the  fol- 
lowing stain,  which  should  be  freshly  pre- 
pared: distilled  water,  10  c.c.  to  winch  is 
added  3 drops  of  a saturated  alcoholic 
solution  of  rose-aniline  violet  and  six  drops 
of  Loeffler’s  methylene  blue  solution;  warm 
until  steam  rises;  pour  off  the  stain;  rinse  in 
water;  allow  to  dry.  ' The  cytoplasm  of  the 
Negri  bodies  is  stained  deep  red,  the  gran- 
ules and  central  body  dark  blue,  the 
nerve  cells  light  blue,  and  the  blood-cells  a 
pale  salmon  red. 

While  waiting  for  a diagnosis,  however, 
the  patient  should  undergo  the  Pasteur 
treatment.  This  treatment  extends  over  a 
period  of  twenty-one  or  fourteen  or  eight 
days,  according  to  the  potency  of  the  vh-us 
or  toxin  used;  and  it  aims  to  actively  im- 
munize the  patient  before  the  termination  of 
the  incubation  period.  After  the  symptoms 
of  the  disease  have  once  appeared,  it  is 
invariably  fatal. 

Pasteur’s  vaccine  is  prepared  from  the 
dried  brains  and  spinal  cords  of  mfected 
rabbits.  First  a cord  which  has  ch-ied  for 
fourteen  days  is  used,  the  virus  of  such  a 
cord  being  quite  attenuated;  the  next  day  a 
cord  dried  thfiteen  days,  and  so  on,  up  to, 
usually  a cord  dried  three  days.  The  brains 
and  cord  are  ground  to  a paste,  frozen,  pul- 
verized, and  rapidly  dried  in  vaccuo.  See 
also  Part  11. 

There  is  an  hysterical  pseudo-hydrophobia. 

Treatment. — Excise  the  woimd,  if  feasible, 
even  though  it  has  healed;  or  place  a liga- 
ture above  the  wound,  open  the  latter  thor- 
oughly, apply  hot  water  and  suction  cups, 
and  then  cauterize  it  with  carbolic  acid  or 
nitric  acid,  followed  by  a saturated  solution 
of  sothum  bicarbonate,  alcohol,  and  a dry 
dressing;  or  employ  the  actual  cautery. 
Then  send  the  patient  to  a Pasteur  institute 
at  once,  or  procure  the  virus  at  once  and 
treat  the  patient  yourself  (see  Part  11). 

On  the  first  appearance  of  symptoms, 
place  the  patient  in  a darkened,  warm,  quiet 
room,  on  concentrated  liquid  nourishment. 
Apply  cocaine  {q.v.  in  Part  11)  to  the  fauces, 
if  necessary,  to  facilitate  swallowing;  nutri- 
ent enemata  (see  Rectal  Feeding)  may  be 
required.  Administer  morphine,  or  hyoscine 


hypodermically,  chloral  and  bromide  per 
rectmn  (see  Convidsions),  and  chloroform 
per  inhalation  as  soon  as  required.  Curare, 
which  paralyzes  the  motor  nerve  endings, 
is  claimed  to  have  cured  cases.  If  it  par- 
alyzes the  respiratory  nerves,  artificial  respi- 
ration (see  Asphyxia)  must  be  resorted  to. 
Tizzoni’s  serum,  obtained  by  immunizing 
sheep  with  attenuated  virus,  may  be  tried 
with  some  hope  of  success;  dosage  10  c.c., 
5 C.C.,  and  5 c.c.  on  three  successive  days. 

The  muzzling  of  dogs  is  an  effectual 
prophylactic  measme. 

Hydropneumothorax. — Gr.  i55cop  water  -f 
weDpa  air-|-chest.  See  Pneumothorax,  dupa^. 

Hydrothorax. — Gr.  ii5wp  water  -f 
chest.  A non-infiammatory  pleural  transu- 
dation. (See  Pleurisy  for  diagnostic  in- 
formation.) 

Etiology. — Heart  disease  (transudation  usu- 
ally right-sided);  kidney  disease  (transuda- 
tion usually  bilateral) ; neoplasms  of  the 
pleura,  lungs,  or  diaphragm;  compression  or 
thrombosis  of  the  azygous  veins. 

Treatment.— Attend  to  the  cause.  Rest, 
cardiac  stimulation,  diuresis,  saline  cathar- 
sis, and  counter-irritation  usually  suffice  to 
dispel  the  fluid.  In  the  presence  of  dysp- 
noea and  cardiac  embarassment,  however, 
paracentesis  had  better  be  performed  (see 
Pleurisy  with  Effusion). 

Hymenolepis  Nana  or  Dwarf  Tapeworm. 
— See  Tapeworm  Infection. 

Hyperacidity ; Hyperchlorhydria. — Gr. 

vwep  over;  L.  acidus,  sour;  xkwpos  green 
(chlorin)  -b  uScop  water.  Excessive  acidity 
of  the  stomach  contents,  i.e.,  more  than 
0.2  per  cent,  or  60°  of  free  hydrochloric  acid 
(see  under  Dj'spepsia  for  Gastric  Analysis). 

Symptomatolog}'. — Sense  of  weight,  pressure, 
and  burning  in  the  epigastrium  and  perhaps 
burning  sensation  in  the  cardia  and  oeso- 
phagus, and  acid  eructations  (cardialgia  or 
heartbiu’n),  occurring  usually  at  the  height 
of  digestion,  or  one-half  to  three  or  four 
hoiu's  after  eating,  and  relieved  by  albumin- 
ous food,  alkalies,  or  vomiting.  Over- 
sensitiveness of  the  nerves  to  acid  may 
cause  s}unptoms  with  even  nonnal  hydro- 
cliloric  acid  secretion,  and  on  the  other 
hand,  hypcrchlorhj'dria  may  be  present 
without  sjuiiptoms. 

Etiology.— Practically  any  or  all  of  the 
functional  or  organic  agencies  enumerated 
uiKler  Dyspepsia.  The  commonest  causes 
are  dietetic  indiscretions  and  chronic  gas- 
tritis (early  stage). 

Treatment.- Attend  first  of  all,  of  course, 
to  the  cause;  hyperclilorhydria  itself  is 
merely  a sjunjttom  (consult  Dyspepsia,  or 
Gastric  Indigestion). 


HYPERJilSTHESIA  GASTRICA 


Enjoin  adequate  rest,  exercise,  and  recrea- 
tion; fresh  air  day  anti  night;  regular  hours 
of  eating  and  sleeping,  slow  and  thorough 
mastication,  rest  before  anti  after  meals, 
anti  good  hygiene  generally,  not  neglecting 
oral  cleanliness. 

The  diet  should  be  blantl,  and  soft,  or 
finely  tlivitled.  Some  clinicians  atlvocate 
an  albimiinous  diet,  some  a carbohytlrate 
diet  and  some  a mixed  diet.  The  carbo- 
hytlrate atlvocates  tleclare  that,  while  pro- 
tein food  neutralizes  hydrochloric  acitl  by 
combining  with  it,  nevertheless  proteins 
cause  increased  secretion  of  hytlrttchloric 
acid,  anti  therefore  tend  to  perpetuate 
the  hyperchlorhytlria. 

Osier  recommends  a strictly  meat  diet  for 
from  four  to  six  weeks,  followetl  by  a gratlual 
return  to  regular  tliet.  He  prescribes  334 
ounces  of  finely  minced  raw  or  rare  meat,  two 
medium  slices  of  stale  bread,  anti  an  ounce 
of  butter,  with  a glass  of  Vichy,  Seltzer, 
Apollonaris,  or  spring  water  (not  too  cold), 
three  times  a tlay. 

R.  C.  Cabot  prescribes  “ six  small  meals 
daily,  containing  an  abuntlance  of  carbo- 
hydrates anti  fats,  and  little  proteitl  footl 
except  a moderate  amount  of  milk.”  A.  E. 
Stansfeltl  and  Rehfuss  also  favor  the  car- 
bohydrate tliet. 

Sippy  recommends  a liberal  mixed  diet: 
lean  meat,  steametl  white  fish  (sole,  hake, 
plaice,  etc.),  oysters,  toast,  zwieback,  butter, 
equal  parts  of  milk  anti  cream,  and  .sodium 
bicarbonate  and  light  or  calcined  magnesia 
(MgO),  aa  gr.  xxx,  in  half  a glass  of  water, 
at  the  height  of  digestion,  i.e.,  two  and  one- 
half  to  three  hours  after  meals  (pulv.  rhei,  gr. 
v-x,  may  be  added  for  constipation);  this 
diet  to  be  continued  t.i.d.  for  four  or  five 
days;  then  well-cooked  cereals  (rice,  farina, 
or  oatmeal,  with  sugar  and  cream)  atltled, 
if  desired,  for  two  more  days;  then,  for  two 
or  three  weeks  longer,  a soft  egg  atlded  in 
place  of  a portion  of  the  lean  meat,  and 
mashed  potatoes  and  vegetable  purees 
added;  then  regular  diet  resumed. 

R Sodii  bioarbonatLs  3iv  (gr.  xxx  per  dose) 
Magne.sii  o.xidi ...  3iv  (gr.  xxx  per  dose) 
Pulveris  rhei ....  gr.  xl-Lxxx  (gr.  v-x  per  dose) 
Aquae,  q.s.,  ad.  . . 5vdii 

M.  Sig. — Shake  well,  and  take  two  tablespoon- 
fuls in  half  a glass  of  water  as  directed.  (Sippy.) 

The  rhubarb  is  added  only  for  constipa- 
tion. The  magnesia  should  be  intermitted 
if  it  causes  (liarrhoea.  For  constipation, 
which  may  arise  after  the  disuse  of  the  mag- 
nesia, Sippy  recommends  rye  and  graham 
breads,  apple  sauce,  stewed  fruits,  marma- 
lades, potatoes,  spinach,  carrgts,  parsnips, 
13 


and  squash.  Sodium  phosphate,  one  tea- 
spoonful in  aqueous  solution,  one  hour 
before  breakfast,  is  a useful  aperient. 

The  bromides  (gr.  x,  three  or  four  times  a 
day)  are  of  temporary  value  in  hypersensi- 
tive reflex  states;  codeine,  gr. 
may  be  added.  Atropine  is  indicated  in 
the  same  conditions:  atroi)ine  sulphate, 

gi’-  Kso.  t.i.d.a.c.,  increased  to  gr.  Viqq,  or 
until  mild  atropine  sjmiptoms  occur  (see 
Part  1 1),  may,  if  watched,  be  continued,  with 
interruptions,  for  weeks  or  months  (Neuhoff). 


R Extract  i belladonna' ....  gr.  Js-Js-K-K 
Magnesii  o.xidi gr.  viiss 


Fiat  pulvis  una;  mitte  talis  xii. 

Sig. — One  powder  t.i.d.p.c.  (Ortncr).  (Watch 
for  toxic  sjunptoms.) 


R Bismuthi  .subcarbonati.s, 

Sodii  bicarbonatis, 

Magnesii  oxidi,  aa gr.  x 

Tincturae  belladonna' ....  i^v 
Aqua,  q.s.,  ad 5i 


M.  Sig. — One  ounce  t.i.d.p.s.  (The  doses  may 
be  varied.  Magnesium  is  added  in  sufficient 
amount  to  obviate  constipation.) 

Belladonna  is  indicated  in  hyperactive 
reflex  gastric  states  (hyperacidity,  hyper- 
secretion, pylorospasm),  together  with  neu- 
tral fats  (olive  or  sweet  almond  oil,  shaken 
with  water  to  remove  fatty  acids;  cream 
and  fresh  butter),  for  the  purpose  of  inhibit- 
ing secretion  and  motility.  Alkalies  (soda, 
magnesia,  bismuth  carbonate)  are  indicated 
to  neutralize  excess  of  acid.  An  oil,  such  as 
a wineglass  of  cream,  may  be  given  a half- 
hour  before  each  meal,  with  marked  relief 
of  symptoms. 

The  following  articles  of  diet  shoifld  be 
interdicted:  stomachics,  bitters,  spices, 

condiments,  acids,  salads,  pickles,  meat 
extracts,  meat  soups,  broths,  peptone  prep- 
arations, stewed  meats,  liver,  kitlney, 
sweetbread,  game,  rumpsteak,  smoked 
meat,  sausage,  all  foods  rich  in  purins  (see 
Gout),  sour  milk,  fried  foods,  raw  fruits 
and  vegetables,  mushrooms,  onions,  rad- 
ishes, coarse  foods,  such  as  cabbage,  tur- 
nips, brown  bread,  rye  bread,  etc.,  pastry, 
friecl  bread,  hot  buttered  toast,  sweets,  nuts, 
sharp  cheese,  excess  of  salt,  tea,  coffee,  malt 
liquors,  alcohol,  tobacco. 

HyperiEsthesia  Qastrica. — Gr.  mrep  over 
d-  alaOricns  sensibility;  yaari]p  stomach.  The 
occurrence  of  gastric  distress  which  appears 
soon  after  eating  and  continues  until  the 
stomach  is  empty. 

Etiology.— Neuroses  (neurasthenia,  hysteria, 
etc.);  ansemia;  tobacco;  morphine;  cocaine; 
gastric  ulcer;  chronic  gastritis;  dietetic 
faults:  heavy  food,  high  seasoning,  very 

hot  or  cold  fluids,  tea,  coffee,  alcohol,  over- 


HYSTERIA 


eating,  hasty  eating  and  imperfect  mastica- 
tion, irregular  eating,  fasting,  exclusive  diet. 

Treatment. — Attend  to  the  cause.  In  non- 
organic  cases,  the  same  treatment  as  for 
hyperacidity  {q-v.)  is  employed.  Alkalies 
in  large  doses  are  given  for  the  relief  of 
pain;  also  silver  nitrate,  gr.  3^  to  34  to 
in  half  a glass  of  water  on  an  empty  stomach; 
or  orthoform  or  ansesthesin  in  l}/2  grain 
powders  after  dinner  and  supper;  or 
menthol,  gr.  ^ to  \}/2  in  solution  in  olive 
oil.  Cold  epigastric  compresses  and  gal- 
vanization (see  Dyspepsia,  Nervous),  are 
useful.  Rectal  feeding  {q.v.)  for  a few  days 
is  sometimes  required.  Prescribe  iron  {q.v.) 
for  anaemia. 

Hyperchlorhydria. — See  Hyperacidity. 

Hypereme.sis. — Gr.  inr'tp  over  -1-  eptcns 
vomiting.  See  Vomiting. 

Hyperesthesia  Qastrica. — See  Hyperaes- 
thesia  Gastrica. 

Hyperosmia. — See  Part  8,  Nose  Diseases. 

Hyperpituitarism. — L.  pitinta,  a glutinous 
phlegm.  See  Acromegaly. 

Hypersecretion  or  Qastrosuccorrhcea. — 
Gr.  vTtkp  over  -1-  L.  secre'tio,  secretion;  Gr. 
yaar-qp  stomach  -|-  L.  suc'cus,  juice  -|-  Gr. 
poLa  flow.  A continuous  or,  rarely,  inter- 
mittent or  periodic  supersecretion  of  gastric 
juice  (which  is  usually  hyperacid),  associ- 
ated with  pain,  acitl  eructations,  and  per- 
haps vomiting  of  a clear,  watery,  highly 
acid  fluid,  and  leading  to  gastric  dilatation 
due  to  pylorospasm.  The  gastric  juice  con- 
tinues to  be  secreted  for  hours  and  some- 
times even  days  after  the  stomach  is  free 
from  food. 

The  diagnosis  is  based  upon  the  presence 
of  at  least  20  to  30  c.c.  of  gastric  juice  in 
the  fasting  stomach,  i.e.,  in  the  morning 
after  lavage  the  previous  evening. 

Etiology. — Neuroses  (neurasthenia,  tabes, 
general  paresis,  myelitis,  and  other  central 
nervous  disorders) ; morphinism ; alcoholism ; 
nicotinism;  pyloric  obstruction  (see  Dilata- 
tion of  the  Stomach,  Chronic.) 

Treatment. — This  is  the  same  as  the  treat- 
ment of  hyperchlorhydria  (q.v.),  with  per- 
haps the  addition  of  lavage.  Atropine  is 
especially  indicated. 

Hypertension,  Vascular.  — See  Blood- 
Pressure. 

Hyperthyroidism.  — See  Exophthalmic 
Goitre. 

Hypertrophic  Arthritis. — Gr.  virep  over  -1- 
Too4>r]  nutrition.  See  Arthritis  Deformans, 
in  Part  10,  Orthopaedics. 

Hypertrophic  Cervical  Pachymeningitis. — 
See  Meningitis,  Chronic. 

Cirrhosis  of  the  Liver. — See  Cirrhosis, 
Biliary,  of  the  Liver. 


Dilatation  of  the  Colon. — See  Colon, 
Dilatation  of  the. 

Hypertrophic  Osteopathies. — See  Osteo- 
pathies, the  Hypertrophic. 

Progressive  Neuritis  of  Childhood.— 
See  Interstitial  Hypertrophic  Pro- 
gressive Neuritis  of  Childhood. 

Pulmonary  Arthropathy.- — See  Osteo- 
Arthropathy. 

Stenosis  of  the  Pylorus.^-See  Dilata- 
tion of  the  Stomach,  Chronic. 

Hypertrophy  of  the  Tongue. — See  Macro- 
glossia. 

Hypoacidity. — Gr.  vtt6  rmder.  See  Ana- 
cidity. 

Hypochlorhydria;  Subacidity. — Gr.  viro 
under  xkwpos  green  vSwp  water;  L.  sub, 
under.  See  Anacidity. 

Hypochondriac  Pain. — See  Pain. 

Hypoglossal  Nerve.-^ — Gr.  vtt6  under  + 
yXwaaa  tongue.  The  twelfth  cranial  or 
hypoglossal  nerve  supplies  the  muscles  of 
the  tongue.  It  is  involved  in  bulbar  paraly- 
sis (q.v.),  and  sometimes  in  tabes,  men- 
ingitis, plmnbism,  trauma,  tumors,  scars, 
bone  disease. 

Hypopituitarism. — See  Acromegaly. 

Hypotyalism. — See  Aptyalism. 

Hypostatic  Congestion. — Gr.  vw6  under  -f- 
arkais  halt.  See  Pulmonary  Congestion. 

Hypotension,  Vascular.— ^ee  Blood-Pres- 
sm’e. 

Hypothyroidism. — Gr.  utto  under,  -f  thy- 
roid. The  following  conditions  are  due 
to  or  accompanied  by  insufficient  thyroid 
secretion,  viz.,  cretinism,  myxoedema,  and 
possible  chlorosis,  amenorrhoea,  goitre, 
eczema,  rickets,  adenoids,  enlarged  glands, 
noctiu-nal  enuresis,  post  influenzal  and 
hysterical  depression,  adiposis  dolorosa, 
lipomatosis,  pregnancy,  vomiting  of  preg- 
nancy, eclampsia,  epilepsy,  melancholia,  slow 
growth  in  cliildi-en,  lactation,  the  meno- 
pause, senility,  and  certain  forms  of  obesity. 

See  Cretinism,  and  Mj^xcedema,  for  the 
mode  of  administering  thyroid  extract. 
It  is  contra-indicated  in  cardio-vascular 
disease. 

Hysteria. — Gr.  varkpa.  womb.  Hysteria 
is  a fixed  mental  disposition  or  temperament 
of  a peculiar  nature,  subject  to  the  recurrent 
exhibition  of  acute  psychical  and  nervous 
phenomena.  The  hysterical  temperament  is 
characterized  by  rapid  changeableness  and 
capriciousness  of  mood,  impulsiveness  or 
lack  of  self-control,  susceptibility  to  sug- 
gestion, exaggerated  perception  of  bodily 
sensations,  exaggerated  egoism,  desire  for 
attention  and  notice,  “ martjTdom,”  and  a 
“ tendenej^  to  confabulation.”  The  acute 
psychical  and  nervous  phenomena  are  very 


HYSTERIA 


variable.  They  include  choking  sensations 
with  the  feeling  of  a ball  rising  in  the  throat 
(globus  hystericus),  contortions  and  assump- 
tion of  attitudes  (clownism),  cries,  hiccough, 
coughing,  stuttering,  shaking,  spasms  and 
contractures  (abdominal  spasm  giving  rise 
to  phantom  tumors,  which  disappear  under 
ansesthetization),  polymorphous  tremors, 
swallowing  and  belching  of  air,  rapid  breath- 
ing, dyspnoea,  crying  and  laughing  spells, 
mutism,  dream  states,  lethargy  states, 
trance  states,  myoclonus,  tetany,  pseudo- 
convulsions, pareses  and  paralyses  (see 
under  Brain  Localization  for  differential 
diagnosis  from  organic  paralysis),  abasia, 
aphonia,  loss  of  special  sense  perception 
(sight,  hearing,  taste,  etc.),  anaesthesias, 
pseudo-tabes,  tender  and  painful  areas 
(hysterogenic  spots),  cardialgia,  psuedo- 
pathies  of  the  various  organs  (stomach, 
intestines,  heart,  genitals,  skin,  joints, 
special  sense  organs,  temperature,  etc.),  etc. 
There  is  scarcely  a disease  which  may  not 
be  simulated  by  hysteria. 

Osier  defines  hysteria  as  “a  disorder, 
chiefly  of  young  women,  in  which  emotional 
states  control  the  body,  leading  to  per- 
version of  mental,  sensory,  motor,  and 
secretory  functions.” 

Ltiology. — The  predisposing  cause  is  a 
neuropathic  heredity  (hysteria,  insanity, 
alcoholism,  exhausting  disease,  consanguin- 
ity, etc.,  in  the  forebears).  Exciting  causes 
are  mental  strain,  worry,  or  shock,  tramna- 
tism,  masturbation,  exhausting  illness,  etc. 

Treatment.— Enjoin  a well-ordered  hygienic 
mode  of  life:  adequate  mental  and  physical 
rest,  daily  exercise  in  the  fresh  air,  agreeable 
occupation,  fresh  air  day  and  night,  a morn- 
ing warm  bath  before  breakfast  in  a warm 
room,  followed  by  a cool  douche  and  brisk 
rubbing  with  a coarse  towel,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
eating,  diet  abundant,  nutritious  and  bland, 
no  alcohol,  tea,  coffee,  or  tobacco,  regula- 
tion of  the  bowels,  wholesome  companion- 
ship with  others.  Prescribe  such  tonics  as 
iron,  arsenic,  and  strychnine  (see  Part  11), 
if  deemed  advisable.  Strychnine  in  small, 
frequently  repeated  doses  is  recommended 
for  vasomotor  atonicity.  I believe  the 
hysteric  is  one  who  is  habitually  more  or 
less  under  the  domination  of  the  subcon- 
scious or  subjective  (emotional,  impulsive 
or  instinctive)  mind,  the  objective  (rational, 
volitional,  critical  or  controlling)  mind 
being  more  or  less  in  abeyance;  in  other 
words,  one  who  is  constantly  hypersuscep- 
tible  to  auto-suggestion  or  self-hypnosis.  I 
believe,  therefore,  that  the  causal  treatment 
should  be  directed  toward  the  strengthening 


of  the  objective  mental  faculties  by  some 
form  of  objective  study  or  occupation,  a 
turning  about  of  the  mind’s  eye  from  within 
to  the  outer  world,  a strengthening  of  the 
will  to  be  sane  by  means  of  sympathetic 
wholesome  advice  and  precept.  Tell  the 
patient,  with  kindness  and  sympathy,  that 
her  sjTnptoms  have  no  organic  basis,  but  are 
purely  nervous  or  functional  and  remedi- 
able, and  will  vanish  just  as  soon  as  she  will 
take  it  upon  herself  to  realize  that  they  are 
but  delusions. 

The  Weir  Mitchell  regimen  (see  Neuras- 
thenia) may,  in  a small  minority  of  cases, 
be  best;  but  there  is  danger  that  it  may 
increase  introspection. 

For  painful  areas  and  other  local  mani- 
festations are  recoimnended,  chiefly  for  pur- 
poses of  suggestion,  massage,  electricity,  the 
actual  cautery,  and  hot  or  cold  douches. 

For  paralyses,  Sachs  recommends  the 
“ slowly  interrupted  faradic  current,  not  too 
strong”;  whereas  Starr  recommends  the 
application,  daily,  of  strong  faradic  cur- 
rents “ wliich  move  the  limbs.”  The  patient 
should  at  the  same  time  be  encom-aged  to 
make  voluntary  efforts. 

For  spasm  and  contractures,  says  Starr, 
“ massage  and  long  continued  hot  baths, 
followed  by  cold  effusions,  are  the  best  reme- 
dies.” Reduction  under  ether  may  be  neces- 
saiy.  James  Collier  recoimnends  for  the 
removal  of  paralyses,  contractures,  and 
aphonia,  that  the  patient  be  lightly  anaesthe- 
tized until  the  active,  noisy,  struggling  stage 
is  reached,  when  the  ether  should  be  immed- 
iately withdrawn,  and  as  the  patient  ap- 
proaches full  consciousness,  her  attention  be 
directed  to  the  fact  that  her  limbs  are  mov- 
ing, or  the  contracture  has  disappeared,  or 
that  she  is  using  her  voice. 

For  hysterical  aphonia  (see  Throat  Dis- 
eases, Part  9,  for  diagnostic  data),  Kyle 
employs  the  falsetto  voice  method  with 
eminent  satisfaction.  The  patient  is  in- 
structed to  sound  a high  falsetto  or  head 
tone,  “ resounding  in  the  vault  of  the  naso- 
pharynx,” with  the  mouth  tightly  closed. 
This  is  kept  up  for  some  time,  while  the 
pitch  is  gradually  lowered  and  the  volume 
increased.  After  a while,  when  the  patient 
has  gained  confidence  in  the  head-tone,  teU 
her,  “ when  making  the  head  tone,  to  open 
the  mouth.”  Repeat  this  several  times, 
lowering  the  pitch  each  time.  Then,  while 
the  patient  is  repeating  the  head-tones  with 
the  mouth  open,  have  her,  in  the  same  tone, 
repeat  a word  after  you,  “ and  she  will 
suddenly  realize  that  she  is  talking.”  Kyle 
adds:  “ I have  never  known  this  method  to 
fail  in  a true  case  of  hysterical  aphonia.” 


INANITION,  SIMPLE  ACUTE 


“ The  attention  of  the  patient  is  directed  to 
the  nose  rather  than  to  the  larynx,  and  she 
does  not  realize  that  the  sound  is  really 
being  produced  in  the  latter  organ.”  The 
patient  should  be  assured  in  the  beginning 
that  her  loss  of  voice  is  only  temporary. 

Faradism  may  be  employed.  Place  one 
electrode  over  the  episternal  notch,  and  the 
other  to  the  sides  of  the  larynx  alternately, 
starting  off  with  a “ fairly  strong  current” 
Or,  apply  one  electrode  to  the  interior  of  the 
larynx,  and  direct  the  patient  to  say  “ Ah,” 
or  “ one,  two,  three,”  on  the  contact  being 
suddenly  made.  Hypnotism  is  effectual. 

For  hypochondriasis  and  for  active  hys- 
terical manifestations,  the  following  seda- 
tive drugs  are  of  service : tr.  valerian, 
ammoniated  tincture  of  valerian,  zinc  valeri- 
anate, menthol  valerianate  or  validol,  asa- 
fmtida,  bromide,  aspirin  (for  drugs  see 
Part  11). 

Fluidextracti  valeriana?, 

Syrupi  rhei  aromatici,  aa 3i 

M.  Sig. — One  teaspoonful  every  two  hours. 
(Forchheiiner.) 

Asafoctida  pills,  says  Forchheiiner,  are 
“ valuable  in.  the  intestinal  troubles  of 
hysterics.” 


rj  Zinci  valeratis gr.  i-iiss 

Pho.sphori gr. 


Misce  et  fiat  pilula  una;  mitte  tails  30. 

Sig. — One  pill  t.i.d.p.c.  (Yeo.) 

Depressant  forms  of  hysteria  may  be 
accompanied  by,  or  possibly  due  to  hypo- 
thyroidism {q.v.) 

In  severe  attacks  one  may  dash  cold 
water  in  the  face,  or  apply  the  wire  brush 
of  a faradic  machine  to  the  region  of  the 
nose,  or  place  ammonia  or  amyl  nitrite  to 
the  nostrils,  anything  to  produce  a strong 
mental  impression  or  counter-suggestion 
which  will  divert  the  patient’s  subconscious 
thought  currents  into  new  channels.  To 
this  end,  the  hypodermic  athninistration  of 
apomorphine,  gr.  J-f  2,  is  very  effectual. 

Icterus. — L.;  Gr.  Urepos  jaundice.  See 
Jaundice. 

Icterus  Gravis. — See  Atrophy,  Acute 
Yellow,  of  the  Liver. 

Neonatorum. — See  under  Jaundice. 

Idiocy,  Amaurotic  Family. — See  Amauro- 
tic Family  Idiocy. 

Ileitis  and  lleo=colitis. — See  Enteritis. 

Ileus. — L.;  Gr.  eiXeos  from  tiXeiV  to  twist. 
See  Intestinal  Obstruction. 

Iliac  Pain. — See  Pain. 

Illuminating  Gas  Poisoning. — See  As- 
phyxia aiul  Poisoning. 


Impaction,  Fecal.^ — See  Intestinal  Ob- 
struction. 

Impotence. — See  Part  3,  Genito-Urinary 
Diseases. 

Inanition,  Simple  Acute. — L.  inanis, 
empty.  Simple  acute  inanition  is  acute 
starvation,  and  is  due  to  anorexia  or  refusal 
of  food,  vomiting,  insufficient  milk  secretion 
(the  baby  stops  nursing  and  cries  after  five 
or  ten  minutes  and  the  breast  is  found  to 
be  empty),  improper  food  (too  weak  or  too 
strong),  feeble  digestion,  retracted  nippies, 
fissured  nipples,  cleft  palate,  hare-lip,  infan- 
tile feebleness  in  sucking. 

The  symptoms  are  failure  to  gain,  usually 
constipation,  sometunes  diarrhoea,  pallid, 
inelastic  skin,  sunken  abdomen,  usually 
more  or  less  continuous  ciying.  If  neglected 
it  goes  on  to  malnutrition  or  marasmus. 

To  distinguish  inanition  from  acute  dys- 
pepsia or  diarrhoea  due  to  overfeeding,  weigh 
the  baby  for  a twenty-four  hour  period 
before  and  after  each  nursing,  and  thus 
ascertain  the  daily  total  intake. 

Treatment.— Attend  to  the  cause.  If  the 
child  is  congenitally  feeble  or  dyspeptic, 
secure  a wet-nurse,  if  possible,  and  dilute 
the  milk  at  first  with  an  equal  amount  of 
plain  boiled  water  or  lime  water,  and  give 
only  a few  teaspoonfuls  every  two  hours. 
If  vomiting  or  diarrhoea  is  present,  one  may 
remove  the  cream  from  the  milk  (Holt). 
Feeding  may  be  accomplished  with  a spoon, 
medicine  dropper,  Breck  feeder,  or,  if  neces- 
sary, by  gavage.  In  performing  gavage,  the 
infant  should  be  recumbent,  with  the  arms 
held  to  the  sides  by  means  of  a towel  or  sheet 
about  the  body.  The  stomach  tube  consists 
of  a No.  12  to  16  (American  scale)  or  No.  24 
(French  scale)  rubber  catheter,  connected 
by  a piece  of  glass  tubing  to  rubber  tubing 
anti  a funnel.  Depress  the  base  of  the  tongue 
with  the  left  forefinger,  and  pass  at  least  ten 
inches  of  the  catheter  rapidly  into  the 
(Dcsophagus  and  stomach.  Then  raise  the 
funnel  high,  to  allow  the  escape  of  gas, 
before  pouring  in  the  food.  In  removing 
the  catheter,  fii’st  pinch  the  tubing  to  pre- 
vent a return  of  the  fluid. 

As  the  child  improves,  gradually  increase 
the  strength  and  quantity  of  milk. 

If  a wet-nurse  is  not  procurable,  give 
modified  cow’s  milk:  P.,  0.5  to  1 i)er  cent.; 
F.,  0.5  to  1 i>er  cent.;  C.,  4 to  5 to  7 per 
cent. ; to  begin  with,  or  low  proteid  and  low 
fat,  according  to  Holt;  relatively  high  carbo- 
hydrate is  needed  (see  Infant  Feeding). 

Sufficient  water  should  be  supplied.  -If 
necessaiy,  give  colonic  injections  of  norma) 
saline  solution  (5i  ad  Oi),  every  five  hours^ 


INFANT  FEEDING 


or  continuously  by  Murphy’s  drop  method. 
For  subnormal  temperature,  employ  the 
measures  recommendetl  for  “ Premature  and 
Delicate  Infants.”  For  high  fever  employ 
tepid  sponging  or  baths. 

In  inanition  due  to  an  insufficient  supply 
of  breast  milk,  nurse  the  baby  more  fre- 
quently or  use  both  breasts  at  each  nursing. 
If,  after  a few  days,  the  weight  curve  does 
not  rise,  add  a bottle  after  each  nursing,  but 
not  until  the  breast  has  been  completely 
emptied.  The  amount  in  the  bottle  depends 
upon  the  amount  in  the  breast. 

For  anorexia,  try  a few  drops  of  pepsin 
and  dilute  hydrochloric  acid  before  each 
rneal,  or  strychnine,  gr.  Moo-Moo,  every 
six  hom’s  before  a feeding,  also  a lukewarm 
bath  followed  by  a cool  (not  too  cool)  spray, 
once  or  twice  a day,  shortly  before  meal- 
time, or  daily  gastric  lavage.  (Be  sure  that 
the  child  gets  sufficient  water) . Feeding  with 
a medicine  dropper  may  be  tried. 

If  all  other  measures  fail,  employ  gavage. 

In  bottle  fed  babies  with  hunger  inanition, 
add  M to  1 ounce  to  each  feeding. 

Says  Gerstley,  in  inanition,  if  the  food  is 
increased  the  child  gains;  in  marasmus  or 
decomposition,  if  the  food  is  increased  the 
child  goes  down. 

For  the  treatment  of  inanition  or  failure 
to  gain  due  to  acute  dyspepsia,  see  under 
Diarrhoea. 

Inanition  or  Starvation  Fever  of  Infants. — 

See  Inanition,  Simple  Acute. 

Incontinence  of  Urine. — See  Parts  2 and 
3,  on  Gynaecology  and  Genito-Urinary  Dis- 
eases. 

Incoordination,  Muscular. — See^Ataxia. 

Indicanuria. — IncUcan  -|-  Gr.  obpov  urine. 
Indican  or  indoxyl  sulphate  of  potassium  in 
the  urine  arises  chiefly  from  the  intestinal 
decomposition  of  protein.  It  is  increased 
in  chronic  intestinal  catarrh,  typhoid  fever, 
intestinal  tuberculosis,  cholera,  diminished 
peristalsis  (as  in  ileus,  peritonitis,  and  con- 
stipation), obstructive  jaundice,  gastric 
hypoacidity,  meat  diet  (there  is  little  or 
none  on  a vegetable  or  milk  diet),  and  pus 
accumulation  with  insufficient  drainage  any- 
where within  the  body  (otitis  media,  empy- 
ema, putrid  bronchitis,  etc.). 

Test  for  Indican. — To  a few  C.C.  of  urine  add 
an  equal  volume  of  concentrated  hydro- 
chloric acid.  To  this  mixture  add  only  one 
or  two  drops  of  a 10  per  cent,  solution  of 
ferric  chloride,  and  invert  the  test-tube 
repeatedly.  Now  add  a few  c.c.  of  chloro- 
form, and  invert  the  tube  as  before.  The 
chloroform  will  absorb  indigo-blue  (formed 
from  indican)  and  consequently  will  be  col- 


ored more  or  less  of  a blue  shade,  according 
to  the  amount  of  indican  originally  present. 
See  also  Intestinal  Intoxication. 

Indigestion,  Gastric. — See  Dyspepsia. 

Intestinal. — See  Diarrhoja. 

Indurative  Headache. — L.  indurdtio,  hard- 
ness. See  Headache. 

Infant  Feeding. — I.  Breast  Feeding. — 
Nursing  Schedule. 


Nursings 
in  24 
houis 

Intervals 
during 
the  day: 
6 a.  in.  to 
9 p.  m. 

N ursings 
between 
9 a.  m.  anJ 
6 a.  m., 
at  2 a.  m. 

First  day 

4 

G hours 

1 

Second  day 

Third  day  to  end  of 

G 

4 liours  . 

1 

4th  or  5th  month . . 

7 

3 hours 

1 

Fifth  to  13tli  month 

G 

3 hours 

0 

During  the  first  two  days  if  the  baby, 
cries  excessively,  give  a little  warm  boiled 
water  or  a very  dilute  solution  of  milk  sugar 
or  plain  sugar.  Dennett,  however,  con- 
demns the  addition  of  sugar.  Czerny  ami 
Wachenheim  begin  twenty-four  hours  after 
birth  with  a four-hour  interval  schedule, 
commencing  at  6 a.  m.,  and  ending  at  10 
p.  M.,  five  meals  a day,  usually  no  night 
feeding.  In  very  undersized  infants  the  two- 
hour  schedule  is  to  be  used.  In  brief,  the 
schedule  is  to  be  adapted  to  the  child,  and 
not  the  child  to  the  schedule. 

The  infant  is  to  be  nursed  until  it  is 
satisfied,  or  goes  to  sleep,  or  ceases  to  suck 
actively,  but  no  longer  than  twenty  min- 
utes. Hold  the  child  upright  just  before 
and  after  nursing  or  every  few  minutes  inter- 
rupting nursing,  and  pat  the  back,  so  as  to 
allow  of  the  escape  of  swallowed  air.  Clean.se 
the  mouth  very  gently  before  each  nursing 
with  a soft  cloth,  or,  according  to  some,  do 
not  cleanse  the  mouth  at  all.  The  mother’s 
nipple  may  be  cleansed  with  plain  boiled 
water  or  with  boric  acid  solution  after  each 
nursing  and  covered  with  a sterile  pad.  If 
boric  acid,  is  used,  the  nipple  should  again 
be  bathed  with  plain  boiled  water  before  the 
baby  nurses.  Alternate  the  breasts  in  nursing. 

Keep  the  windows  open  at  night,  and 
take  the  baby  out  for  an  airing  daily,  in 
the  warmest  part  of  the  day,  except,  of 
cour.se,  in  very  hot  weather;  but  in  winter 
not  until  after  at  least  the  first  month. 
Record  the  baby’s  weight  once  or  twice  a 
week.  The  average  weight  at  birtli  is 
7M  pounds.  The  infant  should  regain  its 
birth  weight,  following  the  first  three  or 
four  days’  loss,  by  the  end  of  the  tenth  day. 
Thereafter  it  should  gain  about  6 to  8 
ounces  a week  under  six  months  of  age,  and 


INFANT  FEEDING 


3 to  4 ounces  a week  thereafter.  It  should 
about  double  its  budh  weight  in  six  months, 
and  treble  it  in  a year  to  fourteen  months. 
At  birth  the  pulse  averages  about  130;  and 
until  the  third  year  is  usually  above  100. 
The  stools  normally  number  from  3 to  G a 
day  during  the  first  two  weeks;  1 to  3 a 
day  after  the  first  month. 

The  luu-sing  woman  should  receive  an 
abundant  plain  diet,  with  milk  at  bedtimes, 
avoiding  tea,  coffee,  alcohol,  spices,  pastry, 
rich  cakes, , excessive  sweets,  and  all  mdi- 
gcstible  articles.  Regular  hours  of  eating 
and  sleeping,  fresh  air  day  and  night,  ade- 
quate rest  and  exercise,  personal  cleanliness, 
a daily  bowel  movement,  and  freedom  from 
worry,  are  hnportant.  After  the  tliird  or 
fourth  month,  substitute  for  the  breast  one 
or  two  feedings  of  bottle  milk  a day;  and 
gradually  wean  the  baby  between  the  ninth 
and  fourteenth  months.  The  milk  need 
not  then  be  mocUfied;  and  well-cooked 
cereals  may  also  be  given.  Withdraw  the 
breast  at  the  rate  of  one  additional  daily 
nursing  every  two  or  three  weeks,  until  the 
breast  is  abandoned  altogether.  Gerstley 
prescribes  a mixed  diet  for  every  child  of 
six  months  of  age,  whether  breast  fed  or 
bottle  fed. 

If  the  baby  does  not  do  well,  if  it  does 
not  thrive,  or  vomits,  or  has  frequent  tliin 
green  stools  containing  curds  and  perhaps 
mucus,  or  perhaps  fat  particles  in  large 
quantity  (shown  by  staining  with  Sudan 
III),  or  is  constipated,  with  abdominal  dis- 
tension, flatulence,  and  colic,  investigate 
into  the  cause.  If  there  are  no  other  sjmip- 
toms  than  a failure  to  gain,  the  milk  is 
either  scanty  or  deficient  in  food  elements. 
To  ascertain  the  amount  of  milk  secreted 
during  twenty-four  hours,  weigh  the  baby 
both  before  and  after  each  nursing  on  scales 
that  inchcate  half-ounces,  and  refer  to  the 
“Nursing  Schedule  for  Healthy  Infants.” 
To  ascertain  the  quality  of  the  milk,  it  must 
be  analyzed,  using  the  entire  amount  from 
one  breast,  or,  more  accurately,  the  entire 
twenty-four-hour  secretion.  ( 

Normal  human  milk  contains  1.6  per  cent. 
j)rotein,  4 per  cent,  fat,  7 per  cent,  sugar, 
and  about  0.2  per  cent,  salts. 

An  accurate  test  for  fat  is  Lewi’s  modi- 
fication of  the  Babcock  test.  Pleasure 
out  2.92  c.c.  of  milk  with  the  Babcock 
pipette,  and  place  it  in  the  Babcock  grad- 
uated flask.  Rinse  the  pipette,  and  add 
very  slowly,  to  prevent  great  heat,  2.92  c.c. 
of  chemically  jiure  suljdiuric  acid,  and  mix 
until  a homogeneous  fluid  results.  Now  add 
0.6  c.c.  of  equal  parts  of  amyl  alcohol  and 


strong  hydrochloric  acid;  and  then  50  per 
cent,  sulphuric  acid,  enough  to  bring  the 
fluid  up  to  the  neck  of  the  flask.  Centrifuge 
four  minutes  and  read  off  the  percentage  of 
fat  on  the  scale,  each  0. 1 on  the  scale  repre- 
senting 0.3  per  cent,  of  fat. 

The  percentage  of  protein  may  be  esti- 
mated approximately  by  the  method  of 
Boggs.  Dilute  the  milk  (1  : 10  for  human 
milk,  1 : 20  for  cow’s  milk),  pour  it  into  an 
Esbach  tube  up  to  the  mark  U,  and  add  to 
the  mark  R the  following  reagent  (phos- 
photungstic  acid,  25  grams,  concentrated 
HCl,  25  C.C.,  distilled  water  up  to  250  c.c.). 
Stopper  the  tube  and  invert  it  several  times 
so  as  to  mix  the  contents.  Then  set  aside 
for  24  horns,  and  read  off  the  percentage  of 
protein  directly  from  the  calibrations  on  the 
tube,  if  the  dilution  was  1 : 10,  whereas 
with  a dilution  of  1 : 20  the  figure  is  to  be 
multiphed  by  two. 

A more  accurate  method  is  that  of  Purdy. 
Fill  a Purdy  centrifuge  tube  with  the 
diluted  milk  to  the  10  c.c.  mark,  and  add 
the  reagent  to  15  c.c.  Centrifuge  for  three 
minutes  and  read  the  percentage  directly. 

The  percentage  of  milk  sugar  is  practi- 
cally always  6 to  7 per  cent.,  and  need  not 
be  tested  for. 

The  presence  of  pus  cells,  or  blood,  or  of 
colostrum  corpuscles  after  the  twelfth  day, 
contraindicates  the  use  of  the  milk. 

The  examination  of  the  milk,  however,  is 
much  less  important  than  the  child’s 
sjnnptoms.  Gerstley  says:  “Makeupyoirr 
mind  that  breast  milk  is  always  all  right  in 
quality.”  “Make  up  yoim  mind  that  the 
only  difficulties  arising  from  breast  feeding 
are  those  of  quantity.” 

If  the  quantity  of  milk  secreted  is  below 
normal,  supplement  it  by  the  bottle,  best 
given  hnmediately  after  each  breast  nursing, 
and  enjoin  good  hygiene  and  an  abundant 
diet,  with  lots  of  milk,  cereals,  and  beef, 
perhaps  malt  extract.  Complete  emptying 
of  the  breast  at  each  nui’sing  stimulates  milk 
secretion. 

If  the  milk  is  too  rich,  the  cliild  suffering 
from  .uichgestion  but  not  necessarily  losing 
in  weight,  restrict  the  mother’s  diet  to  plain, 
bland  food,  excluding  fats,  sweets,  alcohol, 
sour  fruits,  strawberries,  asparagus,  cabbage, 
cauliflower,  turnips,  sprouts,  parsnips,  cu- 
cumbers, radishes,  lettuce,  tomatoes,  onions, 
watercress,  pai-sley,  celeiy,  endive,  peppers, 
spices,  etc.;  attend  to  her  bowels,  enjoin 
adequate  exercise,  sleep,  and  quiet,  and  limit 
each  nursing  to  five  minutes  everj'  three  or 
four  hours,  seven  or  six  or  five  nursings  in 
twenty-four  hours.  Later  lengthen  the  dur- 


INFANT  FEEDING 


ation  of  each  feeding  up  to  the  child’s 
capacity.  Some  advocate  giving  3^  to  1 
ovmce  of  boiled  water  before  each  nursing. 

The  bottle  may  be  substituted  until  the 
breast  milk  has  improved,  the  breasts  being 
emptied  regularly  with  the  breast  pump. 

If,  in  spite  of  good  hygiene,  etc.,  the  baby 
does  not  thrive,  or  continues  to  suffer  with 
indigestion,  do  not  delay  too  long  the  sub- 
stitution of  artificial  feeding. 

Whenever  sudden  weaning  is  required, 
begin  with  a much  weaker  milk  than  the 
age  of  the  infant  normally  indicates.  If 
weaned  at  four  or  five  months,  begin  with, 
say,  formula  III  of  Holt’s  schedule;  but 
give  four  to  six  ounces  every  three  hours, 
and  increase  the  strength  more  rapidly  than 
with  a younger  infant.  If  weaned  at  nine 
or  ten  months,  begin  with  formula  IV;  but 
give  six  to  seven  ounces  every  three  hours, 
and  increase  the  strength  and  quantity 
rapidly.  (Holt.) 

In  febrile  conditions  give  the  infant  one 
or  two  ounces  (1  oz.  = 2 tablespoonfuls)  of 
boiled  water  before  each  nursing. 

Maternal  nursing  is  contraindicated  if  the 
mother  is  tuberculous,  epileptic,  insane, 
pregnant,  delicate,  or  suffering  from  puer- 
peral convulsions,  an  acute  disease  (?),  or  a 
serious  chronic  disease,  such  as  nephritis, 
cardiac  insufficiency,  malignant  disease, 
severe  anaemia,  exophthalmic  goitre,  etc.; 
or  where  no  milk  is  secreted;  or  the  milk  has 
proved  inadequate  on  two  previous  occa^ 
sions;  or  the  infant  is  sickened,  or  does  not 
thrive  sufficiently  on  the  milk  in  spite  of 
intelligent  care. 

For  vomiting,  dyspepsia,  intoxication, 
inanition,  marasmus,  prematurity,  and  con- 
stipation, consult  the  appropriate  heading. 

II.  Artificial  Feeding.— First  ascertain  the 
percentage  of  fat  in  the  milk  to  be  used, 
employing  for  this  purpose  the  Babcock 
test  described  above.  If  the  milk  is  a 
5 per  cent,  milk  (Jersey  or  Alderney)  and 
it  is  desired  to  convert  it  into  a 4 per  cent, 
milk,  skim  off  two  ounces  from  one  quart 
after  standing  four  hours  in  the  cold;  if 
the  milk  is  a 5}/2  per  cent,  milk,  skim  off 
three  ounces.  If  it  is  desired  to  convert  a 
4 per  cent,  milk  into  a 5 per  cent,  milk, 
remove  the  upper  24  ounces  from  one  quart 
of  the  4 per  cent,  milk  which  has  stood  in 
the  cold  at  least  four  hours.  At  the  end  of 
four  hours  the  upper  fourth  contains  nearly 
all  the  cream. 

The  amount  of  protein  and  sugar  in  all 
milks  is  practically  the  same,  and  need  not 
be  tested  for;  e.g.,  about  3.2  per  cent,  pro- 
tein, 4.5  per  cent,  sugar,  and  0.7  per  cent. 


salts.  Whey  contains  4.5  per  cent,  sugar, 
0.9  per  cent,  protein,  0.7  per  cent,  salts, 
and  no  fat. 

The  normal  specific  gravity  is  1.028  to 
1.033.  The  removal  of  cream  raises  the 
specific  gravity;  the  addition  of  water 
lowers  it.  A strongly  acid  or  an  alkaline  milk 
is  abnormal,  indicating  excessive  bacterial 
growth  in  the  former  instance,  and  the  use 
of  preservatives  in  the  latter.  If  the  milk 
coagulates  on  heating,  it  is  nearly  sour  and 
not  good.  The  presence  in  the  sediment 
after  centrifuging,  of  blood  cells  or  more 
than  five  pus  cells  in  the  field  of  an  oil- 
immersion  lens,  is  considered  abnormal. 
Milk  should  not  be  used  that  is  obtained 
within  fifteen  days  before  or  five  days  after 
parturition.  Cows  should  be  tested  annu- 
ally with  tuberculin,  and  all  reacting  animals 
excluded,  unless  the  milk  is  pasteurized  or 
boiled  before  u.sing.  The  milk  when  ob- 
tained from  the  cow  should  be  strained 
through  three  thicknesses  of  cheesecloth  or 
absorbent  cotton,  and  placed  in  cold  spring 
water,  or  on  ice,  or  in  a cold  cave.  If  it  is 
the  usual  4 per  cent,  milk,  and  the  percent- 
age method  of  feeding  is  employed,  allow  one 
quart  to  stand  in  the  cold  at  least  four  hours 
before  using.  The  upper  24  ounces  then 
represents  a 5 per  cent,  milk,  which  is  the 
strength  of  milk  used  by  some  in  the  per- 
centage method.  Some  use  gravity  cream 
and  skimmed  milk. 

The  paraphernalia  required  for  the  modi- 
fication of  the  milk  are  a 16-ounce  glass 
graduate,  glass  fuimel,  Chapin  1 ounce 
dipper  (or  bent  tablespoon,  which  holds 
Yi  ounce),  2-quai-t  mixing  pitcher,  a new 
enamel  or  aluminum  saucepan  for  boiling 
the  food,  graduated  cylindrical  nursing 
bottles  with  wide  mouths,  wire  bottle  rack, 
rubber  nipples,  bottle  brushes,  absorbent 
cotton,  borax  or  boric  acid,  lime  water, 
milk  sugar,  an  ice-box,  and,  if  desired,  a 
Freeman  pasteurizer. 

After  each  nursing  the  bottle  and  nipple 
should  be  rinsed  with  cold  water  and  washed 
with  hot  soap-sud.s,  the  nipple  being  turned 
inside  out.  The  bottle  should  be  kept  full 
of  water  (or  borax  solution,  a heaping  tea- 
spoonful to  the  bottle)  and  the  nipple  in  a 
solution  of  borax  or  boric  acid,  one  table- 
spoonful to  the  pint.  The  bottle  and  nipple 
should  be  rinsed  before  using. 

All  the  milk  for  twenty-four  hours  should 
be  prepared  at  one  time.  The  sugar  may 
first  be  dissolved  in  water,  then  added  to 
the  milk,  after  which  the  lime-water  is 
added.  The  mixture  is  then  poured  into 
the  bottles,  representing  the  number  of 


INFANT  FEEDING 


nursings  in  twenty-four  hours;  the  bottles 
are  stoppered  with  cotton,  pasteurized 
(heated  to  about  140°  to  150°  to  155°  to  160°  F. 
for  thirty  to  twenty  minutes)  or  sterilized 
(boiled  for  four  or  five  minutes),  then  rapidly 
cooled  by  immersing  in  cold  water,  and 
placed  in  the  ice-box.  Boiling  for  one  to 
three  minutes,  however,  kills  pathogenic 
germs,  and  is  preferable  to  long  boiling. 
Lime  water  is  not  added  by  many,  but 
simple  boiling  is  deemed  all  that  is  necessary 
to  render  the  proteids  digestible.  The  water 
is  first  brought  to  an  active  boil,  then  the 
milk  is  added  with  constant  stirring  to  pre- 
vent tlie  formation  of  a scum,  and  the  whole 
is  allowed  to  boil  actively  for  three  minutes. 
The  sugar  is  added  after  removing  the  milk 
mixture  from  the  stove,  but  while  it  is  .still 
hot.  If  the  milk  is  not  boiled,  proceed  as 
follows:  Boil  the  requinxl  amount  of  water, 
and  add  to  it  the  sugar  while  still  hot  but 
after  removing  from  the  stove.  Do  not  add 
the  milk  until  both  milk  and  water  are  ice 
cold..  Divide  the  food  between  the  nursing 
bottles  for  the  day,  stop  the  latter  with  clean 
absorbent  cotton,  and  place  on  ice. 

Before  feecUng,  the  milk  mixture  is  warmed 
to  blood-heat  by  placing  the  bottle  in  a 
vessel  of  hot  water.  Test  the  temperature 
on  the  bare  forearm.  Mix  the  food  well 
before  using  by  pouring  it  into  a clean  pitcher 
and  back  again  into  the  bottle. 

It  should  take  fifteen  to  twenty  minutes  for 
the  baby  to  empty  the  bottle.  If  it  takes 
less  or  longer  than  this,  use  a smaller  or  a 
larger  holed  nipj^le  (the  hole  may  be  en- 
larged with  a hot  hatpin).  If  then  the  food 
is  not  all  taken  in  twenty  minutes,  throw 
what  is  left  away,  and  do  not  feed  again 
until  the  next  feeding  time. 

*At  the  fifth  or  sixth  month,  substitute 
for  plain  water,  in  making  the  dilutions, 
barley,  rice,  arrowroot,  or  wheat  water  (non- 
fermentable  carbohydrate),  if  the  bowels  are 
free;  oatmeal  water  (fermentable  carbohy- 
drate), if  constipated.  The  addition  of 
cereal  favors  protein  digestion.  At  the  tenth 
or  eleventh  month,  add  to  the  dietary  two 
or  more  teas{)oonfuls  daily  of  beef -juice 
(slightly  broiled  beef,  expressed  with  a 
lemon  squeezer,  and  flavored  with  salt),  and 
also  orange-juice,  3^  oz.,  gradually  increased 
to  2 oz.,  given  about  one  hour  l)efore  the 
second  milk  feeding.  If  boiled  milk  is  used, 
add  orange  juice  at  the  end  of  the  first 
month,  one  teaspoonful  daily  (Gerstley); 
one  tablespoonful  tvice  daily.  (Hill.) 

Baiiey  or  other  cereal  water  is  made  by 
Ixjiling  one  even  tablespoonful  of  the  flour 
(1  oz.  by  weight  o 100  calories)  in  twelve 


ounces  of  water  for  twenty  minutes;  or  two 
tablespoonfuls  of  the  grains,  with  a pinch 
of  salt,  in  one  quart  of  water,  for  six  hours, 
the  amount  being  kept  up  to  one  quart  by 
the  addition  of  water.  After  boiling,  the 
gruel  is  strained  through  coarse  muslin. 

In  the  place  of  lime-water,  one  may  use 
sodium  or  potassium  bicarbonate  or  sodium 
citrate,  gr.  i-ii  to  the  ounce,  preferably  the 
latter.  One  fluidounce  = about  two  table- 
spoonfuls. 

L.  W.  Hill  {Boston  Methods  of  Infant 
Feeding)  uses,  in  the  preparation  of  his  per- 
centage milk  mixtures,  top  or  gravity  cream, 
i.e.,  all  the  cream  that  is  visible  in  a quart 
bottle  that  has  stood  for  about  six  hours 
(usually  aljout  G oz.  of  cream).  Its  compo- 
sition is  about  16  per  cent,  fat,  4.5  sugar, 
and  3.2  per  cent,  protein.  The  underlying 
skimmed  milk  contains  the  same  percentage 
of  sugar  and  protein,  but  no  fat.  To  make 
up  a 16-ounce  mixture  containing  f per  cent, 
fat  and  p per  cent,  protein,  use  f ounces  of 
16  per  cent,  (gravity)  cream  and  (pX5) — 


f ounces  of  skimmed  milk. 


pX5 

16 


of  4.5  (per 


cent,  of  sugar)  = the  per  cent,  of  sugar  con- 
tained in  our  mixture  thus  far.  But  we  wish 
s per  cent,  sugar.  The  amount  to  be  added 
is  easily  calculated  when  we  know  that  1 
level  tablespoonful  of  sugar  raises  the  sugar 
percentage  in  a 16-ounce  mixture  2.4  per  cent. 

To  calculate  the  percentage  of  the  three 
ingredients  in  a whole  milk  and  water  mix- 
ture, if  the  latter  contains  milk,  7 oz.,  and 
water,  14  oz.,  then, 

Jf4  of  4.0  = 2.0  per  cent,  of  fat  in  the 
mixture. 

of  4.5  = 2.3  per  cent,  of  sugar  in  the 
mixture. 

K4  of  3.2  = 1.6  per  cent,  of  protein  in  the 
mixture. 

The  addition  of  1 level  tablespoonful  of 
sugar  raises  the  sugar  percentage  in  a 16-oz. 
mixture,  2.4  per  cent.;  in  a 20-oz.  mixture, 
2 per  cent. ; in  a 24  oz.-mixture,  1.6  per  cent. ; 
in  a 32-oz.  mixture,  1.2  per  cent.;  in  a 40-oz. 
mixture,  1 per  cent.;  in  a 42-oz.  mixture, 
0.95  per  cent.;  in  a 48-oz.  mixture,  0.80 
per  cent. 

For  constipation,  vomiting,  diarrhoea.  In- 
toxication, inanition,  marasmus,  and  pre- 
maturity, consult  the  appropriate  caption. 

Principles  and  Application  of  the  Chicago 
Method  of  Artificial  Infant  Feeding  (Gerstlej'; 
see  page  201). — 1.  All  the  elements  of  cow’s 
milk  are  diluted  and  only  carbohydrate 
added. 

2.  Boiling  milk  for  one  minute  prevents 
enteric  infection  (dysentery,  tuberculosis, 


♦See  TaMc,  the  Kirst  Year  Schedule. 


In  fevers  the  bottle  milk  should  be  diluted  at  least  one-half. 


If  the  upper  16  oz, 
is  used  (7  per  cent, 
milk),  still  higher 
percentages  of  fat 
are  obtained,  the 
protein  and  sugar 
remaining  the  same. 
One  ounce  of  7 per 
cent,  milk  has  a 
caloric  value  of  27.5. 


If  lower  percentages 
of  fat  are  desired, 
with  the  same  per- 
centages of  protein 
and  sugar,  use  whole 
4 per  cent,  milk,  one 
ounce  of  which  has  a 
caloric  value  of  20.0. 


Still  lower  percentages  of  fat  are  obtained  by  using  the  remainder 
from  one  quart  of  4 per  cent,  milk  that  has  stood  four  hours,  after 
skimming  off  2 oz.  (=3  per  cent,  milk);  4 oz.  (=2  per  cent,  milk), 
or  8 oz.  (=1  per  cent.  milk).  The  percentages  of  protein  and 
sugar  are  not  altered. 


F. 

Calories 

F. 

1.40 

209.0 

0.80 

1.75 

236.5 

1.00 

2.10 

338.2 

1.20 

2.45 

453.7 

1.40 

2.80 

575.7 

1.60 

3.15 

609.1 

1.80 

3.50 

748.0 

2.00 

3.80 

792.0 

2.20 

. ... 

2.40 

2.60 

2.80 


3 per  cent,  milk,  1 oz. 
=G=  17.5  cal. 


2 per  cent,  milk,  1 oz. 
=0=  15  cal. 


1 per  cent,  milk,  1 oz. 
=0  12.5  cal. 


Calories 

179.0 

199.0 

282.0 
375.0 


F. 

0.60 

0.75 

0.90 

1.05 


Calories 

169.0 

186.5 

263.2 

348.7 


F. 

0.40 

0.50 

0.60 

0.70 


Calories 

F. 

Calories 

159.0 

0.20 

149.0 

174.0 

0.25 

161.5 

244.5 

0.30 

225.7 

322.5 

0.35 

296.2 

470.7 

491.0 

598.0 

627.0 

738.0 


1.20 

435.7 

1.35 

451.6 

1.50 

548.0 

1.65 

572.0 

1.80 

670.5 

0.80 

400.7 

0.90 

412.2 

1.00 

498.0 

1.10 

517.0 

1.20 

603.0 

0.40 

365.7 

0.45 

372.9 

0.50 

448.0 

0.55 

462.0 

0.60 

535.5 

761.0  1.95 

806.0  2.10 


687.8  1.30 

727.2  1.40 


614.7  0.65 

648.5  0.70 


541.6 

569.7 


Sweetened  condensed  milk  (1  oz.  O 132  calories)  diluted  twelve 
times  (P.,  0.5;  F.,  0.6;  S.,  3.6)  for  an  infant  under  one  month, 
and  ten  to  six  times  for  older  children,  is  sometimes  of  temporary 
benefit.  To  unsweetened  condensed  or  evaporated  milk  sugar 
should  be  added.  Equal  parts  of  the  average  unsweetened  con- 
densed milk  and  water  is  equivalent  to  whole  milk.  If  condensed 
milk  is  used  longer  than  a month,  give  orange  juice  once  a day. 


ARTIFICIAL  NURSING  SCHEDULE  FOR  THE  FIRST  YEAR 


(percentage  method,  see  below  another  more  accurate  method  of  estimating  percentages). 


Strength  of  milk  ordinarily  suitable  for  healthy  infants. 

In  fevers  the  bottle  milk  should  be  diluted  at  least  one-half. 

Interval 
between 
meals  by 
day, 

7 a.  m.  to 
9 P.  M. 

Night 
feedings, 
9 P.  M.  to 
7 a.  m. 

Number 
of  feedings, 
in  24 
hours 

Quantity 
for  one 
feeding 

Quantity 
for  24 
hours 

Top-milk  here  means  the  upper  24  ounces  from  one  quart  of  4 per  cent,  milk  that  has  stood  in  the  cold  at  least  four  hours  ( = 5 per  cent.  milk).  If  the 
available  cow’s  milk  is  a 6 per  cent,  milk,  it  may,  of  course,  be  used  at  once.  One  ounce  of  5 per  cent,  milk  has  a caloric  value  of  22.5;  one  even 
tablespoonful  (leveled  with  a knife)  of  milk  sugar,  44.0  [1  gm.  fat  O 9.3  calories;  1 gm.  carbohydrate  0 4.1  calories;  1 gm.  protein  0 4.1  calories). 
Lime-water  is  not  added  by  many;  but  simple  boiling  is  deemed  all  that  is  necessary  to  render  the  proteids  digestible  (no  curds  appear  after  boilingL 
Hill  insists  on  25  to  50  per  cent,  lime-water  in  the  mixtures,  and  says  that  small  amounts  do  no  good.  The  water  is  first  brought  to  an  active  boil; 
then  the  milk  is  added  with  constant  stirring,  and  the  whole  is  allowed  to  boil  actively  for  one  to  three  minutes,  perhaps  preferably  one  minute;  this 
kills  pathogenic  germs.  The  sugar  is  added  after  removing  the  milk  mixture  from  the  stove.  Boiling  may  not  always  be  required.  (Some  advocate 
four-nour  intervals  of  feeding  from  the  beginning,  and  no  night  feedings.]  These  formulse  are  given  merely  as  a guide.  Each  child  is  to  be  fed  according 
to  its  digestive  powers  and  appetite,  and  not  according  to  its  age. 

If  the  upper  20  oz. 
from  one  quart  of 
4 per  cent,  milk  that 
has  stood  four  hours 
is  used,  higher  per- 
centages of  fat  are 
obtained  ( =6  per 
cent,  milk),  the  per- 
centages of  protein 
^ and  sugar  remaining 
the  same.  One  ounce 
of  6 per  cent,  milk 
has  a caloric  value 
•of  25.0. 

If  the  upper  16  oz. 
is  used  (/  per  cent, 
milk),  still  higher 
percentages  of  fat 
are  obtained,  the 
protein  and  sugar 
remaining  the  same. 
One  ounce  of  7 per 
cent,  milk  has  a 
caloric  value  of  27.5. 

If  lower  percentages 
of  fat  are  desired, 
with  the  same  per- 
centages of  protoin 
and  sugar,  use  wliole 
4 per  cent,  milk,  one 
ounce  of  which  has  a 
caloric  value  of  20.0. 

Still  lower  percentages  of  fat  are  obtained  by  using  the  remainder 
from  one  quart  of  4 per  cent,  milk  that  has  stood  four  hours,  after 
skimming  off  2 oz.  (=3  per  cent,  milk);  4 oz.  (=2  per  cent,  milk), 
or  8 oz.  (=1  per  cen>.  milk).  The  percentages  of  protein  and 
sugar  are  not  altered/ 

3 per  cent,  milk,  1 oz. 
O 17.5  cal. 

2 per  cent,  milk,  1 oz. 
=0=  16  cal. 

1 per  cent,  milk,  1 oz. 
O 12.5  cal. 

Second  to  seventh  day 
Eighth  day  up  to  fifth 

Hours 

2 

2 

1 

10 

8 

Ounces 

1-lK 

1^-3^ 

Ounces 

10-15 

12-28 

P.  F.  S.  Calorie 

I.  Top-milk,  4 oz.;  lime  water,  1 oz.;  milk  sugar,  2H  level  tablespoonfuls;  water  up  to  20  oz. — 0.70  1.00  4.84  189.0 

II.  Top-milk,  5 oz.;  lime  water,  1 oz.;  milk  sugar,  2)4  level  tablespoonfuls;  water  up  to  20  oz. — 0.85  1.25  5.04  211.5 

III.  Top-milk,  oz.;  lime  water,  IH  oz.;  milk  sugar,  3 level  tablespoonfuls;  water  up  to  25  oz. — 1.05  1.50  5.70  300.7 

IV.  Top-milk,  10/4  oz.;  lime  water,  IK  oz.;  milk  sugar,  3K  level  tablespoonfuls;  water  up  to  30  oz. — 1.20  1.75  5.93  401.2 

5 

About  100  calories  for 
each  kilogram  (21 
lbs.;  45  cmories  per 
lb.)  of  body  weight  are 
required  daily  for  the 
average  healthy  in- 
fant from  the  third 
week  to  the  sixth 
month;  125  to  150  cal- 
ories (56  to  68  per  lb.) 
are  required  for  very 
active  infants,  and  for 
those  under  weight. 

F.  Calories 

1.20  199.0 

1.50  224.0 

1.80  319.5 

2.10  427.5 

F.  Calories 

1.40  209.0 

1.75  236.5 

2.10  338.2 

2.45  4.53.7 

F.  Calories 

0.80  179.0 

1.00  190.0 

1.20  282.0 

1.40  375.0 

F.  Calories 

0.60  100.0 

0.75  186.5 

0.90  203.2 

1.05  348.7 

F,  Calories 

0.40  159.0 

0.50  174.0 

060  244.5 

0.70  322.6 

F.  Calories 

0.20  149.0 

0.25  161.5 

0.30  225.7 

0.35  296.2 

Fifth  week  up  to  third 
month 

Third  month  up  to 

3 

3 

1 

1 

7 

3- 5 

4- G 

21-35 

28-42 

V.  Top-milk,  14  oz.;  lime  water,  IH  oz.;  milk  sugar,  4J  level  tablespoonfuls;  water  up  to  35  oz. — 1.40  2.00  6.17  505.7 

VI.  rop-milk,  15K  oz.;  lime  water,  IK  oz.;  milk  sugar,  4 level  tablespoonfuls;  water  up  to  35  oz. — 1.60  2.25  6.00  530.4 

VII.  Top-milk,  20  oz.;  lime  water,  2 oz.;  milk  sugar,  4K  level  tablespoonfuls;  water  up  to  40  oz. — 1.75  2.50  6.19  648.0 

VIII.  Top-milk,  22  oz.;  lime  water,  2 oz.;  milk  sugar,  4K  level  tablespoonfuls;  water  up  to  40  oz. — 1.90  2.75  6.17  682.0 

IX.  Top-milk,  27  oz.;  lime  water,  2K  oz.;  milk  sugar,  4K  level  tablespoonfuls;  water  up  to  45  oz. — 2.10  3.00  6.20  805.5 

2.40  540.7 

2.70  569.7 

3.00  698.0 

3.30  727.0 

3.60  873.0 

2.80  575.7 

3.15  609.1 

3..50  748.0 

3.80  792.0 

1.60  470.7 

1.80  491.0 

2.00  698.0 

2.20  627.0 

2.40  738.0 

1.20  435.7 

1.36  451.0 

1.50  648.0 

1.05  572.0 

1.80  070.5 

0.80  400.7 

0,90  412.2 

1.00  498.0 

1.10  517.0 

1.20  603.0 

0.40  365.7 

0.45  372.9 

0.50  448.0 

0.55  462.0 

0.60  636.5 

Ssth  month  up  to 

3 

4 

0 

0 

6 

5 

5-7K 

7-9 

30-^5 

35-32 

X.  Top-milk,  29K  oz.;  lime  water,  2K  oz.;  milk  sugar,  4 level  tablespoonfuls;  water  up  to  45  oz. — 2.25  3.25  6.00  834.1 

XI.  Top-milk,  31K  oz.;  lime  water,  2K  oz.;  milk  sugar,  4 level  tablespoonfuls;  w’ater  up  to  45  oz. — 2.40  3.50  6.20  884.7 

XII.  Whole  milk,  not  over  1 quart  to  a twelve-month  baby — 3.50  4.00  4.50  900.0 

After  the  fifth  month 
the  number  of  calories 
required  gradually  di- 
minish to  about  75  to 
80  (32  to  35  per  lb.) 
at  the  end  of  twelve 
months. 

3.90  907.2 

2.60  761.0 

2.80  806.0 

1.95  087.8 

2.10  727.2 

1..30  014.7 

1.40  048.5 

0.05  541.6 

0.70  609.7 

Tenth  month  up  to 
thirteenth  month.  . . 

Sweetened  condensed  milk  (1  oz.  O 132  calories)  diluted  twelve 
times  (P.,  0.5;  F.,  0.0;  S.,  3.0)  for  an  infant  under  one  month, 
and  ten  to  six  times  for  <jldor  cnildron,  is  sometimes  of  temporary 
benefit.  To  unsweetened  condensed  or  evaporated  milk  sugar 
should  be  added.  Equal  parts  of  the  average  unsweetened  con- 
densed milk  and  water  is  equivalent  to  whole  milk.  If  condensed 
milk  is  used  longer  than  a month,  give  orange  juice  once  a day. 

INFANT  FEEDING 


CHICAGO  OR  MIDDLE  WEST  METHODS  OF  INFANT  FEEDING  (GERSTLEY) 

ARTIFICIAIy  NURSING  SCHEDULE 


Age 

Feeding 
intervals 
by  day, 

6 A.  M.  to 
9 P.  M. 

Night 
feedings, 
2 A.  M. 

Number 
of  feedings 
in 

24  hours 

Quantity 
at  each 
feeding 

Total 

quantity 

in 

24  hours 

Formula 

(To  be  used  merely  as  a guide) 

Hours 

Ounces^ 

about: 

Ounces, 

about: 

First  two  weeks 

3 

1 

7 

1-2 

15 

About  1 part  milk  -{-  2 or  3 parts  water 
-h  3 per  cent,  non-fermentable  carbo- 
hydrate, e.g.,  dextrin-maltose:  milk 

(after  shaking),  4 oz.,  water,  12  oz., 
dextri-maltose,  roughly  4 teaspoonfuls, 
leveled  with  a knife.  Boil  gently  one 
minute  after  coming  to  a boil,  divide 
into  seven  bottles,  stopper  with  clean 
absorbent  cotton,  cool  rapidly  in  cold 
water,  and  place  in  an  ice-box,  cave,  or 
running  water.  Heat  to  body  temper- 
ature in  hot  water  before  feeding.  Test 
the  temperature  on  the  bare  forearm. 
Mix  before  feeding  by  pouring  into  a 
clean  pitcher  and  back  again  into 
the  bottle. 

Third  week  to  second 
month 

3 

1 

2-2K 

15-20 

About  1 part  milk  -|-  2 parts  water  + 3 
per  cent,  dextri-maltose:  milk,  6 oz., 

water,  12  oz.,  dextri-maltose  4>^  tea- 
spoonjfuls.  The  food  should  be  taken 
in  fifteen  to  twenty  minutes.  If  it  is 
taken  quicker  than  that,  use  a nipple 
with  a smaller  hole;  if  not  taken  in 
twenty  minutes,  use  a nipple  with  a 
larger  hole  (the  hole  may  be  enlarged 
with  a hot  hairpin).  If  then  the  food  is 
not  all  taken  in  twenty  minutes,  throw 
what  is  left  away,  and  do  not  feed  again 
until  the  next  feeding  time. 

Second  month 

3 

1 

7 

2K-3 

20-25 

About  1 part  milk  + 1 part  water  + 3 
per  cent,  dextri-maltose:  Milk,  10  oz.; 
water,  10  oz.;  dextri-maltose,  5 tea- 
spoonfuls. Add  orange  juice,  1 tea- 
spoonful daily,  about  one  hour  before 
the  second  feeding,  at  the  end  of  the 
first  month. 

Third  month  or  latter 
half  of  third  and  first 
half  of  fourth  month 

3K 

0 

5 

6 

30 

About  2 parts  milk  -h  1 part  water  3 

per  cent,  dextri-maltose:  Milk,  20  oz.; 
water,  11  oz.;  dextri-maltose,  8 tea- 
spoonfuls. 

Fifth  or  sixth  month  . . 

3K-4 

0 

5-4 

6-7 

30 

About  2 parts  milk  -1-  1 part  water  + 3 
per  cent,  dextri-maltose.  Begin  to  add 
very  gradually  a mixed  diet  including 
vegetable  or  chicken  broth,  Graham 
cracker  or  zwieback  soaked  in  the 
broth  or  in  the  bottle  milk,  or  chewed 
dry,  well-cooked  cereals,  e.g.,  farina, 
cornstarch,  arrowroot.  Cream  of 
Wheat,  purges  of  spinach,  carrots,  and 
potato,  fruit  juices,  e.g.,  orange  juice, 
prune  juice,  apple  sauce,  beef  juice, 
bacon.  On  the  first  day,  after  the 
second  meal,  add  a half  teaspoonful  of 
farina  or  cornstarch  (see  below).  It 
may  be  vomited;  but  repeat  the  next 
day.  Gradually  increase  the  dose  day 
by  day  until,  by  the  end  of  two  or  three 
weeks,  the  whole  amount  is  given.  A 
few  days  after  starting  the  cereal  give, 
in  addition,  a little  broth  or  a teaspoon- 
ful of  vegetable  pur6e,  after  the  2 p.  m. 
bottle.  Increase  the  broth  in  a few 
days  to  an  ounce  or  more,  then  break  a 
few  crumbs  of  zwieback  into  the  broth. 
In  two  or  three  weeks,  at  2 p.  m.,  may 
be  given  broth,  zwdeback,  a little  vege- 
table and  beef  juice,  1 teaspoonful  or 
more  a day,  or  bacon.  As  the  mixed 
diet  is  increased  the  baby  takes  less  of 
the  bottle.  In  the  first  few  days  of  the 
changed  diet  the  baby  does  not  gain 
much. 

To  prepare  farina  or  cornstarch,  add  a tablespoonful  to  a cup  of  water,  boil  for  half  an  hour,  adding  fresh  water  to  make 
up  for  that  lost.  Then  add  half  a cup  of  milk  and  boil  a few  minutes  longer,  stirring  constantly.  Add  a pinch  of  salt  and  a 
very  little  sugar.  If  a double  boiler  is  used  the  cereal  must  be  cooked  for  over  four  hours.  To  obtain  beef  juice,  cut  the  beef 
into  tiny  cubes,  sear  the  outside  in  a hot  pan,  and  squeeze  out  the  juice.  Bacon  should  be  soaked  in  water  to  remove  salt, 
and  broiled  crisp. 

A 4 per  cent,  cow’s  milk  (3.5  per  cent,  protein,  4 per  cent,  fat,  4.5  per  cent,  sugar),  which  is  the  average,  diluted  with 
two  parts  of  water,  gives  about  1 per  cent,  protein,  1.3  per  cent,  fat,  and  1.3  per  cent,  sugar;  diluted  with  one  part  of  water, 
or  half  and  half,  gives  1.5  per  cent,  protein,  2 per  cent,  fat,  and  2 per  cent,  sugar;  three-quarters  milk  and  one-quarter  water 
gives  2.25  per  cent,  protein,  3 per  cent,  fat,  and  3 per  cent,  sugar.  The  6 to  7 per  cent,  sugar  contained  in  human  milk  is 
obtained  by  the  addition  of  sugar.  The  milk  ingredients  most  difficult  of  digestion  are  the  fat  and  sugar,  not  the  protein. 


INFANT  FEEDING 


etc.)  and  renders  the  proteids  more  diges- 
tible. No  curds  appear  in  the  stools  when 
using  boiled  milk.  The  addition  of  orange 
juice  to  the  dietary  at  the  end  of  the  first 
month,  one  teaspoonful  daily,  about  one 
hour  before  the  second  milk  feeding,  pre- 
vents the  development  of  scurvy.  In  infants 
fed  with  boiled  milk  most  of  the  disturbances 
that  arise  are  due  to  (1)  carbohydrate  fer- 
mentation induced  either  by  the  combination 
of  too  much  fermentable  carbohydrate  (lac- 
tose or  cane  sugar)  and  too  concentrated 
whey  (salts)  or  too  much  carbohydrate  and 
too  much  fat,  producing  diarrhoea  with 
greenish,  watery,  sour-smelling,  acid  stools, 
or  (2)  one  of  many  parenteral  factors  (a 
“cold,”  cystitis,  otitis,  constitutional  disease, 
nervous  irritation,  heat,  etc.). 

3.  High  sugar  plus  concentrated  whey 
causes  an  acid  diarrhoea.  High  sugar  plus 
diluted  whey  is  better  borne.  Concentrated 
whey  without  carbohydrate  is  well  boipe. 
High  sugar  plus  high  fat  causes  an  acid 
diarrhoea.  High  fat  plus  high  protein,  low 
whey,  and  non-fermentable  carbohydrate 
{e.g.,  albumen  milk)  is  well  borne.  The  fat 
is  thereby  rendered  harmless.  Fat  in  an  acid 
intestine  favors  diarrhoea.  Fat  in  an  alka- 
line intestine  (rendered  alkaline  by  protein) 
favors  constipation.  High  fat  feeding  with 
insufficient  carbohydrate  produces  flabby, 
pasty,  constipated,  non-thriving  infants. 
High  starch  feeding  produces  emaciated, 
weak  infants. 

4.  If,  when  first  seen,  the  baby  is  weak, 
or  has  dyspepsia  or  a parenteral  infection  (a 
“cold,”  cystitis,  etc.),  never  order  over  3 per 
cent,  carbohydrate  to  begin  with.  Later, 
according  to  the  reaction,  this  may  be  in- 
creased gradually  to  5 per  cent.  In  begin- 
ning decomposition  (malnutrition,  atrophy, 
marasmus)  and  also  following  recovery  from 
an  infection,  more  carbohydrate  is  needed. 
It  should  then  be  given  in  a non-fermentable 
form  so  as  not  to  disturb  the  intestine. 

5.  The  weight  curve  should  be  the  guide  in 
feeding.  If  there  is  a gain  of  5 to  7 ounces 
per  week  and  the  baby  looks  well,  let  it  alone, 
ignoring  slight  vomiting,  diarrhoea,  or  colic, 
but,  at  the  same  time,  excluding  as  a cause 
of  the  gain  in  weight  high  sugar  or  salt 
mixtures,  nephritis,  or  fever,  all  of  which 
cause  water  retention,  and  also  rickets  which 
may  be  associated  with  a gain  in  weight. 
If  vomiting  is  severe  and  the  baby  neverthe- 
less gaining,  reduce  the  daily  total  quantif  y 
of  food.  If  the  baby  is  not  gaining,  do  not 
reduce  the  total  amount,  but  give  less  at 
each  nursing  and  nurse  oftener.  (See  also 


Vomiting.)  The  normal  stool  is  described 
as  soft,  smooth,  homogeneous,  and  yellow, 
but  green,  slightly  watery,  somewhat  acid, 
mucous  and  curdy  stools  may  occur  in  healthy 
infants.  If  the  child  is  contented  and  thrives, 
ignore  the  stool.  If  there  is  only  one  stool 
a day  and  the  baby  is  happy  and  thriving, 
do  not  interfere. 

6.  If  the  weight  becomes  stationary  or 
drops,  and  the  stools  are  not  more  than  2 or 
3 per  day,  and  the  baby  appears  hungry 
(cries  directly  after  nursing,  sucks  the  fingers 
between  nursings,  frets  before  nursing  time, 
seizes  the  nipple  eagerly  and  empties  the 
bottle  rapidly),  add  a few  ounces  to  the 
total  quantity  of  food.  If,  however,  the 
baby  does  not  appear  hungry,  increase  only 
the  milk  by  1 or  2 ounces,  or  the  carbohy- 
drate by  1 to  2 per  cent.,  but  not  both 
together.  Increase  the  carbohydrate  (to  4 
to  5 per  cent.)  if  there  is  constipation,  using 
a fermentable  sugar  (lactose  or  saccharose) 
to  correct  the  constipation. 

7.  If  the  weight  becomes  stationary  and 
‘the  stools  are  4 or  5 daily,  and  fermentative 
(greenish,  watery,  acid,  sour-smelling,  mu- 
cous), the  cause  is  either  underfeeding,  when 
the  baby  will  manifest  hunger  symptoms, 
or  it  is  dyspepsia,  which  is  manifested  by 
loss  of  appetite.  If  underfeeding  is  the 
cause,  cautiously  increase  the  total  daily 
quantity,  but  not  the  carbohydrate.  If 
beginning  dyspepsia  is  the  cause,  give  the 
patient  only  what  he  desires  and  wait.  If, 
added  to  the  anorexia  and  diarrhoea,  slight 
fever  develops,  the  skin  becomes  ashen  gray, 
and  the  weight  begins  to  drop,  this  means 
definite  dyspepsia  with  beginning  intoxica- 
tion or  decomposition  (see  Diarrhoea  in 
Bottle-Fed  Infants;  and  Marasmus). 

8.  The  daily  total  of  food  should  rarely 
be  increased  much  over  a quart  (about  32 
ounces),  so  that  if,  at  the  fifth  to  sixth  month, 
the  baby  ceases  to  gain,  start  gradually  to 
add  more  food  in  the  form  of  a mixed  diet. 

9.  Use  the  caloric  system  chiefly  as  a 
check.  The  average  infant  under  fom- 
months  of  age  and  moderately  tliin  infants 
of  any  age,  says  Dennett,  need  50  to  55 
calories  per  pound;  emaciated  infants  need 
60  to  65  calories  per  pound;  fat  infants  over 
four  months  of  age  need  40  to  45  calories  per 
pound.  The  baby  should  be  weighed  regu- 
larly t^rfce  a week.  The  average  weight  at 
birth  is  about  7^  pounds.  The  infant  should 
regain  its  birth-weight,  following  the  first 
three  or  four  days’  loss,  by  the  end  of  the 
tenth  day.  Thereafter  it  should  gain  about 
6 to  8 ounces  a week  under  six  months  of  age, 


INFANT  FEEDING 


One  ounce 

U H 

u u 
u u 
u a 
u u 
u it 


of  4 per  cent,  milk 
“ 5 “ 


cane  .sugar 
milk  sugar  (3 

dextri-maltose  (4 

malt  soup  extract  (2 
flour  (4 


yields  20 
“ 22.5 

(2  tablespoons  leveled  with  a knife)  “ 120 


120 

120 

90 

100 


calories 

U 

(( 

u 


a 


and  3 to  4 ounces  a week  thereafter.  It 
should  about  double  its  birth-weight  in  six 
months,  and  treble  it  in  a year  to  fourteen 
months. 

Meade’s  dextri-maltose  contains  51  per 
cent,  maltose  and  47  per  cent,  dextrins. 
Malt  soup  extract  contains  about  59  to  62 
per  cent,  maltose,  about  15  per  cent,  dex- 
trins, and  7 grains  of  potass,  carbonate  to 
the  ounce.  Mellin’s  Food  contains  58  per 
cent,  maltose  and  20  per  cent,  dextrins;  its 
composition  is  P.,  10;  F.,  0.16;  S.,  80.  Hor- 
lick’s  Malted  Milk  contains  P.,  16;  F.,  9; 
S.,  67. 

10.  Correct  hygiene,  proper  clothing,  fresh 
air,  bathing,  protection  against  flies,  clean- 
liness, etc.,  is  of  prime  importance. 

11.  For  constipation;  vomiting;  diarrhoea; 
intoxication  (cholera  infantum);  inanition; 
decomposition  (malnutrition,  atrophy,  ma- 
rasmus); prematurity;  or  anorexia,  consult 
the  appropriate  caption. 

One  ounce  of  barley  (oatmeal  if  constipa- 
tion occurs)  is  boiled  in  one  pint  of  water,  a 
pinch  of  salt  added,  and  the  whole  strained ; 
then  sugar  is  added,  then  milk.  The  latter 
may  be  boiled  for  tlwee  minutes,  if  need  be. 

Feeding  During  the  Second  Year. — 
Thirteenth  Month. — At  7 or  8 a.  M.,  6 to  8 
oz.  milk,  mixed  with  2 to  3 oz.  strained  barley 
or  wheat  gruel,  cooked  at  least  three  hours, 
flavored  with  salt  and  sugar;  small  piece  of 
zwieback  or  toast.  At  10  or  11  a.  m.,  a cup 
(8  oz.)  of  warm  milk.  At  12  or  1 p.  m., 
4 to  8 oz.  beef,  veal,  mutton,  or  chicken 
broth;  well-cooked  cereal,  macaroni  or 
spaghetti;  pureed  spinach,  carrots  or  potato; 
stale  bread,  toast,  or  cracker;  milk,  4 or  5 oz. 


orange  juice,  1 to  2 oz.  At  5 or  6 p.  m.,  6 to  8 
oz.  milk,  mixed  with  2 to  3 oz.  strained 
barley  or  oatmeal  gruel  cooked  at  least  three 
hours  and  flavored  with  salt  and  sugar;  small 
piece  of  zwieback;  apple  sauce  or  prune  juice. 
At  9 or  10  p.  M.,  a cup  (8  oz.)  of  warm  milk. 

Fifteenth  Month. — At  7 or  8 a.  m.,  8 oz. 
milk  with  6 oz.  strained  barley,  oatmeal,  or 
wheat  gruel,  cooked  three  hours,  and  flavored 
with  salt;  or  milk  and  stale  bread.  At  12  or 
1 p.  M.,  well  cooked  cereal,  stale  bread;  beef 
juice,  1 to  2 oz.,  orange  juice,  1 to  2 oz.; 
custard  or  tapioca,  milk,  4 or  5 oz.;  or  8 oz. 
beef,  veal,  mutton,  or  chicken  broth,  with 
stale  breadcrumbs,  or  a little  barley  added; 
or  scraped  beef  or  minced  cliicken,  milk,  4 to 
5 oz. ; 1 to  2 oz.  orange  juice.  At  5 or  6 p.  m., 
8 oz.  milk  mixed  with  6 oz.  strained,  well- 
cooked  gruel,  flavored  with  salt;  crackers, 
zwieback,  or  stale  bread.  At  9 or  10  p.  m. 
8 to  10  oz.  of  warm  milk. 

(Meat  juice  is  prepared  as  follows;  four 
parts  of  finely  chopped  fresh  raw  steak  is 
stirred  with  one  part  of  cold  water  allowed 
to  stand  for  half  an  hour  in  the  cold,  and 
the  juice  then  expressed  through  a cloth  or 
meat  press;  or  cubes  of  meat  may  be  seared 
in  a hot  pan  and  the  juice  then  expressed 
with  a lemon  squeezer). 

Eighteenth  Month. — At  7 or  8 a.  m.,  8 oz. 
milk  with  8 oz.  gruel;  or  1 to  3 tablespoonfuls 
oatmeal  or  other  porridge  cooked  at  least 
three  hours,  with  2 tablespoonfuls  cream; 
milk  to  drink;  or  1 egg  boiled  three  minutes, 
with  stale  bread  and  milk.  At  12  or  1 p.  m., 

1 egg  boiled  three  minutes,  with  stale 
bread  and  butter;  4 ounces  clear  soup; 

2 to  4 ounces  orange  juice,  or  baked 


Wachenheim’s  Modification  of  Jacobi’s  Schedule. 


Formula 

No. 

Age. 

Num- 
ber of 
feed- 
ings. 

Ounces 

per 

meal. 

Ounces 

of 

milk. 

Ounces  of 
sugar. 

Ounces 
of  bar- 
ley water 

Calories 

per 

kilo. 

P. 

F. 

s. 

.Salts. 

I 

Birth 

6 

1.5 

1.5 

0.25  (M) 

7.5 

25 

0.7 

0.7 

4.5 

0.13 

II 

1 week 

6 

2.0 

3.0 

0.375  {%) 

9.0 

45 

1.0 

1.0 

5.1 

0.19 

HI 

2 weeks 

6 

2.5 

5.0 

0.5  (H) 

10.0 

55 

1.2 

1.3 

5.7 

0.25 

rv 

1 month 

6 

3.0 

7.0 

0.75  m 

11.0 

65 

1.4 

1.5 

6.8 

0.30 

V 

2 months 

6 

4.0 

11.0 

1.0 

13.0 

75 

1.7 

1.8 

7.0 

0.34 

VI 

3 months 

6 

5.0 

15.0 

1.25  (IM) 

15.0 

85 

1.8 

2.0 

7.2 

0.38 

VII 

4 months 

5 

6.0 

18.0 

1.25 

12.0 

85 

2.0 

2.3 

7.4 

0.43 

VIII 

5 months 

5 

7.0 

22.0 

1.25 

13.0 

90 

2.2 

2.5 

7.1 

0.48 

IX 

6 months 

5 

8.0 

26.0 

1.25 

14.0 

95 

2.4 

2.7 

6.6 

0.52 

X 

8 months 

5 

8.0 

30.0 

1.25 

10.0 

100 

2.7 

3.0 

7.0 

0.57 

XI 

To  be  use 

10  months  1 5 

d merely  as  a guide 

8.0 

34.0 

1.0 

6.0 

100 

3.0 

3.4 

6.6 

0.63 

INFLAMMATION  OR  INFECTION,  LOCAL 


apple,  or  stewed  prunes,  strained.  Or, 
8 oz.  meat  broth,  with  l^arley,  rice,  or 
breadcrumbs  added;  stale  bread  and  but- 
ter; rice  and  milk  pudding,  or  junket  (curds 
and  whey)  made  by  adding  a junket  tablet 
or  two  teaspoonfuls  of  essence  of  pepsin  or 
liquid  rennet  to  a pint  of  fresh,  lukewarm 
milk  and  allowed  to  stand  at  room  tempera- 
ture until  firmly  coagulated ; a cooked  fruit, 
a.s  above.  Baked  potato,  or  pureed  spinach 
or  carrot;  finely  minced  meat.  (Potatoes 
cooked  in  their  skins  retain  the  potas- 
sium salts.) 

Hill  says:  “It  is  a bad  mistake  to  feed 
eggs  to  most  babies  under  fifteen  or  sixteen 
months.” 

Fp:eding  from  the  Third  to  the  Sixth 
Year. — Breakfast,  7 to  8 a.  m. — Oatmeal, 
wheaten  giits,  cornmeal,  farina,  hominy,  or 
arrowioot,  cooketl  at  least  three  hours, 
flavored  with  salt  and  a little  sugar  and 
served  with  cream;  stale  bread  and  butter; 
milk;  orange  juice.  Or,  one  egg,  boiled 
thi'ee  minutes,  or  lightly  poached,  or 
scrambled,  or  coddled  {i.e.,  placed  in  cold 
water  on  the  stove,  the  water  allowed 
to  come  to  a boil,  then  removed  from  the 
stove,  the  egg  being  allowed  to  remain  in 
the  water  for  a minute  or  two  after  remov- 
ing from  the  stove);  stale  bread  and  butter; 
milk;  orange  juice. 

Lunch,  10  a.  m. — A cup  of  milk  and  a 
cracker.  This  is,  perhaps,  best  omitted. 

Dinner,  12  to  1 p.  m. — Beef,  veal,  mutton, 
chicken,  clam,  or  oyster  broth,  thickened  if 
desired  with  a cereal;  rare  roast  beef  or 
beefsteak,  rare  mutton  chop  or  lamb,  or 
chicken;  mashed  baked  potato  mixed  with 
cream  or  meat  juice;  a green  vegetable,  w^ell 
cooked  and  mashed — spinach,  cauliflower 
tops,  asparagus  tips,  stewed  celery,  peas, 
young  string  beans;  dessert — junket,  or  rice 
and  milk  pudding,  or  custard,  or  tapioca 
pudding;  ice-cream  once  a week. 

Supper,  5 to  6 p.  m. — Gruel,  milk,  milk 
toast,  stale  bread  and  butter;  baked  apple 
or  stewed  prunes. 

Articles  Prohibited  (Holt). — “Meats:  ham, 
sausage,  pork  in  all  forms,  tripe,  salt  fish, 
corned  beef,  dried  beef,  goose,  duck,  game, 
kidney,  liver,  meat  stews  and  meat  dress- 
ings.” Give  meat  nooftenerthan  once  a day. 

“Vegetables:  Fried  vegetables  of  all 

varieties,  cabbage,  potatoes  (except  when 
boiled  or  baked),  raw  or  fried  onions,  raw 
celery,  radishes,  lettuce,  cucumbers,  toma- 
toes (raw  or  cooked),  beets  (unless  very 
small  and  fresh),  eggplant,  and  green  corn. 

“ Bread  and  cake:  All  hot  bread  and  rolls, 
buckwheat  and  all  other  griddle  cakes,  all 


sweet  cakes,  particularly  those  containing 
dried  fruits  and  those  heavily  frosted. 

“Desserts:  All  nuts,  candies,  pies,  tarts, 
and  pastry  of  every  description;  also  all 
salads,  jellies,  syrups,  and  preserves. 

“Drinks:  Tea,  coffee,  wine,  beer,  cider, 
and  soda-water. 

“ Fruits:  All  ckied  fruits,  bananas,  all 
fruits  out  of  season  and  stale  fruits,  particu- 
larly in  sunmrer”;  watermelon;  green  fruits; 
any  of  the  orange  but  the  juice. 

Infantile  Convulsions.— ^ee  Convulsions 
of  Infancy  and  Childhood. 

Meningeal  Hemorrhage. — See  Hemor- 
rhage, IMeningeal,  in  the  New-Born; 
and  Spastic  Paralysis. 

Paralysis. — See  Spastic  Paralysis;  In- 
fantile Cerebral  Paralysis;  and  Polio- 
myelitis, Acute. 

Scurvy. — See  Scuivy,  Infantile. 

Infantilism.— Causes.— Chronic  debilitating 
or  toxic  affections,  e.g.,  sypliilis,  tuberculosis, 
malaria,  ankylostomiasis,  congenital  heart 
cUsease,  adenoids  and  enlarged  tonsils,  Ijnn- 
phatism  (?),  renal  insufficiency  (?),  phmib- 
ism,  tobacco  addiction,  alcoholism ; and  other 
causes,  e.g.,  hypothjToidism  (cretinism), 
hyi^opituitarism,  hypoadrenalism  (?),  pan- 
creatico-intestinal  dyscrasia  or  hypopan- 
creatism,  absence  of  certain  Adtamines  in 
the  chet  (?),  unknown  causes. 

Treatment.— Get  at  the  cause  and  correct 
it,  if  possible.  Correct  hygiene,  of  course, 
is  essential : clean,  nutritious  food,  fresh  air 
day  and  night,  light,  warm  clothing,  ade- 
quate rest  and  exercise,  a daily  morning 
warm  bath  in  a warm  room,  followed  by  a 
cool  spinal  douche  and  brisk  rubbing  with  a 
coarse  towel,  or  a wann  bath  at  night,  regu- 
lar hours  of  eat  mg  and  sleeping,  rest  before 
and  after  eating,  regulation  of  the  bowels, 
perhaps  massage. 

ThjT’oid  extract,  pancreatic  extract,  anti 
hypophyseal  extract  (see  Part  11)  may  be 
tentatively  tried.  Specific  growth-producing 
vitamines  occur  in  fresh  milk,  fresh  eggs, 
fresh  meat,  jTast,  meat  extract,yeast  extract, 
testicular  ejrtract,  pancreas,  malt,  cereals  not 
deprived  of  the  pericarp,  brans,  all  rapidly 
gi’owing  vegetables,  and  in  Hongo  or  Kat  jang 
idjo  beans.  Another  kind  ofvitamine  occursin 
eggs,  meat,  fish,  brain,  cereals,  legumes,  fresh 
vegetables,  and  yeast.  It  is  the  freshness  of 
the  food  that  is  the  ess6ntial  desideratum. 
^dtamines  are  destroyed  by  drj'ing,  pressing, 
tinning,  jirocessing,  pickling,  autoclaving. 

Infarction. — L.  infarcir'e,  to  stuff  in.  See 
Embolism. 

Inflammation  or  Infection,  Local. — L.  in- 

Jkwimdtio;  inflammdre,  to  set  on  fire.  i. 


INFLAMMATION  OR  INFECTION,  LOCAL 


Acute.  Prescribe  local  and  systemic  rest,  and 
a light,  nutritious  diet,  and  see  that  the 
bowels  and  kidneys  are  active. 

In  the  early  stages,  cold  may  be  applied, 
with  the  object  of  aborting  the  inflamma- 
toiy  process;  but  if  it  is  ineffectual,  heat 
should  be  apphed  in  the  form  of  hot  air, 
hot  water  bags,  hot  poultices,  or  hot  boric 
acid  or  bichloride  solution,  in  order  to  pro- 
mote the  reaction  of  inflammation.  Bier’s 
hyperaemia  is  also  employed  for  tins  pur- 
pose. It  is  obtained  either  by  means  of 
vacuum  cups,  or  by  compression  of  the 
veins  proximal  to  the  site  of  inflammation 
with  a bandage  or  Martin  rubber  band. 
The  constriction  should  not  cut  off  the 
arterial  circulation,  or  cause  pain,  white 
oedematous  swelling,  coldness,  or  anaesthesia. 
In  inflammation  of  the  foot  it  is  placed  above 
the  knee;  in  inflammation  of  the  hand  it  is 
placed  above  the  elbow.  It  is  kept  on  for 
from  one  to  tlu-ee  hoiu’s  a day  or  longer. 
Vacuum  cups  should  not  be  kept  on 
any  longer  than  from  one  to  three  hom’s. 
For  the  purpose  of  preventing  the  rapid 
absorption  of  toxins,  Kanavel  aj^plies  Bier’s 
constriction  for  from  twelve  to  eighteen 
hours,  and  sometunes  reapplies  it  for 
another  eighteen  hours,  after  an  inter- 
mission of  several  hours. 

Should  suppui’ation  occur,  make  one  or 
more  free  incisions,  and  drain  the  abscess 
cavity  by  means  of  gauze  or  gutta  percha 
strips.  Do  not  scrape  the  walls  of  the 
cavity,  but  use  the  finger  or  blunt  closed 
haemostatic  forceps  to  break  down  necrotic 
tissue.  Do  not  hrigate  as  a rule,  but  use 
dry  dressings,  wliich  should  be  changed 
every  day,  or  less  often  as  required  to  keep 
the  parts  dry.  The  gauze  may  be  anointed 
with  sterile  vaseline  to  prevent  sticking.  If 
irrigation  is  deemed  advisable,  boric  acid 
(pii  ad  Oi)  or  nonnal  saline  solution  (pi  ad 
Oi)  is  perhaps  the  best,  because  the  least 
irritating.  The  presence  of  pus  is  inchoated 
by  a brawny,  clark-red  induration;  not  a 
pink,  pitting  oedema.  Before  making  the 
incision,  it  is  well  to  have  the  patient  press 
gently  over  the  whole  involved  area,  in 
order  to  locate  the  point  of  greatest  tender- 
ness. The-  incision,  as  a rule,  should  be 
made  here. 

For  the  treatment  of  infected  wounds, 
see  Wounds. 

In  gas  infection  (caused  by  the  sapro- 
phytic anaerobes:  • B.  perfringens  or  aerog- 
enes  capsulatus,  B.  oedematiens,  B.  sporo- 
genes,  vibrion  septique),  revealed  by  the 
presence  of  crepitation  due  to  subcutaneous 
emphysema,  if  multiple  free  incisions,  to 


remove  gaseous  pressure  and  also  all  foreign 
material,  blood-clots  and  dead  or  infected 
muscle  (muscle  that  is  dull,  dry,  pale  lustre- 
less pink  or  brick  red,  or  that  does  not  con- 
tract or  bleed;  infection  spreads  along  the 
fibres  of  individual  muscles,  not  from  one 
muscle  to  another),  continuous  ii’rigation 
with  1 to  10  per  cent,  qiunine  hydrochloride 
(Taylor),  rubber  or  gauze  drainage  and  ab- 
solute local  rest  is  not  promptly  remedial, 
resort  to  high  amputation  at  once.  In  case 
of  doubt,  amputate.  Do  a guillotine  ampu- 
tation, leaving  the  stump  open.  It  need 
not  be  carried  above  the  area  of  crepitation. 

Hospital  gangrene  is  manifested  by  the 
appearance  of  a dirty  gray  adherent  mem- 
brane associated  with  severe  toxemia,  and 
is  due  to  streptococci.  Apply  under  ether, 
concentrated  nitric  or  nitro-hydrochloric 
acid,  or  acid  nitrate  of  mercury,  bromine, 
or  the  actual  cautery  (Keen). 

Tuberculous  abscesses  demand  special 
treatment  (see  Orthopaedics,  Part  10). 

Superficial  inflannnatory  processes  may 
be  treated  wdth  benefit  by  means  of 
ionization. 

Ionic  medication,  or  cataphoresis,  Gr. 
Kara  across  + (f>6pr)(TLs  bearing,  is  the  intro- 
duction of  medicinal  substances,  usually 
antiseptics,  into  and  tlnough  the  skin  and 
mucous  membranes  by  means  of  the  action 
of  the  constant  current  (see  IMedical  Elec- 
tricity). The  mecUcinal  substances  used 
must  be  electrolytes,  that  is,  their  solutions 
in  water  must  be  good  conductors  of  elec- 
tricity, dm-ing  the  passage  of  which  the 
dissolved  substance  undergoes  a chemical 
decomposition,  with  the  migration  of  a part 
to  the  anode  (anions,  carrying  a nega- 
tive charge)  and  a part  to  the  cathode 
(kathions,  carrying  a positive  charge.  For 
example,  if  a current  of  electricity  be  con- 
ducted through  an  aqueous  solution  of  zinc 
sulphate,  the  zinc  ions,  positively  charged, 
will  migrate  to  the  catlrode,  and  SO4  ions, 
negatively  charged,  will  migrate  to  the 
anode,  accorchng  to  the  law  that  like  charges 
repel  one  another  and  unlike  charges  attract 
one  another.  Kathions  are  those  of  zinc, 
copper,  silver,  mercury,  magnesium,  litluum, 
the  alkaloids  (cocaine,  quinine),  adrenalin, 
anunonia,  hydrogen,  etc.  They  enter,  of 
course,  only  from  the  anode.  Anions  are 
those  of  the  halogens  (chlorine,  iodine),  the 
acid  radicles,  and  hydroxyl  (OH).  They 
enter,  of  course,  only  from  the  cathode. 

The  apparatus  for  ionic  medication  con- 
sists of  a steady  galvanic  current,  with  the 
conducting  cords  preferably  of  flexible 
stranded  copper  wire,  insulated  with  India- 


INFLUENZA;  LA  GRIPPE 


rubber.  The  electrode  employed  for  flat 
surfaces  is  a metal  (say  aluminum)  disc, 
about  two  inches  in  diameter,  pierced  with 
small  holes  around  its  margin,  through  which 
three  layers  of  thick  felt  may  be  attached 
with  thread.  The  first  layer  of  felt  is  larger 
than  the  metal  disc,  and  each  succeeding 
layer  larger  than  the  preceding.  The  felt, 
before  using,  should  receive  a prolonged 
soaking  in  hot  ammonia  or  soda  water,  in 
order  to  dissolve  out  all  grease. 

Between  the  felt-covered  electrode  and 
the  skin  is  placed  a table  napkin  folded  four 
times,  so  as  to  form  sixteen  layers.  This  is 
soaked  in  the  electrolytic  solution  to  be  used. 
A 1 per  cent,  solution  is  generally  employed. 
Metal  rod  or  button  electrodes  are  used  for 
the  ionization  of  ulcers,  metal  sounds  for 
flstulae  and  sinuses,  and  needles  (preferably 
zinc)  for  the  purpose  of  piercing  the  part 
to  be  ionized. 

The  skin  should  fii-st  be  freed  of  grease, 
by  means  of  soap  and  water,  and  rinsed. 
Abrasions  or  acne  lesions  should  be  covered 
with  collodion  or  adhesive  plaster.  The 
folded  napkin  (or  lint  or  cotton  wool),  well 
moistened  with  the  electrolytic  solution,  is 
applied  smoothly  and  evenly,  in  order  to 
avoid  irregular  penetration;  then  the  well- 
moistened  felt-covered  electrode  is  applied, 
and  the  whole  bandaged  on  firmly. 

A steady  galvanic  current  is  employed. 
It  is  turned  on  very  slowly  up  to  the  maxi- 
mmn  required;  then,  after  no  longer  than 
fifteen  to  twenty  minutes,  it  is  turned 
slowly  off.  If  point  pain  is  complained  of, 
examine  to  see  that  no  blister  or  burn  is 
being  produced.  If  the  current  is  applied 
too  long,  there  is  danger  that  superficial 
necrosis  may  be  produced. 

Zinc  is  perhaps  the  best  electrolyte  for 
antiseptic  use,  because  it  is  more  penetrating, 
and  is  not  precipitated  by  the  body  fluids 
like  silver  or  mercmy,  and  thus  early  thrown 
out  of  action.  (After  Lewis  Jones.) 

For  painful  wounds  employ  a 2 per  cent, 
solution  of  sodium  salicylate,  2 milliamperes 
per  square  centimetre,  for  one  hour. 

In  treating  sinuses  and  fistulae,  first 
cleanse  the  passages,  and  then  fill  them  with 
a solution  of  the  electroljde,  copper  sulphate 
or  zinc  sulphate.  Insert  a positive  copper 
or  zinc  electrode,  and  employ  a current  of 
6 to  8 ma.  for  six  to  eight  minutes.  Gradually 
reduce  the  current ; then  reverse  it  to  2 or 
3 ma.  for  a short  time  in  order  to  loosen 
the  electrode  from  the  tissues.  One  or  two 
treatments  a week  may  be  given.  See  also 
Ulcers,  Cutaneous;  and  the  various  captions 
covering  inflammatory  conditions. 


II.  Chronic.  Here  are  employed  heat,  elec- 
tricity, counter-irritation,  massage,  and 
active  and  passive  movements. 

Inflammatory  Rheumatism. — See  Rheu- 
matic Fever. 

Influenza;  La  Grippe. — Ital.,  “ influenza”; 
Fr.  La  Grippe.  An  acute  endemic,  epidemic, 
and  pandemic  infectious  disease  caused  by 
the  bacillus  influenzae,  and  characterized  by 
an  incubation  period  of  from  one  to  four 
days,  followed,  usually  abruptly,  by  clfilli- 
ness,  fever,  malaise,  anorexia,  headache  and 
muscular  and  neuralgic  pains,  prostration, 
and  respiratory  inflammation  (naso-pharyn- 
gitis,  sinusitis,  tonsillitis,  otitis  media,  laryn- 
gitis, tracheitis,  bronchitis,  broncho-pneu- 
monia, pleuritis,  even  pulmonary  abscess  and 
gangrene).  The  symptomatology  is  com- 
plex. Conjunctivitis  is  common.  Gastro- 
intestinal symptoms  may  predominate. 
Severe  neuralgias  and  other  nervous  symp- 
toms may  arise.  Peripheral  neuritis  oc- 
curs in  children.  There  is  an  influenzal 
memngitis  and  encephalitis.  The  myo- 
cardium is  apt  to  share  in  the  general  mus- 
cular debility.  The  disease  sometimes 
resembles  typhoid  fever.  There  is  usually 
httle  or  no  leucocytosis. 

A chi'onic  cough,  with  perhaps  occasional 
hsemoptysis,  simulating  tuberculosis,  may 
follow  the  acute  attack,  and  be  due  to 
chronic  influenzal  bronchitis,  bronchiectasis, 
solidification,  or  cavity  formation. 

The  diagnosis  of  influenza  is  made  from 
the  microscopic  and  cultural  characteristics 
of  the  bacillus.  The  common  endenfic, 
catarrhal  fever,  commonly  called  the  grip, 
may  reveal  no  influenza  bacilli,  but  only  the 
streptococcus,  pneumococcus,  or  micrococ- 
cus catarrhalis. 

n Prognosis.— In  uncomplicated  cases  the 
prognosis  is  usually  good,  and  the  majority 
of  cases  convalesce  rapidly  after  an  illness 
of  from  three  to  five  days.  Recurrences, 
however,  are  common.  Sometimes  con- 
valescence is  prolonged  for  months. 

Treatment.— Put  the  patient  to  bed,  and 
keep  him  there  for  at  least  four  to  six  days 
after  defervescence.  Prescribe  a liquid  or  soft, 
but  nutritious,  diet,  with  plenty  of  water. 
Open  the  bowels  \rtth  calomel  followed  by  a 
saline  (see  Part  11).  A hot  bath  in  a warm 
room,  the  patient  going  immediately  to  bed 
between  wanned  blankets,  with  hot  water 
bottles  to  the  feet,  and  a di’ink  of  hot 
lemonade  with  a little  whiskey,  and  perhaps 
a dose  of  quinine,  gr.  v,  with  aspirin,  gr.  v, 
or  a dose  of  Dover’s  powder,  gr.  v-x,  may 
prove  very  beneficial. 

To  prevent  reinfection  and  the  spread  of 


INSOMNIA 


the  disease,  the  respiratory  secretions  and 
the  patient’s  person  and  surroundings  should 
be  treated  just  as  in  tuberculosis  {q.v.,  see 
also  Disinfection). 

For  the  nose  and  throat,  employ  alkaline 
antiseptic  sprays  and  gargles,  such  as 
Dobell’s  solution  or  liquor  antisepticus 
alkalinus  (Part  11).  Consult  also  Nose  Dis- 
eases, Part  8,  and  Throat  Diseases,  Part  9. 

For  headache  and  general  pains,  employ 
the  ice-cap  or  hot  water  bag,  the  thermo- 
cautery, electricity,  chloroform  liniment, 
menthol,  oil  of  wintergreen,  or  internal 
analgesics,  e.g.,  salipyrin,  antipyrin,  lacto- 
phenin,  phenacetin  with  salol,  aspirin, 
Dover’s  powder,  with  or  without  antipyrin 
or  phenacetin;  codeine,  with  phenacetin. 
Ortner  prefers  salipyrin  and  aspirin.  Holt 
gives  to  a child  of  one  year,  phenacetin,  gr.  i, 
with  codeine,  gr.  3^^0i  every  three  or  four 
hours;  to  a child  of  two  years,  double  the 
dose.  Remember,  however,  that  these 
drugs  are  cardiac  depressants  (for  Drugs 
see  Part  11). 

For  depression  and  prostration,  employ 
strychnine. 

For  high  fever,  one  may  employ  cold 
sponging  or  the  cold  pack  (see  Fever),  but, 
says  Ortner,  “ the  antipyretics  are  preferable 
to  cold  baths”;  “in  general,  heat  is  preferable 
to  cold.” 

For  cough  with  difficult  expectoration, 
prescribe  ammonium  chloride  or  calcium 
iodide  or  sodium  benzoate,  with  plenty  of 
water,  for  several  days.  For  an  irritative 
cough  prescribe  codeine,  heroin,  or  morphine. 
Apply  mustard  poultices  or  large  flaxseed 
poultices  to  the  chest.  Medicated  steam 
inhalations  are  useful  (see  Bronchitis, 
Acute).  Indeed,  the  disease  should  be 
treated  symptomatically  (consult  the  appro- 
priate captions). 

Ammonii  chloridi 5ii  (gr.  x per  dose) 

Ammonii  carbonatis 5i  (gr.  v per  dose) 

Sodii  bicarbonatis 3i  (gr.  v per  dose) 

Fluidextracti  senegaj ,3iii  (i^xv  per  dose) 

Vini  ipecacuanhee 3i  (tt^v  per  dose) 

Aquse  chloroformi,  q.s  , ad  5vi 

M.  Sig. — One  tablespoonful  every  two  hours  in 
hot  water  as  required.  Yeo’s  (modified)  expector- 
ant mixture. 

Quinine  is  well  recommended  in  influenza. 
Croftan  gives  quinine  and  aspirin,  aa  gr.  v, 
every  five  hours  for  three  or  four  days,  and 
recommends  a little  whiskey  throughout  the 
illness.  In  high  fever  and  delirium,  phe- 
nacetin may  be  combined  with  the  quinine, 
but  quinine  and  aspirin  had  better  be  given 
separately,  because  of  the  danger  of  the 
formation  of  the  very  poisonous  quinotoxin 


when  the  two  drugs  are  in  contact  for 
some  time. 

During  cont^alescence  prescribe  fresh  air, 
warm  clothing,  an  abundance  of  good  food, 
and  elixir  of  iron,  cjuinine,  and  strychnine. 
Give  codliver  oil  and  creosote  for  persistent 
cough.  The  heart  may  at  this  time  show 
some  irregularity  in  rate  and  rhythm,  due, 
perhaps,  to  parenchymatous  myocarditis  (see 
Myocarditis.  Leonard  Williams  advises  the 
administration  of  thyroid  extract  during 
convalescence,  because  of  the  depressant 
action  of  influenza  upon  the  thyroid  gland; 
but  the  di'ug  should  be  used  with  caution 
where  the  heart  is  affected. 

After  the  patient  has  left  his  room,  the 
latter  should  be  fumigated  with  formalde- 
hyde. See  Disinfection. 

Injuries  to  Soft  Parts. — See  Contusion. 

Insolation. — L.  in,  in  -f-  sol,  sun;  insoldre, 
to  expose  to  the  sun.  See  Sunstroke. 

Insomnia. — L.  in,  not-  -j-  som'nus,  sleep. 

Causes.— A heavy  supper,  or  the  taking  of 
food  or  drink,  especially  tea  or  coffee,  soon 
before  retiring;  use  of  tobacco  just  before 
retiring;  mental  activity,  intellectual  or 
emotional,  just  before  retiring;  ill-ventilated 
bedroom;  cold  feet;  constipation;  gastro- 
intestinal disturbance;  gastric  hyperacidity; 
overwork;  mental  strain;  e.xhaustion  from 
insufficient  food;  neurasthenia;  hysteria; 
insanity;  drug  addiction:  tobacco,  tea,  cof- 
fee, alcohol,  cocaine,  morphine,  etc.;  hyper- 
thyroidism and  thyroid  medication;  pyrexia; 
pain;  dyspnoea;  cough,  cerebral  anaemia; 
cerebral  hyperaemia;  arteriosclerosis;  gouty 
or  rheumatic  diathesis;  cardiac,  renal,  pul- 
monary, and  other  diseases;  heredity  (?). 

Treatment. — Attend  to  the  cause.  In 
insomnia  due  to  mental  activity,  the  latter 
should  be  avoided  for  at  least  an  hour  before 
retiring,  when  it  is  also  best  to  take  a little 
exercise  in  the  open  air.  The  bedroom 
should,  of  course,  be  well  ventilated.  For 
physical  or  mental  exhaustion,  Yeo  recom- 
mends a “ teacupful  of  beef-tea  or  gruel  or 
arrowroot  with  a dessertspoonful  of  brandy,” 
before  retiring.  The  bromides  (Part  11)  are 
here  of  service.  For  insomnia  due  to  gastric 
hyperacidity,  prescribe  sodium  bicarbonate, 
gr.  x-xxx  in  a tumblerful  of  hot  water  fifteen 
minutes  before  bedtime.  (Yeo.) 

Change  of  life  and  environment,  such  as 
tent  life  in  the  woods,  is  beneficial  in 
chronic  cases. 

Physical  soporific  agencies  of  the  first 
importance  are  the  hot  bath,  followed  by 
friction,  the  hot  sitz-bath,  hot  foot-bath, 
cold  foot-bath,  the  wet  pack,  massage,  and 
electricity  (particularly  the  “head  breeze,” 


INTESTINAL  COLIC 


see  Medical  Electricity)  If  the  cold  pack 
is  used,  hot  water  bottles  should  be  placed 
to  the  feet;  some  advise  that  the  pack  be 
removed  at  the  end  of  five  to  twenty  min- 
utes, and  the  skin  rubbed  with  a coarse  towel. 

Soporific  Drugs  of  value  for  occasional 
use:  Sodium  bromide,  gr.  xv-xxx  well 
diluted  in  water  or  milk,  tlu-ee  hours  before 
reth’ing,  and  again  on  retiring. 

Chloral  hydrate,  gr.  v-x,  well  diluted,  by 
mouth,  every  two  hours,  gradually  increased, 
if  necessary  to  15  to  20  gi-ains;  per  rectiun, 
gr.  xv-xxx,  well  diluted  (double  the  dose  by 
mouth).  It  is  a cardiac  depressant  and 
gastric  irritant;  but  Price  says  that  he  has 
used  it  very  extensively,  and  has  never 
found  it  dangerous  in  heart  disease.  He 
says  it  should  be  avoided,  however,  where 
there  is  much  bronchial  secretion  or  cedema 
of  the  lungs. 

Sodium  bromide  and  chloral,  aa  gr.  xv, 
per  rectum;  or  sodium  bromide,  gr.  xl  and 
chloral,  gr.  xx,  in  a single  dose,  per  rectum, 
well  diluted. 

.Chloralamide,  gr.  xxx-lx,  in  capsule;  not 
so  depressant  as  chloral;  “ the  safest  and 
best  ” of  mild  hyiinotics,  says  Allbutt. 

Chloralamide  and  sodium  bromide,  aa 
gr.  XX. 

Chloretone,  gr.  v-xv,  in  water;  not  so 
depressant  as  chloral. 

Hypnal  or  chloral-antipyrin,  gr.  xv-xxx, 
in  aqueous  solution,  best  per  rectum;  for 
insomnia  due  to  pain  or  cough. 

Sulphonal,  gr.  x-xx,  with  potassium  bro- 
mide, gr.  XX,  in  a cup  of  warm  broth,  milk, 
or  chocolate,  two  to  three  hours  before  bed- 
time, or  at  bedtime,  if  the  patient  awakes  in 
the  early  morning.  The  action  of  sulphonal  is 
slow  but  prolonged.  It  should  not  be  used 
habitually,  because  of  its  toxic  effects. 

Trional,  gr.  x-xxx,  in  hot  liquid,  with  or 
without  codeine,  gr.  H ^.cts  in  ten  to 
twenty  minutes,  but  its  action  is  transient. 
It  is  useful  where  there  is  difficulty  in 
getting  to  sleep. 

Veronal,  gr.  v,  in  a cup  of  weak  teaor  w'arm 
water,  one  and  one-half  to  two  hours  before 
retiring.  Never  give  over  5 grains,  says 
J.  Collier,  and  keep  the  bowels  active. 

Trional,  gr.  x,  with  veronal,  gr.  v, 
at  bedtime. 

Trional,  gr.  v-x,  with  sulphonal,  gr.  v-x, 
at  bedtime. 

Paraldehyde,  oss-ii,  in  diluted  brandy. 
It  acts  rapidly.  ' 

Amylene  hydrate,  ii^xxx-lxxx,  thor- 
oughly dissolved  in  warm  water  or  milk, 
before  retiring. 

Tr.  cannabis  indicse,  npxv-xxx,  in  water; 


or  Ext.  cannabis  indicse,  gr.  3^-ii; 
for  neuralgia. 

Aspirin,  gr.  v-x-xx,  with  or  without 
veronal,  gr.  hi,  for  insomnia  with  headache 
or  other  pain. 

Alcohol : 1 to  2 tablespoonfuls  of  whiskey 
in  hot  water,  one-half  to  one  hour  before 
retiring;  especially  useful  in  the  aged. 

Spt.  setheris  nitrosi,  spit,  setheris  co.,  and 
spit,  ammon.  aromat.,  aa  irgxx,  well  diluted, 
as  a (Uffusible  stimulant. 

Spt.  chloroformi,  or  spt.  letheris,  or  spt. 
setheris  co.,  3i  of  either,  with  spt.  cam- 
phorse,  oss,  in  a little  hot  wlhskey,  well 
diluted.  (Osier.) 

FI.  ext.  ergotse,  5ss,  pot.  bromid.  5ss, 
syr.  aurantii,  5ss,  aq-  menth.  pip.,  5iss. 
M.  Sig. — One  teaspoonful  in  water;  for 
the  insomnia  of  arteriosclerosis  or  neuras- 
thenia. (Forchheimer.) 

Hyoscine,  gr.  Hoo~Ho  hypodermically 
for  motor  restlessness  or  insane  excitement. 

Morphine,  gr.  to  or  opium;  for 
insomnia  due  to  pain. 

Tincture  of  hop,  3i-ii,  in  water,  5i“ii,  is 
often  added  to  other  hypnotics.  Do  not 
despise  the  hop-pillow. 

Insular  Sclerosis. — L.  in'sula,  island.  See 
Multiple  Sclerosis. 

Intercostal  Myalgia  or  Pleurodynia. — L. 
int'er,  between  -f-  cos'ta,  rib;  Gr.  irXevpa  rib 
-h  68w7]  pain.  See  Myalgia. 

Intercostal  Neuralgia. — See  Neuralgia. 

Intermittent  Claudication. — See  Claudi- 
cation, Intermittent. 

Pulse. — See  Arrhythmia,  Cardiac. 

Internal  Popliteal  Nerve. — See  Sacral 
Plexu.s. 

Interstitial  Hypertrophic  Progressive  Neu= 
ritis  of  Childhood, — A very  rare  familial 
paralysis  of  children,  characterized  by  hyper- 
trophy and  hardness  of  the  peripheral  nerv'e 
trunks,  with  secondary  degeneration  of  the 
dorsal  columns  of  the  cord,  progressive  mus- 
cular atrophy,  kyphoscoliosis,  nystagmus, 
rnyosis,  inequality  of  the  pupils,  and  symp- 
toms of  locomotor  ataxia,  viz.,  ataxia  of  the 
four  limbs,  diminution  of  sensation,  light- 
ning pains,  loss  of  reflexes,  and  Argyl- 
Robertson’s  sign  (see  also  Atrophies,  the 
Progressive  Muscular). 

The  Treatment  is  similar  to  that  of  tabes, 

(q.v.) 

Interstitial  Pneumonia,  Chronic. — Sec 

Pulmonaiy  Cirrhosis. 

Intestinal  Atony. — L.  inte^tin'um,  from 
mtus,  within.  See  Constipation. 
Cancer. — See  Cancer  of  the  Intestines. 
Catarrh. — See  Enteritis 
Colic. — See  Colic,  Intestinal. 


INTESTINAL  NEUROSIS 


Intestinal  Distomiasis.- — ^See  Dis- 
tomiasis. 

Hemorrhage. — See  Hemorrhage,  In- 
testinal. 

Indigestion. — See  Diarrhoea. 

Inflammation. — See  Enteritis. 

Intestinal  Intoxication. — The  following 
classification  is  that  of  W.  Langdon  Brown: 

1.  Indolic  Type,  due  to  the  bacillus  coli 
and  perhaps  the  bacillus  putrificus,  with 
marked  indicanuria  {q.v.,  for  test),  seen 
most  commonly  in  marasmic  children  with 
a distended  abdomen  and  chronic  intes- 
tinal indigestion. 

2.  Butyric  Type,  due  chiefly  to  the  bacil- 
lus serogenes  capsulatus,  which  sets  free 
nascent  hydrogen,  which  causes  reduction 
of  the  bile  pigment,  with  resulting  excess  of 
urobilin  in  the  faeces  and  urine,  so  that  a 
red  color  is  produced  on  the  addition  to  the 
faeces  of  a strong  solution  of  mercuric 
chloride,  the  red  color  being  intensified  by 
throwing  the  treated  faeces  into  water.  The 
chief  symptoms  are:  a sour  smell  to  the 
patient;  desquamation  of  the  epithelium  of 
the  tongue,  mouth,  and  digestive  tract, 
with  a resulting  tendency  to  diarrhoea; 
anaemia  due  to  toxic  haemolysis;  little  or 
no  indican  in  the  urine;  perhaps  only  an 
“ indefinite  invalidism.” 

3.  Combined  Indolic  and  Butyric  Type, 
with  chiefly  mental  depression  and  muscu- 
lar fatigue. 

4.  Carbohydrate  Fever,  connected  by  rigid 
restriction  of  carbohydrates. 

5.  Sulphaemoglobinaemia,  due  possibly  to 
Wallis’s  nitrifying  bacillus,  found  in  the 
saliva,  which  produces  nitrites,  the  latter 
after  absorption  from  the  intestines,  caus- 
ing a reduction  of  oxyhaemoglobin,  which 
with  sulphuretted  hydrogen  then  forms  sul- 
phaemoglobin  (detected  by  means  of  the  spec- 
troscope) . Cyanosis  is  the  symptom  of  note. 

6.  Methaemoglobinacmia,  detected  by 
means  of  the  spectroscope,  also  causes 
cyanosis;  usually  there  is  also  diarrhoea. 
The  habitual  use  of  the  coal-tar  drugs  (ace- 
tanelid,  antipyrin,  phenacetin,  etc.),  and 
potassium  chlorate,  carbon  monoxide,  etc., 
are  causative. 

7.  Pressor  diamines  in  the  intestines 
causing  increased  blood-pressure. 

Possible  consequences  of  intestinal  tox- 
semia,  according  to  Watson,  are  neuras- 
thenia, dyspepsia,  and  rheumatoid  arthritis. 

Treatment. — Asepsis  is  first  to  be  consid- 
ered: clean  nose,  mouth,  and  throat;  cor- 
rection of  catarrh,  suppuration,  dental 
caries,  pyorrhoea,  etc.;  the  use  of  castile 
soap,  toothbrush,  and  warm  water,  espe- 

14 


cially  before  breakfast;  clean  hands;  clean 
dwelling  (no  dry  sweeping,  promiscuous 
spitting,  etc.) ; clean  food. 

Antisepsis  is  next  to  be  considered: 

Calomel  (Part  11),  followed  by  a saline. 

Morning  salines,  especially  sodium  sul- 
phate in  the  indolic  type,  to  provide  sul- 
phate for  the  formation  of  nontoxic  ethereal 
sulphates  (indican,  etc.). 

Fasting  and  purgation  for  three  or  four  or 
more  days,  with  the  copious  drinking  of 
mineral  waters  and  daily  colonic  lavage; 
later  returning  gradually  to  regular  diet. 

Naphthalene  tetrachloride,  gr.  v-x,  in 
hardened  capsules,  three  or  four  times  daily. 

Beta-naphthol,  gr.  v-x,  in  intestinal 
coated  pill,  t.i.d. 

Menthol,  gr.  ss-i-v,  in  formalin-hardened 
capsule,  grade  II  of  hardness,  3 to  5 times 
a day. 

Thymol,gr.  v-xv,  in  hardened  capsule,  t.i.d. 

Manganese  dioxide,  gr.  iv,  in  pill,  t.i.d.p.c. 

Hydrogen  peroxide,  3ss-i-ii,  t.i.d.p.c. 

Ichthyol,  TTpiii-x,  in  hardened  capsule, 
t.i.d.;  up  to  piss  daily. 

Salol,  gr.  viiss,  in  capsule,  2 to  3 tiiues 
a day. 

Milk  soured  by  lactic-acid-producing  bac- 
teria; or, 

Lactobacilline  or  Lactone  (preparations 
of  lactic  bacilli:  b.  bulgaricus  and  b.  para- 
lacticus),  2 to  4 tablets,  p.c.,  followed  by  a 
little  sweetened  food  or  water;  antagonize 
the  growth  of  putrefactive  bacteria;  indi- 
cated if  the  faeces  are  not  acid;  contraindi- 
cated in  hyperchlorhydria,  rheumatism,  and 
abnormal  carbohydrate  fermentation  in 
the  bowel. 

Autogenous  vaccines  prepared  with  organ- 
isms from  the  stools  which  are  agglutinated 
or  destroyed  by  the  patient’s  blood. 

Irrigation  of  the  colon  through  an  appen- 
dicostomy  wound. 

Correction  of  constipation  {q.v.)  and 
enteritis  (q.v.). 

In  the  indolic  type  of  toxaemia,  carbo- 
hydrates should  be  restricted,  and  the  milk 
peptonized  or  boiled.  Finely  divided  meat 
and  gelatine  should  be  given  (gelatine  con- 
tains no  tryptophan,  the  precursor  of  indol) ; 
well-cooked  rice  and  biscuits  are  allowed. 

Intestinal  Neuralgia. — See  Enteralgia. 

Intestinal  Neuroses. — Motor,  sensory,  or 
secretory  disturbances  not  associated  with 
demonstrable  anatomic  change. 

1.  Motor:  peristaltic  unrest;  nervous 

diarrhoea ; atony ; enterospasm ; and 
intestinal  paralysis. 

2.  Sensory:  enteralgia. 

3.  Secretory:  mucous  colitis. 


INTESTINAL  OBSTRUCTION 


Intestinal  Obstruction. — i.  Acute  Obstruc= 
tion.— Acute  intestinal  obstruction  is  charac- 
terized by  the  sudden  occurrence  of  severe 
abdominal  pain,  without  tenderness  in  the 
beginning,  without  pyrexia  in  primary  cases, 
associated  with  constipation,  nausea  and 
vomiting,  and  later  abdominal  distention, 
prostration,  and  collapse. 

In  intussusception,  which  occurs  usually 
in  infants,  there  are  present  in  well-marked 
cases  a sausage-shaped  tumor  and  often 
tenesmus  and  bloody  stools.  A bloody 
diarrhoea  may  also  occur  in  infarction  of 
the  bowel.  Infectious  diarrhoea  is  often 
diagnosed  in  infants.  Never  neglect  a rectal 
digital  examination. 

The  Prognosis  is  always  serious. 

Causes  of  Acute  Obstruction. — Stran- 
gulation of  the  gut  due  to  bands  and  adhe- 
sions (adherent  appendix,  oviduct,  etc.), 
omphalo-mesenteric  remains,  mesenteric  and 
omental  slits,  peritoneal  pouches  and  open- 
ings (internal  and  external  hernise),  pedun- 
culated tumors,  retroflexed  gravid  uterus, 
twists  and  knots  (volvulus,  involving  usually 
the  sigmoid),  rarely  strictures  or  tumors; 
intussusception;  severe  spastic  contraction 
of  the  gut  (enterospasm) ; foreign  bodies 
(fecal  masses,  enteroliths,  gall  stones,  para- 
sites, swallowed  bodies,  magnesia,  bismuth, 
etc.);  congenital  stenosis,  usually  anorectal; 
intestinal  paralysis  (a.  Functional,  due  to 
abdominal,  hernial,  testicular,  or  ovarian 
trauma,  including  operations,  operation  for 
hemorrhoids,  torsion  of  an  ovarian  cyst, 
renal  or  gall-stone  colic,  paracentesis  for 
ascites,  hemorrhage,  acute  pancreatitis,  in- 
flammation in  the  inguinal  region,  toxic 
states,  e.g.,  pleurisy,  pneumonia,  cholera, 
typhoid  fever,  enteritis,  intestinal  intoxica- 
tion, uraemia,  plumbism,  opium  poisoning, 
spinal  or  cerebral  disease,  e.g.,  meningitis, 
myelitis,  tabes,  cerebral  tumor,  apoplexy, 
mania,  melancholia,  hysteria,  hypochondria- 
sis, heart  disease;  b.  Organic,  due  to  perito- 
nitis, mesenteric  embolism  or  thrombosis, 
intestinal  obstruction,  ulcerative  enteritis, 
perforation  of  the  stomach  or  intestine, 
ruptured  tubal  pregnancy,  fatty  degenera- 
tion of  the  muscular  coat  of  the  bowel, 
senile  changes). 

(See  also  Hernia;  Dilatation  of  the  Stom- 
ach, Acute;  and  Enterospasm.  Volvulus  of 
the  omentum,  appendicitis,  and  diverti- 
culitis may  produce  the  same  symptoms  as 
those  of  acute  intestinal  obstruction.) 

Tre.\tment  of  Acute  Obstruction. — 
Withhold  all  food,  and  for  thirst  allow  the 
patient  to  suck  but  not  swallow  ice,  and  give 
normal  saline  solution  (5i  ad  Oi)  per  rectum 


or  subcutaneously.  To  lessen  peristalsis, 
relax  spasm,  and  relieve  pain,  the  hypo- 
dermic administration  of  morphine,  gr.  34, 
with  atropine,  gr.  34  o>  is  indicated,  togetW 
with  hot  poultices  to  the  abdomen  (for  tym- 
panites, mustard  poultices,  or  hot  turpen- 
tine stupes,  see  Part  11  for  all  drugs).  In 
non-operable  paralytic  ileus,  however,  is 
indicated  the  hypodermic  administration  of 
eserin  or  physostigmin  sulphate  or  salicylate, 
gi’-  H20  to  /h4)  t.i.d.;  or  better,  pituitrin,  1 
c.c.  every  hour,  for,  say,  from  three  to  six 
doses;  together  with  copious  cool  saline 
colonic  douches,  with  or  without  the  addi- 
tion of  turpentine,  or  asafoetida. 

Gastric  lavage  should  be  practiced  every 
two  or  three  hours  in  all  cases  (Kussmaul 
and  others).  It  is  said  to  have  accom- 
plished cures. 

In  fecal  unpaction,  use  the  finger  or  the 
handle  of  a spoon  to  break  up  the  fecal 
masses,  employing  a proctoscope,  if  neces- 
sary, and  then  inject  oil  and  warm  saline 
enemata,  or  the  following:  castor  oil,  5h 
glycerine,  oh,  soapsuds,  Oi,  which  should 
be  injected  into  the  colon  everj^  two  hours, 
and  retained  as  long  as  possible.  (Gant.) 

Copious  colonic  injections  of  warm  fluid 
are  advised  by  some  in  all  cases  of  acute 
obstruction,  and  condemned  by  others. 

For  collapse,  administer  cardiac  stimu- 
lants and  suiTound  the  patient  with  hot 
water  bottles  (see  Shock). 

Most  cases  of  intestinal  obstruction  re- 
quire surgical  intervention,  and  the  lat- 
ter should  not  be  delayed  beyond  twelve  to 
twenty-four  to  forty-eight  hours,  when  medi- 
cal measures  do  not  relieve. 

In  very  grave  cases,  make  a subumbilical 
incision  in  the  median  line  under  local 
novocaine  anaesthesia  (see  Part  11),  employ- 
ing little  or  no  general  anaesthesia,  draw  the 
distended  coil  of  intestine  forward,  incise 
the  outer  coats  with  a scalpel,  insert  a large 
trocar  and  cannula  attached  to  a long  rub- 
ber tube  to  keep  the  faeces  away  from  the 
wound,  and  suture  the  gut  to  the  wound. 
Wash  out  the  stomach. 

If  the  case  is  not  so  urgent,  search  for  the 
obstruction,  passing  the  hand  first  to  the 
caecum.  If  this  is  empty,  the  obstruction 
is  above  it.  If  necessary,  during  the  search, 
allow  the  intestines  to  escape  through  the 
incision  and  protect  them  with  hot,  moist 
cloths.  Even  though  the  obstruction  be 
found  and  corrected,  it  is  wise  to  perform 
enterostomy  above  the  site  of  the  obstruction. 

Reduce  an  intussusception,  not  by  pulling 
upon  the  gut,  but  by  upward  compression 
of  the  enveloping  bowel.  After  the  reduc- 


INTEAVEXOUS  MEDICATIOX 


tion,  correct  any  possible  causal  factor; 
excise  a polypus,  tuinor,  ulcer,  or  diverticu- 
lum; shorten  a long  mesentery  by  plication; 
fix  a long  colon  or  ctecum  to  the  parietal 
peritoneum;  correct  a phimosis.  The  j^res- 
ence  of  gangrene  demands  resection. 

If  a volvulus,  when  untwisted,  immedi- 
ately recurs,  fix  the  bowel  to  the  abdominal 
wall,  or  shorten  the  mesentery,  or  excise 
the  gut. 

Cover  denuded  areas  with  peritoneum  to 
prevent  the  formation  of  adhesions. 

Excise  strictures  of  the  small  intestine, 
unless  the  proxhnal  segment  of  gut  is  much 
distended,  when  a lateral  anastomosis  should 
be  performed.  Later,  if  the  stricture  is 
malignant,  it  should  be  excised.  In  malig- 
nant stricture  of  the  large  intestine,  in 
which  the  obstruction  is  acute,  and  the 
proximal  bowel  therefore  weak,  always  per- 
form first  a colostomy;  then,  after  three  or 
four  weeks,  the  diseased  gut  may  be  excised. 

II.  Chronic  Obstruction. — Chronic  intestinal 
obstruction  is  characterized  by  pain  of 
insidious  onset,  occasional  paroxysms  of 
colic  associated  with  visible  peristaltic 
movements  or  “ stiffening  ” of  the  intestine, 
incomplete  constipation,  sometunes  diar- 
rhoea, perhaps  some  flatulent  chstention.. 
Aids  to  cUagnosis  include  the  bismuth  or 
barium  X-ray  examination  (see  under 
Dyspepsia),  a sigmoidoscopic  examination 
(see  under  Enteritis,  Chronic),  and  palpation 
under  anaesthesia. 

A chronic  obstruction  may,  of  course, 
become  acute. 

Causes  of  Chronic  Obstruction. — 
Fecal  impaction;  intussusception;  compres- 
sion of  the  bowel  by  tumors,  or  displaced 
organs,  particularly  the  uterus;  chverticu- 
litis;  strictures,  cicatricial  or  cancerous; 
etc.  (see  also  Constipation,  for  additional 
causes). 

Treatment  of  Chronic  Obstruction. — 
Prescribe  a tumbler  of  water  one  hour 
before  meals,  and  a soft  and  liquid  diet 
which  leaves  little  residue,  e.g.,  buttermilk, 
milk,  gruels,  custards,  eggs,  tender  meats, 
vegetable  purees,  baked  or  stewed  fruit,  an 
orange  for  breakfast,  etc.  Four  or  five 
small  meals  a day  may  be  given.  Employ 
enemata  when  required.  For  pain  employ 
opium  and  belladonna.  Operate  if  feasible 
(see  Constipation,  for  further  information). 
Chronic  cliverticulitis  resembles  and  is 
treated  like  operable  carcinoma. 

Intestinal  Paralysis. — See  Intestinal  Ob- 
struction. 

Spasm. — See  Enterospasm. 


Intestinal  Stasis. — Gr.  araats  halt.  See 
Constipation,  and  Intestinal  Obstruc- 
tion, Chronic. 

Toxaemia. — See  Intestinal  Intoxication. 

Ulceration. — See  Enteritis,  Chronic. 

Worms. — See  Worms. 

Intracranial  Hemorrhage  in  the  New= 
Born. — See  Hemorrhage,  Intracranial. 

Intravenous  Medication. — The  apparatus 
required  includes  a rubber-tube  tourniquet, 
pressure  forceps  to  hold  the  tourniquet  in 
place,  a round  cambric  needle,  a Schreiber 
sliarp-pointcd  needle  or  an  ordinaiy  steel 
aspirating  needle,  with  rubber  tubing  and 
clamp  and  glass  funnel  for  administering 
infusions,  or  a 2 c.c.  all-glass  syringe  with 
steel  needle  (not  too  sharply  bevelled)  for 
intravenous  injections  (keep  needles  oiled 
when  not  in  use),  cocaine  solution,  0.1  per 
cent.,  hypodermic  syringe,  alcohol,  ether,  or 
tincture  of  iodine  for  disinfecting  the  skin, 
glass  beaker  or  cup  for  dissolving  the  drug, 
distilled  or  filtered  boiled  water  as  a solvent. 

For  intravenous  infusion  the  rubber  tub- 
ing is  attached  to  the  glass  funnel,  filled 
with  sterile  normal  saline  solution  (0.8  per 
cent.),  and  clamped.  The  median  basilic 
or  cephalic  vein  at  the  bend  of  the  elbow 
is  usually  selected.  After  applying  the 
stretched  tourniquet  to  the  upper  arm  to 
distend  the  veins  (to  increase  the  distention 
have  the  patient  open  and  close  the  fist 
several  times),  and  swabbing  the  skin  with 
tincture  of  iodine,  one  may  transfix  the  vein 
with  a round  cambric  needle,  under  cocaine 
anaesthesia  (see  Part  11),  if  necessary,  and 
lifting  the  vein  up,  insert  the  Schreiber  or 
other  needle  into  its  lumen,  just  below  the 
cambric  needle.  The  aid  of  the  cambric 
needle,  however,  may  usually  be  dispensed 
with,  and  the  vein  steadied  with  the  left 
thumb  applied  below  the  point  of  insertion 
of  the  needle.  The  latter  should  be  held, 
bevel  up,  nearly  parallel  with  the  surface  of 
the  sldn.  T.  E.  Wiight  inserts  the  needle 
through  the  skin  alongside  the  vein,  “to  get 
a shoulder  or  skin  support  for  the  needle,” 
then  plunges  the  needle  into  the  vein. 

When  blood  flows  from  the  needle,  remove 
the  tourniquet,  and  after  allowing  the  saline 
solution  to  displace  all  bubbles  from  the 
rubber  tube,  connect  the  latter  with  the 
needle,  elevate  the  glass  fimnel,  and  pour 
in  the  medicinal  solution.  Remove  the 
needle  from  the  vein  before  the  glass  funnel 
is  empty;  or  a glass  tube  may  be  interposed 
in  the  course  of  the  rubber  tubing  so  that  it 
may  be  seen  when  to  remove  the  needle  so 
as  to  avoid  the  entrance  of  air  into  the  vein. 

Cease  the  infusion  if  pain  or  oedema  occurs 


JAUNDICE 


at  the  site  of  puncture,  which  indicates  that 
the  fluid  is  entering  the  tissues  instead  of 
the  vein.  In  such  an  event  resort  to  massage 
at  once  to  avert  irritation. 

For  intravenous  injection  a Schreiber  or 
other  suitable  all  glass  syringe  may  be  used. 
After  the  operation,  cleanse  syringe  and 
needle  with  cold  water,  dry  by  air,  and  inject 
the  needle,  if  of  steel,  with  liquid  vaseline. 

Intubation. — L.  in,  into,  + iuha,  tube. 
See  under  Diphtheria. 

Intussusception. — L.  intus,  within  + sus- 
cipcre,  to  receive.  See  Intestinal  Obstruction. 

lodism. — See  Part  11. 

Ionic  Medication. — See  under  Inflamma- 
tion. 

Irritable  Heart. — See  Arrhythmia,  Heart 
Strain,  Palpitation,  and  Neurasthenia.) 

Ischiorectal  Abscess. — Gr.  lo-xi'or  hip  -\- 
L.  rectum,  straight.  Characterized  by 
pyrexia  and  a tender  painful  swelling  beside 
the  anus.  See  Proctitis  for  the  causes. 

Treatment. — Make  a four  to  six  inch 
incision  parallel  with  the  median  line,  open 
up  all  pockets  with  the  finger,  irrigate  thor- 
oughly with  hot  normal  saline  (oi  ad  Oi) 
or  boric  acid  solution  (5ii  ad  Oi),  and  drain 
with  deep  rubber  tubes  and  light  gauze 
packing.  Change  the  dressings  once  or 
twice  a day  or  less  often,  as  required  to 
keep  the  parts  dry. 

Ischuria. — See  Anuria. 

Itching. — See  Part  5,  Skin  Diseases. 

Japanese  River  Fever. — An  acute  dis- 
ease, with  a mortality  of  15  to  70  per  cent., 
endemic  along  certain  rivers  in  the  west 
of  the  Japanese  island  of  Hondo,  and  char- 
acterized by  the  occurrence  of  chills,  head- 
ache and  prostration,  followed  on  the 
second  day  by  pain  and  tenderness  in  the 
lymphatic  glands,  and  nearby  small  spots 
of  skin  necrosis,  fever,  conjunctivitis,  and 
an  enlarged  spleen,  followed  on  the  sixth 
or  seventh  day  by  large  irregular,  dark-red 
papules,  beginning  on  the  face  and  spread- 
ing to  the  forearms,  legs,  and  trunk,  and 
lasting  from  four  to  seven  days. 

Treatment.— This  is  symptomatic.  As  a 
preventive  measure,  insect  bites  should  be 
guarded  against. 

Jaundice. — Slight  jaundice  is  best  detected 
by  inspection  of  the  conjunctiva',  by  the 
occurreTice  of  yellowish  froth  on  shaking  the 
urine,  and  by  the  following  tests  (excepting 
acholuric  jaundice  described  below): 

(a)  Rosenbacli’s  Modification  of  (imclin’s  Test. — 
Acidify  a large  quantity  of  urine  with 
hydrochloric  acid,  and  filter  several  times 
through  a thick  filter-jxiper.  The  latter  will 
hold  back  the  bile-stained  elements  of  the 


urine.  Dry  the  filter-paper  and  its  contents 
by  pressing  with  another  filter-paper.  Now 
drop  upon  it  a drop  of  yellow  nitric  acid. 
Rings  will  appear  in  the  presence  of  bile 
showing  a play  of  colors  from  green,  through 
blue,  violet  and  red  to  yellow.  Says  Web- 
ster: “It  is  sometimes  advisable  to  add  a 
little  milk  of  lime  to  the  urine  before  filtering, 
instead  of  the  hydrochloric  acid,  as  this  will 
throw  down  the  phosphates  which  will 
carry  with  them  the  biliary  pigment.” 

(b)  Smith’s  Test. — Superimpose  upon  the 
urine  (acidified  if  necessary  with  acetic  acid) 
in  a test-tube  a 1 per  cent,  alcoholic  solution 
of  iodine.  The  presence  of  bile  pigment  is 
revealed  by  the  appearance  of  an  emerald- 
green  color  at  the  zone  of  contact. 

The  presence  of  bile-pigment  in  the  blood 
tends  to  produce  the  following  changes, 
viz.,  delayed  coagulation  of  the  blood  (over 
four  and  a half  minutes;  see  under  Blood 
Examination),  and  proneness  to  hemorrhage, 
bradycardia,  sleepiness,  headache,  mental 
depression,  pruritis,  etc.  In  obstructive 
jaundice  the  stools  are  fatty  and  clay-colored. 

Causes  of  Jaundice. — A.  Obstructive  Jaun- 
dice.— Gall-stones  or  parasites  within  the 
common  or  hepatic  ducts;  pancreatic  stone 
in  the  diverticulum  of  Vater;  inflaimnatory 
tumefaction  of  the  ducts  (see  Jaundice, 
Catarrhal);  cicatricial  stenosis;  neoplastic 
stenosis  (cancer  of  liver,  gall-bladder,  bile- 
ducts,  glands,  pancreas);  compression  from 
without  by  tumors  of  the  liver,  gall-bladder, 
pancreas,  stomach,  intestine,  kidney,  omen- 
tum, mesentery,  retroperitoneiim,  or  pelvic 
organs;  compression  by  enlarged  glands  in 
the  fissures  of  the  liver  (leukaemia,  Hodg- 
kin’s disease,  etc.);  by  a stone  in  the  cystic 
duct,  causing  thickening;  by  adhesions; 
fecal  accumulations;  aneurj'sm  of  the  aorta, 
hepatic,  or  mesenteric  arteries;  by  the 
pregnant  uterus;  splanchnoptosis;  hepatic 
abscess,  gumma,  or  tubercle;  hepatic  dis- 
tomiasis;  hepatic  congestion;  suppurative 
cholangitis;  cirrhosis  of  the  liver,  especially 
the  hypertrophic  form  (obstructive  ?) ; 
pancreatitis  and  cirrhosis  of  the  pancreas; 
portal  thrombosis;  icterus  neonatorum  due 
to  congenital  obliteration  of  the  biliary  ducts 
or  congenital  syjihilic  hepatitis. 

B.  Toxemic  and  H.emolytic  Jaundice. 
— Infections  (septico-pya'inia,  syphilis,  ma- 
laria, yellow  fever,  relapsing  fever.  Rocky 
IMountain  siiotted  fever,  typhoid  fever, 
tyjihus  fever,  scarlet  fever,  diphtheria, 
pneumonia,  Weil’s  disease  or  infectious  or 
epidemic  jaundice  (q-i'-)',  acute  yellow  atro- 
jih}^  of  the  liver;  pernicious  amemia;  splenic 
amemia;  paroxysmal  hiemoglobinuria;  poi- 


JAUNDICE,  CATARRHAL 


sons  (ptomaines,  muslirooms,  snake  venom, 
phosphorus,  arsenic,  arseniurettcd  hydrogen, 
male  fern,  chloroform,  pyrogallol,  toluylen- 
diamin,  tetrachlorethane  in  airplane  workers, 
coal  tar  j^roducts,  etc.);  emotional  depres- 
sion (?);  icterus  neonatorum  (iDhysiological 
and  mild,  or  severe  and  due  to  sepsis  or 
thrombophlebitis  of  the  umbilical  veins,  or 
epidemic  htemoglobinuria  without  sepsis  of 
the  umbilical  vessels,  or  morbus  maculosus 
neonatorum — hemorrhagic  puqiura) ; and 
finally  acholuric  jaundice,  either  congenital 
and  familial  or  acquired,  non-fatal,  and 
characterized  by  chronic  or  intermittent 
jaundice,  absence  of  bile  in  the  urine,  spleno- 
megaly, anaemia,  debility,  and  increased  fra- 
gility of  the  red  blood-corpuscles  (see  under 
Blood  Examination  for  test;  the  treatment 
is  splenectomy, which  is  apparently  curative) . 

In  obstructive  jaundice  the  fragility  of  the 
erythrocytes  is  diminished,  while  in  haemo- 
lytic jaundice  it  is  increased. 

Jaundice,  Catarrhal. — Catarrhal  jaundice 
is  the  result  of  inflaimnatory  tumefaction 
of  the  duodenal  portion  of  the  common  duct 
due  to  gastro-duodenal  catarrh.  The  latter 
may  be  caused  by  dietary  indiscretions, 
alcohol,  emotional  disturbances,  exposure  to 
cold,  malaria,  infectious  fevers,  or  passive 
congestion  due  to  portal  obstruction,  heart 
or  kidney  disease. 

The  symptoms  are  jaundice,  usually  with- 
out pain,  clay-colored  stools  (indicative  of 
biliary  obstruction),  and  dyspepsia  or  bilious- 
ness, occurring  usually  in  the  young.  Re- 
covery occurs  in  from  two  to  eight  weeks  or 
longer,  but  recurrences  may  follow. 

Treatment. — First  open  the  bowels  by 
means  of  calomel,  gr.  ii-v,  in  one  dose,  or 
gr.  ss  every  hour  for  six  doses  (children 
according  to  age;  see  Part  11)  followed  by  a 
saline;  and  continue  the  saline  as  required 
to  produce  one  or  two  stools  a day,  until 
the  jaundice  begins  to  abate,  as  shown  by 
the  stools.  Sodium  phosphate  or  sulphate, 
for  instance,  one  tablespoonful,  more  or 
less,  may  be  given,  dissolved  in  hot  water, 
one  hour  before  breakfast;  or  a teaspoonful 
may  be  given  on  an  empty  stomach  two  to 
four  times  a day.  Strong  purgatives,  how- 
ever, should  be  avoided.  One  hour  before 
each  meal  the  patient  should  drink  a glass 
of  Vichy  or  of  warm  water  containing  ten 
grains  of  sodium  bicarbonate. 

The  diet  should  be  restricted,  and  fats 
and  saccharine  foods  excluded.  For  the 
first  few  days  allow  only  warm  skimmed 
milk  diluted  with  an  equal  amount  of  lime 
water;  Vichy,  or  Apollinaris,  or  plain  water 


with  the  addition  of  ten  grains  of  sodium 
bicarbonate  to  each  glassful  of  milk  and 
water,  also  thin  arrowroot  gruel,  barley 
water  and  egg  albumen  flavorecl  witli  lemon, 
broths,  gelatine  preparations,  and  dilutecl 
buttermilk.  Later  there  may  be  added  con- 
somme thickened  with  a cereal,  milk  toast, 
dry  toast,  z\vieback,  and  later,  well-cooked 
gruels,  eggs  boiled  three  minutes,  green  vege- 
tables, non-fatty  fish,  chicken,  chops,  fruit, 
etc.  Only  plain  bland  food  should  be  allowed, 
even  after  recovery. 

Yeo  advises  the  application  of  hot  linseed 
or  mustard  (Part  11)  poultices  over  the  liver 
and  epigastrium.  If  desired,  one  may 
inject  into  the  colon  daily  one  or  two  quarts 
of  cool  water,  with  the  object  of  stimulating 
peristalsis  and  thus  favoring  drainage  from 
the  common  duct. 

For  persi.stent  vomiting  employ  gastric 
lavage  with  a hot  solution  of  sodium  bicar- 
bonate, one  tablespoonful  to  the  quart  (see 
under  Dyspepsia  for  technique),  or  the 
drinking  of  hot  soda  water  in  large  amounts, 
and  apply  heat  to  the  epigastrium  (see 
also  Vomiting). 

For  excessive  flatulence,  see  Tympanites. 

For  troublesome  pruritus  are  recom- 
mended the  following: 

Carbolic  acid,  oss-ii  to  the  pint  of  water, 
as  a wash. 

Menthol  in  alcohol,  gr.  v-xv  ad  Si- 

Menthol  and  talcum  powder,  gr.  xxv  ad 

5i. 

Camphor  and  talcum  powder,  5i  ad  Si- 

Menthol,  gr.  XXX ; camphor,  gr.  xxx,  olive 
oil,  3iss;  lanolin,  Siss. 

Bromocoll  ointment,  20  per  cent. 

Ansesthesin,  Siiss;  lanolin  and  vaseline, 
aaSiss.  The  two  latter  are  the  best,  says 
Ortner. 

Alcohol  rubs:  lukewarm  alkaline  bafhs; 
or  cold  sponging. 

Bromide,  chloral,  paraldehyde,  etc.,  per 
rectum,  in  severe  cases  (see  Part  11  for  drugs). 

Thyroid  extract,  gr.  v,  2 to  3 times  daily 
(diminishes  the  production  of  bile  salts;  the 
best,  says  W.  Langdon  Brown). 

Croftan  says:  “ Only  two  drugs  can  be 
definitely  credited  with  the  power  to  stimu- 
late an  increased  flow  of  bile,  viz.,  prepara- 
tions of  salicylic  acid  and  of  bile  acids.” 
Salicylic  acid  dilutes  the  bile  and  is  a biliary 
antiseptic.  These  drugs  may  be  given,  he 
says,  “ in  small  doses  only.” 

II  iSodii  salicylatis ....  oidi  (gr.  viiss-xv  per  dose) 
Aquae 5 iv 

M.  Sig. — One  tablespoonfiil  in  water,  by  mouth 
or  rectum,  several  times  daily.  (Ortner). 


KALA-AZAR,  INDIAN 


Sodii  glycocholatis  vel  fellis 

bovis  purificati (gr.  v per  dose) 

Pulveris  rhei  compositae,  aa  pi  (gr.  v per  dose) 

M.  et  fiant  capsulae  No.  12. 

Sig. — One  or  two  capsules,  t.i.d.  (Ortner.) 

Forchheimer  gave  purified  ox-gall,  gr.  v> 
after  meals,  in  chronic  cases,  for  the  purpose 
of  aiding  in  the  absorption  of  fats,  increas- 
ing peristalsis,  and  acting  as  an  antiseptic. 

As  the  jaundice  begins  to  subside,  one 
may  prescribe  the  following: 


Acidi  nitrohydrochlorici  diluti ngx-xx 

Tincturae  nucis  vomicaj i^x-xv 

Infusi  calumbae,  q.s.,  ad 5i 


M.  Sig. — One  ounce  in  water,  one  hour  before 
meals. 

If  the  jaunchce  persists  in  spite  of 
medical  treatment,  open  the  abdomen, 
explore  for  gall-stones,  stricture,  etc.,  ancl 
drain  the  biliary  ducts  by  means  of  a 
cholecystostomy. 

Jaundice,  Infectious. — (Epidemic  Jaun- 
dice; Weil’s  Disease).  One  type  of  epidemic 
jaundice  is  due  to  a spirochjeta  transmitted 
probably  by  the  rat  (spirochetosis  ictero- 
haemorrhagica),  and  a second  type  is  caused 
by  a bacillus  related  to  the  paratyphoid 
group,  occurring  in  decomposed  meat  or 
cheese,  etc.  The  disease  usually  begins 
suddenly  with  headache,  backache,  muscular 
pains,  hypersemia  conjunctivse  (in  spiro- 
chetal cases),  nausea  and  vomiting,  chills 
and  fever;  and  jaundice  usually  appears  on 
about  the  second  or  fourth  day.  Colic  and 
diarrhoea  may  occur,  but  rarely.  The  liver 
is  often  enlarged  and  tender,  and  the  spleen 
is  also  somewhat  enlarged  in  bacillary  oases. 
There  is  a tendency  to  hemorrhages,  albu- 
minuria, and  nephritis  in  spirochetal  cases. 
In  spirochetosis  the  temperatm-e  drops  on 
the  appearance  of  jaundice,  but  five  or  six 
days  later  a second  rise  occurs  lasting  sLx 
or  seven  days,  and  a long  convalescence 
follows.  Bacillary  cases  are  milder,  jaundice 
is  not  marked  and  the  urine  is  apt  to  be 
normal. 

The  diagnosis  of  spirochetosis  is  estab- 
lished by  the  intraperitoneal  inoculation,  in 
a guinea  pig,  of  3 to  5 c.c.  of  the  patient’s 
blood  obtained  on  or  before  the  appearance 
of  jaundice;  the  blood  is  rarely  infective 
after  the  seventh  day.  If  the  test  is  positive, 
the  guinea  pig,  after  an  incubation  period 
of  six  to  twelve  days,  develops  jaundice  and 
dies.  The  sediment  of  the  centrifuged  urine 
contains  spirochreta)  after  the  tenth  day. 

Treatment.— This  is  sjunptomatic.  Put  the 
patient  to  bed  on  liqviid  diet.  Calomel  in 
small  doses  (see  Part  11)  followed  by  a saline 


may  be  advisable,  but  drastic  purgation 
should  be  avoided.  For  the  toxaemia  pre- 
scribe copious  water  drinking,  normal  saline 
(5i  ad  Oi)  enemata,  and  hypodermoclysis. 
Employ  hydrotherapy  for  high  fever  (see 
Fever).  After  the  fever  has  subsided,  return 
gradually  to  full  diet.  The  treatment  is,  in 
general,  that  of  catarrhal  jaundice  {q.v.). 

Jaundice,  Splenomegalic. — See  under 
Jaundice. 

Joint  Affections. — See  Arthritis,  in  Part 
10,  Orthopaedics. 

Kakke. — See  Beri-beri. 

Kala=Azar,  Indian  (Native  “ Black 
Fever”);  Tropical  Febrile  Splenomegaly; 
Dum-Dum  Fever. — A common  tropical  and 
subtropical  infectious  disease  of  Asia,  caused 
by  the  Leislnnan-Donovan  protozoon,  and 
characterized  by  a chronic,  irregularly 
remittent  fever,  anaemia  of  the  secondary 
type  (see  Blood  Examination),  leucopenia, 
dark  skin,  enlargement  of  the  liver,  marked 
splenomegaly,  and  emaciation,  terminating 
after  several  months  or  years  in  death, 
rarely  in  gradual  recovery.  The  Leishman- 
Donovan  body  is  a small  oval,  round,  or 
oat-shaped  body,  2)^^  to  3 microns  in  diam- 
eter, containing  a nucleus  and  a bacillus- 
shaped nucleolus.  It  may  be  found  in  the 
peripheral  blood,  the  fluid  from  an  artificial 
blister,  a lymphatic  (post-cervical)  gland,  or 
the  granulation  tissue  taken  from  an  ulcer. 
It  is  usually  intracellular.  WTien  cultivated 
in  the  bedbug  or  in  citrated  blood,  best  at  a 
temperature  of  68°  to  70°  F.,  it  enlarges, 
becomes  pyriform  and  acquires  a flagellum. 
It  multiplies  by  longitudinal  fissure.  It  is 
probably  transmitted  by  some  bug,  possibly 
the  bedbug,  pediculus,  etc.  The  incubation 
period  is  about  ten  days. 

Treatment.— Quarantine  the  patient  and 
infected  localities,  and  sterilize  the  latter 
by  means  of  sulphur  fiunigations,  boiling  of 
the  clothing,  etc.  (see  Disinfection),  or  by 
burning  the  houses.  Exclude  dogs. 

Sustain  the  patient’s  strength  by  means 
of  a concentrated  diet,  fresh  air,  etc.,  and 
keep  the  bowels  regular. 

One  may  try  the  intramuscular  injection 
of  quinine  bihydrochloride,  gr.  x\q  dissolved 
in  water.  Large  doses  are  usually  given  by 
mouth,  gradually  increasing  to  even  5i-iss 
daily,  this  dose  being  continued  for  w'eeks  or 
months,  or  until  the  fever  has  been  reduced 
to  the  low  continued  or  intermittent  type, 
when  the  dose  is  decreased  to  about  20  grs. 
a day.  But  Manson  does  not  sanction  these 
tremendous  doses  of  quinine.  Atoxyl,  gr.  iii 
every  three  days  for  a year  is  recommended; 
also  salvarsan.  Intravenous  injections  {q.v.), 


LEAD  POISONING;  PLUMBISM;  SATURNISM 


at  four-day  intervals,  of  a 2 per  cent,  solution 
of  antimony  tartrate,  beginning  with  4 c.c. 
and  increasing  the  dose  by,  say,  2 c.c.,  until, 
say,  10  c.c.  is  reached,  may  result  in  cure. 

Kala  Azar,  Infantile. — See  Ponos. 

Katayama  Disease. — See  Distomiasis. 

Kidney  Abscess. — See  Pyelonephritis. 

Kidney,  Angioneurosis  of  the. — See  under 
Haematuria. 

Calculus. — See  Nephrolithiasis. 

Cancer. — See  Tumors  of  the  Kidney, 
in  Part  3,;Genito-Urinary  Diseases. 

Cysts. — See  Part  3,  Genito-Urinary 
Diseases,  Tmnors  of  the  Kidney. 

Floating. — See  Splanchnoptosis. 

Hemorrhage. — See  Haematuria. 

Hypernephroma. — Gr.  v-n-kp  over  -j- 
vec^ypos  kidney  -f-  -oypa  tumor.  See 
Tumors  of  the  Kidney,  in  Part  3 
Genito-Urinary  Diseases. 

Inflammation. — See  Bright’s  Disease, 
and  Pyelonephritis. 

Injuries. — See  in  Part  3,  Genito-Urinary 
Diseases. 

Movable. — See  Splanchnoptosis. 

Neuralgia  of  the. — See  under  Haema- 
turia. 

Polycystic. — Gr.  ttoXos  many  -f-  Kvans 
cyst.  See  Tumors  of  the  Kidney. 

Sarcoma. — Gr.  <rap^  flesh  -upa  tumor. 

See  Tumors  of  the  Kidney,  in  Part 
3,  Genito-Urinary  Diseases. 

Stone. — See  Nephrolithiasis. 

Tuberculosis. — See  Pyelonephritis. 

Tumors. — See  Tumors  of  the  Kidney, 
in  Part  3,  Genito-Urinary  Diseases. 

Korsakow’s  Psychosis. — See  Alcoholism, 
and  Neuritis,  Multiple. 

Kubisagari. — A non-fatal  endemic  dis- 
ease of  parts  of  Japan,  Switzerland,  and 
France,  occurring  only  during  the  warm 
season,  and  characterized  by  attacks  of 
vertigo,  diplopia,  dimness  of  vision,  paresis 
of  numerous  muscles,  and  depression,  lasting 
from  a few  minutes  to  several  hours,  and 
sometimes  occurring  several  times  a day. 

Treatment.— Rest  in  bed  on  full  diet  is 
advised.  Nakano  prescribes  a saline,  fol- 
lowed by  quinine,  gr.  viiss,  powdered  opium, 
gr.  ss,  and  a hypodermic  of  camphor,  gr.  ii,  in 
olive  oil,  i^ixv.  Gerlier  prescribes  potassium 
iodide  in  small  doses;  Miura, potassium  iodide 
and  arsenic.  See  Part  11  for  drugs. 

In  the  intervals  between  attacks,  employ 
general  faradization  and  massage. 

Lachrymal  Glands. — L.  la'crima,  tear. 
See  Part  6,  Eye  Diseases. 

La  Grippe. — See  Influenza. 

Landry’s  Acute  Ascending  Paralysis. — 
A rare,  usually  rapidly  fatal  disease,  no 


doubt  of  bacterial  origin,  characterized  by 
a rapidly  ascending  flaccid  paralysis,  begin- 
ning in  the  legs,  and  spreading  upward  to  the 
trunk,  arms,  neck,  and  respiratory  muscles, 
not  associated  with  anaesthesia,  muscular 
atrophy,  electrical  changes  (at  least  for 
several  weeks),  or  sphincter  disturbances. 
Death  is  due  to  respiratory  paralysis  or 
bronchitis  and  pneumonia.  If  recovery 
occiu’s,  it  is  usually  complete.  Microscopic 
cord  changes  can  be  detected  only  by  special 
staining  methods. 

Diagnosis.— In  acute  ascending  myelitis 
there  are  sensory  paralysis,  sphincter  dis- 
turbances, and  fever.  In  acute  toxic  poly- 
neuritis, atrophy  and  electrical  changes 
appear  early,  and  sensory  paralysis  is  pres- 
ent. In  acute  poliomyelitis,  the  constitu- 
tional symptoms,  fever,  etc.,  are  marked, 
and  the  disease  is  epidemic. 

Treatment.— Purge  the  patient  with  castor 
oil,  or  calomel  (Part  11).  Keep  the  head 
slightly  raised,  and  change  the  posture  of  the 
patient  frequently  for  comfort.  Observe 
strict  cleanliness  as  directed  under  Bed-Sore. 
Employ  daily  passive  movements  of  the 
joints  to  prevent  adhesions.  Resort  to 
massage  and  electricity  only  after  the  acute 
stage  has  passed. — See  Poliomyelitis,  Acute. 

Laryngeal  Obstruction. — See  Part  9. 

Laryngismus  Stridulus. — See  Part  9, 
Throat  Diseases. 

Laryngitis. — See  Part  9,  Throat  Diseases. 

Spasmodic. — See  Part  9. 

Lateral  Sclerosis  Amyotrophic. — See 
Atrophies,  the  Progressive  Muscular. 

Lathyrism. — Poisoning  by  the  chick-pea 
{Lath'yrus  cicera),  or  by  lupines  (lupinosis). 
See  Combined  System  Diseases.  It  is 
said,  however,  that  lathyrism  occurs  only 
when  vetch  is  eaten  in  excess  and  not  as  a 
part  of  a mixed  dietary. 

Lead  Poisoning;  Plumbism;  Saturnism. — 
L.  plum'bum,  lead;  L.  satur'nus,  lead.  I.  Acute 
Poisoning. — See  under  Poisoning. 

II.  Chronic  Poisoning.— At  first,  for  several 
weeks  or  longer,  there  are  usually  ill- 
defined  gastro-intestinal  disturbances,  anor- 
sexia,  constipation  (spastic),  headache,  per- 
haps general  pains,  depression,  restlessness, 
insomnia,  and  weakness.  After  a variable 
period,  colic,  anaemia,  and  tremor  appear, 
sometimes  paralysis  (acute  neuritis,  with 
wrist-drop,  etc.) ; the  skin  assumes  an  earthy 
pallor,  and  the  patient  becomes  emaciated. 
Convulsions,  delirium,  mania,  melancholia, 
coma,  or  other  encephalopathies  may  super- 
vene. Sometimes  symptoms  resembling 
those  of  acute  poliomyelitis  or  locomotor 
ataxia  occur.  The  blood-pressure  is  raised. 


LETHARGIC  ENCEPHALITIS 


The  anEemia  is  of  the  secondary  type  (see 
under  Blood  Examination).  It  is  character- 
ized particularly  by  basophilic  (.legenerations 
of  the  red  cells  and  polychroniatophilia. 

The  gray  or  black  (so-called  blue)  line 
(lead  sulj)hide)  situated  about  one  milli- 
metre from  the  free  margin  of  the  gum,  and 
appearing  as  a dotted  line  under  a hand 
lens,  is  almost  pathognomonic.  It  may, 
however,  persist  for  years  after  all  symp- 
toms of  plumbism  have  disappeared.  A 
similar  line  occurs  in  bismuth  poisoning. 

Examine  the  urine  for  lead,  although  a 
negative  result  means  nothing.  Heat  500  c.c. 
of  urine  with  50  c.c.  of  hydrochloric  acid 
and  2 or  3 grams  of  potassium  chlorate; 
drive  off  the  chlorine  and  concentrate  the 
solution  by  evaporation;  then  pass  hydrogen 
sulphide  gas  through  the  solution  from  a 
generator  in  order  to  precipitate  black 
lead  sulphide. 

Prognosis.- — This  is  good,  except  in 
severe  protracteil  paralysis,  and  in  cerebral 
complications.  Chronic  interstitial  nephri- 
tis and  arteriosclerosis  are  common  sequelae. 

Treatment. — Purge  the  patient  freely 
by  the  administration,  each  morning,  one 
hour  before  breakfast,  of  sodium  or  mag- 
nesium sulphate,  or  Rochelle  salt  (Part  11), 
aided,  if  necessary,  by  large  saline  or  oil 
enemata.  The  sulphate  salts  form  with  lead 
the  insoluble  lead  sulphate.  At  the  same 
time  administer  atropine,  gr.  Hoo>  t-i-d.,  or 
tr.  belladonnae,  iipv,  t.i.d.,  as  an  antkspas- 
modic.  To  promote  further  the  elimination 
of  the  poison,  enjoin  copious  water  drinking, 
preferably  the  diuretic  cream  of  Tartar 
lemonade  (q.v.)]  and  also  hot  sulphur  baths 
(sod.  sulphide,  2 oz.,  sod.  chloride,  2 oz.,  and 
sod.  bicarb.,  1 oz.,  to  50  to  60  gallons  of  hot 
water).  For  colic  employ  hot  abdominal 
applications,  and  atropine;  avoid  morjihine, 
if  possible,  since  it  interferes  with  the  elimi- 
nation of  the  lead. 

After  the  patient  has  been  freely  purged, 
prescribe  potassium  iodide,  gr.  iii-v,  well 
diluted,  t.i.d. p.c.,  as  an  eliniinant.  Give  no 
more  than  five  grains,  for  fear  of  suddenly 
washing  a large  amount  of  lead  into  the  cir- 
culation. For  this  reason  the  iodide  is  not 
advised  in  cases  with  acute  symjitoms. 

In  acute  cerebral  ca.ses,  venesection  and 
hypodermoidysis  may  be  useful.  For  delir- 
ium and  convulsions,  give  bromides  in  large 
doses,  together  with  chloral  (Part  11). 

Fresh  air  day  and  night  and  a generous 
diet  are  important  adjuvants.  Prescribe 
iron  for  aiunmia  (q.v.),  and  bitter  tonics 
for  anorexia  (q.v.). 

Treat  paralysis  only  after  the  acute  sjanj)- 


toms  have  subsided.  Then  employ  mas- 
sage, the  constant  current,  graduated  passive 
and  eventually  active  exercises,  and  strych- 
nine in  ascending  doses  until  muscular 
twitching  occurs  (.see  Part  II). 

Prophylaxis. — Effective  preventive 

measures  are  as  follows:  absolute  cleanli- 
ness of  the  skin;  the  wearing  of  gloves;  the 
prevention  of  dust'  inhalation  by  means  of 
respirators,  hoods,  and  exhaust  fan,  the  wet 
grinding  of  lead  colors,  and  the  proper  frit- 
ting of  pottery  glaze,  etc.;  the  free  use  of 
olive  oil  and  protein  food,  e.g.,  milk,  before 
beginning  work  or  at  mid-day  (the  protein 
forms  with  lead  an  insoluble  albuminate 
and  also  saturates  the  gastric  hydrochloric 
acid,  thus  preventing  the  formation  of 
lead  chloride);  the  abolition  of  lead  water- 
pipes,  or  the  introduction  into  the  reservoir, 
when  the  pipes  are  first  put  in,  of  silica  or 
calcium  carbonate,  two  grains  to  the  gallon, 
to  form  a coating  on  the  lead,  or  allowing 
the  water  to  run  some  time  before  using. 
Alcohol  should  also  be  avoided. 

Leg  Pain. — See  Pain. 

Leishmaniasis. — Constitutional,  see  Kala 
Azar;  Cutaneous,  see  Oriental  Sore. 

Lenticular  Degeneration,  Progressive. — 
See  Chorea,  Tetanoid. 

Leontiasis  Ossea. — Gr.  \ecov  lion;  L.  os, 
bone.  A very  rare,  diffuse,  or  nodular  hyper- 
ostosis of  the  bones  of  the  cranium  and  face, 
beginning  usually  in  childhood,  and  termi- 
nating, after  about  twenty  or  thirty  years, 
in  death  from  brain  and  nerve  compression. 
As  the  bones  increa.se  in  size,  the  foramina 
and  cranial  cavity  become  narrowed,  with 
resulting  compression  symptoms,  viz.,  head- 
ache, neuralgia,  facial  paralysis,  deafness, 
blindness,  exophthalmos,  mental  apathy, 
mental  disturbance,  paralysis  of  the  extrem- 
ities, con\Tilsions,  paralysis  of  the  muscles 
of  chewing,  swallowing  and  breathing,  and 
finally  death. 

The  disease  derives  its  name  from  the 
leonine  aspect  imparted  to  the  face. 

Treatment. — If  antiluetic  treatment  fails 
(see  Syphilis),  chisel  away  the  tumor  masses 
that  are  causing  sjmptoms.  No  recurrence 
follows  this  removal. 

Leprosy. — L.  lep'rn.  See  Part  5,  on  Skin 
Diseases. 

Lethargic  Encephalitis. — See  Encephalitis 
Acuto. 

Leucocytosis. — Gr.  XecKos  white  kvtos  cell. 
A leiicoc^ffosis  i.s  chiefly  a pohnnorphonuclear 
noutroi)hilio.sis.  The  normal  average  num- 
ber of  polynuclear  neiitrophiles  per  cmm.  of 
blood  is  5000  to  7000.  The  normal  ratio 
to  other  white  cells  is  65  to  75  per  cent. 


LEUKAEMIA 


Causes. — Digestion  (10,000  to  15,000  cells, 
beginning  about  one  hour  after  eating,  and 
reaching  a inaxiinuni  in  three  to  five  hours) ; 
sonietinies  pregnancy  (al)out  15,000  cells  per 
cinin.) ; new-born  (15,000  to  20,000  -f-  ),  mas- 
sage; brief  cold  bath;  prolonged  hot  bath; 
muscular  exertion,  including  parturition; 
cyanosis;  Bier’s  passive  hypertemia;  shock, 
physical  or  mental;  hemorrhage;  inflamma- 
tion or  infection  (10,000  to  50,000  cells), 
excepting  uncomplicated  measles,  German 
measles,  mumps,  influenza,  malaria,  typhoid 
fever,  typhus  fever,  tuberculosis,  and  small- 
pox prior  to  the  pustular  stage;  various 
toxaemias,  e.g.,  uraemia,  hepatic  toxaemia, 
diabetic  coma,  rickets,  and  carbon  mon- 
oxide poisoning;  injection  of  various  toxins, 
e.g.,  tuberculin,  vaccines,  peptone,  pus, 
organ  extracts,  etc.;  certain  drugs,  e.g., 
tonics,  etherial  oils,  myrrh,  turpentine, 
camphor,  peppermint,  quinine,  chloroform, 
ether,  tissue  extracts  containing  nucleins  and 
nucleinic  acid;  apoplexy;  cachexia;  impend- 
ing death.  A leucocyte  count  of  over  7000 
is  sometimes  normal  to  the  individual. 

For  the  causes  of  an  increase  in  the  other 
white  blood-cells,  see  Eosinophilia,  Lympho- 
cytosis, and  Mast  Cell  Leucocytosis. 

Leucocytosis,  Mast  Cell. — See  Mast  Cell 
Leucocytosis. 

Leucopenia. — Gr.  XevKos  white  -{-  wevrjs 
poor.  A reduction  in  the  leucocyte  count 
below  5000  cells  per  cmm. 

Causes.— Typhoid  fever,  when  limited  to 
the  intestinal  canal;  tuberculous  lympha- 
denitis ; starvation  and  malnutrition ; chronic 
poisoning  with  morphine,  cocaine,  alcohol, 
and  the  heavy  metals;  measles,  following  the 
eruption;  uncomplicated  influenza;  perni- 
cious anaemia;  splenic  anaemia. 

Leukaemia.— Gr.  XevKos  white  -f-  alfia 
blood.  A rare,  fatal  disease  of  unknown 
etiology,  affecting  the  leucoblastic  portion 
of  the  haematopoietic  system  (bone  marrow, 
spleen  and  lymph  glands),  and  characterized 
by  hyperplasia  of  the  leucoblastic  tissues, 
and  the  accumulation  of  leucoc3rtes  in  the 
blood.  If  the  marrow  and  spleen  are  pre- 
dominantly affected,  the  long  bones  and 
sternum  show  tenderness  on  pressure,  the 
spleen  is  considerably  enlarged,  and  numer- 
ous myelocytes  are  found  in  the  blood  (splen- 
omyelogenous  or  myeloid  leukaemia  or 
myelaemia).  If  the  lymph  glands  are 
chiefly  affected,  they  become  enlarged,  and 
numerous  lymphocjdes  appear  in  the  blood 
(lymphoid  or  lymphatic  leukaemia).  See 
Blood  Examination;  Figs.  41  and  42. 

Myeloid  leukaemia  (the  commoner  and 
milder  form),  may  be  acute  or  chronic, 


rarely  the  former.  There  occur  progressive 
enlargement  of  the  spleen,  gastro-intestinal 
disturbances  (nausea,  vomiting,  diarrhcea), 
j)yrexia,  gradual  loss  of  weight  and  strength. 


Fig.  41. — Blood  picture  in  splenomyelogenous  leukaemia. 


tendency  to  hemorrhages  and  to  anaemia; 
and  the  blood  shows  a naarked  increase  of  all 
the  leucocytes,  numerous  large  myelocytes  of 
all  types  (neutrophile,  eosinopliile,  and  baso- 


Fio.  42. — Blood  picture  in  lymphatic  leukaemia. 


phile),  a reduction  in  the  number  of  red 
blood-cells  and  inhai'inoglobin,  basophilic 
granulations  and  polychromatophilia  in  the 
red-cells,  and  normoblasts  and  megaloblasts. 


LINGUAL  TUMORS  AND  CYSTS 


Lymphoid  leuksemia  may  also  be  acute 
or  chronic.  In  acute  cases  there  occur  sore 
throat,  fever,  hemorrhages,  extreme  angemia, 
with  perhaps  little  or  no  enlargement  of  the 
lymph  glands,  and  the  disease  may  resemble 
typhoid  or  typhus  fever,  tuberculosis,  pur- 
pura, or  septicsemia;  but  the  blood  picture 
reveals  the  diagnosis.  Death  occurs  in  from 
four  to  ten  weeks.  In  chronic  lymphoid 
leuksemia,  moderate  glandular  and  splenic 
enlargement  occur,  followed  by  ansemia, 
and  the  blood  shows  a great  increase  in 
lymphocytes  with  reduction  in  the  other 
white  cells,  reduction  of  red  cells  and  hsemo- 
globin,  rarely  nucleated  reds  except  in 
severe  cases.  (For  other  causes  of  lympho- 
cytosis, see  Lymphocytosis.) 

Mixed  types  of  leuksemia  occur. 

Chloroma  designates  a rare  fatal  affection, 
characterized  by  the  occurrence  of  “ green- 
ish, subperiosteal,  lymphoid  masses  and  the 
blood  picture  of  lymphatic  leuksemia.” 
(A.  E.  Stansfeld.) 

Prognosis Acute  leuksemia  is  fatal  within 

about  four  to  ten  weeks.  Chronic  leuksemia 
is  fatal  usually  within  from  one  to  three  or 
five  years.  Occasional  remissions  may 
occur,  either  spontaneously  or  as  a result  of 
the  action  of  arsenic,  quinine,  the  X-rays, 
or  an  intercurrent  infection. 

Treatment. — Enjoin  fresh  air  day  and  night, 
a nutritious  diet,  and  mental  calm.  Treat 
symptoms  as  described  under  their  respect- 
ive captions.  Arsenic,  as  achninistered  in 
pernicious  ansemia  {q.v.),  and  quinine, 
gr.  v-xv,  in  capsule,  t.i.d.,  are  recommended. 
The  elixir  ferri,  quininse,  et  strychninse  phos- 
phati,  5i,  well  diluted,  p.c.,  is  a useful  tonic. 

Croftan  advises  that  a search  be  made 
for  a possible  intestinal  parasite.  Naphtha- 
lene tetrachloride,  gr.  vii,  in  capsule,  every 
three  hours  at  first,  and  later  every  two 
hours,  produced  marked  temporary  im- 
provement in  a case  of  acute  myelogenous 
leuksemia  (Drysdale;  Stansfeld).  Thymol 
(see  Ankylostomiasis)  may  be  tried.  Benzol 
may  be  tried  as  a possible  curative. 


B Benzol  (C.P.) gr.  viiss 

Olei  olivsc irpviii 


Mitte  tails  capsulse  (keratin  coated  or  gelatine 
hardened  with  formalin)  No.  xx. 

Sig. — Two  capsules  (or  one)  twice  daily  after 
meals,  gradually  increased  up  to  six  or  ten  capsules 
a day.  (A.  E.  Stansfeld.) 

AVhile  administering  benzol,  watch  closely 
for  symptoms  of  poisoning,  e.g.,  albumi- 
nuria, hsematuria,  giddiness,  headache,  ab- 
dominal pain,  vomiting,  diarrhoea,  purpura, 
ansemia,  leucopenia.  Keep  close  tab  on  the 
blood  and  urine,  and  stop  the  drug  when  the 


leucocytes  fall  to  12,000  (some  say  to  20,000 
to  25,000),  as  a further  drop  is  to  be  expected. 

Symptomatic  treatment  follows  the  use 
of  the  X-ray  {q.v.).  The  spleen,  lym- 
phatic glands,  epiphyses  of  the  long  bones, 
sternum,  and  liver  may  be  irradiated  at 
first  twice  a week  for  about  six  weeks, 
changing  the  areas  treated  as  frequently  as 
possible;  then,  after  a rest  of  two  or  three 
weeks,  regular  doses  should  be  continued 
every  four  to  six  weeks.  Do  not  irradiate 
the  entire  spleen  in  one  sitting,  but  an  area 
about  twice  the  size  of  a silver  dollar 
once  daily. 

Cabot  says,  “ Results  begin  to  appear 
usually  within  a few  weeks,  and  should  be 
very  marked  within  two  months.”  Make 
frequent  blood  examinations  while  using 
the  X-rays,  and  stop  treatment  if  the  red 
blood-cells  and  their  haemoglobin  content 
diminish.  Remember  that  too  small  doses 
may  overstimulate  the  haemotopoietic  tis- 
sues, while  overdosage  may  prove  fatal  by 
destroying  these  tissues.  Intermission  in 
the  treatment  is  followed  after  several  weeks 
or  months  by  recurrence  of  sjunptoms. 

J.  Citron  looks  rather  askance  at  these 
leucocyte-destroying  measures,  as  probably 
altogether  irrational.  What  we  need,  he 
declares,  is  etiologic  therapy. 

Osier  says:  “ Excision  of  the  leuksemic 
spleen  has  been  performed  43  tunes,  with 
5 recoveries  (J.  C.  Warren).”  Says  Stans- 
feld, it  is  an  “ unjustifiable  and  fatal  opera- 
tion in  leuksemia.”  The  Alayos  have  been 
reducing  the  size  of  the  spleen  with  radium 
{q.v.)  until  the  leucocjde  count  is  about 
30,000,  followed  by  removal  of  the  spleen, 
with  excellent  results. 

Leucoplakia  Buccalis. — Gr.  \evKos  white  -f 
TrXa^  plate;  L.  bucca,  cheek. — See  Part  5, 
Skin  Diseases. 

Lice. — See  Part  5,  Skin  Diseases. 

Lids,  (Edema  of  the. — See  Part  5,  Skin 

Diseases. 

Lingual  Diseases. — L.  lingua,  tongue. 
See  Tongue  Diseases. 

Lingual  Tumors  and  Cysts.— Varieties.— 
Mucous  cyst,  dermoid  cyst,  echinococcus 
cyst,  papilloma,  carcinoma,  sarcoma,  tuber- 
cle, gumma,  chondroma,  osteoma,  fibroma, 
lipoma,  angioma,  adenoma,  lingual  goitre. 

Mucous  cysts  are  thin-walled  and  fluct- 
uate. Dermoid  ej’^sts  occur  betw^een  the 
geniohjT)oglossi  muscles  above  the  mylo- 
hyoid, and  cause  bulging  in  the  floor  of  the 
mouth  and  beneath  the  lower  jaw.  They 
are  not  translucent  and  do  not  fluctuate,  as 
is  the  case  with  ranula.  Papillomata  are 
warty  or  cauliflower-like. 


LOBAR  PNEUMONIA 


Treatment— As  much  as  possible  of  the 
wall  of  a mucous  cyst  should  be  excised,  and 
the  remainder  cauterized. 

Dermoid  cysts  should  be  excised  either 
through  the  mouth  or  from  beneath  the 
lower  jaw.  They  are  ahnost  always  attached 
to  the  periosteum  of  the  lower  jaw  or  the 
hyoid  bone  or  both. 

Malignant  growths  should  be  removed 
early. 

Linitis  Plastica. — Gr.  \Lvov  fabric;  ir'kaaTos 
formed  matter.  See  Cirrhosis  of  the  Stomach. 

Lipomatosis. — Gr.  XIttos  fat  + -una  tumor. 
See  Obesity. 

Lipuria. — Gr.  XiVos  fat  + ovftov  urine.  Fat 
in  the  urine  is  demonstrated  by  the  presence 
of  strongly  retractile  globules  which  are 
stained  black  by  osmic  acid  and  red  by 
Sudan  III. 

Causes — Excessive  fat  diet;  bony  fracture; 
phosphorus  poisoning  producing  fatty  de- 
generation; fatty  tumors;  chyluria  (q.v.); 
prolonged  suppuration,  as  in  phthisis 
and  pyemia;  diabetes  mellitus;  chronic 
nephritis;  chronic  heart  disease;  eclampsia; 
various  affections  of  the  pancreas  and 
hver;  pyonephrosis. 

Little’s  Disease. — See  Spastic  Paralysis 
of  Infants. 

Liver  Abscess. — The  characteristic  symp- 
toms of  suppurative  hepatitis  are  local  pain 
and  tenderness,  often  pain  referred  to  the 
right  shoulder,  enlargement  of  the  liver, 
chilis,  irregular  fever,  sweats,  leucocytosis, 
perhaps  some  jaundice,  or  a pale,  muddy, 
icteroid  complexion,  and  emaciation.  The 
affection  may,  however,  be  entirely  latent. 

Etiology. — Amoebic  dysentery;  tramnatism; 
adjacent  disease,  viz.,  suppurative  chole- 
cystitis, nephritic  or  perinephritic  abscess, 
empyema,  pulmonary  abscess,  gastric  or 
duodenal  ulcer,  or  ulcerating  gastric  cancer; 
suppurative  pylephlebitis  secondary  to  ap- 
pendicitis, gastric  or  duodenal  ulcer,  intes- 
tinal ulcers,  hemorrhoids,  infective  throm- 
bosis following  intestinal  or  anal  operations, 
pelvic  abscess,  suppuration  of  the  mesenteric 
glands,  splenic  abscess,  or  acute  pancreatitis; 
suppurative  cholangitis  (q.v.) ; infected  hyda- 
tid cyst;  septico-pysemia  (q.v.). 

Treatment. — This  is  surgical.  See  Dysen- 
tery, Amoebic,  for  the  treatment  of  single 
or  tropical  abscess. 

Liver,  Active  Congestion  of  the. — The 

symptoms  in  extreme  cases  are  those  of 
bihousness,  viz.,  anorexia,  furred  tongue, 
offensive  breath,  bad  taste  in  the  mouth, 
constipation,  general  malaise,  headache, 
mental  depression,  sallowness,  perhaps  a 
slight  icteroid  complexion,  sense  of  fulness 


or  distress  in  the  epigastric  and  right  hypo- 
chondriac regions,  perhaps  slight  enlarge- 
ment and  tenderness  of  the  liver,  perhaps 
nausea  or  vomiting. 

Etiology.— Excessive  eating  and  drinking; 
spicy  food;  alcohol;  sedentary  habits;  obe- 
sity; suspension  of  the  menses,  or  of  a 
hemorrhoidal  flow;  intestinal  intoxication; 
malaria;  fevers;  arsenic,  phosphorus,  and 
other  mineral  poisons;  cirrhosis  in  its  early 
stage;  hepatitis. 

Treatment.— Attend  to  the  cause.  Purge 
freely  with  calomel,  gr.  ii-v,  in  divided 
doses,  followed  by  a saline.  Give  alkaline 
waters  freely,  such  as  Vichy  or  Apollinaris, 
or  sodium  bicarbonate,  gr.  x-xv  to  the 
tumblerful.  Apply  leeches  or  cold  com- 
presses over  the  liver. 

Ammonii  chloridi, 

Sodii  bicarbonatis,  aa 3ii3ii  (gr.  xx  of 

each  per  dose) 

Aquae,  q.s.,  ad 5viii 

M.  Sig. — Two  tablespoonfuls  t.i.d.p.c.,  in  the 
acute  congestive  stage. 

Acidi  nitrohydrochlorici  diluti  irjx-xx 


Tincturae  nucis  vomicae irgx-xv 

Infusi  calumbae,  q.s.,  ad §i 


M.  Sig. — One  ounce  well  cUluted  in  water,  one 
hour  before  meals,  in  the  convalescent  stage. 

Liver  Atrophy,  Acute  Yellow. — See  Atro- 
phy, Acute  Yellow,  of  the  Liver. 

Cancer. — See  Cancer  of  the  Liver. 

Cirrhosis,  Alcoholic. — See  Cirrhosis, 
Portal,  of  the  Liver. 

Biliary. — See  Cirrhosis,  Biliary,  of 
the  Liver. 

Portal. — See  Cirrhosis,  Portal,  of  the 
Liver. 

Liver  Enlargement. — Causes.— Acute  con- 
gestion; chronic  passive  congestion  in  car- 
diac insufficiency;  suppurative  cholangitis; 
early  stage  of  atrophic  cirrhosis;  hyper- 
trophic cirrhosis;  syphilitic  hepatitis  (diag- 
nosed by  the  Wassermann  or  therapeutic 
test);  abscess;  tumor  (carcinoma,  sarcoma, 
angioma,  echinococcus  cyst);  fatty  degen- 
eration, occurring  in  obesity,  cachexia, 
phthisis,  profound  anaemia,  alcoholism,  and 
phosphorus  poisoning;  amyloid  degeneration, 
due  to  prolonged  suppuration,  tuberculosis, 
syphilis,  rickets,  great  debility,  and  cachexia; 
leukaemia;  pseudo-leukaemia;  obstruction  of 
the  common  duct,  due  to  stone,  stricture, 
catarrh,  tumor,  etc.;  haemochromatosis; 
chronic  malaria;  diabetes;  constricted  liver. 

Liver  Flukes. — See  Distomiasis. 

Ptosis. — See  Splanchnoptosis. 

Lobar  Pneumonia.— See  Pneumonia, 
Lobar. 


LYMPHADENITIS 


Lobular  Pneumonia. — See  Broncho- 
Pneunionia. 

Lock=Jaw. — See  Trismus. 

Locomotor  Ataxia — See  Ataxia, Locomotor. 

Long  Thoracic  Nerve. — See  Brachial 
Plexus. 

Ludwig’s  Angina. — A submaxillary  cellu- 
litis spreading  to  the  tissues  of  the  floor  of 
the  mouth,  base  of  the  tongue,  pharynx,  and 
larynx,  and  caused  by  infection  from  an 
alveolar  abscess,  buccal  ulcer,  carious  tooth, 
the  tonsils,  the  submaxillary  lymph  glands, 
or  indeed  any  septic  wound  of  the  mouth  or 
throat.  The  specific  fevers  (scarlet  fever, 
measles,  diphtheria,  smallpox,  typhoid  fever, 
erysipelas,  tertiary  syphilis,  etc.),  infected 
milk,  poor  health;  alcoholism,  and  trauma- 
tism may  be  causative. 

Causal  bacteria  include  streptococci,  sta- 
phylococci, pneumococci,  Friedlander’s  ba- 
cillus, and  Vincent’s  organism. 

The  condition  is  serious. 

Treatment — Open  the  bowels  with  calomel 
followed  by  a saline  (see  Part  11).  Ad- 
minister concentrated  licpiid  or  soft  nourish- 
ment. If  removal  of  a diseased  tooth,  buccal 
antisepsis  (using,  say,  Dobell’s  solution. 
Part  11,  or  hot  normal  saline  solution,  and  a 
fountain  syringe),  and  cold  or  hot  applica- 
tions do  not  cause  the  inflammation  to  sub- 
side, make  an  early  incision  parallel  to  the 
lower  border  of  the  jaw,  and  carry  it 
inward  until  pus  is  reached.  Then  pack  the 
wound  lightly  with  dry  gauze,  and  renew 
the  dressing  every  day  or  less  often  until 
healing  occurs. 

In  a spreading  phlegmonous  infection 
there  is  danger  of  acute  oedema  of  the 
larynx.  On  the  very  first  appearance  of 
even  the  slightest  respiratory  difficulty 
apply  cocaine  and  adrenalin  (cocaine,  10 
per  cent.,  in  adrenalin  solution  1 : 2000)  to 
the  oedematous  larynx,  and  then  make  mul- 
tiple punctures  with  a laryngeal  lancet.  If 
this  is  not  feasible,  resort  at  once  to  tracheot- 
omy {q.v). 

A polyvalent  serum  may  be  injected, 
in  these  sju-eading  cases,  followed,  if  (leemed 
advisable,  by  an  autogenous  vaccine  (see 
Part  11). 

Lumbago. — L.  lumhuf^,  loin.  See  IMjmlgia. 

Lumbar  Pain. — L.  lum'bus,  loin.  See 
Backache. 

Lumbar  Plexus. — L.  lum'bus,  loin; 

plex'us  braid.  Fig.  43. 

See  the  chart,  under  Nerves,  Peripheral, 
showing  the  distribution  of  sensory  nerves 
in  the  skin. 

The  Anterior  Crural  Nerve Paralysis  of  this 

nerve  results  in  inability  to  flex  the  thigh 


and  to  extend  the  knee,  and  in  loss  of  the 
knee-jerk.  The  causes  are  fracture  or  dis- 
location of  the  hip,  bone  disease,  abdominal 
tumor,  psoas  abscess,  parturition,  neuritis. 

The  Obturator  Nerve. — Paralysis  of  this  nerve 
results  in  weakness  or  loss  of  the  power  of 
adduction  and  inability  to  throw  the  thigh 


Fig,  43. — Diagram  illustrating  plan  of  lumbar  plexus. 


across  its  fellow  while  sitting.  The  causes 
are  intra-abdominal  or  pelvic  tumors,  obtu- 
rator hernia,  parturition. 

The  External  Cutaneous  Nerve. — See  IMeralgia 
PartEsthetica. 

For  the  Treatment  of  Nerve  Lesions  see 
under  Brachial  Plexus. 

Lumbar  Puncture. — See  under  Cerebro- 
spinal Fever. 

Lung  Affections. — See  Pulmonarj"  Affec- 
tions. 

Lymphadenia  Ossea. — See  IMultiple 
Myelomata  of  the  Bones. 

Lymphadenitis. — L.  lym'pha,  Bunph  -b 
Gr.  adrjv  gland  -|-  -trts  inflammation. 

I.  Lymphadenitis  Simplex. — Search  for  the 
portal  of  entry  of  the  infection,  viz.,  a tonsil- 
litis, pharyngitis,  stomatitis,  rhinitis,  ade- 
noids, dental  caries,  alveolar  abscess,  otitis, 
furunculosis,  eczema,  herpes  and  other 
forms  of  dermatitis,  pediculosis,  balanitis, 
vulvo-vaginitis,  acute  infectious  diseases,  etc. 

Open  the  bowels  by  means  of  castor  oil 
or  calomel,  followed  by  a saline.  (See  Part 
1 1 : Drugs.)  Aj^ply  to  the  inflamed  gland, 
cotton  wool,  or  cold  or  hot  compresses, 
perhaps  one  of  the  following  medicaments, 
c.g.,  tincture  of  iodine,  or  iodine-petrogen. 


LYMPHOCYTOSIS 


or  cataplasma  kaolini  or  ung.  Crede,  gr.  xv, 
rubbed  in  twice  daily,  or  the  following: 


Ichthyolis oiiss 

Extract!  bclladonnac  foliorum. ...  gr.  xlviii 
Glycerin!, 

Petrolat!,  q.s.,  ad 5i 


If  suppuration  occurs,  incise  the  gland, 
and  pack  lightly  with  dry  gauze  every  day 
or  less  often  until  healing  occurs.  Wliere 
the  gland  contains  multiple  foci  of  infection, 
it  may  be  best  to  excise  it. 

Ionic  medication  is  recommended  for 
chronic  suppurative  adenitis  (see  under 
Inflammation).  First  aspirate  the  pus,  then 
inject  a solution  of  iodine  or  potassium 
iodide,  and  introduce  a negative  needle 
electrode,  insulated  except  at  its  point. 
Employ  a current  of  10  to  15  milliamperes 
for  ten  minutes.  Three  or  four  applica- 
tions are  usually  required.  (Tousey.) 

In  simple  chronic  adenitis,  prescribe  an 
abundant  diet,  fresh  air  day  and  night,  and 
syrupus  ferri  iodidi,  arsenic  and  codliver  oil. 
X-ray  therapy  (q.v.)  is  beneficial  (see  also 
under  Eczema.) 

II.  Lymphadenitis  Tuberculosa. — This  is  usual- 
ly characterized  by  much  periadentitis.  A 
positive  diagnosis  is  made  by  the  micro- 
scopic examination  of  an  excised  gland.  The 
bacillus  is  almost  always  of  the  bovine 
variety,  evidently  derived  from  infected 
milk. 

A general  hygienic  and  tonic  regimen  is 
inchcated  (see  Tuberculosis,  Pulmonary). 
Prescribe  the  syrupus  ferri  iodidi,  arsenic 
and  codliver  oil  (see  Part  11).  It  is  best 
to  remove  early  and  completely  all  the 
infected  glands.  If  sinuses  are  present,  first 
heal  them  by  curetting  and  injections,  and 
perhaps  ionic  medication  (see  above).  At- 
tend also  to  possible  portals  of  infection 
(see  above).  X-ray  therapy  (q.v.)  is  of  great 
benefit.  One-third  or  one-half  a pastille 
dose  may  be  administered  twice  a week; 
or,  in  bad  cases,  a pastille  dose  once  a week. 
If  operation  is  resorted  to,  a few  prelim- 
inary exposures  should  be  given. 

Lymphadenoma. — L.  lym'pha,  lymph  -f 
Gr.  abi]v  gland  -j-  -w/xa  tumor.  See  Lym[)h- 
Gland  Enlargement. 

Lymphangitis. — L.  lym'plm,  lymph  Gr. 
ayyelou  vessel  -trts  inflammation.  I. 
Acute  lymphangitis  is  caused  by  skin  or 
mucous  membrane  infection,  herpes,  insect 
bites,  ringwonn,  erysipelas,  poison-ivy  or 
sumach,  sunburn,  the  X-rays,  acute  infec- 
tious diseases,  tuberculosis,  syphilis,  gonor- 
rhoea, bubonic  plague,  etc. 

The  symptoms  are  localized  redness, 
oedema,  pain,  and  tenderness,  sometimes 


in  the  form  of  a line  or  lines  advancing 
toward  the  trunlc,  swelling  and  tenderness 
of  the  adjacent  lymph  glands,  and  pyrexia. 
In  lymphatic  infections  on  the  volar  surface 
of  the  hand,  the  inflammation  pursues  the 
shortest  course  along  the  lymphatics  to  the 
back  of  the  hand.  Remember  this  when 
searching  for  the  atrium  of  infection  (Kan- 
avel).  (In  phlebitis  the  symptoms  are  much 
less  marked,  the  inflamed  vein,  if  palpable, 
is  larger,  and  the  lymph  glands  are  not  apt 
to  be  involved.) 

Prognosis — This  is  usually  good.  Teno- 
synovitis and  subcutaneous  phlegmons  some- 
times result.  If  suppuration  occurs,  the 
symptoms  become  more  severe  an  cl  the 
prognosis  serious.  Septico-pyajmia  (q.v.) 
is  to  be  dreaded,  especially  in  those  over 
thirty-five  years  of  age. 

Treatment Apply  continuous  voluminous 

quite  hot  compresses  of  bichloride,  1 : 1000 
in  water,  or  1 : 2000  in  50  per  cent,  alcohol, 
or  lysol,  1 teaspoonful  to  the  quart,  or  boric 
acid,  a heaping  tablespoonful  to  the  quart, 
or  perhaps  ichthyol,  oiiss,  in  glycerine  and 
vaseline,  5 i-  Open  abscesses  freely,  but 
make  no  other  incisions.  For  the  purpose 
of  preventing  the  rapid  absorption  of  tox- 
ines,  Kanavel  applies  Bier’s  constriction 
(see  under  Inflammation)  for  from  twelve 
to  eighteen  hours,  and  sometimes  reapplies 
it  for  another  eighteen  hours,  after  an 
intermission  of  several  hours. 

Local  and  systemic  rest  and  fresh  air  are 
of  importance.  Open  the  bowels,  and  pre- 
scribe a concentrated  liquid  and  soft  diet, 
tonics  and  sthnulants. 

II.  Chronic  lymphangitis  is  caused  by 
neighboring  ulcers  or  abscesses,  gonorrhoea, 
tuberculosis,  syphilis,  bubonic  plague,  filar- 
iasis,  malignant  tumors,  etc. 

Possible  sequelae  of  extensive  acute  or 
chronic  lymphangitis  and  obliteration  of  the 
lymph  vessels  are  chronic  oedema  and  ele- 
phantiasis, lymphangioma  circumscriptum, 
lymph  fistula,  chyluria,  etc. 

Lymphatism.- — See  Status  Lymphaticus. 

Lymph  Gland  Enlargement. — Causes. — 
Pyogenic  infection  (see  Lymphadenitis 
Simplex);  chancroid;  gonorrhoea;  syphilis; 
tuberculosis  (see  Lymphadenitis  Tubercu- 
losa) ; leukaemia;  Hodgkin’s  disease;  lympho- 
sarcoma; cancer;  plague;  sleeping  sickness; 
glandular  fever;  etc. 

Lymph  Gland  Inflammation. — See  Lym- 
phadenitis. 

Lymphocytosis. — L.  hjni'pha,  lymph  + 
Gr.  KCTos  cell.  The  normal  number  of  lym- 
phocytes per  cmm.  of  blood  is  1200  to  1500 
( — 3500)  (see  Blood  Examination).  The 


MALARIA 


normal  ratio  to  other  white-cells  is  20  to  25 
per  cent. 

Causes  of  Lymphocytosis — Infancy;  cUges- 
tion;  poor  nutrition  in  children;  lymphat- 
ism;  rickets;  gastro-intestinal  disturbances 
in  children;  cervical  adenitis;  pertussis; 
most  infectious  diseases  of  children;  syphilis; 
tuberculosis;  scurvy;  chlorosis;  pernicious 
anaemia;  splenic  tumors;  lymphatic  leukae- 
mia; splenomyelogenous  leukaemia;  splenec- 
tomy; acute  sepsis,  especially  tonsillitis, 
with  or  without  glandular  enlargement; 
pyorrhoea  alveolaris:  alveolar  abscess; 

typhoid  fever;  amoebic  dysentery;  disease  of 
the  thjwoid  gland,  hypophysis,  and  supra- 
renal gland. 

Lymph  Vessel  Inflammation. — See  Lym- 
phangitis. 

Macroglossia. — Gr.  /laKpSs  large  -}-  yXuicraa 
tongue.  Causes. — Glossitis,  acute  or  chronic; 
hydrargyrism ; multiple  gummata;  cretinism; 
muscular  hypertrophy  occurring  in 
idiots,  occasionally  in  normal  children; 
cavernous  lymphangioma. 

Treatment. — This  is  causal.  In  appropriate 
cases,  if  the  tongue  is  so  large  as  to  interfere 
with  eating  and  breathing,  excise  a large 
V-shaped  piece  of  the  anterior  portion,  and 
suture  the  cut  edges  with  silk. 

Madura  Disease. — See  Part  5,  Skin  Dis- 
eases. 

Malacosteon. — Gr.  ixaXaKos  soft  -f  osreoi^ 
bone.  See  Osteomalacia,. 

Malaria. — It.  niala  aria,  bad  air. — A com- 
mon infectious  disease,  occurring  south  of 
45°  north  latitude  in  the  Western  Hemi- 
sphere, and  62°  north  latitude  in  the  Eastern 
Hemisphere,  caused  by  four  varieties  of 
hsematozoa,  which  are  transmitted  from 
man  to  man  by  the  anopheles  mosquito, 
and  characterized  clinically  by  an  incuba- 
tion period  of  from  several  days  to  several 
months,  followed  by  chills  or  chilliness  and 
fever  of  various  types.  The  fever  is  always 
intermittent  (quotidian,  tertian,  or  quartan), 
unless  more  than  one  variety  of  parasite  is 
present,  or  more  than  one  generation  of  a 
single  variety  is  present,  which  segment  at 
different  times,  and  thus  produce  a remit- 
tent, continued,  or  irregular  fever.  In 
typical  cases,  following  a prodromal  period 
of  malaise,  anorexia,  and  headache  lasting 
several  days,  there  occurs  a parox\'sm  of 
chill  or  chilliness,  fever,  and  sweating,  in 
the  sequence  named.  These  paroxy'sms 
always  coincide  with  the  segmentation  or 
sporulation  of  a group  of  parasites. 

Masked  infections  occur,  manifested,  per- 
haps, only  by  a subnormal  or  normal  tem- 
perature, headache,  vertigo,  neuralgia,  acute 


pulmonary  congestion,  diarrhoea  or  dysen- 
terjq  etc.,  with  the  presence  of  organisms  in 
the  blood.  Latent  infections  occur,  too,  in 
which  parasites  are  present  in  the  blood 
without  symptoms.  The  disease  may  relapse 
after  a long  interval  of  normal  health.  Other 
diseases  may  mask  a malarial  infection. 
Following  repeated  infections  improperly 
treated,  a marked  aneemia  and  spleno- 
megaly may  develop  (malarial  cachexia). 

Four  varieties  of  malarial  parasite  are  dis- 
tinguished— (a)  tertian  (the  commonest  and 
mildest,  offering  a good  prognosis;  cycle  of  de- 
velopment approxunately  fortj^-eight  hours) ; 
(b)  quartan  (rare,  less  mild,  but  offering  also 
a good  prognosis;  cycle  of  development  sev- 
enty-two hours)  ;(c)  quotidian  sestivo-autum- 
nal,  cycle  of  development  twenty-four  hours, 
and  (d)  tertian  ajstivo-autiunnal,  cycle  of  de- 
velopment seventy-two  hours,  both  the  most 
serious  of  all  forms  and  the  commonest  in  the 
tropics,  and  by  far  the  most  common  cause  of 
the  grave  pernicious  malaria,  forms  of  which 
are  the  comatose,  delirious,  tetanic,  eclamp- 
tic, hemiplegia,  dysenteric,  choleraic,  algid 
(with  collapse),  cardialgic,  hemorrhagic  (See 
Black  Water  Fever,  pneumonic,  and  bilious 
(with  vomiting  and  jaundice). 

The  diagnosis  of  malaria  is  made  by 
repeated  blood  examinations  (apt  not  to  be 
successful  if  the  patient  has  recently  taken 
quinine),  and  by  the  therapeutic  (quinine) 
test.  Periodicity  of  symptoms  and  an 
enlarged  spleen  are  suggestive  signs.  (See 
Blood  Examination.) 

Treatment.— Put  the  patient  to  bed  on  a 
liquid  or  soft  diet  and  open  the  bowels  thor- 
oughly with  calomel,  followed  by  a saline  (See 
Part.  11).  Prescribe  quinine:  for  adults  gr.  v- 
x-xv,  in  capsule  or  in  solution  well  diluted, 
every  four  to  six  to  eight  hours,  usually  gr. 
XXX  in  twenty-four  hours.  Says  Holt,  for  an 
infant  of  one  year,  give  as  a rule  gr.  viii-xii  of 
the  sulphate,  gr.x-xivof  the  bisulphate,  daily; 
even  double  these  amounts  may  be  given. 
“ Children  from  five  to  ten  years  old  require 
almost  as  large  doses  as  do  adults.”  To 
infants  the  quinine  is  perhaps  best  given  in 
powder  form.  Kerleysays:  “ The  best  men- 
struum is  a preparation  of  yerbasanta,  known 
as  yerbazine  (made  by  Lil}"  and  Company).” 
If  it  disagrees  because  of  the  sugar  it  con- 
tains, the  quinine  bisulphate,  he  says,  should 
be  given  in  solution  in  distilled  water,  fol- 
lowed by  a teaspoonful  of  orange  juice:  to 
children  under  eighteen  months,  even  some- 
times under  four  months,  gr.  ii-iii  at  a dose, 
no  more  than  four  doses  in  twentj'-f our  hours; 
two  to  six  years,  gr.  iii  every  two  hours, 
15  to  30  grs.  daily.  He  saj^,  continue  the 


MALARIA 


quinine  in  full  doses  for  a week  after  the 
temperature  fails  to  rise,  unless  the  latter 
is  subnormal;  then  give  it  one  week  out  of 
every  month  for  at  least  a year.  Says  Sand- 
with,  “ For  an  adult,  less  than  five  grains 
or  more  than  thirty  grains  in  the  twenty- 
four  hours  are  useless.”  The  large  dose  of 
15  grains  may  be  given  just  before  the  onset 
of  a paroxysm,  or  during  the  decline  in 
temperature,  with  the  object  of  killing  the 
young  amoeboid  parasites  before  they  seg- 
ment. Some  say  that  it  is  best  given  three 
to  four  to  six  hours  before  a paroxysm,  so 
that  it  will  be  in  the  blood  in  maximmn 
concentration  at  the  time  of  the  attack,  when 
the  spores  are  liberated.  Quinine  should 
not  be  given  during  a paroxysm. 

After  the  paroxysms  have  ceased,  or  the 
fever,  if  remittent,  continued  or  irregular, 
has  disappeared  (about  two  or  three  days), 
give  five  grains  of  quinine  three  times  a day 
for  a week,  then  five  grains  daily  for  three 
months;  and  resume  the  treatment  every 
spring  and  fall  for  several  years.  This  after 
treatment  is  necessary  in  order  to  prevent 
relapses  or  recurrences  due  to  the  multipli- 
cation of  unkilled  parasites. 

Quinine  sulphate  is  practically  insoluble 
in  water;  but  is  dissolved  by  the  addition  of 
one  drop  of  dilute  sulphuric  or  dilute  hydro- 
chloric acid  for  each  grain  of  the  quinine. 
It  should  then  be  taken  well  diluted  in 
water.  Quinine  bisulphate  is  soluble  in 
eleven  parts  of  water  without  acid,  and  is 
therefore  to  be  preferred  to  the  sulphate. 
Quinine  hydrochloride  is  soluble  in  forty 
parts  of  water.  Quinine  bihydrochloride  or 
bimuriate  is  soluble  in  two  parts  of  water. 
It  is  for  this  reason  the  best  preparation. 
Capsicum,  gr.  i,  may  be  added  to  each  dose 
of  quinine  to  promote  absorption, 

Quininte  bisulpha- 

tis 5ii  9ii  (gr-  v per  dram) 

Tincturse  capsici.  . 5iss  (nearly  T^iii  per  dram) 
Aquffl,  q.s.,  ad ... . 5iv 

M.  Sig. — One  dram  every  4 to  6 to  8 hours,  or 
as  directed. 

In  intractable  and  pernicious  cases,  admin- 
ister the  bihydrochloride  intramuscularly: 


Quininae  bihydrochloridi gr.  Ixxv 

Aquae  destillatac,  q.s.,  ad 3iiss 


Boil;  then  add  one  or  more  drops  of  hydrochloric 
acid  to  dispel  the  turbidity.  Fifteen  minims  contain 
7}^  grains  of  quinine. 

Inject  about  twenty-four  grains  in  divided 
doses  every  twenty-four  hours,  deep  into 
the  muscle,  under  careful  asepsis,  until  the 
amoeboid  parasites  disappear  from  the  blood 
(the  crescents  are  not  affected  by  quinine); 


then  give  ten  to  fifteen  grains  every  sixth 
day  for  two  months,  etc.,  as  directed  above. 
Prescribe  also  iron,  arsenic,  and  strychnine 
(see  Part  11),  in  these  cases;  and  remove  the 
patient  to  a high,  dry,  non-malarious  region. 
To  reduce  the  liver  and  spleen,  prescribe 
saline  cathartics,  or  laxative  mineral  waters. 

In  alarming  pernicious  cases,  introduce 
the  quinine  intravenously  (g.v.),  gr.  xv  of 
the  bihydrochloride  in  300  c.c.  of  normal 
saline  solution  (0.  6 per  cent.)  boiled,  given 
slowly  and  carefully  while  watching  the 
pulse  closely.  This  may  be  repeated  every 
six,  eight,  or  twelve  hours,  as  required. 

Rosenau  and  Anderson  write:  “ The  sub- 
cutaneous or  intramuscular  injections  are 
contraindicated  in  cases  suffering  from  ulcer- 
ation or  septic  diseases  and  in  very 
young  children.” 

If  quinine  cannot  be  taken  because  of  an 
idiosyncrasy,  or  in  children  because  of  its 
taste,  give  the  tasteless  euchinin  (ethyl  car- 
bonate of  quinine),  in  double  the  doses  of 
quinine;  or  aristoquin  (di-ethyl  carbonate 
of  quinine),  gr.  vii  per  close,  up  to  22  grs. 
per  day;  or  quinine  tannate  with  choco- 
late; or  try  methylene  blue,  gr.  viii-xv, 
in  capsule,  in  twenty-four  hours.  Discon- 
tinue the  latter  when  the  urine  becomes 
deeply  colored,  or  kidney  irritation  results. 

Rectal  administration  of  the  quinine  may 
sometimes  be  expedient.  It  should  be  pre- 
ceded by  a cleansing  enema,  and  given  in 
twice  the  dosage  per  mouth : quinine  hydro- 
chloride, gr.  x-xv  in  water,  200  c.c.,  with 
tr.  opii,  gtt.  X. 

If  it  is  desired  to  give  the  quinine  intra- 
muscularly in  intermittent  fever,  it  is  best 
given  one  hour  before  the  paroxysm. 

During  a paroxysm,  give,  in  the  cold  stage, 
hot  drinks,  and  wrap  the  patient  in  blank- 
ets; in  the  hot  stage,  give  cold  lemonade  and 
tepid  or  cold  water  sponges.  For  headache, 
apply  an  ice-cap  to  the  head.  Give  cracked 
ice  for  vomiting,  or  inject  morphine  hypo- 
dermically. Give  morphine  also  for  nervous 
symptoms.  Give  strychnine,  brandy,  nor- 
mal saline  infusions  (0.6  per  cent.)  and  hot 
applications  to  the  precordium  for  heart 
weakness  or  collapse.  Give  opium  in  the 
dysenteric  and  choleraic  forms  (see  also 
Diarrhoea). 

After  a cure  has  been  effected,  build  up 
the  patient’s  strength  by  means  of  a liberal 
diet,  fresh  air  day  and  night,  and  tonics, 
such  as  the  elixir  ferri,  quininae,  et  strych- 
ninae  phosphati,  Fowler’s  solution,  and 
Bland’s  pills  (for  all  drugs  see  Part  11). 

(See  Black  Water  Fever,  for  the  consider- 
ation of  haemoglobinuric  cases.) 


MALIGNANT  PUSTULE 


Prophylaxis  embraces:  1.  The  covering 
of  the  surface  of  breeding  pools  with  kero- 
sene, about  one  ounce  to  fifteen  square  feet. 
In  large  bocUes  of  water  the  edges  alone 
need  be  covered. 

2.  The  use  of  fish  in  reservou's  of  drink- 
ing water. 

3.  Drainage,  or  the  filling  up  of  those 
places  that  can  not  be  drained. 

4.  The  removal  of  all  tin  cans,  broken 
bottles,  puddles,  etc.,  in  which  mosquitoes 
can  breed,  and  the  covering  of  water  barrels 
and  privies  with  netting. 

5.  Screens  for  houses:  “ copper  bronze 
screens  of  18  mesh  to  the  inch.” 

6.  Screening  of  the  patient  with  wire 
gauze.  The  dangerous  period  is  between 
sundown  and  bedtmie;  the  anopheles  mos- 
cjuito  is  chiefly  nocturnal  in  its  habits. 

7.  Destruction  of  mosquitoes  in  rooms  by 
saturating  the  rooms  with  the  fiunes  of 
burning  pyrethrmu  powder. 

8.  The  use  of  kerosene,  tiu-pentine,  cam- 
phor, menthol,  citronella,  oil  of  penny- 
royal, oil  of  anise,  oil  of  lavender,  or  oil  of 
eucalyptus  on  the  skin;  oil  of  bergamot,  1 
part,  kerosene,  10  parts. — Craig. 

0.  The  use  of  quinine,  gr.  ii  t.i.d.  (half 
this  amount  to  a child) , or  gr.  v-x  every  day, 
or  gr.  viii-x,  two  or  thi-ee  times  a week. 

Malignant  Jaundice. — See  Atrophy,  Acute 
Yellow,  of  the  Liver. 

Malignant  Neoplasms. — L.  malig'nans  act- 
ing maliciously;  Gr.  veos  new  + TrXdo-Aia 
formation.  No  cure  other  than  by  early 
complete  removal  has  yet  been  discovered. 
In  inoperable  and  reciuTcnt  cases  the 
use  of  radium  or  the  X-ray  (q.v.)  is 
indicated.  These  agents  are  used  also  to 
prevent  recurrence  after  operation.  They 
should  be  used  as  soon  as  pos.sible  after 
operation.  The  racUum  may  be  introduced 
directly  into  the  substance  of  the  growth. 
Says  Knox:  “ In  a large  tumor  a tube  con- 
taining 50  mgrms.  with  .5  mm.  filter  may 
be  left  in  situ  for  twenty-four  hours”;  and 
“ when  the  growth  is  very  large,  several 
tubes  introduced  at  equal  distances  from 
one  another  may  be  left  for  the  same  time.” 
Treat  recurrent  sarcoma  or  carcinoma  by 
external  applications  of  as  large  doses  as 
jwssible,  “ 200  or  300  mgrms.,”  says  Knox, 
“ in  platinum  tubes,  with  2 or  3 mm.  filter 
of  lead  and  about  twelve  layers  of  lint  be- 
tween the  radium  and  the  skin  surface.” 
“ The  area  to  be  treated  may  be  divided 
into  several  portions,  and  an  exposure  of 
twenty-four  hours  given  to  each.”  Finzi’s 
dicta,  quoting  llorder,  are  as  follows: 

1.  “ Use  maximal  doses.” 


2.  “ Repeat  as  frequently  as  is  safe.” 

3.  “ Use  sufficient  filtration.” 

4.  “ Treat  thoroughly,  not  only  the 
growth  itself,  but  any  region  where  it  is 
likely  a metastasis  might  exist.” 

5.  “ Continue  the  treatment  after  all 
traces  of  chsea.se  seem  to  have  disappeared.” 

Metallic  preparations,  e.g.,  iron  or  arsenic, 
may  be  given  when  the  patient  is  receiving 
radiations,  for  the  purpose  of  inducing 
secondary  rachations  in  the  body. 

In  using  the  X-rays,  cover  a wide  area, 
in  series,  if  need  be,  in  order  to  include  all 
possible  lymphatic  cUstribution.  A plan 
similar  to  Adamson’s  in  the  treatment  of 
ringworm  of  the  scalp  (See  Part  5)  should  be 
employed.  The  first  dose  should  be  given 
unfiltered,  the  second,  third,  and  fourth  at 
intervals  of  two  weeks  or  more,  with  a 
.5  mm.  filter,  then  a 2 mm.  filter  for  three  or 
four  doses,  and  later  a 3 mm.  filter  (Knox). 
Says  Knox:  “ In  all,  twelve  exposures  to 
the  whole  area  should  be  given”;  and 
“ towards  the  end  of  the  series  the  inteiwal 
should  be  about  three  weeks.”  The  patient 
should  be  kept  under  observation  for  years 
afterward,  and  any  recurrence  promptly 
dealt  with. 

In  using  large  doses  through  thick  filters, 
one  should  also  use  several  layers  of  chamois 
leather  upon  the  skin,  to  protect  the  latter 
from  the  secondary  rays  given  out  by  the 
filters.  Ulcerated  skin  areas  require  no 
protection.  Such  areas  are  irrachated  fre- 
quently until  they  begin  to  break  down. 

In  recurrent  cases,  employ  vigorous  treat- 
ment, “ until  a marked  reaction  is  obtained 
all  over  the  affected  surface  and  well 
beyond  it.”  (Knox.) 

Fungating  and  sloughing  growths  may  be 
largely  destroyed  by  means  of  diathermy 
{q.v.). 

Treat  ulcerations  antiseptically,  preferably 
with  diy  dressings;  hemorrhage  by  ligation 
of  the  bleeding  vessel,  the  cimette,  or  the 
actual  cautery;  excessive  secretion  of  mucus 
by  belladonna  (Part  11).  For  pain,  admin- 
ister Schlesinger’s  solution  hj'podermically : 

II  ScopolaminsD  hydrobromidi . . 0.0025  {gx.  Ht) 

Dioninse 0.4  (gr.  yi) 

Morphinic  hydrobromidi ....  0.2  (gr.  iii) 

Aquae  dostillatae,  q.s.,  ad.  . . . lO.c.c.  (oiiss) 

M.  Sig. — About  half-a-iiarrclful,  or  5 to  7 minims 
Inyodermically.  irpv  contains  scopolamine,  gr.  Y,w', 
dionin,  gr.  U;  morphine  gr.  Ho. 

(See  also  cancer  of  the  various  organs). 

Malignant  (Edema. — See  Anthrax,  in 
Skin  Diseases,  Part  5. 

Pustule. — See  Anthrax,  in  Skin  Dis- 
eases, Part  5. 


MARASMUS 


Malignant  Tumors. — See  Malignant 

Neoplasms. 

Malnutrition. — See  Marasmus. 

Malta  Fever;  Mediterranean  Fever; 
Undulant  Fever. — A churonic  tropical  and 
subtropical  bactersemia,  caused  by  the  micro- 
coccus melitensis,  and  characterized  by  an 
incubation  period  of  six  to  ten  days,  followed 
by  an  undulating,  relapsing  fever  lasting 
usually  three  months  or  longer,  with  pro- 
fuse sweats,  neuralgia,  neuritis,  arthritis, 
perhaps  orchitis,  enlarged  spleen,  constipa- 
tion, and  cachexia. 

The  diagnosis  may  be  made  from  blood- 
cultures  and  the  agglutination  test.  The 
latter,  however,  is  not  infallible.  Non- 
specific agglutinins  may  be  present.  A high 
dilution,  1 to  400,  should  be  used. 

Recovery  is  the  rule;  although  a series  of 
relapses  may  sometimes  prolong  the  disease 
for  even  several  years. 

Most  cases  are  transmitted  to  man  by 
the  drinking  of  the  milk  of  infected  Maltese 
goats;  but  cows,  oxen,  mules,  asses,  rabbits, 
fowls,  human  beings,  cow’s  milk,  cream, 
butter,  cheese,  urine,  faeces,  and  possibly 
dust  and  insects  may  disseminate  the  disease. 

Treatment. — This  is  symptomatic,  as  in 
typhoid  fever  {q.v.,  for  details).  The  dis- 
infectant precautions  employed  in  typhoid 
fever  must  also  be  employed  here.  Keep 
the  patient  between  blankets  on  account  of 
the  sweats,  and  dry  and  powder  the  sldn 
frequently.  Guard  against  bed-sores  {q.v.). 
Keep  the  mouth  and  teeth  clean.  Employ 
the  cool  pack  every  thi-ee  hours  when  the 
temperature  rises  above  103°  F.  A pitcher 
of  lemonade  should  be  kept  at  the  bedside. 
For  headache  employ  the  ice-cap,  and,  if 
necessary,  phenacetin,  gr.  v-x;  for  insomnia 
some  one  of  the  remedies  enumerated  under 
Insomnia;  for  arthritis,  tr.  iodi,  chloroform, 
or  belladonna  hniment,  hot  lead  and  opium 
fomentations,  or  cotton  mapping  and  immo- 
bilization; for  constipation,  calomel,  cascara, 
sahnes,  or  enemata.  Administer  stimulants 
(strychnine,  alcohol,)  when  required.  Vac- 
cine may  be  tried.  (See  Part  11  for 
Drugs,  etc.) 

The  diet  should  be  liquid  while  there  is 
fever,  and  very  nutritious  soft  food  in  the 
intervals.  Do  not  return  to  ordinary  diet 
until  after  two  weeks  of  normal  temperature. 

Warm  clothing  should  be  worn  after 
recovery,  to  avoid  neuralgic  attacks. 

Prophylaxis. — Sterilization  of  the  water  and 
food,  the  use  of  screens,  general  sanitation, 
and  the  avoidance  of  residence  in  infected 
regions  during  the  hot,  dry  months,  are 
effectual  preventive  measures. 

15 


Mammary  Gland  Affections. — L.  mam'ma, 
breast. — See  Breast  Enlargements. 

Mania  a Potu. — Gr.  ixavia  madness;  ttotoj 
drinking.  (See  Alcoholism.) 

Marasmus;  Atrophy,  or  Simple  Wasting; 
Malnutrition;  Decomposition. — ^A  severe 
grade  of  infantile  malnutrition  and  wasting, 
due  to  no  other  apparent  cause  than  bad 
hygiene  (especially  overcrowding,  lack  of 
fresh  air,  insufficient  food,  and  improper 
food),  and  a feeble  constitution. 

Wasting  due  to  tuberculosis,  syphilis, 
rickets,  malaria,  intestinal  worms,  malignant 
disease,  the  anjemias,  acute  or  chronic  gastro- 
intestinal disease,  and  organic  disease  of  the 
lungs,  heart,  stomach,  intestines,  liver  and 
kidneys,  is  not  here  considered.  These 
diseases  must  be  excluded. 

Treatment.— A healthy  wet-nurse  should  be 
procured  if  practicable;  otherwise  careful 
artificial  feeding  should  be  carried  out.  The 
milk  should  be  well  diluted.  Low  fat,  low 
protein,  and  relatively  high  sugar  formulae 
are  usually  the  best,  says  Holt.  Begin,  say, 
for  a six-months  baby,  with  a three-months 
formula  (Holt’s);  for  a nine-months  baby, 
with  a six-months  formula;  for  a twelve-  to 
twenty-four  months  baby,  \vith  a six-  to 
twelve-months  formula.  The  milk  may  be 
partially  peptonized  {q.v.  in  Part  11).  (See 
Infant  Feeding.) 

If  the  temperature  is  habitually  sub- 
normal, anoint  the  body  with  oil  and  sur- 
round it  wth  cotton-wool  and  hot  water 
bottles.  Gentle  massage  v-ith  cocoa  butter 
may  be  beneficial.  Fresh  air  is  of  primary 
importance. 

The  Middle-West  method  of  treatment, 
as  described  by  Gerstley,  is  as  follows:  If 
serious  diarrhoea  is  present,  withdraw  all 
food  but  water,  or  weak  tea  sweetened  with 
saccharin  (Part  11),  for  six  to  twelve  hours, 
never  longer.  Then  begin  feeding  with 
albumen  milk,  10  feedings  per  day  of  one 
ounce  each.  Begin  with  albumen  milk  at 
once  if  there  is  no  diarrhoea.  Albumen  milk 
is  prepared  as  follows:  Mix  1 quart  of  butter- 
milk and  1 quart  of  water  and  boil  a few 
minutes.  Put  aside  for  at  least  half  an  hour 
and  then  pour  off  the  supernatant  whey 
water  from  the  curd.  Add  to  the  latter  4 oz. 
of  boiled  cream  and  sufficient  whey  water  to 
make  one  quart  (to  supply  salts).  Add  3 
per  cent,  dextrin-maltose  (or  Mellin’s  Food 
or  Horlick’s  Malt  Food),  and,  if  need  be, 
sweeten  with  a little  saccharine.  Every 
other  day  increase  the  total  daily  amount 
(beginning  ■with  10  oz.)  by  2 or  3 ounces,  up 
to  a maximum  of  3 oz.  for  every  pound  of 
body  weight.  Do  not  change  the  albumen 


MEASLES 


milk  until  the  weight  curve  has  straightened 
out  (let  the  weight  curve  be  the  guide  and 
not  the  stools).  Then  cautiously  increase 
the  carbohydrate  to  5 per  cent.  If  no  gain 
in  weight  follows,  increase  gradually  to  7 per 
cent.  If  the  weight  still  continues  station- 
ary, increase  slowly  to  9 per  cent. ; but  make 
no  increase  if  the  weight  falls.  Such  high 
carbohydrate  can  not  be  used  with  any  other 
food  but  albumen  milk.  After  four  to  six 
weeks  of  albumen  milk,  employ  ordinary 
milk  mixtures  (see  Infant  Feeding.) 

In  breast-fed  infants,  express  the  milk 
from  the  breast  and  give  small  quantities, 
beginning  with  an  ounce  and  gradually 
increasing.  When  the  weight  cuiwe  has 
straightened  out  and  the  child  begins  to 
gain,  gradually  put  him  back  on  the  breast, 
preferably  with  half  albumen  milk. 

In  older  children  prescribe  a brief  hunger 
period,  if  diarrhoea  is  present,  then  begin 
feeding  a high  protein  diet,  beginning  with 
small  amounts  and  gradually  increasing, 
using  the  weight  cuiwe  as  a guide.  Withdraw 
milk,  or  else  dilute  it  one-third  or  one-half, 
to  dilute  the  whey,  and  feed  eggs,  custards, 
scraped  meat,  cottage  cheese,  nonfermentable 
carbohydrates,  e.g.,  cornstarch,  farina,  arrow- 
root,  Cream  of  Wheat,  well-boiled  rice,mashed 
Irish  potatoes,  and  z^\^eback,  and  supply 
salts  in  broths,  soups,  and  vegetal)le  purees. 

Mast=cell  Leucocytosis. — German,  Mast- 
zellen,  food-cell.  Normal  number  per  cmni. 
of  blood,  0-50;  about  0.5  per  cent,  of  the 
white  blood-cells. 

Causes.— Myelogenous  leuksemia;  rarely 
cancer,  tuberculosis,  syphilis,  skin  lesions, 
or  bone  infection.  See  Blood  examination. 

Mastitis. — Gr.  fiaards  breast  -b  tns  in- 
flammation. Acute  pyogenic  inflammation 
usually  occurs  in  the  lactating  breast,  rarely 
in  typhoid  fever,  tuberculosis,  osteomyelitis 
of  the  underlying  ribs,  empyema,  trauma- 
tism, etc. 

Treatment. — Open  the  bowels.  Apply  hot 
wet  bichloride  or  boric  acid  compresses  cov- 
ered with  a hot  water  bag.  As  soon  as  the 
presence  of  pus  is  evident,  make  multiple 
incisions  radiating  from  the  nipple,  and 
establish  thorough  drainage,  ('ipen  a sub- 
mammary abscess  at  the  lower  edge  of  the 
breast,  hlmploy  dry  dressings  or  hot  boric 
acid  irrigations  until  healing  occurs.  A 
tuberculous  breast  should  be  removed. 

For  actinomycosis,  see  Part  5,  Skin 
Diseases. 

Syphilitic  mastitis  requires,  of  course, 
specific  treatment  (see  Syphilis). 

Mastodynia. — Gr.  naards  breast  -}-  dSvvg 
pain.  (See  Neuralgia.) 


Masturbation. — L.  ma'nus,  hand,  -f  stu- 
prar'e,  to  rape.  Hypertrophies  and  corruga- 
tions of  the  genitals  are  diagnostic,  says 
Kelley,  and  “ endometritis,  vaginal  catarrh, 
and  trigonitis  result  from  long  indulgence.” 

Etiology.— Neurotic  habit;  habit  of  sucking; 
tight  clothing;  uncleanliness;  adherent  pre- 
puce in  both  boys  and  girls;  elongated 
foreskin;  phimosis;  balanoposthitis;  vulvo- 
vaginitis; eczema  of  the  labia;  pin-worms; 
highly  acid,  concentrated,  or  diabetic  urine; 
anal  fissure;  chronic  constipation;  leucor- 
rhoea;  all  pelvic  disorders. 

Treatment. — Remedy  all  possible  causal 
influences.  Strip  the  prepuce,  apply  a solu- 
tion of  cocaine,  10  to  20  per  cent.,  for  ten 
minutes,  if  necessary,  and  free  adhesions 
with  a blunt  probe  back  to  the  sulcus 
in  back  of  the  .corona;  cleanse  the  pre- 
putial sac,  and  apply  vaseline  every  day 
for  two  weeks. 

Build  up  the  general  health.  Enjoin 
cleanliness,  local  and  spinal  cold  water 
sprays,  a hard  bed,  light  bed  covering, 
prompt  rising  in  the  morning,  ph}"sical 
work,  and  fresh  air  exercise.  Prohibit  tea, 
coffee,  alcohol,  spices,  highly  seasoned  foods, 
sweets,  and  highly  nitrogenous  foods.  Allow 
no  food  within  three  or  four  hours  of  bed- 
time. If  hyperacidity  of  the  urine  seems 
to  be  a factor,  prescribe  sodium  bicarbonate 
(Part  11),  and  restrict  the  eating  of  meat. 

The  Avrists  may  be  tied  to  the  neck.  In 
leg-rubbing  in  infants,  keep  the  legs  apart 
with  a large  coarse  napkin,  or  a towel  over 
the  napkin.  In  older  children  employ  the 
knee-crutch. 

Close  and  persistent  supervision  is  re- 
quired to  effect  a cure. 

Measles. — A common  acute  infectious 
and  contagious  epidemic  disease,  character- 
ized by  an  incubation  period  of  seven  to 
eighteen  days,  followed  by  languor,  head- 
ache, fever,  conjunctival,  nasopharyngeal, 
and  bronchial  catarrh,  vith  lachrymation, 
photophobia,  sneezing,  and  cough,  and  the 
appearance,  on  the  inner  surface  of  the 
cheeks,  of  bluish-white  dots  surrounded  by 
red  areolsp  (Koplik’s  spots),  folloAA'ed,  after 
three  to  four  or  five  da}'s  by  a rose-red, 
blotchy,  maculo-papular  rash,  occurring  in 
crescentic  patches,  and  spreading  from  the 
face  downward.  The  Ijmiphatic  glands  are 
usuallj'  enlarged.  No  leucocjdosis  is  present 
when  the  eruption  appears.  The  fever  and 
rash  begin  to  decline  in  about  three  days, 
followed  by  some  desquamation. 

Prognosis. — Measles  is  a very  serious  dis- 
ease in  those  under  two  years,  and  in  the 
aged.  Tuberculosis  is  a common  sequel. 


MEDIASTINITIS 


Treatment. — Isolate  the  patient  (see  Disin- 
fection). Put  him  to  bed  in  a warm,  well- 
ventilated  room  at  a temperature  of 
60  to  70  F.  If  he  can  be  made  to  wear 
blue  or  smoked  glasses,  the  room  should 
not  be  darkened.  Open  the  bowels  well 
with  calomel,  or  castor  oil,  or  rhubarb,  or 
cascara  (see  Part  11),  and  secure  a daily 
bowel  movement.  Prescribe  concentrated 
liquid  nourishment  every  two,  three,  or 
four  hours,  and  an  abundance  of  water 
in  the  form  of  weak  orangeade  or  lemon- 
ade. In  bottle-fed  infants  the  milk  should 
be  diluted  one-half.  If  the  rash  does  not 
come  out  well,  give  warm  drinks  and  a 
hot  bath.  Keep  the  mouth,  throat,  and 
nostrils  clean  with  Dobell’s  solution  (g.w.), 
used  as  a spray.  For  the  eyes,  instil  boric 
acid  solution,  gr.  x ad  5 i ; and  for  gumming  of 
the  eyelids  employ  sterile  vaseline  or  ung. 
hydrarg.  ox.  flav.,  gr.  i ad  5iv  of  vaseline. 
A mild  fever  mixture  may  be  prescribed : 

Spiritus SBtheris  nitrosi.  . . oil  (gr-  v per  dose) 

Potasii  citratis 3i  (gr.  iiss  per  dose) 

Liquoris  ammonii  acetatis  oiss  (pss  per  dose) 

Syrupi  simplicis 5i 

Aquaj  camphora;,  q.s.,  ad.  5iv 

M.  Sig.— A teaspoonful  every  three  hours  (for  a 
child  of  3 to  5 years). 

If  the  fever  becomes  high,  employ  hot  or 
tepid  sponging,  or  the  tepid  bath  gradually 
reduced,  and  an  ice-cap  to  the  head.  Hydro- 
therapy is  also  useful  in  allaying  nervousness 
and  insomnia,  as  are  also  phenacetin, 
antipyrin,  and  codeine. 

For  laryngitis,  bronchitis,  and  pneumonia 
q.v.),  one  may  employ  for  from  five  to  ten 
minutes,  every  one  or  two  hours,  inhalations 
of  creosote,  ^t.  x to  the  pint,  or  comp.  tr. 
benzoin,  3i  to  the  pint  of  water,  heated  in 
a croup-kettle  or  steam  inhaler;  and  heat  or 
cold  or  counter-irritation  may  be  applied  to 
the  throat  or  chest.  For  troublesome  cough, 
prescribe  paregoric,  or  Dover’s  powder,  or 
codeine.  A croupy  cough  may  be  relieved 
by  a good  dose  of  sodium  bromide. 

Syrupi  ipecacuanha;  qi-ii  (t^v-x  per  dose) 
Arnmonii  chloridi ...  gr.  vi-xii  (gr.  ss-i  per  dose) 

Syrupi  tolutani §ss  (ttjxx  per  dose). 

Aqua;,q.s.,  ad 3ii 

M.  Sig. — One  teaspoonful  every  two  or  three 
hours,  as  an  expectorant  (for  a child  of  from  two  to 
five  years). 

For  vomiting,  withhold  all  food,  and 
administer  an  effervescent  water,  or  equal 
parts  of  lime  water  and  cinnamon  water. 

For  diarrhoea,  clear  out  the  digestive  tract 
with  calomel  in  divided  doses,  followed,  if 
necessary,  by  bismuth  sub-nitrate;  and  diet 
the  patient  carefully. 


Broncho-pneumonia,  ileo-colitis,  otitis 
media,  noma,  etc.,  are  to  be  guarded  against. 

When  desquamation  begins,  anoint  the 
skin  daily  with  sweet  oil. 

Keep  the  patient  in  quarantine  for  three 
weeks  from  the  onset  of  the  rash,  or  four 
weeks  from  the  beginning  of  the  disease; 
longer  if  catarrh  persists;  then  practice  dis- 
infection as  chrected  under  Disinfection. 

Measles,  German. — See  German  Measles. 

Meat  Poisoning. — See  PoLsoning. 

Median  Nerve. — See  Brachial  Plexus. 

Mediastinal  Inflammation. — (See  Medi- 
astinitis. 

Mediastinal  Tumors. — L.  mcdiasti'num, 
median  partition.  Varieties. — Carcinoma, 

sarcoma,  lymphoma,  fibroma,  lipoma,  en- 
chondroma,  teratoma,  gumma,  dermoid  cyst, 
hydatid  cyst,  Hodgkin’s  disease,  leukaemia. 

The  symptoms  are  those  of  intrathoracic 
pressure,  viz.,  pain,  dislocation  of  the  heart 
and  lungs,  dyspnoea,  perhaps  a brassy  cough 
and  alteration  of  the  voice,  perhaps  venous 
engorgement,  oedema  and  cyanosis,  often 
pleural  effusion,  perhaps  dysphagia,  per- 
haps local  bulging,  or  bone  erosion  and  per- 
foration of  the  chest  wall. 

Mediastinal  tumor  is  to  be  distinguished 
from  aneurysm.  The  X-ray  and  the  Was- 
sermann  test  give  valuable  information. 
Some  cases  are  operable.  If  not  operable, 
try  the  X-rays,  as  described  under  Pul- 
monary Tumors. 

Mediastinitis.  — Mediastinal  inflamma- 
tion is  manifested  by  deep-seated  pain, 
tenderness,  pyrexia,  and  in  acute  cases  more 
or  less  prostration. 

Acute  cases  are  serious;  chronic  cases 
less  so. 

Causes  of  Acute  Mediastinitis. — External  pen- 
etrating wound ; blow  on  the  chest ; crushing 
of  the  chest;  internal  penetrating  wound  via 
the  oesophagus,  trachea  or  bronchi,  caused 
by  a foreign  body  or  by  instrumentation; 
adjacent  inflammation,  affecting  the  lung, 
pleura,  bronchi,  trachea,  larynx,  oesophagus, 
pericardium,  peritoneum,  lymphatic  glands, 
ribs,  sternum,  or  cervical  cellular  tissue. 

Causes  of  Chronic  Mediastinitis. — Tuberculosis 
of  the  vertebrae,  l3miphatic  glands,  ribs, 
or  sternum. 

Treatment  of  Acute  Mediastinitis. — Put  the 
patient  to  bed,  apply  an  ice-bag,  and  open 
the  bowels  with  calomel,  followed  by  a 
saline.  Quinine  may  be  administererl  if 
desired;  or  sodium  pyrophosphate.  (for 
drug  formulae  see  Part  11).  Theobald  re- 
gards the  latter  as  a very  useful  agent  in 
combating  suppuration. 

If  symptoms  of  suffocation  occur,  the 


MEDICAL  ELECTRICITY 


anterior  mediastinum  may  be  explored  by 
means  of  trephine,  rongeur  forceps,  and 
aspirating  needle;  the  posterior  mediastinum 
by  removal  of  the  vertebral  transverse  proc- 
esses and  portions  of  the  adjacent  ribs, 
followed  by  blunt  dissection.  If  pus  is 
found,  insert  a rubber  drainage  tube  or 
sterile  gauze. 

Medical  Electricity. — Electricity  is  either 
static  (electricity  at  rest)  or  dynamic  (elec- 
tricity in  motion).  The  latter  is  either  gal- 
vanic (direct  or  unidirectional),  or  faradic 
(induced  electricity  with  rapid  alternations 
of  direction). 


electricity  passes  to  b,  so  that,  if  a is  now 
removed,  it  leaves  b charged  (by  conduction) 
with  positive  electricity. 

If  a is  brought  near  to  b,  but  not  in  con- 
tact with  it,  negative  electricity  will  accumu- 
late on  the  near  pole  of  b,  and  positive  elec- 
tricity on  the  far  pole.  If,  now,  a con- 
ductor is  brought  in  contact  with  the  far  or 
positive  pole  of  b,  and  then  removed,  a 
being  still  near  the  negative  pole  of  b,  the 
latter  will  lose  its  positive  electricity  and 
remain  charged  (by  induction)  with  nega- 
tive electricity. 

If,  during  the  friction  of  two  insulated 


4 


Static  Electricity.— If  two  insulated  dissimilar 
bodies  are  rubbed  together,  one  body  accum- 
ulates on  its  surface,  under  tension,  all  the 
positive  electricity  which  both  bodies  origin- 
ally possessed,  and  the  other  body  accumu- 
lates all  the  negative  electricity. 

Like  charges  of  electricity,  whether 
positive  or  negative,  are  mutually 
repulsive,  whereas  unlike  charges  are  mutu- 
ally attractive. 

If  the  insulated  body,  a,  Fig.  46,  charged 
with  positive  electricity. 


a b 


Fig.  46. 


is  brought  in  contact  \vith  the  neutral  insu- 
lated body,  b,  the  negative  electricity  from 
b is  attracted  to  a,  and  some  of  a’s  positive 


dissimilar  bodies,  one  of  the  bodies,  say  the 
negative,  is  connected  with  the  earth,  it 
receives  more  negative  electricity  from  the 
earth  (attracted  by  the  positive  body), 
wiiich  produces  by  induction  a stiU  stronger 
charge  in  the  positive  body. 

Fig.  44  represents  a static  machine  of  the 
simplest  type.  A positive  charge  is  pro- 
duced on  the  revolving  glass  plate,  a,  by 
friction,  and  a negative  charge  on  the  rub- 
ber, b,  which  is  connected  with  one  pole  of 
the  machine.  C is  a metal  collecting  comb 
near  the  glass  plate.  The  positive  charge 
upon  the  plate  attracts  negative  electricity 
to  the  comb  and  repels  positive  electricity 
to  the  pole.  The  negative  electricity  of  the 
comb  escapes  to  the  plate  and  neutralizes 
the  positive  charge  there,  but  this  is  again 
restored  by  friction  at  another  part  of  its 
revolution.  For  a description,  etc.,  of  the 
more  complicated  static  machines  employed 


MEDICAL  ELECTRICITY 


in  therapeutics,  consult  special  works  on 
medical  electricity,  e.g.,  Tousey’s. 

Static  insulation  or  the  static  or  Frank- 
linic  bath  is  administered  as  follows: 

The  patient  sits  in  a chair  upon  the  plat- 
form (Fig.  45.),  with  the  legs  of  the  chair  or 
his  feet  on  the  metal  plate.  During  the 
operation  of  the  machine  the  surface  of  his 
body  is  charged  with  positive  electricity.  A 
spark  may  be  administered  by  bringing  a 
metal  ball  electrode  (grounded  or  connected 
with  the  negative  pole  of  the  static 
machine)  near  the  patient;  a breeze,  effluve, 
or  spray,  by  bringing  a pointed  electrode 


In  all  static  appliances  the  connections 
should  be  perfect. 

A Leyden  jar  or  condenser  consists  of  a 
glass  jar,  coated  for  about  half  its  height 
from  the  bottom,  on  the  outside  and  inside, 
with  tin-foil,  and  with  a cork  which  is  per- 
forated by  a brass  rotl  terminating  above 
in  a knob  and  connected  within  the  jar 
with  the  inner  coating  of  tin-foil  by  means 
of  a chain.  To  charge  the  jar,  its  knob  is 
brought  near  enough  to  one  pole  of  a static 
machine,  say  the  positive,  to  receive,  by 
conduction,  convection,  or  a spark,  a charge, 
while  the  outer  tin-foil  coating  is  grounded 


no  Volt  A Re «- H at"  «■  M ^ torrent" 


Ammet'cr 


Seconcia  J up  ^r^,r^s/ormer 

or  inaucnon  coil 


Sli'dirt^  wds 

Leyden  jairs 

5mall  solenoid 
o/  cl'ArsonvAl 

To  pafienT 

Fia.  47. — The  d’Arsonval  Apparatus. 


near  the  patient.  If  the  static  wave  or 
Morton  wave  current  is  desired,  the  prime 
conductors  of  the  static  machine  are  placed 
in  contact  to  start  with,  and  then  slowly 
separated. 

If  the  static  induced  current  is  desired,  the 
smallest  Leyden  jars  are  suspended  by  their 
knobs,  one  to  each  pole  of  the  static  machine, 
and  their  outer  coats  are  connected  with  the 
patient  by  means  of  sponge  electrodes.  The 
machine  is  first  charged  before  connecting 
with  the  patient,  and  the  discharging  rods 
aie  in  contact.  The  latter  are  slowly  sepa- 
rated to  a degree  controlled  by  the  sensation 
of  the  patient,  usually  no  greater  than  ^ 
inch  (Tousey). 


by  being  held  in  the  hand.  The  knob  and 
inner  coating  are  thereby  charged  with  posi- 
tive electricity  from  the  static  machine,  and 
the  outer  coating  with  negative  electricity 
from  the  earth.  A Leyden  jar  placed  upon 
an  insulator  cannot  be  charged.  The  outer 
coating  must  be  connected  with  the  earth  or 
with  a conductor  excited  oppositely  to  that 
charging  the  inner  coating.  The  electric 
charge  resides  entirely  upon  the  surface.  If 
the  two  coats  of  the  charged  jar  are  brought 
in  contact,  the  jar  is  discharged  with  the 
occurrence  of  a large  spark.  The  electrical 
neutralization  or  equilibrium  is  not  effected 
instantaneously,  however,  but  there  occurs 
a series  of  oscillations,  back  and  forth,  at  an 


MEDICAL  ELECTRICITY 


extremely  rapid  rate.  These  oscillations 
constitute  what  are  known  as  high-freciuency 
currents  and  as  the  d’Arsonval,  Oiulin,  and 
Tesla  currents.  In  ortler  to  obtain  a more 
or  less  continuous  high-frequency  flow,  the 
Leyden  jar  must  be  continually  recharged 
each  time  it  is  discharged. 

The  d’Arsonval,  Oudin,  and  Tesla  cur- 
rents are  cUfferent  types  of  high-frequency 
currents.  Fig.  4G  represents  the  d’Arsonval, 
Fig.  48  the  Oudin,  and  Fig.  49  the 
Tesla  apparatus. 

The  strength  of  the  current  to  the  patient 
depends  upon  the  strength  of  current  in  the 


primary  circuit  and  the  length  of  the  spark- 
gap.  If  the  supply  current  is  a direct  one, 
an  interrupter  must  be  interposed  in  the 
primary  circuit.  In  the  Oudin  resonator 
the  contact,  a,  is  adjustable,  i.e.,  it  may 
be  moved  up  or  down.  When  it  is 
moved  above  or  below  a certain  point,  the 


discharge  to  the  patient  decreases.  When 
it  is  at  the  point  of  maximum  discharge  the 
apparatus  is  said  to  be  in  resonance. 

The  d’Arsonval  high-frequency  current  is 
of  low  voltage  and  comparatively  high 
amperage.  The  Oudin  ancl  Tesla  currents 


are  of  high  voltage  and  comparatively 
low  amperage. 

Diathermy  or  thermopenetration  (see  Di- 
athermy) is  a form  of  treatment  by  means  of 
high-frecjuency  currents  of  comparatively 
low  voltage  and  great  milliamperage. 

Galvanic  Electricity. — The  simplest  form  of 
generator  of  galvanic  electricity  is  the  gal- 
vanic cell  (Fig.  50).  It  consists  of  a jar  of 
dilute  sulphuric  acid  in  which  are  dipped  a 
zinc  plate  and  a copper  plate  connected 
above  by  a copper  wire.  An  electrical  cur- 
rent is  thereby  generated,  which  flows  from 
the  zinc  to  the  copper  through  the  liquid 
and  from  the  copper  to  the  zinc  above,  and 
bubbles  of  hydrogen  gas  collect  on  the  cop- 
per plate.  This  collection  of  gas  (known  as 
polarization  of  the  cell)  gradually  diminishes 
and  finally  stops  the  action  of  the  cell,  so 


that  various  mochfications  have  been  devised 
to  prevent  it.  In  the  Daniell  cell,  the  zinc 
plate,  immersed  in  dilute  sulphuric  acid,  is 
separatetl  from  the  perforated  copper  plate, 
which  is  immersed  in  a solution  of  copper 
sulphate,  by  a porous  wall,  and  the  hydro- 
gen is  taken  up  by  the  sulphate  before  it 
reaches  the  copper  plate.  In  the  potassium 
bichromate  cell,  zinc  and  carbon  plates  are 
immersed  in  a solution  of  potassium  bichro- 
mate in  tlilute  sulphuric  acid.  Chromic  acid 
is  formed  by  the  action  of  the  sulphuric  acid 
on  the  bichromate,  and  this  oxidizes  the 
hydrogcibto  form  water. 

A so-called  dry  cell  or  diy  batter}'  is  not 
dry,  but  contains  a damp  chemical  paste, 
closely  sealed  against  evaporation,  in  place 
of  the  liquid  of  the  wet  cells. 

Static  electricity  is  comparable  in  its 
properties  to  a tank  of  water  whose  outlet 
pipe  is  stopped.  The  water  is  at  rest,  but  is 
under  pressure  from  its  containing  walls. 
So  static  electricity  is  at  rest,  but  under 


MEDICAL  ELECTRICITY 


tension  or  pressure.  Dynamic  electricity  is 
comparable  to  water  flowing  through  a pipe. 
The  rate  and  strength  of  flow  depend  upon 
the  head  or  pressure  of  water  and  the  fric- 
tional resistance  offered  by  the  pipe.  The 
unit  of  strength  or  rate  of  flow  of  an  electric 
current  is  termed  an  ampere;  the  unit  of 
pressure  or  electro-motive  force  is  termed  a 
volt;  the  unit  of  resistance  an  ohm.  A pres- 
sure of  one  volt  against  a resistance  of  one 
ohm  produces  a current  of  one  ampere;  or 
as  expressed  in  the  terms  of  an  equation: 
Voltage  = amperage  X resistance,  which  is 
called  Ohm’s  law.  A coulomb  is  the  quan- 
tity of  electricity  conveyed  by  one  ampere 
in  one  second.  A watt  is  the  power  exerted 
by  one  ampere  with  a pressure  of  one 
volt.  A milliampere  is  one-thousandth  of 
an  ampere. 

If  a number  of  galvanic  cells  are  united 
with  one  another  in  such  a way  that  the 
positive  pole  of  one  is  connected  with  the 
negative  pole  of  the  next,  and  so  on,  the 
cells  are  said  to  be  grouped  in  series.  By 
such  a method  of  grouping,  the  voltage  is 
increased  in  proportion  to  the  number  of 
cells.  If  all  the  positive  poles  are  joined  on 
one  side  and  all  the  negative  poles  on  the 
other,  the  cells  are  said  to  be  grouped  in 
parallel  or  multiple  arc.  By  this  method  of 
grouping  the  amperage  is  increased  in  pro- 
portion to  the  number  of  cells,  the  voltage 
remains  that  of  only  one  cell,  and  the 
resistance  becomes  that  of  one  cell  cUvided 
by  the  number  of  cells. 

A storage  battery  consists  of  two  elec- 
trodes of  the  same  metal,  such  as  lead,  sur- 
rounded by  an  electrolytic  fluid,  such  as 
dilute  sulphuric  acitl,  through  which  a con- 
stant current  has  been  sent.  During  the 
passage  of  the  current  (charging  of  the  bat- 
tery), the  positive  lead  plate  becomes  cov- 
ered with  brownish  peroxide  of  lead  and  the 
negative  plate  with  finely  divided,  spongy 
metallic  lead.  When  the  two  terminals  of 
the  charged  cell  are  subsequently  connected, 
a current  flows  in  the  opposite  direction  to 
that  of  the  charging  current,  that  is,  from 
the  spongy  lead  through  the  fluid  to  the 
brownish  plate  and  back  through  the  out- 
side circuit. 

Faradic  Electricity. — The  production  of  a 
faradic  induced,  or  alternating  current  is 
shown  in  the  following  diagram  (Fig.  51). 

One  is  the  battery  of  cells  from  which  a 
galvanic  current  is  obtained.  Two  is  an 
adjustable  screw  with  a platinum  tip. 
Three  is  a piece  of  soft  iron,  also  with  a 
platinum  tip  opposite  the  screw,  which  is 
pulled  against  2 by  means  of  a strong  brass 


spring.  Four  is  a coil  of  coarse  wire,  the 
so-called  prunary  coil,  surrounding  the  iron 
bar  or  core,  5,  and  carefully  insulated  from 
it.  Six  is  a secondary  coil  of  fine  wire,  care- 
fully insulated.  The  current  from  the  bat- 
tery passes  in  the  direction  indicated  by 
the  arrows  and  magnetizes  the  soft  rron 
core,  5,  which  attracts  the  iron  hammer,  3, 
away  from  its  contact  with  the  screw,  2, 
and  thus  breaks  the  circuit.  The  core 
thereby  becomes  demagnetized,  3 springs 
back  into  contact  with  2,  and  remakes  the 
circuit,  and  so  on.  At  every  increase  and 
decrease  in  the  strength  of  the  current  flow- 
ing through  the  primary  wire,  and  at  every 
make  and  break  of  this  current,  a secondary- 
current  is  induced  in  the  surrounding  coil 
of  fine  wire,  and  the  more  sudden  the  change. 


Fia.  51. — Faradic  apparatus. 

the  greater  the  strength  of  the  induced  cur- 
rent, the  “ break  ” current  being  the 
stronger.  At  the  instant  when  the  primary 
current  begins  or  increases  in  strength,  a 
weak  current  in  the  opposite  threction  is 
generated  in  the  secondary  wire;  at  the 
instant  when  the  primary  current  stops  or 
decreases  in  strength,  a strong  current  in  the 
same  direction  is  generated  in  the  secondary. 
No  current  is  induced  in  the  secondary  wire 
so  long  as  the  primary  current  flows  steadily. 
The  secondary  or  induced  (faradic)  current 
alternates  in  direction  as  rapidly  as  the 
primary  circuit  is  interrupted  and  made. 
The  effect  of  such  an  arrangement  of  coils 
is  to  change  a current  of  relatively  low  poten- 
tial and  high  amperage  to  a current  of  rela- 
tively high  potential  and  correspondingly 
low  amperage. 


MENINGITIS,  ACUTE  CEREBROSPINAL 


The  so-called  high-tension  transformer 
(Fig.  71)  is  an  induction  coil.  The  voltage 
of  the  secondary  current  is  as  many  times 
greater  than  the  voltage  of  the  liiimary  cur- 
rent as  the  number  of  turns  of  wire  in  the 
secondary  exceed  those  in  the  prmiary.  The 
amperage  at  the  same  time  is  correspond- 
ingly reduced. 

The  so-called  sinusoidal  current  is  an 
alternating  current  with  a gradual  change 
of  strength  and  direction. 

The  Dynamo  and  Electric  Motor. — Wlien  a coil 
of  wire  (Fig.  52a)  is  made  to  revolve  so  as  to 
cut  lines  of  force  between  the  poles  of  a 
magnet,  an  electric  current  is  generated  in 
the  coil,  which  is  in  the  direction  shown  by 
the  arrows  when  the  upper  wires  are  coming 
toward  the  observer,  and  in  the  opposite 
direction  when  the  wires  are  rotating  through 
the  other  half  turn.  If  the  ends  of  the  coil 


110  volts,  either  direct  or  alternating,  for 
medical  purposes,  it  may  be  made  to  run  an 
electric  motor  which  in  turn  operates  a 
dynamo.  When  the  two  are  mounted  on 
the  same  axle  and  revolve  together,  the  com- 
bined apparatus  is  called  a motor  generator. 

Medina  Worm.  — See  Dracontiasis,  in 
Part  5,  Skin  Diseases. 

Mediterranean  Fever. — See  Malta  Fever. 

Megacolon. — Gr.  /xkyas  large  + ku>\oi> 
colon.  See  Colon,  Dilatation  of  the. 

Malaena. — Gr.  neXaLva  black  bile.  See 
Hemorrhage,  Intestinal. 

Melanuria. — Gr.  ne\as  black  + obpov 
urine. 

Causes  of  Black  or  Dark  Colored  Urine. — 
Marked  chronic  jaundice;  hsematuria;  hsemo- 
globinuria  and  hjEmatoporphyrinuria ; mela- 
notic tumors;  ochronosis;  indicanuria;  cer- 
tain ingesta,  e.g.,  black  cherries,  plums,  bil- 


Fig.  52  a.  Dynamo  and  Electric  Motor 


Fig.  52  b. 


are  connected  with  two  rings  which  rotate 
with  the  coil,  and  these  rings  are  made  to 
press  against  two  springs  or  brushes  con- 
nected with  an  external  circuit,  an  alternat- 
ing current  is  produced  in  this  circuit. 

If  the  ends  of  the  coil  are  connected  wdth 
the  two  separated  halves  of  a metal  cylinder 
(Fig.  525)  rotatingwith  the  coils,  and  the  half, 
a,  connects  with  the  spring,  1,  during  the 
half  revolution  that  it  is,  say,  positive,  and 
with  the  spring,  2,  during  the  second  half 
revolution  when  it  is  negative,  the  alternat- 
ing current  in  the  coil  is  thereby  rendered 
unidirectional  in  the  external  circuit.  Such 
a device  is  called  a commutator. 

Part  of  the  electricity  generated  by 
a dynamo  is  made  to  traverse  a coil  sur- 
rounding the  magnet,  thereby  increasing 
its  magnetism. 

A dynamo  is  a machine  by  which  rotary 
motion  between  the  poles  of  a magnet  is 
made  to  generate  electric  currents.  If  the 
action  is  reversed,  and  an  electric  current  is 
sent  through  the  coils  of  wire  between  the 
magnetic  poles,  it  sets  up  rotary  motion  in 
the  coils.  Such  a revers^  dynamo  is  called 
an  electric  motor. 

^Vllen  it  is  desired  to  convert  the  high- 
voltage  street  ciu’rent  into  a current  of,  say. 


berries,  resorcin,  carbolic  acid,  naphthalene, 
creosote,  and  the  salicylates. 

Melena. — See  Meltena. 

Membranous  Colitis. — See  Colitis,  Mu- 
cous. 

Meniere’s  Disease. — See  Part  7,  Ear 

Diseases. 

Meningeal  Hemorrhage. — See  Apoplexy'; 
Concussion,  etc.,  of  the  Brain;  H$matorrha- 
chis;  and  Hemorrhage,  Intracranial  in  the 
New-Born. 

Meningitis,  Acute  Cerebrospinal. — Gr. 

$ membrane  -b  -ins  inflammation.  The 
common  sjunptoms  of  acute  meningitis  are 
as  follows — severe  headache,  neuralgic  pains, 
and  general  hyperjEsthesiiE;  vomiting;  re- 
tracted abdomen;  usuall}'  pyrexia;  rigidity 
of  the  neck  and  extremities  and  retraction 
of  the  neck;  flexion  of  the  joints;  irritability, 
delirium,  grinding  of  the  teeth,  muscular 
twitching,  perhaps  convulsions;  localized 
paral>"ses,  e.g.,  strabismus,  ptosis,  slight 
facial  paralysis,  etc. ; stupor,  coma. 

One  must  remember  that  simple  congestion 
of  the  meninges,  without  inflammation  (men* 
ingism)  may  produce  the  above  symptoms. 
Perform  lumbar  puncture  for  diagnostic  pur- 
poses (see  under  Cerebrospinal  Fever  for  the 
technique  of  performing  lumbar  puncture. 


MENINGITIS,  CHRONIC 


and  of  preparing  and  staining  smears).  The 
presence  of  turbidity  is  pathognomonic  of 
meningeal  inflammation.  In  tuberculous 
meningitis,  however,  the  fluid  is  usually  clear, 
and  contains  a predominance  of  lymphocytes. 
An  excess  of  lymphocjdes  is  said  to  be  indica- 
tive of  chronic  cerebrospinal  irritation.  It 
occiu-s  also  in  poliomyelitis,  syphilis,  brain 
tumor,  venous  thrombosis,  late  meningo- 
coccus infection,  dementia  paralytica,  and 
tabes.  Polymorphonuclear  leucocytes  pre- 
dominate in  other  forms  of  acute  meningitis 
than  the  tuberculous.  Stained  smears  from 
the  sediment  of  the  centrifugalized  spinal 
fluid  (see  under  Cerebrospinal  Fever)  and 
cultures  should  be  made.  Organisms  are 
not  always  found;  but  an  excess  of  leuco- 
cytes is  significant.  The  tubercle  bacillus 
may  be  demonstrated  by  the  inoculation  of 
a guinea  pig  with  the  centrifugalized  fluid. 
The  tuberculin  test  is  also  of  service. 

Prognosis.— This  is  very  bad,  except  in  epi- 
demic cerebrospinal  fever  {q.v.).  Death 
usually  occurs  in  about  two  weeks  or  less; 
in  tuberculous  meningitis,  about  six  weeks. 
Very  rare  cures  have  been  reported,  how- 
ever, in  tuberculous  meningitis. 

Etiology. — Bacterial  causes  are  the  menin- 
gococcus (see  Cerebrospinal  Fever),  tubercle 
bacillus,  pneumococcus,  streptococcus,  sta- 
phylococci, bacillus  influenzae,  spirochseta 
pallidum;  and  rarely  the  following:  Fried- 

lander’s  bacillus  pneumoniae,  bacillus  typho- 
sus, bacillus  coli,  gonococcus,  bacillus  mallei, 
and  bacillus  pestis. 

All  varieties  of  meningitis,  except  that 
caused  by  the  meningococcus,  and  some- 
times the  pneumococcus,  are  practically 
always  secondary  and  not  primary  affections. 
The  primary  etiological  factors  are  cranial 
traumatism,  acute  infectious  diseases  (ery- 
sipelas, septicaemia,  pneumonia,  rarely  scar- 
let fever,  measles,  influenza,  typhoid  fever, 
smallpox,  mumps,  gonorrhoea,  diphtheria, 
anthrax,  actinomycosis,  etc.),  otitis  media, 
nasopharyngeal  disease  and  sinusitis,  acute 
myehtis,  myelomalacia,  malignant  disease, 
sunstroke,  alcoholic  and  other  intoxications. 
Meningitis  also  occurs  as  a terminal  infec- 
tion in  chronic  nephritis,  heart  disease,  gout, 
arteriosclerosis,  and  the  wasting  diseases 
of  children. 

Treatment. — Enjoin  absolute  rest  in  a quiet, 
darkened  room,  and  great  gentleness  in 
handling  the  patient.  Open  the  bowels  with 
calomel,  followed  by  a saline,  and  secure 
a daily  bowel  movement  thereafter,  by 
means  of  salines,  if  necessary,  for  the  pur- 
pose of  relieving  meningeal  congestion.  Clip 
the  hair,  and  apply  an  ice-cap  to  the  head, 


and  if  deemed  advisable,  an  ice-bag  to 
the  spine.  Concentrated  liquid  nourishment 
should  be  administered  every  two  or  three 
hours,  and  water  given  freely.  Gavage  (see 
under  Dyspepsia  and  Inanition)  is  some- 
times required.  Guard  against  bed-sores 
{q.v.). 

For  the  relief  of  pain,  irritability,  restless- 
ness, and  delirium,  employ  every  two,  three, 
or  four  hours,  hot  packs  or  hot  baths  at  a 
temperature  of  100°  to  110°  F.,  for  five  to 
twenty-five  minutes  at  a time,  with  an  ice- 
cap to  the  head  during  the  bath.  Trional, 
chloral,  the  bromides,  pyramidon,  phenac- 
etin,  antipyrin,  codeine,  and  morphine 
may  be  used  with  discretion  when  deemed 
advisable.  (For  drug  formulae,  etc.,  see 
Part  11.) 

Potassium  iodide,  the  perchloride  of  iron, 
and  corrosive  sublimate  (gr.  to  }/q, 
hypodermically,  each  day)  for  adults,  and 
unguentum  Crede  for  children,  are  recom- 
mended in  large  doses.  Hexamethylenamin 
or  urotropin  is  supposed  to  liberate  formal- 
dehyde in  the  cerebrospinal  fluid.  It  is  given 
in  doses  of  gr.  x every  four  hours,  even  to 
young  children;  to  adults,  3i  a day.  But 
since  it  is  stated  that  urotropin  liberates 
formaldehyde  only  in  an  acid  medium, 
whereas  helmitol  can  liberate  the  antiseptic 
in  an  alkaline  medium,  the  latter  drug  should 
be  preferable. 

Lumbar  puncture  is  of  service  as  a 
therapeutic  measure,  both  for  drainage 
and  for  the  relief  of  pressure  symptoms 
(headache,  etc.). 

Meningitis  secondary  to  otitis  media, 
sinusitis,  and  traumatism,  requires  surgi- 
cal treatment. 

See  Cerebrospinal  Fever  for  the  special 
treatment  of  this  variety  of  meningitis. 

Meningitis,  Basilar.  — See  Tuberculous 
Meningitis,  and  Tuberculosis,  Acute  Miliary. 

Meningitis,  Chronic. — The  symptoms  of 
chronic  meningitis  are  similar  to  those  of 
acute  meningitis  (q.v.),  but  they  are  chronic, 
and  pyrexia  is  not  apt  to  be  present. 
A circumscribed  collection  of  subarachnoid 
fluid  may  press  upon  the  cord  producing 
symptoms  of  tumor. 

The  commonest  cause  of  chronic  menin- 
gitis is  syphilis;  and  the  next  most  frequent 
cause,  tuberculosis.  Other  causes  are  chronic 
alcoholism,  traumatism,  compression  of  the 
cord,  exposure,  overexertion,  and  the  causes 
of  acute  meningitis  (q.v.). 

A chronic  thickening  of  the  meninges, 
especially  in  the  cervical  region,  sometimes 
occurs,  causing  compression  of  the  nerve 
roots  and  cord,  with  the  following  symp- 


MIGRAINE:  HEMICRANIA 


toms:  neuralgic  nerve-root  pains,  followed 
by  paralyses  in  the  arms,  and  finally  spastic 
paraplegia.  The  affection  is  called  hyper- 
trophic ceiwical  pachymeningitis,  and  is 
commonly  due  to  syphilis,  sometimes,  per- 
haps, to  traumatism,  exposure,  or  over- 
exertion. It  is  curable.  Examine  the  neck 
for  Pott’s  disease,  in  order  to  exclude  tuber- 
culous meningitis. 

Treatment. — Prescribe  a nutritious  diet, 
tonics,  good  hygiene,  hot  baths,  and  mas- 
sage. Employ  analgesics  for  pain,  and  the 
thermocautery  for  pain  and  stiffness.  Mer- 
cury and  iodide  are  recommendetl  for  non- 
syphilitic as  well  as  for  syphilitic  cases.  For 
the  hypertroj)hic  pachymeningitis,  give 
iodide  in  increasingly  large  closes. 

Meningitis,  Serous. — See  tinder  Hydro- 
cephalus. 

Meningocele,  Cerebral. — Gr.  iir^vLy^  mem- 
brane -f  K7]\r]  tumor  or  hernia.  A congeni- 
tal hernial  protrusion  of  the  brain  mem- 
branes through  an  opening  in  the  skull.  If 
the  meningeal  sac  contains  a portion  of  the 
brain,  the  hernia  is  called  an  encephalocele. 
If  the  latter  contains  a cavity  filled  with 
fluid  communicating  with  the  lateral  ventri- 
cles, the  anomaly  is  called  a hydrencephalo- 
cele  (Gr.  v5a>p  water  -t-  kyKecpaXos  brain  + 
KoiXos  hollow). 

A meningocele  is  fluctuant  and  translu- 
cent, and  sometimes  pulsates;  it  swells  when 
the  child  cries,  and  slowly  increases  in  size 
after  birth.  An  encephalocele  is  neither 
fluctuant  nor  translucent,  but  it  always 
pulsates.  Both  these  tumors  are  usually 
reducible,  but  marked  pressure  symptoms 
are  thereby  produced,  e.g.,  slowing  of  the 
pulse,  respiratoiy  disturbance,  vomiting, 
convulsions,  unconsciousness,  etc.  A hy- 
drencephalocele  is  fluctuant,  it  may  be  some- 
what translucent,  but  it  is  irreducible,  and 
compression  rarely  causes  sjmiptoms. 

Treatment. — Most  cases  die  within  a few 
weeks  from  meningitis,  con\oilsions,  or  rup- 
ture. A very  few  recover  sjtontaneously 
and  equally  few  as  a result  of  operation. 

In  meningocele  the  sac  may  be  closed  at 
its  })odicle  and  removed,  care  being  taken  to 
avoid  any  sudden  loss  of  cerebrospinal  fluid, 
(’hronic  hydrocele,  however,  often  follows. 

In  encephalocele,  if  small,  the  cerebral 
protub(‘rance  may  be  ix'duced  or  am])utated, 
and  the  defect  in  the  skull  closed  by  a flap 
of  bone  and  periosteum,  or  of  periosteum 
alone,  or  of  scalp  alone. 

A hydrencephalocele  should  merely  be 
protected  by  a pad. 

Meningocele,  Spinal. — See  Spina  Bifida. 

Meningomyelitis.^ — See  Myelitis. 


Meningomyelocele. — Gr.  mem- 

brane -f  /jiveXos  marrow  KnXt]  tmnor.  See 
Spina  Bifida. 

Meralgia  Paraesthetica. — Gr.  p.r]p6s  thigh 

aXyos  pain;  Trapd  beside  -|-  aiaOgai.^  sensa- 
tion. An  affection  of  the  external  cutaneous 
nerve  of  the  thigh,  characterized  by  burning, 
tingling,  and  stabbing  pains,  or  perhaps 
only  numbness,  and  tenderness  or  anaes- 
thesia, over  the  outer  surface  of  the  thigh, 
relieved  by  lying  down  and  by  flexion  of  the 
thigh.  The  anterior  crural  nerv^e  supplying 
the  front  of  the  thigh  is  in  rare  instances  the 
nerve  affected. 

Etiology. — Traumatism;  prolonged  sitting, 
standing,  walking,  or  climbing;  pressure  of 
corsets;  flat  foot;  intermittent  claudication; 
pregnancy;  neuritis;  tumor;  alcohol;  gout; 
diabetes;  obe.sity;  syphilis;  tabes;  general 
paresis;  haematomyelia. 

Treatment.— Attend  to  the  cause.  Useful 
palliative  mea.sures  embrace  massage,  elec- 
tricity, the  Paquelin  cautery,  and  the  appli- 
cation of  a 10  per  cent,  alcoholic  solution  of 
menthol.  Ionic  medication  may  be  of  ser- 
vice (see  under  Inflammation). 

As  a last  resort,  thenercemayberesected  as 
it  passes  under  Poupart’s  ligament  just  inter- 
nal to  the  anterior  superior  spine  of  the  ilium. 

Metatarsalgia. — See  Part  10,  Orthopaedics. 

Mercury  Poisoning. — I.  Acute  Poisoning, 
(see  under  Poisoning). 

II.  Chronic  Poisoning. — Chronic  mercury  poi- 
soning occurs  in  workers  in  mercurj"  mines 
and  smelters,  thermometer,  barometer,  and 
felt  hat  factories,  etc.,  and  is  character- 
ized by  tremor,  especially  intense  under 
emotion,  often  ptyalism  and  gingivitis, 
and  a tendency  to  a subjectively  embarass- 
ing  nervousness. 

Prophylaxis. — Thorough  ventilation ; 

thorough  cleanliness;  use  of  rubber  gloves, 
hoods,  and  adequate  covering  of  mer- 
cury containers. 

Treatment. — Potassium  iodide ; give 
frequent  hot  baths;  open  air  exercise; 
abundant  diet;  abstention  from  alcohol  and 
other  exce.sses. 

Recovery  is  the  rule. 

Meteorism. — Gr.  ptrewpL^eiv  to  raise  up. 
See  Tympanites. 

Methajmoglobinsemia.  • — IMethaemoglobin 
+ at  pa  blood.  See  Cyanosis;  and  Intestinal 
Intoxication. 

Micturition. — L.  micturir'e,  to  urinate. 
See  Urination. 

Migraine;  Hemicrania. — Fr.  migraine;  Gr. 
i)PL  — half  -|-  Kpavia  skull.  Perioclical  head- 
ache, localized,  general,  unilateral,  or  bilat- 
eral, lasting  for  minutes,  hours,  or  days, 


MILIARY  FEVER;  SWEATING  SICKNESS 


usually  associated  with  or  preceded  by 
flashes  and  specks  of  lij^ht,  scotomata  or 
hemianopia,  mental  confusion,  tlizziness, 
perhaps  aphasia  (when  the  hemianopia  is 
on  the  right  side  in  right-handed  persons), 
paraesthesias  and  anaesthesias,  chilliness, 
depression,  pallor  (followed  by  flush  when 
the  headache  begins),  etc.,  and  often  termi- 
nating in  nausea  and  vomiting. 

Transient  ophthalmoplegia  and  other 
palsies  may  occur,  due  without  doubt  to 
arteriospasm.  Prodromal  symptoms  some- 
times occur  without  subsequent  headache. 
The  pain  is  increased  by  afferent  impulses, 
such  as  light,  noise,  etc. 

The  affection  is  probably  of  vaso-motor 
origin,  i.e.,  due  to  a paroxysmal  arteriospasm. 
It  usually  chsappears  after  middle  age. 

Etiology.— Hereditary  predisposition;  reflex 
irritation,  due  to  eyestrain,  adenoids,  nasal 
disease,  menstruation,  dysmenorrhoea,  con- 
stipation; dietary  faults  (alcohol,  excess  of 
fats  or  of  carbohydrates,  tea,  coffee,  certain 
articles  of  food  in  some  individuals;  gastro- 
intestinal intoxication;  missing  of  a meal); 
physical  and  mental  weariness;  worry;  arter- 
iosclerosis; plumbism;  gout;  obesity;  chronic 
nephritis;  malaria;  tabes;  general  paresis; 
brain  tumor  or  gumma;  shock;  exposure  to 
cold;  bad  air;  tobacco.  See  Headache,  for 
all  its  causes. 

Treatment.— During  an  attack,  put  the 
patient  to  bed  in  a quiet,  dark  room,  with 
hot  bottles  to  the  feet,  and  either  cold  or 
hot  applications  to  the  head.  Menthol  may 
be  rubbed  on  the  forehead. 

Prescribe  an  analgesic,  viz., — 

Phenacetin  or  antipyrin,  gr.  v-x,  with 
salol  or  aspirin,  gr.  v-x,  in  powder  form, 
repeated  if  necessary. 

Flext.  cannabis  indicae,  gtt.  i,  every  half 
to  one  hour,  imtil  relieved  (2  to  10  drops, 
even  5i,  may  be  required).  It  is  said  to  be 
the  best  remedy. 

Flext.  gelsemis,  nji-v,  every  four  hours, 
as  required. 

Codeine,  gr.  3^  to  3^,  every  three  or 
four  hours. 

Morphine,  gr.  3^  to  3<t,  with  atropine, 
every  three  or  four  hours. 


Ammonii  bromidi gr.  xx 

Caffeinae  citratis gr.  i 

Antipyrinaj gr-  x 

Spiritus  ainmonicB  aromatic! ....  x-xx 
(Sachs.) 


Other  relief  measures  include  a very  hot 
bath,  a hot  mustard  foot  bath,  a mustard 
poultice  (Part  11)  or  dry  cup  {q.v.)  to  the 
back  of  the  neck,  vibratory  massage, 
and  galvanism  (see  Medical  Electricity.) 


Soon  after  giving  the  analge.sic,  administer 
a brisk  saline  purge.  A copious  hot  saline 
enema  is  of  value. 


Sodii  phosphatis  exsiccati 5iv 

Sodii  sulphatis  exsiccati 3-x 

Sodii  salicylatis 3ii 


Mix,  triturate,  and  cork  tightly. 

Sig. — One  teaspoonful  in  a large  tumbler  of  hot 
or  cold  seltzer  water,  on  rising.  (Starr.) 

After  the  attack  is  over,  examine  into  the 
cause.  Enjoin  good  hygiene,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  regu- 
lar hours  of  eating  and  sleeping,  rest  before 
and  after  eating,  regular  bowel  activity,  a 
daily  warm  bath  in  a warm  room  followed 
by  a cold  spinal  douche,  a glass  of  water 
containing  about  a quarter  of  a teaspoonful 
of  sodium  bicarbonate  (or  a glass  of  Vichy) 
one  hour  before  each  meal,  and  a plain 
bland  diet.  Cases  associated  with  obesity 
may  be  cured  by  dieting  (see  Obesity, 
Such  tonics  as  arsenic  and  nux  vomica  may 
be  of  benefit  in  appropriate  cases  (see  Part 
11  for  drugs.) 

Sachs  recommends  as  a preventive 
the  following: 


Sodii  salicylatis gr.  v-x 

Sodii  bromidi gr.  x-xx 

Aquie 5ss-i 


M.  Sig. — One  or  two  tablespoonfuls,  well  diluted, 
t.i.d.p.c.;  or  aspirin  or  novaspirin,  gr.  xv,  three  or 
four  times  a day. 

Mikulicx’s  Disease. — A chronic,  painless, 
symmetrical  enlargement  of  the  lachiymal 
and  salivary  glands,  of  unknown  cause. 

Employ  the  X-rays  {q.v.)  together  with 
the  combined  administration  of  arsenic  and 
iodide  (see  Part  11)  in  full  doses. 

Miliary  Fever;  Sweating  Sickness. — L. 
miliar'is,  like  a millet  seed.  An  acute  infec- 
tious epidemic  disease  of  Europe,  possibly 
transmitted  by  the  fleas  of  field-mice,  char- 
acterized by  fever  of  sudden  onset,  marked 
sweating,  rapid  heart  action  and  palpita- 
tions, respiratory  distress,  insomnia,  epi- 
gastric pain,  and  constipation,  with  the 
appearance  on  the  third  or  fourth  day  of  an 
erythemato-papulo-vesicular  or  sudaminal 
rash,  followed  by  a slow  recovery,  frequently 
interrupted  by  relapses.  Desquamation 
follows  the  rash.  Rapid  death  some- 
times occurs. 

Treatment.— Isolate  the  patient  (see  Disin- 
fection). Put  him  to  bed  between  blankets 
in  a well-ventilated  room.  See  that  the 
bed-covering  is  light  and  that  the  body  is 
kept  dry.  The  diet  should  be  liquid,  and 
water  should  be  drunk  freely.  Cool  baths, 
sponging,  or  packs,  are  indicated  for  high 


MOTOR  NERVES  OF  THE  EYEBALL 


fever,  nervous  symptoms  and  insomnia  (see 
Fever);  morphine  for  tumultuous  heart 
action;  the  ice-bag  or  mustard  plaster  for 
pain. 

Prescribe  tonics  during  convalescence, 
e.g.,  iron,  arsenic,  strychnine  (see  Part  11). 

Infected  houses  should  be  quarantined 
for  at  least  two  weeks,  and  then  fumigated 
(see  Disinfection.) 

Miliary  Tuberculosis.^ — See  Tuberculosis, 
Acute  Miliary. 

Milk  Poisoning. — See  Poisoning. 

Milk  Sickness. — (Called  “ The  Trembles” 
in  cattle.)  A rare  serious  disease,  caused  by 
the  ingestion  of  the  milk,  butter,  cheese,  or 
flesh  of  infected  cattle,  and  characterized 
by  drowsiness,  sometimes  irritability,  ano- 
rexia, persistent  vomiting,  swollen  tongue, 
sweetish  odor  of  the  breath,  great  thirst, 
extreme  constipation,  little  or  no  fever, 
sometimes  convulsions.  Convalescence  is 
slow.  Death  often  occurs. 

Treatment. — Put  the  patient  to  bed,  and 
purge  freely  with  calomel  followed  by  salines 
(see  Part  11).  Employ  alcoholic  sthnula- 
tion,  when  required. 

Give  tonics,  such  as  the  elixir  ferri,  qui- 
ninae,  et  strychninae  phosphati,  3i,  well 
diluted,  t.i.d.,  during  convalescence. 

Milroy’s  Disease;  Persistent  Hereditary 
(Edema  of  the  Legs. — See  under  (Edema. 

Mimic  Spasm. — See  Habit  Spasm. 

Mind=Blindness. — See  Aphasia. 

Mind=Deafness. — See  Aphasia. 

Morphinism. — The  morphine  habit  is  best 
treated  by  isolation  in  an  institution.  The 
drug  should  not  be  withdrawn  abruptly,  but 
it  should  be  gradually  reduced,  usually  by 
one-half  or  one-third  each  day.  For  the  first 
seven  to  ten  days,  the  patient  is  j)erhaps  best 
in  bed.  Free  catharsis  is  essential.  Castor 
oil,  5ss,  t.i.d.,  for  the  first  seven  to  ten  days 
is  advised  (Lambert).  For  heart  weakness, 
administer  cUgitalis  (Part  11)  every  four 
hours,  or  aromatic  spirits  of  ammonia;  but 
return  to  morphine  if  collapse  occurs.  For 
the  relief  of  depression,  nervousness,  and 
insomnia  tluring  the  withdrawal,  give  the 
bromides,  as  much  as  5ii~iv  if  necessaiy, 
in  twenty-four  hours,  well  diluted,  together 
with  ergot  (Lambert;  see  Alcoholism).  Ergot 
reduces  the  cerebral  venous  congestion  which 
morphine  produces.  Hy'oscin  may  be  re- 
quired. A warm  bath  followed  by  a rub- 
down  and  a warm  bed  relieves  nervousness. 
The  cold  pack  is  recommended  for  insomnia. 
Electricity  (q.v.)  and  massage  may  be  of 
service. 

Feed  the  patient  eveiy  two  hours  with 
beef  juice,  broths,  koumyss  (Part  11),  and 


eggs.  Give  a carbonated  water  (Vichy  or 
Apollinaris)  for  nausea. 

R Tincturae  cap.sici  ....  3ii-iv  (njx-xx  per  dose) 
Tinctursc  zingiberis. . 3ii-Siss  (itjx- 5 i per  dose ) 
Tincturae  c i n c h o n ae 
compositae,  q.s.,  ad.  5iv 

M.  Sig. — Two  teaspoonfuls  in  water,  3 to  4 times 
a day,  as  a tonic  and  digestive. 

Strychnine  is  said  to  intensify  the  absti- 
nence symptoms;  but  after  all  morphine  is 
out  of  the  system,  it  should  be  given  in  full 
doses  (see  Part  11)  as  a general  stimulant 
and  tonic. 

The  patient  must  be  constantly  watched 
so  that  he  can  not  procure  morphine  or  com- 
mit suicide,  and  after  convalescence  he 
should  be  watched  to  prevent  a relapse. 

Try  to  correct  the  cause  of  the  habit, 
e.g.,  neuralgia,  insomnia,  etc.;  but  the  usual 
cause  is  the  euphoria  which  the  drug  affords. 

Motor  Nerves  of  the  Eyeball.— The  Third 
or  Oculomotor  Nerve  supplies  the  levator 
palpebrae  superioris  muscle,  the  superior, 
internal,  and  inferior  recti,  the  inferior 
oblique,  the  ciliary  muscle,  and  the  con- 
strictor iridis.  Paralysis  of  all  these  muscles 
results  in  external  strabismus,  diplopia, 
ptosis,  loss  of  accommodation,  and  loss  of 
the  pupillary  reaction  to  light. 

The  Fourth  or  Trochlear  Nerve  supplies 
the  superior  oblique  muscle.  Paralysis  of 
this  muscle  results  in  difficulty  in  looking 
downward  and  inward,  and  diplopia  on 
looking  down. 

The  Sixth  or  Abducens  Nerve  supplies 
the  external  rectus  muscle,  paralysis  of 
which  results  in  internal  strabismus,  inabil- 
ity to  turn  the  eye  outward,  and  diplopia 
on  looking  outward. 

Causes  of  Paralysis  of  the  Motor  Nerves  of  the 
Eyeball. — A.  AcuTE — Poisoning  with  alcho- 
hol,  tobacco,  lead,  sulphuric  acid,  gelsemium, 
conium,  chloral,  carbon  monoxide,  fish,  and 
meat;  acute  infectious  diseases  (diphtheria, 
influenza,  measles,  pertussis,  herpes  zoster, 
acute  poliomyelitis,  “ cold,”  mumps,  tonsil- 
litis, basal  meningitis);  orbital  cellulitis; 
tenonitis;  sinusitis;  fracture;  basal  hemor- 
rhage or  abscess;  cerebral  hemorrhage 
or  injuiy. 

B.  Chronic. — Syphilis;  tabes  (frequently 
ushered  in  by  transitory  and  recurrent  ocu- 
lar paresis);  general  paresis;  progressive 
muscular  atrophj"  (bulbar  paralysis) ; multi- 
ple sclerosis;  myasthenia  gracds;  hj’Bteria; 
exophthalmic  goitre;  gout;  rheumatism;  dia- 
betes; orbital  periostitis;  tumors;  basal 
hemorrhage,  meningitis,  abscess,  or  aneur- 
ysm; cavernous  sinus  disease.  (For  all  the 
causes  of  ptosis,  see  Part  6). 


MULTIPLE  SCLEROSIS 


Causes  of  Spasm.— Hysteria;  meningitis  or 
other  irritative  affections  of  the  brain; 
reflex  irritation  from  decayed  teeth  or  intra- 
nasal disease;  tetanus;  etc.  (See  Eye  Dis- 
eases, Part  6). 

Paralysis  of  the  fourth  and  sixth  nerves 
is  usually  due  to  “ cold  ” (Theobald) ; to  the 
rheumatic  poison  or  diabetes  (Wood  and 
Woodruff);  often  to  influenza. 

Paralysis  of  the  third  nerve  is  usually  due 
to  syphilis  or  “ rheumatism.” 

Periodic  ocular  paralysis  with  headache 
and  often  vomiting  (ophthalmoplegic 
migraine)  may  be  due  to  hysteria,  to  arterio- 
spasm  (see  Migraine),  or  to  a circumscribed 
exudate  or  small  tumor  at  the  base  of  the 
brain,  pressing  upon  the  nerve-tract. 

Conjugate  paralyses,  manifested  by  ina- 
bility to  look  with  both  eyes  conjointly  to 
the  right  or  left,  or  up  or  down,  etc.,  are  due 
to  lesions  (usually  cerebral  hemorrhage, 
sometimes  hysteria)  involving  the  centres 
for  the  associated  movements  of  the  eyes. 
(In  conjugate  spasm,  although  the  eyes  are 
strongly  deviated  in  one  direction,  they  can 
be  moved  in  the  opposite  direction.) 

In  paralytic  or  paretic  squint,  the  latter 
increases  when  the  eye  is  turned  toward  the 
paralyzed  muscle,  by  which  it  is  distin- 
guished from  the  ordinary  concomitant 
squint,  due  usually  to  refractive  anomalies, 
in  which  the  squinting  eye  follows  all  the 
movements  of  the  fixing  eye,  maintaining 
always  the  same  angle  with  it.  Paralytic 
squint  of  long  duration,  however,  in  which 
the  antagonist  of  the  paralyzed  muscle  is 
contractured,  can  scarcely  be  distinguished 
from  concomitant  squint.  “ Indeed,”  says 
Duane,  “ many  cases  of  concomitant  squint 
are  without  doubt  paralytic  in  origin.” 
(See  Part  6,  Eye  Diseases). 

Treatment. — In  acute  cases  with  pain 
apply  to  the  temple  heat,  counter-irritation, 
or  the  artificial  Heurteloup  leech.  Where 
“ cold  ” or  “ rheumatism  ” is  the  supposed 
cause,  prescribe  potassium  iodide,  gr.  v-x, 
well  diluted,  t.i.d.p.c.;  or  sodium  salicylate 
(for  drug  formulae  see  Part  11).  Diaphoresis 
should  be  encouraged  by  means  of  blankets, 
hot  bottles,  and  copious  hot  drinks. 
Syphilitic  cases  call  for  specific  treatment. 
Arsenic  is  recommended,  no  matter  what 
the  cause.  In  order  to  obviate  the  annoy- 
ing diplopia  and  resulting  dizziness,  cover 
the  affected  eye  with  an  opaque  glass,  or 
use  prisms. 

After  the  acute  symptoms  have  subsided, 
prescribe  strychnine,  or  nux  vomica  in 
ascending  doses;  and  employ,  if  desired, 
the  galvanic  current — the  cathode  over  the 


closed  lid  and  the  anode  over  the  temple, 
using  a very  weak  current,  1 to  1)/^  milliam- 
peres,  for  five  minutes  daily. 

If  the  paralysis  proves  incurable,  perform 
tenotomy  of  the  opposing  muscle,  or  ad- 
vancement (resecting  a large  portion  of  the 
tendon)  of  the  paralysed  muscle,  or  both. 

The  Prognosis  in  both  syphilitic  and  rheu- 
matic cases  is  favorable. 

Mountain  Sickness. — The  occurrence, 
during  exertion  in  high  altitudes,  of  rapid 
heart  action,  palpitation,  dyspnoea,  cyanosis, 
nausea,  headache,  weakness,  etc.,  and  per- 
haps syncope;  these  symptoms  subsiding 
with  rest. 

Mouth,  Dry. — See  Aptyalism. 

Mouth,  Inflammation  of  the. — See  Sto- 
matitis. 

Ulcer  of  the. — See  Stomatitis. 

Movable  Kidney. — See  Splanchnoptosis, 
Spleen. — See  Splanchnoptosis. 

Mucous  Colitis.— ^ee  Colitis,  Mucous. 

Multiple  Myelomata  of  the  Bones;  Lym= 
phadenia  Ossea. — Gr.  uveXos  marrow  -|-  -wna 
tumor;  L.  lympha,  water  or  lymph  -|-  Gr. 
adrjv  gland;  L.  os,  bone.  A rare,  malignant, 
fatal,  multiple  primary  tumor  of  the  bone- 
marrow,  diagnosed  by  the  presence  of 
Bence-Jones’  proteid  (albumose)  in  the 
urine  (see  Urinalysis),  the  X-ray  (q.v.),  a 
negative  Wassermann  reaction,  and  the  his- 
tological examination  of  an  excised  node. 

Multiple  Neuritis . — See  Neuritis, 
Multiple. 

Multiple  Sclerosis. — Gr.  cr/cXiypwrijs  hard- 
ness. Syn. — Disseminated  Sclerosis;  Insu- 
lar Sclerosis;  Fr.  Scle'rose  en  plaques.  A not 
uncommon  chronic  affection  of  the  central 
nervous  system  of  unknown  cause,  charac- 
terized anatomically  by  scattered  areas  of 
sclerosis  in  which  the  nerve  elements  are 
replaced  by  neuroglia,  and  clinically  by  the 
following  variable  S3rmptomatology ; usually 
motor  weakness  of  variable  severity,  later 
paraly.sis;  usually  spasticity,  often  combined 
with  sphincteric  trouble,  the  Babinski  re- 
flex; often  more  or  less  ataxia;  commonly 
parsesthesise;  often  volitional  or  intention- 
tremor;  nystagmus;  often  scanning  speech 
(slow,  measured,  syllabic,  monotonous) ; 
often  headache,  vomiting,  giddiness,  trans- 
ient amblyopia;  transient  diplopia  due  to 
motor  nerve  paralysis,  scotomata,  optic 
atrophy;  sometimes  choked  disc.  The  varia- 
bility of  the  symptoms  is  due  to  the  hap- 
hazard distribution  of  the  plaques  or  islets 
of  sclerosis. 

The  affection  should  be  distinguished  from 
hysteria,  paraly.sis  agitans,  cerebrospinal 
syphilis,  general  paresis,  spastic  paraplegia. 


MYALGIA;  MUSCULAR  RHEUMATISM;  FIBROSITIS 


subacute  combined  sclerosis  of  the  cord, 
and  brain  tumor. 

Prognosis. — The  patient  may  live,  with 
remissions  and  relapses,  for  years,  but  he 
eventually  becomes  bed-ridden.  The  remis- 
sions, however,  may  be  marked  in  degree, 
and  prolonged. 

Treatment. — Enjoin  good  hygiene,  fresh 
air  day  and  night,  a nutritious  diet,  and  the 
avoidance  of  muscular  and  mental  fatigue 
and  worry.  Prescribe  arsenic  (see  Part  11) 
in  full  dosage  over  a prolonged  period.  The 
prolonged  use  of  silver  nitrate  and  the  X-rays 
(q.v.)  are  also  recommended. 

For  intermittent  urinary  incontinence, 
prescribe  tr.  belladonn:®,  npx  in  water,  once, 
twice,  or  thrice  a day;  employ  the  catheter 
if  the  incontinence  is  due  to  overflow  of  a 
distended  bladder. 

For  constipation  prescribe  liquid  paraffin 
and  cascara,  and,  if  need  be,  in  obstinate 
cases,  daily  enemata. 

For  troublesome  reflex  spasms,  give  sod- 
ium bromide,  and  belladonna,  and  employ 
hot  applications,*  massage,  and  passive 
movements,  and  in  severe  cases  of  spastic- 
ity, extension  by  means  of  a pulley  and 
weights  (Stewart). 


B Sotlii  bromidi gr.  x.x 

Tincturaj  belladonna; rjv 

Aquaj,  q.s.,  ad %ss 


M.  Sig. — One  tablespoonful,  once  to  thrice  a day, 
for  reflex  spasms. 

In  acute  exacerbations  the  patient  should 
be  put  to  bed.  In  bed-ridden  cases,  bed- 
sores iq.v.)  should  be  carefully  guarded 
against;  a water  mattress  should  be  used, 
if  practicable. 

The  disease  is  aggravated  following 
pregnancy,  therefore  the  latter  should 
be  avoided. 

Mumps;  Epidemic  Parotitis.— Gr.  kiri  on 
-\-8rjnos  people;  wapa  near  -f-ou?  ear  -|-  -ltls 
inflammation.  A common  endemic  and 
epidemic  infectious  and  contagious  non- 
suppurative parotitis,  with  a liability  to 
orchitis  in  the  male  and  mastitis  and  ovaritis 
in  the  female,  occurring  usually  in  children, 
in  whom  it  is,  as  a rule,  mild.  When  occur- 
ring in  adults,  however,  it  is  apt  to  be  very 
severe.  The  incubation  period  is  from  two 
to  three  weeks.  A diagnostic  sign  that  is 
said  to  be  pathognomonic  is  tenderness 
just  beyond  the  angle  of  the  jaw,  elicited 
on  running  the  finger  toward  the  angle 
under  the  mandible  (Hatchcock’s  sign). 
The  swelling  usually  subsides  in  about  ten 
days.  The  submaxillary  gland  is  sometimes 
alone  affected. 


Treatment.— Lsolate  the  patient,  and  put 
him  to  bed  on  liquid  or  soft  diet  with  an 
abundance  of  water;  no  fruits  or  acids. 
Open  the  bowels  with  calomel  followed 
by  a saline  (see  Part  11).  The  following 
local  measures  may  be  employed  for  the 
relief  of  pain  and  tension: — covering  with 
cotton  and  oil  silk;  hot  applications  changed 
every  twenty  to  thirty  minutes;  guaiacol,  5 
per  cent.,  in  glycerine  or  petrolatum;  ich- 
thyol  and  lanolin,  aa;  menthol  or  camphor, 
2 per  cent.,  in  lanolin;  oil  of  wintergreen, 
alone,  or  10  per  cent,  in  petrolatum;  ungu- 
entuni  belladonnae;  iodex  (Pigm.  iodi  M. 
and  J.),  gentle  inunction  every  two  hours,  is 
said  to  remove  all  swelling  and  signs  of 
inflammation  in  about  forty-eight  hours. 

The  oily  preparations  may  be  applied 
three  or  four  times  daily,  and  the  glands 
covered  with  cotton.  Orchitis  may  be 
treated  likewise.  The  inflamed  testicles 
should  be  supported  by  means  of  a wad  of 
cotton.  Should  the  pancreas  become 
affected,  make  hot  applications  to 
the  abdomen. 

An  alkaline  mouth-wash,  such  as  Dobell’s 
solution  iq.v.),  should  be  prescribed. 

During  convalescence,  give  an  iron  tonic. 
If  the  testicles  were  involved,  have  the  patient 
wear  a suspensory  bandage  on  getting  up. 

Quarantine  the  patient  for  three  weeks 
from  the  onset  of  the  sjanptoms.  Fumiga- 
tion is  unnecessary,  because  the  causal  agent 
is  short-lived. 

Muscular  Abscess. — See  Myositis. 

Atrophies,  The  Progressive. — See  Atro- 
phies, The  Progressive  Muscular. 

Dystrophy. — See  Dystrophy,  Progres- 
sive Muscular. 

Incoordination. — See  Ataxia. 

Inflammation. — See  Myositis. 

Rheumatism. — See  INIyalgia. 

Musculo=Cutaneous  Nerve.  — See  Bra- 
chial Plexus. 

Musculo=Spiral  Nerve.  — See  Brachial 
Plexus. 

Mushroom  Poisoning. — See  Poisoning. 

Mussel  Poisoning. — Bee  Poisoning. 

Myalgia;  Muscular  Rheumatism;  Fibro= 
sitis. — Gr.  plus  muscle  + aXyos  pain;  pevpaTia- 
pi'js;  L.  fi'bra,  fibre.  Under  this  caption  are 
considered  the  familiar  affections,  lumbago, 
dorsodynia,  pleurodynia,  scapulodjmia,  omo- 
dynia,  rheumatic  torticollis,  etc.  Myalgia 
may  be  acute  or  chronic.  Sometimes  pain- 
ful oedematous  indurations  occur. 

Etiology.— Exposure  to  cold  and  damp, 
especially  during  fatigue;  strain  or  overuse 
of  the  muscles;  influenza;  gout;  plumbism; 
arteriosclerosis;  nephritis;  anaemia;  dia- 


MYASTHENIA  GRAVIS 


betes;  chronic  alcoholism;  neurasthenia;  flat- 
foot;  varicose  veins;  too  soft  or  sagging  bed, 
causing  lumbago.  (See  Backache,  for  other 
causes  of  this  symptom  besides  lumbago.) 

1.  .Treatment  of  Acute  Myalgia. — If  taken  in 
the  very  beginning,  the  affection  may  perhaps 
be  aborted  by  a hot  relaxing  bath  and  a 
sweat  between  woolen  blankets,  encouraged 
by  means  of  quinine  and  salol  or  quinine 
and  aspirin,  aa  gr.  v,  or  Dover’s  powder, 
gr.  viii-x,  and  copious  water  tlrinking,  with 
one  tablespoonful  of  Rochelle  salts  to  open 
the  bowels  thoroughly.  U.seful  local  meas- 
ures include  the  application  of  very  hot 
flaxseed  poultices;  hot  ironing  over  flannel 
for  ten  to  fifteen  minutes;  exposure  to  a 32- 
candlepower  electric  light  in  a large  para- 
bolic reflector  for  about  ten  minutes  daily; 
acupuncture,  in  lumbago,  by  means  of  a 
sterilized  hatpin,  introduced  four  to  five 
inches,  and  allowed  to  remain  for  five  to  ten 
minutes;  deep  injections  of  nitroglycerin, 
atropine,  or  camphorated  oil  (see  Part  11); 
light  brushing,  six  to  eight  times,  with  the 
Paquelin  cautery;  galvanism  for  five  to  ten 
minutes,  using  the  anodic  roller  electrode; 
dry  cups  {q.v.)  left  on  for  fifteen  to  thirty 
minutes;  support  of  the  back,  in  lumbago, 
with  adhesive  straps,  or  a well-fitting 
ela.stic  binder;  .strapping  of  the  muscles  to 
procure  rest,  the  adhesive  straps,  in  pleuro- 
dynia, extending  from  the  spine  to  be- 
yond the  sternum,  and  applied  in  over- 
lapping layers  during  forced  expiration; 
rubbing  with  camphorated  oil,  turpentine 
liniment,  or  equal  parts  of  chloroform  and 
belladonna  liniments,  followed  by  a covering 
of  hot  cotton  and  a flannel  binder;  applica- 
tion, on  lint,  of  methyl  chloride;  application 
of  menthol,  or  of  unguentum  capsici. 

Analgesic  Drugs  Useful  in  Acute 
Cases. — Aspirin,  gr.  x,  followed  by  gr.  v 
every  hour  for  four  or  five  doses;  anti- 
pyrine  or  phenacetin,  gr.  v-x,  with  salol, 
gr.  v-x,  repeated,  if  necessary;  codeine,  gr. 
34,  phenacetin,  gr.  iii,  salol,  gr.  v.  (Croftan.) 


Sodii  .salicylatis gr.  x-xx 

Sodii  bicarbonatis gr.  v-x 

Aquai,  q.s.,  ad gi 


M.  Sig. — One  ounce,  well  diluted,  every  four 
hours. 

Morphine,  gr.  to  34,  hypodermically, 
only  as  a last  resort. 

2.  Treatment  of  Chronic  Myalgia. — Local  meas- 
ures: (1)  Gentle  vibratory  or  manual  massage 
at  first,  and  later  thorough  deep  massage 
(deep  kneading,  stroking,  and  hacking),  for 
twenty-five  to  thirty  minutes  twice  daily  for 
about  four  to  six  weeks;  (2)  strong  faradiza- 


tion or  the  use  of  the  sinusoidal  current; 
(see  Medical  Electricity) ; (3)  hot  sulphur  and 
mud  baths  (sod.  sulphide,  2 oz.,  sod.  chloride, 
2 oz.,  sod.  bicarb.,  1 oz.,  hot  water,  50  to  60 
gal.)  u.sed  with  discretion;  (4)  active  and  pas- 
sive exercises  (with  the  Zander  machines,  if 
practicable);  (5)  ionic  medication  (g.y.),  em- 
ploying at  the  negative  electrode,  which  is 
placed  over  the  seat  of  pain,  a hot  2 to  4 per 
cent,  solution  of  sodium  salicylate;  in  lum- 
bago each  electrode  should  measure  six  by 
eight  inches;  15  to  80  milliamperes  of  current 
for  fifty  to  sixty  minutes  (?)  is  recommended. 
A too  soft  or  sagging  bed  is  a frequent  cau.se 
of  lumbago,  which  .should  be  borne  in  mind. 

Drugs  Useful  in  Chronic  Cases. — 
Guaiacol,  gtt.  ii-iii,  in  capsule  or  pill,  p.c., 
increased  by  one  drop  daily  up  to  15  to  18 
drops  daily.  Vini  colchici,  njjxv  in  water, 
every  two  to  four  hours  for  8 to  10  doses, 
then  every  four  hours  for  three  or  four  days 
until  the  pain  is  relieved  or  toxic  effects 
appear,  e.g.,  naasea,  vomiting,  diarrhoea,  and 
cardiac  depression.  Potassium  iodide  {q.v.). 

Guaiaci  p'llveris.  . oi  (about  gr.  per  dose) 
Pulverig  rhei.  ...  oh  (about  gr.  iiss  per  do.se) 
Potassii  bitartratis  gi  (about  gr.  x per  dose) 
Sulphurisprecipitati  J ii  (about  gr.  xx  per  dose.) 
Mellis  purificati . . Oi 

Pulveris  Myristi 
cse i 

M.  Sig. — Shake  well,  and  take  two  large  tea- 
spoonfuls night  and  morning.  “The  Chelsea  Pen- 
sioner.” (Yeo.) 

II  Potassii  iodidi, 

Potassii  bromidi, 

aa giv  (about  gr.  v-vi  jjer  dose) 

Tincturse  colchici 

seminis giss  (about  ttjxx  per  dose) 

Syrupi  aurantu 

corticis g ii 

Aqua;,  q.s.,  ad gvi 

M.  Sig. — -One  teaspoonful  3 or  4 times  a day  or 
oftener  until  the  bowels  are  slightly  acted  upon. 
(C.  G.  Hollister.) 

As  tonics,  codliver  oil;  mix  vomica; 
arsenic,  (Part  11). 

A brief  course  of  starvation,  for  five  or 
six  days  or  longer,  with  or  without  the  free 
drinking  of  purgative  waters,  may  be 
of  value.  A change  of  climate  may 
be  desirable. 

Myasthenia  Gravis. — Gr.  muscle  -|- 

aadheca  weakness;  L.  gravis,  severe.  A rare 
disease  of  unknown  cause,  characterized  by 
rapid  fatigue  and  paresis,  on  exertion,  of 
any  or  all  of  the  voluntary  muscles,  particu- 
larly the  glosso-laryngo-labio-pharyngeal 
mu.scles  and  the  levator  palpebrse  (fatigue 
of  the  latter  causing  ptosis),  with  recovery 
during  rest. 

The  “ myasthenic  reaction  ” is  of  diag- 


MYELITIS 


nostic  importance.  It  is  a rapidly  diminish- 
ing response  to  the  rapidly  intermittent 
faradic  current,  (see  Medical  Electricity) 
with  recovery  after  several  minutes’  rest. 

Prognosis.— Recoveries  and  relapses  alter- 
nate. The  disease  is  often  fatal,  but  a cure 
is  possible. 

Treatment.— Enjoin  muscular  rest,  protec- 
tion against  cold,  and  an  abundant  soft  or 
finely  divided  diet  which  does  not  require 
fatiguing  mastication.  Strychnine  in  grad- 
ually increasing  doses  is  recommended; 
also  arsenic,  and  iron  as  tonics.  The  thyroid 
pituitary,  and  ovarian  extracts  may  be  tried 
experimentally  (for  all  drugs,  see  Part  11), 
also  alternate  courses  of  mercury  and  potas- 
sium iodide  (see  Syphilis). 

Search  for  a possible  source  of  infection 
or  intoxication. 

Myatonia  Congenita. — See  Amyotonia 
Congenita. 

Mycetoma;  Madura  Foot. — See  Part  5, 
Skin  Diseases. 

Mycotic  Stomatitis. — See  Stomatitis. 

Myelitis. — Gr.  ixveXds  marrow  -|-  -trts  in- 
flammation. Myelitis,  acute,  subacute,  or 
chronic,  is  an  inflammatory  affection  of  the 
gray  and  white  matter  of  the  spinal  cord. 
It  may  be  transverse,  diffuse,  or  dissem- 
inated. In  an  incomplete  transverse  lesion, 
there  occurs  an  atrophic,  flaccid  paralysis  of 
the  muscles  enervated  by  the  affected  cord 
segment  (see  under  Spinal  Cord  Localiza- 
tion), and  a spastic  paralysis  of  the  muscles 
lower  down,  with  the  Babinski  reflex.  If 
the  transverse  lesion  is  complete,  the  paral- 
ysis below  the  lesion  is  also  flaccid.  There 
are  sensory  (root  pains,  anaesthesia,  paraes- 
thesia,  hyperaesthesia),  trophic  (rapid  wast- 
ing, congested  skin,  localized  sweating, 
bullae,  arthritis,  etc.),  and  sphincter  disturb- 
ances, with  liability  to  bed-sores  and  cystitis. 
These  disturbances  distinguish  the  acute 
ascending  cases  from  Landry’s  paralysis, 
acute  poliomyelitis,  and  multiple  neuritis. 
Fever  is  present  in  the  infective  cases. 

Etiology. — Syphilis,  over-exertion,  exposure 
to  cold,  and  traumatism,  are  the  commonest 
causes.  Spinal  caries,  spinal  cancer,  and 
cord  tumors  are  occasional  causes.  Rare 
causes  are  the  infectious  diseases  (septico- 
pysemia,  gonorrhoea,  measles,  variola,  typhus 
fever,  etc.),  and  toxic  or  degenerative  agen- 
cies, viz.,  pregnancy,  alcoholism,  plumbism, 
ergotism,  lathyrism,  poisoning  with  mer- 
cury and  certain  gases,  diphtheria,  gout, 
anaemia,  diabetes,  etc. 

Prognosis. — This  depends  upon  the  nature 
of  the  case.  The  final  outcome  cannot  be 
foretold  until  some  time  after  treatment  has 


been  begun.  After  the  lapse  of  two  years,  no 
further  hnprovement  can  be  expected.  Of 
recent  years,  surgery  has  promised  much  in 
localizable  cases. 

Treatment. — Try  to  ascertain  the  cause, 
and  also  locate  the  site  of  the  lesion  (see 
Spinal  Cord  Localization).  Absolute  rest  on 
a water  or  air  bed  including  feeding  with  a 
spoon  and  the  use  of  the  bed-pan  and  urinal, 
is  of  first  importance.  Bed-sores  (q.v.) , should 
be  strictly  guarded  against.  In  the  presence 
of  fever,  the  diet  should  be  liquid. 

For  painful  cramps,  employ  hot  applica- 
tions, and  one  or  several  of  the  following 
sedative  drugs — pot.  bromide,  gr.  xx,  with 
tr.  belladonnse,  t^v,  in  water,  5 ss,  well 
diluted,  once  to  thrice  a day;  sul phonal, 
gr.  V,  three  to  four  times  a day;  phenacetin; 
antipyrine;  nitroglycerin;  hyoscine,  mor- 
phine (see  Drugs,  Part  11). 

For  urinary  incontinence,  employ  glass  or 
rubber  urinals  or  absorbent  cotton  fre- 
quently changed,  and  cleanse  the  parts 
frequently  with  a mild  antiseptic.  For 
urinary  retention,  employ  systematic  cathet- 
erization, with  an  occasional  irrigation  of 
the  bladder  with  warm  sterile  boric  acid 
solution,  5i  ad  Oi,  and  the  administration 
of  urotropin  for  the  prevention  of  c}'^stitis. 
Urotropin,  indeed,  is  advised  as  a spinal 
disinfectant;  but  helmitol  is  presupposedly 
preferable,  since  it  is  capable  of  liberating 
formaldehyde  in  an  alkaline  medium. 

Move  the  bowels  every  other  day,  if 
necessary,  by  means  of  liquid  paraffin 
and  cascara  or  enemata. 

If  ijregnancy  exists,  empty  the  uterus 
(see  Part  4,  Obstetrics).  Syphilitic  cases, 
of  course,  require  specific  treatment.  Potas- 
sium iodide  in  large  doses  for  a prolonged 
period  is  advised  also  in  nonsyphilitic  cases. 
For  spinal  caries,  spinal  support  is  indicated 
(see  Part  10,  Orthoptedics).  Vertebral  frac- 
tures and  dislocations  require  spinal  support 
or  operation,  (see  Part  10,  Orthopaedics). 

As  soon  as  acute  sjauptoms  have  sub- 
sided, begin  to  employ,  for  the  flaccid  mus- 
cles, massage,  electricity,  and  active  and 
passive  movements  (see  under  Poliomyelitis 
for  details).  Prolonged  hot  baths  and  pas- 
sive movements  are  serviceable  measures 
for  the  relief  of  spasticity.  Arsenic,  and  the 
elixir  ferri,  quininac,  et  strychninae  phosphati, 
5i,  well  diluted,  t.i.d.,  are  useful  tonics. 

Of  recent  years,  remarkable  results  have 
been  obtained  in  localizable  cases  by  a uni- 
lateral laminectomy,  wide  opening  of  the 
dura,  and  longitudinal  incision  of  the  pos- 
terior columns  of  the  cord;  in  other  words, 
spinal  decompression. 


MYOCARDITIS 


Myelomata,  Multiple,  of  the  Bones. — 

See  Multiple  Myelomata  of  the  Bones. 

Myocarditis.-^r.  nos  muscle  + Kapbia 
heart  + -cns  inflammation.  I.  Acute  My= 
ocarditis.— Acute  myocarditis  is  usually  par- 
enchymatous, very  rarely  interstitial  or  sup- 
purative. There  may  be  no  noticeable 
symptoms,  or  sudden  death  may  occur,  or 
the  following  manifestations  may  be  pres- 
ent, viz.,  tachycardia,  instability  of  the 
pulse,  and  low  arterial  tension  (see  Blood- 
Pressure),  particularly  after  exertion,  in- 
creased area  of  cardiac  dulness,  muffled  first 
sound  and  diminished  sharpness  of  the 
second  sound,  perhaps  a systolic  murmiu" 
due  to  muscular  insufficiency,  perhaps  some 
cyanosis  or  pallor,  perhaps  precordial  pain, 
perhaps  vomiting,  perhaps  restlessness  or 
listlessness,  perhaps  attacks  of  syncope. 

Etiology. — Acute  infection  (typhoid 
fever,  typhus  fever,  diphtheria,  rheumatic 
fever,  tonsillitis,  influenza,  scarlet  fever, 
pneumonia,  variola,  gonorrhoea,  septico- 
pysemia,  etc.);  ptomaine  poisoning;  toxaemia 
of  pregnancy;  coronary  embolism  or  throm- 
bosis, benign  or  septic. 

Treatment. — Absolute  rest  in  bed,  in- 
cluchng  feeding  with  a spoon  and  the  use 
of  the  bed-pan  and  urinal,  is  essential.  The 
room  should  be  well  ventilated.  The  diet 
should  be  liquid  and  soft:  diluted  milk,  egg 
albumen,  beef- juice,  custards,  flavored  gela- 
tine, etc.,  water  to  be  restricted.  To  slow 
the  heart,  apply  the  ice-bag  frequently, 
suspended  from  a bed  cradle.  Morphine  is 
a serviceable  calmative,  especially  when 
heart-failure  is  imminent.  Strychnine  is  rec- 
ommended as  a heart  tonic  (no  digitalis). 
Calcium  lactate,  gr.  iv,  t.i.d.,  or  the  glycero- 
phosphate, gr.  V,  t.i.d.,  may  be  of  benefit. 
Iron  is  indicated  for  anaemia.  Mild  catharsis 
should  be  maintained  by  means  of  divided 
doses  of  calomel,  castor  oil,  sulphur,  com- 
pound licorice  powder,  or  salts  (for  drug 
formulae,  etc.,  see  Part  11). 

The  patient  should  be  kept  in  bed  until 
the  pulse  is  normal,  and  does  not  become 
rapid  upon  slight  provocation,  such  as  the 
taking  of  food,  or  the  visit  of  a stranger,  etc. 
(at  least  two  weeks  after  all  cardiac  symp- 
toms have  subsided).  He  should  then  be 
allowed  up  gradually,  say  for  an  additional 
half  hour  each  day,  being  first  propped  up 
by  pillows  in  bed,  until  he  is  up  all  day. 
Allbutt  recommends,  as  a “ mild  cardiac 
tonic  and  calmative  ” during  convalescence, 
tincture  of  prunus  Virginiana,  irpxxx-lx. 

II.  Chronic  Myocarditis. — Chronic  myocardi- 
tis includes  fibrosis,  fatty  degeneration, 
brown  atrophy,  amyloid  degeneration,  and 
16 


hyaline  degeneration.  The  latter  two  are 
rare.  The  affection  may  be  latent,  and 
first  manifested  by  sudden  death;  or  the 
following  symptoms  may  be  present,  viz., 
breathlessness  on  exertion,  with  tachycardia, 
arrhythmia,  and  dizziness;  commonly  pal- 
pitations and  indigestion;  perhaps  high 
arterial  tension  and  attacks  of  epistaxis; 
perhaps  precordial  pain  or  angina  pectoris; 
sometimes  Stokes-Adams  syndrome.  The 
heart  hypertrophies,  except  in  atrophy  due 
to  exhausting  diseases,  and  myocardial  in- 
competence may  eventually  supervene  (see 
Cardiac  Insufficiency ) . Chronic  interstitial 
nephritis  is  also  a frequent  accompaniment. 

The  Prognosis  is  always  serious,  and  is 
very  grave  when  incompetence  occurs. 

Etiology. — Coronary  sclerosis  (the  com- 
monest cause;  see  Arteriosclerosis,  for 
its  causes);  valvular  heart  disease,  heart- 
strain,  due  to  physical  or  mental  overwork; 
habitual  overeating  and  overdrinking;  over- 
eating combined  with  sedentary  habits; 
chronic  alcoholism;  excessive  use  of  tea, 
coffee,  or  tobacco;  gastro-intestinal  intoxi- 
cation; obesity;  gout;  tliabetes;  exophthalmic 
goitre;  syphilis;  malnutrition  or  starvation 
from  improper  or  insufficient  food;  chronic 
infection  (tonsillitis,  pyorrhoea,  sinusitis, 
pelvic  disease,  bronchitis,  cholecystitis,  ap- 
pendicitis, tuberculosis,  dysentery,  chronic 
suppuration,  etc.) ; exhausting  diseases  (can- 
cer, anaemia,  etc.);  poisoning  with  lead, 
arsenic,  or  phosphorus;  repeated  attacks  of 
rheumatic  fever;  neoplasm,  gumma,  or  para- 
sitic disease  of  the  myocardium. 

Treatment. — Enjoin  a quiet,  well-regu- 
lated life,  free  from  all  excesses — physical  or 
mental  stress,  worry,  over-indulgence  in 
eating  or  drinking,  and  in  the  use  of  tea, 
coffee,  or  tobacco,  and  excessive  sexual 
indulgence;  at  least  ten  or  eleven  hours’ 
sleep  at  night  should  be  obtained.  The 
diet  should  be  light,  bland,  and  easily 
digestible:  meat  in  moderation,  a minimum 
of  salt  and  fluids;  no  tea,  coffee,  alcohol, 
fried  foods,  or  broths  which  contain  stimu- 
lating extractives,  etc.  (see  the  diet  recom- 
mended in  the  stage  of  cardiac  compensation, 
under  Cardiac  Insufficiency).  The  bowels 
should  be  kept  active,  employing,  for  this 
purpose,  as  requirerl,  a mild  laxative,  such 
as  compounrl  licorice  powder,  or  aromatic 
cascara  sagrada,  or  compound  laxative  pills. 
(Part  11).  If  the  patient  is  obese,  prescribe 
the  obesity  cure  described  under  Obesity. 
Fresh  air  day  and  night  is  of  importance.  A 
daily  warm  bath  lasting  about  fifteen  minutes 
should  be  taken.  Daily  moderate  exercise  in 
the  open  air  should  be  practiced,  with  strict 


MYXCEDEMA 


avoidance  of  fatigue,  breathlessness,  palpita- 
tion, sense  of  tightness  across  the  chest,  or 
precorchal  pain  or  chstress.  The  clothing 
should  be  loose.  An  hour’s  rest  should  be 
observed  before  ami  after  meals. 

For  ana?mia,  prescribe  iron  and  arsenic. 

For  high  pulse  tension,  with  palpitation 
and  breathlessness,  prescribe,  besides  laxa- 
tives and  restriction  of  the  diet,  sodium 
nitrite,  or  erjdhrol  tetranitrate.  The  iodides 
are  deemed  of  value  in  arteriosclerosis  (q.v.). 

Myocardial  syphilis  occurs  somethnes  in 
the  tertiary  stage  of  the  disease,  and 
requires  specific  medication. 

For  the  treatment  of  the  stage  of  incom- 
petence, see  Cardiac  Insufficiency. 

Myoclonus. — (See  Paramyoclonus  Multi- 
plex.) 

Myositis. — Gr.  /xus  muscle  + -tns  inflam- 
mation. I.  Suppurative  Myositis. — The  occur- 
rence of  suppuration  in  voluntary  muscle  is 
rare.  The  bacterial  agents  are  staphylococci, 
streptococci,  etc.,  which  gain  entrance 
through  a furuncle  or  other  focus  of  infec- 
tion. The  affected  muscle  is  swollen,  hard, 
contracted,  painful,  and  tender,  and  the 
overlying  skin  is  freely  movable.  Constitu- 
tional symptoms  are  present,  e.g.,  chills, 
fever,  malaise,  headache,  anorexia,  and 
prostration.  Acute  osteomyelitis  may  be 
suspected.  Fluctuation  usually  occurs 
within  ten  days. 

Treatment. — Open  the  bowels  thor- 
oughly. Apply  heat,  and  as  soon  as  fluctua- 
tion occurs,  make  a free  incision  and  drain 
the  pus  cavity  with  dry  sterile  gauze  (see 
Inflammation).  Renew  the  dressing  daily  or 
less  often  until  healing  has  occurred. 

If  contracture  ensues,  employ  massage, 
active  and  passive  movements,  and  if  neces- 
sary, fixation  in  extension  for  a time. 

11.  Dermato-myositis;  Acute  Polymyositis.^ — A 
very  rare  and  serious  acute,  subacute,  or 
chronic  non-suj:)j:)urative  inflammation  of 
the  voluntary  muscles,  of  unknown  origin, 
associated  with  dermatitis  and  an  cedema 
that  may  be  general.  The  onset  is  usually 
gradual,  with  malaise,  anore.xia,  headache, 
vague  })ains,  and  weakness,  followed  after 
some  days  or  weeks,  by  definite  muscle 
pains,  fever,  sweating,  oedema,  dermatitis, 
anti  usually  an  enlarged  spleen.  The  heart 
muscles  may  become  involved;  also 
the  muscles  of  deglutition  or  those  of  res- 
piration, with  death  in  the  latter  instance 
from  asphyxia  or  broncho-pneumonia. 
Disortlers  of  sensation  and  ataxia  may 
occur  (neuro-myositis). 

A still  rart'r  polymyositis  hsemorrhagica 
is  also  described.  There  is  a mild  acute 


polymyositis  associated  with  erythema  multi- 
forme and  urticaria  {q.v.,  in  Part  5,  Skin 
Diseases,  for  treatment). 

The  disease  may  last  from  one  or  two 
weeks  to  two  years.  It  should  be  distin- 
guished from  trichinosis  (by  the  micro- 
scopic examination  of  a piece  of  muscle), 
from  prunary  suppurative  myositis,  syphi- 
litic myositis,  and  scleroderma. 

Treatment. — Open  the  bowels  freely 
by  means  of  calomel  followed  by  salines; 
and  promote  diaphoresis  by  means  of  blankets 
and  hot  bottles  and  copious  draughts  of 
water.  Irrigate  the  colon  with  normal  saline 
solution  (5i  ad  Oi).  Inunctions  of  un- 
guentum  Crede  are  reconunended  (see  Part 
II  for  all  drugs). 

During  convalescence,  employ  massage, 
electricity,  and  strychnine;  and  to  pre- 
vent contractures,  fixation  in  extension, 
or  extension  by  means  of  a pulley  and 
weights,  followed  by  massage  and  active 
and  passive  movements. 

III.  Primary  Myositis  Fibrosa. — A slow  gradual 
hardening  and  contraction  of  one  or  more 
of  the  voluntary  muscles. 

Massage,  electricity,  hot  air,  and  hot 
baths  may  effect  more  or  less  of  a cure. 

IV.  Myositis  Ossificans  Progressiva. — A very 
rare,  chronic,  multiple  inflammatory  affec- 
tion of  the  muscles,  fascise,  aponeuroses, 
tendons,  ligaments,  and  bones,  of  unknown 
cause,  beginning  usually  in  early  life,  and 
resulting  gradually  in  the  formation 
of  bony  masses  in  the  structures  in- 
volved, with  eventual  ankylosis  of  most 
of  the  articulations. 

Traiuna,  sometimes  simple  palpation  of 
a muscle,  and  also  exposure  to  cold,  may 
cause  the  growdh  to  form.  Therefore,  these 
and  similar  deleterious  agencies  should 
be  avoided. 

Myotonia;  Thomsen’s  Disease. — Gr.  ixus 
muscle  Tovos  tension.  A rare,  incurable, 
hereditary,  familial  affection,  characterized 
by  the  occurrence  of  tonic  muscular  cramps 
on  attempting  voluntary'  movements. 

Says  Moffitt,  Thomsen  himself,  who  had 
the  disease,  “ recommended  active  muscu- 
lar exertion.” 

Myxoedema. — Gr.  /xv^a  mucus  -}-  blbrma 
swelling.  A rare,  chronic,  slowly  pro- 
gressive disease  of  variable  severity,  due  to 
impairment  or  loss  of  function  of  the  thyroid 
gland,  occurring  spontaneously  or  as  a 
result  of  operative  removal  of  the  gland,  and 
characterized  by  the  following  symptoms, 
viz.,  mental  inertia,  drymess,  roughness  and 
yellowness  of  the  skin,  brawny,  solid, 
inelastic,  myNoedematous  infiltration  of  the 


NEPH1K3LITHIAS1S;  RENAL  AND  URETERAL  CALCULUS 


skin,  which  does  not  pit  on  pressure;  loss  of 
hair;  lips  thick,  nostrils  broad  and  thick,  and 
mouth  enlarged;  pulse  slow  and  of  low 
tension;  temperature  subnormal;  extremi- 
ties cold  and  blue;  cachexia. 

Occurring  before  the  age  of  fifteen  years, 
the  condition  is  called  cretinism  {q.v.). 

It  is  curable  under  thyroid  treatment. 

Treatment.— Glandulm  thyroideae  sicca? 
(Parke  Davis  Co.)  vel  Thyroidei  sicci  (Bur- 
roughs and  Welcome),  gr.  ss-i,  t.i.d.,  grad- 
ually increased  to  gr.  x-xv  per  day,  if  need 
be.  After  good  results  have  been  attained, 
reduce  the  daily  dose  to  the  amount 
requiretl  to  keep  the  patient  normal  (usually 
three  grains  a day,  or  every  other  day,  or 
even  less  often).  The  occiurence  of  the 
following  toxic  symptoms  calls  for  a sus- 
pension of  the  treatment:  tachycardia,  pal- 
pitation, cardiac  pain,  dyspnoea,  pallor,  faint- 
ness, flushing,  sweating,  urticaria,  anorexia, 
nausea  or  vomiting,  diarrhoea,  headache, 
nervousness,  restlessness,  insomnia,  tremor, 
elevation  of  temperature,  loss  of  weight, 
muscle  pains,  rarely  tonic  spasms,  sometimes 
albuminuria  or  glycosuria,  jicrhaps  delirium. 
Should  these  symptoms  occur,  i?ut  the 
patient  to  bed,  apply  an  ice-bag  to  the 
heart,  and  administer,  if  necessary,  strych- 
nine, atropine,  or  adrenalin  (see  Part  11). 
Says  Leonard  Williams:  “ The  recumbent 
pulse  should  never  be  allowed  to  go 
above  95°;  the  drug  should  also  be  sus- 
pended for  a time  “ when  the  temperature 
rises  to  normal  ”;  and  “ if  the  weight  begins 
to  fall  ”;  “ it  is  a safe  plan  to  intermit  the 
treatment  for  one  week  in  eveiy  four.” 
He  says,  also,  that  the  effect  of  the  thyroid 
extract  is  “ considerably  enhanced  ” if  it  is 
exhibited  in  combination  with  three  other 
drugs,  namely,  iodine,  arsenic,  and  calcium. 


II  Calcii  iodidi gr.  v 

Liquoris  arsenicalis  (Fowler’s  sol.). . . . irgii 
Aqua)  chloroformi,  q.s.,  ad 5ss 


M.  Sig. — One-half  ounce  (tablespoonful)  t.i.d.p.c. 
(suspend  every  fourth  week,  coincidently  with  the 
thyroid  extract).  (Leonard  Williams.) 

(lodothjTin  and  other  similar  prepara- 
tions are  said  to  be  less  effective  than  the 
dried  sheep’s  gland.) 

The  patient  should  avoid  alcohol,  salt, 
meat,  and  cold  baths.  The  diet  should 
consist  of  milk,  eggs,  butter,  vegetables, 
cereals,  and  fruit.  Rest,  fresh  air  day 
and  night,  warm  clothing,  a warm  climate 
in  winter,  and  frequent  warm  baths 
are  of  importance.  General  massage  is 
very  beneficial. 

If  thyroid  extract  should  prove  ineffectual, 
try  pituitary  extract  experimentally. 


Nasal  Diseases. — See  Part  8,  Diseases  of 
the  Nose. 

Nasha  Fever. — A disease  of  India,  of 
three  to  five  days  duration,  characterized 
by  fever,  constijiation,  and  congestion  of 
the  nasal  mucous  membrane,  followed  after 
several  days  by  a chill. 

Treatment.— Give  a saline  purge,  and  spray 
the  nostrils  with  ice- water  several  times  a 
day.  Employ  cold  baths,  wet  packs,  and 
sponging  for  the  fever  {q.v.). 

Nausea. — L.,  Gr.  vavaia  seasickness.  See 
Vomiting. 

Neck,  Cellulitis  of  the. — See  Ludwig’s 
Angina. 

Neck  Enlargements. — Causes.— Lympha- 
denitis, simple  or  tuberculous  {q.v.)\  syphilis; 
carcinoma  ; lynqjho-sarcoma ; leuka'inia  ; 
Hodgkin’s  disease;  actinomycosis;  cellulitis; 
glandular  fever;  German  measles;  parotitis; 
dermoitl  cyst;  branchial  cyst;  echinococcus 
cyst;  congenital  hygroma  (often  disappears 
spontaneously);  lipoma;  enlarged  hyoid 
bursa;  goitre;  aberrant  goitre,  situated  in 
the  median  line;  cetlema  of  the  neck,  due 
to  venous  thrombosis,  mediastinal  tumors, 
or  inflammatory  exudate;  interstitial  em- 
physema. 

Nephralgia. — See  Part  3,  Male  Genito- 
urinary Diseases. 

Nephritic  Abscess. — Gr.  ve(f)p6s  kidney. 
See  Pyelonephritis. 

Nephritis,  Acute. — Gr.  v€(f>p6s  kidney  + 
-ins  inflammation.  See  Bright’s 
Disease. 

Chronic  Interstitial. — See  Bright’s 
Disease. 

Chronic  Parenchymatous.  — See 

Bright’s  Disease. 

Suppurative. — See  Pyelonephritis. 

Nephrolithiasis;  Renal  and  Ureteral  Cal= 
cuius. — -Gr.  ve(j)p6s  kidney  -t-  \idos  stone;  L. 
ren,  kidney;  Gr.  ouprirrip  ureter;  L.  calculus 
pebble.  Symptomatology  and  Diagnosis. — No 
symptoms  at  all,  or  the  following  symptoms 
may  be  present,  viz.,  aching  pain  and  tender- 
ness in  the  region  of  the  kidney  and  in  the 
course  of  the  ureter  (sometimes  the  pain  is 
referred  to  the  oppo.site  side) ; frequent 
urination;  microscopic  ha)maturia  or  attacks 
of  visible  h®maturia;  perhaps  a palpable 
renal  tumor;  perhaps  the  occurrence  of 
renal  (ureteral)  colic,  characterized  by 
sudden,  sharp,  tearing,  paroxysmal  pain, 
extending  along  the  course  of  the  ureter  into 
the  scrotum,  the  end  of  the  penis,  and  the 
thighs,  with  retraction  of  the  testicle,  fre- 
quent desire  to  urinate,  painful  urination, 
scanty  urine  which  is  apt  to  be  blood-tinged, 
and  elevation  of  temperature,  chills,  vomit- 


NEPHROLITHIASIS;  RENAL  AND  URETERAL  CALCULUS 


ing,  and  prostration;  local  soreness  follows 
the  paroxysm,  which  ceases  sutldenly  when 
the  stone  is  passed  into  the  bladder,  or  back 
into  the  renal  pelvis,  or  into  a dilated  por- 
tion of  the  ureter;  in  the  latter  event  there 
may  be  continued  pain  and  tenderness; 
anuria  may  occur  as  a result  of  the  occlusion 
of  both  ureters  with  stone,  or  one  with  stone 
and  the  other  by  reflex  spasm,  or  the  occlu- 
sion of  one  ureter  with  stone  while  the  other 
kidney  is  diseased  or  absent ; partial  retention 
of  urine  in  the  kidney  pelvis  results  in  hydro- 
nephrosis; sometimes  pyonephrosis,  pyelo- 
nephritis, or  perinephric  abscess  occurs. 

Exclude  in  the  diagnosis,  tumor;  tuber- 
culosis; essential  renal  hiematuria;  stricture 
or  torsion  of  the  ureter  with  resulting  hydro- 
nephrosis; stone;  tuberculosis  or  tumor  of 
the  bladder;  prostatic  hypertrophy  or  car- 
cinoma; chronic  prostatitis;  seminal  vesicu- 
litis; Pott’s  disease;  bony  spinal  exostosis; 
spinal  cord  lesions;  lumbago;  neuralgia 
(H.  H.  Young).  Other  causes  of  renal  colic, 
or  of  paroxysms  resembling  renal  colic,  are: 
the  passage  of  crystals,  plugs  of  muco-pus, 
blood-clots  (see  Hjematuria),  parasites,  or 
tumor  fragments;  Dietl’s  crises;  biliary 
colic;  appendicular  colic;  oophoritis;  intes- 
tinal colic;  vesiculitis;  chronic  prostatitis; 
pancreatitis. 

Aids  to  diagnosis  include  vaginal  or  rectal 
palpation;  ureteral  catheterization;  the  pas- 
sage of  a ureteral  wax-tipped  bougie;  radi- 
ography (with  a wire-containing  catheter  in 
the  ureter  to  exclude,  if  possible,  phlebo- 
liths,  etc.,  etc.);  and  Murphy’s  “fist  per- 
cussion ” over  the  lumbar  region,  which 
sets  up  intense  pain,  in  the  presence  of 
stone,  due  to  distention  of  the  renal  pelvis. 

Treatment. — For  renal  colic,  administer  a 
hypodermic  of  morphine,  gr.  to  }/[,  with 
atropine,  gr.  J-foO)  apply  hot  water  bags, 
hot  packs,  or  hot  poultices  to  the  painful 
region,  or  place  the  patient  in  a hot  bath, 
for  the  purpose  of  relaxing  spasm,  and  give 
hot  lemonade,  soda  or  barley  water  freely. 
A copious  hot  colonic  irrigation  is  useful. 
Spt.  setheris  comp.,  3ii~iv,  in  2 to  4 oz.,  of 
normal  saline  solution  (oi  ad  Oi)  may  be 
injected  into  the  rectum.  Ether  or  chloro- 
form inhalations  may  be  required  until  the 
morphine  acts.  One  may  administer  tr. 
belladonna?,  tt^x,  in  two  tablespoonfuls  of 
water,  every  three  or  four  hours,  until  the 
p ipils  become  dilated,  the  face  flushed,  ami 
the  mouth  dry,  for  the  purpose  of  relaxing 
ureteral  spasm  and  jicrmitting  of  the  passage 
of  the  stone.  Inversion  of  the  body  some- 
times helps.  Glycerine  in  large  doses,  2 to 
4 oz.  daily,  is  recommended.  It  may  be 


given  with  equal  parts  of  lemon  juice,  or 
in  lemonade  in  the  place  of  sugar,  1 to  2 oz. 
to  the  quart. 

If  it  is  believed  that  the  stone  is  impacted 
in  the  ureter,  the  latter  may  be  dilated,  and 
sterile  olive  oil  injected;  or  an  attempt  may 
be  made  to  push  the  stone  back  into  the 
kidney  pelvis.  If  the  stone  is  palpable 
through  the  rectum  or  vagina,  gentle  and 
careful  efforts  may  be  made  to  advance  the 
stone  with  the  finger. 

Should  anuria  occur,  administer  large 
quantities  of  water,  4 to  6 ounces  every 
hour,  with  diuretics  (pot.  acetate  or  citrate, 
infusum  scoparii,  triticum  repens;  juniper 
berries,  see  Part  11  for  all  drugs),  hot 
bottles  or  hot  applications  over  the  abdo- 
men and  lumbar  region,  saline  infusions 
(0.6  per  cent.),  and  perhaps  chloroform 
ansesthesia  or  tr.  belladonnae,  for  the  pur- 
pose of  relaxing  ureteral  spasm;  or  olive  oil 
may  be  injected  into  the  affected  ureter; 
or  the  spasmed  ureter  may  be  catheterized. 

If  the  condition  is  not  relieved  on  the 
third  day,  take  a radiograph,  if  practicable, 
and  in  any  case  operate  at  once  on  the  side 
last  affected  with  colic.  Perform  nephrot- 
omy and  drainage.  At  a later  date,  unless 
the  patient’s  condition  is  favorable  at  the 
time,  locate  and  remove  the  obstructing 
ureteral  stone. 

Should  the  stone  pass  spontaneously, 
keep  the  urine  free  and  bland  by  means  of  a 
bland  diet,  lots  of  water,  and  perhaps 
infusion  of  buchu  or  of  uva  ui'si,  oil  of  sandal- 
wood, urotropin,  or  helmitol,  with  the  object 
of  hastening  healing  and  preventing  or  con- 
trolling inflammation  due  to  traumatism. 

Operation  is  incUcated  in  anuria  (see 
above);  profuse  hsematuria;  pjmria  (sup- 
purative pyelonephritis);  recurring  attacks 
of  renal  colic;  unbearable  pain  and  sensa- 
tion of  pressure;  ureteral  stone  measuring 
2 cm.  or  more  in  width ; ureteral  stone  meas- 
uring 1.0  cm.  or  less  which  has  not  passed 
in  six  months;  indeed,  according  to  Casper, 
“ whenever  the  presence  of  a calculus  can 
be  positively  determined.”  “ If  both  kid- 
neys are  functioning  fairly  w’ell,  bilateral 
nephi-o-lithotomy  is  permissible”  (Keyes). 
Do  a nephrectomy  if  the  kidney  is  much 
diseased  and  the  other  kidney  is  sound  (see 
Urinalysis.)  If  the  stone  is  in  the  bladder- 
wall.  a su}?rapubic  intravesical,  or  a cj^sto- 
scopic  opeiation  is  |X'rformed.  For  pressure 
pains,  Casper  recommends  glycerine,  5is^s- 
iii-v,  twice  a week,  given  with  sjTup  of 
orange  peel,  ov,  to  obviate  nausea. 

Prophylaxis.— l^rinary  calculi  may  be  con- 
veniently divided  into  two  categories,  (1) 


NEPHROLITHIASIS;  RENAL  AND  URETERAL  CALCULUS 


primary  calculi,  or  those  not  ordinarily  due 
to  infection,  and  forming  in  an  acid  urine; 
and  (2)  secondary  calculi,  or  those  due  to 
local  infection  (see  causes  under  Retention 
of  Urine,  in  Part  3),  and  forming  in  an  alka- 
line urine  (see  Alkalinuria).  Primary  stones 
consist  of  (a)  uric  acid  or  urate  of  sodium, 
calcium,  or  potassium;  (b)  oxalate  of  cal- 
cium; or,  very  rarely,  (c)  carbonate  of  cal- 
cium; (d)  cystin;  (e)  xanthin;  (f)  crystalline 
phosphate  of  calcium;  or  (g)  indigo.  Second- 
ary stones  consist  of  ammonio-magnesium 
phosphate  (triple  phosphate),  amorphous 
phosphate  of  calcium;  and  tricalcic  phos- 
phate, rarely  urate  of  ammonium  or 
urostealith.  Primary  stones  may  give  rise 
to  infection  and  become  encrusted  with 
calcium  phosphate. 

Primary  stones  occur  as  the  result  of  a 
highly  acid  urine,  favored  by  a sedentary 
life,  alcoholism,  excessive  nitrogenous  or 
purin-rich  food,  or  malnutrition  in  the  chil- 
dren of  the  poor,  constipation,  inactive 
skin,  torpid  liver,  excessive  eating  of  acid 


fruits  (oranges,  grape-fruit,  strawberries, 
tomatoes,  rhubarb),  gout,  plumbism,  obe- 
sity, diabetes,  leukiemia,  fevers,  and  lime 
salts  in  the  drinking  water.  Heredity  is  a 
factor.  Cystinuria  is  due  to  a congenital 
defect  in  the  catabolism  of  the  sulphur- 
containing  amino-acids  of  the  tissues. 

Hofmeister’s  Table  for  Examination  of 
Urinary  Calculi.  (See  below). 

The  murexid  test  is  performed  as  follows: 
To  the  powder,  in  an  evaporating  dish,  add 
a few  drops  of  concentrated  nitric  acid,  and 
evaporate  to  dryness  on  the  water  bath. 
After  cooling,  add  to  the  residue  a few  drops 
of  ammonium  hydrate  solution;  a reddish 
purple  solution  results.  On  adding  water 
and  evaporating  to  dryness,  this  color  dis- 
appears if  the  original  powder  was  uric  acid. 

To  prevent  the  formation  of  uric  acid 
and  urates  (manifested  by  a brick-dust 
deposit  in  a hyperacid  urine),  restrict  foods 
rich  in  purins,  sugars,  fats,  and  alcohol,  and 
allow  milk,  butter,  eggs,  and  red  meats 
(preferably  boiled  to  remove  the  extractives) 


WHEN  HEATED  ON  THE  PLATINUM-FOIL  THE  POWDER 
(hofmeister’s  table) 


Does  not  burn 


The  powder  when  treated  with 
hydrochloric  acid 


Does  not  effervesce 


The  powder  moderately  burned 
plus  hydrochloric  acid 


Does  not  effervesce 

The  native  powder 
moistened  with  po- 
tassium hydrate 


a 


SSkt; 

H “ Jq 

WK  og 


S3 

<D  o 


II 


OT  > • 

^ s 

> O 


cj 

ij’S. 


o 


D.  ci 


Burns 


S a 

S §.2 

gS  $ 
30  H 
a o 

■a 

X5.S.G 
o;5  ? 

s-|:2 


2^  o 

g " § 
g 

° o-s 

III 

>^G- 

a?  ■ 


o3 


O 


SP»P  • 


iXi 

G 

cc 

G 

pG*^ 


.g 


With  flame 


O q;( 

T3  _ 
073 

o ^ 

i'o 

G 

§ = 
li 

O G 
^ O 

fc-  CO 

c3  ^ 
S O 
o "O 
p.  fS 

o a 


a 


2 G 
O 

CO 

o G 
u ^ 
c3  hH 

.IQ 

a 

-4-d  O 

CO  o 

o ^ 

oj  a 

S £ 

O s 
O § 

“ a 5 

G o 

I 

O eG 

3 bo 

o.g 

G ® g 

sM  > 


.g 

"m 

o 


Without  flame 


'"-a  ® 

^ CO  H 

.g  s 
o-a  ^ 
•2  G 

•2-S  § 

M'S 

^ G 
O-Tl  ^ 

^g5 

aj  G 

u-a 

G 'rt 
♦ ^ ^ 

s sw 

^ to 

r2  a;  Ld 

o o G 
u _ a> 
G 2-G 
G bC  5? 

Ill 

> o 

%"8 

iw.s 

Q 


.g 

43 


The 
powder 
gives  the 
murexid  test. 


The 

native  pow- 
der on  the 
addition  of  a 
little  KOH 
in  the  cold. 


a 


se 

o 


O 


G 

i-2 


a 

a 

o 

c 


sc 

o 


> 

5 


NEPHROLITHIASIS;  RENAL  AND  URETERAL  CALCULUS 


in  moderation;  and  poultry,  fish,  bread,  the  alkaline  aerated  waters,  such  as  Vichy 

cereals,  fresh  vegetables  and  fruits  (except-  and  Apollinaris,  or  water  containing  sod. 

ing  very  acid  fruits,  such  as  grape-fruit,  bicarb.,  gr.  xv-xx,  or  pot.  citrate  or  acetate, 

oranges,  strawberries,  tomatoes,  and  rhu-  gr.  xx-xxx,  to  the  tumblerful,  one  or  two 

barb)  in  abundance.  Whey,  a cupful  two  hours  after  meals,  or  night  and  morning,  to 

or  three  times  a day,  is  said  to  prevent  the  prevent  hyperacidity  of  the  urine  and  pre- 


Calcium  Oxalate 


Calcium  Carbonate 


Crystalline  Phosphate 


Monocakium  Phosphate 


Fia.  53. — Urinary  crystals. 


deposition  of  uric  acid.  The  following 
articles  should  be  interdicted,  viz.,  sweet- 
breads, thymus,  spleen,  liver,  brains,  kid- 
ney, fish  roe,  game,  flesh  of  young  animals, 
shell-fish,  salt  meats,  mushrooms,  asparagus, 
strong  tea  and  coffee,  and  fried,  highly  sea- 
soned, and  indigestible  foods  generally. 
Water  should  be  drunk  freely,  especially 


cipitation  of  uric  acitl.  Since  the  urinary 
acidity  rises  at  night  and  in  the  early  morn- 
ing, due  to  fasting,  it  is  advised  that  sod. 
bicarb,  or  pot.  citrate,  gr.  xx-lx,  in  half-a 
pint  of  water,  or  liq.  jwtassae,  gtt.  x-xx  in 
milk,  be  taken  as  late  at  night  as  possible. 
The  bowels  should  be  kept  regular.  For 
this  puiqxjse  the  laxative  Hunyadi  and 


BRAiy  I Cra  n lal  Nerve  j 


External  oculo  motor 

Factal  nerve 
Sptnal  accessory  nerve 
Hypo3lossal 

Superior  cervtcal  ganglion 
Pharyngeal  plexus 

Right  pneumogastric 
Cervical  plexus 
Middle  cervical  ganglion 
Brachial  plexus 

Inferior  cervical  ganglion 
First  thoracic  ganglion 

Inferior  cardiac  nerve 


Bronchus 


Pulmonary  veins 


CEsophagus 
Right  pneumogastric 


Intercostal  nerve 


Last  thoracicganglion 
Hepatic  plexus 
Great  splanchnic  nerve 

Semilunar  ganglion 
Small  planchnic  nerve 
Renal  plexus 

Aorta 


Lumbar  plexus 

Inferiorvena  cava 
Common  iliac  artery 

Sacralganglion 

Rectum 
Sacral  plexus 
Hypogastric  plexus 

Sacral  ganglion 
Terminal  coccygeal  ganglion 


Recurrent  laryngeal  nerve 


Inferior  mesenteric  plexus 


U reter 
Vas  deferens 

Bladder 

Spermatic  cord 


Lacrymal  gland 


Lingual  nerve 
Gloaso-pbaryngeal  nerve 
Submaxillary  ganglion 
Submaxillary  gland 
Ejcternal  carotid 


Thyroid  body 
Trachea 


Heart 

Liver 


Coronary  gastric  plexus 

Transverse  colon 
Splenic  plexus 
Solar  plexus 


Superior  mesenteric  plexus 
Loops  of  intestines 


Superior  maxillary  nerve 
Spheno  palatine  ganglion 
Otic  gang! ion 
Inferior  maxillary  nerve 


Aorta 


Cardiac  plexus 
Pulmonary  artery 
perior  vena  cava 


Diaphragm 


Left  pneumogastric 

Stomach 


LAROUSSE  M.KDICAE 


Cranial  and  visceral  nerves 


Model  showing  Cutaneous  Root  Areas. 

Peripheral  Nerve  Areas  are  indicated  by  white  lines  on  the  right  half  of  the  model, 


L' 


NERVES,  PERIPHERAL,  AFFECTIONS  OF  THE 


Friedrichshall  waters  (containing  sodium 
sulphate)  are  useful.  Enjoin  daily  exercise 
in  the  fresh  air,  breathing  exercises,  frequent 
tepid  baths,  and  fresh  air  day  and  night. 

For  oxaluria  (manifested  by  a light,  floc- 
culent  sediment  showing  oxalate  of  calcium 
crystals  under  the  microscope),  administer 
a calomel  and  saline  purge,  followed  after 
three  or  four  days  by: 


Acidi  nitrohydrochlorici  di- 

luti 3ii  (np_x  per  dose) 

Tincturae  cinchonse,  q.s.,  ad. . 5ii 
M.  Sig. — One  teaspoonful,  well  diluted,  p.c.,  for 
only  a few  days;  to  be  discontinued  after  the  dis- 
appearance of  the  crystals  from  the  urine,  for  fear 
of  causing  hyperacidity  and  irritation.  (Le  Fevre.); 
or. 


Sodii  phosphatis  dihydrogenii ....  gr.  xxx-lxxx 

Aquae  destillata; 5 i 

M.  Sig. — One  ounce,  well  diluted,  every  three 
hours;  up  to  one  ounce  of  the  acid  sodium  phosphate 
a day,  well  diluted.  (Acids  increase  the  solubility 
of  oxalate  calculi.) 


Or  administer: 


Magne.sii  carbonatis 3i 

Acidi  citrici 3u 

Sodii  biboratis 3h 

Aquae  bullientis Sviii 

M.  Sig. — One  tablespoonful,  2 to  3 times  daily 
(borocitrate  of  magnesium) ; or, 

Magnesii  oxidi 3ss-i 

Aquae 5i 


M.  Sig. — Shake  well  and  take  one  ounce  t.i.d.p.c. 
(oxalates  are  more  soluble  in  the  presence 
of  magnesium). 

Potassium  citrate  (or  lemon  juice)  is  also 
recommended,  for  the  purpose  of  combin- 
ing with  calcium  and  thereby  preventing 
the  formation  of  calcium  oxalate  crystals. 

An  occasional  course  of  sodium  phosphate, 
or  sodium  sulphate,  or  magnesium  sulphate, 
3ss,  t.i.d.,  is  recommended. 

The  oxalate-containing  foods,  spinach, 
rhubarb,  and  strawberries,  should  be 
avoided.  Oxalates  are  “ held  in  solution  in 
the  urine  by  salts  of  magnesium  derived 
from  meat,  legumes,  potatoes,  apples,  and 
farinaceous  foods,  and  the  calcium  salts 
found  in  milk,  eggs,  and  green  vegetables  ” 
(Le  Fevre);  therefore  these  foods  should  be 
allowed.  Gastric  or  intestinal  fermentation 
due  to  hypochlorhydria,  chronic  pancrea- 
titis with  or  without  hyperchlorhydria,  and 
neurasthenia  have  some  influence  in  the 
production  of  oxaluria. 

For  cystinuria,  prescribe  ammonium  car- 
bonate (Part  11),  or  sodium  bicarbonate, 
3iss-iiss,  daily;  and  re.strict  albuminous 
food.  Alkalies  prevent  the  formation  of 
cystin,  and  help  to  dissolve  cystin  stones. 


For  alkalinuria,  administer  dilute  nitric, 
hydrochloric  nitrohydrochloric,  or  sulphuric, 
or  aromatic  sulphuric  acid,  gtt.  x-xv,  t.i.d., 
in  a glass  of  sweetened  water;  or  acid 
sodium  phosphate,  gr.  xxx-lxxx,  well  diluted, 
every  three  hours;  or  benzoic  acid  or  sodium 
benzoate,  gr.  x-xv,  well  diluted,  every  two 
to  four  hours;  or  boric  acid,  gr.  v-x,  well 
diluted,  every  two  to  four  hours.  (Fig.  53). 

Nephroptosis. — Gr.  v€<j>p6s  kidney  -h 
TTT  <Tis  falling.  See  Splanchnoptosis. 

Nerves,  Peripheral,  Affections  of  the. — 
The  localization  of  the  disea.se  is  ascer- 
tained by  the  distribution  of  the  resulting 
sensory  and  motor  (flaccid)  paralysis.  In 
incomplete  lesions,  however,  as  in  those  due 
to  compression,  the  sensory  nerve-fibres 
may  be  little,  if  at  all,  affected  (Fig.  54). 

I.  Cranial  or  Cerebral  Nerves: 

1.  Olfactory  Nerve. — See  Olfactory  Af- 
fections. 

2.  Optic  Nerve. — See  Optic  Nerve  Affec- 
tions. 

3.  Oculomotor  Nerve. — See  Motor  Nerv^es 
of  the  Eyeball. 

4.  Trochlear  Nerve. — See  Motor  Nerves 
of  the  Eyeball. 

5.  Trigeminal  Nerve.  — See  Trigeminal 
Nerve;  and  Neuralgia. 

6.  Abducens  Nerve. — See  Motor  Nerves 
of  the  Eyeball. 

7.  Facial  Nerve.— See  Facial  Paralysis, 
and  Tic. 

8.  Auditory  Nerve. — See  Auditory  Nerve. 

9.  Glos.sopharyngeal  Nerve. — See  Glosso- 
pharyngeal Nerve. 

10.  Pneumogastric  Nerve. — See  Vagus 
Nerve. 

11.  Spinal  Accessory  Nerve. — See  Spinal 
Accessory  Nerve. 

12.  Hypoglossal  Nerve. — See  Hypoglos- 
sal Nerve. 

II.  Spinal  Nerves: 

Spinal  Roots. — See  Spinal  Roots. 

Phrenic  Nerve. — See  Phrenic  Nerve  and 
Neuralgia. 

Brachial  Plexus. — See  Brachial  Plexus 
and  Neuralgia. 

Long  Thoracic  Nerve.  — See  Brachial 
Plexus  and  Neuralgia. 

Circumflex  Nerve. — See  Brachial  Plexus 
and  Neuralgia. 

Musculo-spiral  Nerve. — See  Brachial 
Plexus  and  Neuralgia. 

Radial  Nerve. — See  Brachial  Plexus  and 
Neuralgia. 

Ulnar  Nerve. — See  Brachial  Plexus  and 
Neuralgia. 


NEURALGIA 


Median  Nerve. — See  Brachial  Plexus  and 
Neuralgia. 

Suprascapular  Nerve.— See  Brachial  Plexus 
and  Neuralgia. 

Musculocutaneous  Nerve. — See  Brachial 
Plexus  and  Neuralgia. 

Lumbar  Plexus. — See  Lumbar  Plexus. 

Anterior  Crural  Nerve. — See  Lumbar 
Plexus. 

Obturator  Nerve. — See  Lumbar  Plexus. 

External  Cutaneous  Nerve. — See  Meral- 
gia  Paraesthetica. 

Sacral  Plexus. — See  Sacral  Plexus. 

Sciatic  Nerve. — See  Sacral  Plexus  and 
Neuralgia. 

External  Popliteal  Nerve.^ — See  Sacral 
Plexus. 

Anterior  Tibial  Nerve. — See  Sacral  Plexus. 

Internal  Popliteal  Nerve. — See  Sacral 
Plexus. 

Posterior  Tibial  Nerve.— See  Sacral  Plexus. 

Nervous  Diarrhoea. — See  Diarrhoea. 

Dyspepsia. — ^See  Dyspepsia,  Nervous. 

System. — See  Brain  Localization,  Spinal 
Cord  Localization,  and  Nerves, 
Peripheral. 

Neuralgia. — Gr.  veopov  nerve  + ixXyos 
pain.  Neuralgia,  or  pain  in  the  course  and 
distribution  of  a peripheral  nerve,  is  either 
functional  or  organic;  that  is,  the  pain  is 
due  either  to  extraneous  irritation,  or  to 
disease  of  the  nerve  itself.  In  the  latter 
instance  the  condition  is  termed  neuritis. 
Neuritis  is  manifested  by  undue  tenderness 
on  pressure  over  the  nerve,  pain  on  stretch- 
ing the  nerve,  and  perhaps  areas  of  anaes- 
thesia or  paralysis  in  the  distribution  of  the 
nerve.  HyperaBsthesia,  paraesthesia,  and  a 
rash  are  sometimes  associated  with  neural- 
gia. See  also  Neuritis. 

General  Etiology. — Neuropathic  disposition; 
(heretUty,  hysteria,  neurasthenia);  debility; 
anaemia;  arteriosclerosis;  gout;  diabetes; 
nephritis;  beri-beri;  menstruation;  toxaemia 
of  pregnancy;  overexertion;  exposure  to 
cold;  poisons  (lead,  arsenic,  mercury,  iodine, 
alcohol,  morphine,  tobacco,  copper,  ether, 
zinc,  silver,  phosphorus,  carbon  monoxide, 
carbon  disulphide,  dinitrobenzene,  naphtha, 
chloretone,  trional,  sulphonal,  creosote  phos- 
phate, ptomaines,  etc.) ; infection  (influenza, 
malaria,  typhoid  fever,  typhus  fever,  meas- 
les, scarlet  fever,  mumps,  whooping-cough, 
tuberculosis,  syphilis,  Malta  fever,  small- 
pox, gonorrhoea,  diphtheria,  pneumonia, 
leprosy,  trichiniasis,  erj'sipelas,  septico- 
pyaemia,  carious  tcHBth,  pyorrhoea,  infected 
tonsils,  prostatitis  or  other  foci  of  infection) ; 
neighboring  inflammation;  withdrawal  of  the 
drug  in  morphine  or  cocaine  addiction;  cen- 


tral nervous  diseases  (tabes,  general  paresis, 
syphilis,  thalamus  involvement,  tumor,  mul- 
tiple sclerosis,  syringomyelia,  minute  trau- 
matic hemorrhages  in  the  spinal  cord, 
myelitis,  etc.);  reflex  irritation  (from  the 
teeth,  gums,  nasal  sinuses,  eyes,  ears,  lungs, 
heart,  stomach,  liver,  intestines,  kidneys, 
ureters,  bladder,  uterus,  ovaries,  prostate, 
testes) ; inflammation  of  sensory  ganglia 
(herpes  zoster,  q.v.,  in  Skin  Diseases,  Part 
5);  tumors  of  sensory  ganglia;  compres- 
sion due  to  tmnors,  aneurysm,  exostoses,  scar 
tissue,  spinal  caries,  metastatic  fibro-osteal 
spondylitis  involving  the  spinal  foramina 
(examine  the  spinal  column  for  sensitive 
areas  and  fixation, — J.  B.  Murphy) ; fractures 
and  displacements;  traumatism. 

Atmospheric  pressure,  humidity,  high 
electrical  tension,  etc.,  may  act  as  excit- 
ing causes. 

Special  Etiology.— 1.  Trigeminal  OR  TrI- 
FACiAL  Neuralgia;  Tic  Douloureux.— 
Tic  douloureux  is  distinguished  from  mi- 
graine by  the  localization  of  the  pain  in  the 
course  of  the  branches  of  the  fifth  nerve, 
and  not,  as  in  migraine,  in  the  temple  and 
side  of  the  head.  (Starr.) 

Special  Causes. — Dental  caries;  pyorrhoea 
alveolaris;  glossitis;  sinusitis;  otitis;  ophthal- 
mia; eyestrain;  skin  affections  of  the  face  and 
head;  herpes  zoster;  chronic  disease  of  the 
Gasserian  ganglion;  rarely  pressure  upon  the 
ganglion  by  a tumor  or  carotid  anemysm. 

2.  Cervico-Occipital  Neuralgia. — 

Special  Causes. — Cold;  cer\dcal  caries;  syphi- 
lis; meningitis;  tumors;  lymphatic  enlarge- 
ment; adhesions;  aneurysm  of  the  vertebral 
artery;  cervical  arthritis  deformans;  injury 
to  the  vertebrae;  the  carrjdng  of  heavy 
weights  upon  the  shoulder;  pehde  disease. 

3.  Brachial  Neuralgi.a.. — Special 
Causes. — Cold;  traumatism;  excessive  sweep- 
ing, piano-plajdng,  etc.;  arthritis;  subcora- 
coid bursitis  due  to  round  shoulders  (see 
Round  Shoulders  in  Part  10,  Orthopaedics); 
compression  by  a tumor,  aneurj^sm,  cal- 
lous, costal  periostitis,  or  cervical  rib  (see 
under  Brachial  Plexus);  angina  pectoris; 
vertebral,  meningeal,  or  cord  disease;  “small 
punctured  wounds  about  the  ivTist,  forearm, 
and  arm.” 

4.  Phrenic  or  Diaphr.’\.gjl\tic  Neuilal- 
GLA. — INIanifested  by  pain  in  the  lower 
thorax  on  deep  breathing  or  coughing. 

Special  Causes. — Pleurisy;  pericarditis; 
mediastinal  disease;  aortic  aneurj'sm;  carci- 
noma in  the  neck;  goitre. 

5.  Intercostal  Neitr.algla,  Including 
IMastodynia. — Tenderness  is  often  elicited 
at  the  points  of  e.xit  of  the  nerves  in  front, 


NEURALGIA 


Fiq.  54. — The  distribution  of  sensory  nerves  in  the  skin. 


NEURALGIA 


in  the  axilla,  or  in  the  back  near  the 
spine,  thus  distinguishing  the  affection 
from  pleurodynia. 

Special  Causes. — Herpes  zoster;  spinal 
caries;  })leuritis,  especially  tuberculous  and 
carcinomatous;  pericarditis;  spinal  cord  and 
meningeal  disease;  aortic  aneurysm;  angina 
pectoris;  hepatic  carcinoma;  dilatation  of  the 
stomach;  traumatism;  hysteria. 

G.  Lumbo-Abdominal,  Including  Tes- 
ticular AND  Ovarian  Neuralgia. — Spe- 
cial Causes. — Inflammation  or  tumors  in- 
volving the  lumbar  plexus;  ovarian  disease. 
Testicular  neuralgia  or  irritable  testicle  has 
the  following  etiology:  psychic  or  physical 
sexual  excess,  or  prolonged  ungratified  sex- 
ual desire  combined  with  a neurotic  nature; 
renal  or  vesical  calculus;  varicocele;  pros- 
statitis;  vesiculitis;  congestion  of  the  veru- 
montanum  (exclude  gonorrhoea,  tubercu- 
losis, etc.). 

7.  Crural  Neuralgia. — Special  Causes. 
— Chronic  constipation;  hip  or  knee  disease; 
spinal  caries;  pelvic  disease;  enlargement  of 
the  inguinal  glands;  aneurysm  of  the  iliac 
artery;  and  the  causes  of  meralgia  par- 
aesthetica iq.v.). 

8.  Rectal  Neuralgia. — Special  Causes. 
— Constipation;  impacted  faeces;  straining 
at  stool;  se.xual  excitement;  tumors;  foreign 
bodies;  enlarged  prostate;  varicose  veins; 
hemorrhoids;  varicocele;  ulcer  of  the  rectum; 
pressure  fi-om  a pregnant  uterus. 

9.  CoccYDYNiA.— See  Coccydynia. 

10.  Metatarsalgia. — See  Part  10,  Ortho- 
piedics. 

11.  Visceral  Neuralgias. — See  Gas- 
tralgia;  Enteralgia;  Angina  Pectoris. 

12.  Derm.\talgia. — See  Neuralgia  of  the 
Skin,  Part  10. 

13.  Sciatica. — Special  Causes. — Lum- 
bago (q.v.,  under  Myalgia);  exposure  to 
cold  and  wet,  especially  during  fatigue; 
gout;  rheumatism;  tabes  dorsalis;  pressure 
u]X)n  the  nerve  caused  by  sitting,  rectal  or 
sigmoid  accumulations,  pelvic  inflammation, 
uterine  or  ovarian  tumors,  uterine  displace- 
ments, pregnancy,  cauda  equina  tumoi-s,  the 
fetal  head  during  labor,  lymphadenomata, 
bone  disease  (tumors,  etc.);  strain  and 
relaxation,  sometimes  dislocation  of  the 
sacro-iliac  joint  (see  Orthopiudics,  Part  10) ; 
traumatism  (lifting  heavy  weights,  fall  ujxin 
the  buttocks,  fracture,  etc.) ; lesions  of  the 
hip  joint  (arthritis  deformans,  tuberculosis); 
chronic  spinal  arthritis;  knee-joint  disease; 
prostatitis ; pelvic  venous  stasis  due  to  chronic 
myocardial  insufficiency,  hejiatic  disease, 
varicose  veins  of  the  legs,  etc.);  flat-foot. 
(.Vlways  make  a rectal  examination.) 


A.  General  Treatment. — Make  a careful 

examination  into  the  cause  of  the  affec- 
tion. Correct  all  remediable  abnormalities. 
Strengthen  the  patient’s  stamina  by  a 
hygienic  regimen,  e.g.,  adequate  rest  and 
recreation,  regular  hours  of  eating  and 
sleejnng,  fresh  air  day  and  night,  a daily 
tepid  or  hot  bath  in  a warm  room,  followed, 
in  appropriate  cases,  by  a cold  spinal  douche, 
preferably  before  breakfast,  a glass  of 
water  one  hour  before  meals,  regulation  of 
the  bowels,  a generous  diet,  including,  per- 
haps, codliver  oil  and  malt  extract  if  the 
patient  is  feeble,  a plain,  bland,  restricted 
diet  if  the  patient  is  plethoric,  and  finally 
tonics,  such  as  arsenic,  iron,  strychnine, 
quinine,  calcium,  and  glycerophospliates  (see 
Drugs,  Part  11).  General  massage  is  invig- 
orating. Body  hot  air  treatment  twice  a 
week  is  well  recommended.  A change  to 
a warm,  dry  clunate  may  prove  of  the 
greatest  benefit. 

Palliative  and  Remedial  Drugs. — 
Phenacetin,  gr.  v-x,  with  or  without  salol, 
gr.  v-x,  repeated  if  necessary. 

Antipyrin,  gr.  v-xv,  with  strj^chnine,  gr. 
Ho,  to  avoid  cardiac  depression. 

B Phenacetini  vel  anti- 

pjTinaj gr.  Ixxii  (gr.  iii  per  dose) 

Cafieina;  citratis gr.  xii  (gr.  ss  per  dose) 

Cainphora;  monobro- 

matse gr.  xii  (gr.  ss  per  dose) 

Sodii  bicarbonatis gr.  xlviii  (gr.  ii  per  dose) 

Misce  et  fiant  capsiila)  24. 

Sig. — One  every  half  hour  for  no  more  than 
si.x  doses. 

Aspirin,  gr.  xv,  t.i.d. 

14  Sodii  salicylatLs oii  (gr.  xv  per  dose) 

Sodii  bicarbonatis 5ii  (gr.  xv  pi>r  dose) 

Aqua?,  q.s.,  ad 5iv 

M.  Sig. — line  tablespoonful,  well  diluted,  t.i.d. 

R Aspirin gr.  vii 

Codeina? ^r.  )3__ 

Trional gr.  vii 

M.  Sig. — Take  at  bedtime. 

Quinina?  bisulphatls. 

Aspirin,  aa gr.  v 

M.  et  fiant  capsula?  12. 

Sig. — ^One  capsule  every  five  hours. 

Butylis  chloral!  hj'drati  odss  (gr.  v jrer  dose) 

Glycerin! 3y 

Aqua",  q.s.,  ad 5iv 

M.  Sig. — Gne  dram  every  h.alf  hour  for  three  or 
four  hours. 

Alcohol:  hot  whiskey  or  brandy  punch. 
Nitroglycerin,  gr.  H50  lo  ^100.  or 
sodium  nitrite,  gr.  i-ii,  every  two  hours, 
until  the  bloocl  tension  is  lowered  or  flush- 
ing occurs. 

Aconitine,  “ the  best  remedy,”  says 
Starr,  “the  French  pills  of  Chapoteaux 


NEURALGIA 


being  the  best  preparation.”  Prescribe  one 
pill,  gr.  3^500)  every  four  hours,  together 
with  strychnine,  gr.  I50  to  counteract  the 
depressant  action  of  the  aconitine  upon  the 
heart.  Each  day  <.lecrease  the  interval  one- 
half  hour  until  one  pill  is  being  given  every 
two  hours,  or  until  tingling  of  the  tongue 
and  fingers,  a sense  of  general  weakness  and 
feebleness  of  the  pulse  are  evident.”  After 
the  first  two  days,  when  the  aconitine  is 
being  given  every  two  hours,  give  gr.  Hoo 
of  strychnine  with  each  close,  or  if  stiych- 
nine  produces  twitching,  reduce  the  dose,  or 
substitute  caffeine,  gr.  ii,  or  sparteine,  gr. 
Mo-  Warn  the  patient  against  making  any 
sudden  muscular  effort,  and  allow  very  little 
walking.  (Starr.) 

Tr.  Gelsemii,  the  next  best  remedy,  says 
Starr,  10  drops  every  three  hours,  increased 
by  one  drop  at  each  dose  until  the  patient 
perceives  a “ heaviness  of  the  upper 
eyelids  and  a difficulty  in  opening  the  eyes.” 
This  dose  may  be  continued  for  several 
days.  (Starr.) 

Potassium  iodide.  Try  the  iodides  for  three 
or  four  days  in  all  cases,  says  Yeo. 

Morphine,  gr.  to  Mi  or  Schlesinger’s 
analgesic  (Part  11). 

Palliative  and  Remedial  Local  Meas- 
ures.-— Counter-irritation,  etc.,  by  means  of 
the  Paquelin  cautery;  daily  dry-cupping 
iq.v.)  along  the  course  of  the  affected  nerve; 
the  mustard  poultice  (q.v.) ; tincture  of  iodine; 
ung.  capsici;  ung.  mentholis;  the  liniments 
of  belladonna,  chloroform,  and  turpentine; 
methyl  salicylate;  camphor  and  chloral; 
sprays  of  ether  and  ethyl  or  methyl  chloride; 
hot  poultices;  hot  saml,  salt,  or  water  bags; 
filiform  hot  water  tlouches;  ironing  with  a 
hot  iron;  hot  air  douches;  fly  blisters  (see 
Cantharides  in  Part  11)  over  tender  points 
every  other  day;  exposure  to  a 32-can- 
dlepower  electric  light  in  a large  para- 
bolic reflector  for  about  ten  minutes  daily; 
very  hot  air  (250°  to  300°  F.)  for  twenty 
minutes  daily  (the  best  treatment  of  neu- 
ritis); massage;  galvanization,  with  a large 
positive  electrode  over  the  painful  point  and 
the  negative  electrode  of  double  the  size 
over  the  spine:  35  to  50  milliamperes  for 
fifteen  to  thirty  minutes  daily  for  a long 
period  (one  of  the  best  “ palliative  if  not 
curative”  measures,  says  G.  Woolsey). 

Ionic  medication  {q.v.,  under  Inflamma- 
tion). The  electrolytes  employed  in  the 
treatment  of  neuralgia  or  neuritis  are 
quinine  hydrochlorate,  1 per  cent,  solution, 
and  sodium  salicylate,  1 to  2 per  cent,  solu- 
tion. The  quinine,  being  kathionic,  is 
placed  at  the  anode;  the  salicylate,  being 


anionic,  is  placed  at  the  cathode.  A current 
of  20  to  30  to  50  milliamperes  is  employed  for 
thirty  minutes,  three  times  the  first  week, 
twice  a week  thereafter  (Lewis  Jones). 

Gradually  increased  digital  pressure  upon 
the  nerve  at  its  point  of  emergence. 

Injection  into  the  affected  nerve,  near  its 
point  of  emergence,  of  1 to  2 c.c.  of  80  per 
cent,  alcohol,  or  0.5  to  1 c.c.  of  a 2 per  cent, 
aqueous  solution  of  osmic  acid. 

Stretching  of  the  affected  nerve. 

Avulsion  or  re.section,  eligible  in  cases  in 
which  the  neuralgia  is  confined  to  a single 
nerve  branch,  e.g.,  the  supraorbital,  the 
infraorbital,  or  the  inferior  dental  branch  of 
the  fifth  nerve  (avulsion  relieves  usually  for 
about  two  years  or  longer). 

Rontgentherapy  (q.v.). 

B.  Special  Treatment.— 1.  Trigeminal  NEU- 
RALGIA.— a.  Injection  of  the  maxillary  divi- 
sion of  the  fifth  nerve  through  the  foramen 
rotundum,  or  of  the  mandibular  division 
through  the  foramen  ovale,  or  of  both 
divisions,  with  strong  alcohol.  The  opera- 
tion may  be  done  under  general  anaesthesia, 
or  better  under  euphoria  produced  by  a 
hypodermic  of  morphine,  gr.  j^,  and  hyo- 
scine  hydrobromide,  gr.  ffso,  given  twenty 
minutes  before  the  operation.  The  operation 
requires  experience.  To  reach  the  foramen 
rotundum  introduce  the  needle  against  the 
lower  border  of  the  zygoma,  "0.5  cm.  behind 
a vertical  line  corresponding  to  the  posterior 
border  of  the  orbital  process  of  the  malar 
bone,”  and  direct  it  “ slightly  upward  and 
forward,  a distance  of  4.5  to  5 cm.,”  into  the 
pterygomaxillary  fossa,  glancing  the  superior 
surface  of  the  pterygoid  plate  which  lies 
about  1 cm.  external  to  the  foramen  ro- 
tundum (Frazier).  To  reach  the  foramen 
ovale  introduce  the  needle  against  the  lower 
border  of  the  zygoma  2.5  cm.  in  front  of  the 
external  auchtory  meatus,  and  direct  it 
slightly  upward  and  backward  a distance  of 
4 to  4.5  cm.  (Frazier). 

There  is  less  danger,  in  this  procedure,  of 
subsequent  corneal  destruction,  than  in 
excision  of  the  Gasserian  ganglion.  Relief 
is  afforded  for  about  a year,  more  or  less. 

b.  Avulsion  of  the  sensory  root  gives 
permanent  relief.  It  is  jireferable  to  re- 
moval of  the  ganglion. 

c.  Avulsion  of  a single  branch  of  the 
nerve,  e.g.,  the  supraorbital,  infraorbital,  or 
inferior  dental.  It  affords  relief  for  about 
two  years  or  longer. 

d.  Injection  of  the  above  branches  with 
alcohol  is  sometimes  effectual. 

e.  Local  application  of  cocaine,  2 to  4 
per  cent.,  to  the  conjunctiva. 


NEURASTHENIA;  PSYCHASTHENIA 


2.  Brachial  Neuralgia. — Support  the 
arm  in  a sling.  Correct  droop-shoulder  by 
strapping  the  scapuliB  together  with  ad- 
hesive plaster,  or  by  the  use  of  braces. 
Operate  for  flexed  scapula  if  conservative 
measures  fail  (see  Round  Shoulder,  in 
Part  10,  Orthopaedics).  If  ionization  is 
employed,  place  the  active  electrode  above 
the  clavicle,  external  to  the  sterno-mastoid 
muscle,  the  other  electrode  over  the  deltoid 
or  lower  down  the  arm.  Nerve  resection  is 
a measure  of  last  resort. 

3.  Intercostal  Neuralgia  and  Masto- 
DYNiA. — Strap  the  affected  half  of  the  chest 
during  forcecl  expiration  from  the  spine  to 
the  sternum  with  one  or  several  over- 
lapping broad  bands  of  adhesive  plaster. 

In  mastodynia,  the  nerves  may  be 
stretched  by  slowly  lifting  the  whole  breast 
for  thirty  or  more  seconds  several  times  a day. 

4.  Testicular  Neuralgia. — See  Part  3, 
Genito-Urinaiy  Diseases. 

5.  Crural  Neuralgia. — See  Meralgia 
Paraesthetica. 

6.  Rectal  Neuralgia. — Try  the  injec- 
tion of  a 1 per  cent,  solution  of  quinine 
and  urea  hydrochloride  (see  Part,  11),  “ just 
within  the  anus  and  the  surrounding  skin  ” 
(L.  Eliot).  Eliot  apparently  cured  a case  by 
repeating  this  injection  after  three  days, 
then  after  three  weeks,  then  two  months, 
then  six  months. 

7.  Sciatica. — (a)  Acupuncture,  or  trans- 
fixion of  the  nerve  along  its  course  by  four 
to  six  steel  needles,  about  three  inches  in 
length,  to  be  left  in  only  a few  minutes. 

(6)  “Nerve  Blocking,”  or  the  injection  into 
the  painful  region  of  the  nerve,  usually  mid- 
way between  the  trochanter  and  the  ischial 
tuberosity,  of  10  to  15  c.c.  of  a 1 per  cent, 
solution  of  eucaine  in  an  0.8  per  cent,  solu- 
tion of  sodium  chloride  (Lange),  or  2 c.c.  of 
2 per  cent,  eucaine,  followed  shortly  by 
100  c.c.  of  sterile  0.9  per  cent,  saline  at 
100°  F.  (quoted  by  C.  M.  Hinds  Howell),  or 
1 per  cent,  quinine  and  urea  hydrochloride, 
using  a needle  8 to  10  cm.  long,  and  intro- 
ducing it  until  the  occurrence  of  sharp  pain 
indicates  that  the  nerve  has  been  reached. 
Repetition  of  the  injection  every  eight  days 
for  throe  or  four  times  is  often  curative. 

(c)  Nerve  Stretching,  accomplished  by  dor- 
siflexion  of  the  foot,  extension  of  the  leg,  and 
flexion  of  the  thigh,  with  the  patient  on  his 
back;  or,  better,  by  exposure  of  the  nerve 
through  an  incision  just  below  the  edge  of 
the  buttock.  The  nerve  is  freed  for  a cer- 
tain distance,  and  both  the  peripheral  and 
central  ends  gently  and  continuously  pulled, 
while  an  assistant  flexes  and  then  extends 


the  limb  to  the  utmost.  The  entire  length 
of  the  nerve  should  be  stretched. 

(d)  Ionization  {q.v.).  Employ,  in  sciatica, 
a long  lead  negative  electrode  over  the 
nerve,  and  place  the  positive  electrode 
over  the  abdomen,  thigh,  or  leg.  Use  a hot 
3 per  cent,  solution  of  sodium  salicylate  or 
sodium  hyposulphite  (or  thiosulphate).  Em- 
ploy a current  very  slowly  increased  to  200 
milliamperes  for  sixty  to  nmety  minutes 
every  two  or  three  days  at  first.  One  to 
fifteen  seances  are  required.  (Lewis  Jones.) 

(e)  Fixation  of  the  Limb  by  means  of  a 
long  splint  extending  from  the  axilla  to  the 
heel,  or  by  means  of  long  hot  sandbags,  is 
of  value  in  neuritis.  The  limb  should  be 
kept  warm.  It  may  be  wrapped  in  cotton- 
wool. Once  or  twice  during  the  day  the 
joints  should  be  gently  flexed  to  pre- 
vent stiffness. 

(/)  Hot  Air  is  said  to  be  the  best  treat- 
ment of  neuritis;  250°  to  300°  F.  for  twenty 
minutes  daily. 

(g)  “An  Orthoform  Suppository  (gr.  xv) 
pressed  well  against  the  prostate  has  been 
knmvn  to  relieve  a severe  sciatic  neuralgia.” 

{h)  X-radiation,  (q.v.)  from  the  poster- 
ior aspect,  from  the  hip  to  the  knee,  using  a 
hard  tube,  8 to  10  Bauer  or  harder,  and  a 
1 mm.  aluminium  filter,  or  else  pastille 
dose,  three  times  a week,  may  be  bene- 
ficial. (Ivnox.) 

Neurasthenia;  Psychasthenia. — Gr.  redpov 
nerve;  rpvxv  mind  + aadiveia  debility.  A 
chronic  functional  affection  of  the  nervous 
system,  characterized  by  undue  irritability 
and  rapid  and  excessive  fatigue  following 
mental  or  jihysical  exertion  or  other  form  of 
stress,  such  as  emotion,  wony,  disease,  etc. 
The  following  varied  sjmiptomatology  is 
encountered:  lassitude,  deficient  power  of 
concentration,  defective  will-power,  various 
forms  of  anxiety,  various  phobias,  involun- 
tary mental  activity,  irritability,  egoism, 
depression,  insomnia,  headaches,  pressure 
in  the  head,  dizziness,  backaches,  limb- 
aches,  hyperaesthesijB,  pariesthesise,  muscu- 
lar weakness,  exaggerated  knee-jerks,  atonic 
tlyspepsia,  circulator}^  disturbances  (palpita- 
tions, tachycardia,  precordial  pain,  d}"spnoea 
and  dizziness  on  slight  exertion  or  excite- 
ment, coldness  of  the  hands  and  feet,  flushing, 
sweating),  genital  disturbances  (nocturnal 
emissions,  premature  ejaculation,  depression 
after  intercourse,  impotence,  painful  testicle). 

Exclude  organic  disease;  exclude  incipient 
paresis.  Do  not  confuse  neurasthenia  with 
hypochondriasis,  in  which  the  patient  enter- 
tains delusions  regarding  the  condition  of 
his  health,  imagining  that  he  is  ill,  but  pre- 


NEURASTHENIA;  PSYCHASTHENIA 


senting  no  symptoms  of  chronic  fatigue. 
Neurocirculatory  asthenia  (irritable  heart) 
is  sometimes  caused  by  pulmonary  tubercu- 
losis or  hyperthyroidism. 

Etiology.— The  cause  of  neurasthenia  is 
either  a congenital  weakness,  hereditarily 
transmitted  or  prenatally  acquired,  or  some 
post-natal  weakening  influence,  such  as 
overwork,  loss  of  sleep,  worry,  traumatism, 
a “ sudden  change  in  one’s  habit  of  life,” 
excessive  indulgence  in  alcohol,  tobacco, 
morphine,  and  venery,  eyestrain,  unphysi- 
ological  living  in  general,  and  disease 
(dyspepsia,  constipation,  visceroptosis,  arter- 
iosclerosis, ansemia,  nasopharyngeal  disease, 
sinusitis  or  some  other  suppurative  process, 
syphilis,  genital  disease,  myocarditis,  influ- 
enza, typhoid  fever,  sunstroke  or  heat 
exhaustion,  etc.). 

Prognosis. — This  is,  as  a rule,  relatively 
favorable,  but  relapses  are  prone  to  occur. 
In  severe  cases,  says.  Osier,  at  least  six 
months  of  rest  and  treatment  are  required. 
“ The  prognosis  in  traumatic  cases,”  says 
Starr,  “is  never  good.” 

Treatment. — Examine  the  patient  carefully, 
and  attend  to  all  possible  exciting  influences 
(see  Etiology).  In  mild  cases  it  may  be 
sufficient  to  enjoin  adequate  rest  of  mind 
and  body,  perhaps  a change  of  scene,  light 
play  out  of  doors,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals, 
regulation  of  the  bowels,  ten  hours  of  sleep, 
a daily  cold  spinal  douche  before  breakfast 
while  standing  in  warm  water  in  a warm 
room,  an  abundance  of  nourishing  and 
easily  dige.stible  food,  and  tonics,  e.g., 
arsenic,  iron,  nux  vomica,  glycerophosphates 
(see  Drugs,  Part  11.) 

Zinci  phosphidi gr.  i (gr.  Ho  per  dose) 

Extract!  nucis  vomicae . gr.  v (gr.  % per  dose) 
Extract!  gentianae,  q.s. 

Ft.  pilulae  no.  xxx.  S!g. — One  pill  t.i.d.  (Forch- 
heimer.) 

A long  vacation  away  from  home  once  a 
year  is  of  great  prophylactic  value. 

Severe  cases  require  the  Weir  Mitchell 
rest  treatment,  which  consists  of  isolation, 
absolute  rest  in  bed,  superalimentation, 
massage,  electricity,  and  baths,  and  is  best 
carried  out  in  a sanitarium.  The  following 
regimen  is  taken  largely  from  C.  W.  Burr: 

It  may  be  best  to  confine  the  patient  for 
from  two  to  six  w'eeks  to  an  exclusive  milk 
diet,  beginning  with  skimmed  milk,  either 
precligested  (see  pepsin  or  trypsin  in  Part 
11),  or  containing  a tablespoonful  of  lime 
water  to  each  glassful,  3 oz.  every  two  hours 
from  7 A.  M.  to  9 p.  m.,  the  next  day  4 oz.. 


and  so  on  up  to  8 to  10  oz.  every  two  hours, 
or  2 to  2}/2  quarts  daily.  A little  carbo- 
hydrate gruel  (oatmeal,  farina,  etc.)  may  be 
added  to  the  milk. 

After  a time,  gradually  enlarge  the  dietary. 
Replace  the  7 a.  m.  milk  with  a cup  of  cocoa, 
and  at  8.30  a.  m.  give  a breakfast  of  raw  or 
soft-boiled  eggs,  toasted  bread  or  zweiback, 
butter,  milk  and  cream,  and  fruit.  After 
several  days,  add  a noon  dinner  of  meat, 
vegetables,  soup,  bread,  butter,  and  dessert. 
After  about  a week,  add  a light  supper,  still 
continuing  the  milk  three  times  a day,  i.e., 
between  meals  and  at  bedtime.  Water 
should  be  taken  freely,  say  a glassful  one- 
half  hour  before  meals.  Tea,  coffee,  alco- 
hol, and  tobacco  should  be  avoided. 

Binswanger’s  menu  is  as  follows : 

7 A.  M. — Glass  of  boiled  milk,  or  cocoa 
made  with  half  milk  and  half  water,  or 
oat-cocoa;  2 to  3 crackers  or  zweiback. 

9 A.  M. — Cup  of  bouillon;  meat  oz.; 
toast  or  graham  bread,  1 oz.;  butter,  ^ oz. 

11a.  m. — Milk,  4)/^  to  6 oz.,  with  the  yolk 
of  an  egg  or  a tablespoonful  of  malt  extract. 

1  p.  M. — Soup  thickened  with  oatmeal, 
barley,  or  rice,  2]/2  to  3)^  oz.;  roast,  1^  oz., 
potatoes,  34  oz.;  vegetables,  34  to  3^^  oz.; 
rice  pudding,  oz.;  compote  1^  oz. 

4 p.  M. — Cocoa  or  malted  milk,  434  oz.; 

2 crackers. 

6 p.  M. — Meat,  oz.;  Graham  bread  or 

toast,  34  oz.;  butter  34  oz. 

8 p.  M. — Soup,  434  oz.,  containing  butter, 
34  oz.,  and  egg  yolk,  oatmeal,  barley,  etc. 

9.30  p.  M. — Malted  milk,  434  oz. 

The  above  quantities  are  gradually  in- 
creased, until,  at  the  end  of  two  weeks,  the 
milk,  cocoa,  and  soup  are  doubled,  and  the 
meat,  bread,  and  butter  trebled,  richer  com- 
potes given,  and  also  fresh  vegetables  and 
simple  puddings. 

The  following  foods  are  credited  with 
special  value  for  neurasthenics,  viz.,  onions, 
garlic,  leeks,  horseradish,  shalots,  chives, 
mustard,  watercress,  and  spinach. 

A warm  sponge  bath  should  be  given  after 
the  cocoa  and  before  breakfast,  later  a 
warm  plunge,  and  later  a cool  douche  while 
standing  in  warm  water,  or  a cool  plunge. 

If  not  unpleasant  to  the  patient,  daily 
general  massage  may  be  practiced  at  about 

3 p.  M.,  or,  if  there  is  insomnia,  at  bedtime. 
It  should  be  gentle  at  first,  and  of  about 
thirty  minutes’  duration,  gradually  increased 
to  one  hour.  Absolute  rest  for  an  hour 
afterward  should  be  observed.  After  a 
time,  resistance  movements  are  practiced; 
and  after  the  patient  is  out  of  bed,  light 
gymnastic  exercises. 


NEURITIS,  LOCALIZED 


Electricity  is  of  least  importance.  It 
may  be  applied,  say,  at  11  a.  m.  Employ  a 
slowly  interrupted  ^’aradic  current,  not 
strong  enough  to  produce  pain.  Place  the 
electrodes  a few  inches  apart  over  the 
muscles  and  elicit  three  or  four  contractures 
from  each  muscle,  taking  about  forty-five 
minutes  to  go  over  the  entire  body.  The 
treatment  may  be  terminated  by  placing  a 
small  electrode  over  the  nape  of  the  neck 
and  a large  one  covering  both  soles  and 
passing  a rapid  current  for  ten  minutes. 

Isolation  should  at  first  be  absolute  but 
for  the  visits  of  the  nurse  and  physician; 
and  the  normal  mode  of  life  should  later 
be  resumed  very  gradually.  The  patient 
may  be  read  to  by  the  nurse  for  half  an 
hour  twice  daily,  after  the  noon  meal  and 
at  8 p.  M.  On  leaving  his  bed,  the  patient 
should  be  allowed  uj)  an  additional  half-hour 
each  day  until  he  is  up  all  day. 

For  the  treatment  of  dyspeptic  symptoms, 
see  Dyspepsia,  Nervous. 

For  obstinate  constipation,  employ  ab- 
dominal massage,  and,  if  tleemed  advisable, 
an  occasional  dose  of  a mild  laxative,  such 
as  cascara,  (see  Constipation). 

For  visceroptosis,  employ  a binder  (see 
Visceroptosis). 

For  nervous  unrest,  one  may  prescribe, 
if  deemed  advisable,  sodium  bromide,  about 
gr.  XV,  well  diluted,  four  times  daily;  or  com- 
pound sumbul  pill,  t.i.d.  (Part  11). 

For  insomnia,  employ  the  warm  wet  pack, 
and,  if  necessaiy,  drugs  (see  Insomnia). 

For  depression  are  recommended  codeine 
phosphate,  nitroglycerin,  and  atropine. 

For  pains,  employ  the  thermo-cautery. 

Burr  says  that  improvement  shoukl  be 
manifes't  at  the  end  of  six  weeks. 

An  attempt  should  be  made  to  instil  into 
the  patient  a new  interest  in  life,  a new  view- 
point. It  is  well  for  the  patient  to  take  up 
some  hobby,  something  to  distract  the  mind 
from  the  petty  worries  and  annoyances  of 
life.  Outdoor  play  should  be  indulged  in. 
The  hypochondriac,  indeed,  may  need 
enforced  activity  instead  of  inactivity. 

The  traumatic  neuroses  and  psychoses 
are  treatetl  as  neurasthenia  or  hysteria. 

Neuritis,  Alcoholic. — Sec  Neuritis,  Multi- 
ple. 

Interstitial  Hypertrophic  Progressive, 
of  Childhood. — See  Interstitial  Ily- 
j^ertrophic  Progressive  Neuritis  of 
Childhood. 

Neuritis,  Localized. — Gr.  ve^pov  nerv'e  -k 
-iTis  inflammation.  Neuritis  is  characterized 
by  intense  j:>ain  in  the  course  and  distribu- 
tion of  the  involved  nerv'e,  undue  tenderness 
on  pressure  over  the  nerve,  pain  on  stretch- 


ing the  nerve,  and  perhaps  hyperaesthesia 
or  anaesthesia,  paraesthesia,  muscle  twitch- 
ing or  paralysis  in  the  distribution  of  the 
nerve.  (For  localizing  symptoms,  see 
Nerves,  Peripheral.) 

Etiology. — Cold;  traumatism;  extension  of 
a neighboring  inflammation;  spinal  caries; 
arthritis;  infection,  including  the  infectious 
diseases;  toxic  conditioas,  e.g.,  gout,  diabetes, 
chronic  nephritis,  toxaemia  of  pregnancy, 
chemical  poisons;  anaemia;  arteriosclerosis; 
tuberculosis;  syphilis;  aneurysm;  tumors; 
etc.;  practically  all  the  causes  of  multiple 
neuritis  {q.v.;  see  also  Neuralgia). 

Prognosis. — This  is  usually  good  in  acute 
cases,  which  may  recover  in  a few  weeks. 
Chronic  cases  may  last  for  months.  Dia- 
betic neuritis  clears  up  when  the  sugar  dis- 
appears from  the  urine. 

Treatment.— Attend  to  the  cause.  In  the 
acute  stage,  with  pain,  tenderness  and 
fever,  cover  the  part  with  cotton-wool,  and 
keep  it  at  rest,  in  an  elevated  position,  by 
means  of  splints.  Once  or  twice  during  the 
day  the  joints  should  be  gently  flexed  to 
prevent  stiffness.  Counter-irritation  may 
be  applied  by  means  of  hot  poultices,  hot 
sand,  salt,  or  water  bags,  mustard  poultices 
(Part  11),  the  Paquelin  cauter}",  a 32-candle- 
power  electric  light  in  a large  parabolic 
reflector,  employed  for  about  ten  minutes 
daily,  daily  dry-cupping  (q.v.)  along  the 
course  of  the  nerve,  or  best  of  all,  very  hot 
air  (250°  to  300°  F.)  for  twenty  minutes 
daily.  Ionic  medication  may  be  employed 
as  described  under  Neuralgia.  Mercury  in 
small  do.ses,  and  the  salicylates  are  recom- 
mended. (See  Drugs,  Part  11).  The  bowels 
should  bo  kept  active.  For  pain,  employ  the 
the  drugs  enumerated  under  Neuralgia. 

Guard  against  wrist-drop  and  resulting 
stretching  of  the  paralyzed  muscles  by 
means  of  elastic  straps  fastened  from  the 
back  of  a glove  covering  the  hyper-extended 
hand  to  a wrist-band.  Guard  against  foot- 
drop  by  means  of  sandbags  or  a soft  rub- 
ber boot. 

After  the  acute  symptoms  have  subsided, 
begin  measures  for  the  restoration  of  tone 
to  the  paralyzed  muscles.  Apply  to  each 
paralyzeil  muscle,  for  five  minutes  daily,  the 
interrupted  galvanic  current,  of  a strength 
of  about  5 to  10  milliamperes,  or  just  enough 
to  produce  a response,  and  not  enough  to 
cause  pain.  Employ  also  massage,  if  not 
painful,  to  the  healthy  as  well  as  to  the 
affected  muscles,  for  one-half  hour  dail}’; 
and  also  passive  and  active  movements. 
By  these  measures,  and  by  extension,  con- 
tractures due  to  shortening  of  the  healthy 
muscles  is  prevented. 


NEURITIS,  MULTIPLE;  POLYNEURITIS 


Strychnine  may  be  given  in  increasing 
doses.  Nerve  stretching  (see  Neuralgia) 
is  sometimes  of  benefit. 

In  traumatic  cases  which  show  no  im- 
provement after  three  months’  treatment, 
cut  down  U|x>n  the  nerve,  remove  scar  tissue, 
and  unite  severed  nerve  ends  by  means  of 
nerve  flaps  or  a tube  of  decalcified  bone. 

For  brachial  neuritis,  see  Brachial  Plexus. 

For  neuritis  of  the  facial  nerve,  see  Facial 
Paralysis. 

For  sciatic  neuritis,  see  Sciatica,  under 
Neuralgia. 

See  also  Nerves,  Peripheral,  Affections  of 
the,  and  Neuralgia. 

Neuritis,  Multiple;  Polyneuritis. — Gr. 

TToXvs  many  -f  veopov  nerve.  A bilateral, 
usually  syrmnetrical,  degenerative  affection 
of  the  peripheral  nerves,  affecting  chiefly 
the  distal  segments  of  the  limbs,  charac- 
terized by  sensory  and  flaccid  motor  paraly- 
sis, with  stocking-shaped  and  glove-shaped 
areas  of  anaesthesia,  and  ankle-drop  and 
wrist-drop,  of  usually  gradual  onset,  pre- 
ceded, sometimes  for  months,  by  numbness, 
tingling,  pains,  muscle  cramps,  and  tender- 
ness in  the  extremities.  A loss  of  faradic 
irritability,  and  a marked  decrease  in  the 
galvanic  irritability  of  the  muscles  and 
nerves  occur  (reaction  of  degeneration) ; 
and  the  tendon  reflexes  are  lost.  Motor 
incoordination,  due  to  loss  of  sensation, 
sometimes  predominates  (pseudo-tabes). 
Neuralgic  pains  usualR  persist  throughout 
the  Illness,  and  the  muscles  are  very  tender. 

In  alcoholic  neuritis,  and  sometimes  in 
other  forms,  there  is  usually  mental  dis- 
turbance: weakness  of  memory,  disorienta- 
tion, or  delusions  of  time,  place,  and  persons, 
tendency  to  confabulation  and  to  indulge 
in  pseudo-reminiscences,  perhaps  hallucina- 
tions (Korsakow’s  psychosis). 

The  acute  febrile  or  infectious  polyneuritis 
or  meningomyeloneurilis  which  follows  ex- 
posure to  cold  or  overexertion  and  is  due  to 
a globoid-like  organism  (Bradford,  Bashford 
and  Wilson),  may  simulate  Landry’s  acute 
ascending  paralysis  or  subacute  myelitis 
(Osier).  It  is  characterized  by  an  initial 
moderately  febrile  period  of  two  to  four  days 
duration,  with  headache,  backache  and  vo- 
miting, followed  from  three  days  to  a month 
after  the  subsidence  of  the  fever  by  bilateral, 
more  or  less  symmetrical  paralysis,  not  limi- 
ted to  the  distal  portions  of  the  limbs,  and 
in  nearly  all  cases  involving  the  face.  Ana- 
tomically, degenerative  changes  are  observed 
in  the  peripheral  nerves,  spinal  roots,  poste- 
rior root  ganglia,  ventral  horn  cells,  and  Betz 
cells  of  the  cortex.  The  mortality  is  high. 

Etiology.— Certain  poisons,  e.g.,  alcohol, 


ether,  arsenic,  lead,  mercury,  copper,  zinc, 
silver,  phosphorus,  carbon  monoxide,  carbon 
bisulphide  used  in  rubber  factories,  dinitro- 
benzene, naphtha,  trional,  sulphonal,  chlore- 
tone,  creosote  phosphate  administered  to 
phthisical  patients,  ptomaines,  etc.;  toxtemia 
of  pregnancy;  infection,  e.g.,  diphtheria, 
typhoid  fever,  typhus  fever,  Malta  fever, 
scarlet  fever,  measles,  mumps,  whooping- 
cough,  smallpox,  malaria,  pneiunonia,  influ- 
enza, leprosy,  septico-pyaemia,  erysipelas, 
gonorrhoea;  overexertion  and  exposure  to 
cold;  cachectic  states:  anaemia,  malignant 
disease,  syphilis,  tuberculosis,  marasmus, 
senility,  etc.;  diabetes;  gout;  beri-beri.  A 
very  rare  recm-ring  polyneuritis  of  unknown 
cause  is  tlescribed. 

Prognosis. — As  a rule,  the  paralysis  is 
progressive  for  several  weeks,  then  remains 
stationary,  and  eventually,  after  one  or  two 
months  or  longer  from  the  time  of  on- 
set, unprovement  begins.  When  improve- 
ment once  begins,  complete  recovery  may 
usually  be  expected  in  from  four  to  six 
months  or  longer.  Diabetic  neuritis  soon 
clears  up  when  the  sugar  has  disappeared 
from  the  urine. 

Attend  to  the  cause.  Employ 
a water-or  air-mattress,  if  possible,  and  bed- 
cratlle  to  take  the  weight  of  the  bed-clothes 
off  the  tender  muscles.  Guard  scrupulously 
against  bed  sores  {q.v.).  Keep  the  bowels 
active,  and  give  water  freely.  The  diet 
shoukl  be  light  but  nutritious. 

Envelop  the  limbs  in  thick  cotton-wool, 
and,  for  pain,  employ  the  remedies  described 
under  Neuralgia.  For  restlessness  employ 
the  bromides  (Part  11)  about  gr.  xv,  well 
diluted,  four  times  a day. 

To  guard  against  contracture,  keep  the 
limbs  extended,  the  feet  at  right  angles  to 
the  legs  by  means  of  sand-bags,  padded 
boards,  or  a light  rubber  boot,  and  the 
wrists  overextended  by  means  of  gloves 
attached  from  the  back  to  a wrist-band 
with  elastic  straps. 

When  improvement  begins  to  set  in,  and 
the  muscles  are  no  longer  tender,  apply 
interrupted  galvanism  for  three  or  four 
minutes  to  each  muscle  every  other  day, 
with  the  weakest  current  possible  to  pro- 
duce a contraction.  Employ  also  massage, 
at  first  very  gently,  and  passive  and  active 
movements.  These  measures,  practiced 
systematically,  will  usually  overcome  con- 
tractures. Tenotomy  is  rarely  necessary. 

Strychnine,  beginning  with  gr.  ]/qq  to 
t.i.d.,  and  gradually  increasing  the 
dose  (see  Part  11),  is  of  value  as  an  aid  in 
restoring  tone. 

As  tonics,  one  may  prescribe  arsenic  in 


OBESITY 


small  doses,  iron,  quinine,  glycerophosphates, 
or  codliver  oil. 

Kerley  gives,  to  a child  of  five  to  ten  years, 
the  following  tonic  for  ten  days,  alternating 
with  codliver  oil  for  five  days; 

B Strychnina?  sulphatis . gr.  (gr.  ^20  per  dose) 
Extract!  ferri  pomati . . gr.  x (gr.  per  dose) 
Quininaj  bisulphatis.  . 3i  (gr.  ii  per  dose) 

M.  et  ft.  capsulaj  no.  xxx. 

Sig. — One  after  each  meal.  (For  constipation, 
add  to  each  capsule  ext.  cascarae,  gr.  }s  to  34)- 
(Kerley.) 

Neuromyositis. — Gr.  yeOpoy  nerve  + pvs 
muscle  + -cTLs  inflammation.  See  Myositis. 

Neuroses,  Occupation.  — See  Cramps, 
Professional. 

Traumatic. — See  Hysteria;  and  Neuras- 
thenia. 

Night  Blindness.  — See  Part  6,  Eye 

Diseases 

Night  Sweats. — See  Hj'peridrosis  in  Part 
5,  Skin  Disease. 

Night  Terrors. — Causes.— Neurotic  tem- 
perament; indigestion;  heavy  supper;  con- 
stipation; obstruction  to  breathing  due  to 
adenoids,  enlarged  tonsils,  coryza,  etc.; 
over-study;  eyestrain;  malnutrition  and 
anaemia;  dentition;  pin-worms;  elongated 
foreskin;  heavy  bed-covering. 

Treatment.— Correct  the  cause.  The  pa- 
tient should  eat  an  early  light  supper,  and 
should  not  study  in  the  evening.  The  bed- 
room should  have  an  abundance  of  fresh 
air  and  the  bed-covering  should  be  light  in 
weight.  SocUum  bromide  (Part  11)  in  hot 
water  may  be  given  occasionally  in  bad 
cases;  Forchheimer  says,  every  night  for 
about  a week. 

Ninth  Nerve. — See  Glosso-Pharyngeal 

Neiwe. 

Nocardiosis. — See  Actinomycosis,  in  Skin 
Diseases,  Part  5. 

Noma. — Gr.  vop-q  feeding.  See  Stomati- 
tis, Gangrenous. 

Nosebleed. — See  Epistaxis,  in  Part  8, 
Nose  Diseases. 

Nutritive  Enemata. — See  Rectal  Feeding. 

Nyctalopia;  Night  Blindness. — See  Part 
0,  Eye  Disease. 

Nycturia. — Gr.  night  + ovpov  urine. 

A greater  excretion  of  urine  at  night  (be- 
tween 7 p.  M.  and  7 a.  m.)  than  during  the 
day.  Normally,  much  more  urine  is  excreted 
during  the  day  than  at  night.  Nycturia  is 
usual  in  cetlematous  conditions  of  hepatic, 
cardiac,  or  renal  origin,  but  especially  in 
cardiac  insufficiency. 

Nystagmus. — See  Part  6,  Eye  Diseases. 

Obesity. — L.  ohes'itas,  fatness.  A dis- 
order of  fat  metabolism  manifested  by  an 
excessive  accumulation  of  fat  in  the  body. 


Etiology.— Overeating;  alcohol;  chronic  con- 
stipation; sedentary  habits;  heredity;  pu- 
berty; marriage;  pregnancy;  lactation;  meno- 
pause; deficient  development  of  the  genital 
organs;  castration  or  double  oophorectomy; 
anaemia  with  resulting  insufficient  oxidation 
due  to  deficiency  of  haemoglobin;  hypopi- 
tuitarism (see  Acromegaly);  thyroid  insuf- 
ficiency (?:  see  Adiposis  Dolorosa). 

Treatment. — Attend  to  the  cause.  Pre- 
scribe saline  laxatives  (Part  11)  or  laxa- 
tive mineral  waters  as  required,  regular 
hours  of  eating,  fresh  air  day  and  night,  a 
daily  bath,  and  daily  graduated  exercise 
out  of  doors.  Hot  baths  are  indicated  for 
plethoric  and  gouty  subjects;  brief  warm 
baths  in  myocardial  disease,  and  where 
oedema  is  present;  and  cold  baths  for 
flabby,  toneless  individuals.  While  taking 
a cold  bath  the  patient  should  rub  his  body 
vigorously  and  exercise  as  far  as  prac- 
ticable to  prevent  uncomfortable  chilling. 
The  bath  should  be  taken  in  a warm  room, 
and  at  first  cold  douches  may  be  taken  while 
standing  in  warm  water.  The  bath  is  best 
taken  before  breakfast,  never  shortly  after 
a meal.  Local  deep  massage  is  beneficial. 
Where  the  heart  is  weak,  active  exercises 
should  be  preceded  by  rest  and  massage, 
then  passive  movements,  resisted  move- 
ments, Nauheim  baths,  etc.,  as  described 
under  Carchac  Insufficiency.  Drugs  of  the 
digitalis  group  are  apt  to  be  dangei- 
ous,  owing  to  the  possible  existence 
of  atrophy  and  fatty  infiltration  of  the 
heart-muscle. 

In  lieu  of  other  forms  of  exercise  and 
sports,  a healthy  individual  should  walk 
one  or  two  hours  a day,  4)4  to  5 km. 
(33^  miles)  an  hour.  To  reduce  abdom- 
inal adiposity,  employ  the  following  exer- 
cise immediately  on  rising,  with  the  win- 
dows open,  ancl  the  clothing  loose:  Ijdng 
flat  ui)on  the  back,  with  arms  folded  across 
the  chest  and  feet  weighted  or  strapped  to 
the  floor,  rise  slowly  to  the  sitting  posture 
without  bending  the  knees,  and  repeat  this 
movement  three  to  ten  or  more  times  in 
succession;  next,  raise  both  legs,  without 
bending  the  knees,  to  a right-angle  with 
the  trunk. 

For  anaemia,  prescribe  iron,  and  per- 
haps arsenic  (see  Part  11).  For  obesity  asso- 
ciated with  amenorrhoea,  Howard  A.  Kelly 
prescribes  lutein  tablets,  gr.  v,  t.i.d.  Pitui- 
tary or  hypophyseal  (anterior  lobe)  extract, 
gr.  viii-x,  j^er  diem,  by  mouth,  would  seem 
also  to  be  indicated  here  (see  Acromegaly). 

Thyroid  extract  may  be  tried  cautiously 
in  small  doses,  gr.  ss,  twice  daily,  gradually 
increased  to  gr.  ii,  twice  or  tlxrice  daily  (no 


OBESITY 


more  than  gr.  v,  t.i.d.).  It  should  at  once 
be  discontinued  on  the  appearance  of  the 
following  symptoms,  viz.,  weakness,  rest- 
lessness, headache,  vertigo,  syncope,  palpi- 
tation, tachycardia  (see  Myxcedema.) 
The  danger  in  using  thyroid  extract 
lies  in  the  fact  that  the  heart  of  obese  indi- 
viduals is  apt  to  be  atrophied,  the  coronary 
vessels  sclerosed,  and  the  heart’s  action 
impeded  by  fatty  infiltrates.  Many  good 
observers  do  not  recommend  thyroid  ex- 
tract unless  my:xocdema  is  present.  Von 
Noortlen,  however,  advocates  its  use. 

Dieting  and  exercise,  however,  occupy 
first  place,  and  particularly  dieting.  Fats, 
starches, sugars,  and  salt  should  be  restricted, 
but  not  proteids.  CErtel,  Schweininger,  and 
others  restrict  fluids;  Von  Noorden,  Eb- 
stein, and  Gsertner  allow  fluids  ad  libitum. 
Saccharin,  crystallose,  orsaxin  (see  Part  11), 
may  perhaps  be  substituted  to  some  extent 
for  sugar.  Green  vegetables  (spinach, 
Brussels  sprouts,  kale,  cabbage,  string 
beans,  etc.),  skimmed  milk,  and  fruits 
(oranges,  lemons,  raw  apples,  raw  peaches, 
grapes,  cherries,  berries)  are  the  prefer- 
able foods.  The  following  articles  should 
be  avoided,  viz.,  alcohol,  tea,  coffee,  aer- 
ated beverages,  potatoes,  turnips,  carrots, 
beets,  parsnips,  sweet  potatoes,  celery, 
oatmeal,  rice,  hominy,  starch,  peas,  beans, 
lentils,  raw,  canned,  potted,  smoked,  and 
salted  meats  and  fish,  fried  foods,  pork,  veal, 
rich  soups,  stews,  hashes,  meat  extractives, 
liver,  kidney,  sweetbreads,  sausage,  tiuck, 
goose,  lobsters,  crabs,  salmon,  mackerel, 
sardines,  herring,  bluefish,  hot  bread,  cakes, 
pies,  pastry,  spices,  nuts,  candies. 

Bulky  and  therefore  satisfying  foods  with 
low  nutritive  value  are  desirable,  and  the 
food  should  be  well  chewed  in  order  that 
the  appetite  may  be  the  more  quickly 
assuaged.  Gsertner  praises  boiled  beef 
because  of  its  satisfying  bulk  and  its  relative 
tolerance  by  gouty  subjects.  He  regards 
bread  as  the  chief  cause  of  obesity  (excluding 
alcohol),  and  favors  absolute  bread  absti- 
nence as  a rule,  or  only  1 to  2}/^  ounces  for 
breakfast.  In  children,  meat  in  excess  as 
well  as  bread,  is  another  frequent  cause  of 
obesity,  says  Gsertner.  He  allows  boiled 
or  baked  potatoes. 

Iodine  preparations,  minute  doses  of  cam- 
phor, peppermint  lozenges,  and  menthol 
tablets  are  credited  with  anorexic  properties. 

The  following  modified  QUrtel’s  dietary 
(CErtel’s  dietary  consists  of  170  gm.  albumin, 
120  gm.  carbohydrate,  and  45  gm.  fat  in 
twenty-four  hours)  may  be  used  as  a guide, 
bearing  in  mind  that  about  16  calories  per 
pound  of  normal  body-weight  (see  Table  of 
17 


Average  Weight  to  Height  at  Different  Ages, 
under  Food  Values)  are  required  each  day 
for  persons  doing  ordinary  light  work  (see 
Table  of  Caloric  Food  Values). 

Breakfast. 

Wheaten  bread,  1J4  oz 123  calories 

Soft-boiled  eggs,  one  or  rarely 

two 7.5-150  calories 

Milk,  1 oz 21  calories 

Sugar,  1 dram 16.4  calories 

Water,  as  desired,  — ^ ^ — ■ — • 

Total 23.5.4-310.4  calories 

Rye  bread  or  iKimpernickel  may  be  used  instead 
of  wheat  bread;  it  is  less  nutritious. 

Luncheon. 

Beefsteak,  tenderloin,  5 oz., weighed 

after  cooking 405  calories 

Or  sirloin,  5 oz 275  calories 

Or  fowl,  5 oz about  2.50  calories 

Soft-boiled  eggs,  one  or  two 75-150  calories 

Green  salad  (including  cucumbers, 
radishes,  asparagus,  artichokes, 
cauliflower,  watercress,  endive, 
sorrel,  salsify,  lettuce,  tomatoes). 


1 oz 10  calories 

Cheese,  American,  1 dram 16  calories 

Bread,  If^  oz 123  calories 

Fruit  (apples,  berries,  pears,  plums, 
cherries,  oranges),  4 to  5 oz . . . . 

Water  as  desired,  

Total 474-704  calories 

Dinner. 

Clear  bouillon,  3J^  oz.,  or  as 
much  as  desired. 

Non-fatty  fish,  3f4  oz 147  calories 

Beefsteak,  sirloin,  6 to  8 oz.;  or 

roast  lamb ; or  poultry 330-440  calories 

Green  vegetables  If^  oz 15  calories 

Bread,  1 oz 82  calories 

Fruit,  3 to  4 oz about  70  calories 

Sugar,  1 dram 16  calories 

Water  as  desired,  

Total 681-791  calories 

Daily  total 1390-1805  calories 


This  is  the  approximate  number  of  calories 
required  for  one  weighing  about  100  pounds. 
From  this  dietary  can  be  readily  calculated 
the  dietary  for  one  of  any  weight. 

A strictly  adequate  quantitative  dietary 
is,  of  course,  impossible,  because  one’s 
nutritional  needs  depend  upon  other  immeas- 
urable factors  besides  the  age  and  normal 
weight,  e.g.,  the  digestive  and  assimilative 
powers,  the  metabolic  activity,  and  the 
degree  of  mental,  nervous,  and  muscular 
exertion.  Moreover,  the  caloric  values  of 
the  various  foods  recorded  are  not  accurate. 
The  dietaries,  therefore,  should  be  used 
merely  as  guides,  and  each  patient  should 
be  treated  according  to  his  or  her  needs. 

Have  the  patient  visit  the  office  once  a 
week  to  be  weighed  and  interviewed,  and 
to  see  that  the  reduction  in  weight  is  not 
too  rapid.  Gsertner  considers  a daily 
decrease  of  0.15  to  0.2  per  cent,  as  the  ideal. 


(ESOPHAGEAL  DIVERTICULA 


According  to  Gsertner,  the  obesity  treat- 
ment is  permissible  at  twelve  to  thirteen 
years  of  age  in  girls,  and  fifteen  to  sixteen 
years  of  age  in  boys;  the  upper  limit  of  age 
is  indeterminate. 

After  the  desired  reduction  of  weight  has 
been  attained,  which  should  not  ordinarily 
be  the  “ normal  ” weight  given  in  the  table 
(under  Food  Values),  an  orchnary,  well-bal- 
anced, temperate  diet  is  allowed.  The  nor- 
mal amount  of  each  food  element  required  by 
tlie  individual,  per  j^ound  of  the  weight  nor- 
mal to  his  height  and  age,  per  day,  is,  accord- 
ing to  Ortner,  12  grains  of  protein,  5)^  grains 
of  fat,  and  48  grains  of  carbohydrate  (or  1.7 
gm.  of  protein,  0.80  gm.  of  fat,  and  7.1  gm. 
of  carbohydrate  per  kilo;  1 gm.  proteid  o 
4.1  calories;  1 gm.  carbohydrate  o 4.1  calor- 
ies; 1 gm.  fat  =o  9.3  calories). 

Brief  courses  of  starvation  (5-6-1-  days), 
with  or  without  the  free  tlrinking  of  purga- 
tive waters  (see  under  Constipa  ion),  may 
be  of  value  in  plethoric  cases. 

Obstetrical  Palsy.  — See  Hemorrhage, 
Meningeal,  in  the  New-Born,  and  Upper  Ann 
Type  of  Paralysis,  under  Brachial  Plexus. 

Obstruction,  Biliary. — See  Cholelithiasis. 

Bronchial. — See  Bronchostenosis. 

Intestinal. — See  Intestinal  Obstruction. 

Laryngeal. — See  Part  9,  Throat  Dis- 
eases. 

(Esophageal. — See  (Esophageal  Steno- 
sis or  Stricture,  ami  Foreign  Bodies, 
in  Throat  Diseases,  Part  9. 

Tracheal. — See  Tracheal  Obstruction. 

Ureteral. — See  Hydronephrosis. 

Obstructive  Jaundice. — See  Jaundice. 

Obturator  Nerve. — See  Lumbar  Plexus. 

Occipito=Cervical  Neuralgia. — See  Neu- 
ralgia. 

Occupation  Neuroses. — See  Cramps,  Pro- 
fessional. 

Ochronosis. — Gr.  yellowish -|-r6o-os 

disease.  A rare  metabolic  disorder,  charac- 
terized by  blackish  discoloration  of  the  skin, 
sclerotics,  cartilages,  fibrous  tissues,  and  the 
urine,  the  latter  due  to  alkapton  in  congen- 
ital cases  (see  Alkaptonuria),  and  to  carbolic 
acid  poisoning  in  acquired  cases. 

Oculomotor  Nerve. — See  IMotor  Nerves 
of  the  Eyeball. 

(Edema. — -Gr.  6i5r?/Lta  swelling.  Causes. — 
C ardiac,  renal,  hepatic,  or  pulmonary  disease; 
venous  thrombosis ; arterio-venous  aneuiysm ; 
aneuiysm  of  the  ascending  arch;  varicose 
veins;  fiat-foot;  obesity;  anscmia;  purpura; 
leukaemia;  Hodgkin’s  disease;  scurvy^;  exoph- 
thalmic goitre;  cancer  ;trichiniasis;  Ijunphatic 
obstruction,  and  elephantiasis;  dermatomyo- 
sitis;  local  inflammation;  disuse,  as  after 


fracture;  pelvic  cRsease  (tumors,  etc.);  preg- 
nancy; paralysis;  neuralgia  and  neuritis; 
anthrax;  angioneurotic  oedema;  scleroderma; 
beri-beri;  oedema  neonatorum;  profuse  diar- 
rhoea; Milroy’s  disea.se,  or  persistent  heredi- 
tary oedema  of  the  legs  of  unknown  cause  (the 
oedema  is  permanent,  with  occasional  acute 
attacks  accompanied  by  chill,  fever,  and 
increased  swelling;  the  oedema  may  be  kept 
within  bounds  by  bandaging). 

(Edema,  Angioneurotic. — See  Part  5, 
Skin  Diseases. 

Cardiac. — See  Cardiac  Insufficiency. 

Glottic. — See  Part  9,  Throat  Diseases. 

Hepatic. — See  Cirrhosis,  Portal,  of  the 
Liver. 

Hereditary,  of  the  Legs,  or  Milroy’s 
Disease. — See  under  (Edema. 

Laryngeal. — See  Part  9,  Tlu’oat  Dis- 
eases. 

Lids. — See  Part  5,  Skin  Diseases. 

Malignant. — See  Anthrax,  in  Skin  Dis- 
eases, Part  5. 

Neonatorum. — See  Part  5,  Skin  Dis- 
eases. 

Pulmonary. — See  Pulmonary  (Edema. 

Renal. — See  Bright’s  Disease. 

(Edematous  Laryngitis.  — See  Part  9, 
Throat  Diseases. 

(Esophageal  Cancer. — See  Cancer  of  the 
(Esophagus. 

(Esophageal  Dilatation. — Gr.  dLativ  to 
cany  + 4>dyr]fxa  food.  A chronic  affection, 
secondary  to  organic  or  spasmodic  stricture 
of  the  cardia,  or  congenital  or  idiopathic 
(due  possibly  to  atonj'-)  manifested  by  diffi- 
culty and  distress  in  swallowing,  discomfort 
in  tlie  sternal  region  due  to  the  presence  of 
food  and  the  a.ssociated  inflammation,  and 
the  regurgitation  of  undigested  food  and 
mucus  containing  no  hydrochloric  acid, 
pepsin,  or  rennin  (see  tests  under  Dyspepsia). 

The  diagnosis  is  made  (except  in  early 
cases)  by  means  of  a bismuth  X-ray  exam- 
ination (bismuth  sulphate,  5ss,  suspended 
in  mucilage  of  acacia),  the  passage  of  sounds, 
and  oesophagoscop3n 

Treatment. — Attend  to  the  cause  (see  Car- 
diospasm; and  (Esophageal  Stenosis  or  Stric- 
ture. To  allay  inflammation,  wash  out  the 
sac  ever^'  night,  and  irrigate  it  with  boric 
acid  or  borax  solution,  2 per  cent,  (about 
a heaping  tablespoonful  to  the  quart),  or 
silver  nitrate,  1 : 1000.  If  blood  is  present 
(indicating  ulceration),  feed  the  patient  per 
rectum  for  awhile,  for  fear  of  rupture  (see 
Rectal  Feeding). 

(Esophageal  Diverticula. — L.  diverticular  e, 
to  turn  aside.  The  pouch  usuallj'’  occurs 
at  the  junction  of  the  pharjmx  and  oesopha- 


(ESOPHAGEAL  STENOSIS  OR  STRICTURE 


gus,  on  the  posterior  wall,  exactly  opposite 
the  cricoid,  and  is  then  due  to  muscular 
weakness  at  this  point,  plus  food  pressure. 
Sometimes  traction  diverticula  occur,  usu- 
ally near  the  tracheal  bifurcation,  on  the 
anterior  wall,  due  to  contracting  cicatricial 
adhesions  following  tuberculous  lympha- 
denitis. Rare  causes  of  traction  diverticula 
are  disease  of  the  pleura,  lung,  or 
pericardium,  cricoid  perichondritis, 
mediastinitis,  vertebral  caries,  and  thyroitl 
adhesions.  This  variety  of  chverticulum 
is  usually  symptomless. 

The  condition  usually  occurs  in  elderly 
men,  and  is  manifested  by  some  difficulty 
in  swallowing,  the  regurgitation  of  undi- 
gested food  hours  or  days  after  it  has  been 
taken,  a foul  breath,  the  sensation  of  some- 
thing in  the  throat,  and  sometimes  the  pres- 
ence of  a soft  swelling  in  the  lower  part  of 
the  posterior  triangle  of  the  neck. 

The  oesophageal  tube  may  stop  in  the 
cUverticulmn  at  a distance  of  6 to  7 inches 
from  the  teeth  (16  to  17  inches  in  the  trac- 
tion chverticulum).  Take  care  to  cause  no 
perforation.  Employ  also  cosophagoscopy 
and  radiography,  the  latter  immediately 
after  filling  the  sac  with  a suspension  of 
bismuth  sulphate,  § ss,  in  mucilage  of 
acacia. 

Treatment. — The  sac  may  sometimes  be 
emptied  from  the  outside  after  each  meal. 
It  may  be  washed  out  every  night  with 
warm  water,  or  if  there  is  inflammation, 
with  borax  or  boric  acid  solution,  2 to  3 per 
cent.,  or  silver  nitrate,  1 : 1000.  A diverticu- 
lum tube  (bent  at  its  point  at  an  acute 
angle)  may  be  used. 

Operate  and  remove  the  sac,  if  feasible. 
Make  a long  incision  along  the  anterior 
border  of  the  sternomastoid  muscle  with  its 
centre  opposite  the  cricoid  cartilage.  Carry 
the  (hssection  down  to  the  inner  side  of  the 
great  vessels,  and  outside  the  trachea,  divid- 
ing the  omohyoid  muscle  and  the  superior 
thyroid  vessels.  Remove  the  diverticulum, 
close  the  oesophageal  wound  carefully 
with  silk,  and  insert  a drainage  tube 
(St.  Clair  Thomson). 

(Esophageal  Foreign  Bodies. — See  Part  9, 
Throat  Diseases. 

Inflammation. — See  (Esophagitis. 

Neuroses. — See  Cardiospasm  and  (Eso- 
phagismus. 

Obstruction. — See  (Esophageal  Stenosis 
or  Stricture;  and  Foreign  Bodies,  in 
Part  9,  Throat  Diseases. 

Paresis. — See  under  Cardiospasm. 

Spasm.  — See  Cardiospasm  and  (Eso- 
phagismus. 


(Esophageal  Stenosis  or  Stricture. — Gr. 

(TThoais;  L.  strictur'a,  narrowing.  The  diag- 
nosis is  made  from  the  complaint  of  diffi- 
culty in  swallowing,  and  by  means  of  the 
stomach  tube  or  oesophageal  sound,  the 
ODSophagoscope,  and  the  bi.smuth  and  acacia 
meal  (bismuth  sulphate,  5ss,  suspended  in 
mucil.  acaciae)  followed  mimediately  by  flu- 
oroscopy. (See  under  Dj^spepsia). 

Etiology.— Congenital  stenosis,  very  rare; 
spasm  (see  Cardiospasm  and  (Esophagis- 
mus) ; fibrous  or  cicatricial  contraction  due 
to  wounds,  foreign  bodies,  impacted  food, 
burns,  inflammation,  corrosive  poisons, 
syphilis,  and  infectious  diseases;  tume- 
f active  oe.sophagitis;  kinking  or  angulation 
just  above  the  cardia;  pare.sis,  due  to  lesions 
in  the  pons  and  medulla,  e.g.,  hemorrhage, 
tumors,  bulbar  palsy,  multiple  sclerosis, 
tabes,  dementia  paraljTica;  paresis  due  to 
diphtherial  or  influenzal  neuritis;  com- 
pression due  to  goitre,  aneurysm,  tumors, 
retropharyngeal  growths  and  swellings,  cer- 
vical, bronchial,  or  mediastinal  glands  or 
abscesses,  thjunus  tumors,  exostoses,  verte- 
bral disease,  pericardial  and  pleural  effusion; 
oesophageal  polyps;  foreign  bodies  {q.v.,  in 
Part  9,  Throat  Diseases) ; diverticula  {q.v.) ; 
carcinoma  {q.v.,  constitutes  85  per  cent,  of 
cases  of  obstruction. — Osier). 

Treatment  of  Cicatricial  Stenosis. — 
Lubricate  the  oesophageal  canal  with  warm 
oil,  introduced  by  swallowing  or  by  means  of 
a Nelaton  catheter  and  piston  syringe.  Then 
introduce  with  care,  so  as  not  to  cause  irri- 
tation or  perforation,  graduated  flexible 
linen  or  gimi-elastic  or  whalebone  sounds 
with  conical  tips,  beginning  with  the  larger 
sizes,  and  pa.ssing  to  the  smaller  sizes  until 
the  stricture  is  entered.  In  passing  the 
sound,  have  the  patient  seated  on  a low 
chair  with  the  head  well  thrown  back. 
Introduce  the  left  index  finger  far  into  the 
pharynx,  and  pass  the  sound  beside  it  until 
it  impinges  upon  the  posterior  wall  of  the 
pharynx,  then  pass  it  along  the  pharynx,  a 
little  to  one  side  of  the  middle  line,  into  the 
oesophagus.  There  is  nonnally  often  a slight 
obstruction  in  passing  the  cricoid  cartilage. 

Pass  the  largest  sound  possible  (leaving 
it  in  ten  minutes  or  longer)  every  other  day 
until  the  stricture  yields.  Thereafter  pass  a 
large  sound  now  and  then  to  obviate  a 
recurrence  of  the  stricture.  W.  Hill  em- 
ploys the  stomach  tube,  with  the  sealed 
lower  end  weighted  with  metallic  mercury, 
and  directs  the  patient  to  swallow  when  the 
tube  approaches  the  stricture.  The  tube 
is  left  in  situ  for  half  an  hour,  if  possible. 

Thiosinamin  or  fibrolysin  (Part  11)  may 


(ESOPHAGEAL  STEN(JS1S  OR  STRICTURE 


be  administered  hypodermically  every  two 
or  three  days  for  its  alleged  softening  effect 
upon  the  stricture. 

In  cases  due  to  corrosive  poisons,  one 
should  begin  to  pass  bougies  about  ten  days 
(Sippy),  four  to  sLx  weeks  (Gottstein),  after 
the  corrosive  has  been  swallowed;  and  they 
should  be  passed  in  increasing  sizes  every 
three  or  four  days  until  the  largest  size  is 
passed.  Sometimes  they  have  to  be  con- 
tinued every  few  weeks  for  years,  or  even 
throughout  life. 

To  avoid  a false  passage,  and  in  tight  and 
tortuous  strictures,  Mixter  suggests  a silk 
thread  as  a guide.  Sippy’s  technique  is  as 
follows:  “ About  a yard  of  a 25-yard  spool 
of  braided  surgical  silk  thread.  No.  8,  is 
placed  in  a capsule  and  swallowed,  and 
gradually  one  or  two  yards  more  is  swallowed 
each  day.  After  a few  days  the  thread  which 
was  first  swallowed  becomes  deeply  anchored 
in  the  intestine  and  later  passes  out  through 
the  rectum.  The  cUlator  (Fig.  55)  consists 


be  fir-st  cocainized,  (see  Part  11)  to  prevent 
vomiting. 

In  very  young  children,  and  in  adults 
unable  to  swallow  the  capsule,  Sippy  uses 
the  oesophagoscope  by  which  to  pass  a 
filiform  whalebone  bougie  or  one  made  of 
piano  wire  tipped  with  a small  metal  bulb, 
“ to  act  as  a guide  over  which  dilating  bulbs 
may  be  threaded,”  after  the  oesophagoscope 
has  been  withdrawn. 

Another  method  of  entering  a small 
stricture  is  by  the  introduction  of  a lai’ge 
number  of  filiform  bougies,  as  in  urethral 
stricture.  After  the  stricture  has  been 
dilated,  an  intubation  tube,  such  as  that  of 
William  Hill,  or  Symonds,  may  be  worn 
continuously  for  a week  or  two. 

The  styletted  tube  is  inserted  through  the 
oesophagoscope  and  fastened  to  the  teeth. 
At  first  liquids  are  fed  through  the  tube, 
but  later  food  may  be  swallowed  beside  the 
tube  owing  to  the  continuous  bougie  effect 
on  the  stricture. 


Fir,.  55. — < 


CEsophaffoal  dilating  bulbs  A,  introducer  B,  and  threader  C,  described  in  the  text.  From  Mnsscr  a«d 
Kelly's  Practical  Treatment,  Courtesy  VV.  B.  Saunders  Co. 


of  a series  of  graduatetl  conical  metal  bulbs 
(A),  which  may  be  screwed  on  to  a very 
flexible  spiral  introducer  (B)  about  22  inches 
long,  made  of  piano  wire,  size  No.  10.  Each 
conical  bulb  is  provided  with  a central 
canal  that  is  continuous  with  the  lumen  of 
the  spiral  introducer  when  the  bulb  is 
adjusted.  The  end  of  the  silk  thread  pro- 
truding from  the  mouth  is  drawm  back  from 
the  CEsophagus  until  it  is  moderately  taut, 
and  then  threaded  by  means  of  a wire  (C) 
through  the  centre  of  the  bulb  and  spiral 
introfiucer.  By  holding  the  end  of  the 
thread  firmly  in  one  hand  and  pushing  on 
the  sjiiral  introducer  with  the  other,  the 
very  flexil)le  spiral  becomes  rigid,  and  the 
conical  bulb,  guided  l)y  the  thread,  may  be 
very  gently  forced  through  the  stricture. 
Beginning  with  a bulb  which  passes  with  a 
very  easy  pressure,  slightly  larger  bulbs 
should  be  used  in  succession  until  the  stric- 
ture is  sufficiently  dilated.  Usually  an 
ordinary  linen  l>ougie  may  then  be  passed 
safely  and  the  ojx'iiing  through  the  stricture 
maintained  without  the  use  of  the  thread  ” 
(B.  W.  Sippy).  The  pharynx  may  have  to 


Other  measures  which  have  been  employed 
with  success  are  (1)  excision  of  the  stricture; 
(2)  internal  oesophagotomy  (“  applicable 
only  to  very  short,  tight,  annular  strictures  ” 
William  Hill);  (3)  oesophago-gastro-anasto- 
niosis  in  Sauerbruch’s  chamber;  (4)  dilata- 
tion of  a stenosis  of  the  cardia  through  a 
gastrostomy  opening,  by  means  of  the  finger 
or  the  rubber-covered  blades  of  a pah’  of 
tlressing  forceps,  followed  by  tubage;  (5) 
cutting  of  the  stricture  with  a fishing-line 
by  sawing  movements  through  the  mouth 
or  an  oj^ening  in  the  neck  and  a gastrostomy 
opening,  the  stricture  at  the  same  time  being 
made  tense  by  means  of  a conical  bougie, 
this  internal  oesophagotomy  to  be  followed 
l\v  the  systematic  passage  of  sounds.  Gas- 
trostomy is  a palliative  expedient.  (See 
under  Dyspepsia,  for  contra-indications  to 
the  passage  of  sounds.) 

Remove  polypi  through  the  oesophago- 
scope; or,  if  the  pedicle  is  long,  induce  vomit- 
ing by  means  of  apomorphine,  seize  the 
extruded  j^olyp  with  forceps,  and  remove 
it  by  means  of  ligature,  galvano-cauterjq 
or  cold  snare. 


OSTEO-ARTHROPATHY,  PULMONARY 


(Esophageal  Ulcers. — See  (Esophagitis, 
Chronic. 

CEsophagismus. — See  Cardiospasm  and 
(Esophagismus. 

(Esophagitis. — 1.  Acute  fflsophagitis. — SYMP- 
TOMATOLOGY.— Difficulty  and  pain  in  swal- 
lowing; burning  sensation;  salivation;  local 
tenderness;  elevation  of  temperature;  per- 
haps the  regurgitation  of  food,  mucus,  and 
sometimes  blood.  Perioesophageal  abscess 
and  perforation  may  occur.  If  ulceration 
occurs,  stenosis  will  follow. 

Etiology.  — Corrosive  acids  and  alkalies ; 
hot  liquids;  hard  food;  foreign  bodies;  in- 
fectious diseases  (typhoid  fever,  pneumonia, 
scarlet  fever,  measles,  diphtheria,  smallpox, 
pyaemia,  cholera) ; neighboring  inflammation 
(stomatitis,  thrush,  pharyngitis,  laryngitis, 
tracheitis,  gastritis,  mediastinitis) ; peptic 
ulcers  near  the  cardia;  continued  bilious 
vomiting;  uraemia. 

Treatment. — For  the  treatment  of  cor- 
rosive poisoning,  see  Poisoning. 

In  acute  catarrhal  inflammation,  recoveiy 
occurs  in  from  three  to  fourteen  days.  Oil 
and  milk  may  be  given  to  drink,  and  per- 
haps a suspension  of  bismuth  subcarbonate 
in  mucilage  of  acacia  or  of  tragacanth,  gr. 
xxiv  ad  5i,  one  ounce  twice  or  thrice  daily. 
For  thrush,  give  sodium  bicarbonate,  gr. 
XXX  ad  5 i,  one  or  two  tablespoonfuls  four  to 
six  times  a day. 

II.  Chronic  (Esophagitis. — Uneasiness  in  swal- 
lowing is  the  common  complaint  in  chronic 
catarrh.  The  symptoms  of  ulcer  are  diffi- 
culty and  pain  in  swallowing,  regurgitation, 
vomiting,  and  hjematemesis.  Gastric  ulcer 
and  oesophageal  varices  are  to  be  excluded. 

Etiology. — Causes  of  Catarrh. — Acute 
oesophagitis;  chronic  alcoholism;  tobacco 
addiction;  chronic  pharyngitis;  chronic 
gastritis;  chronic  congestion  due  to 
heart  or  lung  disease;  thrush;  oesophageal 
stenosis;  diverticula. 

Causes  of  Ulceration. — Acute  oesophagitis; 
tuberculosis;  syphilis;  actinomycosis  (all 
three  extremely  rare);  cancer;  stenosis; 
uraemia;  acute  infectious  diseases;  pressure 
of  the  cricoid  in  exhausting  diseases  (decu- 
bital  ulcer) ; pressure  of  an  aneurysm,  tumor, 
thyroid,  etc.;  foreign  body;  peptic  ulcer 
(extremely  rare). 

Treatment. — Attend  to  the  cause.  The  diet 
should  be  that  employed  in  cancer  (q.v.) ; 
and  pain  and  spasm  may  also  be  relieved 
as  described  in  cancer. 

Bismuthi  subcarbonatis gr.  xxiv 

Mucilaginis  acaci®  vel  tragacanthi  5i 

M.  Sig. — Shake  well  and  take  one  ounce  (two 
table-spoonfuls)  three  or  four  times  a day,  in  the 
recumbent  posture. 


Argenti  nitratis gr.  i 

Aquae  destillatae 5 i 

M.  Sig. — One  tablespoonful,  swallowed  in  the 
recumbent  posture,  once  every  several  days. 

II  Acidi  tannici gr.  v 

Aqua; 5 i 

M.  Sig. — One  or  two  tablespoonfuls,  several 
times  a day,  swallowed  in  the  recumbent  posture. 

A tube  smeared  with  cacao  butter  and 
tannic  acid,  10  per  cent.,  or  silver  nitrate 
5 per  cent.,  may  be  passed  daily,  and  allowed 
to  remain  in  situ  for  ten  minutes  or  longer; 
or  the  oesophagus  may  be  irrigated  with 
borax  or  boric  acid  solution,  3 per  cent. 
Ulcers  and  fissures  may  be  treated  through 
the  ffisojihagoscope  with  silver  nitrate,  gr.  xx 
d-  ad  5i-  Rectal  feeding  (q.v,)  or  gastros- 
tomy may  be  advisable  in  some  cases  in 
order  to  secure  rest  for  the  diseased  organ. 

(Esophagus,  Affections  of  the. — See  (Eso- 
phageal Affections. 

Oidiomycosis. — Gr.  u>dr  egg  -f-  fivKrjs  fun- 
gus. See  Blastomycosis. 

Olfactory  Affections.  — L.  olfa'cere,  to 
smell.  See  Anosmia,  Cacosmia,  Hyperos- 
mia,  and  Parosmia,  in  Part  8,  Nose  Diseases. 

Oliguria. — See  Anuria. 

Omodynia. — Gr.  2>uos  shoulder  d-  bbvvr] 
pain.  vSee  Myalgia. 

Ophthalmoplegia. — Gr.  64>da\iJ.bs  eye  d- 
wXrjyr]  stroke.  See  Motor  Nerves  of  the 
Eyeball. 

Opium  Eating. — See  Morphinism. 
Poisoning. — See  Poisoning. 

Optic  Nerve  and  Tract. — See  in  Part  6, 
Eye  Diseases,  the  following  captions.  Ambly- 
opia and  Amaurosis  without  Ophthalmo- 
scopic Change;  Optic  Chiasma,  Tract,  and 
Centres;  Optic  Atrophy;  Optic  Neuritis; 
and  Retinitis. 

Osteitis  Deformans;  Paget’s  Disease. — 

Gr.  osreoi'  bone  -p  -tris  inflammation.  A 
very  rare  chronic  affection  of  the  bones, 
occurring  in  adult  life,  characterized  by  a 
gradual  hypertrophy  and  softening  of  the 
bones,  often  associated  with  pain,  and  re- 
sulting in  enlargement  of  the  cranium  and 
clavicles,  anterior  and  lateral  bowing  of  the 
femora  and  tibiae,  and  kyphosis,  with  con- 
sequent shortening  of  the  stature. 

Treatment. — The  disease  is  incurable,  but 
not  fatal.  Prescribe  a tonic  regimen:  good 
food,  fresh  air,  arsenic  (Part  11).  For  the 
relief  of  pain,  employ  hot  applications,  the 
thermo-cautery,  or  other  form  of  counter- 
irritation (see  under  Neuralgia.) 

Ostero=Arthritls. — Gr.  barkov  bone  d- 
apdpov  joint.  See  Arthritis  Deformans,  in 
Part  10,  Orthopaedics. 

Osteo= Arthropathy,  Pulmonary. — See  the 
following: 


OSTEOMYELITIS 


Osteo=Arthropathy,  Secondary  Hyper= 
trophic. — Gr.  barkov  bone  + apdpov  joint  + 
wados  disease;  v-rrep  over  + Tpo<pr]  nutrition. 
A symmetrical  osseous  hypertrophy  and 
arthritis,  involving  usually  the  bones  of  the 
hands  and  feet  (clubbing)  and  the  lower  ends 
of  the  bones  of  the  forearms  and  legs,  occur- 
ring as  a result  of  chronic  suppuration,  chronic 
pulmonary,  cardiac,  and  renal  disease,  con- 
genital syphilis,  chronic  jaundice,  chronic 
diarrhoea,  and  other  chronic  affections. 

The  condition  may  show  improvement  with 
improvement  in  the  primary  chsease.  Em- 
ploy warm  applications  for  the  relief  of  pain. 

Osteogenesis  Imperfecta.-^Gr.  barhv  hone 
+ yevvau  to  beget.  See  Fragilitas  Ossium. 

Osteomalacia. — Gr.  bareov  bone+ p.a\aKLa 
softening.  A very  rare  chronic  affection  of 
the  bones,  occurring  chiefly  in  relation  to 
pregnancy,  lactation,  and  menstruation, 
although  men  and  children  may  have  the 
disease,  characterized  by  softening  of  the 
bones,  which  is  preceded  by  aching  pains  in 
various  parts  (the  extremities,  dorsal  and 
lumbar  regions,  and  anterior  portion  of  the 
pelvis),  increased  by  motion,  bone  tender- 
ness, muscular  weakness,  sometimes  spasm 
or  contracture,  perhaps  paraesthesiae  and 
other  organic  nervous  phenomena,  and 
resulting  in  difficult  locomotion  and  bending 
or  fracture  of  the  bones.  Occurring  in  preg- 
nancy, the  resulting  pelvic  narrowing  neces- 
sitates the  performance  of  Caesarean  section 
at  term. 

There  are  various  endemic  foci  in  Europe. 
Treatment. — Enjoin  absolute  rest  in  bed, 
including  feeding  with  a spoon  and  the  use 
of  the  bed-pan  and  urinal,  in  order  to  avoid 
deformity  or  fractures.  Use  a water-  or 
air-mattress,  if  possible,  and  guard  carefully 
against  bed-sores  (q.v.).  See  that  the  bed- 
room is  w'ell  ventilated;  and  prescribe  an 
abundant  diet,  particularly  the  phosphorus 
foods,  “milk,  eggs,  fresh  meat,  fish,  beans, 
peas,  and  cereals.”  For  the  muscular  pains 
and  cramps,  employ  hot  applications 
and  massage. 

Phosphori gr.  ho  (gr.  ho  per  dose) 

Olei  morrhua;  vel  olei 
amygdalae  dulcis ...  3 ix 
M.  Sig.-— One  dram  t.i.d.  (Gradually  increase 
the  dose  to  gr.  h2  daily.) 

1^  Olei  phosphorati pi  (gr.  Moo  ad  njii) 

Sig. — One  minim,  gradually  increased  to  3 to  4 
minims,  t.i.d. 

Piluli  phosphori 20  pills  (gr.  Moo  per  pill) 

Sig. — One  pill,  gradually  increased  to  four  pills 
t.i.d. 

Elixiris  phosphori.  . . pii  (gr.  Mo  ad  50 
Sig. — itExv,  gradually  increased  to  pi.  t.i.d. 


Continue  the  phosphorus  for  “ at  least 
one  or  tw'o  months.”  (Author  ?) 

Pituitary  extract  (anterior  lobe.  Bur- 
roughs and  Welcome  or  Parke  Davis;  Part 
11)  should  be  tried.  The  anterior  lobe  of 
the  hypophysis  cerebri  is  related  to  the 
general  growth  of  the  body,  especially 
the  skeleton. 

Suprarenal  extract  is  recommended  by 
Bossi;  T^viiss-xv  of  adrenalin,  1 : 1000  in 
one  pint  of  normal  saline  solution  (0.9  per 
cent.),  subcutaneously,  once  daily  for  at 
least  a month. 

Calcium  salts  have  not  proved  of  value. 

Should  no  improvement  follow  the  above 
medication,  remove  the  ovaries,  and  con- 
tinue the  medication.  Oophorectomy  is 
credited  with  80  per  cent,  of  cures.  A case 
of  osteomalacia  in  the  male  treated  by  cas- 
tration was  not  benefited,  say  Elliott  and 
Nadler. 

In  pregnant  cases,  resort  to  Caesaiian  sec- 
tion at  term  (see  Part  4,  Obstetrics),  and  at 
the  same  time  remove  the  ovaries  or  the 
w’hole  uteras.  Nursing  should  not  be 
permitted. 

Osteomyelitis. — Gr.  baTeov  bone  + piveKbs 
marrow  -|-  -txis  inflammation.  Acute  osteo- 
myelitis is  manifested  by  intense  pain, 
increased  by  tapping  the  bone  and  by  steady 
pressure  on  the  bone  even  at  a distance  from 
the  seat  of  pain,  elevation  of  temperature, 
rapid  pulse,  leucocjdosis,  and  prostration, 
soon  follow'ed  by  local  swelling,  and  event- 
ually fluctuation  and  sinus  formation.  The 
adjacent  joint  usually  becomes  swollen, 
even  though  it  may  not  be  infected. 

Brodie’s  abscess  is  a chronic  circum- 
scribed abscess  of  cancellous  tissue,  without 
sequestnun  formation,  recognized  by  the 
X-ray  as  a translucent  area  surrounded  by 
dense  bone,  whereas  a chronic  medullary 
abscess  presents  no  characteristic  X-ra\’ 
picture.  Brodie’s  abscess  may  persist  for 
years  and  give  rise  to  acute  exacerbations  of 
pain  with  tenderness,  and  peihaps  some 
swelling,  but  little  or  no  fever. 

Bone  tuberculosis  usually  begins  in  the 
epiphysis  and  spreads  to  the  joint,  rarely 
to  the  shaft  (see  Part  10,  Orthopaedics). 

Etiology.— (a)  Acute  Osteomyelitis. — 
Early  life;  infectious  diseases  (measles,  scarlet 
fever,  typhoid  fever,  influenza,  pnemnonia, 
syphilis,  tuberculosis,  etc.);  a focus  of  sup- 
puration, either  nearby  or  distant;  trauma- 
tism; exposure  to  cold  and  wet;  great 
fatigue.  The  usual  infecting  agent  is  the 
staphylococcus  pyogenes  aureus;  rarely  the 
staphjdococcus  albus,  streptococcus,  pneu- 
mococcus, or  typhoid  bacillus. 


OXYURIASIS;  PIN-WORM,  THREAD-WORM,  OR  SEAT-WORM  INFECTION 


(b)  Chronic  Osteomyelitis. — Acute  os- 
teomyelitis; tuberculosis;  glanders;  actino- 
mycosis; leprosy. 

Treatment  •of  Acute  Suppurative  Osteo- 
nnjelitis.—Operate  at  once.  Remove  a button 
of  cortical  bone  with  a half-inch  trephine, 
and  enlarge  the  opening  along  the  shaft  for 
one  or  more  inches  with  chisel  and  gouge, 
or  a large  burr  attached  to  a dental  engine. 
Remove  all  necrotic  tissue,  but  do  not 
cutette.  Spare  the  epiphyseal  line  as  much 
as  possible.  Drain  the  abscess  cavity  with 
dry  gauze. 

If  complete  healing  does  not  occur  becau.se 
of  necrosis,  which  usually  involves  most  if 
not  all  of  the  shaft,  the  necrotic  sequestnmi 
should  be  removed.  If  there  is  another  bone 
to  serve  as  a splint,  as  in  the  forearm  and 
leg,  the  sequestrum  should  be  removed 
about  the  eighth  week  after  the  evacuation 
of  the  acute  abscess,  before  a dense,  ossified 
periosteal  involucrum  has  formetl.  The  sup- 
purating portion  of  bone  is  carefully  re- 
moved from  beneath  the  longitudinally 
incised  periosteum,  and  the  latter  is  then 
sutured  with  catgut  so  as  to  form  a flattened 
tube  (which  eventually  fills  up  with  regen- 
erated bone),  the  soft  parts  are  sutured,  and 
the  limb  put  up  in  plaster.  In  five  to  eight 
months  it  may  be  used. 

In  chronic  cases  (old  bone  sinuses)  in 
which  the  sequestnmi  has  become  completely 
separated,  and  may  be  felt  to  be  loose  vath  a 
probe,  and  the  surrounding  involucrum  is 
dense,  and  incapable  of  central  growth,  the 
cavity  resulting  after  the  removal  of  the 
sequestrum  is  perhaps  best  obliterated  by 
inverted  skin  flaps.  Make  a free,  curwed 
incision,  and  remove  thoi-oughly  all  the 
diseased  tissue,  granulation  tissue  and 
sequestra,  and  all  overhanging  bony  tissue, 
bevelling  the  edges  of  the  bone.  A large 
burr  driven  by  a dental  engine  may  bo  used 
to  remove  diseased  bone,  pressure  being 
made  from  within  out  as  in  drilling  out  a 
tooth,  and  leaving  a smooth  even  surface 
(F.  G.  Dyas).  Employ  the  Carrel-Dakin  treat- 
ment or  dichloramine-T  (see  Wounds  and 
Part  11),  until  the  wound  is  sterile  and  the 
bone  surface  is  covered  with  healthy  granu- 
lations. Then  fill  in  the  defect  with  muscle, 
fascia,  or  periosteum.  A lateral  incision  in 
the  periosteum  in  the  long  axis  of  the  bone 
may  enable  it  to  be  drawn  over  to  cover  the 
raw  bone  surface. 

Osteopathies,  the  Hypertrophic. — Gr. 

barkov  bone  -f-  irados  disease;  virkp  over  -j- 
Tpo<t>'ij  nutrition.  Acromegaly;  Leontiasis 
Ossea.  Osteitis  Deformans.  Osteo-Arthiop- 
athy.  Secondary  Hypertrophic. 


Osteopsathyrosis. — See  Fragilitas  Ossium. 

Overstrain  of  the  Heart.  — See  Heart- 
Strain. 

Oxaluria. — L.  ox'alas,  oxalate  fl-  uriria, 
urine.  See  under  Nephrolithiasis. 

Oxycephaly;  Tower  or  Steeple  Head. — 
Gr.  b^iis  sharp  -|-  Ke4>a\T]  head.  A deformity 
of  the  skull,  either  congenital  or  appearing 
in  early  life,  and  due  jirobably  to  premature 
synostosis  of  the  sagittal  and  coronal  sutures. 
As  the  brain  grows,  synnptoms  of  com- 
pression appear,  e.g.,  choked  disc  and 
subsequent  optic  atrophy,  loss  of  smell, 
exophthalmos  with  divergent  strabismus, 
perhaps  headache. 

Cushing’s  intermusculo-temporal  decom- 
pressive craniotomy  (unilateral  or  bilateral) 
should  be  performed  early  in  order  to  pre- 
serve vision. 

Oxyuriasis;  Pin=Worm,  Thread=Worm, 
or  Seat=Worm  Infection. — Gr.  b^vs  sharp  -f- 
ovpd  tail;  L.  vermicular' is  worm-like,  from 
vermis,  worm.  The  pin-worm  (oxyuris 
vermicularis)  lives  in  the  rectum  and  colon, 
and  indeed  as  far  up  as  the  jejunum,  and 
worm  and  eggs  are  discharged  in  the  faeces, 
where  the  former  may  be  seen  as  a minute 
white  thread,  one-sixth  (male)  to  one-third 
(female)  of  an  inch  long. 


a h c 


Fig.  56. — Oxyuris  vermicularis,  a,  natural  size,  and  eggs, 
b and  c,  magnified  420  times.  (I  rom  Pfaundler  and  Schloss- 
mann. 

The  eggs  thus  discharged  may  contam- 
inate the  drinking  water,  vegetables,  fruit, 
the  Angers,  towels,  flies,  etc. 

The  conunon  symptoms  of  oxyuriasis  are 
restlessness  and  irritability,  insomnia,  anor- 
exia, anjEinia,  and  itching  at  the  nose  and 
anus,  worse  at  night  when  the  worms 
migrate.  In  heavy  infections,  . nausea, 
vomiting,  abdominal  pain,  diarrhoea,  tenes- 
mus, headache,  vertigo,  convulsions,  etc., 
may  also  occur. 

Treatment. — Imstruct  the  patient  how  to 
guard  against  auto-infection  by  means  of 
absolute  cleanline.ss  of  the  food,  drink,  and 
person,  including  the  bed-clothing.  The  nails 
should  be  cut  and  the  fingers  scrubbed  with 
a brush;  the  anus  and  buttocks  should  be 
washed  after  each  bowel  movement;  flies 
should  be  screened  against  and  otherwise 
combated. 


PAIN 


First  expel  the  younger  worms  from  the 
small  intestine  by  means  of  active  calomel 
followed  by  saline  catharsis  (see  Part  11) 
for  several  days.  Santonin  is  given  by  some 
with  the  (;aloniel  for  several  days,  as  in 
Ascariasis  {q.v.)]  but  Forchhemier,  Kerley, 
and  Potter  declare  that  it  is  superfluous. 
Thymol,  naphthalene  tetrachloride,  gr.  ii-vi, 
according  to  age,  four  times  a day  for  two 
or  three  days,  betanaphthol,  infusion  of  gen- 
tian, or  of  quassia,  in  large  doses,  and  garlic 
are  recommended.  These  vermicides  should 
be  preceded  and  followed  by  a purge.  Garlic 
is  very  well  recommended.  (For  all  Drugs 
see  Part  11). 

After  the  small  intestine  has  been  cleared 
out,  the  colon  and  rectum  must  be  cleared 
of  adult  worms  by  means  of  injections,  of 
which  the  following  are  used: 

1.  Infusion  of  qua.ssia:  1 to  2 oz.  of 

quassia  chips  in  1]/^  oz.  of  water,  boiled 
clown  to  1 pint,  and  strained  (the  best, 
says  Croftan). 

2.  Vinegar:  2 tablespoonfuls  to  1 quart 
of  boiling  water. 

3.  Benzine:  20  drops  to  1 pint  of 

warm  water. 

4.  Perchloride  of  iron,  5 per  cent. 

5.  Salt  and  water:  4 tablespoonfuls  to 
the  quart,  cold. 

6.  Lime  water. 

7.  Turpentine,  5i  to  a pint  of  soapsuds. 

8.  Glycerine  and  water. 

9.  Infusion  of  garlic:  2 to  3 bulbs  chopped 
up  and  boiled  in  1 quart  of  water  or  milk  and 
strained,  one  third  used  on  successive  days. 

Before  each  injection,  which  should  be 
given  every  evening  for  two  weeks,  or  until 
all  worms  are  expelled,  the  bowel  should  be 
cleansed  of  mucus  with  warm  water  con- 
taining borax,  one  to  four  teaspoonfuls  to 
the  pint.  The  injection  should  be  retained 
as  long  as  possible  (five  to  thirty  minutes), 
with  the  buttocks  elevated  or  the  patient 
in  the  knee-chest  posture,  and  the  anus 
closed.  Six  or  eight  ounces  in  an  injection 
is  sufficient. 

For  itching,  smear  one  of  the  following  into 
the  anal  canal : ung.  mentholis,  5 per  cent. ; 
ung.  hydrarg.  dil. ; ung.  hydrag.  chlorid. 
mitis,  3ss-i  ad  5i;  ^uig.  carbolici,  3 per  cent.; 
ung.  gallic  ct  opii;  ung.  sulphuris,  5 ])er  cent.; 
or  insert  an  iodoform  (gr.  v)  supj)ository. 

Pachymeningitis. — Gr.  iraxG  thick  + 
membrane  + -txts  inflammation. 
See  Meningitis. 

Paget’s  Disease  of  the  Bones. — See  Oste- 
itis Deformans. 

Nipple.' — See  under  Breast  Enlarge- 
ments. 


Pain  (Chiefly  from  R.  C.  Cabot). — 1.  Head= 
ache. — See  Headache. 

2.  Backache. — See  Backache. 

3.  General  Abdominal  Pain. — CAUSES. — Intes- 
tinal colic  {q.v.,  for  causes);  constipation; 
diarrhoea;  enteritis;  appendicitis;  typhokl 
fever;  general  peritonitis;  tabes  mesenterica, 
and  tuberculous  peritonitis;  intestinal  ob- 
struction, including  strangulated  hernia;  lead 
poisoning;  gastro-enteric  neuroses  (see  Gas- 
tralgia,  and  Enteralgia);  malaria;  Pott’s 
disease;  abdominal  tumor;  mucous  colitis; 
extra-uterine  pregnancy;  parturition;  aneu- 
rysm of  the  abdominal  aorta;  angioneurotic 
oedema;  diajjhragmatic  pleurisy. 

4.  Epigastric  Pain. — CAUSES. — Constipation; 
diarrhoea;  enteritis;  acute  indigestion;  ap- 
pendicitis; gastric  neuroses  (see  Gastralgia); 
lead  poisoning;  acute  arsenical  poisoning; 
pernicious  aniemia;  intestinal  obstruction; 
tabes  mesenterica  and  tuberculous  perito- 
nitis; gastro-hepatic  congestion  due  to  cir- 
rhosis or  carohac  disease;  gastric  ulcer; 
cholelithiasis;  hyperchlorhydria;  gastric 
cancer;  pericarditis;  pancreatitis;  pancreatic 
tumors;  pyloric  adliesions;  angina  pectoris; 
hepatic  gumma  or  other  tumor;  toxaemia  of 
pregnancy  with  threatened  eclampsia. 

5.  Right  Hypochondriac  Pain.  — CAUSES. — 
Passive  congestion  of  the  liver;  cholelithia- 
sis; appendicitis  with  a high  appendix; 
hepatic  cancer;  hepatic  gumma;  hepatic 
abscess;  renal  or  ureteral  stone;  gastric  or 
duodenal  ulcer;  subdiaphragmatic  abscess; 
hydronephrosis;  hydronephritis;  renal  and 
perirenal  infections;  sacroiliac  lesions;  retro- 
peritoneal tumors  ; pericarditis  ; gastritis  ; 
splanchnoptosis  ; movable  kidney  ; local 
peritonitis;  pleurisy;  pneumonia;  hysteria. 

6.  Left  Hypochondriac  Pain. — Causes. — Flat- 
ulence (angina  pectoris,  peptic  ulcer, 
hyperchlorhydria,  chronic  ajDpendicitis,  cho- 
lelithiasis, toothache,  etc.);  renal  disease 
(stone,  tuberculosis,  tumor,  infection,  hydi'o- 
nephrosis,  cystic  degeneration);  perisplenic 
adhesions  (leukaemia,  splenic  anaemia,  ma- 
laria, syphilis,  polycythaemia) ; cancer  of 
the  splenic  flexure  of  the  colon;  pleurisy; 
pneumonia;  peptic  ulcer;  debility  of  neu- 
rotic women. 

7.  Right  Iliac  Pain.— CAUSES. — Appendicitis; 
salpingitis;  tubal  adhesions;  extra-uterine 
pregnancy;  dysmenorrhoca;  ovarian  cyst 
with  twisted  j^edicle  or  nipture;  psycho- 
neurosis, including  fear  of  appendicitis; 
mucous  colitis;  ureteral  stone;  iliocaecal 
obstruction  (tumor,  tuberculosis,  adliesions); 
inguinal  hernia;  local  tuberculosis. 

8.  Left  Iliac  Pain.— CAUSES. — Salpingitis; 
tubal  adhesions;  extra-uterine  pregnancy; 


PANCREAS,  CALCULUS  OF  THE 


dysmenorrhoea;  ovarian  cyst  with  twisted 
pedicle  or  rupture;  ureteral  stone;  cancer  of 
the  sigmoid;  inguinal  hernia;  local  tuber- 
culosis; diverticulitis;  vesical  cancer;  con- 
stipation; debility  of  neurotic  women. 

9.  Axillary  Pain.— CAUSES. — Flatulence; 
pleurisy;  pneumonia;  fractured  rib;  inter- 
costal neuralgia;  pleurodynia;  spondylitis 
deformans;  herpes  zoster;  costal  tuberculo- 
sis; costal  neoplasm;  costal  actinomycosis; 
angina  pectoris;  axillary  abscess;  cholelith- 
iasis; pericarditis;  renal  infection;  neurosis. 

10.  Pain  in  the  Arms. — Causes. — Arthritis; 
subacromial  or  subdeltoid  and  subcoracoid 
bursitis;  fatigue,  and  occupation-neurosis; 
osteomyelitis;  aneurysm;  neuralgia;  medi- 
astinal tumor;  tumor  of  the  arm  or  shoulder; 
cervical  rib;  angina  pectoris;  traumatism; 
lymphangitis;  phlebitis;  cellulitis;  poliomye- 
litis; brain  tmnor,  etc.;  aortic  incompetency. 

11.  Pain  in  the  Legs  and  Feet. — CAUSES. — In- 
fectious thseases;  flat-foot;  arthritis;  varicose 
veins;  tabes;  arthritis  deformans;  phlebitis; 
sciatica;  osteomyelitis;  tuberculosis;  myel- 
itis; poliomyelitis;  sprained  ankle;  syphilitic 
periostitis;  tenosynovitis;  neuritis;  sarcoma; 
gout;  Morton’s  metatarsalgia;  intermittent 
claudication;  nephrolithiasis;  Pott’s  disease; 
psoas  abscess;  herpes  zoster;  infections; 
sacroiliac  strain;  er;^hronielalgia;  hysteria. 

Palmar  Abscess. — L.  pal'ma,  palm.  See 
Hand  Infections. 

Palpitation;  Irritable  Heart. — L.  palpi- 
tatio.  “ Irregular  or  forcible  action  of  the 
heart  perceptible  to  the  individual  ” (Osier). 
It  is  usually  produced  by  extra-systoles  (see 
Arrhythmia)  without  organic  disease;  and 
is  usually  of  good  prognosis. 

Etiology. — Neurasthenia;  hysteria;  mental 
or  physical  overwork;  emotional  shock; 
masturbation;  sexual  excitement;  menstrua- 
tion; puberty;  menopause;  debility;  anaemia; 
reflex  and  toxic  influences — (nasal  disorders, 
genital  disorders,  pregnancy,  nephroptosis, 
hernia,  abdominal  plethora,  constipation, 
gastric  or  intestinal  indigestion,  flatulence, 
intestinal  parasites,  hot  bath,  exophthalmic 
goitre,  thyroid  extract,  apical  tuberculosis, 
nephritis,  supernormal  blood  pressure  (q.v.), 
tea,  coffee,  tobacco,  alcohol,  digitalis,  stro- 
phanthus,  strychnine) ; valvular  and  myo- 
cardial heart  cUsease;  heart-block;  convales- 
cence from  the  acute  fevers;  comparatively 
slight  exertion  in  high  altitudes. 

Trea™ent. — Attend  to  the  cause.  Reas- 
sure the  patient,  and  enjoin  correct  hygiene, 
e.g.,  adequate  rest  and  moderate  exercise, 
mental  peace,  regular  hours  of  eating  and 
sleeping,  light  diet,  re.st  before  and  after 
eating,  no  heavy  meals  at  night,  regulation 


of  the  bowels,  fresh  air  day  and  night,  and  a 
daily  morning  warm  bath  before  breakfast, 
in  a warm  room,  followed  by  a cool  douche 
and  brisk  rubdown.  Prohibit  the  use  of  tea, 
coffee,  tobacco,  and  alcohol. 

Osier  recommends  tincture  of  mix  vomica 
in  large  doses  as  a tonic:  ttjjxx  in  water,  t.i.d. 
Give  iron  if  there  is  amemia  (for  all  drugs 
see  Part  11). 

For  neiwousness  and  sleeplessness,  pre- 
scribe the  bromides,  or  ammoniated  tincture 
of  valerian,  t.i.d.  For  nocturnal  palpita- 
tion, give  the  sedative  on  retiring. 

For  abdominal  plethora,  hemorrhoids, 
etc.,  prescribe  sodium  or  magnesium  sul- 
phate, one  tablespoonful  dissolved  in  a little 
water,  one  hour  before  breakfast,  togtdher 
with  colonic  irrigation. 

For  the  relief  of  the  paroxysm  itself,  the 
following  measures  are  recommended:  (1) 
Ijoosen  the  clothing,  if  tight,  and  breathe 
deejily;  (2)  place  smelling  salts  to  the  nose, 
or  take  a diffu.sible  stimulant,  e.g.,  Hoff- 
mann’s anodyne,  or  a teaspoonful,  well 
diluted,  of  equal  parts  of  aromatic  spirits 
of  ammonia,  compound  spirits  of  lavender, 
spirits  of  chloroform,  and  syrup  of  ginger; 
(3)  apply  iodo-glycerine  to  the  nose  on  a 
probe,  or  spray  the  nose  with  Dobell’s  solu- 
tion; (4)  place  an  ice-bag,  belladonna  or  mus- 
tard plaster  to  the  precordium ; (5)  paint  the 
neck,  along  the  course  of  the  vagus  nerve,  with 
strong  iodine;  or  stimulate  the  nerve  with  a 
faradic  current ; (6)  give  tr.  aconiti,  one  drop 
every  fifteen  minutes  for  three  or  four  doses. 

Digitalis  in  moderate  dosage  is  a reliable 
remedy  for  extra  systoles.  In  full  doses,  how- 
ever, it  produces  extra  systoles. 

In  intractable  neurotic  cases  the  Weir 
Mitchell  treatment  is  to  be  recommended, 
(see  Neurasthenia). 

Palsy. — See  Paralysis. 

Pancreas,  Calculus  of  the. — Gr.  ttSs  all  + 
Kpeas  flesh;  L.  cal' cuius,  pebble.  Pancreatic 
lithia  is  quite  rare.  The  symptoms  would 
suggest  cholelithiasis,  e.g.,  pain  in  the  neigh- 
borhood of  the  epigastrium,  somethnes  radi- 
ating to  the  back,  and  sometimes  colicky, 
and  then  accompanied  by  vomiting,  some- 
times temporary  jaundice  during  the  pa.ssage 
of  a stone  through  the  diverticulum  of 
Vater.  Pancreatic  stones,  however,  are 
revealed  by  the  X-ray,  (q.v.)  whereas  biliary 
stones  are  not ; and  should  a stone  be 
recovered  from  the  faeces,  it  would  be  found 
to  be  opaque,  white,  and  composed  of  cal- 
cium carbonate  or  phosphate  .without  bile 
pigment,  bile  salts,  or  cholesterin. 

In  long  standing  cases,  glycosuria  may 
occur  as  a result  of  involvement  of  the 


PANCREATITIS,  CHRONIC 


islands  of  Langerhans  in  a chronic 
interlobular  pancreatitis.  Abscess  or  cyst 
may  occur. 

Treatment. — An  operation  may,  in  certain 
instances,  be  considered. 

Pancreas,  Cancer  of  the. — See  Cancer  of 
the  Pancreas. 

Pancreas,  Cysts  of  the, — Evacuation  and 
drainage  is  usually  the  operation  of  choice. 
A fistula  may  result.  Extirpation  is  rarely 
practicable;  but  it  should  be  attempted  if 
there  is  any  evidence  of  malignancy,  such 
as  the  presence  of  growths  on  the  inner  sur- 
face of  the  cyst.  Consult  surgical  works. 

Pancreas,  Inflammation  of  the. — See 
Pancreatitis. 

Stones  in  the. — See  Pancreas,  Calculus 
of  the. 

Pancreas,  Tumors  of  the. — Varieties.— 

Cancer  {q.v.),  cysts  {q.v.),  and  very 
rarely  sarcoma,  lymphoma,  adenoma,  etc. 
Removal  of  the  growth  is  possible  only 
when  the  head  of  the  pancreas  is  not 
involved.  In  biliary  obstruction,  a chole- 
cystenterostomy  may  be  done. 

Pancreatitis,  Acute  Hemorrhagic. — A rare 
affection,  manifested  by  the  sudden  occur- 
rence of  violent  epigastric  pain,  followed 
by  vomiting  and  collapse,  and  in  the  course 
of  twenty-four  hours  by  a circumscribed 
epigastric  swelling,  due  mostly  to  exudation 
within  the  lesser  peritoneal  cavity.  Con- 
stipation is  usually  present,  but  sometimes 
diarrhoea  occurs.  There  is  slight  elevation 
of  temperature.  If  the  patient  does  not  die 
within  two  to  five  days,  gangrene  or  suppura- 
tion ensues,  and  the  epigastric  swelling 
becomes  marked.  At  operation  the  diag- 
nosis is  made  by  the  discovery  of  opaque 
white  foci  of  fat  necrosis  in  the  mesenteric 
and  sub  peritoneal  fat. 

Recovery  is  rare. 

Etiology. — Lodgment  of  a gall-stone  or  pan- 
creatic stone  in  the  diverticulum  of  Vater, 
with  resulting  entrance  of  bile  into  the  pan- 
creatic duct;  traumatism;  pregnancy;  alco- 
hol; syphilis;  typhoid  fever;  influenza, 
mumps;  gout;  vascular  disease;  glycosuria; 
extension  of  inflammation  from  a gastric  or 
duodenal  ulcer  ; unknown  causes. 

Tre.vtmknt. — Operate  at  once.  Open  the 
abdomen  above  the  umbilicus  through  the 
middle  of  the  rectus,  and  expose  the  pan- 
creas either  through  the  gastro-colic  omen- 
tum or  gastrohepatic  ligament,  depending 
upon  the  height  of  the  stomach.  Make  mul- 
tiple incisions  into  the  pancreas,  and  drain 
freely,  by  means  of  large  drainage  tubes, 
through  a post(>rior  stab-wound  in  the  left 
costovertebral  angle,  or  through  the  anterior 


wound,  or  both.  Explore  the  gall-bladder, 
ducts,  and  diverticulum  of  Vater  for  stones, 
and  drain  the  ducts  and  gall-bladder;  if 
necessary  (see  Cholelithiasis)  . 

If  marked  intestinal  paralysis  is  present, 
drain  the  intestines  by  means  of  an  enteros- 
tomy, perhaps  a typhlostomy  opening  and  ad- 
minister pituitrin  (Part  11).  Enteroclysis 
and  hypodermoclysis  should  be  resorted  to. 
To  obviate  digestion  of  the  operative  wound, 
smear  the  latter  with  an  antiseptic  ointment, 
and  employ  copious  dressings  saturated  with 
a solution  of  1 per  cent.  HCl,  which  destroys 
the  alkalinity  of  the  escaping  pancreatic 
fluid  and  inhibits  the  action  of  the  enzymes. 
(J.  B.  Murphy.) 

Pancreatitis,  Chronic. — The  condition  is 
either  an  interlobular  or  an  interacinar 
sclerosis.  The  former  follows  chronic  ca- 
tarrh of  the  pancreatic  duct,  due  to  gastro- 
duodenal catarrh,  gastric  or  duodenal  ulcer, 
or  a gall-stone  or  pancreatic  stone  in  the 
ampulla  of  Vater.  It  also  accompanies 
ha?mochromatosis  {q.v.).  The  interacinar 
form  may  be  due  to  infection  through 
the  duct,  but  is  more  commonly  associated, 
says  Osier,  with  cirrhosis  of  the  liver  and 
arteriosclerosis.  Alcohol  and  syphilis  are 
important  etiological  factors. 

The  symptoms  may  be  dyspeptic  or 
cholelithic.  Diabetes  occurs  when  the 
islands  of  Langerhans  become  involved. 
Progressive  wasting  occurs. 

Treatment. — Correct  the  cause.  In  chole- 
lithic cases,  taken  early,  “ a perfect  recoverj" 
may  be  expected  in  the  verj'  great  majority 
of  cases,”  says  Moynihan.  Prolonged  drain- 
age (at  least  six  weeks)  from  the  gall-bladder 
or  ducts  is  essential. 

The  dietar}"  best  suited  for  cases  of  defi- 
cient pancreatic  secretion  is  as  follows; 
minced  meat  (digested  largelj^  in  the  stom- 
ach), skimmed  milk,  curds,  gelatin,  dry 
toast,  rusk,  biscuit  or  cornflakes  (requiring 
thorough  mastication  and  insalivation), 
sugars  as  tolerated;  no  fats  or  eggs.  Taka- 
diastase  may  be  given  before  meals  for  the 
digestion  of  carbohydrates,  and  pancreatin 
after  meals  or  with  meals  for  the  digestion 
of  proteids.  Oxgall  or  sodium  glycocholate 
is  also  recommended.  (See  Drugs,  Part  11). 

B Fellis  bovis  purificati 3 i (gr.  iiss  per  pill) 

Extracti  glycjTrhiza;,  q.s. 

M.  et  fiant  pilula;  No.  24. 

Sig. — Two  to  six  pills  after  meals.  (Forchheimer.) 

For  excessive  intestinal  putrefaction,  due 
to  the  pancreatic  insufficiency,  one  may  pre- 
scribe the  intestinal  antiseptics,  calomel, 
beta-naphthol,  naphthalene  tetrachloride,  or 
boric  acid. 


PARAMYOCLONUS  MULTIPLEX;  MYOCLONUS 


Helmitol  and  aspirin  are  excreted  through 
the  pancreatic  ducts,  where  they  exert  a 
disinfectant  action. 

Cholecystostomy  with  prolonged  drain- 
age, however,  should  not  be  postponed. 

Pancreatitis,  Suppurative. — The  symp- 
toms may  be  of  sudden  or  gradual  onset, 
depending  upon  the  cause.  Usually  there 
occur  vomiting,  fever,  sometimes  chills, 
diarrhoea  or  constipation,  and  a tender, 
deep-seated  epigastric  mass.  Peritonitis 
commonly  occurs,  either  from  extension  of 
the  inflammation  or  from  rupture  of  the 
abscess.  In  cases  with  gradual  onset  there 
are  usually  vague  gastro-intestinal  symp- 
toms and  epigastric  tenderness. 

Treatment.— This  is,  of  course,  surgical. 
The  abscess  should  be  freely  incised  and 
drained,  as  described  under  Pancreatitis, 
Acute  Hemorrhagic. 

Pappataci  Fever. — See  Phlebotomous 

Fever. 

Paraesthesia  of  the  Extremities. — See 

Acropara;sthesia. 

Paralysis. — Gr.  irapa.  beside  -|-  Xcetr  to 
loosen.  See  the  following  captions:  Amau- 
rotic Family  Idiocy;  Amyotonia  Congenita; 
Aphasia;  Aphonia;  Apoplexy;  Arsenic  Poi- 
soning; Astasia-Abasia;  Ataxia;  Ataxia, 
Friedreich’s  Hereditary;  Ataxia,  Locomotor; 
Atrophies,  the  Progressive  Muscular;  Beri- 
beri; Brain  Localization;  Brain  Abscess; 
Brain  Tumor;  Bulbar  Paralysis;  Caisson 
Disease;  Chorea,  Tetanoid;  Claudication, 
Intermittent;  Combined  System  Diseases; 
Dementia  Paralytica;  Diphtheria;  Dystro- 
phy, Progressive  Muscular;  Encephalitis, 
Acute;  Facial  Hemiatrophy;  Facial  Paral- 
ysis ; F amily  Periodic  Paralysis ; Gait ; Hsema- 
tomyelia  and  Haematorrhachis;  Hysteria; 
Interstitial  Hypertrophic  Progressive  Neur- 
itis of  Chiklhood;  Kubisagari;  Landry’s 
Acute  Ascending  Paralysis;  Lead  Poison- 
ing; Leprosy;  Malaria,  Pernicious;  Men- 
ingitis; Migraine;  Multiple  Sclerosis;  Mya- 
sthenia Gravis;  Myelitis;  Nerves,  Peripheral; 
Neuralgia;  Neuritis,  Localizecl;  Neuritis, 
Multiple;  Paralysis  Agitans;  Paraplegia; 
Pellagra;  Periodical  Paralysis ; Poliomyelitis, 
Acute;  Spastic  Paralysis;  Spina  Bifida; 
Spinal  Cord  Locahzation;  Spinal  Roots, 
Sunstroke;  Syphilis;  Syringomyelia;  Typhoid 
Spine;  Uraemia. 

Paralysis  Agitans;  Shaking  Palsy;  Park= 
inson’s  Disease. — A not  uncommon  chronic 
affection  of  the  nervous  system,  occurring 
nearly  always  after  the  age  of  forty,  and 
characterized  by  tremor  (pill-rolling  tremor, 
which  usually  ceases  during  voluntary  move- 
ments; sometimes  absent),  muscular  weak- 


ness, and  muscular  rigidity  or  stiffness, 
resulting  in  difficulty  and  slowness  in 
initiating  and  executing  voluntary  move- 
ments, resistance  to  passive  movements,  a 
“ statuesque  ” bending  of  the  upper  part  of 
the  body,  usually  forward,  with  the  arms 
held  away  from  the  body  and  flexed  at  the 
elbows,  an  immobile  mask-like  face  with 
the  eyebrows  elevated,  and  a peculiar  gait, 
which,  after  the  initial  difficulty  in  com- 
mencing is  overcome,  is  rapid  with  a 
tendency  to  fall,  as  though  the  patient  were 
“ running  after  his  centre  of  gravity  ” (fes- 
tination  or  propulsion,  sometimes  latero- 
pulsion  or  retropulsion).  According  to  J. 
Ramsay  Hunt,  the  disease  is  due  to  atrophy 
of  the  efferent  or  motor  extrapyramidal  or 
pallidal  system  of  the  corpus  striatum,  the 
function  of  which  is  to  control  automatic 
and  associated  movement. 

No  cure  can  be  expected.  Remissions  and 
stationary  periods  sometimes  occur,  but  the 
tendency  is  slowly  downward. 

Etiology.— Heredity;  emotion;  shock;  worry; 
traumatism;  overexertion;  exposure  to  cold 
and  wet;  infectious  diseases.  See  Tremor, 
for  all  its  causes. 

Treatment.— Enjoin  a quiet  life,  and 
active  and  passive  exercises  carried  out  for 
several  minutes  at  a time  several  times  a 
day,  for  the  pm-pose  of  lessening  the 
muscular  rigidity.  Vibratory  and  manual 
massage  and  a daily  warm  bath  are  also 
useful  to  this  end.  Fowler’s  .solution  of 
arsenic  (Part  If)  may  be  given  intermittently 
as  a tonic.  Parathyroid  extract,  gr. 
to  Hlo  to  }/Q,  t.i.d.,  is  well  reconunended. 
For  annoying  tremor  the  following  drugs 
are  employed; 

Hyoscine  hydrobromide,  gr.  every 

six  hours,  gradually  increased  in  frequency 
until  the  tremor  is  lessened,  or  dryness  of 
the  mouth  and  dilatation  of  the  pupil 
occur.  It  may  be  increased  to  gr.  Lioo  te 
Mo)  two  to  three  times  a day.  The  ch’ug 
may  be  continued  in  safe  dosage  “ for 
years.”  (Starr.) 

Codeine,  gr.  no  more  than  three  doses 
daily,  aids  the  action  of  hyoscine.  (Starr.) 

Tr.  gelsemii,  gtt.  v,  in  water,  three  or  four 
times  a day. 

Tr.  veratri  viridis,  gtt.  ii-iii,  in  water, 
t.i.d.  (Oppenheim  combines  the  latter 
two  drugs.) 

For  the  treatment  of  insomnia,  consult 
Insomnia. 

Paramyoclonus  Multiplex;  Myoclonus. — 

Gr.  irapa  beside  -|-  gcs  muscle  -|-  k\6vos  dis- 
turbance; L.  mult'iplex,  manifold.  An 
uncommon  chronic  nervous  affection,  char- 


PAROTITIS 


acterized  by  constant  or  paroxysmal,  gen- 
eral, usually  bilateral  and  symmetrical, 
abrupt  clonic,  “ lightning-like  ” or  “ shock- 
like ” muscular  contractions,  usually  aggra- 
vated or  excited  by  emotion  and  mechanical 
irritation  of  the  skin,  muscles,  or  tendons, 
inchuhng  exposure  to  cold.  It  sometimes 
occurs  with  epilepsy;  and  it  may  be  a mani- 
festation of  hysteria. 

Exclude  acute  chorea,  Huntington’s 
chorea,  and  convulsive  tic. 

The  Prognosis  is  unfavorable,  except  in 
hysterical  myoclonus. 

Treatmknt. — Enjoin  good  hygiene,  ade- 
quate rest  and  exercise,  fresh  air  day  and 
night,  warm  clothing,  regular  hours  of  eat- 
ing and  sleeping,  a daily  morning  warm 
bath  in  a warm  room  followed  by  a cool 
spinal  douche,  care  of  the  l)Owels  and 
kidneys,  an  abundance  of  wholesome  food, 
and  Fowler’s  solution  of  arseni(^a  as  a tonic. 
Starr,  who  gives  a favorable  prognosis, 
employs  “strong  galvanic  currents  to  the 
spine  and  neck,  and  the  application  of  the 
anode  to  sensitive  points  in  case  these  exist,” 
together  with  chloral  and  arsenic.  The 
bromides  and  valerian  may  be  of  service. 
(See  Drugs,  Part  11). 

Paraplegia. — Gr.  wapd  across  -f  -n-Xriy^ 
stroke.  Paraplegia  denotes  paralysis  only 
of  the  legs  and  lower  part  of  the  body. 

Causes  and  Varieties. — Ataxic  paraplegia 
(see  Ataxia) ; spastic  cerebral  paraplegia 
of  infants,  or  Little’s  disease  (see  Spastic 
Paraplegia);  myelitis;  hereditary  and 
familial  spastic  paraplegia  (see  Spastic 
Paralysis);  primary  combined  sclerosis; 
spinal  hemorrhagic  pachymeningitis,  or  hse- 
matoma  of  the  dura  mater;  htematomyelia 
and  hsematorrhachis;  cerebral  arteriosclero- 
sis; sacral  plexus  disease  due  to  tumors, 
inflammation,  or  lumbosacral  disarticula- 
tion; multiple  neuritis;  aneurysm  of  the 
abdominal  aorta;  diabetes;  anaemia;  lathyr- 
ism  (vetch  or  chick-pea  jjoisoning);  influ- 
enza; hysteria.  (See  also  Spastic  Paralysis; 
Brain  Localization;  and  Spinal  Cord  Locali- 
zation.) 

Parasitic  Stomatitis — SeeunderStomatitis. 

Paratyphoid  Fever. — Gr.  irapa  near.  An 
acute  infectious  disease,  caused  by  the 
bacillus  paratyphosus  (two  types,  “ A ” 
and  “ B ”),  and  scarcely  to  bo  distinguished, 
clinically,  from  tyqihoid  fever.  The  onset  is 
usually  sudden,  vath  vomiting,  chill,  diar- 
rhoea, and  fever,  and  herpes  appeal’s  early; 
but  the  onset  is  also  often  gradual.  The 
disease  usually  runs  a somewhat  milder 
coui-se  than  typhoid  fever,  and  is  rarely 
fatal;  but  in  some  instances  the  symptoms 


may  be  the  same  in  every  particular  as  those 
of  typhoid  fever,  even  as  to  types,  complica- 
tions, and  severity.  The  incubation  period 
is  from  three  to  fifteen  days.  The  para- 
typhoid bacillus  sometimes  sets  up  a severe 
gastro-enteritis  (so-called  “ infectious  meat 
poisoning”  or  “ptomaine  poisoning”).  The 
paratyphoid  fevers  are  transmitted  in  the 
same  ways  as  typhoid  fever,  and,  in  addi- 
tion, through  the  medium  of  infected  meat, 
sausages,  etc. 

The  agglutination  may  be  greater  in  a 
paratyphoid  case  to  the  typhoid  bacillus 
than  to  the  paratyiihoid  bacillus,  and  vice 
versa;  but  the  paratyphoid  bacillus  is 
agglutinated  more  quickly  by  a paratyphoid 
serum  than  is  the  typhoid  bacillus  by  the 
typhoid  serum.  A positive  serum  agglutina- 
tion in  the  non- vaccinated  means  one  or 
more  of  the  three  typhoid  fevers  is  present, 
but  it  does  not  indicate  which  one.  The 
serum  test  is  useless  in  those  who  have  been 
vaccinated.  A differential  diagnosis  can  be 
made  only  by  an  early  blood  culture.  The 
H.  K.  Mulford  Co.,  Philadelphia,  furnish 
agglutinating  sera  for  the  identification  of 
the  three  types  of  bacillus.  For  Prophylaxis 
and  Treatment,  see  Typhoid  Fever. 

Paresis,  General,  of  the  Insane. — See 
Dementia  Paralytica. 

Paresthesia  of  the  Extremities. — See 
Acroparaesthesia. 

Parkinson’s  Disease. — ^See  Paralysis  Agi- 
tans. 

Parosmia. — See  Part  8,  Nose  Diseases. 

Parotitis. — Gr.  irapd  near  + oDs  ear  -irts 
inflammation.  I.  Acute  Parotitis. — Causes. — 
Mumps  (q.v.)]  infectious  diseases  (typhoid 
fever,  typhus  fever,  scarlet  fever,  measles, 
smallpox,  cerebrospinal  fever,  d3’sentery, 
yellow  fever,  Asiatic  cholera,  pneumonia, 
secondary  s,vphilis,  pj’temia);  drj'  infected 
mouth;  injury’  or  disease  of  the  abdominal  or 
pelvic  viscera;  facial  paralj’sis;  chronic 
metallic  poisoning;  diabetes. 

Treatment. — Apply  an  ice-bag,  or  hot 
v'ater  bag,  or  leeches,  or  mercurj’  ointment. 
Keep  the  mouth  and  teeth  clean  b}^  means  of 
castile  soap,  a soft  brush  or  sponge,  and 
warm  water,  followed  bj^  Dobell’s  solution 
(Part  11).  Should  signs  of  suppuration 
appear,  make  one  or  several  free  incisions, 
parallel  to  the  branches  of  the  facial 
nerve. 

II.  Chronic  Parotitis.— CAUSES. — Acute  paro- 
titis; inflammation  of  the  throat;  secondarj' 
s.vphilis;  tuberculosis  (ex-trcmely  rare); 
chronic  nephritis;  gout;  lead;  inerciirjq  bis- 
muth; potassium  iodide;  .stricture  of  the 
salivary  duct;  foreign  bocK  or  calculus 


PERICARDITIS 


(usual  cause)  in  the  salivary  duct;  unknown 
causes.  (See  atso  Mikulicz’s  Disease.) 

Treatnent. — Attend  to  the  cause.  Ex- 
plore Steno’s  duct  with  a filiform  bougie  or  a 
very  fine  silver  probe.  Remove  foreign 
bodies  or  stone;  dilate  strictures.  Prescribe 
a buccal  antiseptic,  such  as  Dobell’s  solu- 
tion. AjDply  iodine-petrogen  or  iodex  to  the 
gland  itself.  Arsenic  may  be  tried.  (For 
drugs,  see  Part  11.) 

Parotitis  Epidemica. — See  Mumps. 

Paroxysmal  Albuminuria. — 'See  Albumi- 
nuria. 

Hasmoglobinu r ia . — See  Hsemoglobi- 
nuria. 

Tachycardia. — See  Tachycardia. 

Pavor  Nocturnus. — L.  Night  Terrors,  {q.v.) 

Peliosis  Rheumatica. — Gr.  TreXtos  livid. 
(See  Purpm’a,  in  Part  5,  Skin  Diseases.) 

Pellagra. — L.  pel'Iis,  skin  -|-  Gr.  aypa 
seizure.  An  endemic,  chronic,  remittent 
disease  of  unknown  etiology,  characterized 
by  the  following  combination  of  symptoms: 
chronic  alimentary  catarrh;  a recurrent 
erythema,  which  appears  usually  upon  parts 
exposed  to  the  sun  (back  of  the  hands,  lower 
forearms,  face,  neck,  and  dorsal  aspect  of 
the  feet),  followed  by  desquamation  and  pig- 
mentation; nervous  (hsturbances  due  to 
combined  sclerosis  of  the  cord  (see  Combined 
Sy.stem  Diseases);  and  insanity. 

The  cUsease  may  be  infectious  in  its 
nature,  or  due  to  the  eating  of  chseased 
maize,  or  to  a lack  of  certain  “ vitamines  ” 
in  the  chet,  or  to  the  presence  in  the  drink- 
ing water  of  silica  in  colloidal  solution,  or 
to  the  “ presence  in  vegetable  foods  of 
excessive  amounts  of  a substance  such  as 
soluble  aluminum  salts,”  etc.  The  true 
cause  is  yet  to  be  learned. 

Prognosis. — In  non-alcoholic  cases  under 
fifty  years  of  ago,  taken  early,  and  well 
treated,  a cure  may  usually  be  effected;  but 
prolonged  treatment  is  required,  and  the 
physician  and  patient  should  not  be  chs- 
couraged  by  relapses.  The  organic  nervous 
changes  are  apt  to  be  permanent.  Patients 
who  have  had  repeated  severe  attacks  die 
in  from  five  to  ten  to  fifteen  years. 

Treatment. — Enjoin  a strict  hygienic  regi- 
men: adequate  rest  and  exercise,  cheerful- 
ness, fresh  air  day  and  night,  regular  hours 
of  eating  and  sleeping,  a daily  morning  bath 
in  a warm  room  followed  by  a cold  spinal 
douche,  and  a simple  but  abundant,  nutri- 
tious mixed  diet  containing  plenty  of  fresh 
meat,  fresh  milk,  buttermilk,  fresh  eggs,  and 
fresh  or  dried,  but  not  canned  legumes;  no 
alcohol;  no  comrneal  products;  “salt  should 
be  given  freely,”  says  Osier.  Prescribe  such 


tonics  as  iron,  strychnine,  and  particularly 
arsenic  in  full  doses,  and  quinine  (see  Part 
11).  Salvarsan  may  be  tried.  The  patient 
should  keep  out  of  the  sun  and  heat.  He  is 
best  removed  permanently  to  a cold  climate. 

For  the  skin  lesions,  employ  mild  oint- 
ments such  as  those  of  zinc  oxide  and  boric 
acid,  or  calamine  lotion  (see  Part  11). 

For  neuralgic  pains,  prescribe  the  remedies 
recommended  under  Neuralgia. 

For  diarrhoea,  employ  bismuth  in  large 
doses,  etc.  (see  Diarrhoea). 

For  sore  mouth,  prescribe  Dobell’s  solu- 
tion, and  occasional  painting  with  silver 
nitrate,  gr.  xx  ad  5 i- 

For  giddiness  is  recommended  tincture 
cocculus  orientalis,  10  to  15  drops  in 
water  daily. 

For  nervous  symptoms  prescribe  the 
bromitles. 

Pentosuria. — Pentose  -|-  Gr.  ovpov  urine 
The  very  rare,  harmless  occurrence  of  the 
sugar,  pentose  (CiHia05),  in  the  urine, 
derived  from  the  carbohydrate  fraction  in 
the  nuclei  of  the  cells. 

Peptic  Ulcer. — Gr.  Treats  digestion  L. 
ulcus.  See  Gastric  and  Duodenal  Ulcer. 

Perforating  Ulcer. — See  Ulcer,  Cutaneous. 

Pericardial  Effusion. — See  Pericarditis. 

Pericarditis. — Gr.  irepL  around  -t-  Kapdia 
heart  -|-  -ltls  inflanmiation.  At  the  onset, 
pericarditis  is  manifested  by  pain,  which  is 
precordial,  or  referred  to  the  epiga.strium, 
shoulder,  or  left  scapular  region,  sometimes 
anginal  in  character;  there  is  slight  elevation 
of  temperature,  rapid  pulse,  tlyspnoea,  per- 
haps cough,  perhaps  delirium,  and  a to-aml- 
fro  friction  sound  may  be  heard  associated 
with  the  movements  of  the  heart.  With  the 
development  of  effusion,  the  friction  sounds 
tUsappear,  the  area  of  carcUac  dulness 
increases,  and  the  heai't-sounds  and  hnpulse 
diminish,  just  as  in  dilatation  of  the  heart 
(which,  indeed,  is  apt  also  to  be  present), 
and  the  dyspnoea  increases. 

Myocarditis  and  endocarditis  are  usually 
associated  with  the  pericardial  inflammation; 
in  other  words,  the  contlition  is  usually 
a carcUtis. 

Adherent  pericardium  is  a po&sible  sequel. 

Etiology. — Rheumatic  fever  (the  cause  in 
nearly  all  cases);  chorea;  tonsillitis;  infec- 
tious diseases  (scarlet  fever,  pneumonia, 
measles,  cerebrospinal  fever,  smallpox,  acute 
miliary  tuberculosis,  septi co-pyaemia,  gonor- 
rhoea, tuberculosis,  syphilis) ; neighboring 
pleuritis;  traumatism;  gout;  chronic  nephri- 
tis; diabetes;  arteriosclerosis;  cancer;  scur\"y ; 
leukaemia.  It  occurs  in  chronic  wasting  dis- 
eases usually  as  a terminal  event. 


PERIODIC  P.VRALYSIS 


Treatment.— Absolute  rest  in  bed,  in  a 
seini-recumbent  posture,  including  the  use 
of  the  bed-pan  and  urinal  and  feeding  by 
the  nurse,  is  imperative.  Visitors  should  be 
excluded.  The  bowels  should  be  kept  active 
by  means  of  mild  laxatives,  such  as  rhubarb, 
cascara,  and  compound  licorice  powder  (see 
Part  11).  The  diet  should  be  moderate  and 
bland,  and,  in  the  acute  stage,  liquid;  meat 
and  meat  extracts  are  taboo.  The  ice-bag, 
suspended  from  a bed-cradle,  should  be 
applied  over  a layer  of  flannel  more  or  less 
continuously.  Cupping  {q.v.),  or  the  appli- 
cation of  about  six  leeches,  may  be  of  service 
in  robust  subjects.  The  Paquelin  cautery 
and  mustard  poultices  are  also  recom- 
mended. In  cliildren,  warm  flaxseed  poul- 
tices are  usually  better  tolerated  than 
cold. 

If  these  measures  do  not  suffice  to  relieve 
pain,  dyspnoea,  and  restlessness,  prescribe 
morphine  for  adults,  paregoric  or  codeine 
for  children. 

For  a weak  and  rapid  pulse,  administer 
caffeine,  sodium  salicylate,  strychnine,  atro- 
pine, strophanthus,  or  alcohol  (see  Part  11). 

In  the  presence  of  rheumatic  fever,  some 
do  and  some  do  not  stop  the  salicylates  on 
the  appearance  of  ijericarchtis,  because  of 
the  depressant  action  upon  the  heart.  Some 
give,  instead  of  the  salicylates,  alkalies  (sod. 
bicarb.),  and  perhaps  quinine,  gr.  v-xv,  in 
divided  doses,  in  capsule. 

Should  effusion  occur,  restrict  the  fluid  in- 
take, allow  no  salt,  and  promote  mild  saline, 
purgation  and  diuresis,  the  latter  by  means 
of  (liuretin,  theocin,  or  potassium  acetate  or 
citrate.  Repeated  small  blisters  (see  Can- 
tharides  in  Part  11)  are  also  recommended, 
excepting  in  children;  also  mustard  poultices 
{q.v.),  leeches,  and  Bier’s  suction  cups. 

If  the  fluid  accumulation  becomes  so  large 
as  to  cause  dyspnoea,  cyanosis,  and  a small, 
rapid  piflse,  perform  paracentesis  under  local 
anaesthesia.  Introduce  the  aspirating  needle 
in  the  fourth  or  fifth  interspace,  about  one 
inch  to  the  left  of  the  sternum,  to  avoid  the 
internal  mammary  arterjq-  or  insert  it  to 
the  left  of  the  nipple,  between  the  apex  beat 
and  the  outer  line  of  absolute  dulness;  or  if 
the  effusion  is  large,  the  needle  may  be 
inserted  upward  and  backward  close  to  the 
costal  margin  in  the  left  costo-xiphoid  angle. 
After  aspirating,  seal  the  puncture  with 
a thin  wisp  of  sterile  cotton  saturated 
with  collodion. 

If  the  effusion  is  purulent,  free  drainage 
should  be  established;  and  to  this  end  por- 
tions of  the  costal  cartilages  should  be 
removed,  if  need  be. 


Billings  highly  praises  the  hypodermic 
administration  of  sodium  cacodylate  in  rheu- 
matic pericarditis;  for  adults,  gr.  v,  one  to 
four  times  daily,  for  a week,  if  necessary;  for 
cliildren,  gr.  i,  every  six  hours. 

Antitoxic  sera  and  vaccines  (see  Part 
11)  may  be  used  when  the  infecting  agent 
is  knovTi. 

In  tuberculous  pericarditis,  the  injection 
of  naphthol-camphor  {q.v.)  into  the  pericar- 
dial cavity,  after  tapping,  has  resulted  in  cure. 

Dui’ing  convalescence  prescribe  iron  if 
needed;  and  also  potassium  iodide,  gr.  hi, 
well  diluted,  t.i.d.,  for  resorptive  purposes 
(see  Part  11). 

(See  Hydropericardimn,  and  Hannofieri- 
cardium.) 

Pericardium,  Adherent. — This  is  a sequel 
of  pericarditis.  In  adhesion  of  the  peri-  and 
epicardial  layers  alone,  there  may  be  no 
symptoms;  but  in  involvement  of  the  medi- 
astinum and  peritoneum  (chronic  fibrous 
mechastino-pericarcUtis  and  polyserositis)  the 
heart  becomes  markedly  hypertrophied  and 
there  is  marked  ascites,  suggestive  of  hepatic 
cirrhosis.  Acute  cardiac  dilatation  is  apt 
to  supervene. 

The  physical  signs,  taken  singly,  are  not 
pathognomonic.  They  are:  a prominent 
precordimn;  absence  of  the  aiiex  unpulse; 
diastolic  shock;  no  alteration  in  the  area  of 
precordial  dulness  on  turning  the  patient 
on  his  side;  systolic  retraction  of  the  lower 
intercostal  spaces  in  the  left  axilla  and  left 
back,  followed  by  a diastolic  rebound; 
tUminished  respiratory  movements  of  the 
epigastrium  and  lower  left  chest,  due  to 
immobility  of  the  diaphragm;  sudden  chas- 
tolic  collapse  of  the  veins  of  the  neck. 

Treatment. — The  diet  should  be  poor  in 
salt.  Alcohol  and  tobacco  should  be  inter- 
dicted. Heart  tonics  should  be  prescribed 
as  required  (see  Cardiac  Insufficiency).  The 
only  remedial  treatment  possible  is  the  re- 
moval of  the  precordial  osteo-cartilaginous 
wall  (Brauer’s  operation).  A curv'ed  flap 
of  skin  is  turned  up,  and  three  or  four 
inches  of  the  third,  fourth,  and  fifth  left 
costal  cartilages  and  ribs  are  removed, 
taking  care  not  to  damage  the  pleura. 

Pericolitis. — Gr.  irepi  around  -1-  ku>\ov 
colon.  See  Peritonitis,  Circumscribed,  Acute 
or  Chronic,  and  Diverticulitis. 

Perihepatitis. — Gr.  Trepl  around  -|-  ritrap 
liver.  (See  Peritonitis.) 

Perinephric  Abscess. — ^See  Part  3,  Geni- 
to-Urinaiy  Diseases. 

Periodic  Headache. — See  Aligraine. 

Paralysis. — See  Family  Periodic  Paral- 
ysis. 


PERITONITIS,  ACUTE  DIFFUSE 


Periodontitis. — Gr.  irepL  around  + 68ohs 
tooth  + -LTLs  inflammation.  (See  Pyorrhoea 
Alveolaris). 

Periostitis. — Gr.  irepL  around  + barkov 
bone  + -tTts  inflammation.  I.  Acute. — The 
symptoms  and  treatment  of  acute  suppura- 
tive periostitis  are  the  same  as  those  of 
acute  osteomyelitis.  Incise  the  abscess, 
remove  any  necrotic  bone,  and  pack  lightly 
with  gauze. 

II.  Chronic  Periostitis  is  characterized  by 
thickening,  with  or  without  pain.  The 
causes  are  traumatism,  inflammation,  or 
irritation  in  the  adjacent  bone  or  soft  parts, 
syphilis,  and  long-continued  suppuration 
in  some  part  of  the  body  (toxic  osteoperi- 
ostitis ossificans;  pulmonary  hyper- 
trophic osteoarthropathy). 

Peripheral  Nerves. — See  Nerves,  Periph- 
eral. 

Neuritis. — See  Neuritis,  Multiple. 

Periproctitis. — Gr.  wepi  around  + x/xoktos 
anus.  (See  Peritonitis.) 

Perisigmoiditis. — Gr.  wepi  around  + 
(nyp.otLbi]%  like  the  letter  sigma,  A or  S. 
(See  Peritonitis.) 

Perisplenitis. — Gr.  ivepi  around  -1-  air\-r,v 
spleen.  (See  Peritonitis.) 

Peristaltic  Unrest. — Gr.  ivepi  around  -j- 
tjTaXcns  contraction.  See  Dyspepsia,  Ner- 
vous. 

Peritonitis,  Acute  Circumscribed. — ^Gr. 
TvepLTovaLov  : wepL  around  -f-  Telveiv  to  stretch; 
-tris  inflammation.  Acute  circumscribed 
peritonitis  is  the  result  of  trauma,  or 
of  extension  of  inflammation  from  an 
abdominal,  pelvic,  or  thoracic  viscus. 
Localized  residual  abscesses  may  follow 
diffuse  peritonitis. 

The  symptoms  are  local  pain,  tenderness, 
and  muscle  spasm,  elevation  of  temperature, 
perhaps  the  presence  of  a mass,  and  perhaps 
other  indications  of  the  organ  primar- 
ily affected. 

The  formation  of  adhesions  may  later  give 
rise  to  gastro-intestinal  trouble. 

The  Treatment  is  siu'gical.  The  ventral 
decubitus  after  operation  is  strongly  advo- 
cated by  the  Mayos. 

Subphrenic  or  subdiaphragmatic  perito- 
nitis or  abscess  deserves  special  consideration 
(see  Subdiaphragmatic  Abscess) . 

Peritonitis,  Acute  Diffuse. — Symptomatoi- 
ogy.— In  perforative  cases  the  onset  is 
sudden,  with  sharp  pain,  vomiting,  shock, 
abdominal  rigidity,  and  diffuse  tenderness. 
The  patient  may  revive,  but  symptoms  of 
diffuse  peritonitis  soon  supervene,  viz., 
tympanitic  distension,  general  rigidity,  pain, 
and  tenderness,  flexion  of  the  thighs,  vomit- 


ing, constant  thirst,  small  rapid  pulse,  some 
elevation  of  temperature,  irsually  constipa- 
tion, but  often  diarrhoea,  a pinched,  anxious 
expression,  and  usually  death.  In  non- 
perforative  cases  the  onset  may  be  gradual. 

Etiology.— (a)  Primary  or  haematogenous 
peritonitis,  occurring  in  septico-pysemia, 
pneumococcus  and  other  infections,  expo.s- 
ure  to  cold,  and  as  a terminal  event  in 
chronic  nephritis,  gout,  arteriosclerosis,  he- 
patic cirrhosis,  pulmonary  tuberculosis,  can- 
cer, etc. 

(b)  Secondary  peritonitis,  occurring  as  a 
result  of  inflammation,  but  especially  per- 
foration, of  an  abdominal  or  pelvic  viscus; 
or  abscess,  etc.,  e.g.,  gastric  or  duodenal 
ulcer,  or  jejunal  ulcer  following  ga.stro- 
jejunostomy;  cancer;  appendicitis;  salpin- 
gitis; ovaritis;  metritis;  acute  phlegmonous 
gastritis;  acute  corrosive  gastritis;  acute 
enteritis;  intestinal  ulceration  {q.v.,  under 
Enteritis);  intestinal  obstruction;  intestinal 
infarction;  traumatLsm;  cholecystitis;  sup- 
purating hydatid  or  ovarian  cyst;  acute  pan- 
creatitis ; tuberculosis  ; hepatic  abscess  ; 
splenic  abscess;  nephric  aUscess;  retroperi- 
toneal abscess;  abscess  of  a mesenteric 
lymphatic  gland;  empyema;  Pott’s  disease; 
perforating  ulcer  of  the  urinary  bladder; 
phlebitis  of  the  umbilical  vein  in  infants; 
operative  contamination;  perforation  of 
organs  by  sounds. 

The  usual  infecting  organisms  are  the 
colon  bacillus,  streptococcus,  staphylococ- 
cus, and  gonococcus;  rarely  the  pneumococ- 
cus, bacillus  pyocyaneous,  bacillus  lactis 
aerogenes,  Friedlander’s  bacillus,  and  proteus 
vulgaris. 

Treatment. — In  view  of  the  high  mortality 
following  the  operative  treatment  of  diffuse 
peritonitis,  it  seems  wise  (except  in  perfora- 
tion of  the  stomach  or  bowel,  or  ileus,  or 
torsion  of  an  ovarian  cyst,  but  not  excepting 
perforative  appendicitis  seen  late,  perito- 
nitis secondary  to  pyosalpinx,  and  pneimio- 
coccus  peritonitis — Jopson)  to  employ  the 
Ochsner  plan,  in  the  hope  that  the  inflamma- 
tion may  become  localized,  and  an  operation 
then  rendered  more  useful.  The  Ochsner 
plan  is  summarized  as  follows:  absolute 
quiet  in  a semi-sitting  posture  (to  lessen 
absorption  through  the  diaphragm) ; no  food 
or  fluids  by  mouth,  the  latter  to  be  kept 
clean  and  moist;  for  vomiting — gastric 
lavage,  morphine  hypodermically,  or  some 
one  of  the  remedies  enumerated  under 
Vomiting;  constant  proctoclysis,  with  the 
reservoir  elevated  only  about  6 or  7 inches 
above  the  buttocks,  no  tube-clamps  used,  and 
the  saline  solution  (3i  ad  Oi)  kept  warm 


PERITONITIS,  TUBERCULOUS 


(115°  F.)  by  means  of  glass  hot-water  bottles 
immersed  in  the  metal  reservoir,  a flow  of 
\]/2  pints  an  hour  to  be  maintained  (see 
Appendicitis) ; for  tympanites,  hot  turpentine 
stupes  (Part  11),  and  a long  colon  tube  for 
half  an  hour  every  three  hours;  for  pain — ■ 
the  ice-bag,  hot-water  bag,  large  warm 
poultices,  or  50  per  cent,  alcohol  compresses 
changed  every  twelve  hours,  and  morphine, 
if  necessary;  for  hiccough — atropine  (Part 
11)  or  morphine;  and  finally,  nutritive 
enemata  (see  Rectal  Feeding). 

For  a rapid,  weak  pulse,  inject  caffeine 
sodio-salicylate,  or  camphor,  or  ether,  or 
digitalin,  or  adrenalin.  Pituitrin  is  valuable 
in  combating  shock  and  intestinal  paralysis. 
(For  drugs  and  sera  see  Part  11). 

Serum  treatment  may  be  tried.  Gootl 
results  are  reported  from  the  use  of  poly- 
valent anticolon  serum,  but  not  from  the 
polyvalent  antistreptococcus  serum. 

In  the  absence  of  ileus  or  of  perforation  of 
the  stomach  or  bowel,  saline  catharsis  might 
be  of  great  value,  but  it  is  usually  condemned. 

Where  surgical  interference  is  indicated, 
as  in  gastric  or  intestinal  perforation,  ileus, 
and  torsion  of  an  ovarian  cyst,  operate  just 
as  soon  as,  l)y  means  of  warmth,  bandaging 
of  the  limbs,  and  stimulation  with  strych- 
nine, the  patient  reacts  from  the  shock. 
During  the  operation,  keep  the  blood-pres- 
sure up  by  means  of  submammary  saline  (0.9 
per  cent.)  infusion,  or,  better,  gum-salt  solu- 
tion (Part  11).  As  a rule,  diy  local  sponging 
is  considered  safer  than  irrigation,  except 
jierhaps  in  strejitococcus  infection,  in  which 
thorough  irrigation  is  recommended.  All 
clots  ami  food  particles  should  be  carefully 
removed.  In  sponging,  do  only  what  is 
deemed  necessaiy,  and  avoid  irritating  the 
IK'ritoneum.  Introduce  glass  drainage  tubes, 
filled  with  gauze,  through  the  operative 
wound  into  the  pelvis,  or  through  a second 
incision  above  the  pubis.  Then  j)lace  the 
patient  in  the  Fowler  semi-sitting  posture, 
and  employ  iNIurphy’s  constant  proctoclysis, 
etc.,  for  several  days,  allowing  no  food  or 
water  by  mouth,  and  washing  out  the  stom- 
ach as  often  as  necessary  to  j)reventvomiting. 
The  normal  saline  should  be  sto]:)ped  if  the 
jnilse  becomes  full  and  signs  of  mdema  of  the 
lower  ])ortion  of  the  lungs  appear.  The 
ventral  decubitis  is  strongly  advocated  1)}' 
the  Mayos.  The  gauze  drains  should  be 
changed  every  fiA’e  f>r  six  hours. 

The  following  complications  and  sequela3 
must  be  borne  in  mind:  “secondary 
abscesses,  near  or  remote,  in  the  abdominal 
cavity,  lymphatic  infections  in  the  mesen- 
teric ami  retrop('ritoneal  chains,  subphrenic 


and  pleural  infections,  embolic  abscesses  of 
the  liver,  lungs,  heart,  etc.,  nephritis, 
phlebitis  of  the  extremities,  twists  and 
strangulations,  fecal  fistul®,  perforations  of 
an  abscess  into  various  organs,  parietal 
cellulitis,  cutaneous  eruptions,  acute 
pulmonary  cedema,  parotiditis,  the  awaken- 
ing of  latent  systemic  infections,  as 
malaria,  rheumatism,  tuberculosis,  etc., 
etc.”  (Munro.) 

Peritonitis,  Acute  Localized.  — See  Peri- 
tonitis, Acute  Circumscribed. 

Peritonitis,  Simple  Chronic  (Non-Tuber- 
culous,  and  Non-Malignant). — There  is  a 
localized  form  and  a diffuse  form.  The 
localized  form  is  associated  with  dense  pro- 
gressive adhesion  formation,  from  which  the 
following  possible  consequences  may  occur, 
viz.,  dyspepsia  and  persistent  pain  after 
eating;  jaundice  tlue  to  constriction  of  the 
common  bile  duct;  duodenal  or  pyloric 
stenosis  (local  thickening  may  even  suggest 
cancer);  constipation  and  pain,  and  some- 
times local  pericolonic  thickening;  hour-glass 
contraction  of  the  stomach;  acute  intestinal 
obstruction  due  to  kinking  and  strangulation 
of  the  gut. 

I.  Causes  of  Chronic  Localized  Peritonitis. — 
Pelvic  inflammatory  disease;  chronic  appen- 
dicitis; chronic  intussusception;  chronic 
gastric  or  duodenal  ulcer;  chronic  cholecysti- 
tis; chronic  fecal  accumulation  in  the  flexures 
of  the  colon;  pressure  of  a tight  corset  or 
belt;  hernia. 

In  chronic  diffuse  peritonitis,  the  perito- 
neum is  thickened  and  contracted,  with 
resulting  retraction  of  the  mesenterj'  and 
omentum;  it  may  be  nodular  in  places, 
adhesions  are  commonly  present,  and  also 
ascites,  which  necessitates  repeated  tapping. 
The  disease  is  usually  fatal  in  from  two  to 
sixteen  years,  although  repeated  tapping 
has  resulted  in  cure. 

II.  Causes  of  Chronic  Diffuse  Peritonitis. — 
Polyserositis  (chronic  pericarditis,  pleuritis, 
andmediastinitis ; seePericardium, Adherent ; 
arteriosclerosis;  arteriosclerotic  kidne}q  hep- 
atic cirrhosis  ; syphilitic  hepatitis  ; chronic 
cholecystitis;  chronic  gastric  or  duodenal 
ulcer;  chronic  jiassive  congestion;  chronic 
alcoholism;  traumatism;  repeated  tapping  in 
ascites;  unknown  causes. 

Tre.\tmext  cf  Simple  Chronic  Peri- 
tonitis.— Consider  the  cau.se.  In  the  diffuse 
form,  resort  to  jiaracentesis  abdominis  (see 
Ascites)  as  often  as  required. 

Peritonitis,  Tuberculous. — Three  forms 
are  recognized:  (1)  miliary  tuberculous 

peritonitis  with  general  ascites;  (2)  ulcera- 
tive peritonitis  with  resulting  serofibrinous 


PHLEBOTOMOUS  OR  PAPPATACI  FEVER 


or  purulent  exudation,  localized  by  adhe- 
sions and  giving  rise  to  loculated  or  encysted 
or  sacculated  ascites;  (3)  obliterative,  ad- 
hesive, or  chronic  fibroid  peritonitis,  in 
which  there  are  universal  adhesions  with- 
out exudation.  Tumor-like  masses,  due  to 
rolled-up  omentum,  matted  intestine,  and 
enlarged  glands,  may  be  evident  in  both 
the  suppurative  and  obliterative  forms. 
There  is  wasting,  perhaps  moderate  diar- 
rhoea, and  little  or  no  elevation  of  tempera- 
ture. Evidences  of  tuberculosis  are  apt  to 
be  found  elsewhere,  as  in  the  lungs,  pleurae, 
lymphatic  glands,  bones,  testes,  prostate, 
seminal  vesicles,  etc.  The  tuberculin  test 
may  be  employed  (see  Tuberculosis,  Pulm.), 
and  a gmnea-pig  inoculated  with  the  ascitic 
fluid.  Exclude  malignant  cUsease,  ovarian 
tumor;  (see  Ascites),  hepatic  cirrhosis,  and 
simple  chronic  peritonitis  {q.v.) 

Intestinal  obstruction  sometimes  occurs; 
sometimes  a fecal  fistula. 

Prognosis. — A spontaneous  cure  probably 
occurs  in  about  50  per  cent,  of  the  cases. 
The  prognosis  is  most  favorable  in  those 
cases  with  miliary  peritoneal  tubercles  and 
general  ascites.  The  occurrence  of  fecal 
fistula  renders  the  prognosis  grave. 

Treatment. — Prescribe  rest  in  bed,  fresh 
air  day  and  night,  exposure  of  the  abdomen 
to  the  rays  of  the  sun,  a nutritious,  easily 
digestible  diet,  and  tonics  or  alteratives 
such  as  codliver  oil  in  small  doses,  syrup  of 
the  iodide  of  iron,  Fowler’s  solution  of 
arsenic,  compound  syrup  of  glycerophos- 
phates, iodoform,  creosote  or  creosote  carb- 
onate (for  all  drugs  see  Part  11).  Says 
Kerley:  “In  the  non-surgical  treatment  of 

these  cases  the  chief  points  of  importance 
to  be  considered  are  nutrition,  fresh  air, 
and  a thorough  daily  bowel  evacuation.” 
Rontgentherapy  {q.v.)  is  used. 

Tuberculin  injections  are  recommended, 
T.R.,  mg.  Moo, 000  to  Hoo,ooo  every  two 
to  five  days,  the  dose  to  be  increased  grad- 
ually until  the  temperature  is  subnormal, 
and  then  continued  for  at  least  six  months 
or  longer.  It  should  be  discontinued  tem- 
porarily on  the  occurrence  of  pain  or  rise  of 
temperature.  (Woodwork;  see  also  under 
Tuberculosis,  Pulmonary.) 

For  offensive  diarrhoea,  prescribe  bismuth 
salicylate  and  guaiacol. 

The  following  local  applications  are  recom- 
mended by  some  for  the  purpose  of  pro- 
moting absorption  of  the  exudate: 

1.  Iodoform  dis.solved  in  olive  oil,  gr.  xx 
ad  5i,  or  iodoform  ointment  and  codliver 
oil,  aa.,  rubbed  into  the  skin  of  the  abdomen 
tv/ice  daily. 

18 


2.  Soft  or  green  soap  (sapo  mollis),  one 
to  four  teaspoonfuls,  with  a little  warm 
water,  rubbed  into  the  abdomen  every 
evening,  washed  off  after  half  an  hour,  and 
the  skin  dried  and  powdered.  If  the  abdo- 
men becomes  irritated,  apply  the  soap  to 
the  lumbar  region  for  a time. 

3.  Linimentum  hydrargyri  or  ung.  hydrar- 
gyri,  3ss,  spread  upon  a flannel  belt  which 
is  stitched  around  the  abdomen. 

4.  Alcohol  compresses,  50  per  cent., 
changed  every  twelve  hours. 

If  medical  treatment  is  unsuccessful  after 
a trial  of  from  four  to  eight  weeks,  perform 
laparotomy  (except  where  there  is  extensive 
tuberculosis  elsewhere),  and  remove  any 
possible  focus  of  infection,  e.g.,  the  appen- 
dix, caecum,  mesenteric  nodes,  intestinal 
ulcers.  Fallopian  tubes,  etc.  Avoid  tramna 
and  drainage.  Many  cases  recover  after  a 
simple  laparotomy. 

Peritonsillar  Abscess.  — See  Part  9, 
Throat  Diseases. 

Perityphlitis. — Gr.  irepi  around  fl-  rvqAds 
blind.  See  Peritonitis. 

Pernicious  Anaemia. — See  Anaemia,  Per- 
nicious) 

Pertussis.— See  Wliooping-Cough, 

Petechial  Fever. — See  Cerebrospinal  Fever. 

Pharyngeal  Cellulitis. — See  Ludwig’s  An- 
gina. 

Pharyngitis. — See  Part  9,  Throat  Diseases. 

Phlebitis. — Gr.  vein  -|-  -ltis  inflam- 

mation. Inflammation  of  a vein  is  mani- 
fested by  local  pain  and  tenderness,  often 
redness  and  oedema,  thickening  of  the 
affected  vessel,  elevation  of  temperature 
and  increased  pulse  rate.  Thrombosis 
{q.v.)  may  occur.  Its  presence  is  revealed 
by  the  absence  of  danmiing  back  of  the 
blood  when  the  vein  is  compressed  on  the 
side  near  the  heart. 

In  simple  phlebitis  without  thrombosis, 
recovery  usually  occurs  in  from  ten  to 
fourteen  days. 

Etiology.— Traumatism;  neighboring  inflam- 
mation; metastatic  inflammation,  as  in 
septico-pysemia,  puerperal  infection,  ery- 
sipelas, appendicitis,  dysentery,  gonorrhoea, 
syphilis,  tuberculosis,  pneumonia,  influenza, 
rheumatic  fever,  typhoid  fever,  typhus 
fever,  scarlet  fever,  measles,  smallpox, 
diphtheria,  etc.;  anjemia,  debilitating  and 
cachectic  states;  gout  and  rheumatism; 
chronic  passive  congestion;  bilharziasis; 
fracture  of  bone;  surgical  operations. 

Treatment.— See  Thrombosis 

Phlebotomous  or  Pappataci  Fever. — An 
ephemeral  fever  of  two  or  three  days  dura- 
tion, of  abrupt  onset,  with  severe  pains  in 


PLAGUE 


the  head,  eyes,  and  back,  malaise  and 
depression,  occurring  in  the  Mediterranean 
countries,  and  caused  by  the  bite  of  the 
sand-fly  (Phlebotomus  Papatacii),  a hairy 
moth  midge  with  slender  legs  and  leaf-like 
wings,  and  so  small  that  it  passes  through 
ordinary  mosquito  netting.  The  female 
bites  at  night.  After  biting  one  ill  with  the 
disease  the  midge  can  transmit  the  infection 
only  after  six  to  ten  days.  The  virus  is 
filterable.  One  attack  confers  immunity. 

Phlebotomy. — Gr.  4>Xs\J/  vein  -j-  Ttiivtiv  to 
cut.  See  Venesection. 

Phlegmasia  Alba  Dolens;  Milk=Leg; 
White=Leg.- — Gr.  (jAe-ypiaaLa  heat  inflamma- 
tion; L.  al'ba,  white;  dolens,  painful.  See 
Thrombosis. 

Phoresis. — See  under  Inflammation,  Local. 

Phosphaturia. — Phosphate  + Gr.  ovpov 
urine.  See  under  Nephrolithiasis. 

Phosphorus  Poisoning. — See  Poisoning. 

Phrenic  Nerve. — Gr.  4>pi]v  the  diaphragm. 
Paralysis  of  the  phrenic  nerve  is  manifested 
by  dyspnoea  on  exertion,  and  more  or  less 
immobility  of  the  diaphragm,  as  revealed 
by  the  X-rays  and  by  the  dmiinution  or 
absence  of  abdominal  respiration  (the  abdo- 
men may  retract  on  inspmation  and  distend 
on  expiration).  Exclude  immobilization  due 
to  diaphragmatic  pleurisy,  a large  jjleural 
effusion,  marked  emphysema,  peritonitis, 
or  fatty  degeneration  of  the  muscle  follow- 
ing diphtheria. 

Hiccough  (q.v.)  is  due  to  phrenic  nerve 
irritation. 

Etiology  of  Paralysis. — Cervical  Pott’s  dis- 
ease; syphilitic  pachymeningitis;  intraspinal 
hemorrhage  or  tumor;  syringomyelia;  tabes; 
progressive  muscular  atrophy,  wounds,  or 
operations;  intrathoracic  tumors  or  aneu- 
rysm; local  neuritis  (q.v.),  for  causes;  mul- 
tiple neuritis  (q.v.),  e.specially  following 
infectious  diseases;  poliomyelitis. 

Prognosis. — This  is  serious,  owing  to  the 
tendency  to  hypostatic  pulmonarj^  conges- 
tion and  pneumonia. 

Treatment.— Attend  to  the  cause.  In  neu- 
ritis apply  counter-irritation  and  heat  over 
the  lower  part  of  the  anterior  triangle  of  the 
neck.  After  the  acute  symptoms  have  sul)- 
sided,the  mild  faradic  current  for  ten  minutes 
daily  (one  electrode  behind  the  sternomas- 
toid  and  the  other  over  the  epigastrium)  may 
be  useful  (see  Neuritis,  for  further  details.) 

Phrenic  Neuralgia.— ^ee  Neuralgia. 

Phthisis. — Gr.  <t>eLais;  (pdLeiv  to  consume. 
See  Tuberculosis,  Pulmonary. 

Piles. — See  Hemorrhoids. 

Pinworm  Infection. — See  Oxyniriasis. 

Piroplasmosis. — See  Kala-Azar. 


Pituitarism,  Hypo=  and  Hyper= — Latin 
pituUa,  phlegm.  See  Acromegaly. 

Plague. — L.  pla'ga,  pes'tis]  Gr.  lA-qyri 
stroke.  A very  fatal,  epidemic,  acute 
infectious  disease  of  rapid  course,  caused  by 
the  bacillus  pestis,  (which  is  transmitted  by 
the  rat  flea),  and  characterized  by  an  incu- 
bation period  of  from  two  to  ten  days,  fol- 
lowed by  high  fever  and  prostration,  and 
usually  the  occurrence  of  lymphatic  enlarge- 
ment or  buboes.  Subcutaneous  hemorrhages 
and  pustules  are  of  frequent  occurrence. 

Several  clinical  varieties  of  the  plague  are 
distinguished,  (1)  pestis  minor,  an  abortive 
and  ambulatory  form  with  enlarged  glands; 
(2)  the  ordinary  severe  bubonic  form,  with 
enlarged  glands  or  buboes;  (3)  a septicsemic 
or  fulminating  form,  practically  always 
fatal;  (4)  a pneumonic  form,  practically 
always  fatal;  and  (5)  an  intestinal  form. 

In  case  of  doubt,  inoculate  a guinea-pig, 
mouse,  or  rat  with  the  contents  of  a bubo; 
and  observe  the  symptoms  and  make  cul- 
tures from  the  inoculated  animals. 

Prognosis. — The  disease  is  usually  fatal. 
If  the  patient  lives  through  the  fifth  day,  his 
chances  of  recovery  are  said  to  be  good. 

Convalescence  may  begin  in  the 
second  to  the  fourth  week,  and  is 
frequently  protracted. 

Treatment.— Isolate  and  quarantine  the 
patient,  clean  up  the  premises,  killing  rats, 
mice,  insects,  etc.,  and  fumigate  the  houses 
(see  Disinfection) . Relative  immunity  against 
the  disease,  lasting  about  four  months,  is 
conferred  by  the  subcutaneous  injection  of 
Haffkine’s  dead  bacilli,  3.0  to  3.5  c.c.  in  adult 
males;  2.0  to  2.5  c.c.  in  adult  females;  1.0  c.c. 
in  children  over  ten ; 0.1  to  0.5  c.c.  in  small 
children;  a larger  dose  being  given  in  ten 
days,  its  size  depending  upon  the  reaction 
produced  by  the  first  dose.  This  vaccine  is 
said  to  be  harmful  if  used  after  infection 
has  occurred. 

Purge  the  patient  in  the  beginning  with 
castor  oil  or  calomel.  Lustig’s  seriun  (20  to 
320  c.c.  intravenously  or  hypodermically 
eveiyday),  which  confers  passive  immunity, 
should  be  administered.  Bichloride  of  mer- 
cury in  large  doses,  by  mouth  or  intraven- 
ously, is  recommended. 

The  general  treatment  is  .symptomatic: 
hydrotherap.y  for  fever  (q.v.) ; the  ice-cap  for 
headache;  early  stimulation  for  heart  weak- 
ness, emjiloying  for  tins  purpose  camphor, 
ether,  alcohol,  digitalin,  andstrjThnine;  ung. 
hydrargyri  for  the  buboes,  which  should  be 
incised  and  drained  only  when  fluctua- 
tion occurs.  (For  drugs,  see  Part  11). 

In  simple  bubonic  cases,  quarantine  the 


PLEURISY 


patient  for  three  or  four  weeks  after  the 
beginning  of  convalescence.  In  pneumonic 
or  septicsemic  cases  that  recover,  prolong 
the  quarantine  to  ten  or  eleven  weeks. 

Plantar  Neuralgia. — L.  plan'ta,  the  sole  of 
the  foot.  See  Metatarsalgia. 

Plastic  Bronchitis. — Gr.  ifKaarbs  formed 
matter.  See  Bronchitis,  Fibrinous. 

Pleural  Effusion. — See  Pleurisy. 

Pleurisy. — Gr.  TrXeuprns  inflammation  of 
the  pleura.  Pleurisy  may  be  fibrinous,  sero- 
fibrinous, or  purulent. 

1.  Simple  fibrinous,  plastic,  or  dry  pleu- 
risy is  manifested  by  sharp  pain  aggravated 
by  breathing,  usually  cough,  perhaps  some 
dyspnoea,  often  some  elevation  of  tempera- 
ture, and  usually  a friction  rub  on  ausculta- 
tion. In  diaphragmatic  pleuri.sy  the  pain 
may  be  abdominal  and  even  associated  with 
muscle-spasm  and  tenderness.  Two  common 
signs  of  diaphragmatic  pleurisy,  according 
to  Kelly  and  Weiss,  are  tenderness  along  the 
ridge  of  the  trapezius  in  the  neck  and  be- 
neath the  twelfth  rib  posteriorly  on  the 
affected  side. 

2.  Serofibrinous  pleurisy  or  pleurisy  with 
effusion  is  manifested  by  the  following 
symptoms  and  signs,  viz.,  pain;  cough; 
dyspnoea;  elevation  of  temperature;  dimin- 
ished respiratory  mobility  on  the  affected 
side,  perhaps  fullness  of  the  intercostal 
spaces  and  increase  in  size  of  the  affected 
side,  as  ascertained  by  measurement;  ab- 
sence of  tactile  fremitus  over  the  effusion, 
except  where  adhesions  exist;  dulness  or 
flatness  and  a sense  of  resistance  on  per- 
cussion, “ corresponding  roughly  to  the 
position  of  the  fluid  ” (Cabot),  and  some- 
times slowly  changing  its  level  with  change 
in  the  position  of  the  patient;  tympany 
above  the  level  of  the  fluid  over  the  con- 
densed lung;  a paravertebral  triangle  of 
dulness  on  the  opposite  side  with  the  apex 
upward  (Grocco) ; displacement  of  the  heart, 
especially  in  left-sided  effusion;  breath 
sounds  diminished  or  absent,  possibly 
chstanGtubular  in  quality,  especially  in 
children;  exaggerated  breathing  on  the 
sound  side. 

Pleurisy  with  effusion  is  to  be 
distinguished  from  pleural  thickening  with 
pulmonary  atelectasis,  pneumonia,  a large 
pericarchal  effusion,  hydrothorax,  intra- 
thoracic  neoplasm,  liver  abscess,  and 
subdiaphragmatic  abscess  or  hydatid  cyst. 
When  in  doubt,  insert  a large  hypodermic 
needle  with  syringe  attachment.  A 
transudate  is  usually  below  1.015  in  specific 
gravity,  an  exudate  usually  around  1.020. 
The  presence  of  blood  suggests  cancer,  but 


may  occur  in  pnemnonia  and  tuberculosis. 
Centrifugalize  the  fluid  for  five  minutes, 
pour  off  the  supernatant  fluid,  stir  the 
remaining  sediment,  and  spread  a drop  of 
it  with  a platinum  loop  on  a clear  cover- 
glass,  diy  without  heating,  and  stain  as 
follows:  cover  with  Wright’s  stain,  3 

parts,  pure  methyl  alcohol,  1 part;  after 
one  minute  add  distilled  water  until  a 
greenish  metallic  lustre  appears  like  a 
scum;  after  about  two  minutes  wash  very 
gently  with  water  by  means  of  a ch’opper, 
and  dry  with  the  fingers  over  a flame; 
mount  in  Canada  balsam  and  examine  with 
an  oil-immersion  lens.  A great  preponder- 
ance of  lymphocytes  indicates  practically 
always  tuberculosis;  polynuclear  leucocytes 
indicate  septic  streptococcic,  staphylococcic, 
or  pneumococcic  infection;  large  mono- 
nuclear (perhaps  endothelial)  cells  indicate 
a dropsical  transudate.  (Cabot).  Figs.  57, 
58  and  59. 


Fig.  57. — Pleural  fluid  in  primary  tuberculous  pleurisy, 
showTng  lymphocytosis  (x  750  diameters),  (Musgrave). 


Serofibrinous  pleurisy  is  usually  of  grad- 
ual onset;  but  sometimes  it  is  sudden 
and  acute. 

3.  Purulent  pleuritis  or  empyema  presents 
the  signs  and  symptoms  of  serofibrinous 
pleurisy,  with  in  addition  the  symptoms  of 
septic  infection,  e.g.,  weakness,  pallor,  irregu- 
lar fever,  leucocytosis,  and  perhaps  chills 
and  sweats.  Says  Osier,  “ In  pneumonia 
the  practitioner  should  be  on  the  alert  if 
the  crisis  is  delayed  or  the  temperature 
rises  after  the  crisis,  if  chills  and  sweats 
follow,  or  if  the  cough  changes  to  one  of 
paroxysmal  type  of  great  intensity.”  A 
pleuritis  in  children  is  usually  purulent. 
Holt  says,  when  marked  dulness  or  flatness 
on  percussion,  feeble  breathing,  and  dis- 


PLEURISY 


placement  of  the  heart  are  present  in  a 
young  child,  a large  hypodermic  needle 
should  be  inserted  repeatedly  until  a correct 
diagnosis  is  assured.  In  doubtful  cases  an 
exploratory  incision  is  justifiable.  The 


Fig.  58. — Pleural  fluid  from  a case  of  traumatic  acute 
infectious  pleurisy,  showing  polynuclears  and  large  lympho- 
cytes (x  750  diameters),  (Musgrave). 


pus  is  sometimes  encapsulated  between  the 
lung  and  the  diaphragm,  lung  and  chest 
wall,  or  the  lobes  of  the  lung.  The  X-ray 
may  reveal  these  encapsulations. 


Fia.  It'.h — I’lpural  fluid  in  hydrothorax  due  to  cardiac  dis- 
ease, showing  endothelial  pla(iues  and  cells  (x  7r>0  diameters), 
(Musgrave). 


Iltiology  of  F’lcurisy. — Exposure  to  cold  and 
wet;  traumatism;  bronchial  and  pulmonary 
affections  (bronchitis,  j^neumonia,  tubercu- 
losis, abscess,  gangrene,  bronchiectasis, 
cancer,  actinomycosis);  infectious  diseases 
(scptico-pyicmia,  typhoid  fever,  influenza, 
measles,  scarlet  fever);  pericarditis; 


subphrenic  suppuration;  mediastinal  sup- 
puration; oesophageal  disease;  chronic 
debilitating  diseases;  tertiary  syphilis. 

The  organisms  concerned  are  the  tubercle 
bacillus,  pneumococcus,  streptococcus  (espec- 
ially the  haemolytic),  rarely  the  staphylo- 
coccus, typhoid  bacillus,  diphtheria  bacillus, 
and  Frie(ilander’s  bacillus.  The  tubercle 
bacillus  is  perhaps  the  commonest  cause 
of  pleuritis. 

Prognosis. — Simple  dry  pleurisy  is  readily 
cured.  Pleurisy  with  effusion  usually  termi- 
irates  in  recover^"  in  from  six  w'eeks  to  three 
months  or  longer.  Owing  to  obliteration 
of  the  pleural  space  following  the  disappear- 
ance of  the  effusion,  relapses  are  rare. 
Tuberculosis,  however,  is  the  commonest 
cause  of  pleurisy,  which  renders  the  ulti- 
mate prognosis  uncertain.  Pulmonary 
oedema  sometimes  occurs  in  wet  pleurisy; 
also  sudden  death  due  to  thrombosis  or 
embolism.  Empyema  is  always  serious,  but 
with  the  establishment  of  free  drainage,  the 
outlook  is  usually  good,  excepting  in  infants 
under  one  year.  Perforation  sometimes 
occurs  through  the  lung,  with  the  expector- 
ation of  muco-pu,s,  or  through  the  skin  or 
neighboring  organs. 

Treatment.  —(1)  FiBRINOUS  PLEURISY. — 
Put  the  patient  to  bod,  and  open  the 
bowels.  Immobilize  the  affected  side  by 
applying,  from  below  upward,  during  forced 
expiration,  several  w'ell-warmed  overlapping 
strips  of  zinc  oxide  adhesive  plaster,  about 
three  inches  wide,  and  extenchng  from  the 
spine  to  well  over  the  sternum.  It  should 
be  removed  within  seven  days.  If  this 
affords  no  relief,  employ  the  ice-bag;  or 
hot  water  bag;  or  the  Paquelin  cauterj';  or 
hot  linseed  jjoultices;  or  mustard  poultices 
(1:2,  every  six  to  eight  hours);  or  the  hot 
turpentine  stupe  (Part  11);  or  tincture  of 
iodine;  or  menthol,  gr.  iiss,  and  cocaine 
hydrochloride,  gr.  i,  in  vaseline,  5i;  or 
phenacetin  or  antip^Tin,  gr.  v — x,  with 
salol  or  aspirin,  gr.  x-XAq  or  codeine,  gr. 
34  to  3^;  or  morphine,  gr.  to  3i,  rejx'ated 
in  one  hour,  if  necessary. 

Prescribe  fiysh  air  day  and  night,  an 
abundance  of  easily  digestible  food,  elixir 
of  iron,  quinine,  andstr^'chnine,  one  teaspoon- 
ful, well  diluted,  after  meals,  and  correct 
hygiene  generally,  as  in  tuberculosis  (q.v.). 

After  recovery,  instruct  the  patient  in 
the  practice  of  respiratoiy  exercises,  for  the 
purpose  of  jireventing  adhesions  and  their 
possible  sequelae,  e.g.,  bronchiectasis,  chronic 
pneumonia,  and  chest  deformities. 

(2)  Serofibrinous  Pleurisy. — In  the 
presence  of  effusion,  early  tapping  was  for- 


PLEURISY 


merly  considered  the  proper  procedure,  but 
is  now  regartled  as  “ rarely  necessary  or 
atlvisable  ” (Webster).  The  presence  of 
fluid  may  serve  a useful  purpose  by  splint- 
ing the  lung.  The  withdrawal  of  even  a 
small  quantity  of  fluid  is  often  followed  by 
rapid  absorption  of  the  remainder. 

Potain’s  air-tight  apparatus,  with  thick, 
incollapsible  rubber  tubing  and  trocars  with 
a lateral  outlet,  may  be  used.  (Fig.  60.)  It 
should  be  air-tight  to  prevent  pneumothorax 
(always  test  the  apparatus,  and  boil  it  before 
using,  and  see  that  the  air  in  the  bottle  is 
under  negative  pressure).  Before  aspirating, 
the  patient  may  be  given  morphine  as  a 
sedative,  if  deemed  advisable.  It  is  well  to 
have  at  hand  a syringeful  of  a 10  per  cent, 
solution  of  camphor  in  ether  or  oil,  another 


finger  about  four  centimetres  from  the  point 
of  the  trocar  (the  thoracic  wall  is  about 
2 to  4 centimetres  thi(;k) ; push  it  in  until  no 
resistance  is  felt.  Some  press  the  nail  of 
the  left  forefinger  into  the  intercostal  space, 
and  insert  the  point  of  the  trocar  above  it. 
Use  only  just  sufficient  aspiration  to  main- 
tain the  flow.  In  large  effusions,  from  1000 
to  1500  c.c.  (1  to  13^  quarts)  may  be  safely 
removed  as  a rule,  but  the  withdrawal  should 
occupy  about  half  an  hour.  The  safety 
dimini.shes  with  the  duration  of  the  effusion 
and  the  age  of  the  patient.  Stop  at  once 
should  the  patient  begin  to  cough  immod- 
erately, the  pain  become  severe,  or  bloody  or 
albuminous  expectoration,  severe  dyspnoea, 
oi-  faintness  occur  (pulmonary  oedema,  due 
to  sudden  expansion  of  the  lung). 


Fia.  00. — Apparatus  for  aspiration  (Kerley). 


of  strychnine,  gr.  smelling  salts, 

brandy,  or  whiskey.  With  the  patient  in  the 
sitting  posture,  and  the  hand  on  the  oppo- 
site shoulder,  select  the  seventh  or  eighth 
interspace  between  the  scapular  and  pos- 
terior axillary  lines;  or  the  fifth  or  sixth 
interspace  in  midaxilla  (in  large  or  medium 
effusions);  or  the  interspace  which  lies  just 
below  the  angle  of  the  scapula  when  the 
arm  is  advanced  and  drawn  across  the  chest, 
and  about  an  inch  in  front  of  the  posterior 
axillary  line  (Yeo.)  A mark  may  be  made 
at  the  selected  site  of  puncture  with  an 
indelible  pencil.  Wash  the  skin  with  soap 
and  hot  water,  dry  thoroughly  with  sterile 
gauze,  and  paint  with  tincture  of  iodine. 
Anoint  the  trocar  with  sterile  oil  or  vaseline, 
and  introduce  it  just  above  the  rib  by  a 
quick,  firm  thrust,  with  the  tip  of  the  index 


Lacking  the  Potain  aspirator,  one  may 
employ  Cantlie’s  method;  The  aspirating 
needle  is  attached  to  a rubber  tube,  the  free 
end  of  which  is  tied  into  a test-tube;  the 
whole  apparatus  is  filled  with  sterile  normal 
saline  solution  (5i  ad  Oi),  and  the  rubber 
tube  clamped;  the  needle  is  now  inserted 
and  the  clamp  removed,  and  a siphon  action 
is  thus  set  up;  the  overflow  is  caught  in  a 
basin,  and  the  flow  is  regulated  by  raising 
and  lowering  the  test-tube. 

After  the  operation  has  been  completed, 
seal  the  wound  with  a thin  wisp  of  sterile 
(iotton  saturated  with  collodion.  Keep  the 
patient  in  bed  for  about  a week;  and  at  the 
expiration  of  another  week,  cautiously  begin 
respiratory  exercises  for  the  prevention  of 
adhesions,  unless  there  are  present  fever, 
pain,  fluid,  or  active  pulmonary  disease. 


PLEURISY 


Begin  with  deep  inspirations,  repeated  six 
to  twelve  times  every  two  hours;  or  the  slow 
inflation  of  a large  rubber  bag;  or  the  blow- 
ing of  water  from  one  Wolff’s  bottle  to 
another  (see  Fig.  61).  Later,  with  both 
arms  outstretched  at  right-angles  with  the 
body,  bend  the  thorax  toward  the  sound 
side  during  inspiration. 

A repetition  of  the  tapping  is 
rarely  required. 


Fig.  61. — Wolff’s  Bottles  containing  colored  water,  to  be 
blown  from  the  lower  to  the  higher  bottle  as  a respiratory 
exercise  for  the  prevention  of  pleural  adhesions  following 
pleuritis.  (Holt). 

3.  Empyema. — The  treatment  of  pyo- 
thorax  is  surgical.  All  pockets  of  pus  should 
at  once  be  freely  opened  and  drained  to  the 
bottom.  The  occurrence  of  perforation  in 
any  direction  does  not  render  operation 
unnecessary.  In  double  empyema,  one  side 
only  should  be  operated  on  at  one  time,  and 
the  other  side  after  an  interval  of  four  to 
seven  days,  to  avoid  collapse  of  the  lungs. 
An  X-ray  (q.v.)  taken  after  part  of  the  fluid 
has  been  withdrawn  will  show  the  number 
and  distribution  of  pus  pockets.  If  the 
X-ray  is  taken  before  the  chest  has  been 
aspirated  and  air  admitted,  it  shows  a 
general  opacity  of  the  whole  or  part  of  the 
affected  side  (Lilienthal). 

In  acute  general  j)yothorax  with  cyanosis, 
dyspnoea  and  sepsis,  proceed  as  follows, 
with  the  patient  lying  on  his  well  side  slightly 
toward  the  abilomen,  the  knees  and  hips 
flexed,  a pillow  between  the  knees  and  one 
beneath  the  thorax,  the  arm  behind  the 
back,  the  legs  strapped  to  the  table,  and 
sandbags  about  the  thorax.  Under  local 
anaesthesia  (see  Novocaine  in  Part  11)  make 
a short  incision  in  the  seventh  (on  the  right 
side)  or  eighth  (on  the  left  side)  intercostal 
space,  posterior  axillary  line,  close  to  the 
upper  border  of  the  rib,  and  introduce  a 
small,  thick- walled  tube,  connected  with  a 
long,  sterile  tube  the  end  of  which  dips  below 
the  surface  of  boiled  boric  acid  solutioTi  in  a 
bottle  beside  the  bed.  Apply  sterile  gauize 
held  in  place  by  adhesive  plaster  not  encirc- 
ling the  chest. 


If  no  satisfactory  improvement  occurs 
within  six  days,  and  the  X-ray  in  the  erect 
posture  reveals  collections  of  fluid,  proceed 
as  follows,  under  general  anaesthesia,  with 
the  patient  in  the  same  position  as  above 
described.  Make  an  incision  in  the  seventh 
or  eighth  interspace,  close  to  the  upper 
border  of  the  rib,  from  its  angle  to  the  cartil- 
age. Make  a short  incision  through  the 
pleura  and  evacuate  the  fluid  slow'ly.  Then 
open  the  pleura  to  the  same  extent  as  the 
skin  incision,  avoiding  the  diaphragm  in 
front.  Now  spread  the  ribs  apart  gradually 
by  means  of  Lilienthal’s  powerful  rib- 
spreading retractor  (made  by  G.Tiemann  & 
Co.),  to  usually  four  to  sLx  inches.  Remove 
all  fluid  and  coagula,  break  down  soft  adhe- 
sions, separate  the  pulmonary  lobes,  look 
particularly  for  collections  of  pus  between 
the  lower  lobe  and  the  diaphragm,  and,  if 
necessary,  to  secure  expansion  of  the  lung, 
incise  and  peel  off  tough  visceral  mem- 
branous adhesions  from  the  apex  to  the 
base  of  the  cavity,  making  cross  incisions  if 
necessary.  Mobilization  of  the  lung  is 
manifested  by  bulging  of  the  latter  into  the 
wound  on  in.sufflation  by  the  anesthetist 
(see  below).  The  rib  spreader  is  now  re- 
moved and  the  wound  closed,  the  muscles 
sutured  \vith  chromicized  catgut.  No.  2, 
and  the  skin  with  silk.  The  ribs  need 
not  be  drawn  together.  Split  drainage 
tubes  are  left  at  the  angles  of  the  wmund. 
Apply  dry  gauze  held  in  place  by  adhesive 
jDlaster  which  should  not  encircle  the  chest. 
(Lilienthal.) 

Subacute  and  chi'onic  general  pyothorax 
(with  little  fever,  no  cyanosis  or  dyspnoea 
except  on  exertion,  and  the  affected  side  con- 
tracted and  ribs  drawm  together  closer  than 
on  the  sound  side)  should  also  be  treated  as 
above  directed.  (Lilienthal.) 

In  subacute  and  cffronic  localized  or 
encapsulated  pyothora.x,  resect  one  or  tw'o 
ribs  with  the  periosteiun,  and  pack  the 
cavity  lightly  with  gauze.  In  using  local 
aniEsthesia  with  novocaine  {q.v.,  in  Part  11), 
first  infiltrate  the  skin  and  subcutaneous 
tissues,  then  the  intercostal  nerves  of  the 
rib  to  be  resected,  then  block  the  rib  above 
by  injecting  the  subcostal  groove  near  the 
angle  of  the  rib.  (Lilienthal.) 

The  drainage  gauze,  says  S.  Robinson, 
should  be  covered  with  a large  rubber  sheet 
or  dam  covering  the  skin  beyond  the  gauze 
and  smeared  with  ointment  wiiere  it  covers 
the  skin,  so  as  not  to  admit  air,  the  object 
being  to  close  the  drainage  opening  during 
inspiration  wiiile  allowing  evacuation  of  pus 
during  expiration,  and  thus  afford  a valvular 


PLEURISY 


action  admitting  of  expansion  of  the  lung 
and  the  avoidance  of  a permanent  cavity  or 
chronic  empyema. 

A.  McGlannan  expedited  and  increased 
his  cures  by  using  Brewer’s  flanged  drainage 
tube  connected  with  a two-quart  bottle  and 
the  latter  with  a small  hand  exhaust-pump, 
as  shown  in  Fig.  62.  The  suction  is  contin- 


ued for  two  to  four  weeks.  A water  pump 
may  also  be  used  for  continuous  suction. 
The  rubber  collar  of  the  drainage  tube  is 
sutured  to  the  skin  and  hermetically  sealed 
with  gutta-percha  or  with  vaseline  and 
adhesive  plaster. 

The  Carrel-Dakin  treatment  (see  under 
Wounds)  of  empyema  is  of  value.  The 
drainage  aperture  should  be  closed  when  the 
cavity  is  surgically  clean.  Says  Bainbridge, 
quoting  Depage,  “There  is  no  reason  to  fear 
the  result  of  closing  the  opening  in  the  tho- 
racic wall  before  the  lung  is  expanded  and 
the  cavity  filled  up,  for  this  procedure  is  the 
most  successful  method  of  inducing  rapid 
expansion  of  the  lung  and  obliteration  of  the 
pleural  cavity.” 

Following  operation  for  empyema  the 
patient  should  be  instructed  to  practice 
forced  expiration  once  or  twice  a day  by 
blowing  through  a tube  into  a pneumatic 
cushion  with  the  tube  strictured  by  means 
of  a string  tied  around  it,  or  by  blowing 
water  from  one  Wolff’s  bottle  to  another, 
the  bottles  for  children  holding  at  least  a 
gallon  each  (see  Fig.  63),  with  the  object  of 
expanding  the  lungs  and  preventing  the  for- 
mation of  restricting  adhesions.  For  chil- 
dren, “one  bottle  is  placed  a few  inches 
higher  than  the  other,  and  the  child  blows 
a colored  fluid  from  the  lower  into  the  higher 
bottle,  allowing  it  to  siphon  back”  (Holt). 
The  child  may  also  blow  soap  bubbles. 

A persistent  temperature  or  a rise  of  tem- 
perature following  operation  may  mean 
defective  drainage,  or  pneumonia,  or  pul- 
monary abscess,  empyema  of  the  opposite 
side,  pericarditis,  otitis  media,  etc. 

As  a rule,  healing  occurs  in  from  three  to 


six  weeks.  Strict  aseptic  precautions  should 
be  observed  in  changing  dressings,  to  avoid 
secondary  infection. 

In  long  neglected  cases  and  in  operated 
cases  in  which  no  provision  was  made  for 
the  re-expan.sion  of  the  lung,  the  latter 
remains  irermanently  retracted  (chronic 
empyema).  In  such  cases  Beck’s  bismuth 
and  vaseline  paste,  10  per  cent,  (see  Part 
11),  may  be  tried.  If  it  fails,  decortication  of 
the  lung  or  an  osteoplastic  rib-resection  is 
requhed.  Lilienthal’s  procedure  is  as  fol- 


lows: First  disinfect  the  cavity  by  the 

Carrel-Dakin  method  for  four  to  six  days, 
bearing  in  mind  that  the  presence  of  a 
minute  bronchial  fistula  will  lead  to  the 
“gassing”  of  the  patient.  Then,  under 
anaesthesia  by  intrapharyngeal  insufflation 
(hereinafter  described),  and, with  the  patient 
in  the  posture  previously  described,  make 
an  incision  in  the  seventh  interspace,  close 
to  the  upper  border  of  the  rib  from  its  angle 
to  the  cartilage,  avoiding  the  sinus.  Divide 
from  one  to  four  ribs  with  rib  forceps  at  the 
posterior  angle  of  the  wound,  and  then 
employ  the  rib  spreader.  Mobilize  the  lung 
by  incising  the  tough  visceral  pleural  mem- 
brane from  the  apex  of  the  cavity  to  the 
base  and  peeling  it  off,  making  cross  inci- 
sions if  necessary;  then  have  the  anaes- 
thetist inflate  the  lung  as  far  as  possible. 
If  it  is  impos.sible  to  mobilize  the  lung,  due 
to  pulmonary  fibrosis,  a later  “collapse 
operation”  may  be  required.  After  mobil- 
izing the  lung,  insert  a forceps  into  the 
cavity  through  the  old  sinus  and  draw  out  a 
piece  of  iodized  gauze;  then  draw  through  a 
rubber  tube  “just  long  enough  to  reach  the 
inside  of  the  chest.”  If  the  divided  ends  of 
the  ribs  tend  to  overlap,  resect  a small 
portion.  Now  close  the  wound  in  layers, 
using  chromicized  catgut  for  the  muscles 
and  silk  for  the  skin.  Administer  morphine 


PNEUMONIA,  LOBAR 


for  the  first  twelve  to  twenty-four  hours 
following  the  operation,  and  start  blowing 
exercises  as  soon  as  the  patient  is  well  out 
of  the  anaesthesia. 

Intrapharyngeal  etherization  is  accom- 
plished as  follows:  The  apparatus  consists 
of  an  ether  bottle  with  two  tubes  through 
the  stopper,  one  dipping  into  the  ether  and 
the  other  conveying  the  ether  vapor,  a 
catheter  of  the  calibre  of  about  14  F.,  and 
a foot  bellows  or  hand  bulb  wth  a secondary 
bulb  like  that  of  Paquelin’s  cautery.  After 
the  patient  is  anaesthetized  by  means  of  the 
ether  mask,  the  catheter  is  passed  through 
the  nostril  as  far  as  but  no  farther  than  the 
pharynx  (about  33^  inches,  marked  on  the 
tube  with  a piece  of  adhesive  plaster).  To 
distend  the  lung  the  opposite  nostril  is 
closed  and  the  hand  placed  over  the  closed 
mouth.  (Lilienthal.) 

A tuberculous  empyema  should  not,  as  a 
rule,  be  opened;  but  aspiration  may,  per- 
haps, be  allowable,  under  strict  aseptic 
precautions. 

Pleurodynia;  Intercostal  Myalgia. — Gr. 

TrXecpd  rib  -b  68i)vq  pain.  See  Myalgia. 

Plumbism. — L.  plum'hum,  lead.  See  Lead 
Poisoning. 

Pneumatosis. — Gr.  -Kveona  air.  Distension 
of  the  stomach  with  air  that  cannot  be 
expelled  owing  to  the  coexistence  of  pyloro- 
spasm  and  cardiospasm.  Sometimes  alarm- 
ing symptoms  of  dyspnoea  and  collapse  occur, 
and  the  stomach  is  noted  to  be  greatly  dis- 
tended and  tympanitic. 

Causes.  — Atonic  dilatation;  neuras- 
thenia; hysteria. 

Treatment. — Treat  the  underlying  condi- 
tion. Administer  a subcutaneous  injection 
of  morphine  and  atropine.  Pass  the  stom- 
ach tube,  if  necessary. 

Pneumogastric  Nerve. — Gr.  irvevnwv  lung 
+ yaaT-qp  stoinach.  (See  Vagus  Nerve.) 

Pneumokoniosis. — Gr.  wevpujov  lung  + 
KovLs  dust.  Impregnation  of  the  lungs  with 
dust,  e.g.,  the  dust  of  coal,  iron,  brass, 
bronze,  stone,  clay,  cotton,  shoddy,  grain, 
street  dust,  etc.,  with  resulting  fibrosis, 
chronic  bronchitis,  and  usually  emphysema. 
The  sputum  is  colored  according  to  the 
nature  of  the  causal  agent — black  with  coal 
dust,  red  with  iron  dust,  etc. 

The  Progno.sis  is  good  if  the  cause  is 
removed  in  time. 

Treatment.— Correct  the  cause  by  means  of 
respirators,  proper  ventilation,  etc.  The 
treatment  is  tliat  of  chronic  bronchitis 
and  emithysema. 

Pneumonia,  Chronic  Interstitial.  — See 
Pulmonary  Cirrhosis. 


Pneumonia,  Lobar. — Gr.  wvevpoivLa  from 
TTvtvpxjiv  lung.  An  acute  infectious,  some- 
times epidemic  disease,  caused  usually  by 
the  pneumococcus  of  Frankel  (of  which  there 
are  four  types),  sometimes  by  the  strepto- 
coccus, staphylococcus,  or  Friedlander’s 
bacillus  pneumoniae,  and  characterized  by  a 
croupous  or  fibrinous  inflammation  of  the 
lungs,  with  the  following  symptoms  and 
signs,  viz.,  onset  usually  sudden,  with  a 
severe  chill,  followed  by  pain  in  the  side  or 
abdomen,  fever,  leucoc;^osis,  cough  and 
dyspnoea;  herpes  commonly  pre.sent;  cheeks 
flushed,  especially  the  one  on  the  side  of  the 
lesion;  sputum  scanty  and  viscid,  usually 
becoming  rusty  after  several  days;  on  per- 
cussion, dulness  (sometimes  tympany)  and  a 
sense  of  resistance  over  the  affected  area  (do 
not  neglect  the  axillae) ; on  palpation,  usually 
increased  vocal  fremitus;  on  auscultation,  at 
first  crepitant  rales  and  diminished  vesicular 
murmur,  which  later  becomes  broncho- 
vesicular,  and  later  tubular  with  disap- 
pearance of  the  rales  (rales  reappear  when 
resolution  sets  in);  duration  usually  from 
five  to  ten  days  (possibly  one  to  twenty-one 
days);  termination  usually  by  crisis,  some- 
times by  lysis;  in  about  20  per  cent.,  more 
or  less,  by  death. 

The  fever  is  usually  continuous;  it  may 
be  remittent;  sometimes  it  is  relapsing 
(pseudo-crises).  In  asthenic  and  senile 
cases  it  may  be  continuously  normal 
or  subnormal. 

The  physical  signs  of  pneumonia  some- 
times do  not  appear  until  after  the  crisis; 
indeed  the  disease  is  often  atypical.  An 
X-ray  picture  furnishes  valuable  diagnos- 
tic information. 

In  cases  of  delayed  resolution,  consider 
the  possibility  of  tuberculosis,  pleurisy  with 
effusion,  or  empyema,  interlobar  or  parietal. 

Pleurisy  (serofibrinous  or  j:>urulent)  is  the 
commonest  complication  of  pneumonia. 
The  following  occur  but  rarely:  pulmonaiy 
abscess,  pulmonary  gangrene,  pneumothorax, 
meningitis  (meningismus,  with  headache, 
vomiting,  delirium  and  ceiwical  retraction 
is  quite  common),  gastric  and  intestinal 
disturbance,  endocarclitis,  pericarditis,  peri- 
tonitis, parotitis,  arthritis,  sinusitis,  otitis 
media,  mastoiditis,  conjunctivitis  and  kera- 
titis, neuritis,  venous  thrombosis  and  embol- 
ism, jaundice,  nephritis,  mediastinitis,  sub- 
})hrenic  abscess,  hemiiilegia  (embolic  or  toxic). 

Etiology.— Predisposing  influences  are  : 

Winter  and  spring;  dry  climate;  exposure 
to  cold  or  wet;  j^oor  hygiene;  trauma- 
tism; inhalation  of  irritating  fumes  or 
dust;  aspiration  of  foreign  material;  other 


PNEUMONIA,  LOBAR 


diseases ; alcoholism ; senility ; infancy 
and  early  childhood ; a i^rcvious  attack 
of  pneumonia. 

Prognosis. — The  mortality  is  about  20  per 
cent.,  more  or  less.  A pulse  rate  in  adults 
of  over  125,  and  an  irregular  j)ulse  before 
the  crisis,  are  serious  (Mackenzie).  Should 
the  pulse-beat  per  minute  rise  above  the 
systolic  blood-pressure  expressed  in  milli- 
metres of  mercuiy,  the  condition  is  very 
serious  (Gibson).  There  is  a tendency  to 
collapse  at  the  crisis,  which  is  usually  over- 
come by  stimulation.  Named  in  the  order 
of  virulency  are  types  III,  II,  I,  and  IV  of 
the  pneumococcus.  Types  I and  II  pre- 
dominate as  a cause  of  pneumonia. 

Treatment. — (Treat  children  as  described 
under  Bronchopneumonia.)  The  windows  of 
the  sick-room  should  be  kept  open  day  and 
night,  and  the  patient  screened  against 
draughts.  A continuous  supply  of  fresh 
air  is  of  the  very  fii’st  importance.  The 
room  temperature,  in  sthenic  cases,  should 
not  be  allowed  to  exceed  65°  F. ; for  asthenic 
(iases  it  should  be  comfortably  warm,  i.e., 
70°  to  72°  F.  Hot  water  bottles  may  be 
placed  at  the  feet  if  desired,  and  if  the 
temperature  is  not  high.  Light  woolen 
underclothing  should  be  worn,  and  the  bed 
covering  should  not  be  heavy.  The  patient 
should  not  be  allowed  out  of  bed  : a bed-pan 
and  urinal  should  be  used.  He  should  be 
kept  quiet,  and  should  not  be  overburdened 
with  excessive  attention. 

At  the  onset  the  bowels  should  be  opened 
with  calomel,  or  castor-oil,  and  a daily  move- 
ment should  thereafter  be  secured  by  means 
of  enemata  or  salines  (see  Part  11). 

The  mouth  and  nose  should  be  kept  clean 
with  Dobell’s  solution  (Part  11),  and  the 
whole  body  should  be  sponged  daily  with 
tepid  water. 

Feed  the  patient,  whether  adult  or  child, 
no  oftener  than  every  three  hours,  and  give 
only  liquid  or  semi-liquid  food  while  there  is 
fever,  e.g.,  milk,  with  or  without  lime-water 
or  Vichy,  eggs,  beef-juice,  scraped  meat, 
broths,  gelatine,  and  well-cooked  thin  gruels 
of  rice,  barley,  wheat,  or  oatmeal,  which 
may  be  partly  predigested,  if  desired,  with 
pancreatin  or  taka-diastase  {q.v.  in  Part  11). 
Calcium  glycerophosphate,  5i  daily  (Barr), 
may  be  given  to  supply  the  deficiency  in 
calcium  which  occurs  in  pneumonia.  An 
abundance  of  salt  is  also  advised.  Water 
should  be  given  freely — 4 to  8 ounces  every 
hour  or  two.  Keep  a pitcher  of  cream  of 
Tartar  lemonade  at  the  bed-side  (1  teaspoon- 
ful cream  of  Tartar  dissolved  in  1 pint  or  1 
quart  of  boiling  water,  cooled  and  flavored 


with  sugar  and  lemon).  The  following  old- 
fashioned  fever  mixture  may  be  prescribed 
partly  as  a placebo: 


B Hpiritus  actheri.s  nitro.si  ....  oii  (HEv  per  t.sp.) 

Potassii  citratis pi  (gr.  iiss  per  tsp.) 

Liquoris  aminonii  acetatis. . ^iss  (pss  per  tsp.) 

Syrupi  simplicis 5 i 

Aquae  camphorae,  q.s.,  ad.  . §iv 


M.  Sig. — One  teaspoonful  (for  three-year-olds)  to 
one  tablespoonful  (for  adults)  every  three  hours. 

Some  recommend  creosote  carbonate, 
gtt.  V,  in  milk,  a bitter  tincture,  brandy, 
or  wine,  every  two  to  four  hours;  some 
recommend  quinine,  gr.  i-iii,  every  two 
to  four  hours  “ according  to  the  age  of  the 
patient  and  the  severity  of  the  case  ” 
(Author?).  Quinine  is  an  antipyretic  and 
a heart  stimulant. 


B Quininaj  sulphatis gr.  i-iii 

Acidi  citrici gr.  x-xv 

Sacchari  lactis gr.  x 

Misce,  fiat  pulvis. 


Sig. — Dissolve  in  a little  water  and  add  to  the 
following  draught: 


Potassii  bicarbonatis gr.  x-xv 

Aimnonii  carbonatis gr.  iii-v 

Syrupi  aurantii 3 i 

Aqua;,  q.s.,  ad gi 


Misce,  fiat  haustus.  (Yeo.) 

Aufrecht  injects  gr.  vii  of  quinine  hydro- 
chloride intramuscularly  in  the  late  afternoon, 
when  the  fever  is  highest,  and  repeats  it 
when  required  for  high  fever  within  forty- 
eight  hours,  which  is  rarely  necessary. 


TJ  Quinina;  bihydrochloridi gr.  Ixxv 

Aqua;  destillata;,  q.s.,  ad 3 iiss 


Boil,  then  add  one  or  more  drops  of  hydrochloric 
acid  to  dispel  the  turbidity.  Fourteen  minims  con- 
tain 7 grains  of  quinine. 

Camphor  has  been  recently  advocated  as 
an  anti-pneumococcic  agent;  camplujrated 
oil  (boiled;  not  the  liniment),  10  c.c.  sub- 
cutaneously twice  daily  (Hotzel) ; also  opto- 
chin  (see  Part  11). 

Serum  therapy  (antibacterial)  is  of  value 
in  the  cases  due  to  Type  I and  probably 
Type  II  infection.  The  dose  for  adults, 
according  to  Rufus  Cole,  is  at  least  75  to 
100  C.C.,  intravenously  {q.v.),  repeated  every 
six  or  eight  hours  until  effectual.  (See  Ana- 
phylactic Shock,  for  the  method  of  its  avoid- 
ance). To  determine  the  type  of  pneumo- 
coccus causing  the  infection,  wash  a small 
portion  of  the  lung  sputum  several  times 
with  sterile  salt  solution  (0.9  per  cent.), 
grind  it  in  a sterile  mortar  with  about  1 c.c. 
of  bouillon,  and  inject  this  into  the  peri- 
toneal cavity  of  a mouse.  In  about  four  to 


PNEUMONIA,  LOBAR 


eight  hours,  or  as  soon  as  the  bacteria  have 
multiplied  sufficiently,  as  determined  by 
withdrawing  fluid  through  a capillary  pipet 
and  staining  and  examining  microscopically, 
kill  the  mouse,  and  wash  out  the  peritoneal 
cavity  with  sterile  salt  solution.  Centri- 
fugalize  at  low  speed  to  throw  down  the 
cellular  debris,  pipet  off  the  supernatant 
fluid  containing  the  bacteria,  and  throw 
down  the  latter  by  centrifugalization  at  high 
speed.  Resuspend  in  salt  solution,  and 
treat  with  each  of  the  four  types  of  sera 
to  see  which  type  produces  agglutination. 
(Dochez.) 

Mustard  poultices  applied  to  the  whole 
chest,  front  and  back,  three  to  six  times 
daily,  or  as  recpiired,  are  very  valuable, 
especially  for  dyspnoea,  circulatory  failure, 
and  cough.  Employ  at  first  a strength  of 
one  part  mustard  to  two  of  flour,  later  reduc- 
ing the  strength  as  the  skin  becomes  sensi- 
tive. Keep  the  poultice  on  for  five  to  fifteen 
minutes,  or  until  flushing  is  produced,  then 
anoint  the  chest  with  camphorated  oil  or 
equal  parts  of  lard  and  turpentine,  and  cover 
with  a light  piece  of  flannel.  Musser  em- 
ploys dry  cups  {q.v.)  “all  over  the  lungs, 
front  and  back,  to  the  number  of  twenty  or 
thirty.”  They  are  employed  early,  and 
“ repeated  every  six  or  eight  hours  as  long 
as  pain  persists,  the  dyspnoea  or  ojjpression 
continue,  or  the  respiration  rate  rises.” 
Dry  cupping  is  a substitute  for  bleeding, 
which  some  advocate  in  robust,  plethoric 
patients  during  the  first  or  second  day  (250 
to  500  c.c.  of  blood). 

For  pain,  employ  the  ice-bag,  hot  water 
bag,  Paquelin  cautery,  mustard  poultice, 
thy  cups,  strapping  from  the  spine  to  the 
sternum,  or  morphine,  gr.  hypodermi- 
cally (no  morphine  if  the  patient  is  over 
fifty,  or  has  nephritis);  Dover’s  powder 
is  very  serviceable. 

For  severe,  distressing  cough,  prescribe 
codeine,  or  heroin,  or  morphine,  with  dis- 
cretion (see  Part  11,  for  all  drugs). 

For  a temjx’rature  of  102°  F.  or  over,  and 
for  restlessness  and  delirium,  or  stupor, 
rapid  pulse,  dyspnoea  and  cyanosis,  dry 
tongue  and  dry  skin  (severe  toxiemia), 
employ  an  ice-cap  to  the  head,  and  cool 
sponging  eveiy  three  hours ; or  the  cool  pack 
covered  with  dry  flannel  or  a woolen  blanket, 
and  changed  every  hour;  or  cold  linen  com- 
presses reaching  from  the  clavicles  to  the 
umbilicus,  changed  every  half-hour  when 
the  temperature  is  above  102°,  every  hour 
when  below  102°,  and  discontinued  when 
the  temperature  is  99.5°.  Hot  water  bottles 
may  at  the  same  time  be  placed  to  the  feet. 


or  a hot  mustard  foot-bath  (about  one 
tablespoonful  to  the  gallon)  may  be  em- 
ployed for  about  thirty  minutes,  or  until 
sweating  ensues.  As  a last  resort,  to  pro- 
cure sleep,  administer  Dover’s  powder,  gr. 
i-iii,  every  three  hours;  or  morphine,  gr. 
K to  or  hyoscine,  gr.  Koo  to  Ho- 

For  circulatory  failure  (watch  the  pulse, 
blood-pressure,  and  first  sound  of  the  heart), 
prescribe  whiskey  or  brandy,  4 to  12 
ounces  in  twenty-foiu'  hours  (condemned 
by  some);  strychnine,  gr.  Hoj  every  three 
hours;  digitalis  infusion,  3h>  or  tincture, 
Tt^x-xv,  well  diluted,  or  digitalin  {q.v.)  intra- 
muscularly, every  four  hours;  tincture  of 
strophanthus,  Trjjv-viii,  every  two  to  four 
hours;  atropine,  (0.9  per  cent.),  or  enema, 
500  C.C.,  if  the  urine  is  scanty.  In  an  emer- 
gency employ,  hypodermically,  camphor,  gr. 
ii,  in  olive  oil  or  ether,  ti]jx-xv;  or  digitalin; 
or  caffeine  sodiobenzoate  or  sodiosalicylate, 
gr.  H to  H to  2.  The  occurrence  of  pul- 
monary cedema  calls  for  prompt  and  ener- 
getic stunulation:  strychnine,  gr'  with 
atropine,  gr.  Hoo>  hypodermically;  venesec- 
tion; many  dry  cups. 

With  cyanosis  and  rapid  shallow  respira- 
tions, oxygen  may  be  administered  very 
slowly  through  a funnel  draped  with  a cur- 
tain and  held  over  the  mouth  and  nose. 
Says  L.  E.  Hill,  pure  oxygen  may  be  breathed 
for  two  to  four  hours  continuously  without 
harm;  and  an  atmosphere  of  50  per  cent, 
oxygen  can  be  breathed  indefinitely.  He 
says:  “ The  cylinder  valve  must  be  opened 
wide  enough  to  give  a pleasant  cool  current 
(as  tested  upon  the  lips),  and  drive  the 
exhaled  CO2  out  of  the  mask.”  Hill’s  mask 
should  be  very  useful  (made  by  IMessrs. 
Davis  Bros.,  St.  Thomas’s  St.,  London, 
S.  E.).  Osier  regards  oxj^gen  as  of  doubt- 
ful value. 

For  tjunpanites,  reduce  the  diet,  prescribe 
a laxative,  give  a turpentine  and  soapsuds 
enema  (5ss  to  the  enema),  apply  hot  tur- 
pentine stupes  to  the  abdomen  or  an  ice-bag 
if  the  temperature  is  high,  and  inject  ergot 
intramuscularly,  or  eserin  hj’podermically, 
or  best  of  all,  pifuitrin.  The  colon  tube  may 
give  relief. 

For  herpes,  apply  spirits  of  camphor,  or 
comp,  tincture  of  benzoin,  or  boric  or  zinc 
oxide  ointment. 

At  the  crisis  administer  diffusible  stimu- 
lants in  hot  water,  f.e.,  aromatic  spirits  of 
ammonia,  or  Hoffmann’s  anod^me;  together 
with  stiychnine,  gr.  Ho*  or  atropine,  gr.  Moo 
hypodermically;  and  apply  hot  water  bottles 
to  the  feet  and  body. 

For  delayed  resolution,  the  X-rays  {q.v.) 


1\\ EU.M0T110KAX,  AKTIFICIAL 


are  highly  recommended.  Mustard  poultices 
(twice  or  thrice  daily),  dry  cups  (twice 
daily),  tincture  of  iodine,  or  the  Paquelin 
cautery  may  aid  in  promoting  absorption  of 
the  exudate.  Fibrolysin  may  be  tried. 

Convalescence  is  usually  rapid,  and  the 
patient  may,  as  a rule,  be  allowed  up  in 
about  a week;  that  is,  for  an  additional 
half-hour  each  day  until  he  is  up  all  day. 
The  condition  of  the  heart  should  serve  as 
the  guide  in  this  matter.  The  return  to 
normal  diet  should  be  gradual. 

Pneumonokoniosis.— See  Pneumokoniosis. 

Pneumopericardium. — Gr.  -Kveofia  air  + 
-KepiKapbiov  pericardium.  An  extremely  rare, 
usually  fatal  affection,  manifested  by  bulg- 
ing of  the  precordial  intercostal  spaces; 
feeble  or  absent  and  invisible  cardiac  im- 
pulse, returning  on  the  assumption  of  the 
prone  position;  movable  tympany,  which 
disappears  when  the  prone  position  is 
assumed;  and,  on  auscultation,  churning, 
gurgling,  splashing,  and  tinkling  sounds  syn- 
chronous with  the  heart-beat. 

Etiology.— Gas-bacillus  infection;  traumatic 
perforation  caused  by  a crushing  injury,  a 
fractured  rib,  paracentesis,  the  rupture  of 
adhesions  in  pneumothorax,  or  a foreign 
body  from  without  or  from  the  oesophagus; 
ulcerative  perforation  occurring  in  pyopneu- 
mothorax, pulmonary  or  lymphatic  tuber- 
culosis, pulmonary  gangrene,  gastric  cancer, 
gastric  ulcer,  oesophageal  cancer,  or  sub- 
phrenic  abscess  perforating  both  the 
pericardium  and  stomach  or  pericardium 
and  intestine. 

Treatment.— In  traumatic  cases  the  open- 
ing should  be  closed  at  once.  In  the  case  of 
putrid  or  purulent  effusions,  free  drainage 
should  be  established  by  a sufficient  opening. 

Pneumothorax. — Gr.  -KveopLa  air  -k  dupa^ 
thorax.  The  condition  is  almost  always  a 
hydropneumothorax  or  a pyopneumothorax, 
and  the  commonest  cause,  perhaps  in  90  per 
cent,  of  the  cases,  is  tuberculosis.  The 
onset  is  usually  sudden,  with  sharp  pain, 
urgent  dyspnoea,  rapid  pulse,  and  pallor; 
but  it  may  be  very  gradual,  and  even  imper- 
ceptible. The  physical  signs  are  as  follows: 
enlargement  and  immobility  of  the  affected 
and  abdominal  viscera  (the  X-ray,  q.v.,  furn- 
ishes important  information) ; vocal  fremitus 
usually  greatly  diminished  or  absent;  per- 
cussion note  usually  hyperresonant  or  tym- 
panitic, sometimes  normal  or  dull  if  the  air 
is  under  great  tension;  rapid  movable  dul- 
ness  in  the  presence  of  fluid ; respiratory  mur- 
mur usually  dimini.shed  and  amphoric  in 
quality,  the  rales  possessing  a metallic 
tinkle;  clear,  ringing  coin  sound,  obtained  by 


auscultating  the  back  of  the  chest  while  an 
assistant  taps  one  coin  on  another  on  the 
front  of  the  chest;  succussion  splash  in 
the  presence  of  fluid,  obtained  by  shaking 
the  patient  with  the  ear  to  the  chest. 

Pneumothorax  is  simulated  by  hernia  of 
the  intestine  through  the  diaphragm. 

Etiology.— Pulmonary  disease,  usually 

tuberculosis,  rarely  gangrene,  infarction, 
tumor,  or  septic  broncho-pneumonia;  empy- 
ema perforating  the  lung;  infection  of  a 
pleural  exudate  with  the  gas  bacillus;  per- 
foration of  an  abscess  or  hydatid  of  the 
liver  into  the  lung,  or  of  a gastric  ulcer,  or 
an  appendicial  abscess,  or  a cancer  of  the 
stomach,  colon,  or  oesophagus;  penetrating 
wounds  of  the  chest  (stab  and  gunshot 
wounds,  rib  fracture,  thoracentesis) ; rupture 
of  the  lung  by  concussion;  spontaneous  rup- 
ture of  air  vesicles  following  exertion,  or 
occurring  even  while  at  rest. 

Prognosis.— In  tuberculous  cases  the  out- 
look is  unfavorable,  death  usually  occurring 
within  a few  weeks.  In  the  rare  spontaneous 
cases  recovery  occurs  in  from  one  week  to 
several  months.  In  other  cases  the  prog- 
nosis depends  upon  the  cause  and  upon 
whether  or  not  infection  occurs. 

Treatment. — In  the  acute  suffocative  or 
valvular  cases,  in  which  air  readily  enters 
but  can  not  leave  the  pleural  cavity,  insert 
a cannula  at  once,  and  leave  it  in.  Give 
morphine  for  the  severe  pain  and  dyspnoea; 
and  for  the  circulatory  failure  give  rapid 
stimulants  hypodermically,  viz.,  camphor, 
gr.  ii  in  olive  oil,  or  ether,  ttpx-xv;  or  digitalin 
(q.v.) ; or  caffeine  sodiobenzoate,  gr.  to 
to  ii;  or  aromatic  spirits  of  ammonia,  one 
teaspoonful  in  a tumblerful  of  water;  and 
apply  heat.  If  necessary,  a large  opening 
may  be  made,  and  a rigid  drainage  tube 
with  a rubber  collar  inserted,  the  collar 
sutured  to  the  skin,  and  then  hermetically 
sealed  with  gutta-percha  or  with  vaseline 
and  adhesive  plaster.  To  the  rigid  tube  is 
attached  a small  soft  rubber  tube,  which 
easily  collapses  on  inspiration  (see  under 
Empyema). 

In  chronic  cases,  whether  blood,  serum, 
or  pus  is  present,  it  is  perhaps  advisable  not 
to  tap  or  to  perform  rib  resection,  unless 
septic  symptoms  arise  or  the  rapid  accumu- 
lation’of  fluid  causes  increasing  dyspnoea. 

In  the  spontaneous  cases,  enjoin  absolute 
quiet  in  bed,  and  the  avoidance  of 
deep  breathing. 

Pneumothorax,  Artificial. — Nitrogen  com- 
pression of  the  lung  by  means  of  an  arti- 
ficially induced ' pneumothorax  is  indicated 
as  a therapeutic  agent  in  unilateral  tubercu- 


POISONING 


losis,  the  opposite  lung  being  but  slightly 
affected,  in  uncontrollable  or  chronic  hyeniop- 
tysis,  the  side  on  which  the  hemorrhage 
occurs  being,  of  course,  known,  and  in  bron- 
chiectasis that  is  othenvise  incural>le.  Mur- 
phy insisted  that  it  should  be  used  early  in 
tuberculosis,  and  not  reserved  as  a last 
resort.  It  is  sometimes  very  successful,  but 
often  not. 

Contra-indications : Extensive  involve- 

ment of  both  lungs;  extensive  cavitation  in 
the  affected  lung,  with  danger  of  the  needle 
entering  a cavity;  pleurisy,  dry  or  wet,  if 
large;  extensive  pleural  adhesions;  a serious 
complication,  such  as  cardiac  or  renal  disease, 
alcoholism,  intestinal  tuberculosis,  or  other 
serious  constitutional  disease;  abdominal 
distention  due  to  ascites  or  tympanites; 
marked  pain,  dyspnoea,  or  subcutaneous 
emphysema  following  inflation. 

Technique. — There  are  various  makes  of 
apparatus,  viz.,  Forlanini’s,  Deneke’s,  Floyd- 
Robinson’s,  Muralt’s,  Kornmann’s,  etc.  A 
hypodermic  of  morphine,  gr.  one-half 
hour  before  the  operation,  may  be  advisable, 
and  it  is  well  to  have  brandy  or  whiskey  and 
a hyp(xlermic  of  ether  on  hand  in  case  of 
shock.  The  puncture  is  ortlinarily  made 
below  the  angle  of  the  scapula  between  the 
scapular  and  post-axillary  line.  Murphy 
taught  that  when  the  pulmonaiy  lesion  was 
in  the  apex,  “the  needle  should  be  inserted 
in  the  5th  or  6th  space,  between  the  anterior 
and  mid-axillary  line,”  and  when  the  lesion 
is  in  the  middle  or  lower  lobe,  the  needle 
should  be  inserted  “preferably  in  the  4th 
space,  just  outsitle  the  mammary  line.”  The 
patient  should  be  in  bed,  with  a pillow  under 
the  sound  side,  and  the  hand  of  the  affected 
side  on  the  opposite  shoulder.  The  skin  is 
cleansed  with  soap  and  water,  thoroughly 
dried  with  sterile  gauze,  painted  w'ith  tinc- 
ture of  iodine,  anaesthetized  evith  novocaine 
{q.v.  in  Part  11),  a tenotome  puncture  matle 
down  to  the  pleura,  and  the  latter  then 
anaesthetized  (to  avoid  jdeural  shock).  After 
waiting  for  several  minutes  for  ai\aesthesia 
to  occur,  the  pneumothorax  needle  is  intro- 
duced slowly  at  right-angles  with  the  chest 
wall.  The  entrance  of  the  needle  into  the 
pleural  cavity  is  indicated  by  the  respiratory 
oscillations  (negative  in  pressure)  of  the 
fluid  in  the  manometer.  These  oscillations 
should  always  be  oI)tained  before  the  nitro- 
gen gas  is  turiu'd  on,  and,  according  to 
Floyd,  they  should  register  an  excursion  of 
1.5  to  2 cm.  The  needle  should  be  kept 
always  perpendicular  to  the  chest  wall, 
d’he  gas  is  introduc('d  slowly,  not  more  than 
300  to  500  c.c.  at  the  first  inflation,  except 


in  the  presence  of  serious  hemorrhage,  when 
1000  c.c.  or  more  may  be  required.  The 
inflation  should  be  stopped  and  the  needle 
withdrawn  on  the  first  appearance  of  dis- 
tress, pain  or  dyspnoea.  The  puncture  may 
be  sealed  Mth  a wisp  of  sterile  cotton 
saturated  with  collodion. 

Reinfiation  is  practiced  at  first  every  two 
or  three  da3^s  until  neutral  or  slightly  posi- 
tive readings  of  the  manometer  show'  that 
the  lung  is  adequately  compressed.  After 
this,  reinfiation  is  practiced  about  every 
eight  to  twelve  days,  or  often  enough  to 
keep  the  lung  compressed.  Later  the  inter- 
vals may  be  lengthened  up  to  about  four 
weeks.  Continuous  compression  should  be 
maintained  for,  perhaps,  a year  or  two. 

The  patient  should  be  kept  strictly  at  rest 
after  each  inflation.  Serous  pleural  effusion 
is  a common  complication  of  artificial  pneu- 
mothorax, but,  if  moderate,  it  does  not 
contraindicate  continuation  of  the  treatment. 

Podagra. — Gr.  ttoJs  foot  -f-  aypa  seizure. 
See  Gout. 

Poisoning. — Under  this  caption  are  con- 
sidered (1)  poisoning  b\'  drugs,  chemicals, 
plants  and  food;  and  (2)  insect  and 
snake  poisoning. 

I.  Drug,  Chemical,  Plant,  and  Food  Poisoning.— 
When  called  upon  to  treat  a case  of  poison- 
ing in  which  the  nature  of  the  poison  is 
unknown,  first  see  if  the  mouth  is  stained 
If  it  is  .stained,  the  poLson  is  either  an  acid 
(nitric,  hydrochloric,  sulphuric,  carbolic, 
oxalic),  or  it  is  an  alkali  (caustic  potash, 
caustic  .soda,  ammonia).  In  such  cases  no 
emetic  should  be  given.  To  neutralize 
acids,  administer  a warm  alkaline  solution, 
e.g.,  lime  water,  baking  soda  (sod.  bicarb.) 
solution,  washing  soda  (sod.  carb.)  solution, 
soap  solution,  chalk,  magnesia,  wall  plaster; 
but  give  no  soda  or  potash  in  oxalic  acid 
poisoning  (see  appemled  table).  Avoid  chalk 
and  other  carbonates  if  other  alkalies  are 
obtainable.  To  neutralize  alkalies,  adminis- 
ter an  acid,  e.g.,  vinegar  and  water,  equal 
parts,  or  lemon  juice.  The  mouth  should 
alwaj's  first  bo  washed  out  with  the  antidote. 
A soft  stomach  tube  ma3'  be  used  if  no  exten- 
sive corrosion  is  j)resent.  Give  demulcent 
drinks  (see  below).  If  the  throat  is  swollen 
and  bi’cathing  difficult,  ajiijh'  cold  or  heat 
to  the  neck,  ami  perhaps  to  the  sternum, 
stomach,  or  back,  and  give  frequent  sips 
of  ice-water.  Give  morphine  for  pain.  The 
jiatient  ma>'  have  to  be  fed  per  rectum  (sec 
Rectal  Feeding),  or  through  a gastrostony 
opening,  or  a duodenostony'^  opening  if  the 
]i3’loris  is  involved.  (Esophageal  bougies 
should  be  passed,  according  to  Sippy,  seven 


DANGEROUS  PLANTS 


Befladona 


lolocyfith 

’N/ru/t 


•Ichicum 


Dwaj’f  ^tch 


Honeysuckle 
italis  /fcss^ 


j Small  ^ 
•;'>:^hemlo^ 


Poison  hemlock 


Flower 


\E/il,ir^e(l  s£C(i 


Fnlaryed 

flower 


Enlarged  ^ 
flower 


^Base  leaf 


Monks* 


aconite 


elladona 


Seed 


Spotted 

arum 


Seed 


Dioecian  bryony 


Flower 

Female  hem i) 


Male 


hemp 


Section 
of  seed 


, .jSpotled 

* i ^ arum 
< fruit 


Flower 


Spurge 
. flax 


Parsley 
Leaves  of 
the  base 


Veralrum 

sabadilia 


c/;/aryr 


seed 


Imlian  berrv.  < 
Fruit 


Seed 


/^rge  hemlock 


Java 


beans 


LAHOUSSE  MEDIC/VL 


Dangerous  plants. 


liS«i  ‘■x'^m 

>;hi.-iStr 


. ■“ .'v*'^(«.< ■■  '*'/■■■  ' »■'  • 'la  ' "t-:' 


S4'®fii  . , ■ -i  ■ ».>’".«  I yjMfiw  ' • ijii  -’■«■  ^ v'' -'"•  •; '^ 

,v.,v  ji  • ^.j‘.T*S|>1'2J  ■ ' '',  ■ "'-':'’.t  jmHu  ••  'aJ 

r.f<l7vi.V "-.■'»  ■■'  ■■  •- 


’ ' , ..;  .9 ' -If--  _ 

v/i  4'VH 

!^':!  ■••>  - ;'  ' ' ■?'  •.>  Ws 


i . 


- <:^*V  >rtV:Jiy 


.yy 


■'-I  , 

■ * I 


y « . ' W 

'.'I'/' '■■>T<'^- 


‘«ir 


t r-' ' K' ' V 

I’V  -»>|,  -i  ., nJ,  , 


. .s 


POISONING 


to  ten  days  afterward;  according  to  Gott- 
stein,  not  for  four  to  six  weeks  (see  Oesopha- 
geal Stenosis  or  Strictiwe). 

If  the  mouth  is  found  not  to  be  stained, 
vomiting  may  be  induced  by  means  of  mus- 
tard, a tablespoonful  in  half  a pint  of  luke- 
warm water;  or  salt,  two  tablespoonfuls  in 
half  a pint  of  tepid  water;  or  syrup  or  wine  of 
ipecac,  for  a young  child  a teaspoonful  and 
for  an  adult  a tablespoonful  every  fifteen 
minutes  until  effectual;  or  zinc  sulphate, 
5ss,  in  half  a pint  of  water;  or  copper  sul- 
phate, gr.  XV,  in  water;  or  apomorphine,  gr. 
Ho  to  hypodermically.  Any  of  the 
above  may  be  repeated  in  fifteen  minutes, 
if  necessary,  and  the  finger  may  be  inserted 
in  the  throat.  In  place  of  emesis,  gastric 
lavage  may  be  practiced  repeatedly. 

In  any  case  of  poisoning  whatever,  ad- 
minister, either  before  or  after  the  stomach 
has  been  evacuated,  milk,  raw  eggs,  or  two 
to  six  whites  beaten  up  with  milk  or  water, 
cream  and  flour  beaten  uji  together,  some 
animal  or  vegetable  oil  (except  in  phosphorus 
poisoning,  g.r.),  flaxseed  infusion, slippery  elm 
infusion,  mallow  decoction,  mucilage  of 
acacia  or  tragacanth,  a tablespoonful  every 
fifteen  to  thirty  minutes,  emulsion  of  al- 
monds, 10  oz.,  thin  gruels,  hashed  meat, 
strong  tea,  bismuth  subcarbonate  and  acacia 
or  tragacanth,  1 to  2 oz.  of  a 5 per  cent, 
suspension,  two  to  three  times  daily. 

Strong  tea  and  other  tannic  acid  prepara- 
tions (kino,  catechu,  oak-bark,  tannic  acid), 
gr.  xx-xl  in  a half  to  one  tumblerful  of  water 
every  fifteen  to  sixty  minutes,  are  of  special 
value  in  vegetable  poisoning  or  poisoning 
with  alkaloids,  glucosides,  etc.  Lavage 
(see  under  Dyspepsia),  or  a brisk  sa- 
line cathartic  (avoid  salines,  however,  in 
toadstool  poisoning)  should  follow  the 
administration  of  the  tannic  acid  prepara- 
tions, since  the  tannates  slowly  become 
absorbed.  In  alkaloid  poisoning  one  may 
also  give  potassium  permanganate,  gr.  iv-v 


in  a pint  of  water,  or  Lugol’s  solution  (Part 
11)  in  doses  of  tijxx-xxx  in  water.  The 
stomach  may  be  washed  out  with  a light 
pink  solution  of  the  permanganate.  The 
free  administration  of  charcoal  in  teaspoonful 
doses  delays  absorption. 

After  the  stomach  has  been  evacuated, 
free  purgation  should  be  promoted  in  all 
cases  (castor-oil:  2 oz.  for  adults,  children 
in  proportion);  supplemented  perhaps  by 
high  intestinal  irrigations. 

Treat  shock  and  collapse  by  means  of  hot 
applications  and  the  hypodennic  adminis- 
tration of  stimulants,  e.g.,  caffeine  sodio- 
benzoate,  gr.  M to  H to  ii;  camphor,  gr.  ii, 
in  sterile  olive  oil,  ttpx,  every  half-hour 
for  several  doses;  or  strychnine,  gr.  Ho 
to  Ho  every  four  hours,  or  until  mus- 
cular twitching  occurs;  atropin,  gr.  }{oo 
to  3^0  (more  than  gr.  Ho  is  depressant); 
whiskey  or  brandy,  1 to  2 oz.,  repeated 
every  few  hours;  enema  of  3 oz.,  in 
strong  black  coffee  up  to  1 pint;  normal 
saline  (0.9  per  cent.)  subcutaneous  or  intra- 
venous infusion  (no  more  than  one  to  two 
quarts  at  a time,  for  fear  of  pulmonary 
oedema).  Ortner  says  digitalis  is  contra- 
indicated, “on  account  of  its  toxic  effect  on 
the  heart.”  Apply  artificial  respiration,  if 
necessary  (see  Asphyxia) . Continue  it  as  long 
as  the  heart  beats,  for  days,  if  necessary. 

For  pain,  and  for  the  relief  of  excessive 
vomiting,  give  morphine  hypodermically. 
Orthoform,  cocaine,  and  chloretone  are  also 
recommended  for  pain.  (For  drugs  see 
Part  11). 

No  food  should  be  allowed  for  at  least 
twenty-four  hours;  then  concentrated  liquid 
nourishment  should  be  administered. 

For  persistent  diarrhoea  prescribe  bis- 
mutff  and  opium. 

Water  should  be  taken  freely,  best  in  the 
form  of  cream  of  tartar  lemonade  (g.v.), 
in  order  to  dilute  and  to  hasten  elimination 
of  the  poison  through  the  kidneys. 


POISONING 

Table  of  Poisons  and  Poisoning. 


Poison 

Acetanilid . . . . 

Acid,  Acetic 
(Vinegar) 

Acid,  Carbolic 


Acid,  Chromic 

Acid,  Hydrochloric . . 
Acid,  Hydrocyanic . . . 


Acid,  Nitric 

Acid,  Oxalic  (Pot.  ox- 
alate, salts  of  sorrel 
salts  of  lemon,  pol- 
ishing paste) 

Acid,  Prussic 


Symptoms 


Treatment  (Consult  also  what  precedes;  and  for 
dosage,  Part  11) 


Soft,  weak  pulse,  lowered  temperature, 
cyanosis,  sweating,  collapse,  metha;- 
moglobinsemia  and  -uria 
Gastro-enteritis;  vomiting  and  purging.  . 


White  eschar  in  mouth;  carbolic  odor  of 
breath,  vomiting  and  purging,  burning 
pain,  collapse,  dyspnoea,  coma,  some- 
times convulsions,  urine  smoky  or 
black  on  standing. 


Yellow  stain;  vomiting,  purging,  pain, 
often  cramps  in  the  legs,  collapse 
White  stain;  violent  gastro-enteritis; 

vomiting;  purging,  pain. 

Odor  of  bitter  almonds;  cardiac  and  re- 
spiratory failure,  disturbed  cerebra- 
tion, vomiting,  convulsions,  collapse. 


Deep  yellow  stain;  violent  gastro-enteritis 

Pain,  vomiting,  cyanosis,  cold  skin,  stu- 
por, collapse,  sometimes  convulsions. 


Head  lowered;  heat;  stimulants:  strych- 
nine, atropine;  oxygen;  sod.  bicarb.; 
artificial  respiration. 

Alkalies:  sod.  bicarb,  or  carb.,  soap  solu- 
tion, chalk,  magnesia;  warm  w'ater, 
milk,  flaxseed  tea,  oil. 

Epsom  or  Glauber  salts  (sulphates), 
tablespoonful  to  a pint  of  milk,  or 
20  grs.  every  2 hours  until  out  of  dan- 
ger; alcohol,  1 : 4 of  water,  or  whiskey 
or  brandy;  lavage  with  dilute  whiskey 
or  20  per  cent,  alcohol;  demulcent 
drinks  (see  under  Poisoning),  no  oils; 
stimulants:  strychnine,  digitalis;  hot 
applications. 

Demulcent  drinks  (see  under  Poisoning), 
chalk,  hme-water,  magnesia,  lavage. 

Alkahes  and  demulcents  etc.  (see  under 
Poisoning). 

Hydrogen  peroxide  or  ferric  chloride  at 
once;  sod.  hyposulphite  intravenously 
at  once;  patient  on  back  with  feet 
raised,  ammonia  by  inhalation;  open 
air;  dashing  of  cold  water  on  head  and 
spine  continuously;  pot.  permang.  0.3 
per  cent.;  camphor  and  atropine  in- 
jections; lavage;  artificial  respiration. 
The  following  may  be  kept  on  hand  at 
reduction  works:  Ferrous  sulphate,  23 
per  cent,  sol.,  1 oz.  hermetically  sealed; 
pot.  hydroxide,  5 per  cent. sol.,  1 oz. her- 
metically sealed;  powdered  mag.  oxide, 
gr.  XXX ; pint  metal  receptacle.  Mix  in 
receptacle  with  )4  pint  of  water  and 
swaUow  at  once.  (Martin  & O’Brien.) 

Alkahes  and  demulcents,  etc.  (see  under 
Poisoning). 

Chalk,  lime,  magnesia  (no  soda  or  pot- 
ash); demulcents  (see  under  Poisoning); 
stimulants;  mag.  sulphate  as  a cathartic. 


See  Acid,  Hydrocyanic 


Acid,  Salicylic 


Acid,  Sulphuric  (Oil 
of  Vitriol) 

Acid,  Tartaric 


Nausea,  vomiting,  dizziness,  headache, 
sense  of  fullness  in  head,  tinnitus, 
dilated  pupils,  delirium,  deafness, 
dimness  of  vision,  erythematous  and 
other  rashes,  epistaxis  and  other 
hemorrhages,  diaphoresis,  heart 
and  respiratory  depression,  low  blood 
pressure 

Black  stain,  pain,  vomiting,  swelling  of 
parotid  glands,  suppression  of  voice, 
salivation,  collapse 

Gastro-enteritis 


Aconite  (Monks- 
hood) 


Alcohol  (Ethyl) 


Alcohol  (Methyl) . . . . 
Alkalies 


General  tingling  sensation,  feeling  of 
chilliness  and  general  weakness,  sur- 
face anaesthesia,  sense  of  constriction 
in  the  fauces,  salivation,  pulse  slow, 
w'eak  and  intermittent,  fall  of  blood 
pressure  and  temperature;  dilatation  of 
pupils;  respiration  shallow,  slow;  moist, 
cold  slan 

General  relaxation,  anesthesia,  stupor  or 
coma,  lowered  temperature;  face  pal- 
lid; moist,  cool  skin,  pulse  rapid  and 
weak;  breathing  .somewhat  stertorous, 
sometimes  convulsions 
Same  as  above,  with  more  or  less  loss  of 
vision  by  the  third  or  fourth  day 
Staining  of  mucous  membrane;  gastro- 
enteritis 


Lavage;  sodium  bicarbonate  in  large 
doses. 


Alkalies  and  demulcents,  etc.  (see  under 
Poisoning). 

Alkalies  and  demulcents,  etc.  (see  under 
Poisoning). 

Atropine  (best  antidote)  digitalin;  am- 
monia; prone  position,  head  lowered, 
absolute  quiet;  e.xternal  heat;  give  tan- 
nic acid  (see  under  Poisoning);  no 
emetics;  artificial  respiration. 


Lavage,  external  heat,  atropine,  caffeine, 
str3’chnine. 


Same  as  above;  pilocarpine,  gr.  %. 
Sec  under  Poisoning. 


POISONING 


Table  of  Poisons  and  Poisoning — Continued 


Poison 


Symptoms 


Treatment 


Almond,  Bitter 
Ammonia 


Amyl  Nitrite 

Anilin 

Antimony.  . . 


Antipyrine 


Apomorphine 


Arsenic 


Atropine . 


Barium  Salts 


See  Acid,  Hydrocyanic. 

Gastro-enteritis,  pain,  bloody  purging, 
swelling  of  bronchial  tubes  with  suffo- 
cation, convulsions 

Respiratory  and  cardiac  failure 

See  acetanilid. 

Slow  weak  pulse,  moist  skin,  soon  fol- 
lowed by  severe  gastro-enteritis  and 
collapse;  symptoms  resemble  those  of 
Asiatic  Cholera 

Sweating,  cj’anosis,  vertigo,  faintness, 
tinnitis,  lowered  blood  pressure 
and  temperature,  chilliness,  nausea, 
vomiting,  rash  resembling  measles,  res- 
piratory failure;  methajmoglobina;mia 
and  -uria 

Severe  vomiting,  delirium,  sensory  and 
motor  paralysis,  cardiac  and  respira- 
tory depression 

Burning  pain,  sense  of  constriction  in  the 
throat,  metallic  taste  in  mouth,  saliva- 
tion, vomiting  and  purging,  thirst, 
odor  of  garlic  on  breath,  pulse  and 
respiration  rapid,  suppression  of 
urine,  swelling  of  face,  collapse, 
convulsions,  paralysis,  skin  eruption 
in  protracted  cases 


Flushed  face  and  neck,  dilated  pupils,  dry 
mouth,  throat  and  skin;  rapid  heart, 
low  blood  pressure;  rapid  breathing, 
delirium,  motor  activity,  mental  ex- 
citement, tremor,  husky  phonation, 
difficulty  in  swallowing;  later  stupor, 
slow  heart  and  respiration;  convul- 
sions, coma,  paralysis,  retention  of 
urine.  Instil  urine  in  eye  of  dog  and 
note  effect  on  pupil 

Gastro-enteritis 


Belladonna 

Bitter  Almonds 

Bloodroot  (Sanguin- 
aria) 


Bromine 


Buttercup 
Caffeine . . 


Calabar  Bean  (Phys- 
ostigma) 


Calcium  (Slaked 
lime) 


See  Atropine. 

See  Acid,  Hydrocyanic. 

Gastro-enteritis,  salivation,  thirst,  ver- 
tigo, faintness,  disordered  vision, 
dilated  pupils,  muscular  weakness, 
coldness,  slow  pulse,  convulsions 
Palatal  and  pharyngeal  ana?sthesia  with 
loss  of  gagging;  lowered  temper- 
ature and  blood  pressure;  drowsiness, 
stupor;  rapid,  feeble  heart,  pallor, 
reflexes  impaired 

Gastro-enteritis 

Sense  of  heaviness  in  head,  flashes  of  light 
before  eyes,  tinnitus,  vertigo,  headache, 
mental  confusion,  nausea,  faint- 
ness, numbness,  thirst,  tremor,  rest- 
lessness, exaggerated  reflexes;  rapid, 
irregular  heart,  palpitation  due  to 
extra-systoles,  elevation  of  tempera- 
ture, insomnia,  collapse 
Giddiness,  muscular  tremors,  muscular 
relaxation  and  paralysis,  loss  of 
reflexes;  pupils  contracted,  nausea, 
sometimes  vomiting  and  purging^  colic, 
salivation ; respiration  slow  and  irregu- 
lar, bradycardia,  sweating 

Gastro-enteritis 


See  under  Poisoning;  oedema  of  glottis  may 
demand  tracheotomy  (q.v.). 

Head  lowered;  artificial  respiration. 

Tannic  acid,  egg  albimien,  etc.  (see  under 
Poisoning),  followed  by  lavage;  later 
magnesium  carbonate;  patient  prone 
with  head  low,  external  heat;  stimula- 
tion, digitalis. 

Head  low,  external  heat,  stimulants; 
strychnine,  atropine;  oxygen;  sod. 
bicarb.;  artificial  respiration. 


Stimulants:  strychnine,  digitalin,  atro- 
pine in  small  doses. 

Ferri  hydroxidum  cum  magnesii  oxido 
(Part  11),  1 oz.  or  more  every  15  min. 
until  acute  symptoms  and  purging 
cease,  then  every  half  to  one  hour,  fol- 
lowed by  castor  oil;  demulcents;  ex- 
ternal heat;  stimulants;  opium  (see 
Part  11);  copious  draughts  of  water 
and  saline  infusions  ; emesis,  lavage. 
(For  chronic  poisoning,  see  Arsenical 
Poisoning.) 

Tannic  acid;  Lugol’s  solution,  ^i  to  gr.  i of 
atropine;  lavage  (see  under  Dyspepsia) ; 
pilocarpine,  morphine,  physostigmine ; 
external  heat;  caffeine, camphor,  strych- 
nine (for  respiratory  depression),  mus- 
tard poultices;  catheterization  for 
vesical  paralysis;  artificial  respiration. 


Sulphates,  followed  by  lavage;  emetics 
(see  under  Poisoning);  external  heat, 
stimulants,  morphine  for  pain. 


Emesis  ( see  under  Poisoning),  lavage 
stimulation;  strychnine,  atropine,  digi- 
talis; external  heat. 

Alkalies,  egg  albumen,  starch,  followed  at 
once  by  lavage.  Steam  inhalation  if 
bromine  vapor  has  been  inhaled. 


Lavage;  treat  S3anptoms. 

Emetics  (see  under  Poisoning);  external 
heat,  atropine,  morphine. 


Lavage;  atropine  and  strychnine  (best 
physiologic  antidotes);  external  heat; 
stimulants;  artificial  respiration. 


Lavage;  demulcents  (see  under  Poison- 
ing) ; stimulants ; external  heat. 


POISONING 


Table  of  Poisons  and  Poisoning — -Continued 


Poison 


Symptoms 


Treatment 


Camphor 


Cannabis  Indica . . 
(Indian  Hemp) 


Cantharides  (Spanish 
Flies) 


Carbolic  Acid 

Carbon  Bisuljihide . . . 


Carbon  Dioxide 

Carbon  Monoxide . , . 
Sources : 

Electric  furnaces, 
illuminating  gas; 
combustion  pro- 
ducts from  stoves, 
oil  stoves,  furnaces, 
kilns,  etc.,  blasting 
in  mines 


Castor  Oil  Beans . . . . 


Burning  pain,  gastro-cnteritis,  odor  of 
camphor,  languor,  headache,  mental 
confusion,  vertigo,  dimness  of  vision, 
cyanosis,  delirium,  convulsions;  rapid, 
weak  pulse,  collapse 

Sensation  of  enormous  dimensions,  pro- 
longation of  time,  and  double  conscious- 
ness, exhilaration,  later  drowsiness, 
anesthesia,  lowered  reflexes,  weak- 
ness, dilated  pupils,  rapid  pulse,  slow 
breathing,  catalepsy,  coma,  some- 
times convulsions 

Gastro-enteritis,  salivation,  swelling  of 
the  submaxillary  glands,  burning  sen- 
sation and  sense  of  constriction  of 
throat;  burning  pain  in  back,  bladder, 
and  urethra,  priapism,  strangury, 
scanty  bloody  urine,  stupor,  coma, 
sometimes  delirium  and  convulsions 

See  Acid,  Carbolic. 

Multiform  nervous  and  mental  symptoms 
in  chronic  poisoning.  Sources:  rub- 
ber industries,  chemical  use 

Vertigo,  headache,  cyanosis,  somno- 
lence, coma 

Headache,  muscular  weakness,  often 
nausea  and  vomiting,  sometimes  un- 
conscious, often  muscular  twitching, 
sometimes  convulsions;  blood  of  a 
cherry-red  color,  which  forms  a bright 
red  clotted  mass  on  the  addition  of  .sod. 
hydrate  of  about  1.30  s.g.  (normal  blood 
forms  a mucoid-like  mass  of  greenish- 
brown  color).  Sequela! : weakness, 

fever,  bronchitis,  broncho-pneumonia., 
localized  hypera>mias;  palpitations, 
gastro-intestinal  disturbance,  transient 
glycosuria,  skin  lesions,  nervous  and 
mental  .symptoms  of  all  kinds 

Vomiting,  purging,  collapse 


Emetics  (see  under  Poisoning),  heat, 
stimulants,  alcohol 


Stimulation;  atropine;  artificial  respira- 
tion. 


Lavage;  demulcents  (see  under  Poison- 
ing); no  oil;  opium  for  pain  and  irrita- 
tion; alkalies  to  alkalinize  urine,  which 
combats  the  action  of  cantharides. 


Elimination:  purgation,  diuresis,  diaphor- 
esis, fresh  air  e.xercise.  Prophylaxis: 
thorough  ventilation,  use  of  rubber 
gloves.  Early  cases  usually  recover. 

Oxygen,  artificial  respiration;  counter- 
irritation; electricity. 

Oxygen;  venesection  (1  to  \}/2  pints  of 
blood  removed)  and  normal  saline  (Oii) 
infusion;  stimulation:  strychnine,  etc.; 
external  heat;  artificial  respiration  (see 
Asphyxia). 


Demulcents  (see  under  Poisoning) ; ex- 
ternal heat;  stimulants. 


Chenopodium 
Chloral 


Chlorine . . . 
Chloroform 


See  Oil  of  Chenopodium. 

Muscular  relaxation,  somnolence,  coma; 
respiration  slow  and  shallow;  pulse 
slow,  then  rapid  and  thready;  face  livid 
and  cl.ammy;  temperature  lowered; 
pupils  contracted,  later  dilated;  loss 
of  refle.xes 

Respiratory  irritation;  broncho-pneum- 
onia 

Respiration  stertorous,  irregular,  shallow; 
pupils  dilated;  face  livid;  pulse  slowed 
and  weak 


Emetics  (no  apomorjihine) ; lavage  (see 
under  Dyspepsia);  patient  prone  with 
lowered  head;  keep  patient  aroused  by 
slapping  with  wet  towels;  oxygen,  dry 
heat;  stimulants:  str\'chnine,  atro- 

pine, digitalin,  caffeine,  ammonia; 
artifical  respiration. 

Steam  inhalations. 

Lower  head;  stimulate  with  alternate  hot 
and  cold  douches,  strj'chnine,  atro- 
pine, digitalin,  electricity,  artifi- 
cial respiration. 


Chromic  Acid 

Cocaine 


See  Acid,  Chromic. 

Pallor,  or  cyanosis,  dizziness,  nervousness, 
faintness,  small  rapid  pulse,  slow  res- 
piration, dilated  pupils;  prostration 


If  swallowed:  tannic  acid  (see  under 

Poisoning);  lavage;  lower  head;  stimu- 
lants; amyl  nitrite;  artificial  respiration; 
oxygen.  If  injected:  tie  part  tightly 
to  prevent  further  absorption.  (For 
cocainism,  see  Cocainism.) 


f’odeine . . 
Colchicurn 


Sec  Opium. 

Gastro-enteritis,  pain,  vomiting,  purging; 
pulse  rajiid,  later  slow,  prostration,  con- 
vulsions, collapse;  ascending  paralysis 


Emetics  or  lavage,  followed  b}-  cathartics; 
tannic  acid;  demulcents  (see  under 
Poisoning);  warm  water  freely  and 
normal  saline  solution  to  promote 
elimination  through  the  kidneys  (see 
under  Poisoning). 


DANGEROUS  PLANTS 


i: 

!, 

t 


Castor 

oil 

seed 


Beech 


While 

«;.hellebore 


Castor  oil 


Vlaritime  squill 


Black  ^ 
veratrum 


Squill 

Flower 


Black 

lellebore 

^Christmas 

rose" 


^Black 

veratrum 

leaf 


Sabin 
juniper  tree 


Wheat  blight 


Nutmeg  tree 
Seed  surrounded 
its,  mace 


Black  henbane 


Tobacco 


Ffilaraed 

seed 


Housewort 


quint; 

deans 


Section 
of  flower 


Indian 

tobacco 


Oleander 


Enlarged 

flavor 


Datura 

stramonium 


Watery 
Drop  wort 


Enlarged 
seed  , 


Enlarged 

Fruit 


enlarged 
Wo  wen 


f'  S' 


MOES; 


LAHOUSSE  MEDICAL 


Dangerous  plants 


POISONING 


Tabi>k  ok  I’oisons  and  Poisoning — Conlinmd 


Poison 


Symptoms 


Coriium  (IloinlockJ . , 


Coiipor 


Corrosive  Siililiiiitite . 

CntoHote 

Croton  Oil 


V(trtiK<»,  (listiirhod  vision,  muscular  ntlax- 
ation;  nausea,  voinitinfi;,  diltited  pujiils, 
ptosis,  frontal  headache;  pulse  slow, 
litter  rapid 

liurning  itain,  nausea,  vomiting,  metallic 
taste  in  mouth;  gastro-enteritis,  saliva- 
tion; bronchial  secnttions  increased; 
convulsions,  delirium,  oliguria,  fever, 
nipid  rtispiration,  cardiac  deiiression 

See  Mercury. 

See  Acid,  (kirholic. 

Castro-(!nteritis 


C’yanides 

Digitalis  (Fox  Glovej 


Ergot 


Ether 


Fish  Berries 

Fly  Paper 

Food  Poisoning 

Formalin  (Formalde- 
hyde Solution) . . . . 


See  Acid,  Hydrocyanic. 

Nausea,  vomiting,  headtiche;  disordered 
vision,  vertigo,  faintness,  slow  higtari- 
inal  ijulse,  later  delirium  cordis;  falling 
blood  pressun;;  lowentd  temiierature; 
restlessness;  hallucinations;  delirium; 
stipiiression  of  urine;  stupor;  convul- 
sions; coma 

Nausea,  vomiting,  di.arrhata,  vertigo, 
he.'ulache,  tingling  of  lingt-rs,  criimjjs, 
pupils  dihited,  [tulse  small  and  feeble, 
bill  of  temixtrature;  retention  of 
urine  due  to  contraction  of  vesical 
spinoter;  convulsions;  miscarriage  in 
pregnant  women 

Slow  stertorous  respiration;  rapid  heart; 
cyanosis;  fall  of  temperature;  drojiping 
of  jaw 

See  Picrotoxin. 

See  Arsenic. 

Vomiting,  diarrhoea,  colic,  headache, 
chilliness,  muscular  weakness,  etc. 

Pain,  vomiting,  odor  of  formaldehyde, 
cardiac  depression 


Cel.semium  (Yellow 
Jasmine) 


Hemlock 

Henbane 

Hydrochloric  Aiad.  . . 
Hydrocyanic  Acid.  . . 
Hyoscyamus  (Hyos- 
cinc) 

Insect  Powder 

Iodine  (Iodides) 


Iodoform 


Jaborandi  (Pilocar- 
pine) 


Jasmine,  Yellow 

Jimson  Weed 


Heaviness  and  drooping  of  the  eyelids; 
dropping  of  jaw;  languor,  drowsiness, 
vertigo, diplopia.dilated  pupils,  muscu- 
lar relaxation;  slow,  feeble  heart;  slow 
respiration;  ana'sthesia;  diaphoresis; 
loss  of  voice ; fall  of  temperature 

See  Conium. 

See  Atro{)ine. 

See  A(!id,  Hydrochloric. 

See  Acid,  Hydrocyanic. 

See  Atropine. 


See  Arsenic. 

(lastro-entcritis;  metallic  taste  in 
mouth;  salivation,  .swelling  of  .salivary 
glands,  eyelids,  larynx;  iiallor;  rapid, 
feeble  ])ulse;  thirst;  fever;  cyanosis; 
suppression  of  urine;  excitement,  con- 
vul.sions,  collajise 

Headache;  nausea,  vomiting;  restle.ssness ; 
fever;  mental  depn^ssion;  rapid,  feeble 
pul.>.'  insanity;  collapse 

Cardiac  and  respiratory  dejiression;  jial- 
lor;  weakness;  .sweating;  giddiness;  .sal- 
ivaiion;  tremor;  drowsiness;  chilliness; 
colic;  myosis;  jaiin  in  eyeball;  pulmon- 
ary (edema;  vomiting,  purging 

S(!e  (lelsemium. 

See  Atropine. 


Treatment 


d'annic  acid  and  lavage  (see  under 
Poisoning);  external  Iniat,  stimulants; 
strychnine,  atropine,  caffeine,  digitaliii; 
artificial  r(!spiration. 

Pota.ssium  ferrocyanide  (in  .small  doses) 
is  chemical  antidote:  demulcents  (see 
under  Poisoning);  lavage;  morphine 
for  pain. 


Demulcents  (.see  under  Poisoning) ; stimu- 
lants; opium. 

Tannic  acid  or  Lugol’s  solution,  followed 
by  emetics  (sec  under  Poi.soning),  unless 
the  luairt  is  very  wcak^  or  lavage ; nitro- 
glycerine; patient  horizontal  and  abso- 
lutely quiet;  external  heat;  opium. 


Lavage;  castor  oil;  nitroglycerine,  alco- 
hol; external  heat. 


Lower  hc.ad;  strychnine,  atropine,  digi- 
talin; external  heat;  friction,  arti- 
ficial respiration. 


Sec  under  Poisoning. 

Diluted  ammonia  (a  few  drops  in  water), 
or  aromatic  spirits  of  ammonia,  or 
liquor  ammonue  acetatis;  hot  bath; 
emetics  (see  under  Poisoning). 

Stimulation;  ammonia,  digitalin,  atro- 
pine, strychnine;  external  heat;  tannic 
acid;  emetics;  lavage  (see under  Poison- 
ing)- 


Starch  (flour,  arrowroot,  etc.),  boiled  in 
water  and  given  freely ; emetics  (see 
under  Poisoning);  lavage;  extern.al 
heat;  atrojiinc,  strychnine,  alcohol, 
digitalin,  ammonia. 

Lavage;  symptomatic  treatment. 


Tannic  acid;  emetics,  lavage  (.see  under 
Poisoning) ; atropine. 


19 


POISONING 


Table  of  Poisons  and  Poisoning. — Continued 


Poison 


Lead 


Lime . . 
Lobelia 


Matches 

Mercuric  Chloride.  . . 


Symptoms 


Sweet  metallic  taste  in  mouth;  pain; 
gastro-enteritis;  sometimes  constipa- 
tion; pulse  rapid  and  tense,  later  weak 
and  relaxed;  thirst,  cramps  in 
legs;  muscular  twitching;  vertigo; 
anassthesia,  later  paralysis;  collapse, 
coma,  convulsions 
Sec  Calcium. 

Vomiting,  jnirging;  fall  'Of  temperature; 
feeble  heart  action;  muscular  weak- 
ness; muscular  tremblings,  collapse; 
convulsions,  stupor,  coma 
See  Phosphorus. 

Gastro-enteritis,  vomiting,  purging;  me- 
tallic taste  in  mouth;  pain;  collapse; 
convulsions,  coma.  Late  symptoms: 
salivation,  nephritis,  multiple  neuritis 


(For  chronic  poisoning,  see  Mercury' 
Poisoning). 


Treatment 


Sod.  or  mag.  sulphate,  1 oz.;  dilute  HCl, 
teaspoonful  well  diluted;  sod.  chloride; 
emetics;  lavage;  demulcents;  external 
heat.  (See  under  Poisoning).  For 
chronic  poisoning,  see  Lead  Poisoning. 


Tannic  acid;  emetics;  lavage  (see  under 
Poisoning);  external  heat;  stimulants: 
strychnine,  digitalin,  ammonia. 


Emetic  at  once:  apomorphine;  white  of 
egg  to  each  4 grs.  of  poison  (more  albu- 
men causes  solution  of  mercury  albu- 
minate), followed  by  repeated  gastric 
and  colonic  lavage,  since  mercury  is 
secreted  in  the  stomach  and  intestine. 
External  heat;  stimulants.  Induce 
sweating  by  means  of  hot  packs.  Give 
sod.  bicarb,  liberally  and  also  glucose 
in  a 10  to  50  per  cent,  solution.  Later, 
to  prevent  nephritis,  copious  water 
drinking  or  saline  solution  (0.8  per 
cent),  1 quart  daily  hypodermically. 


Morphine . . 
Mushrooms 


See  Opium. 

Pain,  nausea,  vomiting,  purging Tannic  acid  (see  under  Poisoning),  fol- 

lowed by  apomorphine,  or  lavage.  For 
Amanita  muscaria,  atropine  gr.  Ko,'  for 
A.  phalloides,  saline  or  fresh  blood  trans- 
fusion (q.v.) ; stimulants;  opium  for  pain. 


Nicotine 

Nightshade 

Nitric  Acid 

Nitrite  of  Amyd 


Nitrite  of  Potassium 
or  of  Soihum 
Nitrobenzene  or  Ni- 
trobenzol  (Artifi- 
cial oil  of  bitter 
almonds) 

Nitroglycerine 


See  Tobacco. 

See  Atropine. 

See  Acid,  Nitric. 

Muscular  relaxation,  pallor,  nausea, 
vomiting;  fainting;  dilated  pupils; 
pulse  slow  and  almost  imperceptible; 
respiration  irregular,  collapse; 
metha3moglobina;mia 

See  Nitrite  of  Amyl. 

Pallor,  cyanosis;  dizziness;  weak,  rapid 
pulse,  subnormal  temperature;  irregu- 
lar respiration;  coma;  odor  of  bitter 
almonds  in  breath  and  urine 

Flushing,  headache,  giddiness,  palpita- 
tion, buzzing  in  the  cars;  irregular 
pulse,  pupils  dilated;  precordial 
pain;  weakness;  urine  scanty';  some- 
times vomiting,  sometimes  loss 
of  consciousness 


Stimulants:  strychnine,  digitalin; 

alternate  hot  and  cold  douches; 
artificial  respiration. 


Lavage;  respiratory  and  cardiac  stimula- 
tion, but  no  alcohol;  external  heat. 


Stimulants:  atropine,  strychnine,  digi- 
talin; ice-cap  to  head. 


Nux  Vomica 

Oil  of  Bitter  Ahnonds 
Oil  of  Chenopodium . . 
Opium 


See  Strychnine. 

See  Acid,  Hydrocyanic. 

Drowsiness  and  depression 

Stupor;  pupils  contracted;  pulse  slow  and 
strong;  breathing  full;  later  coma, 
cyanosis,  respiration  slow,  irregular  and 
shallow,  pulse  rapid  and  weak;  cold, 
clammy  skin. 


Saline  cathartics;  hot  coffee,  or  caffeine. 

Tannic  acid;  emetics;  lavage  with  pot. 
permanganate  1: 1000  every  hour  (fight 
pink  sol.),  leaving  a little  in  each  time 
(morphine  is  excreted  in  the  stomach 
and  is  oxidized  by  the  permanganate); 
wash  out  bowels  also;  purge;  strong 
coffee  by  mouth  or  rectum;  stry'chnine, 
gr.  1^  to  Ifo;  atropine,  gr.  (more 
than  this  is  depressant;  artificial 
respiration,  when  rc.spirations  fall  to  8 
to  10  per  minute  (continue  as  long  as 
heart  beats,  for  day’s  if  necessary); 
catheterize  the  bladder. 


POISONING 


Table  of  Poisons  and  Poisoning — Continued 


Poison 

Symptoms 

Oxalic  Acid 

See  Acid,  0,xalic. 

Paris  Green 

See  Arsenic. 

Phenacetine 

See  Acetanilid. 

Phosphorus 

Garlicky  breath  and  eructations;  pain 
and  burning  in  stomach;  then  period 
of  rest  for  2 to  3 days,  followed  by 
vomiting  and  purging,  vomitus  and 
stools  luminous  in  the  dark;  often  con- 
stipation; jaundice;  delirium;  head- 
ache; vertigo;  twitchings,  convulsions; 
scanty  urine;  coma.  Fatty  degenera- 
tion of  organs  and  tissues  occurs 

Physostigma 

See  Calabar  Bean. 

Picrotoxin  

Nausea,  salivation;  dizziness;  drowsi- 
ness; perhaps  stupor  and  convul- 
sions; collapse 

Pilocarpine 

See  Jaborandi. 

Poke  Berry 

See  Picrotoxin. 

Potassium  Bichrom- 

Mouth  and  lips  stained  yellow; 

ate 

gastroenteritis 

Potassium  Chlorate . . 

Albuminuria;  nephritis;  suppression 
of  urine;  heart  depression; 

cyanosis;  drowsiness 

PriKssic  Acid 

Sec  Acid,  Hydrocyanic. 

Quinine 

Deafness;  blindness;  transient  erythe- 
mas; ejiistaxis;  headache;  delir- 
ium; coma 

Ratsbane 

See  Idiosphorus. 

Resorcin 

Cardiac  and  respiratory  depression;  ilia- 
jihoresis;  narcosis;  collapse 

Rough  on  Rats 

See  Arsenic. 

Salicylic  Acid 

See  Acid,  Salicylic. 

Salol 

See  Acid,  Carbolic. 

Sangu  inaria 

See  Bloodroot. 

Savin 

Pain;  vomiting;  purging;  convulsions; 
collapse;  coma;  nephritis;  abortion 

Scheclo’s  Green 

See  Arsenic. 

Scopolamin(Hyoscine) 

See  Atropine. 

Silver 

Pain;  diarrhoea;  vomiting  of  white, 
cheesy  matter,  which  turns  black  in 
sunlight;  dizziness;  convulsions; 

coma;  paralysis 

Squills 

Vomiting;  purging;  strangury;  haima- 
turia;  paralvsis;  convulsions. 

Stramonium  (.James- 
town or  .Jimson 
Weed ) 

See  Atropine. 

Strophanthus 

See  Digitahs. 

Strychnine  (Nux 

Muscular  twitching;  slight  vertigo;  mus- 

vomica ) 

cular  stiffness;  restlessness;  trembling; 
stiffness  of  back  of  neck;  tetanic  con- 
vulsions; opisthotonos;  risus  sardoni- 
cus;  complete  relaxation  between 
convulsions;  retention  of  conscious- 
ness; painful  muscular  contractions; 
a slight  touch  or  breath  of  air  origi- 
nates convulsions 

Sulphonal 

Ptosis;  vomiting;  diarrhoea  or  constipa- 
tion; vertigo;  oliguria;  paralysis;  hoemo- 
gl o b i n u r 1 a;  haematoporphyrinuria; 
stupor;  papular  skin  eruptions 

Sulphuric  Acid 

See  Acid,  .Sulphuric. 

Tansy 

Abdominal  pain;  vomiting;  unconscious- 
ne.ss,  convulsions 

Treatment 


Copper  sulphate,  gr.  v,  every  5 min.  until 
vomiting  occurs,  or  stomach  tube  is 
ready  (chemical  antidote  and  emetic); 
lavage  with  pot.  permanganate 
1 ; 1000;  later  mag.  sulphate  (no  oils); 
hyd.  peroxide,  1 to  3 per  cent.;  alkalies 
as  in  acido.sis  (q.v.). 


Lavage;  stunulants. 


Emetics  (see  under  Poisoning);  lavage; 
mag.  carbonate  or  chalk;  egg  albumen; 
external  heat;  stimulants. 

Lavage;  copious  water  drinking  and  in- 
fusions; stimulants;  external  heat. 


Tannic  acid  (see  under  Poisoning);  stimu- 
lants: alcohol,  strong  coffee,  ammonia; 
artificial  respiration. 

See  Acid,  Carbolic. 


Apomorphine  or  lavage;  castor-oil;  de- 
mulcents (see  under  Poisoning);  stimu- 
lants; abdominal  poultices;  morphine 
for  e.xcessive  vomiting  and  purging. 


Salt  water;  milk  and  egg  albumen  in 
large  amounts;  washing  soda  (sod. 
carb.);  soap;  sulphates;  lavage. 


Absolute  quiet,  avoidance  of  noises, 
draughts,  etc.;  tannic  acid,  followed 
at  once  by  lavage,  best  with  pot. 
permanganate,  1 : 1000;  Lugol’s  sol.; 
amyl  nitrite;  physostigmine;  alcohol; 
for  convulsions:  chloroform  by  inhal- 
ation, and  bromide  and  chloral  per 
rectum;  diuresis  to  eliminate  poison; 
o.xygen;  arti  ficial  respiration. 

Alkalies:  sod.  bicarb,  or  mag.  carbonate, 
later  mag.  sulphate;  croton  oil,  gtt.  ii, 
followed  by  a high  turpentine  enema; 
water  freely  by  mouth  and  by  infusion. 

Lavage;  cardiac  .stimulation. 


POLIOMYELITIS,  ACUTE 


Table  of  Poisons  and  Poisoning — Continued 


Poison 

Symptoms 

Treatment 

Tartar  Emetic 

Tartaric  Acid 

Thorn  Apple 

See  Antimony. 

See  Acid,  Tartaric. 
See  Atropine. 

Thymol 

Weakness;  collapse;  albuminuria;  hasma- 
turia 

Gastric  and  colonic  lavage;  saline  cathar- 
tics (no  oil  or  alcohol);  heat;  black  cof- 
fee; hypodermic  of  atropine,  strychnine, 
and  pituitrin. 

Tobacco  (JNicotine) . . 
Trional 

Prostration;  giddiness;  collapse;  dysp- 
noea; muscular  tremblings,  some- 
tunes  convulsions 

See  Sulphonal. 

Tannic  acid,  followed  by  immediate  lav- 
age; head  low;  stimulants:  atropine, 
strychnine,  Hoffmann’s  anodyne;  ex- 
ternal heat. 

Turpentine 

Gastro-enteritis;  vomiting;  diarrhoea; 
lumbar  pain;  dysuria;  strangury;  hse- 
maturia;  suppression  of  urine;  odor  of 
violets  in  the  urine;  pupils  dilated; 
muscular  weakness;  incoordination; 
narcosis;  cyanosis;  feeble,  rapid  pulse. 

Small,  rapid  pulse  (at  first  slow);  skin 
cold  and  clammy;  vomiting;  purging; 
giddiness;  faintness;  impaired  vision; 
great  weakness;  respirations  slowed; 
collapse;  stupor;  often  convulsions 

Sulphates,  especially  mag.  sulphate;  de- 
mulcents (see under  Poisoning);  opium. 

Veratrum 

Tannic  acid  (see  under  Poisoning),  fol- 
lowed immediately  by  lavage;  patient 
prone,  head  low,  absolute  quiet;  alco- 
hol, morphine;  stimulants:  atropine, 
strychnine;  external  heat;  amyl  nitrite. 

Veronal 

Wormseed 

Abdominal  pain;  sweating;  pyrexia;  neu- 
ralgia; nausea;  vomiting;  ohguria;  gly- 
cosuria; erythema;  ataxia;  somnolence 
deepening  to  coma 
See  oil  of  chenopodium. 

See  Sulphonal. 

Zinc 

Pain,  gastro-enteritis;  nausea;  vomit- 
mg;  collapse. 

Demulcents,  emetics  (see  under  Poison- 
ing); lavage. 

II.  Insect  and  Snake  Poisoning. — Apply  a liga- 
ture above  the  bitten  part,  open  the  wound 
thoroughly,  and  suck  with  the  mouth  or 
with  cupping  glasses  {q.v.).  Inject  into  the 
wound  and  the  surrounding  tissues  20  to  30 
c.c.  of  a fresh  solution  of  1 per  cent,  calcium 
or  gold  chloride,  or  calcium  hypochlorite;  or 
pot.  permanganate,  1 : 100;  or  chromic  acid 
1 : 100;  or  rub  in  crystals  of  pot.  permangan- 
ate. The  wound  may  be  excised. 

Administer  antivenin,  if  available;  prefer- 
ably an  antivenin  which  is  specific  for  the 
species  of  snake  which  caused  the  bite;  other- 
wise a polyvalent  antivenin.  Rattlesnake 
antivenin  (anticrotalus  serum)  and  mocassin 
antivenin  are  obtainable  from  the  Rocke- 
feller Institute  in  New  York.  “Cobra  and 
daboia  antivenins  are  furnished  in  India, 
Notechis  antivenin  in  Australia,  and  Lachesis 
antivenin  in  Brazil  and  Japan  ” (Blumer). 
Give  large  doses,  50  to  100  c.c.  in  serious 
cases,  intravenously  {q.v.)  if  possible,  other- 
wise intramuscularly.  Gastric  lavage  is 
recommended,  since  the  poison  is  partly  ex- 
creted in  the  stomach.  Intrc'^enous  or  sub- 
cutaneous infusions  of  normal  saline  solution 
(0.9  per  cent.)  and  large  amounts  of  cream 
of  Tartar  lemonade  {q.v.,  in  Part  11)  by 
mouth  serve  to  dilute  the  poison  and  favor 
elimination.  If  stimulants  are  required,  em- 


ploy alcohol,  coffee,  tea,  aimnonia,  strych- 
nine, atropine  (Part  11).  Muller  employ’s 
strychnine  as  an  antidote:  gr.  }/q  every 
half-hour  “until  slight  tetanic  convulsions 
appear.”  Resort  to  prolonged  artificial 
respiration  when  necessary,  for  the  patient 
may  at  any  tune  suddenly  recover.  Con- 
tinue artificial  respiration  as  long  as  the 
heart  beats. 

The  bites  of  poisonous  spiders,  scorpions, 
and  the  Gila  monster  are  treated  in  the  same 
manner  as  snake  bites. 

Poliomyelitis,  Acute;  Acute  Infantile 
Paralysis. — Gr.  vroXtos  gray  -|-  pLveXos  marrow 
■T  LTLs  inflannnation.  An  acute  infectious, 
sporadic  and  epideinic  disease  usually  of 
children,  involving  particularly  the  gray 
matter  of  the  spinal  cord  and  brain  stem, 
and  characterized  clinicallj'  by  an  incubation 
period  of  from  five  to  ten  or  twelve  days, 
followed  abruptly  bj^  fever,  pain,  especially 
marked  on  handling  the  limbs,  and  an 
atrophic,  flaccid  paralysis  or  paresis  of 
various  muscles,  usuallj'  of  the  limbs,  which 
soon  slowly  disappears  in  some  of  the 
muscles,  while  remaining  permanent,  as 
a rule,  in  the  others.  The  acute  stage  of 
the  disease  usually  lasts  from  five  to  ten  days. 
It  is  most  prevalent  in  the  warm  months. 
The  mortality  is  low.  The  cause  is  possibly 


MUSHROOMS. 


Volvarii 


Amanita  phalloides 


Amanfecifrina 


Amanita  verna 


Volvaria  gloiocephaJa  p 


Yolvaria  speciosa 


ftalliota  campestris 


Russula’virescens 


Amanita  jontjuillea 


muscana 


Amanita  ovoidea^^"^  ^9'"^  i 


Psalliota  silvatica 


Amgniig^  bescens 


Amanita  pantherina 


Amanita  Caesarea 


Lepiota  clypeolaria 


ioletus  Satanas 


Clavaria  formosa 


Brown  Lepiota 


orocera 


Boletus  telleiis 


Lactarfus'  rii 


aurea 


Boletus  edulis 


Lactarius  Theiogaliis 


LactarmB torminosus 


Lactarius  deliciosus 


Russ’jiaT  gueletii 


Cantharedus  cibarius  C^ntharellus auranticus  Russula cyanoxantha  Russula  ’cala  Russula  emetica  \eIIow«ussuIa 


LAItOOSSE  MEDICAL 


Poisonous  mushrooms , edible  ones  ressemblmg  them . 
Fatal  iF);  Dangerously  poisonous  t P)  ; Edible  lE). 


POLIOMYELITIS,  ACUTE 


a filterable  globoid  organism  (Flexner  and 
Noguchi)  or  a pleomorphic  streptococcus 
(Rosenow) . It  is  probably  transmitted  by 
way  of  the  naso-phaiyngeal  secretions  of 
carriers,  and  it  is  also  possible  that  the 
biting  stable  fly,  the  common  house  fly,  and 
bed-bugs  may  transmit  the  disease.  The 
so-called  “ distemper  ” of  dogs  and  horses 
may  be  the  same  affection. 

The  meninges  are  sometimes  chiefly  in- 
volved, with  resulting  meningeal  symptoms. 
Multiple  neuritis  and  Landry’s  paralysis  are 
sometimes  simulated.  The  muscles  of  res- 
piration may  even  become  involved,  in  severe 
cases,  with  resulting  death. 

The  deep  reflexes  of  the  affected  limbs  are, 
of  course,  abolished;  but  there  is  no  loss 
of  sensation. 

Says  E.  F.  Buzzard;  “ A febrile  disturb- 
ance associated  with  a painful  condition  of 
the  limbs,  especially  evoked  by  handling, 
and  with  a pseudo-paralysis,  is  produced 
by  rickets,  scurvy  rickets,  syphilitic  epiphy- 
sitis, osteomyelitis,  and  rheumatic  fever, 
and  must  be  differentiated  from  acute 
poliomyelitis.” 

The  reaction  of  degeneration  occurs  in  the 
seriously  affected  muscles  in  eight  to  ten 
days.  It  is  indicated  by  lack  of  response  to 
the  faradic  current  and  a slow  response  to 
the  galvanic  current,  the  anodic  closing  con- 
traction being  better  than  the  cathodic 
closing  contraction.  A paralyzed  muscle 
which  retains  its  faradic  excitability  may  be 
expected  to  recover. 

Improvement  in  the  paralysis  does  not 
begin  until  from  one  to  three  weeks  after  the 
acute  symptoms  have  subsided,  and  is  indi- 
cated by  a quickened  response  to  the 
galvanic  current.  Much  of  the  paralysis  dis- 
appears within  six  months;  but  spontaneous 
improvement  may  continue  for  even  two 
years  or  longer. 

Treatment. — Isolate  the  patient,  and  ex- 
clude flies;  keep  the  nose  and  mouth  clean, 
and  destroy  the  nasal,  buccal,  and  intestinal 
discharges;  and  instruct  the  attendants  to 
use  a prophylactic  menthol  spray  (Part  11) 
for  their  noses  and  throats  (see  Disinfection, 
for  details).  Contacts  should  be  quarantined 
for  fourteen  days,  the  patient  for  twenty-one 
days,  and  he  should  be  free,  too,  from  all 
nasal,  aural,  or  other  discharges. 

Enjoin  complete  rest  in  bed,  on  light  diet, 
consisting  of  milk  and  cereal  gruels,  with 
plenty  of  water,  preferably  in  the  form  of 
cream  of  tartar  lemonade  (one  teaspoonful 
to  the  pint  or  quart  of  boiling  water;  cooled, 
and  flavored  with  lemon  and  sugar).  Open 
the  bowels  with  calomel  or  castor  oil.  The 


following  old-fashioned  fever  mixture  can 
do  no  harm: 

R Spiritus  setheris 

nitro.si 3ii  (njjv  per  teaspoonful) 

Potassii  citratis,  . . 5i  (gr.  iiss  per  teaspoonful) 
Liquoris  ammonii 

acetatis oiss  (3ss  per  teaspoonful) 

Syrupi  simplicis.  . . 

Aqua;  camphora;, 
q.s.  ad 5iv 

M.  Sig. — One  teaspoonful  (for  three-year-olds)  to 
one  tablespoonful  (for  adults)  every  three  hours. 

Urotropin  is  recommended  as  a spinal 
antiseptic,  but  helmitol  would  seem  prefera- 
ble, because  it  liberates  formaldehyde  in 
an  alkaline  medium.  (For  all  drugs,  see 
Part  11). 

During  the  first  week,  one  may  apply 
counter-irritation  to  the  spine  in  the  form 
of  mustard  poultices  (g.v.),  once  every  three 
hours,  or  frequent  dry  cups  (q.v.),  or  the 
Paquelin  cautery,  or  tincture  of  iodine,  or 
the  ice-bag,  if  well  borne.  Envelop  the 
affected  limbs  in  cotton  wool;  and  in  order 
to  prevent  contractures,  splint  them  in  a 
straight  or  slightly  flexed  position.  The 
lower  limbs  should  be  in  line  with  the  body, 
and  the  feet  at  right  angles  with  the  legs. 

The  occurrence  of  urinary  retention  may 
demand  catheterization. 

After  the  acute  stage  has  subsided,  and  all 
traces  of  pain  and  muscle  soreness  have  dis- 
appeared (four  weeks  to  three  months),  get 
the  patient  on  his  feet,  and  begin  manual  or 
vibratory  massage  (rubbing,  pinching,  knead- 
ing and  hacking),  passive  and  active  move- 
ments (the  latter  are  the  best) , and  electrical 
stimulation  of  the  paralyzed  muscles. 

Each  muscle  or  muscle  group  in  the  body 
(both  arms,  both  legs,  back,  abdomen,  and 
neck)  must  be  tested  and  a note  made  of 
those  which  are  normal  and  those  which  are 
weak.  The  weak  muscles  should  be  accu- 
rately trained  and  strengthened  by  systematic 
exercises,  strictly  avoiding  fatigue.  Be  care- 
ful to  see  that  the  weak  muscles  are  used  in 
any  prescribed  movement,  and  not  the  strong 
ones,  which  would  increase  the  muscular 
imbalance,  with  resulting  deformity. 

For  abdominal  weakening,  employ  a 
supporting  cloth  corset.  In  deltoid  weaken- 
ing, elevate  the  arm  to  shoulder  level 
(after  Lovett). 

In  the  passive  stretching  exercises,  move 
the  lunbs  to  their  normal  limits  in  all  direc- 
tions. Employ  these  measures  at  first  but 
once  every  three  days,  and  later  increase  the 
work  most  carefully  to,  say,  half  an  hour,  two 
or  three  times  daily,  for  the  purpose  of  main- 
taining the  muscles  in  healthy  tone  until  their 


POLYCYTHEMIA  VERA;  ERYTHREMIA 


nerves  have  regenerated,  and  for  tlie  preven- 
tion of  contractures.  In  infants,  a bell  or 
rattle  may  be  tied  to  the  paralyzed  Ihnb. 
Electricity  {q.v.)  is  of  the  least  importance. 
Employ  the  least -strength  of  current  required 
to  protluce  a muscular  contraction.  Devote 
about  three  minutes,  50  to  GO  interruptions  to 
the  minute,  to  each  muscle,  the  cathode  being 
applied  to  the  muscle.  Use  galvanism  for 
those  muscles  which  do  not  respond  to  the 
farachc  current,  faradism  for  those  muscles 
which  do  respond.  In  the  use  of  massage  and 
exercises,  avoid,  above  all  things,  fatigue, 
which  is  very  tletrimental  to  the  return  of 
power.  If  the  muscles  are  exercised  every 
day  in  the  beginning,  even  though  very 
gently,  their  jxjwer  will  tliminish  or  disappear 
(Lovett  and  Martin.) 

For  the  j)urpose  of  producing  active  hyper- 
scmia,  subject  the  limb  for  twenty  to  thirty 
minutes,  three  or  four  times  a week,  to  dry 
heat,  a hot  pack  or  fomentation,  a hot 
sand  bake,  the  electric  light  bath,  or  forcible 
sprays  of  water  at  various  temperatures. 

Continue  the  above  measures  for  several 
years,  if  necessary. 

Prescribetonicsifrequired,e. 3.,  iron,  strych- 
nine, arsenic  (see  Part  11).  Daily  warm 
baths,  fresh  air,  and  good  food  are  important. 

As  soon  as  the  patient  is  able,  he  may  be 
allowed  to  walk  with  the  limb  supported  by 
a brace  (best,  a celluloid  splint),  in  order  to 
prevent  deformity,  such  as  talipes,  genu 
recurvatum,  etc.  (see  Fig.  64),  but  very  little 
walking  is  advisable  during  the  first  year. 

The  foot  is  held  at  right  angles  with  the 
leg  in  order  to  prevent  equinus  (the  result  of 
paralysis  of  the  anterior  leg  muscles),  or 
calcaneus  (the  result  of  paralysis  of  the  calf 
muscles).  The  knee  is  supported  to  prevent 
genu  recurvatum.  There  should  be  no  joint 
at  the  knee  in  young  chikh-en,  but  in  older 
patients  a joint  is  supplied  which  permits  of 
flexion  only  on  sitting.  In  paralysis  of  the 
hip  muscles  a pelvic  baml  is  required.  The 
brace  should  be  changed  as  it  is  outgrown. 
The  foregoing  measures  should  be  continued 
throughout  the  growing  period  of  childhood. 

After  the  tenth  to  fourt(‘onth  year,  if 
residual  incurable  jmralyses  remain,  and 
deformity  has  been  jirevented  or  correcteil, 
tendon  trans])lantation  may  be  considered 
(see  orthopa'clic  texd books).  Late  secondary 
flexion  deformities  should  be  straighteneil 
out,  tenotomy  being  performed  if  necessary 
(see  Whitman’s  “ reverse  leverage  ” method 
of  coi’recting  flexion  of  the  leg,  in  Tubercu- 
losis of  the  Knee,  in  Part  10,  Orthopiedics). 
Thigh  flexion  is  corrected  by  forcible  exten- 
sion, with  the  pelvis  fixed  by  flexion  of  the 


sound  thigh  and  leg  upon  the  abdomen, 
tenotomy  being  performed  if  necessarj\ 
Says  C.  F.  Painter,  “ Tenotomy  of  a long 
contracted  muscle  effects  an  improvement 
in  its  tone  and  muscular  power.”  After 
correction,  or  over  correction,  the  limb  is 


Fio.  64.  Apparatus  for  paralysis. 


fixed  in  plaster.  Arthrodesis  (artificial  anky- 
losis, designetl  to  stiffen  flail  joints)  should 
not  be  done  under  eight  years  of  age.  Oste- 
otomy is  sometimes  incUcated  (see,  in  Part  10, 
Orthopiedics,  Talipes,  Scoliosis,  and  Knock- 
Knee).  For  paraljdic  dislocations,  see  Dislo- 
cations, Paralytic  (in  OrthopaecUcs). 

Poliomyelitis,  Chronic  Anterior. — See  Atro- 
phies, the  Progressive  Muscular. 

Polycythaemia  Vera;  Erythraemia. — Gr. 
•TToXus  maity  KL’Tos  cell  + al/xa  blood;  L. 
wro,  true;  Gr.  epvdpos  red  a[p.a.  blood.  A 
veiy  rare,  chronic  disease,  characterized  bv 
a marked  increase  in  the  amount  of  blood, 
especiallythe  red  blood  cells  andhsemoglobin, 
as.sociated  with  splenomegaly',  with  resulting 
general  vascular  congestion,  high  blood  pres- 
sure {q.v.),  flushing,  perhaps  cy'anosis,  head- 
ache, giddiness,  dysi^noca,  muscular  and 
mental  weakness,  and  a tendency'  to  hemor- 
rhage from  the  skin  and  mucous  membranes, 
to  cardiac  failure,  and  recurring  ascites  or 
pulmonary'  mdema. 


PREMATURE  AND  DELICATE  INFANTS 


Exclude  other  causes  of  cyanosis  (q.v.). 

Treatment — The  X-rays  may  be  applied 
both  to  the  spleen  and  to  the  long  bones,  in 
order  to  duninish,  if  possible,  erythroblastic 
hyperactivity  (see  under  Lukaemia).  “Sple- 
nectomy should  not  be  performed.”  (Osier). 
Hirschfeld  advises  the  iodides.  Benzol,  which 
causes  a fall  in  the  red  blood  count,  may  be 
given  a trial  (see  under  Leuktemia). 

Low  chet,  saline  purgation,  and  occasional 
bleedings  are  of  benefit. 

The  condition  is  perhaps  incurable,  but 
the  patient  may  live  for  about  six  to 
eight  years. 

Polymorphonuclear  Neutrophiliosis. — Gr. 

TToXos  many  + /xopc^i)  form  -b  L.  nu'cleus;  L. 
neu'ter,  neither  -j-  Gr.  (piXeiv  to  love.  See 
Leucocytosis. 

Polymyositis. — Gr.  ttoXus  many  -{-  pus 
muscle  + -trts  inflammation.  See  Myositis. 

Polyneuritis. — See  Neuritis,  Multiple. 

Polyphagia. — See  Bulhnia. 

Polyuria.^ — Gr.  ttoXus  much  or  many  -|- 
oupov  urine. 

I.  Increased  Amount  (i.e.  more  than  about 
2500  c.c.  in  twenty-four  hours). 

Causes. — Copious  liquid  drinking;  diu- 
retics; fright;  anxiety  in  regard  to  studies, 
examinations,  etc. ; convalescence  from  fevers 
(epicritic  polyuria);  neurasthenia;  hysteria; 
epilepsy;  chorea;  convalescent  stage  of  acute 
nephritis;  chronic  nephritis,  both  interstitial 
and  parenchymatous;  arteriosclerosis  of  the 
kidney;  amyloid  kidney;  chronic  pyelone- 
phritis; intermittent  hydronejjhrosis ; con- 
tinuous catheter  drainage  in  prostatic 
obstruction;  essential  phosphaturia;  diabetes 
insipidis;  diabetes  mellitus;  absorption  of 
dropsical  effusions;  exophthalmic  goitre; 
acromegaly;  occasionally  acute  cerebro- 
spinal meningitis;  sometimes  tuberculosis. 

II.  Increased  Frequency  {i.e.  oftener  than 
about  five  times  in  twenty-four  hours). 

Causes. — Increased  amount  of  urine; 
cystitis  (urgency  present  both  day  and 
night) ; vesical  stone  or  foreign  body ; kidney 
stone;  pyelonephritis;  posterior  urethretis 
(urgency  present  both  day  and  night) ; ve.sico- 
urethral  fissure;  vesical  tumors;  prostatic 
hypertrophy  (nocturnal  frequency) ; dis- 
tended colon;  urethral  eversion;  urethral 
caruncle;  pelvic  inflammation;  hemorrhoids; 
anal  fissure;  irritable  rectal  ulcer;  oxyuriasis; 
vaginismus;  excessive  coition  or  masturba- 
tion; neuroses  of  the  bladder  (frequency  only 
during  the  day);  neurasthenia;  hysteria; 
locomotor  ataxia;  general  paresis;  myelitis; 
multiple  sclerosis;  cord  tumors;  spondylitis; 
overwork  and  anaemia;  paralysis  of  the  blad- 
der; malaria;  cold;  acute  fevers;  viscerop- 


tosis, pregnancy;  uterine  displacements; 
uterine  fibro-myomata;  ovarian  cystoma; 
tumor  pressing  upon  the  bladder;  lithaemia; 
excessive  acidity  of  the  urine;  pyuria;  over- 
concentration of  the  urine  (shown  by  the 
color  and  specific  gravity);  crystals  in  the 
urine  (see  Nephrolithiasis) ; irritating  ingesta 
(ginger,  radishes,  spices,  turpentine,  canthar- 
ides,  salicylates,  quinine,  etc.);  contraction  of 
the  lumen  of  the  bladder  due  to  cystitis, 
stone,  tumor,  atrophy  from  disuse,  operation 
upon  the  bladder;  too  high  or  too  low  si^ecific 
gravity;  abdominal  pelvic  operations;  ureth- 
ral stricture;  urethral  cUlatation;  enuresis 
of  childhood  continuing  after  puberty,  in 
which  the  bladder  has  never  held  much 
urine.  Consult  Part  2,  Gyiijecology,  and 
Part  3,  Genito-Urinary  Diseases. 

Ponos;  Infantile  Kala  Azar. — Gr.  wovos 
pain.  A chronic  endemic  disease  of  young 
children,  due  to  the  Leishmania  Infantum 
(po.ssibly  identical  with  the  Leishmania 
Donovani;  see  Kala  Azar),  occurring  in  the 
islands  of  Spezzia  and  Hydra  in  the  dUgean 
Sea,  and  characterized  by  sudden  onset  with 
indigestion  and  fever,  followed  by  gradual 
painful  enlargement  of  the  spleen,  emacia- 
tion, and  eventually  anasarca.  Death  usually 
occurs  in  from  a few  months  to  one  or  two 
years.  The  disease  is  probably  transmitted 
by  dogs  and  their  fleas. 

Treatment. — See  Kala  Azar. 

Popliteal  Nerve. — L.  poplitoe'us;  po'ples, 
ham.  See  Sacral  Plexus. 

Potato  Poisoning. — See  Poisoning. 

Pott’s  Disease.— See  Part  10,  Orthopaedics. 

Posterior  Tibial  Nerve. — L.  poste'rius, 
behind;  L.  ti'bia.  See  Sacral  Plexus. 

Post=Hemiplegic  Chorea. — L.  post,  after; 
Gr.  ripi  — -half  -(-  TrX-qyi]  stroke;  xopda  dance. 
See  Athetosis. 

Premature  Beats  or  Extra=Systoles.  See 
Arrhythmia. 

Premature  and  Delicate  Infants. — Keep 
the  infant  warm,  in  a padded  crib,  wrapped 
in  cotton,  and  surrounded  by  hot  water 
bottles,  or,  better,  lying  upon  the  electric  pad 
or  electrotherm,  which  is  placed  between 
two  or  three  thicknesses  of  blanket.  Keep  a 
thermometer  between  the  bed  clothing  and 
the  cotton,  and  see  that  it  registers  85°  to  95° 
F.,  according  to  the  rectal  temperature  of 
the  infant,  taken  every  few  hours,  which 
should  be  kept  at  98°  to  100°  F.  Incubators 
have  not  proven  satisfactory. 

Administer  breast  milk,  34  to  K fo  1 to  13^ 
ounces,  every  one  to  one  and  a half  to  two 
hours,  12  to  14  to  15  feedings  in  twenty-four 
hours.  If  too  strong,  dilute  the  milk  with 
about  an  equal  amount  of  3 per  cent,  milk 


PROCTITIS  AND  SIGMOIDITIS 


sugar,  or  plain  boiled  water.  If  the  child 
cannot  nurse,  employ  gavage  (see  under 
Inanition,  Shnple  Acute),  or  a medicine 
dropper,  or  the  Breck  feeder.  Increase  the 
amount  and  strength  of  the  milk,  and  the 
intervals  of  feeding,  as  the  child’s  strength 
and  digestive  ability  increase. 

Says  Gerstley,  if  the  amount  of  milk 
nece.ssary  for  the  baby’s  caloric  needs  is  too 
bulky,  overloading  the  stomach  and  causing 
vomiting,  give  boiled  buttermilk  with  5 per 
cent,  dextri-maltose,  but  no  more  than  one- 
third  or  one-half  the  total  amount  of  breast 
milk  taken,  ascertained  by  weighing.  To 
avoid  anaemia  and  rickets,  add,  says  Gerst- 
ley, a little  calcium,  codliver  oil,  and  per- 
haps iron. 


li  Calcii  lactatis g iss 

Syrupi  aurantii,  q.s.  ad 

M.  Sig. — Two  teaspoonfuls  (about  6 gr.  calc.) 
t.i.d. — Gerstley. 

li  Olei  phosphori 3ss 

Olei  morrhuac ,5iv 


M.  Sig. — 1 to  15  drops,  slowly  increased  to  1 
teaspoonful,  t.i.d.,  after  meals  (before  meals  if  the 
patient  vomits.) — Gerstley. 


li  Ferri  carbonatis  saccharati gr.  iii-iv 

Mitte  tails  chartae  ceratse No.  30 


Sig. — A powder  in  a teaspoonful  w'ater,  t.i.d.  (for 
a baby  of  4-5  months). — Gerstley. 

Temporary  inferior  substitutes  for  human 
milk  are: 

1.  Whey  made  from  whole  milk:  To  one 
quart  of  slightly  acid  milk  add  one  teaspoon- 
ful of  rennet;  keep  at  a temperature  of  about 
100°  F.  (38  C.)  until  the  curd  separates;  then 
strain  through  cheesecloth  after  breaking  up 
the  curd.  Boil  three  minutes.  P.,0.8  to  1 
per  cent.;  F.,  1 per  cent.;  S.,  4.5  to  5.5  per 
cent.  About  9 calories  per  ounce. 

2.  Gravity  cream,  1 oz.;  milk  sugar,  1 oz.; 
water,  15  oz.  P.,  0.3  per  cent. ; F.,  1 per  cent. ; 
S.,  5 per  cent. 

3.  Canned  sweetened  condensed  milk, 

1 part;  water,  24.  P.,  0.25  per  cent.;  F., 

0.3  per  cent.;  S.,  1.8  per  cent.  See  also 
Infant  Feeding. 

For  the  first  few  weeks,  use  oil  instead  of 
water  for  cleansing  the  skin.  The  infant 
should  be  handled  as  little  as  possible.  The 
oiling  and  change  of  cotton  may  be  done 
every  other  day.  A little  cotton  wool  may 
be  used  instead  of  diapers. 

Primary  Combined  Sclerosis. — See  Com- 
bined Sj'stem  Diseases. 

Lateral  Sclerosis.— See  Spastic  Paralysis. 

Proctitis  and  Sigmoiditis. — Gr.  rpoiKTos 
anus;  (nynoeidijs  like  the  letter  sitpna  2 ; -f- 
-LTLS  inflanunation.  Symptomatology.— Pain 


and  discomfort  in  the  pelvis,  bladder,  and 
thighs,  tenesmus,  and  the  frequent  passage 
of  small,  thin,  blood-stained,  mucous  stools. 
Examination  with  the  speculum  reveals  an 
inflamed  mucous  membrane  (see  under 
Enteritis,  for  the  manner  of  making  an 
enteroscopic  examination) . 

Etiology.— The  prolonged  use  of  irritating 
enemata  (glycerine,  nutrient  enemata,  etc.); 
long  retained  hardened  scybala;  sudden 
changes  of  temperature;  sitting  on  some- 
thing cold;  traumatism;  ulcerated  hemor- 
rhoids; rectal  polyposis;  pin-worms; 
gonorrhoea ; chancroid ; syphilis ; tuberculosis ; 
actinomycosis;  bilharziasis ; dysentery 
(amoebic,  bacillaiy,  etc.);  diphtheria; 
typhoid  fever;  pyaemia;  carcinoma. 

Treatment. — Attend  to  the  cause.  In  sim- 
ple catarrhal  inflammation,  administer  a 
large  dose  of  castor  oil,  and  mrigate  the 
rectum  or  sigmoid  (the  latter  in  the  knee- 
chest  posture),  once  or  twice  daily  with 
warm  or  cool  normal  saline  (3i  acl  Oi)  or  boric 
acid  solution  ( 3 i ad  Oi) . The  inflamed  sur- 
face may  be  sprayed  or  swabbed  once  or 
oftener  with  silver  nitrate,  gr.  i-x  to  the 
ounce,  or  argjTol,  15  to  30  per  cent.  Touch 
ulcers  with  silver  nitrate,  gr.  xx  ad  5i)  or 
zinc  chloride,  3iss  ad  5i,  or,  in  resistant 
cases,  wnth  nitric  acid  on  a cotton  swab.  To 
relieve  tenesmus,  inject  two  ounces  of  thin 
starch  solution  containing  10  to  15  drops  of 
laudanum,  and  press  gently  on  the  anus  to 
prevent  expulsion  of  the  enema.  In  chronic 
cases,  astringent  injections  may  be  useful, 
e.g.,  tannic  acid,  gr.  v-x-xx  ad  5i,  or  hama- 
melis,  1 per  cent.,  or  silver  nitrate,  1 : 1000, 
repeated  once  or  twice  daily  for  a few  weeks. 
Ionic  medication  may  be  employed  as  for 
colitis  (q.v.).  It  is  sometimes  necessary,  for 
purposes  of  drainage,  to  dilate  or  even  incise 
the  sphincter  (see  under  Fissure  in  Ano). 

Rest  in  bed,  a hot  w'ater  bag  to  the  perin- 
eum, warm  sitz-baths  for  half  an  hour, 
t.i.d.,  and  a bland  soft  diet  are  of  importance. 

Ischiorectal  absces.s  (q-v.)  may  follow  proc- 
titis; perisigmoiditis  and  diverticulitis  (q.v.) 
may  follow  sigmoiditis. 

There  is  a very  contagious,  epidemic, 
ulcerative  and  gangrenous  proctitis  of  the 
tropics,  with  mucous  and  bloody  diarrhoea, 
tenesmus,  fever,  and  great  prostration,  which 
is  treated  as  follows : The  bowels  are  purged, 
following  which  enemas  are  used.  A mix- 
ture of  lemon  juice  and  white  rum  and  a 
decoction  of  spigelia  anthelmintica  are  used 
as  enemata:  and  the  latter  is  also  given  by 
mouth.  The  natives  believe  that  the  dis- 
ease is  caused  by  chewing  the  green  stalks 
of  unripe  maize. 


PROLAPSE  OF  THE  RECTUM  AND  ANUS 


Professional  Cramps  or  Spasms.  — See 

Cramps,  Professional. 

Progressive  Bulbar  Paralysis. — See  Atro- 
phies, the  Progressive  Muscular. 

Central  Muscular  Atrophy. — See  Atro- 
phies, the  Progressive  Muscular. 

Interstitial  Hypertrophic  Neuritis  of 
Childhood. — See  Interstitial  Hyper- 
trophic Progressive  Neuritis  of  Child- 
hood, and  Atrophies,  the  Progressive 
Muscular. 

Lenticular  Degeneration. — See  C'horea, 
Tetanoid. 

Muscular  Atrophy. — See  Atrophies,  the 
Progressive  Muscular. 

Muscular  Dystrophy. — See  Dystrophy, 
Progressive  Muscular. 

Neural  Muscular  Atrophy. — See  Atro- 
phies, The  Progressive  hluscular. 

Prolapse  of  the  Rectum  and  Anus. — L. 
pro,  before  + lah'i,  to  fall;  redum,  straight; 
L.  anus.  Etiology.— Straining  due  to  consti- 
pation, diarrhoea,  ulceration,  hemorrhoids, 
rectal  polypi,  stricture  of  the  bowel,  pin- 
worms,  phimosis,  urethral  stricture,  stone  in 
the  bladder,  or  whooping-cough;  laceration 
of  the  sphincter  due  to  childbirth;  paresis 
or  paralysis.  Ana?mia,  debility,  and  rickets 
may  act  as  predisposing  causes.  Chilcben 
are  mostly  affected. 

Treatment.— Conservative  Treatment  in 
Children. — Correct  the  cause.  Reduce  the 
prolapse  with  oiled  fingers,  aided,  if  need 
be,  by  cold  applications.  To  prevent  the 
extrusion  of  the  bowel  during  defecation, 
strap  the  buttocks  together  with  two  nar- 
row strips  of  adhesive  plaster,  which  should 
not  prevent  defecation  when  the  movement 
is  soft.  After  each  act  of  defecation,  remove 
the  straps,  cleanse  the  parts,  and  reapply 
the  straps.  The  stools  may  be  kept  soft 
by  means  of  milk  of  magnesia  (see  Drugs, 
Part  11),  in  milk;  or  olive  oil  after  meals, 
t.i.d.;  or  aromatic  fluid  extract  of  cascara 
sagrada;  or  milk  of  magnesia  and  aromatic 
syrup  of  rhubarb,  aa — one  to  three  tea- 
spoonfuls daily  (see  Constipation).  In  obsti- 
nate constipation,  inject,  every  night,  high 
into  the  colon,  through  a small  rectal  tube 
or  a No.  18  American  catheter,  with  a 4 
oz.  bulb  syringe,  about  four  ounces  or  less 
of  oUve  oil,  to  be  retained  during  the  night. 
The  next  morning  after  breakfast,  place  the 
child  recumbent  on  a bed-pan  with  the  but- 
tocks at  least  four  inches  higher  than  the 
shoulders,  and  encourage  him  to  defecate. 
If  he  cannot,  insert  a glycerine  suppository, 
or  inject  soapsuds.  After  two  weeks  of 
such  treatment,  gradually  dispense  with  the 
oil  injections,  tentatively.  Two  months 


or  longer  are  required  for  a cure.  (Kerley.) 

For  diarrhoea  and  tenesmus,  inject  tannic 
acid  in  ice-water,  gr.  xx  ad  5i;  or  insert  an 
opium  suppository.  (Holt.) 

Conservative  Treatment  in  Adults. — • 
Prescribe  an  abundant  diet,  tonics  contain- 
ing strychnine,  electric  stimulation  to  the 
fundament,  a daily  gentle  laxative,  such  as 
compound  licorice  powder,  cascara  sagrada, 
or  compound  rhubarb  pill,  defecation  in  the 
recumbent  posture,  and  a cool  enema  fol- 
lowing defecation,  “to  restore  tone  to  the 
anal  muscle.”  (Abbe.) 

To  retain  the  rectum  in  place,  the  patient 
should  wear,  for  several  weeks,  or  until  the 
above  measures  have  restored  the  normal 
tone,  a vulcanite  plug  with  a narrow  anal 
stem  and  perineal  bar,  supported  by  a pad 
and  T-bandage. 

The  above  non-surgical  treatment  is  said 
to  be  successful  in  both  chiklren  and  adults, 
in  the  great  majority  of  cases. 

If  unsuccessful,  then  resort  either  to 
cauterization  or  to  a cutting  operation. 

Robert  Abbe,  writing  in  Keen’s  Surgery, 
describes  the  Paquelin  cautery  method  as 
follows:  “ The  Paquelin  cautery  should  be 
used  under  ansesthesia,  and  should  be  pre- 
ceded by  the  same  precautions  as  before 
other  surgical  work  on  the  rectum,  namely, 
three  days  of  gentle  intestinal  purgation  and 
a cleansing  enema  before  operation.  The 
bowel  may  be  treated  either  when  pro- 
lapsed or  after  reduction.  In  the  latter  case, 
a relaxed  sphincter  will  allow  a rather 
larger  bivalve  or  wire  retractor  to  be  used 
in  the  lithotomy  posture.  In  either  case  the 
cautery  is  slowly  drawn  along  the  mucous 
membrane  lengthwise  of  the  bowel,  at  six 
lines,  one-quarter  inch  wide  from  the  anal 
margin  upward,  and  at  two  or  three  points 
downward  to  the  skin.  This  sears  deeply 
the  mucous  membrane,  and  heats  the  sub- 
mucous layer  enough  to  induce  inflamma- 
tory exudate,  but  does  not  go  deeply  enough 
into  the  muscular  layer  to  burn  through. 
An  opiate  suppository  (aqueous  extract,  gr. 
i,  for  adults)  is  then  placed  in  the  rectum, 
and  a rubber  tube  wound  with  iodoform 
gauze  and  smeared  with  vaseline  is  inserted. 
The  bowels  should  then  be  kept  constipated 
for  five  days  or  more,  and  the  patient  kept 
recumbent  for  ten  to  twelve  days,  all  bowel 
movements  being  accomplished  on  the  bed- 
pan.  This  method  has  uniformly  been  found 
efficient  for  permanent  relief  of  prolapsus 
ani  ami  many  cases  of  rectal  prolapse.  A 
simple  cylindric  speculum,  with  six  lateral 
fenestne,  has  been  devisee!  by  Newman,  of 
Glasgow,  for  linear  cauterization  of  pro- 


PULMONARY  ABSCESS 


lapsus,  and  used  even  in  those  cases  where 
hemorrhoids  are  associated.  The  cauterized 
line  begins  a half-inch  above  the  skin  top 
and  effects  a bloodless  cure.” 

In  mild  cases  in  children,  the  protruded 
mucous  membrane  may  be  cauterized,  under 
general  amesthesia,  with  fuming  nitric  acid 
until  whitened,  using  the  glass  stopper  of 
the  nitric  acid  bottle,  and  taking  great  care 
to  avoid  touching  the  skin  margin  of  the 
anal  opening.  The  bowels  are  first  emptied 
as  described  above.  Before  applying  the 
acitl,  the  mucous  membrane  is  wiped  dry 
with  gauze  After  the  cauterization,  the 
mucous  surface  is  anointed  with  olive  oil,  the 
protrusion  replaced,  a pad  placed  over  the 
anus,  the  buttocks  anti  legs  strapped  and 
bandaged  ttjgt'ther,  and  the  patient  kept  in 
bt'd  for  t(‘ii  to  fourteen  days,  the  bowels 
being  confined  with  opiates  (Part  11)  for  the 
first  six  or  seven  days.  At  the  end  of  this 
time  the  rectum  is  emptied  by  means  of  oil 
enemata  followed  by  warm  water;  and  there- 
after, for  two  weeks,  the  child  is  made  to 
defecate  in  the  recumbent  position  with  the 
hips  elevated.  (Earle.) 

Proliferative  Peritonitis. — L.  proles,  off- 
spring -fer're,  to  bear.  See  Peritonitis,  Sim- 
ple Chronic. 

Pseudo=Angina.  — Gr.  \]/ev6rjs  false.  See 
Angina  Pectoris. 

Psilosis;  Sprue. — See  Sprue. 

Pseudoieukaemia.^ — ^Gr.  \l/ev8->js  false  -|- 
'KevKos  w’hite  -f  alfia  blood.  See  Hodgkin’s 
Disease. 

Pseudoleukaemic  Anaemia  of  Infants. — 

See  Anmmia  Infantum  Pseudoleuksemia  of 
Von  Jaksch. 

Pseudomembranous  Bronchitis.  — See 

Bronchitis,  Fibrinous. 

Psittacosis. — Gr.  xpi-rraKos  parrot.  A rare, 
quite  fatal,  epitlemic  disease,  transmitted  by 
parrots,  and  characterized  by  an  incubation 
period  of  about  seven  to  ten  days,  followed 
by  pneumonic  and  typhoid  symptoms  of 
about  fifteen  to  twenty  days  duration. 

In  parrots  the  disease  is  manifestetl  as 
an  enteritis. 

The  Treatment  is  symptomatic. 

Psychasthenia. — See  Neurasthenia. 

Ptomaine  Poisoning. — Gr.  7rT«>ga  carcase. 
See  Poisoning. 

Ptosis. — See  Part  fi.  Eye  Diseases. 

Ptyalism;  Salivation. — Gr.  wTvaXov  spittle; 
L.  sali'va.  Causes. — Interference  with  swal- 
lowing, due  to  tonsillitis,  quinsy,  pharyn- 
gitis, oesophagitis,  and  jtaralysis  of  the 
muscles  of  deglutition,  lips,  and  tongue,  as 
in  bulbar  palsy;  dentition;  dental  caries; 
stomatitis;  certain  drugs,  e.g.,  mercuiy, 


iodide,  gold,  copper,  tobacco,  pilocarpine, 
muscarin;  gastric  ulcer;  hyperchlorhydria; 
nausea;  pregnancy;  menstruation;  pain; 
worms;  urminia;  cretinism;  exophthalmic 
goitre;  pancreatic  oKstruction;  certain  in- 
fectious disease,  especially  smallpox;  tri- 
geminal neuralgia;  migraine;  chorea;  rabies; 
hysteria;  idiocy. 

Treatment. — Attend  to  the  cause.  Useful 
drugs  are  the  bromides,  opium,  and  atropine, 
in  full  doses,  and  a mouth-wash  or  troches  of 
tannic  acid  (see  Drugs,  Part  11.) 

Pulmonary  Abscess. — L.  pul'nio,  lung; 
absces'sus,  a going  apart. — Symptomatology.— 
Cough,  dyspnoea,  pain,  a septic  temperature, 
and  the  copious  expectoration  of  pus  con- 
taining ela.stic  tissue.  The  local  signs  are 
dulness  on  percus.sion,  and  bronchial  breath 
sounds.  Employ  the  X-ray  as  an  aid  in 
locating  the  abscess.  Possible  sequelae  are 
empyema,  pyoneumothorax,  gangrene,  puru- 
lent pericarditis,  and  brain  abscess. 

Etiology.— Lobar  pneumonia;  bronchopneu- 
monia, especially  the  aspiration  form; 
chronic  pulmonary^  tuberculosis;  foreign 
bodies;  carcinoma;  neighboring  suppuration 
(empyema,  suppurative  mecUastinitis,  liver 
abscess,  suppurating  echinococcus  cyst  of  the 
liver,  subphrenic  abscess);  puncture  of  the 
pleura  with  an  exploring  needle,  broken  rib, 
or  other  body. 

Treatment. — Prescribe  a concentrated  liquid 
diet,  alcohol  freely,  a tonic  of  iron  or  arsenic, 
creosote,  or  guaiacol,  internally  (see  Drugs, 
Part  11),  and  steam  inhalations  medicated 
with  creosote  (10  to  1.5  drops  to  the  pint  of 
steaming  water),  or  carbolic  acid  (same 
strength)  or  guaiacol  (same  strength)  or 
turpentine  (oss  to  the  pint),  or  tinct.  of 
benzoin  (qii-viii  to  the  pint).  A respirator 
may  be  worn  during  the  day  containing  cot- 
ton moistened  with  equal  parts  of  alcohol, 
spirits  of  chloroform  and  creosote  (see  also 
Bronchitis).  Localizable  abscesses,  however, 
should  be  opened  and  drained  without 
delay.  The  following  technique  is  abstracted 
from  S.  Robinson; 

If  thoracentesis  reveals  jms,  excise  an  inch 
of  rib  sul)]:)criosteally,  enter  the  abscess 
cavity  with  the  finger,  and  pack  with  gauze. 
If  thoracentesis  is  negati\'e,  a more  extensive 
operation  is  required  iMake  a semicircular 
skin  anti  muscle  fla]),  with  the  base  upward, 
exposing  three  ribs  for  a distance  of  about 
three  inches.  Resect  the  exposed  ribs  sub- 
periosteally,  and  remove  the  intercostal 
tissue  anti  vessels  after  ligating  opposite  the 
rib  entls.  Then,  to  expose  the  pleura,  care- 
fully' incise  ft>r  two  centimetres  the  posterior 
periosteum  of  that  rib  nearest  the  centre  of 


PULMONARY  CONGESTION 


the  suspected  area.  Introduce  the  forefinger 
and  separate  the  pleura  from  the  posterior 
periosteum.  This  is  rendered  possible  only 
in  the  presence  of  pleural  inflammation, 
thickening,  and  adhesions.  Then  cut  away 
the  posterior  periosteum  and  interlying  con- 
nective tissue  of  all  the  ribs  resected.  Ex- 
plore now  for  underlying  jius  with  a needle 
or  blunt  instrument,  or  the  finger,  until  the 
abscess  cavity  is  reached,  which  should  be 
packed  with  gauze.  Restore  the  skin  flap  and 
suture  it  in  layers,  after  first  excising  a circu- 
lar portion  of  it,  exceeding  in  diameter  the 
size  of  the  abscess  cavity.  Allow  the  gauze 
packing  to  remain  in  place  for  three  days. 

Where  the  abscess  is  more  centrally  situ- 
atetl,  and  the  parietal  and  visceral  layers  of 
the  pleura  are  not  adherent,  the  normal 
pleural  cavity  must  be  ojjened,  the  lung 
sutured  under  inflation  to  the  edges  of  the 
thoracotomy  wound,  and  the  lung  explored 
with  the  finger  or  cautery. 

Pulmonary  Actinomycosis.  — See  Actino- 
mycosis, in  Part  5,  Skin  Diseases. 

Anthrax.— See  Anthrax,  in  Part  5,  Skin 
Diseases. 

Arthropathy.  — See  Osteo- Arthropathy. 

Carcinoma. — See  Pulmonary  Tmuors. 

Pulmonary  Cirrhosis  (Syn. — Pulmonary 
Sclerosis,  Chronic  Interstitial  Pneumonia; 
Pulmonary  Fibrosis;  Fibroid  Phthisis). — A 
comparatively  rare  disease  (excluding  tuber- 
culous fibrosis,  which  is  not  here  considered) . 
The  symptoms  are  those  of  chronic  bron- 
chitis: chronic  cough  and  expectoration,  and 
dyspnoea  on  exertion.  Bronchiectasis  is  often 
present.  Hsemoptysis  is  frequent.  Cardiac 
hypertrophy  and  dilatation  are  consequences. 
The  disease  is  incurable. 

In  marked  cases,  the  affected  side  of  the 
thorax  is  retracted,  especially  between  the 
clavicle  and  the  sixth  rib  in  front,  and  below 
the  angle  of  the  scapula  behind,  the  inter- 
costal spaces  are  narrowed,  the  sternum 
deflected,  the  spine  curved,  the  shoulder 
drooped,  the  respiratory  movements  dimin- 
ished, and  the  heart  displaced  by  traction 
toward  the  diseased  lung.  Tactile  fremitus  is 
usually  increased,  rales  are  present,  and  on 
the  souiul  side  a compensatory  emi)hy.sema. 

Chronic  pulmonary  tuberculosis  is  the 
commonest  cause  of  pulmonary  fibrosis,  but 
it  is  considered  elsewhere  (see  Tuberculosis, 
Pulmonary). 

Etiology.— Local  fibrosis  is  caused  by  an 
abscess,  infarct,  gumma,  tubercle,  tumor, 
hydatid  cyst,  collection  of  pigment,  emphy- 
sema, actinomycosis,  glanders,  and  leprosy. 
Diffuse  fibrosis,  which  is  always  unilateral 
except  in  some  cases  following  broncho- 


pneumonia, is  a result  of  pneumonia  (lobar 
or  lobular),  pneumokonio.sis,  prolonged  bron- 
chitis, chrcmic  pulmonary  congestion,  syph- 
ilis, a foreign  body  in  a bronchus,  chronic 
adherent  pleuritis,  compression  of  the  lung 
by  a pleural  exudate  (empyema,  etc.), 
new  growth,  thoracic  aneurysm,  mediastinal 
tumor,  or  oesophageal  diverticulum. 

Treatment.— Prescribe  correct  hygiene,  warm 
clothing,  preferably  a warm  clhnate,  an 
abundance  of  nutritious  food,  perhaps  a 
tonic,  such  as  the  elixir  of  iron,  quinine,  and 
strychnine  phosphate,  one  teaspoonful  well 
diluted,  t.i.d.p.c.,  the  avoidance  of  dust, 
alcohol,  anti  tobacco,  and  systematic  breath- 
ing exercLses  to  combat  dyspnoea.  Treat  the 
as.sociated  chronic  bronchitis  or  bronchiecta- 
sis symptomatically,  as  tk'scribed  under  these 
captions.  The  occurrence  of  broken  cardiac 
compensation  calls  for  digitalis  (see  Cardiac 
Iirsufficiency.) 

Pulmonary  Collapse  in  Infants  and  Chil= 
dren. — See  Atelectasis. 

Pulmonary  Collapse,  Post=Operative. — A 

gradual  partial  or  complete  collapse  of  the 
lower  lobe  of  one  or  both  lungs,  with  the 
appearance  after  twenty-four  to  thirty-six 
hours,  of  the  following  signs,  viz.,  rise  of 
the  heart,  liver  or  stomach  or  both,  perhaps 
extension  of  stomach  tjanpany  into  the 
axilla;  diminished  breath-sounds,  distant 
bronchial  breathing,  altered  voice-sounds, 
diminished  resonance,  and  perhaps  crepita- 
tions over  the  collapsed  lower  lobe  or  lobes; 
expanded  and  immobile  lower  thorax;  and 
increased  breath-.sounds  over  the  upper 
lobes.  Alarming  attacks  of  dyspnoea  some- 
times occur,  lasting  from  a few  seconds 
to  three  or  four  hours.  The  condition  is 
the  result  of  a toneless  flaccidity  of  the 
abdominal  muscles.  Massive  collapse  of  the 
lower  lobes  occurs  also  in  complete  para- 
plegia and  in  patients  long  bed-ridden. 

Treatment. — Prop  the  patient  up  in  a sitting 
posture,  compress  the  lower  thorax  bimanu- 
ally  at  intervals,  and  encourage  the  patient 
to  breath  deeply,  using  the  abdominal  mus- 
cles. A large  mustard  poultice  (Part  11), 
may  be  of  service.  Oxygen  may  be  adminis- 
tered (see  under  Pneumonia),  and  if  con- 
sidered advisable,  strychnine,  gr.  }<20>  or 
camphor,  gr.  i-ii,  in  ether,  r\,x-xv,  may  be 
admini.stered  hypodermically.  If  tliere  is  no 
fever  (indicative,  possibly,  of  inhalation 
bronchitis  or  pneumonia),  the  patient  may 
blow  fluid  from  one  Wolff’s  bottle  to  another. 
(J.  C.  Briscoe.) 

Pulmonary  Congestion. — I.  Acute  or  Active 
Congestion.- The  symptoms  and  signs  are 
those  of  pneumonia. 


PUL.AIONARY  (EDEMA 


Causes. — Inflammation  (pneumonia, 
bronchitis,  pleurisy,  tuberculosis);  malarial 
or  other  chills;  inlialation  of  very  hot  or 
very  cold  air,  or  of  irritating  gases; 
violent  exertion. 

Treatment. — The  treatment  is  that  of 
the  initial  stage  of  pneumonia,  e.g.,  dry  cups 
over  the  whole  chest,  or  the  withdrawal  of 
20  to  30  ounces  of  blood  in  robust  subjects; 
mustard  poultices;  catharsis. 

II.  Passive  Congestion. — SYMPTOMATOLOGY. 
— Dyspnoea  on  exertion,  cyanosis,  cough, 
with  or  without  expectoration,  which  is 
apt  to  be  blood-stained;  dulness,  increased 
fremitus,  and  moist  rales  over  the  bases  of 
the  lungs. 

Causes. — Valvular  heart  disease; 
compression  of  the  bases  of  the  lungs  by 
abdominal  tumors,  meteorisin,  or  ascites; 
compression  of  the  pulmonaiy  veins  by 
tumor  or  aneurysm;  hypostasis  tlue  to  weak 
heart  action,  prolonged  reciunbency,  and 
deficient  aeration  in  the  aged  and  feeble. 

Treatment. — The  treatment  of  congestion 
due  to  cardiac  insufficiency  is  that  of  the  un- 
derlying affection  (see  Cardiac  Insufficiency). 

Hypostatic  congestion  should  be  avoided 
by  changing  the  patient’s  position  every 
hour  or  two.  When  it  occurs,  the  bowels 
should  be  opened,  the  heart  carefully  stimu- 
lated, dry  cups  (q.v.)  applied  over  the  bases 
of  the  lungs  in  back,  and  perhaps  ammonium 
carbonate  (Part  11)  administered. 

Pulmonary  Distomiasis. — See  Distomiasis. 

Embolism. — See  Embolism. 

Emphysema. — See  Emphysema,  Pul- 
monary. 

Fibrosis. — See  Pulmonary  Cirrhosis. 

Fluke. — See  Distomiasis. 

Pulmonary  Gangrene. — Gangrene  of  the 
lung  is  usually  first  manife.sted  by  an 
abrupt  increase  in  the  preexisting  sjnnptoms, 
increase  of  cough  and  fever,  and  the  occur- 
rence of  chills.  The  sputum  and  breath 
become  intensely  fetid,  and  the  sputum 
usually  copious,  sejiarating  on  standing  into 
three  layers,  the  bottom  layer  thick,  opaque, 
yellow  or  greenish-brown,  and  containing 
pus  and  elastic  tissue,  the  middle  layer  a 
transparent  serous  fluid,  and  the  top  layer 
thick,  opacpie,  dirty  yellow  and  frothy. 
Prostration  and  complete  anorexia  occur. 
Hemorrhage  is  very  ]:>r()ne  to  occur.  Empy- 
ema and  j)ysemia  may  ensue.  The  condition 
is  very  fatal. 

Etiology.— Lobar  ))neumonia;  bronchopneu- 
monia, particularly  asjiiration  penumonia; 
tuberculosis;  bronchiectasis;  pulmonary  ab- 
scess; pulmonary  embolism  or  thrombosis; 
foreign  body  in  a bronchus;  traumatism; 


pressure  upon  the  pulmonary  vessels  by  an 
aneurysm  or  tumor;  rupture  into  the  lung 
of  an  oesophageal  cancer;  debilitating  dis- 
ease, especially  diabetes. 

Treatment. — The  patient  should  be  in 
bed  on  a highly  concentrated  liquid  diet,  in- 
cluding liberal  doses  of  alcohol.  For  excessive 
cough,  pain,  and  hemorrhage,  administer 
morphine.  The  internal  and  external  use  of 
antiseptics  and  deodorants  is  described  under 
feetid  or  putrid  bronchitis  (q.v.),  and  pul- 
monary abscess  (q.v.). 

If  the  gangrene  is  circumscribed,  an  early 
operation,  as  described  under  Pulmonary 
Abscess,  offers  the  best  prospects  of  cure. 
Use  the  X-ray  (q.v.)  as  an  aid  in  locating 
the  diseased  area. 

Pulmonary  Hemorrhage. — See  Haemop- 
tysis. 

Hypertrophic  Osteoarthropathy. — See 

(isteo-Arthropat  hy . 

Infarction. — See  Embolism. 

Neoplasms. — L.  pul'mo,  lung;  Gr.  reos 
new  -f  irXaapoi  formation.  See  Pul- 
monary Tumors. 

Pulmonary  (Edema. — L.  pul'mo,  lung; 
Gr.  oibrifxa  swelling.  I.  Acute.— Acute  pul- 
monary oedema  is  manifested  by  the  sudden 
occurrence  of  dyspnoea,  pallor,  livichty,  a 
rapid  weak  pulse,  perhaps  cough  and  expec- 
toration, the  latter  sometmies  copious  and 
albiuninous,  frothy  and  pinkish,  and  the 
presence  of  loucl  bubbling  rales  heard 
over  the  whole  chest.  The  prognosis  is 
always  serious. 

Etiology.: — Cardiac  and  vascular  dis- 
ease (myocarditis,  vahnilar  disease,  angina 
pectoi’is,  arteriosclerosis);  Bright’s  disease; 
a convulsive  seizure,  but  particularly  status 
epilepticus;  anaesthetization;  apoplexjq  acute 
alcoholism;  asthma;  tabes  dorsalis;  extreme 
cold;  infectious  disease;  pleuritic  effusion; 
too  rapid  paracentesis  thoracis  vel  abdom- 
inis causing  sudden  expansion  of  the  lungs; 
erj-thrsemia;  angioneurotic  oedema;  preg- 
nancy; labor;  intense  mental  emotion; 
hysteria  (?);  jwisoning  with  lead,  iodine, 
adrenalin,  acetic  ether,  nitric  oxide,  aimnonia. 

Treatment.- — Raise  the  foot  of  the  bed, 
unless  the  dyspnoea  is  thereby  increased. 
Apply  dry  cups  to  the  entire  back  of  the 
chest,  followed  by  large  mustard  poultices 
(Part  1 1 ) to  the  whole  chest.  A dry  cup  is 
applied  as  follows:  a tumbler  is  swabbed 
(luickly  with  alcohol,  the  edges  wiped  dry, 
the  alcohol  ignited  and  allowed  to  burn  for 
a few  moments,  and  the  cup  then  quickly 
applied.  A'enesection,  withdrawing  20  to 
30  oz.  of  blood,  or  wet  cupping  (q.v.)  may  be 
advisable.  Atropine  (Part  11)  in  sufficient 


PYELONEPHRITIS 


dosage  to  produce  flushing  is  well  recom- 
mended. I'he  feeble  heart  must  be  stunu- 
lated,  employing  to  this  end — aromatic 
spu’its  of  ammonia,  one  teaspoonful  well 
cUluted  in  water;  caffeine  citrate,  gr.  ii-v; 
digitalin  (q-v.);  camphor,  gr.  i-ii,  in  oil  or 
ether,  njx-xv,  every  half-hour;  strychnine, 
gr.  strophanthin,  gr.  >^oo  to  Hoo, 

intravenously  or  intramuscularly;  amyl 
nitrite  by  inhalation  for  the  purpose  of 
abstracting  blood  from  the  lungs.  Oxygen 
inhalations  (see  under  Pneumonia)  may  or 
may  not  be  of  some  service.  Croftan  rec- 
ommends ergot  hypodermically  as  a vaso- 
constrictor. If  the  patient  is  apprehensive, 
administer  morphine,  gr.  to  34-  Miller 
considers  morphine  the  best  remedy  for  pul- 
monary oedema. 

In  nephritis,  employ  catharsis  and  dia- 
phoresis, and  make  hot  applications  to  the 
kidneys,  as  described  under  Uraemia. 

To  prevent  recurrent  attacks  the  patient 
should  avoid  oveifatigue,  overeating,  emo- 
tional excitement,  and  sudden  chilling. 

II.  Chronic.— Chronic  pulmonary  oedema 
occurs  in  chronic  cardiac  or  renal  disease, 
etc.,  and  is  manifested  by  the  presence  of 
numerous  rales  over  the  depemlent  portions 
of  the  lungs  (see  Pulmonary  Congestion, 
Passive). 

Pulmonary  Sclerosis. — See  Pulmonaiy 
Cirrhosis. 

Tuberculosis. — See  Tuberculosis,  Pul- 
monary. 

Pulmonary  Tumors. — Carcinoma,  endo- 
thelioma, and  sarcoma  occur  both  as  primary 
and  secondary  growths,  usually  the  latter. 
There  is  an  acute  galloping  pleuropneu- 
monic  form  of  carcinoma,  and  a chronic 
pleuro-pulmonarj^  form.  Tuberculosis  is 
usually  diagnosed.  The  X-ray  may  be  of 
assistance.  A Wassermann  test  should  be 
made.  A pleuritic  effusion,  usually  hemor- 
rhagic, may  be  the  most  prominent  feature. 
Mediastinal  pressure  symptoms  sometimes 
occur  early  as  a result  of  involvement  of 
the  glands. 

Echinococcus  cysts  sometimes  occur.  If 
not  operated  upon,  death  from  rupture  or 
septic  infection  is  prone  to  occur.  The  cyst 
wall  should  be  sutured  to  the  external 
wound,  and  continuous  drainage  established. 
It  may  perhaps  be  possible  to  remove  the 
inner  secreting  layer  of  the  cyst  (see  Echino- 
coccus Disease). 

Malignant  intrathoracic  growths  should 
be  subjected  to  radiotherapy  (q.v.).  The 
thorax,  including  the  axillae  and  supra- 
clavicular regions,  should  be  divided  into 
convenient  areas,  and  the  surrounding  skin 


protected  with  lead  screens.  Use  a hard 
tube  (10  Bauer,  if  possible),  as  near  as 
possible  to  the  skin  surface,  with  a current 
of  4 to  5 milliamperes,  using  a 3 mm. 
aluminium  filter.  Measure  the  dose  each 
time  by  means  of  Kienbock  j^aper  or  other 
means.  Give  ten  or  twelve  exposures  at 
one  sitting,  followed  on  succeeding  days 
“ with  as  many  exposures  as  it  is  possible 
to  fit  into  the  thoracic  area  without  over- 
lapping.” A dose  of  lOOX  or  more  may 
thus  be  atlministered  in  one  or  two  days. 
Confine  the  patient  to  bed  and  watch  the 
pulse  and  temperature  for  several  days  there- 
after, as  a marked  reaction  may  occur.  (Knox.) 

Pulsus  Alternans. — L.  pul'sus,  stroke; 
alternans,  alternating.  See  Arrhythmia. 

Purpura. — See  Part  5,  Skin  Diseases. 

Putrid  Bronchitis. — See  under  Bronchitis. 

Sore  Mouth. — See  Stomatitis,  Ulcera- 
tive. 

Pyelitis. — See  Pyelonepliritis,  following. 

Pyelonephritis. — Gr.  irveXos  trough  (pelvis) 
-f  pe<()p6s  kidney  -trts  inflammation. 
Under  this  caption  are  embraced  pyelitis, 
catarrhal  or  suppurative,  pyonejDhrosis,  and 
supijurative  nephritis  or  kidney  abscess. 

Pyelitis  or  pyelonephritis  may  be  acute 
or  chronic.  The  sjanptoms  may  be  very 
mild,  or  they  may  be  severe.  They  are  as 
follows:  some  elevation  of  temperature 

(except,  perhaps,  in  pyonephrosis);  usually 
frequent  urination;  perhaps  dysuria;  in 
acute  cases  usually  oliguria;  in  chronic  cases 
polyuria;  pyuria  or  bacteriuria;  tenderness 
at  the  cast ro- vertebral  angle;  perhaps  some 
enlargement;  sometimes  chills,  fever,  and  a 
septic  state.  Pain  and  even  tenderness  are, 
in  rare  cases,  referred  to  the  sound  side. 
The  affection  is  common  in  children  (espe- 
cially female  infants)  and  in  the  aged,  but  is 
uncommon  in  adult  hfe. 

Have  the  j^atient  void  the  urine  each 
time  during  the  twenty-four  hours  in  sep- 
arate bottles  of  the  same  size,  and  mark 
each  bottle  with  the  time  of  urination. 
“ If  the  case  is  one  of  cystitis  without 
involvement  of  the  kidney,  the  amount  of 
pus  that  settles  is  practically  the  same  in 
each  bottle  (allowing  for  differences  in  the 
amount  of  urine  in  the  different  bottles). 
But  if  the  pus  comes  from  the  kidney,  it  is 
almost  always  discharged  intermittently, 
and  hence  some  of  the  bottles  will  be  almost 
free  from  sediment,  while  in  a group  of 
others  the  amount  of  pus  increases  as  we 
pass  along  the  line,  reaches  a maximum  in 
one  or  two  bottles,  and  decreases  again  in 
those  representing  the  later  acts  of  micturi- 
tion. Pus  from  the  bladder  is  generally 


rYELoxEPiiurns 


alkaline,  although  in  tuberculosis  it  may  bo 
acid;  pus  from  the  kidney  is  generally  acid.” 
Both  organs,  however,  are  frequently  in- 
volved (R.  C.  Cabot).  Says  Howard  A. 
Kelly:  “All  persistent  acid  pyurias  in  young 
p(^ople  are  presumptively  tubercular  (usu- 
ally due  to  disease  of  the  kidney)  until  the 
contrary  is  proved.” 

Examine  the  j)us,  or  centrifuged  (for  at 
least  five  minutes)  urinary  sediment,  for 
tubercle  bacilli  (see  under  Tuberc.  Pulm.), 
and  if  necessary,  inoculate  a guinea  pig 
intraperitoneally.  For  both  purposes  obtain 
(he  urine  under  aseptic  precautions  (first 
cleanse  the  glans  penis  and  prepuce  and 
irrigate  the  urethra  with  boric  acid  solution, 
5i  ad  Oi,  then  take  the  last  urine  voided, 
in  order  to  exclude,  as  far  as  possible,  the 
smegma  bacillus),  centrifuge  it  for  at  least 
five  minutes,  and  use  the  washed  sediment. 
Keep  the  guinea-pig  under  observation  for 
three  or  four  to  six  weeks,  then  kill  it  and 
examine  sections  of  the  retroperitoneal 
glands,  s{)leen,  and  liver  microscopically. 

Says  Keyes:  “ Chronic  pyuria,  frequency, 
and  ]:>ain,  in  the  absence  of  retention,  sug- 
gest jn-ostatitis  (chronic  posterior  urethritis) 
or  i\yelonephritis  rather  than  cystitis.” 
“ When  the  urine  is  ammoniacal,  there  is 
always  cystitis  ”;  but  pyelonephritis  may,  of 
course,  also  be  jn’esent. 

Says  Frank  Kidd:  “ If  fever  is  present,  the 
case  cannot  be  one  of  pure  cystitis.  Fever 
with  pyuria  in  a woman  is  always  pyelitis, 
and  in  a man  is  usually  prostatitis.”  If  the 
second  of  two  glasses  in  which  the  urine  has 
been  passed  “is  cloudy,  the  case  may  be 
either  cystitis  or  pyelitis.  If  there  is  fever, 
it  must  be  pyelitis.  If  there  is  no  fever,  the 
diagnosis  can  only  be  made  by  cystoscopy 
and  cathetei’ization  of  the  ureters.”  In  man, 
if  the  second  glass  is  clear,  gently  massage 
(he  prostate,  and  examine  the  expressed 
secretion  for  j)us  cells  and  bacteria. 

Cystoscojiy  and  ureteral  catheterization 
are  ini])ortant  diagnostic  means.  Indigo- 
(^armine  (0.16  gm.  in  sterilized  water)  or 
methylene  blue  (Part  11)  may  be  injected 
hypodermically  as  an  aid  in  finding  the  ure- 
teral orifices.  Search  the  ureter  for  stricture 
or  stone  (a  wax-tippc'd  bougie  may  be  used  for 
the  latter  purjiose).  Examine  the  separate 
urines  obtained  by  ureteral  catheterization 
(see  Urinalysis).  “The  various  segrega- 
tors,”  says  Young,  “ are  absolutely  unre- 
liable.” “ The  finding  of  a thickened  ureter 
by  vaginal  examination  is  of  the  utmost 
importance  ” in  the  diagnosis  of  renal  tuber- 
culosis. (T.  R.  Brown.) 

The  pelvis  of  the  kidney  may  be  outlined 


I)y  means  of  the  X-ray  after  the  injection  of 
about  20  c.c.  of  25  per  cent,  sodium  bromide 
solution,  through  the  orateral  catheter. 

Etiology. — Acute  infectious  diseases  (catar- 
rhal fever,  scarlet  fever,  measles,  smallpox, 
influenza,  typhoid  fever,  pneumonia,  dysen- 
tery, septicopyaemia,  ulcerative  endocarditis, 
tuberculosis,  syphilis,  etc.);  focal  infections 
(furuncle,  carbuncle,  tonsillitis,  alveolar 
abscess,  pyorrhoea  alveolaris,  sinusitis,  rectal 
ulceration,  osteomyelitis,  contagious  im- 
petigo, actinotnycosis,  etc.),  intestinal 
diseases;  constipation;  neighboring  inflam- 
mation (appendicitis,  hepatitis,  pelvic  peri- 
tonitis, enteritis,  psoas  abscess);  parasites 
(actinomyces,  eustrongylus  gigas,  echino- 
coccus, filaria);  local  irritation  due  to  tur- 
pentine, cantharides,  cubebs,  glycosuria, 
polyuria,  hyperacidity,  calcium  oxalate 
cry.stals  (see  Nephrolithiasis),  and  calculi; 
retention  of  urine  due  to  urethral  stricture, 
ureteral  stricture,  contracted  bladder,  phi- 
mosis, enlarged  pro.state,  stone,  pregnancy, 
pelvic  growths,  nephroptosis,  paralysis  of  the 
bladder  due  to  injury  or  disease  of  the  spinal 
cord,  voluntary  holding  of  urine;  trauma- 
tism; in.strumentation ; malignant  disease; 
gonorrhoea;  overexertion  with  subsequent 
chilling;  chronic  passive  congestion;  debili- 
tating influences  (ana'inia,  malnutrition, 
tabes,  paresis,  etc.);  cystitis. 

C’ausal  bacteria,  named  in  the  order  of 
their  frequency,  are  the  colon  bacillus  (nearly 
always  the  cause),  the  tubercle  bacillus, 
staphylococcus,  streptococcus,  gonococcus, 
typhoid  bacillus,  paratyphoid  bacillus,  pneu- 
mococcus, and  proteus  bacillus  (IMacGowan). 
In  tuberculosis,  colon,  and  typhoid  infec- 
tions, the  urine  is  acid,  in  proteus  infection 
alkaline,  and  in  staj^hylococcus  and  strep- 
tococcus infections  less  acid  than  normal, 
or  alkaline. 

Treatment.— I.  AcUTE  Pyelitis  OR  PYELO- 
NEPHRITIS.— Put  the  patient  to  bed  on  a 
light,  bland  diet,  consisting  largely  of  milk 
or  buttermilk  and  an  abundance  of  water, 
4 to  6 pints  a day  (see  under  Bright’s  Disease, 
for  the  appropriate  dietary).  Exclude  alco- 
hol, condiments,  spices,  radishes,  asparagus, 
rhubarb,  tomatoes,  lemons,  cheese,  red 
meats,  smoked  ancl  salted  meats  and  fish, 
tea,  coffee,  ginger  ale,  carbonated  beverages, 
ami  tobacco,  because  of  their  irritating  effects 
upon  the  kidney.  Ojien  the  bowels  freely. 

The  following  sedative  and  astringent 
diuretics  (see  Part  11  for  all  drugs)  may 
prove  of  service,  e.g.,  flaxseed  or  linseed  tea, 
l)uchu,  uva  ursi,  pareira  brava,  triticum 
repens,  saw  jialmetto;  but  the  remedy  par 
excellence  is  urotropine  or  helmitol.  The 


rvi.oiuc  SPASM 


former  liberates  formaldehyde  011I3'  in  an 
acid  urine;  the  latter  in  either  an  acid  or 
alkaline  urine.  If  the  urine  is  alkaline,  it 
may  be  rendered  acid  by  the  administration 
of  benzoic  acid,  boric  acid,  camphoric  acid, 
sodium  or  ammonium  benzoate,  or  acid 
sodium  phosphate.  Reduce  the  dose  of  uro- 
tropine  if  it  causes  irritation.  For  an  irri- 
tating hyperacid  urine,  prescribe  sotlium  or 
potassium  bicarbonate,  or  potassium  citrate. 
It  may  be  of  advantage  to  produce  a medium 
of  a different  reaction  than  the  offending 
bacteria  are  accustomed  to. 

Of  less  value  than  urotropine  arc  methy- 
lene blue  and  salol. 

Vaccine  therapy  is  recommended  by  some, 
e.g.,  autogenous  colon  vaccine,  five  millions, 
increased  by  five  millions,  every  three 
days,  up  to  fifty  millions  if  necessary. 
(J.  Keogh  Murphy.) 

During  the  first  forty-eight  hours,  the  ice- 
bag  may  be  applied,  followed  by  hot  fomen- 
tations or  hot  water,  sand  or  bran  bags,  or 
dry  or  wet  cups  (see  Cupping). 

In  very  severe  cases,  Hunner  advises  con- 
tinuous irrigation,  through  a No.  5 P’rench 
renal  catheter,  with  normal  saline  solution 
(5i  ad  Oi)  or  boric  acid  (5i  ad  Oi),  or  silver 
nitrate  (1  : 10,000)  until  the  symptoms  sub- 
side; but  J.  Keogh  Alurphy  considers  irri- 
gation “ inadmis.sible.” 

In  pregnancy  cases,  have  the  patient  lie 
upon  the  opposite  side.  The  bladder  may  be 
distended  with  sterile  boric  acid  or  normal 
salt  solution  for  the  pm’pose  of  exciting 
peristalsis  in  the  ureters.  The  induction  of 
premature  labor  is  rarely  required,  but  it 
should  be  resorted  to  promptly  should  serious 
symptoms  arise. 

The  occurrence  of  septic  symptoms  or  of 
enlargement  of  the  kidney  indicates  pus 
retention  and  calls  for  free  drainage  by 
means  of  catheterization,  urethrotomy,  cys- 
totomy, or  nephrotomy,  according  to  the  site 
of  the  obstruction.  Obstructing  stones 
should  be  removed.  A suppurating  kidney 
should  be  removed.  After  nephrostomy, 
a discharging  sinus  remains  in  50  per 
cent,  of  the  cases,  necessitating  nephrec- 
tomy. In  performing  the  latter,  the  ureter 
should  be  ligated  and  divided  as  low  down 
as  possible. 

Acute  pyelitis  usually  clears  up  in  about 
ten  or  fourteen  days.  It  may  become 
chronic.  Continue  the  urotropine  and  copi- 
ous waterdrinking  for  several  weeks  after 
the  inflammation  has  subsided  and  the  urine 
has  cleared. 

II.  Chronic  Pyelitis  or  Pyelonephri- 
tis.— The  treatment  depends  upon  the 


cause.  Calculi  should  be  removed  (see 
Nephrolithiasis);  retention  {q.v.  in  Part  3, 
Genito-Urinary  Diseases),  should  be  cor- 
rected; a ureteral  stricture  should  be  dilated 
eveiy  ten  to  fourteen  days,  or  less  often,  or 
corrected,  if  possible,  by  operation;  a 
tuberculous  kidney  shoukl  be  removed; 
chronic  constipation,  ansemia,  malnutrition, 
or  other  possible  causal  influence  should 
bo  corrected. 

Presiu'ibe  copious  water  ilrinking,  a dietaiy 
like  that  for  chronic  nephritis  {q.v.),  and 
urotropine  or  helniitol.  Vaccine  therapy  is 
well  recommended. 

The  following  stimulating  and  antiseptic 
cUuretics  are  recommended  in  chronic  pye- 
litis, viz.,  juniper,  oil  of  origanmn,  oil  of 
turpentine,  oil  of  sandalwood,  and  oil  of 
copaiba. 

In  chronic  cases  which  are  not  relieved  in 
ten  days  by  urotropine,  Hunner  injects  four 
two-way  glass  syringefuls  of  15  c.c.  capacity 
of  silver  nitrate  solution,  1 : 1000,  followed 
by  a syringeful  of  normal  saline  (oi  ad  Oi)  or 
boric  acitl  (oi  ad  Oi)  solution  to  wash  out 
the  silver.  The  jire.ssure  should  not  be 
carried  to  the  point  of  jiroducing  pain. 
The  renal  {lelvis  may  be  irrigated  once  or 
twice  weekly  with  silver  nitrate,  1 : 10,000 
to  1 : 5000;  or  protargol,  1 : 500;  or  boric 
acid  solution.  If,  however,  the  jius  does 
not  diminish  after  a few  irrigations,  it  is 
useless  to  continue  them.  Local  treatment 
is  contraindicated  in  renal  calculus  and 
tuberculosis. 

Operation  upon  the  kidney  (nephrotomy; 
nephrectomy)  should  not  be  uiulertaken 
unless  considered  ab.solutely  necessary.  Says 
Keyes:  “ To  do  nothing  is  usually  prefer- 
able.” “ If  operation  is  undertaken,  it 
should  be  with  the  deliberate  intention  of 
freeing  the  renal  pelvis  of  adhesions,  decap- 
sulating  the  Iddney  (to  relieve  tension),  and, 
if  necessary,  performing  nephropexy  (to  re- 
lieve retention).”  “ Nephrotony^  should 
not  be  performed  unless  required  in  the 
.search  for  stone.”  Nephrectomy,  of  course, 
should  not  be  considered  until  the  other 
kidney  is  proved  to  be  functionally  active 
(see  Urinalysis).  The  presence  of  albumen 
alone  in  the  urine  from  the  other  kidney  is 
not  a contraindication  to  nephrectomy,  Init 
the  presence  of  pus  and  liacilli  is. 

Pyaemia. — Gr.  ivlov  pus  -t-  al^ta  blood.  See 
Septicsemia  and  Septico-Py®mia. 

Pyloric  Obstruction. — ^Gr.  ttcXt)  gate  -|- 
o'>pos  guard.  See  Dilatation  of  the 
Stomach,  Chronic. 

Pyloric  Spasm. — See  Dilatation  of  the 
Stomach,  Chronic. 


PYORRHCEA  ALVEOLARIS 


Stenosis. — See  Dilatation  of  the  Stom- 
ach, Chronic. 

Pyenophrosis. — Gr.  tt'>ov  pus  -|-  ve4>p6s 
kidney.  See  Pyelonephritis. 

Pyopericardium. — Gr.  w^ov  pus  wepL 
around  + Kapdia  heart.  See  Pericarditis. 

Pyopneumothorax. — ^Gr.  tt'jov  pus  + irvevpa 
air  -|-  dupa^  chest.  See  Pneumothorax. 

Pyorrhoea  Alveolaris;  Rigg’s  Disease; 
Periodontitis,  Chronic  Suppurative. — Gr. 
TTvov  pus  -h  poLa  flow;  L.  al'vem,  a trough; 
Gr.  irepi  around  odovs  tooth  + -irts  inflam- 
mation. Chronic  suppurative  inflammation 
of  the  pericsemental  membrane  or  tissue, 
which  occupies  the  space  between  the  root 
of  a tooth  and  the  alveolus  of  the  jaw, 
manifested  by  the  presence  of  gingivitis, 
loose  teeth,  a characteristic  disagreeable 
odor,  and  the  appearance  of  pus  on  pressing 
the  gum. 

The  disease  occurs  in  gout,  rheumatism, 
nephritis,  tliabetes  mellitus,  pernicious  an- 
semia,  tuberculosis,  syphilis,  tabes,  and  other 
constitutional  affections,  but  it  may  possibly 
be  purely  local.  Various  microorganisms 
may  be  demonstrated,  especially  strepto- 
cocci, pneumococci,  spirochet®,  and  the 
endamoeba  gingivalis  or  buccalis. 

As  a result  of  septic  absorjjtion  the  follow- 
ing complications  are  possible,  viz.,  head- 
ache, indigestion,  diarrhoea,  constipation, 
acne,  nephritis,  pyelitis,  appendicitis,  chole- 
cystitis, pleuritis,  arthritis,  myositis,  neu- 
ritis, endocarditis,  an®mia,  Hodgkin’s 
disease,  etc.,  etc. 

Treatment. — All  stumps  and  dead  or  pulp- 
less teeth  should  be  removed, and  the  remain- 
ing teeth  scaled  and  polished.  Infected 
pockets  should  be  irrigated,  or  filled  once 
daily  with  antiseptics  by  means  of  a hypo- 
dermic syringe;  or,  better,  obliterated  by 
operation.  The  following  antiseptics  are 
used,  viz.,  hydrogen  peroxide,  3 to  10  per 
cent.;  Dobell’s  solution  (Part  11);  emetine 
hydrochloride,  0.5  per  cent,  solution  (should 
not  be  swallowed).  (i)nce  daily  the  gum 
margins  should  be  painted,  by  means  of  a 
cotton-wound  wooden  applicator,  with  tinc- 
ture of  iodine,  or  the  following  preparation; 

Zinci  iodidi 15.0  (gr.  Ixxii) 

Aqua? 10.0  (n^xlviii) 

lodi 2.5.0  (3  ii) 

Glycerini 50.0  (5iv)  (Talbot.) 

.\fter  the  application,  hold  the  lips  and 

cheeks  away  until  the  iodine  has  dried 
(Talbot).  Zinc  ionization  (q.v.)  is  recom- 
mended. A 3 per  cent,  solution  of  zinc 
sulphate  is  used,  with  a current  of  3 to  4 
milliamperes  for  ten  minutes. 


Instruct  the  patient  to  brush  the  teeth 
frequently,  especially  before  breakfast,  with 
Castile  soap  and  warm  water,  and  to  use  an 
antiseptic  mouth-wash,  such  as  Dobell’s 
solution,  or  hydrogen  peroxide,  3 to  10 
per  cent.,  or  fluid  extract  of  ipecac  2 to  3 
drops  in  half  a glass  of  water  (Bass);  or 
the  following: 

B Hydronaphtholis gr.  xv 

AlcoholLs, 

Aquae,  aa 5i 

M.  kSig. — ^Thirty  drops  in  a glass  of  warm  water, 
twice  daily,  as  a mouth-wash.  (Riesman.) 

II  Liquoris  potassae 3 vi 

Acidi  carbolic!. . 3iv 

Liquoris  cocci 3 ii 

Aquam,  ad 5viii 

M.  Sig. — One  teaspoonful  to  half  a tumblerful  of 
warm  water  as  a mouth-wash.  (F.  St.  J.  Steadman.) 

The  hypodermic  injection  of  emetine 
hydrochloride,  gr.  ss  daily,  for  three  to  six 
successive  days,  causes  a prompt  disap- 
pearance of  the  amoeb®;  but  since  rein- 
fection occurs  in  four  weeks  in  12  per  cent, 
of  the  cases,  the  course  of  emetine  must  be 
repeated  every  three  to  four  weeks. 

B.  L.  Wright  and  P.  G.  White  recommend 
intramuscular  mjections  of  mercuric  suc- 
cinimide  every  seven  days  (for  3 or  more 
injections),  gr.  ss  for  men,  to  less  for 
women.  “If  the  patient  is  improtnng,  each 
succeeding  dose  may  be  slightly  reduced.” 

Vaccine  therapy  may  be  of  benefit  in 
chronic  intractable  cases.  A stock  vaccine, 
either  sensitized  or  unsensitized  (see  Part  11) 
may  be  used,  or  an  autogenous  vaccine  pre- 
pared from  the  pus  pockets.  “ If  an  unsen- 
sitized bacterin  is  employed,  the  initial  dose 
advised  is  150  million  of  the  mixed  bacteria; 
from  250  to  270  million  may  be  given  as  the 
initial  dose  if  the  sensitized  cultures  are 
employed.  Subsequent  doses  are  injected 
at  intervals  of  from  seven  to  ten  days, 
gradually  increasing  or  decreasing  accord- 
ing to  indications.  If  the  reactions  are  too 
severe,  the  doses  should  be  reduced  or  tem- 
poraril}^  discontinued.  Every  dose  should 
be  carefull}^  gauged  by  the  effect  obtained 
from  the  preceding  dose.  If  no  improve- 
ment follows  the  initial  dose,  subsequent 
injections  should  be  increased  until  amounts 
large  enough  to  produce  a mild  clinical 
reaction  (demonstrated  by  sjnnptoms  of 
malaise  and  possibly  aggravation  of  the 
local  sjnnptoms)  are  reached.  If  a marked 
clinical  reaction  occurs  after  a dose,  char- 
acterized by  rising  temperature,  the  next 
dose  should  be  smaller.”  (F.  E.  Stewart.) 

Mouth  breathing  should  be  corrected  (see 
Part  8,  Nose  Diseases),  and  the  general 


RADIUM 


health  must  be  looked  after.  Several  months 
may  be  required  for  a cure.  If  conservative 
measures  fail,  a cure  may  be  effected  by  the 
extraction  of  the  teeth. 

Pyothorax. — Gr.  ttuov  pus  + dupa^  chest. 
See  Empyema. 

Pyrexia. — Gr.  wvpkacreLv  to  be  feverish. 
See  Fever. 

Pyrosis;  Heartburn. — Gr.  irvpocns  burning. 
See  Hyperacidity. 

Pyuria. — Gr.  ttvov  pus  + ovpov  urine. 

Causes.— Urethritis  (gonorrhoeal,  etc.); 

prostatis;  vesiculitis;  cystitis;  pyelitis  and 
pyelonephritis ; nephrolithiasis ; renal  tubercu- 
losis; tuberculosis  of  the  prostate;  rupture 
into  the  urinary  tract  of  an  abscess  of  the 
appencUx,  Fallopian  tube,  prostate,  or  spine. 
Exclude  leukorrhoea.  See  Pyelonephritis 
for  diagnostic  data. 

Quincke’s  Disease. — See  Angioneurotic 
(Edema,  in  Part  5,  Skin  Diseases. 

Quinsy. — L.  cynanche,  sore  throat.  See 
Part  0,  Throat  Diseases. 

Rabies. — L.  ra'bere,  to  rage.  See  Hydro- 
phobia. 

Rachitis. — Gr.  pdyts  spine  -|-  -trts  in- 
flammation. See  Rickets 

Radial  Nerve. — L.  radia'lis,  pertaining  to 
a radius.  See  Brachial  Plexus. 

Radiology. — See  Rachum,  and  Rontgen- 
ology. 

Radium. — Radiiun  is  obtained  in  the  form 
of  its  salts,  RaBr22H90,  RaCl22HoO,  RaCOs, 
and  RaS04.  It  is  constantly  2°  or  3°  C. 
higher  in  temperature  than  its  surroundings, 
and  is  constantly  charged  with  negative 
electricity.  The  air  surrounding  radium  is 
ionized  and  becomes  a conductor  of  elec- 
tricity. An  atom  of  radium,  which  in  the 
aggregate  constitutes  a solid,  throws  off 
a positively  electrified  atom  of  heliiun 
(alpha  particle),  and  the  residual  atom  that 
remains,  which  in  the  aggregate  constitutes 
a gas,  is  called  “ radium  emanation,”  and 
Ls  itself  racho-active,  that  is,  it  undergoes 
spontaneous  disintegration.  The  emanation 
expels  alpha  particles,  with  the  further  for- 
mation of  a new  residual  body  called  Rad- 
ium A,  which  by  further  changes  gives  rise 
to  Ra  B and  Ra  C (Ra  Ci  and  Ra  C2). 
Ra  C emits  alpha  particles  (positively 
charged,  and  are  deviated  away  from  a 
magnet),  /3  rays  or  electrons  (negatively 
charged,  the  charge  equal  to  that  of  the 
alpha  particles,  and  deviated  toward  the 
magnet),  and  y rays  (not  deviated  by  a 
magnet),  the  latter  being  ether  pulses,  like 
those  of  light,  of  extremely  short  length  and 
high  penetrability.  All  three  rays  are  not 
refracted  or  reflected.  They  all  penetrate 
20 


substances  opaque  to  ordinary  light;  but 
alpha  rays  are  practically  all  absorbed  by 
aluminum,  0.01  to  0.02  mm.  tliick,  or  glass, 
0.5  mm.  thick.  The  /3  and  7 rays  penetrate 
glass,  particularly  the  7 rays;  4 mm.  of  lead 
or  silver  absorb  all  the  /3  rays;  0.5  mm.  of 
platinum  cuts  off  75  per  cent,  of  the  0 rays, 
and  4 per  cent,  of  the  7 rays;  alpha  and  beta 
rays  may  produce  gamma  rays  when  they 
strike  other  bodies;  2 mm.  of  rubber  (0.5  to 
4 mm. — Knox)  or  5 layers  of  lint  (20  to  30 
layers  in  long  exposures — Knox)  are  prob- 
ably sufficient,  says  Phillips,  to  suppress  the 
secondary  rays  from  the  lead. 

Alpha  rays  constitute  64  per  cent,  of  the 
radiation  from  radium,  beta  rays  about 
24  per  cent.,  and  gamma  rays  10  per  cent. 

Rachum  emanation  disintegrates  rela- 
tively rapidly  at  first,  but  after  a lapse  of 
six  weeks,  a state  of  equilibrium  between 
the  formation  of  emanation  from  radium 
and  the  disintegration  of  the  emanation  is 
reached,  that  is,  the  quantity  formed  per 
unit  of  time  equals  the  quantity  decayed. 
The  amount  of  radium  emanation  in  equi- 
librimn  with  one  gram  of  radium  element 
is  termed  one  curie.  One  milli-curie  equals 
2.7  million  mache  units. 

The  emanation  may  be  administered 
therapeutically  (1)  as  an  inhalation,  alone 
or  combined  with  ox>"gen;  (2)  by  mouth,  in 
solution  in  water,  oil,  or  other  liquids;  (3) 
by  injection,  in  solution;  and  (4)  by  intro- 
duction into  the  tissues  enclosed  in  tubes, 
in  the  same  way  as  rachum  itself  is  adminis- 
tered. One  should  always  bear  in  mind  the 
fact  that  the  emanation  is  continually  under- 
going decay,  0.18  of  the  original  amount 
decaying  per  day,  so  that  the  dose  may  be 
progressively  increased.  The  parent  rad- 
ium does  not  depreciate  noticeably. 

Rachum  is  usually  employed,  however, 
in  the  form  of  one  of  its  salts,  contained  in 
various  forms  of  applicators  (enclosed  in 
gutta-percha,  aluminum,  celluloid,  mica, 
etc.,  or  fixed  in  varnish  upon  the  surface  of 
the  applicator).  The  sound  skin  is  protected 
with  lead,  1 to  2 mm.  thick.  The  effect  of 
radium  upon  the  tissues  varies  with  the 
quantity  of  radium  used,  its  activity,  and 
the  filters  employed. 

Free  radium  in  platinum  tubes  0.2  to 
0.5  mm.  thick,  enclosed  in  a thin  rubber 
tube,  produces  a mild,  superficial  reaction 
on  exposure  of  one-half  to  one  hour.  For  a 
deeper  effect,  or  a surface  effect  free  from 
reaction,  a thicker  filter  is  required  and  a 
more  prolonged  exposure.  Wliere  the  Beta- 
rays  are  practically  all  cut  off,  as  with  a 
2 mm.  platinum  or  4 imn.  lead  or  silver 


RECTAL  STRICTURE 


filter,  the  exposure  must  be  greatly  pro- 
longed (because  of  the  small  percentage  of 
Gamma-rays  present)  even  up  to  twenty- 
four  hours.  The  skin  is  affected  mostly 
by  the  Beta-rays.  In  long  exposures,  cover 
the  skin  with  20  or  30  layers  of  lint.  An 
ulcerated  surface  will  bear  much  longer 
rachation  than  the  intact  skin.  (Knox.) 

Radium  tubes  may  be  sterilized  by  means 
of  carbolic  acid,  not  by  heat. 

Ragpicker’s  Disease. — See  Anthrax,  in 
Part  5,  Skin  Diseases. 

Railway=Brain  and  Railway=Spine. — See 
Hysteria,  and  Neurasthenia. 

Ranula. — L.  dim.  of  ra'na,  frog.  A bluish 
translucent  retention-cyst,  occurring  be- 
neath the  tongue,  and  due  to  obstruction 
and  dilatation  of  the  sublingual  or 
of  a mucous  gland,  rarely  of  the  sub- 
maxillary gland. 

The  treatment  is  excision.  If  a submaxil- 
lary ranula  bulges  externally  it  should  be 
removed  through  an  incision  below  the  jaw. 

Rapid  Heart. — See  Tachycardia. 

Rat=Bite  Fever. — A very  rare  spirochsetal 
affection  (Futaki)  due  to  the  bite  of  a rat, 
cat,  weasel,  or  ferret,  and  characterized  by 
an  incubation  period  of  about  two  weeks, 
followed  by  inflammation  and  ulceration  of 
the  healed  wound,  swelling  of  the  regional 
lymph  glands,  fever,  and  an  erythematous 
skin  rash,  these  symptoms  subsiding  after 
two  to  three  days,  but  recurring  at  five  to 
ten  day  intervals  for  months.  The  mortality 
is  about  10  per  cent. 

Treatment. — Cauterize  the  wound,  and 
treat  the  constitutional  disturbance  sympto- 
matically. Salvarsan  (see  Syphilis)  has  been 
found  of  value.  Two  or  three  injections 
appear  to  be  curative. 

Raynaud’s  Disease. — ^See  Part  5,  Skin 
Diseases. 

Rectal  and  Anal  Tumors. — L.  rectum, 
straight;  L.  amis;  tu'mere,  to  swell,  a.  Benign 
Tumors.— Fibroma;  adenoma  (single  or 
multiple,  sessile  or  pedunculated),  lipoma, 
angioma,  myoma;  my:xoma;  hunphoma; 
enchondroma;  dermoids;  papilloma;  condy- 
loma or  infectious  painlloma  (flat  or  pointed, 
spt^cific  or  non-s])ecific).  A benign  pedun- 
culated tumor  is  called  a polypus. 

b.  Malignant  Tumors. — Sarcoma,  carcinoma. 

Treatment. — For  proctoscopic  technicpie  see 
under  Enteritis.  Rectal  polypi  should  be 
ligated  and  removed ; the  angiotrobe  may  be 
used.  Sessile  tumors  should  be  dissected  out. 
Sigmoidal  pedunculated  growths  may  be 
snared;  but  sessile  tumors  in  the  sigmoid  are 
best  removed  by  transperitoneal  sigmoidot- 
omy  (Mayo).  Colonic  polyposis  is  some- 


times curable  by  ileostomy  and  rest  of  the 
bowel  for  several  months;  but  sometimes 
colectomy  as  far  as  the  lower  sigmoid  is 
required. 

In  inoperable  carcinoma,  keep  the  rectum 
clear  by  means  of  daily  laxatives  and  oil 
enemata.  Perform  colostomy  when  required, 
followed  by  the  systematic  administration 
of  codeine  or  morphine.  Schlesinger’s 
analgesic  solution  (Part  11)  is  of  particular 
service.  Palliative  measures  include  the  use 
of  radium  tubes  (q.v.)  placed  within  the 
stricture,  and  diathermy  (q.v.).  One  hun- 
dred mgrms.  of  radium  in  a platinum  tube 
2 mm.  thick  enclosed  in  a rubber  tube  2 mm. 
thick  may  be  left  in  situ  for  about  fifteen 
hours,  and  the  application  repeated  in 
a month. 

Rectal  Cancer. — ■ See  Rectal  and  Anal 
Tutnors. 

Rectal  Feeding. — The  following  is  a use- 
ful nutrient  enema:  Two  raw  eggs,  well 
beaten;  three  or  four  ounces  of  warm  milk; 
twenty  grains  of  sodium  bicarbonate;  thirty 
grains  of  sodium  chloride  (fifteen  grains  to 
each  egg);  a dessertspoonful  of  liquor  pan- 
creaticus;  perhaps  a tablespoonful  of  grape 
sugar  (to  obviate  acidosis);  and,  if  desired, 
one  or  two  tablespoonfuls  of  claret  or  brandy. 

The  enema  is  administered  every  eight  to 
twelve  hours;  and  the  colon  irrigated  at 
least  once  daily  with  normal  saline  solution 
(5i  ad  Oi) ; or  the  colon  may  be  cleansed  one 
hour  before  each  feeding,  and  one  pint  of 
the  saline  allow'ed  to  remain,  in  order  to 
prevent  or  to  relieve  thirst.  After  adminis- 
tering the  enema,  keep  the  patient  in  the 
same  position  for  half  an  hour,  with  the 
anus  supported  by  a pad.  If  the  enema  is 
not  retained,  five  to  fifteen  drops  of  lauda- 
num may  be  added. 

The  mouth,  gums  and  teeth  should  be 
clean.sed  frequently. 

Rectal  Inflammation. — See  Proctitis. 

Prolapse. — See  Prolapse  of  the  Rectum 
and  Anus. 

Rectal  Stricture. — Rectal  stricture  is  the 
result  of  chronic  proctitis,  of  whatever 
cause.  The  commonest  cause  is  cancer. 

Treatment. — Simple  stricture  may  some- 
times be  cured  by  the  very  careful  daily 
use  of  soft,  flexible  (Wales)  bougies,  left  in 
place  for  from  five  to  ten  minutes,  and  con- 
tinued for  years. 

In  low  stricture,  that  is,  one  within  five 
inches  of  the  anal  margin,  a posterior  inci- 
sion may  be  made  down  to  the  bone,  and 
including  the  sphincters. 

In  high  stricture,  a resection  may  be 
done,  or  an  anastomosis  established 


RETROPERITONEAL  ABSCESS 


between  the  sigmoid  and  the  rectum  below 
the  stricture. 

For  anal  stricture,  employ  various  sizes 
of  the  olive-shaped,  hard-rubber  dilator. 

For  the  treatment  of  inoperable  cancer  .see 
Rectal  and  Anal  Tumors. 

Rectal  Tumors. — -See  Rectal  and  Anal 
Tumors. 

Ulcer. — See  Proctitis. 

Rectitis. — See  Proctitis. 

Red  Neuralgia. — See  Erythromelalgia,  in 
Part  5,  Skin  Diseases. 

Regurgitation. — See  Rumination  and  Re- 
gurgitation. 

Relapsing  Fever;  The  Spirilloses. — An 

acute,  infectious,  usually  epidemic  disease, 
occurring  chiefly  in  Europe,  India,  and 
Africa,  due  to  several  varieties  of  si)irilluni 
or  spirochajte  which  may  be  found  in  the 
blood,  and  characterized  by  an  incubation 
period  of  from  five  to  seven  (to  sixteen)  days, 
followed  abruptly  by  chill,  fever,  head- 
ache, general  muscular  pains,  tender 
enlargement  of  the  liver  ancl  sjileen, 
perhaps  a roseolar  rash  becoming 
petechial,  and  cough  and  rales  over 
the  base  of  the  lungs,  these  symptoms 
terminating  in  from  three  to  ten  days 
(usually  about  six  days)  by  crisis  and 
sweating,  sometimes  diarrhoea,  to  be 
followed  by  a remission  of  usually  about 
six  days,  and  then  by  a second  febrile 
attack,  and  sometimes  a third,  fourth 
or  even  eleventh  attack.  Jaundice  is 
common.  The  causal  organi.sm  is  found 
in  the  blood  only  during  the  febrile 
period,  when  it  is  actively  motile.  Fig. 

65.  (See  Blood  Examination.) 

Recovery  is  the  rule.  The  mortality 
is  about  4 to  15-f  per  cent. 

Etiology.— The  disease  may  be  trans- 
mitted by  ticks,  bedbugs,  body  lice,  or 
mosquitoes.  The  spirilIo.ses  include 
(1)  the  tick  fevers  of  East  and  West  Africa, 
due  to  the  Spirillum  duttoni,  (2)  the  tick 
fever  of  Colombia,  (3)  the  relap.sing  fever  of 
Europe,  due  to  the  Sp.  obermeieri,  (4)  the 
recurrent  fever  of  America,  due  to  the  Sp. 
novyi,  (5)  the  recurrent  fever  of  Bombay, 
due  to  the  Sp.  carteri,  ((>)  the  recurrent  fever 
of  Algeria,  due  to  the  Sp.  berbera,  and  (7) 
the  recurrent  fever  of  Tonkin,  Indo-China. 

Treatment.— Isolate  the  jxatient  (see  Disin- 
fection). Prescribe  liquid  diet,  water  freely, 
hydrotherapy  (see  Fever),  bowel  activity, 
ice-cap  for  headache,  phenacetin,  antipyrine, 
or  morphine  (see  Part  11)  for  pain;  stimula- 
tion with  aromatic  spirits  of  ammonia,  cam- 
phor, caffeine  or  digitalin  at  the  crisis;  iron, 
good  food,  and  fresh  air  during  convales- 


cence. Salvarsan  or  neosalvansan  is  ajjpar- 
ently  a specific.  It  is  administered  intra- 
venously, as  in  Syphilis,  but  in  smaller  doses, 
since  these  patients  seem  peculiarly  sus- 
ceptible to  the  toxic  action  of  the  drug.  One 
dose  may  suffice. 

Quarantine  the  premises  for  at  least  six- 
teen days;  then  fumigate  the  house  with 
formaldehyde  and  sulphur,  etc.  See  Dis- 
infection. 

Renal  Abscess. — See  Pyelone{)hritis. 

Asthma. — See  Bright’s  Disease,  Chronic 
Intei’.stitial  Nephritis. 

Calculus. — See  Nephrolithiasis. 

Colic. — See  Nephrolithiasis. 

Degeneration,  Cystic. — See  Genito-Uri- 
nary  Diseases,  Part  3. 

Dilatation.  — See  Hydronephrosis,  in 
Part  3,  Genito-Urinary  Disea.ses. 

Infarction. — See  Part  3,  Genito-Urinary 
Diseases. 


Fig.  65. — The  spirochjete  of  relapsing  fever  (x  1200). 

Inflammation. — See  Bright’s  Disease, 
and  Pyelonephritis. 

Stone. — See  Nephrolithiasis. 

Suppuration. — See  Pyelonephritis. 

Tuberculosis. — See  Pyelonephritis,  and 
Genito-Urinary  Diseases,  Part  3. 

Tumors. — Sec  Genito-Urinary  Diseases, 
Part  3. 

Respiration,  Artificial.^ — See  under  A.s- 
phyxia. 

Retention  of  Urine. — See  Part  3,  Genito- 
Urinary  Diseases. 

Retroperitoneal  Abscess. — L.  re'tro,  back 
+ peritoneum.  The  symptoms  are  apt  to 
be  obscure,  and  to  suggest  typhoid  fever, 
miliary  tuberculosis,  or  septico-pyajmia. 
Deep  abdominal  tenderness  may  be  present. 


RHEUMATIC  FEVER 


The  abscess  may  point  in  the  lumbar  or  the 
iliac  region. 

Etiology.— Traumatism,  especially  in  the 
kidney  region;  intestinal  perforation,  due 
to  traumatism,  ulceration,  malignancy,  a 
foreign  body,  etc.;  infection  from  the  intact 
intestine;  operative  infection;  appendicitis; 
salpingitis;  rupture  of  an  hepatic  or  splenic 
abscess;  spinal,  pelvic,  or  costal  caries  (see 
Pott’s  Disease,  in  Part  10,  Orthopaedics); 
renal  stone;  renal  suppuration  (see  Pyelone- 
phritis); renal  tuberculosis. 

Treatment  of  Non=Tuberculous  Cases. — If  the 
application  of  large  hot  poultices  to  the 
lumbar  region  is  not  sufficient,  make  a free 
incision  in  this  region,  or  wherever  the 
abscess  points. 

Retropharyngeal  Abscess. — See  Part  9, 
Throat  Diseases. 

Rhachitis. — See  Rickets. 

Rheumatic  Fever;  Acute  Articular  or 
Inflammatory  Rheumatism. — Gr.  pevnana/xos 
from  ptvfia  flux.  An  acute  infectious  disease, 
caused  probably  by  several  varieties  of 
streptococcus,  and  characterized  by  polyar- 
thritis, irregular  pyrexia,  sour  sweating,  per- 
haps sudamina  and  erythema,  sometimes 
subcutaneous  nodules,  aniemia,  prostration, 
and  a tendency  to  valvular  endocarditis. 
The  onset  is  usually  abrupt,  often  with 
sore  throat;  but  it  may  be  insidious,  especi- 
ally in  children,  and  preceded  by  headache, 
lassitude,  sore  throat,  anaemia,  epistaxis, 
and  fleeting  joint  pains.  In  some  cases  in 
children,  joint  symptoms  may  be  scarcely 
noticeable.  Often  only  one  joint  is  affected. 

The  acute  form  lasts  from  three  to  sLx 
weeks  or  longer,  and  usually  terminates  in 
recovery;  but  relapses  may  occur.  The  sub- 
acute or  chronic  form  may  last  even  as  long 
as  eighteen  months.  One  attack  strongly 
predisposes  to  subsequent  attacks. 

The  complications  most  to  be  feared  are 
hyperpyrexia,  which  is  rare,  but  veiy  fatal, 
and  acute  carditis  (endo-,  myo-,  and  peri-). 
Pleurisy  and  pneumonia  may  occur. 

Exclude  (1)  multiple  arthritis  secondary 
to  gonorrhoea,  septico-jfysemia,  tonsillitis, 
scarlet  fever,  dysentery,  and  cerebrospinal 
meningitis;  (2)  acute  epiphysitis  or  osteo- 
myelitis; (3)  acute  arthritis  deformans; 
(4)  gout;  (5)  scur\y  in  infants.  Subcutane- 
ous nodules  occur  in  migraine,  gout,  and 
in  arthritis  deformans,  as  well  as  in 
rheumatic  fever. 

Etiology.— The  disease  is  probably  due  to 
several  varieties  of  streptococcus.  Heredity, 
cold,  dampness,  fatigue,  insufficient  food, 
bail  hygiene,  and  the  excessive  consumption 


of  sugar  and  red  meat  (Kerley)  may  have 
some  causal  influence. 

Treatment. — Enjoin  absolute  rest  in  bed 
(including  the  use  of  the  bed-pan,  urinal,  and 
goose-neck  feeding  cup)  in  a well-ventilated 
room  free  from  draughts,  with  a temperature 
of  00°  to  62°  F.  A flannel  nightgown  should 
be  worn,  and  changed  frequently,  the  skin 
being  bathed  each  time  with  sodium  bicar- 
bonate solution,  1 per  cent.,  dried  thoroughly 
and  dusted  with  a bland  powder.  The 
patient  should  lie  between  blankets;  or, 
perhaps  better,  as  advised  by  Yeo,  on  a soft, 
thin  blanket  and  covered  by  a cotton  sheet. 
The  bed  clothing  may  be  kept  off  the  tender 
joints  by  means  of  a cage  or  cradle. 

The  diet  should  be  liquid  as  long  as  there 
is  fever:  milk,  two  quarts  in  twenty-four 

hours,  diluted  one-third  with  barley  water, 
oatmeal  water,  soda  water,  Vichy,  or  Apollin- 
aris;  whey;  milk  soups;  thin  cereal  gruels 
well  cooked  in  milk;  orange  juice;  ice-cream; 
rice,  barley,  or  oatmeal  water  or  cream  of 
tartar  lemonade  (Part  11)  freely;  as  little 
sugar  as  possible.  Open  the  bowels  in  the 
beginning  with  calomel  followed  by  a saline 
(see  Part  11  for  all  drugs). 

Prescribe  an  antiseptic  gargle  for  sore 
throat,  e.g.,  Dobell’s  solution  (Part  11)  or  the 
following:  one  teaspoonful  boric  acid,  one- 
half  teaspoonful  sugar,  and  30  to  40  drops 
carbolic  acid  in  eight  ounces  of  hot  water. 

Wrap  the  affected  joints  in  warm  cotton- 
batting, and  employ  one  of  the  following 
local  measures  several  times  a day: 

1.  Gentle  rubbing  with  oil  of  wintergreen, 
or  chloroform  liniment,  or  belladonna  lini- 
ment containing  tr.  opii,  5 i to  the  pint. 

2.  Compresses  wet  with  Fuller’s  warm 
alkaline  lotion:  sod.  carb.,  5vi,  tr.  opii,  5i, 
glycerine,  5ii>  water  5ix;  covered  wdth 
oiled  silk. 

3.  Alcohol  compresses  covered  with  rub- 
ber tissue  and  changed  every  twelve  hours. 

4.  Guaiacol  and  glycerine,  aa  10  to 
60  minims. 

5.  Unguentum  mentholis  vel  camphor®, 
10  to  15  per  cent. 

6.  Hot  applications,  or  dry  hot  air. 

If  the  pain  is  very  severe,  immobilize  the 
joint  by  means  of  a padded  splint,  or  a splint 
plaster  or  starch  cast. 

Render  the  urine  alkaline  as  soon  as  pos- 
sible, and  keep  it  so  by  means  of  citrate  or 
acetate  of  potassium,  or  bicarbonate  of 
sodium,  gr.  xc-xxx  in  lemonade,  every  two 
or  three  hours,  or  less  often  as  required.  The 
citrate  or  acetate  is  preferable  to  carbonates 
because  less  disturbing  to  the  digestion. 


RICKETS;  RHACHITIS 


Sodii  salicylatis. . . . 3iv  (gr.  xv  per  dose) 

Sodii  vel  potassii  bi- 

carbonatis 5ss-i  (gr.  xv-xxx  per  dose) 

Aquse,  q.s.  ad 5xii 

M.  Sig. — Sbc  drams,  well  diluted,  every  2-3-4 
hours,  until  pain  is  relieved,  then  every  4-5  hours 
until  the  temperature  begins  to  fall.  (The  bicarbon- 
ate is  added  to  prevent  salicylic  acidosis.)  Should 
toxic  symptoms  appear  (see  below),  stop  the  drug, 
and  resume  later  in  smaller  doses.  To  prevent  a 
recurrence  of  the  inflammatory  symptoms,  give 
gr.  xv-xx,  t.i.d.,  for  at  least  two  or  three  weeks  after 
the  acute  attack  has  subsided. 

For  children  of  2 to  3 years,  give  12  to  15 
grs.  each  of  sod.  salicylate  and  sod.  bicarb, 
daily;  5 years,  20  grs.  of  each  daily;  8 to  10 
years,  30  grs.  of  each  daily.  After  recovery 
give,  for  six  months,  10  grs.  each  of  sod. 
salicyl.  and  sod.  bicarb,  daily  for  five  days 
out  of  every  fifteen;  and  thereafter  for  five 
days  out  of  every  month.  (Kerley.) 

The  following  drugs  are  sometimes  used 
in  place  of  sodium  salicylate: 

(a)  Aspirin  or  acetyl  salicylic  acid,  in  the 
same  dosage  as  sod.  salicylate.  It  should 
not  be  combined  with  an  alkali  which  de- 
composes it  into  salicylic  acid.  It  disturbs 
the  stomach  less  than  sod.  salicylate. 

(b)  Salicin,  a glucoside,  dosage  twice  that 
of  sod.  salicyl. : gr.  xx  in  capsule,  every  hour, 
or  gr.  XXX  every  two  to  three  hours.  It 
is  less  depressing  than  sod.  salicyl.,  and 
is  therefore  recommended  for  children  and 
the  delicate. 

(c)  Oil  of  gaultheria  or  wintergreen  (me- 
thyl salicylate),  ttrxx, in  milk  every  two  hours. 

It  must  be  borne  in  mind  that  the 
salicylates  are  heart  depressants.  Toxic 
symptoms  are:  general  depression,  small, 
sometimes  irregular  or  slow  pulse,  dysp- 
noea, nausea,  vomiting,  deafness,  tinnitus, 
headache,  dizziness,  clelirium,  irritation  of 
the  kidneys. 

For  hyperpyrexia,  employ  the  ice-cap  and 
cold  sponging  or  cold  packs,  or  immerse  the 
patient  in  a cold  bath,  beginning  with  a 
temperature  of  about  85°  F.,  and  rapidly 
cool  with  ice  until  the  fever  drops  to  102°  F. 
Remove  the  patient  at  once  if  collapse 
threatens. 

Administer  strychnine,  camphor  or  aro- 
matic spirits  of  ammonia  for  circulatory 
weakness. 

The  occurrence  of  cardiac  complications 
demands  absolute  rest,  a very  light  diet,  an 
ice-bag  to  the  precordium,  and,  perhaps, 
small  blisters  (see  Cantharides  in  Part  11) 
along  the  course  of  the  third,  fourth,  fifth, 
and  sixth  intercostal  nerves. 

In  protracted  cases  of  joint  involvement 
employ  counter-irritation : the  Paquelin 


cautery  lightly;  or  ichthyol,  10  to  25  per  cent, 
in  glycerine  or  oil ; or  dry  hot  air. 

During  convalescence  keep  the  patient  in 
bed  for  several  weeks  (about  six  weeks  if 
the  heart  is  affected:  see  Endocarditis), 
Prescribe  a tonic  of  iron,  quinine,  and  strych- 
nine elixir,  one  teaspoonful  well-diluted 
t.i.d.p.c.,  and  a nutritious  diet:  milk,  milk 
soups,  junket,  well-cooked  cereal  gruels, 
puddings,  stale  bread,  crackers  or  zweiback, 
butter,  cream,  potatoes  baked  in  their 
skins  (to  retain  potassium  salts),  green 
vegetables,  fish,  fowl,  eggs,  fresh  or  stewed 
fruit. 

Avoid  constipation. 

T.  McCrae  says  that  if  permanent  joint 
changes  follow  the  subsidence  of  acute  symp- 
toms, the  case  is  one  of  acute  arthritis  defor- 
mans iq.v.),  instead  of  rheumatic  fever  (but 
the  distinction  may  be  immaterial). 

In  chronic  cases,  search  for  a focus  of  infec- 
tion, e.g.,  in  the  tonsils,  peritonsillar  tissues, 
teeth,  dental  alveoli,  nasopharynx,  sinuses, 
bronchial  tubes,  bronchiectatic  cavities, 
colon,  gall-bladder,  appendix.  Fallopian 
tubes,  seminal  vesicles,  prostate,  etc. 

Autogenous  vaccines,  obtained  from  the 
pharynx,  nose,  urine,  etc.,  give  good  results 
in  chronic  cases  (Greeley);  but  are  contra- 
indicated in  acute  cases  with  acute  joint 
swelling,  pain,  and  elevation  of  temperature. 
One  hundred  million  to  two  hundred  million 
killed  organisms  (streptococci)  are  injected 
every  five  days. 

Rheumatism,  Acute  Articular.  — See 

Rheumatic  Fever. 

Chronic  Articular.  — See  Rheumatic 
Fever;  and  Arthritis  Deformans. 

Muscular. — See  Myalgia. 

Rheumatoid  Arthritis. — Gr.  pevna  flux  -f 
h5os  form;  ap0poj/ joint  -\-  -ltis  inflammation. 
See  Arthritis  Deformans. 

Rhinitis. — See  Part  8,  Nose  Diseases. 

Rhinoscleroma. — See  Part  8,  Nose  Dis- 
eases. 

Rickets;  Rhachitis. — Gr.  pdxts  spine  -t- 
-trts  inflammation.  A chronic  nutritional  dis- 
order of  infants,  appearing  usually  between 
the  ages  of  three  months  and  two  years, 
associated  with  a deficiency  of  calcium  in 
the  bones,  due  to  a deficiency  of  fat  and 
protein  in  the  diet  (?),  especially  fat  (?),  or  to 
deficient  absorption  of  these  food  elements(?), 
and  manife.sted  by  the  following  symptoma- 
tology, viz.,  insidious  onset,  head  sweating, 
irritability  and  sleeplessness;  flatulence  and 
constipation;  anaemia;  usually  enlargement 
of  the  spleen;  pot-belly;  diffuse  soreness  of 
the  body;  muscular  flabbiness  and  weakness, 


RICKETS;  RHACHITIS 


with  resulting  head  nodding,  nystagmus, 
backward  bowing  of  the  spine  and  inability 
to  walk  at  the  usual  age  (about  sixteen 
months);  delayed  dentition;  large  square 
head;  jn’ominent  or  protruding  sternum 
(pigeon  breast);  transverse  constriction  be- 
low the  level  of  the  nipples,  due  to  traction 
of  the  diaphragm  (Harrison’s  groove) ; bead- 
ing of  the  ribs  at  their  junction  with  the 
costal  cartilages  (rickety  rosary);  delayed 
closure  of  the  anterior  fontanelle  (it  should 
measure  ^ to  1 inch  in  both  chanieters  at 
the  end  of  twelve  months,  and  should  close 
about  the  eighteenth  month);  enlargement 
of  the  epiphyses  of  the  long  bones;  bending 
of  the  bones;  localized  areas  of  thinning  of 
the  cranium  (craniotabes,  from  L.  cra'nium, 
skull,  d-  ta'bes,  wasting) ; tendency  to  bone 
fracture;  tendency  to  laryngismus  stridulus, 
spasmophilia  or  tetany,  convulsions,  bron- 
chitis, and  bronchopneumonia. 

Rickets  sometimes  occurs  congenitally 
when  the  mother  is  ill  during  pregnancy. 
In  very  rare  instances  it  is  said  to  aj^pear  or 
reappear  after  four  years  of  age,  usually 
b(‘tween  the  ages  of  nine  and  fourteen  years 
(late  rickets). 

Wachenheim  defines  rickets  as  a “ mani- 
festation of  calcium  and  phosjjhorus  starva- 
tion, caused  by  the  imperfect  absorption  of 
the  fats  from  cow’s  milk.”  It  may  possibly 
have  something  to  do  with  a deficiency  of 
protamines  or  of  some  internal  secretion. 

Etiology.— A deficiency  of  fat  and  protein  in 
the  diet,  particularly  the  former;  an  excess 
of  carbohydrate  food,  causing  indigestion 
and  thereby  interfering  with  the  cUgestion 
anil  absorption  of  fat;  other  causes  of  im- 
paired digestion,  e.g.,  congenital  feebleness, 
gastro-intestinal  disorders,  prolonged  suck- 
ling, suckling  during  pregnancy,  too  strong 
cow’s  milk,  syphilis,  tuberculosis,  nephritis, 
etc.,  in  the  mother  or  child;  bad  hygiene, 
i.e.,  overcrowding,  dampness,  lack  of  fresh 
air,  sunlight,  anil  exercise. 

Prognosis.— The  disease  is  readily  cured  in 
about  three  to  five  months. 

Treatment.- Enjoin,  first  of  all,  fresh  air 
day  and  night,  sunlight,  a daily  morning 
warm  bath  in  a warm  room,  followed  by  a 
cool  douche,  daily  massage  of  the  muscles 
and  abdomen,  and  manipulation  of  the  limbs 
and  back  to  correct  deformity  (with  the  child 
lying  prone,  raise  the  legs  and  buttocks 
slowly  and  repeatedly,  while  pressing  upon 
the  spine),  and  oil  inunctions  at  bedtime, 
using  lard,  goose-grease,  or  cacao  butter, 
with  at  least  ten  minutes’  rubbing.  The 
patient  should  be  kcjit  in  a reclining  i^osture 
and  not  allowed  to  sit,  stand,  or  walk  for 


from  several  weeks  to  three  months  after 
beginning  treatment. 

The  patient  should  be  fed  according  to 
the  principlesdescribed  under  Infant  Feeding. 
Breast  milk  up  to  the  eleventh  month  is 
be.st.  If  artificial  feeihng  is  required,  the  milk 
should  be  carefully  mochfied,  and  not  steril- 
ized, and  barley  water  had  better  be  omitted. 
During  the  second  year  employ  the  dietary 
given  under  Feeding  During  the  Second 
Year,  under  Infant  Feeding.  Give  at 
this  period  no  less  than  l}/2  pints  of 
fresh  milk  daily,  to  which  may  be  added 
fresh  raw  meat  juice,  l}/2  to  3 ounces, 
obtained  as  follows:  four  parts  of  finely 
chopped  steak  is  stirred  with  one  part  of 
cold  water,  allowed  to  stand  for  half  an 
hour  in  the  cold,  and  the  juice  then  expressed 
through  a cloth  or  meat  press.  Allow  no 
potatoes  until  the  eighteenth  month,  and 
then  sparingly  (best  cooked  in  their  skins) 
mashed  with  milk;  no  sweets,  cakes,  buns, 
biscuits,  or  other  carbohydrate  food  in 
excess;  toast  and  stale  bread  in  moderation. 
Oatmeal  and  wheat  gruels  are  allowed;  also 
soft-boiled  eggs  (boiled  three  minutes)  and 
scraped  beef.  Orange  juice,  2 to  4 ounces, 
should  be  given  daily.  After  the  seconil 
year  add  purees  of  beans  and  peas,  and 
butter  in  abundance. 

The  deficiency  of  fat,  if  such  there  is, 
may  be  supplied  by  ipeans  of  cream,  cod- 
liver  oil,  olive  oil,  cottonseed  oil,  or  egg  yolk 
(20  to  30  per  cent,  fat ; one-half  a yolk  at 
nine  months,  one  whole  yolk  at  ten  to 
eleven  months,  very  lightly  boiled,  as  it  is 
indigestible  raw). 

Dosage  of  the  oils : 

Six  months,  15  minims,  t.i.d.p.c. 

Twelve  months,  20  minims,  t.i.d.p.c. 

Eighteen  to  twenty-four  months,  25-30  minims, 
t.i.d.p.c. 

The  oil  may  be  given  plain,  or  in  the  form 
of  a 50  per  cent,  emulsion,  or  in  combina- 
tion with  malt  extract,  1:4.  If  it  causes 
diarrhoea,  it  may  be  emulsified  with  an 
equal  quantity  of  lime-water. 

If  craniotabes,  or  neiwous  hyperirrita- 
bility  is  present  {e.g.,  contraction  of  the  facial 
or  other  muscles  on  lightly  tapping  thesuper- 
ficial  branches  of  their  nerves;  tetany; 
laryngismus  stridulus),  or  in  the  absence  of 
these  symi;)toms,  add  phosphorus  to  the  oil, 
Iti’-  Moo  t.i.d.;  and  to  prevent  the  occur- 
rence of  convulsions,  prescribe  bromide  or 
chloral  (see  Drugs,  Part  11),  of  the  latter 
gr.  iii-v  per  rectum  everj"  three  hours,  to  a 
child  of  one  year. 

For  ana'inia,  prescribe  saccharated  oxide 
of  iron  or  eisenzucker,  gr.  iii,  t.i.d.,  to  a baby 


RONTGENOLOGY 


a year  old,  or  arsenic.  As  a tonic,  some 
prescribe  the  syrup  of  the  lactophosphate 
of  lime,  or  syrup  of  hypophosphites. 

For  diarrhoea,  Yeo  prescribes  an  occasional 
dose  of  gray  powder,  followed  by  calcium 
carbonate  and  bismuth  salicylate. 

For  the  correction  of  deformities,  employ 
massage,  manipulation,  and  braces  (see 
Part  10,  Orthopaedics).  Operative  meas- 
ures, such  as  subperiosteal  osteotomy  or 
osteoclasis  should  not  be  resorted  to  until 
the  fifth  year  of  age. 

Rickets,  Fetal.-^ee  Achondroplasia. 

Rock  Fever. — See  Mediterranean  Fever. 

Rocky  Mountain  Spotted  Fever;  Tick 
Fever. — An  acute  infectious,  often  fatal  dis- 
ease, confined  to  the  Bitter  Root  Valley  of 
Montana  and  the  neighboring  mountainous 
parts  of  Idaho,  Wyoming,  Nevada,  and 
Oregon,  transmitted  by  the  wood-tick  and 
appearing  with  the  latter  in  the  spring  and 
early  summer,  and  characterized  by  an 
incubation  jDoriod  of  three  to  ten  days, 
followed  abruptly  with  chill,  headache,  and 
severe  pains  in  the  limbs,  a continued  fever, 
jaumlice,  perhaps  nose-bleed,  and  after  from 
two  to  seven  days,  the  appearance,  first  on 
the  ankles  and  wrists  and  later  over  the 
enth'e  body,  of  a macular  eruption  becoming 
hemorrhagic.  C’onvalescence  begins  about 
the  fourth  week  and  is  slow.  Desquama- 
tion occurs  with  convalescence.  One  at- 
tack confers  immunity. 

Whether  the  disease  is  due  to  Wilson  and 
Chowning’s  piroplasma  hominis,  or  to  Rick- 
ett’s  bacillus,  or  to  neither,  is  still  unsettled. 

It  is  probably  a variety  of  typhus  fever. 

Treatment. — Put  the  patient  to  bed  in  a 
quiet,  darkened  room,  on  liquid  diet,  with 
plenty  of  water  in  the  form  of  cream  of 
tartar  lemonade  (Part  11,  q.v.  for  all  drugs). 
Keep  the  bowels  active  by  means  of  calomel, 
salines,  and  enemas.  The  mouth  should  be 
kept  clean  by  swabbing  the  tongue,  cheeks, 
teeth,  and  gums,  every  four  hours,  with  a 
mixture  of  glycerine,  3iv,  boric  acid,  3i 
carbolic  acid,  rrpxx,  and  water  to  5iv;  or 
with  glycerine  and  peppermint  water,  of 
each  5i,  with  the  juice  of  a lemon  added. 
A cotton  stick  or  cotton  or  gauze  sponge 
held  with  haemostatic  forceps  may  be  used 
for  the  purpose.  Guard  against  bed-sores 
{q.v.).  Employ  cool  sponging  or  packs  for 
fever  or  nerv'ous  symptoms  (see  Fever). 
Subcutaneous  saline  infusions  are  recom- 
mended in  severe  cases.  Give  stimulants  as 
required,  e.g.,  camphor,  strychnine,  caffeine, 
digitalin,  aromatic  spirits  of  ammonia. 

Quinine  is  recommended  in  large  and  con- 
tinuous doses:  gr.  xv  every  four  hours  by 


mouth,  or  preferably,  gr.  xv  of  the  bimuriate 
hypodermically  every  six  hours  (see  under 
Malaria),  gradually  decreased  as  convales- 
cence sets  in. 

Calcium  sulphide  and  creosote  are  also 
considered  by  some  to  be  of  value. 

When  bitten  by  a tick,  the  latter  should 
be  removed  after  first  killing  it  with  kerosene 
or  turpentine,  and  the  wound  should  be 
thoroughly  cauterized  with  carbolic  acid. 

Rodent  Ulcer. — See  C'arcinoma  Cutis  in 
Skin  Diseases,  Part  5. 

Rontgenology. — The  passage  of  an  elec- 
tric current  through  a glass  tube  of  low 
vacuum  (Gcissler  tube,  which  transmits 
electric  currents  more  readily  than  air)  pro- 
duces a faint  glow  which  varies  in  intensity 
with  the  degree  of  vacuum.  In  tubes  of 
very  high  vacuum  (Crookes  tube,  which 
offers  great  resistance  to  the  passage  of  the 
current)  this  glow  is  replaced  by  a greenish 
fluorescence.  This  j:)henomenon  is  due  to  a 
stream  of  discharge,  believetl  to  be  com- 
posed of  negatively  electrified  molecules, 
from  the  cathode — cathode  rays — which, 
by  impact  upon  any  solid  body,  produce 
X-rays  or  Rontgen  rays.  Cathode  rays 
are  deflected  by  a magnet;  they  produce 
fluorescence  and  i^hosphorescence  in  cer- 
tain substances;  they  affect  photographic 
plates  like  ordinary  light;  they  exert  no 
known  effect  upon  the  botUly  tissues.  X-rays 
are  not  deflected  by  a magnet ; they  produce 
fluorescence  and  phosphorescence  in  certain 
substances;  they  affect  photographic  plates 
like  ordinary  light;  they  travel  in  straight 
lines  and  cannot  be  reflected  or  refracted 
(except  only  by  the  atomically  smooth  sur- 
face of  the  cleavage  planes  in  crystals,  the 
X-rays  being  of  such  short  wave  lengths) ; 
they  pass  through  all  known  substances  with 
varying  degrees  of  intensity;  they  cause  the 
air  to  become  a conductor  and  consequently 
cause  the  discharge  of  electrically  charged 
bodies;  they  exert  marked  effects  upon  the 
bodily  tissues.  (Quoted  chiefly  from  Christie) . 

Fig.  G6  represents  the  ordinary  type  of 
X-ray  or  focus  tube;  1 is  the  cathode,  made 
of  aluminum  (because  aluminum  does  not 
disintegrate  and  discolor  the  walls  of  the 
tube)  and  concave  or  cup-shapetl  so  as  to 
focus  the  cathode  rays  upon  tlie  obliquely 
(45°)  placed  target  or  anti-cathode,  2, 
which  is  made  of  platinum,  or  better,  tung- 
sten, because  of  the  high  fusion  or  melting 
point  of  these  metals.  The  target  is  usually 
surrounded  by  a good  conductor  of  heat, 
such  as  copper,  sometimes  a water  or  air 
jacket.  It  is  often  placed  just  beyond  the 
focus  point  of  the  cathode,  as  an  acklitional 


RONTGENOLOGY 


precaution  against  fusion.  It  is  placed 
obliquely  in  order  to  throw  the  X-rays  out 
at  one  side.  Three  is  the  anode,  and  4 the 
accessory  anode,  made  of  aluminum.  The 
accessory  anode  is  added  in  order  to  prevent 
too  rapid  an  increase  of  resistance  in  the 
vacuum  tube,  caused  by  a progressive  in- 


boundary of  the  fluorescence.  X-rays  do  not 
make  glass  fluorescent. 

Secondary  rays,  called  also  Sagnac  rays, 
are  rays  which  are  given  off  in  all  directions 
when  the  X-rays  strike  an  object.  They 
may  cause  blurring  of  the  radiogram.  Indi- 
rect rays  are  those  rays  given  off  from  the 


5,  vacuum  regulator;  6,  adjustable  wire;  7,  X-ray  hemisphere. 


crease  in  the  vacuum.  Five  is  the  vacuum 
regulator,  consisting  of  an  accessory  bulb, 
containing,  say,  asbestos  or  mica,  and  pro- 
vided with  the  adjustable  wire,  6.  AVlien  the 
current  sparks  across  from  the  cathode  to 
the  adjustable  wffe,  air  is  thereby  forced 


out  of  the  interetices  of  the  asbestos  and  the 
vacuum  consequently  lowered.  Seven  is  the 
X-ray  hemisphere.  The  green  fluorescence 
presentcid  by  this  hemisphere,  however,  is 
due  to  the  impact  of  reflected  cathode  rays, 
as  shown  by  the  action  of  a magnet  on  the 


target  other  than  at  right  angles,  and  are 
useless  for  radiography.  Both  the  secondarj' 
and  incUrect  rays  may  be  largely  elhninated 
by  means  of  a cylinder  diaphragm  with 
circular  aperture. 

A current  of  high  potential  (high  electro- 
motive force  or  voltage)  is  required  to  over- 
come the  resistance  of  the  high  vacumn 
tubes  used  to  produce  X-rays.  Such  a cur- 
rent is  supplied  by  a static  machine,  or 
better,  an  induction  coil  (see  hledical  Elec- 
tricity), or  better  still,  a high-potential  trans- 
former, which  is  in  principle  an  induction 
coil,  but  does  not  require  an  interrupter 
other  than  the  djmamo  from  which  the 
alternating  current  supply  is  obtained. 

Fig.  67  represents  the  plan  and  connec- 
tions of  an  induction  coil  apparatus. 

One  is  the  storage  batter?'  (other  forms  of 
batter?'  are  practicall?'  never  used)  or  main 
from  which  the  current  is  derived;  2 is  an 
adjustable  screw  with  a platinmn  tip;  3 is  a 
piece  of  soft  iron,  also  with  a platinum  tip 
opposite  the  screw,  which  is  drawn  against 
2 by  means  of  a stout  brass  spring;  4 is  the 
primaiy  coil  surrounding  the  iron  core,  5; 
6 is  the  secondaiy  coil;  7 is  the  condenser, 
the  thin  lines  representing  leaves  of  tin-foil, 
the  thick  lines  representing  insulating  parti- 
tions of  waxed  or  varnished  paper;  8 is  a 
valve  tube  interposed  in  the  secondar?'  cir- 
cuit for  the  purpose  of  permitting  only  a 
unidirectional  current  (the  strong  break  cur- 
rent) to  enter  the  X-ra?'  tube  (a  is  a spiral 
of  aluminum  presenting  a large  surface 
which  transacts  currents  readil?'  when  it  is 


RONTGENOLOGY 


the  negative  pole,  but  not  when  it  is 
the  anode). 

The  current  from  the  batterj"  or  mains 
passes  in  the  direction  imlicated  by  the 
arrows  and  magnetizes  the  soft  iron  core,  5, 
which  attracts  the  iron  hammer,  3,  away 
from  its  contact  with  the  screw,  2,  and  thus 
breaks  the  circuit.  The  core  thereby  becom- 
ing demagnetized,  3 springs  back  into  con- 
tact with  2,  and  remakes  the  circuit,  and 
so  on.  When  the  circuit  is  broken,  the  cur- 
rent passes  into  the  condenser,  7,  which 
greatly  increases  the  suddenness  of  the 
break  and  reduces  the  sjrarking. 

The  vibrating  interrupter  above  described 
is  the  slowest  and  least  desirable  form  of 
interrupter.  More  rapid  are  the 
mercury  interrupters  (dipper,  rotary, 
or  jet,  operated  by  a motor),  and  most 
rapid  and  therefore  best  of  all,  giving 
the  strongest  currents,  the  electrolytic 
interrupters  (Wehnelt  or  Caldwell- 
Simon).  The  Wehnelt  interrupter  con- 
sists of  a tank  of  sulphuric  acid  diluted 
with  six  times  as  much  water,  in  which 
are  immersed  a very  slender  platinum 
(positive)  electrode  enclosed  in  a 
porcelain  sheath,  and  a large  lead 
electrode.  During  the  passage  of  the 
current  the  platinum  electrode  be- 
comes covered  with  a thin  layer  of 
gas  which  stops  the  flow  of  the  cur- 
rent. As  soon  as  the  current  stops, 
the  gas  disappears  and  the  current 
again  flows.  The  deeper  the  platinum 
is  inserted  into  the  liquid,  the  less 
rapid  the  impulses.  In  the  Caldwell-Simon 
interrupter,  both  electrodes  are  large  lead 
ones,  separated  by  a perforated  partition, 
the  small  holes  of  which  become  obstructed 
with  bubbles  of  vapor  when  the  current 
passes,  which  causes  the  break. 

If  an  alternating  instead  of  a direct 
current  is  used  to  operate  the  primary  coil, 
it  must  first  be  rendered  unidirectional. 
This  is  usually  accomplished  by  means  of 
the  aluminum  cell  rectifier  shown  in  Fig.  68. 
In  this  drawing,  1,  1,  1,  1 are  four  glass 
jars  each  containing  a solution  of  Rochelle 
salts  (water  1 part,  saturated  solution  of 
Rochelle  salts  1 part)  and  a lead  and  an  alumi- 
num plate,  marked  L and  A respectively. 
“ The  current  flows  readily  so  long  as  it  is 
passing  from  the  lead  through  the  solution 
to  the  aluminum,  but  not  in  the  opposite 
direction,  polarization  preventing  the  flow 
in  one  direction  while  offering  little  obstruc- 
tion to  its  passage  in  the  other.”  (Christie.) 

Fig.  69  shows  the  connections  of  a high- 
tension  transformer  or  so-called  interrupter- 


less apparatus,  operating  on  an  alternating 
current  (preferably  one  of  220 volts — Christie). 

The  main  alternating  current  from  the 
power  house  dynamo  flows  directly  through 
the  rheostat.  A,  and  primary  of  the  trans- 
former, B.  After  this  current  has  been 
turned  on,  the  starting  motor,  C,  is  included 
in  the  circuit  by  closing  the  switch  at  D. 
When  this  motor  has  reached  its  maximum 
speed,  the  switch  at  E,  to  the  synchronous 
motor,  F,  is  closed.  These  two  motors 
serve  to  revolve  the  rectifying  disc,  G (a 
mica  disc  on  which  are  mounted  two  metal 
strips,  m,  m) ; and  since  the  disc  at  its  maxi- 
mum speed  revolves  at  the  same  rate  as  that 
of  the  dynamo  in  the  power  house  which 


Fio. 


68. — Aluminum  cell  rectifier  (from  Christie’s  Manual  of  X-Ray 
Technic). 

supplies  the  electrical  energy,  the  revolu- 
tions are  exactly  synchronous  with  the  alter- 
nations of  the  current  in  the  secondary  of 
the  transformer.  The  purpose  of  the  recti- 
fier is  to  render  the  current  from  the  trans- 
former unidirectional.  In  the  position 
showm  in  the  diagram,  the  terminal,  a,  is 
positive,  and  b negative,  and  the  current 
flows  in  the  direction  of  the  arrows.  The 
next  phase  of  the  current,  making  the  ter- 
minal, b,  positive,  ami  a negative,  finds  the 
synchronously  revolving  disc,  G,  advanced 
one-quarter  of  a revolution  to  the  position 
shown  in  Fig.  70,  in  which  the  current  takes 
the  course  indicated  by  the  arrows.  Thus  a 
unidirectional  current  for  the  X-ray  tube 
is  ensured. 

The  rheostat  or  resistance  appliance.  A, 
consists  of  a number  of  coils  of  usually  Ger- 
man-silver wire,  which  is  a poor  conductor 
of  electricity.  With  the  movable  arm,  c, 
in  the  position  shown  in  Fig.  69,  all  the 
resistance  coils  are  in  the  circuit,  and 
the  current  is  at  its  lowest  strength.  As 


RONTGENOLOGY 


the  movable  arm  is  shifted  successively  to  the  current,  which  must  first  be  changed  to 
contact  points,  2,  3,  and  4,  successive  coils  an  alternating  current  by  a motor 

are  eliminatcfl  from  the  circuit,  and  the  generator  before  it  can  be  used  to  excite 


current  correspondingly  increased,  until 
the  contact  point,  4,  is  reached,  when  all 


the  resistance  is  cut  out  and  the  current  is 
at  its  maximum. 

Fig.  71  shows  the  connections  of  a high- 
tension  transformer  operating  on  a direct 


an  alternating  current  supply  is  to  be  pre- 
ferred to  the  direct. 

X=Ray  Technique. — The  X-ray  tube  should 
be  carefully  dusted  and  dried  before  using, 
and  in  cold  weather  it  should  be  warmed. 
The  supporting  clamp  should  grip  the 
cathode  neck  lightly,  below  the  level  of  the 
concave  cathode,  this  being  the  strongest 
part.  The  exciting  electrical  apparatus 
should  be  at  least  six  or  seven  feet  aw'ay,  in 
order  to  avoid  the  deflecting  action  of  the 
magnetic  field  upon  the  cathodal  stream. 
The  regulating  wire  should  as  a rule  be 
placed  six  or  seven  inches  away  from  the 
cathode,  and  all  loose  wires  or  metal  fittings 
should  be  quite  clear  of  the  tube.  The  cur- 
rent should  be  turned  on  gradually,  by 
means  of  a rheostat,  “ until  the  tube  fluor- 
esces brightly  and  steadily.”  “ If  the  tube 
is  inclined  to  spark  over,  bring  the  regulator 
(by  means  of  a piece  of  wood,  glass,  or  other 
non-conductor)  to  within  a distance  of  four 
or  five  inches  of  the  cathode,  so  as  to  provide 
a kind  of  safety-valve  action,”  and  also 
reduce  the  vacuum  of  the  tube,  when  the 
sparking  will  cease;  then  remove  the  regu- 
lating rod,  and  cautiously  test  the  tube 
again  (Knox).  If  the  tube  is  of  too  high 
vacuum  to  allow  the  current  to  pass  when 
the  latter  is  at  its  full  strength,  the  current 
sparks  across  between  the  positive  and 
negative  terminals  of  the  exciting  induction 
coil  or  transformer,  the  length  of  the  spark 
being  a measure  of  the  resistance  of  the 
tube.  When  this  occurs,  one  should  place 


RONTGENOLOGY 


the  end  of  the  adjustable  wire  about  two 
inches  from  the  cathode  (never  touching  it), 
and  allow  the  weakest  current  possible  to 
spark  across  to  the  regulator.  “ The  wire 
is  then  moved  to  a distance  of  five  or  six 
inches  from  the  cathode  and  the  current 
turned  on  to  its  full  strength.  This  process 
is  repeated  until  the  tube  lights  up  properly 
and  there  is  no  sparking  at  the  parallel 
spark  gap.  Great  care  must  be  exercised 
in  lowering  the  vacuum;  if  a strong  current 
is  used  it  will  cause  a thick  yellow  spark  to 
jump  across  and  probably  destroy  the 
vacuum.”  (Christie).  The  vacuum  and 
therefore  the  resistance  of  the  tube  increase 


used.  Finally  the  vacuum  becomes  so  high 
that  it  can  no  longer  be  lowered  sufficiently 
to  allow  the  current  to  pass.”  “ When  new 
tubes  are  ordered  it  is  necessary  to  specify 
whether  they  are  to  be  used  with  a coil  or  a 
transformer,  since  tubes  pumped  for  use 
with  a coil  are  of  too  high  vacuum  for  use 
with  a transformer.” 

A tube  of  high  vacuum  is  termed  “ hard 
a tube  of  low  vacuum  “ soft.”  The  penetra^ 
tive  power  or  intensity  of  the  X-rays 
increases  with  the  degree  of  vacuum  or 
hardness  of  the  tube  anti  with  the  strength 
of  the  current.  In  a normal  tube,  there  is  a 
well-marked  hemisphere  of  greenish  fluor- 


with  use.  New  tubes  should  be  used  cau- 
tiously until  they  become  seasoned;  i.e., 
use  weak  currents  or  very  short  exposures 
with  strong  currents.  Overheating  by  too 
prolonged  use  should  be  avoided.  “ Hard- 
ening by  means  of  reversing  the  current,” 
warns  Knox,  "is  a method  which  should 
never  be  resorted  to.”  With  care  a tube 
should  be  good  for  hundreds  of  exposures. 
Says  Christie,  " Wfien  a new  tube  is  re- 
ceived it  is  usually  found  to  be  of  relatively 
low  vacuum,  but  after  being  used  a few 
times  it  reaches  its  point  of  maximum  use- 
fulness. The  vacuum  then  seems  to  remain 
about  stationary  for  some  time  and  then 
gradually  increases  until  it  reaches  a point 
where  it  must  be  lowered  every  time  it  is 


escence  in  front  of  the  target,  while  the 
remainder  of  the  tube  is  dark,  with  the 
exception  of  a faint  blue  cloud  in  the  region 
of  the  anode.  In  a soft  tube,  the  faint  blue 
cloud  is  increased,  and  a blue  line  appears 
extending  from  the  cathode  to  the  target. 
In  a hard  tube,  the  faint  blue  cloud  is 
absent.  A long  spark-gap  together  with  a 
high  milliampe re-meter  reading  (not  the 
latter  alone)  indicates  a high  penetrative 
power.  More  precise  methods  of  estimating 
the  penetrative  power  of  the  X-rays  are  by 
means  of  the  Bauer  qualimeter,  and  the 
Walter,  Benoist,  and  Wehnelt  radiometers. 
The  following  table  from  Knox  gives 
the  comparative  values  or  readings  of 
these  instruments: 


RONTGENOLOGY 


Comparative  Readings  op  Various  Instruments 
FOR  Measuring  the  Hardness  op  Tubes 

Soft  Medium  Hard 

Bauer 12  3 45G  789  10 

Wehnelt. . . 1 .5  3 4.5  6 7.5  9 10.5  12  13.5  15 

Walter. ...  1 1-2  2-3  3-4  4-5  5-G  G-7  7-8 
Benoist  ...1  2 3 4 5 G 7 8 9 10 

If  inverse  or  reverse  currents  enter  the 
X-ray  tube,  the  greenish  hemisphere  loses 
its  clear  cut  appearance  and  irregular  green 
rings  appear  behind  the  target.  If  the 
polarity  is  completely  reversed,  the  green 
hemisphere  disappears,  and  a bright  spot  is 
observed  on  the  glass  wall  opposite  the 
target.  The  presence  of  inverse  currents 
is  best  demonstrated  by  means  of  the 
oscilloscope.  It  consists  of  an  oblong 


too,  the  spark  at  the  negative  pole  is  thick 
and  white,  while  that  at  the  positive  pole 
is  thin  and  wiry. 

The  Coolidge  tube  is  markedly  different 
in  construction  and  operation  from  the  older 
types  of  X-ray  tube.  The  cathode  consists 
of  a spiral  of  tungsten  wire  surrounded  by  a 
sleeve  of  molybdemun  to  focus  the  cathode 
stream.  The  anticathode  is  of  tungsten. 
The  positive  and  negative  terminals  of  the 
tube  are  connected  as  in  the  ordinary  tube, 
but  there  is  also  connected  to  the  cathode 
spiral  a small  accimiulator  batterj^  (thor- 
oughly insulated  from  the  patient  and  from 
the  earth)  with  an  ammeter  in  circuit  (see 
Fig.  72).  The  tube  has  a vacuum  1000 
times  greater  than  the  orcUnary  tube,  and 


Terminal  from  rh«  coils + Terminal  Jrom  the  coils 


glass  vacuum  tube  enclosing  two  aluminum 
wires  separated  by  a small  gap.  If  the  cur- 
rent is  unidirectional,  the  wire  connected 
with  the  negative  pole  shows  a violet 
fluorescence,  while  if  each  wire  is  alter- 
nately negative  and  positive,  both  wires 
become  fluorescent.  The  continued  pres- 
ence of  inverse  currents  gradually  hardens 
the  tube. 

In  order  to  determine  which  terminal  is 
positive  and  which  negative,  (1)  immerse 
them  in  water,  when  bubbles  will  arise  from 
the  negative  pole;  or  (2)  immerse  them  in  a 
solution  of  potassium  iodide,  when  the  solu- 
tion will  turn  red  around  the  negative  pole 
due  to  the  liberation  of  free  iodine  by 
ionization;  or  (3)  apply  wet  blue  litmus 
papi'r  to  the  terminals,  when  it  will  become 
red  in  contact  with  the  positive  pole.  Then, 


therefore  can  not  be  excited  in  the  ordinarj’ 
way,  owing  to  the  insurmountable  resistance 
wliich  it  offers.  The  cathode  is  heated  by 
means  of  the  battery  which  causes  it  to  give 
off  a stream  of  negatively  charged  electrons 
which  are  projected  on  to  the  anti-cathode. 
The  number  of  these  discharged  electrons 
(which  determines  the  quantity  of  the  X-rays 
produced),  depends  upon  the  temperature  of 
the  tungsten  spiral;  and  their  speed  (which 
determines  the  penetrative  jwwer  of  the 
X-rays)  depends  upon  the  potential  at  the 
terminals  of  the  tube.  The  Coolidge  tube 
gives  little  or  no  vi.sible  sign  of  fluorescence, 
and  requires  great  precaution  against  the 
production  of  X-ray  burns. 

The  Coolidge  tube  furnishes  at  will  any 
quantity  of  rays  and  any  desired  degree  of 
I)enetration.  Inverse  radiation  cannot  oc- 


RONTGENOLOGY 


cur.  If  the  polarity  of  the  current  is 
reversed,  the  milliameter  will  register  no 
current.  In  operating  the  tube,  first  close 
the  battery  circuit,  and  obtain  a current  of 
between  3 and  5 amperes  by  shifting  the 
rheostat  handle;  then  close  the  circuit  from 
the  coils.  The  voltage  used  to  run  the  tube 
should  not  be  made  to  back  up  more  than 
a 10-inch  parallel-gap,  to  avoid  punctm'e. 
About  6 milliamperes  with  a spark  gap  of 
9 inches  is  the  average  used  for  deep  pene- 
tration. When  the  target  becomes  intensely 
heated,  the  tube  offers  slightly  less  resis- 
tance, so  that  a little  adjustment  of  the  bat- 
tery rheostat  should  then  be  made. 

Various  tube-stands,  lead-lined  boxes, 
couches,  compressors  (to  keep  the  patient  as 
quiet  as  possible)  and  screening  stands  are 
important  X-ray  appurtenances. 

Radiography.— X-ray  plates  should  be  kept 
unwrapped  in  a lead-lined  box  (as  a precaution 
against  radiations),  in  a cool  dry  place. 

To  take  a radiogram,  place  the  plate  first 
in  a black  envelope  and  then  in  an  orange 
envelope  in  a dark  room  illuminated  only 
by  a ruby  light.  The  film  or  dull  side  of 
the  plate  should  be  placed  facing  the  side  of 
the  envelope  opposite  the  flaps  (not  facing 
the  flaps).  A plate-holder  may  be  used 
instead  of  the  envelopes.  The  plate  is 
taken  to  the  X-ray  room  in  a lead-lined 
box,  to  protect  it,  if  need  be,  against  the 
X-rays,  and  is  placed  under  the  patient 
with  its  centre  beneath  the  centre  of  the 
part  to  be  radiographed.  “ The  target  of 
the  tube  is  then  centred  over  the  centre  of 
the  plate  at  a distance  of  18  to  25  inches 
from  the  plate.”  (Christie.) 

Considerable  latitude  (two  to  thirty  sec- 
onds) is  allowable  in  the  time  of  exposure, 
which  depends  upon  the  penetrative  power 
of  the  rays,  the  strength  of  the  current,  the 
distance  of  the  tube  from  the  plate,  the 
thickness  of  the  part  to  be  radiographed, 
and  the  sensitiveness  or  rapicUty  of  the 
plate.  The  use  of  an  intensifying  screen 
materially  shortens  the  time  of  exposure  but 
gives  less  detail  in  the  picture.  An  intensi- 
fying screen  consists  of  a surface  coated  with 
some  fluorescent  material,  such  as  calcium 
tungstate.  It  should  first  be  carefully 
dusted  with  a wide  camel’s-hair  brush,  and 
placed  snugly  in  contact  with  the  fihn  side 
of  the  plate. 

After  exposure,  the  plate  Ls  taken  to  the 
dark  room,  removed  from  its  envelopes  or 
plate-holder,  and  slid  rapidly,  film  upward, 
into  a tray  containing,  say,  the  following 
developing  solution,  which  should  be  at  a 
temperature  of  about  65°  to  68°  F. : 


No.  1 

Hydroquinone 6 gm.  (reducer) 

Sodium  sulphite ...  50  gin.  (preservative,  tak- 

Water 500  c.c.  ing  up  oxygen  and 

thus  preventing 
o.xidation  of  the 
reducer.) 

No.  2 

Potassium  carbonate  100  gm.  (accelerator) 
Potassium  bromide. . . 1.5  gm.  (restrainer) 

Water 500  c.c. 

For  use,  mix  equal  parts  of  No.  1 and  No.  2. 

When  using  the  following  metol-hydro- 
quinone  developer,  which  should  be  made 
fresh  each  dav,  the  temperature  should  be 
60°  F.: 

Metol,  2G  grs.,  thoroughly  dissolved  in  8 oz.  pure 
warm  water; 

Hydroquinone,  80  grs.,  then  added; 

Sodium  sulphite  (crystals),  2 oz. 

Sodium  carbonate  (crystals),  2 oz. 

Potassiimi  bromide  solution,  10  per 
cent.,  80  minims 

Water  then  added  up  to  20  oz.,  and  the  solution 
allowed  to  cool  to  60  F. 

Other  reducing  agents  are  pjTogallic 
acid,  amidol,  eikonogen,  ortal,  rodinal,  etc. 

During  the  developing  process,  the  tray 
should  be  covered  as  much  as  possible  and 
it  should  be  rocked  so  as  to  remove  air 
bubbles  from  the  surface  of  the  plate.  As 
soon  as  the  back  of  the  plate,  when  held  up 
to  the  ruby  light,  presents  an  even  black 
appearance,  development  is  considered  com- 
plete, and  the  plate  is  washed  in  running 
water  for  thirty  seconds.  It  is  then  placed 
in  the  following  fixing  solution,  and  kept 
there  for  about  fifteen  minutes  after  all 
the  dull  white  film  has  dissolved  away, 
when  it  is  washed  for  at  least  an  hour  in 
running  water: 


No.  1.  Sodium  hyposulphite 1000  gm. 

Water 4000  c.c. 

No.  2.  Water 1000  c.c. 

Sodium  sulphite,  dry 90  gm. 

Sulphuric  acid 15  c.c. 

Chrome  alum,  powdered 60  gm. 


Mix  No.  2 in  the  above  .sequence,  and  pour  into 
No.  1,  while  .stirring.  In  cold  weather,  use  only  half 
of  No.  2,  with  the  full  quantity  of  No.  1. 

Should  the  image  flash  up  almost  immedi- 
ately when  the  plate  is  placed  in  the 
developer,  it  usually  indicates  overexpo.su re, 
and  a few  drops  of  a 10  per  cent,  solution 
of  potassium  bromide  should  be  added  to 
the  developer,  or  a weak  developer  at 
once  substituted. 

If,  after  fixation,  the  plate  is  still  too 
black  and  dense,  it  may  be  dropped  (after 


cbssolved  in  8 
o z . warm 
water  and 
I mixed  with 
( the  above 


RONTGENOLOGY 


rinsing)  into  the  following  reducer  and 
rocked  continuously: 


Potassium  permanganate 0.5  gm. 

Sulphuric  acid 1.0  c.c. 

Water 1050.0  c.c. 


Permanganate  stains  may  be  subse- 
quently removed  by  a 1 per  cent,  solution 
of  oxalic  acid. 

The  following  intensifier  may  be  used  for 
underexposed  plates: 


Mercuric  chloride 11  gm. 

Potassium  bromide 6 gm. 

Water 210  c.c. 


The  plate  is  left  in  this  solution  until  it 
looks  white;  is  then  washed  in  running 
water  for  about  half  an  hour;  then  placed 
in  a solution  of  sodium  sulphite,  45  gms.,  in 
water,  180  c.c.,  until  it  has  turned  black; 
then  thoroughly  washed. 

After  the  plate  is  dry,  a print  may  be 
made  from  it,  if  desired,  just  as  in  photog- 
raphy. (Chiefly  from  Christie’s  “ Manual  of 
X-Ray  Technic  ”). 

To  make  a stereoscopic  radiogram,  pro- 
ceed as  follows:  First  see  that  the  part,  to 
be  rathographed  is  in  an  immovable  position 
upon  the  plate-holder.  Then  put  in  a plate 
and  make  the  first  exposure.  Then  remove 
this  plate  and  put  in  another.  Now  shift 
the  tube  to  the  right  or  left  for  about  three 
inches,  and  make  a second  exiwsure.  When 
viewed  side  by  side  with  a stereoscope,  the 
finished  plates  or  prints  are  fused  into  one 
perspective  image. 

Localization  of  Foreign  Bodies: 

The  plate  is  placed  upon  the  table  and  two 
crossed  wires  placed  uiwn  it,  one  of  the 
wires  being  placed  perpencUcularly  beneath 
and  parallel  to  the  horizontal  bar  carrying  the 
tube,  so  that  the  focus  point  of  the  target, 
when  shifted,  will  always  be  perpendicu- 
larly above  this  wire.  (Fig.  73.)  “ The  focus 
point  of  the  target  is  accm’ately  centred  per- 
pendicularly above  the  point  of  intersection 
of  the  cross  wires,”  and  then  shifted  a known 
di.stance,  say  two  inches,  from  the  centre. 
The  part  to  be  radiographed  is  now  placed 
firmly  upon  the  wires  and  plate,  the  former 
being  inked  to  show  their  jwsition  upon  the 
body,  and  the  i)late’s  position  upon  the  body 
being  also  indicated  l>y  an  indelible  pencil. 
The  first  ex[)osure  is  now  made;  then  the 
tube  is  shifted  two  inches  to  the  other  side 
of  the  centre  and  the  second  exposure  made. 

After  development,  the  plate  is  placed  on 
a table  beneath  a horizontal  bar  representing 
that  carrying  the  focus  tube,  and  with  the 
same  relations  to  this  bar  as  it  bore  previ- 


ously to  that  carrying  the  tube.  Threads 
are  fastened  to  the  bar  at  the  two  points 
occupied  by  the  focus  point  of  the  tube,  and 
the  end  of  one  thread  placed  upon  a point 
of  its  foreign-body  image  on  the  plate,  and 
the  end  of  the  other  thread  on  a correspond- 
ing point  on  the  other  image.  The  point  of 
intersection  of  the  threads  represents  the 
position  of  the  foreign  body  in  relation  to 
the  plate,  and  a mark  can  be  made  on  the 
plate  perpendicularly  beneath  this  point  of 


B A 


Fig.  73. — Showing  Mackenzie-Davidson  method  of  localiz- 
ing a foreign  body  (after  Walsh). 

A,  First  position  of  tube.  D,  Shadow  thrown  on  plate  by 

B,  Second  position  of  tube.  tube  in  A position. 

S,  Skull  or  limb.  C,  Shadow  thrown  on  plate  by 

F B.  Foreign  Body.  tube  in  B position. 

intersection,  and  the  chstance  noted.  The 
distance  of  the  mark  on  the  plate  from  the 
two  cross  wires  can  also  be  measured,  so 
that  all  the  data  required  for  accurately 
localizing  the  foreign  body  are  thus  ob- 
tained. (Abstracted  from  Christie). 

A special  apparatus  for  localizing  foreign 
bodies  in  the  eye  is  that  of  Sweet  (see  Part  6). 

Fluoroscopy. — The  fluoroscope  consists  of  a 
screen  of  platinobarium  cyanide  fitted  into 
the  end  of  a dark  box  into  which  the 
observer  looks.  The  screen  fluoresces  under 
the  action  of  the  X-rays,  and  if  a part  of 
the  body  is  held  against  the  screen  between 
it  and  the  X-ray  tube,  the  fluorescence 
vai’ies  in  intensity  with  the  degree  of 
obstruction  to  the  X-rays  offered  by  the 
interposed  body. 

For  fluoroscopic  work,  a high  voltage  and 
low  amperage  is  required.  This  may  be 
obtained  by  reducing  the  windings  of  the 
primary'  coil,  and  in  other  ways. 

In  order  to  protect  the  patient,  the  expos- 
ure should  be  as  brief  as  possible;  and  for 
the  operator’s  protection  the  room  should 
be  completely  darkened  for  at  least  three 
minutes  before  the  rays  are  turned  on,  and 
the  smallest  practicable  current  and  dia- 
phragm aperture  should  be  used. 


SACRAL  PLEXUS 


Estimation  of  Therapeutic  Dosage. — The  quan- 
tity of  X-rays  received  by  an  exposed 
object  depends  on  (1)  the  quantity  of  rays 
generated  in  the  X-ray  tube  (this  is  ecpial 
to  the  number  of  milliamperes  of  current 
passing  through  the  tube  multiplied  by  the 
number  of  volts);  (2)  the  distance  between 
the  tube  and  the  object  (the  intensity  or 
penetrability  of  the  rays  diminishes  as  the 
square  of  the  distance  increases,  i.e.,  at 
twice  the  distance,  four  times  as  many 
milliampere  seconds  are  required  to  produce 
the  same  effect);  (3)  the  duration  of  expos- 
ure; and  (4)  the  sensitiveness  of  the  object. 

The  quantity  of  X-rays  received  by  an 
object  may  conveniently  iDe  measured  by  the 
method  of  Sabouraud  and  Noire.  A Sabour- 
aud  pastille,  which  is  a disc  of  barium 
platino-cyanide  on  a thin  sheet  of  metal,  is 
placed  at  a chstance  from  the  target  equal 
to  half  that  between  the  target  and  the 
patient’s  skin,  at  least  two  centimetres  from 
the  tube  and  in  a shaded  room,  for  the  discs 
are  acted  upon  by  heat  and  bright  light  in 
the  same  way  as  by  the  X-rays. 

On  exposure  to  the  rays,  the  apple-green 
color  of  the  disc  changes  gradually  to  red 
and  reddish-brown.  Tint  B in  the  booklet 
supplied  with  the  pastilles  shows  the  color 
which  is  assumed  after  exposure  to  a dose 
which  causes  the  hair  to  fall  out.  An  addi- 
tional exposure  of  one-fourth  the  time  is  an 
erythema  dose  (causing  a slight  er>dhema  to 
appear  within  fifteen  to  twenty-one  days). 
The  color  is  compared  with  the  standard 
tint  in  a light  weak  in  actinic  rays,  e.g., 
weak  daylight.  It  must  be  remembered 
that  this  method  of  estimating  dosage  is 
not  perfect.  Says  Knox:  “ Sabouraud  pas- 
tilles show  correctly  when  used  with  medium 
tubes,  but  with  hard  tubes  there  is  a ten- 
dency to  under-exposure,  tint  B being  reached 
a little  too  early,  and  with  soft  tubes  there 
is  a tendency  to  over-exposure,  as  tint  B is 
reached  a little  too  late.”  For  this  reason 
it  is  well  to  have  a Bauer  qualimeter  con- 
nected by  a single  wire  with  the  negative 
pole  of  the  tube,  to  give  an  approximate 
idea  of  the  hardness  of  the  tube.  It  is  a 
static  electrometer  consisting  of  two  wings, 
which  swing  between  two  fixed  plates,  the 
wings  and  ]ilates  being  equally  charged  so 
that  they  repel  each  other.  The  degree  of 
this  repulsion  is  in  proportion  to  the  poten- 
tial of  the  cathode,  and  is  indicated  by  the 
movements  of  a pointer  over  a scale.  The 
same  pastille  should  not  be  used  more  than 
three  or  four  times. 

The  Lovibond-Corbett  tintometer  pro- 
vides an  accurate  way  of  estimating  the 


degree  of  coloration  of  the  Sabouraud- 
Noire  pastille. 

HoRknecht’s,  Bordier’s,  and  Cox’s  radio- 
meters are  similar  to  that  of  Sabouraud.  In 
using  their  pastilles,  the  light  of  a match,  a 
candle,  a benzine  lamp,  or  an  incandescent 
lamp  is  recommended.  Other  methods  of 
estimating  dosage  are  by  means  of  the 
Kienbock  quantimeter,  the  lonto  quanti- 
meter,  and  Hampson’s  radiometer;  lOx 
(Kienbock)  units  = 5H  (Holzknecht)  = IB 
(Sabouraud-Noire)  = 4 (Hampson)  = dose 
sufficient  to  produce  mild  erythema  of  the 
skin  or  epilation  where  no  filter  is  used. 

In  employing  deep  radiation,  the  super- 
ficial structures  are  protected  against  the 
soft  rays  by  means  of  a filter  consisting  of 
some  metlium  such  as  felt,  or,  best,  alumi- 
num, ranging  from  3^  to  3 mm.  in  thick- 
ness, which  absorbs  some  of  the  softer 
xatUation.  When  using  an  aluminum  filter, 
a layer  of  felt,  lint,  wash  leather,  or  paper 
must  be  placed  between  the  filter  and  the 
skin  to  absorb  the  secondary  radiations 
given  off  when  aluminum  is  struck  by  the 
X-rays.  If  the  filter  is  close  to  the  skin,  it 
must  be  connected  to  the  earth  by  means  of 
a wire.  Lead  sheets  are  used  to  protect  the 
healthy  skin  against  the  X-rays. 

Rose  Cold.--^ee  Hay  Fever. 

Rotheln. — See  German  Measles. 

Round=Worm  Infection. — See  Ascariasis. 

Rubella;  Rubeola. — See  German  Measles. 

Rumination  ‘ and  Regurgitation. — L. 
ruminat'io;  re,  hack-\- gurgitar'e,  to  flood. — 
Causes.— Heredity;  neurasthenia;  hysteria; 
epilepsy;  idiocy. 

Treatment. — Urge  voluntary  suppression  of 
the  habit.  Instruct  the  patient  to  eat 
slowly  and  masticate  thoroughly.  Treat 
the  underlying  neurosis.  Strychnine  or  the 
bromides  may  be  tried  (see  Part  11). 

Rupture  of  the  Spleen. — See  Spleen, 
Rupture  of  the. 

Sacral  Plexus. — See  Fig.  74  and  the  chart., 
under  Nerves,  Peripheral,  showing  the  dis- 
tribution of  sensory  nerves  in  the  skin. 

The  Sciatic  Nerve,  Main  Trunk. — Paralysis 
here  results  in  inability  to  flex  the  knee 
and  in  loss  of  motion  in  the  ankle  joint.  The 
causes  are  fracture  of  the  pelvis  or  femur; 
dislocation  of  the  hip;  pelvic  tumors  or 
inflammation;  luxation  of  the  sacrum  due  to 
relaxation  of  the  sacroiliac  synchondrosis; 
parturition;  traction  upon  the  thigh  in 
breech  presentations.  (For  sciatic  neuralgia, 
see  Sciatica,  under  Neuralgia.) 

The  External  Popliteal  or  Anterior  Tibial  Nerve. — 
Paralysis  of  this  nerve  results  in  foot-drop, 
followed  by  talipes  equinus.  The  causes 


SCARLET  FEVER;  SCARLATINA 


are  traumatism,  including  constant  kneel- 
ing or  croucliing,  and  forcible  extension  of 
the  leg;  neuritis;  plumbism;  tabes. 

The  Internal  Popliteal  or  Posterior  Tibial  Nerve. — 
Paralysis  of  this  nerve  results  in  inability  to 
extend  the  foot  or  flex  the  toes,  followed 
eventually  by  talipes  calcaneus.  The  causes 


Fig.  74. — Diagram  illustrating  plan  of  sacral  plexus.  Pier- 
sol’s  Human  Anatomy. 


are  forcible  flexion  of  the  knee;  inflannnation ; 
tumors;  aneurj^sm. 

(See  under  Brachial  Plexus  for  the  Treat- 
ment of  Nerve  Lesions.) 

Saint  Vitus’s  Dance. — See  Chorea,  Acute. 

Salivary  Calculus. — L.sali'va,  spittle;  caV- 
culus,  pebble.  Calculous  obstruction  of  a 
saUvary  duct  is  manifested  by  painful 
swelling  of  the  gland  (usually  the  sub- 
maxillary) immediately  after  each  meal, 
with  slow  subsidence  in  the  inteiwals.  The 
calculus  may  be  felt  by  probing,  and  is  de- 
monstrable by  the  X-ray. 

Cut  down  on  anti  remove  the  stone. 

Salivary  Fistula. — L.  fis'tuln,  jape. 

Trauma  is  the  usual  cause.  Spontaneous 
closure  is  the  rule.  If  dosiretl,  the  fistula 
may  be  closed  bj'^  means  of  the  cauteiy.  A 
fistula  of  the  jairotid  duct  on  to  the  face 
should  be  slit  open  into  the  mouth  and  con- 
verted into  an  internal  fistula. 

Salivary  Hypersecretion. — See  Ptyalism. 


Salivary  Hypertrophy. — See  Mikulicz’s 
Disease. 

Hyposecretion. — See  Aptyalism. 

Inflammation.  — See  INIumps  and 
Parotitis. 

Stone. — See  Salivaiy  Calculus. 

Salivary  Tumor. — The  mixed  parotid 
tumor,  since  it  usually  becomes  malignant, 
should  be  removed  as  soon  as  possible. 
Malignant  gro\\dhs  require  rachcal  removal, 
with  perhaps  subsequent  radium  (q.v.)  or 
X-ray  {q.v.)  treatment.  See  also  Mikulicz’s 
Disease. 

Salivation. — See  Ptyalism. 

Sand=Fly  Fever. — See  Phlebotomous  Fever. 

Sarcoma.— Gr.  aap^,  aapKos  flesh  — o)p.a 
tumor.  See  Malignant  Neoplasms. 

Saturnism. — See  Lead  Poisoning. 

Sausage  Poisoning. — See  Poisoning. 

Scapulodynia. — L.scap'ula,  shoulder-blade 

Gr.  odvvT]  pain.  See  Alyalgia. 

Scarlet  Fever;  Scarlatina. — L.  scarlati'na, 
scarlet.  A common  acute,  infectious,  con- 
tagious, and  epidemic  disease  of  veiy 
variable  severity,  characterized  by  an  in- 
cubation period  of  from  one  to  seven  days, 
followed  abruptly  by  headache,  nausea,  vom- 
iting, sore  throat,  a punctate  erythema  in 
the  roof  of  the  mouth,  fever,  rapid  pulse, 
often  convulsions,  and,  after  twelve  to 
thirty-six  hours  or  longer,  a diffuse  scarlet 
rash  consisting  of  scattered  minute  macular 
red  points  upon  a flushed  skin.  The  rash  is 
brilliant  red  in  severe  cases,  noticeable  only 
in  the  axillae,  groins,  and  loins  in  mild  cases, 
and  sometimes  even  absent.  The  face  is 
relatively  free.  The  papillae  of  the  tongue 
are  enlarged,  especially  at  the  tip  and 
edges  (strawberry  tongue).  After  two  or 
three  days  or  longer  the  rash  and  fever 
gradually  subside,  followed  by  desquama- 
tion. Streptococcic  and  sometimes  other 
pyogenic  infections  frequently  supervene, 
viz.,  angina,  sometimes  resembling  diph- 
theria, toirsillar  abscess,  otitis  metha,  max- 
illary sinusitis,  cervical  Ijunphadenitis, 
arthritis,  pleuritis,  endocarditis,  pericarchtis, 
septicaemia,  bronchopneumonia.  Neplu’itis 
is  very  prone  to  occur. 

Scarlet  fever  should  be  distinguished  from 
ervdhema  scarlatinaforme,  measles,  rubeola, 
septicaemia,  dii:>htheria  with  an  erjdhema- 
tous  rash,  and  drug  eruptions  (quinine,  bella- 
donna, antitoxin,  copaiba,  iodides,  iodo- 
forn\,  strychnine,  antipvTine,  salicylates, 
corrosive  sublimate  used  externally).  Scar- 
let fever  is  accompanied  by  leucocvdosis. 

Prognosis. — The  mortality  averages  about 
8 to  0 per  cent.  The  disease  seems  to  have 
bec'ome  milder  in  recent  years. 


SCARLET  FEVER;  SCARLATINA 


Treatment.— Isolate  the  patient  (see  Dis- 
infection) , and  confine  him  to  bed  in  a quiet, 
well-ventilated  room,  at  a temperature  of 
60°  to  70°  F.  Open  the  bowels  with  calomel, 
or  castor  oil,  and  secure  a daily  movement 
by  means  of  a mild  laxative,  such  as  citrate 
of  magnesia,  or  aromatic  cascara  (for  all 
Drugs,  see  Part  11).  Prescribe  a bland 
liquid  diet  consisting  of  milk,  two  quarts 
daily,  buttermilk,  whey,  thin  cereal  gruels 
properly  salted,  ice-cream,  and  orange  juice. 
If  the  milk  is  not  well  borne,  add  lime  water, 
gruels,  cocoa,  carbonated  water,  malted  milk, 
or  Mellin’s  or  Horlick’s  food,  or  try  koumyss 
(Part  11)  or  Kefir.  In  bottle-fed  infants 
dilute  the  milk  one-half.  Administer  an 
abundance  of  water  in  the  form  of  cream  of 
tartar  lemonade  (Part  11).  Allow  no  meat 
or  meat  extractives  because  of  their  irritat- 
ing effect  on  the  kidneys. 

The  following  old-fashioned  fever  mix- 
ture can  do  no  harm: 

Spiritus  setheris 

nitrosi on  (iIEv  per  teaspoonful) 

Potassii  citratis.  . . 3i  (gr.  iiss  per  teaspoonful) 
Liquor  ammonii 

acetatis Siss  (3ss  per  teaspoonful) 

Syrupi  simplicis ...  5 i 
Aqua)  camphora), 

q.s.  ad giv 

M.  Sig. — One  teaspoonful  (for  a thrce-year-old) 
to  one  tablespoonful  (for  adult)  every  three  hours. 

The  throat  should  be  gargled  or  sprayed 
every  three  hours  with  hot  normal  saline 
solution  (3i  ad  Oi),  or  boric  acid  solution 
containing  carbolic  acid,  gr.  v to  the  ounce, 
and  a little  sugar,  or  Dobell’s  solution  (Part 
11);  or  hydrogen  peroxide  diluted  with 
three  or  four  volumes  of  water.  The  throat 
may  be  gently  swabbed  or  mopped  occa- 
sionally with  Loeffier’s  solution  (Part  11),  or 
diluted  tincture  of  iodine.  If  a nasal  dis- 
charge is  present,  the  nose  may  be  cleansed 
with  swabs  of  absorbent  cotton,  and  calomel 
insufflated  or  liquid  albolene  instilled.  If 
deemed  advisable,  the  nose  and  throat  may 
be  irrigated  by  means  of  a soft  catheter, 
with  hot  normal  saline  solution  every  four 
to  six  hours;  but  the  danger  of  thereby 
forcing  infectious  material  into  the  middle 
ear  should  be  borne  in  mind.  During  the 
irrigation  the  patient  should  breathe  through 
the  mouth  and  should  refrain  from  swallow- 
ing. Meddlesome  treatment  should,  how- 
ever, be  avoided. 

If  diphtheria  is  suspected,  take  cultures 
for  the  diphtheria  bacillus  from  beneath  the 
pseudo-membrane.  Watch  the  ears,  and 
incise  the  drum  membrane  under  cocaine 
anaesthesia  at  the  first  sign  of  bulging  (see 
Part  7,  Ear  Diseases.) 

21 


For  a temperature  of  103.5°  F.,  or  over, 
employ  hot  or  tepid  sponging. 

For  restle-ssness  or  insomnia,  prescribe 
sodium  bromide. 

If  muscular  twitching,  delirium,  and 
stupor,  indicative  of  nephritis,  occur,  or  the 
urine  becomes  scanty,  apply  hot  poultices 
over  the  kidneys,  and  give  saline  infusions 
(0.9  per  cent.,  one-half  to  one  quart,  two  or 
more  times  daily)  and  saline  purgatives. 
Urotropine  is  recommended  by  Widowitz  as 
a preventive  of  nephritis. 

For  circulatory  weakness  administer 
strychnine,  or  digitalis. 

For  marketl  delirium,  achninistermorphine. 

For  adenitis,  apply  the  ice-bag;  or  com- 
pression with  flexible  collodion;  or  ichthyol, 
30  per  cent.,  in  zinc  ointment,  every  three 
hours;  or  cataplasma  kaolini,  every  six 
hours;  or  ung.  Crede  inunctions,  gr.  x, 
rubbed  in  for  fifteen  minutes  twice  daily. 
Should  suppuration  seem  unavoidable,  make 
hot  applications,  and  incise  freely  as  soon 
as  fluctuation  appears. 

Antistreptococcus  serum  (Part  11)  is  well 
recommended  for  severe  cases.  For  com- 
plicating streptococcic  infections  as  well  as 
for  the  scarlet  fever  itself  are  recommended 
injections  of  killed  streptococci,  100,000,000 
at  the  first  injection,  increased  in  subse- 
quent injections  (given  every  five  to  seven 
days)  to  500,000,000.  Autogenous  vaccines 
from  cultures  obtained  from  the  nose  or 
throat  should  be  preferred;  but  the  results 
of  vaccine  therapy  are  not  very  striking. 

As  soon  as  desquamation  begins,  the 
skin  should  be  oiled  daily  with  sweet  oil, 
cold  cream,  lanolin  softened  with  oil,  or 
cacao  butter,  and  a daily  warm  bath  given. 

The  patient  should  be  kept  in  bed  for 
at  least  three  weeks,  and  for  ten  days  after 
the  fever  has  subsided ; and  nephritis  should 
be  guarded  against  for  three  weeks  after 
getting  up.  Warm  clothing  should  be  worn, 
with  a flannel  protector  about  the  loins,  and 
cold  should  be  avoided.  The  liquid  and 
soft  diet  should  be  continued  for  from  four 
to  six  weeks,  then  toast,  crackers,  vege- 
tables, eggs,  fruit,  broths,  and  a little  meat 
added.  Iron  should  be  prescribed,  if  need 
be,  as  soon  as  all  acute  symptoms  have 
subsided.  If  the  appetite  is  poor,  prescribe 
tincture  of  nux  vomica  and  dilute  hydro- 
chloric acid  before  meals. 

Quarantine  should  be  maintained  for  six 
to  eight  weeks  from  the  beginning  of  the 
illness,  and  as  long  as  there  is  present  any 
discharge  from  the  ear  or  nose,  or  any  other 
suppurating  focus,  or  any  desquamation 
or  crusts. 


SCURVY,  INFANTILE;  BARLOW’S  DISEASE 


After  the  patient  has  left  his  room,  he 
should  be  bathed  from  heatl  to  foot  with 
soap  and  hot  water,  followed  with  bichloride 
solution,  1 : 5000  to  1000;  the  bed-clothing, 
etc.,  should  be  boiled,  and  the  room  disin- 
fected, as  described  under  Disinfection. 

Schistosomiasis. — Gr.  crxtoros  cleft  + 
<Tu^Jia  body.  See  under  Distomiasis. 

Schonlein’s  Disease;  Purpura  (Peliosis) 
Rheumatica. — L.  purpura,  purple;  Gr. 
TTeXtos  livid.  See  Purpura,  in  Part  5,  Skin 
Diseases. 

Sciatica. — L.  sdat'iais]  Gr.  laxi-ocStKos  per- 
taining to  the  ischium.  See  Neuralgia. 

Sciatic  Nerve. — See  Sacral  Plexus. 

Sclerema  Neonatorum. — See  Part  5, 
Skin  Diseases. 

Scleroderma. — See  Part  5,  Sldn  Diseases. 

Sclerosis,  Amyotrophic  Lateral. — Gr. 
o’KXrjfXioai.s  hardness;  aneg.  -j-  uvs  mus- 
cle + Tpo4>ri  nourishment;  L.  lat'us, 
side.  See  Atrophies,  the  Progressive 
Muscular. 

Disseminated. — See  Multiple  Sclerosis. 

Gastric. — See  Cirrhosis  of  the  Stomach. 

Insular. — See  Multiple  Sclerosis. 

Multiple. — See  Multiple  Sclerosis. 

Pulmonary. — See  Pulmonary  Cirrhosis. 

Scorbutus. — See  Scurvy. 

Scrivener’s  Palsy;  Writer’s  Cramp. — See 
Cramps,  Professional. 

Scrofula. — L.  “sow-pig.”  See  Lxanpha- 
denitis  Tuberculosa. 

Scurvy ; Scorbutus. — L.  scorbut'us,  scur^’3^ 
A disorder  of  nutrition  caused  by  a defi- 
ciency in  the  dietary  of  certain  vitamines 
which  are  contained  in  fresh  vegetables  and 
fresh  meats,  and  characterized  by  a reduc- 
tion in  the  alkalinity  of  the  blood,  anaemia, 
debility,  mental  apathy,  swelling  and  spongi- 
ness of  the  gums,  ulceration  of  the  mouth, 
and  a tendency  to  mucous,  serous,  intra- 
muscular and  subcutaneous  hemorrhages, 
the  latter  appearing  as  petechise,  ecchymoses, 
and  large  effusions  producing  indurated  sw'el- 
lings.  Exclude  purpura,  mercurialism,  and 
acute  lymphatic  leuka?mia.  Contributing 
causes  are  overcrowding,  overwork,  exposure 
to  cold  and  damp,  and  niental  depression. 

The  Prognosis  under  treatment  is  favor- 
able, a cure  being  usually  accomplished  in 
two  or  three  w^eeks. 

Treatment.— Antiscorbutics  are  fresh  vege- 
tables, fresh  fruits,  and  fresh  meats,  viz., 
cabbage,  carrots,  beets,  turnips,  radishes, 
onions,  spinach,  dandelion  leaves,  lettuce, 
watercress,  yams,  potatoes  (cook  with  the 
skins  to  retain  the  potassium  salts),  squash, 
asparagus,  vinegar,  sauerkraut,  pickles, 
fresh  infusion  of  malt  (very  highly  praised), 


cranberries,  raspberries,  strawberries,  goose- 
berries, grapes,  melons,  apples,  lemons  (two 
to  four  daily),  limes,  oranges,  fresh  meat- 
juice,  milk,  eggs.  It  is  the  freshness  of  the 
food  that  is  the  essential  desideratiun. 
Vitamines  are  destroyed  by  drying,  pressing, 
tinning,  processing,  autoclaving,  or  pickling. 

If  the  patient’s  digestion  is  weak,  begin 
with  small  quantities  of  scraped  meat,  milk, 
and  lemon  juice,  at  short  intervals,  and 
gradually  increase  the  dietary.  For  consti- 
pation give  Rochelle  salts  and  large  enemata. 
For  anaemia  give  iron  (see  Drugs,  Part  11.) 

The  teeth  should  be  kept  clean  with  warm 
water,  castile  soap,  and  a soft  brush 
or  cloth,  and  one  of  the  following  aseptic 
and  astringent  preparations  used  as  a 
mouth- wash: 

Potassium  permanganate,  1 : 300;  car- 
bolic acid,  gr.  v to  the  ounce  of  water; 
peroxide  of  hydrogen;  potassium  chlorate, 
5i,  tr.  myrrh,  oh,  aq.,  5viii  (warmed); 
tr.  myrrh  and  tr.  catechu,  equal  parts;  tr. 
krameria,  5ss,  ahun,  5i,  aq.  5viu. 

The  first  two  are  the  best,  says  Osier. 
Paint  the  gums  with  a strong  solution  of 
silver  nitrate.  To  check  bleeding  from  the 
gums,  apply  adrenalin,  1 : 1000,  or  iron 
perchloride,  concentrated  solution  (see  also 
Gingivitis) . 

Employ  gentle  massage  for  the  purpose  of 
promoting  the  absorption  of  the  hard  sub- 
cutaneous effusions  and  for  stiffened  joints. 

For  scuiwy  in  infants,  see  Scur^y,  In- 
fantile, following. 

Scurvy,  Infantile;  Barlow’s  Disease. — 

Infantile  scur\y  is  the  same  disease  as 
the  scurvy  of  adults  (q.v.).  The  essential 
cause  in  infants  is  the  exclusive  feeding  of 
sterilized  foods.  The  characteristic  sjnnp- 
toms  are  pain,  tenderness,  and  swelling  of 
the  limbs,  elicited  by  handling,  and  due  to 
subperiosteal  hemorrhage;  pseudo-paralysis; 
antemia;  sponginess  and  swelling  of  the 
gums;  hematuria;  cutaneous  hemorrhages; 
rarely  other  hemorrhages;  sometunes  exoph- 
thalmus  due  to  orbital  hemorrhage;  some- 
times fracture  or  epiphyseal  separation 
revealed  by  crepitus. 

Rickets  frequently  accompanies  scurvy. 

Appropriate  treatment  is  promptly  cura- 
tive. 

Treatment.— Prescribe  fresh,  unboiled,  mod- 
ified’s  cow’s  milk  (see  Infant  Feeding), 
together  with  orange,  lemon,  apple,  or 
grape  juice,  sweetened  if  necessary,  1 to  2 
to  4 ounces  daily,  in  divided  doses,  one 
hour  before  feedings.  Fresh  raw  meat 
juice,  34  to  2 ounces  daily,  may  also  be  given. 
It  is  prepared  as  follows:  Four  parts  of 


SHOCK;  COLLAPSE 


finely  chopped  steak  is  stirred  with  one  part 
of  cold  water,  allowed  to  stand  for  half  an 
hour  in  the  cold,  and  the  juice  then  pressed 
through  a cloth  or  meat  press.  To  infants 
over  seven  months  of  age,  one  may  give 
baked  potato,  two  teaspoonfuls,  rubbed  up 
with  milk  into  a thin  cream,  three  or  four 
times  a day. 

The  affected  limbs  may  be  partly  immo- 
bilized by  means  of  cotton-wool,  light 
splints,  and  a bandage. 

During  convalescence  prescribe  codliver 
oil  and  iron  (Part  11.) 

Seasickness. — See  Vomiting. 

Seat=Worm  Infection. — See  Oxyuriasis. 

Second  Nerve. — ^See  Optic  Nerve,  in 
Part  6,  Eye  Diseases. 

Septicaemia  and  Septico=Py«mia.— Gr. 
crrjwTLKos  putrid;  irvov  pus;  alfj,a  blood. 
Bactersemia  (septicaemia)  and  bacteraemia 
accompanied  by  metastatic  abscesses  (sei> 
ticopyaemia)  are  caused  by  the  following 
organisms,  viz.,  streptococci  (haemolyticus, 
viridans,  mucocus),  staphylococci,  pneumo- 
cocci, the  gonococcus,  bacillus  coli,  bacillus 
proteus,  bacillus  pyocyaneus,  bacillus  influ- 
enzae, bacillus  typhosus,  bacillus  tuberculosis, 
bacillus  anthracis,  micrococcus  tetragenes, 
bacillus  aerogenes  capsulatus,  Friedlander’s 
bacillus  pneumoniae.  The  org-anisrn  usually 
enters  through  some  focus  of  infection, 
e.g.,  an  infected  wound,  erysipelas,  alveolar 
abscess,  tonsillitis,  sinusitis,  otitis  media, 
empyema,  fetid  bronchitis,  bronchiectasis, 
pulmonary  abscess,  pulmonary  gangrene, 
periostitis,  osteomyelitis,  phlebitis,  lymph- 
angitis, suppurative  lymphadenitis,  appen- 
dicitis, cholecystitis,  gastro-intestinal  infec- 
tion, gonorrhoea,  prostatic  abscess,  pyelitis, 
renal  tuberculosis,  omphalitis  in  the  new- 
born, puerperal  infection,  malignant  endo- 
carditis, etc.,  etc. 

The  symptoms  of  sepsis  are  as  follows: 
chills  or  chilliness,  irregular  fever,  leucocy- 
tosis,  small  rapid  pulse,  anorexia,  perhaps 
nausea  and  vomiting,  perhaps  diarrhoea,  dry 
tongue  with  red  border,  often  an  erythema, 
delirium,  prostration,  anaemia,  wasting.  Ex- 
clude typhoid  fever,  acute  miliary  tubercu- 
losis, malaria,  profound  anaemia,  cancer, 
gall-stones  in  the  common  duct,  Hodgkin’s 
disease,  and  hysteria.  A blood  culture 
should  be  made,  if  possible,  and  the  causal 
organism  identified. 

Treatment. — Accessible  pus  cavities  should 
be  freely  evacuated  and  drained.  Fresh  air 
is  of  great  importance.  The  mouth  should 
be  kept  clean  by  means  of  an  antiseptic, 
such  as  a mixture  of  glycerine,  3iv,  boric 
acid,  3i)  carbolic  acid,  t^.xx,  and  water  to 


5iv,  with  which  the  tongue,  cheeks,  teeth, 
and  gums  should  be  swabbed  every  four 
hours,  using  for  this  purpose  a cotton-stick 
or  cotton  or  gauze  sponge  held  with  haemo- 
static forceps.  Bed-sores  (q.v.),  should  be 
guarded  against.  The  bowels  should  be 
moved  daily.  Concentrated  liquid  nourish- 
ment should  be  achninistered  every  three 
hours,  e.g.,  milk,  at  least  three  pints  in 
twenty-four  hours,  buttermilk,  three  or 
more  eggs,  gruels  and  meat  juice,  prepared 
as  directed  under  Scurvy,  Infantile.  For  the 
toxaemia,  give  an  abundance  of  water,  by 
mouth,  or  as  normal  saline  solution  (0.9  per 
cent.)  per  colon  by  the  drop  method,  sub- 
cutaneously, or  intravenously  (q.v.) : to 

1 quart,  two  or  more  times  daily.  If  stimu- 
lation is  required,  give  whiskey,  or  brandy 
in  full  doses,  strychnine,  or  digitalis  (see 
Drugs,  Part  11.) 

Quinine  hydrochlorate,  gr.  viiss,  twice 
daily,  may  be  given.  Inunctions  of  unguen- 
tum  Crede  are  reconmiended,  especially 
for  children:  3i  once  to  thrice  daily  for 
infants;  as  much  as  3iv  twice  a day.  for 
older  chikh’en  (Forchheuner).  Collargol 
(argentum  colloidale  Cred6),  2 c.c.  of  a 
sterile  5 per  cent,  solution  may  be  injected 
subcutaneously.  (Ortner.)  Nuclein,  5 per 
cent,  solution,  10  c.c.,  hypodermically,  once 
daily  for  three  or  four  days  out  of  every 
eight,  may  be  tried.  (Austin). 

V accineand  serumtherapy  isrecommended 
by  some  (see  Malignant  Endocarditis). 

Septic  Sore  Throat. — See  Part  9,  Throat 
Diseases. 

Serous  Meningitis. — See  under  Hydro- 
cephalus. 

Serratus  Paralysis. — See  the  Long  Thor- 
acic Nerve,  under  Brachial  Plexus. 

Seventh  Nerve. — See  Facial  Paralysis; 
and  Habit  Spasm. 

Sewer=Qas  Poisoning. — See  Carbon 
Monoxide,  under  Poisoning. 

Shaking  Palsy. — See  Paralysis  Agitans. 

Shock;  Collapse. — Shock  is  manifested  by 
a rapid,  weak  pulse,  low  blood-pressure, 
rapid,  shallow  respirations,  subnormal  tem- 
perature, muscular  relaxation,  dilated  pupils, 
pallor,  cold  clammy  perspiration,  diminished 
urinary  secretion,  and  weakening  or  loss  of 
consciousness. 

The  immediate  cause  is,  perhaps,  de- 
pression of  the  vasomotor  apparatus,  due  to 
overstimulation,  severe  hemorrhage,  exces- 
sive vomiting  or  purging,  toxEemia,  emotion, 
pain,  'etc. 

Other  and  predisposing  causes  are  early 
life  (except  the  first  week),  old  age, 
debility,  anaemia. 


SLEEPING  SICKNESS;  HUMAN  TRYPANOSOMIASIS 


Treatment. — Lower  the  head,  surround  the 
l)ody  with  hot  water  bottles  wrapped  in 
towels,  placed  near  but  not  in  contact  with 
the  skin,  and  observe  absolute  quiet.  Im- 
mobilize wounds.  One  may  bandage  the 
limbs  and  abdomen  evenly  and  tightly  over 
thick  layers  of  non-absorbent  cotton,  or 
employ  Crile’s  rubber  pneumatic  suit  for 
one  or  two  hours;  but  take  care  not  to 
impede  the  diaphragm. 

Atlminister  hot  normal  saline  solution 
(0.6  to  0.7  per  cent.,  or,  say,  gr.  xliv  to  the 
pint,  temperature  102°  E.),  containing  acacia, 
7 per  cent,  (of  the  same  viscosity  as  that  of 
the  blood;  see  Part  11),  per  rectum  by 
Murphy’s  method  (see  uncler  Appendicitis), 
or  subcutaneously,  or  intravenously.  Give, 
according  to  Crile,  no  more  than  a pint  of 
simple  saline  solution  at  a time  (to  avoid 
pulmonary  oedema),  and  repeat  every  hour 
until  the  pulse  is  restored.  Adrenalin 
chloride,  15  minims  of  a 1 : 1000  solution, 
may  be  added  to  the  pint  of  saline  solution. 
Give  the  infusion  very  slowly.  Blood  trans- 
fusion iq.v.)  is  of  value 

If  I’espiration  ceases,  perform  rhjdhmic 
thoracic  compression  (see  Asphyxia)  with  the 
head  low  and  the  tongue  pulled  forward, 
but  not  too  far. 

Brandy,  digitalin,  strychnine,  camphor, 
atrojiine,  caffeine,  and  pituitrin  (see  Drugs, 
Part  11)  may  be  of  some  service,  especially 
pituitrin,  2 to  4 minims  every  half  to 
one  hour.  IMorphine,  gr.  }/g  to  }/i,  is  of 
value  in  psychic  shock.  Matas  injects 
slowly  into  the  rectum,  black  coffee,  8 oz., 
panopepton,  1 oz.,  brandy  or  whiskey,  1 oz., 
tincture  of  digitalis,  15  minims,  and  lauda- 
num, 10  minims,  which  may  be  repeated 
after  two  hours  if  necessary.  Ander’s  fav- 
orite formula  for  shock  is;  Adrenalini 
chloridi  (1  : 1000),  rjv,  morphinse  hydro- 
chloridi,  gr.  >^4,  nitroglycerini,  gr.  ^0, 
atropina?  sulphatis,  gr.  j^o-  Nitroglycerine, 
however,  lowers  blood-pressure.  (See  also 
Hemorrhage  and  Anaphylactic  Shock. 

Prophjiaxis.— In  operating,  endeavor  to 
avoid  shock  by  keeping  the  patient  warm, 
by  careful  ansesthesia,  l)y  guarding  against 
loss  of  blood,  and  by  as  little  exjiosure  as 
possible  and  very  gentle  handling  of  the 
tissues.  Keep  large  wounds  (as  in  breast 
amputation)  and  exposed  viscera  covered 
with  towels  wrung  out  of  hot  normal  saline 
solution  and  frequently  renewed.  The 
Trendelenburg  j)osition  militates  against 
shock.  With  the  object  of  blocking  the 
nerve  jiatlis  and  jn’eventing  jiainful  stimuli 
from  reaching  the  nerve  centres,  Crile  advo- 
cates injecting  the  line  of  the  skin  incision 


with  novocain  (q.v.  in  Part  11),  and  the  peri- 
toneum with  quinin-urea-hydrochloride  (q.v.) 
before  cutting  (Crile’s  anoci-association). 
Come  administer  morphine,  gr.  3^,  and 
atropine  gr  Koo?  one-half  hour  before  the 
operation.  In  amputations,  the  nerve 
tnmks  should  be  blocked  before  dividing 
them,  with  intraneural  injections  of  cocaine 
or  eucaine,  10  to  15  minims  of  a 2 per  cent, 
solution.  In  intralaryngeal  operations,  first 
give  atrojDine  and  apply  cocaine  to  the 
laryngeal  mucous  membrane,  in  order  to 
avoid  serious  reflex  vagus  stimulation. 

Avoid  prolonged  starv'ation  before 
the  operation. 

Shoemaker’s  Cramp. — See  Tetany. 

Shortness  of  Breath. — See  Dyspnoea. 

Sick  Headache. — See  Migraine. 

Sigmoiditis. — SeeProctitisand  Sigmoiditis. 

Siriasis. — Gr.  aipaeiv  to  be  hot.  See  Sun- 
stroke. 

Sixth  or  Abducens  Nerve. — See  IMotor 
Nerves  of  the  Eyeball. 

Skin  Ulcers. — See  Ulcers,  Cutaneous. 

Skull  Fractures. — See  under  Concussion, 
Contusion,  and  Compression  of  the  Brain. 

Sleepiness. — See  Somnolence. 

Sleeping  Sickness;  Human  Trypanoso= 
miasis. — Gr.  rpinravov  borer  -j-  aupa  bod}\ 
A very  fatal  cUsease  of  Central  Africa, 
caused  by  the  trypanosoma  Gamdiense,  an 
actively  motile  flagellate  infusorimn,  which 
is  transmitted  by  the  common  fly  or  by  a 
Tsetse  fly.  (Fig.  75.) 

The  onset  of  the  cUsease  is  slow  and  insid- 
ious, extending  over  a period  of  months,  tlur- 
ing  which  time  the  only  change  noticeable 
in  the  patient  is  a general  enlargement  of  the 
lymphatic  glands,  from  which  the  causal 
agent  may  be  obtained  by  drawing  off  a 
drop  of  l>nnph  with  a small  hypodermic 
syringe;  theorganismis  lesseasily found  in  the 
blood  (citrated  and  centrifugalized  twice.) 

Sooner  or  later  s^nuptoms  of  the  sleeping 
sickness  (meningo-encephalo-myelitis)  may 
supervene,  viz.,  apathy,  rapid  soft  pulse, 
evening  rise  of  temjx'rature  of  one  or  two 
degrees,  tremor  of  the  tongue  and  hands, 
slow,  weak,  tremulous,  indistinct  speech, 
weak  shuffling  gait,  Ixmiphocx-tosis,  organ- 
isms in  the  cerebro-sinnal  fluid,  fatal  termi- 
nation in  coma.  In  examining  for  organisms 
in  the  cerebro-sj^inal  fluid,  gently  centrifuge 
the  latter  for  five  minutes,  and  examine  the 
sediment  under  a vaselined  cover-glass. 

Sleeping  sickness  does  not  occur  in  all 
cases  of  trypanosomiasis.  S]x>ntaneous  cure 
mav  occur. 

The  onlv  remedies  that  have  proved  of 
value  are  (1)  arsenic,  in  the  form  of  atoxyl, 


SMALLPOX;  VARIOLA 


arsenophenylglycin,  or  salvarsan;  (2)  anti- 
mony, in  the  form  of  tartar  emetic;  and  (3) 
trypanroth,  an  aniline  dye  introduced  by 
Ehrlich  and  Shiga. 

Atoxyl,  gr.  viiss,  in  normal  saline  solution 
(0.9  per  cent),  about  38  minims,  freshly 
prepared,  is  injected  intravenously  (q.v.),  or 
intramuscularly,  at  a temperature  of  102°  F., 
on  two  successive  days,  and  this  repeated 
every  eight  days  for  a long  time — six  months 
or  longer.  Permanent  blindness,  due  to 
optic  atrophy,  sometimes  results  (see  also 
Part  11). 


Fig.  75. — Trypanosomes  in  the  blood  (Webster). 


Tartar  emetic,  gr.  ss-iss,  in  normal  saline 
solution,  is  injected  intravenously  on  suc- 
cessive days.  The  technique  is  as  follows: 
The  tartar  emetic  is  added  to  four  ounces  of 
normal  saline  solution  in  a glass  flask,  which 
is  plugged  with  cotton-wool,  and  boiled  for 
ten  minutes.  Another  flask  containing  ten 
ounces  of  normal  saline  is  also  boiled. 
Through  an  intravenous  needle,  rubber  tub- 
ing and  glass  funnel,  such  as  is  used  in  admin- 
istering salvarsan,  all  sterilized  by  boiling, 
one  to  two  ounces  of  normal  saline,  heated 
to  102°  F.,  is  allowed  to  flow  slowly  into  the 
vein  to  make  sure  that  no  leakage  occurs; 
then  the  solution  of  tartar  emetic,  also 
heated  to  102°  F.,  is  gradually  introduced,  at 
no  greater  rate  than  one  ounce  per  minute. 
Near  the  end  of  the  flow,  add  three  ounces 
more  of  the  normal  saline,  to  wash  all  the 
antimony  into  the  vein;  and  withdraw  the 
needle  before  all  the  saline  has  entered 
the  vein.  Never  allow  leakage  into  the 
tissues  (beciause  of  subsequent  necrosis)  or 


the  funnel  to  become  empty  of  fluid. 
(Manson;  Newham.) 

Prophylaxis  embraces  deforestation, 
drainage,  destruction  of  wild  animals  (the 
parasite  passes  from  the  blood  of  wild  game 
to  the  intestine  of  the  fly  to  the  salivaiy 
glands  of  the  fly,  thence  to  man),  clearing 
of  300  yards  around  houses,  clearing  of 
streams  at  fording  places,  destruction  of 
flies,  wearing  of  white  clothing  and  boots, 
head  nets,  mosquito  bars  at  night,  imme- 
diate disinfection  of  bites,  by  boring  with  a 
wooden  tooth-pick  dipped  in  carbolic  acid, 
isolation  and  screening  of  the  sick,  and 
examination  of  the  blood  and  glands  of  all 
persons  every  three  months. 

(Nagana  or  Tsetse  fly  disease  of  Central 
Africa  is  a fatal  trypanosomiasis  of  domestic 
animals.  The  fatal  surra  of  India  is  also  a 
trypanosomiasis  of  domestic  animals.  A 
trypanosomiasis  also  occurs  in  the  Philij>- 
pines  and  in  South  America,  (Chagas  disease 
or  American  Trypanosomiasis.) 

American  Tiypanosomiasis  is  caused  by 
the  Trypanosoma  cruzi,  which  is  conveyed 
by  certain  ticks,  the  bedbug,  and  varioas 
species  of  Triatoma.  Children  are  chiefly 
affected.  The  disease  may  be  acute  or 
chronic.  The  acute  form  is  marked  by 
recurring  attacks  of  pyrexia,  associated 
with  thyroid,  lymphatic,  splenic  and  hepatic 
enlargement,  and  possibly  signs  of  menin- 
gitis, and  trypanosomes  are  demonstra- 
ble in  the  blood.  The  chronic  form  is 
characterized  by  thyroid  and  Ijuirphatic 
enlargement,  tachycardia  and  other  cardiac 
irregularities,  a “bluish  bronze  pallor” 
(attributable  to  suprarenal  involvement), 
organic  nervous  disturbances,  and  often 
convulsions;  perhaps  hypothyroidi.sm.  In 
the  chronic  form  trjqjanosomes  are  not 
found  in  the  blood.  The  diagnostic  methods 
and  treatment  are  those  of  African  try- 
panosomiasis. Sjwntaneous  cure  sometimes 
occurs. 

Sleeplessness. — See  Insomnia. 

Slow  Heart. — See  Bradycardia. 

Smallpox;  Variola  (Variola  is  Latin  for 
Smallpox). — An  acute  infectious,  contagious, 
and  epidemic  disease,  of  verj"  variable 
severity,  caused  probaljly  by  a protozoon, 
the  cytoiyctes  of  Cluaniere,  characterized  by 
an  incubation  period  of  nine  to  fifteen  days, 
followed  rather  abruptly  by  .severe  headache, 
backache,  vomiting,  fever,  chills,  sometimes 
convulsions,  and  marked  depression,  with 
often  a scarlatiniform  or  morbiliform  and 
petechial  rash;  these  symptoms  persist  usu- 
ally three  days,  and  then  subside  coinci- 
dently  with  the  appearance  of  a general  red, 


SMALLPOX;  VARIOLA 


maculo-papular,  hard,  shot-like  rash,  most 
marked  on  the  forehead  and  wrists,  the 
papules  later  becoming  umbilicated  vesicles; 
on  about,  the  eighth  day  of  the  cUsease,  the 
vesicles  become  pustules,  the  temperature 
again  rises,  and  continues  elevated  for  three 
to  six  days  in  light  cases,  six  to  twelve  days  or 
longer  in  severe  cases;  the  jmstules  later 
crust  over  and  dry  up,  and  on  healing  leave 
pitted  scars  or  pock-marks.  The  disease 
may  be  very  mild,  sometimes  not  even  pre- 
senting an  eruption;  or  it  may  terminate  m 
the  vesicular  stage.  The  eruption  is  usually 
discrete.  Confluent  smallpox  is  very  seri- 
ous, the  mortality  averaging  GO  per  cent. 
More  serious  still  is  the  hemorrhagic  pustu- 
lar form  in  which  hemorrhages  occur  in  and 
around  the  pustules  and  from  the  mucous 
membranes.  And  finally,  there  is  the  invari- 
ably fatal  purpuric  variola  in  which  a diffuse 
purpuric  rash  and  hemorrhages  from  the 
mucous  membranes  occur  in  the  initial  stage 
of  the  disease. 

Perhaps  the  most  important  complica- 
tions are  conjunctivitis,  ulcerative  keratitis, 
laiyngitis,  erysipelas,  and  broncho-pneu- 
monia. Boils  may  tlevelop  during  the 
crusting  stage.  Various  paralyses,  due 
to  neuritis  or  myelitis,  may  occur 
during  convalescence. 

Smallpox  must  be  distinguished  particu- 
larly from  chicken-po.x.  The  vesicles  of 
chicken-pox  are  not  so  hard  or  shotty;  they 
are  “ more  sharply  elevated  and  rounder,” 
are  more  translucent,  and  can  be  emptied 
by  a single  needle-prick,  whereas  in  small- 
pox the  fluid  is  contained  in  a “ system  of 
cells.”  Moreover,  the  pocks  of  varicella  are 
abundant  on  the  trunk,  often  appear  upon 
the  mucous  membranes,  and  may  be  seen 
at  one  time  in  all  stages  of  development — 
papules,  vesicles,  crusts.  Pu.stular  syphilis 
may  resemble  smallpox. 

Treatment.— Isolate  the  patient  (see  Dis- 
infection), and  confine  him  to  bed  in  a well- 
ventilatcxl  room  at  a temperature  of  G0°  to 
70°  F.  Open  the  bowels  with  calomel  followed 
by  a saline  (for  all  drugs  see  Part  11).  Pre- 
scribe a liquid  or  soft  nutritious  diet  con- 
sisting of  milk,  eggs,  cereal  gruels  and  In’oths, 
with  an  abundance  of  water.  For  the  pains, 
delirium,  and  high  fever  of  the  initial  stage 
give  ]>hcnacetin  or  morphine,  and  place 
an  ice-cap  to  the  head.  Tepid  or  hot 
sponging,  or  the  continuous  warm  bath 
at  a temperature  of  95°  F.,  is  well  recom- 
mended. The  latter  should  be  employed 
for  all  confluent  and  hemorrhagic  pustular 
ctises.  The  following  fever  mixture  may  be 
of  some  service: 


Spiritu.s  Eetheris 

nitrosi 3 ii  (irjv  per  teaspoonful) 

Potassii  citratis  vel 

acetatis oi  (gr.  iiss  per  teaspoonful) 

Liquoris  anunonii 

acetatis oiss  (3ss  per  teaspoonful) 

Syrupi  simplicis. . . 5i 
Aquaj  camphoraj, 

q.s.  ad 5iv 

M.  Sig. — One  teaspoonful  (for  three-year-olds)  to 
one  tablespoonful  (for  adult)  every  three  hours. 

For  vomiting,  withhold  all  food,  and  give 
only  ice  and  champagne,  or  iced  soda  water. 
Give  alcohol  for  severe  toxaemia.  In  severe 
cases  it  is  well  to  cut  otf  the  hair  in  order 
to  prevent  troublesome  matting. 

Frequently  changed,  cold,  wet  lint  com- 
presses, to  which  may  be  added  glycerine, 
oi  to  the  pint,  and  also  menthol  or  carbolic 
acid,  1 per  cent.,  for  the  itching,  should  be 
applied  to  the  face  and  hands  and  covered 
with  oil-silk,  both  to  afford  relief  and  to 
lessen  the  formation  of  crirsts.  Painting  the 
lesions  once  or  twice  a day  with  tincture  of 
iodine,  pure  or  diluted  according  to  the  sensi- 
tiveness of  the  skin,  is  well  recoimnended. 
Protection  of  the  skin  against  the  chemical 
light  rays,  as  in  a red-light  room  or  in  a 
dark  room,  is  said  to  prevent  suppuration. 
Hardened  scabs  should  be  softened  with 
cold  cream.  The  sheets  should  be  dusted 
with  finely  powdered  boric  acid  and 
changed  frequently. 

For  conjunctivitis,  cleanse  the  eyes  every 
hour  with  warm  boric  acid  solution,  and 
anoint  the  lids  with  vaseline.  Apply  cold 
compresses  if  the  eyes  are  swollen.  The 
eyes  may  be  bandaged  to  keep  the  eyeballs 
quiet.  Keratitis  calls  for  atropine  (see 
Part  6,  Eye  Diseases). 

For  the  nose  and  mouth,  employ  Dobell’s 
solution  (Part  11).  Orthoform  lozenges,  gr.  i, 
are  useful  for  the  relief  of  a painful  mouth. 

In  the  pustular  stage,  achninister  alcohol 
in  full  doses  and  concentrated  food  even 
before  the  appearance  of  such  severe  sjunp- 
toms  of  toxremia  as  delirium,  pallor,  tremor, 
and  subsultus  tendinum.  Give  one-half  to 
two  ounces  of  whiskey  in  a glass  of  milk 
eveiy  two  or  three  hours,  and  two  to  four 
eggs  in  the  twenty-four  hours.  Quinine, 
gr.  ii,  every  three  or  four  hours,  is  also 
recommended.  Give  morphine  for  insomnia 
and  delirium.  Children  should  be  restrained 
from  scratching. 

A patient’s  discharges  should  be  disin- 
fected as  directed  under  Disinfection. 
The  physician  should  don  gown  and  rubbers 
before  entering  the  sick  room,  and  should 
wash  his  liands,  face,  and  hair,  the  latter 
with  alcohol,  after  leaving. 


SMALL-POX 


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LAROUSSR  MEDICAL 


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SPASTIC  PARALYSIS 


All  exposed  persons  should  be  vaccinated 
(see  Vaccinia).  A successful  vaccination  is 
protective  if  performed  within  three  days 
after  exposure.  The  protection  lasts  from 
seven  to  ten  years. 

The  patient  should  be  quarantined  until 
all  dried  discs  of  epidermis,  etc.,  have  been 
removed.  He  is  then  bathed  thoroughly 
from  head  to  foot  with  soap  and  hot  water, 
followed  by  bichloride  solution,  1 : 2000, 
clothed  in  clean  garments,  and  released. 
The  room  is  fumigated  for  twenty-four  hours 
with  formaldehyde  (see  Disinfection),  and 
then  washed  with  bichloride  solution,  1 : 2000 
to  1000;  and  the  bed-clothing  etc.,  boiled  or 
otherwise  sterilized.  The  clothing  should  be 
soaked  in  a 5 per  cent,  solution  of  carbolic 
acid  or  formalin  before  being  removed  to 
be  boiled. 

Smell. — (See  Anosmia,  Cacosmia,  Hyper- 
osmia,  and  Parosmia,  in  Part  8,  Nose 
Diseases.) 

Smoker’s  Tongue. — See  Leukoplakia 

Buccalis,  in  Part  8,  Nose  Diseases. 

Snake  Poisoning. — See  under  Poisoning. 

Soldier’s  Heart. — See  heart-strain,  and 
neurasthenia. 

Somnolence. — L.  so7nnoleritia,  sleepiness. 
Causes.— Hysteria;  rarely  neurasthenia;  sen- 
escence; thyroid  insufficiency;  acromegaly; 
tmnor,  abscess,  syphilis,  or  arteriosclerosis 
of  the  brain;  hydrocephalus;  serous  menin- 
gitis; toxaemia;  dementia  paralytica;  de- 
mentia praecox.  See  also  Coma. 

Soor. — German  for  thrush.  See  Stoma- 
titis, Parasitic  or  Mycotic. 

Spasm,  Cardial. — L.  spasmus;  Gr.  a-n-acr/xos. 
See  Cardiospasm. 

Carpo=pedal. — See  Tetany. 

Cervical  Muscular. — See  Torticollis, 
in  Part  10,  Orthopaedics. 

Facial. — See  Habit  Spasm. 

Glottic. — See  Laryngismus  Stridulus. 

Habit. — See  Habit  Spasm. 

Intestinal. — See  Enterospasm. 

Laryngeal. — See  Larjmgismus  Stridulus. 

Mimic. — See  Habit  Spasm. 

(Esophageal. — See  (Cardiospasm  and 
(Esophagismus. 

Professional.— See  Cramps,  Profes- 
sional. 

Pyloric. — See  Dilatation  of  the  Stom- 
ach, Chronic. 

Spasmodic  Croup. — See  Laryngitis  Acuta; 
and  Laryngismus  Stridulus. 

Laryngitis.  — See  Laryngitis  Acuta; 
and  Laryngismus  Stridulus. 

Spasmophilia;  Hypertonia. — See  Tetany. 

Spastic  Constipation. — Gr.  (jiraaTiKos  char- 
acterized by  spasm.  See  Con.stipation. 


Spastic  Paralysis. — Spastic  paralysis  is 
characterized,  in  uncomplicated  cases,  by 
motor  weakness,  spasticity,  exaggerated 
reflexes,  and  the  Babin.ski  reflex  (extension 
of  the  great  toe  and  flexion  of  the  other 
toes  on  tickling  the  sole).  It  is  an  upper 
segment  paralysis. 

Spastic  paraplegia  refers  to  paralysis  of 
the  legs  alone;  spastic  diplegia  to  paralysis 
of  both  arm  aird  leg. 

Causes. — 1.  Lateral  sclerosis:  not  accom- 
panied by  muscular  atrophy  or  sensory  dis- 
turbance; very  rare. 

2.  Progressive  central  muscular  atrophy, 
see  Atrophies,  the  Progressive  Muscular. 

3.  Compression  of  the  cord,  due  to  frac- 
ture, dislocation  or  other  injuiy,  vertebral 
caries,  aortic  aneurysm,  spondylitis  defor- 
mans, cysticercosis  (q.v.),  and  tumors 
(carcinoma,  sarcoma,  myeloma,  osteoma, 
exostosis,  chondroma,  osteochondroma,  exces- 
sive callus,  myxoma,  fibi’oma,  lipoma, 
endothelioma,  cylindroma,  psammoma, 
lymphangioma,  angioma,  neurofibroma,  gli- 
oma, tubercle,  gumma,  hydatid  cyst).  If 
the  transverse  lesion  is  complete,  the 
paralysis  may  be  flaccid. 

4.  Myelitis  (q.v.). 

5.  Combined  sclerosis  (see  Combined 
System  Diseases). 

6.  Secondary  degeneration  of  the  motor 
tracts  from  cerebral  lesions,  e.g.,  tumor, 
abscess,  hemorrhage,  embohsm,  thrombosis, 
traumatism,  etc.  (including  infantile  cerebral 
paralysis  or  Little’s  disease:  see  Hemor- 
rhage, Meningeal,  in  the  New-Born.) 

7.  Congenital  arrest  in  the  development 
of  the  pyramidal  tracts. 

8.  Hereditary  and  familial  spastic 
spinal  paralysis. 

9.  Amaurotic  family  idiocy  (q.v.). 

10.  Hysteria  (q.v.). 

11.  Multiple  sclerosis  (q.v.). 

12.  Syringomyelia  (q.v.). 

13.  Marie’s  cerebellar  heredo-ataxia  (see 
suffix  to  Ataxia,  Friedreich’s  Hereditary). 

Treatment. — Consider  the  cause,  not  for- 
getting syphilis.  If  in  doubt,  an  exploratory 
operation  may  be  considered.  Divulsion  of 
the  posterior  nerve  roots  (2d  and  3d  lumbar, 
5th  lumbar,  and  2d  sacral)  may  relieve  the 
motor  weakness  when  the  latter  is  due 
chiefly  to  the  spasticity;  and  it  may  also 
be  performed  for  the  relief  of  intractable 
pain  in  inoperable  cases.  No  more  than 
two  consecutive  roots  should  be  cut.  The 
first  sacral  root  should  be  spared,  if  po.ssible, 
because  it  conveys  sensory  stimuli  from  the 
sole  of  the  foot.  Following  section  of  the 
roots,  employ  massage,  exercise,  and  splints. 


SPINAL  CORD  LOCALIZATION 


In  any  case,  employ  passive  movements, 
following  the  application  of  heat,  three  or 
four  times  daily,  in  order  to  relieve  the 
spasticity  and  to  prevent  atihesions.  The 
latter,  when  present,  should  be  broken  up, 
under  anaesthesia  if  necessary.  Encourage 
the  patient  in  the  voluntary  use  of  the 
muscles,  but  not  to  the  point  of  fatigue,  for 
the  latter  increases  the  spasticity.  Employ 
traction  with  weights  to  combat  nocturnal 
reflex  spasms.  Deformities  are  to  be 
treated  by  tenotomy  or  myotomy  and  ortho- 
paedic appliances  (see  Part  10,  Orthopajdics). 

For  retention  of  urine,  catheterize  the 
patient  two  or  three  times  a day. 

For  incontinence  of  urine,  try  ext.  ergotae 
and  ext.  belladonnse,  aa  gr.  3^  to  in  pill, 
and  instruct  the  patient  to  endeavor  to 
empty  the  bladder  every  two  hours.  If 
there  is  residual  urine,  irrigate  the  bladder 
once  or  twice  a day,  and  use  the  catheter 
every  night.  If  the  urine  is  septic,  admin- 
ister helmitol,  or  urotropin,  and  ammonium 
benzoate  (see  Drugs,  Part  11).  Use  a glass 
or  rubber  urinal. 

For  incontinence  of  faeces,  plug  the  rectum. 

For  constipation  employ  cascara,  liquid 
paraffin,  abdominal  massage,  and  enemata. 

For  priapism,  administer  camphor  mono- 
bromate. 

Guard  against  bed-sores  {q.v.). 

The  outlook  in  infantile  cerebral  paralysis 
present  at  birtE  is  unfavorable.  Many  die 
in  infancy,  and  those  who  survive  are 
mentally  defective  or  epileptic.  The  prog- 
nosis in  acute  cerebral  paralysis  developing 
after  birth  (usually  hemiplegia,  and  due  to 
trauma  or  an  acute  infectious  disease,  e.g., 
measles,  scarlet  fever,  pertussis,  diphtheria, 
pneumonia,  smallpox),  is  more  favorable. 

Speech  Anomalies. — Nasal  Voice. — Causes. 
- — Cleft  palate;  paralysis  of  the  velum 
palatinum;  nasal  obstruction  (q.v.  in  Part  8, 
Nose  Diseases). 

Slowed  Speech.— Causes. — Convalescence 

fromacutedisease ; psycho-motor  retardation. 

Scanning  Speech  (long  pauses  between  syl- 
lables) — Cause. — Multiple  Sclerosis. 

Stuttering.— Cause. — Muscle  spasm. 

Stammering.— No  muscle  spasm  is  present. 

Syllable  Stumbling.— CAUSE. — Dementia  par- 
aRdica.  Get  the  patient  to  say  “truly  rural,” 
“artillery  cavalry  brigade,”  and  “around 
the  rugged  rock  the  ragged  ruffian  ran.” 

Aphasia  (see  under  Brain  Localization.) 

Spina  Bifida. — L.  deft  or  bifid  spine.  A 
congenital  sacular  hernial  protrusion  of  the 
spinal  meninges,  with  or  without  neiwous 
elements,  through  an  opening  in  the  spine. 

When  the  membranes  alone  protrude,  the 


anomaly  is  called  a meningocele;  when  the 
sac-wall  contains  filaments  from  the  cord 
and  fluid  from  in  front  of  the  cord,  the  condi- 
tion is  called  a meningomyelocele;  when  the 
sac-wall  contains  cord  elements,  and  is  dis- 
tended with  fluid  of  the  central  canal  of  the 
cord,  the  condition  is  termed  a syringomye- 
locele. The  latter  is  usually  associated  with 
hydrocephalus.  Paralysis  is  coimnonly  pres- 
ent in  the  latter  two  conditions. 

A sj^iiia  bifltla  tumor  usually  gradually 
increases  in  size.  Most  cases  die  within  a 
few  weeks  or  a year  as  a result  of  menin- 
gitis, marasmus,  or  rupture  of  the  sac.  Borne 
recover  spontaneously;  some  as  a result 
of  operation. 

The  tumor  should  be  kept  aseptic  and 
covered,  with  an  antiseptic  powder  and  a 
pad  of  sterile  cotton  or  a rubber  ring- 
cushion.  If  hydrocephalus  (unless  station- 
ary or  relievecl  by  operation)  and  complete 
paraplegia  are  absent,  an  operation  may 
be  considered.  The  most  suitable  age  for 
operation  is  from  nine  to  twenty-four 
months.  No  local  infection  should  be 
present.  Adults  should  not  be  operated 
upon  except  for  serious  reasons. 

Spinal  Accessory  Nerve. — This  nerve  siq> 
plies  the  sternomastoid  and  trapezius  mus- 
cles and  the  larjnix.  It  may  be  involved  in 
bulbar  paralysis,  meningitis,  tumor,  or 
caries.  Spasmodic  torticollis  is  due  to  irri- 
tation of  this  nerve. 

Spinal  Cord  Compression. — See  INIyelitis, 
and  Spastic  Paralysis. 

Spinal  Cord  Localization. — The  Sensory 
Tracts. 

Sensory  neiwe  axones  from  the  posterior 
spinal  ganglia  (see  Fig.  76)  enter  the  cord 
through  the  posterior  nerve  roots  and  divide 
in  the  form  of  a Y into  two  branches,  Avhich 
pass,  the  longer  one  upward  and  the  other 
downward,  in  the  root  zone  of  the  column  of 
Burdach,  a few  of  the  ascending  fibres  occu- 
pying Lissauer’s  tract.  Each  branch  gives  off 
collateral  branches  at  right  angles  to  itscourse. 

The  longer  branch  of  the  Y-shaped  divi- 
sion ascends  to  the  medulla  or  ends,  together 
with  its  collaterals,  in  arborizations  about 
the  dendrites  of  cells  situated  at  various 
levels  in  the  anterior,  central  and  posterior 
portions  of  the  gray  matter  of  the  cord,  some 
crossing  through  the  posterior  commissm'e 
to  the  other  side,  and  some  remaining  on  the 
same  side.  A second  set  of  axones  from  the 
cells  of  the  median  column  of  Clark  pass 
into  the  direct  cerebellar  column  of  the  same 
side  and  upward  to  the  cerebellum  (trans- 
mitting muscle-sense  impressions).  Other 
axones  from  the  central  cells  cross  over  to 


SPINAL  CORD  LOCALIZATION 


the  opposite  side  and  ascend  in  the  antero- 
lateral column  and  the  column  of  Gowers 
(transmitting  temperature  and  pain  im- 
pressions). Axones  from  the  anterior  .cells 
pass  out  into  the  anterior  motor  roots. 

The  short  branch  of  the  Y-shajoed  division 
from  the  posterior  root  descends  in  the 
comma-shaped  bundle  of  Schultze  and  ter- 
minates, together  with  its  collaterals,  in  the 
gray  matter  of  the  posterior  horn.  Its  func- 
tion is  unknown. 

The  column  of  Goll  consists  of  sensory 
fibres  from  the  sacral,  lumbar  and  dorsal 
regions,  the  sacral  fibres  lying  next  to  the 
posterior  septum,  the  lumbar  fibres  external 
and  anterior  to  the  sacral,  and  the  dorsal 
fibres  in  the  lateral  portion  of  the  column. 
The  column  of  Rurdach  consists  of  sensory 
fibres  from  the  cei’vical  region. 


A lesion  of  the  central  gray  matter  results 
in  analgesia  and  thermo-aniEsthesia,  without 
tactile  an£Bsthesia  or  ataxia. 

In  lesions  of  the  cauda  equina  the  distri- 
bution of  the  anaesthesia  suggests  a cord 
lesion  (see  Plate  showing  areas  of  an®s- 
thesia  on  body  corresponding  to  cord  seg- 
ments); but  the  accompanying  paralysis  in 
caudal  lesions  is  much  more  widespread 
than  Avould  be  associated  with  the  suggested 
lesion  of  the  cord.  In  cases  of  fracture,  too, 
it  is  to  l^e  remembered  that  the  coid  ends 
at  the  first  lumbar  vertebra. 

In  hysterical  paraplegia  (traumatic  neu- 
rosis, spinal  concussion,  etc.)  the  anesthesia 
never  involves  the  genital  organs,  perineum 
or  anus  (chareot),  and  it  affects  both  limbs 
up  to  the  trunk  (see  also  under  Brain  Locali- 
zation: Organic  versus  Functional  Paralysis). 


Muscle  sense  impressions  are  conveyed  by 
way  of  the  long  fibres  of  the  posterior  col- 
umns and  the  direct  cerebellar  tract  of  the 
same  side. 

Temperature  and  pain  impressions  tra- 
verse shorter  fibres  to  the  central  gray  matter 
of  the  same  side  of  the  cortl,  whence  new 
neurones  cross  the  cord  and  ascend  in  the 
antero-lateral  columns. 

Tactile  impressions  traverse  the  posterior 
columns  and  also  enter  the  gray  matter, 
whence  new  neurones  carry  them  into  the 
antero-lateral  columns,  mostly  of  the  op- 
po.site  side. 

A lesion  of  the  root  zone  of  the  column  of 
Burdach  results  in  tactile  aniesthesia,  anal- 
gesia, and  ataxia,  the  latter  due  to  loss  of 
muscle  sense. 

A lesion  of  the  posterior  columns  of  the 
cord  results  in  ataxia  alone,  or  associated 
with  tactile  ansesthe.sia. 


In  multiple  neuritis  the  anaesthesia  is  bi- 
laterally and  symmetrically  glove-  or  stocking- 
shaped and  does  not  extend  to  the  trunk. 

The  course  of  the  Motor  Tract  is  described 
under  Brain  Localization. 

Cortico-spinal  or  upper  motor  segment 
paralysis  is  characterized  by  a partial  or 
incomplete  paralysis,  about  equal  involve- 
ment of  all  the  muscles  of  the  paralyzed 
limb,  stiffness  of  the  joints  due  to  tonic 
muscular  rigidity,  sometimes  spasmodic 
muscular  contractions,  absence  of  atrophy 
'except  to  a slight  degree  from  disu.se,  ab- 
sence of  flabbiness  and  of  altered  response  to 
electrical  stimulation,  increased  reflex  irri- 
tability, muscle  clonus,  and,  finally,  sudden 
extension  of  the  great  toe  on  scratching  the 
.sole  of  the  foot  (Babinski’s  reflex).  Camses 
are:  Cerebral  disease  (hemiplegia),  a trans- 
verse lesion  of  the  cord,  as  in  Pott’s  disea.se, 
transverse  myelitis,  thrombosis,  hemorrhage. 


SPINAL  CORD  LOCALIZATION 


and  tumor,  primary  lateral  sclerosis,  syphi- 
litic paraplegia,  traumatism  without  com- 
plete division  or  destruction  of  the  cord. 

Spino-muscular  or  lower  motor  segment 
paralysis,  due  to  disease  of  the  motor  cells 
in  the  anterior  gray  horns  of  the  cord  or  of 
their  efferent  axones,  is  characterized  by  a 
usually  complete  paralysis,  usually  limited 
to  certain  muscles  of  the  paralyzed  limb,  re- 
laxation of  the  joints  due  to  relaxation  and 
flabbiness  of  the  muscles,  loss  of  reflex  irrita- 
bility, atrophy,  loss  of  response  to  electrical 
stimulation  of  the  nerve,  and  loss  of  re- 
sponse to  direct  faradic  stimulation  of  the 
muscle  (reaction  of  degeneration),  sometimes 
fibrillary  twitchings.  Causes  are:  Anterior 
poliomyelitis,  acute  or  chronic;  amyotrophic 
lateral  sclerosis;  myelitis,  focal  or  diffuse; 
S3Tingomyelia ; embolism;  thrombosis;  hem- 
orrhage; tumors;  neuritis;  complete  division 
of  the  cord. 

When  the  spinal  cord  is  injured  by  frac- 
ture or  dislocation  of  the  vertebrae,  but  not 
destroyed,  there  is  total  paralysis  below 
the  level  of  the  injury,  but  the  limbs  are 
rigid  and  the  tendon  reflexes  exaggerated. 
If  the  cord  is  destroyed  the  limbs  are 
completely  relaxed  and  the  tendon  reflexes 


are  lost,  later  on  to  return  automatically. 

The  Reflexes — -Loss  of  tendon  reflexes 
occurs  in  lesions  in  the  sensory  or  motor 
portion  of  the  reflex  mechanism,  in  nerves  or 
cord.  Causes  are:  Locomotor  ataxia,  gen- 
eral paresis,  syringomyelia,  anterior  polio- 
myelitis, transverse  and  diffuse  myelitis, 
disseminated  sclerosis,  hemorrhage  in  the 
cord,  tumors  of  the  cord. 

Exaggeration  of  the  tendon  reflexes  oc- 
curs in  upper  motor  segment  paralysis  and 
in  hysteria.  In  hysteria,  however,  there  is 
no  Babinski  reflex. 

The  bladder  and  rectum  reflexes  are  cen- 
tralized in  the  fourth  and  fifth  sacral  seg- 
ments of  the  cord.  If  a lesion  occurs  above 
these  centres,  thus  cutting  off  connection 
with  the  controlling  or  inhibitory  influence 
of  the  brain,  the  bladder  and  rectiun  auto- 
matically empty  themselves  at  intervals 
without  the  control  of  the  individual.  If 
the  reflex  centers  themselves  are  destroyed, 
however,  retention  of  urine  and  faeces  occurs, 
sometimes  with  passive  or  parado.vical  in- 
continence of  urine  from  overflow,  and  some- 
times, instead  of  retention,  a constant  drib- 
ling  due  to  weakness  of  the  sphincter. 

Gait. — See  Gait. 


Table  I. — -Showins  the  Muscles  Represented  in  Groups  of  Cells  in  the  Various  Segments  of  the  Spinal 
Cord,  Starr’s  Nervous  Diseases.  Lea  & Febiger. 


II.,  III. 
Cervical. 

IV. 

Cervical. 

V. 

Cervical. 

VI. 

Cervical. 

VII. 

Cervical. 

VIII. 

Cervical. 

I. 

Dorsal. 

Diaphragm. 

Sterno- 

mastoid. 

Trapezius. 

Scalenus. 

Diaphragm. 
Lev.  ang.scap. 
Rhomboid. 
Supra-  and 
infraspin. 
Deltoid. 
Supin.  long. 
Biceps. 

Rhomboid. 
Supra-  and 
infraspin. 
Deltoid. 
Supin.  long. 
Biceps. 

Supin.  brev. 
Serratus  mag. 
Pect.  (clav.i. 
Teres  minor. 

Biceps. 

Serratus  mag. 
Pect.  (clav.). 
Pronators. 
Triceps. 
Brach.  ant. 
Long  exten- 
sors of  wrist. 

Pronators. 
Triceps. 
Brach.  ant. 
Long  exten- 
sors of  wrist, 
and  fingers. 
Pect.  (costal). 
LatLs.  dorsi. 
Teres  major. 
Long  flexors 
of  wrist  and 
fingers. 

Long  flexors 
of  wrist  and 
fingers. 
Extensor  of 
thumb. 
Intrinsic 
muscles  of 
hands. 

Extensor  of 
thumb. 
Intrinsic 
muscles  of 
hands. 

SPINAL  CORD  LOCALIZATION 


Fig.  77. — Areas  of  anssthesia  after  lesions  in  the  various  segments  of  the  spinal  cord.  (One  must  remember 
that  each  part  of  the  skin  is  supplied  with  sensory  nerves  from  two  adjacent  segments  of  the  cord,  so 
that  where  the  area  of  ansesthesia  corresponds  to  a certain  segment  of  the  cord  in  the  diagram,  the  lesion 
in  the  cord  must  involve  also  the  next  segment  above.  The  spinal  cord  ends  at  the  first  lumbar  vertebra.) 


SPINAL  CORD  LOCALIZATION 


Table  1.— Continued. 


I.  Lumbar. 

II.  Lumbar. 

III.  Lumbar. 

IV.  Lumbar. 

V.  Lumbar. 

(2uadr  lumlj. 

(Ibliqui. 

Transversahs. 

Psoas. 

lUacus. 

Psoas. 

Ihacus. 

Sartorius. 

Quad.  ext.  cruris. 

Quad.  ext.  cruris. 

Obtutator. 

Adductores. 

Obturator. 

Adductores. 

Glutei. 

Glutei. 

Biceps  femoris. 
Semi-tend. 
Popliteus. 

I.  Sacral. 

11.  Sacral. 

III.  Sacral. 

IV.  and  V.  Sacral. 

Biceps  fern,  or 
Semi-memb. 
E.xt.  long.  dig. 
Gastroc. 
Tibialis  ]>ost. 

Gastroc. 

Tibialis  post. 

Tibialis  anticus. 

Peronei. 

Intrin.sic  muscles  of  foot. 

Peronei. 

Intrinsic  muscles  of  foot. 

Sphincter  ani  et  vesicae. 
Perineal  mu.scles. 

Table  II. — Localization  of  Muscular  Reflex  Acts  in  the  Spinal  Cord,  Starr’s  Nervous  Diseases.  Lea  & Febiger. 


Pupillary  reflex  through  the  sympathetic:  Dilatation  of  the  pupil  pro- 
duced by  irritation  of  the  neck. 

Scapular  reflex:  Irritation  of  the  skin  over  the  scapula  produces  contrac- 
tion of  the  scapular  muscles. 

Biceps  and  supinator  longus:  Tapping  their  tendons  produces  flexion  of 
the  forearm. 

Triceps  reflex:  Tapping  tendon  jjroduces  extension  of  forearm. 

Scapulohumeral  reflex : Tapping  the  inner  lower  edge  of  the  scapula  causes 
adduction  of  the  arm. 

Tapping  extensor  tendons  at  the  wrist  causes  extension  of  the  hand. 

Tapping  flexor  tendons  at  the  wrist  causes  flexion  of  the  hand. 

Palmar  reflex:  Stroking  pahn  causes  closure  of  fingers;  finger  clonus. 

Abdominal  reflex:  Stroking  side  of  abdomen  causes  retraction. 

Genital  reflex : Squeezing  the  testicle  causes  contraction  of  the  abdominal 
muscles. 

Patella  tendon:  Striking  tendon  at  knee  causes  extension  of  the  leg; 
“knee-jerk.” 

Achilles  tendon  reflex:  Tapping  the  Achilles  tendon  causes  flexion  of  ankle. 

Foot  clonus : Extension  of  Achilles  tendon  causes  flexion  of  the  ankle. 

Plantar  reflex:  Tickling  sole  of  foot  causes  flexion  of  the  toes. 

Babinski’s  reflex:  Scratching  .sole  of  foot  causes  extension  of  great  toe  and 
flc.xion  of  the  others. 

Mendel’s  reflex:  Tajqiing  the  tendons  of  the  toes  causes  flexion  or  exten- 
sion of  the  toes. 

Gorilon’s  reflex:  Deep  pressure  on  muscles  of  calf  of  leg  causes  extension  of 
the  toes. 

Oppenhem’s  reflex:  Stroking  the  outer  side  of  the  leg  near  the  tibia  causes 
retraction  of  the  toes  and  contraction  of  the  tibialis  anticus. 

Spasm  of  anus  on  irritation. 


Fourth  cervdeal  to  first  dorsal. 

Fifth  ceiAucal  to  first  dorsal. 

Fifth  and  sLxth  cervical. 

Sixth  cervical. 

Seventh  cervical. 

Sixth  to  eighth  cervical. 
Seventh  to  eighth  cervical. 
Eighth  cervical  to  first  dorsal. 
Ninth  to  twelfth  dorsal. 

First  to  third  lumbar. 

Second  and  third  lumbar. 

First  to  third  sacral. 

First  to  third  sacral. 

First  to  third  sacral. 

First  to  third  sacral. 

First  to  third  sacral. 

First  to  third  sacral. 

First  to  third  sacral. 

Fourth  and  fifth  sacral. 


Table  111. — Localization  of  Skin  Refle.xes  in  the  Spinal  Cord,  Starr’s  Nervous  Diseases.  Lea  & Febiger. 


Reflex  Acts. 

Localization  in  Segment. 

Epigastric  reflex:  Stroking  breast  causes  dimpling  of  the  epigastrium. 
Cremasteric  reflex:  Stroking  inner  side  of  thigh  causes  retraction  of 
testicle. 

Gluteal  reflex:  Stroking  buttock  causes  dimpling  in  the  fold. 

Seventh  to  ninth  dorsiil. 
First  and  third  lumbar. 

Fourth  to  fifth  lumbar. 

SPLANCHNOPTOSIS 


Spinal  Hemorrhage. — See  Hiematomye- 
lia  and  Hgematorrhachis, 

Spinal  Nerves. — (See  Phrenic  Nerve; 

Brachial  Plexus;  Lumbar  Plexus;  Sacral 
Plexus;  Spinal  Roots;  Spinal  Cord  Locali- 
zation; Nerves,  Peripheral). 

For  the  treatment  of  nerve  lesions,  see 
under  Brachial  Plexus. 

Spinal  Roots. — The  diagnosis  of  disease  of 
the  spinal  roots  is  made  by  the  limitation  of 
the  resulting  motor  or  sensory  disturbance 
to  the  so-called  root- areas  (See  Fig.  78). 
Severe  darting  or  shooting  pains  are  char- 
acteristic accompaniments;  but  they  dimin- 
ish as  the  nerve  fibres  are  destroyed,  and 
are  replaced  by  hypersesthesia  and  paralysis. 

Etiology. — Spinal  caries  ; tumors  ; local 
syphilitic  menigitis. 

Treatment.— Attend  to  the  cause.  For  per- 
sistent severe  pain,  it  may  be  considered 
advisable  to  divide  the  affected  nerve 
roots  intradurally. 

Spirillum  Fever. — See  Relapsing  Fever. 

Spirochetosis  Icterohaemorrhagica.  — See 
Jaundice,  Infectious. 

Splanchnoptosis  ; Visceroptosis  ; Qlen= 
ard’s  Disease;  Enteroptosis. — Gr.  (nr\ayxvov 
viscus  ; L.  vis'cus ; Gr.  evrepov  bowel 
Trrwcrts  fall.  General  ptosis  of  the  abdominal 
viscera  is  here  considered,  e.g. — gastro- 
ptosis,  coleoptosis,  nephroptosis,  hepato- 
ptosis,  splenoptosis. 

The  symptoms  which  bring  the  sufferer 
with  visceroptosis  to  the  physician  are 
variable,  depending  largely  upon  the  organ 
which  is  predominantly  affected.  General 
symptoms  are — dyspepsia,  constipation,  ab- 
dominal pain  and  tenderness,  backache, 
headache,  cardiac  distress,  palpitations, 
arrh5dhmia,  perhaps  shortness  of  breath, 
anorexia,  loss  of  weight,  frequent  urina- 
tion, neurasthenic  and  hysterical  mani- 
festations, etc.  Retrodisplacement  and 
prolapse  of  the  uterus  may  be  part  of  a 
general  splanchnoptosis. 

In  coleoptosis  there  is  bulging  of  the  lower 
abdomen  when  the  patient  .sits  up,  which 
disappears  on  lying  down.  Backache  and 
abdominal  distress  are  relieved  on  lying 
down,  or  when  the  pendulous  abdomen  is 
lifted  upward  and  backward  by  the  inter- 
locked hands  of  the  physician  standing 
behind  the  patient  with  his  arms  encircling 
the  latter. 

In  gastroptosis  the  symptoms  are  those 
of  gastric  atony  or  nervous  dyspepsia,  viz. 
sensation  of  fulness  or  pre.ssure  after  eating, 
flatulence,  eructations,  perhaps  heartburn, 
anorexia,  palpitations,  headache,  dizziness, 
lassitude,  anemia,  depres.sion  ; and  these 


symptoms  are  obviously  increased  by  over- 
eating and  by  working  inunediately  after 
eating.  Distend  the  stomach  with  carbon 
dioxide  gas,  as  tlescribed  under  Dilatation 
of  the  Stomach,  Chronic,  (q.v.),  and  note 
that  the  lesser  curvature  as  well  as  the 
greater  is  lower  than  it  should  be.  Normally, 
the  lower  border  of  the  .stomach  lies  a hand’s 
breadth  above  the  umbilicus.  Another 
method  of  ascertaining  the  position  of  the 
stomach  is  by  palpation: — Give  the  patient 
one  or  two  glasses  of  water  to  drink, 
and  beginning  from  below  upward,  make 
short  pushing  strokes  with  the  finger-tips, 
without  raising  the  latter,  until  the  water  is 
felt  to  splash. 

In  nephroptosis  the  following  symptoms 
may  occur: — viz.  local  pain  and  tenderness; 
sharp  attacks  of  pain  radiating  to  the  sacrum, 
back,  and  groins,  increased  by  exertion  and 
during  menstruation  ; frequent,  sometimes 
painful,  urination;  intennittent  haematuria; 
perhaps  intermittent  hydronephrosis;  per- 
haj)s  reflex  gastro-intestinal  and  nervous 
disturbances,  etc.;  perhaps  Dietl’s  crises 
or  paroxysmal  attacks  of  pain,  chill,  fever, 
nausea,  vomiting,  and  collap.se,  due  to  kink- 
ing of  the  renal  stalk.  Nephroptosis  is  more 
common  in  women,  and  occurs  mostly  on 
the  right  side.  By  bimanual  palpation, 
practiced  after  the  patient  has  jarred  her 
body  while  on  her  hands  and  knees, 
it  may  be  possible  to  lift  up  the  loose 
kidney  with  the  fingers  and  palpate  it  with 
the  thumb. 

To  detect  hepatoptosis,  employ  palpation 
and  percussion,  and  examine  the  patient  in 
both  the  recumbent  and  erect  postures. 
Normally  the  liver  dulness  extends  from  the 
fifth  rib  in  the  nipple  line  above  to  the  costal 
margin  below. 

Radiography  following  a bismuth  meal 
gives  important  information  regarding  the 
nature  of  the  ptosis.  A bismuth  meal  con- 
sists of  two  to  four  ounces  of  bismuth  sul- 
phate suspended  in  mucilage  of  acacia  or 
in  milk.  Take  care  that  the  X-ray  tube 
exerts  no  pressure  upon  the  stomach. 

It  should  be  borne  in  mind  that  a marked 
degree  of  visceroptosis  may  exist  without 
symptoms.  Therefore,  when  a ptosis  is 
discovered,  it  should  not  necessarily  be  con- 
cluded that  it  bears  a causal  relation  to 
symptoms  present. 

Etiology.— Congenital  weakness  of  the  sup- 
porting tis.sues;  hereditary  predisposition  (a 
floating  tenth  rib  is  often  found) ; general 
debility  due  to  anaemia,  tuberculosis,  typhoid 
fever,  sepsis  or  other  severe  infectious  cUs- 
ease,  diabetes,  rickets,  chronic  heart,  kidney 


SPLANCHNOPTOSIS 


liver,  or  lung  disease,  excessive  mental  or 
physical  strain,  venereal  excesses,  prolonged 
nervous  depression,  neurasthenia,  insanity, 
lack  of  exercise;  alcohol,  tobacco,  etc.;  loss 
of  retroperitoneal  fat  in  emaciation  and 
wasting  diseases;  relaxed  abdominal  wall 
due  to  repeated  pregnancies,  recurring 
ascites,  or  the  removal  of  an  abdominal 
tumor;  diminished  intra-abdominal  pressure 
due  to  loss  of  fat,  or  to  a relaxed  pelvic 
floor;  enlargement  and  increased  weight  of 
a viscus,  e.g.,  the  kidney;  pressure  from 
neighboring  tumors  causing  displacement,  as 
of  the  kidney;  habitual  overeating  and  over- 
drinking; worldng  immediately  after  eating; 
chronic  constipation;  injuries  and  strains, 
e.g.,  traumatism,  constant  riding  over  rough 
roads,  horseback  riding,  constant  stooping, 
heavy  lifting,  violent  coughing,  straining  at 
stool,  falls,  etc. ; constricting  corsets  and  belts; 
localized  peritonitis;  congenital  or  acquired 
deformities  of  the  thorax  or  the  abdominal 
viscera  (long  shallow  thorax;  scoliosis). 

Prognosis.— As  to  cure,  the  prognosis  is 
uncertain. 

Treatment. — The  treatment  aims  to  combat 
local  atony  by  increasing  the  patient’s  gen- 
eral vigor.  Enjoin  adequate  exercise  in  the 
open  air,  adequate  rest  (rest  in  bed  for 
from  two  to  four  weeks  in  asthenic  cases: 
see  Neurasthenia),  a daily  tepid  bath,  prefer- 
ably before  breakfast,  followed  by  a cool 
douche,  especially  the  spinal  douche,  and 
friction  with  a coarse  towel  (in  gastric  atony 
the  circular  cold  and  warm  douche  over  the 
stomach),  daily  brushing  of  the  teeth  before 
breakfast  with  castile  soaj:)  and  warm  water, 
fresh  air  day  and  night,  regular  hours  of  eat- 
ing, rest  for  one-half  to  one  to  two  hours 
both  before  and  after  eating,  preferably 
reclining  on  a couch  on  the  right  side,  slow 
and  thorough  mastication  of  the  food. 

Gentle  massage,  practiced  no  less  than 
one  and  a half  hours  after  a meal,  is  useful 
for  both  gastric  and  intestinal  atony;  as  is 
also  galvanization  or  faradization,  a large 
well-moistened  sponge  electrode  being  placed 
over  the  stomach,  and  a smaller  sponge 
electrode  over  the  seventh  or  eighth  dorsal 
vertebra.  The  current  should  be  strong 
enough  to  jjroduce  visible  twitchings  of  the 
abdominal  muscles,  but  should  be  ap-plied 
for  no  longer  than  ten  minutes.  The  elec- 
trical abdominal  roller  combines  massage 
with  electricity.  Says  Cohnheim,  employ 
the  galvanic  current  with  irritable  patients, 
the  faradic  current  with  relaxed  patients. 

Iron,  arsenic,  and  strychnine  in  ascending 
doses,  or  mix  vomica  are  indicated  for  aniemia 
and  (lebility  (see  Drugs,  Part  11). 


Prescribe  a bland,  nutritious,  and  fatten- 
ing, soft  or  finely  chvided  diet,  in  small 
amounts  at  three-hour  intervals  (four  or 
five  small  meals  a day),  fluids  being  restricted 
with  meals  but  not  between  meals:  finely 
minced  beef,  mutton,  chicken,  stewed  tripe, 
stewed  whitefish,  eggs,  raw  or  boiled  three 
minutes,  custards,  well-cooked  cereals,  vege- 
tables in  puree  form,  fruits,  olive  oil,  and 
fats  (see  also  the  tuberculosis  dietarjq  in 
Tuberculosis,  Pulm.).  Tea,  coffee,  alcohol, 
and  tobacco  should  be  avoided.  To  stimulate 
the  appetite,  prescribe  a bitter  tonic  to  be 
taken  fifteen  to  thirty  minutes  before  eating 
(see  Anorexia).  The  aim  is  to  increase  both 
muscular  tone  and  the  amount  of  intra-ab- 
dominal fat,  with  due  regard  to  the  patient’s 
digestive  capabilities.  A digestive,  such  as 
taka-diastase,  or  pepsin,  or  pancreatin,  or 
papain,  may  be  of  service  in  suitable  cases 
(see  Part  11); 

Cascara,  senna,  and  rhubarb  are  useful 
laxatives  in  ptosis  of  the  colon,  in  conjunction 
with  the  general  measures  recommended 
under  Constipation.  Do  not  give  phenoh 
phthalein,  which  acts  only  on  the  small  bowel 
(Abel) ; or  agar-agar,  which  is  contraindicated 
in  marked  atony.  (Ortner;  Sailer.) 

The  following  abdominal  exercises 
are  recommended : 

1.  Lying  upon  the  back  with  the  hands 
above  the  head,  raise  the  lower  limbs  to 
a right  angle  with  the  body  and  lower 
them  slowly,  at  the  same  time  breathing 
deeply. 

2.  Lying  flat  upon  the  back  with  the 
hands  above  the  head,  slowly  rise  to  a sitting 
posture  and  back  again,  keeping  the  legs 
upon  the  floor. 

3.  Standing,  move  the  trunk  upon  the 
pelvis  forward  and  backward  and  from  side 
to  side. 

4.  Standing,  hold  one  leg  forward  hori- 
zontally for  ten  seconds. 

Abdominal  supporters  (Teufel,  Ernst, 
Longstreth,  Lane,  Curtis,  the  last-named  b\' 
far  the  best,  saj's  W.  Langdon  Brown,)  are  of 
the  greatest  service.  They  should  support  the 
abtlomen  from  below  upward  and  backward, 
should  fit  snugly  to  the  sjunphysis  pubis  and 
Poupart’s  ligament  below,  and  should  reach 
above  no  liigher  than  the  umbilicus.  They 
should  be  applied  with  the  patient  recum- 
bent, the  pelvis  raised,  the  knees  drawn  up, 
and  the  head  on  a pillow.  If  need  be,  pads 
may  be  attached  for  the  purpose  of  support- 
ing individual  organs,  but  they  are  probably 
superfluous. 

Adhesive  straps,  preferably  of  moleskin 
plaster,  may  be  emploj^ed  until  a belt  is 


SPLENOMEGALY 


procured.  Sailer  describes  their  manner  of 
application  as  follows:  The  skin  is  first 
shaved  and  washed  with  ether.  With  the 
patient  standing,  an  adhesive  strip  2 or  3 
inches  wide  is  applied  so  that  the  anterior 
end  overlaps  the  median  line  ju.st  above  the 
symphysis.  It  is  carried  without  tension 
obliquely  upward  and  outward  above  the 
iliac  crest,  and  across  the  spinal  column  in 
back.  A second  strip  is  placed  in  a symmet- 
rical position  on  the  other  side,  with  the 
ends  of  both  strips  overlapping  both  in  front 
and  back.  Then  both  strips  are  detached 
as  far  as  the  median  axillary  line,  and  while 
the  abdomen  is  supported  with  the  hand  in 
front,  just  as  much  temsion  as  possible  is 
made  upon  the  first  strip,  which  is  fastened 
to  the  back.  The  same  procedure  is  re- 
peated with  the  second  strip.  Then  other 
strips  are  applied  in  the  same  way,  and  made 
to  overlap  the  lower  ones  by  about  an  inch. 
Transverse  strips  may  then  be  applied  in 
front  and  back.  Tliis  support  may  be  worn 
for  several  weeks. 

In  intractable  cases,  and  where  the  condi- 
tion is  confined  to  but  one  or  two  organs,  an 
operation  may  be  considered;  but  it  should 
not  be  undertaken  lightly,  since  it  often 
fails  to  accomplish  any  good.  The  organs 
vhich  may  require  anchoring  are  the 
,tomach,  colon,  liver,  spleen,  sigmoid,  and 
kidney.  In  gastroptosis  a posterior  gastro- 
enterostomy (or  a Finney  pyloroplasty)  as 
well  as  gastropexy  should  be  done;  although 
Hertz  says  it  is  “ never  followed  by  any  im- 
provement.” Resection  of  the  colon  is  even 
performed.  In  marked  kinking  at  the  splenic 
flexure,  a short-circuiting  anastomosis  may 
be  established  between  its  limbs.  The  spleen 
may  be  stitched  in  place,  or  packed  in  place, 
with  gauze,  or  best  removed  (splenectomy 
is  contraindicated  in  amyloid  degeneration 
and  in  leukiemia).  Casper  has  “ completely 
abandoned  suture  of  the  kidney,  fixation  to 
the  ribs,  etc.,”  and  does  “ merely  a (com- 
plete) decapsulation.” 

The  stomach  should  be  operated  upon 
only  where  there  is  dilatation  that  is  not 
relieved  by  medical  treatment;  the  spleen 
only  in  severe  cases  or  cases  complicated 
with  strangulation  or  intestinal  obstruction; 
the  kidney  only  when  definite  kidney  symp- 
toms accompany  its  displacement,  e.g., 
chronic  dragging  pain  not  relieved  by  pallia- 
tive treatment,  dilatation  of  the  stomach  or 
jaundice  from  pressure  of  the  displaced 
kidney,  hsematuria,  intermittent  albumi- 
nuria, intermittent  hydronephro.sis,  Dietl’s 
crises.  Separated  recti  muscles  may  have 
to  be  united. 


In  Dietl’s  crises,  attempt  to  rectify  the 
faulty  position  of  the  kidney  by  posture 
(say  on  the  hands  and  knees)  and  bimanual 
manipulation,  using  general  anajsthesia  if 
necessary.  It  is  recommended  that  heat  be 
applied,  and  morphine  and  purgatives  ad- 
ministered, the  latter  for  the  purpose  of 
setting  up  intestinal  peristalsis  with  the 
hope  of  thereby  correcting  the  twist  in  the 
renal  stalk.  The  attack  usually  passes  off 
within  a few  hours,  but  operative  inter- 
ference is  sometimes  reejuired. 

Spleen,  Movable;  Splenoptosis. — See 
Splanchnoptosis. 

Spleen,  Rupture  of  the. — Rupture  of  the 
spleen  is  manife.sted  by  the  sudden  occur- 
rence of  intense  pain,  shock,  and  abdominal 
distention,  with  dulness  in  the  flanks. 

Causes. — Traumatism;  enlargement  of  the 
organ  due  to  malaria,  typhoid  fever,  re- 
lapsing fever,  etc.;  pregnancy;  splenic  in- 
farction; splenic  abscess;  aneurysm  of  the 
splenic  artery;  varicosed  splenic  veins. 

Treatment. — Immediate  operation  is  de- 
manded, but  the  prognosis  is  grave. 

Splenic  Abscess. — Abscess  of  the  spleen 
is  rarely  diagnosed  except  by  an  exploratory 
operation.  The  symptoms  are  splenic 
enlargement,  pain,  and  tenderness. 

Causes. — Septico-pysemia;  infectious  dis- 
eases; hydatid  cyst;  neighboring  inflamma- 
tion (empyema,  gastric  ulcer,  peritonitis); 
traumatism. 

Treatment. — Free  evacuation  and  drainage, 
or  splenectomy,  is  indicated. 

Splenic  Anemia. — See  Anaemia,  Splenic. 

Enlargement. — See  Splenomegaly. 

Fever. — See 'Anthrax,  in  Part  5,  Skin 
Diseases. 

Splenic  Infarction. — ^Gr.  <nr\r/p;  L.  splen; 
L.  infarcir'e,  to  stuff  in.  Splenic  embolism 
or  infarction  is  manifested  by  the  sudden 
occurrence  of  local  pain  in  the  course  of  an 
endocarditis  or  other  causal  affection,  e.g., 
cardiac  thrombosis,  thrombosis  in  typhoid 
fever,  marantic  and  anaemic  states,  aortic 
atheroma,  aortic  aneurysm,  septico-pyaemia, 
etc.  (see  Embolism.) 

The  Prognosis  is  good  in  non-septic  cases. 

Treatment. — For  the  relief  of  pain,  strap  the 
lower  thorax  from  spine  to  sternum  during 
forced  expiration,  in  order  to  lessen  move- 
ment, and  apply  hot  poultices,  mustard 
poultices  (Part  11),  dry  cups  (q.v.),  or  the 
ice-bag;  morphine  may  be  given.  Operate 
if  an  abscess  forms,  and  drain  the  abscess 
or  remove  the  spleen. 

SplenO'megaly. — Gr.  a-n-Xi/p  spleen  -|-  fxkym 
large.  The  enlarged  spleen  is  superficial, 
hard  and  smooth,  with  a sharp  edge,  and 


STATUS  LYMPHATICUS 


with  its  upper  border  notched  in  one  or 
several  places.  It  lies  over  the  colon,  as 
shown  by  inflating;  the  latter  with  air  per 
rectiun  by  means  of  a Davidson  syringe. 
The  kidney  lies  in  back  of  the  colon. 

Causes  of  Splenic  Enlargement. — Splenic  anae- 
mia (Banti’s  disease) ; familial  or  hereditary 
(congenital)  splenomegaly  with  slight  chron- 
ic or  intermittent  acholuric  jaundice  (without 
bile  pigment  in  the  urine),  undue  fragility  of 
the  red  blood-cells  (see  Blood  Examination), 
and  without  anaemia  (g),  cured  by  splenec- 
tomy; acquired  splenomegaly  with  acholuric 
jaundice,  anaemia,  undue  fragility  of  the  red 
blood  corpuscles,  and  debility,  also  cured  by 
splenectomy;  primary  endotbelioma  of  the 
spleen  ; thrombosis  of  the  splenic  and  portal 
veins,  producing  splenomegaly,  anaemia, 
jaundice,  recurrent  hjematemesis,  and  as- 
cites; (perform  splenectomy,  if  feasible); 
hepatic  cirrhosis  (alcoholic,  syphilitic,  hyper- 
trophic, and  hiemochromatosis  ; all  present- 
ing symptoms  like  those  of  Banti’s  disease)  ; 
kala-azar  or  tropical  splenomegaly  ; hydaticl 
disease  ; distomiasis  ; tumors  ; splenic  ab- 
scess ; ponos  ; acute  infectious  tliseases  ; 
malaria  ; syphilis  ; typhoid  fever  ; debilitat- 
ing conditions  of  childhood  ; rickets  ; tuber- 
culosis ; anaemia  ; leukaemia  ; Hodgkin’s 
disease  ; amyloid  degeneration  ; Addison’s 
disease  ; purpura  ; erjdhremia  ; arthritis 
deformans  ; cardiac  disease,  etc. 

A chronically  enlarged  spleen  may  be  re- 
moved if  it  causes  serious  disturance. 
Splenectomy,  however,  is  contra-in  cheated  in 
leukaemia,  amyloid  degeneration,  and  erjdh- 
ra’inia,  etc.  (see  under  Anjemia,  Splenic). 

Splenoptosis. — Gr.  aifKiju  spleen  -T  wTuais 
fall.  See  Splanchnopto.sis. 

Spondylitis  Deformans. — See  Part  10, 
Orthopaedics. 

Infectious. — See  Ai-thritis,  in  Part  10, 
Orthopaedics. 

Spontaneous  Fractures. — See  Fragilitas 
Ossium. 

Sporotrichosis. — See  in  Part  5,  Skin 
Diseases. 

Spotted  Fever. — See  Cerebro.spinal  Fever, 
and  Pocky  IMountain  Fever. 

Sprue;  Psilosis. — Gr.  \UXcocns  a stripjiing. 
A trojiical  and  subtropical,  chronic  remittent, 
catarrhal  inflammation  of  the  entire  gastro- 
intestinal tract,  from  the  mouth  to  the  anus, 
with  sore  mouth,  raw-looking  tongue,  indi- 
gestion, diarrhoea,  light-colored,  foul,  acid, 
foamy  stools,  (full  of  yeasts),  abdominal 
distensioji,  anpemia,  and  wasting.  A monilia 
may  be  the  cause. 

It  may  last  from  one  to  fifteen  years,  but 
if  taken  early  it  is  usually  cured. 


Treatment. — Put  the  patient  to  bed,  and 
flr.st  cleanse  the  bowels  thoroughly  by 
means  of  a purgative  and  colonic  irrigation. 
The  teeth  and  gmns  shotfld  be  cleansed  each 
morning  before  the  first  meal,  with  castile 
soap,  warm  water,  and  a soft  brush  or  cloth, 
followed,  several  tunes  during  the  day,  by  a 
weak  antiseptic  mouth  wash,  e.g.  borax  or 
sodium  bicarbonate,  one  tablespoonful  of 
either  to  the  pint  of  warm  water  (see  also 
Stomatitis. 

Prescribe  a strictly  milk  diet,  beginning 
with  four  to  six  ounces  of  skimmed  milk 
every  two  hours  (about  60  ounces  a day), 
sipped  or  sucked  slowly  through  a fine  tube  ; 
and  gradually  increase  the  amount  and 
strength  of  the  milk  as  the  symptoms  abate, 
up  to  13  oz.  every  two  hours,  nine  times  a 
day.  The  milk  may  be  diluted,  if  need  be, 
with  lime  water  or  soda  water,  and  the  bacillus 
Bulgaricus  (Part  11)  may  be  added.  Continue 
this  diet  for  at  least  six  weeks  after  the 
mouth  has  cleared  and  the  stools  have  be- 
come solid.  Then  add  gradually,  raw  egg, 
meat  juice,  scraped  beef,  chicken,  chicken 
broth,  fish,  fresh  non-starchy  vegetables, 
fresh  fruit  (excepting  pineapple  and  alligator 
pears),  etc.,  up  to  regular  diet. 

If  milk  is  not  well  borne,  substitute  fresh 
raw  meat  juice,  and  later  scraped  meat,  rare 
beef,  etc.,  together  with  a little  fresh  fruit, 
e.g.  apples,  grapes,  peaches,  strawberries,  etc. 

The  subcutaneous  achninistration  of  eme- 
tine hydrochloride,  gr.  ss-i  daily,  for  five 
days,  is  said  to  be  effectual  (F.  Schmitter). 
Leonard  Rodgers  has  recently  cured  two 
ver>'  severe  and  chronic  cases  by  the  sub- 
cutaneous injection  of  emetine  hydro-chlor- 
ide and  the  administration  of  autogenous 
vaccines  (Part  11)  made  from  streptococci 
cultivated  from  the  mouth. 

• Employ  an  ointment  of  zinc  oxide  or 
bismuth  for  the  anus.  An  abdominal  band 
should  be  worn.  The  patient  is  best  removed 
to  a temperate  zone. 

Squint. — See  Motor  Neiwes  of  the  Eye- 
ball, and  also  Part  6,  Eye  Diseases. 

Starvation  Fever  of  Infants. — See  Inani- 
tion, Simple  Acute. 

Status  Epilepticus. — L.  status,  state. 
See  Epilepsy. 

Status  Lymphaticus;  Lymphatism. — L. 

status,  state  ; lym'pha,  hnnph.  A disorder 
of  childhood,  characterized  by  hjqjerplasia 
of  the  hnnphatic  tissues  throughout  the 
body,  especially  the  hmiphatic  and  thjmius 
glands.  The  subjects  of  the  affection  are 
usually  pale  and  flabby,  the  tonsils  and 
adenoids  are  usually  enlarged,  and  often 
slight  rickets  is  present.  Attacks  of  dysp- 


STOMATITIS 


noea  (thymic  asthma),  asphyxia,  or  convul- 
sions may  occur.  Suclden  death  sometimes 
occurs  when  an  anaesthetic  is  given,  or  a 
slight  operation  performed,  or  even  without 
apparent  cause.  The  operative  risk  is  said 
to  be  dangerous  when  the  lymphocyte  count 
iq.v.)  is  40  per  cent,  or  over.  The  condition 
cannot  usually  be  diagnosed  with  certainty. 
It  may  possibly  be  due  to  overaction  of  the 
thymus  gland.  It  usually  disappears  under 
proper  feeding  (see  Feeding  during  the  sec- 
ond year  and  beyond,  under  Infant  Feeding), 
fresh  air  day  and  night,  and  adequate  rest 
and  exercise.  Carbohydrates  should  be  re- 
duced and  proteins  increased.  Iron  and 
arsenic  may  be  of  service,  (see  Part  11). 
Thyroid  extract  may  be  given  as  in  cretinism 
iq.v.).  The  X-rays  {q.v.)  may  be  applied  to 
the  manubrium  sterni.  See  also  Thymus 
Enlargement. 

Steeple=Head. — See  Oxycephaly. 

Stenosis,  Anal. — Gr.  <xTkvocns,  narrowing. 
See  Rectal  Stricture. 

Bronchial. — See  Bronchostenosis. 

Intestinal. — See  Constipation,  and  In- 
testinal Obstrdction,  Chronic. 

Laryngeal. — See  Part  9,  Throat  Diseases. 

CEsophageal. — See  QEsophageal  Sten- 
osis; and  Foreign  Bodies,  in  Throat 
Diseases,  Part  9. 

Rectal. — See  Rectal  Stricture. 

Tracheal. — See  Tracheal  Obstruction. 

Urethral.  See  Stricture  of  Urethra, 
Part  3. 

Sternocleidomastoid  Haematoma. — Gr. 

arepvov  sternum  + key  -f-  paaros 

breast  -j-  eHos  form  ; aipa  blood  -|-  -w/ua 
tumor.  Birth  traumatism  is  the  cause.  It 
usually  disappears  spontaneously  in  from 
four  to  eight  weeks. 

Treatment. — Massage  the  tumor  very  gently 
for  several  minutes  daily.  Should  wry- 
neck develop,  stretch  the  muscle  by  passive 
rotation  of  the  head.  Do  not  operate. 

Stiff=Neck. — See  Myalgia. 

Stokes=Adams  Syndrome. — This  appella- 
tion designates  an  habitual  bradycardia  and 
arrhythmia  associated  with  vertiginous, 
syncopal,  epileptiform,  or  apoplectiform 
seizures. 

The  cause  is  either  a lesion  of  the  auriculo- 
ventricular  bundle  of  His,  producing  heart- 
block  (q.v.),  or  overstimulation  of  the  vagus 
due  to  disease  of  the  brain,  medulla,  cervical 
cord,  or  vagi  themselves,  or  to  functional 
(neurotic)  irritation.  An  affection  of  the 
muscular  bundle  of  His  is  the  usual  cause. 

In  vagus  irritation  the  auricles  and 
ventricles  may  beat  in  normal  sequence,  but 
slowly  ; or  the  pulsations  may  be  dis- 
22 


sociated.  In  purely  neurogenic  or  vagus 
cases  the  pulse  is  quickened  by  the  adminis- 
tration of  atropine,  gr.  3^eo  to  3^5,  but  not 
in  myogenic  cases. 

Prognosis. — This  is  not  necessarily  bad  in 
all  ca.ses. 

Treatment. — Treat  the  underlying  cause — 
syphilis,  arteriosclerosis,  etc.  The  adminis- 
tration of  salvarsan,  however,  is  dangerous. 
Atropine  (see  Part  11)  may  be  of  some 
benefit  in  bradycardia  due  simply  to  vagus 
u’ritation.  During  an  attack  of  clizziness  or 
syncope, etc.,  lower  the  head  in  order  to 
overcome  the  cerebral  anaemia. 

Stomach  Affections. — See  Gastric  Affec- 
tions. 

Stomach,  Hour=QIass. — See  under  Gas- 
tric Ulcer. 

Stomatitis. — Gr.  arofia  mouth  fi- 
LTLs  inflammation. 

I.  Simple,  Erythematous,  or  Catarrhal  Stoma- 
titis.— Simple  inflammation  of  the  mucous 
membrane  of  the  mouth  is  manifested  by 
pain,  soreness,  swelling,  redness,  and  in- 
creased secretion  of  saliva. 

Etiology. ^Irritants:  hot,  cold,  sour,  or 
highly  seasoned  foods,  tobacco  ; uncleanli- 
ness ; dental  caries  ; traumatism  caused 
by  sharp  teeth,  difficult  or  fruitless  sucking, 
etc.;  dentition,  including  cutting  of  the  wis- 
dom teeth  ; harelip  ; mouth-breathing  ; 
gastro-intestinal  and  hepatic  disorders  ; 
constitutional  disorders  : gout,  diabetes, 
nephritis  (uraemia),  rickets,  scurvy,  tuber- 
culosis, syphilis,  cancer,  urticaria,  leukaemia, 
pregnancy  and  lactation  ; acute  febrile 
diseases  ; central  nervous  diseases  ; sprue 
or  psilosis  ; pellagra  ; certain  poisons  : 
alcohol,  mercury,  iodide,  lead,  bromide, 
chlorine,  sulphuric  acid,  phosphorus,  bis- 
muth, arsenic,  antipyrine. 

Tkeatment.— Attend  to  the  cause.  Enjoin 
cleanliness  of  the  teeth  and  gums  by  the  use 
of  castile  soap,  warm  water,  and  a soft 
brush  or  cloth  ; and  prescribe  an  alkaline 
antiseptic  mouth  wash,  such  as  Dobell’s 
solution  (see  Part  11),  plain  or  diluted;  or 
prescribe  liquor  antisepticus,  or  liquor  anti- 
septicus  alkalinus,  1 : 2 or  3 of  water;  or  per- 
oxide, one-quarter  strength;  or  carbolic  acid, 
gr.  V ad  5 i ; or  boric  acid,  borax,  or  sodium 
bicarbonate,  5v  of  either  to  the  pint  ; or 
zinc  sulphate,  gr.  iiss  to  ivss  ad  5 i ; or  sod- 
ium salicylate,  gr.  x ad  5i  ; or  alum,  gr.  x 
ad  5i;  or  pot.  permanganate,  gr.  iiss  ail  5i- 
The  inflamed  parts  may  be  painted  with 
tannin  in  glycerine,  5 per  cent.,  several 
times  a day  ; or  potassium  permanganate, 
0.8  per  cent,  every  two  hours;  or  silver 
nitrate,  0 .5  to  1 per  cent.,  once  a day. 


STOMATITIS 


Ulcers  may  be  touched  about  once  a week 
with  silver  nitrate,  10  per  cent.,  or  stronger. 

In  fevers,  the  tongue,  cheeks,  teeth  and 
gums  may  be  swabbed  every  four  hours 
with  a mixture  of  glycerine,  oiv,  boric  acid, 
5i,  carbolic  acid,  ilExx,  and  water  to  5iv, 
using  for  the  purpo.se  a cotton  stick  or  cotton 
or  gauze  sponge  held  with  hiemostatic  for- 
ceps. For  dry  mouth,  tongue  and  lips,  use 
liquid  albolene  or  liquid  vaseline. 

Boracis 3 ii 

Sodii  bicarbonatis gr.  xl 

Tincturae  eucalj^iti  foliorum  5i  (vel  olei  euca- 

l}T3ti,  iiEiii) 

Glycerini 5ss 

Aquae,  ad 5viii 

M.  Sig. — Mix  with  an  equal  amount  of  warm 
water,  and  use  freely  as  a mouth-wash.  (Yeo.) 

Thymolis 5 i 

Acidi  benzoici gr.  xlv 

Olei  menthae  piperitae gtt.  xx 

Tincturae  eucalypti 3iv 

Alcoholis  absoluti § iii 

M.  Sig. — One  teaspoonful  in  half  a glass  of  water 
as  a mouth-wash  or  gargle.  (Miller.) 

Acidi  Sailicylici 3ii 

Cocainae  hydrochloridi gr.  xii 

Glycerini, 

Aquae,  aa 5iiss 

M.  Sig. — Mouth-wash  in  very  sore  and  painful 
cases.  (Croftan.)  Ice  may  also  be  sucked. 

II.  Aphthous,  Herpetic,  Follicular,  or  Vesicular 
Stomatitis. — This  form  of  stomatitis  is  char- 
acterized by  the  occurrence  of  vesicles  sur- 
rounded by  red  areolse,  which  quickly 
break  down  into  cream-white  ulcers  (canker 
sores).  It  occurs  mostly  in  chilch’cn  in  con- 
nection with  dentition,  indigestion,  unclean- 
liness, and  febrile  chseases;  and  in  women  in 
poor  health  and  during  pregnancy,  lacta- 
tion, or  menstruation.  Other  causes  are 
arsenic,  disease  of  the  fifth  nerve  (often  the 
result  of  cold),  carious  teeth,  and  gout.  The 
disease  usually  clears  up  in  one  or  two  weeks. 

(Bednar’s  aphthae  are  ulcers  on  the  hard 
palate  caused  by  the  nurse’s  finger  or  the 
artificial  nipple.) 

Trea'cment. — Prescribe  tonics,  whole- 
some food,  fresh  air  day  and  night,  regula- 
tion of  the  bowels,  regular  hours  of  eating 
and  sleeping,  and  adequate  rest  and  exercise. 
Enjoin  oral  cleanliness,  and  prescribe  an 
alkaline  antisejdic  mouth-wash,  as  for  sim- 
ple stomatis.  Touch  the  ulcers  with  silver 
nitrate,  10  per  cent.  (2  per  cent,  for  infants); 
or  tr.  iodi ;or  chronic  acid,  10  per  cent. ; or  pot. 
pc'rmanganate,  gr.  iss  in  5ss;  or  a saturated 
solution  of  iodoform  in  ether.  For  infants 
use  the  following  mouth-wash  or  spray; 


Sodii  biboratls gr.  xx 

Glycerini 3ii 

Aquae,  q.s.  ad oiv 


The  infant  may  have  to  be  fed  with  a 


spoon,  and  the  food  cooled  before  giving. 

III.  Ulcerative  or  Fetid  Stomatitis;  Putrid  Sore 
Mouth. — The  causes  are  those  of  simple 
catarrhal  .stomatitis  {q.v.).  Specific  ulcer- 
ation occurs  in  syphilis,  gonorrhoea,  tuber- 
culosis, cancer,  impetigo,  pemphigus,  foot- 
and-mouth  chsease,  and  Vincent’s  angina 
(due  to  Vincent’s  spirillum  associated  with  a 
fusiform  bacillus). 

Non-specific  cases  and  Vincent’s  angina 
are  usually  cured  in  from  five  to  ten  days. 

Treatment. — Potassium  chlorate,  used 
both  internally  and  locally,  is  considered  a 
specific  in  putrid  sore  mouth;  it  is  excreted 
unchanged  in  the  saliva.  But  it  is  poison- 
ous, and  should  never  be  used  if  the  kidneys 
are  affected.  Toxic  symptoms  are  drowsi- 
ness, carcUac  weakne.ss,  cyanosis,  albumi- 
nuria, and  suppression  of  urine  (see  under 
Poisoning).  The  dosage  is  as  follows: 

Under  eighteen  months — gr.  ii  every  two 
to  three  hours;  not  more  than  10  grs.  in 
twenty-four  hours.  Eighteen  months  to 
three  years — gr.  ii-iii  every  two  to  three 
hours;  not  more  than  15  grs.  in  twenty-four 
hours  (Kerley  says  the  drug  is  without 
danger  in  these  doses);  older  children,  gr. 
X,  t.i.d.;  adults,  gr.  xx,  t.i.d.  Kerley  pre- 
scribes it  in  sjTup  of  raspberry  (syrupus 
rubi  idsei)  one  part  and  water  two  parts. 
Do  not  give  it  any  longer  than  a week  at  a 
time.  Locally  it  is  used  in  the  strength  of 
10  to  20  grains  to  the  ounce. 

One  may  use  as  a mouth-wash  any  of 
the  antiseptics  enumerated  under  simple 
stomatitis.  Kerley  recommends  for  infants 
hydrogen  peroxide,  one  part  of  a 3 per  cent, 
solution  in  two  parts  of  water;  also  concen- 
trated boric  acid  solution.  The  ulcers  may 
be  painted  about  once  a week  with  silver 
nitrate,  10  per  cent.  (2  per  cent,  in  infants); 
or  pot.  permanganate,  gr.  iss  in  5ss;  or  liq. 
hydrargvTi  nitratis,  50  per  cent.;  or  tr. 
iodi;  or  chromic  acid,  concentrated  aqueous 
solution.  For  Vincent’s  angina  the  local  appli- 
cation of  arseno-benzol,  0.1  gm.  in  100  c.c.  of 
water  is  very  effectual.  Ulcerated  cheeks  may 
be  kept  from  the  teeth  with  pledgets  of  cotton 
wet  with  boric  acid  solution,  or  with  a piece  of 
raw  turnip.  (Keyes) 

In  mercurial  stomatitis,  stop  the  mercurv' 
at  once,  open  the  bowels,  and  instruct  the 
patient  to  drink  large  quantities  of  water, 
preferably  an  alkaline  mineral  water,  and 
to  take  a hot  sweat  bath  or  cabinet  vapor 
bath  evciy  evening.  A milk  diet  is  best. 
Potassium  chlorate  may  be  administered  for 
three  or  four  days.  The  local  treatment  is 
that  described  above.  The  spongy  gums 
may  be  painted  once  or  twice  daily  with  the 
following  astringent: 


STRONGYLOIDOSES 


Tincturac  Krameri®, 

Tincturai  iodi,  aa 

Tincturae  myrrhae 5iiss 

or,  Tincturaa  myrrhae, 

Tincturae  iodi  compositae. 

Aquae,  aa 3i-  (Keyes.) 

IV.  Parasitic  or  Mycotic  Stomatitis;  Thrush. — A 
contagious  stomatitis  caused  by  a hypho- 
mycetic  fungus,  the  saccharomyces  albi- 
cans, occurring  chiefly  in  uncleanly  infants 
in  poor  health,  and  characterized  by  the 
presence  of  superficial  white,  pinhead  sized 
and  larger  spots  and  patches,  composed 
principally  of  the  mycelium  of  the  fungus, 
which  is  demonstrable  under  the  microscope 
after  treatment  with  a drop  of  liquor  potassse. 

It  may  be  cured  in  about  a week. 

Treatment.^ — Correct  any  errors  of  diet 
(see  Infant  Feeding),  or  hygiene,  etc.;  and 
enjoin  cleanliness  of  the  mouth,  milk,  bottles, 
and  nipples,  artificial  or  maternal.  Before 
and  after  each  nursing,  the  mother’s  nipples 
should  be  bathed  with  boric  acid  solution, 
followed,  before  nursing,  with  warm  water. 
The  child’s  mouth  should  be  washed  after 
each  nursing  with  saturated  boric  acid  solu- 
tion. The  white  patches  should  be  wiped 
away  with  a soft  cloth  wet  with  a solution 
of  boric  acid,  borax,  or  sodium  bicarbonate, 
one  teaspoonful  of  any  of  these  to  a tumbler- 
ful of  warm  water.  The  following  may  be 
used  as  a spray: 


B Sodii  boratis gr.  x 

Glycerini 3i 

Aqua 5ii 


In  obstinate  cases  pencil  the  lesions  once 
or  twice  a day  with  formalin,  1 per  cent. 

V.  Gangrenous  Stomatitis;  Noma;  Cancrum  Oris. 
A very  rare,  very  fatal,  muco-cutaneous 
gangrene,  occurring  usually  in  children,  and 
as  a compUcation  of  the  infectious  diseases, 
especially  measles.  Bad  hygiene  alone  and 
mercurial  stomatitis  are  very  rare  causes. 
The  nose,  external  auditory  canal,  puden- 
dum, and  anus  may  be  similarly  affected. 

Treatment. — Carefully  remove  all  loose 
sloughs,  dry  the  wound  with  lint,  and  rub 
into  it  sticks  dipped  in  fuming  nitric  acid. 
Then  blow  on  powdered  iodoform,  and  cover 
with  carbolized  oil,  3 per  cent.  Thereafter 
use  frequently,  day  and  night,  antiseptic 
sprays  and  washes,  especially  equal  parts  of 
alcohol  and  water.  Formalin,  1 per  cent., 
pot.  permanganate,  gr.  iss  in  5ss,  or  iodo- 
form are  used  to  destroy  the  horrible  odor. 
The  cauterization  may  have  to  be  repeated. 

If  this  treatment  is  not  efficacious,  do  not 
temporize,  but  resort  promptly,  under 
anaesthesia,  to  the  knife  or  actual  cautery 


and  remove  or  destroy  the  affected  tissues 
well  outside  the  waxy  zone.  If  the  knife  is 
used,  follow  it  with  the  cautery,  or  with  pure 
nitric  or  carbolic  acid.  Indeed,  it  may  be 
best  to  select  this  mode  of  treatment  in  the 
beginning.  Remove  loose  teeth,  and  keep 
the  mouth  clean  with  hydrogen  peroxide, 
3 per  cent. 

Administer  concentrated  liquid  food,  pre- 
chgested  if  need  be  (see  Part  11:  pepsin, 
trypsin,  and  diastase),  and  alcohohe  stimu- 
lants at  frequent  intervals, — 3^  to  1 ounce  of 
whiskey  or  brandy  in  twenty-four  hours,  well 
diluted,  to  a child  of  one  year;  3 to  4 ounces 
in  twenty-four  hours  to  a child  of  five  years. 
Quinine  and  the  perchloride  of  iron  (see 
Part  11)  are  reconmiended.  Diphtheria 
antitoxin  in  large  doses  (see  Diphtheria)  is 
recommended  because  a bacillus  resembling 
that  of  chphtheria  has  been  discovered  in 
the  diseased  tissues. 

The  patient  should  be  isolated. 

“ Plastic  operations  should  be  de- 
ferred for  at  least  one  year  after  the 
attack.”  (Forchhehner.) 

Stone. — See  Calculus. 

Stools,  Bloody. — See  Hemorrhage,  In- 
testinal. 

Colorless.-^See  Colorless  Stools. 

Fatty  . — See  Colorless  Stools. 

Strabismus. — ^Gr.  arpa^LatJ-os  squint.  See 
Motor  Nerves  of  the  Eyeball;  and  also  Part 
6,  Eye  Diseases. 

Strain  of  the  Heart. — See  Heart-Strain. 

Strangulated  Hernia. — See  Hernia. 

Stricture. — L.  strictu'ra,  narrowing.  See 
Stenosis. 

Stridor. — L.  harsh,  whistling  sound. — 

Causes.— Adenoids  (the  stridor  disappears 
when  the  nostrils  are  closed) ; congenital 
malformation  of  the  vestibule  of  the  laiynx 
(stridor  is  only  inspiratory,  and  is  relieved 
by  intubation,  but  it  chsappears  spontan- 
eously by  the  end  of  the  second  year) ; 
thymus  enlargement  (stridor  is  both  inspira- 
tory and  expiratory) ; enlarged  or  tuber- 
culous lymph  nodes  compressing  the  trachea 
or  bronchi  (stridor  is  purely  expiratory,  and 
disappears  during  sleep);  vertebral  abscess 
(difficult  to  distinguish  from  thymic  stridor) ; 
aneurysm  of  the  aortic  arch;  mediastinal 
tumors;  foreign  bodies;  spasm  of  the  glottis; 
laryngeal  paralysis;  any  form  of  stenosis  of 
the  larynx  (see  Throat  Diseases),  trachea,  or 
bronchi,  (see  Tracheal  Obstruction  and 
Broncho-Stenosis) . 

Strongyloidoses. — Gr.  cTpoyyvXos  round. 
Intestinal  infection  with  the  strongyloides 
intestinalis,  a tropical  nematode  worm, 
giving  rise  to  dyspepsia,  diarrhoea,  and 


SUNSTROKE  OR  THERMIC  FEVER 


anaemia,  and  diagnosed  by  the  discovery  of 
larvae  in  the  stools.  Fig.  79. 

The  mother  worm  burrows  in  the  mucous 
membrane  of  the  upper  parts  of  the  small 
intestine,  and  is  expelled  with  difficulty. 
The  eggs  do  not  appear  in  the  faeces  except 
during  purgation.  They  greatly  resemble 
hookworm  eggs.  The  larvae  are  probably 


Fig.  79. — Strongyloides  stercoralis  magnified  about  250  dia- 
meters. (After  Thayer.) 


ingested  in  drinldng  water  or  uncooked 
vegetables  or  from  the  soiled  hands. 

Treatment. — This  is  unsatisfactory.  Thjunol 
may  be  tried,  as  in  ankylostomiasis  (q.v.). 
Preti  recommends  glycerine,  50  grams  of  pure 
glycerine  by  mouth,  half  in  capsules,  and  30 
grams  per  rectum  two  hours  later,  to  be  re- 
peated after  two  days.  Try  Sulphur  (Stiles). 

Struma. — I^.  struma.  See  (Joitre. 

Strumitis. — L.  struma,  goitre  + Gr.  -ins 
inflammation.  See  Thyroitlitis. 

Stupor. — See  C'oma. 

St.  Vitus’s  Dance. — See  Chorea,  Acute. 

Subacidity. — See  Anacidity. 

Subdiaphragmatic  or  Subphrenic  Ab= 
scess. — L.  sub,  under  + Gr.  5id  across  + 
<t>payiJ.a.  wall;  the  diaphragm.  Sub- 

plircnic  abscess  may  be  e.xtra-  or  intra- 


peritoneal.  It  may  or  may  not  contain  gas. 
It  is  almost  always  due  to  appendicitis 
(retrocfEcal,  retrocolic,  or  paracolic  infection, 
or  pylephlebitis),  or  to  liver  suppuration 
(abscess,  cholangitis,  cholecystitis,  pyle- 
phlebitis, operative  handling  of  an  inflamed 
liver,  tuberculosis,  cancer,  gumma,  actino- 
mycosis). Other  causes  are:  pleuritis, 

suppurative,  tuberculous,  or  cancerous; 
pneumonia;  tuberculosis;  splenic  absce.ss; 
gastric,  duodenal,  colic,  or  oesophageal  ulcer; 
gastric  carcinoma;  abscess  and  cysts  of  the 
pancreas;  renal  abscess;  pyosalpinx;  spinal 
or  costal  caries;  traumatism;  general  perito- 
nitis treated  by  drainage  and  recumbency, 
when  the  pus  gravitates  toward  the  spleen, 
causing  a perisplenic  abscess. 

Severe  pain,  vomiting,  dyspnoea,  chills, 
irregular  fever,  and  emaciation  occur.  The 
signs  may  be  those  of  pleural  effusion,  or 
they  may  be  hypochondrial  or  epigastric. 
The  gaseous  abscesses  simulate  pneumo-  or 
pyopneumo-thorax.  They  are  usually  due  to 
perforation  of  agastric  ulcer,  and  are  therefore 
usually  left-sided.  Examine  with  the  X-ray 
in  order  to  see  if  the  chaphragm  is  pushed  up- 
ward and  is  inmiobile. 

Exclude  perh'enal  hpoma,  retroperitoneal 
sarcoma,  aneurj^sm,  pleuritic  effusion  and 
empyema,  liver  abscess,  and  diaphragmatic 
hernia.  In  the  latter  affection  the  abdomen 
is  incurved  instead  of  distended. 

Posterior  abscesses  may  be  explored,  under 
general  anaesthesia,  by  means  of  a long,  thick 
needle  and  syringe.  The  needle  is  first  intro- 
duced for  three  inches  in  the  tenth  interspace  in 
the  scapular  or  midaxillary  line;  and  if  no  pus 
is  found,  the  ninth,  eighth,  seventh,  and  sixth 
interspacesmay  be  tried  (Barnard).  Pleural  in- 
volvement occurs  in  fifty  per  cent,  of  the  cases. 

Treatment.— This  is  surgical  : a trans- 
pleural incision  with  rib  resection. 

The  Prognosis  is  serious. 

Submaxillary  Cellulitis.  — See  Ludwig’s 
Angina. 

Subphrenic  Abscess. — See  Subdiaphrag- 
matic Abscess. 

Suffocation. — L.  suffocdtio.  See  AsphjTda. 

Sugar  in  the  Urine. — See  Glycosuria 
under  Diabetes  Mellitus. 

Sulphaemoglobinaemia. — See  Cyanosis,  and 
Intestinal  Intoxication. 

Summer  Diarrhoea.  — See  Diarrhoea  in 
Infancy  and  Early  Childhood. 

Sunstroke  or  Thermic  Fever  ; Heat  Ex= 
haustion,  and  Heat  Cramps. — These  tliree 
different  conditions  are  caused  by  exposure 
to  excessive  heat,  whether  solar  or  artificial. 
Predisposing  influences  are  alcoholism,  over- 
exertion,  lack  of  sleep,  overclothing,  overeat- 
ing (especially  of  animal  food),  constipation, 


S YPHILIS 


1.  - PapLilo-tiibercii\ous  syphilide. 

N’  1417  D'  Hallopeau. 


2.  — Hereditary  syphilis. 

N'^  18^6  D'  Fournier 


3.  — Syphilitic  roseola. 

N"  2515  D'  Balzer 


4.  — Circinate  syphilide. 

N“  832.  Guibout, 


St.  Louis  Hospital  Museum,  Paris. 


LAROUSSE  MEDICAL. 


Syphilitic  lesions. 


SYPHILIS 


and  a feeble  constitution.  One  attack  pre- 
disposes to  others. 

Thermic  fever  is  characterized  by  head- 
ache, dizziness,  and  nausea,  followed  by 
syncope  or  coma  and  prostration,  with  high 
fever  and  rapid  pulse.  Recovery  usually 
occurs,  but  mental  weakness  may  follow, 
and  the  patient  may  thereafter  never  be 
able  to  bear  even  moderate  heat.  In  severe 
cases,  various  nervous  symptoms  may  result, 
e.g.  headaches,  tremor,  failure  of  memory, 
loss  of  the  power  of  concentration,  deafness, 
blindness,  epilepsy,  paresis  or  paralysis  of 
the  extremities,  neurasthenia,  etc. 

Heat  exhaustion  is  characterized  by  giddi- 
ness, nausea,  staggering  gait,  pallor,  syncope, 
small  soft  pulse,  shallow  respiration,  cold 
skin,  and  subnormal  temperature. 

Heat  cramps  are  characterized  by  the 
occurrence  of  very  painful  spasm  of  the 
muscles  in  those  who  use  the  latter  while 
exposed  to  great  heat. 

Thermic  fever  and  heat  exhaustion  should 
be  distinguished  from  alcoholic  coma,  apo- 
plexy, pernicious  malaria,  and  other  causes 
of  coma  {q.v.). 

Treatment. — In  the  cases  with  hyperpyrexia, 
unclothe  the  patient,  and  put  him  to  bed 
in  a cool  place.  Apply  an  ice-cap  to  the 
head,  and  employ  ice-packs,  ice-water  baths, 
rubbing  of  the  body  with  ice,  sponging  with 
ice-water,  and  ice-water  enemata,  in  order 
to  reduce  the  temperature  ; but  do  not  let 
the  latter  fall  below  100°  F.  The  hypoder- 
mic administration  of  quinine  is  recommen- 
ded (see  under  Malaria). 

Administer  stimulants  hypodermically,  e.g. 
strychnine,  camphor,  caffeine  (see  Part  11). 
Bleeding  may  be  practiced  in  robust  patients 
with  cyanosis;  or  leeches  or  wet  cups  {q.v.) 
may  be  applied  to  the  spine,  mastoids  and 
temples.  Saline  infusions  (0.9  per  cent.)  not 
above  blood  heat,  are  recommended.  Resort 
to  artificial  respiration  (see  Asphyxia)  if 
necessary. 

In  the  cases  with  subnormal  temperature, 
external  heat  should  be  applied. 

Superacidity,  Gastric. — L.  su’per,  above. 
See  Hyperacidity. 

Supersecretion,  Gastric.  — See  Hyper- 
secretion. 

Supra=Orbital  Neuralgia. — L.  su'pra, 
above;  orb'ita,  track.  See  Neuralgia. 

Suprascapular  N erve.— SeeBrachial  Plexus, 

Swallowing,  Difficult  or  Painful.  — See 

Dysphagia. 

Sweating. — See  Hyperidrosis  in  Part  5, 
Skin  Diseases. 

Sweating  Sickness. — See  Miliary  Fever. 

Sweats. — See  Hyperidrosis,  in  Part  5, 
Skin  Diseases. 


Sydenham’s  Chorea. — See  Chorea,  Acute. 

Syncope. — Gr.  avyKoiri]  fainting.  See  Coma. 

Syphilis. — Gr.  aus  swine  -j-  </)tXos  lover. 
A chronic  infectious  and  contagious  dis- 
ease, caused  by  the  spirochajta  pallida  (or 
treponema  pallidum),  and  character izctl  by 
an  initial  sore  (hard  chancre),  which  appears 
usually  within  three  weeks  (two  to  six  weeks) 
of  contagion,  and  is  usually  soon  accom- 
panied by  indolent  swelling  of  the  neighbor- 
ing lymph  glands  (primary  stage);  followed 
after  one  to  two  (to  five)  months  by  fever, 
anaemia,  headache,  sore  throat,  pains  in  the 
bones  and  joints,  worse  at  night,  painless 
enlargement  of  the  lymphatic  glands,  a 
copper-colored,  polymorphous,  indurated 
rash  of  slow  evolution,  arranged  in  groups, 
alopecia,  mucous  patches  (pearly,  slightly- 
raised  patches  upon  a reddish  base),  moist 
papules  and  condylomata  upon  apposed  and 
sweaty  surfaces,  frequently  nephritis,  some- 
times iritis,  perhaps  nervous  symptoms  due 
to  acute  arteritis  with  thrombosis  and  con- 
sequent softening,  acute  meningo-myelitis, 
peripheral  neuritis  or  periosteal  lesions  caus- 
ing compression  paralysis  (secondary  stage) ; 
nearly  always  succeeded,  ordinarily  after 
three  to  four  years,  sometimes  immediately, 
by  “ tertiary  ” lesions,  viz.,  arteritis,  gum- 
matous infiltrations,  ulcerations,  amyloid 
degeneration,  etc.,  which  may  involve  any 
organ  or  tissue  of  the  body.  Like  other 
infectious  diseases,  syphilis  may,  in  any 
individual  case,  be  extremely  mild,  with  few 
manifestations,  or  extremely  severe. 

Following  syiDhilis,  several  so-called  para- 
syphilitic  affections  may  arise  as  sequelae, 
viz.,  tabes,  general  paresis,  arteriosclerosis, 
aneurysm,  leukoplacia  buccalis,  vitiligo, 
Erb’s  spastic  spinal  paralysis,  etc.,  etc. 

In  congenital  syphilis  there  may  be 
observed,  at  birth  or  shortly  after,  some  of 
the  following  symptoms,  viz.,  snuffles,  due 
to  rhinitis,  lip  and  anal  fissures,  mucous 
patches,  a multiform  rash  (palmar  and 
plantar  pemphigus  is  characteristic),  ony- 
chia, a hoarse  cry  due  to  laryngeal  involve- 
ment, swelling  and  pain  at  the  ends  of  the 
bones,  due  to  acute  epiphysitis,  enlargement 
of  the  liver  and  spleen,  anaemia,  malnutri- 
tion, etc.,  etc.  Late  congenital  syphilis, 
however,  may  first  appear  at  puberty  or 
even  later,  and  its  typical  manifestations 
are  an  interstitial  keratitis,  Hutchinsonian 
teeth  (small,  notched,  peg-shaped  upper 
central  permanent  incisors;  not  always 
present),  deafness,  infantilism,  enlargement 
of  the  spleen  and  epitrochlear  glands,  tibial 
or  cranial  nodes,  perhaps  falling  in  of  the 
bridge  of  the  nose,  together  with  any  or  all 
other  tertiary  lesions. 


SYPHILIS 


In  examining  for  the  spirochajta  pallida, 
first  cleanse  the  lesion  thoroughly  with  soap 
and  water  followed  by  boiled  water,  and 
employ  dressings  and  bathings  of  boiled 
water  for  forty-eight  hours.  Then  dry  the 
lesion  and  irritate  the  surface  with  a cotton 
swab  until  serum  exudes,  collect  the  latter  in 
a sterile  capillary  pipette,  blow  it  out  with 
a rubber  bulb  upon  the  slide  of  the  dark 
ground  illuminator,  cover  with  a cover-glass, 
and  examine  by  transverse  illumination.  The 
spirochaetse  appear  as  colorless,  glistening, 
rapidly  motile  spirals. 


In  the  absence  of  the  dark  field  illumina- 
tion, the  same  effect  may  be  obtained  by 
adding  to  a drop  of  the  suspected  serum  one 
drop  of  sterile  India  ink,  allowing  the  mixture 
to  dry,  covering  the  dried  smear  with  oil, 
and  examining  with  an  oil  immersion  lens. 
To  demonstrate  sj:)irochsetes  in  chancres 
which  are  concealed  beneath  an  inflamed 
foreskin  or  which  have  healed  over  on  the 
surface,  insert  a very  fine  needle  attached  to 
a Luer  syi’mge  into  the  most  indurated  por- 
tion of  the  lesion,  in  the  concealed  cases,  or 
into  the  base  of  healed-over  surface  lesions, 
and  aspirate  gently,  avoiding  blood,  for  a 
period  of  5 to  ten  minutes,  turning  the  needle 
about,  until  a goodsized  drop  of  clear  serum 
is  obtained  in  the  syringe  (G.  H.  IMitched.) 

Webster  recommends  the  Goldhorn  stain. 
Obtain  the  serum  as  directed  above,  and 
spread  it  as  thin  as  possible  upon  a slide. 
Fix  the  smear  with  pure  methyl  alcohol  for 
fifteen  minutes;  then  cover  with  polychrome 
methylene  blue  for  three  to  five  seconds; 
drain  off  the  excess;  slowly  introduce,  film 
sitle  down,  into  water;  keep  immersed  for 
four  to  five  seconds;  shake  in  the  water  to 
remove  excess  of  dye;  cover  with  Gram’s 


iodine  solution  for  fifteen  to  twenty  seconds; 
wash;  dry  between  filter  paper;  and  examine 
with  an  oil  hmnersion  lens.  The  spiro- 
chseta  pallida  may  be  distinguished  from 
other  spirochsetjB  by  the  fact  that  its  two 
ends  lie  on  one  side  of  a longitudinal  line 
drawn  tlirough  the  centre  of  its  curvatures, 
whereas  in  other  spirochcetae  the  ends  lie 
on  this  line  (see  Fig.  80). 

To  obtain  blood  for  a Wassermann  test, 
draw  at  least  two  cubic  centimetres  from  a 
vein  by  means  of  a hypodermic  syringe,  or 
from  the  tip  of  the  finger  by  deep  puncture 
with  a large  Hagedorn  needle,  or,  in  very 
young  childi’en,  from  the  heel.  Allow  the 
blood  to  clot  in  a small  test  tube,  and  after 
about  twenty  minutes,  centrifuge  the  tube 
in  order  to  obtain  the  clear  serum.  Forward 
the  latter  to  the  laboratory.  Says  Webster. 
“If  the  cells  are  allowed  to  remain  in  contact 
with  the  serum  for  any  length  of  tune,  so 
much  haemolysis  occurs  that  the  test  can 
not  be  accurately  made  by  a distant  labora- 
tory.” H.  K.  Mulford  Co.,  Phha.,  furnish 
the  required  paraphernalia  with  full  direc- 
tions for  malang  the  Noguchi  modification 
of  the  Wassermann  test. 

The  Wassermann  reaction  is  usually  nega- 
tive until  at  least  two  weeks  after  the 
appearance  of  the  chancre;  sometimes  three, 
or  four,  or  five  weeks,  or  even  up  to  the 
appearance  of  secondaries. 

In  the  tertiary  stage  it  is  positive  in  80 
to  90  per  cent,  of  the  cases. 

In  inherited  sypliilis  it  is  positive  in  about 
90  per  cent,  of  the  cases. 

In  latent  syphilis  it  is  positive  in 
about  50  per  cent,  of  the  cases. 

In  tabes  it  is  positive  in  60  to  70  per  cent, 
of  the  cases. 

In  paresis  it  is  positive  in  practically  100 
per  cent,  of  the  cases. 

It  is  negative  under  treatment. 

A positive  Wassermann  or  Noguchi  reac- 
tion means  syphilis  in  nearly  all  cases;  a 
negative  reaction  does  not  exclude  syphilis. 
It  should  be  remembered  in  this  connection, 
howevei’,  that  if  a specimen  of  blood  from 
the  same  individual  be  submitted  to  differ- 
ent serologists,  the  reports  received  will  not 
agree.  The  significance  of  this  fact  need  not 
be  commented  upon  here. 

The  Wassermann  test  is  explained  as  fol- 
lows: An  immune  serum  is  cjdolytic  toward 
its  particular  antigen.  This  cjdol3dic  prop- 
erty, however,  is  destroved  by  heating  the 
serum  to  50°C.;  but  is  restored  on  the  addi- 
tion of  anj'’  other  normal  serum.  It  is  there- 
fore assumed  that  the  specific  cytoljdic 
properties  of  an  immune  serum  are  due  to 
two  substances  (or  conditions),  one  specific 


SYPHILIS 


and  stable  (called  amboceptor  or  antibody), 
and  the  other  common  to  all  sera  and  de- 
stroyed by  a temperature  of  50°  C.  (called 
complement).  The  solution  of  bacteria  or 
other  foreign  cells,  such  as  red  blood-cells, 
in  an  immune  serum  is  brought  about  by  the 
combined  action  of  amboceptor  and  com- 
plement, which,  united,  combine  with  the 
foreign  cells  and  cause  their  solution. 

If  to  an  immune  sermn,  i.  e.,  one  contain- 
ing both  amboceptor  and  complement,  its 
specific  antigen  is  added,  the  complement 
disappears  as  such  by  union  with  amboceptor 
and  antigen  (fixation  of  complement).  Thus, 
if  the  serum  of  a syphilitic  is  mixed  with  its 
specific  antigen  (the  spirochseta  pallidum), 
the  complement  of  the  serum  becomes  fixed 
by  combining  with  amboceptor  and  antigen; 
so  that  the  mixture  in  its  lack  of  complement 
is  like  any  normal  serum  that  has  been 
heated  to  50°C.  Now,  sheep  cells,  when 
introduced  into  a rabbit,  lead  to  the  forma- 
tion of  a specific  antibody  (amboceptor)  in 
the  rabbit,  which  in  the  presence  of  comple- 
ment dissolves  the  haemoglobin  from  the  red 
blood  cells  of  sheep  (haemolysis).  If  such  a 
rabbit-serum,  which  is  immune  against  sheep 
corpuscles,  is  heated  to  50°  C.,  it  no  longer 
produces  haemolysis  on  the  admixture  of 
sheep  corpuscles.  But  haemolysis  is  produced 
on  the  subsequent  addition  of  any  normal 
serum,  because  the  latter  provides  the  neces- 
sary complement.  Suppose  now  that  serum 
from  a suspected  case  of  syphilis  is  treated 
with  a sufficient  quantity  of  syphilitic  anti- 
gen, and  the  sermn  thus  treated  is  added  to 
rabbit  serum  containing  sheep  corpuscles  and 
anti-sheep  amboceptor  but  no  complement. 
If  haemolysis  results,  it  is  evident  that  the 
suspected  serum  is  not  syphilitic,  because,  if 
it  were,  its  complement  would  have  been 
fixed  by  the  combined  action  of  syphilitic 
amboceptor  and  antigen. 

The  Wassermann  test  is  based  upon  the 
above  facts.  But  it  has  been  found  that 
other  antigens  than  syphilitic  antigens  (i.  e., 
colloidal  lipoids  contained  in  alcoholic  ex- 
tracts of  normal  organs)  serve  the  purpose 
of  fixing  complement  in  the  presence  of 
syphilitic  amboceptor.  Even  amboceptor 
may  not  be  altogether  specific,  but  a 
lipoidal  proteid  complex,  rather  peculiar  to 
the  serum  of  syphilitics,  which,  when  brought 
in  contact  with  other  lipoids,  extracted  from 
any  lipoid-rich  organs,  possesses  the  ability 
to  absorb  complement. 

Thus,  in  certain  conditons  in  which  lipoids 
enter  the  blood,  as  during  digestion,  in 
acidosis,  lipaemia,  and  after  chloroform  or 
ether  narcosis,  and  in  conditions  in  which 
the  blood  becomes  rich  in  euglobulin,  as  in 


necrosing  tumors  pneumonia,  empyema,  and 
infectious  diseases,  etc.,  where  large  amounts 
of  inflammatory  exudate  are  rapidly  resorbed, 
a positive  Wassermann  reaction  may  be  ob- 
tained in  the  absence  of  syphilis.  Therefore, 
says  Horst  Oertel,  blood  should  never  be 
taken  for  a Wassermann  under  these  circmn- 
stances;  nor  should  it  be  taken  by  blister  or 
cupping,  but  directly  from  vessels,  in  order 
to  avoid  subcutaneous  fat. 

Luetin  (killed  spirochsetae)  is  of  use  in 
the  diagnosis  of  syphilis  in  its  tertiary  stage, 
but  rarely  gives  a positive  reaction  in  the 
primary  stage  or  in  untreated  secondary 
cases.  In  patients  under  treatment,  the 
reaction  is  frequently  positive  even  when  the 
Wassermann  test  is  negative.  The  luetin 
test  is  performed  as  follows:  After  cleansing 
and  sterilizing  the  skin  of  the  upper  arm, 
0.07  c.c.  of  luetin,  properly  cUluted,  is  in- 
jected into  but  not  under  the  skin.  In 
twenty-four  to  forty-eight  hours  in  positive 
cases,  there  appears  a large,  redchsh, 
indurated  papule  (usually  from  7 to  10  mm. 
in  diameter),  which  slowly  enlarges  for  four 
or  five  days,  and  then  gradually  cUsappears 
or  else  becomes  more  active,  with  the  forma- 
tion of  vesicles  and  later  pustules  which 
break  and  become  crusted.  In  the  torpid 
type  of  syphilis,  no  reaction  may  appear 
until  after  ten  days  or  longer,  when  the  site 
of  injection  suddenly  shows  activity  and 
goes  through  the  same  changes  as  seen  in 
the  pustular  type.  In  negative  cases  only 
a very  small  erythematous  area  appears 
at  and  around  the  point  of  injection. 
Luetin  is  furnished  by  the  H.  K. 

Mulford  Co.,  Philadelphia. 

Prognosis.— Syphilis  is  curable,  as  a rule, 
when  taken  in  hand  before  the  onset  of  the 
tertiary  stage.  “ Cases  fii’st  treated  in  the 
tertiary  stage  are  difficult  and  often  unpossi- 
ble  to  cure  ” (Osier  and  Churchman). 
“ Syphilitics  may  marry  with  safety  after 
they  have  undergone  three  years  of  thor- 
ough treatment  and  have  been  without 
symptoms  at  least  one  year  (better  two 
years)  after  treatment  has  ceased  ” (Osier 
and  Churchman).  Says  Keyes,  after  the 
fourth  year,  whether  the  patient  has  been 
well  treated  or  not,  the ' danger  of  marital 
infection  is  all  but  nil,  but  is  not  nil. 

The  prognosis  in  congenital  syphilis  is  bad. 
To  prevent  congenital  syphilis,  treat  the 
mother  with  protiodide  pills,  either  continu- 
ously as  some  advise,  or  intermittently 
(twenty  days  each  month)  as  others  advise. 
Treatment  is  too  late,  however,  if  begun 
after  the  fifth  month.  (Pinard.) 

A.  Treatment  of  Acquired  Syphilis. — A hygienic 
and  tonic  regimen  is  of  great  importance. 


SYPHILIS 


Enjoin  fresh  air  day  and  night,  adequate 
rest  and  gentle  exercise,  regular  hours  of 
eating  and  sleeping,  rest  before  and  after 
meals,  an  abundant,  wholesome,  but  not 
excessive  (Uet,  regulation  of  the  bowels,  and 
if  practicable  a daily  morning  warm  bath 
in  a warm  room,  followed  by  a cold  douche, 
or  a cold  douche  wliile  standing  in  warm 
water.  The  teeth  and  gimis  should  be 
brushed  before  breakfast  with  castile  soap 
and  wann  water.  Carious  teeth  should  be 
treated  by  a dentist.  As  a preventive  of 
stomatitis,  the  mouth  may  be  rinsed  morning 
and  night  with  an  alkaline  astringent  wash 
such  as  that  of  Yeo,  given  under  Stomatitis; 
or  jx)tassimn  chlorate,  gr.  xv  to  half  a glass 
of  water.  Alcohol  and  tobacco  should  be 
avoided,  especially  the  former.  Keyes  lays 
great  stress  on  the  necessity  of  abstinence 
from  alcohol.  The  patient  should  lead  a 
quiet  life,  physically,  mentally,  and  sexually. 

If  there  is  loss  of  weight,  prescribe  an 
emulsion  of  codliver  oil,  or  olive  or  cotton- 
seed oil.  If  there  is  anaemia,  prescribe  iron  or 
arsenic.  If  the  patient  is  neurotic,  prescribe 
hypophosphites  or  glycero-phosphates  (for 
all  dings,  see  Part  11). 

The  patient  should  be  encouraged  by  the 
assurance  of  a good  prognosis  under  thor- 
ough treatment.  Do  not  neglect  to  impress 
him  with  the  danger  of  infecting  others 
through  the  medium  of  towels,  napkins, 
drinking  cups,  spoons,  forks,  or  kissing. 

If  the  initial  lesion  can  be  positively  chag- 
nosed  as  syphilitic  by  the  demonstration  of 
the  presence  of  the  spirochseta  pallida  (re- 
peated examinations  every  two  days  may 
be  required),  institute  constitutional  treat- 
ment at  once;  otherwise  wait  for  secondary 
symptoms.  The  Wassermann  reaction,  it 
must  be  remembered,  does  not  appear  until 
the  end  of  the  second  or  fourth  week,  or 
even  later.  The  greatest  success  in  com- 
pletely eradicating  the  disease  is  obtained 
when  treatment  is  begun  before  the  patient 
becomes  Wassermann  positive.  The  chancre 
itself  may  be  excised,  cauterised,  or  treated 
with  calomel,  1 jiart,  in  lanolin  3 parts,  or 
with  ung.  hych-argyri.  (The  calomel  ointment 
is  effectual  as  a prophylactic  after  suspicious 
intercourse  if  used  within  six  hours.)  Some 
prefer  a dry  ch-essing  of  calomel  and  bismuth, 
equal  parts,  after  first  cleansing  the  ulcer 
with  bichloride,  1 : 1000  to  500,  and  drying. 
If  the  chancre  becomes  idiagedenic,  curet 
and  cauterise  it  .with  the  Paquelin  cautery, 
nitric  acid,  zinc  chloride,  10  i)er  cent.,  or 
silver  nitrate,  and  later  rub  in  ung.  hych-ar- 
gjTi.  Employ  the  latter  in  the  vagina.  If 
the  chancre  is  concealed  by  a phimosis,  per- 
form circumcision  or  dorsal  division  of  the 


prepuce.  To  mouth  and  tonsil  chancres 
apply  daily  a 10  per  cent,  solution  of  bi- 
chloride in  alcohol  or  ether  (F.  Kreissl);  or 
cleanse  and  dry,  and  touch  with  pure  car- 
bolic acid.  (St.  Clair  Thomson.) 

The  following  plan  of  intensive  treatment 
is  that  employed  by  G.  Thibierge  in  the 
French  Army.  As  soon  as  chancre  is  cUag- 
nosed,  administer  intravenously  {q.  v.)  once 
daily  or  on  alternate  days,  for  two  or  three 
doses,  mercury  cyanide  in  1 per  cent,  solu- 
tion in  sterile,  distilled  water,  1 c.c.  (0.01 
gm.)  at  a dose.  If  the  patient  is  weak,  one 
may  begin  with  a trial  dose  of  0.5  c.c.  Fol- 
lowing these  two  or  three  doses  of  mercury,  ad- 
minister novarseno-benzol  (neosalvarsan ; for 
contraindications,  see  p.  346)  intravenously, 
0.45  gm.  in  healthy  men,  0.30  gm.  in  women; 
eight  days  later,  O.GO  gm.  for  men;  eight 
days  later,  0.75  to  0.80  gm.  In  the  intervals 
give  intravenous  injections  of  cyanide  of 
mercury,  0.01  gm.,  daily  or  every'  other  day, 
twelve  to  fifteen  injections  in  all,  but,  prefer- 
ably, no  injections  of  mercury  on  the  day 
following  the  arsenic.  Suspend  mercurial 
treatment  on  the  appearance  of  stomatitis, 
colitis  or  bloody  stools.  To  avoid  the  latter 
Thibiergegivesopium,  0.02  to  0.05  gm.,  in  pill 
fonn,  at  the  tune  of  the  injection.  IMercurj' 
injections  should  not  be  continued  if  they 
cause  a recrudescence  of  albuminuria  in  albu- 
minuric subjects.  In  bad  cases  (iritis,  men- 
ingitis, etc.),  one  may  venture  with  2 c.c. 
of  the  mercury  solution  every  other  day, 
with  1 c.c.  in  the  intermediate  days. 

The  preliminaiy  mercurial  injections  are 
given  to  lessen  the  to.xic  effects  of  the  sub- 
sequent arsenic  injections.  The  novarseno- 
benzol,  whatever  the  dose,  is  dissolved  in 
2 c.c.  of  cold  ch.stilled  or  plain  boiled  water 
filtered  through  cotton-wool  (Ravant),  and 
used  at  once.  The  concentrated  solution  is 
safer  than  voluminous  thlutions.  If  toxic 
symptoms  arise  the  dose  should  be  reduced. 
Only  light  food  is  allowed  not  less  than 
three  hours  before  the  injection  of  arsenic, 
and  rest  in  bed  on  strictly  liquid  diet  for 
twenty-four  hours  following. 

In  severe  ulcerous  skin  lesions  and  small 
papulous  sj’philides,  give  five  to  six  injections 
of  novai’seno-benzol  in  doses  of  0.45,  0.60, 
0.60,  0.75,  and  0.90  gm.,  together  with  the 
sjTUi:)  of  the  iodide  of  iron,  a nutritious  diet, 
and  fresh  air. 

For  persistent  headache  and  for  bone 
pains,  prescribe  potassium  iodide,  1 to  2 
gins,  daily  (see  Part.  11).  A lumbar  punc- 
ture may  be  done,  and  the  presence  of  Ijnnph- 
ocytosis  calls  for  more  energetic  treatment 
with  arsenic,  e.  g.,  4,  5 or  6 injections. 
The  occurrence  of  iritis,  meningitis,  and 


SYPHILIS 


paralyses  is  also  an  indication  for  more  pro- 
longed treatment. 

Arsenic  should  be  used  cautiously  or  not 
at  all  in  the  presence  of  jaundice  or  ne- 
phritis and  care  should  be  taken  with  the  diet. 

Serious  accidents  resulting  from  the  use 
of  arsenobenzol  are  (1)  acute  encephalitis, 
with  severe  headache,  fever,  facial  conges- 
tion, vomiting,  deliriimi,  convulsions,  coma, 
and  death;  (2)  paralysis  of  the  cranial  nerves 
due  to  basilar  meningitis;  (3)  icterus;  (4) 
albuminuria;  (5)  vomiting,  diarrhoea;  (6) 
palpitations;  (7)  cutaneous  eruptions. 

Thibierge  advises  against  the  use  of  calo- 
mel or  silver  nitrate  on  the  chancre,  and 
merely  cleanses  it  with  boiled  water  and 
dusts  on  bismuth  subnitrate. 

Following  the  above  intensive  treatment, 
prescribe  protoiochde  of  mercury  pills,  0-025 
gm.  (gr.  four  times  a day,  for  twenty 
days  per  month  for  three  months;  for  the 
next  nine  months,  twelve  to  fifteen  days  per 
month;  for  the  following  year,  twelve  to 
fifteen  days  eveiy  two  months;  for  the  next 
two  or  three  years,  forty  to  fifty  days  twice  a 
year.  Give  novarseno-benzol  injections  on 
the  appearance  of  luetic  symptoms.  Two 
months  after  the  first  course  of  arsenic  and 
mercury  injections  a second  course  may  be 
given,  e.  g.,  arsenic,  0.60  gm.  every  eight 
days  for  two  to  three  doses,  and  mercury 
every  second  day,  or  gray  oil  once  a week. 

Gray  oil,  40  per  cent.,  may  be  given  intra- 
muscularly (never  hypodermically)  once  a 
week  for  six  to  eight  doses  every  three  to 


four  months. 

Purified  mercury 40  gm. 

Sterilized  anhydrous  lanoline 26  gm. 

Sterilized  oil  of  vaseline,  about ....  60  gm. 


Dose,  7 to  8 centigrams  (.07  to  .08  gm.)  of 
mercury.  Calomel  is  too  painful.  The  soluble 
preparations  of  mercury  are  inferior  to  the  insoluble. 
They  must  be  injected  oftener,  e.g.,  three  to  six 
times  a week. 

Use  a steel  needle,  4 to  5 cm.  long.  Inject 
into  the  buttock,  but  avoid  the  neighbor- 
hood of  the  sciatic  notch.  Choose,  says 
Thibierge,  “an  area  the  width  of  two  fingers 
in  height  and  of  three  fingers  in  width,  the 
external  border  of  which  is  3 cm.  behind  the 
great  trochanter  and  the  lower  border  2 cm. 
above  the  lower  border  of  the  trochanter; 
or  in  the  upper  third  of  the  buttock.”  First 
introduce  the  needle  alone,  to  see  that  no 
vessel  is  punctured,  as  would  be  shown  by 
the  flow  of  blood. 

Thibierge  in  his  treatment  pays  no  at- 
tention to  the  Wassermann  reaction. 

Of  the  two  older  specific  remedies,  mer- 
cury is  the  most  important.  Some  employ 
iodine  only  for  the  relief  of  headache  and 
neuralgic  pains  in  the  secondary  stage,  and 


for  the  cure  of  lesions;  others  employ  the 
mixed  treatment  as  a routine  from  the  very 
beginning.  Opium  should  not  be  given. 

The  best  mercurial  prejiarations  for  in- 
ternal use  are  the  protiodide  and  the  bi- 
chloride. Keyes  prefers  Gamier  and  La- 
moureux’s  granules  of  green  protiodide 
(gr.  to  the  yellow  protiodicle  (gr.  34 
to  because  the  latter  is  too  irritating  to 
the  bowel.  Begin,  says  Keyes,  with  one 
granule,  t.i.d.,  two  hours  after  meals.  On 
the  third  and  fourth  days  give  one  granule 
after  breakfast,  one  after  the  noon  meal,  and 
two  after  supper.  On  the  fifth  and  sixth 
days  give  two  granules  after  breakfast,  one 
after  dinner,  and  two  after  supper.  On  the 
seventh  and  eighth  days  give  two  granules 
after  each  meal;  and  so  on,  up  to  three, 
four,  or  more  granules  t.i.d.,  or  until  the 
symptoms  disappear  or  the  first  evidence  of 
hydrargyrism  appears,  viz.,  colicky  diar- 
rhoea. Wlien  diarrhoea  occurs,  reduce  the 
maximum  dose  one-half,  and  continue  at 
this  dose  until  the  luetic  symptoms  subside; 
then  give  the  minimum  tonic  dose  of  2 
granules  t.i.d.  If  the  symptoms  disappear 
before  diarrhoea  occurs,  institute  the  mini- 
mum tonic  dose  at  once.  Continue  this 
dosage  for  two  years,  with  intermissions  of 
a week  or  two  if  indigestion  occurs.  In  the 
third  year,  give  mercury  only  during  the 
last  six  months.  During  the  fourth  year 
give  no  mercury  if  the  patient  has  remained 
free  from  symptoms  for  two  years;  other- 
wise employ  three  months  or  more  of 
treatment.  In  the  fifth  year  employ  the 
same  procedure  as  in  the  fourth.  In  the 
sixth  year  permit  matrimony  “ if  the  patient 
has  been  two  years  without  lesions  and 
without  treatment.”  (Keyes.) 

Instead  of  the  protiochde,  one  may  em- 
ploy pulvis  hydrargyrum  cum  creta,  or  gi’ay 
powder  (minimum  tonic  dose,  gr.  ii,  t.i.d., 
up  to  gr.  V,  t.i.d.,  when  combating  lesions) ; 
or  hydrargjTi  bichloridum  (minimum 
tonic  dose,  gr.  or  pilula  inassiB  hydrar- 
gyri  or  blue  pill  (minimum  tonic  dose,  gr.  iii 
a day);  or  hydrargyri  tannas,  gr.  iv-v,  t.i.d., 
in  pill  form. 

B Hydrargyri  chloridi 

corrosivi gr.  i-ii  (gr.  per  dram) 

Potassii  iodidi.  . . . 3ii-5i  (gr.  iv-.xv  per  dram) 
Syrupi  sarsaparilla; 
composita;,  q.s.  adgiv 

M.  Sig. — One  dram,  well  diluted,  in  water  or  milk 
two  hours  after  meals. 


Soluble  mercury  preparations  for  injection : 


Hydrargyri  chloridi  corrosivi  ....  gr.  v 

Sodii  chloridi gr.  iitss 

Aqua;  destillata; 5i 


Dose,  1.5  minims  or  1 c.c.  (gr.  '4  of  bichloride).  (?) 


SYPHILIS 


II  Ilydrargyri  biiiiodidi gr.x 

Potassii  iodidi gr.v. 

Aqua?  destillataj,  q.s.  ad 5i 

Dose, 


In  the  first  year,  advises  Keyes,  give  three 
courses,  the  injections  being  made  every  other 
day,  the  fii'st  two  courses  lasting  four  to  six 
weeks,  the  last  course  about  four  weeks.  In  the 
second  year,  give  two  courses  of  about  four 
weeks  each.  In  the  tim’d  and  fourth  years, 
give  one  four-weeks  course.  Or  the  injec- 
tions may  be  given  daily  until  the  symp- 
toms disappear,  then  alternately  six  doses 
and  six  days  of  rest  for  the  first  year;  three 
doses  and  nine  days  of  rest  tliroughout  the 
second  year. 

Insoluble  mercury  preparations  for  in- 
jection : 

II  Hydrargyri  chloridi  mitis  (washed  in 

boiling  alcohol ) 1 part 

Albolini  sterilisati 4 parts 

Sterilize  in  a water  bath.  Dose  5 minims  (calo- 
mel, gr.  i). 

II  Hydrargyri  salicylatis gr.  xlviii 

Albolini  sterilisati 5 i 

Sterilize  in  a water  bath.  Dose  10  minims  (mer- 
cury salicylate,  gr.  i). 

II  Hydrargyri  bidestillati  (den- 
tists’mercury) oiiss 

Albolini 5 hi 

Adipis  lanae  hydrosi Jiss.  (Gray  Oil.) 

Gray  oil  mu.st  be  prepared  from  sterile 
materials  under  aseptic  conditions,  and  the 
mercury  must  be  triturated  with  the  lanolin 
for  at  least  two  hours.  Dose  2 to  6 minims. 

In  the  first  year,  says  Keyes,  give  an  in- 
jection every  two  weeks;  in  the  second  year, 
every  three  weeks;  in  the  tliird  year,  one  in- 
jection a month  during  the  last  six  months. 
Should  a relapse  of  symptoms  occur,  resume 
the  injections  “every  two  weeks  for  three 
months  after  their  cure.” 

The  inunction  method  of  treatment  is 
useful  in  the  presence  of  dyspepsia,  diar- 
rhcea,  cachexia,  and  in  infancy  (in  the  latter 
case  to  avoitl  indige.stion) . Employ  for 

munction  either  the  official  mercurial  oint- 
ment (50  per  cent.)  or  mercury  vasogen 
(50  per  cent.),  5 i for  adults  (sometimes  in- 
creased to  two  and  four  ch’ams),  gr.  xv-xxx 
for  infants,  dispensed  m gelatin  capsules, 
one  dose  to  each  capsule.  Give  the  inunc- 
tions at  night,  into  the  non-hairy  regions 
(sides  of  the  thorax  and  abdomen,  back, 
inner  sitles  of  the  arms  and  thighs,  flexor 
surface  of  the  foreanns,  {lalms,  and  soles), 
rubbing  a different  j)art  each  night.  Rub 
the  ointment  in  to  the  ix)int  of  dryness,  at 
least  thirty  minutes  for  one  dram.  If  an- 
other than  the  patient  gives  the  inunction,  he 
should  wear  rubber  gloves.  Give  one  in- 
unction daily  for  six  days,  and  on  the  seventh 


day  give  a hot  sweat  bath,  preferably  a 
vapor  bath  in  a portable  cabinet.  In  the 
first  year,  give  daily  inunctions  for  two  or 
thi’ee  weeks  alternately  with  intervals  of 
rest  of  five  or  seven  weeks  (six  to  eight  inter- 
rupted coirrses  during  the  year).  In  the 
second  year  give  four  to  six  courses  of  three 
or  two  weeks  daily  inunctions,  alternating 
with  periods  of  rest  of  two  or  three  months. 
During  the  tliird  and  fourth  years,  give  two 
or  three  courses.  Discontinue  the  inunc- 
tions temporarily  at  the  first  sign  of  tender- 
ness of  the  gums. 

Salvarsan  or  neosalvarsan  should  be  ad- 
ministered to  every  patient  in  whom  it  is 
not  contraindicated.  Contraindications  are: 
disease  m the  fundus  of  the  eye,  advanced 
central  nervous  degeneration,  functional 
cardiac  disturbances,  angina  pectoris,  broken 
cardiac  compensation,  arteriosclerosis  or 
nephritis  with  a blood  tension  above  200 
millimetres,  hepatitis,  fetid  bronchitis,  car 
chexia,  the  administration  of  other  forms  of 
arsenic  within  two  months,  the  administrar 
tion  of  sedatives  within  forty-eight  hours. 
Reject  any  ampoule  of  salvarsan  that  is 
cracked,  since  it  decomposes  on  exposure 
to  the  air. 

The  drug  is  best  given  intravenously  (q.v.) 
The  patient  is  purged  the  evening  before, 
and  no  breakfast  is  allowed  on  the  morning 
of  the  injection.  The  patient  should  lie 
recmnbent  during  the  injection,  and  for 
twenty-four  hotus  thereafter.  Only  liquid 
food  should  be  allowed  for  twenty-four  hours 
after  the  injection.  Salvarsan  solution  is 
prepared  as  follows:  Pour  30  to  40  c.c.  of 
sterile,  freshly  distilled,  hot  water  into  a 
sterile  glass-stoppered  bottle  or  cylinder 
graduated  up  to  300  c.c.  Drop  into  this 
the  salvarsan  (acid  hydrochloride)  from  its 
glass  container  which  has  pre'viously  been 
scratched  with  a file  and  sterilized  in  alcohol. 
Shake  the  cylinder  until  an  absolutely  clear 
solution  is  obtained.  Then  add,  from  a 
sterile  pipette,  ch’op  by  drop,  a nonnal 
solution  of  sodium  hych’ate  until  the  neutral 
point  is  reached,  when  the  precipitate 
formed  is  entirely  redissolved  on  shaking 
(approxhnately  0.7  c.c.  (about  10  drops)  of 
the  alkali  is  requu-ed  for  each  0.1  gin.  of 
salvarsan).  If  too  much  alkali  is  added,  add 
acetic  acid,  10  per  cent.,  cautiously.  Now 
dilute  the  clear  yellow  solution  with  sterile 
hypotonic  salme  solution  (about  0.5  per  cent, 
chemically  pure  sodium  chloride  in  distilled 
water)  until  for  0.5  gm.  salvarsan  there  is  250 
c.c.  fluid  (40  to  50c. c.  of  fluid  for  each  decigram 
of  salvarsan).  If  the  solution  is  not  quite 
clear,  adtl  the  sodium  hydrate  solution,  a 
di’op  at  a time,  and  shake.  Wann  to  about 


SYPHILIS 


37°  C.,  before  using,  and  place  the  bottle 
in  a dish  of  hot  water  to  prevent  cooling. 

The  dose  of  salvarsan  is  0.4  to  0.6  gm. 
for  men;  0.3  to  0.4  gm.  for  women;  0.1  to 
0.2  gm.  for  children  of  from  five  to  ten  years 
of  age  ; 0.02  to  0.1  gm.  for  infants  (0.001  gm. 
per  pound  of  weight).  An  injection  may  be 
given  every  two  weeks  for  from  five  to  seven 
doses.  Six  to  twelve  months  later,  another 
injection  may  be  given  in  order  to  ascertain 
if  a positive  Wassermann  reaction  is  thereby 
provoked.  If  not  thus  provoked,  a complete 
cure  may  be  considered  accomplished.  No 
mercury  should  be  given  for  at  least  two  or 
three  weeks  prior  to  the  test.  Resume  mer- 
curial treatment  after  a course  of  salvarsan. 
The  patient  should  live  quietly  and  simply 
for  two  weeks  following  the  administration 
of  salvarsan. 

Neosalvarsan  requires  no  other  prepara- 
tion than  mere  solution  in  sterile,  freshly 
distilled,  cold  water,  or  well-boiled  and  cooled 
tap  water,  not  over  22°  C.  (71°  F.);  dosage 
0.60  to  0.75  to  0.90  gm.  for  males;  0.45  to 
0.60  to  0.75  gm.  for  females;  0.15  to  0.30 
gm.  for  children.  (It  is  about  one-third  the 
strength  of  salvarsan;  or  1.5  gm.  of  neosal- 
varsan is  equivalent  to  1.0  gm.  of  salvarsan.) 

For  intramuscular  injections,  rub  up  4 
to  6 decigrams  (0.4  to  0.6  gm.)  of  salvarsan 
in  a mortar  with  2 or  3 c.c.  of  hot  iodipin, 
albohne,  or  liquid  vaseline,  and  inject  2 to 
2J^  inches  into  the  buttock  through  a large- 
calibre  needle.  Intramuscular  injections 
are  more  painful,  dangerous,  and  less  efficient 
than  intravenous  injections,  and  have  been 
largely  discarded. 

The  subarachnoid  injection  of  serum  sal- 
varsanized  in  vivo  (Swift-Ellis)  or  salvar- 
sanized  in  vitro  (Ogilvie)  or  mercurialized 
(Byrnes)  is  probably  of  no  material  value. 
Some  one  has  suggested  lumbar  puncture 
one  hour  after  the  intravenous  injection  of 
arsenic  with  the  idea  of  drawing  serum  into 
the  central  nervous  system. 

For  the  nitritoid  crisis  (respiratory  em- 
barassment,  facial  congestion,  hypersecretion 
from  the  mucous  membranes)  which  some- 
times follows  the  injection  of  arsphenamin, 
Milian  recommends  adrenalin  {q.v.)  subcu- 
taneously. 

Potassium  or  sodium  iodide  is  especially 
valuable  in  the  tertiary  stage,  used  in  con- 
junction with  mercury,  and  for  the  relief  of 
headache  and  neuralgic  pains  in  the  second- 
ary stage  (gr.  v-x  t.i.d.  for  the  latter  pur- 
pose). Many  therefore  employ  the  mixed 
treatment  from  the  beginning,  using  larger 
doses  of  iodide  in  the  tertiary  stage. 

Solutionis  sodii  iodidi  concentrati,  §i  (gr.  i 
to  each  minim). 


Sig. — For  men,  10  minims,  for  women,  5 minims 
t.i.d.p.c.  in  one-half  to  one  glass  of  milk  or  an  alka- 
line water,  gradually  increased  by  one  minim  a day 
up  to  4.5-60  minims  daily  if  need  be;  more  than 
60  minims  only  in  urgent  cases. 

Some  advocate  big  doses,  up  to  250  grs. 
daily,  but  such  doses  are  probably  super- 
fluous and  harmful.  Continue  the  iodide 
until  the  tertiary  lesions  yield,  but  no 
longer  than  three  or  four  weeks  at  a time, 
followed  by  a rest  of  two  or  three  weeks. 
The  rule  is  to  increase  the  dose  of  iodide 
and  of  mercury  (mercury  is  also  demanded 
in  the  tertiary  stage)  until  a dose  is  reached 
that  will  control  the  lesions;  then  to 
continue  this  dose  for  a while  after  the 
lesions  have  apparently  disappeared.  A 
biyearly  course  of  iochde  (about  five  weeks) 
for  an  indefinite  period,  is  advisable  in 
tertiary  cases. 

Hydrargyrism  and  iodism  are  to  be 
avoided.  The  symptoms  of  the  former  are 
diarrhoea,  indigestion,  tenderness  and  spong- 
iness of  the  gums,  salivation,  a metallic 
taste,  anaemia,  loss  of  weight,  perhaps 
stomatitis,  bloody  stools,  albmninuria,  ery- 
thema, or  polyneuritis.  The  occurrence  of 
these  symptoms  calls  for  a remission  of  the 
mercm’ial  treatment  and  the  adoption  of 
purgation,  copious  water  drinking,  prefer- 
ably alkaline  waters,  and  sweating  by  means 
of  the  hot  tub  bath  or  the  cabinet  vapor 
bath  every  evening  (see  under  Stomatitis). 
The  symptoms  of  iodism  are  indigestion,  a 
salty  or  metallic  taste,  coryza  (lachrymation, 
conjunctival  injection,  sneezing)  and  acne; 
less  often  frontal  headache  and  neuralgic 
pains,  salivation,  conjunctivitis,  erythema, 
purpura,  and  other  rashes,  tinnitus,  mental 
depression,  vomiting,  diarrhoea,  cough,  swel- 
ling of  the  salivary  glands,  localized  oedema, 
especially  of  the  eyelids,  rarely  of  the  lar}mx. 

For  mucous  patches,  employ  a bichlorifle 
mouth-wash,  gr.  i ad  5vi,  and  paint  the 
patches,  only  twice  a week,  with  silver 
nitrate  solution,  5 to  10  per  cent.,  or  liquor 
hych’argyri  nitratis,  pure  or  chluted  one-half 
to  one-fourth,  or  iocUne,  qii  in  glycerine,  Si- 
Tobacco  should  be  intercUcted.  Anoint 
cutaneous  syphilides  with  white  precipitate 
ointment  (Part  11),  or  oleate  of  mercury  in 
oleic  acid,  10  to  20  per  cent.;  or  cleanse  and 
dry  the  lesions  thoroughly  and  apply  calo- 
mel, or  equal  parts  of  calomel  and  zinc 
stearate,  talcum,  or  bismuth.  Cleanliness 
and  the  use  of  calomel  dusting  powders  may 
suffice  to  remove  condylomata;  or  they  may 
be  snipped  off  with  scissors;  or  touched  with 
silver  nitrate,  10  to  20  per  cent.,  or  chromic 
acid,  50  per  cent,  (do  not  apply  to  a large 
surface);  or  painted  with  the  following: 


SYPHILIS 


li  Acidi  salicylici 

Tr.  cannabis  indica; oi 

Collodii  flexilLs 51 


Brush  late  “ opalescent  scaly  patches  ” 
with  chromic  acid  solution,  10  per  cent.,  or 
remove  them  with  a sharp  curette  or  the 
actual  cautery  (E.  Martin).  “ Freeze  over 
periosteal  nodes  with  chloride  of  ethyl  and 
apply  compound  iodine  ointment  ” (E.  Mar- 
tin) ; or,  apply  under  oil-silk  twice  daily  for 
three  days,  if  not  too  painful,  the  following: 


li  lodi gr.  xv-xxx 

Potassii  iodidi gr.  xxx 

Glyccrini 3i 


For  eye  lesions,  employ  atropine  instilla- 
tions (see  Iritis,  in  Part  6,  Eye  Dis- 
eases) together  with  mercurial  inunctions 
or  injections. 

For  laiyngeal  complications,  employ  in 
the  acute  stage,  inhalations  of  steam  medi- 
cated with  compound  tincture  of  benzoin 
(a  teaspoonful  to  the  pint  of  steaming  water) 
and  a spray  of  Dobell’s  or  Seiler’s  alkaline 
solution  (see  Part  11).  Prohibit  talking, 
smoking,  and  alcohol.  After  the  acute  stage 
has  subsided,  one  may  apply  weak  silver 
nitrate  solution,  5 per  cent.,  or  insufflate 
iodoform  or  iodol.  Remove  vegetations  by 
means  of  the  curette,  forceps,  galvanocaut- 
ery,  or  cln-omic  acid.  Surgical  measures  are 
required  to  deal  with  adhesions,  fibrous 
bands  or  membranes,  and  stenosis. 

For  nasal  and  pharyngeal  syphilis,  employ 
copious  warm  alkaline  ii-rigations,  using  the 
anterior  or  posterior  nasal  syringes  or  the  nasal 
douche  and  Dobell’s  solution.  Touch  ulcers 
about  once  a week  with  silver  nitrate,  gr. 
x-xxx  ad  5i,  or  chromic  acid,  gr.  x ad  Si- 
Iodoform  may  be  dusted  upon  ulcers.  An 
oily  mercurial  spray  may  be  applied: 

II  Unguenti  hydrargyri 


nitratLs gr.  xl 

Olei  amygdala?, 

Olei  oliva;,  aa §ss.  (St.  Clair  Thomson.) 


Sequestra  should  be  removed,  as  soon  as 
they  are  loose,  untler  cocaine  anaesthesia  (see 
Part  11),  piecemeal,  and  in  several  sittings  if 
necessary.  If  stenosis  threatens,  employ 
large  rubber  drainage  tubes  or  Francis’s 
dilators  smeared  with  a mercurial  ointment. 

For  defective  voice  due  to  perforation  of 
the  palate,  employ  a vulcanite  or  gold 
obturator  made  by  a tlentist. 

For  the  correction  of  saddle-back  nose, 
paraffin  injections  are  made,  in  the  absence  of 
active  syphilis.  If  the  skin  is  atlherent  to  the 
collapsctl  bridge  of  the  nose,  it  must  first 
be  undermined.  Harmon  Smith  injects  cold 
paraffin  (a  hard  paraffin  mixed  wdth  alboline 
until  the  melting  point  is  reduced  to  115°  F. 
or  46.1°  C.),  a special  syringe  being  used. 


Idle  danger  of  embolism  is  thereby  reduced. 
The  technique  is  as  follows,  no  anaesthesia 
being  required:  Pdll  the  sterilized  syringe 
with  the  sterile  paraffin  from  a water  bath 
of  a temperature  5°  or  6°  higher  than  the 
melting  point  of  115°  F.  Then  place  it  in 
cold  sterile  water.  Cleanse  the  skin  of  the 
nose,  and  have  an  assistant  stand  behind 
the  patient  and  make  firm  pressure  with  his 
forefingers  round  the  root  and  sides  of  the 
nose  in  order  to  prevent  the  paraffin  from 
passing  up  towards  the  eyelids.  Immerse 
the  syringe  in  hot  water  until  the  paraffin 
winds  out  in  a hard,  thin,  cylindrical  thread. 
Then  inject  slowly  and  steadily  while  with- 
di’awing  the  needle.  Inject  too  little,  rather 
than  the  least  bit  too  much.  Then  rapidly 
mold  the  parts  into  the  proper  shape.  Apply 
collodion  to  the  puncture;  and  for  any  subse- 
quent reaction  make  iced  applications.  Make 
no  further  injections  for  at  least  a month. 

Says  Webster:  “ To  establish  a basis 

for  the  assertion  of  a cure,  one  should  insist 
that  the  following  points  be  met:  One  year 
without  treatment,  without  any  suspicious 
signs,  with  several  negative  Wassermann 
reactions  and  no  positive  ones,  and  with  a 
negative  provocative  Wassermann  reaction 
and  luetin  test  at  the  end  of  the  year.” 

B.  Treatment  of  Congenital  or  Hereditary  Syphi= 
lis.— Continue  to  treat  the  child  after  its 
birth,  tlirough  its  mother,  but  if  symptoms 
appear  in  the  child,  treat  the  latter  directly. 
In  an  infant  a few  weeks  old,  rub  about  10 
grains  of  unguentum  hydrargjui,  diluted 
with  two  or  three  parts  of  vaseline,  daily 
into  the  abdomen  beneath  the  binder,  or 
into  the  palms,  soles,  axill®,  or  the  inner 
surface  of  the  thighs.  Gray  powder,  gr. 
34  to  3^  to  i to  ii,  according  to  age,  with 
sugar  of  milk,  four  times  a day,  or  calomel, 
gr.  3-io  to  34  > according  to  age,  four  times 
a day,  may  be  given  until  the  bowels  are 
affected,  and  then  some  other  preparation 
substituted.  Kerley  prefers  the  bichloride 
(tablet  triturates),  under  one  year,  gr.  3^^oo. 
well  tUluted,  twice  daily  after  meals,  in- 
creased every  other  day  by  one  tablet  a day 
“ until  five  are  given  daily,  or  until  the 
mercuiy  produces  loose  green  stools.”  If 
no  imj^rovement  occurs  after  gr.  34o  fo  34o 
in  twenty-four  hours  has  been  given  for  a 
week,  and  there  are  no  intestinal  symptoms, 
increa.se  the  dose  to  gr.  in  twenty-four 
hours,  or  enqiloy,  besides  the  bichloride, 
inunctions  of  unguentum  hyth’argjTi,  gr.  x, 
rubbed  into  the  skin  for  about  ten  minutes 
daily.  After  an  apparent  cure,  examine  the 
patient  ever}'  three  months  for  e\'idence  of 
recurrence.  For  a period  of  two  or  three 
years,  give  a course  of  bichloride  one  month 


TACHYCARDIA 


out  of  every  three,  irrespective  of  the  occur- 
rence of  symptoms  (Kerley). 

In  late  hereditary  syphilis  (often  the  only 
manifestation  is  late  malnutrition)  Kerley 
employs  the  mixed  treatment,  e.g.  mercury 
bichloride,  gr.  3^o  to  3-^o>  accorcUng  to  age, 
t.i.d.p.c.,  well  diluted,  with  potassium  iodide 
separately,  well  diluted  in  milk,  enough 
“ to  produce  the  characteristic  coryza,” 
sometimes  as  much  as  12  to  20  grains  daily 
(one  minim  of  a saturated  solution  contains 
one  grain).  To  avoid  indigestion,  the  iodide 
is  given  for  about  ten  days,  and  then  with- 
drawn for  about  five  days,  and  so  on.  After 
the  symptoms  have  chsappeared,  the  mer- 
cury and  iodide  are  given  alternately  for 
ten  days  each.  After  an  apparent  cure,  the 
patient  is  examined  every  three  months  for 
years,  and  treated  for  three  or  four  weeks 
two  or  three  times  a year,  “ during  the  en- 
tire growing  period.”  (Kerley.)  Says  Holt: 
“ The  iodide  is  usually  well  borne  by  chil- 
dren, and  may  be  given  in  almost  any  de- 
sired dosage.  In  infancy  it  is  rare  that  more 
than  20  grains  daily  are  required,  but  in 
older  children  the  necessary  amount  may  be 
from  one  to  two  drams  daily.”  It  is  given 
only  for  tertiary  manifestations. 

Give  also  two  or  more  injections  of  salvar- 
san,  preferably,  in  older  children,  into  a 
vein.  The  dose  is  0.1  to  0.2  gm.  for  children 
of  from  five  to  ten  years  of  age  ; 0.03  to  0.05 
gm.  for  infants  (0.001  per  pound  of  weight). 
In  young  children  the  injection  is  given  into 
the  outer  part  of  the  buttock,  high  enough 
to  avoid  the  sciatic  nerve. 

Give  codlivcr  oil,  maltine  and  iron,  if 
required. 

For  local  lesions,  employ  ammonia  ted 
mercury,  gr.  xv-xx  to  the  ounce  of  cold 
cream;  or  black  wash;  or  dry,  and 
dust  on  calomel  mixed  with  two  parts  of 
starch  or  talcum.  Employ  silver  nitrate, 
gr.  X ad  5i,  about  once  a week  for  fissures 
and  ulcers  of  the  mucous  membrane.  Em- 
ploy nitric  acid  or  the  acid  nitrate  of  mercury 
for  phagedenic  ulcers  of  the  palate  or  nose. 

Syringomyelia. — Gr.  avpiy  ^ tube  + juveXos 
marrow.  An  uncommon  chronic  nervous 
affection,  appearing  usually  in  the  second  or 
third  decade  of  life,  often  associated  with 
congenital  anatomical  defects,  and  character- 
ized anatomically  by  the  presence  of  a cavity 
surrounded  bygliomatous  tissue  in  the  region 
of  the  central  canal  of  the  spinal  cord,  and 
clinically  by  the  occurrence  of  a slowly  pro- 
gressive paralysis  of  the  amyotrophic  type, 
with  more  or  less  spasticity,  usually  the 
retention  of  the  tactile  sense  but  loss  of  the 
pain  and  temperature  senses,  and  a liability 
to  trophic  changes  (glossy  skin,  bullse. 


Charcot’s  joints,  necrosis  of  skin,  muscle, 
bone,  etc.),  with  later,  perhaps,  functional 
bladder  and  rectal  disturbances.  The  proc- 
ess may  extend  to  the  bulb. 

In  some  cases  the  spasticity  predominates, 
in  others  the  amyotrophy.  Retention  of 
tactile  and  loss  of  thermic  and  painful  sen- 
sations is  not  always  present  ; and  trophic 
changes  may  not  occur.  In  such  cases  the 
diagnosis  of  tumor  is  apt  to  be  made. 

Prognosis.— The  affection  often  comes  to  a 
spontaneous  standstill,  and  the  patient  may 
live  many  years. 

Treatment. — Instruct  the  patient  to  guard 
carefully  against  injury  and  skin  infection 
and  the  consequent  production  of  trophic 
sores,  and  to  avoid  overexertion  or  fatigue. 
Prolonged  rest  is  very  beneficial.  Employ 
massage  and  faradism  for  atrophied  muscles 
(see  under  Poliomyelitis) ; massage  and  pas- 
sive movements  for  spastic  muscles.  Treat 
trophic  sores  aseptically  and  support  affected 
joints  (see  Arthropathies).  Moderate  ront- 
gentherapy  (q.v.)  is  recommended.  The  rays 
may  be  applied  to  the  spine  and  bulb  at 
the  affected  levels  once  or  twice  a week. 
Local  spinal  decompression  by  means  of  a 
laminectomy  has  proved  beneficial. 

Syringomyelocele. — Gr.  aupiy  ^ tube 
pveXos  marrow -I-K17X17  tumor.  See  Spina  Bifida. 

System  Diseases,  Combined.-^ee  Com- 
bined System  Diseases. 

Tabes  Dorsalis. — See  Ataxia,  Locomotor 

Tachycardia. — Gr.  raxes  swift  KapSia 
heart. 

Etiology. — Emotion;  mental  or  physical 
shock;  physical  exertion;  hysteria;  neuras- 
thenia; fevers;  convalescence  from  fevers 
(typhoid,  influenza,  malaria,  the  exanthe- 
mata, etc.);  the  menopause;  reflex  irritation 
due  to  uterine  or  ovarian  disease;  gaseous 
distention  of  the  stomach;  tea  and  coffee; 
tobacco;  thyroid  medication;  exophthalmic 
goitre  or  hyperthyroidism;  gout;  myo- 
carditis (cardiac  syphilis,  coronary  sclerosis, 
etc.);  pressure  upon  the  vagi;  pressure  upon 
the  medulla  by  a clot  or  tumor;  a normal 
rate  of  100,  or  even  more. 

Auricular  flutter  is  a condition  character- 
ized by  the  occurrence  of  very  rapid  auricu- 
lar contractions  (above  200)  of  normal 
rhythm,  with  consequently  a rapid  ventricu- 
lar rate,  which,  however,  is  slower  than  the 
auricular  rate  (usually  one-half) , due  to  heart- 
block  (see  Arrhythmia:  Auricular  Flutter.) 
The  condition  is  not  necessarily  serious. 

Treatment.— Consider  the  cause.  Enjoin 
correct  hygiene:  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals, 
a bland  moderate  diet,  excluding  tea,  coffee, 
alcohol,  and  tobacco,  regulation  of  the  bow- 


TAPEWORM  OR  INTESTINAL  CESTODE  INFECTION 


els,  fresh  air  day  and  night,  adequate  rest 
and  exercise,  a daily  morning  warm  bath  in 
a warm  room,  followed  by  a cold  spinal 
douche  and  rubbing,  the  avoidance  of  all 
excesses,  inclucUng  sexual  indulgence. 

Nux  vomica,  tExx,  well  diluted,  t.i.d., 
may  be  prescribed  as  a heart  tonic.  Forch- 
heimer  well  recommends  ovarian  extract, 
gr.  V t.i.d.,  for  women.  The  bromides 
and  valerian  (see  Part  11)  are  useful  in 
nervous  cases. 

Persistent  tachycardia  due  to  auricular 
flutter  calls  for  digitalis,  which,  after  the 
condition  has  come  under  control,  may  have 
to  be  continued  indefinitely  in  small  but  suffi- 
cient dosage.  For  the  treatment  of  an  at- 
tack of  paroxysmal  tachycardia,  fsee  under 
Arrhythjiiia). 


killed  by  thorough  cooking  or  salting  or 
refrigeration  at  15°  F.  for  6 days.  This 
tapeworm  is  distinguished  from  the  tienia 
solium  by  pressing  a segment  between  two 
glass  sides  and  counting  the  lateral  branches 
of  the  uterus.  Figs.  81  to  86. 

The  ta?nia  solium  (armed  or  pork-measle 
tapeworm)  is  not  common.  The  adult 
intestinal  worm  develops  from  the  larva 
or  cysticercus  celluosse  derived  from  the 
ingestion  of  measly  pork,  hogs  being  in- 
fected by  ingesting  eggs  in  hiunan  faeces. 
The  cysticercus  cellulosae  is  killed  by  thor- 
ough cooking,  but  not  by  cold  storage  as  is 
the  cysticercus  bovis.  This  form  of  taeniasis 
is  dangerous,  because  if  the  eggs  should 
gain  access  to  the  human  stomach,  either 
from  without  or  through  vomiting,  cysti- 


Fig.  81. 


Head  of  Taenia  saginata:  a,  natural  size;  Single  link  of  Taenia  saginata:  a,  natural 
6,  magnified  eleven  times.  size;  b,  magnified  four  times. 


Eggs  of  Taenia  solium,  mag- 
nified 470  times:  a,  under  high 
power;  b,  under  low  power. 


Taeniasis. — L.  tcenia,  a flat  band  or  tape. 
(See  Tapeworm  Infection.) 

Tailor’s  Cramp. — See  Tetany. 

Tapeworm  or  Intestinal  Cestode  Infec= 
tion;  Taeniasis. — Gr.  /ceo-ros  girdle  -|-  et5os 
form ; L.  tcenia,  a flat  band  or  tape.  There  are 
at  least  nineteen  different  species  of  intesti- 
nal cestode  or  tapeworm,  of  wliich  the  most 
common  are  the  taenia  saginata,  taenia  solium, 
dibothriocephalus  latus,  anti  taenia  or  h>nne- 
nolepis  nana. 

The  taenia  saginata  (flat,  unarmed,  or 
hookless,  or  becf-measle  tapeworm)  is  the 
commonest.  The  adult  worm  lives  in  the 
human  intestine,  and  is  contracted  by  eating 
rare  beef  (especially  the  tongue  and  muscles 
of  mastication)  that  is  infected  with  the 
larva  or  cysticercus  bovis.  Cattle  become 
infected  by  ingesting  eggs  in  human  faeces. 
The  cysticercus  dies  usually  within  three 
weeks  aifter  the  death  of  its  host.  It  is  also 


cercosis  or  infection  of  the  muscles  and 
solid  organs  including  possibly  the  brain 
and  eye,  will  result.  Therefore  it  should  be 
treated  promptly. 

The  dibothriocephalus  latus,  or  broad  (or 
fish)  tapeworm  is  not  common  (Fig.  83). 
The  adult  intestinal  worm  is  contracted  by 
eating  raw,  under-done,  or  smoked  fresh- 
water fish  (salmon,  pike,  turbot,  perch, 
trout,  grayling,  etc.)  that  contain  the  larvae. 

The  hjnnenolepis  nana  or  dwarf  tapeworm 
is  common  in  children  in  certain  localities. 

The  s\nnptomatology  of  intestinal  cestode 
infection  is  very  variable — abdominal  pain, 
gastro-intestinai  indigestion,  and  pruritus 
ani  being  the  commonest  symptoms. 
The  dibothriocephalus  latus  causes  a severe 
anaemia  of  the  pernicious  t^-pe. 

The  diagnosis  is  made  by  the  discover 
of  the  eggs  and  segments  of  the  worm  in 
the  stools. 


TAPEWORM  OR  INTESTINAL  CESTODE  INFECTION 


Treatment.— For  three  days  keep  the  patient 
on  a light  diet,  giving  on  the  third  day  only 
liquids,  and  each  evening,  except  the  third 
evening,  give  castor  oil,  one  to  two  table- 
spoonfuls, followed,  if  necessary,  by  a saline 
in  the  morning,  one  or  two  tablespoonfuls, 
or  an  enema.  On  the  third  evening  give 
some  other  laxative  besides  castor  oil, 
because  oil  favors  the  absorption  of  male  fern. 
Or  the  following  prescription  may  be  used: 


with  hot  water,  at  10  a.  m.  (For  the  dosage  for  chil- 
dren, see  Part  11.  The  drug  may  be  dispensed  in 
glycerine,  syrup,  or  honey,  5ss.) 

Two  hours  later,  at  12  m.  give  a full  dose 
of  salts,  magnesium  or  sodium  sulphate, 
5ss,  or  3 tablespoonfuls  of  the  above  mag- 
nesium sulphate  mixture,  or  half  a bottle 
of  magnesium  citrate,  in  order  to  drive  the 
male  fern  through  the  intestinal  tract  and 
lessen  the  danger  of  too  much  absorption  of 


Head  of  Ta>nia  solium:  a,  natural  size; 
6,  magnified  18  times. 


Fio,  82. 


Single  segment  of  Tsenia  solium;  a,  natural 
size;  b,  magnified  Syi  times. 


Fig.  83. 


I 

Head  of  Bothriocephalus  latus:  a, 

natural  size;  6,  magnified  17  times. 


rir-i 


Links  of  Bothriocephalus  latus, 
natural  size. 


Egg  of  Bothriocephalus  latus, 
magnified  470  times. 


R Magncsii  sulphati.s 5ii 

Spiritus  chloroformi 3iii 

Aquae,  q.s.  ad ovi 


M.  Sig. — A tablespoonful  in  water  t.i.d.,  one  hour 
a.c.;  with  a soapsuds  enema  at  night,  if  necessary. 

At  nine  o’clock  on  the  morning  of  the 
fourth  day,  after  perhaps  a little  hot  coffee 
to  obviate  nausea,  nothing  else,  give  fresh 
ethereal  extract  or  oleoresin  of  male  fern: 

Oleoresinae  aspidii 3i 

Shake  well,  and  div.  in  caps.  viii. 

Sig. — Four  capsules  (uncapped)  with  half  a gla.ss 
of  hot  water,  at  9 a.  m.,  and  four  capsules  (uncapped) 


the  drug.  The  patient  should  lie  quiet  while 
taking  the  treatment,  and  may  take  lemon 
juice,  iced  tea,  or  black  coffee  to  combat  nau- 
sea. The  contents  of  the  bowel  should  be 
passed  into  a vessel  containing  warm  water, 
preferably  a sitz-bath,  for  if  the  vessel  is  cold, 
the  worm  may  suddenly  retract  and  break,  and 
the  head  remain  in  the  bowel.  Give  a warm 
saltwaterenemaif  theworinisnot  all  expelled. 

SjTnptoms  of  male  fern  poisoning  are 
vomiting,  diarrhoea,  transient  or  permanent 
blindness,  jaundice,  stupor,  collapse,  con- 
vulsions, rarely  tetany.  Administer  strych- 


TETANUS;  TRISMUS;  L(JCKJAW 


nine,  but  no  alcohol,  wash  out  the  stomach, 
and  give  saline  purgatives  with  lots  of  water. 

Do  not  repeat  the  treatment 
within  three  or  four  months. 

Other  usually  less  efficient 
but  useful  anthehnintics  are 
the  following: 

Pelletierine  tannate  (alkaloids 
derived  from  pomegranate),  gr. 
vi,  mixed  with  a little  water, 
taken  in  one  dose,  fasting,  fol- 
lowing in  one-half  to  one  hour 
by  a full  dose  of  castor-oil  or 
magnesium  citrate.  To  avoid  very  un- 
pleasant nausea  and  vertigo,  etc.,  the 


Fig.  84.— 
Taenia  nana. 
Natural  size. 


with  acacia  and  the  decoction  of  granatum.  Then 
add  to  the  paste  of  pepo,  and  flavor  with  syrup  up 
to  nine  ounces. 

Sig. — Take  one-tliird  of  the  above  in  the  morning, 
after  light  diet  and  a la.xative  on  the  previous  day. 
If  not  successful,  take  the  second  and  third  portions 
at  intervals  of  three  hours.  Pass  the  worm  sitting 
in  a tepid  sitz-bath.  (Potter.) 

Thymol  (Part  11)  is  reported  efficacious. 

These  anthelmintics  should  be  preceded 
and  followed  by  cleansing  of  the  bowels. 

ContraintUcations  to  tapewonn  treatment 
are:  gastritis,  enteritis,  grave  heart  or  kid- 
ney disease,  debility,  convalescence  from 
typhoid  fever,  or  an  abdominal  operation, 
or  operation  for  cataract,  recent  apoplexy. 


Fio.  8S. 


a 


Head  of  Tjenia  cucumerina; 
a,  natural  size;  6,  magnified 
seventy  times. 


Cocoon  wnth  eggs  of  T®nia 
cucumerina  magnified  100 
times. 


Link  of  Tania  cucumerina: 
fl,  natural  size;  b,  magnified 
eight  times. 


patient  should  remain  recumbent.  This 
drug  should  never  be  given  to  children, 
says  Forchheinier. 

Pepo  (pumpkin  seed;  must  be  absolutely 
fresh),  5 ii-iv  of  the  powclered  seed  mixed  with 
honey,  followed  in  two  hours  by  a saline 
cathartic.  Owing  to  its  innocuousness,  it  is 
best  to  tr>'  this  first  with  children.  It  is  not 
always  effectual,  however. 

a Granati pii 

Aqua:' Oiss 

Pepo  (deprived  of  the  outer  coats),  3i 
Oleoresina;  aspidii gr.  xxx 

Boil  the  granatum  in  the  water  down  to  seven 
ounces.  Beat  the  pepo  to  a paste  with  finely  pow- 
dered sugar.  Make  the  male  fern  into  an  emulsion 


pregnancy,  the  puerperium,  lactation,  men- 
struation, tendency  to  htemoptysis,  status 
Ijmphaticus.  The  tienia 
solium  and  dibothriocepha-  VI 

lus  latus,  however,  should  VI 

be  expelled  as  soon  as  pos-  fig.  sg.— xa-nia 
sible.  The  tapeworm  dies  in  natural 'sfz? 
six  or  seven  years. 

Telegrapher’s  Cramp. — See  Cramps,  Pro- 
fessional. 

Temperature,  Elevated. — See  Fever. 

Tenth  Nerve. — See  ^’agus  Nen'e. 

Tetanoid  Chorea. — See  Chorea,  Tetanoid. 

Tetanus;  Trismus;  Lockjaw. — Or.  rkravos 
from  TfivHv  to  stretch;  rpisfios  lockjaw.  A 
toxa?mia  due  to  wound  infection  with  the 


TETANUS;  TRISMUS;  LOCKJAW 


tetanus  bacillus,  and  characterized  by  an 
incubation  period  of  from  one  to  twenty 
(to  twenty-seven)  days,  followed  by  restless- 
ness, insomnia,  slight  difficulty  in  swallow- 
ing, starting  at  noises,  bright  light,  or  sudden 
draughts,  sweating,  a tonic  spasm  or  rigid- 
ity, with  resulting  stiffness  and  tension  of 
first  the  muscles  about  the  wound,  causing 
local  induration  and  pain,  then  the masseters 
and  muscles  of  the  neck,  or  the  muscles  of 
the  thorax,  and  eventually,  in  many  cases, 
other  muscles  of  the  body,  the  muscular 
rigidity  being  occasionally  interrupted  by 
convulsions  which  may  be  provoked  by  ex- 
ternal irritation. 

The  tetanus  bacillus  inhabits  manure  and 
garden  soil.  It  is  anaerobic  and  therefore 
thrives  best  in  closed  wounds.  Fourth  of 
July  wounds  are  particularly  dangerous.  The 
organism  does  not  enter  the  blood,  but 
remains  and  multiplies  in  the  tissues  at  the 
site  of  inoculation,  and  the  incubation  period 
represents  the  time  required  for  the  toxin  to 
travel  along  the  nerves  to  the  centres. 

Prognosis. — If  the  patient  survives  the  first 
four  days,  he  has  a chance  of  recovery.  The 
prolonged  or  chronic  cases  are  marked  by 
remissions  and  exacerbations,  and  death  may 
occur  in  one  of  the  latter.  The  mortality 
is  about  60  to  80  per  cent.  The  longer 
the  incubation  period,  the  better  the 
prognosis. 

Prophylaxis.— Any  suspicious  wound  should 
be  freely  opened  and  forcibly  irrigated  with 
hot  sterile  water,  and  all  foreign  material 
removed.  It  should  then  be  further  cleansed 
with  hot  peroxide  of  hydrogen,  and  cauter- 
ized with  tincture  of  iodine  or  pure  carbolic 
acid  followed  by  alcohol,  or  better,  soaked 
for  an  hour  continuously  in  a solution  of 
carbolic  acid,  1.5  per  cent.,  or  iodine  tri- 
chloride, 1 per  cent.,  or  tincture  of  iodine, 
3 per  cent.,  or  silver  nitrate,  1 : 1000,  the 
lips  of  the  wound  being  held  apart  by  sterile 
gauze.  The  carbolic  solution  is  perhaps  the 
best.  Then  dry  antitoxin  powder  or  iodo- 
form may  be  dusted  into  the  wound,  or 
balsam  of  Peru  may  be  poured  in.  Tetanus 
antitoxin  should  be  administered  at  once  in 
the  neighborhood  of  the  wound,  either  intra- 
muscularly or  subcutaneously,  500  to  1500 
units;  and  the  injection  should  be  repeated 
every  seven  days,  two  to  four  times  in  all, 
in  the  presence  of  wound  sepsis  (see  Anaphy- 
lactic shock).  A dose  should  be  given  two 
days  before  any  secondary  operation  on  a 
healed  or  unhealed  wound,  for  fear  of  light- 
ing up  a latent  infection.  It  is  said  to  be 
harmless  in  any  amounts. 

Immunity  lasts  only  about  ten  days. 

23 


Treatment. — Excise  the  wound  of  entry 
en  masse,  or  burn  it  out  thoroughly  with  the 
actual  cautery.  Put  the  patient  to  bed  in  a 
very  quiet,  darkened  room,  and  handle  him 
very  gently  in  order  to  avoid  reflex  excita- 
tation.  Keep  the  bowels,  skin,  and  kidneys 
active,  to  favor  the  elimination  of  toxin. 
A hot  bath  or  hot  pack  may  be  given  two  or 
three  times  a day  for  thirty  minutes  at  a 
time.  Normal  saline  solution  (0.9  per  cent.) 
should  be  given  either  subcutaneously  or 
per  colon  by  the  drop  method,  500  c.c.  every 
six  hours  for  several  days.  Water  should  be 
drunk  freely.  Concentrated  liquid  nourish- 
ment (milk,  eggs,  and  beef  juice)  should 
be  administered  every  hour  or  two,  by 
rectum  if  necessary  (see  Rectal  Feeding). 
“A  very  good  plan,”  say  Bloodgood  and 
McGlannan,  “ is  to  mix  the  nutrient  enema 
(200  c.c.  of  peptonized  milk.  Part  11,  with 
two  eggs)  with  the  salt  solution  (q.s.  ad 
500  c.c.)  and  give  it  by  the  drop  method.” 
Give  stimulants  when  required,  e.g.,  cam- 
phor, gr.  ii,  in  ether,  trp^xv;  or  whiskey  or 
hrandy,  4 to  10  to  16  ounces  daily.  The 
latter  is  also  useful  as  a sedative  and  muscu- 
lar relaxant.  Sedatives  should  be  admin- 
istered for  the  purpose  of  relaxing  the 
muscular  rigidity  and  preventing  convulsions, 
and  they  should  be  given  in  doses  sufficient 
to  accompRsh  this  result: 

Morphine  and  atropine  in  large  doses.  (For  all 
drugs  see  Part  11). 

Chloral  and  bromide,  well  diluted,  per  rectum. 
For  adults,  chloral,  gr.  xx-xxx,  and  bromide,  gr. 
xl-Lx,  every  four  hours.  For  infants,  gr.  ii-iv,  every 
hour  if  required;  double  the  dose  for  older  children. 
For  infants,  sod.  bromide  may  be  given  per  rectum 
in  mucilage  of  acacia,  in  doses  of  gr.  viii-x  every 
three  hours. 

Chloroform  or  ether,  by  inhalation, for  convulsions. 

Carbolic  acid,  2 per  cent,  aqueous  solution,  1 c.c, 
(gr.  Ko),  subcutaneously  every  two  or  three  hours, 
as  required  to  control  convulsions  (BaceUi);  80  to 
100  c.c.  a day  may  be  given  (Sainton).  Say  Blood- 
good  and  McGlannan:  “In  mild  cases  the  dose 

should  not  exceed  3 grains  of  phenol  in  the  first 
twenty-four  hours,  but  the  daily  quantity  is  to  be 
rapidly  increased  to  two  or  three  times  this  amount.” 
It  may  have  to  be  continued  for  three  or  four  weeks 
or  longer. 

Curare,  gr.  Yn,  hypodermically,  every  six  hours. 

Antitetanic  serum  causes  a neutralization 
of  the  tetanus  toxin  while  the  latter  is  still 
circulating  in  the  blood,  but  not  after  the 
toxin  has  become  attached  to  the  nerve 
cells.  This  is  the  explanation  given  for  the 
cUsappointing  results  when  the  serum  is 
achninistered  after  trismus  has  once  set  in. 
However,  favorable  results  are  reported 
after  big  doses:  5000  to  10,000  U.  S.  Anny 
units  intramuscularly  (absorbed  in  twelve 
hours),  3000  to  5000  units  subcutaneously 


TETANY;  SPASMOPHILIA;  HYPERTONIA 


(absorbed  in  about  forty-eight  hours),  and 
3000  to  5000  units  intraspinally  (absorbed 
immediately),  by  lumbar  puncture  {q-v.), 
first  withch'awing  an  equal  amount  of  spinal 
fluid  (about  20  c.c.)  Inject  slowly.  Repeat 
the  intraspinal  injection  daily  for  three  to 
five  days.  Repeat  the  other  injections 
daily  or  oftener,  until  the  symptoms  abate; 
then  reduce  the  size  and  frequency  of  the 
dosage.  After  intraspinal  injections  the 
foot  of  the  bed  should  be  raised  so  that  the 
serum  may  gravitate  up  the  cord.  Another 
method  of  administration  is  by  intraven- 
tricular injection.  “A  sldn  and  periosteal 
flap  is  reflected  from  the  anterior  portion  of 
the  skull  ami  the  cranimn  opened  by  a small 
trephine,  about  an  inch  from  the  bregma, 
just  behind  the  coronal  suture.  Through 
this  opening  a long  needle  is  passed  ver- 
tically, 2 or  23^  inches  into  the  brain  sub- 
stance. When  the  ventricle  is  reached,  fluid 
will  flow  from  the  needle.  The  serum  is 
then  injected  slowly;  1500  units  is  the 
usual  dose,  repeated  if  the  convulsions  con- 
tinue.” (Bloodgood  and  McGlannan.) 

“ Rogers’  (successful)  plan  of  treatment 
consists  in  the  injection  of  10  to  20  c.c.  of 
antitoxin  subcutaneously  in  the  neighbor- 
hood of  the  wound,  of  10  to  20  c.c.  intra- 
venously (q.v.),  with  the  injection  of 
5 to  20  minmis  into  the  nerves  of  the 
axillary  plexus,  if  the  wound  is  in  the  upper 
extremity,  or  into  the  crural,  sciatic  and 
obturator  nerves  if  the  wound  is  in  the  lower 
extremity.  In  adcUtion  to  tins,  he  injects 
10  to  20  c.c.  into  the  nerves  of  the  cauda 
equina;  and  if  the  patient’s  life  is  in  hmni- 
nent  danger,  in  order  to  protect  the  vital 
centres  of  the  respiration  and  the  circula- 
tion, 20  to  30  minims  are  injected  chrectly 
into  the  cord  between  the  sixth  and  seventh 
cervical  vertebrae  ” (Frazier).  Says  Rogers: 
“ In  Imnbar  jjuncture  it  is  necessaiy,  etc. 
(See  p.  501,  Keen,  Vol.  I,  note  at  bottom  of 
pag(\)  (Quoted  by  Frazier  in  Keen’s  Sur- 
gery.) (See  also  Serum  Antitetaniciun,  in 
Part  11.) 

The  use  of  brain  emulsion  is  said  to  be 
equally  as  effective  as  aintitoxin:  10  gms. 
of  freshly  killed  dog,  rabbit,  sheep,  or  pig’s 
brain  is  rubbed  up  in  about  30  c.c.  of  sterile 
normal  saline  solution  (0.9  per  cent.),  the 
emulsion  strained  under  slight  pressure 
through  cheesecloth,  and  injected  sub- 
cutaneously, for  the  purpose  of  binding  the 
tetanus  toxin.  The  injection  is  repeatetl 
eveiy  two  or  throe  days,  as  required. 

Tetany;  Spasmophilia;  Hypertonia. — A 
rare  affection,  characterized  by  a state  of 
neuro-muscular  hyperexcitability,  which  is 


manifested  by  bilateral,  continuous  or  inter- 
mittent, tonic,  mostly  flexor  spa.sms  of  the 
extremities,  particularly  the  hands  (obstet- 
rical or  pen-holchng  hand;  cai’i^o-pedal 
spasm).  The  spasms  last  anywhere  from 
fifteen  minutes  to  even  two  weeks.  They 
may  be  induced  by  tapping  or  pressing  upon 
the  nerves,  very  light  electrical  stimulation, 
temperature  changes,  over-e.xertion,  exhaus- 
tion, and  emotion.  Laryngeal,  respiratory, 
ocular,  and  vesical  spasm  may  occur.  In 
infancy,  tetany  is  associated  with  rickets, 
laryngismus  stridulus,  and  general  convul- 
sions. Tapping  of  the  facial  nerve  near  the 
parotid  causes  contraction  of  the  facial 
muscles  (Chvostek’s  sign).  Compression  of 
the  nerve  trunks  of  the  upper  arm  causes  a 
carpo  pedal  spasm  (Trousseau’s  sign). 

The  disease  is  po.ssibly  due  to  a lack  of 
calcium  in  the  blood,  secondary  to  para- 
thyroid insufficiency.  (MacCallum.) 

Exclude  hysteria  (which  is  usually  uni- 
lateral) and  shnulation. 

Etiology.— Idiopathic  (tailor’s  or  shoe- 
maker’s cramp;  epidemic,  possibly  infectious 
tetany);  gastro-intestinal  chsortlers  (dyspep- 
sia, hyperacitUty,  gastric  dilatation,  gastric 
lavage,  worms,  tUarrhoea,  intussusception : 
producing  possibly  an  intoxication);  acute 
infectious  diseases  (tjqohoid  fever,  measles, 
scarlet  fever,  influenza,  pertussis,  broncho- 
pneumonia, rheumatism,  cholera) ; poisoning 
with  chloroform,  morphine,  ergot,  lead, 
phosphorus,  alcohol;  maternity  (pregnancy, 
parturition,  lactation);  urjemia;  nervous 
disorders  (sjaingomyelia,  brain  tiunor, 
etc.)  ; exophthalmic  goitre ; extirpation 
or  disease  of  the  parathjwoids;  in  children 
— rickets,  gastro-intestinal  disorders,  and 
acute  infections. 

Prognosis. — In  gravida  cases,  in  bacterial 
and  chemical  intoxication,  and  in  children, 
the  prognosis  is  usually  good.  In  gastric 
cases  the  prognosis  is  bad  unless  an  opera- 
tion is  done.  Recurrences  are  frequent. 
Sudden  death  may  occur. 

Treatment.— Put  the  patient  to  bed  in  a 
quiet  room,  and  attend  to  any  possible 
etiological  factor.  Keep  the  bowels  active. 
Warm  or  cold  sponging,  repeated  two  or 
three  times  a day,  is  recommended  for  the 
relief  of  the  spasm,  especially  in  cliildi’en; 
also  massage,  galvanism,  the  spinal  ice-bag, 
and  the  following  sedatives,  viz. — bromide 
(gr.  ii  every  two  hours,  at  least  six  doses  in 
twenty-four  hours,  to  a child  of  one  year  or 
younger),  chloral,  chloretone,  hyoscine,  bella- 
donna, antip>Tin,  valerian,  phenacetin,  aspi- 
rin, cannabis  indica  (see  Drugs,  Part  XI). 

Administer  thyroid  and  parathjToid  gland 


THYMUS  ENLARGEMENT 


and  calcium  salts.  Milk,  whey,  and  eggs 
are  rich  in  calcium.  Fresh  parathyroid  gland 
may  be  injected  subcutaneously  in  the  form 
of  an  emulsion.  Calcium  chloride  may  be 
injected  or  given  per  rectmn.  Transplan- 
tation of  the  parathyroids  may  be  tried. 

In  infants,  the  use  of  parathyroid  or  of 
calcium  has  apparently  no  influence,  says 
Holt;  and  Osier  says,  ‘Tt  is  a mistake  to 
call  instances  of  carpo-pedal  spasm  of  chil- 
dren true  tetany”;  but  some  record  good 
results  with  large  doses  of  calcimu  lactate  or 
chloride,  gr.  v-j-every  three  hours  to  a one- 
year-old. 

S.  V.  Hoes  prescribes  atropine,  1 : 1000 
solution,  1 drop  in  each  bottle  of  food,  in- 
creased if  there  is  no  improvement  m forty- 
eight  hours,  to  2 di’ops  in  each  bottle,  and 
in  another  forty-eight  hours,  if  necessary,  to 
3 drops,  and  later,  if  necessary,  4 drops  or 
more.  Reduce  the  dosage  occasionally,  or 
discontinue  the  drug;  but  resume  it  on  the 
recurrence  of  symptoms.  Months  of  treat- 
ment may  be  required.  Procmre  breast 
milk  for  the  baby,  if  possible. 

Gastric  cases  demaml  operation.  Any 
abnormality  found  should  be  corrected: 
in  simple  cases,  pyloroplasty  or  preferably 
gastro-enterostomy;  in  malignant  cases, 
partial  gastrectomy  or  gastro-enterostomy; 
in  hour-glass  contraction,  gastro-gastros- 
tomy  combined  with  gastro-enterostomy  per- 
formed in  the  larger  pouch  (Mayo  Robson). 
Systematic  gastric  lavage  is  of  some  service. 

Thermic  Fever. — Gr.  depti-q  heat.  See 
Sunstroke. 

Third  Nerve. — See  Motor  Nerves  of  the 
Eyeball. 

Thomsen’s  Disease. — See  Myotonia. 

Thread=Worm  Infection.— See  Oxyuriasis. 

Three=Day  Fever. — See  Phlebotomous 
Fever. 

Thromboangitis  Obliterans. — Gr.  dpop^os 
clot;  ayy etov  vessel  -1-  -trts  inflammation. 
See  Gangrene,  Part  5. 

Thrombosis,  Arterial.— Gr.  dpSpISos  clot. 

See  Gangrene,  in  Part  5,  Skin  Diseases. 

Cerebral. — See  Apoplexy. 

Venous. — For  etiology  and  sympto- 
matology, see  Phlebitis. 

Treatment. — Elevate  and  immobilize  the 
affected  limb  (to  avoid  embolism)  by  band- 
aging it  to  a pillow  folded  about  it.  Raise 
the  bedclothes  from  the  limb  by  means  of 
a cage.  Warn  the  patient  against  exertion 
and  sudden  movements,  such  as  hard  cough- 
ing, straining  at  stool,  etc.  Give  sedatives 
for  the  prevention  of  the  former  and  laxa- 
tives for  the  latter.  For  pain,  administer 
morphine  and  apply  hot  or  cold  compresses 


wet  with  belladonna  liniment,  or  lead  and 
opium  wash  (see  Part  11),  or  the  ice-bag. 
Ichthyol  in  lanolin,  30  per  cent.,  or  bella/- 
donna  ointment  is  recommended  to  be  ap- 
plied along  the  course  of  the  vein. 

In  septic  cases,  the  vein  may  be  ligated 
proximally  to  the  site  of  infection;  or  the 
vem  may  be  incised,  the  clot  turned  out, 
and  drainage  established;  or  the  infected 
vein  may  be  excised. 

After  three  weeks  absence  of  fever,  pro- 
vided there  is  no  local  tenderness,  and  the 
cedema  is  diminishing,  begin  to  employ 
gentle  passive  movements.  At  the  end  of  a 
week,  increase  the  movements  and  begin 
to  massage  the  muscles,  avoiding  the  site 
of  thrombosis.  After  another  week,  remove 
all  splints,  and  after  another  week,  employ 
active  movements;  and  later  get  the  patient 
out  of  bed.  For  the  oedema  which  persists 
after  the  patient  is  gotten  up,  apply  a light 
supporting  (crepon  Velpeau)  bandage  or 
elastic  stocking,  and  employ  massage  and 
electricity,  even  for  weeks  or  months.  For 
persistent  pain,  employ  warm  baths, 
tincture  of  iodine,  and  electricity:  2.'5 

to  50  milliamperes  for  fifteen  to  twenty 
minutes  daily. 

In  idiopathic  recurrent  cases,  it  may  be 
advisable  to  excise  the  affected  vein  if  it  is 
superficial.  (George  Blumer.)  (See  also 
Gangrene,  Part  5.) 

Thrush. — -See  Stomatitis,  Parasitic  or 
Mycotic. 

Thymic  Asthma. — Gr.  dupos  thymus;  aadpa 
panting.  See  Thymus  Enlargement,  fol- 
lowing. 

Thymus  Enlargement. — Appreciable  en- 
largement of  the  thymus  gland  is  mani- 
fested by  an  inspiratory  and  expiratory 
stridor  resembling  asthma.  Sudden  death 
sometimes  occurs.  The  condition  is  be.st 
diagnosed  by  radiography,  less  certainly  by 
inspection  and  percussion.  The  latter 
reveals  an  area  of  dulness  over  the  upper 
sternmn,  particularly  to  the  left,  which 
merges  with  the  cardiac  flatness,  and  shifts 
upward  with  e.xtreme  retraction  of  the  head 
and  neck.  For  other  causes  of  stridor,  see 
Stridor. 

Etiology. — The  usual  condition  is  a hyper- 
plasia due  to  unknown  causes  or  to  con- 
genital syphilis,  rickets,  etc.;  rarely  is  it 
congestion  and  oedema  due  to  an  acute 
infection,  general  circulatory  failure,  or 
trauma.  ITe  gland  may  be  the  seat  of  a 
new  growth.  Associated  conditions  are: 
status  lymphaticus,  adenoids  and  enlarged 
tonsils,  rickets,  scurvy,  congenital  syphilis, 
anaemia,  anencephaly,  cretinism,  myxoedema, 


TIC  DOULOUREUX 


exophthalmic  goitre,  acromegaly,  epilepsy, 
leukaemia,  Hodgkin’s  disease,  Addison’s  dis- 
ease, acute  infections,  myasthenia  gravis. 

Prognosis. — This  is  probably  grave,  as  a rule. 

Treatment.— During  an  attack  of  stridulous 
dyspnoea,  open  the  bowels  freely,  and  if  nec- 
essary perform  intubation  {q.v.)  with  a very 
long  tube.  If  it  should  be  deemed  advisable 
to  remove  the  enlarged  thymus,  proceed  as 
follows:  Make  a mecUan  mcision  about  an 
inch  long  through  the  sldn  and  subcutaneous 
tissue  of  the  suprasternal  fossa  after  the 
skin  has  been  drawn  down  over  the  sternum; 
rake  apart  the  deep  fascia,  the  sternohyoids 
and  thyroids  with  blunt  double-hooked 
retractors;  and  clear  the  loose  capsule  from 
the  gland.  Draw  out  the  gland  as  far  as 
possible,  and  stitch  it  to  the  fascia  over  the 
sternum.  If  necessary,  a portion  may  be 
resected,  but  the  whole  gland  should 
not  be  removed,  for  fear  of  rickets 
(Warthin).  Always  have  ready,  before  oper- 
ating, a long  mtubation  tube  and  trache- 
otomy instrimients  (see  Diphtheria). 

Warthin  gives  the  following  rules  for  the 
prevention  of  thymic  asthma: 

1.  Keep  the  head  high,  using  mechanical 
means,  if  necessary;  but  do  not  throw  the 
head  backward. 

2.  Avoid  excitement. 

3.  Avoid  very  warm  or  cold  baths  and 
sea  bathing. 

4.  Avoid  infectious  diseases. 

5.  Observe  good  hygiene. 

6.  Avoid  anaesthesia  and  operations. 

When  these  are  required,  have  trache- 
otomy instruments  and  a long  tube  on  hand. 

Thymus  feeding,  antirachitic  treatment, 
antiluetic  treatment,  and  the  X-rays  may 
be  tried,  the  latter  cautiously.  (Chiefly 
after  Warthin.) 

_ Thyroid  Enlargement.— Gr.  shield -f 
eibos  form.  Causes. — Shnple  goitre,  chffuse, 
nodular,  cystic,  etc.,  (see  Goitre,  Shnple); 
exophthalmic  goitre;  malignant  neoplasms 
— carcinoma  and  sarcoma;  echinoccus  cyst; 
all  febrile  states;  traumatism;  certam 
poisons;  inflammation,  acute  or  chronic 
(see  ThyroicUtis,);  iniberty;  menstruation; 
pregnancy. 

Malignancy  is  difficult  or  impossible  to 
diagnose  in  the  early  stage,  when  an  opera- 
tion may  be  curative,  therefore  always  bear 
it  in  mind,  especially  in  goitres  appearing 
after  the  age  of  thirty-five  years,  and  in 
those  of  sudden  and  rapid  growdh.  Tiy 
iodothyi'in  and  arsenic  (see  Part  11)  for  in- 
operable cases  of  malignancy,  and  always 
employ  radium  {q.v.)  or  the  X-ray  {q.v.) 
preferably  the  former.  Map  out  the  surface  of 


the  tumor  and  adjacent Ijunphatic  area  with 
a skin  pencil  into  sections.  Cut  a window  in 
a piece  of  lead,  1 cm.  thick,  corresponding 
to  the  size  of  these  sections,  and  mould  it 
to  the  surface  of  the  tumor,  over  30  layers  of 
lint.  Use  a 3 mm.  lead  filter  for  the  radium, 
in  order  to  cut  out  practically  all  of  the  /3  rays. 
Attach  the  tube  enclosed  in  rubber  tubing  in 
place  by  adhesive  plaster.  Give,  say,  twenty- 
four  hours’  exposure  to  each  area,  on  suc- 
cessive days,  until  the  whole  tumor  is 
irradiated. 

Thyroid  enlargement  in  pregnancy  may 
mean  thjToid  insufficiency  and  compensa- 
toiy  hjrpertrophy;  therefore  thyroid  extract 
in  small  do.ses  (Part  11)  may  be  tried. 

Thyroid  ism,  Hyper=. — See  Exophthalmic 
Goitre. 

Hypo=. — See  Hypothyroidism. 

Thyroiditis  and  Strumitis. — Strumitis  is 
inflaimnation  of  a goitre. 

I.  Acute  Inflammation. — The  sj’mptoms  are 
swelling,  pain,  tenderness,  fever,  pain  on 
sw’allowing,  and  sometimes  difficulty  in 
breathing  and  swallowing.  The  symptoms 
usually  subside  in  a few  days;  but  sometimes 
suppuration  occurs. 

Etiology. — Infectious  diseases  (typhoid 
fever,  rheumatic  fever,  malaria,  cholera,  etc.) ; 
chemical  poisons;  alcoholism;  traumatism. 

Treatment. — Put  the  patient  to  bed  on 
light  diet,  and  open  the  bowels  by  means  of 
calomel,  followed  by  a saline,  or  castor  oil 
(see  Part  11).  Apply  cold  or  hot  fomen- 
tations, or  three  or  four  leeches  along  the 
lower  border  of  the  inflammation.  Make  a 
free  transver.se  incision  along  the  lower 
margin  if  suppuration  occurs.  If  a fistula 
remains,  the  affected  lobe  should  be  excised. 

II.  Chronic  Inflammation. — Tenderness 

is  present. 

Etiology.^ — Acute  inflammation;  tuber- 
culosis; syphilis;  actinomycosis;  echino- 
coccus disease;  alcoholism;  prolonged 
iodine  medication. 

Treatment. — Attend  to  the  cause.  Anti- 
luetic treatment  may  be  tried.  Unguentum 
hydrargjTi  biniodidi  (gr.  xxx  in  lanolin, 
5i)  majr  be  nibbed  in  daily  for  periods  of 
four  or  five  days,  the  inunctions  being  inter- 
rupted when  the  skin  becomes  irritated. 
ThjToid  extract,  gr.  ss,  gradually  and 
cautiously  increased  to  gr.  ii,  t.i.d.,  may  be 
tried  for  two  or  three  weeks.  Resection  of 
the  diseased  lobe  may  be  required.  It 
should  be  done  if  dysjmma  is  present. 

Thyrotoxicosis. — See  Exophthalmic  Goitre. 

Tic;  Tic  Convulsif. — Fr.  See  Habit  Spasm. 

Douloureux. — See  Neuralgia,  Trige- 
minal. 


TRICHINOSIS 


Tic  Impulsive. — See  Habit  Spasm. 

Tick  Fever,  African;  African  Relapsing 
Fever. — See  Relapsing  Fever. 

Rocky  Mountain.— ^ee  Rocky  Moun- 
tain Spotted  Fever. 

Tinnitus.— ^ee  Part  7,  Ear  Diseases. 

Tongue  Diseases. — Atrophy  due  to  hypo- 
glossal paralysis,  see  Hypoglossal  Nerve. 

Black  Tongue,  see  Part  5,  Skin  Diseases. 

Furrowed  Tongue,  see  Part  5,  Skin  Dis- 
eases. 

Geograpluc  Tongue,  see  Part  5,  Skin  Dis- 
eases. 

Glossitis,  inclucUng  Lingual  Ulcers,  see 
Glossitis. 

Glossodynia,  see  Glossodynia. 

Glossodynia  exfoliativa,  see  Part  5,  Skin 
Diseases. 

Leukoplakia,  see  Part  5,  Skin  Diseases. 

Lingual  tumors  and  cysts  iq.v.). 

Macroglossia  or  hypertrophy  iq.v.). 

Tonsillitis. — See  Part  9,  ITroat  Diseases. 

Torticollis. — See  Part  10,  Orthopaedics. 

Tower  Head. — See  Oxycephaly. 

Tracheal  Obstruction. — Gr.  rpaxda  rough. 

Etiology. — Foreign  bodies  (see  Part  9, 
Throat  Diseases) ; tumors(benign  papillomas; 
malignant  growths);  scleroma;  cicatricial 
stenosis;  necrosis  of  cartilage  and  exuberant 
granulation  formation  due  to  traumatism; 
oedema  secondary  to  acute  or  chronic 
chondritis  (caused  by  trauma,  syphilis, 
tuberculosis,  typhoid  fever,  diphtheria, 
influenza,  etc.);  fracture  of  the  trachea; 
compression  caused  by  aneurysm,  enlarged 
thyroid,  enlarged  thymus  (q.v.),  mediastinal 
malignant  growths,  vertebral  abscess,  en- 
larged luetic  or  tuberculous  glands,  effusions; 
angioneurotic  oedema;  retention  of  pus  and 
secretions. 

Treatment.— Benign  papillomata  may  be 
removed  through  the  mouth  by  means  of 
bronchoscopy.  Scleroma  is  cured  by  means 
of  radiotherapy,  the  “larynx  being  exten- 
sively laid  open  for  the  purpose.”  (Jackson.) 

Cicatricial  stenosis  of  the  cervical  trachea 
is  “very  successfully  treated  by  the  operation 
of  laryngo-tracheotomy,”  as  described  by 
Chevalier  Jackson  in  Musser  and  Kelly: 
Practical  Treatment,  Vol.  Ill,  p.  212. 

Cicatricial  stenosis  of  the  deeper  trachea 
is  “amenable  only  to  palliative  treatment 
by  the  long  tracheal  cannula,”  or  by  “Brun- 
ing’s  and  von  Schroetter’s  tracheal  and 
bronchial  intubation  tubes,  inserted  with  the 
aid  of  the  bronchoscope.”  (Jackson.) 

Exuberant  granulations  are  “quickly 
cured  by  the  endoscopic  application  of  a 10 
per  cent,  silver  nitrate  or  resorcin  solution.” 

For  oedema,  apply  the  ice-bag  externally 


and  have  the  patient  inhale  a spray  of  adren- 
alin. 1 : 5000.  The  oedematous  tissues  may 
be  incised  through  the  bronchoscope.  Prompt 
tracheotomy  (q.v.)  is  sometunes  demanded. 

In  the  retention  of  pus  and  secretions, 
perform  tracheotomy  promptly,  if  unmediate 
relief  is  not  obtained  by  inverting  the  patient 
(after  Chevalier  Jackson,  q.v.,  on  bronchos- 
copy in  Musser  and  Kelly:  Practical 

Treatment,  Vol.  HI,  p.  216). 

Tracheitis. — See  Bronchitk. 

Tracheotomy. — Gr.  rpaxeia  trachea  fl- 
TepveLv  to  cut.  See  under  Diphtheria. 

Transfusion  of  Blood. — See  Blood  Trans- 
fusion. 

Traumatic  Ecchymosis.  — Gr.  rpadpa 
wound;  €fcout  -j-  xi^Maaflow.  See  Contusion. 

Traumatic  Neuroses. — See  Hysteria  and 
Neurasthenia. 

Trembles. — See  Milk-Sickness. 

Tremor. — L.  from  trem'ere,  to  shake. 

Etiology.— Nervousness;  cold;  fatigue; 
neurasthenia;  hysteria;  senility;  heredity 
(hereditary  or  familial  tremor  beginning  in 
infancy);  paralysis  agitans;  fever  and 
toxaemia;  toxic  influences  (alcohol,  tobacco, 
morphine,  lead,  mercury,  arsenic,  thyroid 
extract);  exophthalmic  goitre;  multiple 
sclerosis  (volitional  or  intention  tremor) ; 
acute  chorea;Huntington’schorea;  posthemi- 
plegic tremor  or  athetosis  or  chorea; 
progressive  lenticular  degeneration  or  tetan- 
oid chorea;  internal  capsule  lesions;  cere- 
bellar tumor;  progressive  central  muscular 
atrophy;  dementia  paralytica  (tremor  of 
tongue  and  lips) ; paramyoclonus  multi- 
plex; poliomyelitis  or  spinal  paraplegia; 
Friedreich’s  ataxia;  exhausting  diseases; 
writer’s  cramp. 

Trichinosis. — Gr.  TpLxt-vos  of  hair.  Trichi- 
nosis (trichiniasis  or  trichinelliasis)  is  caused 
by  eating  raw  or  rare  pork  containing  the  en- 
capsulated trichina  or  trichinella  spiralis. 
The  hog  contracts  the  disease  by  eating  in- 
fected pork  or  rats.  When  the  infected  meat 
is  taken  into  the  stomach,  the  capsules  are 
digested  and  the  trichina3  set  free.  They 
pass  into  the  duodenum  and  jejunum,  and 
reach  maturity  before  the  end  of  the  second 
day.  The  mature  parasite  is  a minute, 
thread-like,  round  worm.  The  adult  fe- 
males are  mnnediately  unpregnated  by 
the  males,  which  soon  thereafter  die,  and 
the  females  bore  into  the  intestinal  lymph 
spaces  where  they  deposit  their  young, 
perhaps  a thousand  or  more  per  female.  The 
embryo  worms  reach  the  striated  muscles 
about  the  tenth  day  after  infection,  and 
here  they  penetrate  into  the  muscle  fibres 
where  they  become  encysted.  In  this  state 


TRICHURIASIS  OR  WHIPWORM  INFECTION 


they  may  remain  alive  for  very  many  years. 
When  taken  into  the  duotlenum  of  another 
animal,  they  develop  into  the  adult  worms. 

The  severity  and  tluration  of  the  symp- 
toms vary  with  the  number  of  trichinai 
ingested  and  the  nmnber  of  successive  infec- 
tions. The  disease  may  last  from  several 
days  to  several  months. 

In  a typical  severe  single  infection  the 
following  symptoms  appear. — One  or  two 
days  after  eating  the  infected  meat,  abdomi- 
nal distress,  nausea  and  vomiting  occur, 
usually  followed  by  charrhcEa,  and  general 
torjjor  and  weakness.  Between  the  seventh 
and  tenth  to  fourteenth  day,  the  embryos 
enter  the  muscles,  with  resulting  muscle 
jiains  of  more  or  less  severity,  ushered  in  by 
a temporary  oedema  of  the  eyelids  and  face, 
lasting  from  two  to  five  days.  Fever,  a 
marked  eosinophilia,  and  emaciation  occm\ 
The  death  rate  is  highest  during  this  stage. 
About  the  twenty-fourth  day  a second 
oedema  appears,  involving  particularly  the 
head.  Then  convalescence  sets  in,  and  is 
sometimes  very  slow,  extending  over  months 
or  even  years.  The  chsease  resembles 
ty]:)hoid  fever.  Rose  spots  may  even  appear. 

The  diagnosis  rests  upon  the  discovery 
of  the  encysted  spiral  trichina  (the  common 
sarcosporidium  is  not  spiral)  in  the  meat 
eaten,  the  minute,  silvery,  hair-like  worms 
in  the  stools,  and  the  eosinophilia.  The 
stools  should  be  diluted  and  shaken  with 
warm  water,  and  the  worms  allowed  to 
settle  to  the  bottom.  The  bottom  portion 
of  the  fluid  is  then  examined  in  a very  thin 
layer  in  a shallow  black  dish,  under  a low- 
power  lens,  the  dish  being  tipped  slowly  from 
one  side  to  another.  After  the  third  week, 
a piece  of  the  deltoid  muscle  may  be  teased 
in  water  and  examined  on  a glass  slide 
under  a cover-glass. 

Prognosis. — This  is  best  in  children  and  in 
cases  of  early  severe  diarrhoea.  It  is  good 
if  the  patient  survives  the  seventh  week. 

Treatment.— If  seen  early,  evacuate  the 
bowels  thoroughly  by  means  of  calomel, 
followed  in  four  hours  by  castor  oil  or  Epsom 
salts  (see  Part  11),  repeated,  together  with 
enemas  if  necessary.  Santonin  (see  Ascari- 
asis,  thymol  (see  Ankylostomiasis),  and  the 
anthelmintics  used  for  tapew’orm  {q.v.)  may 
be  administeretl.  Hemmeter  recommends 
benzine: 

R Benzini 5ii  3ii-3iii  iTtdi 

(iTijx-.xii  per  dose) 

Mucilaginis  acaciae. 

Aqua;,  aa  q.s.  ad oiv 

M.  Sig. — Two  teaspoonfuls  every  two  hours; 
together  with  a high  rectal  enema  of  4-8  c.c.  in  one 
quart  of  water.  (Hemmeter.) 


When  the  embryos  have  once  invaded  the 
muscles,  the  treatment  can  only  be  symp- 
tomatic. For  the  muscle  pains,  employ 
hot  baths  and  hot  camphorated  oil. 

Thorough  cooking  of  pork  and  sausages 
is  preventive. 

Trichuriasis  or  Whipworm  Infection. — 

Intestinal  infestation  with  the  trichuris 


trichiura,  or  whipworm  (Fig.  87),  may  pro- 
duce no  symptoms,  or  it  may  possibly  cause 
diarrhoea,  enteritis,  appendicitis,  anjemia, 
neurasthenia,  hysteria,  convulsions,  etc. 
Treatment. — The  various  anthelmintics 
(chenopodium,  male  fern,  santonin,  thymol, 
chloroform)  are  not,  as  a rule,  entirely  effi- 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  CONSUMPTION 


cacious  when  administered  in  the  usual  way, 
possibly  because  they  do  not  reach  the  cecal 
pouch,  but  success  is  reported  by  Wade  in 
the  use  of  thymol,  gr.  ii,  t.  i.  d.,  for  two 
weeks.  The  enemata  used  in  oxyuriasis 
may  be  tried.  The  latex  or  sap  of  the 
fig  tree  is  used  in  tropical  America, — 
dose,  10  to  40  gm.,  according  to  the  age  of 
the  patient,  dissolved  in  sweetened  water  or 
milk,  and  taken  three  times  a day,  preceded 
and  followed  (on  the  fourth  day)  by  a purge 
It  is  well  recommended. 

Trifacial  or  Trigeminal  Nerve. — L.  ires, 
three;  facia' Us,  facial;  gem'inus,  twin.  Paral- 
ysis of  this  nerve  results  in  anaesthesia  on 
the  affected  side  of  the  face  and  head, 
including  the  conjunctiva,  cornea,  and  naso- 
buccal  mucosa,  and  paralysis  of  the  masse- 
ter  and  temporal  muscles.  The  paralysis 
may  be  preceded  by  tingling  and  pain. 
Herpes  zoster  may  occur. 

Etiology. — Hemorrhage,  sclerosis,  or  other 
disease  of  the  pons,  basal  fracture,  basal 
meningitis;  bone  caries;  tumors;  aneirrysm; 
primary  neuritis;  syphilis;  tabes;  progres- 
sive bulbar  palsy;  removal  of  the  semi- 
lunar ganglion. 

Tonic  irritation  of  this  nerve  results  in 
trismus  or  lockjaw,  which  occurs  in  tetanus, 
tetany,  hysteria,  exposure  to  cold,  irritative 
lesions  of  the  pons,  reflex  irritation  from  the 
teeth,  mouth,  tlxroat,  and  caries  of  the  jaw. 

Treatment. — This  depends  upon  the  cause. 
In  sensory  paralysis  the  ansesthetic  eye 
should  be  guarded  against  injury,  in  order 
to  avoid  an  rdcerative  inflammation. 

Trigeminal  Neuralgia. — See  Neuralgia. 

Trismus;  Lockjaw. — Gr.  rpiajj-us  lockjaw. 

Causes. — Tetanus;  tetany;  hysteria;  ex- 
posure to  cold;  reflex  irritation  due  to 
dental  caries,  stomatitis,  quinsy,  caries  of 
the  bone,  etc.;  irritation  near  the  motor 
nucleus  of  the  fifth  nerve,  as  in  meningitis. 
See  Trifacial  Nerve. 

Trochlear  Nerve. — L.  troch'lea,  pulley 
See  Motor  Nerves  of  the  Eyeball. 

Tropical  Abscess. — See  Liver  Abscess. 

Dysentery. — See  Dysentery,  Amoebic. 

Febrile  Splenomegaly. — See  Kala-Azar. 

Sore. — See  Part  5,  Skin  Diseases. 

Trypanosomiasis. — See  Sleeping  Sickness. 

Tuberculosis,  Kidney. — L.  tuber' culum, 
nodule.  See  Pyelonephritis. 

Lymph  = Gland.  — See  Lymphadenitis 
Tuberculosa. 

Tuberculosis,  Miliary,  Acute. — L.  tuber'- 
culum,  nodule;  mil'ium,  millet-seed.  A 
fatal  tuberculous  septicaemia  with  the  forma- 
tion of  miliary  tubercles  throughout  the 
body,  sometimes  predominating  in  the  cere- 


bro-spinal  meninges  (tuberculous  meningi- 
tis), sometimes  in  the  lungs  (pulmonary 
form),  and  sometimes  uniformly  distributed 
(general  or  typhoid  form).  The  latter  form 
closely  resembles  typhoid  fever. 

The  Treatment  is  symptomatic.  See  Men- 
ingitis, Acute  Cerebro-Spinal,  for  the  con- 
sideration of  tuberculous  meningitis. 

Tuberculosis,  Pulmonary;  Phthisis;  Con= 
sumption. — L.  tuber' culum,  nodule;  pul'mo, 
lung;  Gr.  (f>dLcns  consiunption ; IL.consump'tio, 
wasting.  Pulmonary  tuberculosis  is  either 
acute  (tuberculous  pneumonia;  pneumonic 
phthisis;  galloping  consimiption ; some- 
tunes  acute  miliary  tuberculosis)  or,  more 
conunonly,  chronic.  The  latter  is  either 
ulcerative,  or  more  rarely  fibroid. 

The  clinical  evidences  of  pulmonary 
tuberculosis  are  as  follows:  fever,  especially 
an  evening  rise,  sometimes  chills,  increased 
pulse  rate,  loss  of  weight  and  strength, 
anemia,  often  dyspepsia,  anorexia,  and 
neurasthenia,  night-sweats,  cough  and  ex- 
pectoration, often  hoarseness,  sometimes 
dyspnoea,  usually  thoracic  pain,  perhaps 
pleurisy,  often  haemoptysis,  local  physical 
signs  (impaired  resonance,  jerky  inspiration, 
slightly  prolonged  expiration,  localized  rales, 
etc.),  the  tuberculin  reaction,  and  the  pres- 
ence of  tubercle  bacilli  in  the  sputum. 

One  should  differentiate  particularly  be- 
tween acute  tuberculosis,  chronic  active 
tuberculosis,  chronic  inactive  tuberculosis, 
and  acute  respiratory  colds. 

By  inspection,  note  the  conformation  of 
the  chest,  and  look  for  depressions,  and  for 
lagging  of  one  side  or  one  apex  (due  to  con- 
nective replacement  of  lung  tissue,  a result 
of  tuberculosis).  In  testing  for  vocal  fre- 
mitus, keep  the  palpating  hands  relaxed. 
In  performing  percussion,  begin  in  the  axilla 
(normal  area).  If  one  begins  over  a dull 
apex,  the  dull  note  will  be  carried  downward. 
Percuss  upward  in  front.  In  percussing  the 
back,  have  the  patient  bend  naturally  for- 
ward, with  arms  easily  folded  and  muscles 
relaxed.  Begin  in  the  infra-scapular  area 
(true  vesticular  area).  A dull  note  near  the 
lower  angle  of  the  scapula  is  muscle  dulness. 
An  enlarged  stomach  and  colon  on  the  left 
side  and  liver  dulness  on  the  right  may,  by 
contrast,  cause  mistakes.  Muscle  dulness 
changes  with  the  posture  of  the  patient.  In 
front,  the  liver,  muscles,  and  stomach  modify 
the  percussion  note.  The  latter  gives  a 
hyper-resonant  tone  from  the  6th.  costal 
cartilage  down  to  the  9th.  rib  in  the  mid- 
axillary  line.  A distended  stomach  will 
push  heart  dulness  upward.  Percuss  out 
Kronig’s  isthmus,  standing  behind  the  pa- 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  COXSU^IPTION. 


tient,  to  see  if  it  is  narrowed.  The  isthmus 
is  the  narrowest  portion  of  the  lung,  Ijhng 
above  the  clavicle  in  front  and  the  spine  of 
the  scapula  behind.  It  is  normally  about 
two  inches  wide,  i.e.,  from  neck  to  acro- 
mion. It  is  normally  wider  and  higher  on 
the  left  side,  and  \vider  in  a long,  thin  chest 
than  a short  thick  chest.  Narrowing  means 
contraction  of  the  lung  and  chronic  tubercu- 
losis; in  acute  tuberculosis  there  is  conges- 
tion instead  of  contraction. 

In  auscultating  the  chest,  remember  that 
rales  which  disappear  on  deep  breathing 
several  times  are  marginal  and  normal,  and 
that  fine  crepitations  are  normally  heard 
over  the  edge  of  the  sternum,  due  to  the 
stethoscope  touching  the  edge  of  the  bone, 
also  clicks  are  normally  heard  in  the  vicinity 
of  the  sternocostal  articulations  during 
strong  respiration  and  after  a cough.  Pro- 
longed expiration,  broncho-vesicular  breath- 
ing, and  increa.sed  spoken  and  whispered 
voice-sounds  mean  the  presence  of  connec- 
tive tissue  (not  congested  tissue),  and, 
therefore,  chronic  tuberculosis.  The  pres- 
ence of  persistent  fine  rales  mean  an  active 
lesion.  Practise  auscultation  following  ex- 
halation and  cough,  in  order  to  collapse  the 
bronchioles  and  air  cells,  so  that  rales  may 
be  detected  on  inspiration.  Rales  occurring 
with  an  acute  respiratory  cold  are  usually 
heard  along  the  inner  border  of  the  scapulae 
on  both  sides,  and  have  no  reference  to  inspir- 
ation or  expiration.  They  usually  disappear 
in  eight  to  twelve  days.  In  acute  bron- 
chitis rales  are  scattered  over  the  whole 
chest. 

Hilus  tuberculosis  is  brought  out  only  by 
D’Espine’s  sign:  If  one  listens  over  each 

dorsal  spine  from  the  first  downward,  and 
has  the  patient  whisper  rather  loudly,  the 
sound  will  begin  to  markedly  diminish  in 
normal  individuals  at  the  Gth.  dorsal  spine 
(5th.  spine  in  a thick,  short  chest;  7th.  spine 
in  a long,  thin  chest).  If  the  voice  is  heard 
with  greater  distinctness  below  this  point, 
listen  in  a triairgular  area  on  each  side.  If 
the  voice  is  carried  out  into  this  area,  it 
means  hilus  disease,  i.e.,  tuberculosis, 
aneurysm  of  the  descending  aorta,  enlarged 
gland  or  new-growdh  in  the  mediastinum. 
Make  a radiagram  (see  Rontgenology). 

Peribi’onchial  tiiberculosis  is  indicated  by 
persistent,  indistinct  rales  over  the  outer 
edge  of  the  sternum  at  the  second  and  thii-d 
interspaces.  Make  a radiogram.  The  proc- 
ess is  apt  to  exteird  to  the  superficies  of  the 
lungs  and  into  the  opposite  apex. 

Collections  of  blood,  as  in  the  congestions 
of  lobar  and  bi’oncho-pneumonia  and  acute 
tuberculosis,  cause  shadows  of  fuzzy  outline 


on  the  x-ray  plate;  fibroses  and  calcifica- 
tions produce  shadows  in  the  form  of  sharply 
outlined  spots,  streaks  and  lines. 

The  tuberculin  test  is  performed  as  follows: 

(a)  Koch’s  Method. — A two-hour  tempera- 
ture chart  should  be  kept  for  two  days  pre- 
ceding and  following  the  injection.  Inject 
deeply  beneath  the  skin  in  the  interscapular 
or  gluteal  region,  to  a robust  adult,  Y2  to 
1 mg.,  to  a child  or  a weak  patient  (never  to 
one  with  fever),  q fo  Mo  of  Koch’s  old 
tuberculin  (1  c.c.  =0  1 gm.  of  tuberculin); 
and  take  the  temperature  every  two  hours. 
A rise  of  0.5°  C.,  or  0.9°  F.  within  two  to 
thirty-six  hours  is  a positive  result.  If  no 
rise  in  temperature  follows  the  first  injec- 
tion, a second  and  a third  injection  may  be 
given,  each  three  days  apart,  the  dose 
being  doubled  each  time,  but  never  exceed- 
ing 10  mg.  A pronounced  positive  reaction 
is  marked  by  malaise,  headache,  insomnia, 
aching  pains,  nausea,  cough,  rise  in  tempera- 
ture, rapid  heart  rate,  inflammatory  signs 
at  the  site  of  inoculation,  and  increased 
inflammatory  signs  at  the  focus  of  infection. 

(b)  Moro’s  Method. — Rub  a little  salve,  con- 
sisting of  equal  parts  of  old  tuberculin  and 
lanolin  into  the  skin  over  the  thorax  or 
abdomen.  The  reaction  is  positive  if  small 
pale  nodules  ajDpear  after  twenty-four  to 
forty-eight  hours. 

(c)  Von  Pirqiiet’s  Method. — Cleanse  the  inner 
side  of  the  forearm  with  alcohol  and  ether, 
and  allow  to  dry.  Place  two  drops  of  old 
tuberculin  on  the  skin  at  a distance  of  6 to  8 
cm.  from  each  other.  Then  puncture  with  a 
large  needle  or  gently  scarify  the  skin  be- 
neath the  drops,  and  also  midway  between 
the  drops,  the  latter  as  a control.  After 
ten  to  fifteen  minutes,  or  after  drjdng  has 
occurred,  replace  the  clothing.  A positive 
reaction  is  manifested  by  the  appearance 
within  twenty-four  to  forty-eight  hours  of 
a reddish  papule. 

“A  positive  tuberculin  reaction  merely 
indicates  that  the  patient  has  at  some  time 
been  infected  with  tuberculosis,  and  not 
necessarily  that  he  is  at  present  tuberculous; 
but  the  occurrence  of  a focal  reaction  is  good 
presumptive  evidence  of  an  active  lesion.” 
“In  many  advanced  or  acute  cases  of  tuber- 
culosis, no  tuberculin  reaction  is  obtained, 
so  that  the  result  of  a tuberculin  test  _ is 
never  absolute.”  “After  infancy,  an  in- 
creasing proportion  of  those  who  react  are 
found  to  be  free  from  clinical  tuberculosis.” 
(from  New  and  Non-Official  Remedies.) 
Idle  tuberculin  test  is  dangerous. 

The  Sputum  is  Examined  as  follows:  A thin 
smear  (preferably  of  the  most  purulent  por- 
tion of  the  sputum  or  of  the  fine  cheesy 


DISEASED  MEATS 


TUBERCULOSIS  IN  BIRDS  TA 


BOVINE  TUBERCULOSIS  TB 
T B . Lung 


Small  intestines 


TB.  Gland 


Bovine  pulmonary 
tuberculosis  ) 


TB.  Costal  pleura 


TB.  Mammary  Gland 
‘ , Healthy  portion 


Diseased 


LAROUSSS  .MEDICAL 


Diseased  meals 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  CONSUMPTION 


particles)  is  fixed  upon  a clean,  unused  glass 
slide,  by  passing  it  (after  drying  in  the  air) 
rapidly  thrice  through  a Bunsen  flame,  with 
the  sputum  side  down.  It  is  then  sub- 
jected for  five  to  ten  minutes  to  steaming 
(not  boiling)  cai’bol-fuchsin  (1  part  saturated 
alcoholic — 95  per  cent. — solution  of  fuchsin 
and  9 parts  5 per  cent,  carbolic  acid  solution), 
washed;  decolorized  one-half  minute  with 
spirits  of  nitrous  ether,  or  with  a 10  per  cent, 
solution  of  sulphuric  acid  in  95  per  cent, 
alcohol  until  only  the  faintest  pink  color  is 
seen;  washed  in  water;  counter-stained  with 
Loeffler’s  methylene  blue  (saturated  alcoholic 
solution  of  methylene  blue,30  c.c.,with  aque- 
ous solution  of  KOH,  1: 10,000 — 100  c.c.)  for 
about  thirty  seconds;  washed;  dried  with 
filter  paper;  mounted  in  Canada  balsam; 
and  examined  with  an  oil  immersion  lens. 
A number  of  slides  should  be  examined, 
and  the  sputum  obtained  at  different  times. 

Perhaps  the  surest  method  of  securing 
tubercle  bacilli  is  by  Loeffler’s  modification 
of  the  antiformin  process  of  Uhlenhuth. 
To  5 or  more  c.c.  of  the  sputum  add  an  equal 
quantity  of  a 50  per  cent,  solution  of  anti- 
formin (10  per  cent,  solution  of  sodium  hypo- 
chlorite containing  5 to  10  per  cent.  socUum 
hydrate),  and  boil  for  no  longer  than  fifteen 
minutes.  To  each  10  c.c.  of  the  result- 
ing solution  add  1.5  c.c.  of  a mixture  of  1 
part  chloroform  and  9 parts  alcohol; 
shake  thoroughly  so  as  to  produce  a fine 
emulsion ; then  centrifuge  for  fifteen  minutes. 
Pour  off  the  supernatent  fluid  above  the 
film  which  hes  just  above  the  chloroform, 
and  which  holds  the  tubercle  bacilli,  place 
the  film  upon  a glass  slide,  and  remove  excess 
of  fluid  with  filter  paper.  Add  a drop  of 
egg  albimien  (preserved  with  0.5  per 
cent,  carbolic  acid)  as  a fixative,  and  make 
a thin  spread  by  means  of  a second  slide. 
Allow  to  dry,  and  stain  as  described 
above.  (Abstracted  from  Webster's 
Diagnostic  Methods. 

Prognosis. — This  is  uncertain,  but  experi- 
ence justifies  the  cultivation  of  a hopeful 
attitude  on  the  part  of  both  patient 
and  physician  in  practically  all  cases. 
A cure,  however,  is  not  a matter  of  months 
but  of  years. 

Prophylaxis. — This  embraces  the  abolition 
of  promiscuous  spitting  and  of  dry  sweeping, 
the  destruction  of  tuberculous  sputum  by 
burning  or  boiling,  the  use  by  consumptives 
of  paper  handkerchiefs  to  cover  the  nose  and 
mouth  while  coughing,  the  inspection  of 
dairies  and  abattoirs  and  the  clestruction 
of  diseased  animals,  milk  pasteurization 
(holding  at  a temperature  of  about  140°  F. 
for  fifteen  to  thirty  minutes),  and  correct 


personal  hygiene,  viz. — fresh,  pure  air  day 
and  night,  adequate  rest  and  exercise,  a 
daily  morning  warm  bath  in  a warm  room, 
followed  by  a cold  spinal  douche,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  a plain  but  abundant  diet, 
adequate  clothing  inclucUng  flannel  under- 
wear, cleanliness  of  the  mouth,  teeth,  and 
food,  and  thecorrection  of  abnormalities,  e.g., 
adenoids,  enlarged  tonsils,  dental  caries,  etc. 

Each  incUvidual  should  be  allowed  at 
least  600  cubic  feet  of  air  space.  The  most 
healthful  rooms  are  those  facing  south  in 
whiter  and  north  in  sumaner. 

In  thin  layers  of  sputum,  the  tubercle 
bacillus  is  killed  by  cUrect  sunlight  in 
about  sLx  hours  and  by  diffused  sunlight 
in  several  days. 

Treatment.— Coj’rect  hygiene  and  an  abun- 
dance of  good  food  are  the  fundamental 
requisites.  The  patient  should  observe 
regular  hours  of  eating  and  sleeping.  He 
should  be  out  of  doors  as  much  as  pos.sible, 
and  should  engage  in  light  exercise,  particu- 
larly walking,  except  when  fever  (99°  F.), 
rapid  pulse,  or  haemoptysis  is  present,  when 
he  should  be  at  rest  in  bed.  Exercise  should 
be  restricted  if  it  causes  elevation  of  tempera- 
ture. Fresh  air  day  and  night  is  of  para- 
mount importance,  but  wind  and  draughts 
should  be  guarded  against.  The  under- 
wear should  be  of  flannel,  best  porous,  not 
too  heavy.  No  chest  protectors  should  be 
worn,  nor  tight  corsets  that  restrict  breath- 
ing. The  clothing  and  the  feet  should  be 
kept  dry.  A good  place  for  the  bed  and 
reclining  chair  is  the  veranda,  one  facing 
south  in  winter,  and  one  north  in  sunnner. 
If  a tent  is  used,  the  wooden  floor  should  be 
raised  about  three  feet  from  the  ground,  and 
the  sides  should  be  boarded  up  to  about 
three  feet,  with  a space  of  three  mches 
between  the  latter  and  the  outside  canvas 
walls,  which,  if  desired,  may  be  lifted  up 
to  the  eaves  on  all  sides.  There  should  be  a 
veranda  in  front,  well-covered  with  a fly, 
and  within  the  tent  a small  stove.  A woolen 
cap  may  be  worn  over  the  head  and  ears  at 
night  when  it  is  cold. 

Every  morning  before  breakfast,  but  after 
swallowing  a cup  of  hot  milk  or  bouillon, 
a cold  sponge  should  be  taken,  standing  in 
warm  water  in  a warm  room.  The  skin 
should  then  be  rubbed  vigorously  with  a 
coarse  towel.  Once  or  twice  a week  a 

cleansing  hot  bath,  followed  by  a cold 
douche  may  be  taken.  A bath  should  not 
be  taken  soon  after  a meal.  The  patient 
should  rest  for  an  hour  before  and  after 
each  meal.  The  teeth  should  be  cleansed 
with  castile  soap,  warm  water,  and  a brush 


TUBERCULOSIS,  PULMONARY;  PHTHISIS,  CONSUMPTION 


before  each  meal,  and  the  month  and  throat 
rinsed;  carious  teeth  should  be  treated. 
The  sj)utum  should  be  burned  (paper  spit- 
cups  containing  a solution  of  carbolic  acid 
or  bichloride  may  be  used) ; and  the  patient 
should  be  instructed  to  hold  a handkerchief 
before  the  nose  and  mouth  in  coughing. 
The  handkerchief  should  be  boiled  each  day. 
The  hands  should  be  kept  clean.  No  dry 
dusting  or  sweeping  should  be  allowed. 
In  shoid,  the  strictest  personal  cleanliness 
should  be  observed,  not  only  for  the  pro- 
tection of  others,  but  also  for  the  protec- 
tion of  the  patient  himself  against  auto- 
infection. 

In  the  matter  of  diet,  the  patient  should 
eat  as  much  as  he  can  digest  and  assimilate, 
but  no  more.  Three  good  meals  a day,  at 
five-hour  intei’vals,  is  ortlinarily  better, 
I believe,  than  tlrree  meals  and  three 
lunches;  but  the  latter  may  be  preferable 
in  some  cases. 

Our  most  nutritious  foods  are  bread,  milk, 
eggs,  and  meat.  On  a general  diet,  about 
three  or  four  pmts  of  milk  and  six  eggs  may 
be  taken  daily.  The  milk  should  be  drunk 
slowly,  and  to  render  it  more  digestible 
one  may  add  to  each  tumblerful  a pinch 
of  salt  or  sodium  bicarbonate  or  sochum 
citrate,  or  a tablespoonful  or  more  of  Ihne- 
water  or  Vichy  or  Apollinaris,  or  a little 
cognac,  coffee,  or  tea,  or  it  may  be  pepton- 
ized (see  Part  11).  Two-thircls  milk,  one- 
third  cream,  one  teaspoonful  of  brandy,  and 
one  tablesj^oonful  of  lime-water  forms  a 
nutritious  chink.  Koumyss,  Kefir,  matzoon 
(see  Part  11),  buttermilk,  Horlick’s  malted 
milk,  and  Mellin’s  food  may  be  of  value. 

If  the  yolk  of  the  egg  causes  gastric  dis- 
tress or  diarrhoea,  use  only  the  white. 

Of  the  meats,  beef  and  mutton  are  the 
best.  Chopped  raw,  perfectly  fresh  beef 
seasoned  with  salt,  one-half  pound  two  or 
three  times  a day,  is  a valuable  food;  as 
is  also  meat  juice,  made  by  exj^ressing  the 
muscle  plasma  from  meat  slightly  heated 
in  a dry  saucepan. 

Fats  are  of  importance,  e.g.,  cream,  butter, 
sardines,  salmon,  bacon,  olive  oil,  and  cod- 
liver  oil  in  teaspoonful  doses  (contra- 
indicated, however,  in  warm  weather,  high 
fever,  and  gastric  irritation) : 


II  Olei  morrhua; o xvi  ( 3 ii  per  dose) 

Aciiciaj 5iv  5i 

Ciilcii  hypophosphitis oiiss 

Potassii  hypophosphitis.  . . oi  gr-  xv 

Syriipi  siniplicis Mil  3hss 

Olei  gaulthoriir pi 

Aqiue  destillatii',  q.s.  ad . . . 5 x.xxii 
M.  fiat  emulsuni. 

big. — ^Tahle.spoonful  t.i.d.p.c.  (IT.  S.  P.) 


II  Olei  morrhua; Sxvi  (pii  per  dose) 

Mucilaginis  dextrini giv  5i 

Extracti  malti 5 xitss 

M.  fiat  emulsum. 

Sig. — Tablespoonful  t.i.d.p.c.  (Xat.  Form.) 

R Vitelli  ovi No.  v 

Olei  amygdala;  amara; ....  ngx 

MLx  thoroughly  in  a mortar  and  then  add,  drop 
by  drop  at  first,  constantly  stirring. 

Olei  morrhua; Oi 

Glycerini 3 ii 

Acidi  phosphorici  (Squibb’s 

concentrated) 3 i 

Spiritus  frumenti. 

Aqua;,  aa Oss 

M.  Sig. — Tablespoonful  t.i.d.p.c.  (Otis.) 

Well-cooked  cereals,  vegetables,  fruits,  and 
salads,  dressings,  sauces,  condiments,  pickles, 
chow-chow,  catsup,  and  spices  are  important 
accessory  foods  and  appetizers.  One  or  two 
quarts  of  water  should  be  taken  daily, 
between  and  not  before  meals. 

The  following  daily  routine  may  serve 
as  a guide  for  the  average  afebrile  case: 
On  rising  in  the  morning,  a cup  of  hot  milk 
or  bouillon,  then  a cool  sponge  bath  in  a 
warm  room,  standing  in  warm  water. 

8 A.  M. — Breakfast:  A well-cooked  cereal 

with  sugar  and  cream;  milk  or  weak  tea  or 
coffee;  bacon;  an  egg  boiled  three  minutes, 
or  instead,  a chop,  steak,  or  other  meat; 
plenty  of  bread  and  butter;  fruit.  Rest 
about  half  an  hour  after  breakfast.  ' 

9 A.  M. — -Exercise;  a walk. 

12  M. — Rest,  rechning. 

1 p.  M. — Dinner:  soup,  bouillon  or  broth, 
and  alcohol  as  an  appetizer;  rare  roast  beef, 
mutton,  lamb,  fowl,  fish,  or  oysters;  vege- 
tables, such  as  potatoes,  turnips,  carrots, 
parsnips,  spinach,  asparagus,  corn,  peas, 
beans,  tomatoes,  etc.;  salads  with  olive 
oil  ilressing  or  mayonnaise  ; puddings, 
smiple  cake,  fruit.  Rest  about  an  hour 
after  dinner. 

3 to  4 or  5 p.  M. — Exercise. 

5 to  6 p.  M. — Rest,  recumbent. 

6 p.  M. — Supper:  alcohol  as  an  appetizer; 
meat,  fowl  or  fish;  eggs;  cottage  cheese 
and  cream;  vegetables,  baked  beans;  bread 
and  butter;  milk  or  tea  or  cocoa;  jam, 
marmalade,  or  cooked  fruit. 

9 p.  II. — Warm  milk,  malted  milk,  IMel- 
lin’s  food,  or  bouillon. 

9:30  to  10  p.  M. — Retire. 

A good,  tasty  cook  is  essential. 

In  some  cases,  where  the  patient  is  much 
underweight,  it  may  be  deemed  advisable 
to  give  a glass  of  milk  or  one  or  two  raw 
eggs  at  10  to  10:30  a.  m.,  and  3:30  p.  m. 
It  is  no  doubt  more  satisfactory  to  weigh 
the  foods,  and  prescribe  a diet  which  pro- 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  CONSUMPTION 


vides  a little  more  than  the  full  number  of 
calories  required  for  one  of  the  patient’s 
age,  height,  and  sex  (see  under  Food  Values). 

The  presence  of  moderate  chronic  fever 
does  not  contraintUcate  a full  diet;  but  if 
the  fever  is  high  and  acute,  only  liquid 
nourishment  may  be  given,  e.g.,  diluted 
milk,  buttermilk,  or  koumyss,  raw  eggs, 
meat  juice,  alcohol,  etc.,  every  two  or  three 
hours.  Raw  meat  juice  is  prepared  by  stir- 
ring four  parts  of  finely  chopped  steak  with 
one  part  of  cold  water,  allowing  it  to  stand 
for  half  an  hour  in  the  cold  and  then  expres- 
sing the  juice  through  a cloth  or  meat  press. 

As  appetizers  and  tonics,  one  may  pre- 
scribe the  bitter  tonics  about  fifteen  minutes 
before  meals.  (See  Anorexia) : 

Tincturae  nucis  vomicae.  ...  3iv  (n?x  per  dose) 
Tincturae  cinchonae  com- 

positae 5vss 

M.  Sig. — Two  teaspoonfuls,  t.i.d.a.c. 

Dilute  hydrochloric  acid,  gtt.  xx,  in  a 
tumblerful  of  water,  may  be  sipped 
after  meals. 

An  occasional  antipyretic  may  lessen 
anorexia:  pyramidon,  gr.  ii,  in  capsule,  at 
9,  10,  and  11  a.  m.;  or  lactophenine,  gr.  hi 
to  V,  at  9 or  10  a.  m.,  dinner  being  taken 
at  1 p.  M. 

Creosote  (pure  Beechwood)  is  of  some 
value  when  well  borne:  gt.  i well  diluted 
in  hot  water,  t.i.d.p.c.,  gradually  increased 
to  gtt.  X,  t.i.d.  It  may  also  be  inhaled  from 
steaming  water  (gtt.  x to  xx  ad  Oi)  for  fif- 
teen or  thirty  minutes  twice  daily.  Stop 
the  creosote  if  it  causes  anorexia,  nausea, 
vomiting,  or  albmninuria. 

Creosoti  (Beechwood)..  3 i (w  per  teaspoonful) 
Tincturffi  gentian®  com- 
posite   3 ii 

Alcoholis 5ii  3ss 

Vini  xerici,  q.s.  ad Sviii 

M.  Sig. — One  teaspoonful  to  three  tablespoonfuls 
in  a glass  of  milk  or  water  after  meals.  (Bouchardat 
and  Gimbert.) 

Creoso tails  (creosoti  carbonatis) giv 

Sig. — Minims  v-xx,  gradually  increased  to  one 
teaspoonful  3 or  4 times  a day  in  milk  during  meals. 
(Ortner.)  (highly  recommended.) 

Creosoti  (Beechwood) ttjxxx 

Tinctur®  gentian®,  q.s.  ad 5i 

M.  Sig. — 8 drops  in  one  teaspoonful  of  red  wine, 
t.i.d.p.c.,  increased  by  one  drop  every  three  days  up 
to  20  drops  t.i.d.,  the  latter  dose  to  be  continued  for 
about  three  months.  “Almost  specific  in  phthisical 
dyspepsia.”  (Cohnheim.) 

Calcium  and  phosphorus  are  reputed  to 
be  of  some  value,  e.g.,  calcium  glycero- 
phosphate, gr.  V,  in  tabl-et,  jx)wder,  or  cap- 


sule, t.i.d.p.c.  Garlic  (.see  Part  11)  is 
strongly  recommended  by  Minchin  as  anti- 
septic and  antitubercular. 

For  anaemia,  prescribe  Fowler’s  solution 
of  arsenic  and  Blaud’s  mass,  etc.  (See 
Anaemia.) 

The  temperature  should  be  taken  twice 
or  thrice  daily,  unless  it  has  been  normal 
for  some  time,  and  the  patient  should  be 
weighed  once  a week. 

The  tuberculin  treatment  is,  I believe,  of 
doubtful  value.  It  may  be  administered 
with  safety  only  to  those  whose  comlition 
is  fah’ly  good,  and  who  are  afebrile  or  nearly 
so,  and  who  have  a localized  lesion;  or,  in 
other  words,  to  tho.se  who  get  well  with  good 
hygiene  and  good  food.  Following  haemo- 
ptysis, it  should  not  be  given  until  the 
temperature  has  been  normal  two  weeks. 

One  should  begin  with  a very  small 
dose,  K 0,0 00  to  ^0,000  mg.  of  Koch’s  old 
tuberculin  (O.T.),  or,  if  there  is  fever, 
Hoo,ooo  to  Moo, 000  mg.,  and  increase  tho 
dose  very  gradually  every  three  or  four  days, 
with  the  object  of  attaining  as  high  a grade 
of  tuberculin  tolerance  as  possible,  while 
strictly  avoiding  a reaction,  e.g.,  rise  of 
temperature,  increased  pulse  rate,  and 
constitutional  symptoms. 

“The  dose  at  first  may  be  doubled  each 
tune,  unless  any  evidence  of  reaction  Ls 
observed.  After  Moo  mg.  is  reached,  it  is 
advisable  to  go  more  slowly,  thus,  Moo, 
Moo,  Moo  mg.,  etc.”  “If  a reaction  occurs, 
no  further  injections  should  be  given  for 
ten  days,  or  until  all  symptoms  have 
disappeared,  and  then  one  should  begin 
with  much  smaller  do.ses.” 

“After  a dose  of  Mo  mg.  is  reached,  the 
.injection  is  given  only  once  a week.  The 
dose  is  then  still  further  increased  until 
tuberculin  unmunity  is  finally  attained, 
which  must  necessarily  vary  with  each 
individual  and  may  be  as  high  as  1000  milli- 
grams or  1 gram,  or  more.” 

“The  apparatus  needed  to  make  the 
dilutions  are  a number  of  small,  wide- 
mouthed, glass-stoppered  bottles  and  three 
glass  pipettes,  one  holding  q c.c.,  graduated 
into  hundredths  of  a cubic  centimetre;  the 
second  holding  1 c.c.,  graduated  into  tenths 
of  a cubic  centimetre;  and  the  third  holding 
10  C.C.,  graduated  into  tenths  of  a cubic 
centimetre.  These  should  be  boiled  be- 
fore use.” 

“ The  diluting  solution  generally  used  con- 
sists of  one-fourth  of  1 per  cent,  carbolic  acid 
in  physiologic  salt  solution  (0.8  per  cent.), 
which  should  be  filtered  and  boiled.  There 
should  be  no  sediment  in  the  solution.  To 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  CONSUMPTION 


make  the  solution,  one-tenth  of  the  original 
tuberculin  is  removed  by  the  first  pipette, 
and  to  it  is  added  9.9  c.c.  of  the  diluting 
fluid,  which  gives  a 100-fold  dilution,  of 
which  }/[o  c.c.  equals  1 mg.  of  tuberculin. 
From  this  number  1 tlilution,  c.c.  is 
removed  and  9.9  c.c.  of  the  diluting  fluid 
adtled,  which  gives  a 1000-fold  dilution, 
Hoo  iiig-  in  c.c.  of  the  cUlution. 
Next,  from  this  number  2 dilution,  Ho 
c.c.  is  taken,  to  which  9.9.  cc.  of  the  diluting 
fluid  is  added,  which  gives  a 10,000-fold 
dilution,  or  Ho>ooo  mg.  of  tuberculin  in  Ho 
c.c.  The  dilutions  can  be  thus  continued 
until  in  Ho  c.c.  the  proper  dose  is  obtained.” 
“The  various  solutions  must  be  kept  in  a 
refrigerator  and  fresh  ones  prepared  every 
two  weeks.”  Many  pharmaceutical  firms 
furnish  serial  dilutions. 

The  injections  are  made  subcutaneously 
with  a very  fine  needle  and  a glass  syringe 
of  the  capacity  of  H oi’  1 c.c.,  graduated 
into  hunch’edths  of  a cubic  centimetre  (a 
Randall-Faichney  or  a Burroughs-Wellcome 
syringe).  The  syringe  and  needle  should 
be  boiled  before  using,  and  the  skin  cleansed 
with  alcohol. 

The  patient  should  be  given  a tuberculin 
record  chart,  whereby  the  physician  may 
properly  graduate  the  dosage  of  tuberculin 
so  as  to  avoid  a reaction. 

The  strength  of  the  various  tuberculins 
varies,  not  only  in  those  prepared  by  differ- 
ent methods,  but  also  in  chfferent  batches 
prepared  in  exactly  the  same  way,  so  that, 
when  a correct  dosage  for  an  incUvidual 
has  been  found,  a change  to  a different 
laboratory  number  of  the  same  preparation 
should  be  accompanied  by  a reduction 
in  the  dose  to  one-half  in  order  to 
avoid  a severe  reaction.  (New  and 
Non-Official  Remedies.) 

The  beginning  dose  of  the  bouillon  filtrate 
of  Denys  (B.  F.,  consisting  of  soluble  tox- 
ins) and  of  the  tuberculin  rest  of  Koch 
(T.R.,  consisting  of  dead  bacilli)  is  the  same 
as  that  of  Koch’s  old  tuberculin  (O.T.,  con- 
sisting of  soluble  toxins),  i.e.,  Ho>ooo  mg. 
The  beginning  dose  of  the  bacillen  emulsion 
of  Koch  (B.E.,  consisting  of  dead  bacilli) 
is  Hoo,ooo  mg.;  “ when  Hoo  mg.  is  reached, 
the  interval  should  be  a week.” — Abstracted 
from  E.  O.  Otis  in  Musser  and  Kelly’s 
Practical  Treatment. 

The  initial  dose  of  Koch’s  new  tuberculin, 
either  the  human  (T.R.)  or  the  bovine 
(P.T.R.)  variety,  is  about  Hoiooo  mg.  (C. 
E.  Lakin.) 

Trudeau  says  that  a proper  series  of  in- 
jections, avoiding  any  reaction,  requires 


from  six  months  to  a year  or  longer;  and 
he  advises  a second  course  of  treatment 
should  any  symptoms  reappear  after  an 
apparent  cure. 

Splinting  of  the  lung  by  means  of  an 
artificially  induced  pneumothorax  was  advo- 
cated by  the  late  John  B.  Murphy  (see 
Pneumothorax,  Artificial). 

T reatment  of  Symptoms. — FevER. — F ever  may 
be  excited  by  exercise,  emotion,  constipa- 
tion, simply  coryza,  sore  throat,  etc.  When 
the  morning  or  minimum  temperatm’e  Ls 
99°  F.,  the  patient  should  be  at  rest  in  bed. 
For  a temperature  of  103°  F.,  employ  hot 
sponging  or  cool  sponging  under  covers. 
Pyi’amidon,  lactophenin,  or  phenacetin, 
gr.  ii  of  any  one  of  these,  may  be  given  three 
hours  before  the  expected  rise  of  tempera- 
ture, and  repeated  every  hour  until  three 
doses  have  been  given.  Ortner  prefers 
pyramidon  camphorate,  gr.  v to  xv,  dissolved 
in  one  ounce  of  water,  repeated,  if  necessary, 
even  up  to  45  gr.  a day.  He  says  these  doses 
are  without  the  slightest  ill  effects.  Yeo 
recoimnends  phenacetin,  gr.  ii  to  iii,  with 
hydrobromide  of  quinine,  gr.  ii  to  iv,  t.i.d.; 
or  the  quinine  may  best  be  given  in  a single 
dose,  gr.  v to  viiss,  about  an  hour  before  the 
maximum  temperature.  Guaiacol  (Part  11)  _ 
may  be  used  externally  with  care.  But  rest 
and  fresh  air  are  the  best  febrifuges  and  drugs 
should  be  avoided.  Acute  fever  demands 
only  liquid  nourislmient,  but  chronic  fever 
calls  for  full  diet. 

Night  Sweats. — A flannel  nightgown 
should  be  worn,  and  not  too  much  bed- 
covering. At  bedtime,  the  skin  may  be 
sponged  with  vinegar,  or  alcohol  and  water, 
or  alum  solution,  1 : 30,  or  alcohol  and 
formalin  (the  commercial  40  per  cent.), 
equal  parts,  painted  on;  or  one  of  the  fol- 
lowing dusting  powders  may  be  used,  viz. — 
tannoform,  1 part,  and  talcum  or  compound 
stearate  of  zinc,  2 parts;  or  undiluted  tanno- 
form; or  salicylic  acid,  3 parts,  wheat 
starch,  10  parts,  talcum,  87  parts;  or  zinc 
peroxide,  5i,  with  talcum,  oiss.  The  for- 
malin is  said  to  be  very  efficacious,  its 
effect  lasting  usuallj^  several  nights.  Ortner 
prefers  the  tannoform. 

Milk  may  be  given  at  bedtime,  to  which 
may  be  added  two  or  three  teaspoonfuls 
of  whiskey  or  brandy;  or  the  patient  may 
be  aroused  anti  given  food  two  hours  before 
the  expected  sweat.  Constipation  should 
be  corrected. 

Says  Osier:  “Atropine  in  doses  of  gr. 
H20  to  3^0  (or  gr.  3^1 20  every  hour  for  two  or 
three  doses)  and  the  aromatic  sulphuric 
acid  in  large  doses  (3^s,  well  diluted,  at 


TUBERCULOSIS,  PULMONARY;  PHTHISIS;  CONSUMPTION 


bedtime)  are  the  best  remedies”;  and 
“ when  there  are  eongh  and  nocturnal  rest- 
lessness, an  eighth  of  a grain  of  morphine 
may  be  given  with  the  atropine.” 

Other  antihydrotics,  to  be  given,  at  bed- 
time, are  as  follows: 

Camphoric  acid,  gr.  xii  (L.  Brown);  gr. 
x\’  to  XXX  (Croftan ; Otis) ; gr.  xv  to  lx.  (Yeo.) 

Muscarin,  1 per  cent,  solution,  ttp_  v,  hypo- 
dermically. 

Picrotoxin,  gr.  j^o- 

Agaricin,  gr.  K to  or  agaricinate  of 
soda  or  lithia,  gr.  ii  b)  iv. 

Tincture  of  nux  vomica,  rrpxxx,  in  wr.ter. 

Zinc  oxide,  gr.  iii  to  v. 

Guaiacamphol,  gr.  iii  to  vii  to  xv. 

Bromural,  gr.  v. 

Sodium  or  potassium  tcllurate,  gr.  3^  to 

134,  t.i.d. 

FI.  ext.  hydrastis,  gtt.  xxx,  at  bedtime, 
well  diluted. 

FI.  ext.  ergot,  5ss  -f  t.i.d.,  in  water. 

Tincture  of  digitalis,  irpx,  t.i.d., 
well  diluted. 

Cough. — Useful  alleviative  remedies  are 
as  follows:  (1)  A cup  of  hot  milk  or  water 
containing  one  of  the  following,  viz. — sod. 
bicarb.,  gr.  xv;  or  sod.  bicarb.,  gr.  x,  sod. 
chloride,  gr.  iii,  and  sjit.  chloroform,  tiexx; 
or  sod.  bicarb,  and  sod.  chloride,  aa.  gr.  v, 
and  aromatic  spirits  of  ammonia,  gtt.  xx;  or 
arnmon.  chloride,  gr.  v to  x;  or  amrnon.  car- 
bonate, gr.  ii;  or  a teaspoonful  of  brandy. 
These  hot  draughts  are  particularly  useful 
for  the  morning  cough.  Expectoration  is 
facilitated  by  hanging  the  head  and  trunk 
over  the  edge  of  the  bed,  and  by  raising 
the  foot  of  the  bed.  Tapping  upon  the 
chest  with  the  blade  of  a knife  is  an  aid 
to  expectoration. 

(2)  Inhalations  of  steam  medicated  with 
creosote,  gtt.  x to  xx  ad  Oi  of  steaming 
water;  or  turpentine,  ad  Oi;  or  tincture 
of  benzoin,  5i  ad  Oi;  or  oil  of  pine,  3ks  ad 
Oi;  or  oil  of  eucalyptus,  gtt.  xxx  ad  Oi;  etc. 
(See  Bronchitis.) 

(8)  Continuous  wearing  of  an  oronasal 
respirator  containing  creo.sote  or  carbolic 
acid  and  Sf)t.  chloroform,  aa;  or  menthol, 
pi,  creosote,  pi,  spt.  vini  rect.,  et  spt. 
chloroformi,  aa  5ss;  or  acetone. 

(4)  For  the  nocturnal  cough:  warming  of 
the  bed  before  entering;  and  a cup  of  hot 
milk,  with  or  without  whiskey,  etc.,  thirty 
minutes  before  Ixultime;  or  codeine,  gr.  % 
to  Yi',  or  heroin,  gr.  3^2  i dionin,  gr.  34; 
or,  Morphinai,  gr.  34  t/O  34-  hydro- 
cyanici  dil.,  Trpii  to  iii.  Syrupi  pruni  Virgin., 
5i  (Osier).  But  of)iates  should  be  used  only 
as  a last  resort. 


{T^)  For  an  irritative  cough: 


Codoime  sulphatLs gr.  iv 

Ainmonii  chloridi 3 js-s 

iSyrupi  acidi  citrici .3  i 

Aqua;,  q.s.  ad 3iv 


M.  Sig. — A tca-spoonful,  well  diluted  in  plain 
water  or  Vichy,  every  two,  three,  or  four  hours,  a.s 
needed.  {Ilari/Ibook  of  Therapy  of  the  A.  M.  A.) 

(())  For  profuse  bronchorrhcea : terpin 

hydrate,  gr.  v,  in  tablet,  powder,  or  capsule 
with  plenty  of  water,  four  or  five  times  a day. 

(7)  Mustard  poultice  fPart  11);  or  a hot 
lin.seed  pmiltice. 

(8)  For  throat  irritation:  steam  inhala- 
tions ; warm  alkaline  gargles. 

(9)  IVjr  cough  due  to  larnygeal  ulcera- 
tion, treat  the  local  condition  (see 
Larnygitis,  Tuberculous,  in  Part  9,  Throat 
Diseases). 

(10)  For  an  emetic  cough,  pre.scribe  hot 
water  thirty  minutes  before  meals  to  en- 
courage the  expectoration  of  accumulated 
secretions.  Allow  no  hot  drinks  during  the 
meal.  Enjoin  rest  after  meals. 

f 1 1 ) For  pleuritic  cough,  strap  the  chest 
from  spine  to  sternum. 

(12)  For  cough  due  to  fever,  give  pyrami- 
don,  gr.  ii  to  vi,  at  bedtime. 

Pain. — For  severe  pleuritic  pains,  paint 
the  side  with  tincture  of  iodine;  or  immobil- 
ize it  by  means  of  a broad  band  of  zinc 
oxide  adhesive  plaster  applied  during  forced 
expiration  from  the  spine  to  the  sternum. 
Other  useful  remedies  are  the  mustard  poul- 
tice, hot  water  bag,  ice-bag,  cold  compresses, 
the  thermocautery  lightly  afiplied,  dry  cufi- 
ping  (q.v.),  and  inunctions  of  the  following 
ointment : 


Extract!  belladonna; gr.  xlviii 

Extract!  op!! 3 is-s 

Menthobs gr.  xx!v 

Alcoholis 3s.s 

AdipLs  lana;  hydros!, 

Petrolat!  mollis,  aa 3s.s 


MLsco  et  fiat  unguenturn. 

H!g. — Rub  into  the  skin  over  the  seat  of  pain. 

Painful  Dysphagia. — lasufflate  the  lar- 
ynx just  before  eating,  with  orthoform  pow- 
der; or  spray  it  with  cocaine,  0.5  per  cent.; 
or  paint  it  with  a 2 to  8 pi;r  cent,  cocaine 
solution.  The  swallowing  of  ice-pills  and 
the  external  application  of  cold  may  be  ser- 
viceable. The  patient  may  swallow  with 
gn;ater  comfort  by  lying  upon  the  stomach 
and  sucking  liquid  through  a straw.  The 
superior  laryngeal  nerve  may  be  injected 
with  alcohol  (sec  also  Laryngitis,  Tuber- 
culous, in  Part  9,  Throat  Diseases). 

Diahkhcea. — Finst  evacuate  the  bowels  by 
means  of  castor-oil,  then  prescribe  bismuth 


TYPHOID  FEVER 


in  large  doses,  with  Dover’s  powder,  gr.  v,  a 
day;  or  lead  and  opium  pill  (for  all  drugs 
see  Part  11);  or  silver  nitrate,  gr.  34  to 
34)  with  opium,  gr.  ss,  t.i.d.;  or  a cleansing 
enema  followed  by  starch  solution,  5 ii;  with 
or  without  laudanum,  ttjjx.  Restrict  the 
diet  to  boiled  milk,  milk  puddings;  custards, 
arrowroot,  meat  juice,  egg  albumen;  re- 
strict fluids;  avoid  fruits,  salads,  sweets, 
cold  drinks,  and  most  vegetables;  have  the 
patient  wear  a flannel  abdominal  binder 
constantly.  Creosote  may  be  of  service. 

Dyspepsia  — Gastric  indigestion  should 
be  treated  by  a restricted  liquid  or  soft  diet 
and  gastric  lavage  accomplished  either  by 
means  of  warm  soda-water  taken  one  hour 
before  meals,  or  by  means  of  the  stomach- 
tube,  as  described  under  Gastritis,  Chronic. 
Cohnheim  recommends  creosote  (see  his  pre- 
scription, preceding). 

Treat  flatulence,  vomiting,  anorexia,  etc., 
as  described  under  their  respective  headings 
in  other  parts  of  this  work. 

H^mopty’sis. — See  Haemoptysis. 

Tuberculosis,  Renal. — See  Pyelonephritis. 

Tumor  of  the  Brain. — See  Brain  Tumor. 

Tumors  of  the  Breast. — See  Breast  En- 
largements. 

Tumors,  Malignant. — See  Malignant 
Neoplasms. 

Twelfth  Nerve. — See  Hypoglossal  Nerve. 

Tympanites;  Flatulency;  Meteorism. — 

Gr.  TVfj.Tavov  drum;  ~L.  flatulen'tia,  distention 
with  gas;  Gr.  fierecopL^eiv  to  raise  up.  Gas- 
eous distention  of  the  gastro-intestinal  tract. 

Etiology. — Fermentation  secondary  to  gas- 
tric or  intestinal  catarrh;  excessive  intes- 
tinal fermentation  following  the  ingestion  of 
certain  easily  fermentable  foods,  e.g.,  beans, 
peas,  cabbage,  potatoes,  turnips,  fresh  fruit, 
fresh  bread,  black  bread,  cakes,  sweets,  fatty 
foods,  milk.  Kefir,  beer;  aerated  beverages; 
swallowing  of  air  in  hysteria,  producing 
sometmies  phantom  tumors;  general  intes- 
tinal atony;  chronic  passive  congestion  due 
to  heart,  lung,  kidney,  or  liver  disease;  toxic 
paralysis  of  the  bowel,  occurring  in  acute 
infectious  thseases  (typhoid  fever,  pneu- 
monia, etc.);  paralysis  of  the  bowel  the 
result  of  shock,  caused  by  too  much  hand- 
ling of  the  intestines;  jieritonitis;  intestinal 
obstruction,  partial  or  complete. 

Treatment.— Attend  to  the  cause.  Admini- 
ster laxatives,  if  not  contraindicated  (as  in 
intestinal  obstruction).  Gentle  abdominal 
massage  is  usefid  where  not  contraindicated 
(contraindicated  in  typhoid  fever).  A hot 
turpentine  stupe  applied  to  the  abdomen  is 
of  service.  It  consists  of  flannel  wrung  out 
of  steaming  hot  water  containing  a teaspoon- 


fidl  of  turpentine  to  the  quart  and  covered 
with  dry  flannel.  These  should  alternate 
with  plain  hot  stupes.  High  enemata  of 
turpentine  in  soapsuds  (5ss  i to  iv  to  a large 
enema),  or  of  asafoetida  (four  tablespoonfuls 
of  the  emulsion  to  the  enema)  are  valuable. 
The  tube  may  be  left  in  place  and  the  pa- 
tient turned  frequently  so  as  to  evacuate 
the  gas.  In  typhoid  fever  a large 
soft  catheter  should  be  used,  and  with 
great  care.  Employ  the  stomach  tube  for 
gastric  distention. 

Useful  carminatives  (see  Part  11  for  for- 
mulae, etc.):  Aquae  menthae  piperitae;  olei 
terebinthinae,  (especially  useful  in  typhoid 
fever);  olei  cinnamomi;  olei  cajaputi;  fluid- 
extracti  zingiberis;  olei  caryophylli;  olei 
ani.si;  olei  carui;  olei  thymi;  olei  sassafras; 
spiritus  myristicae;  tr.  cardamomi  comp.; 
olei  foeniculi;  asafoetidae;  olei  hmonis;  tr. 
aurantii;  spt.  ammoniae  arom. ; aquae  chloro- 
formi;  misturae  sodae  et  menthae;  etc. 

B Sodii  bicarbonatis 3i  (gr.  viis.s  per  dose) 

Pulveris  rhei 5ss  (gr.  3%  per  dosej 

Spiritus  menthae  piperitaj  5ii  (tij.xv  per  do.se) 
Aquae,  q.s.  ad % 

M.  Sig. — Tablospoonful,  after  shaking,  t.i.d.p.c., 
in  water. 

Gas  absorbents:  Pulveris  carbonis  ligni; 
magnesii  oxidi;  bismuthi  subnitratis  vel 
subsaUcylatis.  Ortner  considers  these  drugs 
of  very  little  use. 

Intestinal  antiseptics:  Beta-naphthohs; 
resorcinolis;  creosoti;  mentholis;  thjunol; 
salol.  See  also  Intestinal  Intoxication. 

B Mentholis gr.  xlv  (gr.  iss  per  pill) 

Extract!  belladonnoe 

foliorum gr.  ivss  (gr.  ^ per  pill) 

M.  ft.  pil.  no.  X.XX. 

Sig. — One  pill,  t.i.d.  (carminative  and  relaxant  of 
colonic  spasm).  (Cohnheim.) 

Intestinal  tonics:  Physostigmin®  vel  ese- 
rin®  salicylatis,  gr.  J-foo  to  34  o to  3-^o>  by 
mouth  or  hypodermically,  every'  three  or 
four  hours  (for  intestinal  atony  or  paresis); 
pituitrin,  0.5  to  1 c.c.  hypodermically,  every' 
hour,  for  say'  from  three  to  six  doses  (for 
intestinal  paresis). 

Typhoid  Fever. — Gr.  stupor  dbo% 

form.  An  acute  infectious  disease,  a bac- 
ter®mia,  causctl  by  the  bacillus  ty'phosus, 
characterizetl  by'  an  incubation  period  of  from 
eight  to  fourteen  day's  or  longer,  followed 
insidiously  by^  malaise,  anorexia,  headache, 
sometimes  chills,  diarrhoea  or  constipation, 
often  epistaxis,  abdominal  distention  and 
tenderness,  sometimes  abdominal  pain, 
coated  tongue,  commonly  bronchitis,  a 
dicrotic  pulse  of  increased  rate,  and  a con- 


TYPHOID  FEVER 


tinued  fever.  The  condition  becomes  pro- 
gressively worse,  the  temperature  gradually 
attains  a maximum  and  remains  there, 
swelling  of  the  spleen  and  rose  spots 
appear  usually  about  the  end  of  the  first 
week  of  definite  illness,  the  mind  becomes 
dull  and  the  general  symptoms  aggravated. 
In  the  third  week  one  may  look  for  a gradual 
decline  of  the  symptoms,  with  morning 
remissions  of  the  temperature;  and  in  the 
fourth  week  the  beginning  of  convalescence. 
But  the  disease  may  last  anywhere  from  a 
few  days  to  twelve  weeks,  and  death  may 
occur  at  any  time  from  toxaemia,  intestinal 
hemorrhage,  or  perforation,  or  a complica- 
tion. Possible  complications  include  pneu- 
monia, pleurisy,  cholecystitis,  otitis  media, 
pyelitis,  osteomyelitis,  periostitis,  parotitis, 
arteritis,  phlebitis  and  thrombosis,  psy- 
choses, boils,  etc.  Even  after  apparent 
recovery,  recrudescences  and  relapses  some- 
times occur. 

Typhoid  fever  is  a protean  disease.  It 
may  be  very  mild  or  very  severe.  Some- 
times the  onset  is  sudden  with  severe  head- 
ache, or  severe  facial  neuralgia,  or  delirium 
or  stupor,  or  meningism  (headache,  photo- 
phobia, retraction  of  the  head,  muscular 
rigidity  and  twitching,  convulsions),  or 
pneumonia,  or  severe  vomiting  (see  Para- 
typhoid Fever),  or  sharp  abdominal  pain,  or 
acute  nephritis.  There  is  a serious  ambula- 
tory form. 

When  hemorrhage  occurs,  the  tempera- 
ture, blood  pressure  {q.v.),  and  haemo- 
globin percentage  (.see  Blood  Examination) 
fall,  and  symptoms  of  collapse  appear. 

Endeavor  to  diagnose  perforation  before 
peritonitis  sets  in.  Significant  signs  are: 
sudden  abdominal  pain  and  nausea  and 
voiniting,  sudden  rise  or  fall  of  temperature, 
with  perhaps  sweating,  sudden  increase  in 
the  pulse  or  respiratory  rate,  and  rise  of 
blood-pressure,  a leucocytosis  following  a 
leucopsenia;  and  later,  muscle  spasm  and 
rigidity,  distention,  diminished  respiratory 
excursions,  and  lessening  or  disappearance 
of  the  area  of  hepatic  dulness.  With  such 
symptoms,  do  an  exploratory  operation 
before  it  is  too  late  (see  below). 

The  following  diseases  may  simulate  ty- 
phoid fever:  Acute  miliary  tuberculosis, 

tuberculous  peritonitis,  malarial  fever,  enter- 
itis, paratyphoid  fever,  septico-pyaemia,  in- 
fluenza, the  acute  exanthemata,  febricula, 
secondary  syphilis,  osteomyelitis,  appendi- 
citis, acute  nephritis,  meningitis,  pneu- 
monia, pleurisy,  trichinosis,  typhus  fever, 
malignant  disease,  ptomaine  poisoning,  etc. 

In  uncomplicated  typhoid  fever  there  is  no 


leucocyto.sis.  The  Widal  reaction  first  ap- 
pears, in  mo.st  cases,  in  the  second  week  of 
the  disease,  or  by  the  time  the  patient  i.s 
sick  enough  to  consult  a physician.  Some- 
times it  does  not  appear  until  convalescence 
sets  in.  A blood-culture  furnishes  the  sure.st 
means  of  diagnosis.  Typhoid  bacilli  are 
demonstrable  in  the  blood  in  the  early  stage 
of  invasion,  when  the  only  s>Tnptom  is  a 
slight  evening  rise  of  temperature  to 
99°-99.8°  F. 

The  Bass  and  Watkins  method  of  per- 
forming the  Widal  macroscopic  agglutina- 
tion test  is  as  follows:  Drop  on  a slide, 

containing  four  drops  of  water,  one  drop  of 
blood,  and  mix  thoroughly  by  stirring  with 
a toothpick.  Then  add  and  mix  an  equal 
amount  of  a suspension  consisting  of  10,000 
million  killed  typhoid  bacilli  per  c.c.  in 
1.7  per  cent,  sodium  chloride  solution  to 
which  is  added  1 per  cent,  formalin.  Tilt 
the  slide  from  side  to  side  .so  as  to  keep  the 
mixture  flowing  back  and  forth,  when,  if 
the  reaction  is  positive,  a grayish  mealy 
sediment  will  appear  in  the  fluid  around  the 
edges  within  one  minute,  never  later  than 
two  or  three  minutes.  (Webster.)  H.  K. 
Mulford  Co.,  Philadelphia,  furnish  the 
necessary  paraphernalia  for  this  test. 

R.  C.  Cabot  considers  the  following 
method  the  best:  “ Measure  out  in  two 
small  test-tubes  ten  drops  and  fifty  drops 
respectively  of  ^ highly  motile  twelve-  to 
twenty-four-hour  bouillon  culture  of  typhoid 
bacilli,  in  which  the  bacilli  have  no  tendency 
to  adhere  spontaneously  to  each  other. 
Carry  these  tubes  and  a microscope  to  the 
bedside,  puncture  the  patient’s  ear  as  usual, 
and  draw  a little  blood  into  a medicine 
dropper  of  the  same  size  as  that  used  in 
measuring  out  the  typhoid  culture.  Expel 
one  drop  of  blood  into  each  of  the  tubes 
containing  the  typhoid  culture,  and  examine 
a drop  of  each  mixture  between  a slide  and 
cover  glass  with  a high-power  dry  lens.  If 
within  fifteen  minutes  clumping  has  taken 
place  in  the  1 : 10  mixture,  or  if  within  one 
hour  clumping  has  taken  place  in  the  1 : 50 
mixture,  the  reaction  may  be  considered 
positive.  By  clumping  I mean  an  aggluti- 
nation of  the  bacilli  into  large  groups  and 
the  complete  or  nearly  complete  cessation 
of  motility.” 

“ If  it  is  inconvenient  to  carry  the  culture 
and  the  microscope  to  the  bedside,  ten  or 
twenty  drops  of  blood  may  be  milked  out 
of  the  ear  and  collected  in  a test-tube  (a 
three-inch  test-tube  of  small  calibre  is  best). 
After  clotting  has  taken  place,  if  the  edges 
of  the  clot  are  separated  from  the  glass  with 


TYPHOID  FEVER 


a needle  or  a wire,  a few  drops  of  serum  will 
exude,  and  this  serum  can  be  mixed  with 
the  bouillon  culture  in  the  manner  already 
described.”  (Cabot.) 

Prognosis. — This  is  never  certain.  It  is 
better  in  children  than  in  adults. 

Etiology  and  Prophylaxis. — The  typhoid  bacil- 
lus is  transmitted  by  means  of  flies,  soiled 
hands,  dust,  and  water  and  food  contami- 
nated with  the  faeces  or  urine  of  persons 
who  have  or  have  had  the  disease.  Foods 
that  are  especially  likely  to  become  con- 
taminated are  water,  milk,  ice-cream,  ice, 
vegetables,  and  shell-fish. 

In  the  care  of  the  patient,  observe  the 
rules  given  under  Disinfection. 

Vaccination  with  dead  typhoid  bacilli  is 
of  great  prophylactic  value.  To  an  adult 
may  be  given,  subcutaneously,  in  a single 
injection,  3 c.c.  of  triple  vaccine,  containing 
to  each  c.c.,  500  million  typhoid  bacilli  and 
250  million  each  of  paratyphoid  A and  B 
bacilli;  to  a child  of  13  to  16  years,  ^-3  the 
adult  dose;  8 to  12  years,  3^^  the  adult  dose; 
5 to  7 years,  34  fh®  adult  dose;  2 to  4 
years,  the  adult  dose.  The  relative  immu- 
nity thus  afforded  lasts  at  least  two  years. 
Contraindications  to  typhoid  vaccination 
are  any  acute  infection,  no  matter  how  slight, 
even  a coryza,  any  acute  gastro-intestinal 
disturbance,  severe  organic  disease,  tuber- 
culosis, chronic  pleurisy,  arteriosclerosis, 
aortitis,  myocarditis,  noncompensated  endo- 
carditis, diabetes,  renal  insufficiency  (hsema- 
turia,  etc.,  not  necessarily  albiiminuria). 
Small  repeated  doses  of  vaccine  may  be 
given  in  doubtful  cases. 

Treatment.— Enjoin  absolute  rest  in  bed 
(including  the  use  of  the  urinal,  bed-pan, 
and  goose-neck  feeder)  in  a well-ventilated 
room.  Fresh  air  is  of  great  importance. 
The  best  bed  is  the  woven  wire  bed  with  soft 
hair  mattress,  upon  which  are  placed  two 
folds  of  blanket,  a rubber  cloth,  and  a 
sheet.  (Osier.) 

The  diet  shoukl  be  mostly  liquid,  a selec- 
tion being  made  from  the  following:  Milk, 
raw  or  boiled,  j^lain,  or  diluted  (to  render  it 
more  digestible)  with  about  two  ounces  to 
the  tumblerful  of  plain  water,  lime  water, 
Vichy,  or  Apollinaris,  or  a pinch  of  salt 
and  sodium  bicarbonate  added,  or  the 
milk  peptonized  (see  Part  11).  About  one  or 
two  quarts  of  milk  may  be  given  in  twenty- 
four  hours. 

Buttermilk,  koumyss,  matzoon,  or  kefir 
(Part  11),  or  malted  milk,  or  cocoa,  or 
junket. 

V'hey,  made  by  boiling  one  pint  of  milk 
with  one  or  two  tablespoonfuls  of  lemon 


juice,  and  straining  and  expressing  the 
Uquitl  through  muslin. 

Cream,  ice-cream. 

Bouillon  or  strained  soups  made  with 
beef,  veal,  mutton,  chicken,  tomato,  potato, 
oyster,  pea,  squash,  and  thickened  with 
powdered  rice,  arrowroot,  or  flour. 

Raw  meat  juice  made  by  stirring  four 
parts  of  finely  chopped  steak  with  one  part 
of  cold  water,  allowing  it  to  stand  for  half 
an  hour  in  the  cold,  and  then  expressing 
the  juice  through  a cloth  or  meat  press. 
Three  to  six  ounces  may  be  given  in  twenty- 
four  hours. 

Finely  minced  lean  meat,  scraped  beef, 
the  soft  parts  of  raw'  oysters. 

Gruels  made  of  barley,  arrowTOot,  rice, 
cormneal,  cracked  wheat,  and  oatmeal, 
boiled  three  hours,  strained,  and  butter  and 
salt  added  and  served  with  a little  cream  or 
milk  with  sugar;  mashed  potatoes. 

Egg  albumen  or  the  whole  egg,  raw  or 
boiled  three  minutes,  or  custard.  Albumen 
water  is  prepared  by  shaking  together  in 
apposed  glasses  the  wdiites  of  one  or  tw’o 
eggs,  a little  lemon  or  orange  juice,  sugar, 
cracked  ice,  and  w'ater  up  to  4 or  6 ounces. 

Flavored  gelatine,  bovinine,  somatose, 
carnipeptone. 

Stale  bread  or  zwdeback  and  butter;  milk 
toast  or  crackers  and  milk. 

Sugar:  one  teaspoonful  to  each  milk 

feeding;  sugar  in  lemonade;  lactose. 

Apple-sauce,  blanc  mange,  wane  jelly, 
soft  puddings,  fruit  juices. 

Water  freely  in  the  form  of  barley  w'ater 
or  lemonade,  five  to  six  quarts  daily,  sucked 
through  a rubber  tube  with  a glass  mouth- 
piece. If  the  patient  is  delirious  or  toxic, 
administer  the  water  regularly  every  hour 
or  oftener.  It  may  be  given  by  bowel  or 
subcutaneously  if  need  be.  Cream  of  tartar 
may  be  added  as  a diuretic,  one  teaspoonful 
to  the  pint  or  quart  (see  Part  11).  The  more 
urine  passed,  the  better  the  prognosis. 

The  following  schedule  (high  caloric: 
Coleman)  nray  serve  as  a guide : 

7 A.  M. — Alilk,  0 ounces,  with  cream, 
about  one  tablespoonful;  cane,  malt,  or 
milk  sugar,  one  teaspoonful,  and  fime  or 
barley  water  several  tablespoonfuls.  One 
egg,  raw  or  boiled  tw'o  or  three  minutes; 
or  instead,  a w'ell-cooked  gruel.  Stale 
bread  crumbs  or  zwieback  and  butter.  Fruit 
juices  (orange,  lemon,  grape,  strawffierry, 
etc.)  as  much  as  desired. 

10  M. — Albumen  water. 

1 p.  M. — IMilk,  6 ounces,  w’ith  cream  and 
sugar,  etc.  One  egg  with  stale  bread  crumbs 
and  butter;  or  finely  minced  or  scraped 


TYPHOID  FEVER 


meat  with  stale  bread  and  butter;  or  a 
strained  and  thickened  soup. 

4 p.  M. — Albumen  water. 

7 p.  M. — Milk,  cream  and  sugar  mixture. 
One  egg  and  stale  bread  crumbs.  Dessert. 

Up.  m. — Albumen  water,  malted  milk, 
or  cocoa. 

3 A.  M. — Albumen  water,  malted  milk, 
or  cocoa. 

The  above  dietaiy  may  be  modified  to 
suit  each  individual  case.  If  the  abdomen 
becomes  distended,  or  curds  appear  in  the 
stools,  or  diarrhoea  occurs,  reduce  the 
quantity  of  milk;  or  substitute  albumen 
water  made  with  the  whites  of  two  or  three 
eggs;  or  whey,  4 ounces,  beaten  up  with 
one  egg  and  a teaspoonful  of  sugar,  and  if 
desired,  about  two  teaspoonfuls  of  sherry 
wine;  or  buttermilk,  kpumyss,  matzoon, 
peptonized  milk,  or  boiled  milk.  The  gruel, 
too,  may  be  dextrinized  by  adding  “ cereo  ” 
(Cereo  Co.,  Tappan,  New  York),  one  tea- 
spoonful to  the  pint  of  gruel  after  cooking 
and  then  cooling  to  a little  above  bloodheat. 
Leave  out  the  yolk  of  egg  and  beef-tea  if 
diarrhoea  is  present,  and  give  a combination 
of  egg  albumen,  arrowroot,  cornflour,  cinna- 
mon or  nutmeg,  with  boiled  milk  and  per- 
haps a little  brandy.  In  the  presence  of 
constipation  give  beef-tea,  boiled  bread 
with  milk,  oatmeal,  honey  and  syrups, 
fruit  juices,  apple  or  apricot  sauce;  an  occa- 
sional morning  saline  (see  Part  11). 

Be  careful  not  to  overfeed  the  patient, 
nor  yet  to  underfeed.  Keep  a three-  or 
four-hourly  chart. 

Swab  the  tongue,  cheeks,  teeth  and  gums 
every  four  hours  with  a mixture  of  glycerine, 
3iv,  boric  acid,  3i,  carbolic  acid,  njjxx,  and 
water  to  giv,  or  glycerine  and  peppermint 
water,  aa  3i,  with  the  juice  of  a lemon, 
using  for  the  purpose  a cotton  stick  or  a 
cotton  or  gauze  sponge  held  with  haemo- 
static forceps.  Anoint  dry  lips  with  vase- 
line, cocoa  butter,  or  alboline. 

Cleanse  the  whole  body  once  daily  with 
soap  and  water  followed  by  an  alcohol  rub 
and  the  dusting  of  talcum  powder  in  the 
flexures  and  folds.  Rub  the  back  and  bony 
parts  subject  to  pressure  with  alcohol  sev- 
eral times  a day,  and  otherwise  guard  against 
bed-sores  as  directed  under  Bed-Sore. 

Give  a soapsuds  enema  every  second  day, 
if  needed,  but  no  purgatives  except  perhaps 
an  occasional  morning  saline.  Some  advo- 
cate in  the  ver>"  beginning  a large  dose  of 
calomel,  gr.  iv,  followed  by  a saline  cathartic. 

Whenever  the  temperature  reaches  or 
exceeds  102.5°  F.,  sponge  the  body,  especi- 
ally the  back,  with  cold  water  for  about 
24 


thirty  minutes;  or  apply  cold  packs,  begin- 
ning with  tepid  ones,  followed  by  others  of 
increasing  coldness;  or  be.st  of  all,  employ 
tub-baths,  beginning  perhaps  with  a tem- 
perature of  90°  F.,  and  cooling  to  about  70° 
to  65°  F.,  if  not  uncomfortable;  or  the 
lower  temperature  may  be  used  at  the  start. 
“ The  addition  of  half  a pound  of  alum  to 
the  water  is  an  advantage,”  says  Osier. 
The  patient  is  supported  in  the  tub  by  can- 
vas strips  attached  to  the  sides  of  the  tub 
by  clamps.  Continue  the  bath  for  twenty 
minutes,  with  constant  rubbing  except  of 
the  abdomen;  but  remove  the  patient  at 
once  should  any  untoward  symptoins  de- 
velop. The  ears  should  be  plugged  with 
cotton  and  cold  compresses  apphed  to  the 
head  while  in  the  bath.  After  the  bath, 
wrap  the  patient  in  sheets  and  blankets,  and 
give  hot  drinks,  and  if  there  is  no  reaction- 
ary after-glow,  apply  hot  water  bottles. 
After  ten  minutes  rub  the  patient  dry  and 
replace  the  gown,  etc. 

An  oil-cloth  tub  in  bed  may  be  improvised 
by  tying  a loop  of  rope  around  the  head- 
board,  another  around  the  foot-board,  and 
connecting  them  by  two  parallel  ropes  to 
which  the  edges  of  a piece  of  oilcloth, 
passed  under  the  patient,  are  attached 
with  clothespins.  (Haven.) 

The  sponges,  packs,  or  baths  should  be  re- 
peated every  three  or  four  hours,  as  required. 

The  purpose  of  the  tub  baths,  according 
to  their  advocates,  is  not  only  to  reduce 
fever,  but  chiefly  to  increase  the  elimination 
of  toxins  and  the  patient’s  resistive  powers 
by  healthful  stimulation  of  the  nervous 
circulatory,  respiratory,  and  excretory  func- 
tions. Contraindications  to  their  use  are: 
severe  abdominal  pain,  hemorrhage,  peri- 
tonitis, great  prostration,  phlebitis,  chole- 
cystitis, otitis  media,  meningismus. 

Ortner  praises  pyramidon  as  an  anti- 
pyretic, gr.  iii  to  iv  (sometimes  even  6 grs. 
at  the  beginning),  every  two  hours  day  and 
night  as  long  as  there  is  any  fever.  If 
desired,  he  says,  caffeine  sodim  benzoate, 
gr.  iii  to  ivss,  may  be  given  with  it  to  pro- 
tect the  heart.  It  has  never  been  injurious, 
says  Ortner,  and  it  eliminates  the  “ typhoi- 
dal  ” character  of  the  disease.  Quinine 
hydrochlorate,  gr.  vii,  on  three  successive 
evenings,  is  also  of  use  when  hydrotherapy 
is  impracticable  or  contraindicated. 

Osier  says:  “ It  is  usually  advisable  to 
give  urotropin  after  the  second  week,  gr. 
XX  to  XXX  daily,”  to  be  continued  through- 
out convalescence. 

Salomon  reports  remarkable  results  Avith 
the  following  treatment:  An  initial  brisk 


TYPHOID  FEVER 


saline  purge  (if  the  case  is  seen  early),  fol- 
lowed by  arsenite  of  copper; 

(li  Cupri  arsenitis,  Merck’s,  c.  p.,  gr.  ss. 

Aquae  destillatae 5vi. 

Triturate  the  salt  in  a mortar  before  adding  the 
water. 

M.  Sig. — Shake  well  and  take  1 to  2 drams  (gr. 
Vm-'Ao  of  the  arsenite)  every  three  hours); 

a daily  saline  colonic  enema,  and  a liquid 
diet  consisting  of  liquid  peptonoids,  pano- 
pepton,  or  Hart’s  alimentary  elixir,  etc.,  e.g., 
of  liquid  peptonoids,  1 oz.  (62.1  calories) 
every  two  hours,  the  whites  of  three  or  four 
eggs  daily,  in  orange  or  grape  juice,  water, 
preferably  carbonated,  ad  libitum  (1000 
calories  in  twenty-four  hours);  an  ice-cap 
to  the  head  (never  to  the  abdomen);  no 
antipyretics. 

Minchin  strongly  recommends  garlic  (see 
Part  11)  as  an  antiseptic. 

Treatment  of  Symptoms. — Tox^MIA  ANdPros- 
TRATioN  WITH  Feeble  Pulse. — Aihniiiister 
water  systematically  and  bathe  frequently. 
Give  whiskey  or  brandy,  4 to  10  ounces  in 
twenty-four  hours.  Change  the  patient’s 
position  every  hour  or  two  in  such  cases  and 
prop  with  pillows  in  order  to  prevent  hypo- 
stases. F or  great  restlessness  give  morphine 
or  hyoscine  hypodermically.  Lumbar  punc- 
ture iq.v.)  is  also  recommended  for  nervous 
symptoms  (delirium,  stupor,  etc.),  “the  fluid 
being  allowed  to  run  as  long  as  it  flows  under 
pressure,”  (Osier);  or,  according  to  McCrae, 
no  more  than  20  c.c.  at  one  tune.  In  delir- 
ium place  an  ice-cap  to  the  head. 

Headache. — Ice-cap  to  the  head;  phena- 
cetin,  gr.  v,  repeated  if  necessary ; or 
lactophenin,  gr.  x to  xv  (“  safest  and 
best,”  Croftan)  ; or  codeine,  gr.  34 J or 
morphine  hyjiodermically. 

Gastric  Indigestion. — Give  only  albu- 
men water,  or  water  alone;  lavage  is  useful. 
P’or  nausea  and  vomiting,  try  iced  champagne 
or  some  one  of  the  remedies  enumerated 
under  Vomiting. 

Diarrhcha  (More  Than  3 to  5 Stools 
Daily)  . — Restrict  the  diet  to  whey  or  albu- 
men water,  and  give  bismuth,  gr.  xxx  to  xl, 
every  four  hours  (see  Part  11),  with  or  with- 
out Dover’s  powder,  gr.  v,  or  tincture  of 
opimn,  njv;  or  prescribe  the  following: 

Plumbi  acetatis . gr.  viii  (gr.  ii  per  dose) 

Acidi  acetici 

diluti oLoi  Di  (rr^xv-xx  per  dose) 

Morphime  aco- 

tatis gr.  (gr.  jHi  per  dose) 

Aqua},  q.s.  ad ...  3 ii 

M.  Sig. — One  tablespoonful  every  throe  hours. 

An  enema  of  starch  solution,  3ii,  contain- 
ing tincture  of  ojiium,  gtt.  x to  xv,  may 


be  effectual.  For  pain,  apply  an  ice-bag  to 
the  abdomen. 

Meteorism. — See  Tympanites. 

Olei  terebinthinae 

rectificati Trj.xl-^ii-Bii  (iDJv-xx per  dose) 

Mucilaginis  acacias,  5i 
Olei  gaultheria? ....  njviii 
Aquas,  q.s.  ad §iv 

M.  et  fiat  emulsum. 

Sig. — One  tablespoonful  every  three  or  four  hours, 
with  plenty  of  water.  (Continue  no  longer  than  48 
hours;  and  do  not  give  if  nephritis  is  present.) 

Employ  hot  turpentine  stupes  alternat- 
ing with  plain  hot  stupes,  as  described 
under  Tympanites.  But  attend  particularly 
to  the  diet;  milk  may  be  causative. 

Circulatory  Feebleness. — Administer 
strychnine;  digitalin;  tr.  strophanthi;  whis- 
key or  brandy;  normal  saline  subcutanoeus 
infusions  (0.8  per  cent.),  500  to  700  c.c.  once 
or  twice  daily.  Apply  an  ice-bag  to  the  pre- 
cordium.  For  sudden  collapse  administer 
camphor  hypodermically;  or  aromatic  spirits 
of  ammonia  (see  Drugs,  Part  11). 

Abdominal  Pain. — Ascertain  and  cor- 
rect the  cause : meteorism,  constipation, 
improper  feeding,  diarrhoea,  colic,  vomiting, 
chstended  bladder,  enema,  painful  spleen, 
old  adliesions,  hemorrhage,  perforation,  phle- 
bitis, cholecystitis,  pleurisy,  pericarditis, 
appemhcitis,  peritonitis,  intestinal  obstruc- 
tion, liver  abscess,  suppurating  mesenteric 
glands,  cystitis,  hypersesthesia,  hysteria, 
menstruation,  labor,  abortion,  hepatic  or 
renal  colic,  etc. 

Phlebitis  and  Thrombosis. — See 
Thi’ombosis. 

Retention  of  Urine. — Employ  hot  ap- 
plications to  the  epigastrium  and  hot  ene- 
mata  before  resorting  to  the  catheter. 

Bacilluria  and  Gystitis. — Prescribe 
urotrojiin,  gr.  x,  t.i.d.;  and  irrigate  the 
bladder  with  warm  boiled  boric  acid  solution, 
5i  ad  Oi,  if  necessary.  Continue  the  uro- 
tropin  until  no  bacilli  are  present  in  the 
urine,  i.e.,  for  several  weeks  if  necessarjL 
Biernacki  says  that  the  bladder  is  rendered 
sterile  of  typhoid  bacilli  in  ten  days. 

Bed-Sores. — See  Bed-Sores. 

Tender  Toes. — Keep  the  weight  of  the 
bed-clothes  off  the  toes  by  means  of  a cradle. 
Paint  the  toes  with  alcohol  and  tr.  iodi,  aa,  or 
with  oil  of  wintergreen. 

Cholecy'stitis. — Apply  an  ice-bag  or  hot- 
water  bag.  Sjiontaneous  recovery  is  the 
rule;  but  operate  at  once  in  the  presence  of 
severe  pain,  distention,  and  a rising  tempera- 
ture, as  perforation  may  occur  (.see  Chole- 
cystitis). Give  urotropin  (Part  11)  in  large 
doses  for  chronic  cholecystitis. 


TYPHUS  FEVPHl 


Orchitis,  Parotitis,  Mastitis,  Perio- 
stitis, ETC. — Apply  an  ice-bag.  Incise  and 
drain  abscesses.  Use  the  Pacpielin  cautery 
or  morphine  for  painful  bone  conditions. 

Coxitis. — Apply  long  splints  or  sand- 
bags to  prevent  chslocation. 

Hemorrhage. — Elevate  the  foot  of  the 
bed,  place  an  ice-bag  to  the  abdomen  (with 
hot  bottles  to  the  feet  if  necessary),  and 
maintain  absolute  quiet,  giving  morphine, 
gr.  hypodermically,  if  the  patient  is 
restless.  Calcium  lactate  or  chloride  (Part 
11)  and  also  turpentine,  irpxx,  every  three 
or  four  hours  (see  under  Meteorism), 
are  recommended.  Allow  no  food  or  water 
by  mouth,  excepting  ice  to  suck,  for  eight 
to  twenty-four  hours;  then  begin  with 
iced  whey  before  returning  to  milk.  The 
bowels  should  be  kept  at  rest  for  at  least 
three  days;  to  this  end  an  enema  may  be 
given,  consisting  of  starch  solution,  5ih  and 
tr.  opii,  Tijxx.  Avoid  stimulants. 

Perforation. — Operate  at  once.  Incise 
the  abdomen  over  the  seat  of  greatest  tender- 
ness and  muscle  spasm.  Examine  the 
appenchx  and  c£ecum,  and  follow  the  ilium 
from  the  caecum.  Sponge  gently  the  peri- 
toneal cavity  and  pack  off  the  intestines 
with  gauze  while  searching  for  the  perfora- 
tion. Close  the  latter  with  a silk  pur.se- 
string  suture,  reinforced  by  a Lembert  or 
mattress  suture;  or  if  the  perforation  is  too 
large,  make  a fecal  fistula.  Look  for 
threatened  perforations  and  close  them  in 
with  a purse-string.  Keep  the  intestinal 
coils  within  the  abdomen  or  covered  with 
hot  normal  saline  packs.  Carefully  wipe 
up  all  exudate.  Drain  by  means  of  a gauze 
wick  which  should  be  removed  after  tbirty- 
six  hours.  Place  the  patient  in  a semi -sitting 
posture  in  bed,  and  give  normal  saline  solu- 
tion per  rectum  by  Murphy’s  method 
(see  under  Appendicitis),  or  subcutaneous- 
ly. Apply  hot  water  bags.  Give  morphine 
if  necessary.  Begin  feeding  as  soon  as 
nausea  is  over.  Keep  fistulous  margins 
anointed  with  vaseline;  the  opening  usually 
closes  spontaneously  (Finney).  J.  Biernacki 
allows  no  food  for  eight  hours,  then  pep- 
tonized whey,  5 ss,  every  half  hour  for  twelve 
hours,  gradually  increased  to  5v  every  two 
hours  on  the  second  and  third  days,  then 
milk  added,  then  milk  alone. 

Management  of  Convalescence. — 
Withhold  solid  food  for  about  a week  to  ten 
days  after  the  temperature  has  returned  to 
normal;  then  add  to  the  dietary  by  degrees 
until  regular  diet  is  resumed.  Prop  the  pa- 
tient up  in  bed  about  a week  after  deferves- 
cence; a few  days  later  let  him  sit  up;  the 


time  out  of  bed  is  very  gradually  lengthened 
until  he  is  strong  enough  to  be  uji  all  day.  A 
rapid  or  slow  heart  calls  for  rest.  Three  to 
.six  months  of  rest  is  advisable.  Slight 
fever  sometimes  persists.  For  constipa- 
tion, employ  high  enemata  of  water  or  oil, 
and  mild  laxatives,  such  as  cascara,  com- 
pouml  licorice  powder,  or  aloin,  strychnine, 
and  belladonna  pills  (see  Part  11)  For 
persistent  charrhoea,  which  may  mean 
ulceration  in  the  colon,  restrict  the  diet, 
and  administer  bismuth  ami  antiseptic  and 
astringent  injections  (see  Enteritis,  Chronic). 
For  emaciation,  prescribe  a daily  oil  rub; 
for  anaemia,  Bland’s  pills;  for  oedema  of  the 
feet  on  walking,  rest  and  elastic  stockings. 
For  the  typhoid  spine  (acute  painful  symp- 
toms; somethnes  paralyses),  fix  the  patient 
upon  a Bradford  bed  frame,  as  in  acute 
Pott’s  disease,  until  the  very  acute  symp- 
toms have  subsided,  then  apply  a jilaster 
jacket  or  Taylor  brace  (see  Pott’s  Dtsease, 
in  Part  10,  Orthopaedics).  The  Paquelin 
cautery  is  useful  for  the  relief  of  pain.  The 
conchtion  is  usually  cured  in  six  months.  It 
may  be  hysterical  (Osier). 

In  bone  lesions  the  diseased  parts  must 
be  removed. 

The  mental  and  physical  capacity  for 
work  and  the  memory  will  return  in  time. 
The  post-typhoid  nervous  disturbances  usu- 
ally disappear  eventually. 

TyphoidSpine. — See  underTyphoid  Fever. 

Typhus  Fever.  — Gr.  ru<^os  stupor.  An 
acute  infectious,  usually  epidemic  disease 
of  unknown  cause,  transmitted  by  the  body 
louse,  and  characterized  by  an  incubation 
period  of  five  to  twenty-one  days,  followed 
abruptly  by  headache,  veitigo,  vomiting, 
epistaxis,  cough,  congestion  of  the  face  and 
conjunctivse,  general  pains,  chills  or  chilli- 
ness, fever,  and  prostration,  and  about  the 
third  to  sixth  day  a macular  morbilliform 
rash,  in  places  petechial;  there  are  usually 
high  fever,  delirium,  and  severe  toxiemia, 
and  if  death  does  not  occur,  the  symptoms 
decline,  often  by  crisis,  between  the  tenth 
and  fifteenth  days,  and  convalescence 
follows,  with  fine  cutaneous  desquamation. 
Severe  hemorrhagic  cases  sometimes  occur. 
Po.ssible  complications  are  myocarditis, 
bronchitis,  pneumonia,  gangrene  of  various 
parts,  periostitis,  peripheral  neuritis,  sup- 
purations, phlegmasia  alba  dolens. 

It  is  a rare  disease  in  the  United  States  and 
Canada.  It  predominates  in  cold  weather. 

Prognosis. — The  mortality  is  high  after 
middle  life,  and  in  alcoholics  and  those  in 
unsanitary  circumstances.  It  is  very  low 
in  the  young. 


ULCER,  RODENT 


Treatment. — Isolate  the  patient,  and  treat 
him  as  in  typhoid  fever,  except  that  tlie 
bowels  should  be  kept  active.  Immune 
serum  obtained  from  the  horse  or  ass  is 
administered  hypodermically,  10  to  20  c.c. 
daily  until  defervescence.  Allow  water  ad 
libitum,  to  promote  diuresis,  and  administer 
cardiac  tonics  as  retiuired.  A thorough  soap 
and  water  bath  should  be  given  at  once, 
followed  by  bichloride,  1 : 2000,  to  destroy 
louse-eggs;  the  hair  should  be  clipped.  The 
personal  and  bed  clothing  should  be  boiled 
or  soaked  in  bichloride,  1 : 500.  Fumigate  the 
infectetl  room  with  formaldehyde  and  sul- 
phur (see  Disinfection) ; and  keep  the  room 
sealed  for  twelve  hours.  The  patient  should 
be  quarantined  for  not  less  than  four  weeks. 

Ulcerative  Stomatitis. — See  Stomatitis, 
Ulcerative. 

Ulcer,  Buccal. — L.  ulc'us;  buc'ca,  cheek. 
See  Stomatitis  Vesiculosa;  Stomatitis  Ulcer- 
osa; and  Glossitis. 

Ulcer,  Colonic. — See  Enteritis. 

Ulcer,  Cutaneous. — L.  ulc'us,  ulcer;  cut'is, 
skin.  The  commoner  causes  of  cutaneous 
ulceration  are  traumatism,  burns,  frost- 
bite, sunple  pyogenic  infection,  diphtheria, 
ecthyma,  varicose  veins,  decubitus,  herpes, 
chancroid,  syphilis,  tuberculosis,  and  car- 
cinoma. Rarer  causes  are  leprosy,  glanders, 
erythema  induratum,  oriental  sore,  craw- 
craw,  granuloma  inguinale  tropicum,  phage- 
dena tropica,  ulcerating  granuloma  of  the 
pudenda,  and  the  various  causes  of  trophic 
or  perforating  ulcer  (locomotor  ataxia,  de- 
mentia paralytica,  syringomyelia,  fracture 
of  the  spine,  spina  bifida,  cord  tumor,  hemi- 
plegia, Friedreich’s  ataxia,  progressive  mus- 
cular atrophy,  myelitis,  multiple  neuritis, 
division  of  the  peripheral  nerves,  (habetes, 
chronic  alcoholism,  arteriosclerosis,  throm- 
boangitis.)  (See  Gangrene  of  the  Skin,  in 
Part  5,  Skin  Diseases,  etc.),  etc. 

Treatment. — Attend  to  the  cause.  Cleanse 
the  ulcer  with  castile  soap  and  warm  water, 
and  apply  warm  boric  acid  fomentations 
until  swelling  and  pain  subside,  at  the  same 
time  keeping  the  limb  elevated.  Then  dust 
the  ulcer  with  sterile  powder,  such  as  boric 
acid,  iodoform,  bismuth,  aristol,  iodol,  etc.; 
or  apply  sterile  boric  ointment,  10  per  cent., 
or  equal  parts  of  balsam  of  Peru  and  castor 
oil,  or  ung.  hydrarg.  ammoniati  (see  Part 
1 1),  oi- 1 i)cr  cent.  Griibler’s  Fuchsin  in  Lano- 
lin (highly  praised  by  W.  H.  DonnelljO- 

Ionic  medication  is  well  recommended 
(see  under  Inflammation).  Pack  the  ulcer 
with  absorbent  wool  or  lint  soaked  with 
the  selected  electrol^dic  solution.  Finzi 
recommends  that  2 to  3 milliamperes  of 


current  be  employed  per  square  centimetre 
of  surface,  for  two  to  four  minutes.  The 
treatment  may  be  repeated  every  seven 
days.  If  the  ulcer  does  not  heal  satisfac- 
torily, give  large  doses  of  potassium  iotlide 
(Part  11)  and  continue  the  ionization. 

Centripetal  massage  is  of  benefit  in  all 
forms  of  chronic  ulcer;  as  is  also  baking 
with  dry  hot  air  (temp.  250°  to  300°  for 
twenty  to  thirty  minutes,  thrice  a week). 

Indolent  ulcers  may  be  stimulated  by 
thorough  scraping,  or  by  cauterization  every 
few  days  with  silver  nitrate,  pure  carboUc 
acid  followed  with  alcohol,  or  zinc  chloride 
10  per  cent. 

The  actual  cautery  may  be  employed  for 
phagedenic  ulcers. 

In  the  case  of  chronic  ulcers  which  will 
not  heal  because  of  constriction  of  the 
blood  supply  by  scar  tissue,  make  multiple 
radiating  incisions  through  the  scar  tissue, 
or  a circular  incision  thi’ough  the  thickened 
skin,  about  one  to  three  centunetres  from 
the  ulcer. 

The  following  treatment  is  well  recommen- 
ded for  non-inflamed  callous  ulcei’s:  Draw 
the  edges  of  the  ulcer  together  with  over- 
lapping strips  of  one-inch-wide  zinc  oxide 
aclhesive  plaster,  which  should  cover  the 
entire  ulcer  and  nearly  ench'cle  the  leg. 
Change  the  plaster  eveiy  twenty-four  to 
forty-eight  hours. 

If  it  is  decided  to  cover  the  denuded  area 
with  skin  grafts  (Theirsch  grafts),  first  subdue 
all  inflammation,  and  curette  away  granula- 
tions; or  the  ulcer  may  be  fii'st  excised. 

To  prevent  perforating  ulcers,  avoid  pres- 
sure from  shoes  and  much  walking,  and 
pare  callosities.  Rest  constitutes  the  best 
treatment  of  tropluc  ulcers.  Sequestra 
may  require  removal.  Amputation  is 
somethnes  necessary. 

For  the  treatment  of  varicose  ulcers, 
see  Varicose  Wins. 

Clu'onic  ulcers  and  unhealthy  sores  are 
markedly  unproved  and  cured  by  means  of 
rachotherapy,  emjiloyed  as  in  eczema. 

Ulcer,  Duodenal.- — See  Gastric  and  Duo- 
denal Ulcer. 

Gastric. — See  Gastric  and  Duodenal 
Ulcer. 

Intestinal. — See  Enteritis  Chronica. 

Lingual. — See  Glossitis. 

Mouth. — See  Stomatitis  Vesiculo.sa; 
Stomatitis  Ulcerosa;  and  Glossitis. 

CEsophageal.— j^ee  Oesophagitis,  Chronic. 

Perforating. — See  Ulcer,  Cutaneous. 

Rectal. — See  Proctitis. 

Rodent. — See  Carcinoma  Cutis,  in  Part 
5,  Skin  Diseases. 


URAEMIA 


Ulcer,  Skin. — See  Ulcer,  Cutaneous. 

Stomach. — See  Gastric  and  Duodenal 
Ulcer. 

Tongue. — See  Glossitis. 

Varicose. — See  Varicose  Veins. 

Ulnar  Nerve. — See  Brachial  Plexus. 

U ncinariasis. — See  Ankylo.stoiniasis. 

Unconsciousness. — See  Coma. 

Undulant  Fever. — L.  un'da,  wave.  See 
Malta  Fever. 

Uraemia. — Gr.  ovpov  urine  + atya  blood. 

A toxteinia  due  to  renal  insufficiency,  and 
manifested  by  the  following  variable  symp- 
toms, which  are  either  acute  or  chronic: 
headache,  cUzziness,  drowsiness,  hiccough, 
transient  cUmness  or  loss  of  vision,  transient 
paralyses  and  aphasia,  nausea  and  vomiting, 
diarrhcea,  pruritis,  parajsthesise,  cramps  in 
the  muscles  of  the  calves,  stomatitis,  urinous 
breath,  dyspnoea,  Cheyne-Stokes  respiration, 
restlessness,  muscular  twitchmg,  convulsions, 
delusional  insanity,  delirium,  mania,  coma. 
(In  obstructive  anuria,  q.v.,  these  symptoms 
may  be  absent — latent  uraemia.)  The  urine  is 
scanty  and  contains  albumen,  and  its  specific 
gravity  is  low.  The  pulse  tension  is  usually, 
not  always,  high.  The  elhnination  of  phtha- 
lein  on  the  achninistration  of  phenolsulphone- 
phthalein  is  “ nil  or  only  a faint  trace  in  two 
hours.”  Says  Osier:  “ In  patients  with 

chronic  nephritis  in  whom  the  elhnination 
in  two  hours  is  below  10  per  cent.,  there  is 
grave  danger  of  ursemia.”  (See  Urinalysis.) 

Differentiate  uraemia  from  other  causes 
of  coma  (q.v.)  and  convulsions  (q.v.). 

Prognosis.— In  acute  nephritis,  complete 
recovery  may  occur;  but  in  chronic  nephri- 
tis, if  recovery  does  occur,  it  is  only  partial 
and  temporary. 

Treatment.— Restrict  the  diet  to  milk,  one 
quart,  diluted  with  eight  ounces  of  lime 
water,  per  day.  Achninister  hydragogue 
cathartics — 

Calomel,  gr.  v to  x,  with  sothum  bicarbo- 
nate, gr.  XX,  in  a single  dose;  or  divided  doses 
of  about  1 gr.  every  hour  until  effectual, 
followed  by  a saline. 

Elaterin,  gr.  to  }/io,  two  or  three  times 
during  the  day. 

Compound  jalap  powder,  oss  to  i,  in  a 
little  water,  once  or  twice  a day. 

Salines  (Part  11). 

Croton  oil,  gtt.  ii,  upon  the  tongue,  if  the 
patient  is  unconscious. 

Apply  dry  cups  (q.v.),  mustard  poultices, 
(Part  11)  hot  hnseecl  poultices,  or  hot-water 
bags  over  the  kidneys  to  increase  the  flow 
of  mine. 

Once  daily  or  oftener  give  a hot-air,  hot- 
vapor,  or  hot-water  sweat  bath,  an  ice-cap 


being  kept  to  the  head.  The  hot-air  bath  may 
be  given  under  the  elevated  bed-covering 
by  means  of  a stove  pipe.  The  most  con- 
venient methods  of  administering  a sweat 
bath  are  (1)  the  use  of  electric  light  bulbs 
beneath  the  bed-covering,  and  (2)  hot 
bricks  covered  with  wet  towels  sprinkled 
with  alcohol.  Continue  the  sweating  for 
from  fifteen  to  twenty  minutes  to  one  hour, 
and  give  at  the  same  time  hot  drinks  con- 
taining diaphoretics,  e.g.,  spt.  setheris  nitrosi, 
5ss  to  i,  every  half  to  one  hour;  liq.  ammonii 
acetatis,  5ss  to  i,  every  four  hours;  potas- 
sium bicarbonate,  gr.  xxx,  every  two  hours; 
or  give  large  normal  saline  enemas  (3i  ad 
Oi).  Watch  the  pulse  closely  during  the 
sweat,  and  give  stimulants  if  required,  e.g., 
camphor,  chgitalin,  caffeine  (see  Part  11). 
After  the  sweat,  rub  the  jDatient  dry,  and 
cover  with  woolen  blankets. 

Rectal  irrigations  of  hot  normal  saline 
solution  (temp.  120°  to  150°  F.)  are  of  value. 

Large  doses  of  socfium  bicarbonate  and 
also  dextrose  are  recoimnendetl  (see  Aci- 
dosis). Diuresis  may  thereby  be  promptly 
established. 

Venesection  and  the  withdrawal  of  12  to 
24  ounces  of  blood,  replaced  if  oedema  is  not 
present  by  normal  saline  solution  given  sub- 
cutaneously (500  to  1000  C.C.),  may  be  prac- 
ticed in  acute  cases  in  robust  patients  when 
the  pulse  tension  is  lugh.  The  nitrites  may 
be  of  some  service  in  high  tension  cases: 
nitroglycerine,  gr.  }-ioq  to  every  fifteen 
to  thirty  minutes,  until  effectual. 

Diuretics  may  be  of  service  in  chronic 
nephritis;  but  they  are  not  indicated  in 
acute  nephritis,  in  which  they  may  cause 
dangerous  irritation : cUuretin ; agurin ; theo- 
cin;  caffeine;  potassium  acetate;  potassium 
bitartrate;  inf  us.  scoparii;  infus.  tritici  re- 
pentis  (see  Part  11). 

For  restlessness,  insomnia  (q.v.)  mental 
disturbance,  and  dyspnoea,  give  morphine. 
Says  Osier:  “ Morphine  is  of  especial  value 
in  the  dyspnoea  and  Cheyne-Stokes  breath- 
ing of  advanced  arteriosclerosis  with  chronic 
ui’Eemia.” 

For  dyspnoea  or  ursemic  asthma  are  also 
recommended  oxygen  inhalations  (see  under 
Pneumonia).  Croftan  considers  spt.  aetheris, 
gtt.  XX  to  xxx,  well  diluted,  several  timesa  day, 
or  pure  ether  in  teaspoonful  doses  by  mouth, 
or  1 to  2 c.c.  hypoclermically,  three  or  four 
times  in  twenty-four  hours,  the  best  remedy. 
Ortner  gives  two  teaspoonfuls  internally 
every  half-hour,  day  and  night,  or  2 c.c. 
hypodermically  every  hour. 

For  convulsions,  administer  chloral  and 
potassium  bromide  per  rectum,  well  diluted, 


URINALYSIS 


p;r.  XX  to  XXX  of  the  former,  and  gr.  xxx  to  xlv 
of  the  latter;  to  be  repeated  after  two  hours, 
if  recjuired.  Hyoscine  hydrobromide,  gr. 
Hoo  b>  ^50,  hypodermically,  is  also  recom- 
mended. Achninister  chloroform  by  inhala- 
tion until  the  chloral  has  had  time  to  act. 

For  vomiting,  see  Vomiting. 

Thyroid  extract  in  large  doses  (gr.  x,  t.i.d.) 
is  reputed  to  be  of  value  as  an  antidote  to 
nitrogenous  poisoning  in  uraemia. 

Ureteral  Calculus. — See  Nephrolithiasis. 

Urinalysis. — Use  for  analysis  a mixed 
twenty-four  hour  sample  of  the  urine. 
Instruct  the  patient  to  empty  the  bladder, 
say  at  7 a.  m.,  throw  the  urine  away,  and 
save  all  subsequent  voicUngs  up  to  7 a.  m. 
the  next  morning.  The  urine  should  be 
kept  well  corked  in  a cool  place.  To  obtain 
uncontaminated  bladder  urine,  take  the 
urine  voided  in  the  second  of  two  glasses. 

Amount. — The  average  normal  excretion  in 
adults  is  about  1200  to  1500  c.c.  in  twenty- 
four  hours;  or  more  correctly,  about  1 c.c. 
per  kilo  pounds)  per  hour  in  adults; 

about  4 c.c.  per  kilo  per  hour  in  children. 

Reaction.— Test  the  reaction  by  means  of 
litmus  paper  (see  Alkalinuria) . 

Specific  Gravity. — Test  the  specific  gravity, 
first  removing  foam  with  filter  paper.  The 
urinometer  should  float  perfectly  free  in  the 
cylinder.  Take  the  reading  from  the  lower 
meniscus  of  the  urine  as  seen  from  below. 

The  normal  specific  gravity  of  the  twenty- 
four-hour  urine  is  1.015  to  1.020  (average) 
to  1.025.  The  last  two  figures  of  the  s.g.  x 
2.33  equals  the  number  of  grams  of  total 
solids  in  1000  c.c.  of  urine,  which  is  normally 
GO  to  70  gms.  with  a twenty-four-hour  excre- 
tion of  1500  c.c.;  or,  the  last  two  figures  of 
the  s.g.  X number  of  ounces  of  urine  in 
twenty-four  hours  x 1.1.  = total  urinary 
solids  m grains.  The  urea  is  usually  about 
one-half  the  total  solids.  The  normal 
amount  of  urea  in  twenty-four  hours  is  15 
to  40  gms.  The  last  two  figures  of  the 
s.g.  (provided  no  albumin  or  sugar  is 
present)  indicate  practically  the  percentage 
of  urea,  e.g.,  a s.g.,  of  1.015  = 1.5  per  cent, 
urea. 

Albumin.— Filter  the  urine  if  cloudy,  first 
shaking  it  if  necessary  with  powdered  char- 
coal, mag.  oxide,  mag.  carbonate,  barium 
carbonate,  silicic  acid,  sawilust,  or  lime 
water. 

Boil  the  urine — a cloudiness  means  cal- 
cium phosphate  (rarely  calcium  carbonate) 
or  albumin.  Uloudiness  of  the  urine  which 
clears  up  on  heating  is  due  to  urates. 

Add  dilute  acetic  acid  (5  per  cent.)  drop 
by  tlrop — a clearing  means  phosphates 


(effervescence  indicates  carbonates);  cloud- 
ing means  albumin.  Remember  in  adding 
the  acetic  acid  that  albumin  is  soluble  in  a 
very  slight  excess  of  acid;  therefore  add 
only  a few  ch’ops.  Indeed  the  urine,  when 
voided,  may  be  too  acid  to  show  albumin,  and 
may  have  to  be  neutralized  with  an  alkali. 

Acidulate  the  urine  strongly  with  acetic 
acid;  then  add  a few  drops  of  a 10  per  cent, 
solution  of  potassimn  ferrocyanide,  drop  by 
drop — turbidity  means  albumin.  An  excess 
of  potassium  ferrocyanide  will  dissolve  the 
precipitate  first  formed. 

Add  to  the  diluted  urine  in  a tesUtube 
concentrated  nitric  acid  introduced  to  the 
bottom  of  the  test-tube  by  means  of  a glass 
pipette.  The  occurrence  of  a white  ring 
at  the  zone  of  contact  of  the  two  fluids  means 
albumin.  The  ingestion  of  turpentine, 
copaiba,  cubebs,  sandal-oil,  and  benzoin 
interferes  with  the  value  of  this  test;  but 
these  resins  may  first  be  removed  by  shaking 
the  urine  with  ether. 

Add  to  the  acidulated  urine  a small 
fragment  of  solid  sulpho-salicylic  acid — 
turbidity  or  a white  flocculent  precipitate 
means  albumin. 

To  estimate  the  quantity  of  albmnin,  fill 
Esbach’s  albuminometer  with  urine  to  U, 
slightly  acidulate  with  dilute  acetic  acid, 
then  add  to  R the  following  solution,  e.g., 
phosphotungstic  acid,  1.5  gms.,  concentrated 
HCl,  5 C.C.,  alcohol,  .95  per  cent.,  q.s.  ad 
100  c.c.  Reverse  the  tube  several  times,  and 
allow  it  to  stand  for  twenty-four  hoiirs,  or 
until  the  supernatant  fluid  is  water-clear. 
The  figures  on  the  scale  indicate  grams  of 
albumin  per  1000  c.c.  of  urine.  This, 
divided  by  10  gives  the  percentage.  If 
much  albumin  is  present,  the  urine  must  be 
diluted,  the  s.g.  should  be  below  1.008. 

A quicker  and  more  accurate  method  is 
that  of  Purdy:  To  a graduated  Purdy  tube 
add  10  c.c.  of  urine,  3 c.c.  of  a 10  per  cent, 
aqueous  solution  of  potassium  ferrocyanide, 
and  2 c.c.  of  50  per  cent,  acetic  acid.  MLx 
thoroughly  and  allow  it  to  stand  for  ten  min- 
utes; then  centrifuge  for  three  minutes  in  an 
electric  centrifuge  at  the  rate  of  1500  revolu- 
tions a minute.  Then  read  off  the  percen- 
tage on  the  tube,  each  division  representing 
1 per  cent,  by  bulk  or  0.021  i:>er  cent,  by 
weight  of  albmnin.  The  radius  of  the  centri- 
fuge with  tubes  extended  must  be  6% 
inches. 

. Microscopic  Examination. — Examine  the  sedi- 
ment of  the  centrifuged  urine  for  red  blood- 
cells  (see  Htematuria),  leucocxfies  (see  Pjniria), 
casts— hyaline,  granular,  blood,  leucocyte, 
eifithelial,  waxy,  fatty  (do  not  confuse  the 


URINALYSIS 


tapering  cylindroids  with  casts),  crystals 
(leucin,  tyrosin,  etc.),  and  bacteria. 

Bence=Jones’s  Proteid  or  Albumose. — Heat  the 
acidulated  urine  very  slowly.  At  between 
50°  and  60°  a cloucUness  begins  to  appear, 
which  becomes  denser,  but  almost  or  entirely 
disappears  when  the  boiling  point  is  reached. 
On  cooling,  the  precijiitate  reappears.  Add 
concentrated  nitric  acid,  th’op  by  drop.  A 
precipitate  appears  which  disappears  on 
shaking,  but  persists  if  more  acid  be  added. 
Heating  causes  the  precipitate  to  dissolve, 
to  reappear  on  cooling.  (See  Multiple 
Myelomata  of  the  Bones.) 

Glucose.— Albumin  must  first  be  removed 
before  testing  for  sugar.  Always  perform 
several  cUfferent  tests. 

1.  Fehling’s  Test. — Reagents  used:  A. 
Copper  solution:  pure  crystallized  copper 
sulphate,  34.64  gms.,  chstilled  water,  q.s.  ad 
500  C.C.;  B.  Alkaline  solution:  Rochelle 
salt,  173  gms.,  sochum  hydrate,  50  gms., 
distilled  water,  q.s.  ad  500  c.c. 

Mix  equal  quantities  of  the  two  solutions 
and  boil;  then  add  the  tliluted  urine  (freed 
from  albumin  by  acidulating  with  acetic  acid, 
boiling,  and  filtering),  ch'op  by  drop,  no 
more  than  10  to  20  drops,  and  again  boil  for 
only  a few  seconds.  A positive  reaction  is 
indicated  by  a yellow  (hydroxide  of  copper) 
or  red  (cuprous  oxid)  precipitate.  If  only 
traces  of  sugar  are  present,  the  precipitate 
may  only  form  on  cooling. 

Other  reducing  agents  of  copper  are  con- 
jugated glycuronic  acid,  homogentisic 
acid  (alkapton),  lactose,  maltose,  pentose, 
creatinin,  excess  of  uric  acid,  ammonium 
compounds,  albumin,  allantoin,  mucin, 
pyrocatechin,  hydroquinone,  bile  pigments. 
Remember  that  codeine  is  excreted  as 
a glycuronate. 

Quantitative  Fehling’s  Text. — Alix  in  a 
flask  10  c.c.  each  of  the  copper  and  alkaline 
solutions  and  30  c.c.  distilled  water.  Dilute 
the  urine,  freed  from  albumin,  with  chstilled 
water,  five  times  {i.e.,  four  parts  of  water 
added)  if  the  s.g.  is  approximately  1.030, 
ten  times  if  over  1.030.  Fill  a graduated 
burette  with  the  chluted  urine.  Boil  the 
Fehhng’s  solution  and  add  the  urine  a little 
at  a time,  boiling  the  mixture  at  each  addi- 
tion of  urine.  Continue  to  add  urine  and 
boil  until  the  blue  color  chsappears  hmnedi- 
ately  after  boiling,  ^¥hen  this  occurs,  note 
the  amount  of  diluted  urine  used,  divicle  this 
by  5 or  10,  according  to  the  degree  of  dilu- 
tion, and  the  resulting  figure  represents  the 
amount  of  urine  containing  0.05  gm.  of 
glucose  (10  c.c.  of  the  copper  .solution  being 
reduced  by  0.05  gm.  of  gluco.se.)  The 


amount  of  sugar  contained  in  the  whole 
twenty-four-hour  urine  is  then  equal  to — 

^ — X 24-hour  quantity  of  urine; 

c.c.  urine  containing 
0.05  gm.  sugar 

or — (0.05  X 5 or  10  X twenty-four  hour 
quantity  of  urine)  c.c.  of  diluted  urine 
used  in  the  reaction  = the  total  twenty-four- 
hour  excretion  of  sugar. 

2.  Benedict’s  Test. — Dissolve  sodium  or 
potassium  citrate,  173  gms.,  and  crystal- 
lized sodimn  carbonate,  200  gms.  (or  half 
the  amount  of  the  anhydrous  salt)  in  about 
700  c.c.  of  water,  and  filter  if  necessary. 
Dissolve  copper  sulphate  (C.P.  crystallized), 
17.3  gms.,  in  about  100  c.c.  of  water  and 
pour  into  the  alkaline  solution;  cool,  and 
add  water  to  1 litre. 

To  5 c.c.  of  thi.s  reagent  add  not  more  than 
8 or  10  drops  of  urine;  boil  vigorously  for 
one  or  two  minutes,  and  allow  to  cool.  In  the 
presence  of  gluco.se,  a diffuse  red,  yellow,  or 
greenish  precipitate  appears;  but  it  appears 
only  on  cooling  if  the  amount  of  glucose  is 
small  (under  0.3  per  cent.,  says  Webster). 
In  the  absence  of  sugar  the  solution  remains 
clear  or  else  shows  a faint  blue  turbidity  due 
to  urates.  Benedict’s  reagent  is  about  ten 
times  more  sensitive  to  urinary  sugar  than 
are  the  other  copper  solutions,  it  is  not 
appreciably  reduced  by  creatinin  and  uric 
acid,  nor  by  such  preservatives  as  chloro- 
form, chloral,  or  formaldehyde,  but  is 
promptly  reduced  by  the  alkapton  acids 
and  the  conjugated  glycuronic  acids. 

3.  Nylander’s  Bismuth  Test. — Nylan- 
der’s  Reagent. — Rochelle  salt,  4 gms.,  dis- 
solved in  100  c.c.  of  a 10  per  cent,  caustic 
soda  solution;  bismuth  subnitrate,  2 gms., 
added;  and  the  whole  heated  over  a water 
bath  until  as  much  of  the  bismuth  as  possible 
is  cUssolved.  After  cooling,  filter,  and  keep 
in  the  dark. 

Add  1 c.c.  of  Nylander’s  solution  to  10  c.c. 
of  urine,  free  of  albumin,  and  boil  several 
minutes.  A gradually  blackening  precipi- 
tate of  metallic  bismuth  indicates  the  pres- 
ence, usually,  of  sugar.  The  same  reaction  is 
caused  by  conjugated  glycuronic  acid,  excess 
of  urinary  pigment,  pentoses,  and  inge.sted 
chloral,  salol,  turpentine,  antipyrin,sulphonal, 
trional,  salicylic  acid,  camphor,  quinine, 
senna,  eucalyptus,  asparagus,  ami  rhubarb. 

4.  Fermentation  Test. — Urine  with  a 
s.g.  of  1.018  to  1.022  should  be  (hinted 
twice;  1.022  to  1.028,  five  times;  1.028  to 
1.030,  ten  times.  It  should  be  acid,  and 
should  be  sterilized  by  boiling. 

To  10  c.c.  of  the  urine  thus  prepared,  in 


URINALYSIS 


Einhom’s  saccharimeter,  add  one  gram  of 
perfectly  fresh  compressed  yeast  (or  3^6  of 
a cake  or  a pea-sized  piece  of  Fleischmann’s 
yeast),  and  let  stand  for  twenty-four  hours 
in  a warm  room  (temp.,  22°  to  28°  C.).  The 
percentage  of  sugar  is  indicated  on  the  scale 
by  the  amount  of  gas  formed.  This  result 
should  be  multiplied  by  the  degree  of  dilu- 
tion. “ Always  make  a control  test  with 
normal  urine,  since  the  yeast  itself  may 
cause  a small  evolution  of  gas.”  (Futcher.) 

R.  C.  Cabot  describes  the  following  fer- 
mentation test:  Take  the  s.g.  of  the  urine 
very  carefully,  and  acidify  it  with  acetic 
acid,  if  necessary.  Pour  6 to  8 ounces  into 
a wide-mouthed  vessel,  and  add  half  a cake, 
crumbled,  of  fresh  Fleischmann’s  yeast.  Set 
aside  in  a warm  place.  After  twenty-four  to 
forty-eight  hours,  test  for  sugar  with  Fehling’s 
solution.  As  soon  as  the  test  is  negative, 
take  again  the  s.g.  of  the  filtered  urine  at  ap- 
proximately the  same  temperature  as  before. 
For  every  degree  of  s.g.  lost,  0.23  per  cent,  of 
sugar  has  been  fermented  out  of  the  urine. 

The  fermentation  test  is  the  most  reliable 
single  test.  Levulose  ferments  also;  but 
lactose  does  not  ferment  within  twelve  hours. 

5.  Phenylhydrazine  Test. — To25c.c.  of 
urine  add,  if  albumin  is  present,  a few  drops 
of  a solution  of  lead  acetate,  and  filter. 
Acidify  the  filtrate,  if  not  already  acid,  with 
acetic  acid,  and  add  3^  to  1 gm.  of  phenyl- 
hydrazine hydrochloride  and  about  2 gms.  of 
sodium  acetate;  mix  thoroughly  by  shaking; 
and  heat  in  a boiling  water  bath  for  one  or 
two  hours,  adding  water  if  the  salts  do  not 
dissolve.  Filter  while  hot,  and  then  cool 
the  test-tube  by  immersing  it  in  cold  water; 
or  better,  allow  it  to  cool  slowly.  A yellow 
deposit  of  phenylglucosazone  needles,  ar- 
ranged under  the  microscope  in  sheaves  and 
stars,  and  melting  at  204°  to  205°  C.,  indi- 
cates the  presence  of  glucose.  To  deter- 
mine the  melting  point,  first  purify  the 
crystals  by  dissolving  them  in  hot  60  per 
cent,  alcohol  and  recrystallizing  by  adding 
water  and  evaporating  the  alcohol.  Then 
place  the  crystals  in  a perfectly  dry  capillary  ■ 
tube,  seal  one  end  of  the  tube,  and  attach 
it  to  a thermometer  by  means  of  a narrow 
rubber  band  cut  off  from  rubber  tubing,  so 
that  the  crystals  will  be  opposite  the  middle 
of  the  bulb  of  the  thermometer.  Suspend 
the  bulb  in  a beaker  of  water  so  that  it  is 
completely  immersed.  Heat  the  water  gradu- 
ally, and  note  the  temperature  of  fusion. 

Diacetic  Acid.— Gerhardt’s  Test. — To  10 
c.c.  of  freshly  voided  urine  (diacetic  acid 
is  very  volatile  and  disappears  from  the 
mine  in  a short  time)  add  a solution  of 


ferric  chloride  until  all  the  phosphates  are 
precipitated  as  iron  phosphate.  Filter,  and 
continue  to  add  ferric  chloride  to  the  filtrate, 
drop  by  drop.  The  presence  of  diacetic  acid 
is  indicated  by  the  appearance  of  a claret 
or  Bordeaux-red  color.  Salicylic  acid, 
meconic  acid  derived  from  opium,  carbolic 
acid,  antipyrine,  phenacetin,  etc.,  give  the 
same  reaction.  If  the  reaction  occurs  after 
boiling  the  urine,  so  as  to  drive  off  any 
diacetic  acid  present,  it  indicates  the  pres- 
ence of  one  of  the  above-named  substances. 

Arnold’s  Test  Modified  by  Lipliaw- 
SKY.— Two  reagents  are  used,  (1)  para-amido- 
aceto-phenon,  1 gm.,  dissolved  in  distilled 
water,  100  c.c.,  and  concentrated  HCl,  2 c.c., 
added;  (2)  sodium  nitrite,  1 per  cent,  solution. 

To  a mixture  of  6 c.c.  of  solution  (1)  and 
3 c.c.  of  solution  (2),  add  an  equal  volume 
of  urine  (filtered  through  animal  charcoal  if 
highly  colored)  and  a drop  of  ammonia,  and 
shake,  when  a brick-red  color  will  appear  (in 
any  urine  thus  treated).  Now  treat  10  drops 
to  2 c.c.  of  this  mixture  (according  to  the 
probable  content  in  diacetic  acid)  with 
15  to  20  c.c.  of  concentrated  HCl,  3 c.c.  of 
chloroform,  and  2 to  4 drops  of  ferric  chloride 
solution.  Close  the  test-tube  with  a cork 
and  shake  gently  for  one-half  to  one  minute. 
The  presence  of  traces  of  diacetic  acid  is 
indicated  by  a violet  coloration  of  the 
chloroform,  which  would  otherwise  be  yel- 
low or  light  red.  Acetone,  /3-oxybutyric 
acid,  salicylic  acid,  meconic  acid  derived 
from  opium,  carbolic  acid,  antipyrine,  and 
phenacetin  do  not  give  this  reaction. 

Acetone.— Legal’s  or  LeNobel’s  Test. — 
To  10  c.c.  of  perfectly  fresh  urine,  add  a 
few  drops  of  a fresh  solution  or  a crystal  of 
potassium  or  sodium  nitroprusside.  Then 
add  a solution  of  caustic  soda  or  potash  until 
the  fluid  is  strongly  alkaline.  A ruby-red 
color  means  acetone  or  creatinin.  Now  add 
glacial  acetic  acid:  a carmine  or  purplish 
red  color  means  acetone;  a yellow  changing 
to  green  or  blue  means  creatinin. 

Acetone  is  a decomposition  product  of 
diacetic  acid,  so  that  the  acetone  test  is  also 
a diacetic  acid  test.  Indeed,  diacetic  acid 
gives  this  reaction. 

Froivimer’s  Test  (the  best). — Add  about 
1 gm.  of  solid  caustic  potash  to  10  c.c.  of 
urine,  and  before  complete  solution  occurs, 
add  10  to  12  drops  of  a 10  per  cent,  solution 
of  salicyl  aldehyde  in  absolute  alcohol ; now 
warm  to  70°.  In  the  presence  of  acetone  a 
purplish-red  ring  appears  at  the  zone  of  con- 
tact of  the  potash  solution  and  the  salicyl 
aldehyde.  Diacetic  acid  does  not  show  this 
reaction  except  after  prolonged  heating. 


URINALYSIS 


Beta=Oxybutyric  Acid. — Hart’s  Test. — 
Dilute  20  c.c.  of  urine  with  an  equal  volume 
of  water,  add  a few  drops  of  acetic  acid,  and 
boil  down  to  about  10  c.c.,  in  order  to  l emove 
acetone  and  diacetic  acid.  Now  add  water 
to  20  c.c.  and  divide  equally  between  two 
test-tubes.  To  one  of  these  add  1 c.c.  of 
hydrogen  pcu-oxide,  warm  gently,  allow  to 
cool,  and  then  add  c.c.  of  glacial 
acetic  acid  and  a few  drojjs  of  a freshly 
prepared  acpieous  solution  of  sodium  nitro- 
prusside.  Mi.\  and  overlay  with  2 c.c.  of 
concentrated  ammonium  hydroxide  (Lang(?’s 
test  for  acetone).  Allow  the  tubes  to  stand 
for  a few  hours.  The  tube  containing  the 
H2O2  shows  a red  zone  while  the  other  tube 
does  not. 

Ammonia  Output. — The  significance  of  the 
ammonia  output  is  as  follows;  Beta-oxy- 
butyric  acid  and  its  derivatives,  diacetic  acid 
and  eventually  acetone,  are  products  of  the 
incomplete  oxidation  of  fats  (favored  by 
starvation  and  by  the  (lej)rivation  of  carbo- 
hydrates). To  eliminate  these  poisonous 
acids,  the  body  jtrovides  ammonia  from  its 
protein,  and  calcitun  from  the  tissues 
generally;  therefore  the  increased  ammonia 
output,  and  also  the  wasting.  The  normal 
output  of  ammonia  is  0.85  gi:i.  in  twenty- 
four  hours.  An  increase  to  1.5  to  4.0  grams 
is  an  indication  of  acidosis. 

Formalin  Method. — Dilute  10  c.c.  of  urine 
with  50  c.c.  of  water,  add  2 or  3 drops  of  a 
1 per  cent,  alcohol  solution  of  phenolphtha- 
lein  and  neutralize  with  N/wNaOH.  (See 
under  Quantitative  Analysis  of  the  Gastric 
Juice,  under  Dyspepsia) . To  the  neul  ralized 
urine  add  5 c.c.  of  formalin  which  has  also 
been  prevously  neutralized  with  N/ioNaOH. 
Formaldehyde  acts  upon  ammonium  salts 
forming  hexamethylen-tetramin  and  liberat- 
ing the  acid  combimxl  with  the  ammonia. 
The  acid  can  then  Ite  determined  by  titration. 
Titrate  with  N/joNaOH  to  the  appearance  of 
a faint,  permanent  pink  color,  noting  the 
amount  of  alkali  used.  Since  1 c.c.  of 
N/ioNaOH  represents  0.001704  gram  of  NH3, 
to  calculatethe  ammonia  in  10  c.c.  of  urine, 
multiply  this  figure  by  the  number  of  c.c.  of 
N/ioNaOn  used. 

Urea  Output. — The  normal  urea  output  is  15 
to  40  grams  per  diem.  Urea  is  derived  from 
the  nitrogen  both  of  the  food  and  of  the  tissues. 

Fill  a Doremus  unM)niet(!r  with  a freshly 
prepared  solution  of  sodium  hyitobroniite, 
made  by  adding  1 c.c.  of  bromine  to  40  c.c.. 
of  cold  sodium  hydnite,  20  per  cent,  solution. 
Add  1 c.c.  of  urine.  As  soon  as  the  evolution 
of  gas  has  ceased  (5  to  10  minutes),  rt'ad  off 
the  amount  of  urea  directly  from  the  cali- 


brations of  the  tube.  This  test  gives  only 
approximate  results.  The  best  test  is  that 
of  Marshall. 

Chloride  Fstimation. — The  chlorides  may  1)0 
e.stimated  appro.ximately  by  Purdy’s  centi'if- 
ugal  method.  In  a centrifuge  tube  gradu- 
ated to  15  c.c.  ])lace  10  c.c.  of  filtered  albumin- 
free  urine  (see  below),  add  1 c.c.  of  strong 
nitric  acid  and  4 c.c.  of  a 5 per  cent,  silver 
nitrate  solution,  shake  by  invei’sion  and  allow 
to  stand  for  a few  minutes.  Then  centrifuge 
for  three  minutes  at  the  rate  of  1200  revolu- 
tions per  minute,  and  read  off  the  bulk  per- 
centage of  silver  chloride.  One  per  cent,  of 
silver  chloride  by  bulk  represents  0.13  [)cr 
cent,  by  weight  and  0.08  per  cent,  of  chlorine. 

To  free  the  urine  from  albumin,  acidify 
a definite  volume  with  acetic  acid,  boil, 
and  filter,  and  wash  the  precipitate  thor- 
oughly with  a definite  volume  of  water, 
say  twice  the  original  amount  of  urine 
employed.  Use  10  c.c.  of  this  filtrate  for  the 
above  test,  and  multiply  the  results  by  three. 

The  normal  kidney  will  excrete  five  drams 
of  ingested  sodium  chloride  within  twenty- 
four  hours;  whereas,  in  renal  insufficiency, 
several  days  may  be  reejuired.  44ie  chlor- 
ides are  derived  entirely  from  the  food. 

Indican. — Sec  Indic'anuiia. 

Tests  of  Renal  Function. — 1.  Phcnolsulphone- 
phthalein  or  “ Red  ” Test  of  Rowntrc'c 
and  Geraghty: 


PhonoLsulphonephthalcin O.C)  pn. 

Sodium  hydroxide,  8 per  cent,  solu- 
tion   0.84  c.c. 

Sodium  chloride,  0.75  j)er  cent,  solu- 
tion, cj.s.  ad 100.0  c.c. 


Add  2 or  3 drops  more  of  the  sodium  hydrate 
solution,  when  the  color  of  the  .solution  will  change 
to  a Bordeaux-red,  and  it  will  become  less  inltant 
when  injected  (the  monosodium  .salt  of  phenolsid- 
I)honephthalcin  originally  j)rescnt  is  slightly  irri- 
tant). Each  c.c.  of  this  solution  contains  0 rng.  of 
the  phenolsidphonei)hthalein.  One  c.c.  ampoides 
may  be  obtained  from  Ilynson,  Westcott  and  Dunn- 
ing, Baltimore,  Md. 

Tcchniciue. — Give  the  patient,  twenty  to 
thirty  minutes  before  applying  the  test, 
300  to  400  c.c.  of  water,  to  ensure  an  ade- 
quate urinary  flow.  At  the  expiration  of 
the  twenty  or  thirty  minutes,  a catheter 
may  bo  introduced  and  the  bladder  emptied; 
but  some  regard  catheterization  as  undesir- 
able. Noting  the  time,  inject  subcutaneously 
into  the  upper  arm,  or  intravenously,  one 
c.c.  of  the  sterilized  tc.st  solution,  using  an 
accurately  graduated  syringe*.  Allow  the 
urine  to  drain  through  the  (lathcter  into  a 
test-tul)e  (containing  a drop  of  25  per  cent, 
sodium  hydrate  solution.  Note  the  time  of 
appearance  of  the  first  pinkish  tinge.  Now, 


VACCINIA;  VACCINATION 


unless  the  patient  has  a urinary  obstruction, 
withdraw  the  catheter,  ami  have  the  patient 
empty  his  Iiladder  into  a receiver  at  the  end 
of  one  hour,  and  again  into  another  receiver 
at  the  end  of  another  hour.  In  the  presence 
of  urinary  obstruction,  keep  the  catheter  in 
the  bladder,  and  corked,  and  drain  the 
bladder  at  the  end  of  each  hour. 

Measure  the  quantity  of  urine  in  each 
receiver  and  ascertain  the  specific  gravity 
{q.v.  above). 

Now  atld  to  each  sample  of  urine  sufficient 
25  per  cent.  NaOH  to  make  the  urine 
decidedly  alkaline  so  as  to  elicit  the  maxi- 
mum color  (a  brilliant  purple-red) . Place  in  a 
litre- volumetric  flask  and  add  distilled  water 
to  the  litre  mark  and  mix  thoroughly.  Now 
filter  a small  portion  and  compare  it  with 
the  standard  solution  of  phenolsulphone- 
phthalem  (phen.,  3 mg.,  in  water  1 litre, 
made  alkaline  with  1 or  2 drops  of  25  per 
cent.  NaOH),  using  the  Duboscq  or  the 
Rowntree  and  Geraghty  modification  of  the 
Autenrieth-Konigsberger  colorimeter.  Ad- 
just the  standard  solution  to  the  10  nnn. 
mark,  and  make  the  color  of  the  unknown 
solution  to  correspond.  If,  to  illustrate,  the 
reading  of  the  unknown  solution  is  found 
to  be  20,  then  only  50  per  cent,  as  much  dye 
is  contained  in  it  as  in  the  standard  solution, 
i.e.,  the  excretion  equals  50  per  cent,  of  the  3 
mg.  of  the  standard  solution,  or  25  per  cent, 
of  the  6 mg.  injected.  Make  readings  mitil 
the  drug  is  completely  eliminated. 

Says  Webster:  “ In  normal  cases  it  has 
been  found  that  the  time  of  appearance 
varied  from  five  to  eleven  minutes  and  that 
40  to  60  per  cent,  of  the  drug  was  excreted 
in  the  first  hour  and  20  to  25  per  cent,  in 
the  secoml  hour.  The  excretion  of  the  drug 
does  not  run  parallel  to  the  excretion  of 
water.  The  smaller  the  amount  of  urine  in 
normal  cases,  the  greater  the  concentration 
of  the  ch'ug.  It  is  immaterial,  so  far  as  the 
excretion  of  the  drug  is  concerned,  whether 
the  urinary  output  is  50, 200, 400,  or  more  c.c.” 

A tlelay  in  the  time  of  appearance  of  the 
drug  beyond  twenty-five  minutes,  and  an 
output  for  the  first  liour  below  20  per 
cent.,  are  indications  for  delaying  a con- 
tcmplatetl  operation  until  the  Iddneys 
become  more  efficient. 

Says  Cabot:  “ In  elderly  people  confined 
to  bed,  40  to  50  per  cent,  (within  two  hours) 
may  be  considered  normal  ami  does  not 
indicate  nephritis.” 

2.  Phlokidzin  Test. — Ten  milligrams  of 
j)hloridzin  (or  0.005  gm.  (gr.  tf-2) — dis- 
solved in  1 c.c.  of  a 0.5  per  cent,  solution  of 
sodium  carbonate. — N.N.R.)  injected  sub- 


cutaneously into  the  buttocks,  should  be 
followed  by  glycosuria  in  fifteen  to  thirty 
minutes,  passing  off  in  two  or  two  and 
one-half  to  four  hours,  one  to  two  grams 
of  glucose  being  excreted. 

3.  Indigo  Carmine  Test. — Indigo  car- 
mine, 0.16  gm.,  administered  hypodermic- 
ally, colors  the  urine  in  about  ten  minutes 
(green  deepening  to  blue),  the  most  being 
excreted  in  about  an  hour. 

In  the  estimation  of  the  separate  func- 
tional activity  of  the  two  kidneys,  it  is 
necessary  that  the  kidneys  be  not  palpated 
for  twenty-four  horns  before  the  test,  that 
nothing  be  taken  by  mouth  for  at  least  two 
hours  before  the  test,  and  that  a twenty- 
four  hour  collection  of  mine  be  analyzed 
immediately  before  the  test.  The  ureteral 
catheters  should  be  left  in  for  at  least  two 
hours.  Following  ureteral  catheterization, 
an  oliguria  or  anuria  occurs,  lasting  usually 
no  longer  than  ten  minutes  in  a healthy 
kidney,  but  longer  in  a diseased  kidney. 
The  urine  voided  during  this  period  should 
be  discarded.  (Keyes.) 

Keep  the  patient  in  bed  for  thirty-six 
hours  after  ureteral  catheterization  and 
administer  urotropin  (see  Part  11),  a cUuretic, 
and  water. 

“ The  various  urinary  segregators,”  says 
Young,  “ are  absolutely  unreliable.” 

Urinary  Calculus. — See  Nephrolithiasis. 

Incontinence. — See  Enuresis,  Part  3, 
Genito-Urinary  Diseases;  and  Part  2, 
Gynaecology. 

Retention. — See  Part  3,  Genito-Uri- 
nary Diseases. 

Suppression. — See  Anuria. 

Urination,  Frequent. — See  Polyuria. 

Painful. — See  Dysuria,  in  Part  2,  Gynae- 
cologjq  and  Part  3,  Genito-Urinary 
Diseases. 

Superabundant. — See  Poljmria. 

Vaccinia;  Vaccination. — L.  vac'ca,  cow: 
cowpox.  Vaccinia  or  cowpox  is  smallpox 
mocUfied  by  passage  through  the  cow. 

Vaccination. — First  cleanse  the  skin  with 
soap  and  water,  chy,  and  apply'  alcohol. 
Sterilize  a cambric  needle  by'  boiling  or  by 
heating  in  a flame.  Abrade  the  skin  with 
the  dull  eml  of  the  needle,  taking  care  not  to 
draw  blood.  The  gly'cerinated  virus  is  better 
than  the  diy  vuus.  Allow  twenty  minutes 
for  the  virus  to  thy  on  the  arm,  then  apply 
a sterile  bandage  or  clean  handkercliief. 

.After  an  incubation  j3eriod  of  about  three 
tlay'S,  there  appears  a red  papule,  which 
becomes  vesicular  on  about  the  fifth  day. 
It  has  a pearly'  appearance,  becomes  umbili- 
catetl,  and  surrounded  by  a deeji-red,  sw'ollen 


VARICOSE  VEINS 


areola,  and  reaches  its  full  size  by  the  eighth 
day.  There  is  some  fever  and  the  neighbor- 
ing lymphatic  glands  become  enlarged.  On 
the  ninth  day  retrogression  t^egins,  and  a 
scab  forms,  which  falls  off  about  the  end  of 
the  third  or  fourth  week,  leaving  a circular 
pitted  scar. 

Immunity  against  smallpox  is  established 
from  the  eighth  to  the  eleventh  day  after 
a successful  vaccination.  The  protection 
lasts  from  seven  to  ten  years.  A successful 
vaccination  is  protective  if  performed  within 
three  days  after  exposure  to  smallpox. 

Children  should  be  vaccinated  after  the 
age  of  three  months,  and  at  least  every 
five  to  ten  years  thereafter,  except  in  the 
presence  of  a severe  illness.  All  persons 
should  be  vaccinated  during  the  presence 
of  smallpox. 

If  the  first  vaccination  is  unsuccessful, 
it  should  be  repeated  (if  necessary  at  least 
three  times) . 

Vagus  Nerve. — L.  vagus,  wandering.  The 
vagus  supplies  the  pharynx,  larynx,  oesoph- 
agus, heart,  lungs,  and  stomach. 

Paralysis  of  the  pharyngeal  branches 
causes  difficulty  in  swallowing  (See  Dys- 
phagia) of  the  laryngeal  branches,  alteration 
of  the  voice  or  stridor  (see  Aphonia  and 
Stridor  in  Part  9,  Throat  Diseases);  of  the 
carchac  branches,  increased  rapitUty  of  the 
heart’s  action  (see  Tachycardia). 

The  various  causes  of  vagus  disease  are 
bulbar  paralysis,  neoplasms,  meningitis, 
syphihs,  neuritis  (diphtheritic,  alcoholic, 
etc.),  aneurysm. 

Pharyngeal  spasm,  preventing  deglutition, 
may  be  hysterical  or  simply  nervous.  It 
is  one  of  the  prominent  symptoms 
of  hydrophobia. 

Laryngeal  spasm  occurs  in  laryngismus 
stridulus,  the  crises  of  locomotor  ataxia, 
and  spa.stic  aphonia  (in  which  spasm  occurs 
on  attempting  to  speak).  (See  Laryngeal 
Spasm  in  Part  9,  Throat  Diseases.) 

Valvular  Heart  Disease,  Acute. — See 
EndocartUtis,  Acute. 

Chronic. — See  Stage  of  Compensation 
under  Cardiac  Insufficiency. 

Varicella. — See  Chicken-Pox. 

Varicose  Ulcer. — See  Varico.se  Veins 
following. 

Varicose  Veins. — 

Etiology. —Adult  age;  force  of  gravity; 
prolonged  erect  posture;  hard  work;  garters; 
lack  of  periva-scular  support;  pregnancy; 
large  abdominal  tumors;  arteriosclero.sis; 
chronic  phlebitis;  vasomotor  pare.sis  in 
nervous  disea.ses.  The  condition  is  very 
rarely  congenital. 


Treatment. — Attend  to  the  cause.  Enjoin 
frequent  bathing  of  the  legs,  and  the  wearing 
of  properly  fitting  elastic  stockings,  reaching 
to  the  knee  or  higher,  or  a stockinette  or 
crepe  bandage,  firmly  and  evenly  applied 
so  as  to  support  the  veins.  The  bandage 
should  be  applied  before  getting  out  of  bed 
in  the  morning,  and  not  removed  before 
retiring  at  night. 

For  varicose  ulcers  employ,  besides  the 
elastic  stocking  or  bandage,  jjrolonged  soak- 
ing (for  hours)  in  hot  water  containing 
cUssolved  potash  soap  (or  in  eczematous 
subjects,  starch-water) , alternately  with 
hot-air  baths.  If  the  ulcer  is  inflamed, 
bathe  with  boric  acid  solution. 

For  non-inflamed  callous  ulcers,  is  well 
recommended,  together  with  the  above  treat- 
ment, the  application  of  overlapping  strips 
of  one-inch-wide  zinc  oxide  adhesive  plaster, 
covering  the  entire  ulcer  and  nearly  encirc- 
ling the  leg,  with  the  object  of  drawing  the 
edges  of  the  ulcer  together.  The  plaster 
should  be  changed  every  twenty-four  to 
forty-eight  hours. 

Rest  and  elevation  of  the  limb 
hasten  healing. 

For  necessarily  ambulant  cases,  R.  A. 
Bolam  well  recommends  Unna’s  zinc-gela- 
tine dressing.  The  ulcer  is  first  carefully 
cleansed,  then  dried,  and  filled  with  a dusting 
powder  (boric  acid,  or  dermatol,  etc.).  Then 
a gauze  or  muslin  bandage  is  applied  to 
the  leg,  and  the  hot  jelly  brushed  on  and  into 
the  bandage.  Another  firm  bandage  is 
applied,  and  over  all  a third  protective 
bandage. 

The  ulcer  may  be  excised  and  replaced  by 
Ollier-Thiersch  grafts.  The  internal  admini- 
stration of  mercury  (see  Part  11)  is  praised 
for  both  varicose  eczema  and  ulcer.  (See 
also  Ulcer,  Cutaneous.) 

Should  subcutaneous  hemorrhage  occur, 
put  the  patient  to  bed,  apply  a compression 
bandage,  and  elevate  ami  immobilize 
the  limb. 

Should  phlebitis  occur,  whether  purulent 
or  not,  ligate  the  saphenous  vein  at  the 
saphenous  opening,  and,  if  feasible,  extirpate 
the  inflamed  veins  en  masse.  IncLse  and 
drain  abscesses.  Resection  of  the  internal 
saphenous  vein,  together  with  its  tributaries 
below  the  knee,  and  sometimes  also  the 
external  saphenous  vein,  is  usually  curative. 

Before  deciding  upon  operation,  especially 
where  there  is  a liistory  of  a previous  phle- 
bitis, first  ascertain  whether  an  ela.stic 
baiKlage  applied  from  the  foot  to  above 
the  knee  gives  relief.  If  it  causes  discomfort 
it  may  mean  that  the  superficial  veins  are 


VOMITING 


necessary  to  the  circulation  of  the  limb. 
(Mayo  Test.) 

Where  general  anaesthesia  is  contraindi- 
cated, as  in  diabetes,  nephritis,  uncompen- 
sated cardiac  disease,  arteriosclerosis, 
cachexia,  extreme  obesity,  purpura,  etc.,  one- 
may  perform,  under  local  anaesthesia,  the 
Trendelenburg  operation  of  double  ligation 
of  the  internal  saphenous  vein,  near  the 
saphenous  opening,  with  chromic  catgut. 

Variola. — See  Smallpox. 

Vegetable  Poisoning. — See  Poisoning. 

Veins,  Inflamed. — See  Phlebitis. 

Varicose.  —See  Varicose  Veins. 

Vertigo. — L.  vertigo,  dizziness. 

Causes.— Ocular  defects  (muscular  anoma- 
lies, anomalies  of  refraction  and  accom- 
modation, diplopia) ; labyrinthine  exudation 
(M4niere’s  Disease) ; auditory  nerve 
disease  (tumor,  abscess,  tabes,  Bell’s  palsy, 
etc.);  otitis  media;  cerumen,  boils,  sea- 
water or  foreign  bodies  in  the  external 
meatus;  violent  syringing  of  the  ears;  pas- 
sage of  a galvanic  current  through  the  ears; 
increase  of  intracranial  pressure,  especially 
when  due  to  cerebellar  tumor  or  abscess 
or  frontal  tumor;  apoplexy;  epilepsy; 
migraine;  pellagra;  dementia  paralytica; 
locomotor  ataxia;  multiple  sclerosis; 
neurasthenia;  hysteria;  ansemia,  nasal  and 
laryngeal  disorders;  gastric  and  intestinal 
disorders  (gastritis,  enteroptosis,  constipation, 
intestinal  intoxication,  etc.) ; circulatory 
disturbances  (arteriosclerosis — usually  sub- 
sides in  a few  months  or  years — chronic 
heart-disease,  Stokes-Adams  disease,  Addi- 
son’s disease,  menopause,  anaemia,  poly- 
cythaemia)  ; malaria  ; certain  poisons 
(alcohol,  nicotine,  caffeine,  morphine,  quinine, 
salicylates,  coal-tar  products,  etc.);  uraemia; 
severe  muscular  exertion;  sunstroke  and 
heat  exhaustion;  sea-sickness;  kubisagari 
or  Gerber’s  disease. 

Always  examine  the  ears  for  deafness, 
tinnitus,  etc.  (see  Examination  of  the  Ear, 
in  Part  7,  Ear  Diseases). 

Treatment.— Attend  to  the  cause.  Keep 
the  bowels  active.  For  gastric  vertigo, 
give  a large  dose  of  sodium  bicarbonate 
with  or  without  bismuth  in  hot  water  (see 
Drugs,  Part  11). 

As  a last  resort  in  persistent  vertigo,  one 
may  consider  the  operation  of  dividing  the 
auditory  nerve  (see  Tinnitus,  in  Part  7,  Ear 
Diseases). 

Vesical  Calculus. — L.  vesi'ca,  bladder; 
caldulus,  pebble.  (See  Gynaecology,  Part  2, 
and  Genito-Urinary  Diseases,  Part  3). 

Vesicular  Stomatitis. — See  Stomatitis 

Vesiculosa. 


Vestibular  Nerve.— SeePart7,  Ear  Diseases. 

Vincent’s  Angina. — See  Stomatitis, 
Ulcerative. 

Visceroptosis. — See  Splanchnoptosis. 

Volvulus. — L.  knotting  or  twisting.  See 
Intestinal  Obstruction. 

Vomiting. — L.  vomita'rc,  to  vomit. 

I.  Vomiting  in  Adults  and  Children  past  Infancy. 
— Etiology. — Overfeeding;  irritating  in- 
gesta;  gastric  disease  (gastritis,  acute  and 
chronic,  dilatation,  ulcer,  cancer,  cirrhosis); 
central  nervous  and  reflex  irritation  arising 
apparently  from  any  organ  of  the  body,  e.g., 
the  stomach,  intestines,  liver,  gall-bladder  and 
bile  tracts,  pancreas,  kidneys,  suprarenal 
glands,  appendix,  male  and  female  generative 
organs,  peritoneum,  ears,  eyes,  nose,  pharynx, 
larynx,  oesophagus,  bronchi,  lungs,  brain, 
cord,  and  meninges;  toxic  influences,  e.g., 
ether,  chloroform,  morphine,  nicotine,  arse- 
nic, thyroid  extract,  hyperthyroidism,  urae- 
mia, pregnancy,  acute  yellow  atrophy  of  the 
liver,  yellow  fever,  dengue,  retrocedent  gout, 
auto-intoxication,  septico-pysemia,  etc. ; mis- 
cellaneous causes,  e.g.,  sea-sickness;  agita- 
tion, anger,  sorrow,  shock,  fright,  overstudy 
in  the  young;  great  pain;  fatigue;  mastur- 
bation; habit,  cough  (bronchitis,  whooping- 
cough);  cardiac  failure;  anaemia;  leukaemia; 
purpura;  haemophilia;  angioneurotic  cedema; 
paroxysmal  haemoglobinuria;  pellagra;  onset 
of  infectious  diseases  in  children;  pernicious 
malaria  and  the  stage  of  chill  in  ordinary 
malaria;  incipient  tuberculosis;  arteriosclero- 
sis; neurasthenia;  hysteria;  migraine;  loco- 
motor ataxia  (gastric  crises);  nephrolithiasis; 
cholelithiasis;  worms;  intestinal  obstruction; 
aneurysm  of  the  abdominal  aorta;  brain 
tumor;  brain  < abscess;  cerebral  syphflis; 
cerebral  venous  and  sinus  thrombosis;  etc.; 
and,  finally,  the  cycUc,  paroxysmal,  recur- 
rent or  periodic  vomiting  of  children,  of 
abrupt  onset,  preceded  by  furred  tongue, 
offensive  breath,  and  white  stools,  and 
abrupt  termination,  lasting  from  several 
hours  to  two  weeks,  and  recurring  every 
several  weeks  or  months  (acetone,  diacetic 
acid,  and  oxybutyric  acid  occur  in  the  urine 
practically  constantly — see  Urinalysis.  The 
disease  tends  to  disappear  spontaneously 
toward  puberty). 

Treatment.— Attend  to  the  cause.  In  ner- 
vous (neurasthenic  and  hysterical)  cases, 
prescribe  rest  in  bed,  isolation,  and  perhaps 
massage,  electricity,  and  hydrotherapy  (wet 
packs) : see  Neurasthenia,  and  Hysteria.  In 
employing  electricity,  place  the  anode  of  a 
galvanic  current  to  the  epigastrium  and  the 
cathode  to  the  spine,  and  use  a current 
strong  enough  to  produce  visible  abdominal 


VOMITING 


contractions,  but  no  longer  than  ten  minutes. 
In  severe  cases,  it  may  be  necessary  to  ad- 
minister food  per  rectum  for  two  or  three 
days,  with  normal  saline  enemata  (3i  ad  Oi) 
for  the  relief  of  thirst  (see  Rectal  Feeding). 
Try  a liquid  diet  in  very  small  quantities,  e.g., 
teaspoonful  doses  of  ice-cold  milk,  cold  egg 
albumen,  clam  broth,  ice-cold  champagne 
or  Vichy;  although  solids  are  sometimes 
better  retained,  e.g.,  scraped  beef,  eggs  boiled 
three  minutes,  rice,  toast.  Gastric  lavage 
may  be  of  service. 

To  avoid  sea-sickness  or  car-sickness, 
evacuate  the  stomach  and  bowels  before 
starting  upon  the  trip,  and  restrict  the  diet 
during  the  first  few  days  of  the  journey. 
Sodium  bromide,  gr.  xxx  to  lx,  well  diluted, 
taken  two  hours  before  starting,  may  per- 
haps be  of  some  service  in  certain  cases. 

For  vomiting  of  pregnancy,  see  Part  4, 
Obstetrics. 

In  the  cyclic  or  periodic  vomiting  of 
children,  which  is  evidently  an  acidosis, 
purge  the  patient  freely  by  means  of  calomel 
in  divided  doses,  followed  by  a saline  (see 
Part  11)  and  enemas,  and  administer  soda 
water  per  rectum  (3i  of  soda  bicarbonate 
ad  Oi),  about  eight  ounces  five  times  a day, 
or  in  sufficient  amount  to  render  the  urine 
alkaline  (see  Acidosis).  Administer  every 
eight  hours  a nutrient  enema  consisting  of 
6 to  8 ounces  of  completely  peptonized 
skimmed  milk  and  the  whites  of  two  eggs 
(Kerley).  Keep  the  patient  quiet.  After 
the  vomiting  has  ceased  for  several  hours, 
try  the  administration  of  liquids  in  small 
amounts — iced  milk  and  lime  water,  equal 
parts,  koumyss,  matzoon  (Part  11),  egg 
albumen,  barley-water,  clam  broth,  etc.  The 
child  should  lead  a quiet,  well-ordered  life, 
and  the  diet  should  consist  principally  of 
milk,  stale  bread,  green  vegetables,  fruits, 
meat  but  once  every  other  day,  and  cereals 
in  moderation,  no  sweets.  Sodium  bicar- 
bonate may  be  prescribed  as  a preventive. 

Symptomatic  Remedies  for  Nausea 
AND  Vomiting. — Alkaline  effervescing 

waters,  sipped  ice  cold,  e.g.,  champagne, 
Vichy,  Apollinaris,  Seidlitz  powder,  or  sod. 
bicarb,  in  orange  or  lemon  juice. 

Cracked  ice,  alone  or  with  chloroform, 
gtt.  V,  every  hour;  or  ice-cold  chloroform 
water  in  teaspoonful  doses. 

Lime  water,  1 tablespoonful  every  one  or 
two  hours. 

Chloroform,  gtt.  v to  x,  on  sugar  or  cracked 
ice  every  hour. 

Ether,  gtt.  x,  on  cracked  ice  every  hour. 

Menthol  in  ether,  1 : 10,  gtt.  v to  x in 
water,  t.i.d.;  or  menthol,  gr.  ii  to  iii,  in 


a teaspoonful  of  brandy  and  cracked  ice,  one 
teaspoonful,  t.i.d. 

Carbolic  acid,  gtt.  i,  in  a teaspoonful 
of  water,  every  fifteen  minutes,  for  three  or 
four  hours. 

Creosote,  nji,  shaken  up  in  two  tablespoon- 
fuls of  lime  water. 

Tr.  iodi,  gtt.  i,  in  a teaspoonful  of  water 
every  ten  to  thirty  minutes. 

Tr.  iodi,  njji,  and  carbolic  acid,  rr^ss,  in 
water,  3i,  every  fifteen  minutes  for  three  or 
four  hours. 

Resorcin,  gr.  v,  well  diluted. 

Cocaine,  gr.  bi,  in  a teaspoonful  of  water, 
every  hour. 

Cocainaj  hydrochloridi . . gr.  iss  (gr.  Ke  ad  3i) 
Syrupi  aurantii § iii 

M.  Sig. — One  teaspoonful  every  hour  until  re- 
lieved. (Ortner.) 

Chloral  hydrate,  gr.  xv,  aq.  destil.,  3iss; 
10  to  20  drops  on  shaved  ice,  every 
two  hours. 

Sodium  bromide,  gr.  x,  in  one  ounce  of 
milk,  three  or  four  times  a day;  or  gr.  xx  in 
one  dose. 

Valerian,  tincture,  or  1 to  2 teaspoon- 
fuls, t.i.d. 

Validol  (menthol  valerate),  gtt.  v to  xv, 
on  sugar  or  in  coffee,  once  to  thrice  a day. 

Sumbul. 

Orthoform,  gr.  v to  x to  xv,  suspended  in 
water,  3 to  4 to  8 times  daily. 

Antipyrin,  gr.  v,  every  three  hours. 

Hydrocyanic  acid,  dilute,  TT^iii,  in  water, 
cautiously  increased  to  Ttjjvi-viii. 

Tr.  belladonnse,  gtt.  x,  in  water,  three 
or  four  times  a day. 

Cerium  oxalate,  gr.  ii  to  v to  x,  with 
powdered  sugar  or  bismuth,  gr.  v to  x,  every 
two  or  three  hours. 

Wine  of  ipecac,  nji,  in  water,  every  hour. 

Silver  nitrate,  gr.  with  pepsin,  gr.  ii, 
in  capsule,  before  each  meal. 

Pepsin,  gr.  viii. 

Ingluvin,  gr.  %,  one-half  hour 
before  eating. 

Calomel,  gr.  every  fifteen  minutes. 

Morphine,  gr.  with  atropine,  gr. 

Koo,  hypodermically. 

Hyoscine,  gr.  Hoo~Ho,  hypodermically. 

Hot  or  cold  compresses,  or  the  mustard 
plaster,  or  blisters  (see  Cantharides  in  Part 
11),  or  electricity  (q.v.),or  the  ether  spray  to 
the  back  of  the  neck  and  to  the  epigastrium. 
The  latter  may  be  applied  for  four  or  five 
minutes  before  eating. 

Spruce  gum,  chewed. 

II.  Vomiting  in  Infants.— The  condition  may 
be  acute,  due  to  acute  gastritis  or  acute 
indigestion  (q.v.),  poisons,  and  grossly  indi- 


WHOOPING-COUGH;  PERTUSSIS 


sestible  food,  e.g.,  watermelon,  cucuml)ers, 
etc.,  acute  infectious  gastro-enteritis  (see 
Diarrhma  in  Bottle-Fed  Infants  and  in  Early 
('hildhoo(l),  parenteral  infectious  diseases, 
neiwous  influences,  intestinal  obstruction, 
j)eritonitis  nephritis,  meningitis,  brain  tumor, 
etc. ; or  it  may  be  habitual,  due  to  overfilling 
the  stomach,  irregular  feeding,  too  frequent 
fee(hng,  too  rapid  feeding,  too  slow  feeding,  a 
long  nipple  which  causes  gagging,  too  much 
handling  after  feecUng,  a tight  belly-band  or 
tight  clothing,  feeding  in  a reclining  position 
and  not  allowing  the  air  swallowed  during  the 
nursing  to  be  eructated  by  occasionally 
hokhng  the  infant  upright  on  the  mother’s 
shoulder  three  or  four  times  and  patting  upon 
the  back  until  the  air  comes  up ; indigestion, 
the  result  of  casein,  fat,  sugar,  starch,  or 
overfeeding;  (Ulatation  of  the  stomach  due 
to  pyloric  spasm  or  stenosis,  etc. ; too  rich 
mother’s  milk  (in  fat  or  sugar),  neuiopathic 
constitution;  decomposition  or  marasmus. 

Correct  the  cause.  The  nipjde  should  have 
a hole  large  enough  so  that  the  food  drops  out 
freely  when  the  bottle  is  turned  upside  down. 
The  chikl  should  empty  such  a bottle  infifteen 
to  twenty  minutes.  If  it  does  not,  pour  the 
balance  of  the  food  away  at  the  end  of 
tUenty  minutes,  and  give  no  more  food 
until  the  next  feechng. 

Vomiting  due  to  fat,  sugar,  or  starch  is 
corrected,  says  Dennett,  by  giving  one  part 
milk  and  two  parts  water,  without  sugar, 
and  boiled  three  minutes,  etc.,  as  directed 
under  Infant  Feeding,;  “Treatment  of  Simple 
Indigestion,  etc.”  In  bad  cases  boiled  cU- 
hited  skimmed  milk  must  be  used.  Some- 
times the  total  daily  quantity  must  be  re- 
duced and  the  concentration  increased. 

The  vomiting  may  be  recurrent,  due  to 
lowered  gastric  tolerance.  “ Such  infants,” 
says  Dennett,  “ are  best  fed  with  malt  soup 
extract,”  added  to  the  milk  and  water  mix- 
ture in  the  place  of  cane  or  malt  sugar  (see 
Infant  Feeding). 

For  pylorospasm  (vomiting  expulsive), 
increase  the  frequency  and  diminish  the 
quantity  at  each  .feeding,  reduce  the  fat 
(albumin  milk  described  under  klarasmus 
may  be  used),  and  add  sodium  citrate,  1-2 
per  cent,  solution,  one  dram  in  each  bottle. 
Anresthcsin  or  novocaine,  gr.  3-15 o>  or  f r.  bella- 
donna}, 1 to  2 drops,  with  a few  drops  of 
paregoric,  may  be  given  before  meals 
(Gerstley).  Hill  says:  “Feed  a food  low  in 
protein  and  fat  and  high  in  sugar.”  It  is 
surprising  how  doctors  disagree.  For  con- 
genital hypertropic  pyloric  stenosis,  see 
under  Dilatation  of  the  Stomach,  Chronic. 

Wakefulness. — See  Insomnia. 


Weakness. — See  Debility. 

Weight. — See  Tables  under  Food  Values. 

Causes  of  Gain  in  Weight. — Normal  growth; 
seasonal  changes;  occupational  changes; 
carbohydrate  or  fat  diet;  convalescence  from 
wasting  chseases;  obesity;  dropsy,  evident 
or  latent,  due  to  uncompensated  cardiac 
or  renal  disease ; myxoedema. 

Causes  of  Loss  in  Weight. — Seasonal  changes; 
occupational  changes;  insufficient  or  impro- 
per food;  senility;  malnutrition  due  to 
chronic  dyspepsia,  gastric  cancer,  chronic 
tharrhoea,  marasmus,  oesophageal  stricture, 
anorexia  nervosa,  cholelithiasis,  diabetes 
mellitus,  loss  of  sleep,  infective  fevers;  toxse- 
mias  (hepatic  cirrhosis,  tuberculosis,  etc.); 
exophthalmic  goitre.  (R.  G.  Cabot.) 

Weil’s  Disease. — See  JauncUce,  Infectious. 

Weir  Mitchell  Treatment. — See  Neuras- 
thenia. 

Wet=Brain. — See  Alcohohsm. 

Whitlow. — See  Felon. 

Whooping  = Cough  ; Pertussis. — L.  per, 
intensive  tussis,  cough.  An  epidemic 
infectious  and  contagious  chsease,  mostly 
of  children,  due  probably  to  the  bacillus 
of  Bordet  and  Crengou,  and  characterized 
by  an  incubation  period  of  about  one  or 
two  weeks,  followed  by  a coryza  and  bron- 
chial catarrh,  which  lasts  about  one  or  two 
weeks  (catarrhal  stage),  when  the  cough 
becomes  paroxysmal  and  is  marked  by  a 
series  of  short,  rapid,  explosive  expiratory 
efforts,  accompanied  by  congestion  and 
cyanosis  of  the  face,  and  ending  in  a long 
clrawn  insph’atorj"  whoop,  and  often  vomit- 
ing (paroxj'smal  stage).  After  lasting  for 
from  three  to  six  weeks,  more  or  less,  the 
paroxj’smal  stage  is  followed  by  the  stage  of 
decline,  of  one  to  several  weeks’  duration. 
The  leucocjdes,  particularly  the  Ijunpho- 
cjdes,  are  increased. 

The  following  complications  may  occur: 
hemorrhages  due  to  the  intense  venous 
congestion;  emphysema,  both  vesicular  and 
interstitial;  pneumothorax;  prolapsus  ani; 
ulc£r  of  the  frenum  linguae;  herniae;  cardiac 
dilatation;  spasm  of  the  glottis;  diarrhoeal 
(hseases;  neuroses  and  psychoses;  con\ml- 
sions ; bronchopneumonia. 

Asthma  and  tuberculosis  ma}^  follow. 

A cough  resembling  that  of  whooping-cough 
may  occur  in  enlargement  of  the  tracheal  or 
bronchial  glands,  and  the  presence  of  a for- 
eign body  in  the  laiyiix,  trachea,  or  bronchi. 

The  disease  is  always  serious,  and  to  be 
dreaded.  It  is  very  fatal  in  infants. 

Treatment. — Separate  the  patient  from 
others  and  from  cats  and  dogs,  which  are 
susceptible  to  the  disease. 


WORMS 


Arrange  a quiet  life  (in  bed,  if  necessary 
to  lessen  the  paroxysms),  with  plenty  of 
fresh  air  day  and  night,  and  a light  nutri- 
tious diet,  with  plenty  of  water  to  keep  the 
mucous  membranes  moist  and  therefore 
less  irritable.  Feed  the  patient  each  time 
he  vomits.  Give  a daily  tepid  sponge  or  tub 
bath.  Guard  against  emotion,  exertion, 
stale  air,  dust,  tlraughts,  heavy  meals,  cold 
ingesta,  and  inchgestion,  since  the  pai’oxysms 
are  aggravated  by  these  influences.  A snug 
abdominal  binder  should  be  worn;  the  Kil- 
mer belt  may  be  used.  The  sputiun  should 
be  burned.  To  guard  against  reinfection, 
it  is  advised  that  two  rooms  be  used,  and 
each  room  finnigated  with  formaldehyde  on 
alternate  days  (see  Disinfection). 

Where  the  paroxysms  are  too  frequent 
and  severe,  the  following  palliative  remedies 
may  be  employed : 

Quinine,  gr.  t.i.d.,  for  each  month  of 
the  child’s  age;  and  gr.  iss  for  each  year, 
up  to  gr.  V,  t.i.d. 

Belladonna,  tincture,  i^i,  or  fluid  extract, 
ite34)  or  atropine,  gr.  }y'gQQ,{or  a child  of  two 
years,  eveiy  four  hours,  gradually  increased 
to  every  two  hours  (see  Part  11).  The  drug 
should  be  pushed  until  slight  flushing  is 
observed  about  twenty  minutes  after  its 
administration,  and  this  dose  should  be 
maintained.  Toxic  symptoms  are  dry- 
ness of  the  throat,  mydriasis,  rapid  pulse, 
and  delirium. 

Antipyrine  or  phenacetin,  in  plenty  of 
water,  gr.  ss-i,  every  four  to  two  hours  for 
a child  of  six  months;  gr.  i-ii  every  six  to  two 
hours  for  a child  of  eighteen  to  twenty 
months  (see  Part  11).  Sochinn  bromide,  gr. 
ii-iii,  or  codeine,  gr.  o + > may  be  combined 

with  the  antipyrine. 

Godeine,  gr.  3 (?-^’-)  every  six  to  four 

hours. 

Heroin  hydrochloride,  gr.  (q-v-), 

every  six  to  four  hours. 

Paregoric  (q.v.). 

Kerley  has  experimented  with  many 
drugs,  and  finds  a combination  of  antipyrine 
and  sodium  bromide  best  in  relieving 
the  paroxysms: 

Antipyrinac gr.  xviii 

(gr.  iss  per  tea.spoonful) 

Sodii  bromicli gr.  xxx 

(gr.  iiss  per  teaspoonful) 
Syrupi  nibi  id®i. . . 3v 
Aquai,  q.s.  ad 5ii 

M.  Sig. — One  teaspoonful  every  two  hours,  six 
doses  in  twenty-four  hours,  for  a child  fifteen 
months  of  age.  (Kerley.) 

These  drugs  are  given  for  five  days 
alternately  with  quinine  for  five  days. 


They  are  not  commenced  until  the  spas- 
modic stage  is  at  its  height. 

Where  there  is  much  catarrh,  employ 
creosote  inhalations,  as  in  bronchitis  {q.v.,  p. 
64);  or  a spray  of  salicyclic  acid,  2 per  cent., 
or  antipyrin,  5 to  10  per  cent.,  or  glycerine 
of  carbolic  acid,  5i,  and  sod.  bicarb.,  gr.  x, 
to  the  ounce  of  hot  water  (Yeo).  Administer 
the  spray  every  one  to  three  hours,  for  fifteen 
minutes  at  a time,  and  insti’uct  the  child  to 
inhale  the  spray  deeply.  Discontinue  the 
carbolic  acid  for  twenty-four  hours  if  the 
urine  becomes  discolored.  Minchin  strongly 
recommends  garlic  {q.v.  in  Part  11)  as  an 
antiseptic. 

To  render  the  expectoration  more  fluid, 
Yeo  prescribes  the  following: 

K Sodii  benzoatis ....  gr.  bexii 

(gr.  iv  per  teaspoonful) 
Sodii  bicarbonatis . gr.  xlviii 

(gr.  2^3  per  teaspoonful) 
Anunonii  chloridi..  gr.  xxiv 

(gr.  1%  per  teaspoonful) 

Aqua}  chloroformi.  §i 
Aqua;  antsi,  q.s.  ad  oiii 

M.  Sig. — One  to  four  teaspoonfuls,  according  to 
age,  in  a little  hot  milk,  every  four  hours.  Add  to 
each  do.se  pot.  iodidi,  gr.  ss-f-,  if  the  first  prescription 
is  not  effectual. 

For  cardiac  weakness  administer  digitalis 
{q.v.) 

To  relax  spasm  of  the  glottis,  immerse 
the  hands  in  cold  water;  if  this  fails,  perform 
intubation  (see  under  Diphtheria). 

For  debility  and  anjemia,  j^rescribe  cod- 
liver  oil,  iron,  and  arsenic  (see  Part  11). 

The  value  of  vaccine  therapy  {q.v.  in 
Part  11)  is  doubtful. 

The  patient  should  be  isolated  until  the 
spasmodic  stage  is  over;  that  is,  until 
the  whoop  has  gone.  The  catarrhal  stage  is 
the  most  infective  or  contagious. 

Winckel’s  Disease.  — See  Epidemic 
Hsemoglobinuria. 

WooI=Sorter’s  Disease. — See  Anthrax, 
in  Part  5,  Skin  Diseases. 

Word=Blindness. — See  Aphasia. 

Word=Deafness. — See  Aphasia. 

Worms. — 

Dibothriocephalus  latus.  See  Tapeworm 
Infection. 

Eel-Worm.  See  Ascariasis. 

Filaria  sanguinis  hominis.  See  Filariasis. 

Fluke- Worm.  See  Distomiasis. 

Guinea-Worm.  See  Dracontiasis,  in  Part 
5,  Skin  Diseases. 

Hook-Worm.  See  Ankylostomiasis. 

Medina-Worm.  See  Dracontiasis,  in  Part 
5,  Skin  Diseases. 

Pin-,  Thread-,  or  Seat-Worm.  See  Oxy- 
uriasis. 


WOUNDS 


Round-Worm.  See  Ascariasis. 

Strongyloides  Intestinalis.  See  Strongyl- 
oidosis. 

Tape-Worms.  See  Tapeworm  Infection. 

Whip-worm.  See  Trichuriasis. 

In  searching  the  stools  for  ova,  proceed  as 
follows:  mix  about  2 gm.  of  the  feces  with 
5 c.c.  of  a 2 per  cent,  aqueous  solution  of  liq. 
cresolis  comp,  in  a centrifuge  tube,  and 
centrifuge  at  high  speed  for  one  minute; 
decant  the  supernatant  fluid,  and  add 
fresh  liq.  cres.  comp.,  mix  and  centrifuge  as 
before.  Repeat  this  three  times.  Then  place 
on  a clean  slide  by  means  of  a pipette  a little 
of  the  sediment,  and  mix  with  it  a small  drop 
of  aniline  gentian  violet,  and  cover  with  a 
cover-glass.  Everything  on  the  slide  is 
stained  violet  except  the  eggs.  (Fauntleroy 
and  Hayden.)  The  stool  may  first  be 
strained  through  gauze. 

Wounds. — The  modern  treatment  of 
wounds  learned  in  the  late  World  War  is  as 
follows:  If  the  wound  is  seen  wthin  eight 
hours  of  its  reception  (some  say  fifteen  and 
even  twenty-four  hours),  and  it  is  an  open 
wound  (not  a small,  clean,  bullet  wound),  fa- 
vorably situated,  not  too  extensive,  and  the 
patient’s  pulse  not  over  120,  the  wound  should 
be  thorouglfiy  cleansed  with  green  soap  and 
hot  water,  laid  mde  open,  the  tract  of  the 
wound  including  all  devitalized  tissue  ex- 
sected,  all  foreign  matter  and  completely 
detached  bone-siDlinters  removed  (leaving 
attached  bone  fragments  sacredly  alone), 
injured  bone  curetted  and  united,  if  neces- 
sary, all  bleeders  tied,  the  wound  thoroughly 
cleansed  mechanically  with  hot  water 
(swabbed  with  tincture  of  iotline  if  not  very 
large),  then  closed  (primary  suture);  or  else 
covered  with  sterile  gauze  until  the  bacterial 
count  shows  no  more  than  one  microbe  to 
five  fields,  when  it  may  be  safely  closed  (de- 
layed primary  or  early  secondary  suture). 
Suture  may  be  delayed,  accortling  to  Duval, 
for  eight  days.  Excision  of  sldn  should  be 
as  limited  as  possible,  only  a very  thin  paring 
of  the  edge  of  the  wound;  but  any  and  all 
muscle  tissue  that  does  not  contract  or  bleed 
should  be  excised.  Before  attempts  at  ex- 
tracting projectiles  they  should  be  located 
by  means  of  radiography  (q.v.).  After  su- 
tui’c,  the  parts  are  demobilized.  The 
stitches  are  removed  at  the  end  of  twelve 
to  fourteen  days. 

If  the  wound  is  not  seen  before  the  lapse 
of  fifteen  to  twenty  hours,  or  if  it  is  infected, 
or  unfavorably  situated,  or  very  extensive,  or 
the  condition  of  the  patient  is  bad,  e.g.,  pulse 
over  120,  enqiloy  the  Carrel-Dakin  tivat- 
ment,  followed  by  secondary  suture  when 


but  two  or  three  bacteria  may  be  found  per 
field  in  ten  fields  for  three  days.  The 
Carrel-Dakin  treatment  is  as  follows:  Thor- 
oughly cleanse  the  wound  mechanically  with 
green  soap  and  hot  water,  open  all  pockets, 
remove  all  foreign  matter  and  as  much  de- 
vitalized and  infected  tissue  as  is  feasible, 
and  tie  off  all  bleeders  \vith  linen.  Aim  to 
procure  a basin-shaped  wound;  counter 
drainage  or  dependent  drainage  is  to  be 
avoided.  Insert  perforated  tubes,  closed  at 
the  end,  surrounded  wdth  gauze  (to  keep  the 
perforations  open)  into  all  parts  of  the  wound 
Use  no  lateral  perforations  in  penetrating  or 
through  and  through  wounds.  In  the  latter 
instances  insert  the  tubes  from  below.  Keep 
the  tubes  in  place  with  pieces  of  gauze.  Pro- 
tect the  skin  mth  sterilized  vaseline,  poured, 
while  melted,  on  strips  of  gauze.  Apply 
over  the  tubes  and  gauze  non-absorbent 
cotton,  then  absorbent  cotton,  and  then 
gauze  and  adhesive  strips.  The  rubber 
tubes  may  be  connected  by  means  of  glass 
Y-shaped  and  other  shaped  tubes  and  the 
whole  connected  wth  a reservoir  containing 
Dakin’s  solution  (see  Part  11).  The  latter 
should  be  instilled  every  two  hours,  just 
enough  each  time  to  fill  the  cavitj^  The 
dressings  should  be  changed  every  day  and 
the  wound  irrigated  with  Dakin’s  solution. 
The  skin  should  be  cleansed  every  other 
day  with  soap  and  water,  shaved,  dried, 
and  bathed  with  ether  (not  alcohol).  The 
limb,  during  sterilization  of  infected  wounds, 
is  immobilized  on  a splint. 

The  chief  use  of  Dakin’s  solution  is  as  a 
solvent  of  dead  tissue.  If  all  devitalized 
tissue  can  be  removed  Avith  the  knife,  and 
primary  suture  is  not  feasible,  it  is,  perhaps, 
better  to  use  diclfioramine-T — (see  Part  11) 
than  Dakin’s  solution. 

The  causes  of  a continued  high  bacterial 
count  are  the  presence  of  necrotic  tissue, 
poor  blood  supplj^  (due  to  tension  from 
sutures  or  the  pressure  of  splints),  inade- 
quate strength  of  antiseptic,  and  improper 
application  of  the  antiseptic.  Dakin’s  solu- 
tion must  be  reneAA'ed  e\'ery  tAvo  hours  be- 
cause of  its  chemical  instabilitjq  its  chlorine 
uniting  AAuth  the  proteins  of  dead  tissue  to 
form  chloramines. 

After  sterilization,  the  AA'ound  may  be 
closed  by  deep  sutures  or  by  means  of  ad- 
hesiA'e  plaster  strapping,  Avithout  i*efreshing 
or  remoA'ing  granulating  surfaces.  The  skin 
may  luree  to  be  released  from  the  deeper 
jAarts,  if  arlherent,  and  its  edges  freshened. 
DiAuded  muscles,  tendons,  aponeuroses,  and 
nerves  should  be  brought  together.  Osseous 
gaps  may  have  to  be  filled  Avith  Beck’s  paste 


WOUNDS 


{q.v.  in  Part  11)  or  an  adipose  graft.  When 
the  wound  gapes  to  such  an  extent  as  to 
preclude  complete  closure,  lay  a strip  of  ad- 
hesive plaster,  three  inches  wide,  fitted  with 
shoe-lace  hooks,  on  each  side  of  the  wound, 
parallel  with  it,  and  extending  two  inches 
beyond  the  extremities  of  the  wound,  and 
connect  the  strips  across,  the  wound  by 
means  of  elastic  lacing.  To  prevent  retrac- 
tion of  the  soft  parts  in  an  infected  stump, 
employ  traction  by  means  of  adhesive  plaster 
and  a weight. 

In  90  per  cent,  of  cases,  says  Carrel,  the 
wound  may  be  closed,  folio-wing  disinfec- 
tion, between  the  fifth  and  twentieth  day. 

Rutherford  Morison,  after  removal  of  all 
necrotic  tissue,  blood,  secretions,  etc.,  dries 
the  wound  with  alcohol,  and  then  mbs  in 
his  “bipp”  {q.v.  in  Part  11),  and  closes 
the  wound.  This  method  has  many  advo- 
cates. Alcohol,  50  per  cent.,  is  itself  a 
valuable,  non-irritating  antiseptic.  Ether 
is  also  used. 

Joint  wounds  are  treated  exactly  as 
wounds  elsewhere.  In  open  wounds  of  the 
joint  the  latter  should  be  laid  \vide  open,  the 
tract  of  the  wound  excised,  all  foreign  matter 
and  completely  detached  bone-splinters, 
removed,  injured  bone  curetted  and  rectified, 
if  necessary,  and  the  wound  closed  (carefully 
suturing  the  synovial  membrane  with  fine 
catgut),  followed  by  a compressive  bandage. 
If  drainage  for  twenty-four  hours  is  deemed 
advisable,  insert  the  drain  down  to  the 
synovial  membrane,  and  not  into  the  joint 
cavity.  For  knee  cases  use  subsequently  a 
Thomas  splint  {q.v.  in  Orthopjedics,  Part  10) 
with  the  knee  slightly  flexed.  Resection  of 
the  joint  is  permissible  only  in  the  presence 
of  great  bone  destruction.  In  the  pres- 
ence of  serious  suppurative  infection,  lay 
the  joint  wide  open  and  employ  disinfec- 
tion. If  this  fails,  resect  the  joint,  followed 
at  once  by  separation  of  the  ends  of  the 
bones. 

Small  through  and  through  bullet  wounds 
with  punctiform  orifice  and  no  fracture 
should  be  treated  expectantly,  unless  sepsis 
occurs,  when  the  joint  should  be  widely 
opened  and  the  Carrel-Dakin  technique 
employed. 

In  hemarthrosis  with  a small  external 
wound,  tap  the  joint  if  the  effusion  is  con- 
siderable and  causes  pain.  If  aspiration  is 
prevented  by  clotting,  the  joint  may  be 
opened,  the  clot  washed  out,  the  tract  of  the 
wound  excised  if  it  is  in  the  line  of  incision, 
otherwise  superficially  sterilized,  and  the 
joint  then  closed  -without  drainage.  Follow- 
ing joint  injuries  and  infection  it  has  been 
25 


customary  to  immobilize  the  joint,  but 
C.  Willens  advocates  immediate  active 
mobilization  following  either  injury  or  in- 
fection. He  says  the  movements  must  be 
performed  by  the  patient  himself,  they  must 
be  to  their  maximum  limit,  and  must  not  be 
combined  with  passive  motion.  They  must 
be  repeated  at  least  every  three  hours,  each 
time  until  no  more  pus  or  secretion  is  ob- 
served to  exude.  The  patient  should  be 
gotten  out  of  bed  early. 

In  the  pre.sence  of  any  lesion  which 
threatens  ankylosis,  and  after  joint  excision 
(which  should  be  strictly  avoided  if  at  all 
possible),  see  that  the  joint  becomes  ankyl- 
osed  in  a favorable  functional  position,  e.g., 
(1)  the  shoulder  abducted  50-70  degrees, 
the  elbow  slightly  in  front  of  the  coronal 
plane  of  the  body;  (2)  the  elbow  at  a little 
less  than  a right-angle,  and  supinated  nearly 
two-thirds;  (.3)  the  wrist  in  dorsiflexion; 
(4)  the  hip  in  slight  abduction  and  external 
rotation  and  full  extension;  (5)  the  knee  in 
full  extension;  (6)  the  ankle  at  right-angles 
and  very  slightly  varoid  (Sir  Robert  Jones). 

Sir  Robert  Jones  gives  the  folio-wing  ad- 
vice concerning  the  management  of  stiff 
joints  following  gunshot  injury;  If,  on 
mobilizing  the  joint  under  an  anesthetic, 
one  or  two  definite  snaps  are  felt,  the  stiff- 
ness was  due  to  a few  fibrous  bands  about 
the  capsule.  If,  however,  no  great  resist- 
ance to  movement  is  felt,  but  there  is  a 
“soft  tearing  sensation,”  it  indicates 
the  presence  all  through  the  joint,  of  a 
“diffuse  soft  fibrous  tissue,”  the  disturbance 
of  which  will  provoke  the  formation  of  a 
“more  den.se  fibrosis.”  In  such  a case  one 
should  wait  until  the  “pathologic  changes 
are  ended,”  when  “movement  may  be  re- 
stored in  gentle  stages  of  persuasively  con- 
ducted alternate  attack  anti  rest.”  Muscular 
cicatrization  may  cause  restriction  of  joint 
motion.  In  such  a case  the  limb  should  be 
splinted  so  as  to  relax  the  affected  muscle, 
and  the  scar  in  the  latter  should  be  mas- 
saged until  it  loosens  up. 

In  muscle  injuries,  as  soon  as  healing  has 
occurred,  one  should  start  voluntary  move- 
ments of  the  affected  muscles  (not  neces- 
.sarily  of  the  limb),  in  order  to  prevent  con- 
tracture or  overstretching. 

Divided  nerves  are  sutured  primarily  or 
secondarily,  as  indicated,  after  freshening 
the  severed  ends.  After  nerve  injuries,  the 
muscles  supplied  must  be  kept  continuously 
relaxed  by  splinting  the  limb  until  the 
nerve  has  regenerated,  when  voluntary 
action  should  be  begun. 

Contusion  of  blood-vessels  is  manifested 


YELLOW  FEVER 


by.  tlirombosis  wdth  subsequent  embolism 
or  secondary  hemorrhage.  The  vessel  should 
be  ligated  above  and  V)elow  the  thrombus. 
Arteriotomy  and  evacuation  of  the  clot 
should  not  be  done.  In  all  cases  of  second- 
ary hemorrhage  ligate  above  and  below  the 
bleeding  point. 

In  traumatic  aneurysm,  lay  open  the 
sac,  after  .securing  provisional  htemostasis, 
search  for  the  point  of  injury,  and  ligate  the 
vessel  immediately  above  and  below  this 
point  in  orrler  not  to  occlude  important 
collateral  branches;  then  remove  the  sac 
either  completely  or  partially.  Suture  of 
the  injured  vascular  walls  is  the  ideal  pro- 
cedure, but  it  is  rarely  practicable. 

In  open  destructive  wounds  of  the  thorax 
and  lungs,  spread  the  ribs  apart  with  strong 
rib-retractors,  insert  the  hand,  remove  for- 
eign bodies,  deliver  the  injured  lung,  excise 
injured  tissue,  suture  the  lung,  and  close  the 
wound.  Treat  wounds  of  the  soft  parts  and 
fractured  ribs  as  usual.  An  open  thorax 
should  be  closed  promptly  by  plugging  or 
sutm-e. 

In  closed  wounds  of  the  chest,  thora- 
cotomy and  lung  suture  for  the  control  of 
hemorrhage  is  rarely  required.  Do  not 
aspirate  unless  symptoms  of  compression 
demand  it;  then  it  is  best  to  replace  the 
evacuated  blood  with  air  or  oxygen  in  order 
to  keep  the  lung  collapsed  until  hemorrhage 
is  controlled.  Should  htemothorax  pemist 
after  bleeding  has  ceased,  aspirate  repeatedly 
in  order  to  facilitate  exj:>ansion  of  the  lung. 

Operate  upon  all  abdominal  wounds  ex- 
cept those  limited  to  the  liver  or  Iddney  in 
which  hemorrhage  is  not  severe. 

For  intraperitoneal  bladder  wounds,  per- 
fonn  laparotomy  and  suture  the  wound. 
Suture  extraperitoneal  and  supra-pubic 
wounds.  In  inaccessible  wounds  of  the 
walls  or  base  of  the  bladder,  treat  the  wound 
tract  and  drain  the  bladder  through  the 
wound,  later  tying  a catheter  into  the  ur- 
ethra, if  necessary,  to  favor  closure  of  the 
urinary  fistula.  Perform  CA^stotomy  in  the 
presence  of  retention,  perivesical  infiltra- 
tion, serious  hematuria,  foreign  body,  and 
secondary  cystitis  (see  also  Part  3). 

For  intraperitoneal  wounds  of  the  rec- 
tum, perfonn  laparotomy  and  suture  the 
wound.  For  extraperitoneal  wounds,  lay 
open  the  wound,  treat  as  usual,  and  plug. 
Rupture  ■with  extensive  detachment  may 
require  posterior  rectotomy.  Colostomy  is 
rarely  required. 

In  recto-vesical  wounds,  treat,  as  a rule, 
only  the  wound  tract.  To  favor  closure  of 
the  fistula,  employ  ventral  decubitus,  or 


micturition  in  the  knee-chest  posture,  or 
tying  of  a catheter  into  the  urethra. 

Punctiform  wounds  of  the  spinal  cord 
should  be  treated  expectantly;  other  wounds 
in  the  usual  manner  (see  Part  10). 

In  wounds  of  the  brain,  do  not  use  mallet 
and  chisel  to  enlarge  the  bone  wounds,  but 
use  gouge-forceps  or  trephine.  Do  not  dis- 
turb the  dura  mater  if  it  is  intact.  Use 
warm  saline  irrigation  for  the  removal  of 
clots,  etc. 

Wounds  of  the  larynx  demand,  with  rare 
exceptions,  immediate  high  tracheotomy 
{q.v.)  under  local  anesthesia  {q.v.),  and 
the  insertion  of  a tube,  with  the  neck  wound 
left  open.  Never  do  a laryngotomy.  A 
proper  sized  tube  should  be  used,  and  it 
should  be  kept  free  from  secretions  by 
.suction  (e.g.,  a Wappler  small  suction  pump). 
The  outer  tube  should  be  removed  only  by 
the  surgeon,  and  tracheal  dilators  should  be 
kept  at  the  bedside,  to  open  the  trachea  in 
a hurry  so  that  the  tube  can  be  quickly 
reintroduced,  if  necessary.  (Consult  also 
Inflammation,  Local. 

Wright’s  Hypertonic  Solution. — See  Part 
11,  Drugs. 

Writer’s  Cramp. — -See  Cramps,  Profes- 
sional. 

Wryneck. — See  Torticollis. 

Xerostomia. — See  Aptyalism. 

X=Rays. — See  Rontgenology. 

Yaws;  Frambesia. — See  Part  5,  Skin 
Diseases. 

Yellow  Atrophy  of  the  Liver,  Acute. — See 

Atrophy,  Acute  Yellow,  of  the  Liver. 

Yellow  Fever. — An  acute  infectious,  non- 
contagious  disease,  endemic  in  tropical  and 
subtropical  countries,  and  occasionally  car- 
ried to  ot  her  parts  in  warm  weather,  due  to  the 
leptospira  icteroides  (Noguchi)  transmitted 
by  the  bite  of  the  stegomyia  fasciata  mos- 
quito, and  characterized  by  the  follownng 
symptoms;  The  onset  is  usually  sudden,  with 
headache,  general  pains,  sore  throat,  flushed 
face,  perhaps  ocular  injection  and  photo- 
phobia, fever,  perhaps  chilly  sensations, 
usually  nausea  and  vomiting,  perhaps  epi- 
gastric distress.  On  the  second  day  the  fever 
and  pains  may  or  may  not  abate,  but  a 
slight  yellow  tinging  of  the  conjunctivae 
appears,  with  usually  “exquisite  tenderness  ” 
on  gentle  deep  pressure  over  the  epigastrium. 
On  the  third  day,  as  a rule,  the  fever  rises 
to  103°  to  104°  F.,  and  remains  so  for  one, 
two,  or  three  days,  and  gradually  falls  to 
normal.  After  an  intermission  of  one,  two, 
or  three  days,  the  temperature  again  rises, 
except  in  mild  cases,  but  the  pulse  at  the 
same  time  slows  (Faget’s  sign).  By  the 


ZOSTER 


fifth  or  sixth  day  the  jaundice  is  intense, 
the  patient  is  prostrated,  and  in  severe  cases 
there  occur  hemorrhages  from  the  mucous 
membranes  (black  vomit)  and  nephritis. 
Albuminaria,  indeed,  appears  early  in  all 
cases,  but  it  may  be  transient.  After  lasting 
one,  two,  or  three  days,  unless  death  occurs, 
the  secondary  fever  gradually  subsides. 

The  liver  seems  to  bear  the  brunt  of  the 
attack;  the  liver  cells  undergo  fatty  degen- 
eration and  swell,  obstructing  the  bile-ducts 
and  portal  circulation. 

The  mortality  is  about  15  per  cent.,  more 
or  less. 

Exclude  malaria,  typhoid  fever,  dengue, 
and  relapsing  fever. 

The  mosquito  which  has  bitten  a yellow 
fever  patient  (it  must  bite  the  latter  during 
the  first  three  days  of  the  disease)  cannot 
transmit  the  disease  until  twelve  or  more 
days  have  elapsed.  After  this  period,  how- 
ever, it  is  infective  as  long  as  it  lives.  The 
incubation  period,  following  the  bite  of  the 
infected  mosquito,  is  two  to  six  days;  and 
the  total  incubation  period  would,  therefore, 
be  twelve  plus  two  to  six  days,  or  fourteen 
to  eighteen  days. 

Treatment. — Absolute  rest  in  bed,  including 
the  use  of  the  bed-pan,  urinal,  and  goose- 
neck feeder,  is  to  be  enjoined.  The  treat- 
ment is  eliminative;  the  more  urine  passed 
the  better  the  outlook.  Open  the  bowels 
thoroughly  by  means  of  calomel  in  divided 
doses,  followed  by  salines  (see  Part  11), 
and,  if  necessary,  enemata;  and  administer 
water  in  abundance:  cream  of  tartar  lemon- 
ade iq.v.)]  Vichy;  Apollinaris;  sodium  or 
potassium  bicarbonate,  one  teaspoonful 
to  the  quart;  pot.  bicarb.,  gr.  xxx  to  the 
dessertspoonful  of  fresh  strained  lime-juice, 
every  two  hours  (Anderson);  normal  saline 
solution  per  rectum  or  subcutaneously  every 
six  to  eight  hours,  if  fluids  are  not  retained 
by  the  stomach.  For  the  treatment  of 
vomiting,  see  Vorhiting.  During  the  first 
six  or  seven  days,  give  milk  and  Vichy 
or  lime  water,  equal  parts — about  one 
tablespoonful  every  three  or  four  hours,  and 
also  barley  water  (or  give  no  food  at  all  for 
the  first  three  to  five  days).  Later  give 
milk,  broths,  ice-cream,  custard,  gelatine; 
and  after  the  temperature  has  been  normal 


for  three  or  four  days,  light  soft  or  solid 
diet,  gradually  increased  to  regular  diet. 

For  a temperature  of  102°-f-  F.,  employ 
cold  sponges  or  packs  every  two  hours  to 
every  half  hour,  according  to  the  height  of 
the  fever. 

For  a feeble  rapid  pulse,  give  strych- 
nine hypodermically,  and  iced  champagne, 
2 to  3 teaspoonfuls  every  two  to  four  hours. 

For  headache,  apply  an  ice-cap  to 
the  head. 

Should  the  urine  become  scanty  and  albu- 
minous, resort  at  once  to  sweating  (by  means 
of  hot  bricks  covered  with  wet  towels 
sprinkled  with  alcohol),  hot  applications, 
or  dry  or  wet  cups  (see  Cupping)  over  the 
kidneys,  hot  enemata,  copious  hot  drinks, 
perhaps  normal  saline  infusions,  and  cathar- 
tics (see  Uraemia). 

For  the  “ black  vomit,”  see  Haemateniesis. 

Keep  the  patient  in  bed  for  at  least  a week 
after  defervescence,  and  until  the  urine  is 
clear,  feeding  him  carefully. 

Prophylaxis.— On  the  first  appearance  of 
yellow  fever  the  patient  should  be  screened 
against  mosquitoes,  and  the  whole  house 
fumigated  with  sulphur,  two  pounds  to  each 
thousand  cubic  feet,  for  one  and  one-half 
hours,  to  destroy  all  mostiuitoes. 

Standing  water  which  may  serve  as  a 
breeding  place  for  mosquitoes  should  be 
removed,  or  screened,  or  covered  with 
petroleum.  All  cans,  broken  bottles,  and 
rubbish  wliich  might  collect  water,  should 
be  removed,  and  sagging  gutters  straightend. 
Rain-barrels,  small  ponds,  etc.,  should  beoiled. 

Carroll  says,  since  the  stegomyia  mosquito 
feeds,  as  a rule  before  9 m.  and  after  3 
p.  M.,  non-immunes  may  go  about  between 
these  hours,  but  should  protect  themselves 
with  mosquito  netting  at  other  times,  or 
go  to  higher  altitudes.  (3ne-quarter  of  a 
mile  from  shore  is  a safe  distance  to  anchor 
to  avoid  mosquitoes.  Ships  from  infected 
ports  should  be  quarantined  for  six  days 
from  the  day  they  left  port.  Ships  arriving 
at  infected  ports  should  be  anchored  200 
meters  away  from  wharves  and  should  be 
fumigated  before  taking  on  cargo  or  pas- 
sengers. 

Zoster. — (See  Herpes  Zoster,  in  Part  5, 
Skin  Diseases.) 


APPENDIX  TO  PART  I 

Schema  for  the  General  History  and  Ex.amination 


Name 

Single 

Children 


Married,  liow  long 
Widowed,  how  long 


Address 


No. 


Race 


Date 

Occupation 

Sex  Age 

General  appearance 
Height  Weight 

Proper  weight  (sec  Food  Values) 

// ygiene:  Rest  Exercise 

Recreation  Diet  Sleep 

Bowels  Ventilation  Baths 

Sexual  habits  Tea  and  coffee 

Narcotics  Alcohol  Tobacco 

Complaint:  (For  what  form  of  distress  does  the  patient  seek  relief?) 

History  of  Present  Illness:  Date  of  onset  Duration  To  what  does  the 

patient  attribute  his  or  her  illness? 

Initial  Symptoms  and  Mode  of  Onset 

Progress  of  the  Illness 

Is  the  patient  getting  better  or  worse? 

Preiious  History 

Family  History 

Examination:  (The  rise  in  pulse  rate  which  occurs  when  one  stands  after  lying  recumbent  averages  in 

normal  individuals  seven;  it  should  not  exceed  twenty  beats  per  minute). 

Temperature  Pulse  Respiration  Facies 


Skin  and  mucous  membranes 

Head 

Nose 

Larynx 

Arms  and  hands 
Heart 

Genito-urinary  system 
Joints 

Blood-vessels 


Glands  (lymphatic,  salivary,  thyroid) 
Ears 


Eyes 
Mouth 
Neck 
Back 
Abdomen 

Neuro-muscular  system 
Reflexes 

Urinary  analysis  {q.v.) 

Frequency  Color 

Total  solids  Urea 

Sediment 

Diagnosis: 

Treatment:  (On  other  side  of  sheet).  (Including  dates  and  whether  at  office  or  home). 


Pharynx 

Thorax 

Lungs 

Rectum  and  anus 
Legs  and  feet 
Blood  (see  Blood  Exam.) 
Amount  in  24  hours 
Reaction  S.  G. 

Albumin  Sugar 

Renal  Function 


Date 

Name 

Sex 

History  of  Prenous  Children: 
Living 
Dead 


The  Infant  Record  Chart 
Residence 

Age 


No. 

Birth-weight 


Health  of  Mother 

Health  of  Father 

Complaint 

Duration  of  Illness 

Food  given 

Intervals  of  nursing 

Number  of  nursings  in  2Jf  hours 

Amount  taken  at  each  nursing 

Amount  taken  in  24  hours 

Number  of  stools  in  24  hours 

Character  of  the  stools:  Size  Color  Consistency 

Odor  Reaction  Mucus  Curds 

Blood 

Cathartics  employed- 
Vomiting,  and  when  occurring 
A ppetite 

Sleep  in  24  hours:  (The  normal  is  20  hours  up  to  the  si.xth  month,  IG  to  18  hours  thereafter). 
Weight  Color  Skin 

Mouth  Heart  Lungs 

.Abdomen  Temperature  Rickets? 

Diagtiosis 

Treatment  (including  dates,  and  whether  at  office  or  home). 


THE  ARMAMENTARIUM  OF  THE  INTERNIST 


The  Armamentarium  of  the  Internist. 

I.  Office  Diagnostic  Equipment. — Card  index; 
weighing  machine;  baby  scale;  Nicholson’s 
or  Mercer’s  type  of  Riva-Rocci  sphygmo- 
manometer; sphygmograph  (for  recording  the 
time  relations  of  the  pulse  waves,  not  the 
shape) ; steel  spring  binaural  stethoscope  with 
flexible  rubber  tubing;  Bowles’  stethoscope 
with  hard  rubber  bell  attached;  hypodermic 
syringe,  accurately  graduated;  clinical  ther- 
mometer; aspirating  needles;  large  hypo- 
dermic syringe  for  exploring  the  pleural 
cavity  for  pus;  sigmoidoscope;  proctoscope; 
pneumatic  sigmoidoscope;  the  special  table 
of  Mathew  and  Hanes  for  proctoscopic 
examination  in  the  inverted  position;  stom- 
ach tube;  Rehfuss’  stomach  tube;  10  c.c. 
Luer  syringe;  Einhorn  duodenal  tube;  X-ray 
machine;  ophthalmometer;  self-registering 
perimeter  for  measuring  the  visual  and 
color  fields;  tuning-fork;  polygraph;  electro- 
cardiograph; inverted  cone-shaped  glasses 
for  inspection  of  urine  and  sputum;  urethral 
sounds;  cystoscope  and  ureteral  catheters. 

II.  Laboratory  Equipment. — (a)  INSTRUMENTS 
AND  Utensils. — Purdy’s  electrical  centri- 
fuge with  test-tubes  graduated  to  15  c.c.; 
filter-paper;  glass  funnels  and  stand;  Boas 
bulb,  or  Turck’s  aspiration  apparatus;  urin- 
ometer  and  cylinder  for  the  estimation  of 
specific  gravity;  Doremus  or  Doremus-Hinds 
ureometer;  test-tubes  and  rack;  two  burettes 
of  50  c.  c.  capacity ; two  Esbach  tubes ; pipettes ; 
evaporation  dishes;  water- bath;  platinum 
foil;  litre- volumetric  flask;  the  Dubose  or 
the  Rowntree  and  Geraghty  modification 
of  the  Autenrieth-Kbnigsberger  colorimeter; 
Rudolf’s  apparatus  for  estimating  the  coagu- 
lation time  of  the  blood;  Sahli’s  hiemometer, 
or  the  hgemometer  of  Fleischl-Miescher; 
hsemocytometer  of  Thoma-Zeiss,  consisting 
of  erythrocyte  and  leucocyte  pipettes,  count- 
ing chamber,  and  special  cover-glass  (pref- 
erably a Tiirck  counting  chamber);  slides 
and  cover-glasses;  microscope  with  acces- 
sories, including  an  ultra-condenser  or  dark- 
field  illuminator;  Ehrlich’s  locking  or 
crosspoint  forceps;  pinch  forceps;  Strauss’s 
spinalpuncture  needle  with  mercury  man- 
ometer attachment; acidosis  outfit, consisting 
of:  a hot  water  bag  of  about  1500  c.c.  capa- 
city with  a perforated  rubber  stopper  contain- 
ing a short  glass  tube,  % inch  in  internal 
diameter,  and  connected  by  means  of  a short 
rubber  tube  with  a glass  mouth-piece,  \}/2 
inches  long  and  ^ inch  in  internal  diameter, 
atomizer  bulb,  pinch-cock,  and  the  following, 
obtainable  from  Hynson,  Westcott,  and 
Dunning,  Baltimore — eight  standardized 
phosphate  tubes,  standard  bicarbonate  solu- 


tion, test-tubes,  glass  pipette  drawn  out 
to  a capillary  point,  box  for  color  comparison, 
paraffined  stoppers;  Babcock’s  graduated 
flasks  and  pipettes  for  the  Babcock  test  for 
fat  in  milk;  water-still;  alcohol  burner  or 
Bunsen  burner;  tripod,  asbestos  mats;  litmus 
paper,  red  and  blue;  white  porcelain  dish; 
Cohnbeim’s  separating  funnel;  set  of  beakers; 
medicine  droppers;  bath  thermometer;  sepa- 
rating funnel  graduated  up  to  25  c.c. ; cylinder 
graduated  up  to  100  c.c. ; glass  tubing ; spectro- 
scope; hand  lens;  hydrogen  sulphide  generator 
for  the  detection  of  lead;  Einhorn’s  sacchari- 
meter;  polariscope;  Tallquist’s  scale;  plati- 
num loop;  Cornet’s  forceps. 

Utensils  for  the  modification  of  cow’s 
milk:  16-ounce  glass  graduate;  glass  funnel; 
Chapin  1-ounce  clipper;  2-quart  mixing 
pitcher;  new  aluminum  or  enamel  saucepan; 
graduated  cylindrical  nursing  bottles  with 
wide  mouths;  wire  bottle-rack;  rubber  nip- 
ples; bottle  brushes;  cotton- wool;  Freeman 
pasteurizer. 

Epstein’s  instrument  for  the  Lewis  and 
Benedict  blood-sugar  test,  obtained  from 
Ernst  Leitz,  30  East  18th  Street,  New 
York  City. 

The  Fredericia  instrument  for  ascertaining 
the  carbon  dioxide  tension  of  the  alveolar 
air  and  the  Van  Slyke  instrument  for 
ascertaining  the  carbon  dioxide  capacity 
of  the  blood  plasma,  obtainable  from  the 
Emil  Greiner  Company,  55  Fulton  Street, 
New  York  City. 

(b)  Chemicals. — 10  per  cent,  sulphuric 
acid  in  95  per  cent,  alcohol;  .50  per  cent, 
solution  of  antiformin  (10  per  cent,  solution 
of  sodium  hypochlorite  containing  5 to  10 
per  cent,  of  socUum  hydrate) ; ethyl  alcohol ; 
chloroform;  carbolic  acid;  pure  methyl  alco- 
hol; chstilled  water;  potassium  carbonate; 
Giemsa’s  stain;  saturated  alcoholic  solution 
of  ro.se-aniline  violet;  Loeffler’s  methylene 
blue  solution;  nitric  acid,  c.p.;  5 per  cent, 
solution  of  silver  nitrate;  acetic  acid;  bro- 
mine; 8,  10,  20  and  25  per  cent,  solutions  of 
sodium  hydrate;  1 per  cent  alcoholic  solu- 
tion of  phenolphthalein;  tenth  normal  sodium 
hydroxide  solution;  formalin;  hydrochloric 
acid,  c.p.;  solid  sulpho-salicylic  acid;  sodium 
or  potassium  citrate;  crystallized  sodium 
carbonate;  copper  sulphate  crystals,  c.p.; 
silver  nitrate,  pure  anhydrous  crystals; 
solid  potassium  hydroxide;  10  per  cent, 
solution  of  salicyl  aldehyde  in  absolute 
alcohol ; para-amido-acetophenon ; sodium 
nitrite;  concentrated  ammonium  hydroxide; 
hydrogen  peroxide;  glacial  acetic  acid;  osmic 
acid;  Sudan  III;  phenolsulphonephthalcin 
(0.6  gm.);  sodium  chloride,  0.75  per  cent. 


THE  ARMAMENTARIUM  OF  THE  INTERNIST 


solution;  thionin  (Lauth’s  violet),  a saturated 
solution  in  50  per  cent,  alcohol;  0.25  per  cent, 
solution  of  fornialin  in  95  per  cent,  alcohol; 
Canada  balsam;  corrosive  sublimate;  sochum 
sulphate;  sodium  chloride;  neutral  glycerine; 
methyl  violet  5B;  gentian  violet;  ether;  0.5 
I)cr  cent,  solution  of  Grubler’s  “ French 
pme  ” eosin  in  70  per  cent,  alcohol;  0.25 
per  cent,  aqueous  solution  of  methylene 
blue  (B.pat.);  polychrome  methylene  blue; 
liquor  plumbi  subacetatis;  sodimn  sulphide; 
phosphotungstic  acid;  Giinzberg’s  solu- 
tion (phloroglucin,  gr.  xxx,  vanillin,  gr. 
XV,  alcohol  5i);  eosin-hsematoxylin  stain; 
Gram’s  stain  ingredients  (saturated  aniline 
water,  filtered;  saturated  alcoholic  solution 
of  gentian  violet;  iodine;  potassimn  iodide; 
alcohol,  95  per  cent.;  safranin);  ferric 
chloride  solution,  10  per  cent,  (liquor  ferri 
chloridi);  tfimethylamidoazobenzol,  0.5  per 
cent,  alcoholic  solution;  alizarin  (sodium 
alizarin  sulphonate),  1 percent,  aqueous  solu- 
tion; calcium  chloride,  1 per  cent,  aqueous 
solution;  pure  benzidin;  hydrogen  peroxide, 
3 per  cent.;  saturated  alcoholic  solution  of 
fuchsin;  carbolic  acid  solution,  5 per  cent.; 
spirits  of  nitrous  ether;  potassium  ferro- 
cyanide,  10  per  cent.;  dilute  acetic  acid; 
picric  acid;  citric  acid;  sulpluu-ic  acid,  c.p.; 
amyl  alcohol;  Rochelle  salt;  caustic  soda; 
bismuth  subnitrate;  phenylhydrazine  hydro- 
chloride; sodium  acetate;  ferric  chloride; 
potassium  or  sodium  nitroprusside ; Wright’s 
stain;  powdered  charcoal,  magnesium  oxide 
or  carbonate,  barium  carbonate,  silicic  acid, 
sawdust,  or  Imie  water,  for  clarifying  urine; 
acetic  acid,  5 per  cent.;  acetic  acid,  50  per 
cent.;  alcohol,  60  per  cent.;  phloridzin; 
indigo  carmine. 

III.  Therapeutic  Equipment. — Aspiratmg  nee- 
dles; Southey’s  or  Cm'schmann’s  tubes; 
rubber  tubing;  wet-cup  instrument,  con- 
sisting of  lancet  blades  on  a spring;  gasogen 
(conttiining  oxylith,  Na^Os,  or  sodium  per- 
borate, brought  in  contact  with  water,  and 
the  resulting  gas  stored  in  a 15-litre  gasbag) ; 
Davidson  double-bulb  sja’inge;  1 c.c.  “Re- 
cord ” syringe;  O’Dwyer’s  intubation  set; 
tracheotomy  instruments  (knife,  arteiy 
clamps,  sharp  hook,  small-toothed  dissecting 
forceps.  Trousseau’s  three-bladed  dilator; 
tracheotomy  tul)e,  tapes,  horsehair  or 
silkworm-gut  sutures,  sterile  gauze;  jn-obe- 
pointed  bistoury,  retractors);  chloroform 
mask;  a'sophageal  bougies;  Waldenberg’s 
portalde  aj)paratus  for  the  insi)iration  of 
(iompressed  air  and  its  expiration  into 
rarified  air,  used  in  the  treatment  of  jnilmo- 
nary  emi)hysema;  Strauss’  sj)inal-puncture 
needle  with  mercury  manometer  attach- 


ment; pile  ointment  pipe;  rubber  catheter. 
No.  12  to  16  American  scale,  or  24  French; 
No.  18  American  catheter;  electricity  (gal- 
vanic, faradic,  sinusoidal,  static,  high- 
frequency);  vibrassage  machine;  fountain 
syringe;  basins;  hot  water  bags;  ice  caps; 
stomach  tube;  colon  tube;  hypodermic 
sjTinge;  Paquelin  cautery;  electro-cautery; 
douche-pan ; Leiter  coil ; catheters,  male 
(Nelaton)  and  female;  larnygeal  lancet;  laryn- 
geal mirror;  head  lamp;  Kemp’s,  Tuttle’s,  or 
Slaidin’s  double-current  rectal  tubes;  intra- 
venous infusion  apparatus,  consisting  of  a 
special  needle,  rubber  tube,  glass  obser\^a- 
tion  tube,  and  glass  reservoir,  etc.  (see 
Intravenous  Medication) ; adhesive  plaster; 
set  of  abtlominal  trocars  and  cannul* ; 
oxygen  cylinder  with  “ pressure  ” tubing; 
Holt  croup  kettle,  or  tripod,  saucepan,  and 
alcohol  lamp;  corrugated  applicators;  oil 
and  water  atomizers;  piston  sjTinge;  gradu- 
ated flexible  linen  or  gum-elastic  or  whale- 
bone oesophageal  sounds  wdth  conical  tips; 
filiform  whalebone  oesophageal  bougies;  oeso- 
phagoscope;  cRessing  forceps;  Sjunond’s  oeso- 
phageal tube;  plaster  of  Paris  and  plaster 
bandages;  Bier’s  suction  cups;  Potain’s  air- 
tight, thoracentesis  apparatus  with  thick, 
uncollapsible  rubber  tubing  and  trocars  with 
lateral  outlet;  Wolff’s  bottles;  IMohr’s  nose 
protector;  fenestrated  anal  and  rectal  specu- 
lum; medicine  droppers;  Breck  feeder;  dry 
hot  air  apparatus  with  gasoline  attachment; 
blood  transfusion  outfit  (see  Blood  Trans- 
fu.sion);  artificial  pneumothorax  apparatus 
(see  Artificial  Pneumothorax);  32-candle- 
jiower  electric  light  in  a large  parabolic  re- 
flector; Klapp’s  suction  bell;  splint  wood; 
ionic  medication  out  fit,  (galvanic  battery,  with 
the  conducting  cords  preferably  of  flexible 
stranded  copper  wRe,  insulated  mth  india 
rubber;  metal  disc — say  aluminiun — elec- 
trode, about  two  inches  in  diameter,  pierced 
with  small  holes  around  its  margin,  through 
wliich  tluee  layers  of  thick  felt  may  be  at- 
tached with  tlu’ead,  the  fii’st  layer  of  felt 
larger  than  the  metal  disc  and  each  succeed- 
ing layer  larger  than  the  precetling,  the  felt 
before  using  being  well  soaked  in  hot 
anmionia  or  soda  water  in  order  to  dissolve 
out  all  grease;  metal  rod  or  button  electrodes; 
metal  sound  electrodes;  needle  electrodes, 
})referably  zinc);  Priming’s  and  von  Schroet- 
ter’s  tracheal  and  bronchial  mtubation 
tubes;  a number  of  small,  wide-mouthed, 
glass-stoppered  bottles,  and  three  glass 
[fipettes,  one  holding  3^o  c.c.  graduated  into 
lumdredths  of  a cubic  centimeter,  the  sec- 
ond holding  one  cubic  centimeter  graduated 
into  tenths  (of  a cubic  centimeter,  and  the 


THE  GENERAL  SURGEON’S  EQUIPMENT 


third  holding  ten  c.c.  graduated  into  tenths 
of  a C.C.,  for  making  tuberculin  dilutions; 
a Randall-Faichney  or  a Burroughs-Well- 
come  glass  syringe  of  one-half  or  one  c.c. 
capacity,  graduated  into  hundredths  of  a 
C.C.,  for  tuberculin  injections;  electric  pad 
or  electrotherm;  four-ounce  bulb  syringe; 
vulcanite  plug  with  narrow  anal  stem  and 
perineal  bar,  supported  by  a pad  and  T-band- 
age  for  prolapsus  ani  vel  recti;  cystoscope; 
urethral  catheters  and  bougies;  No.  5 
French  renal  catheter,  for  irrigation  of  the 
renal  pelvis;  two-way  glass  syringe  of  15  c.c. 
capacity;  Wales  soft  flexible  bougies  for 
rectal  stricture;  goo.se-neck  feeding  cup; 
long  intubation  tubes  to  pass  mechastinal 
obstruction  of  the  trachea;  bronchoscope; 
long  tracheal  cannula;  cupping  glasses; 
artificial  leech;  diverticulum  sound;  oesopha- 
geal dilators;  William  Hill’s  styleted  oro- 
oesophago-gastric  intubation  tube;  laryngeal 
applicators;  intratracheal  syringe  for  the 
injection  of  medicated  oil;  Seigle’s  steam- 
spray  producer;  nebuHzers;  oronasal  respha- 
tors;  graduated  sounds  for  bronchial  cicatri- 
cial stenosis,  used  through  a tracheotomy 
wound;  Sippy’s  inflatable  rubber  bag  for 
dilating  oesophageal  stricture;  Quincke’s  lum- 
bar puncture  needle;  rubber  bag  rectal 
stricture  dilator;  glass  syringes  for  the 
injection  of  Beck’s  bismuth  paste. 

The  General  Surgeon’s  Equipment. — 
Large  fenestrated  rubber  drainage  tubes; 
gutta-percha  tissue;  Wilson’s  empyema 
drainage  tube ; large  hypodermic  syringe  for 
exploring  the  pleural  cavity  for  pus;  .sterile 
absorbent  cotton-wool;  scalpels;  artery  for- 
ceps; rib-bone  forceps;  raspatory;  sig- 
moidoscope; proctoscope;  pneumatic 
sigmoidoscope;  grooved  director;  scissors; 
sharp-pointed,  curved  bistoury  ; probe- 
pointed  scissors;  Gant’s  angular  director  for 
fi.stula  in  ano  operations;  bandages;  sterile 
gauze  bandages;  plain  gauze;  iodine  gauze, 
and  iodoform  gauze;  tongue  forceps;  2.Tyard 
spool  of  braided  surgical  silk  thread  No.  8; 


dres.sing  forceps;  cold  snare;  trephines  and 
burrs;  chisels  and  gouges;  mallets;  Bier’s 
vacuum  or  suction  cups;  collochon;  large 
metal  fountain  syringe;  linen  thread;  hemor- 
rhoidal clamp;  Martin  I’ubber  band;  splint 
wood ; rigid  drainage  tube  with  rubber  collar, 
for  pneumothorax;  olive-shaped,  hard  rubber 
anal  dilators  of  various  sizes;  Hirschmann 
cUlator  for  rectal  stricture;  Wales  soft  flexible 
bougies  for  rectal  stricture ; rubber  bag  rectal 
stricture  dilator;  blunt  hook;  Gant’s  clamps 
or  Pennington’s  clips,  or  Lynch’s  electric  an- 
giotribe  for  division  of  hy]3ertrophied  rectal 
valves;  four-ounce  bulb  syringe,  thumb 
forceps;  long  rat-toothed  cUssecting  forceps; 
needle-holder;  needles,  assorted  varieties  and 
sizes;  pedicle  needle,  tissue  clamps,  straight 
and  curved;  abdominal  retractors;  long  noz- 
zle drainage  syringe;  glass  and  rubber  drain- 
age tubes;  Moynihan’s  intestinal  clamps; 
Murphy’s  buttons;  large  glass  trocars  and 
tubing  for  tapping  cysts;  small  metal  trocars; 
infusion  apparatus;  adenoid  curettes;  tonsil 
knives;  probes,  snare;  two-way  rectal  tube; 
tonsil  forceps;  bone-cutting  forceps;  bone- 
grasping  forceps;  saw;  silver  and  aluminum 
wire;  beef-bone  plates  and  screws;  tonsil 
hsemostat;  combined  mouth-gag  and  tongue 
depre.ssor;  abdominal  trocars  and  cannulae; 
probang;  tonsil  scissors;  tonsfllotomes;  tonsil 
punch;  periosteal  elevators;  curette;  rib 
forceps;  bone  drill;  aneurysm  needle;  hem- 
orrhoidal clamp;  eyelid  retractor;  nasal 
speculie. 

Operating  table,  stands,  basins,  pitchers, 
hand  brushes,  soap,  Rochester  sterilizer  for 
dres.sings,  in.strument  sterflizer  (fish  kettle), 
operating  gowns,  caps,  nose  and  mouth 
protectors,  laparotomy  sheets,  plam  sheets, 
rubber  sheets,  towels,  laparotomy  pads  with 
tape  attached;  rubber  gloves,  safety  pins, 
Martin  india-rubber  bandage,  adhesive  plas- 
ter, absorbent  cotton,  lint,  suture  material: 
silk,  silkwormgut,  plain  catgut,  chromized 
catgut,  linen  thread,  horsehair;  cautery, 
razor;  Esmarch  inhaler. 


PART  2 

GYNECOLOGY 


Abortion,  Miscarriage,  and  Premature 
Labor. — L.  abor'tio,  from  ah,  from  + ori're, 
to  grow.  The  term  abortion  is  used  arbi- 
trarily to  denote  the  expulsion  of  the  ovum 
during  the  first  three  months  of  pregnancy, 
or  before  the  complete  development  of  the 
placenta.  Miscarriage  denotes  the  expul- 
sion of  the  foetus  during  the  period  between 
the  end  of  the  third  month  and  the  end  of 
the  seventh  month,  or  from  the  time  of  the 
complete  formation  of  the  placenta  to  the 
viability  of  the  foetus.  Premature  labor 
denotes  the  jiremature  termination  of  preg- 
nancy after  the  seventh  month,  when  the 
foetus  is  viable,  i.e.,  capable  of  living  out- 
side the  uterus. 

Symptomatology. — Threatened  abortion  is 
manifested  by  pains  m the  lower  abdomen 
and  back,  and  uterine  hemorrhage.  Abor- 
tion is  unminent  when  the  hemorrhage 
becomes  profuse  and  the  cervix  is  well 
dilated.  It  is  inevitable  on  the  escape  of 
the  hquor  amnii.  In  the  early  months  of 
pregnancy,  the  entire  ovum,  e.g.,  foetus, 
membranes,  and  placenta,  may  be  expelled; 
but  after  the  fourth  month,  the  abortion  is 
usually  incomplete,  the  foetus  being  expelled, 
but  the  placenta  and  membranes  remain- 
ing and  producing  continued  hemorrhage 
until  removed. 

Etiology.— Criminal  interference;  irritable 
uterus;  lacerated  cervix;  excessive  coitus; 
overexertion;  trauma  (falls,  blows,  etc.); 
strong  emotion  (anger,  grief,  fright);  breast 
affections;  rapidly  succeeding  pregnancies; 
excessive  vomiting  or  coughing;  asthma; 
convulsions,  caused  by  eclampsia,  epilepsy, 
tetany,  cholsemia,  or  hysteria;  chorea;  very 
hot  climate;  very  high  altitude;  salpingitis; 
appencUcitis;  tumors;  multiple  pregnancy; 
abortifacient  drugs,  e.g.,  ergot,  cottonroot, 
quinine,  aloes,  juniper,  black  hellebore, 
tansy,  pennyroyal,  cantharides;  death  of  the 
fcetus,  due  to  the  following  causes:  abnor- 
malities of  development,  uterine  cUsplace- 
ments,  particularly  retroflexion  and 
prolapse,  endometritus  or  deciduitis,  chronic 
metritis,  syphilis  (maternal  or  paternal), 
excessive  torsion  of  the  cord,  stenosis  of  the 
umbilical  vein,  hydramnios,  hydatidiform 
mole,  placental  disorders  (obliterating  endar- 
teritis, infarcts,  low  implantation  and  pla- 
centa prsevda,  velamentous  insertion  of  the 


cord,  premature  separation  of  the  placenta), 
uterine  developmental  anomalies,  uterine 
hypoplasia  or  infantile  uterus,  myomata, 
pelvic  adhesions,  chronic  maternal  or  pater- 
nal diseases,  e.g.,  tuberculosis,  nephritis, 
alcoholism,  plumbism,  diabetes,  malaria, 
cancer,  icterus  gravidarum,  etc.,  paternal 
immaturity  or  senility,  obesity,  consanguin- 
ity between  husband  and  wife,  maternal 
heart,  kidney,  liver  or  lung  disease,  antemia, 
plethora,  malnutrition,  acute  infectious  dis- 
eases, toxaemia,  poisoning  with  lead,  arsenic, 
mercury,  phosphorus,  carbon  monoxide, 
tobacco,  etc.,  traumatism,  strong  emotion. 

Says  Williams:  “ The  most  unportant 
etiological  factors  in  the  interruption  of 
pregnancy  in  the  first  four  months  are 
endometritis,  uterine  disj^lacements,  and 
abnormalities  in  development,  while  after 
this  period  syphilis  and  Bright’s  disease  play 
a similar  role.” 

Treatment. — In  threatened  abortion,  put  the 
patient  to  bed  in  a quiet,  darkened  room,  and 
exclude  all  visitors.  Elevate  the  pelvis  and 
administer  morphine,  gr.  to  hjqx)- 
dermically,  both  as  a general  and  local 
sedative,  followed  if  neces.sary  every  four 
to  six  hours,  or  morning  and  evening,  by 
rectal  suppositories  of  extract  of  opium, 
gr.  i;  or  rectal  enemata  consisting  of  tr. 
opii,  TTgx,  in  starch-water,  5 i~ii-  The 
bromides  (q.v.)  and  cliloral  (q.v.)  are  also 
serviceable  sedatives. 


Codeinffi  sulphatis gr.  ss 

Extract!  hyoscyami gr.  i 

Extract!  v!burni  prumfoli!  gr.  v 

Ole!  theobromat!s q.s. 

F!at  suppos!tor!urn. 


S!g. — Insert  one  every  four  to  six  hours. 
(J.  W.  Williams.) 

Sod!!  bromid! 5ss  (gr.  xx  per  dose) 

Elixir  simplicis 5iii 

Tincturae  hyoscyami (nRxx  per  dose) 

Extract!  viburni  pruni- 

folii,  aa §ss  (gr.  xx  per  do.se) 

M.  Sig. — -Two  teaspoonfuls  in  a wine  gl;Ls.s  of 
water  every  three  hours.  (Edgar.) 

Keep  the  patient  in  bed  for  at  least 
a week  after  the  disappearance  of 
all  symptoms. 

Should  the  hemorrhage  continue,  how- 
ever, or  .should  it  at  any  time  become  pro- 
fuse, pack  the  vagina  tightly  with  sterile 


A:\fENORmia:A 


gauze  bandage  through  a Sims  speculum, 
and  after  twelve  to  twenty-four  hours,  pro- 
ceed as  follows : Shave  and  cleanse  the 
external  genitalia  and  neighboring  skin 
thoroughly  with  castUe  or  green  soap  and 
warm  water,  remove  the  vaginal  packing, 
and  cleanse  the  vagina  with  soap  and  water, 
followed  by  bichloride  solution,  1 : 4000. 
Cover  the  lower  Imibs  and  abdomen  with 
sterile  sheets,  exposing  only  the  vulva,  and 
under  ether  carefully  dilate  the  cervix  by 
means  of  steel  dilators  or  Hegar’s  gradu- 
ated cervical  bougies.  When  the  os  is 
sufficiently  dilated,  insert  the  finger  and 
peel  off  the  o'vmm,  wliile  the  other  hand  on 
the  abdomen  squeezes  the  uterus  and 
presses  on  its  contents,  in  an  endeavor  to 
express  the  ovum  “ as  a stone  is  expressed 
from  a cherry  ” (Hoennig’s  method).  Or 
the  ovum  may  be  broken  up  with  the  finger 
and  removed  by  the  aid,  if  need  be,  of 
ovum  or  placental  forceps,  or  Eimnet’s 
curettement  forcejDS  used  as  placental  for- 
ceps. If  the  cervix  is  so  rigid  that  it  cannot 
be  sufficiently  dilated  to  admit  the  finger, 
use  the  sharp  curette;  but  remember  that 
the  uterus  is  sometimes  very  soft  and  easily 
perforated.  Williams  says:  “ In  my  hands 
vaginal  hysterotomy  (see  Part  4,  Obstetrics) 
has  proved  a much  more  satisfactory  and 
less  dangerous  procedure  than  forced  instru- 
mental dilatation  of  a rigid  cer\dx.” 
Hysterotomy,  however,  is  contraindi- 
cated in  the  presence  of  infection,  as  is  also 
curettage. 

After  making  sure  that  the  uterus  is 
empty,  its  cavity  may  be  irrigated  with  hot 
sterile  water  by  means  of  a double  current 
irrigator,  or  with  a single  tube,  if  the  return 
flow  is  free,  attached  by  rubber  tubing  to  a 
large  reservoir,  all  previously  sterilized  by 
boiling.  Some  do  not  nrigate. 

The  after-treatment  is  the  same  as  that 
of  the  normal  jiuerperimn.  Edgar  gives 
ergotin,  gr.  i-ii,  and  stiychnine  sulphate, 
gr.  t.i.d.,  in  capsule  or  tablet,  to  hasten 
involution.  In  the  presence  of  iiffection,  the 
patient  should  be  propped  up  in  a sitting 
po.sturc  to  favor  th’ainage,  and  ergot  {q.v.), 
pituitrin  {q-v.),  laxatives,  and  concen- 
trated nutrunent  a(hnhii.stered.  After  the 
uterus  has  once  been  emptied,  it  should  be 
left  severely  alone. 

A.  Lipkis  praises  pituitrin  in  incomplete 
abortion;  about  0.5  c.c  hypodermically  eveiy 
day  or  two  until  the  placenta  is  expelled, 
which,  he  says,  usually  occurs  in  two  to 
three  days,  rarely  five  days. 

Miscarriage  and  premature  labor  are 
treated  the  same  as  labor  at  term.  Do  not 


use  the  curette  to  remove  an  adherent 
placenta  after  the  twelfth  week;  remove 
it  manually. 

Prophylaxis. — Correct  any  possible  causal 
factor.  If  the  cause  appears  to  be  an 
irritable  uterus,  enjoin  a quiet  life,  re.st  in 
bed  during  the  time  corresponding  to  the 
menstrual  periods,  abstention  from  sexual 
intercourse,  and  the  avoidance  of  drastic 
purgatives,  coughing,  or  vomiting  (give 
sedatives  if  required).  During  the  days 
corresponding  to  menstruation,  a uterine 
sedative  may  be  given,  e.g.,  hydrastis 
or  pulsatilla  see  Part  2. 

Abscess,  Bartholin’s  Gland. — L.  absces- 
sus  a going  apart;  glans,  a cord. 
See  Vulvitis. 

Kidney. — See  Pyelonephritis  in  Part  1. 

Ovarian. — L.  ovarium,  ovary.  See  Pel- 
vic Inflammatory  Disease. 

Pelvic. — L.  pelvis,  basin.  See  Pelvic 
Inflammatory  Disease. 

Perinephric. — Gr.  irepL  aroimd  -f  ve4>p6s 
kidney.  See  Perinephric  Abscess. 

Skene’s  Glands. — See  Gonorrhoea, 
and  Vulvitis. 

Suburethral. — L.  sub,  under  -f-  Gr. 
ovprjdpa  methra.  See  Suburethral 
Abscess. 

Tubal. — L.  tuba,  a tube.  See  Pelvic 
Inflammatory  Disease. 

Uterine. — See  Uterus,  Abscess  of  the. 

Vulvo=Vaginal  Glands. — ^L.  vulva, 
\Tilva;  vagina,  sheath.  See  \^ulvitis. 

Adenoma  Vesicse. — Gr.  gland  -1-  -coga 

tumor;  L.  vesica,  bladder.  See  Tumors  of 
the  Bladder. 

Adhesions  of  the  Clitoris. — L.  adhcesio, 
from  adhcer'ere,  to  stick  to;  Gr.  /cXetropts 
clitoris.  See  Masturbation. 

Adhesions,  Pelvic. — See  Pelvic  Inflam- 
matory Disease. 

Adnexal  Disease. — L.  See  Pelvic  In- 
flammatory Disease. 

Alkalinuria. — Arabic  al-gal,  potash;  L. 
urina,  urine.  See  Part  1. 

Amenorrhoea. — Gr.  a neg.  + p.r,v  month 

poia  flow.  Under  this  caption  are 
included  both  absence  of  menstruation  and 
scanty  menstruation. 

Etiology.— 1.  Causes  of  failure  of  menstru- 
ation to  appear  at  the  usual  age : Absence  of 
the  uterus;  failure  of  its  development; 
imjierforate  hjmien;  atresia  of  the  vagina  or 
cerv^ix  (congenital  or  ix)st-inflaimnatory, 
e.g.,  following  gonorrhoea  or  the  acute 
infectious  tUseases,  etc.  (See  \mlvitis,  and 
Vaginitis).  Obstruction  of  the  genital  tract 
produces  hiematocolpos  or  htematometra 
and  ha'inatosalpinx. 


AMENORRHCEA 


2.  Causes  of  the  cessation  of  menstrua- 
tion after  it  has  once  appeared:  Pregnancy; 
lactation;  menopause;  overwork,  mental  or 
physical;  brain  work  associated  with  a 
sedentary  life;  bad  hygiene;  insufficient 
nourishment;  chronic  digestive  chsturbances, 
especially  gastric  and  duodenal  ulcer;  anae- 
mia; excessive  hemorrhage;  neurasthenia; 
hysteria;  emotional  states  or  nervous  de- 
rangements; masturbation;  fear  of,  expec- 
tation of,  or  longing  for  pregnancy;  emigra- 
tion; exposure  to  cold  during  menstruation; 
cold  vaginal  douche;  surgical  operation; 
progressive  paralysis;  infectious  diseases 
(usually  temporary  amenorrhoea,  lasting 
three  to  six  months  or  longer) ; acute 
diseases  of  all  kinds;  exhausting  diseases; 
malignant  disease;  Addison’s  disease; 
leukaemia;  tuberculosis;  syphilis;  malaria; 
mumps;  chronic  nephritis;  diabetes  mellitus 
and  insipidus;  exophthalmic  goitre;  acromeg- 
aly and  hypopituitarism;  obesity;  hypothy- 
roidism; myxoedema;  uric  acid  diathesis; 
chronic  poisoning  (lead,  mercury,  morphine, 
etc.);  obstructive  lesions,  e.g.,  atresia  of 
the  vagina  or  cervix  due  to  necrosis  follow- 
ing difficult  labor,  burns,  cauterization, 
inflammation,  operations,  or  the  use  of 
pessaries;  superinvolution  or  atrophy  of  the 
uterus  following  a severe  labor  with  much 
hemorrhage,  or  prolonged  lactation,  or 
infection,  or  exhausting  diseases  following 
labor  (the  condition  is  diagnosetl  by  means  of 
bimanual  palpation,  the  uterine  sound,  and 
the  history);  endometritis  and  metritis; 
sharp  cmettage  of  the  uterus;  atmocausis; 
pelvic,  abdominal,  or  thoracic  disease; 
microcystic  degeneration  of  the  ovaries  ancl 
other  bilateral  ovarian  cysts  and  tumors; 
double  ovariotomy. 

Treatment.— Correct  the  cause,  if  possible. 
An  imperfect  development  of  the  sexual 
organs  in  which  the  molimen  (periodic  head- 
ache, dizziness,  and  flushes  (L.  for  “effort”)  is 
absent,  treatment  is  of  no  avail.  If  the 
molimen  is  present,  resort  to  dilatation  and 
curettage  of  the  uterus,  followed  by  a gen- 
eral hygienic  regimen,  massage,  electricity, 
and  emmenagogues  (see  below).  Good  hy- 
giene embraces  adequate  rest  and  exercise, 
fresh  air  day  and  night,  a daily  morning  warm 
bath  before  breakfast,  in  a warm  room,  fol- 
lowed by  a cold  spinal  douche  and  brisk 
rubbing  with  a coarse  towel,  regular  hours 
of  eating  and  sleeping,  nutritious  food,  rest 
before  and  after  eating,  regulation  of  the 
bowels,  and  if  deemed  useful,  tonics,  e.g., 
iron,  arsenic,  nux  vomica  (see  Part  11.) 
Local  faradism  or  galvanism  may  be  em- 
ployed for  fifteen  to  twenty  minutes  every 


other  day  for  about  six  weeks,  one 
electrode  being  placed  on  the  abdomen  over 
the  symphysis  pubis  and  the  other  over  the 
lumbo-sacral  region  or  in  the  vagina. 
Bandler,  in  employing  galvanism,  uses  a cur- 
rent of  10  to  12  milliamperes,  with  the  nega- 
tive electrode  within  the  uterus;  but  intra- 
uterine electricity  is  strongly  condemned 
by  others.  Additional  local  stimulative 
measures  include  bimanual  massage  of  the 
uterus,  three  times  a week,  very  hot  vaginal 
douches  twice  daily,  continued  for  weeks, 
scarification  of  the  cervix  twice  a week  and 
whenever  the  molimen  occurs,  with  removal 
of  to  1 ounce  of  blood,  warm  sitz-baths 
lasting  ten  to  thirty  minutes,  hot  foot-baths, 
and  frequent  sexual  intercourse  to  promote 
local  congestion.  These  stimulative  measures 
are  also  recommended  for  uterine  super-in- 
volution, but  the  latter  is  probably  incurable. 

For  the  treatment  of  imperforate  hymen 
(hsematocolpos),  see  Atresia  of  the  Vagina. 

In  acute  suppression  of  the  menstrual 
flow  due  to  exposure  to  cold,  cold  douching, 
.sea  bathing,  or  sudden  emotion,  put  the 
patient  to  bed,  surround  her  with  hot  water 
bottles,  apply  mustard  (q.v.)  or  hot  appli- 
cations to  the  hypogastrium  and  feet, 
and  give  hot  douches  or  a hot  sitz-bath. 
Administer  a brisk  saline  cathartic  (q.v.), 
followed  by  Dover’s  powder  in  divided  doses 
(q.v.).  Insert  a rectal  suppository  of 
extractum  opii,  gr.  i,  if  the  pelvic  pains  are 
severe;  or  inject  laudanum,  ttjjx-xv,  in  starch 
water,  5i-h,  into  the  rectum.  Should  men- 
struation not  return  the  following  month, 
repeat  the  hot  douches,  hot  abdominal 
applications,  hot  foot-baths,  and  hot  sitz- 
baths,  and  administer  stimulating  emmena- 
gogues. Vaginal  tampons  saturated  with 
ichthyol  in  glycerine,  25  per  cent.,  and 
held  in  place  with  lamb’s-wool,  may  also  be 
inserted  twice  weekly.  If  these  measures 
prove  ineffectual,  resort  to  dilatation  and 
curettage.  The  bromides,  valerian,  and 
sumbul,  singly  or  in  combination,  are 
recoimnended  for  the  relief  of  painful  moli- 
mina,  and  also  for  suppression  due  to 
sudden  emotion. 

For  emigration  amenorrhoea  prescribe  a 
general  tonic  regimen  and  stimulating  em- 
menagogues. 

Treat  obesity  as  described  in  Part  I,  on 
General  Medicine  and  Surgery.  Ovarian 
extract,  thyroid  extract,  or  pituitary  extract 
may  be  of  possible  benefit.  Hypopituitarism 
is  a cause  of  amenorrhoea  and  obesity. 
After  the  obesity  has  been  reduced,  Ashton 
aflvises  dilatation  and  curettage  and  stimu- 
lating emmenagogues. 


ANTEFLEXION  OF  THE  UTERUS 


For  the  menopause,  whether  natural  or 
artificial,  prescribe  ovarian  extract,  gr. 
iii-v,  t.i.d. 

For  anEDinia  prescribe  iron,  and 
perhaps  arsenic. 

Ainenorrhoea  due  to  tuberculosis  and  other 
nutritional  chseases  is  conservative,  and  one 
may  look  for  the  reestablishment  of  men- 
struation in  such  cases  only  as  the  general 
nutrition  unproves.  Local  treatment  in 
these  cases  is  obviously  contraindicated. 
Emmenagogues: 

II  Extract!  ovarii,  tabellas  No.  xxx,  aa  gr.  v. 
8ig. — One  tablet  four  times  a day.  Recommended 
in  obe.sity,  chlorosis,  hyperthyroidism,  etc. 

II  Corporis  lutei,  extract!,  tabellarum,  aa  gr.  v. 
No.  lx.  iSig. — One  or  two  tablets,  t.i.d.p.c. 

II  E.xtracti  pituitri  exsiccati,  gr.  ii-iv,  aa  tabellas 
xxx.  Sig. — One  tablet  t.i.d.  For  ainenorrhoea  asso- 
ciated with  obesity. 

II  Tabellas  thyroidie  glanduhe  siccai.  No.  xxiv, 
aa  gr.  i.  Sig. — One  tablet  t.i.d.p.c.  Perhaps  appro- 
priate in  obesity. 

R Apiolis,  capsulas  No.  xx,  aa  i^iii-vi.  Sig. — 
One  t.i.d.p.c.,  for  one  week  before  the  e.xpected  flow, 
to  be  mcreased  to  four  capsules  in  four  hours  when 
symptoms  of  menstruation  appear.  (Handler. ) 

II  Manganesii  binoxidi,  pilulas  No.  xxx,  aa  gr.  i- 
ii-v.  Sig.— A)ne  pill  t.i.d. 

II  Potassii  permanganatis,  gr.  xv-xxx 

Petrolati  spissi gr.  l.xx 

M.  et  ft.  pil.  No.  -XX. 

Sig. — One  pill  three  or  four  times  a day,  p.c.,  with 
a glass  of  water. 

II  Acidi  salicylici 5ii  (gr-  v per  dose) 

Aquae,  q.s.  ad giv 

M.  Sig. — Teaspoonful  well  diluted  in  water  three 
or  four  tunes  a day  for  a long  period.  Antirheumatic 
and  stimulant  of  the  pelvic  circulation. 

R Acidi  oxalic! gr.  v-xii-xxiv  (gr. 

ho-M-/^  per  dose) 

Syrupi  limonLs  vel  au- 

rantii  corticis gii 

Aquai  fervidoB,  q.s.  ad. , gviii 

M.  Sig. — -Teaspoonful  t.i.d.  for  three  or  four 
months.  Especially  indicated  in  psychic  conditions, 
change  of  residence,  etc.  (Ashton.)  Poulet  pre- 
scribes IH  gr.  every  hour  at  the  time  of  the  usual 
menstrual  period. 

II  Tinctura;  guaiaci  ammoniati,  gii.  Sig. — 

i^x-gi  in  a cupful  of  water,  t.i.d.  For  amenorrhoea 
as.sociated  with  rheumatism. 

II  Fluidextracti  IIoang-Nan,  r^v-xxx,  in  water 
t.i.d.  General  tonic  in  malnutrition  and  anaania. 

II  Aloes  purificatjB,  pilulas  No.  x,  aa  gr.  i-vi. 

Sig. — One  pill  t.i.d.  or  at  bedtime,  for  several  days 
before  the  expected  flow.  Produces  pelvic  conges- 
tion (see  also  Part  11). 

II  Tinctune  ferri  chloridi.  gi  (njxv-xxx  per  dose) 

Glycerini g i 

Syrupi  limonis,  ips.,  ad,  giv 


M.  Sig. — One  or  two  drams  in  water,  t.i.d.p.c. 
to  be  taken  through  a glass  tube,  followed  by  rinsing 
and  brushing  of  the  teeth.  “Greatly  reheves  and 
often  cures  the  vasomotor  disturbances  following  the 
removal  of  the  uterus  and  its  appendages.”  (Ash- 
ton.) (See  Part  11  for  other  preparations  of  iron. 
Iron  is  indicated  in  anmmia,  hysteria,  etc.). 


II  Tinctura;  ferri  chloridi.  ...  3 hi  (tijxv  per  dose) 

Tincturse  cantharidis gi  (HRv  per  dose) 

Tinctura;  aloes gss  (iijxx  per  dose) 

Tinctura;  guaiaci  ammoni- 
ati  giss  (3i  per  dose) 

Syrupi,  q.s.,  ad gvi 

M.  Sig. — One  tablespoonful  in  water  thrice 

daily.  (Dewees.) 

II  Extract!  aloes  aqueosi. . . gi  (gr.  H per  pill) 
Ferri  sulphatis  exsiccati. . . 5h  (gr-  1%  per  pill) 

Asafeetida; 3 iv  (gr.  2%  per  pill ) 

M et.  ft.  pil.  no.  c. 

Sig. — -One  to  three  pills,  t.i.d.  (GoodeU.) 


II  Olei  Sabina;,  ig;h-iv,  in  pill  or  capsule  or  on 
sugar,  t.i.d.  Causes  pelvic  congestion. 

R Fluidextracti  cimifuga;,  gss  in  water,  t.i.d. 
In  mental  depression  and  psychic  disturbances. 

II  Auri  et  sodii  chloridi,  pilule,  gr.  }so-'Ao,  t.i.d. 
In  neurasthenia  and  exhausted  states. 

R Hydrargyri  chloridi  corro- 

sivi gr.  i (gr.  ^4  per  dose) 

Liquoris  arsenic!  clhoridi . nj.xlvhi  (i^ii  per  dose) 
Tincture  ferri  chloridi, 

Acidi  hydrochloric!  di- 

luti,  aa giv  (njx  per  dose) 

Syrupi  zingiberis,  q.s.,  ad.  gvi 

M.  Sig. — One  dessertspoonful  in  water  after  meals, 
as  a tonic.  (Goodell.) 

Anal  Diseases. — Consult  Part  1,  General 
Medicine  and  Surgery. 

Aneurysm  of  the  Renal  Artery. — Gr. 
avtbpvaixa  a widening;  L.ren,  kidney;  arte'ria 
artery.  The  sjanptoms  are  tumor,  pain, 
and  htBinaturia.  The  condition  is  rarely 
diagnosed  before  exploratory  operation. 
The  treatment  is  nephrectomy. 

Angioma  Urethrae. — Gr.  ayyeiop  vessel  -|- 
-cojua  tumor;  ovprjdpa  urethra.  See  Ure- 
thral Caruncle. 

Angioma  Vulvae. — Consult  Tumors  of 
the  Vulva. 

Angioneurosis  of  the  Kidney. — Gr.  ayyeiov 
vessel  -^veupop  nerve.  See  under  Haematuria. 

Anteflexion  of  the  Uterus. — L.  an'te,  be- 
fore -|-  flex' io,  bend;  uterus,  womb.  The 
chief  sjuiiptoms  are  dysmenorrhoea,  enilo- 
metritis,  and  sterility.  Exclude  myoma  in 
the  anterior  uterine  wall  by  means  of  the 
uterine  sound. 

Etiology.— Infantile  uterus  (congenital) ; 
unequal  growdh  of  the  uterine  walls;  in- 
creased weight  of  the  corpus  due  to  the 
presence  of  myoma;  relatively"  rapid  involu- 
tion in  the  anterior  wall  as  compared  with 


ATRESIA  OF  THE  CERVIX 


that  in  the  posterior  wall,  due  to  inflamma- 
tion at  the  site  of  the  posteriorly  inserted 
placenta;  “ inflammatory  thickening  of  the 
posterior  wall  of  the  uterus  and  a cor- 
responding atrophy  of  the  anterior  wall  from 
prolonged  pressure  at  the  angle  of  flexure”; 
traction  of  inflamed  utero-sacral  ligaments 
upon  the  cervix;  traction  from  anterior 
adhesions;  fluid,  or  tumors,  or  an  inflamma- 
tory mass  in  Douglas’s  pouch;  abnormally 
soft  walls. 

Treatment. — First  correct  any  existing  me- 
tritis or  pelvic  inflammatory  disease  {q.v.). 
Forcible  dilatation  performed  one  week 
after  menstruation,  with  curettage  and 
irrigation  if  endometritis  is  present,  followed 
by  tight  packing  with  a strip  of  gauze,  which 
is  allowed  to  remain  in  situ  for  twenty-four 
to  forty-eight  hours,  is  often  of  benefit. 
The  patient  should  be  kept  in  bed  for  one 
week  after  the  operation,  and  in  one  room 
two  weeks.  The  operation  may  have  to  be 
repeated  several  times.  Dudley’s  plastic 
operation  upon  the  cervdx,  preceded  by  dila- 
tation and  curettage,  is  often  of  value. 

For  the  relief  of  dysmenorrhoea,  the  uter- 
ine canal  may  be  straightened  (during  men- 
struation and  in  the  intervals)  by  “ pushing 
the  cervix  upward  and  backward  with  the 
left  index-finger,  wfliile  with  the  right  hand  a 
forward  and  downward  pressure  is  exerted 
on  the  organ.”  (Author?) 

Congenital  anteflexion  is  not  curable 
except  by  pregnancy. 

Antelocation  of  the  Uterus. — L.  ante,  be- 
fore loca'tio,  placement.  The  cervix  is 
sometimes  found  to  have  dropped  back 
toward  the  hollow  of  the  sacrum,  and  back- 
ache and  pelvic  drag  may  be  comj^lained 
of.  (Hutchins.) 

Etiology.— Peritoneal  acUiesions;  contrac- 
tion of  the  bladder;  distended  rectum;  post- 
uterine  tumor  or  hsematocele.  (Dudley.) 

Treatment. — Attend  to  the  cause.  In  post- 
inflammatory  cases,  bimanual  massage  and 
systematic  tamponade  of  the  vagina  may 
restore  the  uterus  to  its  normal  position  and 
mobility  (see  Pelvic  Inflammatory  Disease). 

Cases  designated  by  Hutchins  “ anteposed 
uteri  in  descensus,”  in  which  the  cervix  has 
dropped  back  toward  the  hollow  of  the 
sacrum,  he  treats  by  vaginal  tampons,  so 
introduced  as  to  hft  the  uterus  as  a whole 
well  upward  and  thus  relieve  the  drag  on 
the  cervix.  When  this  is  attained,  he  opens 
the  abdomen  and  suspends  the  uterus. 

Anteversion  of  the  Uterus. — L.  ante,  be- 
fore -f  vers'io,  a turning.  Etiology.— Con- 

genital anomaly;  traction  from  anterior 
adhesions  drawing  the  corpus  forward; 


traction  from  posterior  cervical  adhesions  or 
inflamed  utero-sacral  ligaments  drawing  the 
cervix  upward;  small  fibroids  in  the  anterior 
wall  of  the  uterus;  retro-uterine  tumors; 
increased  weight  of  the  uterus  due  to  metri- 
tis, myoma,  etc. 

The  Symptomatology  is  that  of  the  associ- 
ated lesions. 

Treatment. — Attend  to  the  cause.  For  the 
relief  of  bladder  irritation,  try  an  Albert 
Smith  or  Hodge  pessary  or  a flexible  rubber 
ring,  for  the  purpose  of  lifting  the  uterus 
away  from  the  bladder;  preceded,  if  neces- 
sary to  remove  tenderness,  by  daily  sup- 
porting tampons  of  ichthyol  and  glycerine 
(25  per  cent.)  held  in  place  with  lamb’s- 
wool  (Dudley).  An  abdominal  belt  (see 
Splanchnoptosis  in  Part  1,  on  General  Medi- 
cine and  Surgery),  may  be  useful  (Ashton). 
See  also  the  treatment  of  Ante-location. 

Anuria. — Consult  Part  1,  General  Medi- 
cine and  Surgery. 

Aphthous  Vaginitis. — Gr.  acj)da  a little 
ulcer;  thrush.  (See  Vaginitis.) 
Vulvitis. — See  Vulvitis. 

Appendages,  Uterine,  Diseases  of  the. — 
L.  appen'dere,  to  hang  upon.  (See  Pelvic 
Inflammatory  Disease.) 

Armamentarium. — L.  See  the  Appendix. 

Arteriosclerosis  and  Fibrosis  Uteri. — Gr. 
aptripia  artery  -|-  (rK\r]p6(ns  hardness;  L.  fibra, 
fibre;  uterus,  womb.  (See  Menorrhagia 
and  Metrorrhagia.) 

Ascensus  Uteri. — L.  abnormally  high  posi- 
tion of  the  uterus.  Etiology. — Inflammatory 
contraction  of  the  utero-sacral  ligaments;  in- 
flanunatory  adhesions  formed  during  the  pres- 
ence of  the  pregnant  uterus  in  the  abdomen 
or  upper  pelvis;  growing  pelvic  tumor  drag- 
ging the  uterus  up  with  it ; pelvic  tumor  push- 
ing the  uterus  up;  excessive  distention  of  the 
rectum  or  bladder;  large  accumulation  of 
menstrual  fluid  in  the  vagina.  Dudley. 

Treatment.— Attend  to  the  cause.  In  post- 
inflanmiatory  cases,  bimanual  massage  and 
systematic  tamponade  of  the  vagina  may 
restore  the  uterus  to  its  normal  position  and 
mobility  (see  Pelvic  Inflammatory  Disease). 

Ascent  of  the  Uterus. — See  Ascensus 
Uteri,  above. 

Atmocausis. — Gr.  ar/x6s  steam  -|-  Ka'xns 
burning.  See  under  Menorrhagia. 

Atony  of  the  Bladder. — Gr.  a priv.  -}- 
t6vo%  tone.  See  Paralysis  and  Paresis  of 
the  Bladder. 

Atresia  of  the  Cervix. — Gr.  a neg.  fl- 
a boring:  imperf oration;  L.  cervix,  neck.  I. 
Congenital  Atresia. — Congenital  atresia  of  the 
cervix  results  in  an  accumulation  of  men- 
strual blood  in  the  uterus  (hsematometra), 


BLADDER,  CONTRACTION  OF  THE 


and  possibly  in  the  tubes  (hsematosalpinx). 
Rupture  or  suppuration  (pyometra) 
may  occur. 

Treatment.- — Under  very  rigid  asepsis, 
since  the  tendency  to  infection  in  these 
cases  is  great,  make  a free  incision  at  the 
point  of  atresia,  remove  the  accmnulated 
material,  and  irrigate  thoroughly  with  hot 
sterile  boric  acid  solution,  3i~v  ad  Oi.  Do 
not  apply  pressure  from  above  on  the  abdo- 
men. Then  pack  the  uterine  cavity  loosely 
with  plain  or  iodoform  gauze,  pack  the 
vagina,  draw  the  urine,  and  cover  the  vulva 
with  a pad  and  T-bandage.  Remove  the 
packing  after  twenty-foiu’  to  forty-eight 
hours  and  douche  the  vagina  daily.  Keep 
the  patient  in  bed  one  or  two  weeks.  (vSee 
Dudley’s  Gynaecology  for  plastic  opera- 
tive measures.) 

II.  Acquired  Atresia  andStenosis.^ — Gr.  crreVocrts 
narrowing  or  stricture.  Amenorrhoeaandster- 
ility  are  consequences.  Ha?matometra,  hy- 
drometra,  pyometra,  or  physometra  may 
result.  Leucorrhoea  and  dysmenorrhoea 
may  be  present. 

Examine  with  a sound  under  anaesthesia. 

Etiology. — Sloughing  due  to  labor,  or 
to  the  application  of  caustics;  inflammation 
from  an  ill-fitting  pessary;  myoma;  ulcera- 
tion or  pressure  in  cancer;  ulceration  in 
scarlet  fever,  diphtheria,  smallpox,  syphilis, 
senile  endometritis  and  vaginitis,  gonor- 
rhoea, etc.;  “ too  tight  closure  in  the  opera- 
tion for  cervical  laceration”;  displacements, 
particularly  anteflexion.  “ The  pinhole  os 
is  usually  congenital.” 

Treatment. — The  stricture  or  narrowing 
is  overcome  by  means  of  dilators,  with  the 
aid  of  a straight  bistoury  for  the  incision  of 
cicatrices  and  a narrow  external  os.  Dilate 
the  canal  up  to  1 to  13^  inches,  fi-rigate  the 
uterine  cavity  with  hot  normal  saline  or 
boric  acid  solution,  o i of  either  to  the  pint, 
and  pack  with  gauze.  After  forty-eight  hours, 
remove  the  packing,  irrigate  the  vagina,  and 
pack  the  cervix.  Repeat  this  every  other  day, 
keeping  the  patient  in  bed  one  week.  In 
pyometra,  irrigate  the  uterus  occasionally 
if  there  is  elevation  of  temperature  or  a foul 
discharge  (?).  After  one  week  have  the  patient 
employ  vaginal  douches  twice  daily  for 
several  weeks.  Examine  the  cervical  canal 
eveiy  month  for  several  months,  and  dilate 
again  if  the  stenosis  recurs.  (Ashton.) 

The  pinhole  external  os,  says  Dudley,  is 
likely  to  contract  after  dilatation  and 
incision,  and  he  therefore  prefers  Schroed- 
er’s  operation. 

Atresia  of  the  Rectum.  — See  imder 
Rectal  Stricture. 


Atresia  of  the  Ureter. — See  Hydroneph= 
rosis. 

Urethra. — See  Stricture  of  the  Urethra. 

Uterus. — See  Atresia  of  the  Cervix. 

Atresia  of  the  Vagina. — Causes.— Imper- 
forate hymen;  necrosis  following  difficult 
labor;  the  use  of  pessaries;  burns;  caustics; 
operations;  inflanunation  (see  Vaginitis). 

In  congenital  imperforation  of  the  hymen, 
the  menstrual  blood  accumulates  in  the 
vagina  (haematocolpos),  and  possibly 
in  the  uterus  and  tubes  (hsematomatra 
and  hsematosalpinx). 

Treatment.— See  Dudley’s  Gynsecology  for 
plastic  operative  measures.  Treat  imper- 
forate hjmen  as  follows.  Under  strict 
asepsis,  since  the  tendency  to  infection  in 
these  cases  is  great,  make  a free  crucial 
incision  and  wash  out  all  blood  from  the 
vagina  and  uterus  with  hot  concentrated 
boric  acid  solution  (about  a tablespoonful  to 
the  pint) . Do  not  apply  pressure  from  above 
on  the  abdomen.  Then  pack  the  uterine 
cavity  and  vagina  to  the  outlet  loosely  with 
plain  or  iodoform  gauze,  draw  the  urine,  and 
cover  the  vulva  with  a pad  and  T-bandage. 
Remove  the  packing  after  twenty-four  to  forty- 
eight  hours  and  douche  the  vagina  daily. 
Keep  the  patient  in  bed  one  or  two  weeks. 

Atresia  of  the  Vulva. — See  Atresia  of  the 
Vagina,  above. 

Atrophy  of  the  Vulva. — Gr.  a neg.  -f  rpo4>^ 
nourishment.  See  Kraurosis  Vulvse. 

Backache. — See  Part  1,  General  Medi- 
cine and  Surgery. 

Bartholin’s  Gland,  Abscess  of. — See  Vul- 
vitis. 

Tumors  of.— See  Tmnors  of  the  Vulva. 

Bladder,  Atony  of  the. — Gr.  a priv.  -|- 
Tovos  tone.  See  Paralysis  and  Paresis 
of  the  Bladder. 

Calculus. — See  Vesical  Calculus  and 
Foreign  Bodies. 

Carcinoma  of  the. — See  Tumors  of 
the  Bladder. 

Bladder,  Contraction  of  the. — L.  con, 
together  -b  trdhere,  to  draw.  Frequent 
urination  is  the  only  sjmptom  of  simple  con- 
traction. Ascertain  the  capacity  of  the 
bladder  by  measuring  the  quantity  of  fluid 
it  can  contain,  using  for  the  purpose  a 
fountain  sju-inge. 

Etiology.— Cystitis,  causing  thickening  and 
contraction  of  the  bladder  wall;  stone  in 
the  bladder;  neoplasms;  operations  on  the 
bladder;  atrophy  from  disuse,  where  the 
bladder  has  never  held  much  urine,  as  in 
chronic  cystitis,  chronic  irritability  of  the 
bladder,  and  enuresis  of  childhood  con- 
tinuing after  puberty. 


BLADDER  IRRITABILITY 


Treatment.— Attend  to  the  cause.  Once 
every  day,  for  five  to  ten  minutes  at  a time, 
alternately  distend  and  relax  the  bladder 
by  means  of  warm  sterile  normal  salt  solu- 
tion (5i  ad  Oi)  introduced  through  a glass 
catheter  and  fountain  syringe,  the  reservoir 
being  alternately  raised  and  lowered,  the 
latter  when  the  patient  complains  of  dis- 
tention. Continue  this  for  several  months. 
The  prognosis  under  this  treatment  is  good. 
(After  Ashton.) 

Bladder,  Exostrophy  of  the. — Gr.  out 

-f-  (XTpkcpeiv  to  turn.  Palliative  Treatment. — 
Vaseline,  hot  water,  and  dusting  powder  in 
children;  Earle’s  or  Collins’s  urinal  in  adults. 

Operative  Treatment. — Maydl’s  operation 
(the  implantation  into  the  colon  or  rectum 
of  the  bladder  wall  surrounding  the  mouths 
of  the  ureters)  is,  thus  far,  the  best,  but  it  is 
reputed  dangerous.  Holt,  however,  says 
“ The  results  are  often  most  surprising.  The 
rectum  soon  becomes  tolerant  of  the  urine, 
holds  it  for  hours  without  difficulty,  and 
evacuates  it  without  discomfort.  Ascending 
infection  of  the  kidney  seldom  occurs.” 
Holt  thinks  the  operation  should  always 
be  undertaken. 

Bladder  Fissure. — See  Vesico-Urethral 
Fissure. 

Fistulae.^ — L.  fistula,  pipe.  Consult 
Gynaecological  Textbooks. 

Foreign  Bodies  in  the. — See  Vesical 
Calculus  and  Foreign  Bodies. 

Hemorrhage. — Gr.  alpa  blood  prtyvvvai. 
to  burst  forth.  See  Haematuria. 

Hyperaemia  of  the. — Gr.  birkp  over  -f 
aipa  blood.  See  Bladder  Irritability. 

Hyperaesthesia.— Gr.  vTrep  over-fiaiad-qaLs 
sensibihty.  See  Bladder  Irritability. 

Incontinence.  — See  Incontinence  of 
Urine. 

Inflammation. — L.  injiammdre,  to  set 
on  fire.  See  Cystitis. 

Bladder  Injuries. — Rupture  of  the  blad- 
der, which  may  be  extra-  or  intraperitoneal, 
is  usually  characterized  by  pain,  difficulty 
in  walking,  futile  attempts  to  urinate,  and 
scanty,  blood-tinged  urine  obtained  by 
catheterization.  Shock  usually  occurs;  but 
the  patient  may  appear  in  good  condition. 

Treatment. — An  exploratory  operation 
should  be  performed  promptly  in  all  cases 
presenting  even  a suspicion  of  wound  or 
rupture  of  the  bladder.  After  suturing 
bladder  wounds  with  deep  Lembert  and 
superficial  peritoneal  sutures,  distend  the 
bladder  with  a sterile  fluid  in  order  to  test 
the  efficiency  of  the  sutures.  Irrigate  the 
contaminated  parts  with  hot  normal  saline 
solution  (0.8  to  0.9  per  cent.),  and  insert  a 


small  drain.  Employ  a retained  catheter 
for  seven  days,  and  irrigate  the  bladder  and 
urethra  daily  with  boric  acid  solution, 
3i  ad  Oi. 

Bladder  Irritability. — -L.  irritdre,  to  tease. 

The  symptoms  of  vesical  irritability  are 
pain,  strangury  or  slow  and  painful  urination, 
a frequent  desire  to  urinate,  urgency  of 
urination,  and  incontinence  when  the  detru- 
sor musculature  is  affected  (cystalgia;  hyper- 
sesthesia  vesicse) ; and  frequency  and  diffi- 
culty of  urination,  sometimes  pain,  and 
retention  of  urine  when  the  sphincter  is 
affected  (cysto.spasm;  vesical  spasm;  spasm 
of  the  neck  of  the  bladder;  contracture  of 
the  neck  of  the  bladder;  stammering  of  the 
bladder).  The  cause  may  be  a local  lesion  or 
a nemosis,  reflex  or  central.  In  simple  neu- 
rosis, symptoms  are  present  only  during  the 
day.  Hyperaesthesia  and  spasm  are  both 
conomon  in  children. 

Etiology.— A.  Irritability  Caused  by  a 
Local  Lesion. — Cystitis  or  trigonitis;  pos- 
terior m’ethritis;  organic  stricture;  vesical 
calculus;  foreign  body;  vesico-urethral  fis- 
sure; vesical  tuberculosis;  vesical  tumors. 

B.  Irritability  Without  Local  Or- 
ganic Lesion. — Neura-sthenia;  nervous  irri- 
tability; hysteria;  malaria;  cold;  acute 
fevers;  lithajinia;  excessive  acicUty  of  the 
urine;  irritating  ingesta  (ginger,  radishes, 
spices,  turpentine,  salicylates,  cantharides, 
quinine,  etc.);  pyuria  (pyelonephritis);  crys- 
tals in  the  urine  (see  Nephrolithiasis);  too 
high  or  too  low  specific  gravity;  excessive 
coition  or  masturbation;  overwork  and 
anaemia;  tabes  dorsalis;  dementia  paralytica; 
myelitis;  multiple  lateral  sclerosis;  spastic 
spinal  paralysis;  tumor  jjressing  upon  the 
cord;  spondylitis;  tumor  pressing  upon  the 
bladder,  especially  fibromyoma  of  the  uterus; 
retroflexion  or  anteflexion  of  the  uterus;  pro- 
lapsus uteri;  pelvic  inflaimnation;  distended 
colon;  hemorrhoids;  vaginismus;  abdomino- 
pel  vie  operations;  strangulated  hernia;  preg- 
nancy; urethral  eversion;  urethral  caruncle; 
vulvitis;  oxyuriasis;  fissure  in  ano  and  other 
rectal  diseases;  chronic  tonsillitis,  etc.  (ab- 
sorption of  irritating  toxines). 

Treatment.— Attend  to  the  cause.  Open 
the  bowels.  Prescribe  a bland  diet,  exclud- 
ing spices,  condhnents,  salt,  pepper,  vinegar, 
mustard,  radishes,  sauces,  salads,  pickles, 
sour  foods,  rhubarb,  tomatoes,  asparagus, 
ginger  ale,  lemons,  acid  fruits,  carbonated 
beverages,  alcohol,  meats,  cheese,  greasy  or 
fried  foods,  tea  and  coffee.  Enjoin  copious 
water  drinking  for  the  purpose  of  diluting 
the  urine.  A sedative  diuretic  may  be  pre- 
scribed, e.g.,  infusion  of  pareira  brava, 


CANCER  OF  THE  UTERUS 


infusion  of  buehu,  fluid  extract  of  zea  mays, 
fluid  extract  of  triticum  repens,  sweet 
spirits  of  nitre,  or,  if  the  urine  is  hyperacid, 
potassium  citrate  or  sochum  bicarbonate  in 
large  doses  (see  Drugs,  Part  11). 

Sedative  measures  include  hot  sitz-baths; 
hot  abdominal  or  vaginal  or  rectal  applica- 
tions; a suppository  of  extract  of  opium, 
gr.  Yl,  or  of  belladonna,  gr.  or  of  hyoscy- 
amus,  gr.  34  i or  laudanum,  10  to  20  drops 
in  warm  water,  per  rectum;  or  chloral 
hydrate,  gr.  x-xv,  well  diluted,  per  rectum, 
at  bedtime;  sochmn  bromide,  gr.  xxx,  well 
chluted,  t.i.d.,  and  at  bedtime;  valerian; 
asafoetida  (see  Part  11).  Holt  gives  to  a 
child  of  two  years,  tr.  of  belladonna  or  of 
hyoscyamus,  rnu  every  two  hours,  together 
with  plenty  of  water  and  alkaline  diuretics. 

R Tincturffi  belladonnae, 

Liquoris  potassii  hydrox- 

idi,  aa oi  (aa  itev  per  dose) 

Pota.s.sii  citratis 5 ii  (gr.  x per  dose) 

Aqua}  anisi § ii 

Aquse  cimiamomi,  q.s.,  ad  5vi 

M.  Sig. — One  tablespoonful  every  four  hours. 
(Jour.  Am.  Med.  As.soc.) 

Electricity  may  be  of  service.  One 
electrode  is  placed  over  the  bladder  and  the 
other  (a  metal  sound,  covered,  except  at  the 
tip,  with  hartl  rubber)  in  the  vagina  or  in 
the  bladder,  the  latter  being  filled  with 
sterile  water.  It  may  be  “ carried  to  the 
painful  strength”  Hunner).  Prescribe  rest 
and  tonics  for  overworked  antemic  women. 

Ashton  says:  “ Forcible  cUlatation  of  the 
urethra  (see  Stricture  of  the  Urethra,) 
should  be  performed  at  once  m eveiy  case 
as  a routine,  empiric  plan  of  treatment 
irrespective  of  the  cause  of  the  affection,” 
and  is  very  effectual.  If  tliis  fails,  instil  or 
apply,  after  emptying  the  bladder,  silver 
nitrate,  2 to  10  per  cent,  solution,  to  the 
base  of  the  bladder  and  the  vesico-urethral 
juncture,  every  three  to  five  days.  Humier 
uses  Hegar’s  dilators  up  to  12  to  14 
mm.,  with  which  to  dilate  and  mas- 
sage the  urethra,  together  with  weekly 
applications  of  silver  nitrate,  10  per  cent.,  to 
the  trigonum. 

Bladder,  Neuralgia  of  the. — Gr.  vevpov 
neiwe  + aXyos  pain.  See  Bladder 
Irritability,  above. 

Neurosis  of  the. — Gr.  vevpov  nerve.  See 
Bladder  Irritability,  above. 

Papilloma. — L.  pnpil'la,  nipple-shaped 
elevation  + Gr.  -cojua  tumor.  See 
Tumors  of  the  Bladder. 

Paralysis  and  Paresis  of  the. — 
See  Paralysis  and  Paresis  of 
the  Bladder. 


Rupture  of  the. — See  Bladder  Injuries. 

Sarcoma. — Gr.  aap^,  oapKos  flesh  -| — upa 
tumor.  See  Tumors  of  the  Bladder. 

Spasm. — Gr.  awaapos.  See  Bladder 
Irritabihty. 

Stammering  of  the. — See  Bladder  Irri- 
tability. 

Stone  in  the. — See  Vesical  Calculus 
and  Foreign  BocUes. 

Traumatism. — See  Bladder  Injuries. 

Tuberculosis  of  the. — See  Cystitis. 

Tumors. — See  Tumors  of  the  Bladder. 

Ulcer. — L.  ulcus.  See  Cystitis. 

Bleeding. — See  Hemorrhage. 

Calculus,  Renal. — L.  cal' cuius,  pebble; 
re'n,  kidney.  See  NephroUthiasis. 

Ureteral. — L.  uri'na,  urine  + iter, 
passage.  See  Nephrolithiasis. 

Vesical. — See  Vesical  Calculus  and 
Foreign  BocUes. 

Cancer  of  the  Bartholin  Gland. — L.  for 

crab.  See  Tumors  of  the  Vulva. 

Bladder. — See  Tumors  of  the  Bladder. 

Kidney. — See  Tiunors  of  the  Kidney. 

Rectum. — See  Rectal  and  Anal  Tumors. 

Urethra. — See  Tumors  of  the  Urethra. 

Cancer  of  the  Uterus. — “Any  woman 
between  thirty-five  and  sixty,  who  comes  to 
the  physician  complaining  of  increased 
menstmation,  of  metrorrhagia,  of  pehdc 
pam,  or  of  vaginal  discharge,  should  be 
examined  without  loss  of  time  on  the 
suspicion  of  cancer”  (H.  A.  Kelly).  The 
slightest  bleeding  a year  or  so  after  the  meno- 
ixiuse  is  suspicious  of  cancer.  Pain  is 
usually  a late  sjmiptom.  In  any  suspected 
case  the  endometrium  should  be  curetted, 
the  scrapmgs  placed  at  once  in  5 per  cent, 
formaldehyde  solution  to  harden  them, 
fixed,  unpregnated  with  paraffui  in  prefer- 
ence to  celloicUn,  sectioned,  stained  wqth 
hsematoxjdin  and  counterstained  with 
eosine,  mounted  in  balsam,  and  examined 
microscopically.  IMany  slides  must  be 
examined,  and  if  necessaiy  the  curetting 
repeated  whenever  the  hemorrhage  reap- 
pears. If  the  cervix  is  involved,  a small 
wedge-shaped  portion  should  be  excised  and 
dropped  in  hardening  fluid  for  exanUnation. 
Sections  should  be  made  at  right-angles  to 
the  surface. 

Complete  hj’^terectomy  (Wertheim’s  radi- 
cal pan-hysterectomy  or  Werder’s  ignihyste- 
rectomjd  shoidd  be  performed  in  cancer 
of  the  body  of  the  uterus  if  there  is  the 
least  chance  of  a cm’e.  If  on  opening  the 
abdomen  the  case  is  found  to  be  inoperable, 
one  may  ligate  both  internal  iliac  arteries 
and  one  ovarian  artery,  leaving  only  the 
other  ovarian  artery  to  supply  the  uterus. 


CANCER  OF  THE  UTERUS 


The  growth  of  the  tumor  may  thus  be 
inhibited.  The  X-rays  {q.v.),  radium  {q.v.), 
or  mesothorimn  should  be  employed  in 
inoperable  cases,  as  also  after  hysterectomy, 
in  order,  if  possible,  to  prevent  a recurrence. 
Says  Ashton:  “ If  recurrent  cases  are  taken 
early,  the  induration  usually  disappears 
rapidly  and  a cure  results.” 

Those  cases  are  most  favorable  for  opera- 
tion and  cure  in  which  it  is  possible  to  move 
the  uterus  freely,  that  is,  to  push  it  upward 
readily  by  a finger  on  the  cervix.  The  prog- 
nosis after  hysterectomy  for  cancer  of  the 
body  of  the  uterus  is  very  good;  for  cancer 
of  the  cervix,  bad.  “Cancer  of  the  cer- 
vix, however,  responds  most  favorably  to 
radium,  and  can  almost  always  be  wiped 
out  by  a big  thorough  application.”  (H. 
A.  Kelly.) 

Palliative  Treatment  in  Inoperable  Cases. — 

Under  general  anaesthesia,  with  the  finger 
as  a guide,  curette  away  the  diseased  tissue 
with  a sharp  serrated  spoon  curette  or  loop 
curette,  using  a small  curette  for  small 
pockets,  until  a “ firm,  hard  base  is  reached.” 
In  order  to  avoid  entering  the  peritoneum, 
bladder,  or  rectum,  sounds  may  be  used  in 
the  latter  two  cavities.  Should  the  perito- 
neum be  entered,  insert  an  iodoform  gauze 
tampon  closely  in  the  rent,  continue  cmet- 
ting,  and  after  all  removable  material  has 
been  scraped  away,  cleanse  the  vagina, 
remove  the  tampon,  and  insert  a fresh  one 
(this  should  be  removed  after  three  days 
and  another  inserted).  Fill  the  vagina  with 
loose  iodoform  gauze  wrung  out  of  carbolic 
acid,  2 per  cent.,  and  apply  a vulvar  pad 
(H.  A.  Kelly).  For  profuse  bleeding  follow- 
ing curettage,  apply  pledgets  of  cotton 
dipped  in  half-strength  dilute  acetic  acid,  or 
Monsell’s solution  {q.v.  in  Part  11),  or  anti- 
pyrine,  5 per  cent.,  or  formalin  (25  to  40 
per  cent.)  and  adrenalin  chloride  (1  : 1000), 
equal  parts  (avoid  contact  with  healthy 
mucous  membrane),  or  adrenalin  chloride, 
1 : 1000  alone  (one  may  infiltrate  the 
tissues  with  one  part  adrenalin  to  three 
parts  normal  saline  solution,  0.8  per  cent., 
followed  by  the  “ cautery  knife  at  a dull 
red  heat  until  the  surfaces  are  thoroughly 
charred.”  Cauterization  may,  indeed,  be 
employed  as  a matter  of  routine,  whether 
excessive  hemorrhage  is  present  or  not. 

Douche  the  vagina  daily  thereafter  with 
lysol,  3i  to  the  quart;  or  liq.  sodse  chlorina- 
tae,  3i  to  the  pint;  or  creolin,  3i  ad  Oii-iv; 
or  formalin,  3ss  ad  Oviii;  or  mercury  bi- 
chloride, 1 : 4000;  or  carbolic  acid,  ngxv  ad 
Oii;  or  thymol,  gr.  xv  ad  Oii;  or  hydrogen 
peroxide,  1 part  of  the  commercial  peroxide 
26 


to  3 to  4 parts  of  water;  or  potassium  per- 
manganate, gr.  XV  to  10  to  5 to  3 quarts 
(“  the  best  deodorizer  ”). 

Following  the  douche,  dust  with  talcum, 
or  methylene-blue,  or  methylene-violet  pow- 
der, or  insert  tampons  wet  with  the  1 per 
cent,  solution,  or  dress  with  5 per  cent, 
iodoform  or  carbolic  acid  gauze,  or  inject 
sterile  glycerine  and  olive  oil,  equal  parts, 
or  refined  petrolemn  oil,  and  anoint  the 
vulva  with  the  same,  or  with  vaseline,  or 
with  oil  and  lime  water,  equal  parts,  or  with 
sod.  bicarb.,  one  part  to  three  parts  of 
vaseline,  to  protect  the  vagina  and  vulva 
against  irritating  discharges.  One  may 
swab  the  affected  parts  two  or  three  times 
a week,  with  tr.  iodi,  or  with  a saturated 
solution  of  iodine  crystals  in  pure  carbolic 
acid.  “ A sudden  profuse  hemorrhage  may 
be  checked  by  a douche  of  hot  water,  hot 
vinegar,  or  hot  alum  solution”  (3i  ad  Oi). 

The  cauterization  may  have  to  be  re- 
peated in  two  to  six  months.  According  to 
some,  curettement  and  cauterization  should 
be  repeated  every  four  weeks. 

Gellhorn  strongly  advocates  the  following 
treatment:  After  drying  the  curetted  area 
with  cotton  pledgets,  smear  the  healthy 
vagina  and  vulva  thickly  with  vaseline. 
Then  stop  the  anaesthetic,  place  the  patient 
in  the  Trendelenberg  posture,  and  pour 
3^  to  1 oz.  of  acetone  through  a tubular 
speculum  into  the  cancerous  crater.  After 
twenty  to  thirty  minutes,  lower  the  table 
and  allow  the  acetone  to  run  out  through 
the  speculum.  Wash  all  traces  of  acetone 
from  the  vagina  and  vulva,  pack  into  the 
crater  gauze  wrung  out  of  acetone,  and  hold 
in  place  with  dry  cotton  tampons  firmly 
packed  into  the  vagina.  In’four  or  five  days 
repeat  this  treatment,  except  the  pre- 
liminary curettement.  Thereafter,  two  or 
three  times  weekly,  dry  the  cavity  after 
the  exposure  to  acetone,  and  insert  a cotton 
tampon  covered  with  vaseline  which  should 
be  removed  after  several  hours.  “ More 
than  one  curetting  is  unnecessary.” 

A.  R.  Jackson  packs  the  curetted  cavity 
firmly  with  a gauze  tampon  or  small  balls  of 
cotton  saturated  with  zinc  chloride  solution, 
30  to  50  per  cent.  Webster  employs 
tampons  wrung  from  pure  formalin.  Contact 
with  healthy  mucous  membrane  should  be 
avoided.  The  tampons  are  held  in  place 
by  cotton  or  gauze  tampons  covered  with 
sweet  oil  or  an  alkaline  ointment.  They 
should  be  removed  after  three  days  and 
douches  then  employed. 

Chroback,  after  curetting  and  smearing 
the  healthy  mucous  membrane  with  vase- 


CERVICAL  LACERATIONS 


line,  applies  fuming  nitric  acid,  blowing 
away  the  fumes  from  time  to  time.  Then 
he  packs  with  gauze,  which  he  removes 
after  a few  hours,  then  insufflates  iodoform 
and  tannic  acid,  equal  parts,  or  iodoform 
and  charcoal,  instead  of  douching.  After 
two  or  three  weeks  the  slough  is  thrown  off, 
and  the  resulting  granulating  surfaces  are 
treated  with  silver  nitrate  or  tincture  of 
iodine.  Curettage  and  cauterization  are 
frequently  repeated. 

The  X-rays  (q.v.),  racUum  (q.v.),  and 
mesothorium  are  valuable  therapeutic 
agents  in  the  treatment  of  inoperable  cases. 
C’ures  may  even  possibly  be  effected.  Using 
100  mgrms.  of  radium  in  a platimun  tube 
2mm.  thick,  surrounded  by  rubber,  2 mm. 
thick,  the  exposures  may  be  of  twelve  to 
fifteen  hours  duration  or  longer.  If  the 
tube  can  be  completely  smrounded  by  the 
growth  and  considerable  ulceration  is  pres- 
ent, exposures  of  twenty-four  hom-s  or 
longer  are  admissible.  The  treatment  may 
be  repeated  in  a month. 

Attend  to  the  bowels  and  kidneys,  and 
enjoin  light  exercise,  fresh  ah  day  and 
night,  and  full  diet.  Ashton  gives,  as  a 
tonic,  for  an  indefinite  period  the  following: 

R Hydrargyri  chloridi  corrosivi, 


Acidi  arsenosi,  aa gr.  i 

Extract!  nucis  vomica; gr.  xxv 

Ferri  et  qiiinina;  citratis gr.  c.c. 

M.  et  ft.  pil.  100. 


Sig. — One  pill  t.i.d.p.c.  (Ashton.) 

For  pain,  employ  phenacetin,  antipyrine, 
asphin,  trional,  heroin,  codeine,  morphine 
(see  Part  11).  Schlesinger’s  analgesic  solu- 
tion (q.v.)  is  warmly  reconunended. 

Cancer  of  the  Vagina. — See  Tumors  of 
the  Vagina. 

Vulva. — See  Tumors  of  the  Vulva. 

Carcinoma. — Gr.  xap/chos  crab;  -(-  wpa 
tumor.  (See  Cancer.) 

Caruncle,  Urethral. — See  Urethral  Car- 
uncle. 

Catarrh,  Cervical. — Gr.  Karappeiv  to  flow 
down.  See  Cervicitis  and  Endocervicitis. 

Cauliflower  Excrescences. — L.  ex,  out  -|- 
cres'cere,  to  grow.  See  Verrucse. 

Cellulitis,  Pelvic;  Parametritis. — L.  ceV- 
lula,  little  cell  4-  Gr.  -tns  inflammation; 
pelvis,  basin  ; Gr.  Trapa  beside  -|-  prjrpa 
uterus  fl-  -trts  inflammation.  See  Pelvic 
Inflammatory  Disease. 

Cervical  Atresia. — See  Atresia  of  the 
Cervix. 

Cancer. — See  Cancer  of  the  Uterus. 

Catarrh. — Gr.  sarappeiv  to  flow  down. 
See  Cervicitis  and  Emlocervicitis. 


Cervical  Ectropion. — See  Eversion  or 

Ectropion  of  the  Intra-Cervical  Mucosa. 

Cervical  Erosion. — L.  cer'vix,  neck;  ero'- 
dere,  to  eat  out.  Erosion  of  the  cervix,  so- 
called,  is  characterized  by  a “ red,  granular 
area  surrounding  the  external  os,”  “ due 
to  maceration  and  desquamation  of  the 
squamous  epithelium  and  the  covering  of 
the  denuded  areas  by  cylindric  ciliated 
epithelium  which  grows  out  from  the 
cervical  canal”  (Penrose  ?).  Remember  that 
an  apparent  erosion  is  often  an  everted, 
lacerated  cervix,  as  shown  by  bringing  the 
cervical  lips  together  with  tenacula. 

Etiology.— Cervical  laceration;  cervicitis; 
endometrial  discharge;  congenital  anomaly. 

Treatment. — Treat  the  cause.  “The 
treatment  of  congenital  erosion  of  the 
cervix  when  it  is  so  marked  as  to  produce 
distinct  symptoms,  is  amputation  of  the 
cervix.”  (Penrose.) 

Cervical  Eversion. — See  Eversion  or  Ec- 
tropion of  the  Intra-Cervical  Alucosa. 

Cervical  Hypertrophy. — L.  cer'vix,  neck; 
Gr.  vwep  over  + rpo4>^  nutrition.  Ashton 
describes  (1)  a supravaginal  hypertrophy, 
“ almost  exclusively  limited  to  virgins  and 
those  who  are  sterile,”  with  uterine  pro- 
lapse as  the  essential  symptom,  which 
requires  high  amputation  of  the  cervix, 
followed  later,  if  necessary,  by  anterior  and 
posterior  colporrhaphy  or  hysterorrhaphy, 
or  both  (Gr.  koXttos  vagina  -j-  pa<l>y}  stitch; 
varkpa  womb) ; (2)  infravaginal  hypertrophy, 
very  rare,  “ always  congenital  and  met  only 
in  virgins  and  sterile  women,”  the  treat- 
ment of  which,  if  called  for,  is  amputation; 
(3)  apparent  hypertrophy,  occurring  in  pro- 
lapsus uteri  and  in  laceration  of  the  cervix, 
revealed  by  the  disappearance  of  the 
apparent  hypertrophy  when  the  patient 
assumes  the  knee-chest  posture,  and  when 
the  torn  cervical  lips  are  brought  together 
with  tenacula.  The  “ enlargement  of  con- 
gestion ” (see  Cervicitis),  should  not  be  mis- 
taken for  real  hypertrophy. 

Dudley  says:  “ Infravaginal  elongation  of 
the  cervix  is  often  apparent,  seldom  or 
never  real.” 

Cervical  Lacerations. — L.  cer'vix,  neck; 
lacera're,  to  tear.  Puerperal  laceration  of 
the  cervix  is  prone  to  give  rise  to  cervicitis 
(enlargement,  cystic  degeneration,  erosion, 
eversion),  subinvolution,  endometritis,  met- 
ritis, perimetritis,  parametritis,  chronic 
tubal  and  ovarian  disease  (in  other  words, 
pelvic  inflammatory  disease),  uterine  dis- 
placements, sterility,  repeated  abortions, 
dysmenorrhoea,  menorrhagia,  amenorrhoea, 
leucorrhoea,  fever,  headaches,  backache, 


CERVICITIS  AND  ENDOCERVICITIS ; CERVICAL  CATARRH 


dyspepsia,  and  other  reflex  or  toxic  dis- 
turbances, even  neuralgia  of  the  eyeball; 
indeed,  possibly  any  of  the  numerous  ail- 
ments that  result  from  toxic  absorption. 
The  writer  recently  had  a patient  who  pre- 
sented no  other  symptoms  than  an  uregular 
fever  and  prostration,  which  disappeared 
promptly  on  the  repair  of  a comparatively 
recently  lacerated  cervix.  Cervical  tears 
also  predispose  to  cancer. 

Cervical  laceration  may  be  demonstrated  by 
bringing  the  torn  lips  together  with  tenacula. 
It  should  be  chstinguished  from  endoceiwic- 
itis,  congenital  eversion,  and  cancer. 

Treatment.— The  treatment,  in  cases  with 
symptoms,  is  surgical.  Ashton  gives  the 
following  indications  for  operation : 

1.  “ Operate  upon  all  lacerations  which 
are  complicated  with  induration  and  hyper- 
trophy of  the  cervical  tissues;  eversion  of 
the  intracervical  mucous  membrane;  cystic 
degeneration;  and  erosion.” 

2.  “ Operate  upon  all  lacerations  which 
are  responsible  for  subinvolution  of  the 
uterus,  endometritis,  and  uterine  displace- 
ments”; also  sterility  or  repeated  abortions. 

3.  “ Operate  upon  all  lacerations  which 
are  associated  with  a sensitive  plug  of  scar 
tissue  in  the  angle  of  the  wound.” 

Operation  should  be  preceded  by  two  or 
three  weeks  to  two  or  three  months  of 
general  and  local  preparatory  treatment,  as 
follows;  a nutritious  chet,  regular  hours  of 
eating  and  sleeping,  rest  before  and  after 
meals,  abdominal  and  general  exercises,  gen- 
eral massage,  support  of  the  clothing  from 
the  shoulders,  an  abdominal  binder,  fresh  air 
day  and  night,  a daily  morning  warm  bath  in 
awarm  room  followed  bya  cold  spinal  douche, 
preferably  before  breakfast,  never  shortly 
after  a meal,  hot  sitz-baths,  a daily  morning 
saline  (g.v.),  and  tonics  are  unportant  in- 
vigorating measures.  Twice  a day  the  patient 
should  take  a hot  vaginal  douche,  and  at 
night  insert  far  back  against  the  cervix  and 
vaginal  vault,  by  means  of  dressing  forceps, 
a 25  per  cent,  ichthyol-glycerine  or  plain 
glycerine  tampon  attached  to  a string,  which 
is  to  be  removed  in  the  morning.  Twice  a 
week  the  physician  may  puncture  the  ceiwix 
and  withdraw  from  one-half  to  one  ounce 
or  more  of  blood,  then  dry  thoroughly,  and 
paint  the  cervix  and  vaginal  vault  with 
tincture  of  iodine,  and  insert  an  ichthyol- 
glycerine  tampon,  which  the  patient  should 
remove  by  an  attached  string  at  the 
end  of  twelve  hours.  Iodoform  ointment 
(g.v.)  may  be  applied  to  erosions.  Cysts 
should  be  opened  (no  more  than  six  or  eight 
at  one  sitting)  and  their  walls  cauterized 


with  pure  carbolic  or  nitric  acid  (Ashton). 
Local  treatment  should  be  intermitted 
during  menstruation. 

After  the  parts  have  been  restored  to  a 
favorable  state,  operate.  First  dilate  and 
thoroughly  curette  the  uterus,  irrigate,  and 
swab  the  uterine  cavity  with  a saturated 
solution  of  iodine  in  95  per  cent,  carbolic 
acid.  Then  perform  Emmet’s  trachelor- 
rhaphy (Gr.  Tpaxv^os  neck  + suture), 
or  if  the  cervix  is  much  diseased,  Schrocder’s 
resection  operation  (Dudley).  Says  Ash- 
ton : “ Trachelorrhaphy  should  be  performed 
in  cases  in  winch  there  is  only  slight  loss  of 
tissue,  and  an  absence  of  mduration,  cystic 
degeneration,  and  extensive  erosion.  Ampu- 
tation, on  the  other  hand,  is  indicated  in 
stellate  lacerations;  in  tears  which  are 
associated  with  great  loss  of  tissue;  and  in 
cases  complicated  with  cervical  induration, 
cystic  degeneration,  and  extensive  erosion.” 
If  the  preparatoiy  treatment  does  not 
relieve  the  condition,  amputation  of  the 
cervix  and  not  trachelorrhaphy  is  indicated. 
Dudley  prefers  Schroeder’s  resection  of  the 
cervix  to  amputation. 

After  repairing  the  cervix,  repair  the  pel- 
vic floor,  if  relaxed,  and  draw  the 
uterus  forward,  if  retro-displaced,  by  its 
roimd  ligaments  or  otherwise. 

Contraindications  to  the  performance  of 
cervical  operations  are  acute  pelvic  inflam- 
mation and  acute  or  chronic  suppuration 
(not  chronic  non-suppurative  inflammation). 

Cervical  Polypi. — L.  cervix,  neck;  Gr. 
TToXos  many  -t-  ttoOs  foot.  Three  kinds  of 
polypus  are  distinguishable,  viz.,  mucous 
(the  commonest;  the  result  of  inflammation), 
fibroid,  and  papillary.  Examine  the  growth 
microscopically  for  malignancy.  Menor- 
rhagia, metrorrhagia,  dysmenorrhoea,  and 
leucorrhoea  are  common  symptoms. 

Treatment. — Twist  or  cut  away  pechculated 
polypi.  Excise  sessile  ones  well  below  the 
base  of  the  growth  into  the  healthy  tissue 
of  the  cervix,  and  close  the  wound  with 
intermpted  sutures.  Consult  also  Fibro- 
myoma  Uteri,  and  Cervicitis. 

Cervical  Stenosis. — Gr.  aTePo<ns  narrow- 
ing. See  Atresia  of  the  Cervix 
Tears. — See  Cervical  Lacerations. 
Tuberculosis. — See  Tuberculo.sis  of  the 
Genital  Organs. 

Ulcers. — See  Cervicitis. 

Cervicitis  and  Endocervicitis;  Cervical 
Catarrh. — L.  cervix,  neck;  Gr.  'ivBov  witliin; 
-tTis  inflammation;  Karappeiv  to  flow  down. 

Symptomatology. — Cervical  leucorrhoea  is 
present.  The  cervical  discharge  is  stringy, 
glairy,  viscid,  thick,  tenacious,  and  mucoid, 


CERVICITLS  AND  ENDOCERVICITIS ; CERVICAL  CATARRH 


like  the  white  of  an  egg,  or  it  is  muco-puru- 
lent,  whereas  a vaginal  discharge  is  “ curdy 
or  milky  or  creamy  ”,  and  an  endometrial 
discharge  is  more  serous.  (Remember  that 
endometritis  is  usually  not  present.)  The 
ceiwical  glands  may  become  choked  and 
thus  converted  into  retention  cysts  (Na- 
bothian follicles).  Erosion,  “ due  to  macera- 
tion and  desquamation  of  the  squamous 
eiiithelium  and  the  covering  of  the  denuded 
areas  by  cylindric  ciliated  epithelium 
which  grows  out  from  the  cervical  canal,” 
or  eversion  (ectropion,  q.v.),  or  mucous 
polypi  may  be  present.  Erosions,  both 
simple  and  papillary,  should  be  cUstinguished 
from  carcinoma  by  the  friability  and  bleed- 
ing characteristic  of  the  latter  and  by  the 
microscopic  examination  of  an  excised  piece. 

Etiology. — Vulvo-vaginitis;  cervical  lacera- 
tion; frequent  cold  douches  practiced  to 
prevent  conception;  excessive  coitus;  instru- 
mental and  digital  manipulations;  foreign 
bodies;  polypi;  tumors;  uterine  displace- 
ment; subinvolution  following  labor,  mis- 
carriage, or  menstruation. 

The  gonococcus  is  the  most  frequent 
cause;  but  other  pyogenic  organisms  may  be 
causative.  Cervical  ulceration  may 
be  traumatic  (caused  by  a pessary), 
carcinomatous,  tubercular,  syphilitic, 
or  chancroidal. 

Treatment.— I.  AcUTE  OR  ReCENT  INFLAM- 
MATION.— Attempt  to  destroy  the  infection, 
whether  gonorrhoeal  or  not,  before  it  reaches 
the  body  of  the  uterus.  First  remove 
mucus  from  the  cervical  canal  by  means  of 
suction  bulbs  and  cotton  pledgets  soaked  in 
a solution  consisting  of  one  dram  of  equal 
parts  of  sodium  bicarbonate  and  sodium 
biborate  dissolved  in  six  ounces  of  water. 
Then  apply  thoroughly,  by  means  of  a cor- 
rugated aluminum  applicator  wrapped  with 
cotton,  introduced  up  to  but  not  beyond  the 
internal  os,  a saturated  solution  of  iodine 
in  95  per  cent,  carbolic  acid,  or  formalde- 
hyde, 40  per  cent.,  or  pure  carbolic  acid,  or 
silver  nitrate,  oi  to  the  ounce.  Then  paint 
the  cervix  and  vaginal  vault  with  tincture  of 
iodine,  and  insert  a boroglycerine  gauze 
pack  attached  to  a string,  which  should 
lie  removed  at  the  end  of  twenty-four 
hours,  followed  by  hot  vaginal  douches 
(see  Vaginitis). 

II.  C'hronic  Inflamimation. — In  mild 
cases,  one  may  puncture  all  Naliothian 
cysts  seen,  paint  the  ceiwix  and  vaginal 
vault  with  tincture  of  iodine  or  silver 
nitrate,  20  to  30  per  cent.,  and  insert  a 
glycerine  tampon  attached  to  a string,  to 
be  removed  at  the  end  of  twenty-four  hours. 


The  silver  solution  may  be  applied  every 
ten  days  and  cleansing  douches  (see  Vagi- 
nitis,) used  in  the  intervals  (H.  A.  Kelly). 
If  the  catarrh  persists,  the  canal  may 
be  cleansed  of  mucus  by  means  of 
suction  bulbs  and  cotton  pledgets  soaked  in 
a solution  consi.sting  of  one  dram  of  equal 
parts  of  sodium  bicarbonate  and  sodium 
biborate  dissolved  in  six  ounces  of  water, 
and  then  tincture  of  iodine,  pure  ichthyol, 
silver  nitrate,  gr.  xx-5iss  to  the  ounce,  or 
pure  lactic  acid  applied  thoroughly  up  to 
the  internal  os  by  means  of  a cotton-wound 
applicator,  followed  by  a tampon  of  boric 
ointment,  10  per  cent.,  or  of  ichthyol  and 
glycerine,  25  per  cent.,  or  arg>Tol  and  glycer- 
ine, 25  per  cent.,  or  glycerite  of  boroglycer- 
ine, to  be  removed  at  the  end  of  twenty-four 
hours,  followed  by  daily  hot  normal  saline 
(oi  ad  Oi)  douches.  The  stronger  applica- 
tions should  be  made  every  ten  days,  the 
weaker  two  or  three  times  a week  (Noble 
and  Anspach) . Repeated  cauterization  with 
strong  silver  nitrate  solution  is  said  to  be 
effectual.  The  canal  may  be  dilated,  if 
necessary,  ]/i  to  inch  without  an  anres- 
thetic  (Penrose).  Penrose  employs,  for 
intracervical  application,  zinc  chloride  or 
sulphate,  gr.  i-ii  to  the  ounce;  or  tannic 
acid,  gr.  i-ii  to  the  ounce;  or  silver  nitrate, 
5 to  10  per  cent.;  or  pure  carbolic  acid;  or 
tr.  iodi,  two  parts,  and  carbolic  acid,  one 
part.  If  the  cervix  is  much  congested,  multi- 
ple punctures  may  be  made  or  the  artificial 
leech  applietl.  IVIucous  polypi  should  be 
removed  with  the  sharp  curette  or  scissors. 
If  the  cervix  is  lacerated  and  everted,  the 
diseased  mucosa  may  be  excised,  after  mak- 
ing incisions  in  each  lateral  angle  between 
the  anterior  and  posterior  lips,  followed  bj' 
union  of  the  lips  with  catgut  sutures.  An 
iodoform  pack  is  then  placed  in  the  vaginal 
vault,  and  the  patient  kept  in  bed  five  days, 
after  which  the  pack  is  removed,  and  after 
a few  days  daily  boric  acid  douches  (say 
5i  ad  Oi)  begun.  (H.  A.  Kelly.) 

In  bad  cases,  Hunner’s  use  of  the  actual 
cauteiy  is  recommended  as  very  effectual. 
No  anjBsthetic  is  required.  The  anterior 
cervdcal  lip  is  grasj^ed  with  tenaculum 
forceps,  and  the  canal,  well  up  to  the 
internal  os,  burned  out  all  around  to  a 
depth  of  2 to  5 mm.  (J^  to  inch),  with 
the  cauteiy  heated  to  a bright  red.  This  is 
repeated  eveiy  ten  to  fourteen  days.  Anti- 
septic douches  should  be  employed  in  the 
inteiwals  between  cauterizations.  The  pa- 
tient should  be  warned  that  “ in  a week  or 
ten  days  there  will  be  a slightly  bloody  and 
increased  purulent  discharge.”  Or,  instead 


CHANCROID 


of  cauterizing  superficially  all  around,  one 
may  make  three  deep  linear  cauterizations 
(ana'sthetization  may  then  be  required), 
after  which  the  patient  should  remain  in 
bed  for  three  days.  Six  to  eight  weeks  or 
longer  should  elapse  before  repeating  the 
deep  cauterizations. 

Some  dilate  the  canal  slightly,  and  scrape 
it  out  thoroughly  with  a sharp  curette; 
then  place  a boroglyceride  pack  in 
the  vaginal  vault,  which  is  removed  at  the 
end  of  twelve  hours  and  a hot  boric  acid 
douche  given. 

Dudley  usually  prefers,  in  deep-seated 
disease,  thorough  excision  of  the  mucosa  by 
Schroeder’s  operation. 

Handler  says:  “ Treatment  of  cervical 

catarrh  should  be  conservative  and  carried 
out  entirely  in  the  vagina  and  not  within 
the  cervix.”  Once  or  twice  a week  he 
draws  out  the  cervical  secretion  with  suction 
bulbs;  then  applies  pure  carbolic  acid  to 
erosions,  followed  after  a few  seconds  by 
pure  tincture  of  iodine  to  the  cervix  and 
vaginal  vault.  He  then  pours  in  one  ounce 
or  more  of  boroglyceride  through  a Fergu- 
son speculum,  and  packs  the  vagina  with 
gauze,  which  is  removed  after  twenty-four 
hours  and  the  vagina  douched.  Twice  daily 
the  patient  employs  a douche  of  bichloride 
of  mercury,  1 : 4000  (antiseptic),  or  acetate 
of  alum,  5i  to  the  quart  (healing).  Three 
times  a week  the  negative  electrode  of  a 
galvanic  battery  may  be  inserted  into  the 
cervical  canal,  and  10  milliamperes  admin= 
istered  for  ten  minutes.  (Dudley  condenms 
electrical  treatment  as  both  inefficient  and 
dangerous).  Pelvic  congestion  is  corrected 
by  “ sitz-baths,  Nauheim  baths  {q.v.  in 
Part  I),  and  the  use  of  the  sinusoidal  cur- 
rent applied  to  the  abdomen.”  Later,  to 
stimulate  the  growth  of  squamous  epithel- 
ium, he  paints  on  silver  nitrate,  1 to 5 per  cent., 
once  or  twice  a week.  When  the  canal  be- 
comes clearer  and  the  mucus  colorless,  he 
gently  paints  the  lining  of  the  cervix  with 
tincture  of  iodine  or  1 per  cent,  silver  nitrate. 

All  local  treatment  should  be  preceded,  of 
course,  by  thorough  cleansing  of  the  vagina 
and  vulva.  No  intracervical  treatment 
should  be  performed  if  salpingitis,  ovaritis, 
cellulitis,  or  peritonitis  is  present. 

The  bowels  should  be  kept  active,  and 
tonics  given,  if  necessary. 

Radium  therapy  (q.v.)  may  be  tried. 

Cervix,  Affections  of  the. — (See  Cervical 
Affections.) 

Chancre. — Fr.  See  Syphilis,  in  Part  1. 

Chancroid. — Fr.  chancre  -p  Gr.  elbos  form. 
A local,  contagious,  venereal  disease,  caused 


by  the  dumb-bell  shaped  strepto-bacillus  of 
Ducrey,  and  characterized  by  an  incubation 
period  of  from  one  to  twelve  day.s,  followed 
by  the  appearance  of  one  or  several  ulcers, 
with  unflermined  edges,  a moderately  soft 
base,  and  a profuse,  purulent,  auto-inocula- 
ble  discharge,  and  often  involvement  of  the 
adjacent  lymph  glands  which  tend  to  sup- 
purate. The  ulcers  are  usually  multiple, 
and  present  a punched  out  appearance. 
They  are  slow  in  healing,  and  the  occmrence 
of  buboes  (about  once  in  every  three  cases) 
greatly  protracts  the  case. 

Treatment. — If  the  disease  is  not  over 
seven  days  old  (Keyes),  proceed  as  follows: 
Carefully  cleanse  the  ulcers,  vulva,  and 
vagina  with  bichloride  solution,  1 : 2000; 
dry  thoroughly,  using  blotting  paper  for 
the  ulcers,  and  paint  the  latter  well  with 
cocaine  solution,  4 to  10  per  cent.  Diy 
carefully  again,  and  apply  thoroughly  to 
every  part  of  each  ulcer,  by  means  of  a 
glass  rod,  matchstick,  or  cotton  swab  on 
the  end  of  a toothpick,  pure  carbolic 
acid,  taking  care  not  to  touch  healthy  tissue, 
which  may,  if  desired,  be  protected  with 
vaseline.  Now  dry  again  with  blotting 
paper,  and  apply  pure  nitric  acid  or  sul- 
phuric acid,  letting  no  point  escape.  Douche 
the  vagina  and  vulva  again,  chy  thoroughly, 
and  dust  into  the  vagina  and  into  the  ulcers, 
iodoform  powder,  which  may  be  somewhat 
deodorized  by  means  of  coumarin  or  oil  of 
sassafras  (gtt.  ii  to  each  5hss),  or  equal 
parts  of  powdered  coffee.  Keep  the  vulval 
lips  separated  with  lint  or  cotton  held  in 
place  by  means  of  a T-bandage.  The 
thermocautery  applied  at  a dull  red  heat  is 
also  effectual;  but  Noble  and  Anspach  say 
that  it  is  apt  to  produce  too  much  sloughing. 
The  application  of  argjTol  crystals  follow- 
ing cocainization  is  well  praised. 

The  douches  and  powder  applications 
should  be  continued  twice  daily,  “ until  the 
sloughs  have  separated  and  the  granulations 
have  become  healthy,”  when  the  iodoform 
may  be  replaced  by  unguentmn  hydrargyri 
nitratis,  1 part,  to  vaseline,  7 parts;  or  ung. 
zinci  oxidi  {q.v.)  containing  3 per  cent, 
carbolic  acid;  or  balsam  of  Peru  and  castor- 
oil,  equal  parts;  or  acetanelid,  boric  acid, 
and  calomel,  equal  parts;  or  dermatol;  or 
calomel;  or  boric  acid.  Touch  exuberant 
granulations  with  the  silver  nitrate  stick 
or  solution  (gr.  xxx  ad  5i  )• 

If  the  ulcers  are  over  seven  days  old,  do 
not  cauterize  them;  for,  says  Keyes,  if 
cauterization  then  fails,  which  it  almost 
invariably  does,  it  leaves  the  sore  larger 
than  ever.  Bathe  the  parts,  instead,  for 


CHYLURIA 


twenty  minutes  or  longer,  two  to  four 
times  a day,  with  bichloride  solution, 
1 ; 5000;  or  boric  acid,  4 per  cent.;  then  dry 
with  a sterile  cloth,  and  apply  one  of  the 
above  powders.  Indolent  ulcers,  however, 
may  be  touched  twice  a week  with  tincture 
of  iodine,  or  the  silver  stick,  or  pure  car- 
b(jlic  acid. 

Early  chancroids  may  be  aborted  and 
cured  by  cauterization;  but,  says  Keyes, 
“ if  the  first  cauterization  fads,  it  is  futile 
to  repeat  it.”  ^ 

The  patient  should  keep  off  her  feet  as 
much  as  possible  in  order  to  prevent  bubo. 
Should  the  latter  appear,  put  the  patient 
to  bed,  and  apply  the  ice-bag  until  resolution 
occurs  or  until  the  inflammation  becomes 
active,  when  heat  should  be  substituted. 
Some  recommend  the  application  of  tincture 
of  iochne  or  of  equal  parts  of  img.  hydrar- 
gyri,  ung.  belladonna?,  ung.  iodi,  and  ich- 
thyol  (Noble  and  Anspach),  covered  with 
waxed  paper  and  compression  made  with 
an  ascending  spica  bandage  of  the  groin. 
Keyes  says,  however,  “ Do  not,  under  any 
circumstances,  paint  the  groin  with  iodine,” 
because  it  irritates  the  skin  and  promotes 
autoinoculation  should  the  bubo  break  down. 

If  suppuration  occurs,  it  is  much  prefer- 
able to  excise  the  gland  intact.  If  this  is  not 
practicable,  it  is  generally  advised  that  the 
abscess  be  incised,  all  chseased  tissue  ciu’et- 
ted  away,  the  cavity  irrigated  with  cor- 
rosive subhmate,  1 ; 1000,  dried,  cauterized 
with  pure  carbolic  acitl,  and  packed  with 
iodoform  gauze.  But  Keyes  says,  “ Sup- 
purating bubo  should  be  drained  by  veiy 
small  incisions,  almost  pimctures,  multiple 
if  need  be,  followed  by  injection  of  a 10  per 
cent,  iodoform-m- vaseline  ointment,”  and 
the  application  of  a hot  water  bag,  the 
injection  to  be  “ repeated  every  third  day 
until  the  purulent  di.scharge  ceases.”  Per- 
sistent induration  calls  for  excision;  but  do 
not  excise  the  glands  of  both  groins.  Should 
the  bubo  break  dovm  and  infect  the  edges 
of  the  wound,  employ  the  actual  cautery, 
under  general  ana?sthesia,  and  destroy  thor- 
oughly and  deeply,  witliout  fear,  all  the 
infected  tissue;  then  pack  with  gauze,  or 
ajiply  iodoform  or  wet  di’essings. 

If  the  urethra  is  involved,  as  ascertained 
by  endoscopic  and  bacteriologic  examina- 
tion, introduce,  following  urination,  sup- 
positories of  iodoform  in  cocoa-butter,  and 
cover  the  meatus  with  cotton  or  gauze  to 
keeir  the  suppository  in.  Cure  thereby  is 
said  to  be  rapid. 

Prescribe  a nutritious  diet,  perhaps  cod- 
liver  oil  iq.v),  fresh  air  day  and  night. 


rest,  regiflar  hours  of  eating  and  sleeping, 
regulation  of  the  bowels,  and  as  a tonic, 
elixir  ferri,  quininre,  et  strychninse,  one  tea- 
spoonful well  diluted,  t.i.d.p.c. 

Robbins  and  Seabury  recently  report 
excellent  results  from  the  following  plan  of 
treatment:  After  an  examination  for  spiro- 
chsetes  is  made  (see  under  Syphilis),  a “ 25 
per  cent,  solution  of  copper  sulphate  in 
distilled  water  is  applied  to  the  sore,  and 
the  short  liigh-frequency  spark  from  a 
rather  flne-pointed  vacuum  electrode  is 
applied  directly  to  the  sore  for  one  to  three 
minutes,  depending  on  the  extent  of  the 
ulceration.”  “ Especial  care  is  exercised  in 
carrying  the  point  of  the  electrode  well 
down  into  any  fissure  or  undermined  edge, 
and  the  area  of  application  should  extend 
over  the  edge  of  the  sore  about  inch 
into  the  doubtfully  healthy  area.”  “ The 
cuiTent  is  not  tm-ned  off  until  every  crack 
and  crevice  has  been  thoroughly  treated 
and  the  surface  of  the  sore  is  changed  to  a 
dark  greenish  gray.”  “It  is  then  wiped 
dry  and  some  antiseptic  powder  is  lightly 
applied  to  the  entire  mucous  surface  of  the 
preputial  cavity.”  “ If  the  sore  is  exposed, 
it  should  be  covered  with  a thick  moist 
dres-sing,  say  of  bichloride,  1 : 10,000,  which 
should  be  changed  once  or  twice  daily,  and 
must  not  be  allowed  to  stick.”  It  must  be 
moistened  at  least  three  or  four  tunes  a day. 
The  original  cauterization  may  be  repeated 
if  it  is  evident  that  the  chancroidal  infection 
has  not  been  completely  tlestroyed. 

Change  of  Life. — See  Menopause. 

Chorio=EpitheIioma;  Deciduoma  Malig= 
num;  Syncytioma  Malignum. — Gr.  xoptov 
skin;  eiri  on  -f-  drjXr/  nipple;  -upa  tumor;  L. 
dccid'uus,  falling  off;  Gr.  auv  together  -}- 
KiiTos  cell;  L.  malig'nus,  malicious.  A malig- 
nant, rapidly  metastatic  chorionic  neoplasm, 
appearing  weeks,  months,  or  even  j^ears 
after  an  hydaticUform  mole,  an  abortion,  a 
full-term  labor,  or  an  extra-utei’ine  preg- 
nancy, first  manifested  by  vaginal  metas- 
tases  or  profuse  mtennittent  uterine  hemor- 
rhages and  rapid  enlargement  of  the  uterus, 
aiul  thagnosed  by  microscopic  examination 
of  the  deeper  portions  of  the  uterine  scrap- 
mgs.  The  growdh  is  composed  of  sjuiectimn 
and  Ijanghans’s  layer  of  cells. 

Treatment.— Immediate  pan-ln’^terectomy, 
as  for  cancer,  and  the  excision  of  all  accessi- 
ble metastases  is  demanded.  The  disease  is 
usually  fatal  within  six  months,  even  after 
hysterectomy,  but  spontaneous  recovery  is 
possible,  and  metasttises  may  disappear 
after  the  removal  of  the  primary  growth. 

Chyluria. — See  Part  1. 


CYSTITIS 


Climacterium. — Gr.  K\LiJ.aKTr/p  round  of  the 
ladder.  See  Menopause. 

Clitoris,  Adhesions  of  the. — Gr.  kKutopLs. 
See  Masturbation. 

Coccydynia;  Coccygodynia. — See  Part  1, 
General  Medicine  and  Surgery. 

Coition,  Difficult. — L.  coit'io,  a going  to- 
gether. (See  Vaginismus.) 

Colic,  Renal. — Gr.  k6\ov  colon;  L.  ren, 
kidney.  See  Nephrolithiasis,  in  Part  1. 

Coloptosis. — Gr.  Kw\ov  colon  4-  ttwctis  fall. 
See  Splanchnoptosis,  in  Part  1. 

Colpitis. — Gr.  koXttos  vagina  -f-  -ms  in- 
flammation. See  Vaginitis. 

Colpohyperplasia  Cystica. — Gr.  /coXttos 
vagina  -|-  virkp  over  -f-  vrAdcrts  formation; 
KvffTLs  bag.  See  under  Vaginitis. 

Condylomata. — Gr.  KovdvXcopa  wart.  See 
Verrucse;  Warts,  page  450.  < 

Congestion  of  the  Pelvis,  Chronic.— L. 
conge'rere,  to  heap  together;  pel' vis,  basin; 
Gr.  xpovos  time.  Etiology.— Sedentary  life; 

constipation;  tight  lacing;  excessive  venery; 
“sexual  engorgement  in  love-making”; 
pregnancy;  abdominal  and  pelvic  tumors; 
obesity;  heart  weakness;  cardiac,  pulmonary, 
renal,  hepatic,  and  splenic  disease;  uterine 
displacements;  pelvic  inflammatory  dis- 
ease; etc. 

Symptomatology. — Feeling  of  weight  and  dis- 
comfort in  the  pelvis,  relieved  on  lying  down 
or  on  assuming  the  Icnee-chest  posture;  con- 
gestion of  the  external  genitalia;  leucorrhoea 
due  to  hypersecretion;  menorrhagia.  Vari- 
cocele of  the  broad  ligament  may  result. 

Treatment. — Treat  the  cause.  The  con- 
gestion may  be  ameliorated  by  means  of 
daily  saline  laxatives  {q-v.),  daily  hot 
vaginal  douches  m the  recumbent  posture, 
the  assumption  of  the  knee-chest  posture  for 
about  ten  minutes  several  times  a day, 
sleeping  with  the  hips  elevated,  and  the 
application  every  other  day  to  the  cervix 
and  vaginal  vault  of  tampons  of  glycerite  of 
boroglycerine,  to  be  removed  by  an  at- 
tached string  at  the  end  of  eighteen  to 
twenty-four  hours.  (Ashton.) 

Constipation. — See  Constipation,  in  Part 
1,  General  Medicine  and  Surgery. 

Contraction  of  the  Lumen  of  the  Bladder. 
— See  Bladder,  Contraction  of  the. 

Contracture  of  the  Neck  of  the  Bladder. — • 
See  Bladder  Irritability. 

Cyst. — See  Cysts. 

Cystalgia. — 'Gr.  kIxjtls  bladder  -p  aXyos 
pain.  See  Bladder  Irritability. 

Cystic  Vaginitis. — Gr.  kvctls  bag.  See 
Vaginitis. 

Cystinuria. — Cystin  + Gr.  Zvpov  urine. 
See  Nephrolithiasis,  in  Paid  1. 


Cystitis. — Gr.  Kixms  bag  + -itis,  inflamma- 
tion. Inflammation  of  the  bladder  is  mani- 
fested by  frequent,  painful  micturition, 
urgency,  vesical  tenesmus  or  straining,  burn- 
ing pain  in  the  bladder,  pyuria,  and  some- 
times hiematuria.  In  some  grave  cases  a 
part  or  whole  of  the  vesical  mucous  mem- 
brane may  become  detached  and  expelled 
(exfoliative  cystitis).  Ureteritis  and  pyelitis 
are  possible  sequel®. 

Cystitis  should  be  distinguished  from 
ureteral,  renal,  and  urethral  infection,  vesico- 
urethral fissure,  shnple  irritability  of  the 
bladder,  contraction  of  the  bladder,  and 
vesical  stone  or  foreign  body.  To  this  end 
employ  the  urethroscope,  cystoscope,  ure- 
teral catheter,  and  urinalysis.  (See  Urinaly- 
sis; and  Pyelonephritis,  in  Part  1,  for  unpor- 
tant  diagnostic  criteria.) 

Etiology.— Local  congestion  due  to  men- 
struation, pregnancy,  the  puerperal  state, 
pelvic  or  abdominal  tumors,  uterine,  tubal, 
or  ovarian  disease,  peritonitis,  hemorrhoids, 
fecal  accumulations,  exposure  to  cold,  dis- 
ease of  the  heart,  lungs,  liver,  or  kidneys; 
retention  of  urine  due  to  stricture  or  tumor 
of  the  urethra,  uterine  displacements  (par- 
ticularly prolapse),  cystocele,  extravesical 
growths,  vesical  paralysis  (due  to  tabes, 
general  paresis,  myelitis,  spinal  injury, 
spastic  spinal  paralysis) ; irritating  urine  due 
to  turpentine,  cantharides,  oil  of  sabine,  the 
balsams,  salicylates,  calomel,  alcohol,  etc., 
also  rheumatism  and  gout,  or  the  so-called 
uric  acid  diathesis,  hyperacidity,  hyper- 
alkalinity, too  high  or  too  low  specific  grav- 
ity, crystals  (uric  acid,  calcium  oxalate, 
phosphates — see  Nephrohthiasis) ; foreign 
bodies;  calcuh;  tramnatism  due  to  child- 
bh’th,  external  injury,  operation,  instru- 
mentation, the  pressure  of  pessaries,  the 
injection  of  strong  salt  solution  into  the 
bladder;  vesical  tumors;  contiguous  inflam- 
mation (appenchcitis,  pelvic  inflammatory 
disease);  adherence  of  the  bladder  to  the 
bowel;  chsease  of  the  kidney  or  ureter; 
vulvitis;  urethritis;  masturbation;  inanition 
and  an®mia;  the  exanthemata,  diphtheria, 
“ cold  ”;  overdistention  of  the  bladder  in 
polyuria  or  prolonged  retention  of  urine. 

Offenchng  organisms  are  the  colon  bacil- 
lus, typhoid  bacillus,  gonococcus,  and  tuber- 
cle bacillus,  producing  an  acid  cystitis;  and 
streptococci,  staphylococci,  and  proteus  vul- 
garis, producing  an  alkaline  cystitis. 

Treatment.- 1.  AcUTE  CYSTITIS  (wiTH  DIS- 
CHARGE OF  PUS,  MUCUS,  AND  BLOOD). — 

Avoid  cystoscopy  and  local  treatment.  Put 
the  patient  to  bed,  apply  heat  to  the  epi- 
gastrium in  the  form  of  hot  moist  flannels 


CYSTITIS 


or  hot  bran  bags,  and  have  the  patient 
take  hot  vaginal  douches  or  hot  sitz-baths, 
lasting  ten  to  fifteen  minutes,  two  or  three 
times  daily.  Open  the  bowels  with  Rochelle 
salts  (both  laxative  and  diuretic),  5i  in 
dilute  solution  eveiy  two  or  three  hours;  and 
prescribe  a bland,  liquid  or  soft  diet  with 
copious  water  drinking  between  meals  (2  to 
3 quarts  daily  of  plain  water,  Vichy  water, 
or  flaxseed  tea).  Prohibit  meat,  acid  fruits, 
condiments,  spices,  mustard,  horseradish, 
pepper,  salt  in  excess,  radishes,  rhubarb, 
tomatoes,  asparagus,  lemons,  pickles,  salads, 
sauces,  vinegar,  cheese,  greasy  or  fried  foods, 
tea,  coffee,  ginger  ale,  alcohol.  Milk  is  the 
best  food.  If  the  patient  is  very  septic, 
prescribe  concentrated  liquid  nourishment 
(milk  and  eggs)  and  strychnine  (q.v.). 

For  severe  pain,  prescribe  the  following: 


Extract!  opii gr.  ss 

Extract!  belladonna? gr.  M 


Ole!  theobromat!s,  q.s., 

M.  et  fiat  suppos.,  nutte  tabs  vi. 

S!g. — One  every  six  or  e!ght  hours.  (H.  A.  Kelly.) 

Ashton  and  Dudley  recommend,  for  the 
relief  of  pain  and  tenesmus  in  mild  cases, 
rectal  suppositories  of  ichthyol,  gr.  iii,  once 
or  twice  daily. 

Prescribe,  as  a urinary  antiseptic,  hexa- 
methylenamine  (urotropin),  gr.  v-vii-xv,  in 
capsule  or  powder  with  water,  every  three 
or  four  hours.  Urotropin  liberates  formal- 
dehyde in  the  urine  only  when  the  latter 
is  acid.  Helmitol  (Methylene  citronate 
of  hexamethylenamin),  gr.  vii-x-xxx,  in 
capsule,  t.i.d.,  liberates  formaldehyde  even 
if  the  urine  is  not  acid  (see  Part  II  for 
dosage  at  various  ages,  etc.).  Suspend 
the  ch’ug  if  it  causes  irritation,  and  reduce 
the  dose. 

Other  less  valuable  urinary  sedatives  and 
antiseptics  are: 

Saliformin,  gr.  v,  every  four  hours. 

Salicylic  acid,  sochum  salicylate,  or  salol, 
gr.  v-x,  every  three  hours  (salol  liberates 
carbolic  and  salicylic  acids  in  the  urine. 
It  should  not  be  pushed  to  the  point  of 
producing  “ lumbar  heaviness.”  These 
drugs  are  recommended  in  gonorrhoeal  cys- 
titis, in  which  it  is  important  to  keep  the 
urine  acid.). 

Sod!!  sal!cylat!s oiss  (gr. !!!  per  dose) 

Hcxiunethylenamma? . ...  5!ss  (gr.  !!!  per  dose) 

T!nctun3B  hyoscyam! 5!v  (iikvu!  per  dose) 

Ebxir!s  simpl!c!s,  q.s.  ad . . 5 iv 

M.  S!g. — One  dram  !n  water  every  two 
hours  (“a  valuable  combination”  In  gonorrhoeal 
cystitis — ( Bandler) . 


R Extract!  hyoscyam! gr.  ss 

Phenybs  sabcylatLs gr.  v 

Ilexamethylenamlna? gr.  v 

Ft.  tab  caps.  No.  x.x. 

S!g. — One  every  three  hours,  with  water. 
(Bandler.) 

Fluldextract!  zeae  mays,  teaspoonful,  well  diluted 

every  three  or  four  hours  (“the  best  drug  I know  to 
allay  the  irritability  of  the  bladder.”  H.  A.  Kelly.) 

Fluidextract!  tritic!  repentis,  teasp.,  well  di- 
luted, every  three  or  four  hours. 

Infusiun  uva?  ursi,  §ss-i,  t.i.d. 

Infusum  buchu,  gss-i,  t.i.d.  Casper  says  that 
buchu  leaves  are  the  best  of  the  vegetable  diuretics. 

Fluidextract  of  pareira  brava,  3i-u,  in  lots  of 
water,  three  to  four  times  a day. 

Casper  recommends  for  their  sedative  and  astrin- 
gent properties,  two  tea.spoonfuls  of  a mix-ture  of 
several  herbs;  buchu  leaves,  couch  grass,  pareira 
brava,  cornsilk,  uva  ursi,  alchemilla,  etc.,  to  each 
cup  of  water,  to  be  boiled  for  several  minutes,  three 
or  four  cupfuls  a day. 

01.  santab  or  ol.  copaibse,  irjv-x-xx,  in  capsule, 
t.i.d. p.c.  (suspend  the  drug  if  gastric  indige.stion 
occurs;  01.  santab  is  indicated  in  staphylococcus 
infection  and  gonorrhoea.  Le  Fevre  says,  the  com- 
bination of  ol.  santab  vel  copaiba?  with  salol  or 
sodium  benzoate  is  “especially  efficaeious.” 

Spiritus  aetheris  nitrosi,  1 teasp.,  well  diluted, 
every  two  to  three  hours. 

01.  eucalj-pti,  ttjx  in  water  every  two  hours. 

Tr.  hyoscyami,  30  drops,  well  diluted,  eveiy  two 
or  three  hours. 

For  ammoniacal  urine,  prescribe: 

Benzoic  acid,  gr.  x,  in  capsule,  three  or  four  times 
a day. 

Sod.  or  ammon.  benzoate,  gr.  v-xxx,  t.i.d. 

Boric  acid,  gr.  v-xv,  in  capsule,  three  to  six  times 
a day. 

Acid  sodium  phosphate,  gr.  xxx,  in  water,  every 
three  hours  or  four  tunes  a day. 

Acidi  benzoici 5 ii  (gr.  v per  dose) 

Acidi  borici 3 iii  (gr.  viiss  per  dose) 

Aqua?  cinnamomi. . 5xii 

M.  Sig. — Tablespoonful  in  water,  four  times 
daily  (Emmet.) 

For  strongly  acid  urine,  prescribe,  if  deemed 
advisable : 

Pot.  citrate  or  bicarbonate,  3i-u,  dissolved  in  one 
to  two  pints  of  flaxseed  tea,  and  given  in  divided 
doses  during  the  day.  (Penrose.) 

R Potassii  citratis 3iv  gr.  xx  per  dose) 

Tinctura?  hyoscyami 3vi?  (i^xxx  per  dose) 

Eb,xiris  simpbeis,  q.s.,  ad.  gvi 

M.  Sig. — One  tablespoonful  every  two  or  three 
hours  in  water.  (H.  A.  Kelly.) 

In  hyperacute  cases,  not  improved  by  the 
foregoing  treatment,  open  and  drain  the 
bladder  through  the  vagina,  and  place  the 
l^atient  in  a hot  water  bath  for  several  hours 
ever>^  day.  To  keep  the  fistula  open,  se\v 
the  vesical  to  the  vaginal  mucosa  by  inter- 
rupted catgut  sutures.  (H.  A.  Kelly.) 

Keep  the  patient  in  bed  “ as  long  as 
vesical  pain  and  tenesmus  continue.” 
(Penrose.) 


CYSTITIS 


As  soon  as  the  acute  symptoms  are  allevi- 
ated, irrigate  the  bladder  two  or  three  times 
daily  with  warm  boric  acid  or  ichthyol  solu- 
tion, 2 per  cent,  of  either. 

II.  Subacute  and  Chronic  Cystitis. — 
Treat  the  affection  internally  as  described 
under  acute  cystitis.  Irrigate  the  bladder 
every  day  or  every  other  day  with  warm 
boiled  boric  acid  solution,  3ii-iii~iv  to  the 
pint  (silver  nitrate,  gr.  % may  be  added  ; = 
1 : 10,000) ; or  boric  acid,  3 ii,  borax,  3 i,  and 
sodium  chloride,  3ss,  to  the  pint;  or  carbolic 
acid  solution,  up  to  l]/2  per  cent.;  or  mer- 
cury bichloride,  1 : 100,000  in  normal  saline 
solution  (3i  ad  Oi),  gradually  increased  to 
1 : 10,000  to  1 : 5000  (alternate  with  boric 
acid  irrigations) ; or  creolin,  1 ; 1000  to 
1:500;  or  lysol  1:1000  to  1:500;  or 
potassium  permanganate  1:15,000  to  1: 
6000  to  1 : 1000.  The  strength  of  the 
irrigating  fluid  should  be  tempered  to  the 
sensitiveness  of  the  bladder. 

In  irrigating,  use  a glass  catheter  attached 
to  a fountain  syringe.  The  apparatus, 
hands,  and  vulva  should,  of  course,  be 
sterilized,  the  former  by  boiling  and  the 
latter  by  soap  and  water,  followed  by  bi- 
chloride, 1 : 2000.  The  catheter  may  be 
lubricated  with  sterile  vaseline.  The  flow 
from  the  fountain  syringe  may  be  regulated 
by  pressure  with  the  thumb  and  forefinger 
on  the  rubber  tubing.  Allow  the  solution  to 
enter  the  bladder  slowly  until  the  patient 
experiences  distention.  Then  stop  the  flow, 
and  when  the  patient  can  retain  the  fluid  no 
longer,  remove  the  tubing  from  the  catheter 
and  allow  the  fluid  to  run  out.  Repeat  this 
until  three  or  more  quarts  have  been  used. 

In  obstinate  cases,  instillations  of  stronger 
solutions  may  be  employed,  e.g.,  3^  to  2 
ounces  of  warm  silver  nitrate  solution, 
1 : 1500,  gradually  increased,  if  no  discom- 
fort ensues,  to  1 : 1000  to  1 : 500,  to  1 : 100; 
or  protargol,  1 dram  of  a 1 to  5 per  cent, 
solution;  or  argyrol,  1 dram  of  a 25  per 
cent,  solution.  The  instillations  may  be 
made  every  day  or  every  other  day  by  means 
of  a bulb  or  a funnel  attached  to  a catheter, 
or  a piston  syringe,  or  a Dickinson  two-way 
catheter.  The  fluid  should  be  retained  as 
long  as  possible,  with  the  hips  elevated. 
Ashton  says  that  antiseptic  irrigations  and 
instillations  should  be  followed  by  irrigation 
with  normal  salt  solution  (3i  ad  Oi),  to 
prevent  poisoning. 

Dudley  says;  “ When  the  bladder  is  so 
painful  as  to  resist  all  efforts  at  treatment  it 
may  be  anaesthetized  with  10  to  20  c.c.  of  a 
4 per  cent,  solution  of  antipyrin,  left  in 
about  twenty  minutes.” 


If  the  above  measures  are  not  followed 
by  improvement  within  a reasonable  time, 
make  topical  applications  through  a cysto- 
scope,  of  silver  nitrate,  2 to  5 to  10  to  20 
per  cent.,  or  pure  carbolic  acid,  every  three 
to  five  days,  with  irrigations  in  the  intervals. 
Ulcers  may  first  be  curetted  before  cauteriz- 
ing. Ashton  follows  cauterization  by  irri- 
gation with  hot  normal  salt  solution.  If 
no  improvement  follows  the  silver  applica- 
tions, try  the  actual  cautery  lightly.  Con- 
tinuous irrigation  through  a two-way  cathe- 
ter, for  two  to  four  hours  daily,  with  warm 
boric  acid  solution  3i  to  the  pint,  may  be 
required;  or  perhaps  continuous  drainage 
through  a vesico-vaginal  fistula.  The  latter 
must  be  closed  by  an  operation  after  the 
cystitis  has  been  cured. 

Chronic  ulcers,  not  otherwise  curable, 
should  be  excised  through  a suprapubic, 
extra-peritoneal  incision,  the  bladder  being 
distended  with  sterile  normal  saline  solu- 
tion or  with  air.  “ The  line  of  excision 
should  be  well  outside  of  the  area  of  inflam- 
mation and  the  oedematous  zone  which 
often  surrounds  it  and  should  extend 
through  the  entire  thickness  of  the  bladder 
wall.  The  opening  thus  formed  is  immed- 
iately closed,  leaving,  however,  a small 
space  through  which  a mushroom  catheter 
is  introduced.  Through  this  the  bladder  is 
daily  washed  out  with  silver  nitrate,  start- 
ing with  a 1 : 10,000  solution,  and  grad- 
ually increasing  in  strength  until  all  the 
traces  of  infection  are  eliminated.  After 
removing  the  catheter,  somewhere  from  the 
tenth  to  the  fourteenth  day,  the 
irrigations  may  be  continued  through  the 
urethra.”  (Hunner.) 

In  obstinate  cases  of  cystitis,  three  or 
more  years  may  be  required  for  a cure, 
excepting,  of  course,  tuberculous  cystitis  in 
the  last  stages. 

III.  Tuberculous  Cystitis. — It  is  sus- 
ceptible of  cure  or  amelioration.  An 
infected  kidney,  if  one  alone  is  diseased, 
should  be  removed,  whereby  the  cystitis 
usually  disappears.  Plenty  of  nourishing  food, 
fresh  air,  and  rest  are  of  importance.  Codliver 
oil  and  the  hypophosphites  or  glycerophos- 
phates (see  Part  11)  may  be  prescribed.  Creo- 
sote, guaiacol,  ichthyol,  and  ichthalbin  have 
their  advocates.  Casper  praises  morphine 
and  belladonna  as  valuable  sedative  and 
curative  agents.  Alkalies  may  be  soothing. 
The  application  of  heat  is  especially  soothing. 

In  advanced  cases  (not  in  the  early 
stages),  the  bladder  may  be  iastilled  (never 
irrigated),  once  daily,  or  two  or  three  times 
a week,  through  a small,  soft-rubber  cathe- 


DILATATIOlsT  OF  THE  URETHRA 


ter,  with  an  emulsion  of  iodoform,  5i  to 
Bi  of  liquid  vaseline,  two  or  three  drams 
at  a time,  to  be  retained  as  long;  as  possible; 
or  one-half  dram  of  the  following : guiacol, 
5 gm.,  iodoform,  1 gm.,  sterile  olive  oil, 
100  gm.  (Collin);  or  guaiacol  valerianate, 
25  to  100  per  cent,  in  olive  oil  (Chetwood) 
or  thallin  sulphate  3 to  12  per  cent,  aqueous 
solution  (Chetwood);  or  Gomenol  oil,  15  to 
30  c.c.  of  a 20  per  cent,  solution.  Casper 
regartls  bichloride  of  mercuiy  as  the  “ sov- 
ereign ” local  remedy.  He  begins  with 
instillations  of  1 : 10,000  to  1 : 1000,  no 
oftener  than  twice  a week,  less  often  if 
there  is  much  painful  reaction,  and  as  the 
sjnnptoms  abate,  he  duninishes  the  strength 
and  increases  the  quantity  up  to  50  c.c.  of 
a 1 : 10,000  to  1 : 5000  solution.  Do  not 
inject  enough  to  distend  the  bladder. 
Warn  the  patient  that  a painful  reaction 
follows  each  instillation.  Administer 
morpliine.  Discontinue  the  treatment  “if 
no  result  is  experienced  after  three  or 
four  applications.” 

Keyes,  however,  begins  with  instillations 
of  2 to  10  minims  of  a 1 : 25,000  solution  of 
bichloride,  and  increases  the  strength  of  the 
solution  “ as  far  and  as  rapidly  as 
the  patient’s  symptoms  permit.”  He 
says,  “ The  treatment  should  excite  no 
sharp  reaction.” 

Casper  “ strongly  opposes  ” operative 
methods  of  treating  tuberculous  cystitis, 
i.e.,  curettement  of  ulcers  through  the  cysto- 
scope,  excision,  and  suprapubic  cystos- 
tomy.  Internal  urhiary  antiseptics  and 
silver  nitrate,  boric  acid,  and  potassium 
permanganate  instillations  do  harm. 
Tuberculin  is  still  sub  judice. 

Cystocele. — Gr.  kvotls  cyst  -b  KifK-q 
tumor.  See  Dilatation  of  the  Urethra. 

Cystospasm. — Gr.  Kuems  bladder  -f 
(TTraaixos  spasm.  See  Bladder  Irritability. 

Cysts  of  Bartholin’s  Glands. — Gr. 
Kv(TTLs  bladder.  See  Tumors  of 
the  Vulva. 

Kidney. — See  Tumors  of  the  Kidney. 

Ovaries. — See  Ovarian  Tumors  and 
Cysts. 

Parovarium. — See  Ovarian  Tumors 
and  Cysts. 

Urethra. — See  Tumors  of  the 

Urethra. 

Vagina. — See  Tumors  of  the  Vagina. 

Vulva. — See  Tumors  of  the  Vulva. 

Deciduoma  Malignu m.— See Chorio- 
Epithelioma. 

Descensus  Uteri. — L.  descendere,  to  go 
down;  terns,  womb.  See  Prolapsus  Uteri. 

Dietl’s  Crises. — L.  Gr.;  Kpicris  paroxysm. 
See  Ilydroneplu'osis. 


Dilatation  of  the  Urethra. — The  whole 
urethra  may  be  dilated,  or  only  a portion 
(urethrocele),  producing  in  the  latter  in- 
stance sacculation,  usually  of  the  middle 
third  of  the  posterior  wall.  More  or  less 
incontinence,  and  perhaps  frequent  difficult 
micturition,  result.  The  incontinence  is 
passive  and  intermittent,  caused  by  sneez- 
ing, coughing,  fright,  sudden  change  of 
position,  etc.  Cystocele  may  be  present. 
The  diagnosis  is  made  by  means  of 
the  sound. 

Etiology. — Congenital  anomaly;  difficult 
labor,  traumatism,  and  subinvolution;  pas- 
sage of  a stone;  forcibje  operative  dilatation; 
coitus  per  urethram  and  the  introduction  of 
candles,  etc. ; tumor  or  stricture. 

Treatment. — First  correct  any  inflamma- 
tion present.  In  urethral  sacculation  it  may 
be  necessary  first  to  make  an  artificial 
urethro-vaginal  fistula  through  the  most 
dependent  part  of  the  sacculation  and  unite 
the  urethral  and  vaginal  mucosse  by  inter- 
rupted catgut  sutures,  before  the  methritis 
can  be  treated  successfully.  After  the 
inflanunation  is  cured,  the  redundant,  sac- 
culated portion  of  the  urethra  is  removed, 
and  the  fistula  closed.  The  cause  of  the 
dilatation  (stricture,  tmuor,  etc.)  should,  of 
course,  be  corrected.  After  the  stitches 
have  been  removed,  and  the  patient  is  out 
of  bed,  employ  a Skene’s  pessary  or  Kelly’s 
device  (Fig.  88),  if  the  pelvic  floor  is  intact, 
for  several  months. 


Custiion  ~pTc5dh.(?  onuretHra. 


Fia.  88. — A Skene  pessary,  with  a hard  rubber  pessary  resting  on 
two  pillars,  for  the  purpose  of  making  pressure  on  the  new  urethral 
canal  and  in  this  way  substituting  the  loss  of  the  sphincter  muscle. 
From  Kelly  [&  Noble’s  Gynecology  and  Abdominal  Surgery.  W.  B. 
Saunders  Co. 


In  diffuse  dilatation  due  to  subinvolu- 
tion, enjoin  restraint  from  active  exercise, 
regulation  of  the  bowels,  bland  diet  (see 
Urethritis),  and  daily  hot  sitz-baths;  and 
apply  local  astringents  as  in  prolapse  or  ever- 
sion of  the  urethral  mucous  membrane  {q.v.). 
Skene’s  jiessaiy  or  Kelly’s  device  may  be 
worn  if  the  pelHc  floor  is  intact. 


DYSMENORRHCEA 


If  incontinence  of  urine  persists,  resort  to 
operation.  A portion  of  the  anterior  wall 
of  the  vagina  and  posterior  wall  of  the 
urethra  may  be  excised  and  the  wound 
closed  by  transverse  silkwonn-gut  sutures, 
and  a Skene  pessary  later  employed;  or  the 
Dudley  operation  of  advancement  of  the 
external  urinary  meatus  to  the  clitoris  may 
be  preferable  (cystocele  and  perineal  lacera- 
tion, if  present,  being  first  corrected) ; or 
perhaps  better,  the  Kelly-Dmmu  operation 
described  in  Surgery,  Gynaecology,  and 
Obstetrics,  April,  1914. 

The  faithful  application  of  the  interrupted 
galvanic  current  may  be  useful  for  the  pur- 
pose of  strengthening  the  sphincter  muscle 
(see  under  Bladder  Irritability.) 

Diphtherial  Vulvitis. — See  Diphtheria, 
in  Part  I. 

Displacements  of  the  Uterus. — Anteflex- 
ion, q.v. 

Antelocation,  q.v. 

Anteversion,  q.v. 

Descent,  q.v. 

Lateral  Location,  q.v. 

Prolapse,  q.v. 

Retroflexion,  q.v. 

Retrolocation,  q.v. 

Retroversion,  q.v. 

Diverticulum  of  the  Urethra. — L.  divertic- 
ula're,  to  turn  aside.  See  Dilatation  of  the 
Urethra. 

Dysmenorrhcea. — Gr.  8vs-  difficult  -f 
month  -|-  petv  to  flow.  Painful  and  diffi- 
cult menstruation. 

Etiology.— (1)  Nervous  or  neurotic  disposi- 
tion, inherited  or  acquired  (hypersensitive- 
ness), due  to  or  aggravated  by  improper 
hygiene,  fll-health,  anaemia,  malaria,  syph- 
ilis, gout  and  rheumatism,  obstinate 
constipation,  onanism  (either  masturbation 
or  excessive  sexual  indulgence),  overwork 
(mental  or  physical),  sedentary  habits, 
high  living,  neurasthenia,  hysteria,  gastric 
and  duodenal  ulcer,  floating  kidney,  nasal 
affections,  etc. 

(2)  Pelvic  congestion  or  inflammation,  due 
to  plethora,  sedentary  habits,  obstinate  con- 
stipation, onanism,  uterine  displacements, 
uterine  tumors  (myomata,  polypi,  etc.),  pro- 
lapse of  the  uterine  appendages,  varicocele 
and  tumors  of  the  broad  ligaments,  subm- 
volution,  ovarian  diseases  (tumors,  cystic 
degeneration,  thickening  of  the  capsule,  etc.), 
over-exertion,  portal  congestion,  pelvic  in- 
flammatory disease  (embracing  the  uterus, 
tubes,  ovaries,  and  pelvic  peritoneum) 
chronic  hyperplastic  or  polypoid  endometri- 
tis, pelvic  adhesions,  chronic  appendicitis, 
acute  suppression  of  the  menses. 


(3)  Obstruction,  congenital  or  acquired, 
due  to  flexions  of  tlie  uterus  (especially  acute 
anteflexion),  cervical  or  vaginal  atresia  or 
stenosis,  intra-uterine  (ball-valve)  polypi, 
blood-clots,  membrane  in  membranous  dys- 
menorrhma  (exfoliative  endometritis), 
chi’onic  endometritis. 

(4)  Maldevelopment  or  undevelopment  of 
the  reproductive  organs. 

Treatment. — Endeavor  to  ascertain  and 
correct  the  cause.  Enjoin  proper  hygiene, 
i.e.,  adequate  rest  and  exercise,  sexual  rest, 
rest  in  bed  during  menstruation,  regular 
hours  of  eating  and  sleeping,  rest  before 
and  after  meals,  fresh  air  day  and  night, 
regulation  of  the  bowels,  plain  food,  plenty 
of  water,  a daily  warm  bath  before  l^reak- 
fast  in  a warm  room  followed  by  a cold 
spinal  douche,  an  abdominal  flannel  binder, 
loose  clotliing.  General  massage,  electricity, 
salt  baths,  Nauheim  baths  (q.v.),  Turkish 
baths,  and  the  rest  cure,  are  of  value  in 
appropriate  cases,  if  the  patient  can  afford 
such  luxurious  treatment. 

Hot  vaginal  douches  twice  daily,  hot  sitz- 
baths  two  or  three  times  weekly,  and 
ichthyol-glycerine  (25  per  cent.)  tampons, 
employed  during  the  intermenstrual  periods, 
may  be  of  service  m congestive  cases. 

During  menstruation,  a hot  water  bag  or 
mustard  or  turpentine  stupes  (q.v.)  may 
be  applied  to  the  hypogastrium.  A hot 
mustard  foot-bath  (about  one  tablespoonful 
to  the  gallon),  as  hot  as  can  be  borne,  and 
hot  drinks  are  recoimnended  when  the  flow 
is  delayed.  Following  the  foot  bath,  a hot 
mustard  poultice  (q.v.)  may  be  applied 
along  the  spine,  and  kept  on  for  ten  to  twenty 
minutes,  or  until  the  skin  is  well  reddened; 
or  better,  dry  cups  (see  Cupping,  in  Part  1) 
may  be  applied  on  each  side  of  the  spinous 
processes  in  the  neighborhood  of  tender 
points,  fifteen  to  twenty  minutes  in  each 
place.  Electricity  is  recommended,  the  posi- 
tive electrode,  well  moistened,  being  placed 
over  the  Imnbosacral  region,  and  the  nega- 
tive electrode  moved  about  over  the  hy pogas- 
trimu.  It  relieves  pain  and  increases  the  flow. 

For  the  so-called  uric  acid  diathesis,  is 
recoimnended  on  purely  empiric  grounds, 
sodium  salicylate  (q.v.)  or  ammoniated 
tincture  of  guaiac  (q.v.)  for  one  week  be- 
fore menstruation.  The  bowels  should  be 
opened  thoroughly,  say  with  a bottle  of 
Liq.  magnesii  citratis  (Ashton),  at  or  just 
before  the  onset  of  menstruation. 

Sedative  Drugs: 

R Apiolis,  capsula.s  No.  xxx,  aa  irjiii-vi 

Sig. — One  capsule,  t.i.d.p.c.  for  one  week  before 
and  during  the  period. 


DYSMENORIinCEA 


R Fluidextracti  Hydrastis  Canadensis.  . . 5ss 
Sig. — Twenty-five  drops  in  a wineglassful  of  water 
twice  a day  for  one  week  before  and  during  the  flow. 


Tincturae  pul.satillae 5ss 

Sig. — Five  minims  in  water  t.i.d.,  for  one  week 
before  the  flow. 

R Tinctura;  gelsemii 5ss 

Sig. — Ten  drops,  four  times  daily,  begun  several 
days  before  the  expected  flow,  and  continued 
throughout  the  period. 

1^  Tinctura;  cannabis  indicae 5ss 

Sig. — -ngxx  in  water  every  three  hours. 

Tinctimo  hyoscyami 5 S3 

Sig. — TTgx-xxx  in  water  t.i.d. 

R Tinctura;  belladonnse 3 ss 


Sig. — Ten  to  thirty  drops  in  water  t.i.d.,  or  every 
three  or  four  hours. 

R Atropinse,  gr.  Moo,  t.i.d.,  about  two  days  before 
the  expected  flow.  Regulate  the  dose  according  to 
the  effects,  the  occurrence  of  dryness  and  itching  of 
the  skin  (see  also  Part  11 ) calling  for  lessening  of  the 
dose.  Atropine  diminishes  the  irritability  of  the 
autonomic  nerve  endings  in  the  uterus,  and  should 
be  especially  indicated. 

R Codeina?,  gr.  every  four  hours. 

R Codeina' sulphatis gr.  vi  (gr.  K per  pill) 

Extracti  carmabis  indica',  gr.  iii  (gr.  M per  pill) 

Extract!  hyoscyami gr.  vi  (gr.  K per  pill) 

Hydrastinina;  hydrochlo- 

ridi gr.  iv  (gr.  % per  pill) 

Oleoresina;  capsici irgii  (itkM2  per  pill) 

Fiant  pilula;  No.  xxiv. 

Sig. — One  pill  every  three  or  four  hours. 

R Pulveris  ipecacuanha;  et  opii, 

Acetphenetidinae  vel  antipyrina',  aa gr.  v. 

Ft.  chart,  talis  No.  ii. 

Sig. — One  powder,  repeated  if  necessary. 

R Acetphenetidina;  vel  antipyrinte gr.  v 

Mitte  tabs  chartulce  No.  vi 
Sig. — One  powder  every  half-hour  until  relieved. 

R Acetphenetidina; gr.  xl  (gr.  v per  dose) 

Spiritus  frumenti 3ii 

M.  Sig. — Two  drams  in  hot  water  every  half  to 
one  hour  for  from  three  to  six  doses. 

R Acetanelidi.  

Sodii  bicardonatis gr.  viii 

Caffeina; gr.  ss 

Ft.  talis  chart.  No.  vi. 

Sig. — One  powder  every  hour  for  three  hours. 

R Potassii  vel  sodii  bromidi  5 ii  (gr.  xv  per  dose) 
Tinctura;  asafadidie  vel 

Valeriana; oiv  (oss  per  dose) 

Aqiue,  q.s.,  ad 3ii 

M.  Sig. — (One  dessertspoonful  in  hot  water  every 
four  hours. 

R Tinctura;  gelsemii  . . ....  3 iii 
Tinctura;  cannabis  indica;  5 iii 
Tinctura;  cardamomi 

composita;,  q.s.,  ad . . . 3 iii 
M.  Sig. — One  dram  t.i.d.  and  at  night.  “Begin 
several  days  before  the  flow  and  continue  for  several 
days”  (“valuable”).  (Bandler.) 


R Tinctura;  opii  camphoratae. . 3 i (3 i per  do.se) 

Tincturse  zingiberis 3i  (5i  per  do.se) 

Spiritus  chloroformi 3ii  ("Exv  pwr  dose) 

Syrupi  acacia; 3ss 

Aqua;  mentha'  j)iperita‘, 

q.s.,  ad 3iv 

M.  Sig. — One  tablespoonful  in  water  as  required 
for  cramp.  (B.  C.  Hirst.) 

R Amylis  nitritis qi 

Sig. — Three  to  five  drops  on  a handkerchief  by 
inhalation,  for  severe  pain. 

R Potassii  bromidi. 

Chloral!  hydra ti,  aa.  . . . qiv  (aa  5ss  per  dose) 

Aqua; 3 iv 

M.  Sig. — Two  tablespoonfuls  as  an  enema,  as 
required  for  pain. 

R Spiritus  chloroformi, 

Spiritus  ammonia;  aromatic!, 

Tinctura;  lavandula;  composita;, 

Syrupi  zingiberis,  aa. . . . 3i  (aa  njjxx  per  teasp.) 
M.  Sig. — One  or  two  teaspoonfuls  in  a cupful  of 
hot  water,  as  required  for  cramp.  Useful  in  ordi- 
nary cases. 

R Tabellffi  thyroidei  glandulse  sicese. 

No.  XXX,  aa gr.  iii 

Sig. — (One  tablet  3 to  5 times  daily,  for  8 to  10 
days  before  the  onset  of  menstruation. 

R Solut.  cocaina',  2 to  4 per  cent.  Apply  to 
the  nasal  mucous  membrane  over  Fleiss’s 
“genital  spots”:  the  tuberculum  septi  and  anterior 
inferior  turbinals. 

Alcohol  and  morphine  should  be  used 
with  discretion. 

If  other  measures  are  unsuccessful,  dila- 
tation and  curettage  may  be  resorted  to,  but 
it  often  fails.  After  curetting  and  flushing 
the  uterus,  Kelly  packs  it  tightly  wdth  a 
strip  of  gauze,  which  is  removed  at  the  end 
of  two  days.  The  patient  is  kept  in  bed 
one  w'eek,  and  in  the  same  room  fourteen 
days.  Says  Kelly:  “ When  dysmenorrheea 
returns  after  a few  years  or  months  of  com- 
fort, we  are  justified  in  recommending  a 
second  operation.”  Says  Hirst:  “ By  thor- 
oughly dilating  the  cervix  with  the  dilators 
in  ordinary  use  (to  V/i  inches  on  the  scale), 
including  Cleveland’s  (to  70  to  90  mm.  on 
the  scale),  by  a curettage  with  Suns’  and 
IMartin’s  curettes  (the  latter  for  the  fundus 
and  cornua;  anti  the  uterine  cavity  irrigated 
through  a two-way  catheter),  and  by  leav- 
ing, if  possible,  the  four-branched  metra- 
noikter,  or  if  not,  the  two-branched  metra- 
noikter  in  the  uterus  for  twenty-four  hours 
(the  vagina  is  packed  with  gauze;  10  per 
cent,  of  the  patients  require  morphine;  the 
uterus  is  afterward  irrigated  through  a 
Fritsch-Bozeman  two-way  catheter),  the 
percentage  of  cures  in  mechanical  dysmenor- 
rhciva  ami  sterility  can  be  more  than 
doubled.”  Dysmenorrhma  associated  with 


ENI30METRITIS 


an  infantile  uterus  is  curable  by  pregnancy 
(see  also  Anteflexion). 

Membranous  dysmenorrhoea  is  charac- 
terized by  the  expulsion  of  the  whole  or  part 
of  the  lining  membrane  of  the  uterus.  (Make 
a microscopic  examination  to  distinguish  it 
from  a vaginal  cast,  occurring  in  exfoliative 
vaginitis,  or  a decidual  cast,  occurring  in 
extra-uterine  pregnancy  and  in  ordinary 
abortion).  Its  treatment  is  unsatisfactory 
and  the  prognosis  is  not  good.  Thorough 
curettage  may  be  performed  a few  days 
before  menstruation  followed  by  the  applica- 
tion of  a saturated  solution  of  iodine  in 
95  per  cent,  carbolic  acid.  Bandler  recom- 
mends the  use  of  superheated  steam  (atmo- 
causis:  Gr.  ar/xos  steam  -j-  /caOo-ts  burning) 
following  curettage.  He  also  recommends 
the  prolonged  administration  of  ovarian 
extract  and  potassium  iodide.  Ashton 
recommends  equal  parts  of  fl.  ext.  black  haw 
and  fl.  ext.  hydrastis,Tr)jxxx  twice  daily,  begin- 
ning eight  days  before  menstruation  and 
continuing  during  the  flow.  Maternity  some- 
times effects  a radical  cure. 

Dyspareunia. — Gr.  dvawapewos  badly 
mated.  Difficult  or  painful  coitus.  See 
Vaginismus. 

Dysuria. — Gr.  dvs-  ill  -}-  ovpov  urine.  Pain- 
ful or  difficult  urination. 

Causes. — Urethritis;trigonitis;cystitis;  Vesi- 
cal distomiasis;  vesico-urethral  fissure;  pye- 
Utis  and  pyelonephritis;  urethral  caruncle; 
urethral  stricture;  urethral  dilatation;  ureth- 
ral tumors;  prolapse  or  eversion  of  the 
urethral  mucous  membrane;  vesical  cal- 
culus or  foreign  body;  vesical  tumors;  vesi- 
cular tuberculosis;  neuroses  of  the  bladder; 
uterine  displacements;  fibromyoma  of  the 
uterus;  distended  colon;  pelvic  inflammatory 
disease;  masturbation  or  excessive  coition; 
excessive  acidity  of  the  urine;  pyuria;  crys- 
tals in  the  urine  (see  Nephrolithiasis);  too 
high  or  too  low  specific  gravity;  hemor- 
rhoids; abdominal  pelvic  operations;  vagin- 
ismus; pregnancy;  oxyuriasis;  anal  fissure 
and  other  rectal  diseases;  irritating  ingesta, 
e.g.,  ginger,  radishes,  spices,  turpentine, 
salicylates,  cantharides,  quinine,  urotropin, 
etc.;  bladder  irritability  (q.v.). 

Echinococcus  or  Hydatid  Cyst  of  the 
Kidney. — Gr.  kxi^vos  hedgehog  -(-  kokkos 
berry;  vdaris  vesicle;  kv<7tls  bladder.  See 
Tumors  of  the  Kidney. 

Ectopic  Gestation. — Gr.  Iktottos  displaced; 
L.  gesta'tio,  pregnancy.  See  Extra-Uterine 
Pregnancy. 

Ectropion  of  the  Intracervical  Mucosa. — 

Gr.  eK  out  + rpeireiv  to  turn.  See  Eversion 
of  the  Intracervical  Mucosa. 


Edema. — See  (Edema. 

Elephantiasis. — Gr.,  elephant  disease. — 
See  Part  5. 

Emphysematous  Vaginitis. — Gr.  hp,<i)vcrnpa 
inflation  with  air.  See  Vaginitis. 

Enchondroma  Vesicae Gr.  kv  'm  -f-  x^^pos 

cartilage  H — wpa.  tumor;  L.  vesic'a,  bladder. 
See  Tumors  of  the  Bladder. 

Enchondroma  Vulvae. — See  Tumors  of 
the  Vulva. 

Endocervicitis. — See  Cervicitis  and  En- 
docervicitis. 

Endometritis. — Gr.  ’ivbpov  within  -f  pr]Tpa 
uterus  -f  -iTts  inflammation.  Endometritis 
acute  or  chronic,  with  the  exception  of 
puerperal  infection,  is  as  rare  as  cervicitis 
and  endocervicitis  {q.v.,)  are  common. 

Acute  inflammation  of  the  endometrium, 
which  is  usually  accompanied  by  more  or 
less  involvement  of  the  uterine  parenchyma 
is  manifested  by  local  pain,  tenderness,  and 
distention,  a patulous  os,  sometimes  the  sud- 
den cessation  of  an  existing  leucorrhoeal  dis- 
charge, which  later  increases,  perhaps  rectal 
and  vesical  tenesmus  and  frequent  urina- 
tion, pyrexia,  rapid  pulse,  perhaps  chills, 
headache,  and  perhaps  nausea  and  vomiting. 
The  causes  are  gonorrhoea,  infectious  dis- 
eases (measles,  scarlet  fever,  mumps,  ty- 
phoid fever,  diphtheria,  smallpox,  etc.),  and 
infection  following  abortion,  labor,  cervical 
laceration,  operations  and  intra-uterine  ma- 
nipulations. Gonorrhoea,  while  it  may 
infect  the  endometrium,  often  produces  no 
symptoms  here,  but  manifests  itself  in 
the  tubes. 

Chronic  endometritis  is  manifested  by  a 
leucorrhoeal  discharge,  (not  thick  and  tenaci- 
ous like  a cervical  discharge,  but  more  serous; 
a vaginal  discharge  is  “ curdy  or  milky  or 
creamy  ”),  local  pain  and  sense  of  pressure, 
perhaps  backache,  occipital  headache,  indi- 
gestion, etc.,  menorrhagia  or  metrorrhagia, 
dysmenorrhoea,  perhaps  rectal  and  vesica 
tenesmus  and  frequent  urination.  Metritis 
{q.v.),  is,  no  doubt,  always  present. 

Several  varieties  of  chronic  endometritis 
are  recognized:  (1)  exfoliative  endometritis 
(membranous  dysmenorrhoea,  q.v.)  (2)  senile 
endometritis,  characterized  by  uterine 
atrophy  and  an  irritating  purulent 
discharge,  or  in  the  presence  of  cicatricial 
stenosis,  a pyometra  or  pyophysometra, 
often  cervical  erosions,  and  erosions  and 
cicatricial  adhesions  in  the  vaginal  vault, 
perhaps  anaemia  and  cachexia  due  to  toxic 
absorption;  (3)  polypoid  endometritis,  caus- 
ing hemorrhage;  (4)  subinvolution  or  hyper- 
trophic and  hyperplastic  changes  following 
abortion,  labor,  ectopic  gestation,  submu- 


ENDOMETRITIS 


cous  myoma,  cancer,  sarcoma,  retroflexion, 
cervical  laceration,  pelvic  tumors,  pelvic 
adhesions,  chronic  pelvic  congestion  (q.v.), 
chronic  constipation,  restrictive  clothing, 
sexual  excesses,  suppression  of  menstruation 
following  exposure  to  cold,  acquired  cervical 
stenosis,  tubal  disease;  (5)  decidual  endom- 
etritis, manifested  by  a purulent  discharge, 
bleeding,  and  pain  during  pregnancy, 
which  is  apt  to  result  in  abortion,  “with  a 
firmly  adherent  placenta  (6)  tuberculous 
endometritis,  recognized  by  microscopic 
examination  of  the  uterine  scrapings;  the 
tubes,  when  involved,  are  felt  to  be  indurated 
and  nodular;  (7)  catarrhal  endometritis,  due 
to  circulatory  or  excretory  disturbances 
occurring  in  disorders  of  the  heart,  lungs, 
liver,  and  kidneys,  anaemia,  tuberculosis, 
gout  and  rheumatism,  constipation,  etc. 

The  bacteria  most  frequently  found  in 
both  acute  and  chronic  endometritis  are  the 
streptococcus,  staphylococcus,  and  gonococ- 
cus; less  frequently,  the  colon  bacillus,  pneu- 
mococcus, various  saprophytic  organisms, 
tubercle  bacillus,  typhoid  bacillus,  and  diph- 
theria bacillus. 

Treatment.— A.  AcUTE  Septic  OR  SapRvE- 
Mic  Endometritis.- — Under  careful  asepsis 
remove  all  putrefying  material  from  the 
uterine  cavity  with  the  finger,  curettement 
forceps,  and  dull  curette,  taking  care  not  to 
inflict  traumatism;  then  irrigate  thoroughly 
and  copiously  with  hot  sterile  water,  or 
bichloride  solution,  1 : 8000  to  2000,  or  for- 
maldehyde solution,  1 : 4000,  or  lysol,  1 per 
cent.,  or  dilute  acetic  acid,  5ii  to  the  quart 
of  water,  followed  by  normal  saline  solution 
(5i  ad  Oi).  Then  paint  the  vaginal  vault 
with  tincture  of  iodine,  and  insert  a boro- 
glyceride  tampon  attached  to  a string,  which 
should  be  removed  at  the  end  of  twelve 
hours.  Short  hot  vaginal  douches  may  be 
employed  twice  daily,  unless  they  increase 
the  fever.  After  the  uterus  has  once  been 
emptied,  it  should  be  left  severely  alone. 
The  patient  should  be  placed  in  a semi- 
sitting posture  to  promote  drainage.  Some 
regard  with  disfavor  any  intra-uterine  or 
vaginal  treatment.  Prescribe  salines, 
an  ice-bag  or  heat  to  the  hypogastrium, 
and  concentrated  liquid  and  soft  diet. 
Administer  fluid  extract  of  ergot,  rjxv-xxx 
in  water,  or  ergotol,  iiEXAq  or  ergotin,  gr.  ii, 
four  to  six  times  daily,  or  pituitrin  (q.v.),  to 
contract  the  uterus  and  thereby  limit  the 
invasion  of  microorganisms  (see  alsolNIetritis; 
Pelvic  Inflammatory  Disease;  and  Puer- 
peral Infection). 

B.  Acute  CiONORRiioeAL  Endometritis. 
— Prescribe  rest  in  bed  in  a semi-sitting 


posture,  salines  (q.v.),  an  ice-bag  or  heat 
to  the  hypogastrium,  and  restricted  diet. 
The  discharge  should  be  caught  on  vulvar 
pads  of  absorbent  cotton  or  gauze,  and 
burned.  After  the  more  acute  symptoms 
have  subsided  (three  or  four  days),  or  even 
sooner,  the  uterus  may  be  dilated,  irri- 
gated with  hot  bichloride  solution,  1 : 2000, 
through  a two-way  catheter,  followed  by 
normal  saline  solution,  and  then  swabbed 
with  pure  carbolic  acid  or  a concentrated 
solution  of  iodine  in  95  per  cent,  carbolic 
acid.  Thereafter  the  vagina  is  irrigated 
twice  daily  with  permanganate  solution, 
1 : 4000.  The  value  of  intra-uterine  treat- 
ment, however,  seems  questionable.  (See 
Gonorrhoea) . 

C.  Chronic  Endometritis. — Attend  to 
the  cause.  Enjoin  adequate  rest  and  exer- 
cise, the  avoidance  of  prolonged  standing 
and  slow  walking,  fresh  air  day  and  night, 
loose  clothing  supported  from  the  shoulders, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  regulation  of  the 
bowels  (saline  laxatives,  q.v.,  for  pelvic 
congestion),  sodium  phosphate  in  lots 
of  water  and  the  restriction  of  animal 
foods  in  defective  kidney  elimination  (in 
which  the  urea  and  total  solids,  etc.,  are 
diminished:  see  Urinalysis),  nutritious  food, 
iron  (q.v.),  and  bitter  tonics  for  anaemia. 

Elixiris  ferri,  quininse,  et  strychninae 


phosphati 5 iv 

Sig. — One  teaspoonful  in  water,  t.i.d.p.c. 

R Tincturae  nucis  vomicae 5i  (.nj>x  per  dose) 

Tincturae  cinchonae  cgm- 

positae 5 xi 


M.  Sig. — Two  teaspoonfuls  t.i.d.  (S.  Theobald.) 

Prescribe  digitalis  (q.v.)  for  the  heart, 
if  required.  Trj'  thyroid  extract  (q.v.) 
cautiously  for  anaemic,  fat,  flabby  women. 

Dilate  the  uterus,  curette  the  endome- 
trium thoroughly  by  means  of  Sims’s  and 
Martin’s  sharp  curettes,  the  latter  for  the 
fundus  and  cornua,  irrigate  the  uterine 
cavity  with  hot  water  or  carbolic  acid 
solution,  1 to  2 per  cent.,  drv^  with  gauze, 
and  ajiply,  on  a cotton-wound  applicator 
tincture  of  iodine,  or  silver  nitrate,  5 to  10 
per  cent.,  or  a saturated  solution  of  iodine  in 
95  per  cent,  carbolic  acid.  Then  apply 
close  to  the  cervix  a tampon  soaked  in 
glycerite  of  boroglycerine  attached  to  a 
string,  which  should  be  removed  at  the  end 
of  twenty-four  hours,  followed  by  a douche 
Instruct  the  patient  to  douche  the  vagina 
twice  daily  for  two  weeks  with  hot  boric 
acid  solution,  5i  to  the  pint,  or  the  following: 


EXTRA-UTERINE  PREGNANCY 


3 Acidi  borici §vi 

Acidi  carbolici, 

P*ulveris  aluminis  exsiccati,  aa 5 i 

Olei  gaultherifE 3i 

Olei  menthae  pipcritai oss 


M.  Sig. — ^A  tablespoonful  in  a gallon  of  water. 
(H.  A.  Kelly.) 

Repeat  the  tamponade  two  or  three  times 
a week. 

If  the  uterus  should  be  accidentally  per- 
forated with  the  curette,  one  may  perform 
celiotomy  at  once  and  close  the  rent,  or  else, 
if  the  rent  is  small,  pack  the  vagina  and  give 
ergot,  both  internally  and  hypodermically, 
in  small  repeated  doses,  in  order  to  keep 
the  uterus  contracted.  The  occurrence  of 
peritonitis  demands  celiotomy. 

Polypoid,  senile,  and  exfoliative  endo- 
metritis are  all  treated  as  described  above 
(see  also  senile  vaginitis;  and  membranous 
dy  smenorrhoea) . 

Tuberculous  endometritis  calls  for  hyster- 
ectomy. 

Radium  therapy  {q.v.)  is  particularly  effi- 
cacious in  the  control  of  hemorrhage. 

Enteroptosis. — Gr.  evrepov  bowel  -b  Trrdcrts 
fall.  See  Splanchnoptosis  in  Part  1. 

Epistaxis,  Renal. — See  under  Hsematuria. 

Epithelioma  Vulvae. — Gr.  exl  on  -b  6r]\ri 
nipple  -b  -copa  tumor;  L.  vuVva.  See  Tum- 
ors of  the  Vulva. 

Erosion  of  the  Cervix. — See  Cervical 
Erosion. 

Erysipelas  of  the  Vulva. — See  Erysipelas, 
in  Part  5. 

Essential  Renal  Haematuria.^ — L.  essen- 
tial'is,  inherent  or  idiopathic;  ren,  kidney. 
See  under  Hsematuria. 

Eversion  of  the  Intracervical  Mucosa. — L. 
e,  out  -b  ver'tere,  to  turn;  in'tra,  within; 
cer'vix,  neck;  mu'cus. 

Etiology.— Cervical  laceration  (q.v.) ; cer- 
vicitis and  endocervicitis  (q.v.) ; chronic  pel- 
vic congestion  (q.v.) ; congenital  defect  of 
the  external  os. 

Treatment. — Correct  the  cause. 

Eversion  of  the  Urethral  Mucous  Mem= 
brane. — L.  e,  out  ver'tere,  to  turn;  Gr. 
ouprjdpa;  L.  mucus;  membra na.  A rare  con- 
dition, usually  causing  dysuria. 

Etiology. — Trauma  during  labor;  severe 
urethritis;  overdilatation  of  the  urethra; 
traction  exerted  by  a tumor;  vesical  tenes- 
mus or  straining  (occurring  in  cystitis,  vesi- 
co-urethral  fissure,  stone,  tumor  of  the  blad- 
der) ; rectal  tenesmus  (occurring  in  anal 
fissure,  hemorrhoids);  severe  coughing;  gen- 
eral debility. 

Treatment.— Correct  the  cause.  Operative 
measures  are  usually  required,  even  after 
the  cause  has  been  removed,  but  conserva- 


tive measures  may  be  tried  first:  Put  the 
patient  to  bed  for  three  or  four  weeks  on  a 
bland  diet  (see  under  Urethritis)  and  keep 
the  bowels  loose  with  salines  (q.v.)  Employ 
daily  hot  sitz-baths  or  hot  local  applications. 
When  the  oedema  has  subsided,  reduce  the 
prolapse,  and  then  inject,  by  means  of  a 
reflux  catheter,  or  swab  with  a cotton-wound 
applicator,  astringent  solutions,  e.g.,  alum, 
gr.  x to  the  ounce;  or  tannic  acid,  gr.  v-x 
to  the  ounce ; or  use  suppositories  containing 
alum,  gr.  ii-iv,  tannic  acid,  gr.  ii-iii,  or 
acetate  of  zinc,  gr.  ii-iv.  Twice  a week, 
paint  with  silver  nitrate,  gr.  ii  to  the  ounce. 

If  no  benefit  results  after  two  or  three 
months,  operate  and  excise  the  prolapsed 
mucous  membrane,  and  stitch  the  edges  of 
the  mucosa  to  the  margin  of  the  meatus 
by  fine  sutures.  If  cicatricial  contraction 
of  the  external  meatus  later  occurs,  cor- 
rect it  by  forcible  dilatation  (after  Ashton : 
Practice  of  Gyncecology,  q.v.,  for  the 
operative  procedure). 

Dudley  says:  “ The  treatment  of  exten- 
sive prolapse  from  any  cause  is  to  return 
the  displaced  mucosa,  if  possible;  and  if 
relief  does  not  follow,  it  is  well  to  make  a 
small  vesico-vaginal  fistula,  and  thereby 
give  the  urethra  perfect  rest.  If  this  meas- 
ure fails,  the  prolapse  may  be  cured  per- 
manently by  making  what  Emmet  calls  a 
buttonhole  slit  in  the  urethro-vaginal  wall 
and  drawing  through  this  the  excessive 
mucosa  and  cutting  it  away.  The  sutures 
for  closure  of  the  opening  are  introduced 
before  the  excision.  During  the  placing  of 
the  sutures  a sound  should  be  in  the  urethra.” 

Excrescences. — L.  ex,  out  -f  exes' cere,  to 
grow.  See  Verrucse,  in  Part  2. 

Exfoliative  Cystitis. — L.  ex,  out  + fo'lium 
leaf.  See  Cystitis. 

Endometritis. — See  Endometritis. 

Vaginitis. — See  Vaginitis. 

Exostrophy  of  the  Bladder. — See  Blad- 
der, Exostrophy  of  the. 

Extra=Uterine  Pregnancy. — L.  ex'tra,  out- 
side of;  ut'erus,  womb;  preeg'nans,  with  child. 
“ When  any  woman  after  puberty  and 
before  the  menopause,  who  has  menstru- 
ated regularly  and  painlessly,  goes  four, 
five,  six,  eight,  ten,  fifteen,  to  eighteen  days 
over  the  time  at  which  menstruation  is  due, 
sees  blood  from  the  vagina  differing  in 
quality,  color,  quantity  or  continuance 
(decidual  membrane)  from  her  usual  men- 
strual flow,  and  has  pains,  generally  severe, 
in  one  side  of  the  pelvis  or  the  other,  or 
possibly  in  the  hypogastric  region,  ectopic 
gestation  may  be  presumed  ” (Philander 
Harris  quoted  by  Bandler).  Tubal  preg- 


FIBROMYOMA  UTERI 


nancy  often  follows  long  periods  of  sterility. 
Significant  symptoms  are  the  occurrence  of 
pain,  rapid  pulse,  and  faintness,  with  little 
or  no  elevation  of  temperature,  when  the 
patient  is  on  her  feet,  which  subside  follow- 
ing rest  in  bed.  Examine  for  an  enlarged 
and  very  sensitive  tube.  The  occurrence  of 
abortion  or  rupture  (with  sudden  acute  pain, 
collapse,  abdominal  distention  due  to  hem- 
orrhage, and  a pelvic  hacmatocele  detected 
by  bimanual  palj^ation)  may  be  the  first 
indication  of  tubal  pregnancy.  In  tubal 
abortion,  as  distinguished  from  rupture,  the 
patient,  as  a rule,  soon  rallies  and  gradually 
recovers.  Occasionally,  secondary  abdom- 
inal pregnancy  continues  after  the  occur- 
rence of  rupture,  and  at  term  false  labor 
occurs,  followed  by  a gradual  decrease  in  the 
size  of  the  abdomen. 

Etiology. — Chronic  salpingitis;  tubal  steno- 
sis, congenital  or  accpiired;  adhesions 
constricting  or  kinking  the  tube;  tubal 
diverticula;  accessory  tubal  canal;  accessory 
ostia;  exaggerated  tubal  tortuosity;  fibro- 
myomata;  broad  ligament  tumors;  external 
transmigration  of  the  ovum,  twins,  or  an 
unusually  long  tube,  under  which  circum- 
stances the  ovum  becomes  so  large  before  it 
can  reach  the  uterine  cavity,  that  it  is  held 
in  the  tube;  etc. 

Treatment. — Operate  as  soon  as  the  con- 
dition is  diagnosed.  Penrose  says, 
operate  without  delay  for  all  gross  lesions 
of  the  tubes. 

In  the  presence  of  abortion  or  rupture,  it 
is  probably  wiser  to  operate  at  once,  instead 
of  waiting  for  reaction  from  the  shock  and 
hemorrhage.  After  the  bleeding  vessels  have 
been  secured,  infuse  two  pints  or  more  of 
normal  salt  solution  (0.9  per  cent.)  under 
the  breasts,  and  leave  some  in  the  abdomen. 
Take  care  to  remove  all  blood-clots  from 
the  pelvis.  Gum-salt  .solution  {q.v.)  intraven- 
ously {q.v.)  is  better  than  salt  solution,  and 
blood  transfusion  {q.v.)  still  better. 

In  cases  in  which  the  acute  s>miptoms 
have  subsided  when  the  patient  is  first  seen 
and  a hsematocele  is  present,  the  patient 
may  be  kept  under  observation  in  bed  and 
no  interference  attempted  unless  the  hsema- 
tocele steadily  increases  in  size  or  sup- 
purates, when  it  should  be  evacuated 
through  the  vaginal  fornix  and  the  result- 
ing cavity  packed  with  gaxize. 

In  those  rare  cases  in  which  gestation  has 
advanced  beyond  the  fourth  or  fifth  month 
and  the  fadus  is  alive,  and  in  those  cases  in 
which,  after  rupture,  pregnancy  continues 
the  removal  of  the  i)lacenta  should  not  by 
any  means  be  attempted,  for  fear  of  uncon- 


trollable hemorrhage.  In  these  cases,  incise 
the  sac  with  great  care  to  avoid  the  pla- 
centa, remove  the  foetus,  stitch  the  sac  to 
the  abdominal  wound,  establish  gauze  or 
tubular  drainage,  and  leave  the  placenta  to 
slough  out. 

Falling  of  the  Womb. — See  Prolapsus 
Uteri. 

Fallopian  Tubes,  Inflammation  of  the. — 

Fallopius,  an  Italian  anatomist,  1523-1562. 
See  Salpingitis. 

Fallopian  Tubes,  Tuberculosis  of  the. — 

See  Tuberculosis  of  the  Genital  Organs. 

Fibroid  Turnors  of  the  Uterus. — L.  fi'bra, 
fibre  -|-  Gr.  el8os  form;  L.  tumor,  swelling. 
See  Fibromyoma  Uteri. 

Fibroma  Urethrae. — L.  fi'bra,  fibre  + Gr. 
-wya  tumor.  See  Tumors  of  the 
Uretlu’a. 

Vesicae. — L.  vesi'ea,  bladder.  See  Tum- 
ors of  the  Bladder. 

Vulvae. — See  Tumors  of  the  Vulva. 

Fibromyoma  Uteri. — L.  fi'bra,  fibre  -F  Gr. 
uvs  muscle  -F  -co/xo.  tumor;  L.  ut'erus,  womb. 
Fibromyoma  of  the  uterus  is  characterized 
by  enlargement  of  this  organ,  which  is 
usually  irregularly  nodular,  hemorrhage 
(q.v.,)  particularly  pronounced  in  the  sub- 
mucous myoma,  especially  the  pedun- 
culated v ariety,  and  various  other  symptoms 
caused  by  pressure  and  traction  upon  neigh- 
boring structures,  e.g.,  frequency  of  urina- 
tion, dysuria,  vesical  tenesmus,  retention  of 
urine,  due  to  pressure  upon  the  bladder  or 
urethra;  constipation,  hemorrhoids,  mucous 
diarrhoea,  rectal  tenesmus,  due  to  pressure 
upon  the  rectum;  hydronephrosis,  due  to 
compression  of  the  ureter.  There  is 
apt  to  be  a moderate  amount  of  local  pain 
and  discomfort,  perhaps  displacement, 
sometimes  leucorrheea. 

The  period  of  sexual  maturity,  from 
puberty  to  the  menopause,  and  probably 
heredity  are  etiological  factors. 

Treatment.— Treatment  is  called  for  only 
in  the  jtresence  of  symptoms.  Regulate  the 
bowels,  see  that  the  clothing  is  worn  loose, 
and  build  up  the  general  strength  by  cor- 
rect hygiene,  i.e.,  adequate  rest  and  exercise, 
frequent  bathing,  fresh  air  day  and  night, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  an  abundance  of 
good  food,  and  tonics  (e.g.,  elLx.  ferri,  quin, 
et  strych.  phos.,  5i  in  water,  t.i.d.),  if 
required.  For  the  relief  of  pain,  instruct  the 
patient  to  lie  upon  her  abdomen  or  side  as 
much  as  possible.  Tincture  of  cannabis 
indica  {q.v.)  and  jx)tassium  bromide  {q.v.) 
are  recommended.  If  the  tumor  is  wedged 
in  the  {x;lvis,  release  it  by  manipula- 


FIBROSIS  UTERI  AND  ARTERIOSCLEROSIS 


tions  and  traction  upon  the  cervix,  with  the 
patient  in  the  knee-chest  posture.  To  con- 
trol hemorrhage,  enjoin  rest  in  bed  during 
the  flow,  with  an  ice-bag  to  the  hypogas- 
trium,  and  administer  ergot  {q.v.)  and 
hydrastis  {q.v.),  in  sufficient  dosage  to 
control  the  bleeding.  Tight  packing  of  the 
vagina  or  uterus  with  gauze,  renewed  every 
forty-eight  hours  until  the  flow  has  ceased 
and  also  thorough  curettement  are  very 
efficacious.  Saline  purgatives  {q.v.),  for 
the  purpose  of  depleting  pelvic  congestion, 
are  particularly  useful  just  before  the  men- 
strual period.  (Penrose.) 

About  80  per  cent,  or  more  of  cures  are 
effected  by  means  of  radium  {q.v.),  or 
X-ray  therapy  {q.v.).  In  full  dosage  these 
agents  produce  atrophy  of  the  uterus 
and  ovaries  and  a resulting  artificial  meno- 
pause. Patients  under  forty  years  of  age 
should  not,  as  a rule,  be  irradiated.  Abbe 
uses  from  50  to  100  milligrams  of  radium  in 
celluloid  holders  of  the  size  and  thickness  of 
an  ordinary  goose-quill,  and  10  cm.  long. 
Two  of  these  may  be  joined  end  to  end  by 
means  of  two  or  three  turns  of  chiffon  wrap- 
ping sealed  with  collodion,  if  the  uterine  canal 
is  very  long.  The  radium  is  applied  for  two 
hours;  and  if,  after  two  months,  the  hem- 
orrhage recurs,  the  treatment  is  repeated. 
An  examination  every  six  months  will  reveal 
a diminution  of  the  tumor. 

Kelly  and  Burnam’s  technique  is  as 
follows:  First  the  uterus  is  curretted  and 
any  pedunculated  growths  removed  with 
a polyp  forceps.  Then  300  to  500  milli- 
curies  of  emanation  covered  with  a rubber 
cot  on  the  end  of  a sound  is  introduced 
into  the  uterus  and  allowed  to  remain  for 
about  three  hours.  Nausea  may  follow 
for  twenty-four  hours  and  abdominal 
tenderness  for  several  days,  and  some- 
times a leucorrhoeal  discharge,  for  several 
weeks.  If  one  treatment  is  not  sufficient 
a second  may  be  employed  after  several 
months,  or  one  or  more  grams  of  radium, 
suitably  fijtered  {q.v.)  may  be  applied  over 
various  areas  of  the  abdomen  for  several 
hours.  The  radium  tubes  are  sterilized  in 
formalin,  40  per  cent,  for  at  least  twenty 
minutes.  A string  is  attached  to  the  tube 
to  facilitate  withdrawal.  To  prevent  expul- 
sion of  the  tube,  the  vagina  may  be  packed 
with  sterile  gauze. 

In  employing  the  X-rays,  Bordier  gives 
nine  sittings  on  successive  days  in  the  inter- 
menstrual  period,  over  the  central  region, 
and  the  same  over  each  lateral  region, 
with  an  interval  between  each  series  of 
exposures  of  twenty  to  twenty-five  days, 
27 


repeating  this  three  or  four  times.  High 
tubes  (8°  to  10°  Benoist)  are  used.  A 3.5 
mm.  almninum  filter  is  always  used  in  the 
median  area,  and  to  3 mm.  in  the  lateral 
areas.  The  median  filter  is  connected  to 
the  earth  by  means  of  a wire.  Bordier’s 
radiometer  is  used  to  measure  the  dose  (5H 
or  Holzknecht  = lOX,  unit  of  Kienbock 
quantimeter  = Sabouraud  tint  “ B ”)•  The 
pastille  is  stuck  on  the  filter  and  is  com- 
pared with  the  scale  by  the  light  of  a match 
or  candle.  The  X-ray  bulb  is  always  placed 
the  breadth  of  the  hand  (the  fom’  fingers) 
from  the  filter.  The  time  required  to  obtain 
the  dose  of  5H  should  not  exceed  five  or  six 
minutes.  During  irradiation  of  the  lateral 
or  iliac  areas,  the  median  abdominal  area  is 
protected  by  a strip  of  lead  extending  at 
least  the  breadth  of  two  fingers  to  each  side 
of  the  middle  line. 

Conditions  contraindicating  X-ray  treat- 
ment and  demanding  hysterectomy  or  myo- 
mectomy are  as  follows: 

1.  Pedunculated  submucous  myomata  or 
fibroid  polypi. 

2.  Carcinoma. 

3.  Gangrene  or  suppuration  or  softening. 

4.  Acute  incarceration  of  the  bladder  or 
other  complication  demanding 
surgical  interference. 

A pedunculated  submucous  myoma  may 
be  twisted  from  its  attachment  or  cut  off 
with  curved  scissors,  followed,  if  there  is 
hemorrhage  (which  is  not  alarming),  by 
swabbing  the  uterine  cavity  with  tincture 
of  iodine  and  carbolic  acid,  equal  parts  (the 
vagina  being  protected  with  gauze),  or  by 
irrigating  with  hot  water,  or  packing  with 
gauze.  If  dilatation  of  the  cervix  affords 
inadequate  approach,  it  may  be  necessary 
to  make  bilateral  ceiwical  incisions  up  to  the 
vaginal  junction,  or  a median  incision 
through  the  anterior  wall  of  the  uterus.  If 
the  polyp  is  large,  it  may  first  have  to  be 
removed  in  pieces  before  severing  the  pedicle 
(beware  of  snipping  off  an  inverted  portion 
of  the  uterus) . After  removing  the  polypus, 
curette  the  uterine  cavity,  irrigate  with  hot 
normal  saline  solution  (5i  ad  Oi),  and  pack 
with  gauze,  which  should  be  removed  the 
next  day. 

Thereafter  give  daily  vaginal  douches 
and  keep  the  patient  in  bed  a week. 

Fibromyoma  Vaginae. — See  Tumors  of  the 
Vagina. 

Vulvae. — See  Tumors  of  the  Vulva. 

Fibrosis  Uteri  and  Arteriosclerosis. — L. 
fibra,  fibre;  uterus,  womb;  Gr.  apT-qpia 
artery  -f-  cjK\ripbs  hard.  See  Menorrhagia 
and  Metrorrhagia. 


GONORRHCEA 


Fig  Warts. — See  Verrucse,  in  Part  2 

Fissure,  Vesico=Urethral. — See  Vesico- 
urethral Fissure. 

Fistulae,  Pelvic. — L.  fistula,  pipe;  pel'vis, 
basin.  (Consult  Gynaecological  textbooks.) 

Fistula,  Renal. — L.  fistula,  pipe;  ren,  kid- 
ney. Etiology.— Suppurative  nephritis  sec- 
ondary to  ureteral  obstruction  (see  Hydro- 
nephrosis); when  post-operative  and  lasting 
longer  than  several  weeks,  it  is  due  to 
ureteral  occlusion,  stone,  or  suture,  to 
inefficient  drainage,  tuberculosis,  tmnor, 
loss  of  substance  of  the  pelvis  or  ureter,  fecal 
fistula,  or  low  general  vitality. 

Treatment. — Endeavor  to  restore  the 
patency  of  the  ureter.  If  this  is  impossible, 
remove  the  kidney  if  the  other  is  function- 
ally active  (see  Urinalysis).  If  this  is  im- 
practicable, tie  the  renal  vessels  through 
an  abdominal  incision. 

Flat  Condylomata. — Gr.  /corSuXwyua  wart. 
See  Verrucse,  in  Part  2. 

Flatus,  Vaginal. — L.  flatus,  gas.  See 
Garrulity  of  the  Vulva. 

Floating  Kidney. — See  Splanchnoptosis, 
in  Part  1. 

Follicular  Vulvitis. — L.  folliculus,  little 
bag.  See  Vulvitis. 

Foreign  Bodies  in  the  Bladder. — See 
Vesical  Calculus  and  P^'oreign  Bodies. 

Frequent  Urination. — See  Polyuria. 

Fungus  Disease  of  the  Vagina. — L.  See 
Vaginitis. 

Fungus  Disease  of  the  Vulva. — See  Vul- 
vitis. 

Gangrene  of  the  Vulva. — L. ; Gr.  yayypaiva 
mortification;  L.  vulva.  Etiology.— Traiuna- 
tism  due  to  labor,  corrosives,  etc.;  htema- 
toma;  cedema;  vulvitis;  in  children,  the 
eruptive  fevers,  especially  measles,  poor 
nutrition  and  bad  hygiene  (noma  pudenda: 
usually  fatal). 

The  Prognosis  is  serious. 

Treatment. — Remove  with  the  knife  or 
destroy  with  the  actual  cautery  the  affected 
tissues  well  outside  the  waxy  zone.  If  the 
knife  is  used,  follow  it  with  the  cautery  or 
with  pure  nitric  or  carbolic  acid  or  zinc 
chloride,  8 per  cent,  solution.  Then  blow 
on  powdered  iodoform,  and  cover  with  car- 
bolized  oil,  3 per  cent.  Thereafter,  use  fre- 
quently day  and  night,  antiseptic  sprays 
and  washes,  especially  equal  parts  of  alcohol 
and  water.  Formalin,  1 per  cent.,  potas- 
sium permanganate,  gr.  iss  in  5ss,  or  iodo- 
form is  used  to  destroy  the  horrible  odor. 

Admini.ster  concentrated  liquid  food,  pre- 
digested if  need  be  (see  Part  11),  and 
wliiskey  or  brandy  at  frequent  intervals 
(every  two  or  three  hours).  Quinine  (q.v.) 


and  the  perchloride  of  iron  (q.v.)  are  recom- 
mended. The  patient  should  be  isolated. 

Garrulity  of  the  Vulva;  Vaginal  Flatus. — 

Etiology. — Relaxed  vaginal  outlet  due 
to  trauma  or  general  emaciation;  recto- 
vaginal fistulae;  “ sloughing  uterine  or 
vaginal  tumors.” 

Treatment. — Treat  the  cause. 

Gastroptosis. — Gr.  yaarrjp  stomach  -1- 
TTwais  falling.  See  Splanchnoptosis  in  Part  1 . 

Genital  Tuberculosis. — See  Tuberculosis 
of  the  Genital  Organs. 

Gestation,  Ectopic. — See  Extra-Uterine 
Pregnancy. 

Glenard’s  Disease. — See  Splanchnoptosis, 
in  Part  1. 

Gonorrhoea. — Gr.  yovi]  semen  + ptiv  to 
flow.  A local,  sometimes  systemic,  con- 
tagious pyogenic  infection  of  mucous  and 
serous  membranes,  caused  by  the  gonococ- 
cus of  Neisser,  with  an  incubation  period 
of  from  one  to  eight  days  or  longer,  and  an 
acute  course  of  about  six  weeks,  with  a 
tendency  to  chronicity.  The  onset  may  be 
accompanied  by  chilliness,  fever,  rapid 
pulse,  burning  on  urination,  pelvic  pains, 
and  a purulent  leucorrhcea,  and  bubo  or 
arthritis  may  occur.  In  most  cases,  how- 
ever, the  disease  begins  insicUously.  The 
flea-bite  redness  about  the  orifices  of  Bar- 
tholin’s ducts  is  characteristic.  The  diag- 
nosis is  made  by  the  demonstration  of 
gonococci  in  the  secretions.  The  urethra 
may  be  stripped  through  the  vagina  to 
obtain  pus. 

Gram’s  method  of  staining  is  as  follows 
(Webster):  Place  a drop  of  the  pus  on  one 
end  of  a clean  dry'  slide,  and  with  a second 
slide  held  at  an  angle  of  45°  to  the  first  one, 
touch  the  di’op  of  pus,  and  when  the  latter 
has  spread  out  by  capillarity  along  the  edge 
of  the  second  slide,  draw  the  latter  along 
the  fii’st  slide,  still  maintaining  the  angle 
of  45°,  and  exerting  very'  little  pressure. 
A cigarette  paper  may  also  be  used  as  a 
spreader.  Fix  the  smear  thus  made  by 
passing  it  several  times  through  the  flame, 
allow  it  to  cool,  then  cover  with  a solution 
consisting  of  84  c.c.  of  aniline  water  (water 
saturated  with  aniline  and  filtered) and  16  c.c. 
of  a saturated  alcoholic  solution  of  gentian 
violet.  After  one  to  three  minutes,  pour 
off  the  stain,  wash  in  water,  and  without 
diying,  cover  with  a solution  consisting  of 
1 gram  of  iodine  and  2 grams  of  potassium 
iodide  dissolved  in  300  c.c.  of  water.  After 
one-half  to  one  minute,  wash  in  water,  and 
treat  with  95  per  cent,  alcohol  until  all  the 
color  is  removed.  Now  wash  in  water  and 
cover  with  a dilute  aqueous  solution  of 


GONORRHCEA 


safranine  as  a contrast  stain.  Allow  the 
latter  to  act  for  only  a few  seconds,  then 
wash  off  with  water,  dry  between  folds  of 
filter-paper,  and  examine  under  an_  oil- 
immersion  lens.  Gram-positive  organisms, 
i.e.,  those  not  decolorized  (tubercle  bacillus, 
smegma  bacillus,  diphtheria  bacillus,  pneu- 
mococcus, streptococcus,staphylococcus,  and 
various  saprophytic  cocci)  are  stained  deep 
blue,  while  the  Gram-negative  organisms 
(gonococcus,  meningococcus,  micrococcus 
catarrhalis,  influenza  bacillus,  typhoid 
bacillus,  colon  bacillus,  Koch-Weeks  bacillus, 
and  the  Morax-Axenfeld  bacillus)  and  the 
bodies  of  the  pus-cells  take  the  red  safranine 
stain.  (Webster.) 

Treatment  should  be  continued  until  the 
discharges  are  free  from  gonococci.  Six  to 
twelve  weeks  or  longer  are  required  for  a 
cure,  except  in  invasion  of  the  uterus 
and  tubes. 

Treatment.— In  the  acute  phase  of  the  infec- 
tion, put  the  patient  to  bed  and  keep  her 
there  for  a couple  of  weeks.  A perfectly 
bland  chet,  copious  water  drinking,  and  a 
daily  saline  purge  {q.v.)  should  be  pre- 
scribed. Forbid  alcohol,  coffee,  tea,  ginger 
ale,  lemonade,  carbonated  beverages,  fruit, 
acid  foods,  concUments,  spices,  pepper, 
mustard,  radishes,  horse-radish,  salads, 
sauces,  pickles,  salty  foods,  rhubarb,  toma- 
toes, asparagus,  shellfish,  smoked  and  salted 
meats,  preserved  fish,  cheese,  herring, 
greasy  or  fried  foods.  Allow  no  coitus. 

For  painful  urination,  prescribe  the  fol- 
lowing: 

Potassiiacetatisvelcitratis  (gr.  xx  per  dose) 

Tincturai  hyoscyami 5 i (HRxx  per  dose) 

Aquffi,  q.s.  ad Siv 

M.  Sig. — One  teaspoonful  in  one-third  tumbler 
water  every  3 hours.  (H.  A.  Kelly.) 

R Potassii  citratis 5ii-vi  (gr.  viss- 

XX  per  dose) 

Olei  santali 3iv-vi  (irjxiii- 

XX  per  dose) 

Syrupi  acacise .■ . . . 5 i 

Aqua;  menthse  piperitse,  q.s.  ad  5 id 

M.  Sig. — -Teaspoonful  in  wineglassful  of  water 
after  meals.  (H.  Cabot.) 

A rectal  suppository  containing  ext.  opii, 
gr.  i-ii,  and  ext.  belladonnse,  gr.  34  may 
be  required. 

The  genitals  should  be  bathed  3 or  more 
times  a day  with  boric  acid  solution,  3i  to 
the  pint,  or  lysol,  0.5  to  1.0  per  cent.,  or 
bichloride  of  mercury,  1 : 5000,  and  clean 
pads  worn  constantly,  the  soiled  ones  being 
burnt.  If  the  vagina  and  cervix  are  obvi- 
ously involved,  hot  potassium  permanganate 
irrigations  (1  : 4000)  may,  perhaps,  be 


employed;  but  otherwise  vaginal  douches 
are  contraindicated.  Frequent  hot  sitz- 
baths  are  beneficial.  Multiple  punctures  are 
recommended  for  marked  oedema.  Employ 
no  local  urethral  or  cervical  treatment. 

In  the  subacute  and  chronic  stages,  or  as 
soon  as  the  acute  symptoms  have  subsided, 
employ  direct  local  treatment,  as  follows: 
with  the  patient  in  the  semiprone  or  Sims 
posture  (on  the  left  side  and  chest,  the  left 
ann  along  the  back,  and  the  right  thigh 
flexed),  and  using  Sims’  small  speculum, 
wipe  the  vulva  and  vagina  thoroughly  first 
with  cotton  dippetl  in  warm  water,  then  with 
dry  cotton.  Then  swab  the  cervical  canal 
several  tunes,  up  to  but  not  past  the  inter- 
nal os,  with  a cotton-wound  applicator 
dipped  in  10  per  cent,  silver  nitrate  solu- 
tion (or  10  per  cent,  protargol).  Slight  dila- 
tation with  Hanks’s  dilators  may  or  may 
not  be  necessary.  Then  swab  every  nook 
and  corner  of  the  entire  vagina  in  the  same 
way.  Then  smear  the  mucous  membrane 
with  vaseline  and  insert  two  packs  of 
absorbent  cotton,  with  strings  attached,  to 
prevent  the  formation  of  adhesions.  Then, 
if  the  urethra  is  infected,  after  the  patient 
has  urinated,  and  the  urethra  has  been 
milked  or  massaged  through  the  vagina, 
insert  up  to  but  not  into  the  neck  of  the 
bladder  a No.  8 or  9 Kelly  endoscope,  or  a 
cystoscope,  or  Skene’s  bivalve  urethral 
speculum,  and  swab  the  entire  urethra  with 
3 to  5 per  cent,  silver  nitrate  solution,  or 
5 to  10  per  cent,  protargol,  or  25  per  cent, 
argyrol,  “as  it  rolls  into  the  lumen  of  the 
endoscopeduring  its  withdrawal.”  If  neces- 
sary, the  urethra  may  first  be  anaesthetized 
by  applying  for  five  minutes,  on  a cotton- 
wound  applicator,  a solution  of  eucaine,  2 
percent.,  or  stovaine,  1 per  cent.,  or  alypin, 
5 per  cent.  If  desired,  one  may  flush  the 
urethra  before  applying  the  silver,  with  hot 
normal  salt  solution  (3i  ad  Oi)  through 
Skene’s  reflux  methral  catheter.  A medicine 
dropper  may  be  used  instead  of  the  urethro- 
scope and  cotton-wound  applicator.  Repeat 
the  urethral  treatment  once  or  twice  a week. 

The  vaginal  packs  should  be  removed  after 
forty-eight  hours’  rest  in  bed,  and  the 
vagina  douched.  The  above  treatment  may 
have  to  be  repeated  several  times  at  inter- 
vals of  from  two  to  four  weeks,  first,  how- 
ever, healing  vaginal  congestion  with  ich- 
thyol-glycerine,  3i  ad  3i. 

In  cases  which  cannot  be  treated  as  above 
described,  one  may  employ  bi-daily  douch- 
ing with  hot  potassium  permanganate  solu- 
tion, 1 : 1500,  or  creolin,  0.5  per  cent.,  or 
one  or  two  vaginal  suppositories  at  bed- 


GONORRHCEA 


time,  consisting  of  boro-glyceride,  gelatine, 
and  protargol,  2 per  cent.,  a napkin  being 
worn.  (Chiefly  from  H.  A.  Kelly.) 

Horwitz  treats  chronic  gonorrhoea  as 
follows:  the  uretliritis  is  treated  the  same 
as  in  the  male,  using  a glass  sjTinge  with  a 
capacity  of  not  over  one  dram.  Night  and 
morning  the  vagina  and  vulva  are  irrigated 
with  warm  bichloride  solution,  1 : 5000, 
increasing  to  1 : 2000,  or  potassium  perman- 
ganate, 1 : 4000,  up  to  1 : 1000.  Then  20 
per  cent,  argyrol  is  applied  to  the  whole 
surface  and  a tampon  wet  with  the  same 
solution  is  inserted,  to  remain  until  the 
next  irrigation.  After  a few  days,  1 per  cent, 
protargol  is  substituted  for  the  argyrol. 
After  ten  to  fourteen  days,  when  the  inflam- 
mation has  become  localized,  1 per  cent, 
lysol  irrigations  are  employed,  and  every 
third  day  localized  lesions  are  treated 
through  a speculum,  with  silver  nitrate,  gr. 
xx-xxx  to  the  ounce,  followed  by  the  inser- 
tion of  a wood-wool  tampon  soaked  in 
ichthyol  glycerine  or  boroglyceride.  The 
vulva  may  be  dusted  with  a powder  (see 
Vulvitis),  and  the  labia  kept  apart  with 
sterile  absorbent  cotton. 

The  urethritis  may  be  treated  as  follows 
(Noble  and  Anspach):  After  the  acute 

symptoms  have  subsided  and  the  discharge 
has  become  purulent,  inject  once  daily,  by 
means  of  a medicine-dropper  inserted  one- 
quarter  of  an  inch  into  the  meatus  with  the 
lips  of  the  latter  gently  closed  against  it 
and  with  the  patient  in  the  dorsal  position 
and  the  bladder  empty,  15  drops  of  5 per 
cent,  argyrol  containing  gr.  3^  of  powdered 
burnt  alum  to  the  ounce  (the  femal  urethra 
holds  about  15  minims).  Gradually  increase 
the  strength  of  the  injection  to  20  per  cent. 
argjTol  containing  gr.  iv  of  almn  to  the 
ounce.  When  the  discharge  has  become 
small  and  mucopurulent,  employ  zinc  sul- 
phate and  powdered  biu-nt  alum,  aa  gr.  xv, 
and  fl.  ext.  hydrastis,  5i  in  water  5iv;  and 
later  a more  astringent  solution,  viz.,  tannic 
acid  and  zinc  sulphate,  aa  gr.  xx,  in  aq. 
destil.  5iv.  Together  with  the  local  treat- 
ments give  internally  ol.  santali  and  bals. 
copaibse,  aa  t^v  in  capsule,  three  or  four 
times  daily;  or  t^xv  of  either  alone,  t.i.d. 

When  employing  strong  injections.  Rand- 
ier advises  that  the  bladder  be  first  filled 
with  water  so  as  to  dilute  any  of  the  solu- 
tion that  may  enter. 

In  obstinate  cases,  boroglycerine  may  be 
injected  into  the  urethra  every  other  day  for 
six  to  twelve  days,  and  then  silver  applied; 
or  ichthyol  and  glycerine,  1 : 10  or  1 : 5, 
may  be  applied  on  a cotton-wound  corru- 


gated metal  applicator,  employing  pressure 
in  all  directions  to  efface  the  folds  of  the 
urethra.  (Jullien). 

Stricture  or  marked  infiltration  is  treated 
by  gradual  repeated  dilatations  with  the 
Hegar  dilators,  followed  by  the  apphcation 
of  5 to  20  per  cent,  silver  nitrate  solution, 
made  by  means  of  an  applicator  or  the  tip 
of  a Braun  intra-uterine  syringe  covered 
with  cotton,  which  is  introduced  and  the 
injection  made,  after  which  the  syringe  is 
withdrawn,  leaving  the  cotton  in  place  (see 
Stricture  of  the  Urethra).  The  following 
urethral  pencils  are  used  by  Sheffield: 


II  Protargol gr.  iii-xv 

lodoformi gr.  xv 

Balsami  Peruviani gtt.  vi 

Extract!  belladonnae gr.  i 


Olei  theobromatis,  q.s.. 

Ft.  crayons  (2  in.  long  and  'h  in.  thick).  No.  xv. 

Sig. — Insert  one  into  the  urethra  twice  daily. 
(Sheffield.) 

Inject  infected  suburethral  (Skene’s) 
glands  with  silver  nitrate  or  protargol,  10 
to  20  per  cent.,  or  ichthyol.  Expose  the 
orifices  of  the  ducts  with  the  bent  end  of  a 
hairpin  employed  as  a speculum  (Kelly), 
and  inject  the  solution  through  a large 
blunt-pointed  hj-podermic  needle  attached 
to  the  bulb  of  a medicine-dropper.  In  obsti- 
nate cases  lay  open  the  glands  through  the 
vagina  under  local  anaesthesia  (see  novocaine, 
and  cocaine  in  Part  11),  first  inserting  a 
probe  (about  one-half  inch)  and  cutting 
down  upon  it.  Then  cauterize  the  cavity 
with  10  per  cent,  silver  nitrate  solution,  or 
pure  carbolic  acid,  or  the  actual  cautery. 

Treat  Bartholin’s  glands  likewise.  Excise 
the  glands  in  chronic  cases.  Whether  incis- 
ing or  excising  the  glands,  make  the  incision 
in  the  labium  at  the  junction  of  skin  and 
mucous  membrane. 

In  stubburn  cases  of  gonorrhoeal  vaginitis, 
Kelly  advises  the  trial  of  drjq  non-absorbent 
cotton  tampons  filled  with  iodoform  powder, 
repeated  every  third  day,  the  patient  remov- 
ing the  tampons  on  the  night  of  the  second 
day  and  talong  a douche  of  potassium  per- 
manganate, 1 : 1500. 

In  gonorrhoeal  endometritis,  prescribe 
rest  in  bed  in  a semi-sitting  posture, 
salines,  an  ice-bag  or  heat  to  the  hypo- 
gastrium,  and  restricted  diet;  the  dis- 
charge should  be  caught  on  \ufivar  pads 
of  absorbent  cotton  or  gauze  and  burned. 
After  the  more  acute  symptoms  have  sub- 
sided (three  or  four  days)  or  even  sooner 
the  uterus  may  be  dilated,  irrigated  with 
hot  bichloride  solution,  1 : 2000,  through  a 
two-way  catheter,  followed  by  normal  saline 


GYNATRESIA 


solution  (3i  ad  Oi),  and  then  swabbed  with 
pure  carbolic  acid  or  a concentrated  solu- 
tion of  iodine  in  95  per  cent,  carbolic  acid. 
Thereafter  the  vagina  is  irrigated  twice 
daily  with  permanganate  solution,  1 : 4000. 
Ashton  says  that  curettage  of  the  cervix  and 
uterine  cavity  is  indicated  if  endometritis 
occurs,  or  if  the  discharge  does  not  become 
normal  in  about  ten  days.  It  seems  prob- 
able, however,  that  curettage  is  harmful. 
Indeed,  some  condemn  all  intra-uterine 
treatment,  and  use  instead,  perhaps,  va- 
ginal tampons  saturated  with  glycerite 
of  boroglycerine,  or  ichthyol-glycerine, 
3i  ad  Si- 

In  acute  gonorrhoeal  adnexal  disease,  keep 
the  patient  in  bed  for  two  months,  and  for 
one  week  after  the  temperature  has  returned 
to  normal.  Employ  an  ice-bag  to  the  hypo- 
gastrium,  hot  douches,  ichthyol-glycerine 
tampons,  25  per  cent.,  inserted  at  night  and 
removed  in  the  morning,  salines  and  enemas, 
and  light  diet.  If  at  any  time  the 
tubes  become  distended  with  pus  and  sink 
to  the  floor  of  the  pelvis,  Douglas’s 
cul-de-sac  may  be  opened  widely,  the  pus 
tubes  incised  and  evacuated,  and  a gauze 
drain  or  a T-shaped  drainage  tube  sur- 
rounded with  gauze,  inserted. 

In  chronic  recurrent  cases  of  salpingo 
oophoritis,  operate  and  remove  the  offend- 
ing structures,  after  first,  according  to 
Ashton,  dilating,  curetting,  irrigating  and 
cauterizing  the  uterine  cavity.  In  young 
women,  however,  operate  only  as  a last 
resort,  after  rest  in  bed,  general  tonic  treat- 
ment, hot  sitz-baths,  hot  vaginal  douches, 
hot  fomentations  over  the  hypogastrium, 
and  ichthyol-glycerine  tampons  have  been 
given  a trial  (but  see  also  Pelvic  Inflamma- 
tory Disease). 

Treat  gonorrhoeal  peritonitis  expectantly, 
i.e.,  with  rest  in  bed,  ice  to  the  hypogastrium, 
liquid  diet,  etc.  (see  Pelvic  Inflamma- 
tory Disease). 

For  gonorrhoea  in  pregnancy  employ  no 
treatment,  except,  perhaps,  douches.  Keep 
the  patient  in  bed  for  four  or  five  weeks 
following  labor,  or  until  complete  involution 
has  taken  place. 

For  rectal  gonorrhoea,  employ  daily  irriga- 
tions of  potassium  permanganate,  1 : 5000; 
and  apply  silver  nitrate  to  ulcerations,  first 
dilating  the  sphincter  ani.  Employ  the 
Paquelin  cautery  for  old  stubborn  fissures 
and  ulcerations.  Rectal  gonorrhoea  is  very 
resistant  to  treatment,  about  four  to  six 
months  being  required  for  a cure. 

For  buccal  gonorrhoea  prescribe  frequent 
astringent  mouth  washes,  such  as  zinc  sul- 


phate, gr.  ii-iv  to  the  ounce.  It  lasts 
usually  a few  weeks. 

For  the  treatment  of  other  complications, 
consult  the  appropriate  part  of  this  work. 

In  resistant  cases  of  gonorrhoea,  vaccines 
and  serums  may  be  tried.  The  results, 
however,  are  uncertain,  but  sometimes 
excellent.  One  may  begin  with  a dose  of 
5 million  dead  gonococci,  injected  into  the 
muscle;  the  next  day  10  million;  the  next, 
25  million;  then  the  injection  may  be  given 
every  other  day,  and  the  dose  increased  by 
20  million  or  more  each  time  (unless  the 
s^Tnptoms  are  controlled  or  the  reaction  is 
marked),  until  a dose  of  100  million  is 
reached.  If  the  serum  is  used,  it  should 
bo  given  in  doses  of  “ two  c.c.  every 
day  or  every  second  or  third  day,”  in- 
jected deeply,  “but  not  necessarily  into  a 
muscle.”  (Keyes). 

Gonorrhoea  is  not  uncommon  in  infants 
and  young  girls,  to  whom  it  is  usually  trans- 
mitted by  napkins,  towels,  the  hands,  bath, 
lavatory,  etc.  In  those  under  six  the  infec- 
tion rarely  extends  to  the  uterus.  The 
treatment  in  children  is  as  follows:  Instruct 
the  mother  to  irrigate  the  vagina  once, 
twice,  or -thrice  daily  with  potassium  per- 
manganate, 1 : 2000,  bichloride,  1 : 10,000  to 
1 : 5000,  or  lysol,  0.5  to  1.0  per  cent.,  using 
a soft  rubber  catheter,  with  the  child  on  its 
back  and  thighs  flexed.  In  chronic  cases 
employ  silver  nitrate,  1 : 500,  alternately 
with  the  permanganate.  By  bringing  to- 
gether the  two  halves  of  the  vulva  about  the 
catheter,  the  vagina  may  be  distended  with 
fluid  under  pressure  and  its  folds  opened  out. 
At  first,  on  alternate  days,  the  physician 
may  apply,  through  a No.  10  Kelly  speculum 
or  a small  Ferguson  speculum,  with  the 
child  in  the  knee-chest  posture,  a 3 to  30 
per  cent,  silver  nitrate  solution,  after  first 
anaesthetizing  the  hymen  by  applying  to  it, 
for  five  to  ten  minutes,  a pledget  of  cotton 
saturated  with  alypin,  2 per  cent.  Three 
times  weekly,  after  the  patient  has  urinated, 
and  the  urethra  has  been  milked  through 
the  vagina  and  the  bladder  filled  with  water, 
the  urethra  may  be  injected  by  means  of  the 
Frank  syringe  with  a 5 per  cent,  silver  nitrate 
solution.  For  chafing,  apply  zinc  oxide 
ointment,  or  2 per  cent,  protargol  ointment 
(chiefly  after  Kelly).  If  vaccine  therapy  is 
decided  upon,  one  may  give,  according  to 
Holt,  50  to  75  millon  dead  gonococci  every 
four  or  five  days  until  5 or  6 doses  have 
been  administered.  Four  to  six  months 
are  required  for  a cure. 

Gynatresia. — Gr.  ywi)  woman  -f  a priv.  -f- 
rp^crcs  perforation.  See  Atresia. 


H.EMATURIA 


Haematocele,  Pelvic. — Gr.  al/xa  blood  + 
ktjXt]  tumor;  L.  pelvis,  basin.  See  Extra- 
Uterine  Pregnancy. 

Haematocolpos. — Gr.  atyua  blood  -t-  koKttos 
vaf>;ina.  See  Atresia  of  the  Vagina. 

Hsematoma  Vulva;. — Gr.  alga  blood  + 
-coga  tumor;  L.  vulva.  Etiology. — External 
trauma;  rupture  of  varicose  veins  during 
pregnancy  or  labor,  or  during  heavy  lifting 
or  straining  at  stool,  etc. 

Treatment. — To  arrest  bleeding  in  the  early 
stages,  apply  pressure  and  the  ice-bag. 
Later,  if  the  tumor  is  small,  employ  cleanli- 
ness and  a light  compress;  if  large  or 
infected,  lay  open  freely,  turn  out  the  clot, 
irrigate  with  hot  normal  saline . solution 
(5  i ad  Oi),  or  boric  acid  solution,  o i~ii  ad  Oi, 
and  pack  with  gauze.  It  is  well  to  wait  for 
from  four  to  eight  days,  that  is,  until  all 
danger  of  hemorrhage  has  passed,  before 
making  the  incision.  If  the  clot  has  become 
encapsulated,  dissect  out  the  cyst-wall  and 
close  with  deep  sutui’es. 

Says  Ashton:  “A  hsematoma  of  the  vulva 
should  never  be  trusted  to  nature.” 

Hsematometra. — Gr.  alga  blood  injrpa 
uterus.  See  Atresia  of  the  Cervix,  and 
Atresia  of  the  Vagina. 

Ha;matoporphyrinuria. — Gr.  alga  blood  4- 
Trop<t>vptos  purple  -j-  ovpov  urine.  See  Hsemo- 
^obinuria. 

Haematosalpinx. — Gr.  alga  blood  4- 
aaX-Kiy^  tube.  See  Atresia  of  the  Ceiwix; 
and  Atresia  of  the  Vagina. 

Haematuria. — Gr.  alga  blood  -}-  oopov 
urine.  Hsematuria,  or  the  occurrence  of  red 
blood-cells  in  the  urine,  is  distinguished 
from  luemoglobinuria  {q.v.)  by  the  pres- 
ence of  red  blood-cells  in  the  urinaiy  sedi- 
ment. Employ  the  cystoscope  and  ureteral 
catheterization  for  diagnostic  purposes  in 
regard  to  the  source  of  the  bleeding.  The 
j)resence  of  nimierous  casts  points  to 
the  kidney. 

Etiology. — Hsemophilia;  purpura;  scurvj^; 
leuksemia;  pernicious  ansemia;  splenic  anse- 
mia;  the  hemorrhagic  form  of  infectious  cUs- 
eases,  e.g.,  malaria,  yellow  fever,  cholera, 
typhoid  fever,  typhus  fever,  smallpox, 
septico-pyaemia,  scarlet  fever,  relapsing 
fever,  cerebrospinal  fever,  influenza,  pneu- 
monia; kidney  irritants,  e.g.,  turpentine, 
cantharides,  phosphorus,  aniline  dj'es,  car- 
bolic acid;  varicose  veins  of  the  bladder,  or 
vesical  hemorrhoids,  occurring  in  i)regnancy 
etc.;  passive  congestion  due  to  heart,  lung, 
liver,  or  kidney  disease;  sudden  witlnlrawal 
of  urine  from  a distended  bladiler;  trauma- 
tism to  the  kidney,  ureter,  bladder,  or 
urethra,  due  to  external  violence,  instru- 


mentation, foreign  bodies,  calculi,  the 
passageofcalculior  crystals  (see  Nephrolithia- 
sis); irritation  of  a highly  concentrated 
or  hyperacid  urine;  uric  acid  infarctions; 
local  infections,  e.g.,  urethritis,  cystitis, 
ureteritis,  jiyelitis,  gonorrhoea,  tuberculosis, 
chstomiasis,  filariasis,  acute  nephritis; 
chronic  nephritis  with  local  arteriosclerotic 
infarcts;  renal  tumors;  vesical  tumors;  amyl- 
oid kidney;  polycystic  kidney;  infarction  of 
the  kidney;  floating  kidney;  aneurysm  of 
the  renal  artery;  varicose  veins  of  a renal 
papilla;  prolonged  exercise;  angioneurosis  (?). 

There  is  a so-called  idiopathic  or  essential 
renal  hsematuria  (called  also  nephralgia, 
neuralgia  of  the  kidney,  hsematuric  nephral- 
gia, idiopathic  nephralgia,  renal  hajmophilia, 
renal  epistaxis,  and  angioneurosis  of  the 
kidney)  wliich  is  not  associated  with  any 
local  pathological  condition,  unless  it  be 
varicosity  of  the  veins  of  a renal  papilla.  .4 
constant  or  intermittent  hsematuria  occurs, 
sometimes  associated  with  severe  pain;  or 
pain  may  occur  alone.  Casper  says  that 
renal  pain  may  be  caused  by  “firm  adhesions 
between  the  true  capsule  of  the  kidney  and 
the  surrounding  fatty  capsule,”  and  that 
decapsulation  will  cure  such  cases.  Pain 
may  also  be  caused  by  spasm  of  the  ureter, 
and  is  then  cm’ed  by  the  passage  of  a 
catheter.  The  injection  of  adrenalin  through 
a ureteral  catheter  has  been  curative.  The 
following  drugs  are  recommended  for  the 
bleeding,  viz.,  rectified  spirits  of  turpentine, 
Tijviii  in  capsule  t.i.d.;  cantharides  in  small 
doses;  fl.  ext.  senecio  aureus,  2 c.c.  or  ttjxxx 
t.i.d.,  and  Merck’s  stypticin,  gr.  iv,  t.i.d. 

Keyes  says,  if  other  measures  fail, 
perform  pyelotomy  and  curette  the 
bleeding  papiUa;  and  if  this  fails,  perform 
nephrectomy. 

Treatment  of  Severe  Vesical  Haematuria. — In- 
sert a retention  catheter,  to  quiet  the 
bladder,  and  inject  about  three  ounces  of 
hot  silver  nitrate  solution,  1 : 1000  to  1 : 500; 
or  the  same  amount  of  INIerck’s  sterilized 
solution  of  gelatine,  2 to  5 per  cent.,  hot; 
or  fl.  ext.  hydrastis,  one  ounce  to  the  pint; 
or  antipyrin,  4 per  cent.;  or  a heaping  tea- 
spoonful of  Squibb’s  surgical  powder  (con- 
tains alum)  suspended  in  500  c.c.,  or  1 pint, 
of  hot  water  (“the  best  application  I know,” 
says  Keyes).  Adrenalin,  1 : 5000 to  1 : 1000 
is  not  satisfactory",  say  Casper  and  Keyes. 
Rest  in  bed  is  essential.  Opium,  ergot, 
stypticin,  and  hydrastis  may  be  useful.  The 
vagina  may  be  packed  with  gauze  for  six  or 
eight  hours.  If  these  measures  fail,  resort 
to  suprapubic  cystotomy,  and  ligate  or 
cauterize  any  bleeding  points. 


HYDRONEPHROSIS 


To  evacuate  clots,  insert  a large  glass  or 
metal  catheter  and  irrigate  with  hot  salt 
or  alum  solution,  3i  ad  Oi.;  or  hot  phenol 
solution,  1 per  cent.;  or  a cool  solution  of 
sodimn  bicarbonate. 

Haemoglobinuria. — See  Part  1. 

Haemophilia,  Renal. — Gr.  al^a  blood  + 
(/)tX€tr  to  love;  L.  ren,  kidney.  See  under 
Haematuria. 

Headache. — See  Part  1.  ^ 

Hemorrhage,  Urinary. — Gr.  aTjua  blood  + 
p-qyvvvaL  to  burst  forth;  ovpov  urine. 
See  Haematuria. 

Uterine. — See  Menorrhagia  and  Met- 
rorrhagia. 

Hemorrhoids. — See  Part  1. 

Hemorrhoids,  Vesical. — L.  vesica,  blad- 
der. See  Haematuria. 

Hepatoptosis. — Gr.  ij-zrap  liver  -t-  Trrwcrts 
falling.  See  Splanchnoptosis,  in  Part  1. 

Herpes  Progenitalis. — Gr.  ep-n-ew  to  creep; 
L.  pro,  Gr.  Trpo  before;  L.  genitalis,  genital. 
A non-contagious,  mucocutaneous  affection 
of  the  vulva  and  vagina,  characterized  by 
the  appearance  of  one  or  more  small  vesicles 
upon  an  inflamed  base,  the  vesicles  later 
becoming  ulcers,  and  usually  healing  in  about 
one  or  two  weeks.  Itchiness  accompanies 
the  eruption.  It  is  often  recurrent. 

Etiology.— Local  irritation,  due  to  menstru- 
ation, pregnancy,  excessive  coitus,  unclean- 
liness, inflammation  or  congestion  of  the 
genito-ur inary  organs,  venereal  disease,  irri- 
tating discharges;  lithtemia;  chgestive  dis- 
turbances; excesses  in  eating  or  drinking; 
debility;  nervous  depression;  atmospheric 
changes;  cold. 

Treatment. — Attend  to  the  cause.  Enjoin 
adequate  rest  and  exercise,  fresh  air  day  and 
night,  a simple  diet,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals, 
regulation  of  the  bowels,  and  general  and 
local  cleanliness.  Prescribe  a tonic,  if 
required,  e.g.,  iron,  arsenic,  codliver  oil. 

Elixir  ferri,  quinine,  et  strychninaj 
phosphati 3 iv 

Sig. — One  tea.spoonful  in  water,  t.i.d.p.c. 

R Acidi  nitrohydrochlorici 

diluti 3 ii  (iiEv  per  dose) 

Aqua; 5 iss 

Strychninae  siilphatis ....  gr.  i (gr.  per  dose) 

Misce  et  adde. 

Tincturac  gentianae  compositao, 

Tinct.  cardamomi  comp.,  aa  q.s.  ad.  .5vi 

Sig. — Dessertspoonful  after  meals  in  water.  (H. 
C.  Wood.) 

Douche  the  vagina  and  vulva  twice  daily 
with  bichloride  solution,  1 : 4000,  followed 
by  normal  salt  solution  (3i  ad  Oi),  or  with 


boric  acid  solution,  3i~ii  to  the  pint  (see  also 
V^aginitis).  Protect  the  vulva  against  ffri- 
tating  vaginal  thscharges  by  means  of 
cotton-wool  tampons,  and  keep  the  vulval 
lips  apart  with  lint.  Puncture  vesicles  and 
touch  lightly  with  the  pointed  silver  stick 
or  solution,  gr.  x-xl  ad  3i-  The  following 
astringent  lotion  may  be  applied  on  lint  or 
cotton,  two  or  three  tunes  daily : 

R Calamina;, 

Zinci  oxidi, 

Acidi  borici,  aa 3 i 

Alcoholis 5 ii 

Aquae,  q.s.  ad 5 iv — Shake  well. 

Or,  particularly  useful  for  the  relief  of 

burning  and  itching: 

R Calaminae, 

Zinci  oxidi,  aa 3i-ii 

Acidi  borici 3i 

Glycerini ngxxx 

Acidi  carbolici i^x-xxx 

Liquoris  calcis 5 i 

Aquae,  q.s.  ad 3iv — Shake  well. 

Or,  zinc  sulphate  solution,  0.5  to  2.0  per 
cent.  Zinc  oxide  ointment  and  dusting  pow- 
ders (see  Vulvitis),  are  useful. 

In  obstinate  and  recurring  cases,  apply 
daily,  for  ten  minutes,  the  galvanic  current 
of  ^ to  2 milliamperes,  with  the  positive 
electrode  over  the  lower  lumbar  region  and 
the  negative  electrode  over  the  affected 
part ; or  apply  a mustard  poultice  over 
the  lumbar  spine  every  day  or  two.  Arsenic 
is  also  advised.  Daily  hot  sitz-baths  are 
beneficial. 

Hydatid  Cyst  of  the  Kidney  . — Gr.  vdaris 
vesicle;  kvo-tls  bladder.  See  Tmnors  of  the 
Kidney. 

Hydatidiform  Mole. — See  Part  4,  Ob- 
stetrics. 

Hydrocele  of  the  Labium  Majus. — Gr. 

i)5cop  water  -|-  K-qXr]  tumor;  L.  labium,  lip; 
majus,  greater.  See  Tumors  of  the  Vulva. 

Hydrometra. — Gr.  vdup  water  prirpa 
uterus.  See  Atresia  of  the  Cervix,  Acquired. 

Hydronephrosis. — Gr.  i)5cop  water  -f  ve<pp6s 
kidney.  Hydronephrosis,  or  distention  of 
the  renal  pelvis  with  urine,  is  the  result  of 
gradual  incomplete  urinary  obstruction,  per- 
manent or  intermittent. 

Fixed  hydronephrosis  is  diagno.sed  by  the 
presence  of  a gradually  growing,  non- 
inflammatory tumor,  by  ureteral  catheteriza- 
tion, exploratory  incision,  etc.  Intermittent 
hydronephrosis  is  characterized  by  the  occur- 
rence of  attacks  of  severe  pain  (Dietl’s 
crises),  associated  with  the  sudden  appear- 
ance of  a movable,  enlarged  kidney,  which 
collapses  coincidentally  with  the  relief  of  the 


INCONTINENCE  OF  URINE 


pain  and  the  passage  of  a large  amount 
of  urine. 

Etiology.— A.  Congenital. — Paidial  steno- 
sis of  the  ureter  at  either  extremity;  oblique 
insertion  or  high  insertion  of  the  ureter  into 
the  renal  pelvis;  valve  formation;  compres- 
sion of  the  ureter  by  a supernumerary  or 
aberrant  renal  blood-vessel;  double  ureter; 
malpositions  and  kinking. 

B.  Acquired. — Urethral  stricture;  thick- 
ened bladder  walls;  vesical  tumors;  uterine 
tumors;  ovarian  timiors;  cancer  in  the  broad 
ligaments ; cancer  of  the  csecum ; retroperito- 
neal pelvic  sarcoma;  ureteral  tumors;  uret- 
eral gumma;  periureteritis;  periureteral 
adhesions;  ureteritis  (colon,  gonococcus,  or 
tubercle  infection);  calculus,  blood-clot,  or 
ecliinococcus  cyst  in  the  ureteral  canal; 
traumatism  due  to  the  passage  of  a stone, 
to  external  violence,  or  to  a temporary  liga- 
ture or  clamp;  gravid  uterus;  retroflexed 
uterus;  tumor  or  stone  in  the  renal  pelvis; 
aneurysm  of  the  iliac  artery;  scoliosis  caus- 
ing renal  disjilacement;  movable  kidney, 
producing  a kinking  of  the  ureter,  and  re.sult- 
ing  intermittent  hych’onephrosis;  compres- 
sion of  the  ureter  by  ijerirenal  or  periureteral 
blood-clots  due  to  trauma. 

Treatment.— Remove  the  cause,  if  possible. 
Stretch  ureteral  strictures  by  means  of 
bougies;  remove  obstructing  stones,  tumors, 
etc.;  resect  diseased  portions  of  the  ureter; 
perform  pyeloplication  upon  a dilated  renal 
pelvis;  do  a uretero-pyelotomy,  if  indicated; 
employ  a jiad  and  binder,  or  nephropexy,  or 
decapsulation  for  movable  kidney  (see  under 
Splanchnoptosis).  In  operating  always  ex- 
plore the  ureter  by  means  of  a catheter 
passed  into  the  bladder.  If  very  little 
kidney  substance  is  left,  the  tumor  large, 
the  obstruction  not  relievable,  and  the  other 
kidney  functionally  active  (see  Urinalysis,) 
perform  nephrectomy. 

As  a palliative  measure  in  bilateral  cases 
with  anuria,  and  in  cases  with  severe  pres- 
sure symptoms,  aspirate  the  kidney  just 
below  the  last  intercostal  space  on  the  left 
side,  and  midway  between  the  last  rib  and 
the  crest  of  the  ilium  on  the  right  side. 

Hymen,  Imperforate. — Or.  vurjv  mem- 
brane; L.  imperfom'tus,  not  open.  See 
Atresia  of  the  Vagina. 

Hyperaimia  of  the  Bladder. — Gr.  uirep 
over  + atpa  blood.  See  Bladder  Irritability. 

Hyperassthesia,  Vesical. — Gr.  cirep  over  -f 
aiffd-qais  sensibility;  L.  vesica,  bladder.  See 
Blailder  Irritability. 

Hypernephroma. — Gr.  imkp  over  + ve4>p6$ 
kidney  -f  -wpa  tumor.  “A  tumor  derived 
from  suprarenal  tissue,  either  of  the  gland 


itself  or  misplaced  in  the  kidney  or  else- 
where.”— Borland.  See  Tumors  of  the 
Kidney. 

Hypertrophy  of  the  Cervix. — ^See  Cervical 
Hypertrophy. 

Vulva. — ^See  Elephantiasis,  Part  5,  Skin 
Diseases. 

Idiopathic  Renal  Haematuria;  Idiopathic 
Nephralgia. — Gr.  Uios  own- -|- ira0os  disease; 
L.  ren,  kidney;  Gr.  ve^pbs  kidney  -}-  aXyos 
pain.  See  under  Haematuria. 

Imperforate  Hymen. — L.  imperforatus, 
not  open;  Gr.  vp-qv  membrane.  See  Atresia 
of  the  Vagina. 

Incontinence  of  Urine. — L.  incontinentia; 
uri'na.  Etiology. — Vesical  calculi  and  foreign 
bodies;  cystitis;  vesico-urethral  fissure;  vesi- 
cal tuberculosis;  vesical  tumors;  urinary 
fistula;  posterior  urethritis;  urethral  stric- 
ture; urethral  eversion;  urethral  caruncle; 
urethral  dilatation;  sphincteric  traumatism 
due  to  labor  or  operation;  sphincteric  paraly- 
sis due  to  spinal  cord  disease,  e.g.,  injury  of 
the  cord,  tumors,  myelitis,  tabes,  general 
paralysis,  disseminated  sclerosis,  spondy- 
litis, etc.;  uterine  displacements;  pressure  of 
tumors,  particularly  fibroids  of  the  uterus; 
distended  colon;  pregnancy;  pelvic  inflam- 
matoiy  disease;  abdomino-pelvic  operations; 
rectal  disease;  hemorrhoids;  hernia;  irritat- 
ing purulent  or  acid  urine ; lithsemia ; crystals 
in  the  urine  (see  Nephrolithiasis) ; too  high 
or  too  low  specific  gravity;  irritating  ingesta 
(ginger,  radishes,  spices,  turpentine;  can- 
tliarides,  salicylates,  quinine,  etc.);  excessive 
coitus  or  masturbation;  overwork  and  anse- 
mia;  vaginismus,  neurasthenia,  hysteria; 
epilepsy;  malaria;  nervous  irritability;  cold. 
(For  incontinence  in  children  see  Enuresis, 
in  Part  I,  General  Medicine  and  Surgeiy.) 

In  the  passive  incontinence  due  to  labor 
traumatism  and  subinvolution,  urethrocele 
and  cystocele  are  often  present.  The  incon- 
tinence is  intermittent,  caused  by  sneezing, 
coughing,  fright,  sudden  change  of  posi- 
tion, etc. 

Do  not  mistake  false  or  paradoxical 
incontinence,  due  to  overflow  of  a dis- 
tended bladtler,  for  true  incontinence. 

Treatment.— Attend  to  the  cause.  Consult 
Bladder  Irritabilit}^  and  Dilatation  of  the 
Urethra. 

For  paraljdic  incontinence  prescribe 
the  following: 

R Extract!  ergotte 

Extract!  Belladonnsc,  aa  gr. 

Fiat  pilula  una.  Mitte  tails  xii. 

Sig. — One  or  two  pills  once  or  twice  a day. 

Should  cystitis  develop,  prescribe  uro- 
tropine  or  helmitol,  gr.  v,  twice  or  thrice 


INVERSION  OF  THE  UTERUS 


daily,  and  irrigate  the  bladder  with  boric 
acid  solution,  3Uh  to  the  pint.  The  bladder 
shoiild  be  irrigated  once  a day  if  the  catheter 
reveals  the  presence  of  residual  urine.  En- 
courage the  patient  to  try  to  void  urine 
every  two  hours. 

Infantile  Uterus. — L.  infantilis.  See 

under  Dysmenorrhoea,  and  Sterility. 

Inflammation  of  Bartholin’s  Glands. — L. 

inflammare  to  set  on  fire.  See 

Vulvitis. 

Bladder. — See  Cystitis. 

Cervix. — See  Cervicitis. 

Fallopian  Tubes. — See  Pelvic  Inflam- 
matory Disease. 

Kidney. — See  Pyelonephritis. 

Ovaries. — See  Pelvic  Inflammatory 
Disease. 

Pelvic  Organs. — See  Pelvic  Inflamma- 
tory Disease. 

Pelvic  Peritoneum. — See  Pelvic  In- 
flammatory Disease. 

Rectum. — See  Proctitis,  Part  1,  General 
Medicine  and  Surgery. 

Skene’s  Glands. — See  Gonorrhoea;  and 
Vulvitis. 

Tubes. — See  Pelvic  Inflammatory  Dis- 
ease. 

Urethra. — See  Urethritis. 

Uterus.— See  Metritis. 

Vagina. — See  Vaginitis. 

Vulva. — See  Vulvitis. 

Womb. — See  Metritis. 

Inflammatory  Disease,  Pelvic. — See  Pel- 
vic Inflammatory  Disease. 

Injuries  of  the  Bladder.— See  Bladder 
Injuries. 

Kidney. — See  Kidney  Injuries. 

Intermenstrual  Pain,  Periodic. — L.  inter, 
between  -|-  men  sis,  month;  poena,  pain;  Gr. 
Trepi  around  -f  686s  way.  The  cause  is 
unknown.  Possible  causes  are:  thickening 
of  the  ovarian  capsule,  resisting  the  bursting 
of  mature  graafian  follicles;  a hydrosalpinx 
or  pyosalpinx  discharging  periodically  into 
the  uterine  cavity  (salpingitis  profluens); 
uterine  obstruction  from  stenosis  or  flexure. 

Treatment. — This  is  usually  unsatisfactory. 
Make  a thorough  examination  and  treat  any 
abnormality  present.  Attend  to  the  general 
health.  Enjoin  rest  in  bed  during  the  pain. 
(See  Dysmenorrhoea.) 

Intertrigo. — See  Part  5,  Skin  Diseases. 

Inversion  of  the  Uterus. — L.  in,  into  -f 
ver'tere,  to  turn;  uterus,  womb.  Inversion 
of  the  uterus  is  extremely  rare.  It  may  be 
acute  or  chronic,  partial  or  complete.  Acute 
inversion  is  usually  accompanied  by  acute 
pain,  shock,  and  sometimes  hemorrhage; 
strangulation  and  gangrene  sometimes  occur. 


and  there  is  great  danger  of  infection. 
Chronic  inversion  is  usually  accompanied  by 
a chronic  discharge  and  hemorrhages,  rarely 
few  or  no  symptoms,  and  there  is  danger  of 
acute  infection.  The  condition  is  revealed 
by  vaginal  examination.  Polyp  is  excluded 
by  the  fact  that  in  inversion  a sound  passed 
between  the  cervLx  and  the  protrusion  may 
be  inserted  only  a little  way  before  it  is 
obstructed.  In  partial  inversion,  as  dis- 
tinguished from  complete  inversion,  the 
inverted  uterine  wall  does  not  protrude 
through  the  external  os. 

Etiology.— The  essential  or  primary  predis- 
posing cause  is  local  uterine  inertia  or  relaxar- 
tion  or  paralysis.  Contributory  causes  are 
as  follows,  viz.,  too  frequent  pregnancies; 
multiple  pregnancy;  hydramnios;  systemic 
debilitating  disease;  prolonged  labor;  rapid 
labor;  delivery  in  the  erect  posture;  a short 
cord  or  a cord  wound  repeatedly  around  the 
child’s  neck;  early  traction  upon  the  cord; 
adherent  placenta;  fundal  attachment  of  the 
placenta;  manual  removal  of  the  placenta; 
injuchcious  pressure  over  the  fundus  of  the 
uterus;  uterine  tumors — fibromyoma,  sar- 
coma, carcinoma;  violent  intra-abdominal 
pressure,  as  in  straining,  vomiting,  cough- 
ing, etc.,  during  or  after  the  third  stage  of 
labor;  distention  of  the  uterus  with  retained 
fluids  or  tumors;  weight  of  the  intestines; 
unknown  conditions. 

Treatment.— A.  AcuTE  INVERSION. — Anaes- 
thetize the  patient,  remove  the  placenta 
rapidly  if  still  attached,  then  replace  the 
uterus  by  hand  during  a period  of  relaxa- 
tion, pressing  with  the  fingers  upward  and 
toward  the  abdominal  wall,  i.e.,  in  the  direc- 
tion of  the  axis  of  the  superior  strait.  With 
the  hand  still  in  the  uterine  cavity,  douche 
the  latter  with  hot  normal  salt  solution 
(3i  ad  Oi),  in  order  to  stimulate  contraction. 
Remove  the  hand  only  while  the  uterus 
is  contracting.  Then  administer  ergot. 
Some  advise  replacing  the  uterus  before 
detaching  the  placenta,  to  avoid  serious 
hemorrhage. 

If  the  case  is  seen  after  the  lapse  of  a 
number  of  days,  divide  the  cervix  in  the 
median  line  posteriorly,  reinvert  the  womb, 
and  close  the  incision  with  sutures.  (Hirst.) 

B.  Chronic  Inversion. — First  reduce  con- 
gestion by  means  of  rest  in  bed  with  the 
hips  elevated,  laxatives,  simple  diet,  and  hot 
normal  saline  irrigations,  morning,  noon,  and 
night,  continued  for  two  weeks.  Then 
endeavor  to  replace  the  uterus  gradually 
(the  patient  remaining  in  bed  under  the 
above  regimen)  by  tamponading  the  vagina 
thoroughly  every  second  day  after  irrigation 


LATERAL  LOCATION  OF  THE  UTERUS 


with  hot  nonnal  saline  solution;  or  by 
Braun’s  colpeuiynter,  smeared  with  sterile 
zinc  oxide  ointment,  and  held  in  place 
by  a tight  bandage  (lemove  for  several 
hours  each  day) ; or  by  White’s  spiral  spring 
repositor,  held  in  place  with  two  elastic 
bands  in  front  and  two  behind  attached  to  a 
broad  abdominal  binder,  the  rim  of  the  cup 
being  covered  with  lint  saturated  with  car- 
bolized  oil,  gtts.  viii  ad  5i  (“remove  and 
reapply  eveiy  day  — Penrose).  Continue 
one  or  all  of  these  methods,  with  perhaps 
attempts  at  reduction  by  taxis  under  anjes- 
thesia,  for  at  least  five  or  six  weeks,  if 
necessary.  Prescribe  iron  for  anaemia.  For 
hemorrhage  employ  hot  water  or  vaginal 
gauze  tampons. 

If  these  measures  fail,  split  the  anterior 
and  po.sterior  lips  of  the  cervix,  restore  the 
uterus,  and  suture  the  split  lips;  or  dilate 
the  cervix  through  the  incised  fundus,  close 
the  incision  with  catgut  sutures,  and  replace 
the  uterus  (Browne);  or,  with  two  fingers 
of  the  right  hand  in  the  rectum  and  two 
fingers  of  the  left  hand  in  the  bladder 
(through  a dilated  urethra  or  vesico-vaginal 
fistula)  make  counter  pressure  upon  the 
ceiwix  while  the  balls  of  the  thumbs  press 
firmly  against  the  inverted  fundus  (Tate); 
or  employ  counter-pressure  upon  the  ceiwix 
through  anterior  and  posterior  vaginal 
incisions  into  the  pelvic  cavity;  or  amputate 
the  inverted  fundus;  or  perform  vaginal 
hysterectomy.  The  latter  is  demanded  in 
the  presence  of  infection  or  gangrene. 

Irritability  of  the  Bladder. — See  Bladder 
Irritability. 

Ischuria. — See  Anuria,  in  Part  1,  General 
IVIedicine  and  Surgery. 

Itching. — See  Pruritus. 

Kidney  Abscess. — See  Pyelonephritis,  in 

Part  1,  General  Medicine  aiul  Surgery. 

Angioneurosis  of  the. — See  Hiema- 
turia. 

Calculus. — See  Nephrolitluasis. 

Cancer. — See  Tumors  of  the  Kidney. 

Cysts. — See  Tmnors  of  the  Kidney. 

Degeneration,  Cystic. — See  Tumors  of 
the  Kidney. 

Fistula. — See  Fistula,  Renal. 

Floating. — See  Splanchnoptosis,  in  Part 
1,  General  Medicine  and  Surgeiy. 

Hemorrhage. — See  Ilacmaturia. 

Hypernephroma. — See  Tumors  of  the 
Ividney. 

Inflammation. — See  Bright’s  Disease 
and  Pyelonephritis,  in  Part  I,  General 
Medicine  and  Surgeiy. 

K id  ney  1 n juries. — Symptomatology. — Pain , 
tenderness  and  swelling,  revealed  by  bi- 


manual palpation,  htematuria,  and  oliguria 
followed  usually  by  polyuria  are  the  primary 
local  manifestations.  Ureteral  colic  may 
occur  as  a result  of  the  passage  of  blood-clots. 

Treatment. — Where  the  hasmaturia  and 
swelling  are  slight,  and  there  are  no  sjmip- 
toms  of  shock,  employ  rest  in  bed  for  at 
least  three  weeks,  strap  the  parts,  apply 
an  ice-bag,  and  give  morphine  if  necessaiy 
to  relieve  pain.  Administer  low  diet  to  keep 
the  blood-pressure  low.  The  occurrence  of 
secondary  suppuration,  as  evidenced  by  ele- 
vation of  temperature  and  rapid  pulse,  calls 
for  lumbar  incision. 

Perform  a lumbar  exploratory  operation 
immediately  if  shock  or  h®maturia  is  severe, 
if  the  swelling  (htematoma  or  urohsematoma) 
is  increasing,  or  if  anuria  occurs.  Examine 
the  pelvis  and  ureters;  remove  ureteral 
obstructions;  close  pelvic  rents;  control  kid- 
ney hemorrhage  by  purse-string  suture  or 
packing;  and  if  this  does  not  arrest  the 
bleecUng,  remove  the  kidney.  Irrigate  and 
dram  following  operation. 

Evidences  of  intraperitoneal  bleeding  call 
for  laparotomy.  Gunshot  and  stab  wounds 
usually  demand  an  exploratory  operation. 

If  blood-clots  in  the  bladder  cause  pain  or 
retention,  irrigate  the  bladder  through  a 
catheter  with  warm  boric  acid  solution, 
oi-ii  ad  Oi;  or  use  Bigelow’s  apparatus  to 
break  up  and  evacuate  the  clots.  If  this 
fails,  do  a cystotomy. 

Kidney,  Movable.— See  Splanchnoptosis,  in 
Part  1,  General  Medicine  and  Surgery. 

Neuralgia  of  the. — Gr.  vevpov  nerve 
-p  aXyos  pain.  See  under  Hsematui’ia. 

Polycystic. — Gr.  ttoXws  many  -{-  Kvaris 
cyst.  See  Tumors  of  the  Kidney. 

Sarcoma  of  the. — Gr.  aapKos  flesh 

-p  -upa  tmnor.  See  Tumors  of  the 
Kidney. 

Stone. — See  Nepln*olithiasis  in  Part  1, 
General  Medicine  and  Sm’geiy. 

Traumatism. — Gr.  rpavpa  wound.  See 
Kidney  Injmies. 

Tuberculosis  of  the. — See  Tuberculosis 
of  the  Kidney. 

Tumors. — See  Tumors  of  the  ludney. 

Kraurosis  X'ulvae. — Gr.  Kpavpos  dry;  L. 
vvlv'a,  \nilva.  See  Part  5,  Skin  Diseases. 

Laceration  of  the  Cervix. — See  Cervical 
Lacerations. 

Lateral  Location  of  the  Uterus. — L.  la'tus, 
.side;  locat'io,  placement.  Causes. — Tumor; 
inflammatory  mass;  cicatricial 
contraction.  (Dudley.) 

Treatment.— Attend  to  the  cause.  In  {X)st- 
inflammatory  cases,  bimanual  massage  and 
systematic  tamponade  of  the  vagina  may 


MENORRHAGIA  AND  METRORRHAGIA 


restore  the  uterus  to  its  normal  position  and 
mobility  (see  Pelvic  Inflammatory  Disease). 

Leucorrhcea. — Gr.  Xeu/cos  white  + poG 
flow.  The  cervical  discharge  is  stringy, 
glairy,  viscid,  thick,  tenacious,  and  mucoid, 
like  the  white  of  an  egg,  or  it  may  be  muco- 
purulent; whereas  a vaginal  discharge  is 
“curdy,  or  milky,  or  creamy”;  and  an 
endometrial  discharge  is  more  serous. 

Etiology. — Urethritis;  vulvitis;  vaginitis;  en- 
docervicitis;  endometritis;  salpingitis  pro- 
fluens  (a  hydro-  or  pyo-salpinx  discharging 
periodically  into  the  uterine  cavity);  carci- 
noma; sloughing  myoma;  cervical  laceration; 
menstruation;  polypi;  chronic  pelvic  con- 
gestion {q.v.,  for  causes). 

Treatment.— Attend  to  the  cause.  Cool 
sitz-baths  and  astringent  vaginal  irrigations 
(see  Vaginitis)  are  useful  in  cases  of  hyper- 
secretion. 

Lipoma  Vesicae. — Gr.  XIttos  fat  -copa 
tumor;  L.  vesica,  bladder.  See  Tumors  of 
the  Bladder. 

Lipoma  Vulvae. — See  Tmuors  of  the  Vulva. 

Lupus  Vulvae. — L.  fw'pus,  wolf.  See  Tuber- 
culosis of  the  Genital  Organs. 

Lymphangitis,  Pelvic. — L.  hjmpha,  lymph 
-f  Gr.  ajyelov  vessel  -| — trts  inflammation; 
L.  pelvis,  basin.  See  Pelvic  Inflammatory 
Disease. 

Masturbation. — L.  marius,  hand  fl-  stru- 
pra're,  to  rape.  See  Part  1,  General  Medi- 
cine and  Surgery. 

Membranous  Dysmenorrhcea. — See  Dys- 
menorrhoea. 

Menopause;  Climactery. — Gr.  py]v  month 
-f  TraDcrts  cessation  ; KXiixaKTrjp  round  of  the 
ladder.  The  menopause  occurs  usually 
between  the  ages  of  forty  and  flfty-five  years. 
Menstruation  may  cease  abruptly,  or  it  may 
become  irregular  preceding  its  cessation. 
The  genital  organs  atrophy.  The  following 
symptoms  commonly  occur,  viz.,  conges- 
tions, flushes,  sweatings,  palpitations, 
dizziness,  flatulence  and  other  gastric  and 
intestinal  disorders,  neuralgias,  insomnia, 
mental  unrest  and  anxiety,  UTitabflity 
of  temperament. 

Treatment. — Enjoin  the  observance  of  cor- 
rect hygiene,  i.e.,  adequate  rest  and  exer- 
cise, fresh  air  day  and  night,  a cold  bath 
every  morning  on  arising,  in  a warm  room 
standing  in  warm  water,  a hot  bath  twice  a 
week  at  bedtime  (for  nervous  symptoms), 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  eating,  plain  food,  three  or 
four  pints  of  water  daily,  an  occasional  morn- 
ing saline.  Ovarian  extract,  or  ovarin 
(Merck)  is  highly  recommended  in  both 
the  artificial  and  natural  menopause.  Dried 


corpus  luteum  is  also  recommended.  Thy- 
roid extract  is  recommended  for  irregular 
hemorrhages.  For  constipation,  digestive 
disturbances,  vertigo,  etc.,  Gant  recommends 
physo.stigmine  and  nux  vomica.  Sodium 
bromide,  valerian,  and  asafcetida  may  be  of 
occasional  service  for  the  relief  of  nervous 
symptoms.  For  annoymg  flushes,  Ashton 
prescribes  cold  baths,  and  sodium  bromide, 
gr.  XX,  well  diluted,  three  or  four  times  daily 
or  picrotoxin,  gr.  3-i’oo  to  t.i.d.;  and,  if 
headache  accompanies  the  flushes,  fl.  ext. 
gelsemii,  njii-iii,  every  three  hours,  and  a 
dram  of  sodium  phosphate  every  morning 
before  breakfast.  For  pelvic  congestion  one 
may  employ  an  occasional  saline  purge,  hot 
vaginal  douches,  glycerine  tampons,  and 
scariflcation  of  the  cervix.  One  must  remem- 
ber that  increase  in  the  flow,  or  return  of 
the  flow  after  its  ce.ssation,  or  an  increase  of 
leucorrhcea  may  possibly  mean  cancer. 
Lacerations  of  the  cervix  and  perineum  may 
be  repaired  in  order  to  prevent  cancer  and 
senile  prolapse  (Ashton).  One  should  bear 
in  mind  the  great  value  of  the  obesity  tUet- 
cure  in  appropriate  cases. 

Hemorrhage  at  the  menopause  responds 
readily  to  radio-therapy. 

Menorrhagia  and  Metrorrhagia;  Uterine 
Hemorrhage. — Gr.  fx-qv  month;  prjrpa  uterus; 
pqyvvpL  to  burst  forth.  Etiology.— A.  LoCAL 
Causes. — Chronic  pelvic  congestion  {q.v., 
for  causes);  fibromyoma,  especially  when 
submucous;  polypi  (mucous,  fibroid,  or 
placental,  the  latter  followmg  protrusion 
of  an  ovmn) ; cancer  or  sarcoma  or  adenoma 
of  the  fundus  or  cervix;  chorio-epithelioma; 
inversion  of  the  uterus;  uterine  cUsplace- 
ments;  subinvolution  and  metritis;  endo- 
metritis, acute  or  chronic  (both  rare  causes)  ; 
endocervicitis;  hypertrophy  or  chronic 
hyperplasia  of  the  endometrium  (polypoid  or 
fungoid  endometritis) ; endometrial  tubercu- 
losis; tubal  tuberculosis;  ovarian  disease 
(functional  hyperactivity,  inflammation, 
cystic  degeneration,  tumors);  tubal  inflam- 
mation; tubal  tumors;  broad  hgamenv 
affections  (varicocele,  hsematoma,  tumors, 
cysts);  tumors  of  the  pelvis,  rectmn,  or 
bladder;  pelvic  inflammatory  disease;  a{> 
pendicitis;  pelvic  hsematocele;  laceration  of 
the  ceiwix  or  perineum;  sclerosis  of  the  uter- 
ine blood  vessels  and  fibrosis  uteri;  foreign 
substances  in  the  uterine  cavity;  preg- 
nancy (abortion,  extra-uterine  pregnancy, 
placenta  praevia,  separation  of  the  placenta, 
hydatidiform  mole). 

B.  Constitutional  Causes. — Anaemia; 
purpura;  haemophilia;  scurvy;  lead;  phos- 
phorus; infectious  diseases  (malaria,  syphi- 


MENORRHAGIA  AND  METRORRHAGIA 


lis,  influenza,  pneumonia,  typhoid  fever, 
rheumatic  fever,  scarlet  fever,  smallpox, 
diphtheria,  cholera,  sepsis,  etc.) ; the  rheu- 
matic diathesis;  alcohol  and  rich  food; 
obesity;  sedentary  life;  constipation;  general 
debility;  phthisis;  cardiac,  pulmonary, 
hepatic,  renal,  or  splenic  disease,  producing 
passive  congestion;  emotional  states  and 
hysteria;  “ reflexes  incident  to  puberty, 
the  menopause,  or  lactation  ” (Ashton) ; 
“ change  of  residence  from  a low  to  a high 
altitude,  or  from  a temperate  to  a tropical 
country.”  (Ashton.) 

Treatment. — Treat  each  case  according  to 
its  cause.  A microscopic  examination  of  the 
uterine  scrapings  furnishes  important 
information,  either  positive  or  negative. 
Gurettage  followed  by  the  application  of  pure 
carbolic  acid  is  curative  in  only  about  10  per 
cent,  of  the  cases.  Polypoid  endometritis  is 
only  temporarily  benefited  by  curettage. 
The  application  to  the  endometrium  of  a 
30  to  40  per  cent,  solution  of  formaldehyde 
on  cotton  for  fifty  seconds  is  well  recom- 
mended (Gerstenberg) . Several  curettings 
or  cauterizations  may  be  necessary.  Atmo- 
causis,  or  the  application  of  steam  at  a tem- 
perature of  100°  C.  for  thirty  to  forty  seconds 
(five  to  eight  minutes  if  it  is  desired  to 
produce  oblitio  cavi,  as  in  fibrosis  uteri  and 
arteriosclerosis)  is  described  by  Bandler. 
The  cervix  should  be  dilated;  and  the  patient 
should  remain  in  bed  for  ten  to  fourteen  days 
after  the  treatment.  Intrauterine  electricity 
is  generally  condemned  as  highly  dangerous. 
The  X-rays  and  radium  produce  more  or  less 
atrophy  of  the  uterus  and  ovaries,  which 
explains  their  usefulness.  To  produce  amen- 
orrhcea  with  the  X-ray  requires  large  doses 
for  nine  to  eighteen  weeks;  whereas  one 
treatment  with  radium  may  produce  it.  For 
the  menorrhagia  of  young  girls,  Kelly  and 
Burnham  employ  with  great  success,  12 
mg.  of  rachiun  (see  Radimn,  Part  1)  in 
the  uterine  cavity  for  from  five  to  twenty- 
four  hours. 

The  following  uterine  stjq^tics  are  useful: 
Ergot,  administered  before  and  during  the 
menses;  useful  in  subinvolution,  metritis, 
fibromyoma,  active  and  passive  congestion. 

Pituitrin  or  pituglandol,  1 c.c.,  or  less, 
hypodermically,  every  one  to  three  days  for 
from  five  to  twenty  doses. 

Hydrastis,  administered  before  and  during 
the  menses;  useful  in  subinvolution,  metritis, 
endometritis,  fibromyoma,  active  and  pas- 
sive congestion,  pregnancy  (“  does  not 
interfere  with  the  normal  course  of  gesta- 
tion ” — Ashton).  It  may  be  combined 

with  ergot. 


R Fluidextracti  ergotae, 

Fluidextracti  hydrastis,  aa §i 

M.  Sig. — One  dram,  in  water,  three  or  four 
times  a day. 

R Hydrastininae  hydrochloridi gr.  x 

Ergotini gr.  xl 

Strychninae  sulphatis gr.  ss 

M.  et  ft.  pil.  No.  XX. 

Sig. — One  pill  t.i.d.  (Ashton.) 


Stypticin  (cotarninse  hydrochloridi),  cap- 
sulas  No.  50,  aa  gr.  i.  Give  gr.  i,  t.i.d.,  for 
about  a week  before  the  expected  flow; 
then  gr.  iiss-v  every  two  or  three  hours 
until  the  flow  is  lessened  (do  not  continue 
if  three  doses  of  2]^,  to  5 grs.  are  ineffectual) ; 
then  decrease  the  dose  to  gr.  i-iiss  every 
three  or  four  hours  (Boldt).  For  a quick 
result,  give  3 to  6 grs.  in  a 10  per  cent,  solu- 
tion (6  grs.  to  the  dram)  subcutaneously  in 
the  buttocks  (Boldt);  1 to  2 minims  of  a 
10  per  cent,  aqueous  solution  (H.  A.  Kelly). 
Kelly  gives,  of  styptol,  gr.  i,  t.i.d.,  until  the 
flow  begins,  then  gr.  iss  every  tlu'ee  hours 
throughout  the  period.  Useful  in  “ cli- 
macteric hemorrhage;  subinvolution  not 
depending  on  the  retention  of  products  of 
conception;  disease  of  the  appendages 
or  parametrimn,  the  uterus  itself  being 
healthy;  congestive  haemorrhage  in  young 
girls;  fibrosis  (not  submucous  polypi)”. 
(H.  A.  Kelly.) 


ErgotinjE gr.  i-iii 

CotarninsD  hydrocliJoridi gr.  ss-iii 

Hydrastininaj  hydrochloridi gr-  M 


(vel  Pulveris  hydrastis,  gr.  v) 

M.  et  ft.  pilula  una.  Mitte  taKs  60. 

Sig. — One  pill  tlrree  or  four  times  daily. 

Adrenalini  chloridi,  1 : 1000,  15  drops  in  water 
t.i.d. 

Calcii  chloridi,  5ii  3ii,  Aquse,  giv.  M.  Sig. — 
One  di’am  (gr.  v)  well  diluted,  t.i.d. p.c.  during 
the  intermenstrual  period,  and  eveiy  two  hours 
during  the  flow.  “Avoid  milk  during  its  use.” 
(Bandler.)  “ Especially  indicated  for  bleeding  due 
to  myomata.”  (Bandler.) 

R Acich  galhci 3 ii  (gr.  x per  dose) 

Tincturce  cinnamomi ....  3 vi 
Aqua;  destillatae,  q.s.  ad.  § vi 

M.  Sig. — One  tablespoonful  every  three  or  four 
hours.  (Emmet  and  Taylor.) 

Other  remecUes  in  appropriate  cases  are 
digitalis  begun  one  week  before  the  flow 
(it  may  be  combined  with  ergot — Fordyce 
Barker);  dilute  sulphuric  acid  and  other 
mineral  acids;  alum;  hamamelis;  cotton 
root,  \’irburnum  prunifolium;  stagnin;  nuc- 
lein; thyroid  extract;  mammary  extract; 
ovarian  extract;  bromide;  opium;  cannabis 
indica;  iron.  Digitalis  is  of  service  in  con- 
gestive states  and  in  pregnancy.  The 
salines  are  of  value  in  congestive  cases. 


METRITIS 


Repeated  subcutaneous  injections  of  whole 
blood  are  effectual  in  many  cases,  according 
to  Curtis.  If  hemorrhage  is  due  to  lactation, 
the  child  should  be  weaned.  In  cases  of 
presumable  fibrosis  uteri  and  arteriosclerosis, 
if  curettage  and  other  measures,  including 
x-ray  therapy,  thyroid  therapy,  and  at- 
mocausis  (to  produce  oblitio  cavi),  fail, 
perform  vaginal  hysterectomy  (Bandler). 
In  cases  with  a hemorrhagic  diathesis,  one 
may  prescribe  “ an  abundance  of  gelatine” 
in  the  food. 

In  all  cases  enjoin  the  observance  of  cor- 
rect hygiene,  viz.,  adequate  rest  and  exer- 
cise, mental  and  sexual  rest,  fresh  air  day 
and  night,  regular  hours  of  eating  and  sleep- 
ing, rest  before  and  after  meals,  a daily 
morning  warm  bath  in  a warm  room,  fol- 
lowed by  a cold  spinal  douche,  bland  food, 
chiefly  vegetable,  water  freely,  no  alcohol, 
coffee,  tea,  spices,  or  red  meats,  free  bowel 
activity.  A tonic  may  be  prescribed, 
if  indicated. 


Acidi  arsenosi gr.  Ko 

Extract!  calumbae gr.  i 

Quininac  sulphatis gr.  ss 


M.  et  ft.  pilula  una.  Mitte  tails  100. 

Sig. — One  pill  t.i.d.p.c.  (H.  A.  Kelly.) 

Strychnine  may  be  given,  but,  as  a rule, 
no  iron. 

At  the  commencement  of  the  flow,  or 
before,  the  patient  should  take  a hot  bath  if 
convenient,  and  go  to  bed  in  a quiet  room. 
The  foot  of  the  bed  should  be  elevated.  A 
hot  water  bag  may  be  placed  to  the  spine. 
The  bowels  should  be  free.  Hot  douches, 
from  one  to  three  gallons  at  a temperature 
of  110°  to  120°  F.,  lasting  fifteen  to  twenty 
minutes,  may  be  taken  two  or  three  times 
a day,  in  the  intermenstrual  as  well  as  dur- 
ing the  menstrual  period.  If  the  flow  per- 
sists, the  vagina  may  be  tamponed  with 
sterile  wool,  or  gauze  or  cotton  covered  with 
sterile  vaseline.  The  tampon  is  left  in  for 
from  eighteen  to  twenty-four  hours,  then 
removed,  a douche  given,  and  another  tam- 
pon inserted.  “ Intra-uterine  applications  of 
adrenalin  have  been  recommended  highly  ” 
(Dudley).  In  cases  where  much  blood 
has  been  lost,  administer  normal  saline  (0.9 
per  cent.)  infusions  and  inject  strychnine 
hypodermically. 

Dudley  says;  “ The  treatment  of  uterine 
hemorrhage  in  girls  and  young  women  is 
often  that  of  a systemic  cause;  the  treat- 
ment in  married  women  of  the  child-bearing 
age  is  usually  that  of  endometritis  (metritis) , 
benign  tumors,  or  displacements;  the  treat- 
ment of  the  menorrhagia  of  spinsters  is  com- 
monly that  of  benign  tumors;  and  of  women 


between  the  ages  of  forty  and  fifty  years, 
often  that  of  malignant  growths  or  myo- 
mata; the  treatment  during  senility  is  often 
that  of  malignant  disease.” 

Menstruation,  Absent. — L.  mensis, 

month.  See  Amenorrhoea. 

Excessive. — L.  mensis,  month.  See 
Menorrhagia. 

Painful. — See  Dysmenorrhoea. 

Menstruation,  Precocious.  — Etiology.  — 
Heredity;  parasites  (genital  or  rectal:  ascar- 
ides,  etc.);  adherent  prepuce;  uncleanliness, 
especially  cheesy  accumulations  about  the 
clitoris;  neoplasms  of  the  generative  organs; 
masturbation;  “reading  lewd  literature”; 
“immoral  associations”;  “undue  nervous 
and  mental  excitement.” 

Treatment. — Attend  to  the  cause.  Pre- 
scribe adequate  rest,  recreation,  and  exer- 
cise, fresh  air  day  and  night,  regular  hours, 
regulation  of  the  bowels,  a bland  diet,  cold 
baths,  etc.  See  Masturbation,  in  Part  1, 
General  Medicine  and  Surgery. 

Menstruation,  Profuse.— See  Menorrhagia. 

Scanty. — See  Amenorrhoea. 

Supplementary.  — See  Menstiuation, 
Vicarious  and  Supplementary. 

Suppression  of. — See  Amenorrhoea. 

Menstruation,  Vicarious  and  Supplement= 
ary. — L.  vicdrius,  taking  the  place  of.  Peri- 
odic bleeding,  at  the  menstrual  period,  from 
some  part  of  the  body  other  than  the  uterus 
is  rare.  It  is  “ most  often  met  with  in  cases 
of  undeveloped  genital  organs,  atresia,  and 
premature  menopause  ” (Ashton).  Neuras- 
thenia is  often  present. 

Treatment.— If  amenorrhoea  exists,  seai:ch 
for  its  cause.  Build  up  the  general  health. 
A prolonged,  copious  hot  douche,  hot  appli- 
cations to  the  hypogastrium,  and  hot  sitz- 
baths  may  be  tried  at  the  supposed  men- 
strual period.  Ermnenagogue  drugs  may  be 
prescribed.  The  cervix  may  be  scarified, 
especially  if  there  is  distressing  headache, 
flusliing  and  dizziness  not  relieved  by  the 
vicarious  hemorrhage. 

In  cases  of  undeveloped  generative  organs 
with  severe  molimina,  the  ovaries  may  have 
to  be  removed. 

Metritis. — Gr.  ii-qTpa  womb  -f  -tns  in- 
flammation. Metritis  is  inflammation  of  the 
uterus,  embracing  the  endometrium,  myo- 
metrium, and  parametrium  (Gr.  irapd  beside; 
the  cellular  tissue  about  the  uterus).  The 
symptoms  are  those  of  endometritis 
together  with  enlargement  and  tenclerness 
of  the  uterus,  which  is  apt  to  be  soft 
and  boggy. 

Acute  metritis  is  manifested  by  local  pain, 
tenderness,  and  muscular  rigidity,  perhaps 


METRITIS 


painful  urination  and  defecation,  a variable 
temperature,  perhaps  chills,  perhaps  nausea 
and  vomiting. 

Chronic  metritis  (including  subinvolution 
following  labor,  miscarriage,  or  menstrua- 
tion) is  manifested  by  lumbo-sacral  pain, 
feeling  of  weight  in  the  pelvis,  perhaps  painful 
urination  and  defecation,  leucorrhoea, 
menorrhagia  or  metrorrhagia,  vertical  and 
occipital  headache,  gasti'o-intestinal  and 
neurasthenic  symptoms,  and  general  debility. 
The  ceiwix  is  patulous  and  easily  dilatable. 

Etiology. — Vulvo-vaginitis;  endometritis; 

puerperal  infection ; infection  following  oper- 
ations and  examinations;  cervical  laceration; 
laceration  of  the  pelvic  floor;  retention,  fol- 
lowing childbirth,  of  portions  of  the  pla- 
centa, the  membranes,  the  decidua,  or 
blood-clots;  exposure  to  cold;  non-lactation; 
too  early  out  of  bed  following  labor;  re- 
peated abortions;  tumors  in  or  near  the 
uterus;  uterine  displacements;  pessaries, 
chronic  pelvic  congestion  {q.v.,  for  causes); 
traimiatism. 

Causal  bacteria  include  the  gonococcus, 
staphylococci,  streptococci,  colon  bacillus, 
pneumococcus,  bacillus  tuberculosis,  diph- 
theria bacillus,  etc. 

Treatment.— I.  AcUTE  Metritis. — Put  the 
patient  to  bed  in  a semi-sitting  posture, 
place  an  ice-bag  or  hot  water  bag  to  the 
hypogastrium,  and  purge  freely  with  calo- 
mel, gr.  ii-iv  followed  by  salines.  Administer 
concentrated  liquid  and  soft  diet  every  three 
or  four  hours,  and  water  in  abundance. 
Dudley  recommends,  for  abortive  purposes, 
five  or  more  leeches  over  each  inguinal  region 
and  five  to  the  perineum;  a large  blister 
may  also  be  applied  to  the  hy]wgastrium,  or 
turpentine  stupes,  or  alcohol  fomentations, 
or  mustard  or  flaxseed  poultices.  Hot  or  warm 
vaginal  douches  may  serve  to  promote  the 
reaction  of  inflammation.  For  severe  pain, 
insert  a suppository  containing  ext.  opii  aq., 
gr.  i,  and  ext.  belladonna?,  gr.  Jg.  Later, 
when  the  acute  symptoms  have  subsided, 
glycerine  tampons  attached  to  a string,  to 
facilitate  removal,  may  be  placed  against 
the  external  os.  These  should  be  removed  at 
the  end  of  twenty-four  hours,  followed  by  a 
douche.  Iodine,  painted  upon  the  ceiwix 
and  vaginal  vault,  is  recommended  as  a 
counter-irritant.  Ergot  or  quinine  (gr.  iii, 
twice  daily),  or  pituitaiy  extract,  may  be 
administered  for  the  purpose  of  contracting 
the  uterus. 

Should  the  patient’s  condition  become 
worse,  with  the  appearance  of  marked 
symptoms  of  toxaemia,  it  is  often  difficult  to 
know  what  to  do.  If  the  condition  is 


sapraemic,  that  is,  due  to  retained  decom- 
posing material,  such  as  blood-clots,  frag- 
ments of  placenta  or  membrane,  or  decidua 
(causing  ptomaine  blood  poisoning),  this 
should  probably  be  removed  with  the  finger, 
curettement  forceps,  and  large  dull  wire 
curette,  with  care  not  to  inflict  traumatism, 
and  the  uterine  cavity  then  copiously  irri- 
gated with  hot  water,  or  formaldehyde, 
1 ; 4000,  or  bichloride,  1 : 4000,  followed  by 
normal  salt  solution,  and  drainage  estab- 
lished by  means  of  gauze,  which  should  be 
removed  at  the  end  of  twenty-four  hours. 
Uterine  retention  tubes  may  be  used.  Fol- 
lowing the  irrigation  the  uterus  may  be 
swabbed  (using  cotton  wound  on  dressing 
forceps)  with  creolin,  or  with  a saturated 
solution  of  iodine  crystals  in  pure  carbolic 
acid,  or  with  a 25  per  cent,  solution  of  ich- 
thyol  in  glycerine.  Sharp  curettage  of  the 
endometrium  is  generally  condemned.  After 
the  uterus  has  once  been  emptied,  it  should 
be  left  severely  alone. 

Many  gvn®cologists  regard  with  disfavor 
any  intrauterine  or  vaginal  treatment,  and 
recommend  an  “ attitude  of  watchful  ex- 
pectancy,” performing  abdominal  or  vaginal 
section  when  indicated  (see  Pelvic  Inflanuna- 
tory  Disease),  and  draining  abscesses  or  re- 
moving the  uterus  and  its  appendages. 

If  a blood  culture  reveals  the  presence  of 
streptococci,  antistreptococcic  serimi  may 
be  tried  in  large  doses — 20  c.c.  t.i.d.,  hypo- 
dermically, according  to  Edgar;  80  c.c 
every  six  horn’s,  320  c.c.  during  the  first 
twenty-four  hours,  according  to  J.  S.  Evans. 
Its  action,  however,  is  uncertain. 

Yeast  is  recommended  because  it  in- 
creases leucocjdosis.  One-fourth  of  an 
ordinary  compressed  yeasUcake  may  be 
given  tlu-ee  times  a day,  dissolved  in  a glass 
of  water.  Nuclein,  10  to  60  minims  of  a 
5 per  cent,  solution,  hypodermically,  is  also 
reconunended  for  the  same  reason;  as  is 
also  Credo’s  ointment,  15  to  45  grs.  rubbed 
into  the  skin  for  twenty  minutes  once 
to  thrice  daily,  and  covered  with  rub- 
ber tis.sue ; or  daily  intravenous  injections  of 
argentum  colloidale,  gr.  xvq  in  a 2 per  cent, 
emulsion,  and  neo-sal varsan.  Normal  saline 
solution  (0.9  per  cent.),  one  litre  everj’  six 
hours,  subcutaneously,  or  34  to  1 litre  everj' 
three  to  six  hours  per  rectum  by  the 
Murphy  drop-method,  is  advised.  A plenti- 
ful supply  of  fresh  air  is  all  important.  If  a 
cardiac  stimulant  is  required,  employ  strych- 
nine, or  caffeine,  or  camphor.  The  body 
should  be  bathed  frequently  with  warm 
water  and  perhaps  alcohol  and  water, 
equal  parts. 


METRORRHAGIA 


II.  Chronic  Metritis. — Enjoin  a quiet 
life,  partial  rest  in  bed,  the  avoidance  of 
sitting,  no  coitus,  fresh  air  day  and  night,  a 
nutritious  diet,  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals, 
abdominal  exercises,  the  wearing  of  an 
abdominal  support  for  relaxed  abdomen 
(see  Visceroptosis) , frequent  bathing,  hot  sitz- 
baths,  and  support  of  the  clothing  from  the 
shoulders  instead  of  from  the  hips.  A daily 
morning  saline  is  indicated  for  the  relief  of 
local  congestion.  A tonic  containing  iron, 
arsenic,  quinine,  or  stiychnine,  may  be  of 
service.  General  massage  is  of  value  if  it 
can  be  afforded. 

Elixiri.s  ferri,  quininsc,  et 
strychnin®  phosphati ....  5 iv 

Sig. — One  teaspoonful  in  half  a glass  of  water,  t.i.d 

Tincturse  nucis  vomic®, ...  3v  (tt^x  per  dose) 

Tinctur®  gentian®  com- 
posit®,  q.s.  ad oiv 

M.  Sig. — A teaspoonful  in  a quarter  glass  of 
water,  t.i.d. 

Prescribe  digitalis  for  the  heart,  if  required. 
Try  thyroid  extract  cautiously  for  ansemic, 
fat,  flabby  women. 

In  order  to  reduce  the  size  of  the  uterus, 
have  the  patient  take  a hot  vaginal  douche 
twice  a day,  and  at  bedtime  insert,  far  back 
against  the  cervix  and  vaginal  vault  by 
means  of  dressing  forceps,  a cotton-wool 
tampon  saturated  with  glycerine  and  at- 
tached to  a thread  for  removal  the  next 
morning.  Twice  a week  the  physician  may 
puncture  the  cervix  and  withclraw  from  one- 
half  to  one  ounce  or  more  of  blood,  then  dry 
thoroughly,  paint  the  cervix  and  vaginal 
vault  with  tincture  of  iodine,  and  insert  a 
glycerite  of  boroglycerine  or  an  ichthyol 
glycerine  (25  per  cent.)  tampon,  which  the 
patient  should  remove  by  an  attached 
string  the  next  day,  followed  by  a douche. 
Iodoform  ointment  may  be  applied  to 
erosions.  Cysts  should  be  opened  (no 
more  than  six  or  eight  at  one  sitting),  and 
their  walls  cauterized  with  pure  carbolic 
or  nitric  acid  (Ashton).  Local  treatment 
should  be  intermitted  during  menstruation. 
Ergot,  and  quinine  (gr.  hi  twice  daily) 
may  be  of  service  in  the  inter-menstrual 
period  for  the  purpose  of  stimulating  uterine 
contraction.  Digitalis  and  hydrastis  may 
be  of  service  for  their  action  upon  the 
circulation. 

R Ergotin gr.  iii 

Pulveris  digitalis gr.  i 

Quinin®  sulphatis gr.  ii 

Strychnin®  sulphatis gr. 

M.  et  fiat  pihila  una.  Mitte  tahs  xxx. 

Sig. — One  pill  t.i.d.  (Author?). 


1^  Ergotin gr.  ii 

Hydrastinin®  hydrochloridi gr.  ss 


M.  et  pone  in  capsula  una.  Mitte  talis  xxx. 

Sig. — One  capsule  four  times  a day.  (Author?). 

After  the  parts  have  been  restored  to  a 
favorable  state  by  the  faithful  employment 
of  the  above  depletive  measures,  the  uterus 
may  be  dilated  and  thoroughly  curetted  by 
means  of  Sims’s  and  Martin’s  sharp  curettes, 
the  latter  for  the  fundus  and  cornua,  taking 
care  nol  to  perforate  the  uterus.  Then 
irrigate  the  uterine  cavity  with  hot  water, 
or  hot  carbolic  acid  solution,  1 to  2 per 
cent.,  or  lysol,  0.5  to  1 per  cent.,  diy  with 
gauze,  and  apply  on  a cotton-wound 
applicator,  tincture  of  iodine,  or  silver 
nitrate,  5 to  10  per  cent.,  or  a saturated  solu- 
tion of  iodine  in  95  per  cent,  carbolic  acid. 
Says  Bandler:  “ in  tho.se  ca.ses  in  which  the 
uterus  is  quite  large  and  quite  flabby, 
especially  if  the  cavity  of  the  uterus  is  large, 
and  the  walls  thin  and  atonic,  atmocausis 
(the  application  of  steam  at  a temperature 
of  100  C.),  carried  out  for  half  a minute  to  a 
minute  after  the  curetting,  has  a splendid 
action  in  contracting  the  uterus  and  in  pro- 
moting a serous  exudation  which  greatly  aids 
the  subsequent  involution  of  the  uterus.” 
Repair,  resect,  or  amputate  a lacerated  and 
diseased  cervix;  repair  a relaxed  perineal 
floor.  After  curettage,  apply  close  to  the 
cervix  a tampon  soakccl  in  glycerite  of  boro- 
glycerine attached  to  a string,  to  be  removed 
at  the  end  of  twenty-four  hours,  followed 
by  a douche.  The  patient  should  be  kept  in 
bed  two  weeks,  and  the  vagina  douched 
twice  daily  with  hot  boric  acid  solution,  3i 
to  the  pint,  or  the  following: 


Acidi  borici Svi 

Acidi  carbolic!, 

Pulveris  aluminis  exsiccati,  aa 5i 

Olei  gaultheri® 3i 

01eimentb®piperit® 5ss 


M.  Sig. — A tablespoonful  in  a gallon  of  water. 
(H.  A.  Kelly.) 

Repeat  the  tamponade  two  or  three  times 
a week.  If  the  uterus  is  displaced,  try  to 
replace  it,  after  having  employed  the  above 
described  depletive  measures,  and  retain  it 
in  place  with  a pessary  (see  qv.).  One- 
third  of  the  cases  of  displacement  are 
cured  in  this  way,  (Kelly  and  Noble). 
Or,  the  uterus  may  be  drawn  forward 
by  its  round  ligaments  at  the  time  of 
operation.  In  old  intractable  cases  and 
those  with  tubo-ovarian  involvement, 
perform  hysterectomy. 

Metrorrhagia. — See  Menorrhagia  and 
Metrorrhagia. 


PAIN,  MENSTRUAL 


Micturition. — L.  micturi're,  to  urinate. 
See  Urination. 

Miscarriage. — See  Abortion. 

Moist  Warts. — See  Verrucjs. 

Movable  Kidney. — See  Splanchnoptosis  in 
Part  1,  General  IMedicine  and  Surgery. 

Mucous  Patches. — See  Syphilis,  in  Part 
1,  General  Medicine  and  Surgery. 

Mulberry  Excrescences.— See  Verrucse. 

Mycosis  of  the  Vagina. — Gr.  fxvK-qs  fungus. 
See  Vaginitis. 

Vulva. — See  Vulvitis. 

Myoma  Uteri. — Gr.  /xCs  muscle  + 
tumor.  See  Fibromyoma  Uteri. 

Vesicae. — See  Tumors  of  the  Bladder. 

Myxoma  Vulva;. — Gr.  ixv^a  mucus  + 
-w/xa  tumor.  See  Tumors  of  the  Vulva. 

Nabothian  Follicles. — See  Cervicitis  and 
Endocervicitis. 

Nephralgia. — Gr.  v€4>p6s  kidney  + aXyos 
pain.  See  under  Hsematuria. 

Nephritis,  Suppurative. — Gr.  v€4>p6s  kid- 
ney -j — LTLs  inflammation;  L.  sub,  under  fl- 
pus,  pu'ris,  pus.  See  Pyelonephritis,  in  Part 
1,  General  Medicine  and  Surgery. 

Nephrolithiasis. — See  Part  1,  General 
Medicine  and  Surgery. 

Nephroptosis. — Gr.  ve4>p6s  kidney  -f  ■KToiai'i 
falling.  See  Splanchnoptosis,  in  Part  1. 

Neuralgia  of  the  Bladder. — Gr.  vtvpov 
nerve  -f  aXyos  pain.  See  Bladder 
Ii’ritability. 

Kidney.— See  under  Hsematuria. 

Neuroma  Vulvae. — Gr.  vevpov  nerve  + -cojua 
tumor.  See  Tumors  of  the  Vulva. 

Neurosis  of  the  Bladder. — Gr.  vevpov  nerve. 
See  Bladder  Irritability. 

Noma  Pudendi. — Gr.  vopi]  feeding;  L. 
pudendum,  from  pude're,  to  be  ashamed. 
See  Gangrene  of  the  Vulva. 

Obesity. — See  Part  1,  General  Medicine 
and  Surgery. 

Obstruction. — L.  obstruc'Ho.  See  Atresia. 

CEdema  of  the  Vulva. — Gr.  blb-ppa  swell- 
ing; L.  vulva.  Etiology. — Renal  insuffici- 

ency; cardiac  disease;  varicose  veins;  labial 
inflammation ; traumatism ; angioneurotic 
oedema;  pressure  upon  the  pelvic  veins  in 
pregnancy,  etc. 

Treatment.— Attend  to  the  cause.  When 
due  to  venous  obstruction,  the  usual  cause, 
enjoin  rest  in  bed  with  the  liips  elevated, 
and  the  occasional  assumj^tion  of  the  knee- 
chest  posture.  Hot  applications  may  be 
made.  In  extreme  cases,  the  fluid  may  be 
evacuated  by  means  of  multiple  incisions, 
with  strict  aseptic  precautions,  and  sterile 
boric  acid  powcler  applied  on  lint. 

Oliguria. — See  Anuria,  in  Part  1 , General 
Medicine  and  Surgery. 


Oophoritis. — Gr.  w6v  egg  -f-  (popelv  to  bear 
+ -iTLs  inflammation.  See  Pelvic  Inflam- 
matory Disease. 

Osteoma  Vulvse. — Gr.  ocrkov  bone  + -wpa 
tumor.  See  Tumors  of  the  Vulva. 

Ovarian  Abscess. — L.  ova'rium.  See  Pel- 
vic Inflammatory  Disease. 

Cysts. — See  Ovarian  Tumors  and  Cysts. 

Inflammation. — See  Pelvic  Inflamma- 
tory Disease. 

Prolapse. — See  Prolapsus  of  the  Ovary. 

Tuberculosis. — See  Tuberculosis  of  the 
Genital  Organs. 

Ovarian  Tumors  and  Cysts. — L.  ova'rium-, 
tu'mere,  to  swell;  Gr.  Kvans  bladder.  Solid 
tumors  (fibroma,  myoma,  sarcoma,  carci- 
noma, s}mc3dioma,  benign  papilloma)  are 
rare,  constituting  about  5 per  cent,  of  all 
ovarian  tumors  (Dudley).  Ovarian  cysts 
are  either  unilocular  or,  more  commonly, 
multilocular.  They  may  be  follicle  cysts 
(large  or  small),  or  corpus  luteiun  cysts 
(small),  or  cystadenomata,  simple  or  papil- 
lary (the  largest  and  commonest  of  ovarian 
cysts,  sometimes  becoming  malignant),  or 
dermoid  cysts  (sometimes  becoming  malig- 
nant) . Cystadenoma  is  usually  fatal  within 
three  years  unless  operated  upon. 

Parovarian  cysts,  large  hydatids  of  Mor- 
gagni, and  the  rare  ovarian  hydrocele  (com- 
munication between  the  abdominal  ostium 
of  the  dilated  fallopian  tube  and  a cyst) 
are  scarcely  to  be  distinguished  clinically 
from  ovarian  cysts. 

Treatment. — Very  small,  benign,  symptom- 
less  tumors  of  the  ovary  require  no  treatment. 
Others  require  removal,  i.e.,  ovariotomy, 
or  if  conservative  measures  are  desirable, 
the  puncturing  of  small  cysts  and 
the  excision  of  large  ones,  with  closure  of 
the  wound  by  a continuous  suture  of  fine 
catgut.  In  performing  ovariotomy,  papil- 
lary cysts  should  not  be  tapped,  if  possible, 
for  fear  of  infecting  the  peritoneum  with 
new  growtlis. 

The  occurrence  of  inflammation,  hemor- 
rhage, torsion  of  the  pedicle,  or  rupture,  with 
their  resulting  acute  sjonptoms,  demands 
iimnechate  ovariotomy. 

Ovaritis. — See  Pelvic  Inflammatory  Dis- 
ease. 

Ovary,  Affections  of  the. — See  Ovarian 
Affections. 

Oxaluria.^ — L.  ox'alas,  oxalate  + uri'na, 
urine.  See  under  Nephrolithiasis,  in  Part  1, 
General  IMedicine  and  Surgery. 

Painful  Coitus. — See  Vaginismus. 

Pain,  Intermenstrual,  Periodic. — See  In- 
termenstrual  Pain,  Periodic. 

Pain,  Menstrual. — See  Dj^smenorrhoea. 


PELVIC  INFLAMMATORY  DISEASE 


Pain  on  Urination. — See  Dysuria. 

Papilloma  Vesicae. — L.  papil'la,  nipple- 
shaped elevation  + Gr.  -wfxa  tumor.  See 
Tumors  of  the  Bladder. 

Papilloma  Vulvae. — See  Verrucae. 

Paralysis  and  Paresis  of  the  Bladder. — Gr. 
Trapa  beside  + }^vetv  to  loosen ; Trdpecrts  relaxa- 
tion. Paralysis  of  the  detrusor  musculature 
with  unimpaired  tonicity  of  the  sphincter 
causes  complete  retention  of  urine.  Paraly- 
sis of  the  sphincter  causes  incontinence  or 
overflow,  the  urine  lying  below  the  level  of 
the  sphincter  being  retained  (incomplete 
retention).  Simple  muscular  atony  is 
characterized  by  a frequent  desire  but 
weakened  power  to  urinate,  and  increased 
capaciousness  of  the  bladder,  as  shown  by 
percussion,  catheterization,  and  the  pas- 
sage during  urination  of  an  abnormal 
amount  of  urine. 

Etiology.— Overdistention  of  the  bladder 
(see  Retention  of  Urine) ; injury  of  the  blad- 
der; arteriosclerosis  of  the  vesical  vessels; 
severe  parenchymatous  cystitis  leading  to 
sclerosis;  comatose  states;  shock;  operations; 
fevers;  cerebral  or  spinal  disease  or  injury, 
e.g.,  general  paresis,  tabes,  fracture  of  the  ver- 
tebral column,  compression  of  the  cord  by 
hemorrhage  or  exudate;  myelitis;  dissemi- 
nated sclerosis,  hemiplegia,  hysteria,  etc. 

“The  Prognosis  is  by  no  means  bad  in  all 
cases,”  says  Casper.  The  condition  pre- 
disposes to  cystitis  and  stone. 

Treatment. — Attend  to  the  cause.  Unless 
cystitis  is  present,  manual  expression  of  the 
urine  should  be  practiced  every  six  hours,  by 
means  of  the  fingers  of  both  hands  grasping 
the  bladder  from  above,  and  the  thumbs 
resting  on  the  symphysis  pubis,  the  fingers 
being  pressed  downward  and  inward  (Ort- 
ner).  If  manual  expression  is  unsuccessful, 
catheterize  the  bladder  regularly,  twice  or 
thrice  daily,  and  guard  against  infection  by 
an  occasional  irrigation  with  hot  boric  acid 
solution,  5Uiv  ad  Oi,  or  silver  nitrate, 
1 : 5000  to  1 ; 1000,  and  perhaps  urotropin 
by  mouth  (see  Part  II). 

To  restore  muscular  tone,  employ  abdom- 
inal and  spinal  massage,  vibratory  and 
manual ; galvanization  or  faradization  of  the 
bladder,  with  one  electrode  over  the  bladder 
and  the  other  (a  metal  sound  covered  with 
the  exception  of  the  tip  with  hard  rubber) 
within  the  bladder  or  vagina;  and  strychnine 
in  large  doses,  and  perhaps  ergot. 

In  organic  nervous  cases,  such  as  tabes 
etc.,  the  regular  passage  of  full-sized  dilators 
is  recommended. 

Parametritis;  Pelvic  Cellulitis. — Gr.  Trapd 
near  -f  womb;  inflammation  of  the 

28 


cellular  tissue  about  the  uterus.  (See  Pelvic 
Inflammatory  Disease.) 

Parovarian  Cysts. — Gr.  Trapd  near  -f-  L. 
ovarium,  ovary.  See  under  Ovarian  Tum- 
ors and  Cysts. 

Pediculosis  Pubis;  Crab=Lice. — See  Part 
5,  Skin  Diseases. 

Pelvic  Abscess. — L.  pel'vis,  basin.  See 
Pelvic  Inflammatory  Disease. 

Adhesions. — See  Pelvic  Inflammatory 
Disease. 

Cellulitis;  Parametritis. — See  Pelvic 
Inflammatory  Disease. 

Congestion,  Chronic. — See  Conge.stion 
of  the  Pelvis,  Chronic. 

Haematocele. — See  Extra-Uterine  Preg- 
nancy. 

Pelvic  Inflammatory  Disease. — Under  this 
caption  are  included  pelvic  lymphangitis, 
phlebitis,  and  cellulitis  (parametritis), 
salpingitis,  ovaritis,  and  pelvic  perito- 
nitis (perimetritis). 

The  acute  stage  is  marked  by  more  or  less 
local  pain,  tenderness,  muscle  spasm,  rapid 
pulse,  pyrexia,  perhaps  chills,  perhaps  nausea 
and  vomiting,  perhaps  painful  urination  and 
defecation.  The  symptoms  may  be  very 
mild  or  very  severe.  In  gonorrhoeal  infec- 
tion the  acute  symptoms  usually  subside  in 
three  days.  A diagnosis  of  the  parts  affected 
may  be  made  by  bunanual  palpation.  Pelvic 
cellulitis  or  parametritis  is  characterized 
by  a boggy,  often  bulging  mass  in  the  lower 
portion  of  one  of  the  broad  ligaments  or 
uterosacral  ligaments;  whereas  in  pelvic 
peritonitis  the  infiltrate  is  usually  felt  all 
around  the  uterus.  In  adnexal  disease  the 
tube  or  ovary  or  both  are  enlarged  and  tender. 

In  the  chronic  stage  of  pelvic  inflammation 
the  uterus  and  adnexa  may  be  displaced  and 
bound  down  by  adhesions,  and  there  are  apt 
to  be  backache,  local  and  radiating  pain, 
constipation,  painful  defecation,  painful 
coitus,  frequent  and  painful  urination,  per- 
haps even  gastric  pain,  especially  if  there 
are  omental  adhesions,  dysmenorrhoea,  men- 
orrhagia, leucorrhoea,  sterility,  debility,  etc. 
In  chronic  ovaritis  (including  the  cirrhotic 
ovary)  pain  and  tenderness  are  the  chief 
symptoms.  In  tubercular  salpingitis  the 
tubes  are  indurated  and  nodular. 

Etiology — Vulvo-vaginitLs ; cervicitis  or  en- 
docervicitis;  endometritis;  metritis;  cervical 
laceration;  perineal  laceration;  uncleanly 
manipulations;  gonorrhoea;  tuberculosis; 
syphilis;  puerperal  infection;  acute  infectious 
diseases;  infection  from  the  intestines,  blad- 
der, peritoneum,  or  general  circulation;  ap- 
pendicitis; infected  ovarian  and  uterine 
tumors  and  cysts;  suppurating  broad-liga- 


PELVIC  INFLAMMATORY  DISEASE 


ment  hsematoma  or  pelvic  hsematocele 
resulting  from  ectopic  gestation.  Chronic 
pelvic  congestion  {q.v.,  for  causes),  rheuma- 
tism, gout,  alcoholism,  and  over-exercise  or 
taking  cold  during  menstruation,  act  as  pre- 
disposing causes.  Ovaritis  alone  may  be 
caused  by  arsenic  and  phosphorus  poisoning, 
acute  suppression  of  the  menses,  adhesion 
to  the  intestine,  the  exanthemata,  mumps, 
rheumatic  fever,  pneimionia,  cholera,  ton- 
sillitis, etc. 

The  chief  microorganisms  concerned  are 
the  gonococcus,  staphylococci  (albus,  aureus, 
and  citreus),  streptococci,  colon  bacillus, 
tubercle  bacillus,  diphtheria  bacillus,  pneu- 
mococcus, typhoid  bacillus,  and  actinomyces. 

Treatment.— I.  AcUTE  INFLAMMATION. — 
Put  the  patient  to  bed  in  a well-ventilated 
room  with  the  head  of  the  bed  somewhat 
elevated.  Apply  to  the  hypogastrium  an 
ice-bag  or  hot  water  bag  or  hot  flaxseed 
poultices  or  turpentine  stupes.  Open  the 
bowels  freely  by  means  of  calomel  followed 
by  salines,  or  the  latter  alone,  e.g.,  Epsom 
salts,  a tablespoonful  of  the  saturated  solu- 
tion every  one-half  to  one  hour  until  the 
bowels  are  freely  moved;  or,  according  to 
Penrose,  Rochelle  salts,  one-half  to  one  tea- 
spoonful dissolved  in  water  every  one  to  two 
hours  “ until  mild  purgation  is  produced.” 
Two  or  three  tmies  daily  give  a prolonged  hot 
vaginal  douche,  lasting  about  thirty  minutes, 
of  normal  saline  solution  (pi  ad  Oi),  or  lysol, 
1 per  cent.,  for  the  purpose  of  promoting  the 
reaction  of  inflaimnation.  Allow  no  food 
until  the  bowels  have  been  thoroughly 
moved,  the  abdominal  ilistention  relieved, 
and  appendicitis  excluded.  Then  give 
liquids,  and  water  freely,  gradually  increas- 
ing the  diet  as  the  patient  improves.  If 
appendicitis  is  suspected,  and  the  abdom- 
inal distention,  pain,  nausea  and  vomiting 
are  not  relieved  at  the  end  of  twenty-four 
hours,  operate  (Noble  and  Anspach).  If,  in 
the  presence  of  pelvic  cellulitis  or  peritonitis, 
fluctuation  becomes  manifest,  or  the  tem- 
perature continues  high,  the  pain  severe, 
and  the  exudate  increasing  in  size,  make  a 
free  vaginal  incision  through  the  posterior 
vault,  from  side  to  sitle,  with  scissors, 
evacuate  the  pus,  employ  the  finger  gently 
to  open  up  all  pockets,  and  pack  loosely 
with  gauze  or  employ  rubber  tubing,  as 
deemed  best.  Place  the  patient  in  the  semi- 
sitting or  Fowler  position.  The  drain  is 
gratlually  removed  by  the  end  of  the  fifth 
day.  It  should  not  be  removed  too  early. 
If  the  abscess  points  in  the  groin,  or  in  the 
loin,  incise  here.  Do  not  operate  too  early, 
but  wait  until  the  infection  has  become 


localized,  or  in  other  words,  until  the  resist- 
ive powers  of  the  body  have  formed  a bar- 
rier against  the  invasion  of  the  enemy. 
These  resistive  powers  are  aided  by  the 
application  of  heat.  The  abdomen  or  pelvis 
should  be  opened  without  delay  for  all 
gross  diseases  of  the  tubes.  Some  advise 
the  evacuation  of  tubal  and  ovarian  ab- 
scesses through  the  vagina,  while  others 
deem  it  best  to  remove  the  diseased  struct- 
ures, if  practicable,  by  way  of  the  abdomen, 
followed  if  necessary  by  abdominal  or  va- 
ginal drainage.  Normal  saline  solution  (5i 
ad  Oi)  may  be  administered  per  rectum  by 
Murphy’s  drop-method. 

If  the  inflammation  subsides  without  the 
necessity  of  operating,  keep  the  patient  in 
bed  for  the  most  part,  as  long  as  tenderness 
about  the  vaginal  vault  exists,  keep  the 
bowels  active,  and  prescribe  daily  hot 
vaginal  douches  of  normal  saline  solution 
lasting  about  fifteen  minutes.  Ever\"  third 
day  paint  the  vaginal  vault  with  tincture 
of  iodine,  and  insert  a boroglyceride  pack, 
which  should  be  removed  at  the  end  of 
twenty-four  hours,  followed  by  a douche 
(H.  A.  Kelly).  Warm  sitz-baths  are 
of  value. 

In  gonorrhoeal  salpingitis,  after  the  dis- 
appearance of  the  acute  symptoms,  ccelio- 
tomy  should  be  performed  and  the  diseased 
tubes  removed.  If  operation  is  declined,  or 
is  not  feasible,  keep  the  patient  in  bed  and 
give  hot  douches  until  there  is  no  pain  on 
walking;  then  allow  the  patient  up  and 
insert  glycerite  of  boroglycerine  tampons 
three  times  a week  (to  be  removed  at  the 
end  of  twenty-four  hours),  and  prescribe 
daily  hot  vaginal  douches  (Noble  and  Ans- 
pach, but  see  also  under  Gonorrhoea.) 

For  the  treatment  of  puerperal  cases,  con- 
sult Metritis. 

II.  Chronic  Inflaaevl^tion. — Evacuate 
walled-off  abscesses  per  vagina,  and  later 
remove  diseased  structures  through  the 
abdomen.  Open  the  abdomen  for  all  gross 
diseases  of  the  tubes. 

In  non-suppurative  cases,  where  the 
uterus  and  adnexa  are  dislocated,  and  per- 
haps bound  down  by  adhesions,  employ, 
twice  daily,  hot  sitz-baths  and  prolonged 
very  hot  vaginal  douches,  which  may  at 
times  be  followed  immediately  by  vagino- 
abdominal massage,  for  the  purpose  of 
stretching  adhesions  and  correcting  dis- 
placements. The  bladder  and  rectum  should 
be  empty  when  giving  massage.  Discon- 
tinue the  latter  if  fever  or  pain  results. 
Eveiy  third  day,  paint  the  vaginal  vault 
and  erosions  with  tincture  of  iodine,  and 


POL\TI  OF  THE  URETHRA 


insert  a boroglyceride  or  ichthyol  and  glycer- 
ine (25  per  cent.)  pack,  to  be  removed  at  the 
end  of  twelve  to  twenty-four  hours.  If  the 
uterus  can  be  replaced,  support  it  by  means 
of  a pessary  {q-v.).  Calomel,  gr.J^o  to  Ko> 
t.i.d. , and  atso  saline  laxatives,  and  potassium 
iodide,  are  recommended  to  promote  absorp- 
tion (see  Drugs,  Part  11). 

Enjoin  a quiet  life  with  frequent  rest,  no 
coitus,  careful  exercise  out  of  doors,  fresh 
air  day  and  night,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals,  a 
daily  morning  warm  bath  in  a warm  room 
before  breakfast,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regulation  of  the  bowels,  a nutritious 
non-stunulating  diet,  “ no  tea  or  coffee  in 
neurotic  cases,”  an  abdominal  binder  for 
relaxed  abdomen  {q-v.),  and  support  of  the 
clothing  from  the  shoulders  instead  of  from 
the  waist.  General  massage,  practiced  daily 
or  thrice  weekly,  is  very  beneficial.  A tonic 
may  be  desirable. 

If  faithful  conservative  treatment  is  insuf- 
ficient, an  operation  may  be  required.  Be- 
fore opening  the  abdomen,  curette  the 
uterus,  and  if  required  perform  trachelor- 
rhaphy or  resection  or  amputation  of  the 
cervix  (see  Cervical  Lacerations).  The 
intra-abdominal  measures  demanded  may 
be  removal  of  adhesions;  restoration  of 
the  patency  of  the  abdominal  tubal  ostium 
(rarely  permanently  effectual);  resection  of 
portions  of  the  ovary  (“  may  be  followed  by 
great  benefit  ”—E.  E.  Montgomery);  re- 
placement of  a displaced  uterus;  single  or 
double  salpingectomy  or  salpingo — oophor- 
ectomy; hysterectomy.  Tuberculosis  of  the 
reproductive  organs  calls  for  hysterectomy. 

Pelvic  Lymphangitis. — L.  lym'pha,  lymph 
-j-  Gr.  ayyeiov  vessel  -] — ltls  inflam- 
mation. See  Pelvic  Inflaimnatory 
Disease. 

Peritonitis;  Perimetritis. — Gr.  irepL 

around  -|-  reiveLv  to  stretch.  See  Pel- 
vic Inflammatory  Disease. 

Phlebitis. — Gr.  vein  -f  -ins  in- 

flammation. See  Pelvic  Inflamma- 
tory Disease. 

Perimetritis;  Pelvic  Peritonitis. — Gr.  Trepi 
around  -f-  prirpa  uterus  -f  -irts  inflammation. 
See  Pelvic  Inflammatory  Disease. 

Perinephric  Abscess. — Gr.  Trepi  around  -f 
veeppos  kidney.  Symptomatology. — Local  pain, 
tenderness  and  swelhng;  irregular  pyrexia; 
leucocytosis;  flexion  of  the  trunk  toward  the 
affected  side;  flexion  of  the  thigh;  pain  in  the 
knee.  There  is  a resemblance  to  hip  disease 
{q.v.,  in  Part  10,  Orthopsedics).  The  aspirat- 
ing needle  maybe  employed  in  doubtful  cases. 


Etiology.— Kidney  infection  (calculus  or 
other  variety  of  pyelitis  or  pyelonephritis, 
pyonephrosis,  metastatic  abscess,  tubercu- 
losis); pelvic  inflammatory  disease  in  either 
sex;  abscess  of  the  liver,  gall  bladder,  appen- 
dix, rectum,  psoas  muscle-sheath;  duodenal 
ulceration;  empyema;  spinal  tuberculosis; 
peripheral  infections  (furuncle,  tonsillitis, 
etc.) ; infectious  diseases  (typhoid  fever, 
measles,  scarlet  fever,  influenza,  gonorrhoea, 
puerperal  infection,  etc.) ; tramnatism  (contu- 
sion, penetrating  wound,  heavy  lifting,  hard 
riding,  sudden  strain);  foreign  body  from 
the  intestines;  diabetes;  general  debility. 

Treatment. — Make  a free  incision  and  gently 
explore  the  abscess  cavity  with  the  finger,  in 
search  of  an  appendix  or  other  source  of 
infection.  If  the  kidney  is  diseased,  it 
should  be  mci.sed;  and  if  it  is  mostly  des- 
troyed, it  should  be  removed.  A tubercu- 
lous kidney  should  be  removed.  Drain  the 
evacuated  abscess  cavity.  Irrigation  with 
hot  normal  saline  solution  (qi  acl  Oi)  may 
or  may  not  be  advisable. 

The  Prognosis  is  usually  good. 

Periodic  Intermenstrual  Pain.— See  In- 
termenstrual  Pain,  Periodic. 

Peritonitis,  Pelvic. — See  Pelvic  Inflam- 
matory Disease. 

Pessaries. — L.  pessa'rium  (See  under 

Retro-displacement) . 

Phlebitis,  Pelvic. — See  Pelvic  Inflamma- 
tory Disease. 

Phosphaturia. — Phosphate  -|-  Gr,  olpov 
lU’ine.  See  under  Nephrolithiasis,  in  Part  1, 
General  MecUcine  and  Surgery. 

Physometra. — Gr.  (pva-a  gas  + pyrpa 
uterus.  See  Atresia  of  the  Cervix. 

Pointed  Condylomata. — Gr.  KovSvKccixa 
wart.  See  Verrucse. 

Polycystic  Kidney. — Gr.  ttoXvs  many  -f 
Kvcms  cyst.  See  Tumors  of  the  Kidney, 

Polypi  of  the  Cervix. — Gr.  ttoXvs  many  + 
-b  irovs  foot;  L.  cer'vix,  neck.  A cervical 
pol}q)us  may  be  fibroid,  papillary,  or 
mucous.  The  latter,  a result  of  inflamma- 
tion, is  the  commonest.  Examine  micro- 
scopically for  malignancy.  Menorrhagia, 
metrorrhagia,  dysmenorrhoea,  and  leucor- 
rhoea  are  common  symptoms. 

Treatment. — Twist  or  cut  away  peduncu- 
lated polyiii.  The  hemorrhage,  which  is  not 
alarming,  may  be  checked  by  means  of 
gauze  or  hot  douching.  Excise  sessile  polypi 
well  below  the  base  of  the  growth  into  the 
healthy  tissue  of  the  cervix,  and  close  the 
wound  with  interrupted  sutures  (see  also 
under  Fibromyoma  Uteri). 

Polypi  of  the  Urethra. — See  Tumors  of 
the  Urethra. 


PROLAPSUS  UTERI 


Polypi  of  the  Uterus. — See  Fibromyoma 
Uteri. 

_ Polypoid  Endometritis. — Polypus  + Gr. 
ei5os  form.  See  Endometritis. 

Polyuria. — See  Part  1,  General  Medicine 
and  Surgery. 

Precocious  Menstruation. — See  Men- 

struation, Precocious. 

Pregnancy,  Extra=Uterine. — See  Extra- 
Uterine  Pregnancy. 

Premature  Labor. — See  Abortion,  Mis- 
carriage, and  Premature  Labor. 

Proctitis  and  Sigmoiditis. — See  Part  1, 
General  Medicine  and  Surgery. 

Profuse  Menstruation. — See  Menorrha- 
gia and  Metrorrhagia. 

Prolapse  of  the  Ovary. — L.  pro,  before  -f- 
la'bi,  to  fall.  The  condition  is  diagnosed  by 
the  palpation  of  a painful  prolapsed  ovary. 

Etiology. — Increase  in  weight  of  the  ovary 
due  to  subinvolution  (the  commonest  cause) ; 
clu’onic  ovaritis;  ovarian  tmuor;  chronic 
debility  causing  relaxation  of  the  ovarian 
supports;  external  violence;  sudden  strain; 
retrodisplacement  of  the  uterus;  adhesions; 
pelvic  tumor. 

Treatment.— Treat  cases  due  to  subinvolu- 
tion or  to  debility  as  described  under  Chronic 
Metritis.  The  prolapse  may  often  be  cured, 
if  no  adhesions  are  present,  by  the  per- 
sistent use  of  tampons  inserted  in  the  knee- 
chest  posture.  A pessary  cannot  be  worn. 
Have  the  patient  assmne  the  knee-chest 
posture  for  ten  or  fifteen  minutes  three 
times  a day,  at  the  same  tune  opening 
the  vaginal  orifice  with  the  fingers  so  as  to 
allow  air  to  enter.  She  should  sleep  on  her 
side  or  abdomen.  The  general  health  should 
receive  attention. 

If  palliative  measures  fail,  operate.  If 
the  ovary  has  dropped  into  Douglas’s  cul- 
de-sac,  one  may  break  tlu-ough  the  thin 
part  of  the  broad  ligament  between  the 
fallopian  tube  and  the  round  ligament, 
bring  the  ovary  through  the  opening,  and 
close  the  latter  by  suture  (E.  E.  Mont- 
gomery). The  infunchbulo-pelvic  ligament 
may  be  sutured  above  the  brhii  of  the  pelvis. 
If  the  ovary  is  chseased,  resect  the  diseased 
portion  or  perform  salpingo-oophorectomy. 

Prolapse  of  the  Rectum  and  Anus. — See 
Part  1,  General  MccUcine  and  Surgery. 

Prolapse  of  the  Urethral  Mucous  Mem= 
brane. — See  Eversion  of  the  Urethral 
Mucous  Membrane. 

Prolapsus  Uteri. — L.  pro,  before  -la'bi,  to 
fall;  ut'erus,  womb.  Three  degrees  of 
descensus  are  recognized,  1st  degree,  uterus 
in  extreme  retroversion;  2d  degree, 
cervix  descended  to  the  vulva;  3d  degree. 


uterus  partially  or  wholly  protruding 
from  the  vulva. 

Symptomatology. — Abdominal  and  pelvic 

pains,  the  latter  th’agging  in  character,  and 
extending  to  the  thighs;  vesical  and 
rectal  disturbances;  increased  menstrual 
flow  at  first,  later  diminished  flow;  leucor- 
rhoea;  sterility;  vaginitis. 

Etiology.— Pregnancy,  labor,  and  vaginal 
and  perineal  tears,  producing  relaxation  of 
the  uterine  supports;  increased  weight  of  the 
uterus  due  to  subinvolution,  metritis,  con- 
gestion, retained  fluid,  fibroids  and  other 
tmuors,  and  pregnancy;  uterine  retrodis- 
placement; fecal  accumulations,  pelvic  or 
abdominal  tmnors,  and  ascites,  causing 
pressure  from  above;  tight  lacing;  heavy 
clothing;  hea\y  work  and  lifting;  straining 
at  stool;  chronic  cough;  enlarged  or  habit- 
ually overchstended  bladder;  deformities  of 
the  vertebral  column;  vaginal  cicatrices, 
congenital  shortening  of  tlae  vagina,  and 
cervical  or  vaginal  tumors,  causing  traction 
from  below;  senile  atrophy  of  the  pelvic 
floor,  poor  general  health,  causing  relaxation 
of  the  supporting  stmetures  (visceroptosis) ; 
abnormally  large  pelvis. 

Treatment. — Treat  first  degree  of  descensus 
as  retrodisplacement  (q.v.).  One  may  try 
the  Albert  Smith  or  the  Hodge  pessary. 
A ring  pessary  may,  however,  be  required. 
(Ashton.) 

The  patient’s  general  health  should  re- 
ceive attention  in  all  cases,  and  correct 
hygiene  should  be  observed,  viz.,  adequate 
rest  and  exercise,  fresh  air  day  and  night, 
plain,  non-{X)isonous,  nutritious  food,  regu- 
lar hours  of  eating  and  sleeping,  rest  before 
and  after  meals,  regulation  of  the  bowels,  a 
daily  morning  warm  bath  before  breakfast 
in  a wamr  room  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  an  abdominal  binder  for  relaxed 
abdomen  {q-v.),  and  support  of  the 
clothing,  which  should  be  loose,  from  the 
shoulders  instead  of  from  the  waist.  A 
tonic  may  be  desirable. 

In  advanced  cases  of  prolapse,  prepare  the 
patient  for  radical  operation  by  the  following 
six  to  eight  weeks  treatment,  which  is 
designed  to  reduce  congestion  and  render 
local  and  constitutional  conditions  more 
favorable  for  a successful  result:  Enjoin  the 
observance  of  good  hygiene  as  directed 
above.  Replace  the  uterus  with  the  patient 
in  the  knee-chest  position  (the  bladder  and 
rectum  being  first  emptied) , and  retain  it  in 
place  by  means  of  tampons  inserted  daily 
anti  secureil  by  a \mivar  compress  and 
T-bandage.  Before  each  insertion  douche 


PRURITIS  VULV^ 


the  vagina  with  hot  normal  salt  solution 
(5i  ad  Oi),  or  alum,  3i  to  the  pint,  and 
dust  ulcerations  or  excoriations  with  equal 
parts  of  boric  acid  and  zinc  oxide,  or  boric 
acid  and  alum,  or  any  of  the  powders 
recommended  under  Vulvitis.  Twice  a week 
ulcers  may  be  touched  with  silver  nitrate, 
gr.  x-xxx  to  the  ounce.  Massage  of  the 
pelvic  organs  is  beneficial.  The  bowels 
should  be  kept  soft  with  laxatives,  e.g.,  cas- 
cara  sagrada,  or  compound  licorice  powder, 
or  rhubarb  (Part  II).  Three  or  four  times 
daily  the  patient  should  as.sume  the  knee- 
chest  posture  for  ten  to  fifteen  minutes  at 
a time.  The  clothing  should  be  loose  and 
supported  from  the  shoulders,  and  an  ab- 
dominal support  should  be  worn. 

Radical  operative  measures  embrace  dila- 
tation and  curettage  of  the  uterus;  repair, 
resection,  or  amputation  of  a lacerated  and 
diseased  cervix;  repair  of  a torn  perineum; 
anterior  and  posterior  colporrhaphy ; ventral 
suspension  or  fixation  of  the  uterus;  shorten- 
ing of  the  broad,  round,  and  utero-sacral 
ligaments;  supra- vaginal  hysterectomy  and 
fixation  of  the  cervical  stiunp  to  the  abdom- 
inal wall;  vaginal  hysterectomy  and  fixation 
of  the  vagina  to  the  broad  ligaments  by 
end-to-end  approximation  of  their  severed 
ends;  interposition  of  the  uterus  between 
the  bladder  and  the  anterior  vaginal  wall, 
permissible  after  the  child-bearing  period; 
correction  of  diastasis  of  the  recti  muscles 
in  pendulous  abdomen. 

Ventral  fixation  and  hysterectomy  are  not 
always  satisfactory.  The  former  operation 
should  be  accompanied  by  efficient  steriliza- 
tion in  order  to  insure  against  subsequent 
pregnancy.  The  “ interposition  ” operation 
of  Wertheim-Schauta,  combined  with  peri- 
neorrhaphy, is  indicated  in  elderly  women 
who  are  approaching  the  menopause  and 
where  there  is  a marked  cystocele.  The 
patient  should  be  rendered  sterile.  The 
operation  is  usually  curative,  but  it  is  con- 
traindicated if  the  uterus  is  very  large  or 
very  small  through  senile  atrophy. 

If  operation  is  refused,  or  is  not  feasible, 
or  the  patient  desires  children,  employ  a 
ring  pes.sary,  as  large  as  is  compatible  with 
comfort;  or  a cup  and  stem  pessary,  if  the 
cervix  is  not  excoriated,  attached  to  the 
waist  by  means  of  a T-binder;  or  colpeuryn- 
ters;  or  tampons,  which  should  fill  the  whole 
vagina.  Pessaries  and  colpeurynters  should 
be  removed  and  cleansed  at  bedtime,  and 
should  be  well  oiled,  say  with  zinc  ointment 
before  introducing  into  the  vagina.  A vag- 
inal douche  of  hot  water  should  be  taken 
night  and  morning.  Tampons  may  be 


dusted  over  with  any  of  the  powders 
enumerated  under  Vulvitis,  and  should  be 
removed  nightly.  If  the  patient  has  passed 
the  menopause,  the  vagina  may  be  packed 
with  gauze  or  oakimi  every  several  days. 

Pruritis  Vulvas — L.  prurir'e,  to  itch;  vul'va, 
vulva.  Etiology.— Pelvic  congestion  due  to 
constipation,  sedentary  life,  tight  lacing, 
pent-up  sexual  energy,  excessive  venery, 
pregnancy,  menstruation,  abdominal  and 
pelvic  tumors,  cardiac,  pulmonary,  renal, 
hepatic,  and  splenic  disease,  uterine  dis- 
placements, pelvic  inflammatory  disease; 
clhnacteric;  uterine  fibroids;  cancer;  tuber- 
culosis; leucorrhoea;  cervical  polyp;  cervi- 
citis; endometritis;  metritis;  salpingitis; 
vulvar  varices;  traumatism;  trichiasis;  ure- 
thral stricture;  uretln-al  polyp  or  caruncle; 
vulvitis ; vaginitis ; pessaries ; urethritis ; vul- 
var syphilis ; pediculosis ; fleas ; scabies ; thrush 
(mycosis,  characterized  by  white  patches); 
herpes;  zona;  eczema;  intertrigo;  urticaria; 
kraurosis  vulvse;  hemorrhoids;  proctitis  or 
sigmoiditis;  anal  fissure;  anal  fistula;  rectal 
tumors,  stricture,  or  foreign  body;  intestinal 
worms;  vesical  calculus;  cystitis;  uncleanli- 
ness; too  frequent  cleansing;  medicinal  sub- 
stances or  toilet  preparations  applied  to  the 
vulva;  decomposition  of  sweat;  incontinence 
of  urine;  very  acid,  alkaline,  purulent,  or 
saccharine  urine;  certain  foods  and  drugs 
(tea,  coffee,  alcohol,  tobacco,  morphine, 
iodine,  iodoform,  etc.);  ga.stro-intestinal 
toxaemia;  dental  caries;  gouty  or  rhemnatic 
diathesis;  nephritis;  diabetes;  toxaemia 
of  pregnancy;  jaundice;  heat;  cold; 
congenital  hyperaesthesia;  nervous  and 
psychical  disturbance. 

Treatment. — Endeavor  to  discover  and  re- 
move the  cause.  Enjoin  the  observance  of 
good  hygiene,  viz.,  adequate  rest  and  exer- 
cise, fresh  air  day  and  night,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
meals,  regulation  of  the  bowels,  a daily 
morning  warm  bath,  in  a warm  room, 
followed  by  a cold  spinal  douche  and  brisk 
rubbing  with  a coarse  towel,  bland  diet 
(excluding  spices,  comliments,  acids,  sauces, 
pickles,  sweets,  sausages,  veal,  fish,  shell- 
fish, tomatoes,  strawberries,  gooseberries, 
cabbage,  cauliflower,  cheese,  fried  foods, 
chocolate,  beer,  tea,  coffee,  excess  of  meat), 
water  in  abundance;  and  local  cleanliness, 
by  means  of  castile  soap  and  hot  water,  fol- 
lowed perhaps  by  hot  saturated  boric  acid 
solution  (4  per  cent.). 

In  pruritis  due  to  urinary  irritation 
(urethritis,  cystitis,  incontinence,  very  acid, 
alkaline,  purulent,  or  saccharine  urine,  etc.), 
cleanse  the  parts  after  each  urination,  and 


PRURITIS  VULV^ 


dust  on  subnitrate  of  bismuth  and  prepared 
chalk,  equal  parts  (Penrose),  or  apply  stiff 
vaseline  containing  10  to  20  or  more  grains 
of  menthol  to  the  ounce.  If  the  urine  is 
highly  concentrated  (high  s.g.),  prescribe 
potassiiun  acetate  or  citrate  in  large  doses, 
with  plenty  of  water  and  a skimmed  milk 
diet,  and  prohibit  alcohol,  spices,  and  acids 
(Noble  and  Anspach).  For  over-acid  urine 
prescribe  liquor  potassse,  or  sodium  bicar- 
bonate, or  potassium  salts,  and  belladonna. 
For  alkaline  urine  prescribe  sochmn  or  am- 
monium benzoate,  or  acid  sodium  phosphate 
or  boric  acid,  or  the  mineral  acids  (see 
Part  11).  For  diabetic  pruritus  Simpson 
reconunends  the  internal  administration  of 
sodium  salicylate,  gr.  xv,  in  glycerine,  every 


four  hours: 

II  Sodii  salicylatis oil 

Glycerini 5 i 

Aquae,  q.s.  ad 5iv 


M.  Sig. — Tablespoonful  in  water  every  four  hours. 

In  pruritus  due  to  irritating  vaginal  dis- 
charges, douche  the  vagina  several  times 
daily  with  sod.  bicarb,  and  sod.  biborate, 
aa5ss  to  the  gallon  of  warm  water,  and 
place  within  the  vagina  a lamb’s-wool  and 
cotton  tampon. 

In  the  pruritus  of  pregnancy,  enjoin  rest, 
and  prescribe  tepid  or  hot  douches  of  pot. 
permang.,  I to  3 per  cent.,  or  borax  or  tan- 
nin, 3i  to  the  pint.  The  parts  may  also  be 
bathed  with  1 to  2 per  cent,  cocaine  solution 
in  equal  parts  of  alcohol  and  water.  The 
vagina  may  be  lightly  packed  with  dry  cot- 
ton covered  with  a powder  to  absorb  secre- 
tions. If  these  measures  fail,  the  vagina 
may  be  swabbed  with  5 per  cent,  silver 
nitrate  solution  with  the  patient  in  the  knee- 
chest  posture,  or  the  silver  solution  may  be 
poured  in  through  a cylindrical  speculum, 
the  latter  slowly  withdrawn,  and  the  vagina 
douched  with  salt  water.  After  the  slough 
has  separated,  the  douches  are  resumed. 
“A  rigid  milk  chet  is  somethnes  followed  by 
excellent  results,”  says  J.  W.  Williams.  In 
extreme,  intractable  cases,  pregnancy  must 
be  terminated. 

For  post-menstrual  pruritus  are  recom- 
mended hot  douches  of  saturated  boric  acid 
solution  (4  per  cent.) 

In  trichiasis  (inverted  or  ingrowing  hairs), 
epilate  the  hairs  or  destroy  their  papillae  by 
electrolysis  (see  Hypertrichosis  under  Hair 
Diseases,  in  Part  5,  Skin  Diseases). 

For  thrush,  dust  the  parts  twice  a day, 
after  cleansing,  with  the  following  powder 


Acidi  salicylici gr.  ii 

Pulveri.s  camphora; gr.  iv 

Acidi  borici 5vi 

I’ulveris  ainyli oii 


or  employ  a saturated  solution  of  potassium 
chlorate  (H.  A.  Kelly). 

For  pediculosis  pubis  the  following  is 
highly  recommended  by  Noble  and  Anspach: 

II  Ilydrargyri  bichloridi gr.  iv 

Alcoholis, 

jEtheris,  aa gii 

Local  Antipruritic  Remedies: 

II  Pulveris  camphorse gr.  iv 

Mentholis gr-  x 

Acidi  carbolici gr.  xxv 

Adipis  lanse  hydrosi 5 i 

(H.  A.  Kelly.; 

II  Liquoris  plumbi  subacetatis ....  3 ii 

Tinctura;  opii qd 

Liquoris  calcis 5 vi 

II  ThymoUs gr.  xlviii 

Petrolati 5 i 

(Gottschalk.) 

II  Chlorali  hydrati, 

Camphorae,  aa 5i 

Tere  una  ad  liquorem,  dein  adde  cum  tritu  (rub 
together  until  an  oil  is  formed,  and  add) 

Unguenti  aquae  rosae Si 

Misce  et  fiat  unguentum. 

II  Acidi  acetici Si 

Glycerini S di 

(Goodell.) 

II  Potassd  hydratis  solutionis,  7 per  centum. 
Sig. — Apply  with  a brush.  (Scanzoni.) 


II  Olei  terebinthinae 5iv 

Petrolati  molhs,  q.s.  ad Si 

(W.  B.  Small.) 

II  Argenti  nitratis gr.  v-x 

Spiritus  aetheris  nitrosi Si 


II  Argenti  nitratis  solutionis,  1 per  centum. 

Sig. — Soak  for  hours  at  a time.  (H.  A.  Kelly.) 

II  Aquae  laurocerasi.  (H.  A.  Kelly.) 

II  Potassii  permanganatis,  0..5  to  1.0  per  cent. 

II  Tincturae  benzoinae  compositae. 

Sig. — Paint  on  every  night.  (Crocker.) 

II  Ichthyolis,  5 per  cent,  lotion,  or  10  per  cent, 
ointment. 

II  Unguenti  picis  liquidae. 


II  Chloroformi 3ss-i 

Petrolati Si 


II  Aquae  chloroformi. 

II  Cocainae,  gr.  i-x,  ad  lotionem  vel  unguen- 
tum S'i. 

II  Balsami  Peruvianae,  q.s. 

Petrolati,  q.s. 

Lavage  of  the  tailva  by  means  of  a pad  of 
absorbent  cotton  dipped  in  boiling  hot 
water  containing  three  or  four  tablespoon- 
fuls of  vinegar  to  the  quart.,  followed  by 
talcum  powder,  gives  prompt  but  usually 
only  transient  relief  (Dechaux).  Hot  sitz- 
baths  may  be  of  service.  The  X-rays  (light 
exposure  with  a hard  tube  every  one  to 
three  days)  are  highly  recommended.  Gal- 


RETENTION  OF  URINE 


vanism  with  the  anode  in  the  vagina  and 
the  cathode  (cotton  wet  with  salt  solution) 
moved  all  over  the  affected  parts,  and  using 
a current  as  strong  as  can  be  borne,  is  very 
highly  recommended.  Shaving  the  parts, 
under  an  anaesthetic,  and  scrubbing  off  the 
epidermis  with  soap  and  brush,  avoiding 
hemorrhage,  is  advocated  by  C.  Ruge.  Says 
Hirst:  “ The  best  single  remedy  I have 
found  is  a strong  solution  of  carbolic  acid  in 
cream,  3ss  to  5i,  followed  by  cold  cream.” 

If  all  other  measures  fail,  resort  to  linear 
scarifications  or  superficial  cauterization  or 
excision  of  the  diseased  tissues,  or  resection 
of  all  the  sensory  nerves  (see  Kelly  and 
Noble:  Gyncecoloqy  and  Abdo?ninal  Surgery, 
Vol.  I,  p.  329). 

Internal  Antipruritic  Remedies. — 
Tincturse  cannabis  indicse,  t^v,  increased  to 
i5^xx-xxx,  well  diluted,  t.i.d.p.c. 

Pilocarpinae  hydroclilorich  vel  nitratis,  gr. 
1^2  to  Mo)  or  sufficient  to  produce  slight 
perspiration,  to  be  repeated  when  the  effect 
wears  off. 

Tinctune  gelsemii,  i^x,  in  water,  every 
half  hour  until  3i  has  been  administered, 
unless  toxic  symptoms  (see  Part  II)  appear. 

Antipyrine,  phenacetin,  acetanelid,  lacto- 
phen,  bromide,  chloral,  valerian,  belladonna, 
lupulin,  strychnine,  calcium  chloride,  arsenic, 
quinine  in  large  doses  (see  Drugs,  Part  II). 

Puerperal  Infection. — L.  pu’er,  boy  + 
'par' ere,  to  bear.  See  Metritis. 

Pyelitis. — See  Pyelonephiatis,  below. 

Pyelonephritis.— See  Part  1,  General 
Medicine  and  Surgery. 

Pyometra. — Gr.  ttuov  pus  + ixi\Tpa  womb. 
See  Atresia  of  the  Cervix. 

Pyonephrosis. — Gr.  ttDoi'  pus  + ve4>p6$  kid- 
ney. See  Pyelonephritis. 

Pyuria. — See  Part  1,  General  Medicine 
and  Surgery. 

Rectal  and  Anal  Tumors. — L.  rec'tum, 
straight;  L.  a'nus;  L.  tu'mere,  to  swell.  See 
Part  1,  General  Medicine  and  Surgery. 

Rectal  Cancer. — See  Rectal  and  Anal 
Tumors,  in  Part  1,  General  Medicine 
and  Surgery. 

Fistulae. — Consult  gynaecological  text- 
books. 

Inflammation. — See  Proctitis,  Part  1. 

Prolapse. — See  Prolapse  of  the  Rectum 
and  Anus,  in  Part  1. 

Stricture. — See  Part  1. 

Tumors. — See  Rectal  and  Anal  Tumors, 
in  Part  1. 

Ulcer. — See  Proctitis,  in  Part  1. 

Rectitis. — See  Proctitis,  in  Part  1. 

Rectocele. — L.  rec'tum  -j-  Gr.  KrfKr]  hernia. 
See  Prolapsus  Uteri. 


Recto=Vaginal  Fistulae. — Consult  gynae- 
cological textbooks. 

Renal  Abscess. — L.  ren,  kidney.  See 
Pyelonephritis,  in  Part  1. 

Artery,  Aneurysm  of  the. — See  Aneur- 
ysm of  the  Renal  Artery. 

Calculus. — See  Nephrolithiasis,  in  Part  1. 

Cancer. — See  Tumors  of  the  Kidney. 

Colic. — ^See  NephroUthiasis,  in  Part  1. 

Cysts. — See  Tumors  of  the  Kidney. 

Epistaxis. — See  under  Haematuria. 

Fistula. — See  Fistula,  Renal. 

Hemorrhage. — -See  Haematuria. 

Inflammation. — See  Bright’s  Disease, 
and  also  Pyelonephritis,  in  Part  I, 
General  Medicine  and  Surgery. 

Injuries. — See  Kidney  Injuries. 

Stone. — See  Nephrolithiasis,  in  Part  1. 

Traumatism. — Gr.  rpavpa  wound.  See 
Kidney  Injuries. 

Tuberculosis. — See  Tuberculosis  of  the 
Kidney. 

Tumors. — See  Tumors  of  the  Kidney. 

Retention  of  Urine. — L.  retentio;  urina. 
The  condition  may  be  acute  or  chronic. 
Acute  retention  is  accompanietl  by  great 
pain.  In  chronic  retention,  dribbling  of 
urine  is  an  important  early  symptom.  In- 
spection and  percussion  reveal  a dis- 
tended bladder. 

Etiology.— Congenital  occlusion  of  the  mea- 
tus; inflaimnation  of  the  neck  of  the  bladder; 
prolonged  voluntary  retention;  effusion  of 
blood  within  the  bladder;  urethral  stricture; 
pelvic  tumors  (fibromyoma  uteri,  carcinoma, 
sarcoma,  cysts,  etc.);  vesical  tumor;  urethral 
tumor;  impacted  stone  or  foreign  body;  dis- 
placement of  the  pregnant  uterus;  exostosis 
of  the  pelvic  bones;  fecal  accumulation; 
peritonitis;  appendicitis;  paravesical  inflam- 
mation; atony  of  the  bladder,  due  to 
arteriosclerosis  of  the  vesical  vessels,  severe 
parenchymatous  cystitis  leading  to  sclerosis, 
and  unknown  causes;  paralysis  or  paresis  of 
the  bladder,  due  to  cerebral  or  spinal  dis- 
ease or  injury,  overdistention  or  injury  of 
the  bladder,  operation,  shock,  hysteria, 
fevers  (malaria,  diphtheria,  scarlet  fever, 
typhoid  fever);  vesical  spasm  (see  Bladder 
Irritability);  vaginitis;  fibrosclerosis  or  stric- 
ture of  the  neck  of  the  bladder;  valves 
at  the  neck  of  the  bladder;  contusion 
or  laceration  of  the  abdomen,  bladder,  or 
urethra;  operations  within  the  pelvis,  in  the 
rectum,  or  along  the  genito-urinary  tract, 
causing  sjihincteric  spasm;  jiarturition ; 
strangulated  hernia;  masturbation  and  nym- 
phomania; sudden  chilling  of  the  body. 

Treatment. — In  acute  retention,  employ  hot 
applications  to  the  hypogastrium  and  peri- 


RETRODISPLACEMENT  OF  THE  UTERUS 


neum,  hot  vaginal  lavage,  or  a hot  hii>bath, 
and  have  the  patient  attempt  to  urinate 
while  in  the  bath.  At  the  same  time  admin- 
ister hot  drinks,  and  perhaps  morphine  and 
atropine  hypodermically  for  the  purpose  of 
relaxing  sphincteric  spasm.  The  sound  of 
trickling  water  may  be  helpful.  If  these 
measures  fail,  resort  to  catheterization.  If 
the  bladder  is  extremely  chstended,  do  not 
withdraw  all  the  urine  at  once,  for  fear  of 
hemorrhage  and  collapse,  but  wait  a few 
hours  before  emptying  the  bladder;  or 
empty  the  bladder  very  slowly,  allowing  no 
less  than  twenty  minutes  for  its  complete 
evacuation.  Then  wash  it  out  with  warm 
boric  acid  solution,  5i“ii  to  the  pint,  if 
deemed  advisable,  and  achiiinister  urotropin. 
Continue  the  hot  applications  to  the  hypo- 
gastrium  and  perineimi,  and  give  a brisk 
purgative  (calomel,  or  castor-oil.) 

To  evacuate  clots,  insert  a large  glass  or 
metal  catheter,  and  irrigate  with  hot  salt 
or  alum  solution,  pi  acl  Oi;  or  hot  phenol 
solution,  1 per  cent.;  or  cool  sodium  bicar- 
bonate solution.  Rest  in  bed  is  essential. 
Opium,  fluid  extract  of  ergot,  hydrastis, 
stypticin,  and  fl.  ext.  senecio  aureus  may 
be  useful  (see  under  Htematuria). 

For  the  consideration  of  atony  and  paraly- 
sis or  paresis  of  the  bladder,  see  Paralysis 
and  Paresis  of  the  Bladder. 

For  the  consideration  of  vesical  spasm, 
see  Bladder  Irritability. 

Retrod isplacement  of  the  Uterus;  Retro= 
flexion,  and  Retroversion. — L.  ret'ro,  back- 
ward; bent;  versio,  turning.  Sympto= 

matology.— Pelvic  pain  or  discomfort  or 
heaviness  or  dragging  sensations,  especially 
marked  on  walking  or  standing;  backache; 
headache  (particularly  vertical);  constipa- 
tion and  chfficult  or  painful  defecation;  fre- 
quent and  painful  urination;  menorrhagia, 
metrorrhagia,  and  prolonged  menstruation; 
dysmenorrha?a;  leucorrhcea;  amenorrhoea; 
frequent  abortions;  sterility;  anaemia; 
digestive  and  nervous  disturbances; 
general  debility. 

Before  making  a bunanual  examination, 
always  see  that  the  bladder  and  rectum  are 
empty;  and  employ  by  preference  the  left 
hantl  m the  vagina  or  rectum.  Use  a uterine 
sound  or  probe  if  a tumor  or  inflaimnatoiy 
mass  causes  confusion  as  to  the  location  of 
tlu'  uterus. 

Etiology.— Relaxed  vaginal  outlet;  subinvo- 
lution or  chronic  metritis;  fibroids  in  the 
fundus;  intrapclvic  tumors;  traction  from 
inflammatoiy  adhesions;  tight  lacing; 
“ heavy  clotliing  suspended  from  the  waist  ” ; 
habitual  bending  forwartl  of  the  body  at  a 


bench  or  table;  increased  intra-abdominal 
pressure  caused  by  growths  or  the  accmnu- 
lation  of  fat  in  the  omentum  and  mesentery ; 
use  of  a tight  abdominal  binder  after  labor; 
“ lying  upon  the  back  too  long  after  con- 
finement ”;  sudden  muscular  effort,  straining 
at  stool,  lifting,  a fall  (particularly  upon  the 
buttocks),  and  active  exertion;  repeated 
pregnancies  causing  overstretching  of  the 
musculature;  chronic  cystitis  causing  con- 
traction of  the  bladder  and  consequent 
shortening  of  the  vesico- vaginal  septum; 
habitual  overcUstention  of  the  bladder  or 
rectum,  the  former  pushing  the  fundus 
backward,  the  latter  pushing  the  cervix 
forward;  general  debility  (visceroptosis); 
congenital  anomaly  (rare). 

Treatment. — According  to  Ashton,  recent 
cases,  of  less  than  a year’s  duration,  are 
possibly  amenable  to  conservative  treat- 
ment, while  chronic  cases  of  over  a year’s 
duration  demand  operative  treatment. 

About  15  per  cent,  or  more  of  the  cases 
are  claimed  to  be  cured  by  pessaries. 

Conservative  Treatment  (often  only 
palliative). — The  uterus  may  be  replaced, 
unless  it  is  fixed  by  adhesions  or  is  too  large 
or  too  tender,  by  either  the  bunanual 
method  or  the  knee-chest  method. 

Bimanual  method;  The  bladder  and  rec- 
tum being  empty,  the  clothing  loose,  and 
the  patient  in  the  dorsal  position,  the  follow- 
ing manoeuvre  may  be  employed.  With  the 
fingers  of  one  hand  in  the  vagina,  push  up 
against  the  fundus  uteri,  while  with  the 
fingers  of  the  other  hand  on  the  abdomen, 
get  behind  the  fundus  in  order  to  bring  it 
forward,  at  the  same  time  pushing  against 
the  anterior  surface  of  the  cervix  with  the 
internal  fingers  so  as  to  push  the  latter 
upward  and  backward.  H.  A.  Kelly  draws 
the  cervix  down  with  tenaculum  forceps 
grasping  its  anterior  lip,  then  with  a 
finger  in  the  rectimi  he  pushes  the  fundus 
forward,  then  pushes  the  cervix  well  back 
into  the  pelvis,  at  the  same  time  drawing 
forward  the  fundus  wdth  the  fingers  on 
the  abdomen. 

Knee-chest  method:  The  bladder  and 
rectum  being  empty,  the  clothing  loose, 
and  the  patient  in  the  knee-chest  or  the 
elevated  knee-chest  position,  retract  the 
perineum  well  with  Simon’s  speculum;  the 
uterus  may  then  fall  forward.  If  it  does  not, 
seize  the  anterior  lip  of  the  cerv'ix  with 
tenaculum  forceps,  and  draw  it  forward;  if 
the  fundus  does  not  then  fall  forw'ard,  push 
against  its  posterior  wall  with  a ball  of  absorb- 
ent cotton  held  in  dressing  forceps.  Then 
turn  the  patient  cautiously  on  her  back. 


RETRODISPLACEMENT  OF  THE  UTERUS 


After  replacing  the  uterus,  insert  a pack 
or  pessary.  Periuterine  adhesions,  pelvic 
inflammatory  disease  (pelvic  tenderness), 
inflammation  of  the  vagina,  bladder,  or 
urethra,  prolapse  of  the  ovary,  and  a 
relaxed  pelvic  floor,  contraindicate  the  use 
of  a pessary. 

If  the  uterus  is  too  large  or  tender  to  be 
replaced,  or  is  fitxed  by  adhesions,  employ 
intravaginal  pressure  with  glycerine  tam- 
pons and  massage,  for  the  purpose  of 
diminishing  uterine  congestion,  stretching 
adhesions,  and  increasing  the  tonicity  of  the 
ligaments.  Once  to  thrice  weekly,  with  the 
patient  in  the  knee-chest  posture,  insert 
into  the  posterior  fornix  a tampon  of  glycer- 
ite  of  boroglyceride  or  ichthyol-glycerine 
(10  to  15  to  25  per  cent.),  and  hold  in  place 
by  one  or  two  or  more  pledgets  of  cotton 
followed  by  a tampon  of  wool.  Attach 
strings  to  the  tampons  by  which  the  latter 
may  be  removed  by  the  patient  at  the  end 
of  eighteen  to  twenty-four  hours.  Have 
the  patient  employ,  twice  daily,  in  Sims’s 
semiprone  postme,  a prolonged  hot  vaginal 
douche  with  potassium  permanganate,  2 to 
3 per  cent.;  or  liquor  sodse  chlorinatse,  one 
teaspoonful  to  the  pint;  or  boric  acid,  one 
teaspoonful  to  the  pint;  or  lysol,  one  tea- 
spoonful to  the  quart;  or  formaldehyde. 


1 : 4000;  or  salt  solution,  one 
to  the  pint;  or  the  following: 

teaspoonful 

R Acidi  borici 

. 5vi 

Acidi  carbolici 

Pulveris  aluminis  exsiccati,  aa 

» i" 

. . oi 

Olei  gaultheriae 

..  3i 

Olei  menthae  piperitae 

, . 5ss 

M.  Sig. — A tablespoonful  in  a gallon  of  water. 
(H.  A.  Kelly.) 


At  bedtime  she  may  take  a hot  sitz-bath 
of  twenty  minutes’  duration,  and  on  retiring 
should  assume  the  knee-chest  posture  for 
ten  or  fifteen  minutes,  while  hokUng  the 
vagina  open  with  the  nozzle  of  a syringe  so  as 
to  allow  air  to  enter.  She  should  sleep  upon 
her  abdomen.  Twice  a week,  following  a 
bath,  vagino-abdominal  massage  may  be 
practiced  for  two  to  five  minutes,  for  the 
purpose  of  loosening  and  stretching  adhe- 
sions. It  is  followed  by  a glycerine  pressure 
tampon.  Massage  is  contraindicated  in 
the  presence  of  acute  or  subacute  peri- 
uterine inflammation. 

Enjoin  the  observance  of  good  hygiene, 
viz.,  adequate  rest  and  exercise,  abdominal 
exercises,  no  coitus  if  tenderness  is  present, 
fresh  air  day  and  night,  plain,  non-poisonous, 
nutritious  food,  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals,  regula- 
tion of  the  bowels,  a daily  morning  warm 


bath  before  breakfast  in  a warm  room,  fol- 
lowed by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  an  abdominal 
binder  for  relaxed  abdomen  {q.v.),  and  sup- 
port of  the  clothing  from  the  shoulders 
instead  of  from  the  waist.  A tonic  may 
be  desirable. 

After  all  inflammation  has  subsided  and 
adhesions  have  been  stretched,  an  attempt 
may  be  made  to  replace  the  uterus  by  one 
of  the  methods  above  described.  Dudley 
says;  “ The  length  of  time  that  should 
elapse  after  an  acute  inflammation  before 
manipulative  reposition  may  be  undertaken 
with  safety  is  not  less  than  two  months. 
Pyosalpinx  is  always  a contraindication.” 

If  the  uterus  cannot  be  replaced  (under 
anaesthesia  if  necessary)  after  two  or  three 
months  of  the  above  treatment,  operate  if 
feasible.  Says  Dudley:  “ In  certain  cases 
in  which  replacement  is  impracticable  or 
impossible  on  account  of  inflammation  or 
adhesions,  a soft  rubber  ring  may  be 
inserted,  and  will  sometimes  give  decided 
relief  by  lifting  the  uterus  and  pelvic  floor 
nearer  to  the  health  level.” 

If  the  retrochsplaced  uterus  is  pregnant, 
and  cannot  be  replaced  manually,  have  the 
patient  assiune  (the  bladder  and  rectum 
being  empty)  the  knee-chest  posture  night 
and  morning  for  gradually  increasing  per- 
iods up  to  twenty  minutes,  always  followed 
by  Sims’s  semiprone  posture.  Laparotomy  is 
demanded  in  severe  incarcerations  when 
reduction  cannot  otherwise  be  effected. 

Use  of  Pessaries. — The  physician  should 
keep  on  hand  an  assortment  of  hard  rubber 
pessaries  of  various  sizes  and  shapes.  Kelly 
says  that  the  ring  pessary  (no  less  than 
6 mm.  in  tliickness)  is  the  most  widely 
applicable;  and  that  the  Smith-Thomas- 
Munde  lever  pessary  comes  perhaps  next  in 
usefulness.  The  Albert  Smith,  Hodge,  and 
Thomas  pessaries  are  also  widely  used.  The 
Thomas  retroflexion  pessary  with  bulbous 
upper  extremity,  “ is  especially  applicable  in 
cases  of  great  relaxation  of  the  pelvic  floor 
and  of  comphcating  prolapse  of  the  ovaries,” 
says  Dudley.  “ The  thick  ring  pessaries, 
the  disc  pessaries,  the  shell  pe.ssaries,  and 
the  bayonet  handle  pessaries  (Menge)  should 
be  reserved,”  says  Kelly,  “ for  prolapsus 
cases.”  Schultze’s  sleigh  pessary,  Gehrung’s 
and  Skene’s  pessaries  are  employed  for  the 
correction  of  cystocele. 

After  replacing  the  uterus  and  pushing 
the  cervix  “ far  back  and  high  up,”  measure 
the  distance  between  the  inner  surface  of 
the  symphysis  and  the  sacral  promontory. 
This  should  be  the  length  of  the  pessary 


STERILITY 


(lever  pessary).  If  necessary,  the  anterior 
bar  may  be  indentured  to  form  an  arch 
beneath  the  urethra.  The  pessary  should 
be  wide  enough  to  fill  out  the  posterior 
fornix  (the  distance  the  fingers  can  be 
separated)  and  of  sufficient  curvature  behind 
the  cervix.  The  anterior  end  should  “ dis- 
appear behind  the  symphysis”  (Handler). 

The  pessary  should  extend  from  the 
posterior  fornix  to  the  internal  urinary 
meatus,  i.e.,  to  where  the  “ small  transverse 
folds  ” of  the  anterior  vaginal  wall  “ become 
merged  into  the  larger  oblique  folds  of  the 
vaginal  walls.”  The  curvature  of  a pessary 
may  be  altered  by  first  oiling,  then  heating 
the  pessary  over  an  alcohol  lamp,  then  bend- 
ing and  plunging  in  cold  water. 

“A  pessary  should  fit  snugly,  but  rather 
loosely.”  It  should  remain  in  place  when 
the  patient  bears  down  in  the  upright  pos- 
ture. It  should  never  cause  pain. 

The  vagina  should  be  cleansed  and  the 
bladder  and  rectum  emptied  before  introduc- 
ing a pessary,  and  the  latter  should  be  well 
lubricated.  While  wearing  a pessary  the 
patient  should  tlouche  the  vagina  once  or 
twice  a day  (night  and  morning)  with  plain 
hot  water  (adding  no  salt),  or  water  con- 
taining sod.  bicarb,  and  sod.  biborate, 
aaqi,  and  menthol,  gtt.  i,  to  each  pint 
(Kelly);  or  she  may  insert  a vaginal  sup- 
pository of  boroglyceride  and  gelatine, 
plain,  or  medicated  with  hydrastis,  ichthyol, 
tannin,  or  alum.  After  each  menstrual 
period  for  several  months,  and  thereafter 
every  two  or  three  months,  the  pessary 
should  be  removed  to  see  whether  its 
surface  has  become  roughened  or  it  fits 
well  or  not  (Kelly).  It  may  be  removed 
tentatively  at  the  end  of  three  or  four 
months.  Bfifteen  per  cent,  or  more  of  cures 
are  claimed  for  the  pessary. 

Radical  operative  measures  for  the  cure  of 
uterine  retrodisplacements  embrace  dilata- 
tion and  curettage;  repair,  resection,  or 
amputation  of  a lacerated  and  diseased  cer- 
vix; repair  of  a torn  and  relaxed  vaginal 
outlet;  ventro-suspension  of  the  uterus  by 
means  of  an  artificial  peritoneal  ligament 
(Kelly);  shortening  of  the  round  ligaments 
by  drawing  them  tlirough  the  abdominal 
wall  (Gilliam) ; or  through  the  canal  of 
Nuck  (Alexander) ; or  by  folding  them  behind 
the  uterus  (Webster);  shortening  of  the 
uterosacral  ligaments;  removal  of  tumors,  etc. 
The  best  results  are  usually  obtained  by  some 
method  of  shortening  the  round  ligaments. 
Alexander’s  operation,  however,  is  applicable 
only  rarely,  in  slight  cases  free  from  adhesions, 
tumors,  and  diseased  appendages. 


Following  any  form  of  operation,  preg- 
nancy should  not  be  allowed  for  a year. 

Retroflexion  of  the  Uterus. — See  Retro- 
displacements.) 

Retrolocation  of  the  Uterus. — L.  re'tro, 
backward  -|-  loca'tio,  placement.  Etiology. — 
Distended  bladder;  ante-uterine  tumor; 
traction  of  peritoneal  adhesions.  (Dudley.) 

Treatment. — Attend  to  the  cause.  In  post- 
inflammatory  cases,  bimanual  massage  and 
systematic  tamponade  of  the  vagina  may 
restore  the  uterus  to  its  normal  position  and 
mobility  (see  Pelvic  Inflammatory  Disease.) 

Retroposition  of  the  Uterus. — L.  ret'ro, 
backward  -T  pos'itus,  placed.  See  Retro- 
location,  above. 

Retroversion  of  the  Uterus. — See  Retro- 
displacements. 

Rupture  of  the  Bladder. — L.  ruptu'ra  from 
rum'pere,  to  break.  See  Bladder  Injuries. 

Sacculation,  Urethral. — L.  sac'culus,  little 
bag.  See  Dilatation  of  the  Urethra. 

Salpingitis. — Gr.  o-dXTriy?  tube  -F  -itls 
inflammation.  See  PeKfic  Inflammatory 
Disease. 

Salpingo=oophoritis. — Gr.  crakivLy  ^ tube  -f 
d)6r  egg  -F  4>optiv  to  bear  -| — trts  inflamma- 
tion. See  Pelvic  Inflammatory'  Disease.^ 

Sapraemia. — Gr.  aaTrpos  rotten  -F  al/xa 
blood.  See  under  Xletritis. 

Sarcoma. — Gr.  cdp^,  aapKos  flesh  + -ccpa 
tumor.  See  under  Tumors. 

Scanty  Menstruation. — See  Amenorrhcea. 

Senile  Vaginitis. — L.  seni'lis.  See  Vaginitis. 

Sigmoiditis. — Gr.  aLypa  letter  I + etdos 
form.  See  Proctitis  and  Sigmoiditis  in  Part  1. 

Skene’s  Glands,  Abscess  of. — See  Gonor- 
rhoea and  Vulvitis. 

Spasm,  Vesical. — Gr.  airaapios  spasm. 
See  Bladder  Irritability. 

Splanchnoptosis. — See  Part  1,  General 
Medicine  and  Surgery. 

Splenoptosis. — Gr.  aw\r]v  spleen  + -n-Tua-Ls 
fall.  (See  Splanchnoptosis,  above.) 

Stammering  of  the  Bladder. — Irregular 
spasmodic  urination.  See  Bladder  Irrita- 
bility. 

Stenosis. — Gr.  arevucLs  narrowing  or  stric- 
ture. (See  Atresia.) 

Sterility. — L.  steril'itas,  barrenness.  EtU 
ology.— Sterility  in  the  male  (see  Part  3,  on 
Genito-Ur inary  Diseases);  absent  or  rudi- 
mentaiy  or  maldeveloped  genital  organs, 
e.g.,  atresia,  imperforate  or  cribriform  hy- 
men, infantile  \ailva,  abnormal  backward 
location  of  the  vulva,  transverse  vaginal 
septum,  double  vagina,  shallow  vagina, 
vesical  or  rectal  vaginal  outlet;  elongated, 
shortened,  or  conical  cervLx,  one  cervical 
Up  overlapjiing  the  e.xteraal  os,  double 


STRICTURE  OF  THE  URETHRA 


uterus,  displacements  of  the  uterus,  exces- 
sively convoluted  or  lengthened  tubes,  tubal 
diverticula;  operative  removal  of  the  uterus, 
tubes,  or  ovaries;  uterine  and  ovarian 
atrophy;  tumors  of  the  genital  organs 
(fibroids,  polypi,  cancer,  ovarian  cysts,  etc.) ; 
microcystic  degeneration  of  the  ovaries; 
ovaritis;  salpingitis,  acute  and  chronic  and 
its  sequelae;  uterine  atresia;  hyperinvolution 
of  the  uterus;  uterine  displacements;  metri- 
tis; endometritis;  endocervicitis;  pelvic  ad- 
hesive peritonitis;  atresia  of  the  cervix; 
lacerated  cervix;  vaginitis,  producing  nocu- 
ous secretions,  adhesions,  stenosis,  shorting 
of  the  vagina,  or  dyspareunia;  vaginal  stric- 
ture following  sloughing  due  to  cUfficult 
labor;  broken  down  vaginal  outlet;  hyper- 
acid vaginal  secretions;  dyspareunia  due  to 
urethral  caruncle,  pruritis;  or  kraurosis  vul- 
vse,  traumatism,  tumors,  stricture,  vaginis- 
mus, vesico- vaginal  fistula;  genital  tubercu- 
losis; genital  syphilis;  conditions  associated 
with  menorrhagia  (q.v.)  ; overwork;  de- 
bility; wasting  diseases;  anaemia;  obesity; 
lithaemia;  chronic  alcoholism;  morphinism; 
cocainism;  chabetes;  chronic  nephritis;  infec- 
tive chseases  (tuberculosis,  syphilis,  rheu- 
matic fever,  typhoid  fever,  scarlet  fever, 
smallpox,  cholera,  mumps);  advanced  heart 
disease;  haemophilia;  cretinism;  exophthal- 
mic goitre;  habitual  masturbation;  violent 
psychic  disturbances;  impotence;  sexual 
incompatibility;  habitual  abortion  (q.v.). 
Gonorrhoea  often  causes  “one-child  sterility.” 

Hlihner’s  test  is  as  follows:  Have  the 
patient  come  to  the  office  at  least  one  hour 
after  coitus.  If  at  this  time  living  sperma- 
tozoa are  found  in  the  vaginal  secretions,  the 
husband  is  probably  potent.  If  dead  sperm- 
atozoa are  found,  either  the  husband  or  the 
vaginal  secretions  may  be  at  fault. 

Treatment. — One  should  aim,  of  course,  to 
correct  the  cause.  The  observance  of  good 
hygiene  goes  without  saying,  viz.,  adequate 
rest  and  exercise,  fresh  air  day  and  night,  a 
daily  morning  warm  bath,  before  breakfast, 
in  a warm  room,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
adequate  nutrition,  rest  before  and  after 
eating,  and  regulation  of  the  bowels.  The 
regimen  required  for  each  patient  depends, 
of  course,  upon  her  condition.  Iron,  arsenic, 
calcium  glycerophosphate,  ovarian  extract, 
thyroid  extract,  etc.,  may  be  variously 
indicated  (see  Part  11). 

An  infantile  or  hypoplastic  uterus  may 
develop  to  normal  in  the  course  of  months 
or  years.  Some  recommend,  beside  the 
above  hygienic  regimen,  daily  hot  douches. 


intra-uterine  electricity,  and  the  wearing  of 
a cervical  stem  pessary,  say  the  Wylie  drain. 
The  positive  electrode  of  a galvanic  battery 
is  placed  upon  the  abdomen  and  the  nega- 
tive electrode  within  the  uterus.  A weak 
galvanic  current  up  to  50  milliamperes  for 
five  minutes  is  employed  two  or  three  times 
weekly,  followed  by  light  uterine  massage 
(Bumm).  Many,  however,  condemn  intra- 
uterine electricity  as  highly  dangerous. 
Zekete  recommends  the  use  of  a cervical 
stem  pessary.  He  first  dilates  and  curettes 
the  uterus  and  swabs  its  cavity  with  tincture 
of  iodine;  then  inserts  the  pessary  which  is 
held  in  place  by  gauze  packing.  The  latter 
is  changed  each  day.  The  patient  is  kept 
in  bed  eight  days,  and  the  pessary  is  worn 
for  twenty  days  in  all,  being  removed  and 
cleansed  two  or  three  times.  The  use  of  an 
intra-uterine  pessary,  however,  is  attended 
by  great  danger  of  infection. 

For  cervical  stenosis,  Dudley’s  or  Rey- 
nold’s plastic  operation  may  be  indicated. 

An  elongated  cervic  may  be  amputated. 

Metritis,  pelvic  congestion,  and  leucor- 
rhoea  may  be  treated  as  directed  under 
Chronic  Metritis.  Gonorrhoeal  inflammation 
should  be  cured. 

A shallow  vaginal  vault  may  perhaps  be 
stretched  by  systematic  tamponing. 

Myomectomy  may  be  effectual. 

In  chronic  oophoritis,  E.  E.  Montgomery 
advises  resection  of  portions  of  the 
ovarian  structure. 

If  the  vaginal  secretions  are  hyperacid, 
instruct  the  patient  to  inject  a solution  of 
sod.  bicarb.,  5ii  to  the  quart  of  warm  water, 
or  milk  of  magnesia  immechately  before 
intercourse;  and  treat  a possible  gouty 
diathesis.  Alkalies  may  be  tried  internally. 

The  hips  may  be  elevated  upon  a pillow 
during  copulation  in  order  to  facilitate  the 
entrance  of  spermatozoa  into  the  cervi- 
cal canal. 

Says  Ashton:  “ The  most  frequent  causes 
of  sterility  are  tubal  in  origin  ” ; and  in  some 
cases  a plastic  operation  may  be  corrective. 
Says  Hirst:  “A  thorough  dilatation  of  the 
cervical  canal  cures  more  cases  of  sterility 
than  any  other  single  procedure.” 

Stone. — See  Calculus. 

Stricture  of  the  Cervix. — L.  strict 'ura. 

See  Atresia  of  the  Cervix. 

Rectum. — See  Rectal  Stricture. 

Ureter. — See  Hydronephrosis. 

Stricture  of  the  Urethra. — Urination  is 
slightly  slower,  more  frequent,  and  more 
difficult.  Partial  retention  and  incontinence 
may  occur.  The  diagnosis  is  made  by  means 
of  the  bougie-a-boule. 


TUBERCULOSIS  OF  THE  GENITAL  ORGANS 


Etiology.— Urethritis;  traumatism  resulting 
from  labor  or  operations;  caustics;  chancre; 
chancroid;  tuberculosis;  tumors;  periureth- 
ral infiltration  due  to  adjacent  malignant 
disease,  tumors  or  displacements  of  neigh- 
boring organs. 

Treatment. — The  treatment  of  cicatricial 
contraction  embraces:  (1)  Forcible  and 

gradual  dilatation,  under  anaesthesia,  at  one 
sitting,  up  to  one-half  an  inch,  employing 
Hegar’s  uterine  dilators;  the  latter  being 
passed  every  three  days  thereafter  for  two 
weeks,  and  after  that  every  four  to  six  weeks 
by  the  patient  herself;  (2)  Dilatation  by 
gradual  increments,  eveiy  third  day,  with 
bougies,  under  local  cocaine  anaesthesia  (10 
per  cent,  applied  on  a pledget  of  cotton), 
until  the  urethra  is  stretched  to  half  an  inch; 
subsequent  treatment  the  same  as  above; 
(3)  Division  of  dense  strictures,  under  gen- 
eral anaesthesia,  with  the  knife  or  Otis’s 
straight  dilating  urethrotome,  followed  by 
Hegar’s  dilators;  (4)  The  making  of  an  arti- 
ficial urethro-vaginal  fistula  just  behind  the 
stricture,  uniting  the  mucosae  with  inter- 
rupted catgut  sutures  (after  Ashton). 

Stricture  of  the  Uterus. — See  Atresia  of 
the  Cervix. 

Vagina. — See  Atresia  of  the  Vagina. 

Vulva. — See  Atresia  of  the  Vagina. 

Subinvolution. — L.  sub,  under  -J-  invo- 
lu'tio,  from  in,  into  -f  vol'vere,  to  roll. 
See  Metritis. 

Suburethral  Abscess. — L.  mb,  under  -f- 
Gr.  ovprjdpa  urethra.  Etiology.  — Inflamma- 
tion of  Skene’s  glands  or  of  a urethrocele. 

Treatment. — See  under  Gonorrhoea,  and 
Vulvitis. 

Superinvolution. — L.  sii'per,  over  -f  invo- 
lu'tio,  from  in,  into  vol'vere,  to  roll.  See 
under  Ainenorrhoea. 

Supplementary  Menstruation.— L.  sup- 
plement ar'ius.  See  JMenstruation,  Vicarious. 

Suppression  of  Menstruation. — L.  sup- 
pres'sio.  See  under  Ainenorrhoea. 

Suppurative  Nephritis. — L.  sub,  under  -f- 
pus,  pu'ris,  pus.  See  Pyelonephritis  in 
Part  1. 

Suprarenal  Inclusion  Tumor  of  the  Kid= 
ney. — L.  su'pra,  above  ren,  kidney; 
inclu'sio.  See  Tumors  of  the  Kidney. 

Syncytioma  Malignum. — See  Chorio-Epi- 
thelioma. 

Syphilis. — See  Part  1.  General  Medicine 
and  Surgery. 

Thrush. — See  Vulvitis,  and  Vaginitis. 

Traumatism. — Gr.  rpadpa  wound.  See 
Injuries. 

Trichiasis  of  the  Vulva. — Gr.  Tptx<ao-«  in- 
growing hairs.  See  under  Pruritus  Vulvte. 


Trigonitis. — Gr.  rpLyuvov  triangle  -b  -iris 
inflammation.  See  Cystitis. 

Tubal  Pregnancy. — L.  tu'ba.  See  Extra- 
Uterine  Pregnancy. 

Tuberculosis  of  the  Genital  Organs. — L. 

tuberc'ulum,  nodule;  genita'lis;  or'ganum;  Gr. 
opyavov.  A.  Vulva. — Lupus  vulgaris  is  a 
chronic,  painless,  granulomatous  disease  of 
the  skin  and  mucous  membranes,  caused  by 
the  tubercle  bacillus,  and  characterized  by 
the  occm’rence  of  deep  brownish-red  or 
apple-butter  colored  nodules  or  tubercles 
and  infiltrated  patches,  which  either  ulcerate 
or  atrophy,  leaving  scars  and  disfigurement. 
Under  pressure  with  glass,  yellow  spots  are 
visible.  A positive  diagnosis  is  made  by 
microscopic  examination  or  animal  inocula- 
tion. The  disease  usually  begins  in  early 
life.  It  is  rare  in  the  New  World,  but  com- 
mon in  Emope.  It  is  rebellious  to  treat- 
ment, but  usually  responds  eventually  if 
treatment  is  persisted  in.  Recurrence,  how- 
ever, is  conunon. 

Treatment.— Fresh  air  day  and  night,  ade- 
quate rest  and  exercise,  and  an  abundant 
nutritious  diet,  with  perhaps  codliver  oil, 
and  such  tonics  as  the  syrupus  ferri  iodidi, 
the  hypophosphites,  glycerophosphates,  and 
tinct.  cinchonse  comp,  are  of  the  first  im- 
portance. Thyroid  extract  is  well  recom- 
mended; also  tuberculin  (for  details  consult 
Tuberculosis,  Puhnonary,  in  Part  1,  General 
Medicine  and  Surgery). 

The  best  local  treatment  is  by  means  of 
the  X-rays  (q.v.  Part  1).  Stelwagon  gives 
the  following  directions:  “ Give  the  first 
exposures  cautiously  with  a tube  of  low  to 
mecUum  vacuum,  at  ten  inches  distance,  and 
for  five  minutes,  and  at  intervals  of  three  to 
four  days.”  “After  a period  of  ten  days  to  two 
weeks,  if  no  susceptibility  has  been  shown, 
the  chstance  can  be  gradually  reduced  to 
three  or  four  inches,  and  the  time  lengthened 
to  ten  or  fifteen  mmutes,  and  the  exposures 
made  at  more  frequent  interv'als.”  “ In 
those  instances  where  moderate  reaction 
has  been  purposely  provoked  and  kept  up, 
after  a few  weeks,  treatment  should  be  dis- 
continued till  this  subsides,  and  in  some 
cases  unprovement  sets  in  and  continues. 
The  method  should  again  be  resumed  as 
soon  as  improvement  begins  to  lag.”  The 
healthy  skin  is  protected  with  lead  or  tin 
foil.  While  employing  radio-therapy,  ulcers 
should  be  daily  cleansed  with  mild  anti- 
septics, such  as  boric  acid  solution,  3 to  4 
per  cent.,  or  bichloride,  1 : 4000  to  2000,  and 
continuous  wet  dressings  applied;  or  perhaps 
ung.  iodoformi,  or  ung.  hydrargvTi  aimnoniati, 
or  ung.  acidi  carbohci  may  be  deemed  prefer- 


TUMORS  OF  THE  BLADDER 


able.  Where  there  is  an  associated  acute 
inflammation,  calaminzinc  oxide  lotion  may 
be  applied  until  the  inflammation  subsides; 


Calamina', 

Zinci  oxidi,  aa 3i-ii 

Acidi  borici 3i 

Glycerini trgxxx 

Acidi  carbolici gr.  x 

Liquoris  calcis 5j 

Aqme,  q.s.  ad 5 iv 


M.  Sig. — Shake  well  before  applying. 

Ulcers  may  be  cauterized  with  lactic 
acid  applied  on  a wad  of  cotton  for  ten  to 
thirty  minutes  once  or  twice  daily,  using 
boric  ointment,  10  per  cent.,  in  the 
intervals  (Stel wagon). 

If  the  disease  is  limited  to  the  vulva,  a 
wide  excision  may  be  practiced,  and  the 
wound  closed  with  catgut  sutures.  Or  if 
excision  is  not  feasible,  one  may  under  gen- 
eral anaesthesia  curette  away  the  diseased 
tissues  thoroughly  with  a small  sharp  spoon, 
looking  well  after  the  edges,  followed  by  the 
application  of  pure  carbolic  acid,  or  pure 
nitric  acid,  or  the  actual  cautery.  Recur- 
rent nodules  may  be  bored  out  with  a 
matchstick  dipped  in  fuming  acid  nitrate 
of  mercury  (Crocker).  Iodoform  or  tincture 
of  iocUne  may  be  used  as  a dressing. 

B.  Vagina.— Excise  the  diseased  parts,  if  no 
other  organs  are  involved,  and  if  practicable; 
otherwise  employ  the  curette,  etc.,  as  des- 
cribed above.  In  the  presence  of  stenosis, 
the  scar  tissue  may  be  removed  and  the 
resulting  wound  sutured;  then,  after  union 
has  occurred,  vaginal  cUlators  may  be 
employed  until  the  danger  of  contraction 
is  past. 

C.  Cervix. — If  prunarily  and  solely  affected, 
amputate  the  cervix.  If  the  uterus  and 
tubes  are  involved,  do  a pan-hysterectomy. 
If  this  is  not  feasible,  employ  the  treatment 
described  under  vulvar  tuberculosis. 

D.  Uterus. — The  diagnosis  is  made  by  a 
microscopic  examination  of  the  uterine 
scrapings.  Do  a pan-hysterectomy,  if 
feasible;  otherwise  curette,  and  apply  tinc- 
ture of  iodine,  the  latter  to  be  repeated  twice 
weekly,  indefinitely.  An  iodoform  (gr.  v) 
suppository  may  be  inserted  into  the  uterus 
two  or  three  times  a week. 

E.  Fallopian  Tubes  and  Ovaries. — The  affection 
is  usually  bilateral.  The  ovaries  are  rarely 
affected.  The  tubes  are  indurated  and  nodu- 
lar. Do  a pan-hysterectomy,  if  feasible. 

Tubes,  Fallopian,  Inflammation  of  the. — 
See  under  Pelvic  Inflammatory  Disease. 

Tumors  of  the  Bladder.— L.  tu'mor,  from 
tu'mere,  to  swell.  Varieties.— Papilloma  or 
villous  tumor  (the  most  common;  it  tends 


to  become  malignant,  therefore  examine  the 
base  microscopically  for  signs  of  malig- 
nancy); carcinoma  (next  in  frequency,  but 
rare) ; adenoma,  fibroma,  myoma,  lipoma, 
angioma,  enchondroma,  sarcoma,  chorio- 
epithelioma,  cysts  (all  very  rare).  Papil- 
loma and  carcinoma  are  often  multiple  as  a 
result  of  contact  inoculation. 

Symptomatology.— Hsematuria,  usually  abun- 
dant (the  most  unportant  symptom) ; 
frequent  micturition;  pain;  cystitis;  sudden 
stoppage  of  the  urinary  stream  (may 
also  occur  in  stone);  fragments  of  tumor  in 
the  urine.  Make  a bimanual  and  cysto- 
scopic  examination.  A general  anaesthetic 
may  be  required  on  account  of  pain. 

Treatment. — Papillomata  are  best  treated 
through  a ureteral  catheterizing  cystoscope 
by  means  of  the  high-frequency  current 
(fulguration  h.Jul'gur,  lightning).  If  very 
many  tumors  are  present,  it  may  be  neces- 
sary to  open  the  bladder  suprapubically 
and  then  employ  fulguration.  The  tech- 
nique is  as  follows : Distend  the  bladder  with 
boric  acid  solution,  and  introduce  the  cysto- 
scope. Through  the  catheter  channel  of  the 
latter  introduce  a fulguration  catheter  con- 
nected with  one  pole  of  the  electrical  appara- 
tus, and  approach  it  to  the  tmnor.  The 
other  electrode,  in  the  form  of  a large  flat 
plate,  is  placed  under  the  buttocks  if  the 
tumor  occupies  the  base  of  the  bladder,  and 
over  the  hypogastrimn  if  the  tumor  is  in 
the  upper  wall  of  the  bladder.  Apply  the 
current  to  the  pedicle  of  the  tmnor,  if 
possible,  otherwise  begin  the  sparking  at  the 
periphery.  A large  pedunculated  tumor  may 
first  be  snared,  and  then  the  base  fulgurated. 
The  wire  may  either  be  inserted  into  the 
substance  of  the  tumor,  or  brought  almost 
in  contact  with  it.  Each  application  of  the 
current  may  last  from  three  to  five  minutes, 
or  less,  or  until  the  part  treated  is  thoroughly 
blanched.  The  whole  tumor  may  be  gone 
over  in  one  sitting,  or  several  sittings  at 
intervals  of  ten  to  fourteen  days  may  be 
required.  Remember  that  a certain  amount 
of  local  reaction  follows  this  mode  of  treat- 
ment. It  should  not  be  mistaken  for 
cancer.  (Kretschmer.) 

Casper  advises  against  excision  or  resec- 
tion operations  where  the  tumor  is  benign 
and  causes  inconsiderable  symptoms,  and 
also  in  malignant  cases  unless  “ stanchless 
hemorrhage  or  intolerable  and  uncontroll- 
able tenesmus  exist,”  when  a vesico-vaginal 
fistulashould  be  made  or  a suprapubic  cysto- 
tomy performed,  and  the  bladder  irrigated 
daily  through  the  urethra  with  warm  boric 
acid  solution,  5 i to  the  pint. 


TUMORS  OF  THE  VULVA 


The  X-ray  {q.v.  in  Part  1)  may  be  tried  in 
inoperable  cases,  and  also  following  operation, 
in  order  to  prevent  recurrence,  if  possible. 
For  the  latter  purpose,  irrigation  of  the  blad- 
fler  once  weekly,  for  at  least  a year,  with  a 5 
per  cent,  solution  of  resorcin  is  also  advised. 
Once  or  twice  a year,  for  at  least  three 
years  following  operation,  the  bladder  should 
be  examined  cystoscopically  for  possible 
recurrence. 

For  the  relief  of  pain,  strangury,  and  hem- 
orrhage, employ  rest,  an  ice-bag  to  the 
hypogastrium,  and  opiates  with  belladonna. 
For  the  treatment  of  severe  hemorrhage, 
see  under  Hsematuria. 

Tumors  of  the  Kidney. — The  diagnosis  is 
made  usually  only  on  exploratory  operation. 

1.  Simple  Cyst.— Characterized  by  slow 
growthunaccompanied  by  urinary  symptoms. 

Excise  as  much  of  the  cyst  as  possible, 
and  swab  any  remaining  portions  of  its  wall 
with  pure  carbolic  acid;  drain  by  means 
of  a tube. 

2.  Hydatid  orEchinococcusCyst. — Slow-growth. 
Should  the  cyst  rupture  into  the  renal 
pelvis,  the  urine  would  contain  booklets 
and  vesicles. 

Incise  the  cyst,  wash  out  its  contents, 
and  drain. 

3.  Polycystic  Degeneration. — The  symptoms 
and  urinary  changes  are  those  of  chronic 
interstitial  nephritis,  including  cardiac  hy- 
pertrophy and  arteriosclerosis,  together  with 
kidney  enlargement  presenting  an  irregular 
lumpy  surface.  Haematuria  is  common. 
Pyuria  may  occur.  It  is  often  congenital 
and  usually  bilateral,  therefore  nephrectomy 
is  contraindicated. 

The  treatment  is  that  of  chronic  nephritis 
{q.v.,  in  Part  1,  General  JMedicine  and 
Surgery).  Puncture  of  the  cysts  may  be  of 
use  in  controlling  symptoms.  (Rovsing). 

4.  Malignant  Tumors  (hypernephroma  or  su- 
prarenal inclusion  tumor,  sarcoma,  carci- 
noma).— Profuse  haematuria,  tumor,  pain, 
and  cachexia  are  the  characteristic  symp- 
toms. Catheterize  the  ureters  in  order  to 
ascertain  the  source  of  the  bleeding  and  also 
the  functional  activity  of  the  kidneys  (see 
Urinalysis,  Part  1). 

The  Prognosis  is  bad,  with  or  with- 
out operation. 

Perform  neiihrectomj',  unless  metastases 
have  occurred. 

5.  Benign  Tumors.— (fibroma,  lipoma,  ade- 
noma, myoma,  chondroma,  osteoma, 
myxoma,  angioma,  lymphangioma,  hunph- 
aclenoma,  papilloma  of  the  pelvis). 

Benign  tumors  are  very  rare.  They  are 
likely  to  become  malignant.  Hiematuria  is 


unusual;  enlargement  of  the  kidney  may 
be  the  only  symptom.  Nephrectomy 
is  indicated. 

Tumors  of  the  Ovaries. — See  Ovarian 
Tumors  and  Cysts. 

Rectum. — See  Rectal  and  Anal  Tumors, 
in  Part  1. 

Tumors  of  the  Urethra. — Varieties.— Pa- 
pilloma (see  Verrucae);  condyloma  (see 
Verrucse);  angioma  (see  Urethral  Caruncle); 
cyst  (known  as  mucous  polyp  if  peduncu- 
lated); fibroma;  sarcoma;  carcinoma  (all 
three  very  rare) ; elephantiasis  {q.v. ; in  Part 
5;  Skin  Diseases). 

Treatment. — Remove  benign  and  pedun- 
culated tumors  with  the  cold  or  galvano- 
cautery  snaje  or  scissors,  and  cauterize  the 
base.  Remove  small  multiple  growths  with 
the  themiocautery.  Excise  large  tumors 
(under  general  anaesthesia;  first  dilating  the 
urethra  with  the  cone  dilator)  with  the  knife 
in  their  long  axis,  and  suture  the  cut  sur- 
faces with  fine  interrupted  catgut. 

In  primary  malignant  disease,  remove  all 
the  growth  including  the  lymphatic  struc- 
tures extending  to  and  including  the  glands 
of  the  groin;  or  employ  radium  or  the  X-rays, 
(see  Part  1). 

In  non-pedunculated  cysts  of  the  urethra 
or  vagina,  snip  off  the  superficial  portion  of 
the  sac  with  scissors,  and  touch  the  base  with 
pure  carbolic  acid. 

Tumors  of  the  Uterus. — See  Cancer  of 
the  Uterus;  Cervdcal  Polypi;  and  Fibro- 
myoma  Uteri. 

Tumors  of  the  Vagina. — Varieties.— 
Cysts;  fibroma  or  fibromyoma;  sar- 
coma; carcinoma. 

Cysts  may  be  excised;  or  the  superficial 
portion  of  the  sac  may  be  snipped  off  with 
scissors  and  the  base  touched  with  pure 
carbolic  acid. 

Do  not  excise  growths  during  pregnancy 
or  the  puerperium,  because  of  the  danger  of 
severe  hemorrhage. 

Tumors  of  the  Vulva. — Varieties.- Varix 
{q.v.)]  haematoma  {q.v.)\  elephantiasis  {q.v.)\ 
cyst  of  a viil VO -vaginal  gland;  abscess  of  a 
\Tilvo-vaginal  gland  (see  Vulvitis) ; hydrocele 
of  the  labiimi  majus;  verrucse  {q.v.)]  papil- 
loma (see  Verrucse) ; lupus  {q.v.,  under  Tuber- 
culosis); lipoma;  fibroma,  or  myofibroma; 
mj-Tcoma;  osteoma;  enchondroma;  neuroma; 
angioma;  sarcoma;  carcinoma. 

Benign  tumors  may  be  excised.  A hydro- 
cele, if  irreducible,  may  be  aspirated,  and 
tincture  of  iodine  injected.  If  this  fails,  the 
sac  should  be  exsected. 

In  malignant  disease,  remove  all  the 
growth  including  the  lymphatic  structures 


UTERUS,  ABSCESS  OF  THE 


extending  to  and  including  the  glands  of  the 
groin;  or  employ  radium  or  the  X-rays  (see 
Part  1). 

Ulcer  of  the  Bladder. — L.  ul'cus.  See 
Cystitis. 

Rectum. — See  Proctitis. 

Vagina. — See  Vaginitis. 

Vulva. — See  Vulvitis. 

Ureteral  Calculus. — Gr.  ovprjTrjp  ureter;  L. 
calc'ulus,  pebble.  See  Nephrolithia- 
sis, in  Part  5. 

Obstruction. — See  Hydronephrosis. 

Urethral  Angioma. — Gr.  ovpiidpa;  ayyetov 
vessel  H — co/xa  tumor.  See  Urethral 
Caruncle. 

Carcinoma. — Gr.  KapKivos  crab  + -wpa 
tumor.  See  Timiors  of  the  Urethra. 

Urethral  Caruncle. — Gr.  ovpijdpa;  L.  car- 
un'cula,  dim.  of  car'o  flesh;  a little  fleshy 
tumor.  Urethra,!  caruncle  designates  a small 
painfid  vascular  tumor  of  the  urethra,  asso- 
ciated with  dysuria,  and  caused  by  irritating 
discharges  (due  to  gonorrhoea,  vulvitis, 
vaginitis,  senile  endometritis,  etc.). 

Treatment.— Benumb  the  mucous  mem- 
brane with  cocaine,  10  per  cent.,  applied  for 
ten  minutes.  If  the  tumor  is  pedunculated, 
draw  it  forward  with  toothed  forceps,  trans- 
fix the  pedicle  with  needle  and  silk  thread, 
tie  both  ways,  then  cut  off  the  pedicle  well 
beyond  the  ligature.  If  the  growth  is 
sessile,  lift  it  up  with  toothed  forceps,  re- 
move it  well  below  the  base,  in  order  to 
avoid  recurrence,  and  close  the  wound  with 
five  interrupted  catgut  sutures.  If  it  is 
large,  dilate  the  urethra  with  a cone  dilator, 
under  general  anaesthesia,  and  excise  the 
tumor  in  the  long  axis  of  the  urethra.  The 
actual  cautery  is  not  advised. 

Urethral  Condyloma. — Gr.  Kov8v\wpa  wart. 
See  Verrucae. 

Cyst. — Gr.  kvcttls  cyst.  See  Tumors  of 
the  Urethra. 

Dilatation. — See  Dilatation  of  the 
Urethra. 

Diverticulum. — L.  diverticuV are,  to  turn 
aside.  See  Dilatation  of  the  Urethra. 

Elephantiasis. — See  Elephantiasis,  in 
Part  5. 

Eversion. — See  Eversion  of  the  Ure- 
thral Mucous  Membrane. 

Fibroma. — L.  fl'bra,  fibre  + Gr.  -w/xa 
tumor.  See  Tumors  of  the  Urethra. 

Inflammation. — See  Urethritis. 

Papilloma. — L.  papil'la,  nipple-shaped 
elevation  -f  Gr.  -wpa  tumor.  See 
Verrucae. 

Prolapse. — L.  pro,  before  + lab'i,  to 
fall.  See  Eversion  of  the  Urethral 
Mucous  Membrane. 


Urethral  Sacculation. — L.  sac'culus,  little 
bag.  See  Dilatation  of  the  Urethra. 

Sarcoma. — Gr.  crap^,  aapKos  flesh  + -w/xa 
tumor.  See  Tumors  of  the  Urethra. 

Stricture. — See  Stricture  of  the  Urethra. 

Tumors. — See  Tumors  of  the  Urethra. 

Urethritis. — Gr.  obpr]dpa  urethra  + -ms 
inflammation.  Symptomatology. — F r c q u e n t 
and  painful  micturition;  if  pus  is  present, 
it  may  be  expressed  from  the  urethra  or 
from  Skene’s  glands  by  pressure  through  the 
vaginal  wall.  Examine  the  discharge  micro- 
scopically. See  Gonorrhoea. 

Etiology. — Gonorrhoea  (the  commonest 

cause) ; traumatism  (especially  in  childbuffh, 
sometimes  due  to  the  pas.sage  of  a calculus, 
to  chemical  irritants,  etc.);  urethral  tumors; 
foreign  bodies;  masturbation;  coitus;  pro- 
longed ungratified  sexual  desire;  concen- 
trated urine;  very  acid  or  alkaline  urine; 
unclean  catheter,  sound,  hand  or  pe.ssary; 
the  acute  exanthemata  (measles,  scarlet 
fever,  smallpox) ; syphilis;  tuberculosis;  diph- 
theria; erysipelas;  cystitis;  pyelonephritis; 
vulvar,  vaginal,  or  uterine  discharges. 

Treatment. — Attend  to  the  cause.  Salol, 
urotropin,  helmitol,  sandalwood,  copaiba,  and 
cubeb  maybe  of  service  (see  Drugs,  Part  11). 
If  the  urine  is  excessively  acid,  prescribe' sod. 
bicarb,  and  potassium  salts;  if  alkaline,  pres- 
cribe socL  or  ammon,  benzoate,  salol,  boric 
acid,  or  acid  sodium  phosphate.  Infusions 
of  uva  ursi  and  buchu  are  useful  sedative 
diuretics.  See  Eversion  of  the  Urethral  Muc- 
osa, for  the  treatment  of  this  complication. 

Urethrocele. — Gr.  ovpijopa  urethra  + /07XT7 
tumor.  See  Dilatation  of  the  Urethra 

Urethro=Vesical  Fissure. — ^See  Vesico- 
Urethral  Fissure. 

Urinalysis. — See  Part  1,  General  Medicine 
and  Surgery. 

Urinary  Incontinence. — See  Incontinence 
of  Urine. 

Retention. — See  Retention  of  Urine. 

Urination,  Absent. — See  Anuria. 

Abundant. — See  Polyuria. 

Difficult. — See  Dysuria. 

Frequent.— See  Polyuria. 

Painful. — See  Dysuria. 

Scanty. — See  under  Anuria. 

Uterus,  Abscess  of  the. — L.  uterus,  womb. 
I.  Abscess  within  the  uterine  cavity,  or 
pyometra,  due  to  cervical  atresia,  congenital 
or  acquired  (see  Atresia  of  the  Cervix.) 

II.  Abscess  within  the  uterine  wall, 
due  to  puerperal  infection,  gonorrhcea, 
or  traumatism. 

Diagnosis  is  difficult  or  impossible,  pyo- 
salpinx  being  frequently  diagnosed.  A lap- 
arotomy should  be  performed,  and  if  a 


VAGINISMUS 


solitary  abscess  is  found,  with  no  involve- 
ment of  the  adnexa,  the  abscess  should  be 
simply  evacuated  and  drained  through  the 
abdominal  wall.  If  multiple  abscesses  are 
present,  or  if  the  adnexa  are  involved,  or  the 
patient  has  passed  the  menopause,  hyster- 
ectomy should  be  performed. 

Uterus,  Anteflexion  of  the. — See  Ante- 
flexion of  the  Uterus. 

Antelocation  of  the. — See  Antelocation 
of  the  Uterus. 

Anteversion  of  the.- — See  Anteversion 
of  the  Uterus. 

Appendages  of  the. — See  under  Pelvic 
Inflammatory  Disease;  Ovarian  Tu- 
mors and  Cysts,  and  Prolapse  of  the 
Ovary. 

Ascent  of  the. — See  Ascensus  Uteri. 

Atresia  of  the. — See  Atresia  of  the 
Cervix. 

Cancer  of  the. — See  Cancer  of  the 
Uterus. 

Descensus  of  the. — See  Prolapsus  Uteri. 

Displacements  of  the. — See  Displace- 
ments of  the  Uterus. 

Fibroid  Tumors  of  the. — See  Fibro- 
myoma  Uteri. 

Hemorrhage  from  the. — See  Menor- 
rhagia and  Metrorrhagia. 

Inflammation  of  the. — See  Metritis. 

Inversion  of  the. — See  Inversion  of  the 
Uterus. 

Lateral  Location  of  the. — See  Lateral 
Location  of  the  Uterus. 

Prolapse  of  the. — See  Prolapsus  Uteri. 

Uterus,  Retrod isplacements  of  the. — See 
Retrodisplacements  of  the  Uterus. 

Retroflexion  of  the. — See  Retrodis- 
placements of  the  Uterus. 

Retrolocation  of  the. — See  Retroloca- 
tion  of  the  Uterus. 

Retroversion  of  the. — See  Retrodis- 
placements of  the  Uterus. 

Subinvolution  of  the. — See  Metritis. 

Superinvolution  of  the. — See  under 
Amenorrhcna. 

Tuberculosis  of  the. — See  Tuberculosis 
of  the  Genital  Organs. 

Tumors  of  the. — See  Cancer  of  the 
Uterus;  Cervical  Polypi;  and  Fibro- 
myoma  Uteri. 

Vaginal  Atresia. — L.  mgin'a,  a sheath. 
See  Atresia  of  the  Vagina. 

Cysts. — See  Tumors  of  the  Vagina. 

Fistulas. — Consult  gynaecological  text- 
books. 

Flatus. — See  Garrulity  of  the  Vulva. 

Inflammation. — See  Vaginitis. 

Tumors. — See  Tumors  of  the  Vagina. 

Ulcers. — See  under  Vaginitis. 


Vaginismus. — Spasmodic  contraction  of 
the  vaginal  orifice  upon  attempted  coitus  or 
examination.  The  patient  may  have  to  be 
anaesthetized  to  be  examined.  During  the 
examination,  if  nothing  is  discoverable,  over- 
stretch the  vagina  with  the  fingers. 
(H.  A.  Kelly.) 

Etiology.— Neurotic  temperament;  local  hy- 
peraesthesia;  masturbation;  ineffectual  at- 
tempts at  coitus  by  an  impotent  husband; 
inflammation  of  the  h>Tnen,  urethra,  bladder, 
vulva,  vagina,  rectum,  uterus,  tubes,  or 
ovaries;  painful  carunculae  myrtiformes; 
painful  scar  of  the  perineum  or  posterior 
vaginal  wall;  urethral  caruncle;  coccygody- 
nia;  neuroma  of  the  fossa  navicularis;  vari- 
cose veins;  prolapse  of  an  ovary;  unyielding 
hymen;  too  large  penis;  “ displacement  of 
the  fourchette  and  vulvar  orifice  upwards 
and  forwards”;  uterine  displacement;  lead 
poisoning. 

Treatment.— Attend  to  the  cause.  Treat 
fissures  by  divulsion  and  the  application  of 
silver  nitrate  solution,  10  per  cent.;  or  make 
a linear  dissection,  and  unite  the  cut  edges 
with  fine  catgut  (Kelly).  Destroy  sensitive 
papill*  with  the  electro-cautery  needle 
(Hirst)  . Remove  a urethral  caruncle  {q.v.) ; 
etc.  Prescribe  a hygienic  regimen  for 
the  strengthening  of  the  nervous  stamina. 
Correct  hygiene  embraces  adequate  rest  and 
exercise,  regular  hours  of  eating  and  sleep- 
ing, rest  before  and  after  meals,  nutritious 
food,  no  tea,  coffee,  or  alcohol,  regulation  of 
the  bowels,  fresh  air  day  and  night,  and  a 
daily  morning  warm  bath  in  a warm  room, 
before  breakfast,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel.  Have  the  patient  sleep  alone  during 
the  treatment,  and  take  hot  sitz-baths  night 
and  morning.  The  galvanic  current  (with 
the  positive  pole  to  the  vulva),  employed  for 
four  or  five  minutes  at  a time  every  two  or 
three  days  for  six  or  more  weeks,  is  well 
recommended.  The  bromides  may  be  of 
service  for  a time  as  a neiwous  sedative. 

Gradual  dilatation  of  the  vaginal  orifice 
may  be  jjracticed  three  or  four  times  a week 
by  means  of  a narrow  bladed  bivalve  specu- 
lum, which  is  slowly  opened  after  its  intro- 
duction; or  by  means  of  graduated  rectal 
bougies,  warmed  and  lubricated,  preceded 
by  the  application  of  cocaine  solution,  5 per 
cent.,  for  five  minutes.  The  bougie  should 
remain  in  place  one  hour,  with  the  patient 
recumbent.  It  should  be  inserted  at  fii’st 
every  day;  and  later,  at  the  patient’s  home, 
eveiy  other  day. 

If  gradual  dilatation  is  unsuccessful,  one 
may  resort  to  forcible  bimanual  dilatation 


VAGINITIS 


under  anaesthesia,  followed  by  the  use  of 
Sims’s  glass  vaginal  plug  for  a week,  with 
the  patient  in  bed,  the  plug  being  removed 
daily  and  the  vagina  douched.  For  two  or 
three  months  thereafter  the  patient  should 
insert  the  plug  for  one  hour  every  night  and 
morning.  (Ashton.) 

Or,  incisions  may  be  made  through  the 
levator  ani  muscles;  or  the  internal  pudic 
nerve  resected  (see  Kelly’s  Medical  Gynae- 
cology, p.  290;  Ashton’s  Gynaecology,  p. 
227;  Keen’s  Surgery,  Vol.  v,  p.  398). 

“ Normal  pregnancy  usually  effects  a 
cure,”  to  facilitate  which  the  cervix  may  be 
dilated. 

In  mild  cases,  it  may  be  sufficient,  before 
coitus,  to  apply  on  cotton  a solution  of 
cocaine,  4 to  10  per  cent.,  for  ten  minutes, 
followed  by  vaseline. 

Vaginitis. — L.  vagi'na,  sheath  + Gr.  -trts 
inflammation.  Symptomatology. — Local  swell- 
ing and  redness,  and  a curdy  or  milky  or 
creamy  leucorrhoeal  discharge.  A cervical 
discharge  is  stringy,  glairy,  viscid,  thick, 
tenacious,  and  mucoid,  like  the  white  of  an 
egg,  or  it  is  muco-purulent;  an  endometrial 
chscharge  is  more  serous.  A microscopic 
examination  may  be  made  (see  Gonorrhoea). 

Etiology.— Gonorrhoea  (q.v.) ; diphtheria 
{q.v.,  in  Part  1) ; vulvitis  (q.v.) ; constitutional 
diseases  (measles,  scarlatina,  varicella, 
anaemia,  chlorosis,  tuberculosis,  constipation, 
debility);  uncleanliness;  unclean  pessaries; 
lacerated  perinemn  causing  infection  from 
the  rectum ; excessive  masturbation  or  coitus; 
foreign  bodies;  uterine  discharges  occurring 
in  cervical  catarrh,  cancer,  sloughing  myoma, 
etc.  (see  Leucorrhoea) ; dysenteric  rectal  dis- 
charges; pelvic  congestion  (g.w.) ; operations; 
senile  changes  (senile  vaginitis,  occurring 
after  the  menopause  and  characterized  by 
the  formation  of  adhesions);  exposure  to 
cold;  fungi  (aphthous  vaginitis,  character- 
ized by  the  presence  of  white  patches,  and 
diagnosed  with  the  microscope  by  the 
demonstration  of  mycelium  and  spores,  after 
treating  with  a drop  of  liquor  potassse); 
traumatism;  scabies;  oxyuriasis;  strong 
astringents  (alum,  silver  nitrate,  jequirity, 
etc.)  producing  exfoliation;  fistulae,  gas- 
forming bacillus,  producing  gas  cysts  (em- 
physematous vaginitis) ; colpohyperplasia 
cystica,  a rare  cystic  vaginitis  characterized 
by  the  presence  of  numerous  small  cysts  in 
the  hypertrophied  mucous  membrane, 
of  good  prognosis,  and  occurring  mostly 
in  pregnancy. 

Treatment.— Attend  to  the  cause.  In  early 
or  acute  cases  put  the  patient  to  bed  for 
several  days,  on  liquid  and  later  soft  diet 
and  open  the  bowels.  Have  the  patient 
29 


douche  the  vagina  for  five  to  fifteen  minutes, 
twice  or  thrice  daily  with  a warm  or  hot 
solution  of  sochum  chloride,  3i  to  the  pint; 
or  sod.  bicarb,  and  sod.  biborate,  of  each 
3ss  to  the  pint;  or  boric  acid,  3i~ii  to  the 
pint;  or  alum,  3i  to  the  pint;  or  pot.  per- 
manganate, gr.  ii-viii-xv  to  the  pint;  or 
bichloride,  1 : 5000;  or  the  following: 


Olei  menthae  piperitae oiss 

Acidi  carbolici 3 iii 

Aluminis  pulveris 5 i 

Acidi  borici 5iv 


M.  Sig. — One  teaspoonful  to  one  quart  of  water. 
(H.  A.  Kelly.) 

If  the  pain  and  distress  are  great,  insert 
a rectal  suppository  containing  ext.  opii, 
gr.  i-ii,  and  ext.  belladonnse,  gr.  }/i.  Cool 
(vasoconstrictor)  or  tepid  (vasodilator)  or 
hot  (vasocon.strictor)  sitz-baths  may  be 
taken  once  or  twice  daily  for  the  relief  of 
pelvic  pain  and  distress.  The  discharge 
should  be  caught  on  cotton  pads  and  the 
latter  burned.  The  skin  may  be  protected 
with  boric  ointment,  10  per  cent.,  or  less. 

Once  or  twice  a week,  or  on  alternate  days, 
the  physician  may  introduce  at  the  office 
(best  through  a Sims  speculum  in  Sims’s  or 
the  knee-chest  posture)  with  long  dressing 
forceps  or  Kelly’s  two-pronged  packer,  from 
a dish,  tampons  saturated  with  borogly- 
ceride,  or  ichthyol  glycerine,  5 per  cent.,  or 
tannin-glycerine,  2 to  5 per  cent.,  or  argyrol, 
25  per  cent.,  or  protargol,  2 per  cent. 
Strings  are  attached  to  the  tampons  by 
which  they  are  removed  at  the  end  of 
twenty-four  hours,  followed  by  a douche. 
If  deemed  of  service,  the  entire  vagina  may 
be  dusted,  by  means  of  a puff  box,  with  one 
of  the  powders  mentioned  under  Vulvitis. 
Apply  to  erosions  twice  a week  pure  carbolic 
acid,  or  tincture  of  iodine,  or  silver  nitrate, 
gr.  XXX  to  the  ounce,  or  perhaps  carbolized 
vaseline,  3 to  5 per  cent.,  or  boric  oint- 
ment, 10  per  cent.,  or  ichthyol  in  lanolin, 
25  per  cent. 

Astringent  douches  are  useful  in  chronic 
vaginitis,  e.g.,  powdered  alum  and  zinc 
sulphate,  of  each  3ss  to  the  quart;  or  tannic 
acid  and  zinc  sulphate,  of  each  3i  to  the 
quart;  or  powdered  aluminum  acetate,  3i 
to  the  quart;  or  pot.  permanganate,  1 : 4000. 

In  intractable  cases,  one  may  apply 
through  a Ferguson  speculum,  by  means  of 
a cotton  swab,  to  all  parts  of  the  vagina 
including  the  cervix,  a 5 to  20  per  cent, 
solution  of  silver  nitrate,  or  50  per  cent, 
argyrol,  or  liq.  iocU  comp.,  or  1 to  2 per  cent, 
formaldehyde.  Kelly  paints  on  the  silver 
nitrate  until  the  whole  surface  is  blanched 
white,  then  packs  the  vagina  loosely  with 
iodoform  gauze,  and  keeps  the  patient  in 


VESICAL  CALCULUS  AND  FOREIGN  BODIES 


bed  for  several  days.  After  sloughing  occurs 
(in  a few  days),  hot  pot.  permanganate 
douches,  1 : 4000  are  employed.  The  silver 
nitrate  treatment  should  not  be  repeated 
within  two  to  four  weeks. 

Senile  vaginitis  is  treated  as  described 
above.  Bandler  recommends  daily  douches 
of  pyroligneous  acid,  3 to  5 drams  to  the 
quart.  Ulcerated  spots  should  be  painted, 
twice  a week,  with  silver  nitrate,  gr.  xxx  to 
the  ounce.  Kelly’s  cauterization  may  be 
employed.  Glycerine  tampons  and  oint- 
ments may  be  of  service. 

In  mycotic  vaginitis  (thrush),  employ 
boric  acid  douches,  and  apply  to  the  patches 
through  a Ferguson  speculum,  1 per  cent, 
corrosive  sublimate  or  3 per  cent,  carbolic 
acid.  Cleanliness  is  essential  for  prevention 
and  cure. 

In  cystic  vaginitis,  prick  the  vesicles,  and 
douche  with  boric  acid  solution.  The  dis- 
ease cUsappears  of  itself  after  delivery. 

In  vaginitis  due  to  constitutional  dis- 
eases, employ  a daily  mild  cleansing  douche, 
say  of  boric  acid  solution,  5i  to  the  pint. 

Varix  Vulvae;  Varicose  Veins  of  the  Vulva. 
— L.  va'rix,  pi.  va'rices,  swollen,  tortuous 
vein.  Etiology. — Pregnancy;  abdominal  or 
pelvic  tumors;  uterine  displacements;  portal 
obstruction;  pelvic  inflammator>^  disease; 
habitual  constipation;  straining  at  stool; 
prolonged  standing;  heavy  lifting. 

Treatment. — Correct  the  cause.  When  due 
to  pregnancy,  regulate  the  bowels,  support 
the  uterus  with  an  abdominal  binder,  and 
the  vulva  with  a compress  and  T-bandage, 
prescribe  hot  or  cold  lead  and  opium  wash 
for  the  relief  of  itching,  and  enjoin  frequent 
recumbency.  Unguentum  gallse  may  be  of 
service.  Rupture  should  be  guarded  against, 
because  of  the  danger  of  serious  hemor- 
rhage. The  condition  usually  disappears 
after  parturition.  (For  drugs,  see  Part  11.) 

Accidental  hemorrhage  should  be  con- 
trolled by  means  of  firm  gauze  compresses 
or  deep  catgut  sutures. 

In  non-pregnant  cases,  if  necessarj', 
the  veins  may  be  excised  between 
catgut  ligatures. 

Venereal  W'arts. — L.  vene'reus,  pertaining 
Venus.  (See  Verrucse,  below.) 

Verruca;;  Warts. — L.  verruca,  wart.  Clas= 
sification.— 1.  Ordinary  wart  or  shnple  papil- 
loma, verruca  xmlgaris. 

2.  Verruca  acuminata — pointed  condy- 
loma— venereal  wart — moist  wart — fig  wart — 
caulifiower  excrescences — vegetations;  skin 
colored,  pinlc,  or  purplish  led,  finger-like 
vegetations,  resembling  cauliflower,  cocks- 
comb, bunch  of  grapes,  or  mulberries. 

Causes. — ^Uncleanliness,  irritating  dis- 


charges, congestion  and  leucorrhcea  of  preg- 
nancy, gonorrhoea,  syphilis,  etc. 

3.  Flat  condyloma  or  moist  papule  of 
secondaiy  syphilis — modified  mucous  patch: 
“ soft,  grayish,  with  a broad  base.” 

Treatment.— 1.  VERRUCA  VuLGARIS. — Pick 
up  the  wart  with  toothed  forceps,  and  cut 
off  below  the  base  with  curv'ed  scissors,  or, 
better,  a sharp  knife.  Suture  the  skin  with 
catgut,  or  cauterize  with  pure  carbolic  acid 
or  silver  nitrate. 

2.  Verruca  Acuminata. — Pick  up  the 
growths  with  toothed  forceps,  and  excise 
with  curved  scissors  or  the  knife.  Cauterize 
the  base  with  silver  nitrate,  nitric  acid,  or 
the  thermocautery  at  a dull  red  heat,  or 
close  the  wound  with  interrupted  catgut 
sutures.  Enjoin  local  cleanliness.  Prescribe 
vulvar  and  vaginal  douches  with  hot  boric 
acid  solution,  5i  to  the  pint,  and  hot  sitz- 
baths.  Always  remove  the  growths  before 
the  onset  of  labor,  in  order  to  avoid  puerperal 
sepsis  and  ophthalmia  neonatorum. 

If  excision  is  not  feasible,  have  the  patient 
cleanse  the  parts  daily  with  soap  and  water, 
followed  by  a solution  of  pot.  permanganate, 
1 : 2000,  or  bichloride,  1 : 2000,  or  sahcylic 
acid,  5 to  10  per  cent,  in  equal  parts  of  alco- 
hol and  water;  then  dry  and  apply  an 
astringent  antiseptic  dusting  powder  of  cal- 
omel and  salicylic  acid,  aa;  or  zinc  oxide 
and  bismuth  subnitrate,  aa;  or  tannic  acid 
and  lycopodium,  aa;  or  alum,  gr.  vl  to  the 
ounce  of  boric  acid;  or  resorcin,  8 parts, 
bismuth  subnitrate  and  boric  acid,  aa  one 
part  (BcEck).  If  this  plan  fails,  curette  the 
growths,  and  apply  cautiously  glacial  acetic 
acid,  chromic  acid,  nitric  acid,  or  lactic  acid, 
the  surrounding  skin  being  protected  with 
vaseline.  Or,  freeze  the  growths  once  or 
twice  with  a stream  of  ethyl  chloride,  pro- 
tecting the  surrounding  sldn  with  drj'  cot- 
ton. “ The  most  valuable  local  application,” 
says  Keyes,  is  a 10  per  cent,  mixture  of 
salicylic  acid  in  acetic  acid  (not  glacial). 
“ It  forms  a chalk-and-w'ater  mixture  of 
which  the  moist  chalk  is  smeared  over  the 
warts.”  “ One  or  two  applications  cause  the 
growths  to  wither  away  and  drop  off.” 

3.  Condyloma  Syphilitica. — Employ  lo- 
cal antisepsis  and  specific  internal  medica- 
tion (see  Syphilis,  in  Part  1.) 

Vesical  Atony. — L.  vesi'ca,  bladder;  Gr.  a 
priv.  -f-  Tovos  tone.  See  Paralysis  and  Pare- 
sis of  the  Bladder. 

Vesical  Calculus  and  Foreign  Bodies. — L. 

vesi'ca,  bladder;  cal' cuius,  pebble.  Sympto- 
matology.—Frequency  of  micturition,  occur- 
ring during  the  day  and  increased  by  motion ; 
pain,  often  increased  at  the  end  of  micturi- 
tion, and  aggravated  by  motion;  possibly 


VESICO-URETHRAL  FISSURE 


reflex  pains  in  various  parts;  vesical  tenes- 
mus or  straining;  sometimes  sudden  stoppage 
of  the  urine;  hsematuria,  usually  at  the  close 
of  micturition. 

Examine  the  bladder  with  the  sound,  the 
cystoscope,  and  by  bhnanual  palpation.  The 
X-ray  {q.v.)  may  also  be  used.  Sterilize  the 
bladder  after  each  examination. 

Etiology.— Stone  from  the  kidney  (see 
Nephrolithiasis) ; foreign  body ; sutures  intro- 
duced through  the  mucous  membrane,  in- 
stead of  only  up  to  the  mucous  membrane; 
cystocele;  retention  of  urine  {q.v.)]  alkaline 
cystitis;  vesical  tumors. 

Treatment.— (chiefly  from  Ashton).  1. 
Vaginal  Cystotomy. — May  be  done  under 
local  anaesthesia.  It  is  contraindicated 
before  puberty.  If  cystitis  is  present,  unite 
the  vesical  and  vaginal  mucosae  with  inter- 
rupted catgut  sutures,  and  close  the  fistula 
when  the  inflammation  is  cured. 

2.  Suprapubic  Cystotomy'. — Indicated 

before  puberty  and  in  older  women  when 
the  stone  is  top  large  to  remove  per  vaginam. 
Distend  the  child’s  bladder  with  air  or  fluid 
before  making  the  suprapubic  incision. 

3.  Litholapaxy.— Crushing  of  the  stone 
by  means  of  a lithotrite  under  general  anaes- 
thesia, after  forcible  dilatation  of  the  urethra 
(see  Stricture),  and  washing  away  the  frag-, 
ments.  The  operation  should  be  preceded 
and  followed  by  the  achninistration  of  urotro- 
pin  and  bladder  irrigations.  It  is  contra- 
indicated if  the  stone  is  hard  or  encysted,  or 
over  134  to  2 inches  in  diameter,  if  the  blad- 
der capacity  is  less  than  four  ounces,  if  cystitis 
or  tumor  is  present,  and  before  puberty. 

4.  Extraction  per  Urethram. — Con- 
traindicated if  the  stone  is  over  one-half  inch 
in  diameter,  or  is  rough  or  sharp,  if  cystitis 
or  tumor  is  present,  and  before  puberty. 

Foreign  bodies  may  be  removed  through 
the  cystoscope  by  means  of  alligator  forceps 
or  hooks,  or  a suprapubic  or  vaginal  cysto- 
tomy may  be  required.  Wax  or  glass  bodies 
require  cystotomy  for  their  removal;  al- 
though Keyes  mentions  the  successful  use 
by  several  Germans  of  repeated  benzine 
injections  for  the  purpose  of  dissolving  wax 
or  tallow,  the  solution  being  washed  out  at 
the  end  of  half  an  hour.  The  benzine  is  said 
to  be  non-irritating. 

Vesical  Carcinoma. — See  Tumors  of  the 
Bladder. 

Contraction. — See  Bladder,  Contrac- 
tion of  the. 

Exostrophy. — See  Bladder,  Exostrophy 
of  the. 

Fistulae. — Consult  gynaecological  text- 
books. 


Vesical  Foreign  Bodies. — See  Vesical 
Calculus  and  Foreign  Bodies. 

Hemorrhoids. — Gr.  aina  blood  + poLa 
flow.  See  Haematuria. 

Hyperaemia. — Gr.  vwep  over  -|-  dcpa 
blood.  See  Bladder  Irritability. 

Inflammation. — See  Cystitis. 

Injuries. — See  Bladder  Injuries. 

Irritability. — See  Bladder  Irritability. 

Neuralgia  or  Neurosis. — -Gr.  vevpov  nerve 
-k  aXyos  pain.  See  Bladder  Irrita- 
bility. 

Papilloma. — L.  papil'la  -f-  Gr.  -upa 
tmnor.  See  Tumors  of  the  Bladder. 

Paralysis  and  Paresis. — See  Paralysis 
and  Paresis  of  the  Bladder. 

Rupture. — See  Bladder  Injuries. 

Sarcoma. — Gr.  crdp^,  aapKos  flesh  -| — wpa 
tumor.  See  Tumors  of  the  Bladder. 

Spasm. — Gr.  (nracrpds.  See  Bladder 
Irritability. 

Stone. — See  Vesical  Calculus. 

Traumatism. — Gr.  rpZvpa  wound.  See 
Bladder  Injuries. 

Tuberculosis. — L.  tuber'culum,  nodule. 
See  Cystitis. 

Tumors. — See  Tumors  of  the  Bladder. 

Ulcer. — L.  ul'cus.  See  Cystitis. 

Vesico=Urethral  Fissure. — L.  vesi'ca,  blad- 
der; Gr.  ovpr]6pa  urethra;  L.  fissura,  cleft. 

Symptomatology. — Constant  desire  to  urin- 
ate; constant  burning;  pain  on  pressure  over 
the  neck  of  the  bladder;  pain  during  and  at 
the  end  of  micturition;  vesical  tenesmus 
or  straining. 

The  diagnosis  is  made  by  means  of 
the  urethroscope. 

Etiology.— Gonorrhoeal  urethritis;  bladder 
displacements;  traumatism  due  to  labor,  or 
instrumentation,  or  the  passage  of  a stone. 

Treatment.— Prescribe  a perfectly  bland 
diet,  preferably  milk  (see  under  Gonor- 
rhoea), and  copious  water  drinking,  two 
to  three  quarts  daily  for  several  days. 
For  painful  urination,  where  the  urine  is 
acid,  prescribe  the  following: 

Potassii  acetatis  vel  ci- 

tratis §i  (gr.  xx  per  do.se) 

Tincturffi  hyoscyami 5i  (HExx  per  dose) 

Aquae,  q.s.  ad giv 

M.  Sig. — Teaspoonful,  well  diluted,  three  or  four 
times  a day. 

If  the  urine  is  alkaline,  prescribe  sod.  or 
ammon.  benzoate,  boric  acid,  acid  sodium 
phosphate,  or  salol  (see  Part  II). 

Under  general  anaesthesia,  dilate  the 
urethra  forcibly  and  gradually  up  to  half  an 
inch  with  Hegar’s  uterine  dilators;  keep 
the  patient  in  bed  one  week,  and  give 
diluent  drinks. 


VULVITIS 


Should  the  above  treatment  fail,  make  an 
artificial  vesico-vaginal  fistula,  after  first 
dilating  the  urethra  a second  time,  and 
irrigate  the  bladder  daily  through  the  fistula 
with  boric  acid  solution,  gr.  xv  to  the  ounce. 
Use  no  sutures;  the  fistula  “ usually  closes 
spontaneously  by  the  time  the  fissure  is 
healed.”  (After  Ashton.) 

Vesico=Vaginal  Fistulae. — Consult  gynse- 
cological  textbooks. 

Vicarious  and  Supplementary  Menstrua= 

tion. — See  Menstruation,  Vicarious  and 
Sup])lementaiy. 

Visceroptosis. — L.  vis'cus,  viscus  + Gr. 
TTTuaLs  fall.  See  Splanchnoptosis  in  Part  1. 

Vulva,  Angioma  of  the. — L.  vul'va;  Gr. 
ayyeLov  vessel  + -cofia  tumor.  See 
Tumors  of  the  Vulva. 

Atresia  of  the. — See  Atresia  of  the 
Vagina. 

Atrophy  of  the.— Gr.  a neg.  + rpo<^j) 
nutrition.  See  Kraurosis  Vulvse. 

Cancer  of  the. — L.  can'cer,  crab.  See 
Tumors  of  the  Vulva. 

Cysts  of  the  . — Gr.  KvcTTLs  cyst.  See 
Tumors  of  the  Vulva. 

Elephantiasis  of  the. — See  Elephantia- 
sis, in  Part  5,  Skin  Diseases. 

Enchondroma  of  the. — Gr.  ev  in  + 
xbvbpos  cartilage  + -copa  tmnor.  See 
Tmnors  of  the  Vulva. 

Epithelioma  of  the. — Gr.  evrl  on  + 077X17 
nipple  -b  -w/xa  tiunor.  See  Tumors 
of  the  Vulva. 

Fibroma  of  the. — L.  fi'bra,  fibre  -|-  Gr. 
-copa  tumor.  See  Tumors  of  the  Vulva. 

Gangrene  of  the. — See  Gangrene  of  the 
Vulva. 

Garrulity  of  the. — See  Garrulity  of  the 
Vulva. 

Haematoma  of  the. — See  Hacmatoma 
Vulvae. 

Herpes  of  the. — SeeHerpes  Progenitalis. 

Hypertrophy  of  the. — Gr.  vwep  over  -|- 
Tpoi.^  nutrition.  See  Elephantiasis, 
(in  Part  5,  Skin  Diseases). 

Inflammation  of  the. — L.  inflamvia're,  to 
set  on  fire.  See  Vulvitis. 

Itching  of  the. — See  Pruritls  Vulvae. 

Kraurosis  of  the. — See  Kraurosis  Vulvae. 

Lipoma  of  the. — Gr.  Xliros  fat  + -copa 
tumor.  See  Tumors  of  the  Vulva. 

Lupus  of  the. — L.  lup'us,  wolf.  See 
Tuberculosis  of  the  Genital  Organs. 

Myoma  of  the.^ — Gr.  pus  muscle  + -copa 
tumor.  See  Tumors  of  the  Vulva. 

Myxoma  of  the. — Gr.  pu^os  mucus  + 
-topa  tumor.  See  Tumors  of  the  Vulva. 

Neuroma  of  the. — Gr.  vevpov  nerve  -f- 
-oipa  tumor.  See  Tumors  of  theVulva. 

(Edema  of  the.— SeeQ^dema  of  the  Vulva. 


Vulva,  Osteoma  of  the. — Gr.  oarkov  bone  -f- 
-wpa  tumor.  See  Tiunors  of  the  Vulva. 

Pruritus  of  the. — See  Priu-itus  Vulvae. 

Sarcoma  of  the. — Gr.  o-ap^,  aapKo%  flesh 
H — copa  tiunor.  See  Tumors  of  the 
Vulva. 

Trichiasis  of  the. — Gr.  TpixtoL(ns  in- 
growing hairs.  See  under  Pruritus 
Vulvae. 

Tuberculosis  of  the.- — See  Tuberculosis 
of  the  Genital  Organs. 

Tumors  of  the. — See  Tumors  of  the 
Vulva. 

Ulcers  of  the. — L.  uVcus,  ulcer.  See 
Vulvitis. 

Varicose  Veins  of  the.— See  Varix  Wilvae. 

Vulvitis. — L.  vul'va,  -|-  Gr.  -ins  inflamma- 
tion. Etiology.— Gonorrhoea  (5.P.) ; lupus  (q.v.); 
herpes  progenitalis  (q.v.);  epithelioma  (g.w.) ; 
diphtheria  {q.v.,  in  Part  1);  acute  infectious 
chseases  (scarlet  fever,  measles,  smallpox); 
noma  (q.v.) ; erysipelas  (q.v.,  in  Part  1) ; tuber- 
culosis (q.v);  syphilis  (q.v.);  chancroid  (q.v.); 
fungi  (mycosis;  aphthous  vulvitis : character- 
ized by  yellow  or  white  spots  which  show 
mycelium  and  spores  under  the  microscope, 
after  treating  with  a drop  of  liq.  potassie); 
pecUculosis  pubis  {q.v.);  oxjnirias  (q.v.,  in 
Parti);  uncleanliness;  irritating  discharges 
from  the  urethra,  bladder,  ureters,  kidneys, 
vagina,  ceiwix,  uterus,  tubes,  and  rectiun; 
fecal  and  urinarj^  fistulae;  diabetic  urine; 
masturbation;  excessive  coitus;  traumatism; 
constitutional  diseases  (debility,  anaemia, 
constipation,  diabetes,  gout,  rheumatism, 
tuberculosis);  obesity,  causing  intertrigo; 
folliculitis  (inflanunation  of  a sebaceous, 
hair  or  sweat  follicle) ; senile  changes  (see 
senile  vaginitis).  Ulcer  of  the  vulva  maybe 
due  to  simple  inflammation,  tuberculosis, 
epithelioma,  chancre,  chancroid,  or  herpes 
progenitalis. 

Treatment. — Treat  the  cause. 

1.  Acute  Inflamaiation. — ^Enjoin  rest  in 
bed,  on  a light,  bland  diet,  and  open  the 
bowels.  Instruct  the  patient  to  keep  the 
parts  cleansed  with  castile  soap  or  glycerine 
soap  and  warm  water,  and  to  douche  or 
lave  the  \ulva  three  or  four  times  daily 
with  boric  acid  solution,  pi  to  the  pint;  or 
aluminum  acetate  gr.  xv  to  the  pint;  or 
bicarbonate  and  biborate  of  socUum,  aa5i 
to  the  pint;  or  bichloride  of  mercury, 
1 : 10,000  to  1 : 5000.  She  may  use  for  the 
purpose  cotton  balls  held  in  dressing  forceps 
and  soaked  in  the  solution.  The  folds  of  the 
\ulva  should  bo  kept  apart  with  moist  gauze. 
To  relieve  burning,  itching,  and  throbbing, 
employ  the  hot  sitz-bath  for  fifteen  minutes 
twice  daily,  or  the  constant  application  of 
lead  and  opium  wash  (Part  11).  The 


THE  GYNAECOLOGICAL  ARMAMENTARIUM 


local  application  of  the  ice-bag  may  also 
be  useful  for  this  purpose. 

In  suppurative  Bartholinitis,  lay  open  the 
gland  by  means  of  an  incision  in  the  labium 
at  the  junction  of  skin  and  mucous  mem- 
brane, and  drain  the  abscess  cavity  with 
gauze.  Lay  open  infected  urethral  or  Skene’s 
glands  through  the  vagina,  after  inserting  a 
probe  (about  half  an  inch),  and  cauterize 
with  pure  carbolic  acid,  or  zinc  chloride, 
2 per  cent.,  or  the  silver  stick,  or  the 
actual  cautery. 

2.  Chronic  Inflammation. — Have  the 
patient  douche  the  parts  with  bichloride 
solution,  1 : 3000,  or  carbolic  acid,  3 per 
cent.,  or  an  astringent  such  as  copper  or 
zinc  sulphate,  3ss  to  the  pint;  or  paint  on 
argyrol,  25  per  cent.,  or  silver  nitrate,  10 
per  cent.,  or  formaldehyde,  1 per  cent.,  or 
bichloride,  1 : 1000;  and  keep  the  apposed 
surfaces  of  the  vulva  separated  with  gauze 
and  dusted  with  powder,  e.g.,  tannic  acid 
and  bismuth  subnitrate,  equal  parts;  or 
salicylic  acid,  gr.  xx,  and  zinc  oxide  and 
powdered  starch,  aa5ss;  or  menthol,  gr.  xv, 
salicyhc  acid,  3 i,  zinc  oxide,  3 h,  and  starch 
and  talcum,  3v;  or  calomel  and  subnitrate 
of  bismuth,  equal  parts;  or  boric  acid  and 
subnitrate  of  bismuth  or  zinc  oxide,  equal 
parts;  or  camphor,  gr.  iii,  and  boric  acid, 
5i;  or  alum,  3i,  and  boric  acid,  3iv,  or 
equal  parts  of  each;  or  powdered  burnt  alum 
and  acetanelid,  equal  parts.  For  itching, 
add  carbolic  acid,  2 to  5 per  cent.,  to  the 
powder.  For  profuse  secretion,  add  alum, 
lead  acetate,  or  tannic  acid,  25  per  cent. 
Ulcers  should  be  touched  with  silver  nitrate, 
10  to  20  per  cent.;  and  zinc  oxide  ointment 
may  be  applied.  Intractable  ulcers  should 
be  excised  and  the  resulting  wound  closed 
by  suture. 

In  mild  infection  of  the  suburethral  or 
vulval  glands,  one  may  dilate  the  duct  of  the 
gland  with  a fine  probe,  evacuate  the  gland 
by  gentle  pressure,  and  then  inject,  through 
a blunt  hypodermic  needle,  a solution  of 
silver  nitrate,  5 per  cent.,  or  of  argyrol, 
25  per  cent.  (Anna  M.  Fullerton).  This 
may  be  repeated  several  times  a day. 

Chronically  inflamed  glands  may  be 
excised  under  local  cocaine  or  novocaine 
anaesthesia  (see  Part  11),  and  the  wound 
either  packed  or  closed  with  interrupted 
silk-worm-gut  sutures,  leaving  several  strands 
of  the  silk-worm-gut  in  the  wound  for  forty- 
eight  hours  or  longer,  as  a drain. 

In  furunculosis  or  folliculitis,  cleanse  the 
parts  daily,  puncture  and  drain  abscesses 
and  swab  the  resulting  cavity  with  silver 
nitrate,  gr.  xxx  ad  5i,.  carbolic  acid,  or 
alcohol  ; destroy  chronically  affected 


follicles  with  the  fine  galvano-cautery  needle 
or  a red-hot  probe ; and  apply  to  the  affected 
surface  ung.  hydrargyri  biniodicU,  gr.  viii 
ad  Si;  or  ichthyol,  3i,  carbolic  acid,  tt^x, 
glycerine,  3i,  and  petrolatiun,  q.s.,  ad  Si- 
The  ointment  must  be  continued  for  two 
weeks  after  the  last  boil  has  disappeared 
(Dudley).  “ The  X-rays,”  says  Dudley, 
“ are  most  efficacious.”  (See  Rontgenology, 
in  Part  1).  General  tonics  are  incUcated. 
Yeast  internally  is  recommended. 

For  thrush,  cleanse  the  parts  twice  a day, 
and  dust  on  a powder  consisting  of  salicylic 
acid,  gr.  ii,  powdered  camphor,  gr.  iv,  boric 
acid,  3vi,  and  powdered  starch,  3h; 
or  apply  a saturated  solution  of  pot. 
chlorate.  (Kelly.) 

In  granular  vulvitis,  paint  the  granulated 
part  with  silver  nitrate,  5 per  cent.,  and 
pack  the  vagina  daily  with  gauze;  or  apply 
frequently,  upon  a compress  secured  by  a 
T-bandage,  ichthyol  in  glycerine,  10  to  20 
per  cent.  (Dudley.) 

In  vulvitis  due  to  urinary  irritation, 
cleanse  the  vulva  after  each  urination,  ami 
apply  carbolic  ointment,  2 to  5 per  cent., 
or  boric  ointment,  10  per  cent.,  and  powders. 
If  the  urine  is  over-acid,  prescribe  sod. 
bicarbonate,  and  potassium  salts.  If  it  is 
alkaline,  prescribe  sodium  or  ammonium 
benzoate,  salol,  boric  acid,  or  acid  sodium 
phosphate  (see  Part  11). 

Vulvo=Vaginal  Glands. — See  Bartholin’s 
Gland. 

Warts. — See  Verrucse. 

Whites. — See  Leucorrhoea. 

Womb, Falling  of  the.— See  Prolapsus  Uteri. 

The  Gynaecological  Armamentarium. — 
I.  Office  Equipment. — Examining  table;  X-ray 
machine;  electrical  outfit:  galvanic,  faradic, 
sinusoidal,  and  high-frequency  currents, 
electric  fight  furnished  by  street  current  or 
storage  battery,  galvano-cautery  or  Paquelin 
cautery;  satchel;  scales. 

Instrument  case  with  drawers,  containing 
head  mirror;  pelvimeter;  powder-puff  box 
for  dusting  the  vagina  and  vulva;  suction 
bulb  for  evacuating  the  cervical  canal; 
aluminum  corrugated  applicators;  oakum; 
Kelly  pad;  Robb’s  leg- holder;  sterile  gauze 
compresses;  sterile  gauze  bandage;  sterile 
absorbent  cotton;  lamb’s-wool;  wood-wool; 
sterile  vulval  pads;  lint;  heemostatic  forceps; 
douche  pan;  glass  bowl  for  holding  sterile 
gauze  while  packing  the  vagina  or  uterus; 
Davidson  syringe;  T-bandages;  safety  razor; 
safety  pins;  vaginal  specula,  large  and  small, 
Sims’s,  Simon’s,  Ferguson  (three  sizes), 
tubular,  bivalve,  trivalve,  weighted;  long 
dressing  forceps;  tenaculmn  forceps;  Kelly’s 


THE  GYNAECOLOGICAL  ARMAMENTARIUM 


two-pronged  gauze-packer;  knives;  scissors, 
blunt  and  pointed,  straight  and  curved; 
thumb  forceps;  long  rat-toothed  dissecting 
forceps;  Wliite’s  spiral  spring  repositor  for 
inversion  of  the  uterus;  Shns’s  glass  vaginal 
plug;  artificial  leech;  medicine-droppers; 
minim  graduate;  probe;  small  ulcer  curette; 
Braun  colpeurynter;  pessaries,  various  sizes, 
hard-rubber  ring  and  lever  pessaries:  Albert 
Smith,  Hodge,  Gehrung,  Skene,  Munde- 
Thomas-Smith,  Thomas  retroflexion  pessary 
with  bulbous  upper  extremity,  cup  or  ring 
with  external  support,  Schultze’s  sleigh 
pessary,  soft-rubber  ring  pessary,  thick-ring 
pessaries,  disc  pessaries,  shell  pessaries, 
bayonet  handle  pessaries;  stethoscope;  blood- 
pressure  apparatus;  hair  epilator;  uterine 
sound;  urinaiy  and  rectal  instruments. 

2,  Laboratory  EEquipment. — Microscope;  slides; 
cover-glasses;  stains;  Gram’s  stain  chemi- 
cals: saturated  aniline  water,  filtered;  sat- 
urated alcoholic  solution  of  gentian  violet; 
iodine;  pot.  iothde;  alcohol,  95  per  cent.; 
safranin;  drug  scales;  spatulas;  waxed  pa- 
pers; plain  white  papers;  mortar  and  pestle; 
alcohol  lamp  or  Bunsen  burner;  glass  funnel; 
filter  paper;  spectroscope;  Gram  stains  (see 
G.  U.  Diseases,  Part  3). 

Urinalysis  Outfit.— I.  UtenSILS. — Litre-vol- 
umetric  flask;  htmus  paper,  red  and  blue; 
urinometer  and  cylinder  for  the  esthnation 
of  specific  gravity;  filter  paper;  glass  funnels 
and  stand;  alcohol  lamp  or  Bunsen  burner; 
test-tubes  and  rack;  glass  tube  with  drawn 
out  tijj;  Esbach’s  albuminometer;  Purdy’s 


electrical  centrifuge  with  Purdy’s  graduated 
test-tubes;  microscope,  slides,  and  cover- 
glasses;  water  still;  two  graduated  burettes 
of  50  c.c.  capacity;  water  bath;  Einhorn’s 
saccharhneter;  Doremus  ureometer;  cathet- 
ers; accurately  graduated  hypodermic  sy- 
ringe; the  Duboscq  or  the  Rowntree  and 
Geraghty  modification  of  the  Autenrieth- 
Konigsberger  colorimeter;  cystoscope  and 
ureteral  catheters. 

II.  Chemicals. — Powderedcharcoal,  mag. 
oxide  or  carbonate,  barium  carbonate, 
silicic  acid,  sawdust,  or  lime  water,  for 
clarifying  urine;  acetic  acid  solution,  5 per 
cent.;  10  per  cent,  solution  of  pot.  ferro- 
cyanide;  nitric  acid,  c.p.;  ether;  solid 
sulpho-salicylic  acid ; phospho-tungstic  acid ; 
hydro-chloric  acid,  c.p.;  alcohol,  95  per  cent; 
acetic  acid,  50  per  cent.;  copper  sulphate 
crystals,  c.p.;  distilled  water;  Rochelle  salt; 
sod.  hydrate;  sod.  or  pot.  citrate;  crystallized 
sod.  carbonate;  10  per  cent,  solution  of 
caustic  soda;  bismuth  subnitrate;  lead  ace- 
tate; phenylhydrazin  hydrochloride;  sod. 
acetate;  60  per  cent,  alcohol;  liquor  ferri 
chloridi;  para-amido-aceto-phenon ; sodium 
nitrite;  concentrated  ammonia  water;  chloro- 
form; pot.  or  sod.  nitroprusside;  glacial  acetic 
acid;  solid  caustic  potash;  10  per  cent,  solu- 
tion of  salicyl  aldehyde  in  absolute  alcohol; 
acetic  acid;  hych’ogen  peroxide;  1 per  cent, 
alcoholic  solution  of  phenolphthalein;  deci- 
normal  sod.  hydroxide  solution;  formalin; 
bromine;  20  per  cent,  sodium  hydrate  solu- 
tion; 5 per  cent,  solution  of  silver  nitrate; 


ScHEM.^.  FOR  THE  GyX.ECOLOGICAL  HiSTORY  AX'D  EXAMINATION 


Name  Address 

Single,  married  (how  long)  Widow 

No.  and  ages  of  children 

Miscarriages 

Labors 

Puerperia 

Leucorrhcra:  urethral,  vulval,  vaginal,  cervical, 
or  uretine. 


Date 

(how  long)  Occupation 

Age  Race 

General  appearance 

Height  Weight 

Appropriate  or  proper  weight  (see  Part  1) 
Hygiene:  Rest  Exercise 

Recreation  Diet 

Bowels  Ventilation 

Sexual  habits  Tea  and  Coffee 


Alcohol 


Tobacco 


Menstruation — intervals  duration 

amount  pain 

Complaint, 

To  what  does  the  patient  attribute  her  illness: 

H istory  of  jrresent  illness: 

Previous  history: 

Family  and  Husband's  history: 

Examination. 

Vulva  Vaginal  outlet 

Cervix  Uterus 

Bladder  Rectum 

Heart,  blood  vessels,  lungs,  and  other  organs  and  tissues 
ITinary  analj'sis  (see  Part  1).  .Amount  in  24  hours 
Color  Reaction  s.g. 

Urea  .Albumen  Sugar 

Renal  function 
Diagnosis: 

Treatment  (including  dates;  and  whether  at  office  or  home). 


Vagina 

Tubes  and  ovaries 
Abdomen 

Frequency 

Total  solids 
Sediment 


No. 


Sleep 

Baths 

Narcotics 


THE  GYNiECOLOGICAL  ARMAMENTARIUM 


phenolsulphonephthalein  (0.6  gm.) ; sod.  hy- 
droxide, 8 per  cent.;  sod.  chloride,  0.75  per 
cent;  25  per  cent.  sod.  hydrate  solution; 
phloridzin;  indigo  carmine. 

3.  Operating  Room  Equipment. — Operating 
table;  stands;  irrigation  reservoir  with  tubes 
and  stand;  basins;  pitchers;  hand  brushes; 
soap;  Rochester  sterilizer  for  dressings;  in- 
strument sterilizer  (fish  kettle) ; douche  pan ; 
Kelly  pad;  operating  gowns;  caps;  nose  and 
mouth  protectors;  laparotomy  sheets,  plain 
sheets,  rubber  sheets;  towels;  laparotomy 
pads  with  tape  attached;  rubber  gloves; 
safety  pins;  Martin  india-rubber  bandage; 
leggings;  Robb’s  leg-holder;  adhesive  plaster, 
2 to  3 inches  wide;  plain  gauze;  iodoform 
gauze;  absorbent  cotton;  lint;  gauze  band- 
age; lamb’s- wool;  wood-wool;  vulval  pads; 
suture  material:  silk,  silkworm-gut,  plain 
catgut,  chromicized  catgut,  linen  thread; 
glass  bowl  for  holding  sterile  gauze  while 
packing  the  vagina  or  uterus;  actual  caut- 
ery; Davidson  syringe;  T-bandages;  razor; 
Esmarch  inhaler;  tongue  forceps. 

Instrument  cases  containing  the  following; 

A.  Genital  Instruments.  — Scalpels; 
haemostatic  forceps,  straight  and  curved;  scis- 
sors, blunt  and  pointed,  straight  and  curved; 
Emmet’s  slightly  curved  and  fully  curved 
scissors  (curved  to  the  left  for  use  in  the 
right  hand) ; thumb  forceps;  long  rat-toothed 
dissecting  forceps;  needle-holder;  needles, 
assorted  varieties  and  sizes;  Hank’s  coniform 
and  olive-shaped  cervical  dilators;  Garrigue’s 
olive-shaped  cervical  dilators;  Goelet’s  ex- 
panding dilator;  Hegar’s  dilators;  Cleve- 
land’s dilator;  light  and  heavy  steel  uterine 
dilators;  Wylie  drain;  Braun  intra-uterine 
syringe;  corrugated  aluminum  applicator; 
Sims’s  sharp  curette;  Martin’s  fundus 
curette;  vaginal  specula,  large  and  small: 
Sim’s,  Simon’s,  Ferguson’s  (three  sizes), 
tubular,  bivalve,  trivalve,  weighted;  long 
dressing  forceps-;  tenaculum  forceps,  single 
and  double;  uterine  sound;  Kelly’s  two- 
pronged gauze  packer;  pedicle  needle; 
tissue  clamps,  straight  and  curved;  Fritsch- 
Boseman  uterine  two-way  catheter; 
abdominal  retractors;  self-retaining  abdom- 
inal retractors;  placenta  forceps;  Bean’s 
hysterectomy  forceps;  curved  hysterectomy 
clamps;  right-angled  hysterectomy  clamps; 
Kelly-Cullen  enucleator;  heavy  hysterectomy 
traction  forceps : sharp  serrated  spoon  curette 
or  loop  curette;  obstetrical  forceps;  long 
nozzle  drainage  syringe;  glass  and  rub- 
ber drainage  tubes;  Moynihan’s  intestinal 
clamps;  Murphy’s  buttons;  two-branched 
and  four-branched  metranoikter;  atmocausis 
apparatus;  large  glass  trocars  and  tubing 
for  tapping  cysts;  small  metal  trocars; 


infusion  apparatus;  White’s  spiral  spring 
repositor  for  inversion  of  the  uterus; 
Braun  colpeurynter. 

B.  Urinary  Instruments. — Skene’s  bi- 
valve urethral  speculum;  Kelly’s  urethral 
endoscopes;  Skene’s  reflux  ureteral  catheter; 
glass  urethral  syringe  of  one  dram  capacity; 
Franck  urethral  syringe;  ureteral  catheter- 
izing  cystoscope;  ureteral  catheters  and 
graduated  bougies;  lithotrite;  bladder  alli- 
gator forceps;  bulb  ear  syringe;  piston 
syringe ; bougies  a boule ; Otis’  straight  dilat- 
ing urethrotome;  bladder  snare;  No.  5 
French  renal  catheter;  aspirating  needles; 
glass  funnel  and  rubber  tubing;  self-retaining 
catheter;  glass  or  metal  and  soft  rubber 
urethral  catheters;  Hegar  dilators;  Dickin- 
son two-way  catheter;  cone  urethral  dilator; 
medicine  droppers;  Earle’s  or  Collins’s 
urinal  for  exostrophy  of  the  bladder. 

C.  Rectal  Instruments. — Proctoscopes; 
sigmoidoscopes;  long  rectal  alligator  forceps; 
Kelly’s  conical  sphincter  dilator;  graduated 
rectal  bougies;  rectal  tube  and  funnel. 

4.  Internal  Drugs  Mentioned  in  the  Text. — A. 
Alteratives  and  Antiluetics  (L.  altera're 
to  change;  an'ti-,  against  -|-  lu'es,  syphilis). — 
Salvarsan;  neosalvarsan;  liq.  arsenii  chloridi; 
arsenious  acid;  sod.  arsenate;  liq.  potassii 
arsenitis;  Gamier  and  Lamoureux’s  granules 
of  green  protiodide,  gr.  3^;  biniodide  of 
mercury;  protiodide  of  mercury;  bichloride 
of  mercury,  gr.  3^oo5  gray  powder;  tannate 
of  mercury;  blue  pill;  blue  ointment,  50  per 
cent.;  mercury- vasogen;  salicylate  of  mer- 
cury; potassium  iodide;  calcium  sulphide; 
fibrolysin ; creosote ; hypophosphites ; glycero- 
phosphates; codliver  oil;  maltine;  comp, 
syrup  sarsaparilla. 

B.  Emmenagogues  (Gr.  efiiJLrjpa  menses  -|- 
ixyeiv  to  lead). — Oxalic  acid;  ammoniated 
tincture  of  guaiacum;  manganese  binoxide; 
chloride  of  gold  and  sochum;  ovarian  extract; 
corpus  luteum  extract;  thyroid  extract; 
pituitary  extract;  apiol;  pot.  permanganate; 
salicylic  acid;  fl.  ext.  hoang-nan;  aloes; 
iron;  »tinct.  cantharidis;  asafoetida;  ol. 
sabinse;  fl.  ext.  cimicifuga;  oil  of  rue;  oil 
of  tansy;  ol.  hedeoma;  santonin;  tr.  pulsa- 
tilla;ol.  cinnamomi;  quinine;  tr.  cinnamomi; 
gossypii  cortex  (cotton  root  bark);  ol. 
origanum;  sod.  salicylate. 

C.  Haemostatics  (Gr.  ai^a  blood  -|- 
(XTaTiKos  standing).  — Pituitrin;  ergotin; 
ergotol;  fl.  ext.  ergot;  fl.  ext.  hamamelis; 
gallic  acid;  tannic  acid;  cal.  chloride; 
stypticin;  styptol;  stagnin;  dilute  or  aro- 
matic sulphuric  acid;  gelatine  (Merck’s 
sterile);  hydrastinin  hydrochloride;  fl.  ext. 
hydrastis;  strophanthus;  digitalis  pulv.;  fl. 
ext.  senecio  aureus. 


THE  GYNECOLOGICAL  ARMAMENTARIUM 


D.  Neuromuscular  Sedatives  (L.  se'do, 

I allay). — Ether;  chloroform;  powd.  opium; 
suppos.  of  ext.  opii,  gr.  i-ii,  and  ext.  bellad., 
p;r.  3^  to  34;  camph.  tr.  opii;  Dover’s  powder; 
morphine;  dionin;  codeine;  tr.  and  ext. 
belladonna);  atropine;  sod.  or  pot.  bromide; 
valerian;  tr.  and  fl.  ext.  gelsemii;  sumbul; 
chloral  hydrate;  trional;  phenacetin; 
aspirin;  whiskey;  brandy;  asafoetida;  tr.  and 
ext.  hyoscyamus;  tr.  cannabis  indica;  stra- 
monium; triphenin;  pyramidon;  tr.  veratri; 
tr.  aconite;  aq.  laurocerasi;  antipyrine. 

E.  Haematics  (Gr.  aijia  blood). — Re- 
duced iron;  peptomanganate  of  iron;  iron- 
tropon;  ferrum  exsiccatmii;  elix.  ferri,  quin, 
et  strych.  phosphati;  syr.  ferri  iodidi; 
iron  and  quinine,  citrate;  tr.  ferri  chlo- 
ridi ; arsenhemol ; ferrum  sulphatum  exsicca- 
tum ; ferromannin. 

F.  Acids  (L.  a'cidus,  sharp).— Dilute  hydro- 
chloric, nitric,  nitromuriatic,  and  acetic  acids. 

G.  Antacids  (Gr.  avri  against). — Milk  of 
magnesiiun;  liq.  calcis;  sod.  bicarb.;  mag- 
nesia; Vichy;  Apollinaris;  borocitrate  of 
magnesimn;  liq.  potassse;  ammon.  carbonate. 

H.  Purgatives  (L.  purga're,  to  cleanse). — 
Castor  oil;  calomel;  cascara  ext.;  senna; 
pulv.  rhubarb;  aloes  purif.;  aloin;  tr.  aloes; 
liq.  mag.  citratis;  Carlsbad  salts;  sod.  phos- 
phate; Glauber’s  salt;  Epsom  salt;  Rochelle 
salt;  Hunyadi;  Friech-ichshaU. 

I.  Stomachics. — Syrup  of  ginger;  tr.  zin- 
giberis;  ext.  calmnba);  tr.  cinchonse;  tr. 
cinchonie  comp.;  tr.  gentiame;  tr.  gent, 
comp. ; tr.  and  ext.  nucis  vomicae;  strychnine. 

J.  Urinary  Sedatives  and  Astringents. 
— Inf.  and  fl.  ext.  pareira  brava;  inf.  and 
fl.  ext.  triticum  repens;  fl.  ext.  uva  ursi; 
fl.  ext.  saw  palmetto;  fl.  ext.  zea  mays;  inf. 
melon  seed;  grated  nutmeg;  copaiba;  cu- 
bebs;  sandalwood. 

K.  Urinary  Antiseptics. — Helmitol; 

cystogen;  salol;  urotropin;  saliformin;  meth- 
ylene blue;  ol.  eucalypti. 

L.  Urinary  Acidifiers. — Acid  sodium 
phosphate;  benzoic  acid;  sod.,  lithium,  and 
ammon.  benzoate;  camphoric  acid. 

M.  Diuretics  (Gr.  diovprjcrLs  urination). — 
Liq.  potassii  citratis;  pot.  citrate;  pot. 
bicarb.;  pot.  acetate;  sweet  spirits  nitre;  inf. 
and  fl.  ext.  buchu;  inf.  and  ol.  juniper. 

N.  Carminatives  (L.  car'men,  charm; 
acrmi'no,  I soothe). — Spts.  chloroform;  aqua 
menth.  pip.;  ol.  menth.  pip.;  tr.  card, 
comp.;  ol.  sassafras;  spts.  letheris  comp.; 
aq.  cinnamomi. 

O.  Vasodilators. — Amyl  nitrite;  spt.  glo- 
noini;  tabella)  trinitrini,  gr.  3Too- 

P.  An.usthetics  (Gr.  av  without  -|- 

perceiition). — Ether;  chloroform. 


Q.  Vaccines,  Sera,  and  Constitutional 
Antiseptics. — T uberculin ; antistreptococ- 
cus serum;  nuclein;  collargol;  ung.  Crede. 

R.  Menstrua  and  Flavors. — Syr.  aca- 
cise;  syr.  orange  peel;  syr.  simple;  elixir 
simple;  sacchar.  alb. 

S.  Miscellaneous. — Pot.  chlorate,  pipe- 
razin ; sod.  chloride ; coumarin;  di.stilled  water. 

5.  Local  Preparations  Mentioned  in  the  Text. — 
A.  Antiseptics  (Gr.  avri  against  <ri]ipL$ 
putrefaction). — Squibb’s  surgical  powder 
(containing  alum) ; salicylic  acid ; pjTogallol ; 
pyroligneous  acid;  iodine  crystals;  menthol; 
sod.  bicarbonate;  sod.  biborate;  sod.  chlor- 
ide; europhen;  resorcin;  iodoform;  aristol; 
thymol;  pyoktannin;  methylene  violet;  boric 
acid;  alum,  acetate;  mere,  bichloride;  calo- 
mel; ichthyol-glycerine;  borogly ceride ; ich- 
thyol;  yellow  oxide  of  mercury  oint.,  1 per 
cent. ; iodoform  oint. ; ung.  hydrarg.  ammon. ; 
ung.  ac.  carb.;  balsam  of  Peru;  ung.  hydrarg. 
nitratis;  ung.  hydrarg.;  ung.  iocU;  zme  oint.; 
ung.  ac.  borici;  pot.  permanganate;  protar- 
gol;  comp.  sol.  of  iocline;  alcohol;  formalin; 
tr.  iocU;  creolin;  lysol;  liq.  sod.  chlorinatse; 
hyd.  perox. ; acetone;  formaldehyde;  argjTol; 
comp.  sol.  of  cresol  (U.  S.  P.) ; bismuth  sub- 
gallate;  bismuth  subnitrate;  dilute  acetic 
acid;  ung.  hydrarg,  biniodidi,  1 : 60;  oleate 
of  mercury. 

B.  Stiptics  and  Astringents  (Gr. 
(TTv<j)ei.v  to  contract ; L.  ad,  to  -f-  sirin' gere,  to 
bind). — Adrenalin;  suprarenal  ext.;  gelatine; 
Monsell’s  solution;  powdered  bmmt  alum; 
tannic  acid;  neutral  lead  acetate;  alum, 
acetate;  liq.  phunbi  subacetatis;  liq.  calcis; 
comp.  tr.  benzoin. 

C.  Caustics  (Gr.  KaUiv  to  burn). — Caustic 
potash;  zinc  acetate,  chloride,  and  sulphate; 
acetic  acid  (not  glacial);  lactic  acid;  nitric 
acid;  carbolic  acid;  salicyhc  acid;  silver 
nitrate;  copper  sulphate. 

D.  Local  Analgesics  or  Anodynes  (Gr. 
av  without;  aXyos  pain;  ohiivq  pain). — Co- 
caine; novocaine;  alypm;  ethyl  chloride;  ol. 
gaultheriae;  camphor;  lead  water  and  laudar 
nmn;  ung.  bellad.;  ung.  veratri. 

E.  Emollients  and  Protectives  (L. 
emol'lio,  I soften). — Petrolatum  molle;  lan- 
olin; benzoated  lard;  olive  or  cottonseed  oil; 
petroleum  jelly;  ol.  theobromae;  ol.  cacao; 
glycerine;  ung.  aquae  rosae;  refined  petrolemn 
oil;  starch;  talcum;  calamine;  lycopodimn; 
prepared  chalk;  charcoal;  albolene;  oleic  acid. 

F.  Counter  Irritants. — Mustard;  tur- 
pentine; flaxseed. 

G.  iMiscELLANEOUS. — I iidigo-carmine; 
radium;  Nauheim  bath  salts;  soap;  castile, 
glycerine,  and  green;  coumarin;  distilled 
water;  sodium  chloride. 


PART  3 

GENITO-URINARY  DISEASES 


Abscess,  Cowper’s  Gland. — L.  abscessus, 
a going  apart;  glans,  a cord. 
See  Cowperitis. 

Kidney. — See  Pyelonephritis  in  Part  1. 

Perinephric. — See  Perinephric  Abscess. 

Periurethral. — Gr.  wepL  around  + 
ovfrqpda  urethra.  See  under  Gonor- 
rhoea; and  Stricture  of  the  Urethra. 

Prostatic. — See  Prostatitis. 

Adenitis,  Inguinal.  — See  Lymphadeni- 
tis, Inguinal. 

Albuminuria. — See  Part  1,  Genewd  Medi- 
cine and  Surgery. 

Alkalinuria.— ^ee  Part  1. 

Aneurysm  of  the  Renal  Ariery. — See  Part 
2,  Gynaecology. 

Angioma  Urethrae. — Gr.  ayyeiov  vessel  4- 
-upa  tumor;  ovprj'dpa.  See  Tmnors  of 
the  Urethra. 

Angioneurosis  of  the  Kidney — Gr.  ayyeiov 
vessel  vevpov  nerve.  See  under  Haematuria. 

Anorectal  Gonorrhoea. — L.  anus]  red  turn, 
straight.  See  under  Gonorrhoea. 

Anuria.^ — See  Part  1,  General  Medicine 
and  Surgery. 

Arthritis,  Gonorrhoeal. — Gr.  ap^pof' joint  + 
-ins  inflammation.  See  under  Gonorrhoea. 

Atony  of  the  Bladder. — Gr.  a priv.  -p 
rbvos  tone.  See  Paralysis  and  Paresis  of 
the  Bladder. 

Atrophy  of  the  Prostate. — ^Gr.  a neg.  + 
rpoc^rj  nourishment;  irpb  before  + lo-ravac 
to  stand.  Atrophy  of  the  prostate  occurs 
as  a result  of  wasting  diseases,  senile 
sclerosis,  long-continued  compression  due 
to  the  damming  up  of  mine  behind  a stric- 
ture, or  to  adjacent  tumors,  atrophy  or 
destruction  of  the  testicles,  and  as  a con- 
genital affection. 

Incontinence  of  urine  gradually  develops; 
very  rarely  retention.  Urgency  of  urination 
is  usually  present,  and  cystitis  occurs.  Rectal 
examination  reveals  a small  prostate,  and 
the  passage  of  urethral  sounds  encounters  no 
resistance  as  in  prostatic  hypertrophy. 

Treatment. — The  pas.sage  of  large  metal 
sounds  and  faradization  are  recommended, 
one  electrode  at  the  bladder  sphincter  and 
the  other  in  the  rectum;  but  the  results 
are  not  apt  to  be  striking.  Regular  cathe- 
terization is  demanded  in  cases  of  retention. 

Azoospermia. — Gr.  a neg.  + ^coov  animal 
-f  (jTveppa  seed.  See  Sterility. 

Balanitis. — See  Balanoposthitis. 


Balanoposthitis. — Gr.  baXavos  glans  -f 
TvbaQt]  prepuce  -p  -ins  inflammation.  Inflam- 
mation of  the  mucosa  of  the  glans  penis 
(balanitis)  and  the  prepuce  (posthitis). 

Etiology. — Uncleanliness;  long  prepuce;  irri- 
tating female  discharge;  violent  coitus; 
gonorrhoea;  herpes;  eczema;  venereal  wart; 
chancrokl;  chancre;  the  acute  exanthemata; 
gouty  nature;  diabetes. 

Treatment. — Cleanse  the  parts  two  to  four 
times  daily  with  a mild  antiseptic  solution 
such  as  boric  acid,  oUii  to  the  pint;  carbolic 
acid,  5'  to  the  pint;  bichloride,  1 : 10,000  to 
1 : 5000;  potassium  permanganate,  gr.  iiss 
to  the  pint;  aluminum  acetate,  gr.  x to  the 
ounce;  silver  nitrate,  gr.  iiss  to  the  ounce; 
or  peroxide  of  hydrogen  and  water,  equal 
parts;  then  dry  the  parts,  and  apply,  with 
a camers-hah’  brush,  one  of  the  following 
powders,  e.g.,  tannic  acid  and  bismuth 
sub  nitrate,  equal  parts;  calomel  and  bis- 
muth, equal  parts;  boric  acid  or  zinc  oxide 
and  bismuth,  equal  parts;  alum,  3i  and  boric 
acid,  3iv;  calomel,  aristol;  dermatol;  noso- 
phen;  compound  stearate  of  zinc;  etc.  Tuck 
small  strips  of  gauze  under  the  prepuce  for 
the  purpose  of  keeping  the  apposed  surfaces 
separated  and  for  drainage.  Ulcers  may  be 
painted  with  silver  nitrate,  gr.  v to  the 
ounce.  If  great  swelling  and  tension  are 
present,  slit  up  the  dorsum  of  the  prepuce, 
and  apply  wet  antiseptic  dressings. 

After  the  inflammation  is  cured,  circum- 
cision is  advisable. 

Bed=Wetting  . — See  Enuresis. 

Bilharziasis,  Vesical. — See  under  Cystitis. 

Bladder,  Atony  of  the. — Gr.  a priv.  + 
rbvos  tone.  See  Paralysis  and  Paresis 
of  the  Bladder. 

Bilharziasis  of  the. — See  under  Cystitis. 

Calculus. — L.  calculus,  pebble. 

Symptomatology. — Diurnal  frequency  of  uri- 
nation, increased  by  motion;  pain,  often 
referred  to  the  end  of  the  penis,  often  in- 
creased at  the  end  of  micturition,  and 
aggravated  by  motionj  possibly  reflex  pains 
in  various  parts;  haematuria,  usually  at  the 
clo.se  of  micturition;  tenesmus  or  straining; 
sometimes  sudden  stoppage  of  the  urinary 
flow;  pulling  at  the  prepuce  (a  common 
sign  in  children). 

Explore  the  bladder  by  means  of  a stone 
searcher,  such  as  that  of  Thompson’s,  or  a 
lithotrite  or  Utholapaxy  pump,  with  the 


BLADDER  DIVERTICULA  OR  SACCULATIONS 


hips  elevated  and  the  bladder  filled  with 
boiled  boric  acid  solution.  3i~iv  ad  Oi;  or 
employ  the  cystoscope  X-ray,  {q.v.)  or  bi- 
nianual  palpation  through  the  rectmn.  Irri- 
gate the  bladder  after  each  examination. 

Etiology. — Stone  from  the  kidney  (see 
Nephrolithiasis);  retention  of  urine  {q.v.)\ 
alkaline  cystitis;  vesical  tumors;  foreign 
bodies,  including  retained  sutures. 

Prophylaxis. — Refer  to  Etiology;  see  also 
Nephrolithiasis. 

Treatment. — Employ  litholapaxy  (Gr.  Wda 
stone  + Xa-wa^Ls  removal)  by  means  of  a 
Bigelow  or  Chismore  or  Thompson  and 
Guyon  lithotrite  and  evacuator  (Gr.  \idos 
stone  -|-  L.  ter' ere,  tri'fus,  to  rub),  if  practic- 
able, preferably  under  general  anaesthesia, 
with  the  hips  elevated  and  the  bladder  filled 
with  boric  acid  solution.  Cystitis,  if  present, 
should  first  be  corrected  (see  Cystitis). 
Casper  prefers  the  lithotrite  of  Thompson 
and  Guyon,  using  first  the  large  instrument, 
then  the  small  one  for  small  fragments. 

The  operation  should  be  preceded  and 
followed  by  the  achninistration  of  urotropine 
(Part  1 1)  andby  irrigation  of  the  bladder  with 
silver  nitrate  solution,  1 : 10,000.  If  severe 
hemorrhage  follows  the  operation,  or  the 
patient  cannot  empty  the  bladder,  insert 
a retention  catheter  (see  under  Bladder 
Diverticula) . Keep  the  patient  in  bed  four 
days.  Examine  the  bladder  cystoscopically 
for  stone  fragments  one  month  later. 

If  litholapaxy  is  mipracticable,  perform 
sujirapubic  or  perineal  lithotomy  (Gr.  \l6os 
stone  -b  rinveiv  to  cut) . 

Keyes  gives  the  following  indications : 

“ For  children,  whose  urethra  will  take 
a 16  F.  sound,  litholapaxy;  otherwise 
suprapubic  lithotomy.” 

“ For  prostatics,  suprapubic  lithotomy 
and  prostatectomy  in  one  or  two  stages.” 
“For  cases  with  grave  stricture,  peri- 
neal lithotomy.” 

“ For  sacculated  bladders  {q.v.)  supra- 
pubic lithotomy.” 

“ For  cases  requiring  good  drainage,  such 
as  have  severe  pyelonephritis,  uncontrollable 
ammoniacal  cystitis,  or  prostatic  abscess, 
perineal  or  suprapubic  lithotomy.” 

“ All  other  cases  may  be  submitted  to 
litholapaxy.  Very  large  stones  are,  however, 
better  cut  for  than  crushed.” 

Bladder  Carcinoma. — Gr.  KapKivos  crab 
-co/xa  tumor.  See  Tumors  of  the  Bladder. 

Bladder,  Contracted. — L.  con,  together 
tra'here,  to  draw.  F requent  urination  is  the 
only  symptom  of  .simple  conti'action.  The 
capacity  of  the  bladder  is  ascertained  by 
measuring  the  amount  of  fluid  it  is  capable 


of  holding,  using  for  the  purpose  a catheter 
attached  to  a fountain  sjTinge. 

Etiology. — Cystitis  (causing  thickening  and 
contraction  of  the  bladder  wall);  stone  in 
the  bladder;  neoplasms;  operations  on  the 
bladder;  atrophy  from  disuse,  where  the 
bladder  has  never  held  much  urine,  as  in 
chronic  cystitis,  chronic  irritability  of  the 
bladder,  and  enuresis  of  childhood  continu- 
ing after  puberty. 

Treatment. — Attend  to  the  cause.  Once 
every  day,  for  five  to  ten  minutes  at  a time, 
alternately  distend  and  relax  the  bladder 
by  means  of  warm  sterile  normal  saline 
solution  (oi  ad  Oi)  introduced  through  a 
metal  catheter  and  fountain  syringe,  the 
reservoir  being  alternately  raised  and 
lowered,  the  latter  when  the  patient  com- 
plains of  distention.  Continue  this  for 
several  months.  The  prognosis  under  this 
treatment  is  good.  (Ashton.) 

Bladder,  Contracture  of  the  Neck  of  the. — 
L.  con,  together  -|-  tra'here,  to  draw.  See 
Bladder  Irritability. 

Bladder  Distomiasis. — Gr.  hs  twm  -f- 
(TTo/xa  mouth ; fluke-worm.  See  under  Cystitis. 

Bladder  Diverticula  or  Sacculations. — 
L.  diveriicula're,  to  turn  aside;  sac' cuius, 
little  sac  or  pouch.  The  diagnosis  is  made 
by  means  of  the  cystoscope.  Congenital 
diverticula  have  a sharply  defined  round 
or  oval  border  in  contrast  to  the  acquired 
diverticula.  The  latter  are  due  to  luinary 
obstruction  (see  Retention  of  Urine).  Diver- 
ticula predispose  to  cystitis  and  stone. 

Treatment.— Remove  the  cause  of  obstruc- 
tion, if  possible.  Then  employ  systematic 
catheterization,  or  even  the  retained  cathe- 
ter, in  order  to  prevent  distention  of  the 
bladder.  The  eye  of  the  retained  catheter, 
which  should  be  of  soft  rubber  or  silk,  should 
be  just  within  the  bladder.  If  a silk  catheter 
is  used,  the  penis  should  be  laid  up  over 
the  groin,  in  order  to  prevent  ulceration  at 
the  peno-scrotal  angle.  The  bladder  and 
urethra  should  be  irrigated  with  warm 
boiled  boric  acid  solution,  3 i“iv  to  the  pint, 
before  inserting  the  catheter.  The  bladder 
should  be  urigated  tlaily  during  the  reten- 
tion of  the  catheter,  and  the  latter  should 
be  removed  and  cleansed  and  the  urethra 
irrigated  every  three  to  six  daj's.  A tube 
reaches  from  the  catheter  to  a urinal,  con- 
taining carbolic  acid,  1 : 40,  which  should 
be  cleansed  and  boiled  daily.  The  penis 
should  be  kept  wrapped  in  a moist  bichloride 
(1  : 10,000)  compress. 

Abdominal  massage,  vibratory  and  man- 
ual, faradic  electricity,  good  hygiene  and 
tonics  are  valuable  adjuvant  measures. 


BLADDER  IRRITABILITY 


Should  the  above  treatment  fail,  excise 
the  sac. 

Bladder,  Echinococcus  Disease. — Gr. 

exfws  hedgehog  + kSkkos  berry.  See  un- 
der Cystitis. 

Bladder,  Exostrophy  of  the. — See  Part 
2,  Gynaecology. 

Bladder  Filiariasis. — See  under  Cystitis. 

Bladder  Fistula. — L.  fis'tula,  pipe.  The 
diagnosis  is  aided  by  cystoscopy,  proctos- 
copy, and  the  injection  of  methylene  blue 
or  indigo-carmine  into  the  bladder,  etc. 

Etiology. — Congenital  anomaly;  surgical 
operations;  trauma;  ulceration  or  abscess 
due  to  vesical  stone  or  to  stercoral  concre- 
tions; tuberculosis;  malignant  neoplasms. 

Treatment. — Simple  fistulae  may  be  made 
to  close  spontaneously  by  daily  irrigation  of 
the  bladder,  say  with  warm  sterile  boric 
acid  solution,  3i  ad  Oi;  and  if  the  fistula  is 
a vesico-intestinal  one,  irrigation  also  of  the 
bowel.  It  is  essential  that  any  urethral 
obstruction  be  first  removed,  either  by  opera- 
tive means  or  the  retained  catheter  (see  under 
Bladder  Diverticula,  for  particulars) . 

If  this  conservative  treatment  fails,  an 
operation  is  required. 

Bladder=Fluke. — See  under  Cystitis. 

Bladder,  Foreign  Bodies  in  the. — Extract 
the  foreign  body  per  urethram,  if  possible, 
by  means  of  the  lithotrite  or  cystoscopic 
alligator  forceps  or  hooks,  with  the  assis- 
tance, if  need  be,  of  the  operating  cysto- 
scope;  otherwise  resort  to  suprapubic 
cystotomy.  Glass  bodies  require  suprapubic 
cystotomy  for  their  removal.  For  the 
removal  of  wax  or  tallow  bodies,  Keyes 
mentions  the  successful  use,  by  several 
Germans,  of  the  injection  of  benzine,  the 
resulting  solution  being  washed  out  after 
half  an  horn.  The  injection  may  be  repeated, 
if  necessary.  It  is  said  to  be  non-irritating. 

Bladder  Hemorrhage. — Gr.  al/ia  blood  -f 
p-qyvhixL  toburstforth.  See  Heematuria. 

Hydatid  Disease. — Gr.  vdarLs,  vesicle. 
See  under  Cystitis. 

Hyperaesthesia. — Gr.  virep  over  -f  a'la- 
drjais  sensibility.  See  Bladder  Irri- 
tability. 

Inflammation. — L.  inflamma're,  to  set 
on  fire.  See  Cystitis. 

Bladder  Injuries. — Rupture  of  the  blad- 
der, which  may  be  extra-  or  intraperitoneal, 
is  usually  characterized  by  pain,  difficulty 
in  walking,  futile  attempts  to  urinate,  and 
scanty,  blood-tinged  urine  obtained  by 
catheterization.  Shock  usually  occurs,  but 
the  patient  may  appear  in  good  condition. 

Treatment. — An  exploratory  operation 
should  be  performed  promptly  in  all  cases 


presenting  even  a suspicion  of  wound  or 
rupture  of  the  bladder.  After  suturing 
bladder  wounds  with  deep  Lembert  and 
superficial  peritoneal  sutures,  di.stend  the 
bladder  with  a sterile  fluid  in  order  to  test 
the  efficiency  of  the  sutures.  Irrigate  the 
contaminated  parts  with  hot  normal  saline 
solution  (0.8  to  0.9  per  cent.),  and  insert 
a small  drain.  Employ  a retained  catheter 
for  seven  days.  The  eye  of  the  retained 
catheter,  which  should  be  of  soft  rubber  or 
silk,  should  be  just  within  the  bladder.  If  a 
silk  catheter  is  used,  the  penis  should  be 
laid  up  over  the  groin,  in  order  to  prevent 
ulceration  at  the  peno-scrotal  angle.  The 
bladder  and  urethra  should  be  irrigated 
with  warm  boiled  boric  acid  solution,  3i  ad 
Oi,  before  inserting  the  catheter.  The 
bladder  shoukl  be  irrigated  daily  during  the 
retention  of  the  catheter,  and  the  latter 
should  be  removed  and  cleansed  and  the 
urethra  irrigated  every  three  to  six  days. 
A tube  reaches  from  the  catheter  to  a urinal, 
containing  carbolic  acid,  1 : 40,  which  should 
be  cleansed  and  boiled  daily.  The 
penis  should  be  kept  wrapped  in  a moist 
bichloride  (1  : 10,000)  compress.  If  urethral 
catheterization  is  impracticable,  do  a 
perineal  section. 

Bladder  Irritability. — L.  irrita're,  to  tease. 
The  symptoms  of  vesical  irritability  are 
pain,  stranguary,  or  slow  and  painful  urina- 
tion, a frequent  desire  to  urinate,  urgency 
of  urination,  and  incontinence  when  the 
detrusor  musculature  is  affected  (cystalgia; 
hyperaesthesia  vesicae);  frequency  and  diffi- 
culty of  urination,  sometimes  pain,  and 
retention  of  urine  when  the  sphincter  is 
affected  (cystospasm;  vesical  spasm;  spasm 
of  the  neck  of  the  bladder;  contracture  of 
the  neck  of  the  bladder;  stammering  of  the 
bladder).  The  cause  may  be  a local  lesion 
or  a neurosis,  reflex  or  central.  In  simple 
neurosis,  symptoms  are  present  only  during 
the  day.  Hyperaesthesia  and  spasm  are 
both  common  in  children. 

Etiology.— (a)  Irritability  Caused  by  a 
Local  Lesion. — Cystitis  or  trigonitis; 
vesico-urethral  fissure;  posterior  urethritis; 
vesical  tuberculosis;  vesical  calculus;  vesical 
tmnors;  foreign  body;  organic  stricture. 

(b)  Irritability  Without  Local 
Organic  Lesion. — Neurasthenia;  nervous 
irritability;  hysteria;  excessive  coitus  or 
masturbation;  overwork  and  anaemia;  tabes 
dorsalis;  dementia  paralytica;  myelitis; 
multiple  lateral  sclerosis;  spastic  spinal 
paralysis;  tumors  pressing  upon  the  cord; 
spondylitis;  malaria;  lithiemia;  excessive 
urinary  acidity;  pyuria  (pyelonephritis); 


CALCULUS,  SEMINAL 


crystals  in  the  urine  (see  Nephrolithiasis); 
too  high  or  too  low  specific  gravity ; irritating 
ingesta  (ginger,  radishes,  spices,  turpentine, 
salicylates,  cantharides,  quinine,  etc.);  cold; 
acute  fevers;  oxyuriasis;  fissure  in  ano, 
hemorrhoids  and  other  rectal  diseases;  tumor 
})ressing  upon  the  bladder;  chstended  colon; 
pelvic  inflammation  (appendicitis,  etc.); 
abdomino-pelvic  operations;  strangulated 
hernia;  orchitis;  prostatis;  enlarged  prostate; 
chronic  tonsilitis,  etc.  (absorption  of  irritat- 
ing toxines). 

Treatment. — Attend  to  the  cause.  Open 
the  bowels.  Prescribe  a bland  diet,  exclud- 
ing spices,  condmients,  salt  in  excess,  pepper, ' 
vinegar,  mustard,  rachshes,  sauces,  salads, 
pickles,  sour  foods,  rhubarb,  tomatoes, 
asparagus,  ginger  ale,  lemons,  acid  fruits, 
carbonated  beverages,  alcohol,  meats,  cheese, 
greasy  or  fried  foods,  tea,  and  coffee.  Enjoin 
copious  water  drinking  for  the  purpose  of 
diluting  the  urine.  A sedative  tUuretic 
may  be  prescribed,  e.g.,  infusion  of  pareira 
brava  infusion  of  buchu,  fluid  extract  of 
zea  mays,  fluid  extract  of  triticmn  repens, 
sweet  spirits  of  nitre;  or,  if  the  urine  is 
hyperacid,  potassium  citrate  or  sodium  bi- 
carbonate in  large  doses  (see  Part  II). 

Sedative  measures  include  hot  sitz-baths; 
hot  abtlominal  or  rectal  applications;  a 
suppositoiy  of  ext.  opii,  gr.  3^,  or  ext. 
belladonnie,  gr.  or  ext.  hyoscyami,  gr. 
34;  or  laudamun,  10  to  20  drops  in  warm 
water,  per  rectum;  or  chloral  hydrate,  gr. 
x-xv,  well  diluted,  per  rectum,  at  bedtime; 
sochum  bromide  gr.  xxx,  well  diluted,  t.i.d. 
and  at  bedtime;  valerian;  asafoetida.  Holt 
gives,  to  a child  of  two  years,  tincture 
of  belladonna  or  of  hyoscyamus,  Tiji  every 
two  hours,  together  with  plenty  of  water 
and  alkaline  dimetics. 

Tincturaj  belladonna}, 

Liquoris  potassii  hydrox- 

idi,  aa 3i  (aa  iTCV  per  dose) 

Potassii  citratis 5d  (gr.  x per  dose) 

Aqua}  anisi 5 d 

Aqua}  cinnamomi,  q.s.  ad.  ovi 

M.  Sig. — One  tablespoonful  every  four  hours. 
{Journ.  Am.  Med.  Assn.) 

Electricity  may  be  of  service.  One  elec- 
trode is  {tlaced  over  the  bladder,  and  the 
other  (a  metal  sound,  covered,  except  at  the 
tip,  with  hard  rubber)  on  the  perineum  or  in 
the  bladder,  the  latter  being  filled  with 
sterile  water.  It  may  be  “ carried  to  the 
{)ainful  strength.”  (Ilunner.) 

The  passage  of  large  dilating  sounds,  left 
in  for  a brief  time  (up  to  five  minutes), 
acts  very  beneficially.  Should  dilatation  fail. 


apply,  after  emptying  the  bladder,  silver 
nitrate,  10  per  cent.,  to  the  trigonum  and 
the  vesico-urethral  juncture,  about  every 
five  days. 

Casper  has  cured  cases  by  slitting  a 
contracted  meatus  urinarius  and  “ keeping 
it  open  by  means  of  proper  sutures.” 

Bladder  Neck,  Contracture  of  the. — L. 
contractu'ra.  See  Bladder  Irritability. 

Spasm  of  the. — Gr.  awaapLos  spasm. 
See  Bladder  Irritability. 

Stricture  of  the. — See  Stricture  of  the 
Neck  of  the  Bladder. 

Bladder  Neuralgia. — Gr.  vevpov  nerve  + 
aXyos  pain.  See  Bladder  Irritability. 

Neurosis. — Gr.  vevpov  nerve.  See  Blad- 
der Irritability. 

Papilloma. — L.  papilla,  nipple-shaped 
elevation  Gr.  -copa  tumor.  See 
Tumors  of  the  Bladder. 

Bladder,  Paralysis  and  Paresis  of  the. — 
See  Paralysis  ancl  Paresis  of  the  Bladder. 

Bladder  Parasites. — Gr.  Trapatrtros.  See 
under  Cystitis. 

Bladder,  Rupture  of  the. — L.  ruptu'ra 
from  rurn'pere,  to  break.  See  Bladder  Injuries. 

Bladder  Sacculations. — See  Bladder  Di- 
verticula. 

Sarcoma. — Gr.  adp^,  oapKos  flesh  + 
-copa  tumor.  See  Tumors  of 
the  Bladder. 

Spasm. — Gr.  (nraa-p6s.  See  Bladder 
Irritability. 

Stammering. — See  Bladder  Irritability. 

Stone. — See  Bladder  Calculus. 

Bladder,  Stricture  of  the  Neck  of  the. — 
See  Stricture  of  the  Neck  of  the  Bladder. 

Bladder  Traumatism. — Gr.  rpavpa  wound. 
See  Bladder  Injuries. 

Tuberculosis. — L.  tuber'culum,  nodule. 
See  under  Cystitis. 

Tumors. — See  Tumors  of  the  Bladder. 

Bubo. — L.  from  Gr.  /3ou/3wr  groin.  See 
Lymphadenitis,  Inguinal. 

Buccal  Gonorrhoea. — L.  bue'ea,  cheek 
See  under  Gonorrhoea. 

Calcification  of  the  Tunica  Vaginalis.— 
L.  calx,  line  + ja'cere,  to  make.  See  Tumors 
of  the  Testis. 

Calcification,  Urethral. — See  Tumors  of 
the  Urethra. 

Calculus,  Renal. — L.  calculus,  pebble; 
ren,  kidney.  See  Nephrolithiasis,  in  Part  1, 
General  iMedicine  and  Surgery. 

Calculus,  Seminal. — L.  se' inert,  se'mini.s, 
seed.  If  the  ejaculatory  duct  is  occluded, 
severe  spasmodic  or  colicky  pain  occurs 
during  orgasm,  and  semen  is  retained.  Pain 
on  micturition  and  defecation  may  be  pres- 
ent. The  stone  may  be  felt  by  means  of  a 


CHANCROID 


metal  sound  in  the  bladder  and  the  finger 
in  the  rectum. 

Treatment.— For  the  pain,  administer  hot 
rectal  douches  or  the  hot  sitz-bath, 
and  morphine,  gr.  to  %,  with  atropine, 
S,r.  KoO)  hypodermically. 

Attempt  to  crush  the  stone  through  the 
rectum  by  compressing  it  against  a sound 
in  the  bladder. 

Calculus,  Ureteral. — Gr.  ovpr\Ti}p.  See 
Nephrolithiasis,  in  Part  1. 

Urethral. — See  Urethral  Calculi  and 
Foreign  Bodies. 

Vesical. — See  Bladder  Calculus. 

Carcinoma. — L.  can'cer;  Gr.  KapKivos  crab 
+ -oipa.  tumor.  See  Tumors. 

Catheter  Fever. — Gr.  Kaderrip;  L.  fe'bris, 
fever.  See  Urethral  Chill. 

Catheter,  Retained. — ^See  under  Fis- 
tula, Urethral. 

Cauliflower  Excrescences. — L.  ex,  out  -j- 

cres'cere,  to  grow.  See  Verrucse. 

Chafing. — See  Intertrigo,  in  Part  5, 

Skin  Diseases. 

Chancre. — Fr.  See  Syphilis,  in  Part  1, 
General  Medicine  and  Surgery. 

Chancroid. — Fr.  chancre,  -f-  Gr.  eibos  form. 
A local,  contagious  venereal  disease,  caused 
by  the  dumb-bell  shaped  strepto-bacillus  of 
Ducrey,  and  characterized  by  an  incubation 
period  of  from  one  to  twelve  days,  followed 
by  the  appearance  of  one  or  several  ulcers, 
with  undermined  edges,  a moderately  soft 
base,  and  a profuse,  purulent,  auto-inocu- 
lable  discharge,  and  often  involvement  of 
the  adjacent  lymph-glands  which  tend  to 
suppurate.  The  ulcers  are  usually  multiple, 
and  present  a punched-out  appearance. 
They  are  slow  in  healing,  and  the  occurrence 
of  buboes  (about  once  in  every  three  cases) 
greatly  protracts  the  case. 

Treatment. — If  the  disease  is  not  over  seven 
days  old  (Keyes),  proceed  as  follows:  Care- 
fully cleanse  the  ulcers  and  surrounding 
parts  with  warm  saturated  boric  acid  solu- 
tion (4  per  cent.),  or  carbolic  acid,  2 per  cent., 
or  bichloride  of  mercury,  1,:  2000  or  copper 
sulphate,  1 per  cent.,  or  hydrogen  peroxide 
and  water,  equal  parts.  Then  dry  carefull}" 
by  means  of  blotting  paper,  and  paint  the 
ulcers  well  with  cocaine  solution,  5 to  10 
per  cent. — Dry  carefully  again,  and  apply 
thoroughly  to  every  part  of  each  ulcer,  by 
means  of  a glass  rod,  or  matchstick,  or 
cotton  swab  on  the  end  of  a toothpick,  pure 
carbolic  acid,  for  the  purpose  of  additional 
anesthesia.  Take  care  not  to  touch  healthy 
tissue,  which  may,  if  desired,  be  protected 
with  vaseline.  Now  dry  again  with  blotting 
paper,  and  apply  pure  nitric  acid  or  sul- 


phuric acid,  taking  care  to  let  no  point 
escape.  Wash  again  with  an  antiseptic,  and 
dust  with  iochform,  which  may  be  somewhat 
deodorized  by  means  of  coumarin  or  oil  of 
sassafras  (gtt.  ii  to  each  5hss),  or  equal 
parts  of  powdered  coffee.  The  thermo- 
cautery applied  at  a dull-red  heat  is  also 
effectual;  but  Noble  and  Anspach  say  that  it 
is  apt  to  produce  too  much  sloughing. 
Cleanse  and  powder  the  parts  twice  daily, 
“ until  the  sloughs  have  separated  and 
the  granulations  have  become  healthy,” 
when  the  iodoform  may  be  replaced  by 
unguentum  hydrargyri  nitratis,  one  part, 
to  vaseline,  seven  parts;  or  ung.  zinci 
oxidi  containing  3 per  cent,  carbolic  acid; 
or  balsam  of  Peru  and  castor- oil;  equal 
parts;  or  acetanelid,  boric  acid  and  calomel, 
equal  parts;  or  dematol;  or  calomel;  or 
boric  acid,  etc.  Touch  exuberant  granula- 
tions with  the  silver  nitrate  stick  or  solution 
(gr.  XXX  ad  Bi)- 

The  application  of  argyrol  crystals  follow- 
ing cocainization  is  well  praised. 

If  the  ulcers  are  over  seven  days  old,  do 
not  cauterize  them;  for,  says  Keyes,  if 
cauterization  then  fails,  which  it  almost 
invariably  does,  it  leaves  the  sore  larger  than 
ever.  Bathe  the  parts  instead,  for  twenty 
minutes  or  longer,  two  to  four  times  a day, 
with  one  of  the  above  antiseptic  solutions; 
then  dry  with  a sterile  cloth,  and  apply  one 
of  the  above  powders.  Indolent  ulcers, 
however,  may  be  touched  twice  a week  with 
tincture  of  iodine,  or  the  silver  stick,  or  pure 
carbolic  acid. 

Early  chancroids  may  be  aborted  and 
cured  by  cauterization;  but,  says  Keyes, 
“ if  the  first  cauterization  fails,  it  is  futile 
to  repeat  it.” 

If  a complicating  phimosis  is  present,  irri- 
gate the  preputial  sac  frequently  and  slit  it 
dorsally  if  it  interferes  with  the  proper  treat- 
ment of  the  sores.  Threatening  gangrene,  of 
course,  demands  prompt  dorsal  incision  of 
the  prepuce.  Abscesses  call  for  incision  and 
drainage  and  elevation  of  the  penis. 

Timberlake  employs  the  following  plan 
of  treatment:  Under  general  anaesthesia, 
cleanse  the  parts  with  soap  and  water,  fol- 
lowed with  alcohol,  dry,  and  paint  the 
whole  penis  with  three  coats  of  tr.  iodi. 
Wash  off  the  shank  of  the  penis  with  alcohol. 
With  the  thermocautery  burn  the  chancroid, 
carrying  the  cauterization  into  3 mm.  of 
healthy  tissue.  Then  circumcise,  painting 
the  line  of  incision  with  tr.  iodi,  and  apply 
a wet  bichloride  (1  : 3000)  dressing.  Soak 
the  penis  every  day  for  fifteen  minutes  with 
bichloride  solution,  followed  by  iodine. 


CORD,  TUMORS  OF  THE 


The  patient  should  keep  off  his  feet  as 
much  as  possible  in  order  to  prevent  bubo. 
Should  the  latter  appear,  put  the  patient 
to  bed,  and  apply  the  ice-bag  until  resolution 
occurs,  or  until  the  inflammation  becomes 
active,  when  heat  should  be  substituted. 
Some  recommend  the  application  of  tincture 
of  iocUne  or  of  equal  parts  of  ung.  hydrargyri, 
ung.  belladonnse,  ung.  iodi,  and  ichthyol 
(Noble  and  Anspach),  covered  with  waxed 
paper  and  compression  made  with  an  ascend- 
ing spica  bandage  of  the  groin.  Keyes  says, 
however,  “ Do  not,  under  any  circumstances, 
paint  the  groin  with  iodine,”  because  it 
irritates  the  skin  and  promotes  auto-inocu- 
lation should  the  bubo  break  down. 

If  suppuration  occurs,  it  is  much  prefer- 
able to  excise  the  gland  intact.  If  this  is  not 
practicable,  it  is  generally  advised  that  the 
abscess  be  incised,  all  diseased  tissue  curetted 
away,  the  cavity  irrigated  with  corrosive 
sublimate,  1 : 1000,  dried,  cauterized  with 
pure  carbolic  acid,  and  packed  with  iodo- 
form gauze.  But  Keyes  says,  “ Suppurating 
bubo  should  be  drained  by  very  small  inci- 
sions, almost  punctures,  multiple  if  need  be, 
followed  by  injection  of  a 10  per  cent, 
iodoform-in- vaseline  ointment,”  and  the 
application  of  a hot- water  bag,  the  injection 
to  be  “ repeated  every  third  day  until  the 
purulent  discharge  ceases.”  Persistent  indu- 
ration calls  for  excision;  but  do  not  excise 
the  glands  of  both  groins.  Should  the  bubo 
break  down  and  infect  the  edges  of  the 
wound,  employ  the  actual  cauteiy,  under 
general  anaesthesia,  and  destroy  thoroughly 
and  deeply,  without  fear,  all  the  infected 
tissue;  then  pack  with  gauze,  or  apply  iodo- 
form or  wet  dressings. 

If  the  urethra  is  involved,  as  ascertained 
by  endoscopic  and  bacteriologic  examina- 
tion, introduce,  following  urination,  sui> 
positories  of  iodoform  in  cocoa-butter,  and 
cover  the  meatus  with  cotton  or  gauze  to 
keep  the  suppository  in.  Cure  thereby  is 
said  to  be  rapid. 

Prescribe  a nutritious  diet,  perhaps  cod- 
liver  oil,  fresh  air  day  and  night,  rest, 
regular  hours  of  eating  and  sleeping,  regu- 
lation of  the  bowels,  and,  as  a tonic,  elixir 
ferri,  quininse,  et  strychninje,  one  teaspoon- 
ful well  diluted,  t.i.d.p.c. 

Robbins  and  Seabury  report  excellent 
results  from  the  following  plan  of  treatment: 
After  an  examination  for  spirochetes  is 
made  (see  under  Syphilis),  a “ 25  per  cent, 
solution  of  copper  sulphate  in  distilled  water 
is  applied  to  the  sore,  and  the  short  high 
frequency  spark  from  a rather  fine-pointed 
vacuum  electrode  is  applied  directly  to  the 


sore  for  one  to  three  minutes,  depending  on 
the  extent  of  the  ulceration.” 

“ Especial  care  is  exercised  in  carrying  the 
point  of  the  electrode  well  down  into  any 
fissure  or  undermined  edge,  and  the  area  of 
application  should  extend  over  the  edge  of 
the  sore  about  one-sixteenth  inch  into  the 
doubtfully  healthy  area.”  “ The  current 
is  not  turned  off  until  every  crack  and  crev- 
ice has  been  thoroughly  treated  and  the 
surface  of  the  sore  is  changed  to  a dark  green- 
ish gray.”  “ It  is  then  wiped  dry  and  some 
antiseptic  powder  is  lightly  applied  to  the 
entire  mucous  surface  of  the-  preputial 
cavity.”  “ If  the  sore  is  exposed,  it  should 
be  covered  with  a thick  moist  dressing,  say 
of  bichloride,  1 : 10,000,  which  should  be 
changed  once  or  twice  daily,  and  must  not 
be  allowed  to  stick.”  It  must  be  moistened 
at  least  three  or  four  times  a day.  The 
original  cauterization  may  be  repeated  if  it 
is  evident,  that  the  chancroidal  infection  has 
not  been  completely  destroyed. 

Chill,  Urethral. — See  Urethral  Chill. 

Chordee. — Fr.  cords,  corded.  (See  under 
Gonorrhoea.) 

Chylocele. — Gr.  ycXos  chlye  -f-  Krfkri  tumor. 
An  accumulation  of  milky  lymph  within  the 
tunica  vaginalis  of  the  testis. 

Etiology.— ‘The  tropical  filaria  sanguinis 
hominis  (elephantia.sis;  lymph  scrotum,  q.v.), 
traimiatic  rupture  of  a lymphatic  vessel  into 
the  tunica  vaginalis. 

Treatment. — Excise  the  sac. 

Chyluria. — See  Part  1,  General  Medicine 
and  Surgery. 

Coloptosis. — Gr.  ku>\ov  colon  -f-  TTTu)ats  fall. 
(See  Splanchnoptosis  in  Part  1.) 

Condyloma. — Gr.  Kovdv\uiJ.a  wart.  (See 
Verrucse.) 

Congenital  Syphilis. — L.  con,  together 
gen'iius,  born.  (See  Syphilis  in  Part  1.) 

Conjunctivitis,  Gonorrhoeal. — See  Part  6, 

Eye  Diseases. 

Contraction  of  the  Bladder. — See  Blad- 
der, Contracted. 

Contracture  of  the  Neck  of  the  Bladder. — 

L.  con,  together  -|-  ira'here,  to  draw.  See 
Bladder  Irritability. 

Cord,  Spermatic,  Carcinoma  of  the. — L. 

cho'rda;  Gr.  xop^'n',  cireppa  seed; 
Kapdvos  crab  + -upa  tumor.  (See 
Tumors  of  the  Testis,  Epididjmiis, 
and  Spermatic  Cord.) 

Hydrocele  of  the. — See  Hydrocele. 

Torsion  of  the. — L.  lor'sio;  torquer'e,  to 
twist.  (See  Injuries  of  the  Testicle.) 

Tumors  of  the. — See  Tumors  of  the 
Testis,  Epididymis,  and  Sper- 
matic Cord. 


CYSTITIS 


Corpora  Cavernosa  et  Spongiosum,  Fibro= 

sis  of  the. — L.  fib'ra,  fibre.  See 
Tumors  of  the  Penis. 

Sclerosis  of  the. — L.  cor'pus,  cor'pora, 
bodies,  cavernous  and  spongy.  See 
Tumors  of  the  Penis. 

Cowperitis. — Inflammation  of  Cowper’s 
glands.  The  point  of  tenderness  is  situated 
about  one  inch  in  front  of  the  anus  and 
to  one  side  of  the  middle  line.  The  inflamed 
glands  may  be  palpated  by  means  of  the 
index  finger  in  the  rectum  and  the  thumb 
on  the  perineum.  Their  contents  may  be 
expressed  into  the  urethra  from  which  they 
may  be  obtained  for  microscopic  examina- 
tion. The  normal  glands  are  not  palpable. 

Etiology. — Gonorrhoea;  rarely  typhoid  fever, 
measles,  endocarditis,  pysemia,  tuberculosis. 

Treatment. — If  a large  abscess  forms,  incise 
it  and  pack  with  gauze,  preceded  or  not 
by  irrigation  with  bichloride  solution, 
1 : 1000.  If  the  abscess  is  small,  the  whole 
gland  may  be  removed. 

If  a fistula  has  formed,  first  cure  the  ure- 
thritis, then  dissect  out  all  the  diseased 
tissue,  freshen  the  margins  of  the  urethral 
opening,  and  close  with  fine  interrupted 
catgut  sutures,  not  involving  the  mucous 
membrane.  Then  insert  a soft  catheter  into 
the  bladder,  and  keep  it  there  until  healing 
occurs  (for  particulars  in  regard  to  the 
retained  catheter,  see  under  Bladder  Diverti- 
cula). Administer  urotropine  before  and  after 
the  operation  until  healing  has  occurred. 

For  chronic  cowperitis  one  may  employ 
very  gentle  massage. 

Tuberculous  cowperitis  is  very  rare. 
Excise  the  gland,  if  possible;  otherwise 
curette  away  all  diseased  tissue,  irrigate  with 
bichloride  solution,  1 ; 5000,  dry,  swab  with 
pure  carbolic  acid  followed  by  alcohol,  and 
pack  with  iodoform  gauze. 

Cryptorchidism. — Gr.  kpvtttos  hidden  -|- 
6pm  testis.  (See  Undescended  Testicle.) 

Cyst. — Gr.  kv<ttls  bag.  See  Tumors. 

Cystalgia. — Gr.  kvctls  cyst  d'Xyos  pain. 
See  Bladder  Irritability. 

Cyst,  Epididymal  Retention. — See  Sper- 
matocele. 

Cystitis. — Gr.  Kvam  bladder  -f  -ltis  inflam- 
matio.n.  Inflammation  of  the  bladder  is 
manifested  by  frequent,  painful  micturition, 
urgency,  vesical  tenesmus  or  straining,  burn- 
ing pain  in  the  bladder,  pyuria,  and  some- 
times hsematuria.  Ureteritis  and  pyelitis 
are  possible  sequelae. 

Cystitis  should  be  distinguished  from 
ureteral,  renal,  urethral,  and  prostatic  infec- 
tion, vesico-urethral  fissure,  simple  irritabil- 
ity of  the  bladder,  contraction  of  the  bladder. 


and  vesical  stone  or  foreign  body.  To  this  end 
employ  the  urethroscope,  cystoscope,  ureteral 
catheter,  and  urinalysis,  etc.  See  Pyelone- 
phritis for  important  diagnostic  criteria. 

The  Prognosis,  under  treatment,  is  good. 

Etiology. — Catheterization;  unclean  instru- 
mentation; traumatism;  “cold”;  focal  in- 
fection (pyorrhcea,  dental  infection,  etc.); 
masturbation;  excessive  coitus;  constipa- 
tion; hemorrhoids;  retention  of  urine  {q.v., 
for  causes) ; overchstention  of  the  bladder  due 
to  polyuria  (q.v.);  calculi;  foreign  bodies; 
vesical  tumors;  parasites,  e.g.,  echinococcus 
(very  rare;  the  characteristic  booklets  may 
be  voided  in  the  urine,  or  the  cyst  may  be 
seen  through  the  cystoscope);  the  tropical 
filaria  sanguinis  hominis  (chyluria  or  hsema- 
tochyluria  may  result),  and  distoma  haema- 
tobium (Bilharzii,  occurring  in  Egypt  and 
the  African  coast,  causes  frequent  hemor- 
rhage, strangury  and  pain) ; irritating  ingesta 
(cantharides,  turpentine,  balsamics,  salicy- 
lates, calomel,  alcohol,  etc.);  urinary  crys- 
tals (uric  acid,  calcium  oxalate,  phosphates, 
see  Nephrolithiasis);  too  high  or  too  low 
specific  gravity;  hyperacidity;  alkalinity; 
injection  of  strong  silver  nitrate  solution, 
etc.;  bladder  diverticula  or  sacculations 
(q.v.);  operations. 

Casual  bacteria  include  the  colon,  typhoid, 
and  tubercle  bacilli,  and  the  gonococcus, 
which  produce  an  acid  cystitis;  and  the 
staphylococci,  streptococci,  and  proteus 
vulgaris,  which  produce  an  alkaline  cystitis. 
Bacteria  gain  access  to  the  bladder  by  way  of 
the  kidney,  ureter,  lu’ethra,  prostate,  epi- 
didymis, vas  deferens,  seminal  vesicles, 
intestine,  appendix,  blood,  etc.  Tuberculous 
cystitis  is  almost  invariably  secondary  to 
tuberculosis  of  the  kidney  or  testis,  or 
possibly  the  prostate. 

Treatment.— A.  Acute  Cystitis. — Avoid 
cystoscopy  and  local  treatment.  Put  the 
patient  to  bed,  and  apply  heat  to  the  hypo- 
gastrium  in  the  form  of  hot  moist  flannels, 
or  hot-bran  bags,  or  hot-water  bags.  Hot 
sitz-baths  and  hot  rectal  lavage  for  fifteen 
minutes  two  or  three  times  a day  are  of 
service.  Open  the  bowels  with  Rochelle 
salt  (both  laxative  and  diuretic),  5i  in 
dilute  solution  every  two  or  three  hours,  and 
prescribe  a bland,  liquid  or  soft  diet,  with 
copious  water-drinking  between  meals  (two 
to  three  quarts  daily  of  plain  water,  Vichy, 
or  flaxseed  tea).  Prohibit  meat,  acid  fruits, 
spices,  condiments,  mustard,  horseradish, 
pepper,  salt  in  excess,  radishes,  rhubarb, 
tomatoes,  asparagus,  pickles,  salads,  sauces, 
vinegar,  cheese,  greasy  or  fried  foods,  lemons, 
ginger  ale,  alcohol,  tea,  coffee.  Milk  is  the 


CYSTITIS 


best  food.  If  the  patient  is  very  septic, 
prescribe  concentrated  liquid  nourishment 
(milk  and  eggs)  and  strychnine. 

For  severe  pain  and  tenesmus,  one  of  the 
following  formulae  may  be  prescribed: 

Extract!  hyoscyami ...  gr.  viii  (gr.  per  dose) 
Extract!  cannab!s  !n- 

d!cse gr.  v!!!  (gr.  per  dose) 

Sacchar!  alb! gr.  xlvui 

M.  et  d!v.  !n  pulv.  No.  24. 

S!g. — One  powder  every  four  hours.  (Da  Costa.) 

Extract!  op!! gr. 

Extract!  belladonna) gr. 

Ole!  theobromatis,  q.s. 

M.  et  ft.  suppos.  M!tte  talis  No.  6. 

S!g. — One  every  six  or  eight  hours.  (H.  A.  Kelly.) 

Ashton  and  Dudley  recommend,  for  the 
relief  of  pain  and  tenesmus  in  mild  cases, 
rectal  suppositories  of  ichthyol,  gr.  iii,  once 
or  twice  daily. 

If  the  desire  to  urinate  is  constant,  one 
may  instill  10  minuns  of  a 5 per  cent,  solu- 
tion of  silver  nitrate  or  4 per  cent,  solution 
of  cocaine,  using  an  Ultzmann  instilla- 
tor. 

Prescribe  as  a urinary  antiseptic,  hexa- 
methylenamine  (urotropine) , gr.  v-vii-xv, 
in  capsule  or  powder,  with  water,  every 
three  or  four  hours.  Urotropine  liberates 
formaldehyde  in  the  urine  only  when  the 
latter  is  acid.  Helmitol  (methylene  citro- 
nate  of  hexamethylenamine),  gr.  vii-x-xxx, 
incapsule,  t.i.d.,  liberates  formaldehyde  even 
if  the  urine  is  not  acid  (see  the  appendix 
for  the  dosage  at  various  ages,  etc. ; suspend 
the  drug  if  it  causes  irritation,  and  reduce 
the  dose). 

Other  less  valuable  minary  sedatives  and 
antiseptics  are: 

Saliformin  gr.  v every  four  hours. 

Salicylic  acid,  sochum  salicylate,  or  salol, 
gr.  v-x,  every  three  hours  (salol  liberates 
carbolic  and  salicylic  acids  in  the  urine;  it 
should  not  be  pushed  to  the  point  of  produc- 
ing “ Imnbar  heaviness”;  these  drugs  are 
recommended  in  gonorrhoeal  cystitis,  in 
which  it  is  important  to  keep  the  urine  acid) . 

Sodi!  sallcj'latis 5iss  (gr.  ii!  per  dose) 

Hexamethylenaminte . ...  3iss  (gr. !!!  per  dose) 

Tinctura)  hyoscyam! oiv  (t^jvu!  per  dose) 

EUxir  s!mpl!c!s,  q.s.  ad. . . 5iv 

M.  S!g. — One  dram  !n  water  every  two 
hours  (“a  valuable  combination”  in  gonorrhceal 
cystitis.  (Handler.) 

Extract!  hyoscyami gr.  ss 

Phenylis  salicylatls gr.  v 

Hexamethylenamlna) gr.  v 

Ft.  tab  caps.  No.  20. 

S!g. — -Oneevery  three  hours,  with  water.  (Handler.) 

Fluidextract  of  zea  mais,  Yi  teaspoonful, 
well  diluted,  every  three  or  four  hours 


(“  the  best  drug  I know  to  allay  the  irri- 
tability of  the  bladder.”)  (H.  A.  Kelly.) 

Fluidextract  of  triticum  repens,  Y 
teaspoonful,  well  diluted,  every  three  or 
four  hours. 

Fluidextract  of  pareira  brava,  5i~ii,  well 
diluted,  three  or  four  times  a day. 

Infusion  of  uva  ursi,  5ss-i,  t.i.d. 

Infusion  of  buchu,  5ss-i,  t.i.d.  Buchu 
leaves  are  the  best  of  the  vegetable  diure- 
tics, according  to  Capser,  who  recommends, 
for  their  sedative  and  astringent  properties 
two  teaspoonfuls  of  a mixture  of  several 
herbs:  buchu  leaves,  couch  grass,  pareira 
brava,  cornsilk,  uva  ursi,  alchemilla,  etc., 
to  each  cup  of  water,  to  be  boiled  for  several 
minutes — three  or  four  cupfuls  a day. 

Oleum  santali  or  ol.  copaibse,  njv-x-xx, 
in  capsule,  t.i.d.p.c.  Suspend  the  drug  if 
gastric  indigestion  occurs.  01.  santali  is 
inchcated  in  gonococcus  and  staphylococcus 
infection.  Says  Le  Fe\Te,  the  combination 
of  ol  santali  vel  copaibse  with  salol  or  sodium 
benzoate  is  “ especially  efficacious.” 

Spiritus  setheris  nitrosi,  one  teaspoonful 
well  diluted,  every  two  or  three  hours. 

Oleum  eucalypti,  ngx  in  water,  every^ 
two  hours. 

Tincture  of  hyoscyamus,  thirty  drops, 
well  diluted,  every  two  or  three  hours. 

For  ammoniacal  urine,  prescribe: 

Benzoic  acid,  gr.  x,  in  capsule,  three  or 
four  times  a day. 

Sodium  or  aimnoniimi  benzoate,  gr.  v-xxx, 
t.i.d. 

Boric  acid,  gr.  x-xv,  in  capsule,  three  to 
six  times  a day. 

Acid  sodium  phosphate,  gr.  xxx,  in  water, 
four  times  a day. 

Acid!  benzoic! oi!  (gr.  v per  dose) 

Acid!  boric! 5ii!  (gr.  viiss  per  dose) 

Aqua)  cinnamom! oxii 

M.  S!g. — Tablespoonful  in  water,  four  times 
daily.  (Emmett.) 

For  strongly  acid  urine,  prescribe,  if 
deemed  advisable: 

Potassium  citrate  or  bicarbonate,  5i-ii, 
dissolved  in  one  or  two  pints  of  flaxseed 
tea,  and  given  in  divided  doses  during  the 
day.  (Penrose.) 


Potass!!  citratis gr.  xx 

Tincturae  hyoscyami ^x 

Infus!  uvae  ursi,  q.s.  ad oi 


IM.  S!g. — One  ounce  every  four  to  six  hours. 

Keep  the  patient  in  bed  “ as  long 
as  vesical  pain  and  tenesmus  contin- 
ue.” (Penrose.) 

As  soon  as  the  acute  symptoms  are  alletd- 
ated,  irrigate  the  bladder  two  or  three  times 


CYSTITIS 


daily  with  warm  boric  acid  or  ichthyol 
solution,  2 per  cent,  of  either  (see  below). 

B.  Subacute  and  Chronic  Cystitis. — 
Treat  the  affection  internally  as  described 
under  acute  cystitis.  Irrigate  the  bladder 
every  other  day,  or  less  often,  with  warm 
boiled  boric  acicl  solution,  5ii-iii-iv  to  the 
pint  (silver  nitrate,  gr.  %,  may  be  added, 
making  a 1 ; 10,000  solution);  or  boric 
acid,  3ii,  borax,  3i,  and  .sodium  chloride, 
3ss,  to  the  pint  (boric  acid  solutions,  being 
mild,  may  be  used  every  day,  if  desired); 
or  carbolic  acid  solution,  up  to  per  cent.; 
or  oxycyanide  of  mercury,  1 : 10,000  to 
1 : 1000;  or  bichloride  of  mercury,  1 : 100,- 

000  in  normal  saline  solution  (3i  ad  Oi), 
gradually  increased  to  1 : 10,000  to  1 : .5000 
(alternate  with  boric  acid  irrigations;  the 
bichloride  irrigations  are  painful) ; or  creolin, 

1 : 1000  to  1 ; 500;  or  lysol,  1 : 1000  to 
1 : 500;  or  potassium  permanganate,  1 
15,000  to  1 : 6000  to  1 : 1000;  or  protargol, 
1 : 10,000;  or  silver  nitrate,  1 : 10,000  to 
1 : 8000  to  1 : 500  (“  the  remedy  par  excel- 
lence,” says  Casper,  “ the  best  solution  for 
general  use  being  1 : 1000”;  it  should  be 
alternated  with  milder  antiseptics;  the 
stronger  solutions  should  be  followed  by 
normal  saline  solution,  3i  ad  Oi).  The 
strength  of  the  irrigating  fluid  should  be 
tempered  to  the  sensitiveness  of  the  bladder. 
The  latter  should  be  completely  filled. 

Introduce  the  irrigating  fluid  by  hydro- 
static pressure  from  a fountain  syringe  with 
a blunt  nozzle  attachment  (as  in  the  treat- 
ment of  urethritis),  instructing  the  patient 
to  open  his  mouth  and  bear  down  in  order 
to  relax  the  compressor  ui-ethrse  muscle  and 
allow  the  fluid  to  enter  the  bladder.  If 
the  sphincters  do  not  relax  so  as  to  admit 
the  fluid  with  moderate  elevation  of  the 
reservoir,  it  is  recommended  by  Bransford 
Lewis  that  15  minims  of  a 2 per  cent,  solu- 
tion of  cocaine  (f)  or  alypin  be  injected, 
“following  with  air  pressure  to  advance  it  to 
the  compressor  urethrae  muscle  for  a minute 
or  two.” 

In  obstinate  cases,  instillations  of  stronger 
solutions  may  be  employed,  e.g.,  34  to  2 
ounces  of  warm  silver  nitrate  solution, 

1 : 1500,  gradually  increased,  if  no  discom- 
fort ensues,  to  1 : 1000  to  1 : 500,  to  1 : 100; 
or  protargol,  1 tlram  of  a 1 to  5 per  cent, 
solution;  or  argyrol,  1 dram  of  a 25  per 
cent,  solution;  or  collargol,  3 ounces  of  a 

2 per  cent,  solution;  or  iodoform  emulsion, 
1 : 10  of  liquid  vaseline,  2 to  3 drams. 
The  instillations  may  be  made  every  day  or 
every  other  day  by  means  of  a bulb  or  a 
funnel  or  a small  glass  piston  syringe 

30 


attached  to  a silver  or  hard-rubber  catheter. 
No.  18  F.,  or  by  means  of  Ultzmann’s 
instillator.  The  hips  should  be  elevated; 
and  the  fluid  should  be  retained  as  long  as 
possible.  Dudley  says,  “ When  the  bladder 
is  so  painful  as  to  resist  all  efforts  at  treat- 
ment, it  may  be  amesthetized  with  10  to  20 
c.c.  of  a 4 per  cent,  solution  of  antipyrine, 
left  in  about  twenty  minutes.”  Obstinate 
ulcers  may  be  curetted  and  swabbed  with 
silver  nitrate  through  an  operating  cysto- 
scope  (general  anaesthesia  may  be  necessary) ; 
but  excision  through  all  the  coats  of  the 
bladder,  including  the  peritoneum,  is  proba- 
bly required  to  cure  the  condition  (followed 
by  suprapubic  drainage  and  irrigations  for 
the  ensuing  cystitis). 

In  intractable  cases  or  in  cases  of  “ marked 
retention  with  much  pus  and  mucus,”  it 
may  be  advisable  to  fasten  in  place  a soft 
catheter  for  frequent  irrigations  and  constant 
drainage  (see  under  Bladder  Diverticula,  for 
details  in  regard  to  the  use  of  the  retained 
catheter).  Casper’s  self-retaining  catheter 
or  Pezzer’s  catheter  may  be  used.  “ If  the 
retained  catheter  is  not  well  supported,  it  is 
sometimes  possible  to  remove  the  difficulty 
by  stretching  the  posterior  urethra  with  a 
Kollman  dilator,  up  to  38  or  40  F.,  under 
efficient  local  an8e.sthesia.”  (Bransford 
Lewis.)  Morphine  may  be  given  to  make 
the  retention  of  the  catheter  more  tolerable. 

If  retention  of  a catheter  is  not  possible, 
resort  to  suprapubic  or  perineal  cystotomy, 
preferably  (as  a rule)  the  former,  and  insert 
a permanent  drainage  tube.  Treat  con- 
ditions as  found — excise  ulcers  and  diver- 
ticula; open  perivesical  abscesses  wherever 
they  point,  etc.  Interstitial  and  pericystic 
inflammation,  in' which  the  bladder  wall  is 
thick  and  contracted,  usually  requires  supra- 
pubic drainage  for  weeks  or  months. 

Good  hygiene  is,  of  course,  important, 
e.g.,  rest,  only  the  lightest  exercise,  warm 
clothing,  hot  full  baths  with  friction,  fresh 
air  day  and  night,  regulation  of  the  bowels, 
good  food,  at  least  four  pints  of  fluid  in 
twenty-four  hours,  and  perhaps  a tonic. 
Do  not  neglect  to  eradicate  any  possible 
foci  of  infection. 

In  filariasis  (see  Part  1),  a spontaneous 
cure  usually  occurs  if  the  patient  is  removed 
from  the  infected  region. 

In  bilharziasis  (see  Part  1),  treatment 
can  only  be  directed  to  the  checking  of 
hemorrhage  by  means  of  irrigations  with 
hot  silver  nitrate  or  creolin  solution, 
1 : 1000  to  500,  and  continuous  catheterism 
for  about  ten  days  to  quiet  the  bladder.  If 
retention  of  urine  occurs,  a perineal  section 


ELEPHANTIASIS  OF  THE  SCROTUM 


may  be  required  and  the  clots  broken  up 
with  the  finger  and  washed  out.  Excise 
urethral  fistuljE  freely;  scrape  perineal  fistulse 
with  a sharp  spoon,  and  pack  with  gauze  so 
as  to  keep  the  wound  open  to  granulate.  It 
is  said  that  spontaneous  cure  often  occurs. 

In  echinococcus  disease,  open  and  oblite- 
rate the  cyst. 

C.  Tuberculous  Cystitis. — It  is  sus- 
ceptible of  cure  or  amelioration.  An  infec- 
ted kidney,  testis,  or  prostate  should  be 
removed,  whereby  the  cystitis  usually  dis- 
appears. Plenty  of  nourishing  food,  fresh 
air,  and  rest  are  of  importance.  Codliver 
oil  and  hypophospliites  or  glycerophosphates 
may  be  prescribed.  Creosote,  guaicol, 
ichthyol,  and  ichthalbin  have  their  advo- 
cates (see  Part  11).  Casper  praises  mor- 
phine and  belladonna  as  valuable  sedative 
and  curativeagents.  Alkalies  may  be  sooth- 
ing. The  application  of  heat  is  especially 
soothing. 

In  advanced  cases  (not  in  the  early 
stages),  the  bladder  may  be  instilled  (never 
hrigated),  once  daily,  or  two  or  three  thues 
a week,  through  a small,  soft-rubber  catheter, 
with  an  emulsion  of  iodoform,  pi  to  5i  of 
liquid  vaseline,  two  or  three  drams  at  a 
time,  to  be  retained  as  long  as  possible; 
or  one-half  dram  of  the  followdng:  guaiacol, 
5 giu.,  iodoform,  1 gm.,  sterile  olive  oil,  100 
gm.  (Collin);  or  guaiacol  valerianate,  25  to 
100  per  cent,  in  olive  oil  (Chetwood);  or 
thallin  sulphate,  3 to  12  per  cent,  aqueous 
solution  (Chetwood);  or  Gomenol  oil,  15  to 
30  c.c.  of  a 20  per  cent,  solution.  Casper 
regards  bichloride  of  mercury  as  the  “ sove- 
reign ” local  remedy.  He  begins  wdth 
instillations  of  1 : 10,000  to  1 : 1000,  no 
oftener  than  twice  a week,  less  often  if 
there  is  much  painful  reaction,  and  as  the 
symptoms  abate,  he  dhiiinishes  the  strength 
and  increases  the  quantity  up  to  50  c.c.  of  a 
1 : 10,000  to  1 : 5000  solution.  Do  not 
inject  enough  to  distend  the  bladder.  Warn 
the  patient  that  a i^ainful  reaction  follows 
each  instillation.  Achninister  morphine. 
Discontinue  the  treatment  “ if  no  result  is 
experienced  after  three  or  four  applications.” 

Keyes,  however,  begins  with  instillations 
of  2 to  10  minims  of  a 1 : 25,000  solution 
of  bichloride,  and  increases  the  strength  of 
the  solution  “ as  far  and  as  rapidly  as 
the  patient’s  symptoms  permit.”  He 
says,  “ The  treatment  should  excite  no 
sharp  reaction.” 

Casper  “ strongly  opposes”  operative 
methods  of  treating  tuberculous  cystitis, 
i.e.,  curettement  of  ulcers  through  the 
cystoscope,  excision,  and  suprapubic  cys- 


tostomy.  Internal  urinary  antiseptics  and 
silver  nitrate,  boric  acid,  and  potassium 
permanganate  instillations  do  harm.  Tuber- 
culin is  still  subjudice. 

Cystospasm. — Gr.  Kuaris  bladder  -|- 
(XTaa-fj.6s  spasm.  Bee  Bladder  Irritability. 

Cyst,  Retention,  Epididymal. — See  Sper- 
matocele. 

Cysts. — Gr.  kvcttls  bag.  See  Tumors. 

Distomiasis  of  the  Bladder. — Gr.  two 

-f  arona  mouth.  See  under  Cystitis. 

Diverticula  of  the  Bladder.-^ee  Bladder 
Diverticula  or  Sacculations. 

Dysuria. — Gr.  6cs-  ill  -f  olpov  urine.  Pain- 
ful or  difficult  urination. 

Causes. — Urethritis;  trigonitis;  cystitis; 
vesico-uretliral  fissure;  vesical  distomiasis; 
pyelitis  and  pyelonephritis;  urethral  stric- 
ture; stricture  of  the  neck  of  the  bladder; 
urethral  tumors;  prostatis;  enlarged  pros- 
tate; neuroses  of  the  prostate;  vesical  calculi 
and  foreign  bodies;  uretliral  calculus  and 
foreign  bodies;  urethral  injuries;  bladder 
injuries;  seminal  calculus;  vesical  tumors; 
vesical  tuberculosis;  prostatic  tuberculosis; 
vesicular  tuberculosis;  distended  colon;  mas- 
turbation or  excessive  coitus;  excessive 
acidity  of  the  urine;  pyuria;  crystals  in  the 
urine  (see  Nephrolithiasis);  too  high  or  too 
low  specific  gravity;  hemorrhoids;  abdominal 
pelvic  operations;  oxyuriasis;  anal  fissure 
and  other  rectal  diseases;  irritating  in- 
gesta,  e.g.,  ginger,  racUshes,  spices,  turpen- 
tine, salicylates,  cantharides,  quinine, 
urotropine,  etc.;  neuroses  of  the  bladder 
(see  Bladder  Irritability). 

Echinococcus  Disease  of  the  Bladder. — 
Gr.  ex^vos  hedge-hog  -|-  kokkos  berry. 
See  under  Cystitis. 

Kidney. — See  Tumors  of  the  Kidney. 

Eczema  of  the  Scrotum. — Gr.  eK^tlv  to 
boil  out;  L.  scro'tum,  bag.  See  Eczema, 
in  Part  5,  Skin  Diseases. 

Ejaculation,  Premature. — L.  ejacula’tio, 
to  throw;  prce^natu'rus,  early  ripe.  See  Sex- 
ual Neuroses. 

Elephantiasis  of  the  Scrotum;  Lymph 
Scrotum. — Gr.  for  “elephant  disease”;  L. 
hjm'pha,  water;  scro'tmn,  bag.  Lymphatic 
obstruction  anti  distention  caused  by  the 
tropical  filaria  sanguinis  hominis,  or  exten- 
sive disease  or  removal  of  the  inguinal 
Ijanphatic  glands. 

Treatment.— The  X-rays  {q.v.)  may  be  of 
sendee.  The  scrotal  overgrowdh  may  also  be 
satisfactorily  removed  with  the  knife.  First 
(hain  the  parts  of  blood  for  some  hours. 
Then  apply  an  elastic  bandage  to  the  scro- 
tum and  a ligature  at  the  base,  as  the  vascu- 
laidty  is  very  great.  Then  dissect  out  the 


ENURESIS 


penis  and  testicles  by  incisions  along  the 
dorsum  of  the  penis  and  along  the  course  of 
the  cords,  bearing  in  mind  that  hernia  is 
apt  to  be  present.  Take  away  the  whole  of 
the  affected  skin  to  obviate  recurrence. 

Enlarged  Prostate. — See  Prostate,  Hyper- 
trophy of  the. 

Enteroptosis. — Gr.  evrepop  bowel  + irruais 
fall.  See  Splanchnoptosis,  in  Part  1,  Gen- 
eral Medicine  and  Surgery. 

Enuresis;  Incontin^ce  of  Urine. — Gr. 
Ivovpetv  to  void  urine;  ovpov  mine;  L.  inconti- 
nen'tia.  Enuresis  is  most  commonly  met  with 
in  children,  and  is  then  usually  nocturnal. 

Do  not  mistake  false  or  paradoxical  incon- 
tinence, due  to  the  overflow  of  a distended 
bladder  (see  Retention  of  Urine)  for  true 
incontinence. 

A.  Incontinence  in  Male  Adults.— Causes. — 
Cystitis;  vesical  tuberculosis;  vasical  calculus 
or  foreign  bodies;  vesical  tmnors;  paralysis  or 
paresis  of  the  sphincter,  due  to  general 
paresis,  tabes,  injuries  of  the  cord,  compres- 
sion of  the  cord  by  hemorrhage  or  exudate, 
myelitis,  disseminated  sclerosis,  etc.;  opera- 
tive injurj'  to  the  sphincter  muscle;  urinary 
fistula;  irritating  purulent  or  acid  urine; 
atrophy  of  the  prostate;  hemorrhoids;  hernia; 
hysteria;  neurasthenia;  epilepsy. 

Treatment. — Correct  the  cause,  if  possible. 
To  restore  muscular  tone,  employ  faradiza- 
tion three  to  five  times  weekly.  Casper 
places  the  negative  electrode  over  the 
bladder  and  the  other  (a  metal  sound 
covered,  with  the  exception  of  the  tip,  with 
hard  rubber)  within  the  rectum,  and  employs 
as  strong  a current  as  the  patient  can  endure, 
increasing  the  strength  at  short  intervals 
for  a few  seconds,  in  order  to  impart  an 
electric  shock.  Guyon  “ places  one  elec- 
trode in  the  membranous  urethra,  the  other 
over  the  pubes.”  (Keyes.)  Spinal  and 
abdominal  massage,  manual  or  vibratory, 
is  no  doubt  of  benefit. 

Strychnine  in  large  doses  and  ergot  may  be 
of  additional  service  as  muscular  tonics. 
See  Part  11. 

For  hyperacidity  of  the  urine,  prescribe 
potassium  salts  or  sodium  bicarbonate. 

For  incontinence  following  perineal  pro- 
statectomy, which  persists  longer  than 
several  weeks,  train  the  patient  by 
filling  his  bladder  with  boric  acid  solution 
and  “ bidding  him  start — stop — 

start — stop,”  until  the  bladder  is  empty. 
(De  Alexander — Keyes.)  Chetwood’s  urethral 
clip  is  helpful,  says  Keyes. 

B.  Bed=Wetting  in  Children. — CAUSES. — Neu- 
rosis (90  per  cent. — Kerley) ; thyroid  inade- 
quacy (“  by  far  the  commonest  cause  ” — 


Leonard  Williams);  anaemia  and  malnutri- 
tion; rickets;  adenoids;  masturbation; 
chronic  constipation;  fecal  accumulations; 
pin- worms;  rectal  polypus;  anal  fissure; 
preputial  adhesions;  phimosis;  narrow 
meatus;  balano-posthitis;  vulvo-vaginitis ; 
exposure  to  wet  and  cold;  ill-breeding; 
terror;  hyperacidity  of  the  urine;  crystals 
in  the  urine  (see  Nephrolithiasis) ; irritating 
ingesta;  cy.stitis;  renal  or  vesical  stone. 

The  treatment  is  often  unsatisfactory; 
but  the  affection  disappears  spontaneously 
at  puberty. 

Treatment. — Correct  any  possible  etiological 
factor.  Aim  to  improve  the  general  health 
by  means  of  fresh  air  day  and  night,  ade- 
quate rest  and  exercise,  avoidance  of  over- 
study, regular  hours  of  eating  and  sleeping, 
rest  before  and  after  meals,  regulation  of  the 
bowels,  a daily  morning  wann  bath,  before 
breakfast,  in  a warm  room,  followed  by  a 
cold  spinal  douche  and  brisk  rubdown  with 
a coarse  towel,  perhaps  tonics  (arsenic, 
iron,  strychnine),  and  an  abundant  but  un- 
.stimulating  diet.  Prohibit  tea,  coffee,  ginger 
ale,  beer,  lemonade,  spices,  condiments,  acid 
or  sour  foods,  radishes,  rhubarb,  tomatoes, 
asparagus,  cheese.  Reduce  meat,  eggs,  and 
othe)’  highly  nitrogeneous  foods,  and  sugar, 
if  the  urine  is  very  acid  and  the  specific 
gravity  high  (1.020  or  over),  and  give  alkalies 
and  plenty  of  water,  except  at  supper  time. 
The  supper  should  be  light,  and  little  or  no 
water  should  be  allowed  in  the  evening. 
Le  Fevre  says:  “ Many  cases  of  nocturnal 
polyuria,  especially  in  children,  can  be  con- 
trolled by  abstinence  from  starchy  foods 
and  sugars  at  the  evening  meal.” 

Before  retiring,  the  bladder  should  be 
emptied.  The  patient  should  sleep  upon  a 
hard  mattress,  the  bed-covering  should  be 
light,  and  the  foot  of  the  bed  elevated  so  as 
to  keep  the  urine  away  from  the  sphincter. 
For  the  latter  purpose,  too,  it  is  recom- 
mended that  a towel  be  placed  about  the 
waist  and  knotted  on  the  back,  to  prevent 
the  child  from  sleeping  on  the  back. 
The  child  may  be  taken  up  to  urinate  at 
10  or  11  o’clock. 

Atropine  is  recommended.  It  should  be 
begun  in  small  doses,  and  gradually  increased 
until  its  physiological  effects  are  noticed, 
e.g.,  dilatation  of  the  pupils  and  flushing  of 
the  skin. 

Kerley  employs  a solution  of  one  grain  to 
the  ounce  (500  drops,  gr.  to  the 

drop),  and  gradually  brings  the  do.se  up 
to  not  more  than  one  drop  twice  a day  (at 
4 p.  M.  and  7 p.  m.),  for  every  year  of  the 
child’s  age;  thus,  for  a child  of  five  years: 


EXTRAVASATION  OF  URINE 


4 P.M. 

7 P.M. 

First  day 

. . . . 0 drop 

1 drop 

Second  day 

. . . . 1 drop 

2 drop.s 

Third  day 

. . . . 2 drops 

2 drops 

Fourth  day 

....  2 drops 

3 drops 

Fiftli  day 

. . . . 3 drops 

3 drops 

Sixth  day 

....  3 drops 

4 drops 

Seventh  day 

....  4 drops 

4 drops 

Eighth  day 

....  .5  drops 

5 drops 

No  improvement  in  the  enuresis  may  be 
noted  for  several  weeks.  Kerley  says : “ The 
full  treatment  should  be  continued  until  the 
child  has  ceased  wetting  the  bed  for  at  least 
two  weeks,  when  the  daily  amount  of  atro- 
pine should  be  reduced  one-half  and  kept 
at  this  point  for  six  weeks.  If  at  the  end  of 
two  months  from  beginning  treatment  there 
is  no  incontinence,  the  drug  may  be  cUscon- 
tinued,  but  the  ilietetic  regulations,  particu- 
larly the  chy  supper,  should  be  continued 
for  three  months  longer.”  Strychnine  may 
be  given  during  the  day.  If  the  enuresis 
occurs  only  during  the  day,  give  the  atropine 
after  breakfast  and  the  noonday  meal,  and 
give  also  strychnine  and  reduce  fluids  if 
taken  in  excess.  To  a child  of  five  years, 
give  of  strychnine  gr.  3'foo  twice  daily, 
gradually  increased  to  gr.  t.i.d.  (Kerley.) 

Holt  begins  with  )fooo  gr.  of  atropine  for 
each  year  of  the  child’s  age  up  to  seven 
years;  and  after  the  enuresis  has  ceased, 
contmues  it  for  at  least  two  months  in 
gradually  duninishing  doses. 

If  atropine  proves  ineffectual,  discontinue 
its  use,  and  try  other  drugs,  e.g.,  quinine, 
rhus  aromatica,  strychnine,  strontimn  bro- 
mide, antipjTine,  thyroid,  extract  (see 
Part  II). 

Leonard  Williams  prescribes  thyroid  sub- 
stance, a half-grain  tabloid  (Burroughs  and 
Wellcome)  once  a day  for  a child  of  five, 
gradually  increased,  if  well  borne,  to  half 
a grain  three  times  a day.  A rise  in  the  pulse 
rate,  temperature,  and  weight  “ indicate 
that  the  dose  is  sufficient;  a fall  in  weight 
shows  that  it  is  excessive.”  The  treatment 
should  be  suspended  for  one  week  in  every 
four;  and  also  if  the  pulse  should  become 
more  rapid  than  normal,  or  a sudden  nasal 
catarrh  occur.  Williams  also  gives,  besides 
the  thyroid,  the  following; 

Calcii  iodidi gr.  ii 

Liquoris  arsonicalis  (Fowler’s  sol.) . . irjii 

Tincturaj  nucis  voiiiica; Tr^ii 

Syrupi  aurantii 5i 

Aqiuc,  ad 5ss 

M.  Sig. — 5ss,  t.i.d.p.c.  For  a child  of  eight  years. 

This  should  be  suspended,  too,  for  one 
week  in  every  four. 

“ Faradization  of  the  bladder  from  three 
to  five  times  weekly  (see  under  Bladder  Irita- 
bility)  is  of  considerable  value,”  says  Casper. 


Deep  urethral  injections  of  silver  nitrate, 
gr.  34  to  1 to  the  ounce,  are  also  recom- 
mended; and  if  other  measures  fail,  full 
dilation  of  the  urethral  sphincter  with 
increasing  sizes  of  steel  sounds  and  Ober- 
liinder’s  dilators. 

Cahier  warmly  recommends  the  rapid 
subcutaneous  injection  of  physiologic  salt 
solution  (5i  ad  Oi)  directly  into  the  peri- 
neum, on  each  side  of  the  raphe — 40  to  60 
c.c.  on  each  side  for  children;  80  to  100  c.c. 
for  adults. 

Chetwood’s  urethral  clip,  which  prevents 
urination  until  removed,  may  be  applied 
each  night,  if  practicable  (Keyes).  The 
prepuce  may  be  pulled  forward  and  collo- 
dion smeared  over  to  form  a cap;  this  to  be 
continued  for  two  weeks.  The  collodion 
is  easily  picked  off  with  the  finger-nail. 
(D.  Corrigan.) 

Epididymis,  Carcinoma  of  the. — Gr.  em 

on  -|-  dLSviJos  testis;  KapKivos  crab 
-copa  tumor.  See  Tumors  of  the 
Testis,  EpicUdymis,  and  Sper- 

matic Cord. 

Cyst,  Retention  of  the. — See  Spermato- 
cele. 

Inflammation  of  the. — L.  inflamma’re,  to 
set  on  fire.  See  Orchitis  and  Epi- 
didymitis. 

Retention  Cyst  of  the. — See  Spermato- 
cele. 

Sarcoma  of  the. — Gr.  cdp^,  aapKos 

flesh  -|-  -co/ua  tmnor.  See  Tumors  of 
the  Testis,  Epididymis,  and  Sperma- 
tic Cord. 

Tuberculosis  of  the. — See  under  Orchitis 
and  Epididjunitis. 

Tumors  of  the. — See  Tumors  of  the 

Testis,  Epididjnnis,  and  Sper- 

matic Cord. 

Epididymitis.  — See  Orchitis  and  Epi- 
didjnnitis. 

Epistaxis,  Renal. — Gr.  eTrlcrra^ts;  L.  ren, 
kitlney.  See  under  H®maturia. 

Erection,  Deficient. — L.  erec'tio.  See 
Sexual  Neuroses. 

Excessive. — See  Priapism. 

Essential  Renal  Haematuria. — L.  essen- 
tial'is,  inherent;  ren,  kidney.  See  un- 
der Hsematuria. 

Exostrophy  of  the  Bladder. — See  Bladder, 
Exostrophy  of  the. 

Extravasation  of  Urine. — L.  ex'tra,  beyond 
-F  ws,  vessel;  nr'ifia,  urine.  This  occurs  as 
a result  of  rupture  of  the  urethra,  due  either 
to  trauma  or  to  straining  in  cases  of  obstruc- 
tion of  the  urethra  by  a stricture,  stone,  or 
foreign  body,  the  urethral  tissues  being 
already  weakened. 


FREQUENCY  OF  MICTURITION,  INCREASED 


If  the  rupture  occurs  in  front  of  the 
trianp;ular  ligament,  tlie  urine  advances  into 
the  perineum,  scrotum,  and  up  the  abdomen; 
there  is  great  swelling,  and  gangrene  occurs 
in  places. 

Treatment. — Perform  external  perineal  ure- 
throtomy at  once,  and  drain  the  bladder 
through  a soft  retained  catheter  until  heal- 
ing occurs  (see  under  Bladder  Diverticula, 
for  details  concerning  the  use  of  the  retained 
catheter).  If  stricture  is  the  primary  cause 
of  the  rupture,  it  should,  of  course,  be  cor- 
rected (see  Stricture  of  the  Urethra).  In 
traumatic  rupture,  coapt  the  parts  by  means 
of  fine  catgut  sutures  not  penetrating  the 
mucous  coat,  and  retain  a catheter  until 
healing  occurs. 

Wherever  swelling  and  redness  are  present 
in  the  skin,  make  free  multiple  incisions  for 
the  purpose  of  draining  off  the  accumulated 
urine,  flush  the  wound  with  warm  boric 
acid  solution,  3i-iv  ad  Oi,  and  pack  widely 
open  with  gauze. 

Fibroma  Urethrae. — L.  fib'ra,  fibre  -f-  Gr. 
-una  tumor.  See  Tumors  of  the  Urethra. 

Fibrosis  of  the  Corpora  Cavernosa  et 
Spongiosum. — L.  cor'pus,  pi.  cor'pora,  bodies, 
cavernous  and  spongy.  (See  Tumors  of 
the  Penis.) 

Fig  Warts. — See  Verrucse. 

Filariasis,  Vesical. — L.  filamen'tum,  deli- 
cate thread.  (See  under  Cystitis.) 

Fistula,  Renal. — See  Part  2,  Gynaecology. 

Fistula,  Urethral. — L.  fis'tula,  pipe;  Gr. 

ovprjdpa. 

Etiology.— Urethral  stricture;  periurethral 
abscess;  tuberculosis;  prostatic  abscess; 
rectal  abscess  secondary  to  hemorrhoids; 
suppurating  gumma  of  the  penis;  phage- 
denic venereal  ulcer;  gangrene  of  the 
penis;  malignant  neoplasms;  rupture  of  the 
urethra  (see  Extravasation  of  Urine,  for 
causes) ; prostatectomy. 

Treatment. — 1.  UretHROPENILE  FistuLA. 
— First  correct  the  cause.  Treat  any  existing 
inflammation.  If  there  is  stricture,  dilate 
the  urethra  gradually  (see  Stricture  of  the 
Urethra),  and  employ  at  the  same  time 
continuous  catheterism.  The  eye  of  the 
retained  catheter,  which  should  be  of  soft 
rubber  or  silk,  should  be  just  within  the 
bladder.  If  a silk  catheter  is  used,  the 
penis  should  be  laid  up  over  the  groin  in 
order  to  prevent  ulceration  at  the  peno- 
scrotal angle.  The  bladder  and  urethra 
should  be  irrigated  with  warm  boiled  boric 
acid  solution,  3i-iv  to  the  pint,  before 
inserting  the  catheter.  The  bladder  should 
be  irrigated  daily  during  the  retention  of 
the  catheter,  and  the  latter  should  be 


removed  and  cleansed  and  the  urethra 
irrigated  every  three  to  six  days.  A tube 
reaches  from  f.he  catheter  to  a urinal  con- 
taining carbolic  acid,  1 : 40,  which  should 
be  cleaiLsed  and  boiled  daily.  The  penis 
should  be  kept  wrapped  in  a moist  bichlo- 
ride (1:10,000)  compress. 

Small  fistulce  secondary  to  periurethral 
abscess  are  treated  as  follows:  Expose  the 
urethral  end  of  the  fistula  by  means  of  a 
wire  urethral  speculum,  and  enlarge  the 
internal  orifice  of  the  fistula  if  it  is  very  nar- 
row. By  means  of  a glass  pipette  with  bent 
tip,  inject  into  the  fistula  a few  drops  of  a 
25  per  cent,  etherial  solution  of  hydrogen 
peroxide.  Repeat  this  after  three  days. 
Then  use  a 5 per  cent,  solution  every  second 
day  until  the  fistula  closes  (Chetwood 
quoted  by  Keyes).  Horwitz  injects  into  the 
fistulous  tract,  through  a hypodermic  syringe 
with  a blunt  needle,  three  cffops  of  silver 
nitrate  solution,  gr.  v ad  5 i- 

If  the  fistula  does  not  close,  cauterize  it 
with  a fine  wire  heated  to  a dull  red;  or 
excise  it  (consult  Horwitz  in  Keen’s  Surgery, 
Vol.  iv,  p.  581). 

2.  Urethroscrotal  and  Urethroperi- 
neal FisTULiE. — CoiTect  the  cause.  Gradu- 
ally dilate  a constricted  urethra  (see  Stric- 
ture of  the  Urethra),  and  employ  continu- 
ous catheterism  (see  above).  It  is  usually 
necessary,  however,  to  perform  a com- 
bined internal  and  external  urethrotomy, 
lay  open  and  scrape  the  fistulous  tract,  and 
employ  continuous  catheterism  until  healing 
occurs  and  the  fistula  is  obliterated. 

3.  Urethrorectal  and  Urethroperi- 
NEORECTAL  FisTUL^. — 111  noii-tuberculous 
and  non-malignant  fistulae,  if  the  fistula  does 
not  close  spontaneously  in  a month  or  so, 
first  remove  any  urethral  obstruction,  divide 
the  sjihincter  ani  posteriorly,  and  employ 
Tuttle’s  operation  for  the  removal  of  the 
fistula  (consult  Horwitz  in  Keen’s  Surgery, 
Vol.  iv,  p.  584). 

Fistula,  Vesical. — L.  vesi'ea,  bladder.  See 
Bladder  Fistula. 

Floating  Kidney. — See  Splanchnopto.sis, 
in  Part  1. 

Fluke=Worm  Disease  of  the  Bladder. — 

See  under  Cystitis. 

Foreign  Bodies  in  the  Bladder. — -See 
Bladder,  Foreign  Bodies  in  the. 

Foreign  Bodies  in  the  Urethra. — Bee 
Urethral  Calculi  and  Foreign  Bodies. 

Foreskin,  Inflammation  of  the. — See 
Balanoposthitis. 

Frequency  of  Micturition,  Increased. — 

L.  inicturi're,  to  urinate.  See  under  Polyu- 
ria, in  Part  1. 


GONORRHCEA 


Gangrene  of  the  Penis. — Gr.  yayypaiva 
mortification;  L.  pe'nis. 

Etiology.— Inflammations;  infectious  dis- 
eases (scarlet  feVer,  typhoid  fever,  typhus 
fever,  smallpox,  cholera,  etc.);  exposure  to 
cold;  diabetes;  ergotism;  chronic  Bright’s 
disease;  acute  alcoholism;  trophic  nervous 
diseases;  extravasation  of  urine;  carbolic 
acid  poultice;  mechanical  constriction; 
traumatism  ; foreign  boches  in  the 
urethra  ; prolonged  priapism  ; iliac  throm- 
bosis; senile  sclerosis  of  the  dorsal  artery; 
phimosis ; paraphhnosis. 

Treatment. — Attend  to  the  cause.  Elevate 
the  penis  and  testicles,  apply  heat,  and  keep 
the  parts  clean  and  dry.  Prescribe  bromide 
camphor  and  opimn  (Part  11)  to  allay  sexual 
irritation  and  prevent  priapism.  Maintain 
the  general  strength.  Remove  promptly  all 
gangrenous  sloughs.  Employ  perineal  drain- 
age if  the  anterior  urethra  is  closed. 

Gangrene  of  the  Testicle. — L.  tes'tis, 
testicle.  See  Orchitis ; and  Injuries  to  the 
Testicle. 

Gastroptosis. — Gr.  yaarrip  stomach  -1- 
TTTwo-ts  fall.  See  Splanchnoptosis,  in  Part  1. 

Gians  Penis,  Inflammation  of  the. — L. 
glans,  gland.  See  Balanoposthitis. 

Gleet. — Chronic  gonorrhoeal  urethiitis. 
See  Gonorrhoea. 

Glenard’s  Disease. — See  Splanchnopto- 
sis, in  Part  1. 

Gonorrhoea. — Gr.  yov^  semen  -f  petr  to 
flow.  A local,  sometimes  systemic,  contagi- 
ous, pyogenic  infection  of  mucous  and  serous 
membranes,  caused  by  the  gonococcus  of 
Neisser,  with  an  incubation  period  of  one  to 
ten  days. 

Gonorrhoeal  urethritis  is  ushered  in  by 
tickling  at  the  external  meatus,  which  is 
soon  followed  by  burning  on  urination, 
recurring  painful  erections  (chordee),  and  a 
purulent,  sometimes  sanguuiolent  discharge 
containing  the  characteristic  paired,  biscuit- 
shaped, Gram-negative  cocci. 

Gram’s  method  of  staining  is  as  follows 
(Webster):  Place  a drop  of  the  pus  on  one 
end  of  a clean  dry  slide,  and  with  a second 
slide  held  at  an  angle  of  45°  to  the  first  one, 
touch  the  drop  of  pus,  and  when  the  latter 
has  spread  out  by  capillarity  along  the  edge 
of  the  second  slide,  draw  the  latter  along  the 
fu-st  slide,  still  maintaining  the  angle  of  45°, 
and  exerting  veiy  little  pressure.  A cigar- 
ette paper  may  also  be  used  as  a spreader. 
Fix  the  smear  thus  made  by  passing  it 
several  times  through  the  flame,  allow  it  to 
cool,  then  cover  with  a solution  consisting  of 
84  c.c.  of  aniline  water  (water  saturated  with 
aniline  and  filtered)  and  16  c.c.  of  asaturated 


alcoholic  solution  of  gentian  violet.  After 
two  to  three  minutes,  pour  off  the  stain, 
wash  in  water,  and  without  drying,  cover 
with  a solution  consisting  of  one  gram  of 
iodine  and  two  grams  of  potassium  iodide, 
dissolved  in  300  c.c.  of  water.  After  one- 
half  to  one  minute,  wash  in  water  and  treat 
with  95  per  cent,  alcohol  until  all  the  color 
is  removed.  Now  wash  in  water,  and  cover 
with  a dilute  aqueous  solution  of  safranin 
as  a contrast  stain.  Allow  the  latter  to  act 
for  only  a few  seconds,  then  wash  off  with 
water,  dry  between  folds  of  filter-paper,  and 
examine  under  an  oil-immersion  lens.  Gram- 
positive organisms,  i.e.,  those  not  decolor- 
ized (tubercle  b.,  smegma  b.,  diphtheria  b., 
pnemnococcus,  streptococcus,  staphylococ- 
cus, and  various  saprophytic  cocci)  are 
stained  deep  blue,  while  the  Gram-negative 
organisms  (gonococcus,  meningococcus,  mi- 
crococcus catarrhalis,  influenza  b.,  typhoid 
b.,  colon  b.,  Koch-Weeks  b.,  and  tbe  Morax- 
Axenfeld  b.)  and  the  bodies  of  the  pus  cells 
take  the  red  safranin  stain.  (Webster.) 

Uncomplicated  anterior  urethritis  is  usu- 
ally cured  in  from  four  to  six  weeks.  Treat- 
ment should  be  continued  until  the  discharge 
is  free  from  gonococci. 

Posterior  urethritis,  wliich  occurs  in  from 
50  to  95  per  cent,  of  the  cases,  usually 
develops  insichously;  or  its  occurrence  may 
be  manifested  by  a temporarj^  cessation  of 
the  discharge,  and  an  increased  frequency  of 
the  desire  to  urinate;  or  it  may  be  ushered 
in  by  severe  symptoms,  e.g.,  dull,  fever, 
frequent  and  vugent  urination,  burning 
pain  not  reheved  when  the  bladder  is 
empty,  and  often  bleeding  at  the  end  of 
micturition.  The  diagnosis  in  posterior 
urethritis  is  made  by  the  two-glass  luinarj" 
test,  the  second  glass  voided  being  cloudy  as 
well  as  the  first.  It  is  best  to  use  the  first 
luine  passed  in  the  morning  for  the  test.  To 
exclude  phosphates  as  a cause  of  the 
clouchness,  add  several  drops  of  acetic  acid 
to  each  glass  of  urine  (the  acid  dissolves 
phosphates).  The  followmg  plan  may  also 
be  employed:  Irrigate  the  anterior  uretfira 
by  means  of  a soft  catheter  mserted  down 
to  the  cut-off  muscle,  with  potassiiun  per- 
manganate, 1 : 2500.  Then  have  the  patient 
empty  his  bladder.  The  urine  should  be 
clear  of  colored  threads,  if  the  posterior 
urethra  is  not  involved. 

The  possible  complications  of  gonorrhoeal 
urethritis  are:  periurethritis  and  abscess, 
inflammation  of  the  erectile  tissues,  balano- 
posthitis, ljunphangitis,  hunphadenitis,  pros- 
tatitis and  abscess,  seminal  vesiculitis  and 
deferentitis,  epididjunitis,  peritonitis,  cysti- 


GONORRHCEA 


tis,  pyelonephritis,  urethral  stricture,  sys- 
temic skin  lesions,  arthritis,  osteo-arthritis, 
osteitis,  periosteitis,  bursitis,  tenosynovitis, 
myositis,  phlebitis,  endocarditis,  pleuritis, 
pneumonia,  parotitis,  systemic  conjuncti- 
vitis, u-itis,  neuritis,  meningitis,  neuroses. 

Prophylaxis. — -Thorough  cleansing  of  the 
genitalia  with  soap  and  hot  water,  as  soon 
as  possible  after  coitus,  followed  by  the  in- 
jection of  2 per  cent,  protargol,  held  in  the 
urethra  for  five  minutes. 

Treatment.— A.  ABORTIVE  TREATMENT. — 
This  may  be  attempted  in  the  -prodromal 
stage,  with  tickling  at  the  meatus  and  a 
slight  glahy  discharge.  Pinching  the  ure- 
thra at  a depth  of  two  inches  or  more,  one 
may  inject,  twice  a day,  for  seven  or  eight 
days,  about  a pint  of  protargol,  5 per  cent., 
or  argyrol,  25  per  cent.  Says  McDonagh, 
this  “ almost  invariably  proves  successful,” 
if  done  within  four  days  of  contagion  and 
the  subjective  symptoms  are  slight.  Hor- 
witz  injects  a hot  solution  of  potassium 
permanganate  or  bichloride  of  mercury 
1 : 20,000  twice  a day  for  seven  or  eight  days, 
with  good  results.  If  a discharge  persists, 
use  astringent  injections  (see  p.  472  or  see 
next  page).  Rest,  a light,  bland  diet  (see 
below),  copious  water  drinking,  and  the  usual 
balsamics  are  important.  Discontinue  treat- 
ment should  hyperacute  symptoms  occur. 

B.  Treatment  of  Acute  Urethritis. — 
Enjoin  as  much  rest  as  possible,  and  pre- 
scribe a light,  bland  diet,  with  plenty  of 
water  between  meals.  Interdict  alcohol, 
tea,  coffee,  ginger  ale,  carbonated  bever- 
ages, lemonade,  fruit,  sour  foods,  pickles, 
sauces,  salads,  spices,  concUments,  mustard, 
pepper,  horseradish,  radishes,  tomatoes, 
asparagus,  salty  foods,  smoked  and  salted 
meats,  preserved  fish,  herring,  shellfish, 
cheese,  greasy  or  fried  foods,  tobacco  in 
excess.  Keep  the  bowels  active.  Have 
the  testicles  and  penis  supported  by  means 
of  a suspensory  bag,  and  the  meatus  anointed 
with  vaseline  and  covered  with  gauze  as  a 
protection  to  the  clothing.  The  gauze 
should  be  changed  frequently,  to  prevent 
damming  back  of  the  discharge,  and  all 
soiled  dressing  should  be  burned.  Caution 
the  patient  against  infecting  the  eyes. 

In  the  acute  stage,  the  penis  should  be 
immersed  in  hot  water  for  ten  minutes  or 
longer,  frequently,  at  least  three  times  a day. 
This  promotes  the  reaction  of  inflammation, 
and  relieves  ardor  urinae,  scalding  during 
urination,  and  chordee.  The  latter  is  also 
quickly  relieved  by  immersion  in  cold  water. 

For  the  relief  of  painful  urination  and 
chordee,  the  following  is  useful : 


B Potassii  citratis  vel  acetatis  5i  (gi-  xx  per  dose) 

Tincturae  hyoscyami gi  (irRxx  per  dose) 

Aquas,  q.s.  ad giv 

M.  Sig. — One  teasisoonful  in  one-third  tumbler 
of  water  every  three  hours.  (H.  A.  Kelly.) 

Sodium  bromide  in  large  doses  during 
the  evening,  and  heroin,  gr.  to  ^^-Iso 
lessen  painful  erections. 

The  balsamics,  especially  sandalwood, 
are  of  proven  efficacy.  Paul  Vidal  advises 
largo  doses.  Some  do  not  prescribe  it  in  the 
acute  stage. 

II  Olei  santali it)jx-xv-xx,  aa  capsulas  No.  20 

Sig. — One  capsule,  three  to  four  times  daily,p.c., 
or  two  hours  a.c. 

II  Potassii  citratis 5ii~vi 

(gr.  vi-xviii  per  dose) 

Olei  santali 5 iv-vi 

(T^.xii-xviii  per  dose) 

Syrupi  acacia; gi 

Aquae  menthae  piper- 

itae,  q.s.  ad giii 

M.  Sig. — Tea.spoonful  in  wineglassful  of  water 
after  meals. 

Discontinue  sandalwood  for  a time  if  it 
causes  lumbar  pain  or  intestinal  irritation. 

B Oleoresinae  copaibae,  capsulas  No.  20,  aa,  igjv-xv 
Sig. — -One  capsule,  t.i.d.p.c. 

II  Balsam!  copaibae (njx  per  teasp.) 

Spiritus  actheris  nitrosi, 

Tincturae  lavandulae  com- 

positae,  aa .giii 

Liquoris  potassae irjl 

Syrupi g viii 

Mucilaginis  acaciae,  q.s. 

ad 3 XXV 

M.  Sig. — One  or  two  teaspoonfuls,  t.i.d.p.c.,  to  be 
well  shaken.  (Lafayette  mixture.) 

Discontinue  copaiba  for  a time  if  it 
causes  much  nausea  or  erythema. 

II  Oleoresinae  cubcbae,  cajjsulas  No.  20,  aa  tijjv-xv 
Sig. — One  capsule,  t.i.d.p.c. 

Discontinue  cubebs  if  it  causes  much  nau- 
sea or  irritation  of  the  neck  of  the  bladder. 
Methylene  blue  may  be  of  some  value: 

II  Methylthioninae  hydro- 
chloridi, 

Myristicae,  aa gr.  iiss-v 

Mitte  tabs  capsulas  No.  ,xx. 

Sig. — One  capsule,  t.i.d, 

Urotropine  and  salol  are  considered  use- 
less by  Casper. 

After  the  severe  pain,  redness,  and  swell- 
ing have  subsided,  have  the  patient  inject 
three  or  four  times  a day,  with  a glass  or 
hard-rubber  hand  syringe  holding  not  over 
four  drams,  and  always  after  first  urinating, 
a 5 to  10  to  20  per  cent,  argyrol  solution 


GONORRHCEA 


or  0.25  to  1 to  2 per  cent,  protargol  solution, 
or  0.1  per  cent,  silver  nitrate  solution,  to  be 
retained  three  or  five  or  ten  minutes  by  the 
watch,  according  to  the  pain  produced.  He 
should  try  to  retain  it  fifteen  minutes  at  bed- 
time, but  should  allow  it  to  flow  out  if  it 
causes  pain.  He  should  inject  at  first  one 
dram  of  the  solution,  and  gradually  increase 
to  no  more  than  four  drams.  Argyrol  is  less 
irritating  than  protargol,  and  protargol  is 
less  irritating  than  silver  nitrate.  Stains 
caused  by  argju’ol  can  be  removed  with  a 
1 : 500  solution  of  corrosive  sublimate. 
Should  severe  pain,  swelling,  profuse  puru- 
lent discharge,  hemorrhage,  or  chordee  at 
any  time  occur,  cease  local  treatment  until 
the  acute  inflanmiation  has  subsided. 

After  about  ten  days  or  longer,  the  period 
of  decUne  sets  in,  and  the  discharge  becomes 
mucopurulent.  At  about  the  end  of  the 
fourth  week,  when  only  a mucoid  discharge 
is  present,  discontinue  the  silver  prepara- 
tions, and  substitute  astringent  injections: 


R Zinci  sulphatis gr.  ii-vi 

Liquoris  plumbi  subacetatis  diluti . . 5 iii 
M.  Sig. — Shake  well,  and  inject  two  or  three  times 
daily.  (Keyes.) 

Zinci  sulphatis gr.  ii-vi 

Bismuthi  subnitratis 5i 

Aquae,  q.s.  ad 5 hi 

M.  Sig. — Shake  well  and  inject  two  or  three  times 
daily.  (Hugh  Cabot.) 

Zinci  sulphatis, 

Pulveris  aluminis,  aa gr.  iv-.\ii 

Acidi  carbolici gr.  iv 

Aquae 5iv 

M.  Sig. — Shake,  and  inject  two  or  three  times 
daily.  (Ultzmann.) 

Zinci  sulphatis gr.  xvi 

Plumbi  acetatis gr.  xxx 

Extract!  krameriae  fluidi oiv 

Tincturae  opii 3 id 

Aquae  destillatae,  q.s.  ad 5vi 

M.  Sig. — Shake,  and  inject  two  to  four  times  daily 

Hydrargyri  chloridi  corrosivi gr.  %-}/2 

Zinci  sulphocarbolatis gr.  xii-3i 

Acidi  borici 5ii 

Acidi  carbolici gr.  xii-xv 

Boroglycerini  (25  per  cent.) 5d 

Aquae  destillatae,  q.s.  ad §vi 

M.  Sig. — Shake  well,  and  inject  twice  daily,  after 


urinating.  Dilute  if  painful.  (White  and  Martin.) 

After  the  sjTnptoms  have  disappeared, 
gradually  weaken  the  astringent  injections 
by  replacing  every  syringeful  removed  by  a 
syringefvd  of  boiled  water.  If  no  symptoms 
return  after  seven  to  ten  days  of  the  weaker 
injections,  the  patient  may  be  considered 
cured.  No  alcohol  or  sexual  indulgence 
should  be  allowed  for  at  least  three  weeks. 

The  following  tests  of  a cure  are  jirac- 
tically  conclusive : Mas.sage  the  |)rostate  and 


vesicles  vigorously;  if  no  discharge  results 
after  forty-eight  hours,  give  three  glasses  of 
beer;  if  there  is  still  no  clischarge  after  forty- 
eight  hours,  dilate  the  urethra  with  a full- 
sized  sound.  Keyes  says,  “ If  these  three 
tests  fail  to  excite  a discharge,  the  gono- 
cocci have  almost  certainly  disappeared, 
even  if  the  urine  or  expressed  prostatic 
secretion  continues  to  show  pus.” 

In  the  period  of  decline,  the  home  treat- 
ment may  be  supplemented  by  office  treat- 
ment (Hugh  Cabot) : — Daily  or  several  times 
weekly  the  urethra  may  be  irrigated  by 
means  of  a fountain  syringe  with  a blunt 
nozzle  attached,  with  potassium  perman- 
ganate, 1 : 5000  or  1 : 6000,  increased,  as  the 
inflammation  subsides,  to  1 : 2500  to 
1 : 2000  to  1 : 1000;  or  silver  nitrate, 
1 : 50,000  to  1 : 5000. 

To  irrigate  the  anterior  urethra,  elevate 
the  reservoir  two  feet  above  the  penis, 
approach  the  nozzle  to  the  meatus  gradually, 
and  allow  free  exit  of  the  fluid  beside  the 
nozzle ; whereas,  in  cases  of  posterior  involve- 
ment, raise  the  pressure  by  elevating  the 
reservoir,  apply  the  nozzle  snugly  to  the 
meatus,  and  have  the  patient  breathe 
through  the  mouth  and  bear  down  as 
though  to  empty  the  bladder,  when  the  fluid 
will  enter  the  latter.  A very  small  soft 
catheter  may  be  cautiously  employed,  if 
desired,  instead  of  hydraulic  pressure. 

During  the  first  week  the  patient  should 
visit  the  physician  every  day  or  two,  and 
thereafter  twice  weekly,  and  the  two-glass 
test  should  be  employed  at  intervals  to 
ascertain  whether  or  not  the  posterior 
urethra  has  become  involved. 

For  posterior  urethritis,  employ  daily  irri- 
gations with  silver  nitrate,  1 : 50,000  to 
1 : 10,000;  or  potassium  permanganate, 
1 : 8000  or  1 : 6000;  or  protargol,  1 : 2000; 
or  argjTol,  1 : 100.  Keyes  cUstinctly  pre- 
fers the  silver  salts  to  permanganate.  He 
says,  “ Permanganate  reduces  the  inflamma- 
tion much  more  rapidly  and  clears  the  urine 
far  more  brilliantly  than  the  silver  salts, 
but  gives  a much  larger  proportion  of 
chronic  gonorrheeas.”  AIcDonough  lauds 
sodium  salicylate  (Part  II)  by  mouth  in 
acute  posterior  urethritis. 

The  occurrence  of  acute  inflammatoiy 
symptoms  demands,  of  course,  the  immedi- 
ate cessation  of.  local  treatment  until  the 
acute  sjunptoms  have  subsided.  When 
posterior  involvement  is  accompanied  by 
much  pain,  fever,  hemorrhage,  dysuria,  and 
tenesmus,  put  the  patient  to  bed  on  liquid 
diet  and  flaxseed  tea  in  large  quantities,  open 
the  bowels,  place  hot  water  bags  over  the 


GONORRHCEA 


hypogastrium  and  perineum,  and  employ 
frequent  hot  sitz-baths,  orslow  hot  rectal  irri- 
gations lasting  one  hour  and  repeated  every 
two  or  three  hours,  using  a Kemp  or  Chet- 
wood  double-current  tube.  If  need  be,  a 
hypodermic  of  morphine  and  atropine  may 
be  injected  into  the  perineum  or  given 
by  mouth.  For  retention  of  urine  if  the  pa- 
tient cannot  urinate  while  in  the  hot  sitz- 
bath,  catheterize  him  with  a small  soft 
catheter  regularly. 

The  above  symptoms  probably  mean 
acute  prostatitis,  and  the  prostate  may  be 
found  to  be  enlarged  and  very  tender. 
Should  suppuration  occim  in  the  prostate, 
the  abscess  may  break  into  the  urethra  or 
rectum  with  spontaneous  cure,  rarely  else- 
where. Hugh  Cabot  advises  reasonably 
early  operation,  preferably  per  perineum,  in 
abscess  cases,  before  rupture  occurs. 

Acute  epididymitis  occurs  only  after  the 
posterior  urethra  has  become  invaded. 
Stop  local  treatment,  put  the  patient  to  bed, 
open  the  bowels,  support  the  testicles,  and 
apply  heat,  say  in  the  form  of  hot  flaxseed 
poultices.  One  may  apply  guaiacol  in 
glycerine,  50  per  cent,  once  or  twice  daily 
(see  Orchitis  and  Epididymitis,  for  further 
important  information).  Two  weeks  or 
longer  after  the  testicular  symptoms  have 
subsided,  resume  the  hot  silver  or  perman- 
ganate irrigations,  and  instil  into  the  pos- 
terior urethra  with  a Keyes-Ultzmann 
syringe,  every  second  day,  5 to  20  minims 
of  a 1 to  2 per  cent,  silver  nitrate  solution; 
or  inject  into  the  bladder,  posterior  urethra 
and  bulb,  every  second  day,  3 to  6 ounces 
of  a 1 per  cent,  silver  nitrate  solution, 
through  a soft  rubber  catheter  ancl 
hand  syringe,  pressing  the  lips  of  the 
meatus  together  during  the  injection  to  dis- 
tend the  urethra.  Gonorrhoeal  cystitis  is 
also  thus  treated. 

Should  periurethral  inflammation  occur, 
apply  compresses  wet  with  weak  bichloride 
solution,  or  three  per  cent,  almninum  acetate 
solution,  or  ichthyol,  and  bind  the  penis  to 
the  abdomen.  Should  an  abscess  form, 
open  it  preferably  within  the  urethra.  If  an 
external  incision  is  chosen,  make  it  above 
and  on  the  side  of  the  corpus  spongiosum 
and  urethra,  and  not  below. 

Acute  inflammation  of  fhe  corpora  caver- 
nosa, whi(;h  is  very  rare,  is  treated  as 
described  above. 

Iodine,  ichthyol,  or  blue-ointment  may  be 
applied  to  buboes. 

Consult  Cowperitis,  Balanoposthitis,  Pros- 
tatitis, Seminal  Vesiculitis,  and  Fistula. 

“ The  occurrence  of  periurethral  abscess 


balanitis,  or  lymphangitis  does  not  call  for 
cessation  of  local  treatment.” 

If,  in  the  terminal  stage  of  acute  urethri- 
tis, vesicular  and  prostatic  massage  reveals 
the  presence  of  prostatitis,  practice  gentle 
massage  “ not  oftener  than  every  other  day, 
nor  less  often  than  once  a week.”  The 
vesicles  and  prostate  are  examined  for 
inflammation  as  follows:  First  have  the 
patient  pass  a little  urine  to  wash  out  the 
anterior  urethra.  The  vesicles  and  prostate 
are  then  massaged,  a small  soft  catheter 
introduced,  and  the  first  urine  passing 
through  this  examined  for  pus  (Keyes). 

Cases  which  persist  beyond  the  sixth 
week  are  considered  chronic,  and  should 
be  treated  as  such.  Remember  that  too 
energetic  treatment  may  itself  cause  catarrh 
and  a continuation  or  augmentation  of 
the  discharge. 

Ionic  medication  is  recommended  for  gon- 
orrhoea (see  in  Part  1 on  General  Medi- 
cine and  Surgery).  A copper  or  zinc  rod 
wrapped  with  fine  lint  wet  in  a two  per 
cent,  solution  of  zinc  sulphate  is  introduced 
through  a cannula  down  to  the  neck  of  the 
bladder,  whereupon  the  cannula  is  with- 
drawn. The  rod  is  attached  to  the  positive 
pole  of  a galvanic  battery,  and  four  milli- 
amperes  of  current  gradually  turned  on,  and 
allowed  to  act  for  fifteen  minutes.  The 
treatment  is  repeated  in  ten  days.  In 
chronic  cases  ten  milliamperes  are  employed 
for  fifteen  minutes  once  a week. 

Russ  employs  the  following  technique 
with  gratifying  results:  “The  patient  is 

cUrected  to  pass  about  half  of  the  m-ine  and 
retain  the  rest.  He  then  reclines  on  the 
couch  and  a platinized  catheter  is  lubri- 
cated (see  under  Stricture)  and  passed  gently 
down  to  the  compressor  urethrae.  This 
catheter  is  quite  smooth,  has  numerous 
perforations,  and  it  is  furnished  with  a 
stylet  of  platinum  wire  and  a rubber  collar 
which  just  enters  the  meatus.  A lint- 
covered  pad  lined  by  a flexible  metallic 
core  is  wrung  out  in  warm  saline  and 
applied  to  the  perineum,  scrotum,  and 
root  of  the  penis.  A two  per  cent,  solu- 
tion of  sodium  iodide  is  then  gently  injected 
into  the  catheter.  The  rubber  collar  pre- 
vents its  flowing  away  between  the  instru- 
ment and  the  urethra.  The  pad  is  con- 
nected to  the  negative  and  the  stylet  (within 
the  catheter)  to  the  jmsitive  pole  of  the 
battery.  A current  of  one  or  two  iiiil- 
liamperes  is  passed  for  twenty-five  minutes 
and  the  catheter  is  kept  full  of  the  solution 
from  time  to  time  by  means  of  a syringe. 
The  current  being  turned  off,  the  catheter  is 


GONORRHCEA 


withdrawn  and  placed  in  a glass  of  water. 
After  the  first  few  treatments,  the  perfora- 
tions in  the  catheter  will  be  seen  choked 
with  masses  of  yellowish  muco-pus,  which 
are  laden  with  gonococci,  drawn  from  the 
urethra.  On  shaking  the  catheter  in  water, 
most  of  these  masses  become  detached  from 
the  instrmnent  and  soon  settle  at  the  bottom 
of  the  vessel.  The  patient  now  passes  the 
rest  of  the  urine,  and  similar  masses  of 
muco-pus  will  be  seen  in  it.  As  the  patient 
progresses,  this  harvest  diminishes,  and  when 
the  discharge  has  ceased  there  is  nothing 
visible  in  the  perforations  at  the  end  of  such 
treatment.  This  treatment  is  applied  every 
day  in  cases  of  acute  gonorrhoea,  and  every 
other  day  when  the  discharge  has  ceased, 
and  after  from  three  to  six  more  applications 
the  urine  is  free  from  purulent  threads. 
Avoiding  alcohol  and  other  abuse,  a cure  is 
to  be  expected  in  three  to  four  weeks.” — 
Practical  Medicine  Series,  1915,  Vol.  IX. 

C.  Chronic  Urethritis. — Chronic  ure- 
thi'itis  is  usually  a posterior  urethritis,  and 
consequently  usually  implies  the  existence 
of  a chronic  prostatitis.  There  are  usually 
no  other  symptoms  than  a scanty  mucoid 
or  mucopurulent  discharge  in  the  morning 
(“  morning  drop  ”)  and  shreds  in  the  urine. 
If  the  anterior  urethra  alone  is  involved,  the 
two-glass  urinary  test  will  reveal  a cloudy 
first  glass  while  the  second  glass  remains 
clear.  But  even  then  the  posterior  urethra 
may  be  involved.  In  chronic  posterior 
urethritis  both  glasses  usually  contain 
threads.  Irrigate  the  anterior  urethra,  by 
means  of  a soft  catheter  inserted  down  to 
the  cut-off  muscle,  with  potassimn  perman- 
ganate, 1 : 2500;  then  have  the  patient 
empty  his  bladder.  The  urine  should  be 
clear  of  colored  threads  if  the  posterior 
urethra  is  not  involved. 

Endoscopic  examination  reveals  con- 
gested, granular  patches,  erosions,  or  papil- 
lomatous vegetations.  On  inserting  a steel 
sound  and  passing  the  finger  along  the  un- 
der surface  of  the  urethra,  small  nodules  may 
be  felt  if  the  glands  of  Littre  are  inflamed. 

If  the  anterior  urethra  alone  is  involved, 
care  should  be  taken  in  applying  treatment 
not  to  pass  beyond  the  cut-off  muscle.  To 
irrigate  the  anterior  urethra  by  the  hydraulic 
method,  elevate  the  resei-voir  two  feet  above 
the  penis,  approach  the  nozzle  to  the  meatus 
graclually,  and  allow  free  exit  of  the  fluid 
beside  the  nozzle;  whereas,  in  cases  of  pos- 
terior involvement,  raise  the  pressure  by 
elevating  the  reservoir,  apply  the  nozzle 
snugly  to  the  meatus,  and  have  the  patient 
breathe  through  the  mouth  and  bear  down 


as  though  to  empty  the  bladder,  when  the 
fluid  will  enter  the  latter.  Or,  in  posterior 
urethritis,  after  irrigating  the  anterior  ure- 
thra, a soft  rubber  catheter  may  be  pas.sed 
into  the  bladder,  the  latter  filled,  the 
catheter  then  withdrawn,  and  the  bladder 
evacuated  by  the  patient. 

Irrigate  the-  urethra  every  day  or  every 
other  day  with  potassium  permanganate, 

1 : 8000  to  1:  5000  to  1000,  alternating  occa- 
sionaUjrwithsilvernitrate,  1 : 10,000tol  ;2000 
or  protargol,  0.5  to  1 to  2 per  cent.  After 
the  urinary  turbidity  has  disappeared, 
lengthen  the  intervals  of  treatment  to  every 
three  or  four  days,  and  so  on  until  discon- 
tinued. At  home  the  patient  may  use  weak 
astringent  injections  twice  daily.  Re- 
member that  the  too  frequent  use  of 
astringents  may,  in  itself,  cause  catarrh; 
therefore  intermit  the  irrigations  and  injec- 
tions every  few  weeks.  The  presence  of 
prostatitis  will  keep  the  discharge  up.  It  is 
diagnosed  by  the  presence  of  pus  cells  in  the 
prostatic  secretion  obtained  by  massaging 
the  prostate  after  urination.  In  such  cases, 
massage  the  prostate  systematically,  for 
months,  three  times  weekly,  at  the  same 
time  employing  irrigations  and  weak  astring- 
ent injections. 

After  irrigating  the  urethra,  the  anterior 
or  posterior  urethral  endoscope  may  be 
inserted,  and  ulcers,  erosions,  and  granu- 
lations touched  once  or  twice  a week,  by 
means  of  an  applicator,  with  carbolic  acid. 

2 per  cent,  alcoholic  solution,  or  silver 
nitrate,  5 to  20  per  cent. ; or  copper  sulphate, 
same  strength,  or  iodine  and  carbohc  acid, 
equal  parts.  Or,  instillations  of  a 0.5  to  1 
to  2 per  cent,  silver  nitrate,  or  a 0.25  to 
2 per  cent,  protargol  solution  may  be  made, 
introducmg  5 to  10  mirums  of  the  solution 
drop  by  drop  to  the  parts  required,  by 
means  of  a Guyon  instillating  sjTinge  with 
catheter  attached,  or  if  the  latter  will  not 
pass  the  bulb,  a Keyes-Ultzmann  instillating 
syringe.  Papillomata  or  polypi  may  be 
removed  with  the  curette  or  snare,  and  the 
base  cauterized,  preferably  wdth  the  galvano- 
cautery.  Urethroscopic  treatment,  however, 
is  verj"  rarely  necessary.  (Keyes). 

If  there  is  periurethral  infiltration  and 
thickening,  pass  lubricated  steel  sounds 
of  gradually  increasing  calibre,  once  or 
twice  a week,  following  irrigation.  Keep 
the  sound  in  the  urethra  five  minutes,  unless 
painful,  at  the  same  tune  massaging  the 
under  surface  of  the  urethra.  Employ 
sounds  up  to  23  or  24  F.,  then  dilators 
(Oberlander’s  or  Kollmann’s),  and  if  neces- 
sary the  Otis-Kreisl  urethrotome,  making 


GONORRHCEA 


one  or  more  incisions  at  the  site  of  infiltra- 
tion. After  dilating  and  massaging  the 
urethra,  h-rigate,  and  then  instil  an  ointment 
with  Young’s  or  Robbin’s  ointment  appli- 
cator or  Keyes’s  instillator.  Applications 
as  far  as  the  compressor  urethrje  muscle 
may  be  made  on  a cotton-wound  Kolhnan 
intra-urethral  probe.  Ointments  should  be 
prepared  with  lanolin  as  a base. 


Acidi  carbolic! gr.  x 

Adipis  lanae  hydros! oi  (Young.) 

lod! gr.  vi 

Potass!!  !od!d! gr.  xxx 

Ole!  amygdalae  dulcis 5 ! 

Adipis  lanae  hydros! 5i  (Finger.) 


Acid!  sahcylic! 

Adipis  lanae  hydros! 


Iodoform! 

Adipis  lanae  hydros! 


gr.  V 

o ! (for  epithelial 
thickening)  _ 

gr.  xlviii 

5i 


Ichthyolis gr.  xlviii 

Glycerin!  vel  adipis  lanae 
hydros! 3i 


For  hypersensitiveness,  Casper  recom- 
mends the  followmg: 


I^  Cocainae gr.  iiss 

Zinci  oxidi 3 ss 

Unguenti  acidi  borici 5 iiss 

Olei  amygdalae  dulcis 3i 

Adipis  lanae  hydros! 3 iv 


When  using  sounds,  administer  urotro- 
pine  and  irrigations  in  order  to  prevent 
acute  inflammation.  The  presence  of  gon- 
ococci or  free  pus  in  the  urethra  renders 
dilatation  dangerous. 

“ Follicular  (infiltrative)  urethritis  maybe 
treated  locally  by  exposing  the  diseased  ori- 
fice by  means  of  the  endoscope,  evacuating 
any  discharge  with  Kollman’s  capillary 
aspirator,  and  then  injecting  any  desired 
preparation  into  the  structure  of  the  gland 
by  means  of  Kollman’s  cannula  and  syringe.” 
(Horwitz).  Or,  in  inveterate  cases,  the 
“ diseased  glands  may  be  destroyed  by 
means  of  Kollmann’s  or  Oberlander’s  elec- 
trolytic needles,  or  split  open  with  Koll- 
mann’s or  Bierhoff’s  knife,”  or  Janet’s  tra- 
jectotome.  “ These  instruments  are  used 
through  the  urethroscope  under  direct 
guidance  of  the  eye.  Kollmann’s  needle  is 
connected  to  the  negative  pole  of  a battery 
supplying  the  constant  current  and  a flat 
electrode  is  attached  to  the  positive  pole. 
The  flat  electrode  is  placed  on  the  thigh, 
the  needle  is  passed  through  the  urethro- 
scope and  its  point  inserted  into  the  opening 
of  the  diseased  gland.  From  three  to  five 
milliamperes  (no  more)  of  the  current  are 


now  turned  on  and  the  needle  left  in  situ 
for  one  to  two  minutes.  Oberlander’s  double 
needle  may  be  used  in  this  way,  or  one 
needle  may  be  attachetl  to  the  positive  pole 
and  the  othei’  to  the  negative.  The  current 
should  always  be  turned  off  before  the 
instrument  is  withdrawn  from  the  urethra. 
Not  more  than  two  or  three  glands  .should 
be  destroyed  at  one  sitting.”  “ Mundorff 
advises  the  use  of  large  steel  sounds  during 
the  process  of  healing  ” (Casper).  Says 
Keyes:  “ Suppurating  follicles  are  best 

treated  by  destroying  them  with  a galvano- 
caustic  needle,  which  is  plunged  into  the 
suppurating  focus.”  After  cutting  opera- 
tions, no  dilatation  should  be  employed 
until  gonococci  have  disappeared. 

If,  in  spite  of  all  treatment,  the  discharge 
persists,  the  parts  should  be  allowed  a rest 
for  a time,  when  the  discharge  may,  in  con- 
sequence, disappear.  Over-treatment  often 
does  more  harm  than  good. 

The  discharge  may  resist  every  thera- 
peutic measure.  “ If  the  secretion  obtained 
by  stripping  the  urethra,  massaging  the 
prostate,  and  probing  with  the  bougie  a 
boule  has  been  found  free  from  gonococci 
after  repeated  examination,  and  if  they  do 
not  appear  after  the  urethra  has  been  sub- 
jected to  different  forms  of  irritation,  then 
we  may  discharge  the  patient  from  treat- 
ment, and  also  give  our  consent  to  his 
marriage.”  “In  my  opinion  it  is  not  neces- 
sary to  treat  the  patients  as  long  as  pus  cells 
continue  to  be  found  in  the  filaments  or  in 
the  discharge.  The  shreds  often  remain 
permanently  ” (Casper).  See  also  Ionic 
Medication. 

A full  diet  and  open  air  exercise  are  to  be 
enjoined  in  chronic  urethritis.  A tonic  may 
be  prescribed,  if  deemed  advisable. 

In  systemic  infection,  autogonoccus  vac- 
cine or  serum  is  recommended.  Keyes  says, 
begin  with  a dose  of  “ 40,000,000  ” (Holt 
gives  these  doses  also  for  children)  dead 
gonococci,  “ or,  in  acute  cases,  60,000,000 
and  increase  by  20,000,000  or  more  at  each 
dose  (unless  the  symptoms  are  controlled 
or  the  reaction  is  marked)  until  a do.se  of 
100,000,000  is  reached.  Only  in  exceptional 
cases  is  it  necessary  to  go  higher  than  this. 
The  injections  are  given  into  the  muscle. 
They  should  not  be  repeated  oftener  than 
every  other  day.”  Keyes  praises  the  vac- 
cine highly  in  systemic  and  beginning  local 
complications.  If  the  serum  is  used  it  is 
given  in  doses  of  2 to  4 c.c.  every  day  or 
every  second  or  third  day,  injected  deeply, 
but  not  necessarily  into  a muscle,  gradually 
increased  to  6 to  8 c.c.  every  fifth  day. 


HEMATURIA 


Says  McDonagh : “A  vaccine  to  be  potent 
must  be  prepared,  without  the  employment 
of  heat,  from  a fresh  culture,  or  the  first 
subculture  which  has  not  been  allowed  to 
grow  for  more  than  forty-eight  hours.  The 
vaccine  should  be  fresh,  as  it  begins  to 
deteriorate  after  the  tenth  day,  even  when 
kept  in  the  dark  at  0°  C.”  “ The  initial 

dose  of  ordinary  vaccine,  given  subcutan- 
eously or  intramuscularly,  should  not  exceed 
five  million,  and  the  second  dose  of  the  same 
size  should  not  be  given  for  ten  days  or 
more;  and  each  subsequent  injection  of  very 
gradually  increasing  doses  should  not  be 
given  more  than  every  seven  or  ten  days.” 
“ Injections  of  sensitized  vaccines  should 
be  given  on  three  successive  days  in  doses 
of  20,  50,  and  100  million.  If  the  patient 
has  no  reaction,  doses  of  200,  500,  and  1000 
million  may  be  prescribed  on  the  fourth, 
fifth,  and  sixth  days.  Should  a reaction 
appear  after  any  one  of  these,  fourteen  to 
twenty-one  days  should  elapse  before  a 
further  series  is  given.” 

Vaccines  and  serums  are  of  question- 
able utility. 

D.  Rectal  Gonorrhea. — Employ  daily 
irrigations  or  injections  of  potassium  per- 
manganate, 1 : 5000  to  1 : 200  to  1 : 25; 
or  silver  nitrate,  1 : 4000;  or  protargol  2 to 
10  per  cent.;  or  alum,  5i  ad  Oi;  or  tannin, 
5i  ad  Oi;  the  poisonous  solutions  to  be  fol- 
lowed by  plain  warm  water.  Swab  fissures 
and  ulcers  with  silver  nitrate,  10  to  20  per 
cent.,  first  dilating  the  sphincter  ani  (see 
Fissure  in  Ano,  in  Part  1,  on  General  Medi- 
cine and  Surgery).  Apply  zinc  ointment 
to  granulating  surfaces.  Employ  hot  sitz- 
baths.  It  is  very  resistant  to  treatment, 
about  four  to  six  months  being  required 
for  a cure. 

E.  Buccal  Gonorrh/ea. — Employ  fre- 
quent astringent  mouth  washes,  e.g.,  zinc 
sulphate,  gr.  ii-iv  to  the  ounce.  It  lasts 
usually  a few  weeks. 

F.  Gonorrheal  Arthritis  and  Other 
Complications. — Consult  the  appropriate 
Part  of  this  book. 

Haematocele. — Gr.  aliia  blood  ktjXt] 
tumor.  Hemorrhage  within  the  tunica 
vaginalis.  It  is  rarer  than  scrotal  hiematoma 
{q.v.}.  Employ  the  aspirating  syringe  in 
order  to  exclude  new  growths. 

Btiology.  -Injury  of  the  normal  testis; 
injury  of  a hydrocele  from  puncture 
or  external  trauma ; chromic  hemorragic 
inflammation,  with  thickening  of  the 
tunica  vaginalis. 

Treatment.— For  traumatic  hipinatoma  oc- 
cui’ing  in  the  normal  testis,  put  the  patient 


to  bed,  open  the  bowels,  support  the  te.sti- 
cles,  and  apply  cooling  lotions,  e.g.,  lead  and 
opium  wash  or  aluminum  acetate  solution, 
(see  Part  11).  Have  the  patient  wear  a 
suspensory  bag  when  he  gets  up.  Incise  and 
evacuate  the  clot  if  the  tension  is  great. 

Treat  hemorrhagic  hydrocele  by  radical 
operation  as  for  hydrocele. 

Chronic  hemorrhagically  inflamed  sacs 
should  be  dissected  out  and  the  wound 
closed  with  temporary  (twenty-four  hours) 
drainage.  Keyes  says:  “Ancient  haemato- 
cele demands  castration.” 

Haematochyluria. — See  Part  1,  General 
Medicine  and  Surgery. 

Haematoma,  Scrotal. — Gr.  alfia  blood  -f- 
-uiia  tumor;  L.  scro'tum,  bag.  Effusion  of 
blood  external  to  the  tunica  vaginalis.  It  is 
more  common  than  haematocele. 

Treatment. — ^Employ  rest  and  a supporting 
bandage.  Evacuate  the  clot  and  drain 
should  infection  occur. 

Haematoporphyrinuria. — Gr.  alna  blood  -}- 
7Top</)Lip€os  purple  d-  ovpov  urine.  See  Haemo- 
globinuria,  in  Part  l._ 

Haematuria. — Gr.  alpa  blood  -|-  obpov  urine. 
Haematuria,  or  the  occurrence  of  red  blood 
cells  in  the  urine,  is  distinguished  from 
haemoglobinuria  {q.v.,)  by  the  presence 
of  red  blood-cells  in  the  urinary  sediment. 
Employ  the  cystoscope  and  ureteral  cathe- 
terization for  diagnostic  purposes  in  regard 
to  the  source  of  the  bleeding.  The  presence 
of  numerous  casts  points  to  the  kidney. 

Etiology.— Haemophilia;  purpura;  scurvy; 
leukaemia;  pernicious  anaemia;  splenic  anae- 
mia; the  hemorrhagic  form  of  infectious  dis- 
eases, e.g.,  malaria,  yellow  fever,  cholera, 
typhoid  fever,  typhus  fever,  smallpox, 
septico-pyaemia,  scarlet  fever,  relapsing  fever, 
cerebrospinal  fever,  influenza,  pneumonia; 
kidney  irritants,  e.g.,  turpentine,  cantharides 
phosphorus,  aniline  dyes,  carbolic  acid; 
varicose  veins  of  the  bladder;  passive  con- 
gestion due  to  heart,  lung,  liver,  or  kidney 
disease;  sudden  withdrawal  of  urine  from  a 
distended  bladder;  traumatism  to  the  kid- 
ney, ureter,  bladder,  or  urethra,  due  to 
external  violence,  instrumentation,  foreign 
bodies,  calculi,  the  passage  of  calculi  or 
crystals  (see  Nephrolithiasis);  irritation 
of  a highly  concentrated  or  hyperacid 
urine;  uric  acid  infarctions;  local  infec- 
tions, e.g.,  urethritis,  cystitis,  ureteritis, 
pyelitis,  gonorrhoea,  tuberculosis,  distomia- 
sis,  filariasis,  acute  nephritis;  chronic  nephri- 
tis with  local  arteriosclerotic  infarcts;  renal 
tumors;  vesical  tumors;  amyloid  kidney; 
polycystic  kidney;  embolic  infarction  of  the 
kidney;  floating  kidney;  aneurysm  of  the 


HERPES  PROGENITALIS 


renal  artery ; varicose  veins  of  a renal 
papilla;  prolonged  exercise;  angioneurosis 
(f);  prostatitis;  prostatic  hypertrophy. 

There  is  a so-called  idiopathic  or  essential 
renal  hseinaturia  (called  also  nephralgia, 
neuralgia  of  the  Iddney,  hseinaturic  nephral- 
gia, idiopathic  nephralgia,  renal  haemophilia, 
renal  epistaxis,  and  angioneurosis  of  the  kid- 
ney) that  is  not  associated  with  any  local 
pathological  condition,  unless  it  be  varicosity 
of  the  veins  of  a renal  papilla.  A constant  or 
intermittent  haematuria  occurs,  sometimes 
associated  with  severe  pain;  or  pain  may 
occur  alone.  Casper  says  that  renal  pain 
may  be  caused  by  “ firm  adhesions  between 
the  true  capsule  of  the  kidney  and  the  sur- 
rounchng  fatty  capsule,”  and  that  decapsula- 
tion will  cure  such  cases.  Pain  may  also  be 
caused  by  spasm  of  the  ureter,  and  is  then 
cured  by  the  passage  of  a catheter.  The 
injection  of  adrenalin  through  a ureteral 
catheter  has  been  curative.  The  following 
drugs  are  recommended  for  the  bleeding, 
viz.,  rectified  spirits  of  turpentine,  njjviii,  in 
capsule,  t.i.d.;  cantharides  in  small  doses; 
fl.  ext.  senecio  aureus,  njjxxx,  t.i.d.;  and 
Merck’s  stypticin,  gr.  iv,  t.i.d.  Keyes 
says,  if  other  measures  fail,  perform  pyelot- 
omy  and  curette  the  bleeding  papilla;  and 
if  this  fails,  perform  nephrectomy. 

Treatment  of  Severe  Vesical  Hsematuria. — In- 
sert a retention  catheter  (see  under  Bladder 
Diverticula)  to  quiet  the  bladder,  and 
inject  about  three  ounces  of  hot  silver 
nitrate  solution,  1 : 1000  to  1 : 500; 
or  the  same  amount  of  Merck’s  steri- 
lized solution  of  gelatine,  2 to  5 per 
cent.,  hot;  or  fl.  ext.  hydrastis,  one  ounce  to 
the  pint;  or  antip}Tine,  4 per  cent.;  or  a 
heaping  teaspoonful  of  Squibb’s  surgical 
powder  (contains  alum)  suspended  in  500 
c.c.  (one  pint)  of  hot  water  (“  the  best 
application  I know,”  says  Keyes).  Adrena- 
lin, 1 : 5000  to  1 : 1000,  is  not  satisfactory, 
say  Casper  and  Keyes.  Rest  in  bed  is 
essential.  Opium,  ergot,  stypticin,  and  hy- 
dra.stis  (see  Part  11)  may  be  useful. 

If  these  measures  fail,  resort  to  suprapubic 
cystotomy,  and  ligate  or  cauterize  any 
bleeding  points. 

To  evacuate  clots,  employ  a large  woven 
catheter,  or  Brodie’s  overcurved  silver 
catheter,  or  Gross’s  blood  catheter,  or  Bige- 
low’s lithotrite  and  evacuator,  and  forcibly 
inject  or  irrigate  with  hot  salt  or  alum 
solution,  3i  ad  Oi;  or  hot  phenol  solution, 
1 per  cent.;  or  a cool  solution  of 
sodium  bicarbonate. 

Haemoglobinuria. — See  Part  1,  General 
Medicine  and  Surgery. 


Haemophilia,  Renal. — Gr.  aiiia  blood  -|- 
4>i\etv  to  love;  L.  ren,  kidney.  See  under 
Haematuria. 

Hemorrhage,  Urinary. — Gr.  ai^a  blood  + 
prjyi/ufu  to  burst  forth;  ovpov  urine.  See 
Haematuria. 

Hepatoptosis. — Gr.  -qirap  liver  -f-  ttwctis 
falling.  See  Splanchnoptosis,  in  Part  1. 

Hernia. — L.  See  Hernia,  in  General  Med- 
icine and  Surgery,  Part  1 . 

Herpes  Progenitalis. — Gr.  tpirecv  to  creep; 
L.  'pro,  before,  -j-  genitaVis,  genital.  A non- 
contagious  recurrent  affection  of  the  glans 
and  prepuce,  characterized  by  the  appear- 
ance of  one  or  more  small  itching  vesicles 
situated  upon  an  inflamed  or  reddened 
base,  the  vesicles  later  breaking  down  into 
ulcers,  and  usually  healing  in  about  one 
or  two  weeks. 

Etiology. — Local  irritation  due  to  uncleanli- 
ness, excessive  coitus,  irritating  discharges, 
and  a long,  tight  foreskin;  excesses  in  eating 
or  drinking;  lithaemia;  digestive  disturb- 
ances; debility;  nervous  depression;  atmos- 
pheric changes;  cold. 

Treatment. — Attend  to  the  cause.  Enjoin 
adequate  rest  and  exercise,  fresh  air  day 
and  night,  a simple  diet,  regular  hours  of 
eating  and  sleeping,  rest  before  and  after 
meals,  regulation  of  the  bowels,  and  general 
and  local  cleanliness. 

A tonic  may  be  useful,  e.g.,  iron,  arsenic, 
codliver  oil  (Part  11). 

II  ELixiris  ferri,  quininse,  et  strychninae 
phosphati 5iv 

Sig. — One  teaspoonful  in  water,  t.i.d.p.c. 

B Acidi  nitrohydrochlorici 

diluti 5ii  (iRv  per  dose) 

Aquae g iss 

Strychninae  sulphatis ...  gr.  i (gr.  per  dose) 

Misce  et  adde 
Tincturae  gentianae  com- 
positae, 

Tincturae  cardamomi  com- 
positae,  aa  q.s.  ad gvi 

Sig. — ^Dessertspoonful  after  meals  in  water. 
(H.  C.  Wood.) 

Cleanse  the  parts  twice  daily  with  boric 
acid  solution,  3i  ad  5iv,  and  dust  with  an 
antiseptic  powder,  e.g.,  calomel;  calomel  and 
bismuth  subnitrate,  equal  parts;  boric  acid 
and  bismuth  or  zinc  oxide,  equal  parts; 

aristol;  nosophen;  etc.;  or  apply  the  follow- 
ing astringent  lotion  two  or  three  times  daily : 

Calaminse, 

Zinci  oxidi, 

Acidi  borici,  aa gi 

Alcoholis gii 

Aquae,  q.s.  ad giv.  (Shake  well) 


HYDROCELE 


Or,  particularly  useful  for  the  relief  of 
burning  and  itching; 

Calaminse, 

Zinci  oxidi,  aa 3i~ii 

Acidi  borici 5i 

Glycerini ryxxx 

Acidi  carbolici npx-xxx 

Liquoris  calcis o i 

Aquae,  q.s.  ad 3iv  (Shake  well) 

Or,  zinc  sulphate  solution,  0.5  to  2.0 
per  cent. 

Zinc  oxide  ointment  may  be  of  sei’vice. 
Apply  silver  nitrate,  gr.  x-xl  ad  5 i to  per- 
sistent ulcers. 

In  obstinate  and  recurring  cases,  apply 
daily,  for  ten  minutes,  the  galvanic  current 
of  one-half  to  two  milliamperes,  with  the 
positive  electrode  over  the  lower  lumbar 
region  and  the  negative  electrode  over  the 
affected  part  ; or  apply  a mustard  poultice 
over  the  lumbar  spine  eveiy  day  or  two. 
Arsenic  is  also  advised.  Circumcision  is 
advisable  in  relaj:)sing  cases. 

Horns  of  the  Penis. — See  Tumors  of  the 
Penis. 

Hydatid  Disease  of  the  Bladder. — Gr. 

vdaris  vesicle.  See  under  Cystitis. 

Kidney.— See  Tumors  of  the  Kidney. 

Hydrocele.- — Gr.  vSap  water  -|-  K-qX-q  tumor. 
An  accumulation  of  serous  fluid  within 
the  tunica  vaginalis  of  the  testis  or 
spermatic  cord. 

A.  Acute  Hydrocele. — Acute  hydrocele  is 
diagnosed  by  the  sudden  occurrence  of  a 
painful,  red,  fluctuating  swelling  in  front  of 
the  testis.  It  is  translucent  unless  blood 
or  pus  is  present.  Withdraw  some  of  the 
fluid  with  a hypodermic  syringe. 

Etiology. — Traumatism  ; acute  (usually 
gonorrhccal)  epididjanitis;  acute  infectious 
diseases;  tuberculosis;  syphilis;  injection  of 
irritating  fluids  in  chronic  hydrocele;  unclean 
tapping  of  a chronic  hydrocele. 

Treatment. — This  is  the  same  as  that  of 
acute  orchitis  and  epididymitis  (q.v.).  If 
great  tension  and  pain  occur,  incise  and 
drain  with  a broad  strip  of  gutta  percha. 
Should  suppuration  occur  (tliagnosed  by 
means  of  the  aspirating  syringe),  make  a 
free  incision  ami  drain,  j:>receded  or  not,  as 
deemed  advisable,  with  hot  boric  acid  irri- 
gation, 5 i-iv  ad  ( )i.  Keep  the  parts  elevated. 

B.  Chronic  Hydrocele. — Chronic  hydrocele  is 
slow-growing,  jiainless,  usually  translucent, 
distinctly  fluctuant,  not  tymipanitic,  and 
with  no  impulse  on  coughing.  Hydrocele 
of  the  testis  grows  from  below  upward;  it  is 
usually  pear-shaped  (larger  below  than  above) 
or  oval,  and  is  usually  situated  in  front  of 
the  testis.  The  diagnosis  of  hydrocele  of 


the  cord  “ can  u.sually  be  made  from  the 
sense  of  fluctuation  and  the  delicate  bluish 
color  of  the  sac,  showing  through  the  thin 
integument.”  (Bevan.) 

Hydrocele  should  be  distinguished  from 
hernia.  Do  not  resort  to  puncture  unless 
hernia  can  be  excluded  by  bringing  the 
Angers  together  above  the  tumor  and 
feeling  nothing  but  the  normal  tissues  of 
the  cord.  (Keyes.) 

Etiology.— Traumatism;  gonorrhoeal  inflam- 
mation, with  or  without  involvement  of 
the  epididymis;  chronic  orchitis  or  epididy- 
mitis; tuberculosis;  syphilis;  neoplasms; 
typhoid  fever;  small  spermatocele  within 
the  tunica  vaginalis;  lesion  of  the  hydatids 
of  Morgagni;  congestion  due  to  venous 
obstruction  (the  result  of  a hernia  or  truss) ; 
elephantiasis;  congenital  continuation  of 
the  tunica  vaginalis  with  the  peritoneum 
(congenital  hydrocele:  reducible;  may  be 
complicated  by  hernia);  development  ano- 
maly (infantile  hydrocele),  differing  from 
a congenital  hydrocele  by  being  shut  off 
from  the  peritoneal  cavity,  and  being 
therefore  irreducible;  it  is  rarely  bilocular, 
i.e.,  partly  in  the  scrotmn  and  partly  in 
the  abdomen. 

Treatment. — If  the  sac-wall  is  thin,  the 
injection  treatment  may  be  tried.  One 
injection  cures  more  than  80  per  cent.;  but 
two  or  three  injections  are  sometimes  re- 
quired. First  cleanse  the  parts,  and  inject 
a few  drops  of  1 per  cent,  cocaine  solution 
into  the  skin,  “ in  front  and  a little  above 
the  centre  of  the  swelling.”  Then  plunge 
in  a cannula  and  trocar  perpendicularly  to 
the  long  axis  of  the  scrotum,  remove  the 
trocar,  and  withdraw  all  the  fluid,  using  a 
half-ounce  aspirating  syringe  for  the  last 
portion.  Then  inject  through  the  cannula 
5 to  20  drops  of  pure  carbolic  acid  and  with- 
draw the  cannula.  With  a finger  over  the 
puncture  knead  the  sac  so  as  to  bring  the 
acid  in  contact  with  all  parts  of  its  inner  wall. 
Keep  the  i^atient  in  bed  until  the  resulting 
acute  reaction  subsides,  i.e.,  two  to  four 
days;  and  have  him  wear  a suspensory  bag 
for  three  to  six  weeks.  If,  after  ten  to  four- 
teen days,  the  sac  is  still  enlarged,  aspirate 
again  without  injection'.  Small  hydroceles 
in  infants  disappear  spontaneously  in  two  or 
three  months.  Large  ones  may  be  cured  by 
aseptic  aspiration  with  a hypodermic  syringe, 
the  puncture  being  sealed  with  collodion. 

Andrews’s  modification  of  the  Jabouley 
o]>cration,  called  Andrews’s  bottle  operation, 
is  of  advantage  in  thin-walled  sacs  (consult 
Keen’s  Surgery,  Vol.  IV,  p.  607). 

In  old-standing,  thick-walled  sacs,  and 


IMPOTENCE 


in  hour-glass  hydroceles,  incise  the  sac, 
stitch  to  the  skin,  and  drain  with  gauze,  or 
gutta-percha,  or  rubber  tube,  with,  if 
desired,  daily  irrigations  with  iodine  solu- 
tion of  the  color  of  sherry  wine,  until  the 
sac  fills  with  granulation  tissue,  or  preferably, 
excise  the  parietal  wall  of  the  sac  and  close 
immediately,  or  drain  for  twenty-four  hours. 

Congenital  and  infantile  hydroceles  and 
those  occurring  in  hernial  sacs  require 
excision  of  the  sac. 

Hydronephrosis. — Gr.  vSwp  water  -b 
ve4>p6s  kidney.  Hydronephrosis,  or  disten- 
tion of  the  renal  pelvis  with  urine,  is  the 
result  of  gradual  incomplete  urinary  obstruc- 
tion, permanent  or  intermittent. 

Fixed  hydronephrosis  is  diagnosed  by  the 
presence  of  a gradually  growing,  non-inflam- 
matory  tumor,  by  ureteral  catheterization, 
exploratoiy  incision,  etc.  Intermittent 
hydronephrosis  is  characterized  by  the  occur- 
rence of  attacks  of  severe  pain  (Dietl’s  crises) , 
associated  with  the  sudden  appearance  of  a 
movable,  enlarged  kidney,  which  collapses 
coincidently  with  the  relief  of  the  pain  and 
the  passage  of  a large  amount  of  urine. 

Etiology.— A.  Congenital. — Partial  steno- 
sis of  the  ureter  at  either  extremity;  oblique 
insertion  or  high  insertion  of  the  ureter  into 
the  renal  pelvis;  valve  formation;  compres- 
sion of  the  ureter  by  a supernumerary  or 
aberrant  renal  blood-vessel;  double  ureter; 
malpositions  and  kinking. 

B.  Acquired. — Phhnosis;  urethral  stric- 
ture; prostatic  hypertrophy;  vesical  tumors; 
thickened  bladder-walls;  pelvic  or  abdomi- 
nal tumors;  cancer  of  the  ciecum;  retro- 
peritoneal pelvic  sarcoma;  ureteral  tmnors; 
ureteral  gumma;  periureteritis;  periureteral 
adhesions;  ureteritis  (colon,  gonococcus, 
or  tubercle  infection);  calculus,  blood-clot, 
or  echinococcus  cyst  in  the  ureteral  canal; 
traumatism  due  to  the  passage  of  a stone,  to 
external  violence  or  to  a temporary  ligature 
or  clamp;  tumor  or  stone  in  the  renal  pehis; 
aneurysm  of  the  iliac  artery;  scoliosis  cau.s- 
ing  renal  displacement;  movable  kidney, 
producing  a kinking  of  the  ureter,  and  result- 
ing intermittent  hydronephrosis;  compres- 
sion of  the  ureter  by  perirenal  or  periureteral 
blood-clots  due  to  trauma. 

Treatment.— Remove  the  cause,  if  po.ssible. 
Stretch  ureteral  strictures  by  means  of 
bougies;  remove  obstructing  stones,  tumors, 
etc.;  resect  diseased  portions  of  the  ureter: 
perform  pyeloplication  upon  a dilated  renal 
pelvis;  do  a ureteropyelostomy,  if  indicated; 
employ  a pad  and  binder,  or  nephropexy,  or 
decapsulation  for  movable  kidney  (see  untler 
Splanchnoptosis).  In  operating  always  ex- 


plore the  ureter  by  means  of  a catheter 
passed  into  the  bladder.  If  very  little  kid- 
ney sub-stance  is  left,  the  tumor  large,  the 
obstruction  not  relievable,  and  the  other 
kidney  functionally  active  (see  Urinalysis), 
perform  neplu’ectomy. 

As  a palliative  measm’e  in  bilateral  cases 
with  anuria,  and  in  cases  with  severe  pres- 
sure symptoms,  aspirate  the  kidney  just 
below  the  last  intercostal  space  on  the  left 
side,  and  midway  between  the  last  rib  and 
the  crest  of  the  ilium  on  the  right  side. 

Hyperaesthesia  Vesicae. — Gr.  vrep  over  -\- 
alV^Tjo-is  sensibility ; L.  vesi'ca,  bhulder.  See 
Blaclder  Irritability. 

Hypernephroma. — Gr.  v-irkp  over  d-  vt<i)pm 
kidney  -b  -co/ia  tmnor.  See  Tmnors  of  the 
Kidney. 

Hypertrophy  of  the  Prostate. — See  Pros- 
tatic Hypertrophy. 

Idiopathic  Nephralgia;  Idiopathic  Renal 
Haematuria. — -Gr.  Ibios  own  -f-  irados  disease 
ve<j)p6s  kichiey  -f-  akyos  pain;  L.  ren,  kidney. 
See  under  Haematuria. 

Impotence. — L.  in,  not  -t-  -potefitia,  power. 
Lack  of  reproductive  power ; lack  of  vii-ility 
(L.  vir,  man). 

Etiology  (Casper). — I.  Psycliical  Impotence 
(the  most  important  form). 

(a)  Congenital  deficiency  or  absence  of 
the  sexual  impulse. 

(b)  Acquired  deficiency  or  absence  of  the 
sexual  hnpulse,  due  to  mental  work  or 
diversion;  distrust,  fear,  anxiety,  or  disgust 
in  the  performance  of  copulation ; super- 
stition; hypochoiKh’iasis;  perverse  .sexual 
feeling.  A man  may  be  relatively  impotent, 
that  is,  unable  to  have  intercourse  with  his 
wife,  but  potent  with  other  women. 

II.  Nervous  Impotence. — General  ner- 
vousness or  irritable  weakness  may  be  the 
fault.  Prematine  ejaculation  may  occur. 
It  is  commone.st  in  “ young  men  who  have 
indulged  in  .sexual  intercourse  very  rarely 
or  not  at  all  ” (Casper). 

III.  Paralytic  Impotence. — In  tins  form 
of  impotence,  erection  does  not  occur  at  all 
(true  paralytic  impotence),  or  is  deficient 
(atonic  unpotence;  curable  by  “ proper 
treatment  and  rest  ”)• 

Causes. — -Excessive  venery ; masturbation ; 
antemia;  obesity;  hypopituitartsm;  rliabetes 
mellitus;  exhausting  diseases;  diphtheria; 
brain  and  spinal  cord  affections,  particu- 
larly tabes;  certain  drugs,  viz.  alcohol  in 
excess,  tobacco,  morphine,  cannabis  indica, 
chloral,  cocaine,  bromine,  iodine,  lead,  anti- 
mony, arsenic,  carbon  bisulphide,  potassium 
nitrate,  salicylic  acid,  camphor,  conium. 

IV.  Organic  Impotence.-^ee  Sterility 


IMPOTENCE 


Treatment.— Examine  the  patient  carefully, 
and  attend  to  any  possible  causal  influence. 
Disjiel  his  fears  and  anxiety,  and  increase 
his  stamina  by  insistence  upon  the  following 
hygienic  regimen,  viz.,  abstention  from 
sexual  indulgence  for  months;  adequate  rest 
and  exercise;  regulation  of  the  bowels;  fresh 
air  day  and  night;  a daily  morning  tepid 
bath,  before  breakfast,  in  a warm  room, 
followed  by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel;  regular  hours 
of  eating  and  sleeping;  rest  before  and  after 
eating;  a light  but  nutritious,  bland  or  non- 
stimulating diet,  excluding  alcohol,  tea, 
coffee,  ginger  ale,  carbonated  beverages, 
lemonade,  acid  fruits,  sour  foods,  pickles, 
sauces,  salads,  spices,  condiments,  mustard, 
pepper,  horseradish,  radishes,  tomatoes, 
asparagus,  salty  foods,  smoked  and  salted 
meats,  preserved  fish,  herring,  shellfish, 
greasy  or  fried  foods,  fat,  tobacco.  No  food 
should  be  taken  for  four  hours  before  bed- 
tune.  The  patient  should  sleep  upon  a hard 
mattress,  with  light  covering,  and  should 
avoid  sleeping  upon  his  back,  to  prevent 
which  a towel  may  be  fastened  around  the 
waist  and  knotted  in  the  back.  Distention 
of  the  bladder  and  constipation  are  to  be 
avoided.  The  patient  should  engage  in  some 
form  of  occupation,  such  as  gardening.  A 
hunting  or  fishing  trip,  rowing,  bathing, 
swunming,  walking,  or  gymnastic  exercises 
may  be  prescribed,  but  too  much  exercise 
should  be  avoided,  hlassage  is  beneficial. 
Natural  or  artificial  brine  baths  are  good. 
Carbonic  acid  or  Nauheim  baths  (see 
Part  II)  are  very  stimulating,  and  should 
not  be  used  by  those  who  have  indulged  in 
excessive  venery.  They  are  indicated  in 
nervous  impotence.  Protracted  warm  baths 
are  contrainiUcated. 

Electricity  is  of  value.  The  constant  or 
Galvanic  current  is  best  for  paral}dic 
unpotence,  the  induction  or  Faradic  current 
for  psychical  and  nervous  impotence.  The 
current  should  jjroduce  sharp  tingling,  and 
should  be  applied  especially  to  the  spinal  col- 
umn, penis,  testicles  and  perineum.  Very 
weak  currents,  however,  should  be  used  for 
the  testicles.  One  electrode  may  be  placed 
on  one  side  of  the  vertebral  colmnn,  while 
the  other  electrode  is  moved  up  and  dowm 
on  the  other  side  of  the  spinous  processes, 
and  vice  versa;  or  one  electrode  may  be 
placed  over  the  sacrum  and  the  other  over 
the  perineum,  employing  not  so  strong  a 
current,  and  applying  it  but  one  to  two 
minutes.  Then  one  electrode  may  be  placed 
on  the  perineiun  and  the  other  run  along 
the  anterior  and  posterior  surfaces  of  the 


penis.  “ Very  gratifying  results  ” are 
obtained  by  a sponge  over  the  perineum  or 
spinal  column,  and  a metal  brush  attached 
to  an  induction  apparatus,  used  upon  the 
penis,  the  current  being  increased  until 
slight  smarting  is  produced,  and  then  con- 
tinued for  two  minutes;  this  repeated  every 
three  days.  Franklinization  may  be  em- 
ployed. “ The  patient  sits  upon  an  insu- 
lated plate,  being  stripped  down  to  the 
thighs,  and  by  means  of  a copper  sphere 
sparks  are  carried  along  the  entire  length 
of  the  spine.”  The  negative  pole  of  a 
galvanic  batter>^  within  the  prostatic  ure- 
thra and  the  other  over  the  perineum,  with 
a current  no  greater  than  five  milliamperes, 
is  reconunended  for  frequent  seminal  losses. 
(After  Casper). 

Occasional  cauterization  (once  every  week 
or  two)  of  the  veriunontanum  with  silver 
nitrate,  1 to  10  to  20  per  cent.,  is  useful  for 
the  purpose  of  reducing  congestion  anti 
obtunding  its  sensibility,  especially  in  cases 
of  deficient  erection,  premature  ejaculation, 
prostatorrhoea,  and  nocturnal  emissions,  in 
which  dilated  vesicles  and  prostate  should 
also  be  massaged  every  four  to  seven  days. 

The  cauterization  may  be  accomplished 
by  means  of  Guyon’s  or  Ultzmann’s 
syringe,  which  is  inserted  xmtil  the  mem- 
branous urethra  is  passed,  as  ascertained  by 
feeling  the  resistance  subside  or  by  rectal 
examination.  Then  one  drop  of  the  silver 
solution  is  injected,  the  bougie  pushed  a little 
farther  and  another  drop  injected,  and  so  on 
up  to  the  internal  sphincter  of  the  bladder; 
or  one  may  begin  at  the  bladder  (Casper). 
Says  Keyes:  “ If  some  benefit  is  not  derived 
from  the  first  two  or  three  applications,  it 
should  not  be  continued.”  Cold  or  hot 
lavage  through  a double  catheter  or  psyclrro- 
phore  (Gr.  yf/vxp^s  cold  -j-  ^opdv  to  bear)  is 
beneficial;  also  the  passage  of  metal  sounds 
of  increasing  sizes  every  three  or  four  days 
for  five  minutes  at  a time. 

Aphrodisiac  Drugs:  ' 


1.  Phosphorus  (said  to  be  the  best;  it  increases 
desire). 

Olei  phosphorati  (1  per  cent.),  oss  (gr.  Hoo 
to  each  minim.) 

Sig. — One  minim,  gradually  increased  to  three  or 
four  minims,  t.i.d. 

Zinci  phosphidi gr. 

Fiat  pillula.  Mitte  talis  No.  100. 

Sig. — One  piU  three  or  four  times  a day. 

Acidi  hypophosphorici  diluti 5i 

Sig.  Twenty  drops  in  water,  t.i.d. 

2.  Strychnine. 

II  Strychninae  sulphatis gr.  1 

.\cidi  hypophosphorici  diluti oiv 

M.  Sig. — Ten  drops  in  water,  t.i.d.,  graduallj' 
increased  to  twenty-five  drops. 


INJURIES  OF  THE  PENIS 


StrychninsB,  gr.  %o,  aa  tabellas  No.  40. 

Sig. — One  tablet  t.i.d.  (see  Part  11,  Drugs,  for 
toxic  signs). 

Tincturae  nucis  vomica; 5 i 

Sig. — Ten  to  fifteen  minims,  in  water,  t.i.d. 

3.  Atropine. 

Atropina;  sulphatis,  gr.  }4bo~H2o,  aa  tabellas 
No.  30. 

Sig. — One  tablet  two  or  three  times  a day  (see 


Part  11,  Drugs,  for  toxic  signs). 

4.  Ergot. 

Fluidextracti  ergotse 5 i 

Sig. — Thirty  drops  in  water,  t.i.d. 

5.  Cantharidis,  Tinctura; 5ss 


Sig. — Three  to  eight  drops,  t.i.d.  (see  Part  1 1 for 
injurious  effects;  it  produces  erection  without  desire). 

6.  Oxygen  inhalations:  ten  litres  at  each  sitting. 

The  above  drugs  should  not  be  given  until 
after  the  normal  sexual  function  has  been 
restored  by  functional  rest  (for  a period  of 
months),  a hygienic-dietetic  regimen,  and 
tonics,  such  as  the  elixir  of  iron,  quinine, 
and  strychnine  (q.v.).  Remember  hypo- 
pituitarism iq.v.,  in  Part  1)  as  a possible 
cause  of  impotency  and  obesity. 

Nervous  impotence  is  cured  by  marriage. 

In  some  instances  of  perverse  sexuality, 
sexual  desire  is  evoked  only  by  the  con- 
templation or  conception  of  certain  inani- 
mate objects,  such  as  a night-cap,  stocking, 
etc.  Such  cases  may  be  treated  successfully 
by  having  the  patient  use  such  object  during 
coitus.  (Casper.) 

Incontinence  of  Urine. — See  Enuresis. 

Infiltration  of  Urine. — L.  in,  into  + fil'- 
trum,  filter.  See  Extravasation  of  Urine. 

Inflammation  of  the  Bladder. — L.  inflam- 
ma're,  to  set  on  fire.  See  Cystitis. 

Inflammation  of  Cowper’s  Glands. — See 
Cowperitis. 

Inflammation  of  the  Epididymis. — See 
Orchitis  and  Epididymitis. 

Inflammation  of  the  Foreskin. — See 

Balanoposthitis. 

Inflammation  of  the  Qians  Penis. — L. 

glans,  gland.  See  Balanoposthitis. 

Inflammation  of  the  Inguinal  Glands. — 

See  Lymphadenitis,  Inguinal. 

Inflammation  of  the  Kidney. — See  Pye- 
lonephritis, in  Part  1,  General  Medicine  and 
Surgery. 

Inflammation  of  the  Penis. — L.  pefds. 

Causes.— Gonorrhoea,  chancroid;  syphilis; 
herpes;  tuberculosis;  ery.sipelas;  malignant 
ulceration;  balanoposthitis;  urethritis;  ure- 
thral stricture;  gout  or  rheumatism;  typhoid 
fever;  traumatism,  etc. 

Treatment.— Attend  to  the  cause.  Prescribe 
rest,  laxatives,  and  light  diet,  and  frequent 
31 


prolonged  immersion  of  the  penis  in  hot 
bichloride  solution,  1 : 10,000  to  2000,  fol- 
lowed by  a dressing  of  gauze  wet  with 
aluminum  acetate  solution,  2 per  cent.,  or 
ichthyol,  50  per  cent,  in  glycerine  and  water, 
the  latter  especially  for  erysipelas.  Open 
and  drain  abscesses,  and  remove  sloughs. 
Incise  tense  areas  to  avert  gangrene.  Keep 
the  penis  and  testicles  elevated.  If  a 
sexual  sedative  is  required,  prescribe  bro- 
mides (q.v.),  camphor  (q.v.),  or  morphine. 

Correct  later  any  resulting  phimosis 
or  paraphimosis. 

Inflammation  of  the  Perinephric  Tissues. 

— See  Perinephric  Abscess. 

Inflammation  of  the  Prepuce. — L.  prcep'u- 
tiurn,  foreskin.  See  Balanoposthitis. 

Inflammation  of  the  Prostate. — See  Pros- 
tatitis. 

Inflammation  of  the  Scrotum. — L.  Scro'- 
tum,  bag. 

Causes.— Traumatism;  furunculosis;  erysip- 
elas; chancre;  mycosis;  infectious  diseases 
(diphtheria,  scarlet  fever,  typhoid  fever, 
etc.);  urinary  infiltration;  poison-ivy  or 
poison  oak;  irritation  from  carbolic  or 
bichloride  dressings. 

Gangrene  is  a complication  to  be  feared. 

Treatment.— Prescribe  rest  in  bed,  laxa- 
tives, light  diet,  and  frequent  prolonged 
immersion  of  the  parts  in  hot  boric  acid 
solution,  5iv  ad  Oi,  followed  by  moist 
boric  acid  dressings.  Keep  the  scrotum 
elevated.  Open  and  drain  abscesses,  and 
remove  sloughs.  In  tense  areas,  make 
multiple  free  incisions,  parallel  with  the 
raphe,  to  prevent  gangrene. 

Inflammation  of  the  Seminal  Vesicles. — 
See  Seminal  Vesiculitis. 

Inflammation  of  the  Testis. — L.  testis, 
testicle.  See  Orchitis. 

Inflammation  of  the  Urethra. — See  Ure- 
thritis; and  Gonorrhoea. 

Inguinal  Lymphadenitis. — See  Lympha- 
denitis, Inguinal. 

Injuries  of  the  Bladder. — See  Bladder 
Injuries. 

Kidney. — See  Kidney  Injuries. 

Penis.— For  contusion,  apply  heat  or 
cloths  wet  with  aluminum  acetate  solution, 
2 per  cent.,  or  boric  acid  solution,  4 per  cent. 
Large  blood-clots  should  be  incised  and 
evacuated.  Tense  oedematous  areas  should 
be  incised  in  several  places  to  avert  gangrene. 

Wounds  should  be  cleansed  and  sutured. 
Perform  external  perineal  urethrotomy  if 
the  urethra  is  injured  (see  Injuries  of  the 
Urethra). 

For  fracture,  prescribe  rest,  laxatives, 
light  diet,  elevation  of  the  penis,  cold  appli- 


KIDNEY,  POLYCYSTIC 


cations,  and  bromides  {q.v.)  in  large  doses, 
with  perhaps  camphor  {q.v.),  or  morphine 
{q.v.),  to  prevent  priapism.  In  severe 
cases,  make  an  incision  down  to  the  seat 
of  injury,  remove  clots,  approximate  the 
deep  structures  with  buried  catgut  and  the 
skin  with  interrupted  silkworm-gut  sutures, 
and  apply  moist  antiseptic  dressings.  Per- 
form external  perineal  urethrotomy  if  the 
urethra  is  injured. 

It  is  advised  that  a silver  retention 
catheter  (see  under  Bladder  Diverticula)  be 
tied  in  place  in  every  case  of  severe  injury, 
since  retention  from  swelling  may  occur. 

Injuries  of  the  Testicle. — L.  tes'tis]  testic- 
ulus.  For  contusion,  prescribe  rest  in  bed, 
laxatives,  elevation  of  the  penis  and  testicles, 
and  application  of  boric  acid,  4 per  cent.,  or 
aluminum  acetate,  3 per  cent.  Do  not 
apply  pressure  bandages, for  fear  of  gangrene. 
Should  inflammation  threaten,  make  free 
incisions  and  evacuate  effused  blood.  Should 
gangrene  of  the  testicle  occur,  as  manifested 
by  local  swelling  and  violent  constitutional 
disturbance,  remove  the  gland  at  once. 

Dislocation  of  the  testicle  should  be 
reduced  by  pressure  or  traction  or  operative 
means,  to  forestall  gangrene. 

Torsion  of  the  spermatic  cord  produces 
gangrene  of  the  testicle,  with  symptoms 
resembling  strangulated  hernia.  If  the 
testicle  can  not  be  untwisted,  operate. 

Open  wounds  should  be  cleansed, 
hernia  of  the  testicular  contents  should  be 
reduced,  and  the  tunica  albuginea  sutured 
or  pressure  applied. 

Injuries  of  the  Urethra. — Gr.  ovp-qdpa. 
For  simple  contusion,  prescribe  rest  in  bed, 
laxatives,  a light  bland  diet,  sodium  bromide 
{q.v.)  for  the  prevention  of  priapism,  and 
a cooling  sedative  lotion,  such  as  aluminum 
acetate,  2 to  3 per  cent,  solution.  Urotro- 
pine  {q.v.)  may  be  administered,  and, 
if  deemed  advisable,  bidaily  gentle  injec- 
tions or  irrigations  of  boric  acid  solution, 
3i-iv  ad  Oi;  or  potassium  permanganate, 
1 : 4000;  or  protargol,  1 : 1000  (3  to  5 c.c.); 
or  silver  nitrate,  1 : 2000  (3  to  5 c.c.).  Do 
not  employ  the  catheter. 

For  wounds,  prescribe  sodium  bromide, 
irrigate  with  boric  acid  or  permanganate 
solution,  approxunate  with  fine  interrupted 
catgut  sutures  (not  penetrating  the  mucous 
coat)  any  wounds  communicating  with  the 
exterior,  and  keep  in  a catheter  until  union 
occurs  (see  under  Bladder  Diverticula), 
or  in  slight  cases,  catheterize  carefully, 
at  each  urination,  for  several  days. 

Retention  follows  severe  injuries: — Per- 
form external  urethrotomy  at  once,  suture 


the  divided  ends  of  the  urethra,  and  keep 
in  a catheter  until  healing  occurs. 

Should  extravasation  of  urine  occur 
perform  immediate  external  perineal  ure- 
throtomy and  establish  drainage  (see  Extra- 
vasation of  Urine). 

Casper  says:  “ Large  doses  of  quinine, 
gr.  xv-xxx  a day,  should  always  be  adminis- 
tered in  every  injury  of  the  urethra.” 

Intractable  stricture  is  prone  to  follow 
urethral  injuries  in  about  six  weeks. 

Intertrigo;  Chafing. — ^L.  inter,  between  -|- 
ter'ere,  to  rub.  (See  Part  5,  Skin  Diseases.) 

Inunction,  Mercurial. — ^L.  in,  into  -f 
ung'uere,  to  anoint.  (See  under  Syphilis, 
in  Part  1). 

Irritable  Bladder. — See  Bladder  Irri- 
tability. 

Irritable  Testicle. — See  Neuralgia  of  the 
Testicle. 

I Itching. — See  Pruritus. 

Kidney  Abscess. — L.  absce'ssns,  a going 
apart.  See  Pyelonephritis,  in  Part  1,  Gen- 
eral Medicine  and  Surgery. 

Kidney,  Angioneurosis  of  the. — Gr. 
b.yjeiov  vessel  -|-  vevpov  nerve.  See  under 
Htematuria. 

Kidney  Calculus. — ^L.  calculus,  pebble. 
See  Nephrolithiasis,  in  Part  1,  General 
Mecheine  and  Surgery. 

Kidney,  Carcinoma  of  the. — ^Gr.  Kapdiios 
crab  -f-  -copa  tumor.  See  Tmnors  of 
the  Kidney. 

Cysts  of  the. — Gr.  kvutis  bag.  See 
Tumors  of  the  Kidney. 

Echinococcus  Disease  of  the. — Gr. 
Exiws  hedge-hog  kvkkos  berry.  See 
Tumors  of  the  Kidney. 

Kidney  Fistula. — See  Fistula,  Renal. 

Kidney,  Floating. — See  Splanchnoptosis, 
in  Part  1,  General  IMedicine  and  Surgery. 

Kidney  Hemorrhage. — Gr.  dpa  blood  -f- 
pejvvpi  to  burst  forth.  See  Hsematuria. 

Kidney,  Hydatid  Disease  of  the. — Gr. 
vdatLs  vesicle.  See  Tmnors  of  the 
Kidney. 

Hypernephroma  of  the. — Gr.  birkp  over 
+ ve4>p6s  kidney  -|-  -co/xa  tumor.  See 
Tumors  of  the  Kidney. 

Kidney  Infections. — ^L.  injectio.  See 
Pyelonephritis,  in  Part  1,  General  IMedicine 
and  Surgery. 

Kidney,  Injuries  of  the. — See  Gynsecologjq 
Part  2. 

Movable.  — See  Splanchnoptosis,  in 
Part  1. 

Neuralgia  of  the. — Gr.  vevpov  nerve  -1- 
aXyos  pain.  See  under  H*maturia. 

Polycystic. — Gr.  ttoXG  many  -j-  werrts 
cyst.  See  Tumors  of  the  Kidney. 


NEURALGIA  OF  THE  PENIS 


% 

Kidney,  Sarcoma  of  the. — Gr.  aap^,  aapKos 
flesh  + -upa  tumor.  See  Tumors  of 
the  Kidney. 

Stone  in  the. — See  Nephrolithiasis,  in 
Part  1. 

Kidney  Suppuration. — L.swh, under  + pus, 
pur' is,  pus.  See  Pyelonephritis,  in  Part  1. 

Kidney,  Suprarenal  Inclusion  Tumor  of 
the. — See  Tumors  of  the  Kidney. 

Tuberculosis  of  the. — See  Pyelonephri- 
tis, in  Part  1. 

Kidney  Tumors. — See  Tumors  of  the 
Kidney. 

Litholapaxy. — Gr.  \Wo^  stone  d-  Xawa^is 
removal.  See  Bladder  Calculus. 

Loss  of  Semen,  Abnormal. — L.  semen, 
seed;  ah,  from  + 7ior'nia,  rule.  See  Sexual 
Neuroses. 

Lubricants,  Urethral. — See  under  Stric- 
ture of  the  Urethra. 

Lues. — L.  See  Syphilis,  in  Part  1. 

Lymphadenitis,  Inguinal. — L.  lym’pha, 
lymph  -f-  Gr.  abi]v  gland  H — trts  inflanmia- 
tion;  L.  in'guen,  groin. 

Causes. — Urethi’itis;  balanoposthitis ; gonor- 
rhoea; chancroid  (q.v.);  chancre;  infected 
excoriations;  eczema;  herpes;  tuberculo- 
sis; acute  infectious  diseases;  secondary 
syphilis;  etc. 

Treatment.— This  depends  ipwn  the  cause 
(q.v.).  Where  suppuration  threatens,  employ 
rest  in  bed,  1-axatives,  cold  applications  of 
aluminum  acetate  solution  (q.v.),  and  nightly 
application  of  unguentum  hydrargyri  {q.v.) 

For  chronically  enlarged  glands,  employ 
inunctions  of  unguentum  iodi  (q.v.),  or  paint 
on  tincture  of  iodine. 

Lymph  Scrotum. — See  Elephantiasis  of 
the  Scrotum. 

Masturbation. — L.  ma/ms,  hand  stu- 
prar'e,  to  rape. 

Etiology. — Neurotic  habit;  habit  of  sucking; 
tight  clothing;  uncleanliness;  adherent  pre- 
puce; elongated  foreskin;  phimosis;  balano- 
posthitis; eczema;  pin-worms;  highly  acid, 
concentrated,  or  diabetic  urine;  anal  fissure; 
chronic  constipation. 

Treatment.— Remedy  all  possible  causal 
influences.  Strip  the  prepuce,  apply  a solu- 
tion of  cocaine,  10  to  20  per  cent.,  for  ten 
minutes,  if  neces.sary,  and  free  adhesions 
with  a blunt  probe  back  to  the  sulcus  in 
back  of  the  corona;  cleanse  the  preputial 
sac,  and  apply  vaseline  every  flay  for  two 
weeks.  Build  up  the  general  health.  Enjoin 
cleanliness,  local  and  spinal  cold  water 
sprays  or  douches,  a hard  bed,  light  bed- 
covering, prompt  rising  in  the  morning, 
physical  work  and  fresh  air  exercise. 
Prohibit  tea,  coffee,  alcohol,  spices,  highly- 


seasoned  food,  sweets,  and  highly  nitrog- 
enous food.  Allow  no  food  within  three 
or  four  hours  of  bedtime.  If  hyperacidity 
of  the  urine  seems  to  be  a factor,  prescribe 
sodium  bicarbonate  {q.v.)  or  potassiiun  ci  trate 
{q.v.)  and  restrict  the  eating  of  meat. 

The  wrists  may  be  tied  to  the  neck.  In 
leg-rubbing  in  infants,  keep  the  legs  apart 
with  a large  coarse  napkin,  or  a towel  over 
the  napkin.  In  older  children  employ  the 
knee-crutch. 

Close  and  persistent  supervision  is 
required  to  effect  a cure. 

Meatotomy. — L.  mea'tus,  passage  -f  Gr. 
Tepvetv  to  cut.  See  under  Stricture  of  the 
Urethra. 

Micturition. — L.  miciurir'e,  to  urinate. 
See  Urination. 

Misplaced  Testicle. — See  Undescended 
Testicle. 

Moist  Warts. — See  Verruc®. 

Mouth,  Gonorrhoea  of  the. — See  Buccal 
Gonorrhoea,  under  Genorrhoea. 

Movable  Kidney. — See  Splanchnoptosis, 
in  Part  1. 

Mumps,  Orchitis  of. — See  Orchitis. 

Neck  of  the  Bladder,  Contracture  of  the.— 

L.  con,  together  -|-  tra'here,  to  draw. 
See  Bladder  Irritability. 

Spasm  of  the. — Gr.  awaapos.  See  Blad- 
der Irritability. 

Stricture  of  the. — See  Stricture  of  the 
Neck  of  the  Bladder. 

Nephralgia. — Gr.  ve(j>pos  kidney  -f-  aXyos 
pain.  See  under  Haematuria. 

Nephritis,  Suppurative. — Gr.  ve4>p<>s  kidney 
-f  -iTLs  inflammation;  L.  sub,  under  -|-  jnis, 
pur 'is,  pus.  See  Pyelonephritis,  in  Part  1. 

Nephrolithiasis.^^ee  Part  1,  General 
Medicine  and  Surgery. 

Nephroptosis. — Gr.  pe<t>p>'s  kidney  -p  TrTwms 
falling.  See  Splanchnopto.sis,  in  Part  1. 

Neuralgia  of  the  Bladder. — Gr.  vevpop 
nerve  -p  akyos  pain.  See  Bladder 
Irritability. 

Neuralgia  of  the  Kidney. — See  under 
Haematuria. 

Neuralgia  of  the  Penis. — Correct  any  dis- 
coverable fault,  local  or  constitutional.  The 
gouty  diathesis  may  be  causative  (see  Gout, 
in  Part  1,  General  Medicine  and  Surgery) 
Enjoin  the  observance  of  correct  hygiene, 
general  and  sexual,  e.g.,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  a 
daily  morning  warm  or  tepid  bath  in  a warm 
room,  before  breakfast,  followed  by  a cold 
spinal  douche,  regulation  of  the  bowels,  simple 
bland  diet,  plenty  of  water  between  meals, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  abstention  from 


ORCHITIS  AND  EPIDIDYMITIS 


poisons,  such  as  tea,  coffee,  alcohol, 
and  tobacco. 

Neuralgia  of  the  Testicle;  Irritable  Tes= 
tide. — L.  irritar'e,  to  tease;  test'is,  testic'ulus. 

Etiology. — Neurotic  disposition;  excessive 
venery,  psychical  or  physical;  prolonged 
ungratified  sexual  desire;  varicocele;  con- 
gestion of  the  veruniontanum ; prostatitis; 
vesiculitis;  renal  or  vesical  calculus. 

Treatment. — Attend  to  the  cause.  Enjoin 
the  observance  of  correct  general  and  sexual 
hygiene,  e.g.,  adequate  rest  and  exercise, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  eating,  a suuple  bland  diet, 
regulation  of  the  bowels,  fresh  air  day  and 
night,  a daily  tepid  bath  in  a warm  room, 
before  breakfast,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel.  A suspensory  bag  should  be  worn, 
and  guaiacol,  10  per  cent,  in  glycerine,  may 
be  applied.  The  ice-bag  may  be  of  service. 

Cauterization  of  the  verumontanvun,  rec- 
tal douching,  and  massage  of  the  vesicles 
and  prostate  may  be  indicated  (see  under 
Impotence).  Marriage  may  be  curative. 

Neurasthenia,  Sexual. — Gr.  vtvpov  nerve 
-b  acrdeveLa  debility.  See  Sexual  Neuroses. 

Neuroses  of  the  Bladder. — Gr.  vevpov 
nerve.  See  Bladder  Irritability. 

Neuroses  of  the  Prostate.— Gr.  vevpovnerve; 
Tpo-  before  -f-  la-Tavai  to  stand.  JMost,  but  not 
all,  of  the  cases  follow  chi-onic  gonorrhoea. 
There  may  be  constant  pain  and  heaviness 
with  exacerbations,  but  there  are  no  objective 
signs  of  inflammation,  no  swelling,  although 
tenderness  may  be  present,  no  pus  cells  in 
the  prostatic  secretion,  and  the  urine  is 
clear,  except  perhaps  for  the  presence  of  a 
few  filaments  from  a previous  catarrh. 
Micturition  and  the  passage  of  instrmnents 
may  be  painful.  Difficulty  of  urination  is 
most  frequent,  but  it  is  inconstant,  “ being 
present  at  one  time  and  absent  at  another.” 
Catheterization  with  metallic  instruments 
is  easy,  and  the  urethra  is  not  lengthened 
as  in  prostatic  hypertrophy;  moreover, 
the  condition  occurs  mostly  in  young 
men.  Urgency  of  micturition  is  of 
inconstant  occurrence;  “ it  is  never  present 
at  night.”  (Casper.) 

Treatment. — Employ  prostatic  massage, 
cauterization  of  the  prostatic  urethra,  irri- 
gations, and  sounds,  as  in  chronic  prostatitis 
{q.v.) ; but  discontinue  the  treatment  if 
it  causes  pain.  Faradization  or  galvaniza- 
tion of  the  prostate  and  bladder,  one  elec- 
trode in  the  rectum  and  the  other  over  the 
symphysis,  very  hot  or  cold  lavage  through 
a double  catheter  or  psychrophore  (Gr. 
\f/vxp6s  cold  H-  (poptlv  to  bear),  Casper’s 


rectal  thennophore  (Gr.  6ipp.rj  heat),  sitz- 
baths,  and  cqld  perineal  douches  are  useful. 
For  vesical  spasm,  introduce  a large  sound 
and  keep  it  in  for  about  five 'minutes,  and 
administer  belladonna  (q.v.). 

An  invigorating  hygienic  regimen  should 
be  enforced,  viz.,  adequate  rest  and  open 
air  exercise,  fresh  air  day  and  night,  tepid 
or  cold  tub  baths  and  cold  spinal  douches 
with  brisk  rubbing,  general  massage,  vibra- 
tory and  manual,  regular  hours,  simple 
bland  diet,  rest  before  and  after  meals, 
regulation  of  the  bowels.  Sanatorium  life 
is  to  be  preferred. 

Neuroses,  Sexual. — See  Sexual  Neuroses. 

Nocturnal  Pollutions. — L.  nox,  night; 
pollut'io,  defiling.  See  Sexual  Neuroses. 

Ophthalmia,  Gonorrhoeal. — Consult  Part 
6,  on  Eye  Diseases. 

Orchitis  and  Epididymitis. — Gr.  opxts 
testis;  ewL-  on  -f-  dLdvpos  tesfis;  -f-  -irts 
inflammation.  There  are  the  local  signs  and 
symptoms  of  inflammation.  Atrophy  of 
the  testicle  may  follow  orchitis.  Sterility, 
due  to  occlusion  of  the  epididymis,  may 
follow  epididymitis. 

I.  Acute  Inflammation.  — ETIOLOGY. — Ure- 
thritis, usually  gonorrhoeal;  traumatism; 
cold  and  wet;  prostatitis;  vesiculitis;  pro- 
longed sexual  excitement;  gout;  infectious 
diseases:  mumps,  typhoid  fever,  influenza, 
smallpox,  rheumatic  fever,  pneumonia,  malar 
ria,  appendicitis,  tonsillitis,  pyaemia. 

Treatment. — Put  the  patient  to  bed,  open 
the  bowels,  and  prescribe  a light,  bland  diet. 
Elevate  the  testicles  by  means  of  a broad 
band  of  adhesive  plaster  spanning  the 
thighs,  or  by  means  of  a square  piece  of 
cloth  folded  in  a triangle,  to  the  centre  of 
the  base  of  which  is  fastened  the  middle  of  a 
piece  of  tape;  the  base  of  the  triangle  is 
placed  beneath  the  scrotum  and  the  acute 
angle  pinned  to  a waistband  in  front,  while 
the  two  tapes  are  carried  around  the  folds 
of  the  nates  and  fastened  to  the  waistband 
in  back.  Hot  flaxseed  poultices  or  ice-cold 
acetate  of  aluminum  solution,  2 per  cent., 
may  be  applied  eveiy  two  hours,  or  for  two 
hours  in  the  forenoon  and  two  hours  in  the 
afternoon.  Some  apply  guaiacol,  50  per 
cent,  in  glycerine,  or  guaiacol,  gtt.  xx,  in 
alboline  or  olive  oil,  3i>  twice  daily  for 
about  a week.  For  the  relief  of  pain  in  the 
acute  stage,  one  may  administer  tinc- 
ture of  aconite,  irei-ii,  in  water,  every  hour 
(praised  by  Keyes);  or  salicylic  acid,  gr.  x, 
well  diluted,  twice  daily,  or  antipyrine,  gr. 
XV  in  twenty-four  hours  (Casper).  Anti- 
gonococcus vaccine  or  serum  may  be  tried 
(see  under  Gonorrhoea). 


ORCHITIS  AND  EPIDIDYMITIS 


Keep  the  patient  in  bed  for  two  or  three 
days  after  the  temperature  has  returned  to 
normal,  and  have  him  wear  a suspensory 
bag  until  completely  cured.  After  the  acute 
sjTnptoms  have  subsided,  Martin’s  epididy- 
mitis bag,  made  by  Lentz  and  Sons,  of 
Philadelphia,  may  be  worn,  both  to  suspend 
the  parts  and  to  exert  slight  compression. 
The  skin  should  be  lightly  anointed  with 
lanolin  and  the  bag  lined  with  soft  cotton. 

For  persistent  induration  and  swelling, 
the  indurated  parts  may  be  strapped  with 
overlying  strips  of  adhesive  plaster  every 
two  days,  after  shaving  the  scrotum;  or 
Chetwood’s  rubber  bandage  may  be  em- 
ployed as  follows: 

First  encircle  the  base  of  the  scrotum  of 
the  affected  side  rather  snugly  with  a-piece 
of  tape.  Then  take  a rectangular  strip  of 
light  rubber  (Martin)  bandage,  10  cm.  wide 
and  about  20  cm.  long,  and  wrap  it  around 
the  inflamed  testicle  as  snugly  as  the  patient 
can  bear  it,  and  retain  it  in  place  with  an 
overlying  strip  of  adhesive  plaster.  Remove 
the  bandage  daily  and  reapply  it  more  snugly. 
To  promote  absorption,  potassium  iodide 
{q-v.)  may  be  administered  internally,  to- 
gether with  external  applications  of  unguen- 
tum  ioch  (q.v.),  or  tincture  of  iodine,  or  oleate 
of  mercury,  or  unguentum  ichthyolis,  20  per 
cent.,  continued  for  months. 

In  the  presence  of  suppuration,  and  in 
stubborn  recurring  cases,  one  may  make 
an  incision,  under  general  anaesthesia,  two 
to  three  inches  long,  on  the  outer  side  of 
the  scrotum  at  about  the  junction  of  the 
epididymis  with  the  testicle,  opening  the 
tunica  vaginahs  and  evacuating  contained 
fluid.  The  red  swollen  epididymis  which 
presents  may  then  be  punctured  in  places 
to  see  if  it  contains  pus  (Hagner).  The 
wound  is  washed  out  with  salt  solution 
(3i  ad  Oi)  and  packed  lightly  with  gauze. 

McDonagh  advocates  early  operative 
interference  in  acute  epididymitis.  He 
takes  the  scrotum  in  one  hand  and  makes 
tense  the  skin  over  the  epididymis.  A 
scalpel  is  then  plunged  into  the  substance  of 
the  epididymis  in  its  long  axis  in  two  or 
three  places,  or  1 to  2 c.c.  of  electrargol  is 
injected.  Rapid  relief  and  cure,  he  says, 
usually  follow  one  of  these  procedures. 

Crosbie  and  Riley  report  excellent  results 
from  epididymotomy  in  acute  gonorrhoeal 
epididymitis.  Local  anaesthesia  is  accom- 
plished as  follows,  using  20  to  30  c.c.  of  a 
1 per  cent,  solution  of  novocaine  containing 
3 to  6 drops  of  adrenalin,  1 : 1000,  and  pref- 
erably a 10  c.c.  glass  syringe  with  a two- 
inch  needle.  The  cord  is  grasped,  at  the 


point  where  it  emerges  from  the  external 
ring,  between  the  thumb  and  forefinger  of 
the  left  hand,  the  needle  is  inserted  into  the 
cord,  and  5 to  10  c.c.  of  the  solution  injected 
in  all  directions,  not  neglecting  the  inguinal 
canal  surrounthng  the  cord,  in  order  to 
block  completely  all  the  nerves  in  the  cord. 
“ The  needle  is  then  pushed  downward 
through  the  same  point  of  entry,  along  the 
cord,  to  the  region  of  the  globus  major,  and  a 
little  more  solution  injected.”  The  scrotmu 
is  then  circuminjected  where  the  scrotal 
skin  merges  with  the  skin  of  the  thigh,  all 
the  way  to  the  perineum,  or  according  to 
Braun,  all  the  way  around,  as  for  a double 
operation.  Finally,  the  line  of  incision  is 
injected.  “ In  order  to  get  perfect  anaes- 
thesia, it  is  well  to  wait  ten  or  fifteen 
minutes.”  A lateral  incision  is  made,  open- 
ing the  tunica  vaginalis  near  the  epididymis, 
taking  care,  in  advanced  cases  in  which 
adhesions  have  formed  between  the  tunica 
vaginalis  and  tunica  albuginea,  not  to  cut 
into  the  testicle.  Adhesions  are  freed  and 
the  testicle  and  epicUdymis  delivered  through 
the  incision.  The  lower  pole  or  globus  minor 
is  usually  most  inflamed.  Multiple  punc- 
tures with  a tenotome  are  then  made  in  all 
parts  of  the  epididymis  that  show  indura- 
tion, whether  pus  is  evident  or  not,  the 
tenotome  being  plunged  deeply  into  the 
substance  of  the  organ.  Where  pus  is 
found,  the  opening  is  enlarged  for  drainage. 
Bleeding  vessels  are  ligated  by  means  of  a 
fine  catgut  stitch.  The  parts  are  washed 
with  warm  saline  solution,  a rubber  or  gauze 
drain  placed  lengthwise  along  the  epididy- 
mis and  brought  out  at  the  lower  end  of  the 
incision,  the  testicle  pushed  back  into  the 
tunica,  and  the  wound  closed  loosely  with 
silkworm-gut  sutures  passed  through  all  the 
layers.  A large  dressing  is  applied  and  held 
in  place  with  a T-bandage,  and  a cathartic  is 
given.  The  drain  is  removed  on  the  third  or 
fourth  day,  and  the  stitches  in  about  a week. 

Do  not  employ  local  urethral  treatment 
for  two  weeks  or  longer  after  the  epicUdymis 
has  healed. 

In  acute  orchitis  (of  mumps,  etc.)  with 
very  acute  symptoms,  or  with  symptoms  of 
threatening  gangrene,  Keyes  advises  that 
the  tunica  albuginea  be  incised  subcuta- 
neously with  a sharp  tenotomy  knife,  “ three 
to  six  short  cuts  5 to  10  c.m.  long  being 
made  at  different  points,”  to  relieve  tension. 
Gangrene,  manifested  by  violent  constitu- 
tional disturbance,  requires  castration. 

II. — Chronic  Inflammation.  ETIOLOGY. — Acute 
inflammation  {q.v.,  above);  tuberculosis; 
syphilis.  Tuberculosis  nearly  always  begins 


PARAPHIMOSIS 


in  the  epididymis,  whereas  syphilis  nearly 
always  affects  the  testis  instead  of  the 
epididymis.  Tumor  should  be  excluded. 
Primary  tuberculosis  may  heal  spontane- 
ously or  be  entirely  cured  by  operation. 

Treatment. — (a)  Simple  Chronic  Inflam- 
7uation. — Employ  the  suspensory  bag,  ich- 
thyol,  iodine,  or  mercury  ointment, 
potassium  iodide  by  mouth,  compression,  or 
operative  treatment,  as  describetl  above. 

(b)  Tuberculosis. — Prescribe  a reconstruc- 
tive hygienic  regimen,  rest,  fresh  air,  an 
abundant  diet,  and  tonics,  etc.,  as  described 
in  detail  under  Tuberculosis,  Pulmonary, 
in  Part  1,  General  Medicine  and  Surgery. 

Support  the  testicles  by  means  of  a sus- 
j:)ensory  bag.  Bier’s  hypersemia  may  be 
tried  for  two  or  three  hours  or  longer  every 
day.  If  the  condition  grows  worse  in  spite 
of  good  hygiene,  lay  open  and  thoroughly 
curette  suppurating  foci,  emj)loy  Bier’s 
cups,  and  apply  iodine  or  iodoform.  Do 
not  tap  small  hydroceles;  but  large  ones  may 
be  tapped  and  carbolic  acid  injected  as 
described  under  Hydrocele. 

If  the  epididymis  is  extensively  diseased, 
it  should  be  removed,  together  with  the 
greater  part  of  the  vas  deferens,  and  the 
contiguously  involved  testicle  cauterized 
with  the  actual  cauteiy,  or  removed  if 
deemed  advisable.  Keyes  says:  “ I believe 
that  the  removal  of  one  testicle  tends,  if 
anything,  to  encom’age  reciuTence  on  the 
opposite  side.” 

(c)  Syphilis.— Treat  with  mercury,  potas- 
sium iodide,  and  salvarsan,  as  described 
under  Syphilis,  in  Part  1. 

Papilloma  of  the  Bladder. — L.  papil'la  + 
Gr.  -w/xa  tumor.  See  Tumors  of  the 
Bladder. 

Penis. — L.  penis.  See  Verrucse. 

Urethra. — See  Tumors  of  the  Urethra. 

Paralysis  and  Paresis  of  the  Bladder. — 
Gr.  Trapa  beside  + Xueu'  to  loosen;  irapecns 
relaxation.  Paralysis  of  the  detrusor  muscu- 
lature with  unimpaired  tonicity  of  the 
sphincter  causes  complete  retention  of  urine. 
Paralysis  of  the  sphincter  causes  inconti- 
nence or  overflow,  the  urine  lying  below  the 
level  of  the  sphincter  being  retained  (incom- 
j)lete  retention).  Simple  muscular  atony 
is  (‘haracterized  by  a frequent  desire  but 
weakened  power  to  urinate,  and  increased 
capaciousness  of  the  bladiler,  as  shown 
by  percussion,  catheterization,  and  the 
passage  during  urination  of  an  abnormal 
amount  of  urine. 

EtioloR}'.— Overdistention  of  the  bladder 
(see  Retention  of  Urine);  injury  of  the 
bladder;  arteriosclerosis  of  the  vesical  ves- 


sels; severe  parenchymatous  cystitis  lead- 
ing to  sclerosis;  comatose  states;  shock; 
operations;  fevers;  cerebral  or  spinal  disease 
or  injury,  e.g.,  general  paresis,  tabes,  fracture 
of  the  vertebral  column,  compression  of 
the  cord  by  hemorrhage  or  exudate, 
myelitis,  disseminated  sclerosis,  hemiplegia, 
hysteria,  etc. 

“ The  prognosis  is  by  no  means  bad  in  all 
cases,”  says  Casper.  The  condition  pre- 
disposes to  cystitis  and  stone. 

Treatment.— Attend  to  the  cause.  Unless 
cystitis  is  present,  manual  expression  of  the 
urine  should  be  practiced  every  six  hours,  by 
means  of  the  fingers  of  both  hands  grasping 
the  bladder  from  above,  and  the  thumbs 
resting  on  the  sjunphisis  pubis,  the  fingers 
being  pressed  downward  and  inward  (()rt- 
ner).  If  manual  expression  is  unsuccessful, 
catheterize  the  bladder  regularly,  twice  or 
thrice  daily,  and  guard  against  infection  by 
an  occasional  irrigation  with  hot  boric  acid 
solution,  3i~iv  ad  Oi,  or  silver  nitrate, 
1 : 5000  to  1000,  and  perhaps  urotropine 
(q.v.)  by  mouth.  To  restore  muscular  tone, 
employ  abdominal  and  spinal  massage, 
vibratory  and  manual;  galvanization  or 
faradization  of  the  bladder,  with  one  elec- 
trode over  the  bladder,  and  the  other  (a 
metal  sound  covered  with  the  exception  of 
the  tip  with  hard  rubber)  wdthin  the  bladder 
or  rectum;  and  strj^chnine  (q.v.)  in  large 
doses,  and  perhaps  ergot  (q.v.). 

In  organic  nervous  cases,  such  as  tabes, 
etc.,  the  regular  passage  of  full-sized  dilators 
is  recommended. 

Paraphimosis. — Gr.  s-a/ja  amiss  -f-  <j>ifideLv 
to  muzzle.  Tight  retraction  of  the  prepuce 
behind  the  corona  glandis. 


Etiology. — Voluntary  retraction  of  a tight 
prej)uce;  inflammation:  balanoposthitis, 

gonorrhoea,  herpes,  verrucae,  chancre,  chan- 
croid, etc.;  circumcision  with  but  little  of 
the  foreskin  removeti. 


PROSTATE,  HYPERTROPHY  OF  THE 


Treatment.— Retract  the  prepuce  further, 
and  squeeze  the  oedema  back  into  the  shaft 
of  the  penis;  skin  punctures  may  be  made. 

The  penis  should  be  grasped  behind  the 
stricture  between  the  index  and  middle 
fingers  of  both  hands,  and  the  thumbs,  one 
on  each  side  of  the  glans,  made  to  compress 
the  glans  laterally,  not  from  before  back- 
ward, while  the  stricture  is  at  the  same 
time  pulled  over  the  glans  (not  the  glans 
pushed  back  thi’ough  the  stricture). 

If  attempts  at  manipulative  reduction 
fail,  cUvide  the  constricting  ring  on  the 
dorsum  in  the  median  line  (see  Fig.  89.) 

If  necrosis  has  occurred,  do  nothing  but 
keep  the  parts  clean  by  means  of  antiseptic 
lotions,  such  as  boric  acid  solution,  4 per 
cent.,  or  bichloride,  1 : 4000,  dried,  and 
powdered  with  boric  acid  and  zinc  oxide, 
equal  parts,  until  nature  has  effected  a cure. 

Parasites,  Vesical. — Gr.  irapa  near 
(TITOS  food;  L.  vesica,  bladder.  See  Cystitis. 

Paresis  of  the  Bladder. — See  Paralysis 
and  Paresis  of  the  Bladder. 

Pediculosis  Pubis. — See  Part  5,  Skin 
Diseases. 

Penis,  Gangrene  of  the. — See  Gangrene 
of  the  Penis. 

Horns  of  the. — See  Tumors  of  the  Penis. 

Inflammation  of  the. — See  Inflamma- 
tion of  the  Penis. 

Injuries  of  the. — See  Injuries  of  the 
Penis. 

Neuralgia  of  the. — See  Neuralgia  of 
the  Penis. 

Papilloma  of  the. — L.  papil'la  + Gr. 
-w/za  tumor.  See  Verruca. 

Sarcoma  of  the. — Gr.  crap^,  aapKos 
flesh  -(-  -w/xa  tumor.  See  Tumors  of 
the  Penis. 

Tumors  of  the. — See  Tumors  of  the 
Penis. 

Penitis. — L.  penis  -|-  Gr.  -tns  inflamma- 
tion. See  Inflammation  of  the  Penis. 

Perinephric  Abscess. — See  Part  2,  Gyna- 
cology. 

Periurethral  Abscess. — Gr.  irepi  around  -|- 
ovprjdpa  urethra.  See  under  Gonorrhoea; 
and  Stricture  of  the  Urethra. 

Phimosis. — Gr.  <f>tpt«;crts  a muzzling. 

Etiology.— Congential  anomaly;  balano- 
posthitis;  traumatism.  Phimosis,  or  tight 
application  of  the  foreskin  over  the  glans, 
may  give  rise  to  reflex  nervous  disturbances, 
retention  of  urine,  urethritis,  cystitis,  pye- 
litis, hernia,  prolapsus  ani,  enuresis,  pru- 
ritus scroti,  etc. 

The  Treatment  is  operative. 

Pneumaturia. — See  Part  1,  General  Medi- 
cine and  Surgery. 


Pollution. — L.  pollut'io.  See  Sexual  Neu- 
roses. 

Polycystic  Kidney. — Gr.  ttoXus  many  -|- 
Kvaris  cyst.  See  Tumors  of  the  Kidney. 

Polyuria. — See  Part  1,  General  Medicine 
and  Surgery. 

Posthitis. — See  Balanoposthitis. 

Premature  Ejaculation. — L.  prce?natur'us, 
early  ripe;  e,  out  + jacere,  to  throw.  See 
Sexual  Neuroses. 

Prepuce,  Inflammation  of  the. — L.  proe- 
pu'tium,  foreskin.  See  Balanoposthitis. 

Priapism. — L.  priapismus;  Gr.  TcpLaTnapos. 
Abnormal,  persistent  erection  of  the  penis, 
usually  without  sexual  desire. 

Causes. — Certain  injuries  and  diseases  of 
the  cerebellum  and  spinal  cord;  prolonged 
mental  stress;  cantharides;  leuksemia;  inju- 
ries to  the  penis;  inflammation  of  the  penis; 
urethritis;  spermatocystitis ; prostatic  hyper- 
trophy in  the  early  stages;  vesical  calculus; 
rectal  worms;  adherent  prepuce;  etc. 

Treatment. — Prescribe  rest,  purgation, 

counter-irritation  to  the  lower  spine  and 
perineum  (or  electricity),  bromides,  mor- 
phine, chloral, belladonna,  ergot  or  potassium 
iochde,  and  local  applications  of  cold  water 
or  cold  lead  and  opium  wash  (see  Part  11 
for  all  drugs). 

Catheterize  the  bladder  if  retention  of 
urine  is  present.  Incise  and  evacuate  blood 
clots,  if  causal. 

In  chronic  cases,  make  an  incision  at  the 
seat  of  pain,  or  in  the  most  turgid  portion, 
or  where  any  nodular  masses  are  present. 

Proctitis,  Gonorrhoeal. — Gr.  -wposKTos  anus 
or  rectum  + -trts  inflammation.  See  under 
Gonorrhoea. 

Prostate,  Abscess  of  the. — Gr.  irpo  before 
+ [(TTOLvaL  to  stand ; L.  abscessus,  a going 
apart.  See  Prostatitis. 

Prostate,  Atrophy  of  the. — See  Atrophy 
of  the  Prostate. 

Carcinoma  of  the. — Gr.  KapKivos  crab  + 
-co^ta  tumor.  See  Tumors  of  the 
Prostate. 

Prostate,  Hypertrophy  of  the. — Gr.  virkp 
over  -1-  Tpo<i>y]  nutrition. 

Symptomatology. — Nocturnal  frequency  of 
urination  and  difficulty  of  urination  after 
the  age  of  fifty  years;  dribbling  from  over- 
flow (paradoxical  incontinence) ; bladder 
irritability;  true  incontinence  very  rarely; 
sometimes  temporary  complete  retention 
due  to  congestion  (the  result  of  overeating, 
constipation,  alcohol,  exposure,  etc.);  even- 
tually the  stage  requiring  systematic  cathe- 
terization, when  cystitis  and  stone  are 
prone  to  occur. 

Examination  reveals  an  enlarged  prostate 


PROSTATE,  HYPERTROPHY  OF  THE 


(sometimes  only  evident  on  cystoscopic 
examination),  the  presence  of  residual  urine, 
a lengthened  urethra  (normal  length  = 
about  eight  inches),  and  perhaps  a distended 
bladder,  as  shown  by  hypogastric  palpation 
and  percussion.  A stony  hardness  of  the 
prostate  points  to  cancer  (q.v.).  If  the 
bladder  is  found  to  contain  more  than 
one  quart  of  urine,  do  not  withdraw  more 
at  one  sitting,  for  fear  of  collapse,  but  wait 
three  to  six  hours  before  withdrawing  the 
remainder.  After  exploring  with  the  cathe- 
ter, irrigate  the  bladder  and  urethra  with 
warm  silver  nitrate  solution,  1 : 8000,  or 
potassium  permanganate,  1 : 6000,  give 
three  10-grain  doses  of  urotropine  at  four- 
hour  intervals,  and  have  the  patient  rest, 
preferably  in  bed,  for  two  days.  Examine 
the  urine  for  pus  and  evidences  of  pyelone- 
phritis {q.v.  in  Part  1). 

According  to  Keyes,  retention  of  urine 
without  obvious  prostatic  hypertrophy  is 
due  to  one  of  three  causes,  viz.  (1)  a median 
prostatic  bar,  which  calls  for  Chetwood’s 
galvano-jirostotomy,  (2)  paralysis  of  the 


protracted  sitting,  constipation,  overdisten- 
tion of  the  bladder,  cold  and  damp.  An 
occasional  hot  sitz-bath  or  hot  enema  at 
night  adds  to  the  patient’s  comfort.  Vigor- 
ous prostatic  massage,  once  or  twice  a week, 
is  recommended,  especially  when  the  bladder 
is  irritable.  Kidd  well  recommends,  for  the 
amelioration  of  symptoms,  urotropine  (q.v.), 
gr.  iii,  and  acid  sodium  phosphate  (q.v.),  gr. 
xx;  also  nux  vomica  {q.v.),  and  ergot  {q.v.). 
Ammonium  chloride  {q.v.)  is  also  recom- 
mended. 

When  the  residual  urine  reaches  four 
ounces  or  over,  systematic  catheterization 
should  be  employed,  once,  twice,  or  thrice 
daily,  or  oftener,  at  regularly  appointed 
hours — on  retiring,  on  rising,  etc.  If  the 
residual  urine  amounts  to  four  ounces,  use 
the  catheter  night  and  morning;  if  six  ounces, 
catheterize  every  eight  hours ; if  eight  ounces, 
every  six  hours  (J.  W.  White).  The  best 
catheter  for  patient  and  physician,  says 
Young,  is  a Purges  coude  gum  catheter, 
which  can  be  boiled  (Fig.  90),  it  may  be 
strengthened  with  a whalebone.  The  best 


Fig.  90. — Forges  coudd  gum  catheter. 


bladder  {q.v.),  and  (3)  stricture  at  the  neck 
of  the  bladder  {q.v.),  which  also  calls  for 
Chetwood’s  galvano-prostotomy. 

About  15  or  16  per  cent,  of  old  men  suffer 
with  hypertrophy  of  the  prostate,  although 
more  have  it.  About  90  per  cent,  of  pros- 
tatic enlargements  are  fibro-adenoma 
(hypertrophy);  about  10  per  cent.,  carci- 
noma. (Kidd.) 

Treatment.— According  to  Casper,  Keyes, 
and  others,  prostatectomy  is  best  reserved 
for  those  cases  in  which  catheter  life  becomes 
wretched,  and  in  which  there  are  frequent 
attacks  of  acute  retention.  Young  and 
Kidd,  however,  advise  early  operation  in  all 
cases  with  symptoms. 

Enjoin  a simple,  quiet  life,  adequate  dry 
clotliing,  and  light  diet,  excluding  spices, 
condunents,  salt  in  excess,  acids,  sauces, 
salads,  radishes,  rhubarb,  asparagus,  toma- 
toes, acid  fruits,  meats,  cheese,  greasy  or 
frieci  foods,  and  too  much  alcohol,  tea,  or 
coffee.  Plenty  of  water  should  be  drunk — 
alkaline  diuretic  waters  (potassium  acetate 
or  citrate,  ((7.F.)  when  symptomsof  irritability 
(see  Bladder  Irritability)  occur.  Instruct  the 
patient  to  avoid  sexual  excess,  irregularities 
in  eating  and  drinking,  fatiguing  exercise. 


catheter,  says  Kidd,  is  a No.  10,  English 
scale,  black  or  yellow  gum-elastic,  called 
“ the  Marshall,”  supplied  by  Bell  and 
Croyden;  it  can  be  boiled.  The  following 
lubricant  is  recoimnended : 


Glycerine 20  parts 

Tragacanth 2 parts 

Oxy cyanide  of  mercury 34  part 

Sterilized  distilled  water 100  parts 


“K-Y  lubricant.” 

While  the  patient  is  using  the  catheter, 
he  should  take  10  to  20  grains  of  urotropine 
daily,  and  also  daily  intravesical  irrigations 
of  warm  boric  acid  solution,  one  teaspoonful 
to  the  pint,  until  the  first  cystitis,  which 
always  appears  in  from  one  to  eight  weeks, 
has  subsided,  when  the  irrigations  may  be 
made  less  frequent,  down  to  once  weekl3^ 
Combat  the  acute  cystitis  with  daily  irriga- 
tions of  silver  nitrate,  1 : 8000,  or  p>otassium 
permanganate,  1 : 6000.  The  cystitis  is 
ordinarily  an  acid  C}^stitis.  Ammoniacal 
cj’stitis  suggests  the  presence  of  stone.  If 
it  can  not  be  controlled,  whether  due  to 
stone  or  not,  prostatectomy  should  be  done. 

In  sudden  complete  retention  of  urine, 
apply  heat  to  the  lower  abdomen  and  peri- 
neum, give  hot  enemata,  hot  sitz-baths,  and 


PROSTATE,  HYPERTROPHY  OF  THE 


morphine  hypodermically,  or  a rectal  injec- 
tion of  laudanum,  10  to  20  drops,  with  anti- 
pjTine,  IY2  grains,  or  pyramiclon,  5 grains. 
If  these  measures  are  unsuccessful,  inject 
warm  sterile  oil  into  the  urethra,  and  try  to 
pass  first  a soft  Nelaton  catheter;  if  this 
fails,  try  a silk  web  catheter  with  Mercier’s 
or  Guyon’s  curve,  or  Guyon’s  mandarin 
coude  (Fig.  91),  or  the  English  semi-hard 
catheters,  which  after  placing  in  hot  water 
may  be  bent  to  any  curve  desired.  If  flex- 
ible catheters  fail,  try  silver  catheters  with 
a large  prostatic  curve,  even  up  to  Brodie’s 
curve.  Before  attemping  to  pass  the  metal 
instruments,  it  may  be  necessary  to  inject 
into  the  anterior  and  posterior  urethra  about 
134  drams  of  2 per  cent,  cocaine  solution  with 
adrenalin,  followed  by  sterile  oil,  the  but- 
tocks being  elevated.  Do  not  withdraw  all 
the  urine  at  once,  for  fear  of  shock;  20  ounces 
may  be  drawn  off  every  four  hours  until  the 
bladder  is  empty.  When  this  is  accomplished. 


of  Bottini’s  instrument,  (2)  suprapubic  pro.s- 
tatectomy  (best,  say  Casper,  Keyes,  and 
others),  and  (3)  perineal  prostatectomy 
(best,  says  Young). 

Young  and  Frontz  emphasize  the  great  im- 
portance of  a careful  examination  of  each 
candidate  for  prostatectomy,  and  the  employ- 
ment of  appropriate  preliminary  treatment  to 
prepare  the  patient  for  operation.  They  em- 
ploy a series  of  routine  tests  before  operation : 

1.  Physical  examination,  including  a 
blood-pressure  reading  (see  Blood-Pressure, 
in  Part  I,  General  Medicine  and  Surgery). 

2.  Examination  of  the  urinary  system. 

(a)  Residual  urine. 

(b)  General  urinalysis  (g.v.  in  Part  1). 

(c)  Renal  function,  ascertained  by  means 
of  the  phenolsulphonephthalein  test  (see 
Urinalysis) . 

3.  Presence  or  absence  of  acidosis  (see 
Acidosis,  in  Part  1,  General  Medicine  and 
Surgery). 


Fig.  91. — Guyon  stylet  to  facilitate  introduction  of  cathf  ter  in  prostatic  hypertrophy.  Keen’s 
Surgery.  Courtesy,  W.  B.  Saunders  Co. 


irrigate  the  bladder  with  warm  boiled  boric 
acid  solution,  3 i ad  Oi,  and  administer  uro- 
tropine  gr.  x,  t.i.d.,  for  the  first  day. 

If  no  catheter  can  be  passed,  aspirate  the 
bladder  suprapubically  as  often  as  neces- 
sary, or  perform  suprapubic  cystotomy. 

Casper  treats  cases  of  difficult  catheteriza- 
tion in  which  cystitis  is  present  by 
permanent  catheterization.  He  uses  his  own 
self-retaining  catheter  closed  with  a cork, 
allowing  it  to  remain  in  place  for  months  or 
indefinitely,  with  the  patient  up  and  about. 
The  bladder  is  irrigated  once  or  twice  daily, 
and  the  catheter  is  changed  every  one  or 
two  months.  “At  first  a suppurative  ure- 
thritis is  produced,  but  it  soon  heals  and 
the  urethra  becomes  dry.”  “ If  the  patient 
experiences  much  difficulty  at  first,  he 
should  be  kept  in  bed  and  given  morphine.” 
Suprapubic  or  perineal  cystotomy  is  also 
done  in  such  cases,  to  strengthen  the  patient 
for  a subsequent  prostatectomy. 

Radical  operative  procedures  are  (1)  the 
Bottini  operation  with  Young’s  modification 


“ If  the  first  phenolsulphonephthalein 
test  is  good,  the  amount  of  residual  urine  not 
great  (say  not  over  200  c.c.),  and  the  general 
condition  good,  operation  is  usually  not 
delayed.”  “ If  the  phenolsulphonephthalein 
test  is  poor  (appearance  time  over  fifteen 
minutes,  excretion  first  hour  under  30  per 
cent.),  the  patient  is  put  on  preluninary 
treatment,”  and  semi  weekly  tests  made 
until  improvement  becomes  stationary. 

The  preliminary  treatment  in  cases  in 
which  the  kidneys  have  become  impaired 
by  long-standing  back  pressure  is  as  follows : 
(a)  Catheterization,  two  to  four  to  six 
times  daily,  according  to  the  amount  of 
residual  urine  (250  c.c.  in  the  first  instance 
to,  say,  over  400  c.c.  in  the  second  and  third 
instances)  and  the  degree  of  renal  insuffi- 
ciency. At  each  catheterization,  the  bladder 
should  be  irrigated  or  injected  with  5 per 
cent  argyrol.  In  the  extreme  cases  of  reten- 
tion, a retained  catheter  may  be  preferable 
to  frequent  catheterization,  especially  if 
the  latter  is  difficult  or  painful.  The  catheter 


PROSTATITIS 


should  be  changed  every  one  to  three  days, 
depending  on  infection  and  irritation,  and 
the  urethra  shoukl  be  injected  with  5 per 
cent,  argyrol  anti  rested  several  hours  before 
a new  catheter  is  inserted.  “ A small  soft 
rubber  catheter  is  preferable  to  a gum  coude, 
but  sometimes  will  not  pass.  The  inlying 
catheter  may  be  closed  with  a clip  or  cork 
and  emptied  at  inteiwals,  or  allowed  to 
drain  in  a bottle,  the  patient  being  up  and 
outdoors  if  possible.  In  very  acute  urethri- 
tis and  epididymitis  a retained  catheter 
should  not  be  employed.  Epididymotorny 
(see  under  Orchitis  and  Epididymitis)  may 
be  required,  and  intermittent  catheteriza- 
tion until  acute  symptoms  subside.”  Supra- 
pubic ch-ainage  is  rarely  required. 

(b)  Si.\  ounces  of  water  every  hour, 
usually  three  quarts  daily.  In  uriemia, 
saline  solution  (0.8  per  cent.)  by  infusion  or 
per  rectum,  often  several  quarts  daily,  with, 
perhaps,  in  severe  urtemia,  simultaneous 
blood-letting. 

(c)  Hexamethylenamin,  gr.  xv,  three  or 
four  times  daily.  If  the  urine  is  alkaline, 
render  it  acid  by  means  of  aci(^l  sodium  phos- 
phate iq.v.),  or  sodimn  benzoate  {q.v.)  in 
large  doses,  given  at  different  times  from 
the  hexamethylenamin. 

(d)  For  acidosis,  sodium  bicarbonate,  by 
mouth,  rectum,  or  intravenously,  until  the 
urine  is  rendered  alkaline,  together  with  glu- 
cose or  lactose  and  free  catharsis  (see  Acido- 
sis, in  Part  1 , General  Medicine  and  Surgerj^ . 

(e)  For  cardiac  impairment,  if  present, 
the  establishment  of  full  compensation  by 
means  of  rest  in  bed,  free  bowel  activity, 
digitalis,  etc.  (see  Cardiac  Insufficiency,  in 
Part  1,  General  Medicine  and  Surgery). 

In  appropriate  cases.  X-ray  {q-v.)  or 
radium  {q.v.)  therapy  may  be  of  service 
in  the  treatment  of  prostatic  hypertrophy. 

pastille  dose,  through  a 2 nun.  filter, 
may  be  given  perineally  once  a week,  for 
three  or  four  doses,  and  then  the  filter 
increased  to  3 mm.  and  later  4 mm.  or  more. 
The  suprapubic  route  should  be  substituted 
if  the  skin  becomes  affected,  and  a cylindrical 
(^ompre.ssor  then  employed. 

Prostate,  Inflammation  of  the. — L.  inflam- 
ma're,  to  set  on  fire.  See  Prostatitis. 

Neuroses  of  the. — See  Neuroses  of  the 
Prostate. 

Sarcoma  of  the. — Gr.  aap^,  aapKos  flesh 
H — u>pa  tumor.  See  Tumors  of  the 
Prostate. 

Tuberculosis  of  the. — See  Tuberculosis 
of  the  Prostate. 

Tumors  of  the. — See  Tumors  of  the 
Prostate. 


Prostatitis. — Glr.  wpoaTaT-qs,  from  irp6 
before -|- tordi^at  to  stand;  - Ltls  inflammation. 

Prostatitis  is  either  acute  or  chronic, 
glandular  (catarrhal)  or  parenchymatous 
(involving  both  glandular  and  interstitial 
tissue,  with  ultimate  abscess  formation). 

Acute  glandular  or  catarrhal  prostatitis  is 
usually  gonorrhoeal  in  origin,  and  is  diag- 
nosed by  the  association  of  symptoms  of 
posterior  urethritis  (q.v.)  with  the  presence 
of  a swollen,  tender  prostate,  which  yields 
on  massage  a secretion  containing  pus 
cells  (the  urethra  and  bladder  having  been 
first  irrigated) . 

In  acute  parenchymatous  prostatitis,  rec- 
tal examination  reveals  an  enlarged,  hot, 
sensitive  prostate.  Do  not  examine  with 
urethral  instruments. 

Chronic  prostatitis  may  follow  the  acute 
form,  or  the  inflaimnation  may  be  subacute 
or  chronic  from  the  beginning.  The  symp- 
toms are  many  and  various,  e.g.,  slight 
watery  urethral  discharge,  sometimes  haema- 
turia,  slight  strangury,  painful  urination, 
pain  upon  defecation,  pain  in  the  back 
and  legs,  testicular  pain,  perineal  discomfort, 
intermittent  urgency  and  frequency  of 
urination,  hesitancy,  dribbling,  premature 
ejaculation,  delayed  ejaculation,  painful 
ejaculation,  nocturnal  pollutions,  loss  of 
erection,  loss  of  desire,  sometiines  pains 
simulating  renal  colic,  vesical  stone,  sciatica, 
lumbago,  neurasthenia,  psychasthenia,  etc. 
Chronic  arthritis  is  a possible  consequence. 
The  diagnosis  is  made  by  the  detection  of 
pus  cells  and  bacteria  in  the  expressed 
secretion. 

Etiology. — Posterior  urethritis,  gonorrhoeal 
or  non-gonorrhoeal;  traumatism  (urethral 
instrumentation,  falls,  riding,  bicycling, 
marching);  vesical  calculus;  prostatic  calcu- 
lus; cystitis;  prostatic  hypertrophy; 
urethral  stricture; pericystitis;  proctitis ; peri- 
proctitis; hemorrhoids;  perirectal  fistul®; 
constipation;  excessive  purgation;  infectious 
diseases  (typhoid  fever,  typhus  fever,  pneu- 
monia, parotitis,  angina,  the  exanthemata, 
etc.);  onanism;  prolonged  unsatisfied  sexual 
desire;  sedentary  habits;  the  balsamics;  cold; 
tuberculosis  {q.v.). 

Causal  bacteria  include  the  gonococcus, 
colon  bacillus,  staphylococci,  streptococci, 
pneumococcus,  anaerobes,  and  the  tubercle 
bacillus  (see  Tuberculosis  of  the  Prostate). 

Treatment.— I.  AcUTE  Pr0ST.\TITIS. — Put 
the  patient  to  bed  on  liquid  diet  and  flaxseed 
tea  in  large  quantities;  open  the  bowels; 
jtlace  hot  water  bags  to  the  hypogastrium 
and  i^erineum,  and  employ  frequent  hot  sitz- 
baths,  or  slow  hot  or  cold  rectal  irrigations 


PROSTATITIS 


lasting  one  hour  and  repeated  every  two  or 
three  hours,  using  a Kemp  or  Chetwood 
double-cm’rent  tube.  For  severe  pain,  inject 
morphine  and  atropine  into  the  perineum, 
or  administer  the  drugs  by  mouth,  or  insert 
the  following  suppository : 


Extract!  opii gr.  H 

Extract!  belladonna3 gr.  M 


Ole!  theobromat!s,  q.s. 

M.  et  ft.  suppos.  M!tte  tabs  v!. 

S!g. — One  every  s!x  or  e!ght  hours. 

lodex  suppositories  are  recommended. 
Prescribe  diuretics  and  balsamics  (see  Gon- 
orrhoea.) Aspirin  {q.v.)  relieves  pain  and 
produces  diaphoresis.  Casper  prescribes 
salicylic  acid,  gr.  15,  per  day.  If  retention 
of  urine  occurs,  and  the  patient  cannot 
urinate  while  in  the  hot  sitz-bath,  and  after 
the  adrninistration  of  morphine,  catheterize 
him  with  a small  soft  catheter  regularly, 
using  sterile  oil  as  a lubricant,  and  wash 
out  the  bladder  with  silver  nitrate  solution, 
1 : 8000.  The  congestion  causing  the  re- 
tention usually  soon  subsides. 

Even  should  an  abscess  form,  spontaneous 
resolution  may  occur,  or  the  abscess  may 
break  into  the  m-ethra,  rectum,  or  externally, 
followed  by  quick  healing.  If,  however,  the 
urethra  is  obstructed,  or  the  inflammation  is 
spreading,  evacuate  the  abscess  through  the 
perineum.  Make  a lateral  incision  down  to 
the  bulb,  avoichng  the  compressor  urethrae 
muscle.  Use  the  finger  to  bore  with.  The 
seminal  vesicles  may  also  be  involved  (see 
Seminal  Vesiculitis).  After  packing  the 
abscess  cavity  with  gauze,  “ carefully 
approximate  the  levator  ani  muscles,  if 
these  have  been  divided  in  the  operation, 
so  as  to  prevent  pressure  necrosis  of  the 
rectum”  ( Y oung) . The  prognosis  in  abscess 
cases  in  young  persons  is  good. 

II.  Chronic  Prostatitis. — Enjoin  the 
observance  of  correct  hygiene,  viz.  adequate 
rest  and  exercise,  sexual  continence,  fresh 
air  day  and  night,  a daily  morning  tepid 
bath,  in  a warm  room,  before  breakfast, 
followed  by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
meals,  a sunple  blaml  diet,  no  alcohol,  and 
regulation  of  the  bowels.  Prescribe  a 
tonic  of  nux  vomica  {q.v.)  or  strychnine(5.r.). 

About  once  every  four  to  seven  days  (no 
oftener),  after  urination,  massage  the  pros- 
tate with  attention  to  periprostatic  indura- 
tions, followed  by  irrigation  of  the  bladder 
and  urethra,  by  means  of  hydraulic  pressure 
(see  under  Gonorrhoea),  with  bichloride, 
1 ; 60,000  to  1 : 10,000,  or  silver  nitrate. 


1 : 50,000  to  1 : 10,000  to  1 : 1000,  or  potas- 
sium permanganate,  1 ; 8000  or  1 : 6000  to 
1 : 1000,  or  protargol,  1 : 2000,  or  argyrol, 
1 : 100.  Then,  after  the  patient  has  emptied 
his  bladder,  (some  advise  a full  bladder), 
pass  a large  steel  sound,  (not  under  16  F.) 
keep  it  in  five  minutes,  unless  painful,  and 
massage  indurated  areas  on  the  under  surface 
of  the  urethra  upon  the  sound.  Employ  a 
larger  sound  at  each  subsequent  sitting,  up 
to  23  or  24  F.,  then  Oberlander’s  or  Kol- 
Iman’s  dilators.  After  dilating  and  massag- 
ing the  urethra,  irrigate,  and  then,  after 
the  patient  has  emptied  his  bladder,  apply 
with  Young’s  or  Robbin’s  ointment  de- 
positor, to  the  posterior  urethra'  and  ver- 
umontanum,  an  ointment  prepared  with 
lanolin  as  a base: 


R Acid!  carbolic! gr.  x 

Adipis  lance  hydros! 5!  (Young). 

Ichthyolis gr.  .xlviu 

Adipis  lance  hydros! 5 i 

R lod! gr.  v! 

Potass!!  iodid! gr.  xxx 

Ole!  amygdala?  dulcis 3 ! 

Adipis  lance  hydros! 5!  (Finger). 


Once  every  week  or  two,  instil  into  the 
posterior  urethra  by  means  of  a Keyes- 
Ultzmann  or  Guyon  syringe,  two  to  three 
drops  of  a 5 per  cent,  silver  nitrate  solution 
(Young),  or  one  dram  of  a 1 per  cent, 
solution  (Kidd).  Make  topical  applica- 
tions to  the  anterior  urethra,  if  required. 
The  verumontamun  may  be  painted  with  a 
20  per  cent,  solution  of  silver  nitrate  through 
the  endoscope.  Cold  or  hot  lavage  through 
a double  urethral  catheter,  or  psychrophore 
(Gr.  \pvxpos  cold  -j-  (popeXv  to  bear),  prolonged 
hot  rectal  lavage,  morning  and  night, 
through  a Martin,  Kemp,  or  Chetwood  two- 
way  tube,  hot  sitz-baths,  and  faradization  of 
the  prostate  (one  electrode  in  the  rectum 
and  the  other  over  the  pubes)  are  beneficial. 

After  four  to  six  weeks  of  the  above  treat- 
ment, give  the  patient  a rest  for  at  least 
three  weeks  (Kidd),  “ to  see  what  has  been 
accomplished”  (Young).  Prostatic  mass- 
sage  is  of  most  importance. 

If  obstructive  prostatitis  is  not  correctetl 
by  the  above  measures,  “ the  median 
obstruction  may  be  removed  by  the  Bottini 
operation,  or  by  prostatectomy  (perineal  or 
suprapubic),  or  by  sunple  division  of  the 
bar,  by  means  of  one  or  two  incisions, 
through  a perineal  incision.”  (Young.) 

In  obstinate,  severe  chronic  prostatitis 
which  does  not  respond  to  conservative 
treatment,  especially  where  there  is  a 
constant  presence  of  residual  urine  in  the 


RETENTION  OF  URINE 


bladder,  a partial  “ conservative  perineal 
prostatectomy”  (leaving  the  median  lobe) 
may  be  performed.  (Young.) 

Young  says:  “ The  prognosis  under  treat- 
ment is  excellent.”  H.  Cabot  says  it  is 
rarely  cured  under  a year. 

Prostatorrhoea. — Or.  ttpo<jt6.ti]s  prostate  + 
poia  flow.  See  Sexual  Neuroses. 

Pruritus. — L.  pruri're,  to  itch. 

Etiology.— (a)  Pruritus  Scroti. — Pelvic 
conge.stion  due  to  cardiac,  renal,  hepatic, 
pulmonary,  or  splenic  disease,  pelvic  tumors, 
constipation,  intestinal  catarrh,  etc.;  gouty 
diathesis;  diabetes;  hyperthyroidism;  jaun- 
dice; heat;  cold;  certain  foods  and  drugs 
(morphine,  iodine,  iodoform,  alcohol,  tea, 
coffee,  tobacco,  etc.);  traumatism;  uncleanli- 
ness; too  frequent  cleansing;  decomposition 
of  sweat;  urethritis;  cystitis;  vesical  calculus; 
urinary  incontinence;  alkaline,  hyperacid, 
purulent,  or  saccharine  urine;  onanism; 
pent-up  sexual  energy;  neurotic  disposition; 
pechcuiosis;  scabies;  fleas;  eczema;  inter- 
trigo; etc. 

(b)  Pruritus  Meati  Urinarii.— Urethri- 
tis; urethral  stricture;  stone;  cystitis. 

Treatment. — Attend  to  the  cause.  Local 
remedies  for  scrotal  itching  are  the  following : 

R Argenti  nitrati.s gr.  x 

Spiritus  ffitheris  nitrosi § i 

M.  Sig. — Paint  on  the  itching  parts  with  a camel’s- 
hair  brush. 

R Liquoris  potassaj 5 a 

Acidi  carbohci 5iv 

Olei  bergamot t^x 

Olei  lini,  q.s.  ad 5a 

M.  Sig. — Apply  as  required,  for  itching. 

R Hydrargyri  ammoniati gr.  x-xx 

. Petrolati o i 

Pyelitis. — See  Pyelonephritis  in  Part  1. 

Pyelonephritis. — See  Part  1,  General 
Medicine  and  Surgery. 

Pyronephrosis. — See  Pyelonephritis,  in 
Part  I. 

Pyuria. — See  Part  1,  General  hlcdicine 
and  Surgery. 

Rectal  Gonorrhoea. — L.  rec'ium,  straight. 
See  under  Gonorrhoea. 

Renal  Abscess.-^L.  ren,  kidney;  absc'es- 
snis,  a going  apart.  See  Pyelone- 
phritis, in  Part  I. 

Angioneurosis. — Gr.  ayyeXov  vessel  -|- 
vevpov  nerve.  See  under  Hscmaturia. 

Artery,  Aneurysm  of  the. — L.  ren,  kid- 
ney. See  Aneur\'sni  of  the  Renal 
Arteiy,  in  Part  2. 

Calculus. — L.  cni'culus,  pebble.  See 
Nephrolithiasis,  in  Part  1. 


Renal  Cancer. — L.  can'cer,  crab.  See 
Tumors  of  the  Kidney. 

Colic. — G.  KuXiKos.  See  Nephrolithia- 
sis, in  Part  I. 

Cysts. — Gr.  kvcttls  bag.  See  Tumors 
of  the  Kidney. 

Echinococcus  D i s e a s e. — Gr.  ex'ii'os 
hedge-hog  -|-  kokkos  berry.  See 
Tumors  of  the  Kidney. 

Epistaxis. — Gr.  e-KLara^Ls.  See  under 
Hsematuria. 

Fistula. — See  Fistula,_Renal,  in  Part  2. 

Hemorrhage. — Gr.  aLpa  blood  + prjyv- 
vpi  to  burst  forth.  See  Hsematuria. 

Hydatid  Disease. — Gr.  Ibaris  vesicle. 
See  Tumors  of  the  Ividney. 

Hypernephroma. — Gr.  inrkp  over  + 
vecppos  kidney  -upa  tumor.  See 
Tumors  of  the  Kidney. 

Infections. — L.  infec'tio.  See  Pyelone- 
phritis, in  Part  1. 

Injuries. — See  Kidney,  Injuries  of  the. 

Neuralgia. — Gr.  vevpov  nerve  -|-  akyos 
pain.  See  under  Hsematuria. 

Sarcoma. — Gr.  crap^,  crapKos  flesh  -1- 
-upa  tumor.  See  Tumors  of  the 
Kidney. 

Stone. — See  Nephrolithiasis,  in  Part  I. 

Suppuration. — L.  sub,  under  -f-  pus, 
pur'is,  pus.  See  Pyelonephritis, 
in  Part  1. 

Tuberculosis. — See  Pyelonephritis,  in 
Part  I. 

Tumors. — See  Tumors  of  the  Kidney. 

Retention  Catheter. — Gr.  Koderrjp;  L. 
retentio.  See  under  Fistula,  Urethral. 

Cyst,  Epididymal. — Gr.  k'Vtis  cyst;  eid 
on  -f  StSuMos  testis.  See  Spermatocele. 

Retention  of  Urine. — L.  retentio]  wriim. 
The  condition  may  be  acute  or  chronic. 
Acute  retention  is  accompanied  by  great 
pain.  In  chronic  retention,  dribbhng  of  urine 
is  an  important  early  sjnnptom.  Inspection 
and  percussion  reveal  a distended  bladder. 

Etiology.— Paralysis  or  paresis  or  atony  of 
the  detrusor  musculature  of  the  bladder, 
due  to  prolonged  voluntary  retention, 
arteriosclerosis  of  the  vesical  vessels,  severe 
parench>miatous  cystitis  leading  to  sclerosis, 
cerebral  or  spinal  disease  or  injury,  injuiy 
of  the  bladder,  operation,  shock,  hysteria, 
fevers  (malaria,  diphtheria,  scarlet  fever, 
typhoid  fever);  sphincteric  spasm  due  to 
peritonitis,  appendicitis,  strangulated  hernia, 
orcliitis,  epidichmiitis,  paravesical  inflamma- 
tion, contusion  or  laceration  of  the  abdomen, 
bladder,  or  urethra,  operations  within  the 
pelvis,  in  the  rectum,  or  along  the  genito- 
urinaiy  tract,  masturbation,  sudden  chilling 
of  the  body;  urethral  spasm  occurring  com. 


SCROTUM,  LYMPH 


monly  in  urethritis  and  stricture;  obstruc- 
tive lesions,  e.g.,  congenital  occlusion  of  the 
meatus,  congenital  phimosis  or  imperforate 
prepuce,  congenital  cyst  in  the  sinus  pocu- 
laris,  inflammation  of  the  neck  of  the  blad- 
der, effusion  of  blood  within  the  bladder, 
urethral  stricture,  stricture  at  the  neck  of 
the  bladder,  pelvic  tumors,  vesical  tumor, 
urethral  tumor,  hnpacted  stone  or  foreign 
body,  exostosis  of  the  pelvic  bones,  fecal 
accumulation,  valves  at  the  neck  of  the 
bladder,  deep-seated  urethral  abscess,  extra- 
vasation of  urine,  priapism,  prostatic  hyper- 
trophy, a median  prostatic  bar,  prostatic 
atrophy,  prostatitis. 

Treatment.— In  congenital  phimosis,  slit 
up  the  dorsum  of  the  prepuce  or  exsect  the 
latter.  If  the  meatus  is  occluded,  perform 
meatotomy  as  described  under  Stricture  of 
the  Urethra.  Rupture  a cyst  in  the  sinus 
pocularis  by  passing  a small,  slightly 
curved  silver  probe.  Attend  to  other 
causal  conditions  as  directed  under  their 
respective  headings. 

For  acute  retention  employ  hot  applica- 
tions to  the  hypogastrimn  and  perineum, 
hot  rectal  lavage  through  a double-way  tube, 
or  a hot  hip-bath,  and  have  the  patient 
attempt  to  urinate  while  in  the  bath.  At 
the  same  time  administer  hot  drinlcs,  and 
perhaps  morphine  and  atropine  hypodermi- 
cally, for  the  purpose  of  relaxing  sphincteric 
spasm.  The  sound  of  trickling  water  may 
be  helpful.  If  these  measures  fail,  try  to 
pass  a soft  rubber  catheter  (in  a child  of  one 
year,  a No.  4 or  5 American  catheter).  If 
the  bladder  is  extremely  distended,  do  not 
withdraw  all  the  urine  at  once,  for  fear  of 
hemorrhage  and  collapse,  but  wait  a few 
hours  before  emptying  the  bladder,  or  empty 
the  bladder  very  slowly,  allowing  no  less 
than  twenty  minutes  for  its  complete  evacua- 
tion. Then  wash  it  out  with  warm  boiled 
boric  acid  solution,  5i~iv  to  the  pint,  if 
deemed  advisable,  and  administer  urotro- 
pine,  gr.  x,  t.i.d.,  for  the  first  day.  Continue 
the  hot  applications  to  the  hypogastrium 
and  perineum,  and  give  a brisk  purgative, 
i.e.,  calomel  {q.v.)  or  castor-oil  {q.v.). 

If  the  soft  rubber  catheter  can  not  be 
passed  because  of  spasm,  the  latter  may  be 
made  to  relax  slowly  by  holding  a good  sized 
metal  catheter  “ firmly  against  the  face  of 
the  spasmed  area.” 

In  stricture,  it  may  be  advisable  to  pro- 
duce slight  general  anaesthesia  or  to  inject 
into  the  urethra  one  dram  of  2 per  cent, 
cocaine  solution,  with  adrenalin,  followed 
at  the  end  of  ten  minutes  by  irrigation  with 
warm  boric  acid  solution,  3i“iv  ad  Oi,  and 


the  injection  of  sterile  oil.  Then  try  to  pass 
a metal  or  soft  catheter,  the  latter  aided, 
if  need  be,  by  a stylet,  down  to  the  smallest 
sized  catheter;  or  try  to  pass  a Gouley  tun- 
nelled catheter  over  a filiform,  or  a filiform 
with  follower.  If  unsuccessful,  try  to  pass 
a filiform  (see  under  Stricture  of  the 
Urethra),  to  be  left  in  place  for  the 
urine  to  dribble  past.  Then  place  the 
patient  in  a hot  bath  for  fifteen  to 
thirty  minutes;  then  wrap  him  in  blankets, 
and  administer  hot  lemonade,  10  grains 
of  quinine,  and  34  grain  of  morphine, 
and  place  a hot  flaxseed  poultice  over 
the  lower  abdomen.  Later  it  may  be 
possible  to  pass  the  tunnelled  catheter  over 
the  retained  filiform.  If  the  symptoms  of 
retention,  however,  are  urgent,  aspirate  the 
bladder,  suprapubically,  and  induce  free 
perspiration.  Aspiration  may  be  repeated 
every  eight  hours  for  one  day;  then,  if  cathe- 
terization is  still  unpossible,  perform  peri- 
neal urethrotomy,  reestablish  the  normal 
calibre  of  the  urethra,  and  insert  a catheter 
(see  Stricture  of  the  Urethra). 

In  cases  of  hemorrhage  in  which  a clot 
obstructs  the  passage  of  the  catheter,  for- 
cibly inject  hot  salt  or  alum  solution,  3iad 
Oi,  or  hot  phenol  solution,  1 per  cent.,  or  a 
cool  solution  of  sodium  bicarbonate.  A 
large  woven  catheter,  or  Brodie’s  over- 
curved silver  catheter,  or  Gross’s  blood 
catheter,  or  Bigelow’s  lithotrite  and  evacua- 
tor  may  be  employed.  Afterward  insert  a 
full-sized  soft  rubber  retention  catheter, 
etc.,  as  described  under  Hsematuria. 

For  inoperable  malignant  cases,  perineal 
or  suprapubic  drainage  may  be  required. 

For  acute  retention  associated  with  pros- 
tatic hypertrophy,  see  the  latter. 

For  the  consideration  of  atony  and  paresis 
or  paralysis  of  the  bladder,  see  Paralysis  and 
Paresis  of  the  Bladder.  In  connection  with 
vesical  spasm,  see  Bladder  Irritability. 

Sacculations  of  the  Bladder. — See  Blad- 
der Diverticula  or  Sacculations. 

Sarcoma. — Gr.  aap^,  aapKos  flesh  -f-  -coyua 
tumor.  (See  Tumors.) 

Sclerosis  of  the  Corpora  Cavernosa  et 
Spongiosum. — Gr.  aKXrjpwaLs  hardness.  See 
Tumors  of  the  Penis. 

Scrotum,  Elephantiasis  of  the. — L.  scro'- 
tum,  bag.  See  Elephantiasis  of  the 
Scrotum. 

Haematoma  of  the. — See  Hsematoma, 
Scrotal. 

Inflammation  of  the. — See  Inflamma- 
tion of  the  Scrotum. 

Lymph.  — See  Elephantiasis  of  the 
Scrotum. 


SEXUAL  NEUROSES 


Scrotum,  Pruritus  of  the. — See  Pruritus. 

Semen,  Abnormal  Loss  of. — L.  se'men, 
seed;  ab,  from  + nor'ma,  rule.  See  Sexual 
Neuroses. 

Seminal  Calculus. — L.  se'men,  seed; calc'u- 
lus,  pebble.  Pain  on  micturition  and  defeca- 
tion may  be  present,  and  the  stone  may  be 
felt  by  means  of  a metal  sound  in  the  bladder 
and  the  finger  in  the  rectum.  If  the  ejacula- 
tory duct  is  occluded,  severe  spasmodic  or 
colicky  pain  occurs  during  orgasm  and 
semen  is  retained. 

Treatment. — For  the  relief  of  pain,  admini- 
ster hot  rectal  douches  or  hot  sitz-baths  and 
morphine.  Attempt  to  crush  the  stone 
through  the  rectum  by  compressing  it 
against  a sound  in  the  bladder. 

Seminal  Pollutions. — L.  pollu'tio.  See 

Sexual  Neuroses. 

Vesicles,  Inflammation  of  the.  — See 

Seminal  Vesiculitis. 

Vesicles,  Tuberculosis  of  the.  — See 

Tuberculosis  of  the  Seminal  Vesicles. 
Vesiculitis ; Spe  rma  t oc  y s t i t i s. — L. 

se'men,  seed;  vesi'cula,  vesicle;  Gr.  airkpua 
seed  -1-  KuaTLs  bladder  -1 — trts  inflammation. 
Spermatocystitis  is  usually  gonorrhoeal 
in  origin  (for  tuberculous  infection,  see 
Tuberculosis  of  the  Seminal  Vesicles).  It  is 
frequently  not  distinguishable  from  pros- 
tititis.  Diagnostic  features  are  the 
occurrence  of  frequent  erections  and 
pollutions,  the  presence  of  pus  in  the  semen, 
and  perhaps  colicky  pains  referred  to  the 
lower  rectum. 

Treatment. — Mild  cases  recover  without 
treatment.  In  acute  cases,  put  the  patient 
to  bed  on  light  diet,  with  plenty  of  water, 
open  the  bowels,  administer  urotropin  (q.v.), 
or  diuretics  and  balsamics  (see  Gonorrhoea), 
and  employ  frequent  hot  sitz-baths,  or  slow 
hot  or  cold  rectal  irrigations  lasting  one 
hour  and  repeated  every  two  or  three  hours, 
using  a Martin,  or  Kemp,  or  Chetwood 
double-current  tube.  For  severe  pain, 
administer  morpliine  and  atropine,  or  insert 
the  following  suppository: 

PI  Extract!  opii gr.  ss 

Extract!  belladonnsB  gr.  M 

Ole!  theobromat!s,  q.s. 

M!tte  tabs  suppos!toria  No.  6. 

S!g. — One  every  s!x  or  e!ght  hours. 

If  an  abscess  occurs,  open  it  through  the 
rectum,  first  dilating  the  sphincter  ani  under 
anaesthesia,  and  cleansing  the  rectum.  Con- 
fine the  bowels  afterward. 

In  subacute  and  chronic  cases,  strip  the 
vesicles  through  the  rectum  with  “a  smooth 
metal  bulb  mounted  on  a handle”  (Felecki’s 


instrument),  with  the  bladder  full,  about 
once  every  two  to  seven  days.  Follow  this, 
after  the  patient  has  urinated,  by  irrigation 
of  the  bladder  and  urethra,  as  described 
under  Chronic  Prostatitis.  Prolonged  hot 
lavage  through  a rectal  thermophore  and 
hot  sitz-baths  are  beneficial.  Forbid  sexual 
excess.  Avoid  overtreatment  in  neura.s- 
thenic  patients. 

Sexual  Neurasthenia. — L.  sexua'lis;  Gr. 
vevpov  nerve  -f  aad'tveia  debility.  See 
Sexual  Neuroses. 

Neuroses. — L.  sexua'lis;  Gr.  vevpov 
nerve. 

Symptomatology. — Frequent  pollutions;  sper- 
matorrheea;  prostatorrhoea;  urethrorrheea; 
hnpairment  of  sexual  vigor;  deficient  erec- 
tion; premature  ejaculation;  pain  in  the 
testicles  and  epididymis;  hypersesthesia  of 
the  glans  penis;  pain  over  the  bladder  before 
and  aftqr  urination;  urgency  of  ruination 
and  dribbling  of  urine,  the  ruine  being  nor- 
mal; involuntary  contractions  of  the  cre- 
master muscles;  lumbo-sacral  neuralgia; 
general  neurasthenic  symptoms,  cerebral, 
spinal,  circulatory,  and  digestive. 

SpermatojrhcEa  differs  from  pollution  in 
that  the  semen  lost  is  not  forcibly  ejected, 
and  is  not  associated  with  erection,  volup- 
tuous feeling,  or  orgasm.  It  generally  follows 
defecation,  rarely  micturition.  The  secre- 
tion should  be  examined  microscopically 
to  distinguish  it  from  that  of  prostatorrhoea 
and  urethrorrhoea. 

Pollutions  are  usually  nocturnal.  They 
are  normal  when  resulting  from  sexual 
abstinence.  They  become  pathological  only 
when  they  occur  as  frequently  as  several 
nights  in  succession,  when  erection  and 
voluptuous  feeling  are  considerably  dunin- 
ished,  and  when  the  general  health  appears 
to  be  suffering. 

Etiology.— Neurotic  or  neurasthenic  tem- 
perament; excessive  onanism,  particularly 
masturbation;  coitus  interruptus  rarely; 
prolonged  unsatisfied  sexual  desire; 
early  stage  of  spinal  cord  disease  (mye- 
litis, tabes,  etc.);  spermatocystitis; 
gonorrhoea;  pro.statitis. 

Prognosis— The  prognosis  is  good,  except 
in  cases  with  an  hereditary  neurotic  dis- 
position. Noctm’nal  pollutions  are  of  favor- 
able prognosis;  but  (hurnal  pollutions,  says 
Casper,  are  “ difficult  to  influence.” 

Treatment. — Enjoin  the  obsert'ance  of  good 
hygiene,  e.g.,  adequate  rest  and  exercise, 
fresh  air  day  and  night,  a daily  morning 
tepid  bath  in  a comfortable  room,  before 
breakfast,  followed  by  a cold  spinal  douche 
and  brisk  rubdown  with  a coarse  towel,  a 


STERILITY  IN  THE  MALE 


bland  nutritious  diet,  excluding  tea,  coffee, 
alcohol,  spices,  sweets,  highly  nitrogenous 
food,  and  tobacco  in  excess;  rest  before  and 
after  eating;  regular  hours  of  eating  and 
sleeping,  no  food  within  three  or  four  hours 
of  bedtime,  a hard  bed,  light  bed  covering, 
prompt  rising  in  the  morning,  regulation  of 
the  bowels,  local  cleanliness  and  cold  water 
sprays  or  douches.  To  prevent  sleeping 
upon  the  back,  with  resulting  nocturnal 
pollutions,  have  the  patient  tie  a towel 
around  the  waist  knotted  in  the  back.  Cor- 
rect masturbation  (q.v.);  but,  in  order  to 
allay  hypochondriasis,  assure  the  patient 
that  the  evil  results  of  masturbation  are 
generally  exaggerated.  Pollutions  and 
spermatorrhoea  associated  with  chronic 
gonorrhoea,  prostatitis,  or  vesiculitis  respond 
to  the  treatment  of  these  conditions  {q.v., 
under  their  respective  titles) ; but  over- 
treatment should  be  avoided.  Occasional 
cauterization  (once  every  week  or  two)  of 
the  vermnontaniim  with  silver  nitrate,  1 to 
10  to  20  per  cent.,  is  useful  for  the  purpose  of 
reducing  congestion  and  obtunding  its  sensi- 
bility, especially  in  cases  of  deficient  erection, 
premature  ejaculation,  prostatorrhoea,  and 
nocturnal  emissions,  in  which  dilated  vesicles 
and  prostate  should  be  massaged  every 
four  to  seven  days.  The  cauterization  may 
be  accomplished  by  means  of  Guyon’s  or 
Ultzmann’s  syringe,  which  is  inserted  until 
the  membranous  urethra  is  passed,  as  ascer- 
tained by  feeling  the  resistance  subside  or 
by  rectal  examination.  Then  one  drop  of  the 
silver  solution  is  injected,  the  bougie  pushed 
a little  farther  and  another  drop  injected, 
and  so  on  up  to  the  internal  sphincter  of  the 
bladder;  or  one  may  begin  at  the  bladder 
(Casper).  Says  Keyes:  “ If  some  benefit 
is  not  derived  from  the  first  two  or  three 
applications  it  should  not  be  continued.” 
Cold  or  hot  lavage  through  a double  cathe- 
ter, the  passage  of  metal  sounds  of  increasing 
sizes  every  three  or  four  days  for  five  minutes 
at  a time,  vibratory  massage  of  the  prostate, 
and  galvanization  of  the  prostate  with  the 
negative  electrode  within  the  prostatic 
urethra  and  the  other  over  the  perineum, 
with  a current  no  greater  than  five  milli- 
amperes,  may  be  serviceable.  The  bromides, 
ergot,  strychnine,  iron,  or  arsenic  may  be 
prescribed  when  deemed  useful  (see  Drugs, 
Part  11). 

Assure  the  patient  that  he  will  get  well. 
Marriage  iscurativein  purely  functional  cases. 

Spasm  of  the  Neck  of  the  Bladder. — Gr. 
cnraafxos.  See  Bladder  Irritability. 

Spasm,  Urethral. — See  Stricture  of  the 
Urethra. 


Spasm,  Vesical. — L.  vesica,  bladder.  See 
Bladder  Irritability. 

Spermatic  Cord,  Carcinoma  of  the. — Gr. 

cnrepiJLa  seed;  xop^v  cord;  KapKiuos  crab 
-(-  -wpa  tumor.  See  Tumors  of  the 
Testis,  Epididymis,  and  Spermatic 
Cord. 

Hydrocele  of  the. — See  Hydrocele. 

Sarcoma  of  the. — Gr.  crap^,  aapKos 
flesh  -|-  -copa  tmnor.  See  Tumors  of 
the  Testis,  Epichdymis,  and  Sperma- 
tic Cord. 

Torsion  of  the. — L.  tor'sio,  torquere,  to 
twist.  See  Injuries  of  the  Testicle. 

Tumors  of  the. — See  Tumors  of  the 
Testis,  Epididymis,  and  Spermatic 
Cord. 

Spermatocele. — Gr.  aireppa.  semen  -f-  KifKr) 
tmnor.  An  epiclid5unal  retention  cyst  situ- 
ated above  and  behind  the  testicle  and  con- 
taining spermatozoa. 

Treatment.— Let  alone  if  giving  no  trouble; 
otherwise  excise  the  sac.  Aspiration  and 
the  injection  of  carbolic  acid,  as  employed 
for  hydrocele,  is  rarely  effectual. 

Spermatocystitis.— See  Seminal  Vesiculitis. 

Spermatorrhoea. — Gr.  airkppa.  seed  -1-  poia. 
flow.  See  Sexual  Neuroses. 

Splanchnoptosis. — See  Part  1,  General 
Medicine  and  Surgery. 

Splenoptosis. — Gr.  a-n-X-qv  spleen  -f-  ittukhs 
fall.  See  Splanchnoptosis  in  Part  1. 

Stammering  of  the  Bladder. — See  Blad- 
der Irritability. 

Sterility  in  the  Male. — L.  steril'itas,  bar- 
renness. 

Etiology. — Tight  stricture  of  the  urethra; 
congenital  urethral  narrowing;  phimosis; 
urethral  fistula;  extreme  grades  of  epispachas 
and  hypospadias;  congenital  or  acquired 
shortness  of  the  frenum,  causing  the  penis 
to  bend  downward;  congenital  obstruction 
or  deviation  of  the  ejaculatory  ducts  (very 
rare;  with  the  ducts  directed  posteriorly  the 
semen  is  ejaculated  into  the  bladder); 
acquired  obstruction  or  deviation  of  the 
ejaculatory  ducts  due  to  perineal  abscess, 
gonorrhoea,  trauma,  fibrous  degeneration, 
tuberculous  ulceration,  stones  or  concre- 
tions in  the  ejaculatory  ducts,  prostatic 
hypertrophy,  or  prostatic  calculi;  absent  or 
rudimentary  penis;  exostrophy  of  the  blad- 
der with  very  short  penis;  tumors  of  the 
penis  or  scrotum;  mutilation  of  the  penis; 
abnonnal  size  of  the  penis;  urethral  or  pre- 
putial calculi;  varix  of  the  dorsal  vein  of 
the  penis;  sclerosis  of  the  corpora  cavernosa, 
rarely  of  the  corpus  spongiosum,  causing  a 
bending  of  the  penis  during  erection  (pos- 
sible causes  are  a gouty  diathesis,  injury 


STRICTURE  OF  THE  URETHRA 


(luring  coitus,  violent  erections,  gonorrhcea, 
diabetes  mellitus — the  sclerosis  diminishes  as 
the  diabetes  unproves) ; curvatures  of  the 
]ienis,  due  to  periurethral  abscess,  gonor- 
rhoeal indications,  ossification  of  the  septum 
or  fibrous  sheath  of  the  corpora  cavernosa, 
gummata  of  the  corpora  cavernosa,  and 
fracture  of  the  penis;  scrotal  hernia;  hydro- 
cele; elephantiasis;  non-irritability  of  the 
ejaculatory  centre,  either  congenital  (incur- 
able) or  acquired  (curable),  the  latter  due  to 
excessive  venery,  particularly  masturbation; 
absence  of  sensibility  of  the  penis,  either 
congenital  or  acquired,  the  latter  due  to 
ulceration  or  scar  formation  or  other  causes; 
azoospermia  (absence  of  spermatozoa  from 
the  semen),  due  to  absence,  arrest  of  develop- 
ment, or  atrophy  of  the  testicles,  the  latter 
caused  by  ciypt orchidism,  disease  or  injuiy 
of  the  central  nei’vous  system,  orchitis, 
prolonged  compression  by  hydrocele,  scrotal 
hernia,  or  varicocele,  syphilis,  carcinoma, 
and  tuberculosis;  azoospermia  due  to  absence 
or  occlusion  of  the  epididymis  and  vas 
deferens,  either  congenital  or  acquired,  the 
latter  due  to  epididymitis,  usually  gonor- 
rhoeal; azoospermia  due  to  prostatitis  and 
vesiculitis;  azoospermia  due  to  general 
syphilis,  excessive  morphinism,  chronic  alco- 
holism, and  debilitating  diseases,  but  rarely 
tuberculosis;  physiological  azoospermia, 
resulting  from  too  frequent  sexual  inter- 
course (after  a period  of  rest  the  spermatozoa 
gradually  increase  in  size,  munbers,  and 
vitality — Casper);  voluntary  prevention  of 
ejaculation;  prevention  of  ejaculation  due 
to  aversion,  etc. 

(See  Part  2,  on  Gynjecology,  for  Sterility 
in  the  Female.) 

Treatment.— Correct  the  cause,  if  possible. 
Divide  the  frenum  if  it  is  short  and  causes 
the  penis  to  bend  downward.  Cases  due  to 
excessive  venery  should  be  treated  by  pro- 
longed sexual  abstinence,  a generous  diet, 
local  treatment  if  the  urethra  is  hyper- 
£Esthetic,  and  the  faradic  current  for  lost 
local  sensibility,  etc.,  as  described  under 
Impotence.  “ Azoospermia,  due  to  occlu- 
sion of  the  vas  deferens  resulting  from 
gonorrhoeal  inflammation  has  been  treated 
by  anastomosing  the  vas  with  the  head 
of  the  epididymis  ” (Bonney).  (The  pre- 
ceding is  chiefly  from  Casper.) 

Stomatitis,  Gonorrhoeal. — Gr.  arona 
mouth  -b  -iTts  inflammation.  See  Buccal 
Gonorrhoea. 

Stone. — See  Calculus. 

Stricture  of  the  Neck  of  the  Bladder. — L. 
stridu'ra.  \"esical  cendcal  stricture  is  the 
result  of  a chronic  posterior  urethritis. 


nearly  always  post-gonorrhoeal,  but  some- 
times due  to  stone  in  the  bladder  or  pros- 
tatic hypertrophy.  Both  young  and  old 
are  affected  (Keyes).  (Tuberculous  stric- 
ture is  not  here  considered.) 

Keyes  says:  “ When  a chronic  urethritis, 
whether  gonorrhoeal  or  not,  drags  on  indefi- 
nitely and  is  rebellious  to  treatment,  stric- 
ture may  be  diagnosed  if  difficulty  of  urina- 
tion and  imperative  urination  are  present 
without  any  acute  inflammation,  and  the 
presence  of  residual  urine  without  hyper- 
trophy of  the  prostate  clinches  the  diag- 
nosis.” “ In  the  second  place,  when  there 
are  all  the  symptoms  and  signs  of  prostatic 
hypertrophy,  and  yet  the  prostate  is  not 
hypertrophied  sufficiently  to  account  for 
the  symptoms  (and  cystoscopy  shows  the 
absence  of  ball-valve  middle  lobe)  there  must 
be  either  stricture  or  bar.”  “ The  treatment 
for  each  is  the  same,”  viz.  “ Chetwood’s 
gal  vano-prostotomy . ’ ’ 

Stricture  of  the  Urethra. — L.  stridu'ra-, 
Gr.  ovpridpa.  Urethral  stricture  is  either 
congenital  or  acquired.  Acquired  stricture 
is  (a)  spasmodic  or  muscular;  (b)  cicatricial 
or  organic;  (c)  inflammatory  or  tumefactive. 
The  first  and  last  are  temporary.  The  rare 
occurrence  of  retention  in  inflammatory 
stricture  is  due  to  muscle-spasm. 

I.  Congenital  Stricture. — Congenital  stricture 
of  the  urethra  occurs  at  or  within  the  meatus 
or  at  the  bulbo-membranous  junction.  It 
very  rarely  causes  retention  of  urine. 

Meatotomy  is  performed  as  follows:  After 
cleansing  the  parts,  insert  a cocaine  tablet 
(gr.  bfo)  just  within  the  meatus  into  the 
pocket  on  the  floor  of  the  urethra,  and  drop 
upon  it  two  drops  of  adrenalin,  1 : 1000. 
Then,  with  a curved  bistoury,  divide  the 
stricture  on  the  floor  of  the  urethra  in  the 
middle  line  sufficiently  to  admit  a full-sized 
sound  or  bulbous  bougie.  Then  pack  the 
meatus  with  gauze  or  cotton  (dusted  with 
glutol — Keyes)  to  check  the  oozing.  If  the 
hemorrhage  is  severe  and  not  checked  by 
gauze  packing,  insert  a full-sized  catheter 
and  compress  the  urethra  against  the  cathe- 
ter with  a bandage.  Pass  sounds  daily 
until  healing  is  complete. 

For  premembranous  and  penile  stricture, 
employ  gradual  dilation,  rarely  internal 
urethrotomy,  as  described  under  cica- 
tricial stricture. 

II.  Spasmodic  or  Muscular  Stricture;  Urethris= 
mus. — The  following  characteristics  of  spas- 
mothc  stricture  distinguish  it  from  cicatri- 
cial stricture,  viz. : 

(1)  Spasmodic  stricture  occurs  only  in 
the  membranous  urethra. 


STRICTURE  OF  THE  URETHRA 


(2)  A full-sized  sound  is  often  more 
readily  passed  than  a small  one  if  it  be 
allowed  to  rest  against  the  face  of  the  stric- 
ture long  enough  to  tire  the  muscle. 

(3)  When  a large  sound  is  withdrawn,  it 
is  not  gripped  as  in  cicatricial  stricture. 

(4)  Spasm  relaxes  under  general  anaes- 
thesia. 

(5)  No  urethral  discharge  accompanies 
spasmodic  stricture  unless  cicatricial  stric- 
ture is  present. 

Etiology. — Nervousness;  shock;  fatigue; 
masturbation;  sudden  chilling  of  the  body; 
local  strain;  contusion  or  laceration  of  the 
urethra,  bladder,  or  abdomen;  operations 
within  the  pelvis,  in  the  rectum,  or  along  the 
genito-urinary  tract;  peritonitis;  appendi- 
citis; strangulated  hernia;  orchitis  or  epididy- 
mitis; paravesical  inflammation;  rectal  or 
neighboring  diseases;  vesical  calculus; 
urethritis-;  congenital,  inflammatory,  or 
cicatricial  stricture;  hypersesthesia  of  the 
urethra;  concentrated  urine;  gouty  or 
rheumatic  diathesis. 

Treatment. — For  the  treatment  of  reten- 
tion, see  Retention  of  Urine.  As  a preven- 
tive measure,  one  may  pass  a full-sized 
steel  sound,  in  order  to  overstretch  the 
compressor  urethrae  muscle,  and  instil  silver 
nitrate  into  the  deep  urethra  (see  under 
Sexual  Neuroses)  in  order  to  “ blunt  its 
sensibility.”  (Keyes.) 

III.  Cicatricial  or  Organic  Stricture. — ETIOL- 
OGY.— Gonorrhoea  (about  90  per  cent.) ; trau- 
matism; tuberculosis;  syphilis;  chancroid; 
abscess;  neoplasms;  hydatid  cyst;  etc. 

Symptomatology. — A slight  urethral  dis- 
charge (gleet);  frequent  and  often  painful 
micturition;  a slow,  small,  irregular  urinary 
stream;  dribbling  at  the  end  of  micturition; 
perhaps  hsematuria;  sometimes  acute  reten- 
tion following  overeating,  alcoholism,  or 
exposure  to  cold. 

Gonorrhoeal  stricture  appears  in  from  two 
to  five  to  ten  years  following  the  urethral 
inflammation;  whereas  traumatic  stricture 
follows  the  injury  within  a few  weeks  to  a 
year.  Gonorrhoeal  stricture  may  occur  in 
any  part  of  the  urethra  except  the  prostatic 
portion,  but  rarely  involves  the  bulbo- 
membranous  junction  or  the  membranous 
urethra.  Traumatic  stricture  usually  in- 
volves the  membranous  urethra,  except 
when  caused  by  foreign  bodies,  bullet  or 
knife  injuries.  The  prognosis  in  gonorrhoeal 
stricture  is  good,  in  traumatic  stricture  not 
so  good.  The  points  of  distinction  between 
organic  and  spasmodic  stricture  are  enu- 
merated above,  under  Spa.smodic  Stricture. 

The  possible  consequences  of  stricture  are 
32 


hemorrhoids,  hernia,  prostatitis,  cy.stitis, 
pyelonephritis  or  pyonephrosis,  stone,  peri- 
urethral inflammation,  urinary  infiltration 
or  extravasation,  urinary  fistula. 

Diagnosis  and  General  Instructions. — The  num- 
ber of  strictures,  if  more  than  one,  the 
location  and  calibre  ar-e  diagnosed  by  in- 
strumental exploration.  The  instruments 
required  for  this  purpose  and  for  gradual 
dilatation  are: 

Conical  .steel  sounds  or  bougies  with  the 
Thompson  curve.  Nos.  12  to  35,  French 
scale.  The  double  taper  sound  is  best 
because  it  cairses  but  tran.sitory  stretching 
of  the  meatus. 

Filiform  bougies,  one  dozen,  French 
or  whalebone,  the  latter  being  useful  in 
very  tight  strictures.  Keyes  prefers  the 
Banks  bougie. 

Gouley’s  tunnelled  catheter.  Nos.  8 to  16. 

Janet-Guyon  or  Le  Fort  or  Thompson 
dilators,  various  sizes. 

Flexible  bougies  with  conical,  bulbous, 
and  oval  tips. 

Instrument  lubricants  are  sterile  liquid 
cosmoline  (albolene  or  liquid  petrolatum), 
sweet  oil,  vaseline,  glycerine,  synol  soap, 
lubrichondrin,  and  the  following: 


1^  Hydrargyri  oxycyanidi gr.  iii.ss 

Glycerin! 3vss 

Tragacanthae gr.  xlvi 

Aquae  destillatae 5iii  Casper. 


In  order  to  prevent  “ urethral  chill,”  one 
should  achninister  urotropine,  gr.  v-x,  t.i.d. 
p.c.,  for  two  days  before  and  after  instru- 
mentation; and  following  instrumentation 
the  urethra  should  be  irrigated  with  silver 
nitrate,  1 : 10,000,  or  potassium  perman- 
ganate, 1 : 4000,  or  boric  acid,  3i-iv  ad  Oi; 
and  the  patient  should  be  instructed  to 
remain  quiet  and  to  take  a laxative.  Some 
order  5 grains  of  quinine  and  one  ounce  of 
whiskey  one  hour  before  in.strumentation. 
Before  introducing  the  instrument,  have 
the  patient  empty  the  bladder,  cleanse  the 
parts  with  soap  and  water  and  bichloride, 
1 : 1000,  and  irrigate  the  urethra  (see  under 
Gonorrhoea)  with  warm  boiled  boric  acid 
solution.  One  may  then  inject,  if  deemed 
advisable,  half  a dram  of  a 5 per  cent, 
emulsion  of  iodoform  in  glycerine  (Beck’s 
prophylactic  injection),  preceded,  if  need 
be,  by  one  dram  of  cocaine  solution,  2 per 
cent.,  to  be  retained  five  minutes,  and  then 
washed  out  with  warm  boric  acid  solution. 

To  explore  the  urethra,  introduce  a warm, 
conical  steel  sound,  lubricated  at  its  tip, 
as  large  as  the  meatus  will  admit  without 
difficulty  (enlarge  the  meatus  if  it  is  con- 


STRICTURE  OF  THE  URETHRA 


traded — see  Meatotomy,  under  Congenital 
Stricture).  The  patient  lies  upon  his  back 
with  shoulders  raised;  the  operator  stands 
on  the  patient’s  left.  The  sound  is  passed 
as  follows : With  the  left  hand  holding  the 
penis  and  exposing  the  meatus,  and  the 
fingers  of  the  right  hand  holding  the  sound 
lightly  with  its  staff  “ horizontal  to  and  in 
the  line  of  the  fold  of  the  left  groin,”  “draw 
the  penis  up  over  the  beak  of  the  sound 
with  the  left  hand,  while  the  right  hand 
sweeps  the  shaft  or  handle  across  the  ab- 
domen to  the  median  line,  still  keeping  it 
horizontal  to  the  skin  surface.”  “ By  this 
time  the  beak  has  reached  the  penoscrotal 
junction  and  is  entering  the  fixed  part  of  the 
urethra.”  “ Then,  and  then  only,  is  it  proper 
to  begin  to  elevate  the  shaft.”  While  elevat- 
ing the  shaft,  with  the  left  hand  against  the 
perineum  behind  the  scrotmn,  gently  lift  the 
beak  over  the  lower  segment  of  the  triangu- 
lar ligament  which  lies  posterior  to  the 
bulbous  urethra.  “ This  introduces  the 
beak  into  the  membranous  urethra.”  Then 
depress  the  handle  between  the  thighs  “ as 
its  inner  end  mounts  the  upward  inclination 
of  the  prostatic  urethra  and  enters  the 
bladder.”  Further  elevation  of  the  beak  by 
a finger  against  the  perineum  or  in  the  rec- 
tum is  sometimes  required  (in  prostatic 
hypertrophy  or  in  narrowing  of  the  vesical 
neck)  just  before  the  sound  enters  the  blad- 
der. The  latter  event  is  evidenced  by  the 
ability  to  rotate  the  sound  freely.  “ The 
withdrawal  of  the  sound  is  simply  the 
reverse  of  the  steps  taken  in  introducing 
it.”  (After  Bransford  Lewis.) 

If  the  first  sound  will  not  pass,  employ 
smaller  sizes  down  to  No.  20  or  15  F. ; then 
employ  soft  bulbous  bougies  (bougies  a 
boule);  and  finally  filiform  bougies,  until  a 
pa.ssage  is  made.  Insert  the  filifonn  until 
obstruction  is  met,  then  gently  rotate  it 
between  the  thumb  and  finger  until  the 
aperture  of  the  stricture  is  found.  If  it  is 
not  found,  insert  another  filiform,  and  so  on, 
up  to  six  or  eight.  Then  rotate  each  in 
turn.  If  unsuccessful  in  finding  the  orifice, 
rest  for  awhile  and  try  again,  if  necessary 
withdrawing  two  or  three  whalebones  and 
reinserting  them  after  standing  on  the  other 
side  of  the  patient.  If  further  effort  is  of 
no  avail,  cease  the  attempt  for  twenty-four  to 
forty-eight  hours,  purge  the  patient,  admin- 
ister belladonna  (^.r.)  and  bromide  (q.v.)  for 
the  purpose  of  relaxing  spasm,  and  before 
attempting  to  pass  an  instrument,  inject 
one  dram  of  cocaine  solution,  2 per  cent.  (?) 
to  be  retained  ten  minutes,  then  irrigate 
gently  with  warm  boric  acid  solution,  and 


inject  one  dram  of  a 10  per  cent,  emul- 
sion of  iodoform  in  glycerine.  A general 
anajsthetic  may  also  be  given  for  trouble- 
some spasm.  It  may  be  possible  (rarely) 
to  insert  the  filiform  through  the  endoscope, 
using  adrenalin  with  which  to  wipe  the  stric- 
ture until  it  ceases  to  bleed.  If  the  filiform 
should  engage  the  stricture  but  cannot  pass, 
leave  it  in  for  a few  hours,  when  it  may  be 
pa.ssed.  If  successful  in  passing  a filiform, 
pass  the  smallest-sized  Gouley  tunnelled 
catheter  over  the  filiform  as  a gmde,  and 
then  the  next  larger  size,  if  possible;  no  more. 
Then  put  the  patient  to  rest  for  twenty-four 
hours,  and  two  to  four  days  later  resume 
treatment  as  hereinafter  described  for  fili- 
form stricture. 

To  ascertain  the  site  and  length  of  a 
stricture,  pass  a bulbous  bougie,  large  enough 
not  to  enter  the  stricture,  down  to  the  latter, 
and  mark  off  the  meatus  level.  Then  pass 
a flexible  olive-tip  bougie  or  bougie  a boule 
into  the  bladder  and  withdraw  it  until  an 
obstruction  is  encountered,  and  mark  off 
the  meatus  level  again.  The  Otis  urethrom- 
eter  may  also  be  used.  Remember  that 
“ the  differentiation  of  a spasmodic  (due 
to  irritation  or  pain  in  passing  instruments) 
from  an  organic  stricture  may  give  rise  to 
perplexity  at  four  points  along  the  course  of 
the  urethra;  these  are,  mentioned  from  before 
backward:  just  behind  the  meatus;  at  a 
depth  of  about  four  inches  from  the  urinary 
outlet;  at  the  bulbo-membranous  junction; 
and  finally,  at  the  junction  of  the  mem- 
branous and  prostatic  urethra.”  (Horwitz.) 

Ahvays  bear  in  mind  the  importance  of  • 
employing  extreme  gentleness  in  passing 
sounds;  never  use  force,  and  do  not  pass 
sounds  oftener  than  everj’’  fourth  day. 
Urotropine,  gr.  v,  t.i.d.p.c.,  may  be  given 
during  the  treatment,  and  the  patient  should 
be  advised  against  alcoholism,  sexual  excite- 
ment, and  exposure  to  cold  or  wet. 

Should  a false  passage  be  made,  put  the 
patient  to  bed,  achninister  urotropine,  and 
leave  absolutely  alone  for  two  weeks  if  the 
patient  can  urinate  (Keyes),  otherwise 
employ  continuous  catheterism  (see  under 
Fistula,  Urethral)  for  a week  or  two. 

Should  urinarj^  infiltration  or  extravasa- 
tion occur,  perform  external  j^erineal  ure- 
throtomy under  ether  at  once,  dilate  the 
deep  urethra  and  drain  the  bladder,  and 
incise  freely  the  scrotal,  and  if  necessary', 
the  abdominal  subcutaneous  tissues,  flush 
the  wounds  with  warm  boric  acid  solution, 
5i-iv  ad  Oi,  in  order  to  w’ash  out  the  urine, 
and  i:>ack  widely  open  with  gauze. 

Treat  periurethral  abscess  as  follows: 


STRICTURE  OF  THE  URETHRA 


Under  ether,  with  the  patient  in  the  extreme 
lithotomy  position,  and  a guide  in  the  ure- 
thra, incise  the  swelling  and  lay  open  all 
parts  of  the  abscess,  avoichng  the  urethra, 
then  pack  with  gauze  (H.  Cabot).  Keyes 
says,  a mechan  perineal  incision  should  be 
made  to  evacuate  and  drain  the  abscess, 
“ the  urethra  should  be  opened  and  the 
stricture  cut.” 

Should  prostatic  abscess  occur,  perform 
perineal  section,  cut  the  stricture,  and  drain 
the  abscess  (see  under  Prostatitis.) 

In  acute  pyelonepliritLs  or  pyonephrosis 
{q.v.),  drain  the  kidney  through  a retained 
urethral  catheter  (see  under  Fi.stula, 
Urethral),  or  per  perineum  until  the  tem- 
perature returns  to  normal.  If  the 
temperature  persists,  however,  perform 
neplu'otomy,  or  if  called  for,  nephrectomy. 

These  compUcations  require  alkaline 
diluents  (see  potassium  salts,  in  Part  11, 
Drugs)  and  rest. 

For  the  treatment  of  fistula,  see  Fistula, 
Urethral. 

Treatment  of  Organic  Stricture. — A.  GENERAL 
Remarks. — Employ  gradual  dilatation  for 
all  pa.ssable  strictures  that  are  not  highly 
irritable  (marked  by  pain,  hemorrhage,  chill 
and  fever  following  instrumentation,  and 
due  to  an  associated  catarrhal  prostatis), 
or  resilient  (marked  by  a tendency  to  recon- 
tract after  ever\"  dilatation),  or  nodular 
or  indurated. 

Employ  internal  urethrotomy  to  di\dde 
firm  bands  near  the  meatus  or  in  the  pendu- 
lous urethra  which  resist  cUlatation,  and  for 
irritable  or  resilient  strictures  between  the 
meatus  and  the  bulbo-membranous  urethra, 
but  not  including  the  latter. 

Employ  external  urethrotomy,  as  a rule, 
for  irritable  stricture  at  the  bulbo-membra- 
nous  junction  and  beyond,  and  when  there 
is  chronic  urinarj'  fever.  Says  Keyes: 
“ By  bracing  the  patient’s  general  health, 
by  emplojdng  rather  large  doses  of  hexa- 
methylenamine  iq.v.),  by  using  the  utmost 
gentleness  in  souncUng,  by  preferring  bou- 
gies, which  are  less  violent  to  the  prostatic 
urethra  than  sounds,  or  else  blunt  sounds 
whose  points  need  not  enter  the  prostate 
at  all,  and  by  treating  the  stricture  only 
sufficiently  to  permit  local  treatment 
of  the  prostatitis  until  the  latter  is 
materially  improved — by  such  means  the 
operation  (external  urethrotomy)  may  often 
be  avoided.” 

Strictures  situated  at  or  beyond  the  bulbo- 
membranous  junction  that  are  resilient 
(all  traumatic  strictures  are  such),  nodular, 
impa-ssable,  or  complicated  by  a persistent 


fistula,  require  external  urethrotomy  and 
the  complete  removal  of  all  scar  tissue, 
followed  by  suture  or  grafting. 

B.  Treatment  of  Large  Calibre  Stric- 
tures (f.e.,  those  admitting  a sound  of  15  or 
20  F.). — The  patient  having  taken  urotro- 
pine,  gr.  v,  t.i.d.p.c.,  for  two  or  three  days, 
and  the  parts  rendered  aseptic,  pass  a sound 
a little  smaller  than  that  corresponding  to 
the  previously  ascertained  calibre  of  the 
stricture.  Withdraw  it  umnechately,  and 
pass  the  next  two  or  three  larger  sizes,  if 
they  will  enter  almost  by  their  own  weight ; 
not  otherwise.  Cease  if  blood  appears. 
Follow  instrumentation  by  irrigation  with 
boric  acid  solution,  5 Uiv  ad  Oi,  or  potassium 
pennanganate,  1 : 4000,  or  silver  nitrate, 
1 : 10,000  (see  under  Gonorrhoea  for  irriga- 
tion technique).  Repeat  the  dilatation 
everjGourth  day,  if  in.strumentation  isea.sy; 
ever\'  seventh  to  tenth  day,  if  chfficult. 
Use  increasing  sizes  of  steel  sounds  up  to 
27  to  32  F.,  the  gauge  of  the  normal  meatus. 
The  latter  may  be  enlarged,  if  necessary 
(see  Meatotomy)  to  admit  the  passage 
of  sounds  above  No.  25.  “ Dilatation  need 
rarely  be  carried  beyond  the  calibre  of 
the  normal  meatus,”  says  Keyes.  “If  the 
stricture  when  cUlated  to  the  size  of  the 
meatus  recontracts  with  undue  rapidity,” 
however,  further  dilatation  may  be  carried 
on  by  means  of  the  Kollman  dilator.  After  a 
calibre  of  30  or  32  has  been  reached,  the 
chlating  sound  should  be  passed  every  week, 
later  everj^  two  weeks,  then  every  month, 
everj^  two  months,  to  six  months,  to  a year. 
A stricture  in  the  pendulous  urethra  that 
does  not  recontract  after  a rest  of  three 
months  is  considered  cured.  A stricture  in 
the  bulb,  however,  requires  the  pas.sage 
of  a full-sized  sound  once  or  twice  a year  or 
oftener  after  its  apparent  cure.  This  may 
be  done  by  the  patient  himself. 

Firm  bands  in  the  pendulous  urethra  that 
resist  cUlatation  should  be  divided,  under 
ether  anaesthesia,  by  internal  urethrotomy, 
on  the  floor  of  the  canal  (Horwitz),  on  the  roof 
of  the  canal  (Keyes),  using  Maisonneuve’s 
urethrotome  or  Otis’s  chlating  urethrotome, 
or  for  strictures  near  the  meatus,  the  bis- 
tourjL  Divide  the  constriction  from  behind 
forward.  After  withdrawing  the  urethro- 
tome, explore  with  a full-sized  bougie  a 
boule  for  any  remaining  constricting  bands, 
which  should  be  incised.  After  the  opera- 
tion, a bougie  corresponcUng  to  the  full  size 
of  the  meatus  (at  least  No.  30  F.)  should  be 
readily  passed.  Then  irrigate  the  urethra 
and  bladder  with  hot  normal  saline  solution 
(3i  ad  Oi),  and  insert  a soft  rubber  catheter 


STRICTURE  OF  THE  URETHRA 


to  be  retained  for  two  to  four  days,  with  the 
patient  in  bed  (see  under  Fistula,  Urethral). 
Thereafter  pass  conical  steel  bougies  of 
gradually  increasing  size  twice  a week, 
until  one  can  be  readily  passed  that  corre- 
sponds in  calibre  to  the  full  size  of  the 
meatus.  Then  instruct  the  patient  to  pass 
the  sound  twice  a week  for  at  least  six 
months,  and  thereafter  once  a week  for 
three  months,  etc. 

Keyes  says:  “ Internal  urethrotomy 
shoidd  always  be  performed  upon  the  roof 
of  the  urethra.  It  should  not  be  employed 
for  strictures  in  the  perineal  urethra,  or  at 
the  bulbo-membranous  junction,  unless  peri- 
neal section  is  done  at  the  same  time.” 
After  performing  external  urethrotomy, 
insert  a perineal  tube,  which  should  be 
removed  on  the  first  or  second  day.  The 
first  sound  should  not  be  passed  until  the 
tenth  to  fourteenth  day.  (Keyes.) 

To  control  profuse  hemorrhage  ajter  ure- 
throtomy.— If  witliin  the  first  two  inches  of 
the  urethra,  pack  with  a roll  of  absorbent 
cotton  soaked  in  adrenalin,  1 : 1000,  and 
ajiply  compression  by  means  of  a narrow 
baiulage.  After  several  hours  insert  a soft 
rubber  catheter  to  be  retained.  If  the  bleed- 
ing is  farther  back,  inject  one  dram  of 
aclrcnalin,  1 : 2000,  and  retain  five  minutes. 
Then  insert  a rubber  catheter  and  exert 
comjjression  with  a narrow  gauze  bandage. 
If  this  fails,  try  compression  of  the  perineum 
with  the  finger,  or  with  a crutch  with  the 
patient  in  bed,  the  ferrule  of  the  crutch 
braced  by  the  footboard,  and  the  arm- 
piece  making  pressure  upon  a perineal 
compress. 

If  the  dorsal  vein  or  plexus  of  San- 
torini has  been  wounded,  a free  perineal 
incision  should  innnediately  be  made 
and  the  bleeding  vessel  secured  by  lig- 
ature or  purse-string  suture.  The  ur- 
ethra should  be  opened  on  the  floor. 

C.  Treatment  OP  Small  Calibre  Stric- 
tures {i.e.,  those  admitting  a sound  not 
over  15  or  20  F.). — Dilate  up  to  No.  15  or 
20  F.  with  soft  bougies,  then  employ  steel 
sounds  as  for  large  calibre  strictures. 

D.  Treatment  of  Filiform  Strictures. 
— After  injecting  half  a dram  of  a 5 per 
cent,  emulsion  of  iodoform  in  glycerine, 
preceded,  if  need  be,  by  one  dram  of  a 2 
l>er  cent,  cocaine  solution,  retained  five 
minutes,  insert  a filiform  bougie  until 
obstruction  is  met.  Then  gently  rotate  it 
between  the  thumb  and  finger  until  the 
aiiorture  of  the  stricture  is  found.  If  it  is  not 
found,  insert  another  filiform,  and  so  on  up 
to  six  or  eight.  Then  rotate  each  in  turn. 


If  unsuccessful  in  finding  the  orifice  rest 
for  a while,  and  try  again,  if  necessary  with- 
drawing two  or  three  whalebones  and  rein- 
serting them  after  standing  on  the  other 
side  of  the  patient.  If  further  effort  is  of 
no  avail,  cease  the  attempt  for  twenty-four 
hours.  It  may  be  rarely  possible  to  insert 
the  filifomi  through  the  endoscope,  using 
adrenalin  with  which  to  wipe  the  stricture 
until  it  ceases  to  bleed.  If  the  filiform 
should  engage  the  stricture  but  can  not  pass, 
leave  it  in  for  a few  hours,  when  it  may  be 
passed.  If  successful  in  passing  a filifonn, 
pass  the  smallest  sized  Gouley  tunnelled 
catheter  over  the  filiform  as  a guide,  and  then 
the  next  larger  size,  if  gently  possible;  no 
more.  Then  put  the  patient  to  rest  for 
twenty-four  hours.  Two  to  four  days  later, 
reinsert  the  filiform  and  try  to  pass  a larger- 
sized  tunnelled  catheter.  Fought’s  flexible 
whip  bougies  with  metal  shaft  attachment 
may  be  used.  Use  increasingly  larger  sizes 
until  about  16  mm.  is  reached,  then  continue 
the  dilatation  every  fourth  day  with  rubber 
bougies  until  No.  24  is  reached,  when  steel 
dilators  may  be  substituted.  In  difficult 
cases  in  the  region  of  the  bulbous  and  mem- 
branous portions  of  the  urethra,  one  may  pass 
the  largest  filiform  possible  and  allow  it  to 
remain  in  place  for  two  to  four  days,  when 
the  stricture  may  be  found  to  be  sufficiently 
dilated  to  admit  a Gouley  tunnelled  cathe- 
ter or  the  Janet-Guyon,  Le  Fort,  or  Thomp- 
son dilator  (chiefly  from  Horwitz). 

If,  however,  gradual  dilatation  proves 
impossible,  one  may  resort  to  “ modified 
rapid  dilatation,”  as  described  by  Horwitz, 
provided  the  stricture  is  not  resilient,  irri- 
table, or  nodular,  and  urinarj^  fistula  and 
prostatic  or  perineal  abscess  are  not  present. 
The  operation  may  also  be  performed 
“ primarily  to  facilitate  the  introduction  of 
a urethrotome  or  the  passage  of  a grooved 
staff,  so  that  a required  perineal  urethrot- 
omy may  be  performed  by  means  of  a 
guide.”  The  operation  is  performed  as 
follows  (Horwitz) : 

Equipment:  “ Set  of  metallic  sounds; 

filiform  bougies;  half  a dozen  Gouley  tun- 
nelled catheters  of  assorted  sizes;  a soft 
rubber  and  two  flexible  silk  catheters,  one 
of  which  should  terminate  in  an  oval  tip 
and  the  other  in  a ‘ rat -tail  ’ extremity;  a 
glass  syringe  with  a capacity  of  four  ounces ; 
a wire  stylet  to  render  the  soft  rubber 
catheter  film;  a Thompson  and  a Gross 
dilator;  six  ounces  of  a 5 per  cent,  emulsion 
of  iodoform  in  glycerine;  bichloride  solution, 
1 : 1000;  warm  sterile  boric  acid  solution  in 
a fountain  syringe;  sterile  gauze  sponges; 


STRICTURE  OF  THE  URETHRA 


sterile  tape  with  which  to  fasten  the  catheter 
in  place  after  the  operation.” 

First  do  a meatotomy  {q.v.),  if  required, 
and  introduce  a whalebone  filiform  bougie 
up  to  the  neck  of  the  bladder  and  fasten  it 
there;  then  put  the  patient  to  bed. 

Four  days  later,  after  a preliminary  purge, 
etherize  the  patient,  irrigate  the  anterior 
urethra  with  bichloride,  1 : 20,000,  and 
inject  two  drams  of  the  iodoform  emul- 
sion. Now  thread  the  protruding  end  of 
the  filiform  through  the  tunnel  of  the 
Thompson  dilator  and  pass  the  latter  “ very 
gently  along  the  whalebone  until  the  obstruc- 
tion is  reached;  then  slightly  withdraw  the 
filiform,  grasp  both  the  bougie  and  dilator 
and  move  them  both  forward  together  into 
the  bladder.”  “ Then  stretch  the  stricture 
in  three  directions  (anterior,  middle,  and 
posterior),”  by  slowly  turning  the  thumb- 
screw on  the  handle  of  the  instrument, 
“alternately  lessening  and  increasing  the 
screw  power.”  After  dilating  the  posterior 
segment,  lessen  the  tension  2 mm.,  slightly 
withdraw  the  blades,  and  dilate  the  middle 
and  anterior  segments  “ up  to  the  full 
capacity  of  the  Thompson  dilator.”  With- 
draw both  filiform  and  dilator,  insert  the 
Gross  dilator,  and  dilate  to  the  full  normal 
dilatability  (perhaps  a little  larger  than  the 
calibre  of  the  meatus);  then  pass  a full-size 
metallic  bougie  to  determine  this  point. 
Then  (the  following  to  be  done  after  all 
operations  for  stricture)  insert  a soft  rubber 
catheter  by  the  aid  of  the  wire  stylet,  and 
fasten  it  in  place  by  tying  to  it  a piece  of 
tape  under  the  penis,  bringing  the  two  ends 
of  the  tape  around  the  body  of  the  penis, 
tying  them  on  the  dorsum,  and  then  fasten- 
ing the  ends  to  a band  around  the  waist, 
held  in  position  by  perineal  straps.  Then 
irrigate  the  bladder  with  boric  acid  solution, 
and  inject  into  the  bladder  two  drams  of 
iodoform  emulsion. 

Remove  the  catheter  on  the  fourth  day, 
and  thereafter  pass  conical  steel  bougies  of 
gradually  increasing  size  twice  a week, 
until  one  can  be  readily  passed  that  corre- 
sponds in  calibre  to  the  full  size  of  the  meatus. 
Instruct  the  patient  to  pass  the  bougie 
twice  a week  thereafter  for  at  least  six 
months,  and  after  that  once  a week  for 
three  months,  etc. 

For  the  division  of  resilient,  irritable,  or 
nodular  filifonn  strictures,  situated  anterior 
to  the  bulbo-membranous  junction,  one 
may  employ  Horwitz’s  knife,  designed  for 
such  cases.  It  is  guided  by  means  of  a 
filiform  threaded  through  a ring  at  the  end 
of  the  instrument,  the  blade  being  directed 


toward  the  floor  of  the  urethra,  to  the 
obstruction,  which  it  divides  “ directly  in 
the  median  line  ” from  before  backward. 
After  cutting  the  stricture,  stretch  it  with 
a Thompson  dilator  up  to  18  to  23  mm.; 
then  use  the  Gross  or  Otis  urethrotome  to 
thvide  the  remaining  bands  upon  the  floor 
of  the  canal,  from  behind  forward. 

The  Gross  Urethrotome  (circumference 
at  the  bulb  23  mm.)  is  “ reserved  for  stric- 
tures that  are  either  resilient  or  irritable,  of 
comparatively  recent  origin,  and  not  exten- 
sively organized,  or  where  the  constriction 
assumes  the  form  of  a band  or  a bridle.” 
The  bulbous  extremity  must  be  passed  at 
least  one-half  an  inch  beyond  the  stricture; 
the  knife  blade  is  then  protruded  and  drawn 
forward,  while  being  firmly  pressed  against 
the  urethral  tissue,  “ until  all  sense  of 
resistence  is  overcome,”  to  about  one-half 
an  inch  in  front  of  the  constriction.  The 
Otis  urethrotome  (circumference  18  mm.)  is 
used  “for  strictures  resilient,  irritable,  nodu- 
lar, or  fibrous,  well  organized,  and  that  in- 
volve the  submucous  structure.”  (Horwitz.) 

After  withdrawing  the  urethrotome,  ex- 
plore with  a full-sized  bougie  a boule  for  any 
remaining  constricting  bands  which  should  be 
incised.  After  the  operation,  a bougie  corres- 
ponding to  the  full  size  of  the  meatus  (at  least 
No.  30  F.)  should  be  readily  passed.  Then 
irrigate  the  urethra  and  bladder  with  hot 
normal  salt  solution,  and  insert  a soft- 
rubber  catheter,  to  be  retained  for  two  to 
four  days,  with  the  patient  in  bed.  There- 
after pass  conical  steel  sounds  of  gradually 
increasing  size,  twice  a week,  until  one  can 
be  readily  passed  that  corresponds  in  calibre 
to  the  full  size  of  the  meatus.  Instruct 
the  patient  to  pass  the  sound  twice  a week 
thereafter  for  at  least  six  months,  and  after 
that  once  a week  for  three  months,  etc. 

Perform  external  urethrotomy  for  resil- 
ient, irritable,  nodular,  or  impassable  stric- 
tures situated  at  or  beyond  the  bulbo- 
membranous  j unction  (see  General  Remarks) . 

E.  Treatment  of  Stricture  Compli- 
cated BY  Retention. — It  may  be  advisable 
to  produce  slight  general  aniesthesia,  or  to 
inject  into  the  urethra  one  dram  of  2 per 
cent,  cocaine  solution,  with  adrenalin,  to 
be  retained  ten  minutes,  and  then  washed 
out  with  warm  boric  acid  solution,  followed 
by  the  injection  of  one  dram  of  .sterile  oil 
or  of  a 10  per  cent,  emulsion  of  iodoform  in 
glycerine.  Then  try  to  pass  a metal  or 
soft  catheter,  the  latter  aided,  if  need  be, 
by  a stylet,  down  to  the  smallest  sized 
catheter;  or  try  to  pass  a Gouley  tun- 
nelled catheter  over  a filiform.  If  unsuccess- 


TUBERCULOSIS  OF  THE  PROSTATE 


ful,  try  to  pass  a filiform,  to  be  left  in 
place  for  the  urine  to  dribble  past.  Then 
place  the  patient  in  a hot  bath  for  fifteen 
to  thirty  minutes;  then  wrap  him  in  blankets 
and  admini.ster  hot  lemonade,  10  }>:rains  of 
ciuinine,  and  ]/^  grain  of  morj^hine,  and  jdace 
a hot  flaxseed  poultice  over  the  lower  abdo- 
men. Later  it  may  be  possible  to  pass  the 
tunnelled  catheter  over  the  retained  filiform. 
If  the  symptoms  of  retention,  however,  are 
urgent,  aspirate  the  bladder  suprapubically, 
and  induce  free  perspiration.  Aspiration 
may  be  repeated  every  eight  hours  for  one 
day;  then,  if  catheterization  is  still  unpos- 
sible,  perform  perineal  urethrotomy,  reestab- 
lish the  normal  calibre  of  the  urethra,  and 
insert  a catheter,  as  previously  described. 

In  evacuating  a very  distended  bladder, 
allow  no  less  than  twenty  minutes  for  the 
evacuation  of  the  urine,  in  order  to  avoid 
hemorrhage  and  collapse. 

Suppurative  Nephritis. — L.  sm&,  under  -|- 
p^iSfpur'ispus;  Gv.ve4>p6s  kidney  + -itls  in- 
flammation. See  Pyelonephritis,  in  Parti. 

Suprarenal  Inclusion  Tumor  of  the  Kid= 
ney. — L.  supra,  above  + ren,  kidney; 
inclus'io.  See  Tumors  of  the  Kidney. 

Syphilis. — See  Part  1,  General  Medicine 
and  Surgery. 

Testis,  Carcinoma  of  the. — L.  tes'tis  or 
testic' ulus',  Gr.  KapKivos  crab  -upa 
tumor.  See  Tumors  of  the  Testis. 

Gangrene  of  the. — Gr.  ydyypat.va  mor- 
tification. See  Orchitis;  and  Injuries 
of  the  Testicle. 

Hydrocele  of  the. — See  Hydrocele. 

Inflammation  of  the. — L.  inflammdre, 
to  set  on  fire.  See  Orchitis. 

Injuries  of  the. — See  Injuries  of  the 
Testicle. 

Irritable. — L.  irritar'e  to  tease.  See 
Neuralgia  of  the  Te.sticle. 

Misplaced. — See  Undescended  Testicle. 

Neuralgia  of  the. — See  Neuralgia  of 
the  Testicle. 

Sarcoma  of  the. — Gr.  udp^,  aapKos 
flesh  + -wpa  tumor.  See  Tumors  of 
the  Testis. 

Tuberculosis  of  the. — L.  iubcrcuhun, 
nodule.  See  under  Orchitis. 

Tumors  of  the. — See  Tumors  of  the 
Testis. 

Undescended. — See  Undescended  Tes- 
ticle. 

Torsion  of  the  Spermatic  Cord. — L.  tors' io, 
torque' re,  to  twist ; Gr.  aireppa  seed ; xopd-h 
coi'd.  See  Injuries  of  the  Testicle. 

Traumatism. — Gr.  rpavpa  wound.  See 
Injuries. 

Tuberculosis  of  the  Bladder. — L.  tuber' - 


culum  nodule.  See  Tuberculous 
Cystitis  under  Cystitis. 

Cowper’s  Gland. — See  Cowperitis. 

the  Epididymis. — See  under  Orchitis 
and  Epididymitis. 

the  Kidney. — See  Pyelonephritis,  in 
Part  1. 

Tuberculosis  of  the  Prostate. — Gr.  vrpo 
before  -f-  iaravaL  to  stand.  The  symptoms 
are  dysuria  and  a chronic  urethral  discharge. 
The  presence  of  isolated  nodules  revealed 
by  rectal  palpation  is  pathognomonic. 
Tuberculous  cystitis  is  prone  to  occur. 

Examine  the  prostatic  secretion  obtained 
by  rectal  massage  for  tubercle  bacilli,  first 
cleansing  the  glans  penis  and  prepuce  and 
irrigating  the  anterior  urethra  by  means  of 
a soft  catheter  and  boric  acid  solution, 
5i  ad  Oi,  in  order  to  exclude  the  smegma 
bacillus.  A thin  smear  of  the  secretion  is 
fixed  upon  a clean  unused  glass  slide  by 
thying  it  in  the  air  and  then  passing  it 
rapidly  thrice  through  a Bunsen  flame,  with 
the  smear  side  down.  It  is  then  subjected 
for  five  to  ten  minutes  to  steaming  (not 
boiling)  carbol-fuchsin  (one  part,  saturated 
alcoholic — 95  per  cent. — solution  of  fuchsin 
and  nine  parts  5 per  cent,  carbolic  acid 
solution);  washed;  decolorized  one-half 
minute  with  spirits  of  nitrous  ether,  or  with 
a 10  per  cent,  solution  of  sulphuric  acid  in 
95  per  cent,  alcohol  until  only  the  faintest 
pink  color  is  seen;  washed  in  water;  counter- 
stained  with  Loeffier’s  methylene  blue 
(saturated  alcoholic  solution  of  methylene 
blue,  30  C.C.,  with  aqueous  solution  of 
potassium  hydroxide — 1 : 10,000,  100  c.c.) 
for  about  thirty  seconds;  washed;  dried  with 
filter  paper;  mounted  in  Canada  balsam; 
and  examined  with  an  oil  immersion  lens. 
Perhaps  the  surest  method  of  securing 
tubercle  bacilli  is  by  Loeffier’s  modification 
of  the  antiformin  process  of  Uhlenhuth : 
To  one  or  more  c.c.  of  the  secretion  add  an 
equal  quantity  of  a 50  per  cent,  solution  of 
antiformin  (10  per  cent,  solution  of  sodium 
hypochlorite  containing  5 to  10  per  cent, 
sochum  hydrate),  and  boil  for  no  longer  than 
fifteen  minutes.  To  each  10  c.c.  of  the  result- 
ing solution  add  1.5  c.c.  of  a mixture  of  one 
part  chloroform  and  nine  parts  alcohol ; 
shake  thoroughly  so  as  to  produce  a 
fine  emulsion;  then  centrifuge  for  fifteen 
minutes.  Pour  off  the  supernatant  fluid 
above  the  film  which  lies  just  above  the 
chloroform,  and  which  holds  the  tubercle 
bacilli,  place  the  film  upon  a glass  slide,  and 
remove  excess  of  fluid  with  filter  paper.  Add 
a drop  of  egg-albumen  (preserved  with  0.5 
per  cent,  carbolic  acid)  as  a fixative,  and  make 


TUMORS  OF  THE  BLADDER 


a thin  spread  by  means  of  a second  slide. 
Allow  to  dry,  and  stain  as  described  above 
(from  Webster’s  Diagnostic  Methods). 

The  Prognosis  is  not  necessarily  bad. 

Treatment. — Enjoin  correct  hygiene— rest, 
fresh  air,  an  abundant  diet,  etc.,  as  described 
under  Tuberculosis,  Pulmonary,  in  Part  1, 
on  General  Medicine  and  Surgery. 

If  one  of  the  kidneys,  the  testis,  or  epididy- 
mis is  involved,  it  should  be  removed.  Says 
Young,  nephrectomy  and  epididymectomy 
will  cure  many  cases  of  prostatic  and  seminal 
vesicular  tuberculosis.  Do  not,  as  a rule, 
employ  local  treatment.  For  the  treatment 
of  a complicating  tuberculosis  cystitis,  see 
under  Cystitis. 

Tuberculosis  of  the  Seminal  Vesicles. — 

L.  se'men,  seed;  vesic'ula,  vesicle.  The 
vesicles  are  dilated  and  tender  and  show 
nodular  thickening.  Their  implication  is 
suspected  only  when  the  prostate  or  epididy- 
mis is  known  to  be  tubercular. 

Treatment. — Enjoin  correct  hygiene — rest, 
fresh  air,  an  abundant  diet,  etc.,  as  described 
under  Tuberculosis,  Pulmonary,  in  Part  1, 
on  General  Medicine  and  Surgery.  Do 
not  employ  massage  or  douches. 

If  one  of  the  kidneys,  the  testis,  or  epididy- 
mis is  involved,  it  should  be  removed.  Says 
Young,  nephrectomy  and  epididymectomy 
will  cure  many  cases  of  prostatic  and  seminal 
vesicular  tuberculosis.  If  the  disease  is 
limited  to  the  vesicles  and  vas  deferens, 
one  may  perform  Young’s  suprapubic-retro- 
cystic-extraperitoneal  operation.  Keyes, 
however,  advocates  vesiculectomy  only  in 
the  exceptional  cases  with  “ extensive  case- 
ation, suppuration,  or  fistulization.” 

Tuberculosis  of  the  Testicle. — I;,  tes'tis, 
or  testic'ulus.  See  under  Orchitis. 

Urethra. — See  Da  Costa  for  pictures. 

Tumors  of  the  Bladder. — L.  tumor,  from 
tum'ere,  to  swell. 

Varities.— Papilloma  or  villous  tumor  (the 
most  common;  it  tends  to  become  malignant, 
therefore  examine  the  base  microscopically 
for  signs  of  malignancy);  carcinoma  (next 
in  frequency,  but  rare);  adenoma;  fibroma; 
myoma;  lipoma;  angioma;  enchondroma; 
sarcoma;  cysts  (all  very  rare).  Papilloma 
and  carcinoma  are  often  multiple  as  a result 
of  contact  inoculation. 

Symptomatology. — Hsematuria,  usually  abun- 
dant (the  most  important  symptom);  fre- 
quent micturition;  pain;  cystitis;  sudden 
stoppage  of  the  urinary  stream  (may  also 
occur  in  stone);  fragments  of  tumor  in 
the  urine. 

Make  a bimanual  and  cystoscopic  exami- 
nation. A general  anaesthetic  may  be 


reqtured  on  account  of  the  extreme  pain. 

Treatment. — Papillomata  are  best  treated 
through  a ureteral  catheterizing  cystoscope 
by  means  of  the  high-frequency  current 
(fulguration;  from  h.fulg'ur,  lightning;  see 
Medical  Electricity,  in  Part  1).  If  very 
many  tumors  are  present,  it  may  be 
necessary  to  open  the  bladder  suprapubi- 
cally  and  then  employ  fulguration.  The 
technique  is  as  follows:  Distend  the  bladder 
with  boric  acid  solution,  and  introduce  the 
cystoscope.  Through  the  catheter  channel 
of  the  latter  introduce  a fulguration  cathe- 
ter connected  with  one  pole  of  the  electrical 
apparatus,  and  approach  it  to  the  tumor. 
The  other  electrode,  in  the  form  of  a large 
flat  plate,  is  placed  under  the  buttocks  if 
the  tumor  occupies  the  base  of  the  bladder, 
and  over  the  hypogastrium  if  the  tumor  is 
in  the  upper  wall  of  the  bladder.  Apply  the 
current  to  the  pedicle  of  the  tumor,  if  pos- 
sible, otherwise  begin  the  sparking  at  the 
periphery.  A large  pedunculated  tumor 
may  first  be  snared,  and  then  the  base 
fulgurated.  The  wire  may  either  be  inserted 
into  the  substance  of  the  tumor,  or  brought 
almost  in  contact  with  it.  Each  application 
of  the  current  may  last  from  three  to  five 
minutes,  or  less,  or  until  the  part  treated  is 
thoroughly  blanched.  The  whole  tumor 
may  be  gone  over  in  one  sitting;  or  several 
sittings,  at  intervals  of  ten  to  fourteen  days, 
may  be  required.  Remember  that  a certain 
amount  of  local  reaction  follows  this  mode 
of  treatment,  and  it  should  not  be  mistaken 
for  cancer.  (Kretschmer.) 

Casper  advises  against  excision  or  resec- 
tion operations  where  the  tumor  is  benign 
and  causes  inconsiderable  symptoms,  and 
also  in  malignant  cases  unless  “ stanchless 
hemorrhage  or  intolerable  and  uncontrol- 
lable tenesmus  exist,”  when  suprapubic 
cystoscopy  should  be  performed,  and  the 
bladder  irrigated  daily  through  the  urethra 
with  warm  boric  acid  solution,  3i  to 
the  pint. 

The  X-ray  may  be  tried  in  inoperable 
cases,  and  also  following  operation,  in  order 
to  prevent  recurrence,  if  possible.  For  the 
latter  purpose,  irrigation  of  the  bladder  once 
weekly,  for  at  least  a year,  with  a 5 per 
cent,  solution  of  resorcin  is  also  advised. 
Once  or  twice  a year,  for  at  least  three 
years,  following  operation,  the  bladder 
should  be  examined  cystoscopically  for 
possible  recurrence. 

For  the  relief  of  pain,  strangury,  and 
hemorrhage,  employ  rest,  an  ice-bag  to 
the  hypogastrium,  and  opiates  with  bella- 
donna (see  Drugs,  Part  11).  For  the  treat- 


TUMORS  OF  THE  URETHRA 


ment  of  severe  hemorrhage,  see  under 
Hematuria. 

Tumors  of  the  Cord. — ^See  Tumors  of  the 
Testis,  Epididymis,  and  Spermatic 
Cord. 

Epididymis. — See  Tumors  of  the  Tes- 
tis, Epididymis,  and  Spermatic  Cord. 

Kidney. — See  Part  2,  Gynaecology. 

Penis. — 

Varieties. — Simple  papilloma  or  ordinary 
wart  (see  Verrucse) ; verruca  acuminata  or 
venereal  wart  (see  Verructe);  syphilitic 
condyloma;  gumma;  .sarcoma;  epithelioma; 
adenoma;  angioma;  lipoma;  chondroma; 
osteoma;  dermoid  cyst;  sebaceous  cyst;  horns; 
circumscribed  fibrosis  or  sclerosis  of  the  corp- 
ora cavernosa  and  corpus  spongiosum. 

Sclerosis  of  the  corpora  causes  bending  of 
the  penis  during  erection.  Possible  causes 
are  a gouty  diathesis,  injury  during  coitus, 
violent  erections,  gonorrhoea,  and  diabetes 
mellitus  (the  sclerosis  diminishes  as  the 
cUabetes  improves) . 

Papillomata  and  horns  sometimes 
develop  malignancy. 

Treatment. — Sarcoma  and  epithelioma 

demand  early  removal  of  the  penis  and  ingui- 
nal glands. 

Horns  should  be  completely  excised 
because  of  their  tendency  to  become 
malignant. 

There  is  no  known  effectual  treatment 
of  sclerosis. 

For  the  treatment  of  warts  of  all  kinds, 
see  Verrucse. 

Tumors  of  the  Prostate,  Malignant. — 

Cancer  of  the  prostate  is  not  very  rare. 
According  to  IGdd,  it  constitutes  10  per 
cent,  of  prostatic  enlargements.  Stony 
hardness  of  an  enlarged  prostate  in  a man 
over  forty  or  fifty  years  of  age,  especially 
when  associated  with  pain  in  the  urethra, 
pcrmeum,  or  rectiun,  and  lumbago 
or  sciatica,  points  to  cancer.  A piece  of 
the  prostate  may  be  cut  out  per  perineum 
for  examination. 

Sarcoma  is  very  rare.  It  occurs  usually 
in  children,  and  usually  grows  rapidly. 

Treatment.— Young’s  radical  perineal  opera- 
tion should  be  undertaken  if  the  seminal 
vesicles  are  not  involved.  Palliative  mea- 
sures in  inoperable  cases  include  (a)  cathe- 
terization, preferably  with  a straight  rubber 
catheter,  or,  if  necessary,  the  stiff  gum  or 
silver  catheter,  whenever  re(|uired;  (b)  supra- 
pubic drainage,  using  a Bloodgood  bag 
(consult  Young  in  Keen’s  Surgery,  Vol.  IV, 
p.  402);  (c)  partial  perineal  or  suprapubic 
prostatectomy;  (d)  the  Rottini  electro- 
cautery operation ; (e)  the  use  of  radium  {q.v., 


in  Part  1)  per  rectum,  bladder,  or  in  the 
substance  of  the  gland.  Per  rectum  one 
may  use  100  mgrms.  of  radimn  filtered 
through  2 mm.  of  platinum,  in  a 2 mm. 
rubber  tube,  left  in  situ  for  twelve  to  fifteen 
hours.  Longer  exposures  may  be  given  if 
the  tube  can  be  completely  buried  in  the 
growth.  In  the  bladder,  since  thick  filters 
can  not  be  used,  the  exposures  must  be 
corresponchngly  reduced.  The  treatment 
may  be  repeated  in  a month. 

Tumors  of  the  Spermatic  Cord. — See 
Tumors  of  the  Testis,  Epididjunis,  and 
Spermatic  Cord,  below. 

Tumors  of  the  Testis,  Epididymis,  and 
Spermatic  Cord. — L.  tes'tis;  Gr.  em  on  -fi 
StScyuos  testis;  cTreofio.  seed;  xopSy  cord. 

Varieties. — Fibroma;  enchondroma;  oste- 
oma; myoma;  myxoma;  lipoma;  teratoma; 
dermoid  cyst ; cystic  degeneration ; 
carcinoma;  sarcoma;  calcification  of  the 
tunica  vaginalis. 

Treatment. — If  the  tumor  does  not  yield 
rapidly  to  large  doses  of  mercury  and  iodide, 
it  is  not  syphilitic,  and  castration,  to- 
gether with  excision,  of  the  iliac  glands 
should  be  resorted  to. 

No  treatment  is  required  for  calcification 
of  the  tunica  vaginalis. 

Tumors  of  the  Urethra. — Gr.  ovprjdpa. 
The  diagnosis  is  made  by  endoscopy  and  the 
microscopical  examination  of  excised  por- 
tions of  the  growth. 

(a)  Papilloma  or  Polypus  (occurring 
mostly  in  chronic  gonorrhoeal  urethritis). 
If  the  growths  are  near  the  meatus,  remove 
them  through  a urethral  speculum  with 
scissors,  forceps,  or  snare,  curette  the  base, 
and  cauterize  with  silver  nitrate  or  a satu- 
rated alcoholic  solution  of  salicylic  acid. 
The  latter  may  be  used  twice  a week,  for  a 
time,  to  prevent  recurrence. 

If  the  vegetations  are  deep  in  the  urethra, 
employ  the  curette,  or  galvanocauter>q 
or  fulguration  (see  under  Tumors  of  the 
Bladder)  through  the  urethroscope,  first 
aniEsthetizing  the  urethra  with  novocaine, 
1 per  cent.,  or  cocaine,  0.25  to  0.5  per  cent., 
or  quinine  and  urea  hydrochloride,  5 per 
cent.,  freshly  prepared  (see  under  Drugs, 
Part  11). 

(b)  Angioma  (extremely  rare).  Excise 
or  destroy  the  growdh  with  the  thermo- 
cauteiy  or  high-frequency  current. 

(c)  Cyst.  Excise  the  cyst  and  cauterize 
the  base. 

(d)  Fibroma  (pedunculated).  Curette 
away  the  gro\vth. 

(e)  Calcification.  Remove  the  scales 
periodically  through  the  urethral  speculum. 


UKETII RA  L II EMORRHAGE 


(f)  Carcinoma  (characterized  by  its  hanl- 
ness  to  the  curette) . Remove  the  penis  and 
inguinal  glands  at  once. 

(g)  Sarcoma.  Remove  the  penis  and 
inguinal  glands  at  once. 

Undescended  Testicle. — L.  iest'is  or  testic'- 
ulus.  The  undescended  testicle  is  pecu- 
liarly liable  to  inflammation,  atrophy,  or 
malignant  degeneration.  If  it  has  not 
descended  spontaneously  by  the  time  of 
puberty,  it  should  be  brought  down,  if 
possible,  by  operative  means.  If  it  cannot  be 
brought  down,  it  should  be  replaced  in  the 
abdomen,  or  perhaps  preferably,  removed. 

Uraemia. — See  Part  1,  General  Medicine 
and  Surgery. 

Ureteral  Calculus. — Gr.  ovprjTTjp  ureter; 
L.  calculus  pebble.  See  Nephrolithiasis,  in 
Part  1. 

Urethral  Angioma. — Gr.  ovprjdpa;  ayyeiov 
vessel  + -copa  tumor.  See  Tumors 
of  the  Urethra. 

Calcification. — L.  calx,  lime  + faCere, 
to  make.  See  Tumors  of  the  Urethra. 

Calculi  and  Foreign  Bodies. — L.  cal' cu- 
ius, pebble.  If  the  stone  is  not  firmly 
impacted,  it  may  possibly  be  expelled  by 
the  patient  closing  the  meatus  and  bearing 
down,  the  urethra  having  first  been  filled 
with  sterile  oil.  Or,  if  it  is  in  the  anterior 
urethra,  the  latter  may  be  distended  with 
sterile  olive  oil  or  liqmd  albolene,  and 
an  attempt  made  to  milk  the  stone  for- 
ward to  the  meatus,  where  it  may  be 
crushed  and  extracted,  or  meatotomy  (see 
under  Stricture  of  the  Urethra)  performed. 

An  impacted  stone  in  the  anterior  urethra 
may  be  removed  with  long  slender  forceps, 
or  pushed  back  into  the  deep  urethra  or 
bladder  and  removed  by  external  urethrot- 
omy or  litholapaxy  (see  Vesical  Calculus). 
A stricture  may  sometimes  have  to  be 
divided  before  the  stone  can  be  extracted. 
“The  penile  or  the  scrotal  urethra  should 
not  be  incised  for  fear  of  fistula  in  the  one 
case,  infiltration  in  the  other.”  (Keyes.) 

Remove  foreign  bodies,  if  possible,  by 
means  of  urethral  forceps.  Various  scoops 
and  forceps  specially  designed  for  this  pur- 
pose are  those  of  Collin,  d’Etiolles,  Thomp- 
son, Dittel,  Mathieu,  and  Nelaton.  If  this 
is  not  practicable,  external  urethrotomy  may 
be  performed,  or  the  foreign  body  may 
possibly  be  gently  pushed  into  the  bladder, 
and  then  extracted  by  means  of  the  cysto- 
scopic  forceps. 

A pin  may  be  removed  by  grasping  the 
head  and  forcing  the  point  out  through 
the  corpus  spongiosum,  then  reversing  its 
direction  and  pushing  the  head  out  through 


the  meatus,  which  is  not  difficult  surgery. 

Urethral  Carcinoma.— Gr.  KapKLvo%  crab  + 
-wpa  tumor.  See  Tumors  of  the 
Urethra. 

Chill;  Catheter  Fever. — Urethral  or 
vesical  instrumentation  sometimes  causes 
shock,  chill,  with  or  without  fever,  sepsis, 
or  uraemia. 

Prophylaxis. — During  the  two  days  preceding 
and  following  insti'umentation,  have  the 
patient  rest,  preferably  in  bed,  open  his 
bowels,  take  a warm  bath,  drink  large 
quantities  of  water,  and  take  urotropine, 
gr.  v-xx,  t.i.d.  The  urethra  or  bladder  may 
be  irrigated  daily  with  silver  nitrate, 
1 : 10,000,  or  potassium  permanganate, 
1 : 4000  or  boric  acid,  3Uiv  ad  Oi,  if 
deemed  of  importance.  See  under  Gonor- 
rhoea for  the  technic  of  irrigation. 

Before  introducing  the  instrument,  have 
the  patient  empty  the  bladder,  cleanse  the 
parts  with  soap  and  water,  and  bichloride, 
1 : 1000,  and  irrigate  the  urethra  with  one 
of  the  above  antiseptic  solutions.  Then 
inject  half  a dram  of  a 5 per  cent,  emulsion 
of  iodoform  in  glycerine  (Beck’s  prophy- 
lactic injection),  preceded,  if  deemed  advis- 
able, by  one  dram  of  cocaine  solution,  2 
per  cent.,  to  be  retained  five  minutes,  and 
then  washed  out  with  warm  boiled  boric 
acid  solution. 

Employ  extreme  gentleness  in  passing 
instruments,  and  afterwards  irrigate  the 
urethra  and  bladder. 

Treatment.— Put  the  patient  to  bed,  give 
a hot  foot-bath,  and  employ  diuresis  and 
urinary  antisepsis  as  above  described. 
Should  sepsis  or  uraemia  supervene,  institute 
free  drainage  by  means  of  the  retained 
catheter  (see  under  Fistula,  Urethral)  for 
several  days,  with  antiseptic  irrigations;  or 
by  means  of  suprapubic  or  perineal  cysto- 
tomy; and  employ  hot  packs,  hot-air  baths, 
cups  to  the  loins,  stimulants,  and  if  neces- 
sary, venesection  and  normal  saline  infusion 
(see  Uraemia,  in  Part  1).  If  perineal  cys- 
totomy is  done,  introduce  two  rubber 
catheters,  tied  together,  and  irrigate  with 
normal  saline  solution  (3i  ad  Oi). 

Urethral  Cysts. — Gr.  kvgtis  cyst.  See 
Tumors  of  the  Urethra. 

Fibroma. — L.  fib'ra,  fibre  -f-  Gr.  -wpa 
tumor.  See  Tumors  of  the  Urethra. 

Fistula. — See  Fistula,  Urethral. 

Urethral  Foreign  Bodies. — See  Urethral 
Calculi  and  Foreign  Bodies. 

Hemorrhage. — Gr.  aipa  blood  -f  prjyvh- 
vaL  to  burst  forth.  See  under  Stric- 
ture of  the  Urethra — under  B,  Treat- 
ment of  Large  Calibre  Strictures. 


VERRUCiE;  WARTS 


Urethral  Injuries. — See  of  Urethra. 

I.ubricants. — See  under  Stricture  of  the 
Urethra. 

Papilloma. — L.  papil'la  + Gr.  -o^fxa 
tumor.  See  Tumors  of  the  Urethra. 

Sarcoma. — Gr.  crap^,  aapKos  flesh  — topa 
tumor.  See  Tumors  of  the  Urethra. 

Spasm. — Gr.  atraapos.  See  Stricture 
of  the  Urethra. 

Stricture. — See  Stricture  of  the  Urethra. 

Tumors. — See  Tumors  of  the  Urethra. 

Warts. — See  Tumors  of  the  Urethra. 

Urethrismus. — L.  See  Stricture  of  the 
Urethra. 

Urethritis. — Gr.  oiipridpa  urethra  + -itls 
inflammation. 

Etiology. — Gonorrhoea  (q.v.);  herpes  pro- 
genitalis;  chancroid;  chancre;  urethral  wart 
or  papilloma,  or  other  form  of  neo- 
plasm; animal  parasites;  unclean  instru- 
mentation; infections:  typhoid  fever, 

pneumonia,  diphtheria,  chronic  tonsillitis, 
chronic  eczema,  syphilis,  tuberculosis,  etc.; 
traumatism ; the  retained  catheter;  menstrual 
and  leucorrhoeal  discharge,  and  the  discharge 
from  malignant  disease  of  the  uterus;  rectal 
worms;  hyperacidity  of  the  urine;  gouty 
or  rheumatic  diathesis;  diabetes;  chronic 
constipation;  irritating  ingesta:  alcohol, 

mineral  waters,  asparagus,  ginger,  arsenic, 
potassium  iodide,  turpentine,  cantharides, 
etc.;  sexual  excess;  prolonged  sexual 
excitement;  calculi  or  foreign  bodies  in  the 
lu’ethra;  stricture;  irritating  injections,  or 
the  too  energetic  treatment  of  a chronic 
localized  urethritis. 

Non-gonorrhoeal  urethritis  is  rare  as 
compared  with  the  gonorrhoeal  form.  It 
usually  subsides  under  treatment  in  eight 
to  ten  days. 

Treatment. — Attend  to  the  cause.  Treat 
the  urethra  with  mild  astringents  (see  under 
CJonorrhoea). 

Urethrorrhoea. — Gr.  ovprjepa  urethra  + 
poLa  flow.  See  Sexual  Neuroses. 

Urethrospasm. — Gr.  ovpijOpa  urethra  + 
awaapos  spasm.  See  Stricture  of  the  Urethra. 

Urinalysis. — See  Part  1,  General  Medicine 
and  Surgery. 

Urinary  Alkalinity. — L.  uri'na;  Gr.  oupoj/. 
See  Alkalinuria  in  Part  1. 

Calculus. — L.  calc'uius,  pebble.  See 
Nephrolithiasis,  in  Part  1. 

Diminution. — See  Anuria  in  Part  1. 

U ri  nary  E xtravasat  ion.  — See  Extravasation 
of  Urine. 

Incontinence. — See  Enuresis. 

Increase. — See  Polyuria,  in  Part  1. 

Infiltration. — L.  in,  into  -f  fil'trum, 
filter.  See  Extravasation  of  Urine. 


Retention. — See  Retention  of  Urine. 

Stone. — See  Nephrolithiasis,  in  Part  1. 

Urination,  Absent. — See  Anuria,  in 
Part  1. 

Difficult. — See  Dysuria,  in  Part  1. 

Diminished. — See  Anuria,  in  Part  1. 

Excessive. — See  Polyuria,  in  Part  1. 

Frequent. — See  Polyuria,  in  Part  1. 

Increased. — See  Polyuria,  in  Part  1. 

Painful. — See  Dysuria. 

Urine. — See  Urinary. 

Varicocele. — L.  va'rix,  vein  -t-  Gr.  KJiK-q 
tumor.  Dilatation,  tortuosity  and  elonga- 
tion of  the  veins  of  the  spermatic  cord  (the 
pampiniform  plexus),  with  a feel  like  a mass 
of  angle-worms,  almost  invariably  limited 
to  the  left  side,  and  accompanied  by  a 
dragging  pain. 

Etiology.— Heredity;  prolonged  ungratified 
sexual  desire;  sexual  excess;  chronic  constipa- 
tion; or  protracted  standing,  sudden 
strain  (coughing,  etc.);  pressure  from  an 
intra-abdominal  growth,  usually  a renal 
malignant  neoplasm. 

Treatment. — Attend  to  the  cause.  Pre- 
scribe proper  general  and  sexual  hygiene, 
a suspensory  bag,  cold  applications  night 
and  morning,  adequate  rest  and  exercise, 
fresh  air  day  and  night,  a daily  morning 
tepid  bath  before  breakfast  in  a comfortable 
room,  followed  by  a cold  spinal  douche,  regu- 
lation of  the  bowels,  regular  hours  of  eating 
and  sleeping;  rest  before  and  after  meals,  a 
bland,  nutritious  diet,  and  tonics.  Reassure 
the  patient.  Marriage  may  be  curative. 
(See  also  Neuralgia  of  the  Testicle.) 

If  the  above  measures  are  insufficient, 
the  pain  and  dragging  very  annoying,  the 
patient  much  depressed,  or  the  testicle 
beginning  to  atrophy,  perform  subcuta- 
neous ligature;  or  Bevan’s  open  resection 
operation,  with  abbreviation  of  the  scrotum, 
if  required  (consult  Keen’s  Surgery,  Vol.  IV, 
p.  613). 

Venereal  Warts. — L.  vene'reus,  pertaining 
to  Venus.  See  Verrucae,  below. 

Verrucae;  Warts. — L.  verru'ca,  wart. 

Classification. — 1.  Ordinary  wart  or  simple 
papilloma — verruca  vrilgaris. 

2.  Verruca  acuminata;  pointed  condy- 
loma; venereal  tvart;  moist  wart;  fig  wart; 
cauliflower  excrescences;  vegetations:  skin 
colored,  pink,  or  purplish  red,  finger-like 
vegetations,  resembling  cauliflower,  cocks- 
comb, bunch  of  grapes,  or  mulberries. 
Causes:  uncleanliness,  irritating  discharges, 
gonorrhoea,  syphilis,  etc. 

3.  Flat  condyloma  or  moist  papule  of 
secondary  syphilis — modified  mucous  patch: 
“ soft,  grayish,  with  a broad  base.” 


WOUNDS 


Treatment.— 1.  VERRUCA  VULGARIS. — Pick 
up  the  wart  with  toothed  forceps,  and  cut 
off  below  the  base  with  curved  scissors,  or 
better,  a sharji  knife.  Suture  the  skin  with 
catgut,  or  cauterize  with  pirre  carbolic 
acid  or  silver  nitrate. 

2.  Verruca  Acuminata. — Pick  up  the 
growths  with  toothed  forceps,  and  excise 
with  curved  scissors  or  the  knife.  Cauterize 
the  base  with  silver  nitrate,  nitric  acid,  or 
the  thermocautery  at  a dull  red  heat,  or 
close  the  wound  with  interrupted  catgut 
sutures.  Enjoin  local  cleanliness. 

If  excision  is  not  feasible,  have  the  patient 
cleanse  the  parts  daily  with  soap  and  water, 
followed  by  a solution  of  potassium  perman- 
ganate, 1 : 2000,  or  bichloride,  1 : 2000,  or 
salicylic  acid,  5 to  10  per  cent,  in  equal  parts 
of  alcohol  and  water;  then  dry,  and  apply 
an  astringent,  antiseptic  dusting  powder  of 
calomel  and  sahcylic  acid,  aa;  or  zinc  oxide 
and  bismuth  subnitrate,  aa;  or  tannic  acid 
and  lycopodium,  aa;  or  alum,  gr.  v-1  to  the 
ounce  of  boric  acid;  or  resorcin,  eight  parts, 
bismuth  subnitrate  and  boric  acicl,  aa  one 
part  (Boeck).  If  this  plan  fails,  curette  the 
growths  and  apply,  cautiously,  glacial  acetic 
acid,  chromic  acid,  nitric  acid,  or  lactic  acid. 


the  surrounding  skin  being  protected  with 
vaseline.  Or,  freeze  the  growths  once  or 
twice  with  a stream  of  ethyl  chloride,  pro- 
tecting the  surrounding  skin  with  dry  cotton. 
“ The  most  valuable  local  application,” 
says  Keyes,  is  a 10  per  cent,  mixture  of 
salicylic  acid  in  acetic  acid  (not  glacial).  “ It 
forms  a chalk-and-water  mixture  of  which 
the  moist  chalk  is  smeared  over  the  warts.” 
" One  or  two  applications  cause  the  growths 
to  wither  away  and  drop  off.” 

3.  Condyloma  Syphilitica. — Employ 
local  antisepsis  and  specific  internal  medica- 
tion (see  Syphihs,  in  Part  1.). 

Vesical  Affections. — L.  vesica,  bladder. 
See  Bladder  Affections. 

Vesicular  Tuberculosis. — See  Tuberculosis 
of  the  Seminal  Vesicles. 

Vesiculitis. — See  Seminal  Vesicuhtis. 

Visceroptosis. — L.  vis'cus,  viscus  -f-  TTTtuo-ts 
fall.  See  Splanchnoptosis,  in  Part  1. 

Warts,  Muco=Cutaneous. — L.  mu'cus, 
mucus;  cu'tis,  skin.  See  Verrucse. 

Warts,  Urethral. — See  Tmnors  of  the 
Urethra. 

Venereal. — L.  vener'eus,  pertaining  to 
Venus.  See  Verrucie. 

Wounds. — See  Injuries. 


APPENDIX 

Schema  for  the  Genito-Urinary  History  and  Examination 


Name  Address 

Single,  rnarried  (how  long),  widower  (how 

Children  Age 

Frequency  of  micturition  (diurnal,  nocturnal 

Changes  in  the  Urinary  stream 
Pain 

Hcematuria 

Co7nplaint 

To  what  does  patient  attribute  his  illness: 


II istory  of  jrresent  illness: 

Previous  History: 

Family  and  wife’s  history: 


Date  No. 

long)  Occupation 

Race 

, or  constant) 

General  appearance 

Height  Weight 

Appropriate  or  proper  weight  (see  Part  1)) 

Hygiene:  Rest  Exercise 

Recreation  Diet  Sleep 

Bowels  Ventilation  Baths 

Sexual  habits  Tea  and  coffee 

Narcotics  Alcohol  Tobacco 


Examination: 

IGdneys  Ureters 

Penis  Urethra 

Vas  Deferens  Prostate 

Rectum  Abdomen 

Heart,  blood-vessels,  lungs,  and  other  organs  and  tissues. 

Urmary  Analysis  (q.v.  in  Pait  1).  Amount  in  24  hours 
Color  Reaction  s.g. 

Urea  Albumen  Sugar 

Renal  function 
Diagnosis: 

(On  other  side)  Treatment  (including  dates,  and  whether  at  office  or  home). 


Bladder 

Testis 

Seminal  Vesicles 


Frequency 
Total  solids 
Sediment 


The  Qenito=Urinary  Armamentarium. 

I.  Office  and  Operating  Room  Equipment. — 
Examining  and  operating  table;  stands; 
basins;  pitchers;  Rochester  sterilizer  for 
dressings;  instrument  sterilizer  (fish  kettle); 
dressing  material:  plain  and  iodoform  gauze, 
absorbent  cotton,  gauze  bandages,  towels; 
rubber  sheets;  douche  pan;  Kelly  pad;  rub- 
ber gloves;  operating  gowns;  caps;  nose  and 
mouth  protectors;  laparotomy  and  other 
sheets;  sheet  with  perforation  for  the  penis; 
adhesive  plaster;  safety  pins;  hand  brushes; 
finger  cots;  reservoir  with  tubes  and  stand; 
soap;  laparotomy  pads  with  tape  attached; 
suture  material:  silkworm-gut,  catgut  plain 
and  chromicized,  silk,  linen  thread;  safety 
razor;  Esmarch  inhaler;  tongue  forceps; 
electric  light  furnished  by  street  current  or 
storage  battery;  hypodermic  syringe  and 
tablets  (morphine,  strychinne,  atropine, 
digitalin) ; hot  water  bags. 

Instrument  cases  containing  the  following: 
Pedicle  needle;  knives;  scissors,  blunt  and 
pointed,  straight  and  curved ; thumb  forceps ; 
rat-toothed  dissecting  forceps;  tissue  clamps, 
straight  and  curved;  artery  forceps;  needle 
holders;  assorted  needles;  abdominal  retrac- 
tors; proctoscopes;  sigmoidoscopes;  long 
rectal  alligator  forceps;  Kelly’s  conical 
sphincter  dilator;  graduated  rectal  bougies; 
rectal  tube  and  funnel;  urethroscope,  ante- 


rior and  posterior;  Pezzer  self-retaining 
catheters;  long-nozzle  drainage  syringe; 
glass  and  rubber  drainage  tubes;  INIoynihan’s 
intestinal  clamps;  Murphy’s  buttons;  Paque- 
lin  cautery;  electro  cautery;  head  mirror; 
infusion  apparatus;  minun  graduate;  medi- 
cine droppers,  straight  and  curv'ed;  applica- 
tors; long,  narrow-bladed  volsellum  forceps; 
snare;  Sym’s  rubber  bag  retractor;  varicocele 
needle;  circumcision  forceps;  lithotomy  for- 
ceps; lithotomy  scoop;  grooved  urethral 
staff;  sharp-pointed  curved  perineal  tube; 
grooved  director;  bistoury;  female  catheter; 
Luy’s  urine  separator  or  segregator;  Kemp 
or  Chetwood  double-way  rectal  tube;  wire 
urethral  speculum;  Young’s  prostatic  trac- 
tor; Nelaton  soft  rubber  catheters,  full  set; 
woven,  olivaiy,  elbowed,  double-elbowed, 
and  olive-tipped  elbowed  catheters,  full  set; 
Guyon  elbowed  obturator,  for  use  in  a 
flexible  rubber  or  woven  catheter,  to  pass  an 
enlarged  prostate;  silver  catheters,  tunnelled 
or  threaded  (for  attachment  to  filiforms) ; set 
of  whalebone  filiform  bougies  and  tunnelled 
sounds;  set  of  Janet  sounds  and  filiforms; 
Banks  bougies,  full  set;  set  of  olive-tipped 
conical  woven  bougies;  set  of  bulbous 
bougies,  flexible  or  metallic;  set  of  double- 
taper, conical,  steel  urethral  sounds,  with 
Thomson  curv^e;  Kollman  or  Oberlander 
dilator;  Keyes  instillator;  Young’s  or  Rob- 


THE  GENITO-URINARY  ARMAMENTARIUM 


bin’s  ointment  applicator;  urethrotome; 
two-dram,  blunt-nozzled  glass  syringe; 
Janet  or  Heyden  syringe  (keep  rubber 
piston  out  of  barrel  when  not  in  use) ; glass 
fountain  syringe  with  rubber  tube  and  blunt 
nozzle  for  urethral  irrigations;  irrigating 
operating  cystoscopes  and  accessories,  such 
as  ureteral  forceps,  scissors,  cUlators,  cathe- 
ters, bougies,  and  searchers;  stone  searcher; 
Chetwood  urethral  clip;  suspensory  bags; 
glass  or  hard  rubber  hand  syringe  holding 
not  over  four  drams;  Keyes-Ultzmann 
syringe;  urethral  applicator  for  use  through 
endoscope;  Guyon  instillating  syringe;  Otis- 
Kreisl  urethrotome;  Kollmann  intra-urethral 
probe;  intra-urethral  curette;  intra-urethral 
snare;  Ultzmann’s  instillator;  Kollmann’s 
capillary  aspirator;  Kolhnann’s  cannula  and 
sjTinge ; Kollmann’s  or  Oberlander’s  electro- 
lytic needles;  Kolhnann’s  or  Bierhoff’s  knife; 
Janet’s  trajectome;  cmwed  bistoury;  Otis 
dilating  urethrometer;  Janet-Guyon,  Gross, 
Le  Fort,  or  Thompson  dilators,  various 
sizes;  Maisonneuve’s  urethrotome;  Fought’s 
flexible  whip  bougies  with  metal  shaft 
attachment;  grooved  urethral  staff;  two 
flexible  silk  catheters,  one  terminating  in  an 
oval  tip,  and  the  other  in  a rat-tail  extremity; 
glass  four-ounce  syringe;  wire  stylet  to 
render  rubber  catheters  firm;  tape;  Horwitz 
urethrotome  for  filiform  strictures;  Forges 
coude  gum  catheters,  various  sizes;  silk- 
web  catheter  with  Mercier’s  or  Guyon’s 
curve;  Enghsh  semihard  catheters;  Guyon’s 
mandarin  coude  catheter;  silver  catheters 
with  large  prostatic  curve,  up  to  Brodie’s 
curve;  aspirating  needles  for  tapping  the 
bladder  suprapubically;  Casper’s  self-retain- 
ingcatheter  closed  with  acork;  Young’s  modi- 
fication of  Bottini’s  instrument;  metal 
double-current  irrigating  catheter;  supra- 
pubic bladder  drainage  tube;  Bransford  Lewis 
operating  cystoscope;  two-way  glass  syringe 
of  15  c.c.  capacity  for  connection  with  ure- 
thral catheter;  Thompson’s  stone  searcher; 
Bigelow  or  Chismore  lithotrite  and  evacua- 
tor;  Thompson’s  lithotrite;  Guyon’s  litho- 
trite; cystoscopic  alligator  forceps;  bladder 
hooks;  urethral  forceps;  bladder  scoops  and 
forceps  for  extracting  foreign  bodies  (Collin, 
d’Etiolles,  Thompson,  Dittel,  Mathieu,  and 
Nelaton);  fulguration  catheter;  urethral  scis- 
sors, forceps,  snare,  curette,  galvano-cautery ; 
Bloodgood  bag  for  suprapubic  drainage  of 
bladder;  Earle’s  or  Collin’s  urinal;  Martin’s 
epididymitis  bag  (made  by  Lentz  and  Sons, 
of  Philadelphia);  Chetwood’s  rubber  ban- 
dage; gutta-percha  tissue ; half-ounce  aspira- 
ting syringe  for  tapping  hydrocele;  cannula 
and  trocar  for  tapping  hydrocele;  Felecki’s 


instrument : smooth  metal  bulb  mounted  on  a 
handle,  for  stripping  the  seminal  vesicles  per 
rectum  ; rectal  thermophore  ; urethra-psy- 
chrophore  (double  catheter)  ; camel’s-hair 
brushes;  silver  urethral  probe;  No.  4 or  5 
American  catheters  for  children;  Gross’s 
blood  catheter;  glass  syringe  with  long 
needle  for  intramuscular  injections;  salvar- 
san  outfit:  (see  Syphilis,  in  Part  1). 

X-ray  machine;  electrical  outfit:  static 
electricity,  galvanic,  faradic,  sinirsoidal,  and 
high  - frequency  currents  ; blood  - pressure 
apparatus ; stethoscope ; portable  vapor 
bath  cabinet. 

Ionic  outfit:  galvanic  battery  with  mil- 
liamperemeter,  copper  and  zinc  electrodes, 
m-ethral  rods  introduced  through  a can- 
nula, fine  lint  to  wrap  the  rods.  Hot  air 
apparatus. 

Metal  instuments  are  sterilized  by  boiling 
in  sodium  carbonate  solution  (washing  soda) 
1 per  cent.,  for  five  minutes.  Woven  instru- 
ments may  be  boiled  in  plain  water,  but 
they  should  not  lie  in  contact  with  other 
instrmnents  while  boiling,  nor  be  touched 
until  cooled.  Operating  cystoscopes  are 
sterilized,  after  taking  apart  and  cleansing 
with  green  soap  and  water,  in  an  air-tight 
cabinet  for  one  hour  with  formaldehyde  gas 
generated  by  the  Lowe  cUsinfecting  lamp; 
or  else  by  immersing  all  but  the  eye-piece 
in  alcohol. 

2.  Laboratory  Equipment. — Microscope;  slides; 
cover-glasses;  stains:  saturated  aniline  water, 
filtered;  saturated  alcoholic  solution  of 
gentian  violet;  iocUne;  potassium  iodide; 
alcohol,  95  per  cent.;  safranin.  Alcohol 
lamp  or  bunsen  burner;  drug  scales;  spat- 
ulas; mortar  and  pestle;  capsules. 

Urinary  analysis  outfit: 

3.  Internal  Drugs  Mentioned  in  the  Text. — 

(a)  Ajsttileutics.  Gr.  drrt  against  -F  L. 
lu'es,  syphilis  or  the  plague. — Salvarsan  ; 
neosalvarsan;  protiodide  of  mercury:  Gamier 
andLamoureux’sgranulesof  green  protiothde, 
gr.  Ffi  bin  iodide  of  mercury;  bichloride  of 
of  mercury;  salicylate  of  mercury;  oleate  of 
mercury;  tannate  of  mercury;  black  wash; 
gray  powder;  blue  pill;  blue  ointment,  .50 
per  cent. ; mercury  vasogen ; white  precipitate 
ointment;  potassiimi  iocUde;  comp,  syrup 
of  sarsaparilla. 

(b)  Urinary  Sedatives  and  Astrin- 
gents. L.  sedo,  I allay;  ad.  to  -j-  string' ere 
to  bind. — 01.  santali;  oleoresina  copaibte; 
oleore.sina  cubebse;  inf.  uvaursi;  inf.  buchu; 
inf.  pareira  brava;  alchemilla;  fl.  ext.  zea 
mais;fl.ext.  triticum repens ; rhusaromatica. 

(c)  Diuretics.  Gr.  diovprjcTL^  urination. — 
Potassium  citrate,  acetate,  and  bicarbonate; 


THE  GENITO-URINARY  ARMAMENTARIUM 


infusion  and  oil  of  juniper;  inf.  buchu;  spt. 
setheris  nitrosi;  tr.  cantharides. 

(d)  Urinary  Antiseptics.  Gr.  drrt  against 
+ ar}rpis  putrefaction.  — Methylene  blue; 
urotropine;  cystogen;  forinin;  lielinitol;  sali- 
formin;  ol.  eucalypti;  salol. 

(e)  Urinary  Acidifiers. — Acid  sodium 
phosphate;  sodium  benzoate;  benzosol;  ben- 
zoic acid;  salicylic  acid;  sodium  salicylate. 

(f)  Antilithics.  Gr.  o.vtL  against  -f-  M0os 
stone. — Piperazin;  dilute  nitric  acid;  dilute 
nitromuriatic  acid;  magnesia;  aimnonium 
carbonate;  dilute  hydrochloric  acid;  liquor 
potassse;  borocitrate  of  magnesium;  sodium 
bicarbonate;  Vichy;  Apollinaris;  colchicum. 

(g)  Neuromuscular  Sedatives. — Ether; 
chloroform;  morphine;  codeine;  heroin;  dio- 
nin;  tr.  opii;  ext.  opii;  tr.  hyoscyami;  ext. 
hyoscyami;  morphine  anti  atropine  hypo- 
dermic tablets;  tr.  belladonna;  ext.  bella- 
donna; whiskey;  sodium,  potassium,  and 
strontium  bromides;  chloral;  phenacetin; 
antipyrine;  py  rami  don;  salophen;  salipyrine; 
ext.  and  tr.  cannabis  indica;  trional;  valerian; 
asafoetida;  spt.  setheris  comp.;  atropine. 

(h)  Laxatives. — Calomel;  pulv.  rhei; 
cascara;  senna;  sodium  sulphate;  Rochelle 
salt;  Epsom  salt;  sodium  phosphate;  Hun- 
yadi;  Friedrichshall. 

(i)  Tonics  and  Alteratives. — Quinine; 
tr.  cinchona ; dilute  hypophosphoric  acid; 
syr.  hypophosphites;  glycerophosphates; 
elixir  ferri,  quin.,  et  strych.  phos.;  ferrmn 
reductum;  peptomanganate  of  iron;  iron- 
tropon;  Fowler’s  solution;  sodium  arsenate; 
tr.  nucis  vomicse;  strychnine;  phosphorus; 
zinc  phosphide;  codUver  oil;  maltine; 
tr.  gentian. 

(j) .  Hemostatics  Gr.  alfia  blood  -f- 
(TTaTLKos  standing. — Adrenalin  solution, 
1 ; 1000;  dilute  or  aromatic  sulphuric  acid; 
fl.  ext.  senecio  aureus;  stypticin;  ergot; 
gelatine,  Merck’s  sterilized;  fl.  ext.  hydrastis. 

(k)  Menstrua  and  FuAvoRs.-^accha- 
rum  album;  elixir  simplex;  syr.  simpL; 
syr.  acaci®;  syr.  and  aq.  cinnamomi;  aq. 
anisi;  mucil.  acacise;  glycerine;  tragacanth; 
syrup  of  orange  peel. 

4.  Local  Preparations  Mentioned  in  the  Text. — 

(a)  Antiseptics  and  Astringents. — 
Liq.  plumbi  subacetatis  dil.;  argyrol;  pro- 


targol;  silver  nitrate;  zinc  sulphate;  zinc 
chloride;  tr.  krameria;  tr.  myrrh;  tr.  iodi; 
glycerite  of  tannin;  fl.  ext.  kxameria;  car- 
bolic acid;  boroglyceride,  25  per  cent.;  hydro- 
gen peroxide;  alcohol;  creolin;  lysol;  ich- 
thalbin;  liq.  alum,  acetatis;  bichloride  of 
mercury;  comp,  stearate  of  zinc.;  dermatol; 
tannin;  borax;  boric  acid;  bismuth  subni- 
trate ; lead  acetate ; iodipin ; europhen ; hydra- 
stin  (Lloyd’s);  ichthyol;  potassium  perman- 
ganate; alum;  iodine;  iodoform;  copper 
sulphate;  salicylic  acid;  glutol;  hydrarg. 
oxycyanate;  re.sorcin;  camphoric  acid;  calo- 
mel; aristol;  iodol;  nosophen;  mere,  oint- 
ment; iodine- vasogen;  ichthyol  ointment; 
zinc  sulphocarbonate;  carbolic  ointment; 
blue  ointment;  comp,  iodine  ointment;  silver 
stick;  lactic  acid;  nitric  acid;  acetic  acid; 
chromic  acid;  liq.  hydrargyri  nitratis;  comp, 
tr.  benzoin;  pot.  chlorate;  collargol;  Dobell’s 
or  Seiler’s  alkaline  solution. 

(b)  Emollients  and  Protectives  L. 
emol'lio,  I soften. — Zinc  ointment;  boric 
omtment;  cold  cream;  petrolatum  molle; 
lanolin;  olive  or  cottonseed  oil;  oil  of  sweet 
almond;  liquid  cosmoline  or  liquid  vaseline 
or  liquid  albolene;  oleic  acid;  ol.  theobromie; 
lycopodium;  talcum;  starch. 

(c)  Lubricants. — Lubrichrondrin;  synol 
soap;  boroglyceride: 


Hydrargyri  oxycyanati gr.  iiiss 

Glycerini 3vss 

Tragacanthaj gr.  xlvi 

Aquae  destillatae  sterilisata; oiii  (Casper) 


(d)  Local  Analgesics  Gr.  av  without  -f 
aXyos  pain. — Cocaine,  novocaine,  eucaine; 
alypin;  camphor;  ethyl  chloride;  tr.  aconiti. 
ung.  belladonnae;  lead  and  opium  wash; 
Sterile  5 per  cent,  alypin  lubricant,  5 to  7c.c. 
instilled  with  a Keyes  instillator,  produces 
anaesthesia  in  ten  minutes  which  lasts 
about  thirty  minutes. 

Miscellaneous. — Oxygen  tank;  coumarin; 
salt;  collodion;  normal  sodium  hydrate 
solution;  flaxseed;  distilled  water;  guaiacol; 
creosote  (Beechwood);  guaiacol  valerianate; 
thallin  sulphate;  gomenol  oil;  ol.  origanum; 
indigo  carmine,  4 per  cent,  in  salt  solution, 
boiled  two  hours;  phloridzin,  1 per  cent, 
in  33  per  cent,  alcohol. 


PART  4 

OBSTETRICS 


Abderhalden  Test.  — See  Diagnosis 
of  Pregnancy. 

Abdomen,  Pendulous. — L.  ab'dere,  to 
hide;  pend’ulus,  hanging. 

Causes. — Antedisplacment  of  the  pregnant 
uterus  iq.v.);  relaxed  abdominal  walls;  dias- 
tasis of  the  recti  muscles  (q.v.);  kyphosis, 
causing  a diminution  in  length  of  the 
abdominal  cavity ; lack  of  engagement,  due 
to  contracted  pelvis,  etc.  (See  Dystocia.) 

An  abdominal  supporter  should  be  worn. 

Abdominal  Caesarian  Section. — See 
Ctesarian  Section. 

Abdominal  Diastasis. — See  Diastasis  of 
the  Abdominal  Muscles. 

Abdominal  Distention. — See  Tympanites. 

Abdominal  Muscles,  Diastasis  of  the.— 
See  Diastasis  of  the  Abdominal  Muscles. 

Abortion. — L.  ab,  from  + ori're,  to  grow. 
See  Abortion,  Miscarriage,  and  Premature 
Labor,  in  Part  2,  Gynsecology. 

Abortion,  Induction  of. — L.  indu'cere,  to 
lead  in.  The  artificial  termination  of  preg- 
nancy before  the  twenty-eighth  week  or 
sixth  month,  i.e.,  before  the  viability  of  the 
foetus,  or  its  ability  to  live  after  birth. 

Indications.  — Intractable  vomiting  {q.v.) ; 
marked  renalinsufficiency  (seeToxsemia)  ;per- 
sistent  excessive  jaundice;  acute  yellow  atro- 
phy of  the  liver;  serious  exophthahnic  goitre; 
serious  cardiac  insufficiency;  pulmonary 
tuberculosis;  spontaneous  or  induced  onset  of 
abortion  with  persistent  hemorrhage  or  with 
infection ; missed  abortion;  intrauterine  infec- 
tion; acute  hydramnios;  hydatidiform  mole. 

Technique. — See  under  Abortion,  Mis- 
carriage, and  Premature  Labor,  in  Part 
2,  Gynaecology. 

Abruptio  Placentae. — L.  ab,  from  -f 
rup'tura,  break.  See  Premature  Separation 
of  the  Normally  Situated  Placenta. 

Abscess,  Bartholin’s  Gland. — L.  abscessus, 
a going  apart;  glans,  a cord.  See 
Vulvitis,  in  Part  2,  Gynaecology. 

Breast. — See  IMastitis. 

Skene’s  Glands. — See  Gonorrhoea;  and 
Vulvitis;  in  Part  2,  Gynaecology. 

Submammary. — L.  svb,  under  -f 
mam’ma,  breast.  (See  Mastitis.) 

Suburethral. — L.  sib,  under  -f  Gr. 
ovfyfjdpa  iirethra.  See  Gonorrhoea,  and 
Vulvitis;  in  Part  2,  Gynaecology. 

Vulval.  — L.  vul'va.  See  Vulvitis,  in 
Part  2,  Gynaecology. 


Accidental  Complicating  Diseases  of 
Labor.— See  Complications  of  Labor. 

Pregnancy.  — See  Complications  of 
Pregnancy. 

Accouchement  Force. — Fr.  forcible  arti- 
ficial delivery.  See  under  Premature  Labor, 
Induction  of. 

Achondroplasia. — See  Part  1,  General 
Medicine  and  Surgery. 

Acid  Eructations. — L.  a’cidus,  sour;  eruc- 
ta'tio,  belching.  See  Dyspepsia  Complica- 
ting Pregnancy. 

Acromio^Iliac  Presentations. — Gr.  aKpov 
point  -T  tu/xos  shoulder;  L.  il'ium,  haunch- 
bone.  See  Transverse  Presentations. 

Acute  Yellow  Atrophy  of  the  Liver. — See 
Part  1,  General  Medicine  and  Surgery. 

Adherent  Placenta.— L.  adhcer'ere,  to 
stick  to;  placen'ta,  a flat  cake.  The  diagno- 
sis is  made  by  the  association  of  alarming 
hemorrhage  with  inability  to  express  the 
placenta  by  Crede’s  method.  The  hemor- 
rhage is  due  to  the  fact  that  a part  of  the 
placenta  is  usually  detached. 

Frequency. — about  1 : 312  (Hirst). 

Etiology. — Endometritis ; syphilis. 

Treatment. — The  third  stage  of  labor  is 
conducted  as  follows:  After  the  fundus 

uteri  has  risen  up  to  or  above  the  umbilicus, 
indicating  the  expulsion  of  the  placenta  into 
the  lower  uterine  segment,  or  after  the  lapse 
of  thirty  minutes,  or  at  once  in  the  event 
of  alarming  hemorrhage,  attempt  to  express 
the  placenta  by  Crede’s  method,  as  follows: 
Grasp  the  uterus,  with  the  fingers  posteriorly 
and  the  thumb  anteriorly,  and  knead  and 
rub  until  it  contracts  strongly;  then,  while 
it  is  contracting,  squeeze  it  and  press  down 
in  the  direction  of  the  axis  of  the  superior 
strait.  Persist  in  Crede’s  manoeuvre  at 
intervals  for  two  hours,  or  longer  if  necessary, 
unless  there  is  alarming  hemorrhage,  before 
resorting  to  manual  removal  of  the  placenta. 

The  use  of  pituitrin  {q.v.  in  Part  11)  may 
replace  Crede  s manoeuvre  and  produce 
prompt  expulsion  of  the  placenta. 

If  manual  removal  is  demanded,  proceed 
as  follows:  With  one  hand  over  the  fundus, 
insert  the  other  hand,  under  strict  asepsis, 
along  the  cord  as  a guide,  seek  a detached 
edge  of  the  placenta,  under  which  insert  the 
fingers,  and  separate  the  placenta  by  sawing 
with  the  fingers  from  side  to  side.  It  may 
be  necessary  to  “ pinch  through  dense 


ANOREXIA  COMPLICATING  PREGNANCY 


adhesions  with  the  thumb  and  forefinger.” 
After  the  placenta  has  been  detached, 
squeeze  the  uterus  from  the  outside,  and 
allow  the  “ uterine  contractions  to  expel 
the  hand  and  the  contained  placenta,” 
to  avoid  inversion  of  the  uterus  (Hirst). 
Irrigate  the  uterine  cavity  thoroughly  with 
hot  normal  salt  solution  (3i  ad  Oi)  after 
introducing  the  hand. 

If  it  is  unjxjssible  to  detach  the  placenta, 
which  is  extremely  rare,  pack  the  uterus 
with  gauze.  On  removing  the  latter  at 
the  end  of  twenty-four  hours,  the  placenta 
may  come  away.  ( Ahlfeld,  quoted  by  Hir-st) . 

Adynamic  Diseases  Complicating  Labor. 
— Gr.  a priv.  + dwafjus  might.  Employ 
active  stimulation  during  the  first  stage  of 
labor  in  order  to  prevent  shock  (q.v.).  As 
soon  as  the  os  is  dilated  to  the  size  of  a 
silver  dollar,  apply  forceps  (q.v.),  or  perform 
internal  jx)dalic  version  (q.v.),  and  hasten 
dilatation  of  the  cervix  by  occasional 
judicious  traction,  and  extract  the  child  as 
soon  as  the  cervix  is  practically  completely 
tUlated.  Be  very  careful  not  to  tear  the  cer- 
vix by  injudicious  traction  upon  the  child. 

After=Pains,  Severe. — 

Causes.— Precipitate  labor;  overstretching 
of  the  uterine  musculature  due  to  prolonged 
labor,  twins,  or  hydrarnnios;  retention  of 
blood-clots  or  portions  of  the  placenta; 
suckling  infant. 

Treatment.— If  the  uterus  appears,  from  its 
size,  to  contain  much  clotted  blood,  employ 
Crede’s  method  of  expulsion.  Grasp  the 
uterus  with  the  fingers  posteriorly  anti  the 
thumb  anteriorly,  and  knead  and  rub  until 
it  contracts  strongly;  then,  while  it  is  con- 
tracting, squeeze  it  and  press  down  in  the 
direction  of  the  axis  of  the  superior  strait. 
Then  prescribe  fliud  extract  of  ergot,  5ss-i, 
with  tincture  of  opium  trjx,  or  paregoric, 
3ii,  or  morphine,  gi\  with  atrophine, 

gi‘.  50  every  four  to  six  hours,  as  required, 
together  with  very  hot,  frequently  changed, 
wet  compresses  to  the  lower  abdomen. 

As  a rule,  the  after-pains  dinunish  appreci- 
ably after  twenty-four  hours. 

Agalactia. — Gr.  a neg.  -f  ya\a  milk.  See 
Milk  Secretion,  Deficient. 

Age  of  Foetus,  Calculation  of. — ^L.  fae'tus. 
See  Stage  of  Pregnancy. 

Albuminuria;; — Albuiiiin,  from  L.  alb'us, 
white  -|-  Gr.  ovpov  urine.  For  tests,  see 
Urinalysis,  Part  1.  Slight  albuminuria  is 
common  (luring  pregnaiuw,  and  in  itself  is 
of  no  serious  significance.  In  large  amounts 
it  is  an  important  symptom  of  toxajmia  (q.v.). 

Alkalinuria. — See  Part  1,  General  Medi- 
cine and  Surgery. 


Amaurosis  During  Pregnancy. — L.  from 
Gr.  afxavpdeiv  to  darken:  blindness.  See 
Paralyses  Complicating  Pregnancy. 

Amblyopia  During  Pregnancy. — Gr.  ap.- 
0\vs  dulled  -T  wi//  eye:  dimness  of  vision. 
See  Paralyses  Complicating  Pregnancy. 

Amenorrhoea. — Consult  Part  2,  Gynae- 
cology. 

Anaemia  Complicating  Pregnancy  or  the 
Puerperium. — Gr.  av  neg  -p  alpa  blood. 
Associated  symptoms  include  breathlessness, 
dizziness,  imperfect  vision,  arterial  throb- 
bing, perhaps  oedema  of  the  legs,  perhaps 
nervous  manifestations.  (For  blood  tests, 
see  Blood  Examination,  in  Part  1,  General 
Medicine  and  Surgery.) 

The  Prognosis  is  usually  good. 

Treatment. — Rest,  fresh  air  and  sunlight, 
and  a nutritious,  easily  digestible  diet  are 
the  chief  requisites:  fresh  beef  juice,  finely 
minced  meat,  bovinine,  vinsip,  ferroglidine, 
iron  somatose,  blood,  fish,  raw  oysters, 
bone-marrow,  eggs,  milk,  carbohydrates 
(oatmeal  or  wheat  gruel),  vegetables  in 
puree  form  (spinach,  lentils,  beans,  peas, 
asparagus),  apple  sauce,  strawberries.  If 
the  stomach  is  in  good  condition,  and  fever 
and  tuberculosis  are  absent,  iron  may  be 
prescribed.  Arsenic  may  also  be  of  value, 
except  in  nephritis. 

Pil.  ferri  carbonatis  (Blaudii) gr.  v 

Recent.  pra;parat.  pulv.  in  caps..  No.  c. 

Sig. — One  pill  t.i.d.,  p.c.  increased  by  one  pill  each 
week  until  three  or  four  or  five  pills  are  taken  t.i.d. 
(To  prevent  gastric  solution  and  irritation  the  pow- 
der may  be  dispensed  in  gelatine  capsules  hardened 
with  formahn;  Sahli’s  glutoid  capsules,  grade  II 
of  hardness.) 

I^  Liquoris  ferri  et  ammonii  acetatis 

(Mist.  Bashami),  recent,  praeparat.  S viii 

Sig. — One  ounce  t.i.d.,  in  water.  (Used  in  nephri- 
tis because  of  its  diuretic  and  diaphoretic  properties.) 


Fern  albuminatis gr.  x-xxx-pii 

Dent.  tal.  caps.  No.  xx. 

Sig. — One  capsule  t.i.d. p.c. 

I^  Liquoris  potassii  arsenitis o ss 


Sig. — Two  drops,  well  diluted,  t.i.d.p.c.,  gradually 
increased  by  three  to  five  drops  every  five  or  six  days, 
up  to  10  to  15  to  20  to  25  drops  t.i.d.  (Consult  Part 
11,  for  toxic  symptoms;  also  for  other  preparations 
of  iron  and  arsenic.) 

If  the  anremia  is  of  the  pernicious  type, 
and  is  growing  progressively  worse  in  spite 
of  treatment,  induce  premature  labor  (q.v.). 

Anorexia  Complicating  Pregnancy. — Gr. 
av  without  -k  ape^is  appetite.  Regulate 
the  bowels  and  prescribe  a bitter  tonic : 

I^  Tr.  nucis  vomicae ...  5 i (lEX  per  dose) 

Tr.  cinchonre  comp. . 5 xi 

M.  Sig. — Two  teaspoonfuls  t.i.d.  (S.  Theobald.) 


ASEPSIS 


Tinctura3  rhei  aro- 

matici 3iiss  (irifx  per  dose) 

Tinctura)  nucis 

voniicffi o iii-iv  (irj^xii-xvi  per  dose) 

Tinctura)  gentianaj 

composita; 5 iss 

Tincturaj  aurantii 
amara;,  q.s.  ad  . . . 5iv 

M.  Sig. — Two  teasp.  in  water,  shortly  before  meals 
(Modification  of  Huchard’s  formula). 

Tr.  nucis  vomicaj. . . 3v  (njx  per  dose) 

Tr.  gentiana;  comp., 
q.s.  ad giv 

M.  Sig. — A teasp.  in  a quarter  glass  of  water, 
t.i.d.a.c. 

Anteflexion  of  the  Pregnant  Uterus. — L. 

«/de,  before  + flex'io,  bend.  See  Displace- 
ments of  the  Pregnant  Uterus. 

Ante=partum  Hemorrhage. — See  Hemor- 
rhage, Ante-partum. 

Anterior  Fontanelle  Presentations. — L. 

ante,  before;  Fr.  fontanelle,  little  fountain. 
See  Bregma  Presentations. 

Anterior  Parietal  Bone  Presentations. — 
L.  pa'ries,  pi.  parietes,  wall.  See  Ear 
Presentation. 

Anteversion  of  the  Pregnant  Uterus. — 

L.  ar'de,  before  4-  ver'sio,  a turning.  See 
Displacements  of  the  Pregnant  Uterus. 

Anuria. — Gr.  av  neg.  -|-  ovpov  urine.  See 
the  Toxaiinias. 

Aphasia. — Gr.  a priv.  -f-  4>aaLs  speech. 
See  Paralyses  Gomi)licating  Pregnancy. 

Appendicitis  Complicating  Pregnancy. — 
L.  appendix,  from  append'ere,  to  hang  upon 
-|-  Gr.  -tTts  inflammation.  Treat  the 
condition  according  to  indications,  irre- 
spective of  the  existence  of  pregnancy  (see 
Appendicitis,  in  Part  1,  General  Medicine 
and  Surgery). 

Armamentarium. — L.  See  the  Appendix, 
following  Part  4. 

Arm,  Backward  Displacement  of  an.— This 
condition  interferes  with  delivery  and  is  diag- 
nosed by  passing  the  hand  above  the  head. 

Treatment. — In  cephalic  presentations,  if 
the  arm  can  not  be  replaced  manually, 
try  to  deliver  the  child  by  moderate  traction 
with  forceps.  If  this  is  impracticable,  per- 
form mternal  podalic  version  (q.v.) 

In  breech  presentations,  bring  down  the 
non-displaced  arm  and  attach  a sling  to  it; 
then  by  traction  upon  this  arm  and  rotation 
of  the  trunk  it  may  be  possible  partially  to 
disengage  the  displaced  arm;  then  with  the 
whole  hand  in  the  pelvis,  replace  the  arm 
completely.  In  breech  presentations,  of 
course,  the  child  should  be  extracted  as 
expeditiously  as  possible  to  prevent 
its  asphyxiation,  and  to  this  end  it  may 
be  necessary  deliberately  to  fracture  the 
arm.  (Edgar.) 

33 


Arm,  Displacement,  Dorsal,  of  an. — L. 

dor' sum,  back.  (See  Arm,  Backward 
Displacement  of  an,  above.) 

Dorsal  Displacement  of  an. — (See  Arm, 
Backward  Displacement  of  an, 
above.) 

Prolapse  of  an. — L.  pro,  before  -t- 
la'bi,  to  fall. 

Etiology. — Pelvic  contraction ; shoulder, 
brow,  or  face  presentations;  pendulous 
abdomen;  premature  foetus;  dead  foetus; 
tumor;  hydramnios;  twins;  “ rupture  of  the 
membranes  in  the  sitting  or  standing  pos- 
ture, especially  in  multipara)”;  “sudden 
exertion  on  the  part  of  the  mother  during  or 
even  after  engagement.”  (Edgar.) 

Treatment.— It  requires  correction  only 
in  cephalic  presentations,  not  in  shoulder 
or  breech  presentations,  in  which  it  is  “a 
rather  favorable  condition.”  (Edgar.) 

If  the  prolapse  is  observed  when  the  head 
is  not  yet  engaged,  postural  reposition  may 
be  attempted  by  placing  the  patient  in  the 
Trendelenberg  or  knee-chest  position;  but 
manual  reposition  will  probably  be  required. 
If  the  latter  fails,  one  may  resort  to  version 
and  extraction  (see  Podalic  Version). 

If  the  head  is  already  engaged,  leave  the 
case  to  nature,  and  if  labor  is  delayed,  apply 
forceps  and  extract  the  head,  while  moderate 
traction  with  a sling  is  made  upon  the  arm. 

In  shoulder  and  breech  presentations, 
secure  the  prolapsed  arms  with  a sling,  to 
prevent  their  extension  and  the  consequent 
danger  of  impaction  of  the  after-coming 
head.  (Edgar.) 

Artificial  Infant  Feeding. — L.  ars,  art  -\- 
fa'cere,  to  make.  See  Infant  Feed- 
ing, in  Part  1,  General  Medicine 
and  Surgery. 

Respiratio n. — L.  respira'iio.  See 
Asphyxia  Neonatorum. 

Asepsis. — Gr.  a priv.  4-  crrjxpLs  decay.  The 
strictest  asepsis  should  be  observed  in  all 
intra-vaginal  manipulations.  The  vulval 
hair  should  be  cut  short  with  scissors, 
or  better,  shaved  off  by  means  of  a safety 
razor.  The  external  genitalia  and  neigh- 
boring skin  should  be  cleansed  thoroughly 
with  castile  or  green  soap  and  hot 
water,  rinsed,  and  douched  with  bichloride 
solution,  1 : 2000. 

The  vagina  should  be  thoroughly  cleansed 
with  soap  and  hot  water  and  rinsed,  followed 
by  bichloride  solution,  1 : 4000,  or  hot  water. 

The  finger  nails  should  be  cut,  and  the 
hands  scrubbed  with  brush,  soap,  and  hot 
water,  and  soaked  in  hot  bichloride,  1 : 1000, 
both  before  and  after  cleansing  the  patient. 
Rubber  gloves  are  best  worn. 


ATRESIA  OF  THE  VAGINA  AND  VULVA  CAUSING  DYSTOCIA 


Then  the  lower  limbs  and  abdomen  are 
covered  with  sterile  sheets,  exposing  only 
the  vulva.  Where  only  an  examination  is 
to  be  made,  the  sterile  sheets,  are  of  course, 
unnecessary.  The  examining  fingers 
may  be  anointed  with  soft  vaseline  that  has 
been  boiled  in  a tin  salve-box  on  the 
kitchen  stove. 

Asphyxia  Neonatorum. — Gr.  a priv. 

<7<pv^Ls  pulse;  vkos  new  + L.  na'tus,  born. 

Etiology. — Maternal  convulsions ; hemor- 
rhage; prolonged  second  stage  of  labor; 
tetanic  contraction  of  the  uterus;  the  use  of 
ergot  in  the  second  stage;  grave  systemic 
disease  in  the  mother;  death  of  the  mother; 
compression  of  the  cord;  sj^^hilitic  peri- 
phlebitis of  the  cord;  multiple  coils  of  cord 
about  the  neck;  premature  separation  of 
the  placenta;  birth  with  unruptured  mem- 
branes; precipitate  labor;  prenatal  respira- 
tion ; brain  c o m j)  r e s s i o n ; congenital 
resph’atory,  circulatory,  or  bram  malfor- 
mation or  cUsease;  laying  the  infant  in  an 
improper  position. 

Cerebral  hemorrhage  {q.v.)  is  diagnosed  by 
the  presence  of  a bulgmg  fontanelle,  coma, 
and  possibly  paralysis. 

The  signs  of  intra-uterine  asphyxia  are 
the  escape  of  meconium  in  vertex  presenta- 
tions, and  a fetal  pulse  rate  below  100  or 
above  160. 

Treatment.— See  Asphyxia,  in  Part  1,  Gen- 
eral Mechcine  and  Surgery. 

Asthma  Complicating  Pregnancy. — Gr. 
aadiia  panting.  Consult  Asthma  in  Part  1, 
General  Medicine  and  Surgery. 

If  the  dyspnoea  is  extreme,  pregnancy 
may  have  to  be  terminated  (see  Premature 
Labor,  Induction  of). 

Atelectasis  in  Infants. — See  Part  1,  Gen- 
eral Medicine  and  Surgery. 

Atony  of  the  Uterus. — Gr.  a priv.  -f  tovos 
tone.  See  Inertia  Uteri. 

Atresia  of  the  Cervix  Causing  Dystocia. — 
Gr.  a neg.  -f-  a boring;  L.  cer'vix, 

neck;  Gr.  dvs-  ill  -f-  tokos  bu’th. 

A.  Imperforate  Os.— Perforate  the  cervix 
during  labor,  at  the  site  of  the  external  os, 
with  the  finger  or  uterine  sound,  or  make 
crucial  incisions.  Dilatation  then  usually 
proceeds  rapidly.  Bleeding  points  may  be 
closed  by  suture  after  labor. 

B.  Cervical  Stricture.— CAUSES. — Pressure 
necrosis  and  sloughing  from  a previous  labor; 
action  of  caustics;  inflammation  from  an 
ill-fitting  pessaiy;  ulceration  or  pressure  in 
cancer;  ulceration  in  scarlet  fever,  smallpox, 
diphtheria,  sypliilis,  gonorrhoea,  etc.;  “too 
tight  closure  in  the  operation  for  cervical 
laceration  myoma. 


Tre.vtment. — Dilatation  usually  pro- 
gresses well  enough  and  may  be  aided,  if 
need  be,  by  means  of  hydrostatic  dilators 
(see  Premature  Labor,  Induction  of).  In 
some  instances  it  may  lie  necessary  to  make 
radiating  incisions  with  scissors  or  a probe- 
pointed  bistomy,  or  even  to  perform 
Cffisarian  section  (q.v.). 

C.  Cervical  Rigidity.  I.  Functional  or  Spastic 
Rigidity. — CAUSES. — ^Primiparity  in  elderly 
women;  painful  uterine  contractions;  dry 
labor,  due  to  premature  rupture  of  the  mem- 
branes; difficult  labor;  pre-existing  cervicitis; 
distended  bladder;  distended  rectum. 

Treatment. — •Administer  nerve  seda- 
tives in  order  to  relax  the  muscular  spasm, 
e.g.,  chloral  hydrate,  gr.  xv-xx,  well  diluted, 
per  rectum,  repeated  every  twenty  minutes, 
up  to  maximum  of  50  grains;  morphine,  gr. 
34;  cocaine,  10  per  cent,  solution,  applied  to 
the  cervix  for  a few  minutes;  copious  warm 
douches  directed  against  the  cervix  every 
fifteen  minutes;  chloroform  or  ether  inhala- 
tions. If  these  fail,  resort  to  manual,  bi- 
manual, instrumental,  or  hydrostatic  dilata- 
tion, and  finally,  incisions  (see  Premature 
Labor,  Induction  of). 

II.  Organic  Rigidity. — 'CAUSES. — 'Congenital 
elongation  of  the  ceiwix;  cervicitis  and  en  do- 
cervicitis;  cervical  hypertrophy;  cervical 
adhesions;  cervical  deviations;  anterior, 
posterior,  or  lateral  tumors. 

Treatment. — If  dilatation  shows  no  prog- 
ress after  the  administration  of  sedatives, 
insert  the  finger,  and  if  the  os  is  deviated 
from  its  usual  position,  hook  a finger  into 
it  during  a pain  and  try  to  draw  the  ceiwix 
into  its  proper  position.  If  adhesions  are 
found  to  exist  between  the  cervix  and  mem- 
branes, detach  them,  and  failing  in  this, 
puncture  the  membranes.  If  other  measures 
fail,  resort  to  manual,  bunanual,  instru- 
mental, or  hydrostatic  dilatation,  and  finally, 
incisions  (see  Premature  Labor,  Induction  of) . 

Atresia  of  the  Vagina  and  Vulva  Causing 
Dystocia. — Gr.  a neg.  rp-ga-Ls  a boring; 
L.  vagina,  sheath;  vul'va,  \nilva;  Gr.  dvs- 
ill  -f-  TOKOS  birth. 

Causes.— Unruptured  hjTnen;  congenital 
narrowing;  vaginismus;  vaginal  septa;  cica- 
ti'icial  adhesions;  tumors  (fibroma,  fibro- 
myoma,  cysts,  sarcoma,  carcinoma);  h$ma- 
toma;  abscess  of  Bartholin’s  gland. 

Treatment.— Incise  an  unruptured  hymen. 
In  congenital  narroMng  of  the  vagina  and 
vuilva,  Itydrostatic  dilators  (see  under  Pre- 
mature Labor,  Induction  of),  may  be  useful; 
multiple  incisions  are  rarely  required.  For 
vaginismus  or  muscular  spasm,  employ 
sedatives  (see  under  Atresia  of  the  Cervix). 


BREECH  PRESENTATIONS 


Divide  unyielding  longitudinal  or  transverse 
septa;  they  show  little  tendency  to  bleed. 
Stretch  adhesions  with  the  hand  or  with 
instrumental  or  hydrostatic  dilators,  or  make 
multiple  incisions;  extract  the  child  with 
forceps;  Caesarian  section  may  be  required. 
Incise  and  evacuate  cysts  (or  snip  off  the 
superficial  portion  of  the  sac  with  scissors 
and  touch  the  base  with  pure  carbolic  acid). 
Incise  and  evacuate  haematomata,  and  check 
hemorrhage  by  packing  with  gauze;  the 
excision  of  growths  is  apt  to  be  attended 
by  severe  hemorrhage;  Caesarian  section 
may  be  required.  Incise  a vulvar  abscess 
early  in  the  first  stage  of  labor,  curette, 
swab  with  carbolic  acid,  and  pack  with 
iodoform  gauze. 

Atresia  of  the  Vulva  Causing  Dystocia. — 

See  Atresia  of  the  Vagina  and  Vulva  caus- 
ing Dystocia. 

Atrophy  of  the  Liver,  Acute  Yellow. — 

See  Acute  Yellow  Atrophy  of  the  Liver, 
in  Part  1. 

Baby,  Care  of  the. — See  under  Manage- 
ment of  the  Puerperium. 

Diet  of  the.  — See  Infant  Feeding, 
in  Part  1. 

Diseases  of  the  New=Born. — See  Dis- 
eases of  the  New-Born  Infant. 

Dress  of  the. — See  under  Management 
of  the  Puerperium. 

Feeding  of  the. — See  Infant  Feeding, 
in  Part  1. 

Giant. — See  Child,  Large. 

Large. — See  Child,  Lai’ge. 

Baby’s  Outfit. — See  under  Management 
of  Pregnancy. 

Backward  Displacement  of  an  Arm. — 

See  Arm,  Backward  Displacement 
of  an. 

of  the  Uterus. — See  Displacements  of 
the  Uterus. 

Bags,  Dilating. — See  under  Premature 
Labor,  Induction  of. 

Bartholinitis.  — See  Vulvitis,  in  Pa,rt 
2,  Gynaecology. 

Belching,  Acid. — See  Dyspepsia  Compli- 
cating Pregnancy. 

Binder,  Breast. — See  under  Caked  Breasts. 

Bipolar  Version  of  Braxton  Hicks. — See 
Cephahc  Version. 

Birth  Palsies. — See  Part  1,  General  Medi- 
cine and  Surgery. 

Bladder=Calculus. — L.  calculus,  pebble. 
If  the  stone  is  large,  remove  it  per  urethram 
or  per  vaginam  during  the  last  month  of 
pregnancy  (see  Vesical  Calculus  and  Foreign 
Bodies,  in  Gynaecology,  Part  2). 

Bladder  Irritability. — L.  irrit'are,  to  tease. 
The  frequency  of  micturition  or  inconti- 


nence which  occurs  during  the  early  months 
of  pregnancy  and  is  due  to  pressure  from 
the  enlarging  uterus,  is  relieved  by  the 
middle  of  the  fourth  month,  but  reappears 
by  the  end  of  the  seventh  month,  due  then 
to  the  weight  of  the  foetus.  In  the  latter 
instance  it  is  usually  relieved  by  an  abdomi- 
nal supporter.  Rest  upon  the  back  and  the 
knee-chest  posture  should  also  afford  relief. 
Any  abnormality  of  position  or  presenta- 
tion of  the  foetus  or  uterine  displacement 
should  be  corrected.  (Consult  Bladder 
Irritability,  in  Part  2,  Gynjecology,  for 
other  causes.) 

Bladder=Stone. — See  Bladder  Calcu- 
lus, above. 

Bleeding. — See  Hemorrhage. 

Blindness. — See  Paralyses  complicat- 
ing Pregnancy. 

Blood=Pressure. — ^See  Part  1,  General 
Medicine  and  Surgery. 

Blood  Transfusion. — See  Part  1,  General 
Medicine  and  Surgery. 

Brain  Hemorrhage  in  the  New=Born. — 
See  Intracranial  Hemorrhage  in  the  New- 
Born,  in  Part  1. 

Braxton  Hicks  Bipolar  Version.  — See 

Cephalic  Version. 

Breast  Abscess. — L.  abscessus,  a going 
apart.  See  Mastitis. 

Binder. — See  under  Caked  Breasts. 

Breast,  Caked. — See  Caked  Breasts. 

Breasts,  Care  of  the. — ^See  under  Manage- 
ment of  Pregnancy. 

Drying  up  the. — See  under  Management 
of  the  Puerperium. 

Engorgement  of  the.  — See  Caked 
Breasts. 

Infection  of  the. — See  Mastitis. 

Inflammation  of  the. — See  Mastitis. 

Breech  Presentations. — L.  proesenta'tio. 

Frequency. — About  1.3  per  cent,  of  mature 
births,  and  3.0-t-per  cent,  of  unmatiu-e  births. 

Varieties,  in  order  of  frequency. — L.S.A. ; 
L.S.P.;  R.S.A.;  R.S.P. 

Etiology.— Flaccid  uterine  and  abdominal 
walls;  lower  uterine  segment  larger  than  the 
upper;  uterine  malformation  or  deformity 
(uterus  arcuatus,  bicornis,  etc.;  fibroids); 
contracted  pelvis;  foetal  monstrosities;  dead 
foetus;  small  child;  twins;  abnormal  mobility 
of  the  uterus  or  foetus;  large  head;  hydro- 
cephalus; hydramnios;  placenta  praevia. 

The  foetal  mortality  is  high. 

Treatment. — If  the  condition  is  observed 
before  the  onset  of  labor,  and  there  is  no 
marked  disproportion  between  the  size  of 
the  child  and  the  pelvis,  attempt  external 
version  (see  Cephalic  Version),  followed 
by  the  application  of  an  abdominal  binder 


BROW  PRESENTATIONS 


over  two  long  cylindrical  compresses  of 
gauze  placed  at  the  sides  of  the  uterus,  to 
prevent  reversion. 

Version  is  more  apt  to  be  successful,  how- 
ever, if  performed  at  the  beginning  of  labor 
and  the  fcetus  held  in  place  manually  until 
engagement  occurs. 

If  firm  engagement  has  already  occurred 
when  the  case  is  first  seen,  one  may  resort 
to  the  combined  external  and  internal  or 
bipolar  method  of  version  of  Braxton  Hicks 
(see  Cephalic  Version),  as  soon  as  the  cervix 
will  admit  two  fingers. 

In  uncorrected,  breech  presentations,  aim 
to  prolong  the  first  stage  of  labor  and  to 
prevent  the  rupture  of  the  membranes  (in 
order  to  secure  full  dilatation  of  the  cervix) , 
by  keeping  the  patient  quiet  in  the  re- 
cumbent posture,  tUscouraging  voluntary 
abdominal  action,  and  by  the  use  of  chloro- 
form, if  necessary.  Have  everything  ready 
to  resuscitate  an  asphyxiated  child 
(see  Asphjoda). 

As  soon  as  the  breech  appears,  have  an 
a.ssistant  exert  firm  downward  pressure  upon 
the  fundus,  in  order  to  preserve  head  flexion 
and  to  prevent  extension  of  the  arms.  Do 
not  interfere  until  the  umbilicus  appears, 
even  though  a foot  prolapses  and  appears 
at  the  vidva  and  tempts  one  to  extract, 
unless,  of  course,  the  foetal  heart  is  slower 
than  100  or  faster  than  IGO,  or  the  cord 
prolapses,  or  the  mother  is  not  doing  well. 
Hasty  extraction  may  cause  extension  of 
the  head  and  arms  and  laceration  of  the 
cervix. 

When  the  umbilicus  appears,  drawn  down 
the  cord  for  a few  inches,  place  it  to  the 
rear,  opposite  a sacro-iliac  joint,  if  possible, 
and  constantly  note  the  pulsation  in  it. 
Wrap  the  child’s  body  hi  a hot  towel 
(100°  F.)  to  prevent  the  cold  air  from 
stimulating  resphation.  As  the  chin  appears, 
elevate  the  trunk  and  urge  the  woman  to 
bear  down,  while  suprapubic  pressure  is 
exerted  by  the  assistant.  If  the  head  does 
not  come  readily,  employ  the  index  finger 
in  the  mouth  to  flex  and  extract  the  head. 
Rotate  the  chin  posteriorly  if  the  head  lies 
transversely  at  the  pelvic  outlet.  (In  the 
exceptional  cases  of  backward  rotation  of  the 
occiput,  carry  the  body  of  the  child  down- 
ward if  the  head  is  flexed;  upward  over  the 
mother’s  abdomen  if  the  head  is  extended). 
If  the  arms  are  extended  above  the  head, 
bring  them  down  immediately  by  flexing 
them  at  the  elbow,  usually  the  posterior 
arm  first.  If  necessary,  forceps  may  be  used 
for  the  after-coming  head,  the  body  of  the 
child  being  elevatetl  toward  the  mother’s 


abdomen.  The  head  should  be  born  in  less 
than  eight  minutes  after  the  umbilicus. 

If  it  is  advisable  to  assist  or  to  hasten 
labor,  one  may  employ  forceps,  applied 
obliquely,  one  blade  over  the  sacrum  and 
the  other  over  the  thigh;  or  a foot  may  be 
brought  down  by  Pinard’s  manoeuvre,  as 
follows:  Pass  the  fingers  up  the  thigh  to 
the  under  surface  of  the  knee  and  push  the 
latter  away  from  the  middle  line  of  the 
child’s  body;  this  will  produce  flexion  of  the 
leg,  whereby  the  foot  can  be  grasped  and 
brought  down.  A fillet  placed  about  the 
ankle,  as  shown  in  Fig.  92,  may  be  of  assist- 
ance in  extracting  the  foot. 


Fig.  — 92  A fillet  placed  abofit  the  ankle. 

The  fillet  or  the  blunt  hook.  Fig.  93,  is 
somethnes  of  use  in  breech  extractions.  The 
fillet  is  passed  around  the  anterior  groin  or 
hip  by  means  of  Olivier’s  fillet-carrier  or  a 
flexible  catheter  containing  a flexible  stylet. 




^ 

Fig.  93. — Blunt  hook. 

Bregma  Presentations. — L.;  Gr.  /Speyga; 
L.  proesenta'iio.  Presentation  of  the  anterior 
or  greater  fontanelle,  due  to  imcomplete 
flexion  of  the  head,  diagnosed  by  vaginal 
palpation  which  reveals  the  bregma  as 
the  most  prominent  part  of  the  foetus  pre- 
senting. It  is  very  rare,  saj's  Hirst;  common, 
says  Edgar. 

The  causes  are  the  same  as  for  brow  and 
face  presentations. 

Treatment.— Convert,  into  a vertex  presen- 
tation by  pulling  down  the  occiput  with  the 
Angers  or  pushing  up  the  brow,  during  a 
uterine  contraction,  while  pressure  is  made 
from  above. 

If  uncorrected  it  causes  tedious  labor  and 
perineal  tears. 

Brow  Presentations. — 

Frequency.— About  0.25  per  cent.  The 
diagnosis  is  made  by  digital  examination. 

It  is  the  most  unfavorable  of  all  presenta- 
tions for  both  mother  and  child,  due  to  the 


CiESARlAN  SECTION,  ABDOMINAL 


prolongation  of  labor,  the  occurrence  of  tears, 
and  moulding  of  the  head.  If  the  chin  is 
posterior,  spontaneous  birth  is  impossible. 

The  Causes  are  the  same  as  for  face 
presentations. 

Treatment.— If  the  head  is  not  deeply 
engaged  or  impacted,  try  to  substitute  a 
vertex  presentation  in  the  following  manner: 
With  one  hand  over  the  fundus  attempting 
to  flex  the  child’s  body,  introduce  the  other 
hand  into  the  vagina  and  uterus,  and  attempt 
to  push  the  brow  up  and  pull  the  occiput 
down.  If  this  cannot  be  done,  perform 
internal  podalic  version  iq.v.),  unless  con- 
traindicated by  draining  off  of  the  liquor 
amnii,  impaction,  tetanic  contraction  of 
the  uterus,  or  dangerous  thinning  of  the 
lower  uterine  segment. 

If  the  head  is  impacted,  and  the  chin 
anterior,  forceps  {q.v.)  may  succeed,  but  are 
reputed  to  be  dangerous.  Forceps  should 
never  be  employed  when  the  chin  is  posterior. 

Measures  of  last  resort  include  pubiotomy 
iq.v.),  if  the  child  is  alive,  and  craniotomy 
(g.i;.)  if  it  is  dead. 

Byrd’s  Method  of  Artificial  Respiration. — 
See  Asphyxia  Neonatorum. 

Caesarian  Section,  Abdominal. — ^L.  sec'- 
tio  ccesarea. 

Indications.— Insuperable  obstacles  to  the 
birth  of  the  child  per  vaginam,  e.g.,  a 
markedly  contracted  pelvis,  uterine  fibroids, 
ovarian  and  pelvic  tumors,  cervical  or 
vaginal  atresia,  malignant  growths,  etc. ; 
also  previous  Caesarean  section;  perhaps 
also  placenta  praevia,  premature  separation 
of  the  placenta,  senile  uterus,  rigid  birth 
passage  in  elderly  primiparae,  eclampsia, 
pernicious  vomiting  of  pregnancy,  broken 
cardiac  compensation,  pulmonary  oedema. 

Contraindications. — Child  dead  or  dying; 
infection  evidently  or  probably  present 
(if  Caesarean  section  is  necessary  in  the  pres- 
ence of  infection,  remove  the  entire  uterus 
including  the  cervix.) 

A.  Technique  of  the  Classical  Intra- 
Peritoneal  Cesarean  Section.— Empty 
the  bowels  and  bladder,  the  latter  by  cathe- 
terization, and  shave  and  cleanse  the  vulva 
and  vagina  thoroughly  with  soap  and  water, 
followed  by  bichloride  solution,  1 : 4000, 
or  alcohol.  Swab  the  abdomen  with 
tincture  of  iodine.  Administer  ergotole, 
njxl,  hypodermically. 

Make  an  incision  through  skin,  sub- 
cutaneous fat,  linea  alba,  preperitoneal  fat, 
and  peritoneum,  about  seven  inches  long, 
“ about  two-thirds  below  and  one-thinl 
above  the  umbilicus,”  and  to  the  left  of 
the  latter  (Williams),  or  from  just  below 


the  umbilicus  to  two  inches  above  the  pubis 
(Chandler),  thus  avoiding  the  bladder. 
Some  deliver  the  uterus  through  the  abdo- 
minal incision,  then  clamp  the  edges  of  the 
latter  together  behind  the  cervix  and  cover 
with  a towel  in  order  to  prevent  contamina- 
tion of  the  abdominal  cavity.  Others  do 
not  deliver  the  uterus,  but  wall  off  the  intes- 
tines with  gauze.  The  uterus  is  opened  by 
a median  longitudinal  incision,  made  small 
at  first  with  a scalpel,  and  enlarged  with 
scissors  to  about  seven  inches,  extending 
down  to  the  peritoneal  reflexion  of  the 
bladder.  The  placenta  is  cut  through  if 
necessary.  The  membranes  are  ruptured, 
and  the  child  extracted  by  the  anterior  foot. 
If  the  uterus  has  been  allowed  to  remain 
within  the  abdomen,  it  should  be  seized 
with  volsellum  forceps  by  an  assistant,  and 
brought  up  into  the  abdominal  wound,  as 
the  child  is  delivered,  in  order  to  jirevent 
the  escape  of  blood  and  liquor  amnii 
into  the  peritoneal  cavity.  The  cord  is  cut 
between  clamps,  and  all  traces  of  placenta 
and  membranes  are  peeled  off  the  interior 
of  the  uterus.  The  latter  may  be  exposed 
to  view  with  small  retractors.  Close  the 
uterine  wound  accurately  by  buried  layers 
of  interrupted  ckromicized  catgut  sutures 
extending  down  to,  but  not  through  the 
endometrium,  and  above  this  a “ running 
sero-muscular  stitch  of  linen  placed  close  to 
the  edge  and  invaginating  the  sero.sa.” 
Sponge  out  all  blood,  etc.,  from  the  peri- 
toneal cavity,  and  close  the  abdominal  wound 
in  layers. 

If  the  cervix  had  not  been  cUlated, 
do  this  now,  to  insure  free  drainage  from 
the  uterus. 

B.  Technique  of  the  Kronig  Trans- 

PERITONEAL  C.ESAREAN  SECTION. With  the 

patient  in  a high  Trendelenburg  position, 
make  a mecUan  incision  from  the  pubis  to 
within  two  inches  of  the  navel.  Open  the 
peritoneum,  with  care  to  avoid  the  bladder, 
which  may  be  very  high.  Locate  the  peri- 
toneal line  of  junction  with  the  bladder, 
lift  it  up  with  forceps,  and  make  a short 
transverse  incision  in  the  peritoneum  similar 
to  that  for  amputation  of  the  uterus.  Now 
push  off  the  peritoneum  and  bladder  from 
the  anterior  wall  of  the  uterus,  well  down 
toward  the  external  os,  uncovering  the  mus- 
cle of  the  lower  uterine  segment  for  a space 
large  enough  to  make  a 4)^  inch  incision. 
Carefully  incise  the  thin  lower  segment. 
Pull  the  face  into  the  opening,  and  deliver 
the  head  with  forceps.  After  delivering 
the  child,  express  the  placenta,  clean  out  the 
uterus,  pack  the  latter,  if  need  be,  and  care- 


CARDIAC  DISEASE  COMPLICATING  PREGNANCY  AND  LABOR 


fully  coapt  the  incision  by  two  rows  of 
sutures  closely  set.  Then  draw  up  the 
peritoneiun  and  bladder  over  the  line  of 
sutures  and  unite. 

Gellhorn  unites  the  parietal  to  the  visceral 
peritoneum,  temporarily,  with  a continuous 
suture,  before  incising  the  uterus. 

C.  Technique  of  the  Latzko  Extra- 
peritoneal  CESAREAN  Section. — The 

abdominal  incision  may  be  either  a median 
or  a transverse  one,  just  above  the  pubis. 
If  a median  incision  is  employed,  it  should 
begin  one  or  two  cm.  above  the  symphysis 
and  extend  upward  to  about  six  cm.  below 
the  mnbilicus.  It  is  advisable  to  fill  the 
bladder  with  about  200  c.c.  of  sterile  boric 
acid  solution.  The  muscles  and  prevesical 
tissue  are  separated  by  blunt  dissection  with 
the  finger,  gauze  pads,  and  scissors,  the  left 
margin  of  the  bladder  is  reached,  and  the 
bladder  is  then  emptied  and  separated  by 
blunt  dissection  toward  the  median  line, 
exposing  the  uterine  muscle.  Take  care 
not  to  mistake  the  bladder  for  the  peritoneal 
fold.  Push  the  latter  upward  toward  the 
navel.  With  the  bladder  retracted  toward 
the  right,  the  cervix  and  lower  uterine 
segment  are  incised,  a finger  is  introduced 
into  the  mouth  of  the  child  to  rotate  the 
head,  and  delivery  is  accomplished  with 
short  forceps.  The  placenta  is  extracted 
manually,  the  uterine  incision  closed  by 
means  of  a continuous  suture,  the  bladder 
is  replaced,  and  the  abdominal  wound  closed. 

Ceesarean  Section,  Vaginal. — See  under 
Premature  Labor,  Induction. 

Caked  Breasts.^ — J.  W.  Williams  well 
recommends  firm  compression  of  the 
breasts  by  means  of  a tight  binder,  which 
usually  relieves  the  condition  in  twenty- 
four  hours.  If  not,  employ  digital  massage 
toward  the  nipple  through  a hot  moist 
flannel,  or  the  breast-pump,  followed  by 
reapplication  of  the  binder.  Saline  cathar- 
tics (see  Part  11)  may  be  useful  together  with 
the  restriction  of  liquids.  Codeine,  gr.  }4, 
repeated  in  three  hours,  if  necessaiy,  may 
be  administered  for  distressing  pain. 

Calculus,  Vesical. — L.  calc'ulus,  pebble; 
vesic'a,  bladder.  See  Bladder  Calculus. 

Cancer  of  the  Cervix  Complicating  Preg= 
nancy. — L.  cancer,  Gr.  Kapdvos  crab ; -upa 
tumor;  L.  cer'vix,  neck.  If  discovered  in 
the  fir.st  four  months,  and  if  operable,  i.e., 
if  it  has  not  extended  beyond  the  cervix, 
perform  complete  hysterectomy  (see  Cancer 
of  the  Uterus,  in  Part  2,  Gjma'cology).  If 
inoperable,  allow  pregnancy  to  go  on  to  term, 
and  if  the  child  can  not  be  delivered  per 
vaginam,  perform  Cresarean  section  {q.v.). 


In  the  later  months,  in  operable  cases, 
perform  complete  hysterectomy,  and  do 
not  open  the  uterus  until  after  it  has  been 
removed. 

Cancer  of  the  Vagina  and  Vulva  Compli= 
eating  Pregnancy. — Radical  removal  is,  of 
course,  indicated,  if  possible.  Inoperable 
cases  may  require  Csesarean  section  {q.v.) 
at  term. 

Cardiac  Disease  Complicating  Pregnancy 
and  Labor. — Gr.  Kap5La  heart. 

A.  Palpitations. — “Irregular  or  forcible  action 
of  the  heart  perceptible  to  the  individual  ” 
(Osier)  is  usually  produced  by  extra-sys- 
toles, the  result  of  central,  local,  or  reflex 
nervous  excitation,  and  is  not  serious  if 
unassociated  with  organic  heart  disease. 

Etiology  and  Treatment. — (See  Palpi- 
pation,  in  Part  1,  General  Medicine  and 
Surgery. 

B.  Valvular  Heart  Disease. — This  is  serious; 
abortion  often  occurs,  and  the  stress  of 
labor  is  ill  borne. 

Enjoin  mental  and  physical  quiet,  very 
moderate  exercise  in  the  open  air,  free  bowel 
activity  (employing,  if  necessary,  a mild 
laxative,  such  as  compound  licorice  powder, 
or  aromatic  cascara  sagrada,  or  compound 
laxative  pill,  see  Part  11),  regular  hours 
of  eating  and  sleeping,  at  least  ten  or  eleven 
hours  of  sleep  at  night,  fresh  air  day  and 
night,  a daily  tepid  bath  of  about  ten  or 
fifteen  minutes’  duration,  and  a fair  abund- 
ance of  shnple,  bland,  and  nourisliing  food, 
such  as  milk,  buttermilk,  eggs,  raw  or 
boiled  three  minutes,  stale  bread  and  fresh 
butter,  well-cooked  farinaceous  gruels,  pota- 
toes in  moderation,  fresh  vegetables,  meat, 
and  stewed  fmits,  if  the  patient  is  feeble; 
and  a restricted  diet,  especially  as  to  carbo- 
hych-ates,  if  the  patient  is  stout.  Foods  that 
are  likely  to  cause  flatulency  should  be 
forbidden,  e.g.,  cabbage,  peas,  beans,  lentils, 
sourkrout,  starchy  foods,  such  as  potatoes 
in  excess,  and  aerated  beverages.  Meat 
extractives,  liver,  kidney,  sweetbreads,  raw 
and  smoked  meats,  condiments,  spices,  tea, 
and  coffee,  should  also  be  avoided.  They 
irritate  the  heart  and  raise  the  blood 
jiressure.  The  patient  should  rest  for  one 
hour  before  and  after  meals. 

Give  digitalis  (see  Part  11)  and  strych- 
nine on  the  first  appearance  of  inadequate 
compensation  (consult  Cardiac  Insufficiency, 
in  Part  1,  General  Medicine  and  Surgery). 

In  the  presence  of  inadequate  compensa- 
tion, do  not  allow  pregnancy  to  continue 
longer  than  the  thirty-sLxth  week.  Then 
induce  labor  (see  Labor,  Premature,  Induc- 
tion of)  or  perform  Caesarean  section  (g.y.). 


CHILD,  LARGE 


Abortion  should  be  induced  sooner  (see 
Abortion,  Induction  of)  should  the  symp- 
toms become  grave. 

During  labor,  use  ether  instead  of  chloro- 
form and  give  strychnine  or  digitalin 
hypodermically  in  adequate  doses.  Hasten 
dilatation  of  the  cervix  manually.  As  soon 
as  the  os  is  dilated  to  the  size  of  a silver 
dollar,  forceps  may  be  applied,  or  a leg 
brought  down,  and  dilatation  hastened  by 
judicious,  gentle  traction  at  intervals,  wait- 
ing until  the  cervix  is  practically  completely 
dilated  before  extracting  the  child.  Mode- 
rate bleeding  during  the  tliird  stage  may  be 
beneficial.  Ergot,  one  should  remember, 
is  a cardiac  depressant. 

Care  of  the  Child. — See  under  Puer- 
perium.  Management  of  the. 

Mother. — See  Puerperium,  Manage- 
ment of  the. 

Pregnant  Woman.  — See  Pregnancy, 
Management  of. 

Puerperal  Woman. — -See  Puerperium, 
Management  of  the. 

Caries,  Dental. — See  Dental  Caries. 

Pelvic. — L.  car'ies,  rottenness;  pelv'is, 
basin.  See  under  Contracted  Pelvis. 

Cellulitis,  Pelvic. — L.  cell'ula,  irdnute  cell 
-p  Gr.  -LTLs  inflammation;  L.  pelv'is,  basin. 
See  Puerperal  Infection. 

Cephalhaematoma. — See  Part  1,  General 
Medicine  and  Surgery. 

Cephalic  Version. — Gr.  Ke</>aXi)  head;  L. 
ver'sio,  turning.  The  manual  turning  of 
the  foetus  so  as  to  make  the  head  present. 

Indications. — Breech  and  transverse  pres- 
entations. 

Contraindications.— Marked  pelvic  contrac- 
tion; escape  of  the  liquor  amnii. 

Technique.— A.  External  Version. — The 
child  is  turned  by  gently  stroking  the  fetal 
poles,  one  toward  the  pelvis  and  the  other 
in  the  opposite  direction.  Then  an  abdom- 
inal binder  is  applied  over  two  long  cylin- 
drical compresses  of  gauze  placed  at  the 
sides  of  the  uterus  to  prevent  reversion. 

Version  is  more  apt  to  be  successful  if 
performed  at  the  beginning  of  labor,  and 
the  foetus  held  in  place  manually  until 
engagement  occurs. 

B.  Combined  External  and  Internal 
Version  or  the  Bipolar  Method  of 
Braxton  Hicks. — This  method  of  version 
may  be  performed  at  the  time  of  labor 
when  the  cervix  is  sufficiently  dilated  to 
admit  two  fingers,  the  membranes  being  in- 
tact. The  external  hand  upon  the  abdomen 
pushes  the  upper  pole  of  the  foetus  around 
toward  the  pelvis  while  the  internal  fingers 
push  the  lower  pole  in  the  opposite  direction. 


Cerebral  Hemorrhage  in  the  New=Born. — 

L.  cer'ebrum,  brain;  Gr.  aipa  blood  + 
prjyvvvaL  to  burst  forth.  See  Intra- 
cranial Hemorrhage  in  the  New- 
Born,  in  Part  1,  General  Medicine 
and  Surgery. 

Meningocele. — See  Meningocele,  Cere- 
bral, in  Part  1. 

Cervical  Atresia  Causing  Dystocia. — L. 

cer'vix,  neck.  See  Atresia  of  the 
Cervix  cau.sing  Dystocia. 

Carcinoma  Complicating  Pregnancy. — 
See  Cancer  of  the  Cervix  complica- 
ting Pregnancy. 

Dilatation. — See  Premature  Labor, 
Induction  of. 

Laceration. — -L.  lacera're,  to  tear.  See 
under  Management  of  the  Puer- 
perium. 

Rigidity  Causing  Dystocia. — L.  rigid'i- 
tas,  stiffness.  See  under  Atresia  of 
the  Cervix. 

Spasm  Causing  Dystocia. — Gr.  airaafid^. 
See  under  Atresia  of  the  Cervix.  ' 

Stenosis  or  Stricture  Causing  Dystocia. 
— Gr.  aTev(t)OLs;  L.  strictu'ra.  See 
Atresia  of  the  Cervix. 

Tears. — See  under  Management  of 
the  Puerperium. 

Cesarian  Section.  — See  Caesarean 
Section. 

Child,  Care  of  the. — See  Management  of 
the  Puei’i^eriiun. 

Diet  of  the. — See  Infant  Feeding, 
in  Part  1,  General  Medicine  and 
Surgery. 

Diseases  of  the. — See  Diseases  of  the 
New-Born  Infant. 

Dress  of  the. — See  Management  of  the 
Puerperium. 

Feeding  of  the. — See  Infant  Feeding, 
in  Pait  1. 

Giant. — See  Child,  Large,  below. 

Large. — 

Causes.— Prolonged  pregnancy;  one  or  both 
parents  large;  multiparity;  advancing  age 
of  the  mother. 

Treatment. — Pregnancy  should  never  be 
allowed  to  go  over  two  weeks  beyond  term. 
If  the  patient  has  previously  given  birth 
with  difficulty  to  large  children,  the  diet 
should  be  restricted  in  the  last  two  or  three 
months  of  pregnancy,  especially  in  starches 
and  sugars. 

If  during  labor  the  head  does  not  engage, 
even  after  the  employment  of  Walcher’s 
hanging  posture,  the  procedure  is  the  same 
as  that  employed  in  generally  contracted 
pelvis  iq.v.) 

If  the  after-coming  shoulders  are  exces- 


COMPLICATIONS  OF  THE  PUERPERIUM 


sively  large,  the  clavicles  may  be  divided 
with  heavy  scissors. 

Chin  Presentations. — See  Face  Presenta- 
tions. 

Chloasma  in  Pregnancy. — Gr.  x^oafeir 
to  be  green.  Diffuse  or  patchy,  yellowish 
or  brownish  pigmentation  of  the  skin  is  a 
common  accompaniment  of  the  pregnant 
state.  It  is  of  no  therapeutic  importance. 

Chondrodystrophia  Fcetalis. — See  Achon- 
droplasia, in  Part  1. 

Chorea  Complicating  Pregnancy. — Gr. 

xopka  dance.  For  the  treatment  of  chorea, 
consult  Part  1,  on  General  Medicine  and 
Surgery.  In  pregnancy  it  may  be  a mani- 
festation of  toxa?niia  One  might  try 

calcium,  parathyroid  extract,  corpus  luteum 
(See  Part  11)  and  nonnal  pregnancy  serum 
(20  (!.c. — Albrecht).  In  severe  cases  it  is 
advisable  to  terminate  pregnancy  (see  Abor- 
tion and  Premature  Labor) . Aljortion  may 
ensue  in  severe  cases,  in  which  event  the 
maternal  mortality  is  high. 

Chorio=  Epithelioma ; Deciduoma  Malig= 
num;  Syncytioma  Malignum. — See  Part  2, 
Gjmaecology. 

Chyluria. — Gr.  ycXos  chyle  ovpov  urine. 
Chyluria  is  of  no  pathological  import. 

Cleft  Palate. — See  Harelip  and  Cleft 
Palate,  in  Part  1. 

Cleidotomy. — Gr.  /cXels  clavicle  rop^ 
cut.  See  under  Craniotomy. 

Colic. — See  Part  1,  General  Mechcine  and 
Surgery. 

C o 1 1 a p s e. — L.  collap'siis.  See  Shock, 
in  Part  1. 

Colpeurysis. — Gr.  koXttos  vagina  -p  evpv- 
veiv  to  stretch.  Distention  of  the  vagina 
by  means  of  a dilatable  bag. 

Colpitis. — Gr.  koXttos  vagina  -f  -ins  inflam- 
mation. See  Vaginitis. 

Colpohyperplasia  Cystica. — Gr.  koXttos 
vagina  vnep  over  + TrXacns  formation; 
Kvans  bag.  See  under  Vaginitis. 

Combined  External  and  Internal  Version 
of  Braxton  Hicks.— See  Cephalic  Version. 

Complications  of  Labor. — L.  cum,  to- 
gether, + p(fco're,  to  fold.  See  the  following 
headings: 

I.  Inherent.— Abruptio  placenta?,  or  pre- 
mature separation  of  the  normally  situated 
placenta;  adherent  placenta;  malpresenta- 
tions,  e.g.,  bregma  or  anterior  fontanelle; 
ear  or  parietal  bone;  breech;  brow;  chin 
or  face;  posterior  occipital;  transverse  or 
shoulder;  backw^ard  displacement  of  an  arm; 
prolapse  of  an  arm;  prolapse  of  the  cord; 
hiematoma;  hemorrhage,  intra-part  um; 

hemorrhage,  post-partum;  inertia  uteri; 
inversion  of  the  uterus ; cervical  laceration ; 


perineal  laceration;  locked  twins;  multiple 
pregnancy;  oedema  of  the  vulva;  placenta 
pra?via;  rupture  of  the  pelvic  joints;  rupture 
of  the  uterus;  shock  and  collapse;  syncope. 

II.  Extraneous. — Adynamic  di.sea.ses;  atresia 
of  the  cervix;  atresia  of  the  vagina  and 
vulva;  cardiac  disease;  large  child;  con- 
tracted pelvis;  uterine  displacement; 
eclampsia;  fibroid  tumors;  hsematoma; 
hydrocephalus;  ovarian  tumors;  pneumonia; 
typhoid  fever;  prolapse  of  the  uterus;  rigid 
cervix;  transverse  position  of  the  head  at 
the  pelvic  outlet;  vaginal  or  vulval  tumors; 
vaginismus;  vesical  calculus. 

Complications  of  Pregnancy.  — See  the 
following  captions: 

I. — Inherent. — Varicose  veins  of  the  vulva; 
urtemia;  abdomen,  pendulous;  toxaemia; 
rupture  of  the  uterus;  varicose  veins  of  the 
legs;  abortion,  miscarriage,  and  premature 
labor;  abruptio  placentae,  or  premature 
separation  of  the  normally  situated  placenta; 
acid  eructations;  acute  yellow  atrophy  of  the 
liver;  amaurosis  and  amblyopia;  aphasia; 
bladder  irritability ; chloasma;  chorio-epithe- 
lioma;  deafness;  eclampsia;  extra-uterine 
pregnancy;  epistaxis;  gingivitis;  glycosuria; 
headache;  heartburn;  ha?maturia;  haemop- 
tysis; hemorrhage,  ante-partum;  vesical 
hemorrhoids;  dermatitis  herpetiformis;  hic- 
cup; hydatidiform  mole;  hydramnios;  un- 
petigo  herpetiformis;  incarceration  of  the 
uterus;  incontinence  of  urine;  insanity; 
jaundice;  leucorrhoea;  oliguria;  poljmria; 
nausea  and  vomiting  of  pregnancy;  osteo- 
malacia; paralyses;  phlegmasia  alba  dolens; 
hemorrhoids;  placenta  prsevia;  herpes  ges- 
tationis;  relaxation  of  the  pelvic  joints;  pru- 
ritis;  ptyalism  or  salivation;  pyelitis  and 
pyonephrosis;  skin  diseases;  toothache. 

II.  Extraneous. — Anaemia;  anorexia;  appen- 
dicitis; asthma;  hartholinitis;  vesical  calcu- 
lus; cervical  cancer;  vaginal  and  \nilval 
cancer;  cardiac  disease;  chorea;  constipation; 
convulsions;  cough;  death  of  the  foetus;  den- 
tal caries;  diabetes;  diarrhoea;  uterine  dis- 
placement; dyspepsia;  emphysema;  enter- 
algia;  fibroid  tumors;  gonorrhoea;  hernia  of 
the  uterus; myometrial  rheumatism;  neuritis; 
ovarian  tumors;  anteflexion  of  the  uterus; 
anteversion  of  the  uterus;  prolapse  of  the 
uterus;  retrocUsplacement  of  the  uterus; 
syphilis;  tuberculosis;  vaginitis;  venereal 
warts;  xmlval  abscess;  indigestion. 

Complications  of  the  Puerperium.— See  the 
following  headings: 

Severe  after-pains;  anaemia;  caked  breasts; 
cervdcal  laceration;  diastasis  of  the  abdom- 
inal muscles;  uterine  displacement  (genito- 
urinary fistula;  galactocele;  galactorrhoea; 


CONDUCT  OF  NORMAL  LABOR 


hemorrhage  puerperal ; inertia  uteri ; inversion 
of  the  uterus;  mastitis;  milk  fistula;  deficient 
milk  secretion;  excessive  milk  secretion; 
night  sweats;  inverted  nipples;  sore  nipples; 
phlegmasia  alba  dolens;  prolapse  of  the 
utems;  fever;  hiematonia;  infection;  in- 
sanity; retention  of  urine;  subinvolution; 
superinvolution. 

Conduct  of  Normal  Labor. — L.  cum,  with 
-f  du'cere,  to  lead;  nor'ma,  rule.  The  dura- 
tion of  labor  in  primiparse  is  about  sixteen 
to  eighteen  hours  or  longer,  in  multiparse 
about  eight  to  twelve  hours.  The  first 
stage,  or  the  period  from  the  onset  to  com- 
plete dilatation  of  the  os,  is  about  ten  to 
sixteen  hours  in  primiparse,  about  six  to 
eleven  hours  in  multiparse.  The  second 
stage,  or  the  period  from  the  completed 
dilatation  of  the  os  to  the  expulsion  of  the 
child,  during  which  the  woman  bears  down 
with  each  pain,  is  about  one  and  three- 
quarters  to  two  hours  in  primiparse,  about 
one  hour  in  multiparse.  The  third  stage,  or 
the  period  from  the  expulsion  of  the  cMld 
to  that  of  the  placenta  and  membranes,  is 
about  fifteen  to  thirty  minutes  or  longer. 

For  the  physician’s  obstetrical  outfit,  see 
the  Appendix  following  Part  4. 

On  entering  the  confinement  room, 
inquire  as  to  the  time  of  onset,  frequency, 
and  duration  of  the  pains  (fifteen  to  thirty 
minutes  apart  at  the  beginning,  they  gradu- 
ally increase  in  frequency  until  they  eventu- 
ally occur  every  two  or  three  minutes) ; map 
out  the  foetus,  and  listen  to  the  foetal  heart. 
An  internal  examination  (safest  per  rectum) 
affords  satisfying  information  as  to  the  prog- 
ress of  labor,  indicated  by  the  degree  of 
dilatation  of  the  cervix  and  the  location  of 
the  presenting  part,  and  also  as  to  the  shape 
and  size  of  the  pubic  arch,  the  presentation 
and  position  of  the  child,  the  thickness  and 
consistency  of  the  perineum,  the  curvature, 
vertical  and  lateral,  of  the  sacrum,  and  the 
diagonal  conjugate.  When  the  cervix  is 
normal,  its  complete  dilatation  is  indicated 
by  the  fact  that  Bandl’s  contraction  ring 
(evident  only  during  uterine  contraction) 
is  four  fingers’  breadth  above  the  pubis, 
the  bladder  being  empty. 

Caution  the  patient  against  bearing  down 
during  the  first  stage,  and  thereby  exhausting 
herself  needlessly.  Remind  her  to  empty 
the  bladder.  Dilatation  of  the  cervix  may 
be  hastened  in  the  first  stage  of  prolonged 
labors,  and  excessive  suffering  relieved,  by 
the  administration  of  chloral,  or  morphine,  or 
scopolamine.  (See  Inertia  Uteri.)  Chloro- 
form or  ether  is  admissible  as  an  analgesic, 
a few  whiffs  during  pains,  only  during  the 


second  stage,  when  the  pains  are  unendurable 
or  when  the  head  begins  to  distend  the  vulva. 

The  patient  should  go  to  bed  on  the  begin- 
ning of  bearing  down  pains  (an  indication  of 
the  onset  of  the  second  stage  of  labor),  or 
on  the  rupture  of  the  membranes;  Hirst  says, 
“ as  a rule,  as  soon  as  the  os  has  reached  the 
size  of  a silver  dollar.”  She  may  be  pro- 
vided with  a “ puller,”  in  the  form  of  a 
twisted  sheet  fastened  to  the  foot  of  the  bed. 

As  soon  as  bearing  down  pains  appear, 
make  preparations  for  delivery.  Place  on  a 
table  at  the  side  of  the  bed  a basin  of  warm 
bichloride  solution,  1 : 2000  (wliich  may 
contain  sterile  gloves),  gauze  sponges, 
cotton  pledgets,  boric  acid  solution  in  a 
glass,  sterile  towels,  sterile  safety  pins, 
bobbin  or  tape  for  tying  the  cord,  curvetl 
needles,  needle-holder,  silkworm-gut,  cat- 
gut, scissors  (plain  and  umbilical),  artery 
clamps,  long  dressing  forceps,  tenacuhun 
forceps,  and  vaginal  speculae.  Cleanse  the 
genitalia  with  soap  and  water  followed  by 
bichloride  solution,  and  apply  compresses 
wet  with  the  latter.  Disinfect  the  hands. 
As  soon  as  the  head  can  be  palpated  through 
the  perineum  place  at  least  four  sterile 
towels  about  the  vulva,  one  beneath  the  but- 
tocks, and  pin  them  in  place.  Begin  to  use 
chloroform  or  ether,  giving  it  only  during 
pains,  as  soon  as  the  head  begins  to  distend 
the  vulva.  If  the  membranes  are  still 
intact  after  the  os  is  fully  dilated  (not  before) 
they  should  be  ruptured;  but  do  not  rupture 
them  during  a pain,  for  fear  of  prolapse  of 
the  cord.  When  the  head  begins  to  emerge 
from  the  vulva,  push  the  chloroform  to 
complete  anjesthesia.  Protect  the  perineum 
by  restraining  the  oncoming  head. 

As  soon  as  the  head  is  born,  examine  the 
neck  to  see  if  it  is  encircled  by  the  cord,  and 
if  so,  try  to  slip  the  cord  over  the  head.  If 
this  is  hnpossible,  cut  the  cord  between 
ligatures  or  clamps,  and  then  extract  the 
child  immediately,  before  it  is  asphyxiated. 
If  the  neck  is  free,  support  the  head  with 
the  hand,  and  wait  for  nature  to  expel  the 
remainder  of  the  child.  Do  not  pull  upon 
the  child,  even  though  the  head  becomes 
alarmingly  congested.  While  waiting  for 
the  birth  of  the  body,  the  child’s  eyes  may  be 
cleansed  with  boric  acid  solution.  If  there 
is  any  possibility  of  gonorrhoea,  instill  two 
or  three  drops  of  a 2 per  cent,  solution  of 
protargol.  The  uterus  may  then  be 
stimulated  by  rubbing  or  kneading  it  and 
by  pressure  over  the  fundus.  As  soon  as 
the  child  is  born,  apply  the  hand  to  the 
abdomen  and  see,  by  pressure  and  kneading, 
that  the  uterus  remains  contracted. 


CONSTIPATION  COMPLICATING  PREGNANCY 


Tie  the  cord  in  two  places,  after  it  has 
ceased  to  pulsate  (about  two  or  three 
minutes  required),  and  cut  it  between  the 
ligatiu-es.  If  the  child  does  not  cry  well, 
crook  the  little  finger  back  of  the  epiglottis 
and  clear  out  any  mucus  or  blood  present, 
then  spank  the  inverted  child.  Wrap  it  in 
warm  soft  flannel,  and  place  it  between 
blankets  in  its  crib. 

While  waiting  for  the  birth  of  the  placenta, 
repair  perineal  tears.  Close  them  by  deep 
sutures  of  silkworm  gut,  introduced  far 
from  the  wound  margins,  and  tied  loosely 
from  below  upward.  It  is  advisable  first  to 
approximate  torn  muscles  with  buried 
chi'omic  catgut  sutures,  if  asepis  is  assured. 
In  complete  tears,  suture  first  the  rectal 
mucosa  and  then  the  ends  of  the  sphincter 
ani  with  buried  catgut  sutures.  Remove  the 
silkworm-gut  sutures  about  the  tenth  day. 
In  complete  tears,  aim  to  prevent  a stool 
for  three  or  four  days,  keeping  a tube  in 
the  rectum,  then  give  a high  enema  of  sweet 
oil,,  followed  by  calomel,  or  castor  oil  by 
mouth.  (Williams.) 

After  the  fundus  has  risen  up  to  or  above 
the  umbilicus  (inchcating  the  expulsion  of 
the  placenta  into  the  lower  uterine  segment), 
or  after  the  lapse  of  thirty  mmutes,  or  at 
once  in  the  event  of  alarming  hemorrhage, 
attempt  to  express  the  placenta  by  Crede’s 
manoeuvre.  Grasp  the  uterus  with  the  four 
or  eight  fingers  posteriorly  and  the  thmnb 
or  thumbs  anteriorly,  and  knead  and  rub 
it  until  it  contracts  strongly;  then,  while 
it  is  contracting,  squeeze  it  as  one  would 
squeeze  a lemon,  and  press  down  in  the 
direction  of  the  axis  of  the  superior  strait. 
Persist  in  Crede’s  method  at  intervals  for 
two  hours  or  longer,  if  necessary,  unless 
there  is  alarming  hemorrhage,  before  resort- 
ing to  manual  removal  of  the  placenta 
{q.v.,  under  Adherent  Placenta).  The  use 
of  pituitrin  {q.v.  in  Part  11)  may  replace 
Credo’s  manoeuvre  and  produce  jn-ompt 
expulsion  of  the  placenta. 

Examine  the  placenta  to  see  if  it  is  all 
there.  If  portions  are  missing,  it  is  advisable 
to  remove  then  manually,  to  avoid  subse- 
quent hemorrhage. 

After  the  expulsion  of  the  placenta, 
administer  ergot  {q.v.).  Give  it  or  pituitrin 
hypodermically  if  the  uterus  tends  to  relax 
immediately  after  labor. 

A neivous  or  vasomotor  chill,  of  no 
unportance,  often  follows  the  completion 
of  the  third  stage  of  labor. 

After  labor  is  comi)leted,  cleanse  the  parts 
with  bichloride  solution,  1 : 2000,  apply  a 
large  .sterile  pad  to  the  ^mlva,  and  tie  the 
knees  together  loosely  with  a cloth  or  ban- 


dage. A snug,  folded,  unbleached-muslin 
binder,  reaching  from  below  the  trochanters 
to  the  lower  ribs,  and  pinned  from  below 
upward  or  from  above  downward  with  safety 
pins  placed  longitudinally  and  not  trans- 
versely, may  or  may  not  be  applied.  It  is 
customary  to  place  a folded  cloth  or  pad 
above  the  fundus  of  the  uterus  before  apply- 
ing the  binder.  After  the  patient  has  been 
made  comfortable,  give  her  a cup  of  milk, 
weak  tea,  cocoa,  orhroth;  darken  the  room, 
and  allow  her  to  sleep. 

Remain  with  the  patient  for  at  least  one 
hour,  to  see  that  the  uterus  remains  firmly 
contracted,  kneadmg  it  if  necessary,  i.e.,  if 
hemorrhage  occurs,  but  not  otherwise  (see 
Hemorrhage,  Post-Partum).  There  is 
usually  no  danger  of  hemorrhage  after  the 
expiration  of  an  hour,  if  no  relaxation  has 
occurrred  within  that  time. 

Inspect  the  baby’s  cord  for  hemorrhage 
before  leaving,  and  leave  printed  directions 
for  the  care  of  the  mother  and  child  (see 
under  Management  of  the  Puerperium). 

Confinement,  Estimation  of  the  Date  of. — 
See  under  Stage  of  Pregnancy. 

Congenital  Rickets.— See  Achondroplasia 
in  Part  1. 

Congestion  of  the  Breasts. — L.  conge'rere, 
to  heap  together.  See  Caked  Breasts. 

Conjunctivitis  of  the  New=Born. — L.  con- 
juncti'va  -)-  Gr.  -^T^%  inflammation.  See 
Ophthalmia  Neonatorum. 

Constipation  Complicating  Pregnancy. — 
L.  constipa'tio,  a crowding  together.  Enjoin 
fresh  air  day  and  night,  regular  hours  of 
eating  and  sleeping,  a daily  morning  tepid 
sponge  bath,  before  breakfast,  in  a comfor- 
table room,  followed  by  a cool  spinal  douche 
and  vigorous  rubdown  with  a coarse  towel, 
and  plenty  of  outdoor  exercise,  with  about 
one  hour’s  rest  before  and  after  meals. 
The  diet  should  consist  chiefly  of  fruits  and 
vegetables,  with  plenty  of  water,  avoiihng 
tea,  cocoa,  chocolate,  thick  bi'oths,  sago, 
rice,  farina,  potatoes,  liver,  pork,  salted, 
liotted,  or  smoked  fish  and  meats,  cheese, 
excess  of  eggs  or  milk,  nuts,  huckleberries, 
red  wines.  A sugared  orange  for  breakfast 
is  often  efficacious.  The  patient  should  eat 
slowly,  and  not  overeat.  A glass  of  cold 
water  should  be  taken  on  rising,  and  a car- 
bonated mineral  water,  such  as  Mchy  or 
Apollinaris,  or  a glassful  of  cold  or  hot  water 
to  which  may  be  added  about  fifteen  grains 
of  sodium  bicarbonate,  should  be  taken  one 
hour  before  each  meal.  Water  may  be 
drunk  freely  between  meals.  About  one- 
half  to  one  hour  after  breakfast,  the  patient 
should  repair  regularly  to  the  toilet. 

Useful  laxatives  are  the  compound  laxa- 


CONTRACTED  PELVES 


tive  pill,  containing  aloin,  strychnine,  bella- 
donna, and  ipecac,  two  pills  at  bedtime, 
aromatic  fluid  extract  of  cascara  sagrada, 
3i-ii  at  bed-time,  compound  licorice  powder, 
3 i-ii  at  bed-time,  sodium  phosphate,  3 i~iv, 
one  hour  before  brealcfast,  and  broken 
doses  of  calomel  followed  by  a saline  (see 
Part  11)  about  once  a month.  To  remove 
hardened  fecal  masses,  give  a high  oil  enema 
followed  after  one  or  two  hours  by  glycerine 
and  soapsuds,  two  tablespoonfuls  of  the 
former  to  each  quart  of  the  latter.  Strong 
cathartics  tend  to  produce  abortion. 

(Persistent  constipation  may  be  due  to 
uterine  displacement,  q.v.) 

Contracted  Pelves. — L.  con,  together  -f- 
tra'here,  to  di’aw ; pel'vis,  basin. 

The  normal  pelvic  measurements  are: 

1.  Between  the  anterior  superior  iliac 
spines,  26  cm. 

2.  Between  the  widest  parts  of  the  iliac 
crests,  29  cm. 

3.  Between  the  widest  parts  of  the  tro- 
chanters, 32  cm. 

4.  Between  the  depression  beneath  the 
last  lumbar  spine  and  the  anterior  upper 
margin  of  the  symphysis  pubis  (external 
conjugate  or  Bandeloque’s  diameter),  21  cm. 

5.  Conjugata  vera  (estunated  by  sub- 
tracting 1.5  or  2 cm.,  according  to  the  height 
and  inclination  of  the  symphysis  pubis, 
from  the  diagonal  conjugate — distance  from 
the  lower  margin  of  the  symphysis  to  the 
sacral  promontory),  11  cm. 

6.  Di, stance  between  the  tubera  ischii, 
11  cm. 

The  external  conjugate  is  of  only  approxi- 
mate value.  Internal  pelvimetry  should 
be  employed  if  it  is  below  18  cm.  If 
it  is  below  17  cm.,  the  pelvis  is  invariably 
contracted;  if  it  is  between  18  and  19  cm., 
the  pelvis  is  contracted  in  half  the  cases. 
(J.  W.  Williams). 

In  rachitic  pelves  the  first  two  measure- 
ments approximate  each  other.  If  all  the 
measurements  are  equally  considerably 
shortened,  the  pelvis  is  a generally  contracted 
one.  If  the  antero-posterior  diameters 
alone  are  shortened,  the  pelvis  is  flat.  If 
the  distance  between  the  tubera  ischii  is 
8 cm.,  or  less,  the  pelvis  is  of  the  funnel 
type.  According  to  Litzmann,  a pelvis 
is  contracted,  when,  if  flat,  the  conjugata 
vera  measures  9.5  cm.  or  less,  and,  if  gen- 
erally contracted,  10  cm.  or  less.  Williams’s 
careful  statistics  show  that  7.46  per  cent, 
of  white  women  and  34.5  per  cent  of  black 
women  have  contracted  pelves,  and  about 
6 per  cent,  of  both  races  have  funnel 
pelves. 


Classification  : 

1.  Simple  Flat,  Non=Rachitic  Pelvis. — The 
antero-posterior  diameters  are  shortened; 
the  transverse  diameters  are  normal.  There 
is  no  widening  of  the  transverse  diameters 
of  the  pelvic  outlet  as  in  the  rachitic  form. 
Williams  says,  “ In  general,  if  the  diagonal 
conjugate  falls  below  9 cm.,  the  pelvis  does 
not  belong  in  this  category.” 

2.  Generally  Equally  Contracted  Pelvis. — 
Remember  that  the  external  conjugate  may 
be  longer  than  usual  in  this  type. 

3.  Generally  Contracted,  Flat,  Non=Rachitic  Pel= 
vis. — A combination  of  the  flat  and  generally 
contracted  type. 

4.  Funnel  Pelvis.— This  includes  the  rare 
male  type,  the  infantile,  and  the  hunchback 
or  kyphosis  pelvis  (of  dorso-lumbar  or 
lumbo-sacral  kyphosis).  The  distance 
between  the  tubera  ischii  is  8 cm.  or  less. 
The  funnel-shaped  pelvis  is  the  most  fre- 
quent type  of  contracted  pelvis  in  white 
women  (37  per  cent. — Thoms;  14.5  per 
cent,  in  black  women — Thoms). 

5.  Rachitic  Pelves. — (a)  Flat,  generally  con- 
tracted; (b)  Simple  flat;  (c)  Generally  equally 
contracted;  (d)  Pseudo-osteomalacic. 

The  distance  between  the  iliac  spines 
approaches  or  exceeds  that  between  the 
crests;  the  tubera  ischii  are  everted;  the 
anterior  surface  of  the  sacrum  is  convex 
from  side  to  side,  instead  of  concave,  while 
the  lower  portion  is  sharply  bent  forward. 
In  rachitic  pelves  labor  progresses  easily 
after  the  head  has  passed  the  superior  strait. 

The  following  general  signs  are  character- 
istic of  rickets,  viz.,  small  stature,  short, 
thick,  curved  extremities,  low,  broad  brow, 
large  square  head,  flat  nose,  chicken  breast, 
rachitic  rosary  or  beading  of  the  ribs  at  their 
junction  with  the  costal  cartilages,  enlarged 
joints,  lordosis,  late  walking  (after  about 
the  sixteenth  month),  and  late  teething 
(after  about  the  eighth  month). 

6.  Obliquely  Contracted  Pelvis. — This  type 
of  deformity  is  diagnosed  by  the  marked 
inequality  of  the  following  bilateral  measure- 
ments: (1)  “from  the  anterior  superior 
spine  of  one  side  to  the  opposite 
posterior  superior  spine”;  (2)  “from  the 
spine  of  the  last  lumbar  vertebra  to  the 
anterior  superior  spine  on  either  side.” 
It  includes  the  very  rare  Naegele  pelvis,  in 
which  the  sacral  alte  on  one  side  are  imper- 
fectly developed,  and  the  obliquely  con- 
tracted . pelvis  of  unilateral  lameness  (the 
result  of  coxitis,  congenital  dislocation  of  the 
hip,  infantile  paralysis,  shortening  of  one  leg) . 

7.  Transversely  Contracted  or  Robert  Pelvis. — 
A very  rare  type  of  contraction,  due  to 


CONTRACTED  PELVES,  TREATMENT  OF  LABOR  IN 


imperfect  development  of  both  sacral  alae, 
in  which  all  the  transverse  diameters  are 
markedly  shortened  while  the  antero-pos- 
terior  diameters  are  normal. 

8.  Osteomalacic  Pelvis  — A rare  form  of 
extreme  tleformity  (see  Osteomalacia, 
in  Fart  1). 

9.  Spondylolisthesis. — Dislocation  of  the  last 
lumbar  vertebra  forward  and  downward  in 
front  of  the  sacrum.  There  is  lordosis  and  a 
waddling  gait,  and  internal  examination 
reveals  the  forward  displacentent  of  the  body 
of  the  last  lumbar  vertebra.  The  condition 
is  rare. 

10.  Tumors  of  the  Pelves. — Enchondroma, 
exostosis,  osteoma,  fibroma,  sarcoma,  carci- 
noma, cyst,  all  very  rare. 

11.  Fracture  (very  rare);  Caries,  and  Necrosis. — 

Contracted  Pelves,  Treatment  of  Labor  in. 
— I.  Flat  and  Generally  Contracted  Pelves. — The 
procedure  in  any  given  case  should  be 
governed  largely  by  the  history  of  previous 
labors,  the  size  of  the  child,  the  age  and  par- 
ity of  the  woman  (the  expulsive  forces  are 
greater  in  primiparte). 

If  the  conjugata  vera  measures  10-7.5 
cm.,  labor  usually  occurs  spontaneously. 
If  Caesarean  section  at  term  has  not  been 
deemed  advisable,  assume  an  expectant 
attitude  at  the  time  of  labor,  and  watch  the 
mother  and  child  for  the  first  indications  of 
exhaustion,  etc.,  viz.,  steady  increase  in  the 
frequency  of  the  pulse,  elevation  of  tempera- 
ture, irritability,  despondency,  irregularity 
in  the  rhythm  of  the  uterine  contractions, 
the  situation  of  Bandl’s  contraction  ring 
(the  contraction  ring  rises  higher  and  higher 
toward  the  umbilicus  as  the  lower  uterine 
segment  becomes  more  and  more  stretched; 
normally  it  is  four  fingers’  breadth  above 
the  pubis  when  the  cervix  is  completely 
dilated),  marked  oedema  of  the  cervdx, 
fa'tal  pulse  below  100  or  above  160,  and  the 
ajjpearance  of  meconium  in  vertex  presenta- 
tions. If  engagement  does  not  occur,  even 
after  the  emplojanent  of  Walcher’s  hanging 
posture,  one  may  try  high  forceps  cautiously 
and  tentatively,  placing  “ one  blade  over 
the  mastoid  and  the  other  over  the  opposite 
brow  but  it  is  perhaps  better  to  resort 
at  once  to  internal  podalic  version,  if  it  is 
thought  that  the  danger  to  the  child  is  not 
too  great.  In  j>erforniing  podalic  version  in 
head  presentations,  insert  the  right  or  left 
hand  according  as  the  back  of  the  child  is 
directed  to  the  right  or  left,  and  attempt  to 
grasp,  if  possible,  the  anterior  foot.  In 
transverse  j^resentations,  seize  the  lower 
foot  if  the  back  is  directed  anteriorhq  the 
upper  foot  if  the  back  is  directed  posteriori^'. 


in  order  to  bring  the  back  against  the  sym- 
physis pubis.  During  extraction,  an  assis- 
tant should  exert  firm  pressure  upon  the 
fundus  uteri  to  prevent  extension  of  the 
arms  and  to  aid  deliverj'. 

If  version  does  not  seem  advisable  (it  is 
contrainchcated  in  tetanic  contraction  of 
the  uterus,  dangerous  thinning  of  the  lower 
uterine  segment,  as  evidenced  by  the  high 
position  of  Bandl’s  contraction  ring,  and 
early  rupture  of  the  membranes,  with  loss 
of  the  liquor  amnii),  one  may  consider 
pubiotomy  {q.v.),  or  Caesarean  section  {q.v.). 
Craniotomy  {q.v.)  should,  of  course,  be  done 
if  the  chikl  is  dead.  It  may  even  be  de- 
manded in  the  living  child,  if  the  facilities 
for  performing  pubiotomy  or  Caesarean 
section  are  seriously  inadequate. 

Pubiotomy  and  Caesarean  section  are 
contraindicated  in  the  presence  of  infection. 
In  such  cases,  if  version  and  forceps  {q.v.) 
are  inapplicable,  employ  craniotomy.  If 
Caesarean  section,  however,  is  necessary 
the  entire  uterus,  including  the  cervix, 
should  be  removed. 

If  the  conjugata  vera  measures  7 cm.  or 
less,  perform  Caesarean  section  at  term.  If, 
however,  when  seen  at  the  time  of  labor,  the 
mother  is  in  poor  condition,  the  uterus  is 
infected,  or  the  child  is  in  a poor  way,  per- 
form craniotomy,  providing  the  conjugata 
vera  is  above  5.5  cm.  (the  latter  figure  is  an 
absolute  indication  for  Caesarean  section). 
Pubiotomy  is  contraindicated  when  the  con- 
jugata vera  measures  7 cm.  or  less.  If  the 
uterus  is  infected,  the  entire  organ  may  be 
removed  after  the  birth  of  the  child. 

Williams  emphasizes  “ the  great  value  of 
intelligent  expectant  treatment  in  contracted 
pelves,”  and  the  employment  of  pubiotomy 
or  Caesarean  section  if  forceps  or  version  are 
impracticable.  He  says,  “ It  should  always 
be  remembered  that  a spontaneous  outcome 
may  be  expected  in  from  75  to  80  per  cent, 
of  all  contracted  pelves,  and  that  radical 
surgical  interference  will  be  necessary  in  less 
than  one-half  of  the  oj^erative  cases.”  He 
condemns  the  induction  of  premature  labor 
(advocated  by  Hirst,  Garrigues,  and  others 
at  the  thirty-sixth  week  when  the  conjugata 
vera  measures  8. 0-9. 5 cm.)  as  futile. 

2.  Funnel  Pelvis. — If  the  transverse  dia- 
meter at  the  outlet  is  not  much  below  7.5 
cm.,  pubiotomy  {q.v.)  is  best.  A diameter 
of  5 cm.  or  less  demands  Caesarean  section 
Lesser  grades  of  narrowing  may  permit  the 
spontaneous  termination  of  labor  or  the 
successful  use  of  forceps  {q.v.).  Posterior 
rotation  of  the  occiput  is  favorable  to 
spontaneous  childbirth  in  these  cases.  (Hirst.) 


COUGH  COMPLICATING  PREGNANCY 


3.  Obliquely  Contracted  Pelvis. — The  Naegele 
pelvis  calls  for  Cajsarean  section  {q.v.)] 
but  the  latter  is  rarely  required  for  cases  due 
to  unilateral  lameness.  In  the  latter  cases, 
says  Williams,  “ When  the  obstacle  to  the 
engagement  of  the  head  is  not  serious,  ver- 
sion iq.v.)  gives  better  results  than  forceps” 
{q.v.).  Pubiotomy  iq.v.)  should  not  be  at- 
tempted because  of  the  possible  existence  of 
ankylosis  of  the  sacroiliac  synchrondro.ses. 
(Williams.) 

A.  Transversely  Contracted  or  Robert  Pelvis. — 
This  demands  Caesarean  section  iq.v.). 

5.  Osteomalacis  Pelvis. — See  Osteomalacia, 
in  Part  1. 

6.  Tumors  of  the  Pelvis. — Caesarean  section  is 
indicated. 

7.  Spondylolisthesis. — If  the  pseudo-con- 
jugate  is  below  8 cm.,  perform  Caesarean 
section  {q.v.)  at  term.  After  childbirth 
employ  a brace  (consult  Part  10,  on  Ortho- 
pedics). 

Convulsions. — L.  convul'do,  from  convel'- 
lere,  to  pull  together. 

Causes. — Eclampsia  (q.v.);  exaggerated 
nervous  irritability,  in  which  “ an  over- 
distended bladder  or  bowel,  j)ressure  of 
the  head  on  the  perineum,  the  introduction 
of  a hand  to  perform  version,  or  exciessive 
after-pains”  may  bring  on  a convulsion; 
uraiinia;  hysteria;  epilepsy;  apoplexy  (cere- 
bral hemorrhage,  embolism,  or  thrombosis); 
cranial  fracture;  traumati.sm;  Stokes-Adams 
di.sease;  meningitis,  acute  or  chronic;  enceph- 
alitis; brain  tumor;  brain  abscess;  sclero- 
sis cerebri;  general  paresis;  cerebral  syphilis; 
cerebral  tuberculosis;  cerebral  arteriosclero- 
sis; and  other  cerebral  affections;  chronic 
alcoholism;  plumbism;  pernicious  malaria; 
hepatic  toxemia  (acute  yellow  atrophy, 
portal  cirrhosis,  eclampsia,  etc.);  poisoning 
with  strychnine,  picro toxin,  camphor,  phos- 
phoru.s,  nitrcbenzol,  ergot,  etc.;  profound 
post-hemorrhagic  anaemia;  Addison’s 
disease;  passage  of  a gallstone;  tapping  of  a 
pleuritic  effusion. 

Cord,  Prolapse  of  the. — L.  cho'rda;  Gr. 
Xop5r);  L.  pro,  before  -1-  la'hi,  to  fall. 

Frequency.— 1.18  per  cent.  (Edgar.) 

Etiology.— Conditions  which  interfere  with 
engagement,  viz.,  pelvic  contraction,  large 
child,  deformity  of  the  head,  twins,  mal- 
presentations;  “ excessive  right  lateral  obliq- 
uity of  the  uterus  ”;  hydramnios;  “ abnor- 
mal flaccidity  of  the  lower  uterine  segment  ” ; 
fibromyomata;  too  long  cord;  marginal 
insertion  of  the  cord;  placenta  prsevia; 
pendulous  abdomen;  multiparity;  very  small 
foetus  in  premature  labor;  sudden  est^ape  of 
the  liquor  amnii,  especially  when  the  mother 


is  in  an  upright  position ; violent  movements 
of  the  mother. 

The  Prognosis  is  bad  for  the  child. 

Treatment.- If  the  cervbc  is  completely  dila- 
ted, extract  the  child  immediately  by  internal 
podalic  version  (q.v.),  unless  the  head  is 
deeply  engaged,  when  forceps  (q.v.)  should 
be  used.  When  using  forceps,  place  the 
cord,  if  possible,  next  the  rectum. 

If  the  cervix  is  not  completely  dilated, 
attempt  to  rei)lace  the  cord  by  manipulation, 
under  anaesthesia,  if  nece.ssary,  with  the 
patient  in  the  knee-chest,  or  better,  the 
Trendelenburg  posture  (over  the  back  of  a 
chair).  With  the  tips  of  the  fingers  push  the 
cord  up  beyond  the  head,  and  with  the 
hand  on  the  abdomen,  press  upon  the  fundus 
and  gradually  withdraw  the  hand.  After 
reposition  has  been  accomplished,  place  the 
woman  on  the  side  opi)osite  to  that  on  which 
I)rolapse  occurred. 

If  manual  reposition  is  unsuccessful,  one 
may  employ  a long  dressing  forceps  or  an 
English  catheter  with  enclosed  stylet,  as 
shown  in  Fig.  94,  leaving  the  rubber  rcjM)- 

^ 

Fio.  04. — English  catheter 

sitor  in  the  uterus  to  ensure  against  recur- 
rence of  the  prolapse. 

Measures  to  keep  the  cord  replaced,  how- 
ever, are  nearly  always  unsuccessful,  and 
it  is  usually  necessary,  if  the  head  is  not 
deeply  engaged,  to  perform  podalic  version 
as  soon  as  possible,  bring  down  a leg,  and  as 
soon  as  the  os  is  well  dilated,  extract  rapidly. 

Cough  Complicating  Pregnancy. — 
Causes  of  Cough. — Uterine,  hepatic,  gastric, 
nasal,  aural,  and  pharyngeal  reflex  in- 
fluences ; nervousness  ; hysteria  ; habit ; 
pharyngitis;  tonsillitis;  elongated  uvula; 
adenoids;  pressure  upon  the  vagus  caused 
by  mediastinal  tumors,  posterior  medi- 
astinal abscess  due  to  Pott’s  disease,  and 
enlarged  tracheobronchial  glands;  aneurysm 
or  tumors  pressing  upon  the  trachea  or 
bronchi;  heart  disease,  valvular,  myocardial, 
or  congenital;  pericardial  effusion;  pleurisy; 
adherent  pleura;  laryngitis;  tracheitis; 
bronchitis;  foreign  bodies  in  the  air  pas- 
sages; acute  pulmonary  (congestion;  pneu- 
monia; phthisis;  influenza;  pertussis;  asth- 
ma; hay  fever;  emphysema;  bronchiectasis; 
pulmonary  abscess;  pulmonary  gangrene; 
pulmonary  oedema;  pulmonary  cirrhosis; 
pulmonary  actinomycosis;  pulmonary 
tumors;  pulmonary  distorniasis;  echino- 
coccus cyst  of  the  lung;  pneumokoniosis; 
pulmonary  infarction. 


DENTAL  CARIES  COMPLICATING  PREGNANCY 


Treatment  of  Neurotic  or  Reflex  Cough. — Exa- 
mine the  generative  organs  for  abnormali- 
ties. If  cervical  granulations  are  present, 
curette  them  away  and  touch  the  raw  sur- 
faces with  pure  carbolic  acid  (Edgar).  A 
nerve  sedative  may  be  of  service,  e.g.,  bro- 
mide, chloral,  valerian,  or  asafoetida  (see 
Drugs,  Part  11).  Hirst  has  obtained  “better 
results  from  oil  of  sandalwood  {q.v.)  than 
from  any  other  single  remedy,”  whether 
the  cough  is  due  to  a neurosis  or  to  bron- 
chial catarrh. 

Cracked  Nipples. — See  Nipples,  Sore. 

Craniotomy. — Gr.  Kpavlov  skull  -f-  Topi] 
a cut. 

Indications. — Difficult  labor  from  any  cause, 
or  eclampsia,  or  any  other  grave  disea.se,  the 
foetus  being  dead  or  dying;  hydrocephalus; 
inability  to  extract  the  after-coming  head. 

Contraindications. — A conjugata  vera  less 
than  ,5.5  cm.  Caesarean  section  is  here 
absolutely  necessaiy. 

Technique.— The  head  may  be  perforated 
by  means  of  Smellie’s  scissors,  or  Blot’s 
perforator,  or  an  ordinary  long,  sharp- 
pointed  pair  of  scissors.  In  occipital  pres- 
entations it  is  perforated  through  one  of 
the  fontanelles;  in  face  j^resentations, 
through  the  brow.  In  breech  presentations, 
the  after-coming  head  may  be  perforated 
through  the  temporal  suture,  the  roof  of  the 
mouth,  behind  the  ear,  or  through  the 
foramen  magmmi.  In  the  latter  instance, 
a cervical  vertebral  arch  is  first  excised,  and 
a catheter  is  then  passed  through  the  spinal 
canal  into  the  cranial  cavity. 

After  breaking  up  the  brain,  it  is  washed 
out  with  normal  salt  solution  (5i  ad  Oi). 
Braun’s  cranioclast  may  then  be  applied,  if 
necessary,  one  branch  within  and  the  other 
without  the  skull,  the  latter  crushed,  and 
the  child  extracted.  Tarnier’s  basiotribe 
and  Simpson’s  basilyst-tractor  serve  as 
perforator,  crusher,  and  extractor. 

Decapitation  is  sometimes  required  in 
neglected  transverse  presentations.  It  is 
performed  by  means  of  Braim’s  blunt  hook, 
or  Ramsbotham’s  sickle  knife,  or  Gigli’s 
wire  saw,  or  a string,  or  scissors,  the  index 
finger  being  used  as  a guide.  The  head  may 
then  be  perforated,  and  extracted  with  a 
cranioclast,  while  an  assistant  exerts  pres- 
sure upon  the  fundus  uteri. 

Where  the  shoulders  are  excessively  broad, 
the  clavicles  may  be  cut  through  with  strong 
scissors , (cleidotomy) . 

Grade’s  Method  of  E.xpressing  the  Pla= 
centa. — See  under  Conduct  of  Normal  Labor. 

Cystic  Vaginitis. — Gr.  Kvans  bladder  or 
cyst.  (See  Vaginitis.) 


Cystitis. — Gr.  Kvans  bladder  -b  -itls  inflam- 
mation. See  Part  2,  Gynaecology. 

Cyst,  Milk  Retention. — Gr.  kvotis  cyst; 
L.  reten'tio.  See  Galactocele. 

Vaginal. — 'See  under  Atresia  of  the 
Vagina,  and  Vaginitis. 

Date  of  Confinement,  Estimation  of  the. — 
See  Stage  of  Pregnancy. 

Death  of  the  Foetus. — 

Causes. — Abnormalities  of  development; 
uterine  displacements,  particularly  retro- 
flexion and  prolapse;  endometritis  or 
deciduitis;  chronic  metritis,  due  to  cervical 
laceration,etc.  ;syphilis(maternalorpaternal) ; 
excessive  torsion  of  the  cord;  stenosis  of  the 
umbilical  vein;  hydramnios;  hydatidiform 
mole;  placental  cUsorders  (obliterating endar- 
teritis, infarcts,  low  implantation  and  pla- 
centa prsevia,  velamentous  insertion  of  the 
cord,  premature  separation  of  the  placenta) ; 
uterine  developmental  anomalies;  uterine 
hypoplasia  or  infantile  uterus;  myomata; 
pelvic  adhesions;  maternal  or  paternal 
diseases,  e.g.,  tuberculosis,  nephritis,  alco- 
holism, plumbism,  diabetes,  malaria,  cancer, 
icterus  gravidarum,  etc.,  paternal  immatu- 
rity or  senility,  obesity,  consanguinity 
between  husband  and  wife,  maternal  heart, 
kidney,  liver,  or  lung  disease,  anaemia, 
plethora,  malnutrition,  acute  infectious  dis- 
eases (even  a mild  pharyngitis),  toxaemia, 
poisoning  with  arsenic,  mercury,  phosphoius, 
carbon  monoxide,  lead,  tobacco,  etc.,  trau- 
matism, strong  emotion. 

Symptomatolog}'. — The  uterus  ceases  to 
enlarge  (the  abdominal  circumference  may 
be  measured  weekly  with  a tape  measure), 
the  foetal  movements  and  heart-sounds 
cease,  the  breasts  become  flabby,  and  there 
may  develop,  perhaps,  slight  elevation  of 
temperature,  perhaps  loss  of  flesh,  foul  taste 
in  the  mouth,  feeling  of  weight  and  discom- 
fort in  the  pelvis,  and  mental  disturbance. 
The  foetus  is  usually  soon  expelled. 

Prophylaxis.— This  depends  upon  the  cause. 

Deafness  Complicating  Pregnancy. — See 
Paralyses. 

Decapitation. — L.  de,  from  -|-  cap'ia,  head. 
See  under  Craniotomy. 

Deciduoma  Malignum. — See  Chorio-Epi- 
thelioma,  in  Part  2,  Gynaecology'. 

Deficient  Milk  Secretion.  — See  Milk 
Secretion,  Deficient. 

Delayed  Labor. — See  Dystocia. 

Delivery. — See  Conduct  of  Normal  Labor. 

Dental  Caries  Complicating  Pregnancy . — 
L.  dens,  tooth;  car'ies,  rottenness.  Instnict 
the  patient  to  keep  the  teeth  and  gums 
clean  by  frequent  brushing  with  castile 
soap  and  warm  water,  folloyved  if  desired  by 


DIASTASIS  OF  THE  ABDOMINAL  MUSCLES 


an  antiseptic  mouth-wash,  such  as  peroxide 
of  hydrogen,  1 ; 4,  or  Dobell’s  solution  {q.v.) ; 
or  liquor  antisepticus  {q.v.)  1 : 2 or  3 of 
water;  or  boric  acid,  borax,  or  sodium 
bicarbonate,  5iv  of  either  to  the  pint;  or 
carbolic  acid,  gr.  v ad  5ij  or  milk  of  mag- 
nesia {q.v.) ; or  lime  water;  drawing  the  fluid 
between  the  teeth.  Swab  necrosed  cavities 
with  pure  carbolic  acid  or  tincture  of  iodine. 
Only  palliative  dental  work  is  admissible 
during  pregnancy.  Calcium  is  advised; 


Syrupi  calcii  lactophosphatis 5viii 

Sig. — A teaspoonful  to  a tablespoonful,  t.i.d.p.c. 

II  Syrupi  hypopho-sphituni 5viii 


Sig. — Two  teaspoonfuls  to  one  tablespoonful 
t.i.d.p.c. 

Dermatitis  Herpetiformis  Complicating 
Pregnancy. — See  Part  5,  Skin  Diseases. 

Detachment,  Premature,  of  the  Normally 
Situated  Placenta. — See  Premature  Separa- 
tion, etc. 

Diabetes  Complicating  Pregnancy. — Gr. 

vbLo.  through  + ^aiv€Lv  to  go.  See  Glycosuria 
in  Pregnancy. 

Diagnosis  of  Pregnancy. — Gr.  5td  apart  + 
yvcoais  knowledge;  L.  proeg'nans,  with  child. 

Signs  of  the  First  Three  Months. — 

Cessation  of  the  menses. 

Morning  sickness,  or  nausea  and  vomiting, 
which  usually  first  appears  at  about  the  sixth 
or  seventh  week,  and  usually  disappears  by 
the  fourth  month. 

Breast  changes:  tingling  and  fulness, 
deepened  pigmentation  of  the  areolse, 
enlargement  of  Montgomery’s  glands, 
appearance  of  colostrum  on  pressure. 

Bladder  irritability,  occurring  in  the  first 
few  months. 

Uterine  enlargement  and  softening. 

Hegar’s  sign  or  an  apparent  disconnection 
of  the  cervix  from  the  body  of  the  uterus, 
due  to  softening  of  the  lower  uterine  segment, 
and  revealed  by  bimanual  examination  by 
means  of  a finger  in  the  rectum  and  thumb 
in  the  vagina,  the  uterus  at  the  same  time 
being  pressed  down. 

Softening  of  the  cervix. 

Chadwick’s  sign  or  purple  congestion  of 
the  vulva  and  vagina. 

Change  in  disposition. 

Depraved  or  unusual  appetite. 

Chloasma. 

Abderhalden’s  test,  based  upon  the  sup- 
position that  the  parenteral  introduction  of 
foreign  protein  or  carbohydrate  into  the 
body  brings  about  the  appearance  in  the 
blood  serum  of  a specific  proteolytic  or 
amylolytic  ferment,  is  probably  of  no  value. 


Signs  of  the  Fourth  and  Fifth  Months. — 

Most  of  the  above  signs. 

Quickening,  or  the  perception  of  fcetal 
movements  by  the  mother. 

Balottement,  vaginal  and  abdominal. 

Braxton-Hicks  mtermittent  uterine  con- 
tractions. 

Fmtal  heart  sounds,  usually  first  heard  in 
the  fifth  month. 

Signs  of  the  Last  Five  Months. — 

Most  of  the  above  signs. 

Progressive  enlargement  of  the  abdomen. 

Abdominal  cutaneous  strife. 

Protrusion  of  the  umbilicus. 

Perception  of  foetal  movements  by 
the  palpating  hand,  possible  after  the 
fifth  month. 

Ability  to  outline  the  foetus  by  palpation. 

Recurrence  of  bladder  irritability  in  the 
last  month. 

Conditions  which  may  simulate  preg- 
nancy are:  Fibromyoma,  sarcoma,  hiema- 
tometra,  hydrometra,  pyometra,  tumors  and 
cysts  of  the  appendages  and  broad  liga- 
ments, ovarian  cyst,  inflammatory  swelling 
of  the  appendages  and  broad  ligaments, 
inflammatory  exudates,  metritis,  obesity 
(abdominal  or  omental),  ascites,  abdominal 
hernia,  tumor  in  the  upper  abdomen,  dis- 
tended bladder,  tympanites,  hypertrophy 
of  the  supravaginal  portion  of  the  cervix. 

An  examination  under  anaesthesia  may  be 
advisable. 

Diarrhoea  Complicating  Pregnancy. — Gr. 

5ta  through  -|-  peXi'  to  flow.  First  clear  out 
the  intestinal  tract  by  means  of  a careful 
dose  of  castor  oil,  or  calomel,  in  divided 
doses,  followed  by  a saline  : then,  if  the  diar- 
rhoea continues,  administer  an  astringent; 

II  Bismuth!  subnitratis. ...  oiv  (3ss-i  per  dose) 

Mucilaginis  acaciae 5 ii 

Aquae,  q.s.  ad 5*v 

M.  Sig. — Shake  wcU,  and  take  one  to  two  table- 
spoonfuls every  four  hours. 

If  astringents  fail,  try  nerve  sedatives, 
(even  intestinal  pains  may  be  neurotic) : 

II  Sodii  vel  potassii  bromidi  3iv  (gr.  x per  teasp.) 
Aquam,  ad 5iv 

M.  Sig. — One  teaspoonful  in  water,  half  an  hour 
before  meals,  together  with  the  following: 

II  Tincturae  belladonnae.  . . 5ss 

Sig. — Minims  v,  in  water,  half  an  hour  before  meals. 

Valerian  {q.v.),  or  codeine  {q.v.)  may  also 
be  of  service.  (For  more  comprehensive 
information,  consult  Diarrhoea,  in  Part  1, 
General  Medicine  and  Surgery.) 

Diastasis  of  the  Abdominal  Muscles. — • 
Gr.  Siaaraa-Ls  separation;  L.  ab'dere,  to  hide; 


DISPLACEMENTS  OF  THE  PREGNANT  UTERUS 


L.  mus'culus.  Apply  during  the  puerperium 
a firm  abdominal  binder,  of  folded  un- 
bleached muslin,  reaching  from  below  the 
trochanters  to  the  lower  ribs,  and  pinned 
from  below  upward  or  from  above  down- 
ward with  safety-pins  placed  longitudinally 
and  not  transversely.  Ifl^his  is  not  effectual, 
massage,  electricity,  and  abdominal  exer- 
cises are  recommended;  and  finally,  J.  C. 
Webster’s  operation. 

Diet  of  the  Infant  and  Child. — See  Infant 
Feeding  in  Part  1,  General  Medicine 
and  Surgery. 

Pregnant  Woman. — See  Management 
of  Pregnancy. 

Puerperal  Woman. — See  Management 
of  the  Puerperium. 

Difficult  Labor.-^ee  Dystocia. 

Dilatation  of  the  Cervix. — See  Premature 
Labor,  Induction  of. 

Heart. — See  Cardiac  Disease  Compli- 
cating Pregnancy  and  Labor. 

Diseases  Complicating  Labor. — See  Com- 
plications of  Labor. 

Pregnane y . — See  Complications  of 
Pregnancy. 

the  Puerperium. — See  Complications  of 
the  Puerperium. 

Diseases  of  the  New=Born  Infant. — 

See  the  following  headings: 

Asphyxia  neonatorum;  atelectasis;  cephal- 
htematoma;  harelip  and  cleft  palate;  hemor- 
rhagic diseases  of  the  newly  born;  icterus 
neonatorum;  intracranial  hemorrhage  in  the 
new-born ; meningocele,  cerebral ; spina  bifida; 
oedema  neonatorum;  prematurity;  sclerema 
neonatorum  ; sternocleidomastoid  haema- 
toma;  stridor;  achondroplasia  (congenital  or 
fetal  rickets;  chondrodystrophia  foetalis; 
micromelia);  birth  palsies,  cerebral  hemor- 
rhage in  the  new-born;  colic;  ophthalmia 
neonatorum ; melacna. 

Displacement,  Backward  or  Dorsal,  of  an 
Arm.^eeArm,BackwardDisplacementofan. 

Displacement  of  the  Parturient  Uterus 
Causing  Dystocia. — L.  partu'ricns,  giving 
birth;  u'terus,  womb;  Gr.  8vs  ill  -|-  tokos 
birth.  In  sacculation  of  a retroplaced  uterus, 
where  the  cervix  is  above  the  pelvic  inlet 
and  is  pressed  against  the  anterior  abdom- 
inal wall,  perform  artificial  dilatation  (see 
Premature  Labor,  Induction  of),  and  version 
and  extraction  (see  Podalic  Version) ; rarely  is 
Caesarean  section  (q.v.)  demanded. 

If  the  cervix  is  displaced  posteriorly, 
apply  an  abdominal  binder,  in  order  to 
correct  anteflexion,  and  “ hook  the  ceiwix 
forward  with  the  finger  during  two  or  three 
pains.”  (Hirst.) 

In  persistent  prolapse  with  marked  oedema 


of  the  protruding  cervix,  “ multiple  inci- 
sions may  be  necessary  in  order  to  effect 
delivery.”  (Williams.) 

Displacements  of  the  Pregnant  Uterus. — 
L.  preeg'nans,  with  child;  u'terus,  womb. 

A.  Antedisplacement. — If  associated  with 
adhesions,  or  if  due  to  operative  anterior 
fixation,  the  rising  of  the  uterus  into  the 
abdominal  cavity  may  be  hindered  giving, 
rise  to  pain  and  difficult  urination,  and  pos- 
sibly abortion  or  incarceration . Hirst  recom- 
mends bimanual  pelvic  massage,  pressure 
tampons,  and  digital  pressure  for  the  purpose 
of  stretching  or  breaking  adhesions.  Lapa- 
rotomy, to  free  the  uterus,  may  be  necessary. 

In  the  later  months  of  pregnancy,  pendu- 
lous abdomen  may  result,  for  which  an 
abdominal  supporter  should  be  worn. 

B.  Retrodisplacement. — Early  in  pregnancy 
the  patient  complains  of  persistently  fre- 
quent and  painful  micturition.  Spontaneous 
reposition,  or  abortion,  or  incarceration  may 
occur.  The  latter  is  manifested  by  retention 
and  overflow  of  urine,  dysuria,  pain  in  the 
lower  abdomen  and  back,  possibly  inflam- 
mation or  gangrene  of  the  uterus,  bladder, 
and  rectum,  possibly  peritonitis,  urtemia, 
rupture  of  the  bladder,  or  septico-pyaemia. 

Replace  the  uterus,  if  possible.  First 
catheterize  the  patient  with  a soft  rubber, 
a semi-stiff,  or  a metal,  perhaps  a prostatic, 
catheter  (never  glass),  assisting  its  intro- 
duction, if  need  be,  by  traction  upon  the 
cervix  with  a tenaculum  (the  urethra  is 
apt  to  be  greatly  lengthened) . If  the  bladder 
is  very  much  distended,  do  not  withdraw 
all  the  urine  at  one  time,  for  fear  of  vesical 
hemorrhage  and  collapse,  but  wait  a few 
hours  before  emptying  the  bladder,  or 
empty  the  bladder  very  slowly,  allowing  no 
less  than  twenty  minutes  for  its  complete 
evacuation.  Then  attempt,  under  anaes- 
thesia if  necessary,  with  the  patient  in  the 
lithotomy  or  knee-chest  position,  to  push 
the  fundus  upward  and  forward  with  the 
fingers  or  a cotton  tampon  held  by  forceps 
in  the  posterior  vaginal  vault,  drawing  the 
cervix  down  with  a tenaculum  if  necessary. 
If  the  uterus  is  bound  down  bj^  adhesions, 
pack  tampons  in  the  posterior  vaginal  vault 
(employing  Suns’  semiprone  posture  and 
Suns’  speculum),  and  renew  these  daily, 
or  employ  the  “ watch-spring  ” pessarjq  or 
leave  in  a colpeun-nter  for  twenty-four 
hours  at  a time.  These  measures  are  apt, 
of  course,  to  provoke  abortion.  If  replace- 
ment is  accom]:)lished,  emploj'  a large- 
sized Smith-Hodge  pessary  until  the  uterus 
has  risen  into  the  abdomen,  which  occurs 
about  the  fourth  month. 


DYSTOCIA;  PROLONGED  OR  DIFFICULT  LABOR 


If  the  first  efforts  at  replacement  fail, 
Williams  advises  waiting  well  into  the  third 
month,  “ in  the  hope  that  spontaneous 
reduction  may  still  occur”;  and  then,  if 
necessary,  repeating  the  efforts  at  reduction. 
If  again  unsuccessful,  however,  laparotomy 
should  be  performed  and  the  uterus  replaced, 
or  abortion  (q.v.)  should  be  induced. 

If  incarceration  has  occurred,  catheterize 
the  bladder  as  before  described,  or  aspirate 
suprapubically  if  catheterization  is  impo.s- 
sible,  and  if  extreme  congestion  and  cedema 
are  present,  keep  the  patient  upon  her  back 
with  hips  elevated  for  several  days,  and 
administer  saline  cathartics  (q.v.),  scarify 
the  cervix,  and  insert  vaginal  tampons, 
soaked  in  equal  parts  of  glycerine  and  water, 
twice  daily  (Reynolds  and  Newell).  Then 
attempt  to  replace  the  uterus  umler  ether 
anjBsthesia.  If  replacement  is  impossible, 
perform  laparotomy,  unless  symptoms  of 
infection  or  gangrene  are  present,  when 
abortion  should  be  induced  by  digital  dilata- 
tion of  the  cervix  and  rupture  of  the  mem- 
branes, or  by  incision  of  the  fundus  uteri 
through  the  posterior  vaginal  vault. 

C.  Prolapse. — Complete  or  incomplete  spon- 
taneous reposition,  abortion,  or  incarcera- 
tion (see  above)  may  occur. 

After  emptying  the  bladder  and  bowel, 
replace  the  uterus  with  the  patient  in  the 
knee-chest  posture,  after  which  insert  a 
globe,  air,  or  water  pessaiy,  retained  by  a 
T-bandage.  Examine  the  patient  every 
two  or  three  weeks,  and  alter  the  shape  and 
size  of  the  pessary  as  required. 

If  the  pelvic  floor  is  too  relaxed  to  retain 
a pessary,  keep  the  patient  as  much  as 
possible  in  the  reciunbent  posture  until 
after  the  fourth  month. 

If  a tumor  or  adhesions  are  pres- 
ent, abdominal  or  vaginal  section  may 
be  required. 

If  the  uterus  is  incarcerated,  proceed  as 
directed  above.  Vaginal  hysterectomy  is 
advised  if  the  uterus  is  infected. 

D.  Hernia  (Inguinal,  Ventral,  or  Vaginal). — 
Try  to  replace  the  uterus.  If  this  is  impos- 
sible, dilate  the  cervix,  insert  the  hand,  and 
perform  version  and  extraction,  and  restore 
the  uterus  to  the  abdominal  cavity.  Caesa- 
rean section  (q.v.),  or  hysterectomy  may 
be  required. 

Displacements  of  the  Puerperal  Uterus. — 

L.  pu'er,  boy  -J-  pa'rere,  to  bear;  u'terus, 
womb. 

Causes. — Distended  bladder  or  rectum; 
subinvolution ; straining ; getting  up  too 
soon ; sudden  physical  effort ; application  of 
pad  and  binder  over  the  uterus,  instead 
34 


of  placing  the  pad  above  the  fundus; 
previous  clisplacement. 

Treatment. — Employ  the  knec-chest  pos- 
ture for  five  to  fifteen  minutes  twice  daily, 
until  the  sixth  week,  when  a pessary  shoukl 
be  employed  (consult  Displacements  of  the 
Uterus,  in  Part  2,  Gynaecology).  Do  not 
postpone  the  correction  of  displacements 
much  beyond  the  sixth  week.  Pessaries  and 
packs  are  contraindicated  before  the  sixth 
week.  Early  operation  is  advised  for  pro- 
lapsus uteri. 

Displacements  of  the  Uterus. — (Partu- 
rient Uterus,  Pregnant  Uterus,  Puerperal 
Uterus. 

Distention  of  the  Abdomen.— See  Tym- 
panites. 

Dorsal  Displacement  of  an  Arm. — L. 

dor'sum,  back.  See  Arm,  Backward  Dis- 
placement of  an. 

Drying  up  the  Breasts. — See  under  Man- 
agement of  the  Puerperium. 

Duration  of  Labor. — See  under  Conduct 
of  Normal  Labor. 

Pregnancy,  Estimation  of  the.— See 

Stage  of  Labor. 

the  Puerperium. — See  under  Manage- 
ment of  the  Puerperium. 

Dyspepsia  Complicating  Pregnancy. — Gr. 

dvs  — ill  TreTTTHv  to  concoct.  The  sour  eruc- 

tations and  heartburn  of  pregnancy,  due 
probably  to  a reflex  hyperchlorhydria,  are 
relieved  by  alkalies:  sodium  bicarbonate, 
magnesium  carbonate  in  chalk  form,  or 
milk  of  magnesia  (see  Part  II). 

Sodii  bicarbonatis 3iv  (gr.  xxx  per  dose) 

Magnesii  o.xidi 3 iv  (gr.  x.\x  per  dose) 

Aquse,  q.s.  ad gviii 

M.  Sig. — Shake  well,  and  take  two  tablespoonfids 
in  half  a glass  of  water,  as  required. 

Correct  constipation  (q.v.).  A liberal  diet 
is  usually  allowable.  Neutral  fats  (olive  or 
sweet  almond  oil  (q.v.)  shaken  with  water  to 
remove  fatty  acids,  cream,  and  fresh  butter) 
are  useful  for  their  action  in  inhibiting 
secretion.  An  oil  may  be  given  a half  hour 
before  each  meal. 

Dystocia;  Prolonged  or  Difficult  Labor. — 

Gr.  dvs  — ill  -f-  TOKOS  birth. 

Causes. — Contracted  pelvis  (q.v.) ; large 
child  (q.v.);  malpositions  and [malpresenta- 
tions  of  the  foetus  (see  Presentations) ; 
vaginal  or  vulvar  atresia  (q.v.);  cervical 
atresia  (q.v.),  including  rigidity,  spasmodic 
or  organic;  cervical  carcinoma  (q.v.);  patho- 
logical enlargements  or  deformities  of  the 
foetus  (hydrocephalus  (q.v.),  etc..);  fibroid 
tumors  and  polypi  (q.v.);  ovarian  tumors 
(q.v.) ; pelvic  tumors  (see  under  Contracted 


ECLAMPSIA 


Pelves);  uterine  displacements  (g.r.);  full 
bladder;  full  rectinn;  adhesions  between 
the  membranes  and  the  cervix;  vaginal 
enterocele  (see  D.  Hernia,  under  Displace- 
ments of  the  Pregnant  Uterus);  tumors  of 
the  bladder;  tumors  of  the  rectum;  large 
stone  in  the  bladder  (see  Bladder  Calculus) ; 
dorsal  displacement  of  an  arm  (q.v.);  pro- 
lapse of  an  arm  (q.v.);  inertia  uteri  (q.v.); 
premature  rupture  of  the  membranes  (dry- 
labor);  deficient  action  of  the  abdominal 
muscles  in  the  second  stage;  tetanic  con- 
traction of  the  uterus  due  or  not  to  a 
mechanical  obstacle;  isolated  contraction  of 
Bandl’s  ring  (hour-glass  contraction) ; opera- 
tions for  the  relief  of  retrochsplacements  of 
the  uterus. 

Ear  or  Parietal  Bone  Presentations. — L. 

par'ies,  wall;  proesenla'tio.  Presentation  of 
the  anterior  parietal  bone  or  anterior  ear 
is  termed  Naegele’s  obliquity;  of  the  pos- 
terior parietal  bone  or  ear,  Litzmann’s 
obliquity.  The  condition  is  diagnosed  by 
internal  palpation,  the  whole  hand  being 
introduced.  The  cause  is  some  form  of 
obstruction,  especially  a contracted  pelvis 
{q.v.).  The  faulty  presentation  should,  if 
necessary,  be  corrected  manually  during 
labor.  For  pendulous  abdomen  during 
pregnancy,  an  abdominal  supporter  should 
be  worn. 

Eclampsia. — Gr.  k out  Xa^tTretr  to  flash. 

The  occiu’rence  of  coma,  with  or  without 
convulsions,  in  the  pregnant,  parturient,  or 
puerperal  woman  as  a result  of  the  hepatic 
(pre-eclamptic)  toxaemia  of  pregnancy  {q.v.). 
Rarely  does  eclampsia  occur  without  pre- 
cechng  .symptoms  of  toxaemia. 

The  Frequency  is  about  one  in  every  five 
hundred  pregnancies. 

The  Prognosis  is  grave  for  both  mother 
and  child. 

One  attack  of  eclampsia  seems  to  render 
the  patient  unmune  against  subsequent 
attacks  in  later  pregnancies,  whereas,  “ in 
patients  suffering  from  chronic  nephritis, 
the  recurrence  of  uraemic  convulsions  is  not 
uncommon.”  (Williams.) 

Treatment. — Two  plans  of  treatment  are  in 
vogue,  one  rachcal  or  operative,  and  the 
other  inclining  to  conservatism. 

A.  First  Plan. — Empty  the  uteins  at 
once.  If  labor  and  dilatation  of  the  cervix 
have  not  begun,  perform  either  vaginal 
hysterectomy  {q.v.)  and  version  and  e.xtrac- 
tion  {q.v.)  under  ether  anaesthesia,  or  Caesar- 
ean section  {q.v.),  which  is  perhaps  best, 
because  of  its  celerity  {?).  If  labor  and 
cervical  dilatation  have  begun,  one  may 
attempt  to  hasten  the  process  by  careful  and 


gentle,  not  too  rapid,  manual  dilatation  by 
Harris’s  method,  under  full  ether  anaes- 
thesia, followed  by  forceps  {q.v.)  or  version. 

After  delivery  has  been  effected,  promote 
free  catharsis,  diuresis,  and  diaphoresis, 
as  described  below. 

B.  Second  Plan. — Place  two  or  three 
drops  of  croton  oil  in  half  a teaspoonful  of 
olive  oil,  or  else  a triturate  of  elaterin,  gr. 
ss-i,  on  the  back  of  the  tongue;  or  better, 
insert  a stomach  tube  and  introduce  2 oz. 
of  Epsom  salts  in  concentrated  solution,  or 
2 oz.  of  castor  oil  containing  2 drops  of 
croton  oil;  or,  if  the  patient  can  swallow, 
administer  a dessertspoonful  of  a concen- 
trated solution  of  Epsom  salts  everj^  fifteen 
minutes  until  free  catharsis  begins.  Employ 
also  repeated  copious  high  enemata.  At 
the  same  time  sweat  the  patient  by  means  of 
hot-  wet  packs,  under  blankets,  or  hot  water 
bottles,  or  hot  air,  or  best,  by  surrounchng 
her  lower  limbs  and  trunk  with  six  or  eight 
hot  bricks,  wrapped  in  towels,  over  which  is 
poured  a pint  or  more  of  alcohol,  and  the 
whole  covered  with  a rubber  sheet  or  blankets 
(Hir.st).  Apply  ice-bags  to  the  back  of  the 
head  and  neck  during  the  sweat  bath. 

As  soon  as  catharsis  and  diaphoresis  are 
established,  give  normal  salt  solution  (0.85 
per  cent.)  under  the  breasts.  Give  a thor- 
ough sweat  for  thirty  minutes,  together 
with  a saline  infusion,  one  to  two  pints, 
every  four  to  six  hours. 

To  control  the  convulsions,  administer 
ether,  also  chloral  hydrate  per  rectum, 
gr.  xxx-lx  in  solution,  every  six  to  ten  hours; 
or  morphine,  gr.  }/i  to  ]/2  hj'podermically; 
or  tincture  of  veratrmn  viride,  t^x-xx,  hj-po- 
dermically,  then  t^x  every  half  hour,  “ till 
the  pulse  continues  below  60  to  the  minute  ” 
(“it  diminishes  the  pulse  rate,  controls  the 
con\oilsions,  reduces  the  temperature,  pro- 
motes diaphoresis  and  diuresis,  and  relaxes 
the  cervical  ring  ” — Edgar;  and  also  lowers 
the  blood-pressure;  “ whiskey,  or  morphine 
will  easily  control  vomiting  and  collapse  if 
they  occur,”  says  Edgar).  \’eratrum  viride 
is  not  universally  advocated. 

Puncture  the  membranes,  in  order  both 
to  lower  the  blood  pressure  and  to  hasten 
labor.  When  the  os  is  dilated  to  the  size  of 
a dollar,  dilatation  being  assisted  with  the 
fingers,  appl}^  forceps  {q.v.)  if  the  head  is 
engaged,  or  j)erform  podalic  version  (g.r) 
if  the  head  is  not  engaged,  or  bring  down  a 
leg  if  the  breech  presents.  Do  not  attempt 
to  ch’ag  the  child  tlrrough  an  undilated  os, 
but  pull  down  cautiously  against  the  os  and 
so  hasten  its  dilatation,  when  delivery  may 
then  be  affected.  Some  prefer  the  use  of 


FACE  PRESENTATIONS 


hydrostatic  dilators  (see  Premature  Labor, 
Induction  of). 

Avoid  the  use  of  ergot  after  delivery. 
Continue  free  catharsis,  diuresis  and  cha- 
phoresis,  and  if  the  convulsions  continue, 
withdraw  500  to  600  c.c.  of  blood,  “ no  mat- 
ter what  the  condition  of  the  pulse  ” (Wil- 
hams),  followed  perhaps  by  the  infusion  of 
an  equal  or  less  amount  of  normal  salt  solu- 
tion. Bleeding  removes  toxin,  and  tends  to 
prevent  pulmonary  oedema  and  apoplexy, 
frequent  causes  of  death  in  eclampsia.  Liun- 
bar  punctm’e  {q.v.  in  Part  1)  is  recommended. 
Apply  wet  or  dry  cups  {q.v.  in  Part  1)  over 
the  chest  in  pulmonary  oedema.  Administer 
stimulants  hypodermically  as  required,  e.g., 
alcohol,  strychnine,  ether  (see  Part  11). 
Diuresis  is  promoted  by  means  of  diy  or 
wet  cups  over  the  kidneys,  followed  by  hot 
fomentations.  Oxygen  per  inhalation  is 
recommended  for  the  stupor  or  coma.  It 
may  be  administered  through  a funnel 
draped  with  a curtain  and  held  over  the 
mouth  and  nose.  Says  L.  E.  Hill,  pure 
oxygea  may  be  breathed  for  two  to  four 
hours  continuously,  without  harm,  and  an 
atmosphere  of  50  per  cent,  oxygen  can  be 
breathed  indefinitely.  He  says:  “The 

cylinder  valve  must  be  opened  wide  enough 
to  give  a pleasant  cool  current  (as  tested 
upon  the  lips),  and  drive  the  exhaled  CO2  out 
of  the  mask.”  After  consciousness  is  re- 
gained, give  four  or  five  quarts  of  milk  daily 
for  a few  days.  Many  obstetricians  recom- 
mend thyroid  as  one  of  the  best  remedies  for 
eclampsia,  e.g.,  gr.  xv,  repeated  in  two  hours. 

Ectopic  Gestation.— Gr.  Utotos  displaced; 
L.  gestat'io,  pregnancy.  See  Extra-Uterine 
Pregnancy. 

Edema  of  the  Vulva. — See  (Edema  of  the 
Vulva. 

Elevation  of  Temperature,  Puerperal. — 

L.  elevdre,  to  lift;  lemperatura.  See  Puer- 
peral Fever. 

Emphysema  Complicating  Pregnancy. — 

Gr.  kiJi.4>vaav  to  inflate.  Consult  Part  1, 
General  Medicine  and  Surgery,  for  the 
treatment  of  emphysema.  If  dyspnoea  is 
extreme,  pregnancy  may  have  to  be  termi- 
nated (see  Premature  Labor,  Induction  of). 

Emphysematous  Colpitis. — Gr. 
inflation;  koXwos  vagina.  See  Vaginitis. 

Endometritis,  Puerperal.— Gr.  ’iv5op  within 
-f-  iirjTpa  uterus  d-  -trts  inflammation.  See 
Puerperal  Infection. 

Engorgement  of  the  Breasts. — See  Caked 
Breasts. 

Enteralgia  Complicating  Pregnancy. — Gr. 

ivTtpov  intestine  -j-  aXyos  pain.  See  Dys- 
pepsia Complicating  Pregnancy. 


Epistaxis  Complicating  Pregnancy. — Gr. 

exto-ra^ts  nose-bleed.  Consult  Part  8,  on 
Nose  Diseases.  Hirst  says,  “ It  can  only  be 
checked  by  the  rapid  termination  of  labor.” 

Eructations,  Acid,  Complicating  Preg- 
nancy.— L.  eructdtio,  belching;  acidus,  sour. 
(See  Dyspepsia  Complicating  Pregnancy.) 

Excessive  Milk  Secretion. — See  Milk 
Secretion,  Excessive.) 

Expression  of  the  Placenta  by  Crede’s 
Method. — L.  expressio;  placen'ta,  flat  cake. 
See  under  Conduct  of  Normal  Labor. 

External  Version. — L.  exter'nus,  outside. 
See  Cephalic  Version. 

Extra=Uterine  Pregnancy. — See  Part  2, 
Gynaecology. 

Face  Presentations. — L.  prcesenta’iio. 

Frequency.— About  0.4  per  cent. 

Varieties,  in  Order  of  Frequency. — L.M.A. ; R. 

M.P.;  R.M.A.;  L.M.P. 

On  external  palpation,  there  is  noted  a 
marked  cephalic  prominence  on  the  same 
side  as  the  back,  the  latter  being  felt  dis- 
tinctly only  near  the  breech;  but  the 
diagnosis  is  usually  made  only  by 
internal  palpation.  Spontaneous  delivery  is 
the  rule,  especially  in  multiparse,  provided 
the  chin  is  directed  anteriorly.  Should  the 
chin  rotate  into  the  hollow  of  the  sacrum, 
spontaneous  delivery  is  usually  impossible. 
Such  an  event,  however,  is  of  very  rare  occur- 
rence, about  1 percent . of  allface  presentations. 

Etiology.— Conditions  which  prevent  flexion 
or  favor  extension  of  the  head,  e.g.,  oblique 
position  of  the  uterus;  multiparity;  con- 
tracted pelvis;  large  child;  low  implantation 
of  the  placenta;  tumors  of  the  neck;  rigid 
os;  constriction  of  the  cervix  about  the  neck; 
coils  of  cord  around  the  neck ; tonic  contrac- 
tion of  the  neck  muscles;  foetal  obesity; 
foetal  dropsy;  muscular  flaccidity  of  an 
asphyxiated  or  dead  foetus;  mobility  of  the 
foetus;  dolichocephalic  head;  spinal  menin- 
gocele or  other  tumor  on  the  back;  distended 
maternal  bladder;  prominent  ischial  spines; 
hemicephaly;  prematurity;  hydramnios; 
multiple  pregnancy;  monstrosity;  pendulous 
abdomen;  “ triangular  and  saddle-shaped 
uteri  ”;  deformed  pelvis;  pelvic  tumor; 
occiput  posterior. 

Treatment.— If  deep  engagement  has  not 
occurred,  anaesthetize  the  patient,  and  with 
one  hand  or  an  assistant  producing  flexion 
of  the  back,  introduce  the  other  hand,  and 
try,  by  pushing  up  the  chin  or  by  traction 
upon  the  occiput,  to  convert  the  face  into  a 
vertex  presentation,  unless,  perhaps,  the 
chin  is  directed  anteriorly.  Even  in  the 
latter  instance,  however,  conversion  may 
be  practiced,  followed  by  rotation  of  the 


FORCEPS 


occiput  to  an  anterior  position  and  extrac- 
tion with  forceps  (see  Occipito-Posterior 
Presentations) . 

If  the  above  measures  fail,  and  the  face 
is  not  impacted,  perform  internal  podalic 
version  (q.v.). 

If  the  face  is  deeply  engagetl  or  impacted, 
and  the  chin  directly  posteriorly,  allow  labor 
to  proceed,  “ in  the  hope  that  anterior 
rotation  will  occur  when  the  face  reaches 
the  pelvic  floor.”  One  may  aid  rotation  by 
pressing  on  the  posterior  cheek  and  chin 
with  the  Angers,  to  favor  increased  exten- 
sion, or  by  placing  a single  blade  of  the 
forceps  under  and  behind  the  chin,  to  supply 
the  normal  resistance  of  the  pelvic  floor. 
Or,  rotation  may  be  attempted  with  the 
forceps,  if  the  chin  is  not  imbedded  in  the 
pelvic  floor,  and  when  the  chin  is  anterior, 
the  forceps  removed  and  reapplied  and  trac- 
tion exerted.  Never  employ  traction  when 
the  chin  is  posterior. 

If  these  measures  fail,  resort  to  pubiotomy 
(q.v.)  or  craniotomy  (q.v.). 

Failure  of  Vision. — See  Paralyses  Com- 
plicating Pregnancy. 

False  Pregnancy. — ^See  Diagnosis  of 
Pregnancy. 

Feeding. — See  Diet. 

Fetus. — See  Foetus. 

Fever,  Puerperal. — See  Puerperal  Fever. 

Fibroid  Tumors  Causing  Dystocia. — L. 

fi'bra,  fibre  -f  Gr.  eldos  form;  L.  tu'mor, 
swelling;  Gr.  5us  — ill  -f-  tokos  birth.  If,  at 
labor,  the  tumor  is  in  the  pelvis,  and  can  not 
be  pushed  above  the  pelvic  brim,  with  the 
])atient  in  the  knee-chest  posture  and  under 
ansesthesia,  perform  Csesarcan  section  {q.v.), 
followed  by  enucleation  of  the  tumor  or 
supravaginal  amputation  of  the  uterus. 
Even  if  the  child  could  be  delivered  past  the 
tumor,  the  latter  is  apt  to  slough  and  give 
rise  to  fatal  infection. 

Polypoid  tumors  should  be  removed 
at  the  time  of  labor,  after  dilatation  has 
begun,  by  ligating  the  pedicle  and  cutting 
off  the  tumor. 

Fibroid  Tumors  Complicating  Pregnancy. 

— Ij.  fi'bra,  fibre  -1-  Gr.  eidos  form;  L.  tu'mor, 
swelling;  praiifnans,  with  chikl.  Should 
serious  symptoms  at  any  time  occur,  such 
as  marked  hemorrhage,  extreme  distention, 
or  symj^toms  of  unpaction,  perform  supra- 
vaginal hysterectomy  (in  preference 
to  myomectomy) , first  removing  the  child 
if  it  has  reached  the  age  of  viability 
(seven  months). 

Polypoid  tuhiors  should  be  removed  only 
at  the  time  of  labor,  because  of  the  danger 
of  provoking  abortion  if  removed 


earlier  (see  also  Fibroid  Tmnors  causing 
Dystocia,  above). 

Fissured  Nipple. — L.  fissu'ra.  See  Sore 
Nipples. 

Fistula,  Qenito=Urinary. — L.  fis'tula,  pipe; 
L.  (jenita'lis;  uri'na.  The  condition  is  diag- 
nosed by  the  presence  of  urinary  inconti- 
nence, by  colposcopy,  cystoscopy,  a sound 
in  the  bladder,  and  the  injection  into  the 
bladder  of  a colored  fluid. 

Treatment. — The  wound  may  be  allowed 
to  close  spontaneously;  or  it  may  be  closed 
by  an  operation  four  to  sLx  w'eeks 
after  childbirth. 

Fistula,  Milk. — See  under  Mastitis. 

Flat  Pelvis. — See  Contracted  Pelves. 

Flatulence. — L.  flatuien'tia.  See  Tym- 

panites. 

Foetus,  Death  of  the. — L.  See  Death  of 
the  Fcetus. 

Presentation  of  the. — See  Presenta- 
tions. 

Rickets. — See  Achondroplasia  in  Part  1. 

Fontanelle  (Anterior  or  Greater)  Presen= 
tation. — Fr.  fontanelle,  little  fountain.  See 
Bregma  Presentations. 

Forceps. — L. 

Indications. — Maternal  or  foetal  danger,  viz., 
broken  cardiac  compensation,  pulmonary 
ccdema,  tuberculosis,  nephritis,  acute  infec- 
tious disease,  local  infection,  hemorrhage, 
exhaustion,  inertia  uteri,  eclampsia,  stran- 
gulated hernia,  rupture  of  the  uterus,  weak 
abdommal  cicatrix,  dry  labor,  contracted 
pelvis,  large  child,  resistant  vaginal  outlet, 
transverse  or  posterior  position  of  the  head, 
cord  around  the  neck,  prolapse  of  the  cord, 
fetal  pulse  below  100  or  above  IGO,  escape 
of  meconium  in  vertex  presentations,  etc. 

Contraindications. — Head  too  large  or  pelvis 
too  contracted;  chin  posterior  in  face  or 
brow  presentations  (q.v.). 

Simpson’s  or  Tarnier’s  axis-traction  for- 
ceps are  the  best. 

Before  attempting  to  extract  with  forceps 
the  cervLx  should  be  fully  dilated.  The  mem- 
branes should,  of  course,  be  ruptured  before 
the  forceps  are  applied,  and  the  bladder 
should  be  emptied. 

The  forceps  may  be  lubricated  with  creolin 
or  lysol  solution,  one  teaspoonful  to  the 
quart,  or  with  sterile  vaseline.  The  firet 
blatle  is  always  inserted  beneath  the  pos- 
terior ear,  the  hand  being  used  as  a guide. 

If  forceps  are  used  where  the  head  is 
floating,  apply  “ one  blade  over  the  mastoid 
and  the  other  over  the  opposite  brow.” 
Internal  podalic  version,  however,  is  prac- 
tically always  to  be  preferred  in  these  cases. 

In  occipito-posterior  presentations,  if  the 


HEART  DISEASE 


occiput  cannot  be  rotated  manually  to  a 
transverse  or  anterior  position,  try  to  rotate 
it  with  the  forceps.  The  latter  are  applied 
as  though  the  occiput  were  anterior;  then, 
after  rotation  has  been  accomplishecl,  they 
are  removed  ami  reapplied.  If  rotation  is 
impossible,  extract  with  the  occiput  posterior. 

Fractured  Pelvis.— L./ractw'ra,  homjrang'- 
ere,  to  break.  See  under  Contracted  Pelves. 

Funnel  Pelvis. — See  Contracted  Pelves. 

Galactocele;  Milk  Retention  Cyst. — Gr. 
ydXa  milk  + ^17X77  tumor;  kvcttls  cyst;  L. 
rete'ntio.  Milk  retention  cyst  is  rare.  If 
small,  it  may  be  removed  by  massage,  or  by 
the  application  of  heat  and  firm  compression. 
Otherwise  it  must  be  tapped  and  drained. 

Galactorrhoea. — Gr.  7dXa  milk  + poia 
flow.  The  constant  escape  of  milk,  imle- 
pendently  of  nursing.  It  may  persist  for 
years  in  spite  of  treatment. 

Treatment. — ^The  breasts  should  be  sup- 
ported with  or  "without  firm  compression. 
Potassium  iodide,  belladonna,  ergot,  chloral, 
antipyrine,  and  laxatives  are  variously  recom- 
mended (see  Part  1 1) . Edgar  has  found  the 
local  apphcation  of  atropine,  gr.  i,  in  glycerine, 
§i,  “ of  great  value.”  The  application  to 
the  nipples  of  cocaine  hydrochlorate,  5 per 
cent.,  fit  equal  parts  of  glycerine  and  water, 
is  also  advocated. 

It  is  said  that  the  flow  usually  ceases  on 
the  return  of  menstruation;  therefore  the 
latter  ynay  be  encouraged  by  means  of  warm 
douches  and  local  applications  to  and 
scarification  of  the  cervix.  Intra-uterine 
galvanism  (10  to  12  milliamperes,  with  the 
negative  pole  within  the  uterus)  is  considered 
the  most  effectual,  but  at  the  same 
time  dangerous. 

Genito=Urinary  Fistula. — See  Fistula, 
Genito-Urinary. 

Giant  Children. — See  Child,  Large. 

Gingivitis  Complicating  Pregnancy. — L. 

gingiv'a,  gum  + Gr.  -itls  inflammation;  L. 
■prceg'nans,  with  child.  Spongy  and  bleeding 
gums  may  persist  obstinately  until  the 
termination  of  pregnancy. 

Treatment. — The  teeth  should  be  kept  clean 
with  wann  water,  castile  soap,  and  a soft 
brush  or  cloth,  and  one  of  the  following 
aseptic  and  astringent  preparations  used 
as  a mouth-wash: 


II  Acidi  carbolici rjlxxx 

Sodii  boratis, 

Sodii  bicarbonatLs,  aa 5ii 

Glycerini ^ ss 

Aqua;,  q.s.  ad Oi 

M.  Sig. — Mouth-wash. 

II  Tinctura;  myrrha; 5 i 

Aqua;,  q.s.  ad Oi 


Once  daily  the  gums  may  be  painted  with 
tincture  of  iodine  or  a strong  solution  of 
silver  nitrate,  or  one  of  the  following : 

II  Tinctura;  kraineria;. 


Tr.  iodi,  aa ov 

Tr.  mvrrha' ohss 

II  Tr.  krameria', 

Tr.  myrrha-,  aa 5ss 


Edgar  recommends  milk  of  magnesia  as 
a mouth-wash,  and  at  bedtime  precipitated 
chalk  pressed  between  the  teeth. 

Enjoin  the  observance  of  correct  hygiene, 
e.g.,  fresh  air  day  and  night,  adequate  rest 
and  exercise,  regulation  of  the  bowels,  a 
daily  tepid  bath  in  a comfortable  room 
before  breakfast  followed  by  a cool  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
and  abundance  of  fresh  food.  For  ancemia, 
prescribe  iron  (q.v.  in  Part  11). 

Glycosuria  in  Pregnancy. — GF  yXvKos 
sweet  -h  ovpov  urine;  L.  prceg’nans,  with 
child.  If  the  sugar  is  Iqctose,  as  determined 
by  the  fermentation  test  (see  Urinalysis,  in 
Part  1),  it  is  of  no  significance.  Even  if  it  is 
glucose,  it  usually  disappears  shortly  after 
childbii-th.  If  the  glucose  is  abundant, 
however,  the  case  should  be  treated  as  one 
of  diabetes  mellitus  (consult  Part  1,  on 
General  Medicine  and  Surgeiy),  and  if  the 
symptoms  progress,  abortion  should  be 
performed  (see  under  Abortion). 

Gonorrhoea  Complicating  Pregnancy. — Gr. 
yorij  semen  -{-  pelv  to  flow ; L.  prceg'nans,  with 
child.  (Consult  Part  2,  on  Gynaecology.) 
Intracervical  treatment,  however,  should  be 
employed,  if  at  all,  with  care,  because  of  the 
danger  of  provoking  abortion. 

Gonorrhoeal  Ophthalmia  Neonatorum. — 
See  Ophthalmia  Neonatorum. 

Granular  Vaginitis. — L.  gran'uhmi,  grain. 
See  Vaginitis  Complicating  Pregnancy. 

Gynatresia.— Gr.  yw-q  woman  -j-  a priv. 
-f  rpqais  perforation.  See  Atresia. 

Haem. — See  Hem. 

Hanging  Posture,  Walcher’s. — See  under 
Contracted  Pelves. 

Harelip  and  Cleft  Palate. — See  Part  1, 
General  Medicine  and  Surgery. 

Headache  in  Pregnancy. — See  Toxaemias 
of  Pregnancy. 

Heads,  Locked. — See  Multiple  Pregnancy. 

Head,  Transverse,  at  the  Pelvic  Outlet. — 

See  Transverse  Position  of  the  Head  at  the 
Pelvic  Outlet. 

Heartburn. — See  Dyspepsia  Complica- 
ting Pregnancy. 

Heart  Disease. — See  Cardiac;  Disease 
Complicating  Pregnancy  and  Labor. 


HEMORRHAGE,  POST-PARTUM 


Heart,  Palpitations  of  the. — L.  palpita'Ho. 
See  Cardiac  Disease. 

Haematoma  of  the  Vagina  or  Vulva. — Gr. 
atfia  blood  + tumor.  A vaginal  or 

vulval  haematoma  that  interferes  with 
labor  should  be  incised,  the  blood-clot  evac- 
uated, and  the  cavity  packed  with  gauze  to 
check  bleeding. 

A puerperal  haematoma  may  be  subcu- 
taneous, vaginal,  cervical,  or  subperitoneal. 
If  extensive,  it  may  be  first  manifested  by 
severe  local  pain,  collapse,  and  acute  anaemia, 
occurring  wfithin  twelve  hours  after  delivery. 
If  it  is  of  moderate  size,  it  usually  becomes 
absorbed,  with  rest  and  careful  cleanliness, 
i.e.,  frequent  bathing  or  irrigation  with 
boiled  boric  acid  solution,  5i~iv  ad  Oi.  If 
it  is  very  large,  is  steathly  increasing  in  size, 
or  gangrene  threatens,  it  should  be  lai(l 
wide  open,  evacuated,  and  packed  with 
gauze.  Laparotomy  is  demanded  for 
large  subperitoneal  ha}matomata.  If  spon- 
taneous rupture  occurs,  enlarge  the  opening, 
turn  out  the  clot,  and  pack  firmly  with 
gauze  if  the  bleeding  vessel  can  not  be 
quickly  found  and  ligated. 

Suppuration,  of  course,  calls  for  free 
drainage. 

Haematoma  of  the  Sternocleidomastoid. — 

See  Part  1,  General  Medicine  and  Surgery. 

^Haematuria  Complicating  Pregnancy. — Gr. 
at/ua  blood  fi-  ovpou  urine;  L.  prceg' nans,  with 
child.  The  haematuria  of  pregnancy  is 
usually  due  to  varicose  veins  of  the  bladder. 
It  is  sometmies  severe. 

Treatment. — Tight  clothing  and  consti- 
pation should  be  avoided,  and  the 
patient  should  assume  the  knee-chest  pos- 
ture frequently. 

Should  the  hemorrhage  become  serious, 
insert  a retention  catheter,  to  quiet  the 
bladder,  aiul  inject  about  three  ounces  of 
hot  silver  nitrate  solution,  1 : 1000  to 
1 : 500;  or  the  same  amount  of  Merck’s 
sterilized  solution  of  gelatine,  2 to  5 per  cent., 
hot;  or  fluid  extract  of  hydrastis,  one  ounce 
to  the  pint;  or  antipyrine,  4 per  cent.;  or  a 
heaping  teaspoonful  of  Squibb’s  surgical 
pow'der  (contains  alum)  suspended  in  500 
C.C.,  or  one  pint  of  hot  water  (“  the  best 
application  I know,”  says  Keyes).  Adren- 
alin, 1 : 5000  to  1 ; 1000,  is  not  satisfac- 
tory, say  Casper  and  Keyes.  Rest  in  bed, 
with  the  hips  elevated,  is  essential.  To 
evacuate  clots,  insert  a large  glass  or  metal 
catheter,  and  irrigate  with  hot  salt  or  alum 
solution,  oi  ad  Oi;  or  hot  phenol  solution,  1 
per  cent.;  or  a cool  solution  of  sodium  bicar- 
bonate. (For  other  causes,  etc.,  of  haema- 
turia, consult  Part  2,  on  Gynaecology.) 


Haemoptysis  in  Pregnancy. — Gr.  alpa 
blood  -p  TTTveLv  to  spit;  L.  proeg'nans,  with 
child.  Haemoptysis,  says  Hirst,  may  occur, 
independently  of  any  lung  disease,  in  the 
later  months  of  pregnancy,  as  the  result  of 
“ cardiac  nerve  storms  ” in  neurotic  women; 
and  rest  together  with  “ chloral  and  the 
bromides  will  control  the  attack.”  For  a 
fuller  consideration  of  Haemoptysis,  consult 
Part  I,  on  General  Medicine  and  Surgery, 

Hemorrhage,  Ante=Partum  or  Pre=Partum. 
— Gr.  alpa  blood  -f-  prjyvvvai  to  burst  forth; 
L.  ante  or  pree,  before;  par'tus,  labor. 
Hemorrhage  occurrmg  during  pregnancy, 
and  before  the  onset  of  labor. 

Causes. — Abortion,  miscarriage,  or  pre- 
mature labor  (q.v.) ; extra-uterine  pregnancy 
iq.v.) ; hydatichform  mole  (q.v.) ; cervicitis  and 
endocervicitis;  cancer  of  the  cervds  (q.v.)] 
fibroid  polyp  (q.v.) ; prolapsus  with  extreme 
congestion  (q.v.) ; hemorrhoids  of  the  vagina 
or  vulva  (g.v.) ; placenta  prsevia  (q.v.);  per- 
sistence of  menstruation  (rare);  premature 
detachment  of  the  normally  situated  pla- 
centa (q.v.). 

Hemorrhage,  Cerebral,  in  the  New=Born. 
— See  Hemorrhage,  Intracranial,  in 
the  New-Born  in  Part  1. 

General,  in  the  New=Born. — See  Part  I. 

Intracranial,  in  the  New=Born. — See 
Part  1. 

Intra=Partum.— L.-intrawithin,-|-par'/us, 
labor.  Hemorrhage  occurring  during  labor. 

Causes.— 1.  FiRST  AND  SECOND  STAGES. 

Placenta  prsevia  (q.v.);  premature  sepa- 
ration of  the  normally  situated  placenta 
(q.v.);  rupture  of  the  uterus  (q.v.);  lacera- 
tions of  the  cervix  or  vagina;  rupture  of 
varicose  veins;  rupture  of  a haematoma 
(q.v.);  intra-uterine  rupture  of  the  cord; 
tearing  of  the  vessels  of  a velamentously 
inserted  cord  when  the  membranes  rupture; 
uterine  fibroids  (q.v.);  malignant  disease 
(see  Cancer.) 

2.  Third  Stage. — Inertia  uteri  (q.v.) ; lac- 
erations of  the  lower  uterine  segment,  cer\dx, 
vagina,  or  perineum;  incomplete  separation 
of  the  placenta  (see  Adherent  Placenta); 
“ insufficient  contraction  of  the  lower 
uterine  segment  in  cases  of  low  implantation 
of  the  placenta  ”;  rupture  of  varicose  veins: 
rupture  of  a haematoma  (q.v.) ; inversion  of 
tlie  uterus  (q.v.);  fibroids  (5.1’.);  cancer  (q.v.). 

Hemorrhage,  Meningeal,  in  the  New= 
Born. — Gr.  pVviy^  membrane.  See 
Hemorrhage,  Intracranial,  in  the 
New-Born,  in  Part  1. 

Post=Partum. — L.  post,  after  -|-  par'tus, 
labor.  Hemorrhage  occurring  within 
twenty-four  hours  after  the  birth  of  the 


HEMORRHAGE,  POST-PARTUM 


placenta.  Hemorrhage  occurring  later  than 
this  is  designated  puerperal  hemorrhage 
{q.v.).  The  hemorrhage  is  rarely  concealed 
and  associated  with  shock  and  abdominal 
distention. 

Frequency. — About  5 per  cent.  (Edgar); 
one  in  several  hundred  (J.  W.  Williams). 

Causes.— The  conamon  causes  are  atony  or 
relaxation  of  the  uterus,  retention  of  por- 
tions of  the  placenta  (due  to  too  early 
employment  of  Crede’s  manoeuvre  or  to 
decidual  endometritis),  and  cervical,  vaginal, 
or  perineal  tears. 

Rare  causes  are  fibromyomata,  polypi, 
carcinoma,  ulceration,  inversion  of  the 
uterus,  rupture  of  varicose  veins,  rupture  of 
a hsematoma  (q.v.) ; aneurysm  of  the  uterine 
artery,  congestion  due  to  heart,  liver,  lung, 
or  kidney  disease,  alcoholism,  malaria,  leuco- 
cythemia,  hemon’hagic  diathesis,  change 
from  a temperate  to  a tropical  clhnate. 

Predisposing  causes  of  uterine  relaxation 
are  as  follows:  poor  health;  difficult  labor; 
multiparity;  over-distention  due  to  hydram- 
nios  or  twins;  neighboring  disease;  old  peri- 
toneal adhesions;  uterine  fibroma;  ovarian 
cyst;  rapid,  especially  instrumental  labor; 
malposition  of  the  uterus;  too  much  anaes- 
thetic; distended  bladder  or  rectum;  emo- 
tion; exertion;  e.g.,  coughing,  laughing, 
sneezing,  defecation,  sitting  up  in  bed,  etc. ; 
undeveloped  musculature;  retention  of  pla- 
cental remnants  or  clots ; imperfect  innerva- 
tion; placenta  praevia;  paralysis  at  the 
placental  site. 

Treatment. — Look  first  to  the  uterus,  and  if 
it  is  not  firmly  contracted,  knead  it  vigor- 
ously until  it  contracts.  Zweifel  massages 
the  fimdus  with  the  right  hand,  while  the 
left  hand,  pahn  upward,  is  pressed  down  for- 
cibly between  the  uterus  and  pubis,  against 
the  lower  uterine  segment  (this  may  not  be 
possible  in  fat  women).  As  soon  as  the 
uterus  is  firmly  contracted,  entrust  it  tem- 
porarily to  an  assistant,  and  inject,  deep 
into  the  muscles  of  the  thigh,  40  to  60  min- 
ims of  ergotol  or  fluid  extract  of  ergot,  or 
0.5  tb  1 c.c.  of  pituitrin.  The  action  of  the 
latter  is  transient. 

Howat,  in  cases  of  sudden  relaxation  of 
the  uterus,  first  compresses  the  abdominal 
aorta,  then  with  a rapid  change  in  the  posi- 
tion of  the  hand,  grasps  the  fundus,  and  with 
the  other  hand  in  the  vagina  and  behind  the 
cervix,  effects  a bimanual  anteflexion  of  the 
fundus  and  cervix  by  pressure  between  the 
two  hands.  In  this  way  the  open  channels 
of  the  placental  site  are  blocked,  and  the 
uterus  emptied  of  blood  and  stimulated  to 
contract.  Immediately  after  this  the  pelvis 


is  Ufted  by  an  assistant  to  an  angle  of  about 
30  degrees,  and  an  inverted  chair  placed 
beneath  the  patient,  to  unprovise  an  exag- 
gerated Trendelenburg  position.  When  the 
uterus  is  firmly  contracted,  the  vaginal  hand 
may  be  withdrawn  and  a vulvar  dressing 
and  firm  abdominal  binder  (q.v.)  applied. 
The  elevation  of  the  pelvis  should  be  main- 
tained for  at  least  seven  hours. 

The  aorta  may  be  effectually  compressed 
by  means  of  a stout  rubber  tube  about  the 
waist.  (Momburg.) 

Other  means  of  checking  hemorrhage  in 
atony  are  (1)  the  hot  intra-uterine  douche  of 
several  quarts  of  normal  saline  solution  (3i 
ad  Oi),  or  better, creolm  emulsion,  1 per  cent., 
or  the  injection  of  one  ounce  of  undiluted 
tincture  of  iodine;  (2)  tight  packing  with 
sterile  gauze,  or  better,  0.5  per  cent,  lysol 
gauze,  or  iodoforai  gauze,  which  should  be 
removed  at  the  end  of  twelve  to  twenty-four 
hours,  followed  by  irrigation;  (3)  ice  or  ether 
to  the  hypogastrium  for  a few  seconds;  (4) 
the  strong  faradic  current;  (5)  strong  trac- 
tion upon  the  uterus  with  bullet  forceps 
grasping  the  lips  of  the  cervix;  (6)  compres- 
sion of  the  uterus  with  the  fingers  of  one 
hand  in  the  anterior  fornix  and  the  other 
hand  over  the  uterus.  (Breisky.) 

If  it  is  suspected  that  portions  of  the 
placenta  are  retained  witffin  the  uterus, 
insert  the  gloved  hand,  and,  assisted  by  the 
external  hand  upon  the  abdomen,  remove 
any  placental  fragments,  blood-clots,  etc., 
that  may  be  found,  at  the  same  tune  irrita- 
ting the  uterus ; then,  with  the  external  hand 
still  upon  the  abdomen,  remove  the  internal 
hand  while  the  uterus  is  contracting. 

If,  on  the  occurrence  of  post-partum 
hemorrhage,  the  uterus  is  foimd  to  be  con- 
tracted, the  hemorrhage  is  probably  due  to 
laceration  of  the  birth  canal.  In  order  to 
facilitate  examination  and  treatment,  the 
aorta  may  be  compressed  by  means  of 
Momburg’s  rubber  tube,  bub  the  latter  is  not 
without  danger,  e.g.,  intestmal  necrosis, 
hemorrhage,  spinal  paralysis,  etc.  The  cer- 
vix may  be  drawn  to  the  vulva  with  the 
fingers  or  with  bullet  forceps,  an  assistant 
at  the  same  time  pressing  down  firmly  upon 
the  uterus.  Vaginal  retractors  may  be 
employed,  if  desired.  The  tear  should  be 
sutured  from  the  upper  angle  downward 
with  chromicized  catgut.  If,  however,  suture 
can  not  be  advantageously  accomplished, 
insert  a tight  vaginal  pack  ‘‘  in  the  form 
of  a half  ring  in  the  lateral  vault  of  the 
vagina.”  (Hirst.) 

If  the  patient  has  lost  much  blood,  sur- 
round her  with  hot  water  bottles,  raise  the 


iiK:\roifpjiAaE,  puerpeka l 


foot  of  the  bed,  provide  plenty  of  fresh  air, 
enjoin  absolute  quiet,  and  administer  per 
colon  or  subcutaneously  a pint  of  warm 
normal  saline  solution  (0.8  to  0.9  per  cent., 
or,  say,  gr.  xlvi  to  the  pint,  temperature 
102°  F .)  or,  better,  gum-salt  solution  (see 
Part  11).  Give  the  infusion  slowly,  and 
repeat  every  hour  until  the  pulse  is  restored. 
If  the  pulse  is  very  rapid,  or  syncope  occurs, 
give  stimulants  hypodermically,  e.q.,  strych- 
nine, gr.  1/^0  to  Hsl  camphorated  oil,  rjxv- 
xxx;  digitalin  {q.v.)]  ether,  nj)x-lx;  or  give  a 
hot  rectal  enema  of  black  coffee  and  salt 
solution,  equal  parts.  In  severe  cases,  band- 
age the  extremities  evenly  and  firmly  toward 
the  trunk,  over  thick  layers  of  non-absorbent 
cotton,  for  one  or  two  hours. 

As  soon  as  the  stomach  will  retain  any- 
thing, give  very  small  quantities  of  hot  milk, 
hot  coffee,  or  hot  water  and  brandy  eveiy 
fifteen  minutes.  Later,  give  beef-juice, 
panopeptone,  mutton  broth,  etc.  If  there 
is  vomiting,  feed  per  rectum.  The  following 
is  a useful  nutrient  enema:  two  raw  eggs, 
well  beaten;  three  or  four  ounces  of  warm 
milk;  twenty  grains  of  sodium  bicarbonate; 
thirty  grains  of  sodium  chloride  (fifteen 
grains  to  each  egg);  a dessertspoonful  of 
liquor  pancreaticus;  perhaps  a tablespoonful 
of  grape  sugar  (to  obviate  acidosis) ; and,  if 
desired,  one  or  two  tablespoonfuls  of  claret 
or  brandy. 

When  reaction  is  established,  morphine, 
gr.  Vs  to  34)  niay  be  given  to  calm  the  patient 
and  to  relieve  intense  headache  due  to 
cerebral  anaemia  (morphine  produces  cere- 
bral congestion). 

Later,  to  restore  the  blood,  prescribe  rest, 
fresh  ah-,  a liberal  diet,  and  iron  (see  Part  11). 

Hemorrhage,  Puerperal. — L.  pu'er,  boy  -j- 
par'ere,  to  bear.  Hemorrhage  occurring  at 
any  time  from  twenty-four  hours  after  the 
birth  of  the  placenta  to  the  end  of  the  sixth 
week.  Hemorrhage  occurring  within  twenty- 
four  hours  after  the  birth  of  the  placenta 
is  designated  post-partum  hemorrhage  (q.v.). 

Etiology.— Retained  placental  or  clecidual 
fragments;  uterine  displacements  (q.v.); 
“ dislodgement  and  disintegration  of  clots 
at  the  placental  site,”  due  to  sudden 
exertion  or  to  infection  of  the  clots  (the 
hemorrhage  is  usually  sudden  and  copious) ; 
emotion;  rarely  relaxation  of  the  uterus,  due 
to  retention  of  portions  of  the  after-birth,  or 
to  physical  anil  mental  (lej^ression  resulting 
from  prolonged  labor,  poor  food,  or  bad 
hygiene;  retention  of  blood-clots,  due  to 
uterine  relaxation,  displacements,  or  reten- 
tion of  ixu’tions  of  the  after-birth;  fibroiils; 
cancer;  inversion  of  the  uterus  (q.v.); 


rupture  of  a hsematoma;  wounds  of  the 
cervix,  vagina,  or  vulva;  pelvic  congestion, 
due  to  overuse  of  chloroform  or  stimulants, 
cardiac,  renal,  or  hepatic  lUsease,  increaseil 
intra-abdominal  pressure  from  tumor,  etc., 
malaria,  acute  infectious  diseases,  puerperal 
infection  {q.v.)]  chill  (causing  congestion  of 
the  internal  organs),  periuterine  inflamma- 
tion, subinvolution  {q.v.),  ovarian  irritation, 
constipation,  premature  sexual  mtercourse, 
or  “erethism  following  the  return  of  the 
husband  to  the  wife’s  bed.” 

Treatment.— Shave  and  cleanse  the  external 
genitalia  and  neighboring  skin  thoroughly 
with  castile  or  green  soap  and  warm  water, 
and  cleanse  the  vagina  with  soap  and  water, 
followed  by  bichloride  solution,  1 : 4000; 
then  cover  the  lower  limbs  and  abdomen  with 
sterile  sheets,  exposing  only  the  vulva,  and 
make  an  examination. 

Ligate  any  bleeding  vessels  discovered. 
Explore  the  uterine  cavity  with  the  Anger, 
dilating  the  cervix  with  Hegar’s  bougies,  if 
necessary,  evacuate  the  uterus,  and  irrigate 
it  through  a return-flow  tube  with  hot  water 
at  a temperature  of  110°  F.  If  there  are 
symptoms  of  infection,  treat  as  such  (see 
Puerperal  Infection). 

In  cases  of  relaxation,  infection,  or  dis- 
lodged thrombi,  pack  the  uterine  cavity 
with  gauze,  preferably  iodoform  or  0.5  per 
cent,  lysol  gauze.  Seize  the  anterior  lip 
of  the  cervix  as  high  as  possible  with  two 
bullet  forceps,  introduce  a strip  of  gauze 
with  the  long  forceps,  grasp  the  fundus  with 
the  left  hand,  and  then  push  in  the  forceps 
gently,  as  far  as  they  will  go,  and  so  on  until 
the  uterus  is  packed  (Hirst).  Ergot,  fl.  ext., 
3i-ii,  may  be  administered.  The  packing 
must  be  removed  at  the  end  of  twelve  to 
twenty-four  hours  and  the  uterus  irrigated. 

Treat  chsplacements  of  the  uterus  as 
described  under  Displacements  of  the  Puer- 
peral Uterus. 

In  rupture  of  a hiematoma,  enlarge  the 
opening,  turn  out  the  clot,  and  if  the  bleeding 
point  cannot  be  quickly  found  and  ligated, 
pack  firmly  with  gauze. 

Remove  accessible  fibroids  by  means  of 
the  wire  ecraseur,  by  torsion  or  ligation  of 
the  pedicle  and  cutting  with  scissors,  by 
splitting  of  the  capsule  followed  by  enuclea- 
tion, or  by  hysterectomy.  One  must  bear 
in  mind  that  the  uterine  wall  is  apt  to  be 
veiy  thin.  For  severe  hemorrhage,  pack  the 
uterus  with  gauze  and  administer  ergot;  if 
this  fails,  perfonn  hysterectomy. 

In  operable  cancer,  apply  a uterine  or 
vaginal  tampon,  and  perform  hysterectomy 
at  once.  If  inoperable,  curettage  and  pack- 


HYDATIDIFORM  MOLE 


ing  may  be  indicated,  but  if  the  hemorrhage 
is  uncontrollable,  the  internal  iliac,  ovarian, 
and  round  ligament  arteries  must  be  ligated. 

Hemorrhagic  Diseases  of  the  New=Born. 
— See  Hemorrhage,  General,  in  the  New- 
Born  in  Part  1. 

Hemorrhoids  Complicating  Pregnancy  and 
the  Puerperium. — Gr.  alfia  blood  -|-  poia 
flow.  Employ  only  palliative  treatment, 
viz.,  recumbency,  with  the  hips  elevated; 
the  knee-chest  posture  for  about  fifteen 
minutes  several  times  daily;  laxatives  (cas- 
cara,  licorice  powder,  rhubarb,  magnesia, 
sulphur,  compound  laxative  pills,  (see  Part 
11) ; local  analgesics;  a bland  diet;  alkalies  for 
gastric  hyperacidity  (E.  Palier) ; local  cleanli- 
ness with  castile  soap  and  water,  and  perhaps 
a cool  cleansing  enema  after  each  bowel 
movement,  and  local  astringent  applications: 

B Ackli  tannici gr.  x 

Pulveris  camphorsc gr.  v 

Ichthyoli oiss 

Unguenti  zinci  o.xidi,  q..s.  ad 5i 

M.  Sig. — ^Apply  by  means  of  a pile-pipe,  night 
and  morning,  and  after  each  bowel  movement,  the 
parts  being  first  cleansed  with  castile  soap  and 
water.  (Kerlcy.)  t,  . 

For  painful,  oedematous,  irreducible  piles, 
cleanse  the  j)arts  with  castile  soap  and  water, 
rinse,  and  bathe  with  boric  acid  solution, 
3i-iv  ad  Oi,  and  apply  either  (1)  hot 
fomentations  or  hot  poultices  or  a hot  sitz- 
bath  for  about  half  an  hour;  or  (2)  compres- 
ses wet  with  lead  and  opium  lotion  {q.v.  in 
Part  11),  or  aluminum  acetate,  one  table- 
spoonful to  a cup  of  water,  and  covered  with 
an  ice-bag.  A suppository  containing  opium, 
aq.  ext.,  gr.  i,  may  be  inserted,  if  necessary. 
Other  soothing  applications  are  the  following : 


Unguenti  gallae  et  opii 5 i 

Sig. — Apply  several  times  daily,  as  required. 

B Unguenti  gallse, 

Unguenti  stramonii,  aa oSS 

Apply  several  times  daily,  as  required. 

B Pulveris  opii gr.  x 

Extracti  hyoscyami gr.  xii 

Extracti  hamamelidis 3 h 

Petrolati  mollis,  q.s.  ad 5 i 

M.  Sig. — Apply  every  three  to  four  hours  about 
one-twelfth  of  the  above.  (Earle.) 

B Chrysarobini gr.  xii 

lodoformi gr.  ivss 

Extracti  bcUadonn®  foliorum gr.  viiiss 

Petrolati  mollis oiv 

M.  Sig. — Apply  several  times  daily.  (Cohnheim.) 

B Chrysarobini gr.  iss 

Acidi  tannici gr.  iss 

lodoformi gr.  iii 

Extracti  belladonna;  foliorum gr. 

Olei  theobromatis gr.  xxx 

M.  ft.  .suppos.  I,  No.  12. 


Sig. — Use  two  or  three  daily.  (Cohnheim.) 


A hard,  painful,  thrombotic  hemorrhoid 
may  be  incised  under  local  cocaine  or  novo- 
caine  anaesthesia  (see  Part  11),  and  the  clot 
turned  out. 

(For  the  I’adical  treatment  of  chronic 
hemorrhoids,  consult  Part  1,  on  General 
Medicine  and  Surgery.) 

Hemorrhoids,  Vesical. — L.  vesi'ea,  blad- 
der. See  Haematuria. 

Hepatic  Insufficiency. — Gr.  i77rap  liver;  L. 
in,  not  -f  suffic'iens,  sufficient.  See 
Toxaemias  of  Pregnancy. 

Toxaemia. — See  Toxaemias  of  Preg- 
nancy. 

Hernia  of  the  Pregnant  Uterus. — L.  See 

under  Displacements  of  the  Pregnant  Uterus. 

Herpes  Qestationis. — Gr.  epirrjs;  L.  (jestd- 
tio,  pregnancy.  See  Dermatitis  Herpeti- 
formis. 

Hiccough  Complicating  Pregnancy. — For 

uncontrollable  hiccough,  prescribe  morphine 
and  atropine,  or  hyoscine,  or  chloral  (see 
Part  11).  The  induction  {q.v.)  of  labor  is 
sometimes  necessary. 

Hicks  Bipolar  Version. — -See  Gejffialic 
Version. 

Hydatidiform  Mole. — L.  hy'datis;  Gr. 
vdarLs  vesicle]  L.  mo'les  mass.  A veiy  rare 
disease  of  pregnancy,  char,acterized  anato- 
mically by  cystic  degeneration  of  the  ter- 
minal extremities  of  the  chorionic  villi,  and 
clinically  by  rapid  enlargement  of  the  uterus 
toward  the  third  or  fourth  month,  uterine 
hemorrhage,  and  sometimes  the  expulsion 
of  small,  transparent  vesicles.  The  vesicles 
may  sometimes  be  palpated  by  the  finger 
introduced  through  the  cervical  canal. 

Treatment. — Abortion  (q.v.)  should  be  in- 
duced as  soon  as  the  condition  is  diagnosed, 
since  fatal  perforation  of  the  uterine  wall 
or  malignant  degeneration  of  the  mole  into 
chorio-epithelioma  (q.v.,)  may  occur  if  the 
mole  is  allowed  to  remain.  It  shovdd  be 
removed  thoroughly  by  means  of  the  fingers 
and  placenta  forceps,  and  the  uterus  then 
irrigated  and  packed  with  gauze  to  stimulate 
contraction  and  control  hemorrhage.  One 
must  remember  that  the  uterine  wall  may  be 
very  thin  and  weak.  Ergot  (q.v.)  should  be 
given  for  several  days  following  the  removal 
of  the  mole. 

If  vaginal  or  vulvar  metastases  occur,  and 
the  uterine  scrapings  show  no  evidence  of 
chorio-epithelioma,  it  is  sufficient  to  excise 
the  metastases. 

Should  metrorrhagia  later  occur,  even 
after  the  lapse  of  months  or  years,  the  endo- 
metrium should  be  curetted  and  examined 
for  chorio-epithelioma.  The  presence  of 
the  latter  demands  immediate  hysterectomy. 


INERTIA  UTERI 


Hydraemia. — Gr.  v5up  water  -f  aipa 
blood.  See  AnEemia. 

Hydramnios. — Gr.  vdwp  water  + apvLov 
amnion,  lamb.  Excess  of  amniotic  fluid, 
e.g.,  about  five  pints  or  more.  The  fre- 
quency is  about  one  in  250  to  300  pregnan- 
cies. The  diagnostic  characters  are  a 
cystic  abdominal  tmnor  associated  with  the 
history  of  pregnancy. 

In  very  rare  cases  the  fluid  accumulates 
rapidly,  with  severe  dyspnoea,  cyanosis, 
pain,  vomiting,  and  fever. 

Treatment. — In  acute  hydramnios,  dilate 
the  os  and  rupture  the  membranes,  prefer- 
ably at  a point  far  within  the  uterine  cavity, 
in  order  to  avoid  too  rapid  escape  of  the 
amniotic  fluid  and  consequent  syncope. 
The  hand  or  gauze  may  possibly  be  used  as 
a plug  to  prevent  too  sudden  escape  of 
fluid.  Labor  is  thus  induced. 

In  chronic  hydranmios,  employ  rest  and 
an  abdominal  support.  If,  however,  respira- 
tory and  circulatoiy  embarrassment  become 
severe  and  the  patient  becomes  weak, 
terminate  pregnancy  as  described  above. 

Post-partum  hemorrhage  from  inertia 
uteri  is  apt  to  occur;  therefore  it  is  probably 
wise  to  admmister  jjituitrm  (q.v.)  immedi- 
ately after  delivery. 

The  foetus  in  hydramnios  is  apt  to  be 
deformed,  and  about  25  per  cent.  die. 

Hydrocephalus  Causing  Dystocia. — Gr. 
v5wp  water  /ce0aXi7  head;  8vs  ill  -f-  tokos 
birth.  The  condition  is  diagnosed  by  the 
presence  of  a large  skull  which  fluctuates 
and  crackles  on  palpation;  on  vaginal 
examination  the  sutm’es  are  found,  besides, 
to  be  widely  separated. 

Treatment. — Perforate  the  skull  as  soon  as 
the  cervix  is  completely  dilated,  and  if 
spontaneous  labor  does  not  then  occur, 
extract  the  foetus  with  the  cranioclast  (see 
Craniotomy). 

Hygiene  of  Pregnancy. — Gr.  vyuLvbs 
healthful.  See  Management  of 
Pregnancy. 

the  Puerperium.  — See  Management 
of  the  Puerperium. 

Hyperemesis  of  Pregnancy. — Gr.  hirkp 
over  -k  epeens  vomiting.  See  Nausea  anti 
Vomiting  of  Pregnancy. 

Hyperthermia  Occurring  in  the  Puer= 
perium. — Gr.  virkp  over  dkppr)  heat.  See 
Puerperal  Fever. 

Hysterotomy,  Vaginal. — Gr.  varkpa  uterus 
-k  Topi)  cut;  L.  vagina,  a sheath.  See  under 
Premature  Labor,  Induction  of. 

Icterus  Neonatorum. — L.  ; Gr.  Urepos 
jaundice;  vk>s  new  -k  L.  na'tm,  born.  Jaun- 
dice in  the  new-born  may  be  physiological 


and  mild,  or  severe  and  due  to  mnbilical 
thrombophlebitis,  or  epidemic  haemo- 
globinuria  without  sepsis  of  the  umbilical 
vessels,  or  hemorrhagica  pmpura  (morbus 
maculosus  neonatorum). 

Impetigo  Herpetiformis  Complicating 
Pregnancy. — See  Part  5,  Skin  Diseases. 

Incarceration  of  the  Pregnant  Uterus. — 
L.  in,  in  -k  car'cer,  prison.  See  Displace- 
ments of  the  Pregnant  Uterus. 

Incontinence  of  Urine. — L.  incontineiitia; 
ur'ina.  See  Bladder  Irritability. 

Indigestion  Complicating  Pregnancy. — L. 
in,  not  -k  dis,  apart  -k  ge'rere,  to  carry.  See 
Dyspepsia. 

Induction  of  Abortion. — L.  in,  in  -k  du'cere, 
to  lead.  See  under  Abortion,  Miscarriage,  and 
Premature  Labor,  in  Part  2,  Gynaecology. 

Induction  of  Premature  Labor.  — See 
Premature  Labor,  Induction  of. 

Inertia  Uteri. — L.  Sluggishness  of  the 
uterine  contractions  during  labor  should  not 
be  confused  with  prolonged  labor  due  to 
an  obstruction  but  with  good  pains.  In 
inertia,  the  uterine  contractions  are  slight, 
brief,  and  infrequent,  whereas  in  obstructed 
labor  with  good  pains  the  upper  uterine  seg- 
ment may,  indeed,  be  tetanically  contracted, 
as  revealed  by  inspection  and  palpation. 

Etiology.— Imperfect  muscular  development 
of  the  uterus;  weakened  musculature,  the 
result  of  rapidly  succeeding  pregnancies, 
overdistention  due  to  multiple  pregnancy  or 
hydramnios,  exhausting  diseases,  the  anaemic 
form  of  obesity,  and  profuse  hemorrhage,  as 
in  placenta  praevia;  disadvantageous  action, 
as  in  the  presence  of  fibroid  tumors,  uterus 
bicornis,  uterine  displacements,  old  peri- 
toneal adhesions,  or  fresh  periuterine  inflam- 
mation; inhibitory  nervous  influences,  as 
in  nervousness,  emotion,  or  pain  (in  inertia 
due  to  pain  the  contractions  recur  rapidly 
and  are  very  brief  and  painful);  premature 
rupture  of  the  membranes  (dry  labor) ; 
mechanical  obstructions  to  labor;  full  blad- 
der; full  rectum;  physiological  fatigue. 

Treatment.— 1.  FiRST  St.^GE. — If  excessive 
pains  and  nervous  apprehension  are  e\d- 
dently  exerting  an  inhibitoiy  influence  upon 
the  regular  course  of  labor,  one  may  admini- 
ster a calmative,  such  as  chloral  hydrate,  gr. 
x-xv',  well  (hluted,  by  mouth,  and  repeated 
in  fifteen  to  sbety  minutes,  if  necessary',  or 
gr.  XXX  in  warm  milk,  oiv,  per  rectum, 
repeated  in  one  hour,  if  necessary';  or  mor- 
phine, gr.  % to  with  atropine,  gr.  M50, 
hypodermically;  or  scopolamine  (hj'oscine), 
gr.  or  antipjTine,  gr.  x,  repeated,  if 

necessary;  or  a “ wineglassful  of  sherry, 
taken  slowly,  with  a biscuit  ” (Hirst).  These 


INSTRUMENTS,  OBSTETRICAL 


drugs,  by  alleviating  suffering,  promote  more 
regular  contractions  of  the  uterus  with 
corresponding  relaxation  of  the  cervix 
and  perineum.  A hot  full  bath  renders  the 
same  service. 

As  a uterine  stimulant,  quinine,  gr.  xv,  is 
much  used  in  the  first  stage  of  labor,  and 
is  especially  valuable  in  multiparas.  It 
occasionally  produces  a “ violent  post-par- 
tum  hemorrhage  ” Hirst).  Pituitrin  is  best 
reserved  for  the  second  stage. 

The  mother  and  child  should  be  watched 
for  the  first  indications  of  exhaustion,  e.g.,  a 
steady  increase  in  the  frequency  of  the  pulse, 
elevation  of  temperature,  irritability,  despon- 
dency, a foetal  pulse  below  100  or  above  160, 
and  the  appearance  of  meconium  in  vertex 
presentations,  when  labor  should  be  has- 
tened by  artificial  means. 

In  order  both  to  stimulate  the  uterus  and 
to  hasten  cervical  dilatation,  one  may  insert 
a bougie  or  a small  Champetier  de  Ribes  or 
Voorhees  rubber  bag  (see  under  Premature 
Labor,  Induction  of). 

When  the  head  is  well  engaged  and  the 
os  dilated  to  the  size  of  a silver  dollar.  Hirst 
recommends  that  forceps  be  applied,  and 
the  head  at  intervals  pulled  down  firmly 
upon  the  cervix,  the  forceps  to  be  removed  as 
soon  as  dilatation  begins  to  progress  and 
“ efficient  pains  are  established.” 

Manual  dilatation  by  Harris’s  method, 
where  the  external  os  alone  remains  unch- 
lated,  and  vaginal  hysterectomy  (q.v.)  are 
reserved  for  urgent  cases. 

If  the  os  is  nearly  dilated,  artificial  rupture 
of  the  membranes  often  hastens  labor. 

2.  Second  Stage. — In  cases  of  nervous 
inhibition,  the  light  administration  of  chloro- 
form or  ether  during  a pain  may  hasten  the 
second  stage. 

In  suitable  cases,  pituitrin,  0.5  c.c., 
repeated  if  necessary,  is  of  value  as  a uterine 
stimulant  in  the  second  stage.  The  dangers 
attendant  upon  its  use  should  be  borne  in 
mind;  they  are:  rupture  of  the  uterus, 
tearing  of  the  cervix  and  perineum,  pre- 
mature separation  of  the  placenta,  asphyxia- 
tion of  the  child.  Contraindications  to 
the  use  of  pituitrin  are  serious  mechanical 
obstruction  to  labor,  threatened  or  actual 
rupture  of  the  uterus,  the  presence  of  uterine 
scars,  placenta  prtevia,  multiparity,  extreme 
obesity,  cardiac  disease,  high  blood  pressure 
(arteriosclerosis,  nephritis,  preeclamptic 
toxsemia,  eclampsia). 

Employ  forceps  (q.v.)  or  version  (q.v.)  in 
high  arrest  of  the  head,  forceps  in  low  arrest; 
but  do  not  attempt  version  for  two  hours 
following  the  administration  of  pituitrin. 


3.  Third  Stage. — In  a delayed  third 
stage,  persist  for  at  least  two  hours  in  inter- 
mittent gentle  efforts  at  expression  of  the 
placenta  by  Crede’s  method,  before  resort- 
ing to  manual  removal,  unless,  of  course, 
alarming  hemorrhage  occurs  (see  Adherent 
Placenta).  Pituitrin  may  be  of  seiwice. 
Administer  ergot  after  the  birth  of  the  pla- 
centa (see  Part  11,  Drugs). 

Infant,  Care  of  the. — See  under  Manage- 
ment of  the  Puerperium. 

Diseases  of  the  New  Born. — See  Dis- 
eases of  the  New-Born  Infant. 

Feeding. — See  Part  1,  General  Medi- 
cine and  Surgery. 

Infection,  Puerperal. — See  Puerperal 
Infection. 

Infectious  Diseases. — L.  injec'tio.  See 

Diseases. 

Inflammation  of  the  Breast. — L.  inflam- 
ma're,  to  set  on  fire.  See  Mastitis. 

Uterus. — See  Puerperal  Infection. 

Vagina. — ^See  Vaginitis. 

Inguinal  Hernia  of  the  Pregnant  Uterus. — 
L.  in'guen,  groin.  See  Hernia,  under  Dis- 
placements of  the  Pregnant  Uterus. 

Insanity  of  Gestation. — L.  in,  not  + 
sanus,  sound;  gesta'tio,  pregnancy.  Insanity 
occurs  oftenest  during  the  puerperium,  next 
in  frequency  during  lactation,  and  least 
often  during  pregnancy.  It  should  be  dis- 
tinguished, says  Hirst,  from  the  temporary 
delirium  of  labor,  the  delirium  of  fever, 
delirium  tremens,  and  pre-existing  insanity. 

Most  of  the  patients  recover  reason  in 
from  three  to  six  months;  some  die  of  infec- 
tion or  exhaustion. 

Etiology. — Infection  (q.v.)]  anaemia  (due  to 
hemorrhage  or  prolonged  lactation,  see 
Anaemia);  physical  and  mental  exhaustion; 
worry,  and  strong  emotion;  heredity;  toxae- 
mia (q.v.)]  chorea  (q.v.). 

Treatment. — Endeavor  to  ascertain  and 
correct  the  cause  (q.v.).  Cases  due  to  ner- 
vous instability,  worry,  or  exhaustion  sh'ould 
be  benefited  by  rest,  change  of  environment, 
wholesome  food,  fresh  air,  hydrotherapy, 
and  perhaps  iron,  arsenic,  or  calcium  (see 
Part  11.).  The  patient  should  be  kept  under 
careful  supervision  to  prevent  her  doing 
harm  to  herself  or  others.  She  should  not 
nurse  her  child. 

For  maniacal,  excitement  and  insomnia, 
hot  packs  are  better  than  drugs,  e.g.,  mor- 
phine, gr.  M;  hyoscin,  gr.  3^o  to  Ho', 
bromide,  gr.  xxx-xl,  well  diluted;  paralde- 
hyde, 5i~ii,  in  diluted  brandy. 

Instruments,  Obstetrical — L.  instru'ere, 
to  furnish;  ob-  in  front  of  -|-  sto,  I stand. 
(See  the  Appendix,  following  Part  4.) 


MANAGEMENT  OF  PREGNANCY 


Interlocking  of  the  Heads  in  Multiple 
Pregnancy. — See  Multiple  Pregnancy. 

Internal  Podalic  Version. — See  Podalic 
Version. 

Intracranial  Hemorrhage  in  the  New= 
Born. — See  Part  1. 

Intra=Partum  Hemorrhage.^ — See  Hem- 
orrhage , Intra-Partum. 

Inversion  of  the  Uterus. — See  Part  2, 
Gynaecology. 

Inverted  Nipples. — See  Nipples,  Inverted. 

Irritability  of  the  Bladder. — See  Bladder 
Irritability. 

Ischuria. — Gr.  I'oxetr  to  check  -1-  ovpov 
urine.  See  the  Toxaemias. 

Jaundice. — ^See  Icterus 

Joints,  Relaxation  of  the  Pelvic. — See 
Relaxation  of  the  Pelvic  Joints. 

Rupture  of  the  Pelvic. — See  Rupture 
of  the  Pelvic  Joints. 

Kidney  of  Pregnancy. — See  under  Toxae- 
mias of  Pregnancy. 

Labor,  Adynamic  Diseases  Complicating. 
— Gr.  a priv.  -|-  Svvaius  might.  See 
Adynamic  Diseases  Complicating 
Lalx)r. 

Cardiac  Disease  Complicating. — See 

C'ardiac  Disease. 

Conduct  of  Normal. — See  Conduct  of 
Normal  Labor. 

Difficult  or  Prolonged. — See  Dystocia. 

Diseases  Complicating. — See  Coinj)!!- 
cations  of  Labor. 

Duration  of. — See  under  Conduct  of 
Normal  Labor. 

Heart  Disease  Complicating. — See 

Cardiac  Disease. 

Induction  of. — See  Premature  Labor, 
Induction  of. 

Management  of  Normal. — See  Con- 
duct of  Normal  Labor. 

Missed. — See  Missed  Labor. 

Obstructed. — L.  obstnic'tio.  See  Dys- 
tocia. 

Pneumonia  Complicating. — See  Pneu- 
monia Complicating  Labor. 

Premature. — See  Abortion,  Miscar- 
riage, and  Premature  Labor,  in  Part  2. 

Premature,  Induction  of. — See  Prema- 
ture Labor,  Induction  of. 

Prolonged. — See  Dystocia. 

Stages  of. — See  under  Conduct  of 
Normal  Labor. 

Typhoid  Fever  Complicating. — See 
Typhoid  Fever  Comj)licating  Labor. 

Valvular  Heart  Disease  Complicating. — 
See  Cardiac  Disease. 

Laceration,  Cervical. — L.  laccrn're,  to  tear; 
cervix,  neck.  See  under  IManagement 
of  the  Puerperium. 


Laceration,  Perineal. — Gr.  Treptraior.  See 
under  Conduct  of  Normal  Labor. 

Large  Child. — See  Child,  Large. 

Laxatives. — L.  laxuH'vus.  See  under 
Constipation. 

Leg,  Milk. — See  Phlegmasia  Alba  Dolens. 

Leucorrhoea  of  Pregnancy. — Gr.  XecKos 
white  + poi'a  flow.  See  Vaginitis  in  Preg- 
nancy. 

Lightening. — See  Stage  of  Pregnancy. 

Lipuria. — Gr.  XIttos  fat  + ovpov  urine. 
Lipuria  is  of  no  pathological  miport. 

Litzmann’s  Obliquity. — L.  obli'quus,  slant- 
ing. See  Ear  or  Parietal  Bone  Presenta- 
tions. 

Liver,  Acute  Yellow  Atrophy  of  the. — See 

Acute  Yellow  Atrophy  of  the  Liver,  in  Part  1. 

Lochia. — Gr.  Xoxla.  See  under  Manage- 
ment of  the  Puerperium. 

Locked  Twins. — See  Multiple  Pregnancy. 

Malacosteon. — Gr.  paXaKos  soft  -)-  barkov 
bone.  See  Osteomalacia,  in  Part  1. 

Mammary  Abscess. — L.  mam'ma,  breast, 
absces'sus,  a going  apart.  SeelNIastitis. 
Engorgement. — See  Caked  Breasts. 

Inflammation. — L.  injiammar'e,  to  set 
on  fire.  See  Mastitis. 

Management  of  Normal  Labor. — See  C'on- 
duct  of  Normal  Labor. 

Pregnancy. — Give  the  patient  and  nurse 
the  following  printed  directions: 

Hygiene  of  Pregnancy 

1.  Fresh  air  day  and  night;  moderate 
daily  exercise  in  the  open  air;  frequent  bath- 
ing; regular  hours  of  eating  and  sleeping; 
rest  before  and  after  meals;  the  avoidance 
of  lifting,  reaching,  or  fatiguing  labor,  and 
exposure  to  cold  and  wet;  daily  brushing 
of  the  teeth  before  breakfast,  with  warm 
water  and  castile  soap  (see  Dental  Caries). 

2.  Clothing  loose  and  supported  from 
the  shoulders;  maternity  corset;  an  abdom- 
inal support  if  the  abdomen  is  pendulous; 
elastic  bandages  or  stockings  for  varicose 
veins  {q.v.). 

3.  Diet  abundant,  but  plain. 

4.  Daily  bowel  movement.  Employ,  when 
necessary,  compound  laxative  pdl,  one  or 
two  pills  at  bed-time;  or  aromatic  fluid 
extract  of  cascara  sagrada,  one  or  two  tea- 
spoonfuls at  bedtune;  or  comjxiund  licorice 
powder,  one  or  two  teaspoonfuls  at  bedtime 
(see  Constipation  Compl.  Preg). 

5.  During  the  last  two  or  three  months, 
bathe  the  nipples  night  and  morning,  for 
the  inu’{X)se  of  hardening  them,  with  glycerol 
of  tannin  and  water,  equal  parts  (Hirst); 
or  compound  tincture  of  lavender,  *ii,  and 
glycerine,  5ss  (Edgar);  or  borax  or  boric 


MANAGEMENT  OF  PREGNANCY 


(see 

Toxaemias). 


acid,  one  tablespoonful  in  a tumbler  of 
alcohol  and  water,  equal  parts  (J.  W.  Wil- 
liams). Draw  out  the  nipples  gently  every 
day,  if  retracted.  The  breast-pump  may  be 
used  for  this  purpose. 

6.  During  the  first  six  months,  send  the 
physician  a mixed  twenty-four  hour  sample 
of  urine  once  a month;  during  the  next 
several  months  every  two  weeks,  and  during 
the  last  month  every  week.  Empty  the 
bladder,  say  at  7 a.m.,  throw  the  urine  away, 
and  save  all  subsequent  voidings  up  to 
7 A.M.  the  next  morning.  Keep  the  urine 
well  corked  in  a cool  place  (see  Urinalysis, 
in  Part  1). 

7.  No  sexual  intercourse  during  the  last 
month  of  pregnancy. 

8.  Notify  the  physician  at  once  should 
any  of  the  following  symptoms  occur: 

(a)  Scanty  mine. 

(b)  Persistent  headache. 

(c)  Disturbance  of  vision. 

(d)  Swelling  of  the  feet  or 

face. 

(e)  Any  loss  of  blood,  no  matter  how 
slight  (see  Hemorrhage,  Ante-Partum). 

(f)  Persistent  constipation  {q.v.).  (After 
J.  W.  Williams.) 

9.  Things  required  at  the  time  of  labor: 
Three  to  five  basins,  cleansed  with  soap  and 
water,  rinsed,  and  scalded  out;  plenty  of 
boiling  water  on  the  stove;  a large  pitcher, 
first  cleansed  with  soap  and  water,  rinsed 
and  scalded  out,  then  filled  with  boiling 
water  which  is  allowed  to  cool,  the  pitcher 
being  covered  with  a clean  towel;  bed-pan 
or  douche-pan;  two-  or  three-quart  fountain 
syringe,  or  Davidson  bulb  syringe  for  rectal 
enemata;  fifteen  yards  of  gauze,  two  pounds 
of  cotton  batting,  and  two  pounds  of  absor- 
bent cotton  for  making  bed-pads,  or  six 
prepared  sanitary  bed-pads  (an  expensive 
luxury  that  few  of  my  patients  have  availed 
themselves  of) ; two  pieces  of  rubber  sheeting 
or  oil  cloth,  one  1x2  yards  and  the  other 
1 X 134  yards  (the  larger  sheet,  at  the  time 
of  labor,  is  placed  over  the  mattress  and 
covered  with  a bed  sheet,  over  which  is 
placed,  under  the  buttocks  of  the  patient, 
the  smaller  sheet;  this  is  covered  by  a draw- 
sheet  and  a sterile  bed-pa<l) ; four  ounces  of 
boric  acid  powder;  100  bichloride  tablets; 
three  or  four  dozen  vulvar  pads  (absorbent 
cotton  covered  with  gauze,  six  in  a cloth 
package,  sterilized  at  the  time  of  labor  by 
placing  in  an  oven  until  the  covering  is 
scorched);  waste  bucket;  an  oilcloth  or  old 
iTjg  to  protect  the  floor  beside  the  bed; 
small  and  large  safety  pins;  binder  for  the 
mother,  made  of  unbleached  muslin,  and 


about  134  yards  long;  long  stockings,  canton- 
flannel  in  winter,  thin  muslin  in  summer,  to 
be  worn  at  the  time  of  labor;  a warm  blanket 
or  warm  soft  flannel  to  receive  the  baby 
when  born. 

10.  Baby’s  outfit : Four  soft  flannel  umler- 
shirts,  made  with  waists  instead  of  bantls, 
with  long  sleeves  and  high  neck,  and  but- 
toned all  the  way  in  front;  six  8 to  10  inch 
wide  abdominal  binders,  made  of  soft 
flannel,  not  hemmed,  but  overstitched,  and 
long  enough  to  overlap  one-third;  four  to 
six  dozen  cotton  or  old  soft  linen  or  stocki- 
nette or  canton-flannel  diapers,  not  hemmed 
or  ironed  (canton-flannel  is  least  desirable) ; 
four  to  six  pairs  of  knit  woolen  socks  reaching 
nearly  to  the  knee;  flannel  dress,  opening  in 
front,  25  inches  from  neck  to  hem;  muslin 
slip  (over  the  dress);  knit  woolen  jacket; 
woolen  shawl  or  wrap;  light  flannel  cap;  soft 
pillow,  about  14  x 18  inches;  bibs;  .soft 
towels;  soft  hair-brush;  soft  sponge;  sweet 
oil;  castile  soap;  bath  thermometer;  ix)Wfler 
box  containing  lycopodium  or  fine  starch 
powder,  or  compound  talcum,  or  borated 
talcum,  or  rice-floiu-  powder. 

11.  Remind  the  physician  in  regard  to 
the  examination  four  weeks  before  the 
expected  date  of  confinement  (see  below). 

12.  At  the  commencement  of  labor  the 
patient  should  receive  a soapsuds  enema 
(containing  perhaps  one  teaspoonful  of  tur- 
pentine or  two  tablespoonfuls  of  glycerine 
to  the  quart),  followed  by  a full,  warm  .soap 
bath,  cleansing  thoroughly  the  external 
genitals  and  anus  and  surrounding  skin  (but 
not  entering  the  vagina),  and  taking  great 
care  to  rinse  off  with  fresh,  clean,  warm 
water  all  soap,  especially  from  the  vulva. 
Then  dry  the  skin  thoroughly. 

The  physician  should  examine  the  patient 
four  weeks  before  the  expected  date  of 
confinement  (see  Stage  of  Pregnancy),  note 
her  general  physical  condition,  measure  the 
pelvis  (see  under  Contracted  Pelves),  and 
ascertain  the  size,  position,  and  presentation 
of  the  child  (see  the  schema  provided  in  the 
Appendix,  following  Part  4). 

An  internal  examination,  under  anjes- 
thesia  if  necessary,  should  Ije  made  if  the 
head  is  not  engaged  in  the  last  month  in  a 
primipara,  if  the  pelvic  outlet  is  conti’acted, 
if  the  patient  lunps,  or  has  a deformity  of 
the  spine  or  legs,  and  if  Baudeloque’s  dia- 
meter is  18.5  cm.  or  less. 

A breech  {q.v.),  transverse  {q.v.),  or  face 
presentation  {q.v.)  may  be  converted  into  a 
vertex  presentation  at  this  time. 

If  the  patient  has  usually  given  birtff  with 
difficulty  to  very  large  children,  the  diet 


IklAXAGEMEXT  OF  THE  PUERPERIHM 


(especially  starches  and  sugars)  should  be 
restricted  in  the  last  two  or  three  months 
of  pregnancy. 

Management  of  the  Puerperium. — L. 

pu'er,  boy  + par'ere,  to  bear.  Give  the 
nurse  the  following  printed  directions: 

Care  of  the  Mother 

1.  After  the  patient  has  been  made  com- 
fortable, following  the  completion  of  labor, 
give  her  a cup  of  milk,  weak  tea,  cocoa,  or 
broth,  darken  the  room,  and  allow  her  to 
sleep. 

2.  Exclude  visitors  during  the  first  ten 
days. 

3.  Change  the  vulval  pads  as  often  as  they 
become  soiled,  and  after  each  stool  or  uri- 
nation, and  before  applying  another  pad 
cleanse  the  external  genitalia  from  above 
downward  with  bichloride  solution,  1 : 4000, 
or  lysol,  one  teaspoonful  to  the  cjuart,  perhaps 
best  poiu’ed  from  a pitcher  with  the  patient 
on  a douche-pan.  (During  the  first  four 
or  five  days  the  pads  normally  require 
changing  no  oftener  than  six  tmies  in  the 
twenty-four  hours.) 

4.  Place  no  pillow  beneath  the  head  for 
six  hours  after  labor;  and  do  not  allow  the 
patient  to  turn  on  her  side  for  a day  or  two, 
to  avoid  the  entrance  of  air  into  the  uterine 
sinuses  and  possible  air  embolism.  The 
semi-Fowler  position  may  be  adopted  after 
the  expiration  of  twenty-four  hours  for  the 
purpose  of  better  drainage. 

5.  If  the  patient  has  not  urinated  after 
twelve  hours,  get  her  in  a sitting  posture, 
apply  hot  cloths  to  the  lower  abdomen  and 
vulva,  and  make  the  sound  of  trickling 
water;  the  bmder  may  also  be  tightened. 
(The  physician  employs  catheterization 
as  a last  resort,  repeating  it  thrice  daily, 
if  necessary.) 

6.  Diet  light  and  nourishing  during  the 
first  five  days: 

First  twenty-four  hours:  Milk,  cocoa, 

clear  bouillon  or  beef  tea,  milk  toast,  oatmeal 
or  farina  gruel. 

Second  and  third  days:  Milk,  cocoa, 

gruel,  eggs  boiled  three  minutes,  milk  or 
butterecl  toast,  chicken  fricassee,  sweet- 
bread, the  hearts  of  raw  or  stewed  oysters, 
flavored  gelatin. 

Fourth  and  fifth  days:  The  same,  with 
the  addition  of  beefsteak,  mutton  chops, 
potatoes,  rice,  bread  and  butter,  and  fniit. 

7.  Administer,  forty-eight  hours  after 
labor,  a half  bottle  of  effervescent  citrate  of 
magnesia;  or  one  tablespoonful  of  Rochelle 
salts  in  solution,  repeated  in  four  hours  if 
necessary;  or  one  to  two  tablespoonfuls  of 


castor  oil.  Thereafter,  to  secure  a daily 
movement,  give  when  required  compound 
laxative  pills,  one  or  two  pills  at  bedtime; 
or  aromatic  fluid  extract  of  cascara  sagrada, 
one  or  two  teaspoonfuls  at  bedtime;  or 
compound  licorice  powder,  one  or  two  tea- 
spoonfuls at  bedtime;  or  enemata. 

8.  Cleanse  the  nipples  with  plain  boiled 
w'ater  before,  and  with  boric  acid  solution, 
gr.  X to  the  ounce,  after  each  nursing,  and 
keep  them  covered  with  sterile  gauze  or 
flannel.  Apply  sterile  sweet  oil  after  each 
nursing  to  prevent  cracks  and  fissimes.  Do 
not  touch  the  nipples  with  the  fingers. 
Report  cracked  nipples  to  the  physician 
(see  Nipples,  Sore). 

9.  For  painful  distention  and  caking  of 
the  breasts,  employ  firm  compression  by 
means  of  a tight  binder  (see  under  Caked 
Breasts) , which  usually  relieves  the  condition 
in  twenty-four  hours;  or  massage  and  milk 
the  breasts  through  hot,  moist  flannel, 
allowing  the  milk  to  flow  into  the  flannel. 
Avoid  the  breast-pump;  but  if  used,  assist  its 
action  by  massage  toward  the  nipple.  For 
very  great  distention,  administer  Rochelle 
salts,  a tablespoonful  in  solution,  repeated  in 
four  hours,  if  necessary;  and  restrict  hquids. 

10.  The  mother  should  remain  in  bed 
until  the  uterus  has  disappeared  within  the 
pelvis,  or  about  ten  to  fourteen  days.  There- 
after she  may  be  allowed  up  one  additional 
hour  each  day  until  she  is  up  all  day.  At 
the  end  of  three  weeks  she  may  walk  about 
the  room;  and  at  the  end  of  four  weeks  she 
may  be  allowed  downstairs.  She  should 
do  no  work  until  after  the  end  of  the  sixth 
week.  (This  is  to  prevent  subinvolution, 
and  its  sequelse,  metritis,  endometritis,  retro- 
displacement,  and  prolapse.) 

Care  of  the  Child 

1.  As  soon  as  the  baby  has  been  received 
from  the  accoucheur,  wrap  it  in  warm,  soft 
flannel,  and  place  it  in  its  crib,  between 
blankets.  Place  hot  water  bottles  near  it, 
it  it  is  cold  or  blue. 

2.  After  the  mother  has  been  made  com- 
fortable, take  the  baby  in  a warm  room,  near 
the  fire,  anoint  it  with  sweet  oil,  and  bathe 
it  with  wann  water  (temperature  100°  F.) 
and  castile  soap.  Diy  carefully,  then  dust 
the  skin  with  powder  in  the  folds  and  about 
the  flexures  and  genitals;  then  powder  the 
cord  with  sterile  talcum,  bismuth,  or  boric 
acid,  and  wrap  it  in  sterile  gauze  or  cotton. 
The  mouth  may  perhaps  be  very  gently 
cleansed  with  warm  boiled  water  and  a 
soft  cloth,  if  deemed  advisable. 

Apply  a soft  flannel  binder,  reaching  from 


OE  THE  PUERPERIUM 


the  pubes  to  the  axillae  (8  to  10  inches  wide), 
and  pin  it  in  back  rather  snugly.  Over  this 
put  on  a soft  flannel  undershirt,  with  long 
sleeves  and  high  neck,  and  buttoned  all 
the  way  in  front;  then  a flannel  dress  opening 
in  front,  25  inches  from  neck  to  hem;  over 
this  a muslin  slip;  then  long  woolen 
socks  reaching  nearly  to  the  knee  (cold  feet 
may  cause  indigestion  and  colic) ; and  finally 
the  diaper. 

The  second  full  bath  should  not  be  given 
until  the  cord  has  separated. 

3.  After  the  cord  has  separated  (four  to 
seven  days  or  longer),  cover  the  stump  with 
sterile  talcum,  bismuth,  or  boric  acid  powder, 
and  apply  a sterile  gauze  pad  about  two 
inches  square  and  about  one-quarter  of  an 
inch  thick  beneath  the  binder.  Con- 
tinue the  use  of  the  pad  for  one  month,  to 
prevent  hernia. 

4.  Bathe  the  child  once  daily,  at  noon, 
near  a fire,  with  warm  water  (not  over  100° 
F.,  preferably  98°  F. : use  a bath  thermom- 
eter), castile  soap,  and  a soft  sponge,  after 
the  cord  has  come  off.  Before  this,  sponge 
the  baby  in  the  lap. 

5.  On  the  sixth  or  seventh  day  after  birth, 
begin  daily  retraction  and  cleansing  of  the 
prepuce.  Two  or  three  days  may  be 
required  gradually  to  break  up  adhesions; 
then  sterile  vaseline,  cotton,  or  gauze  should 
be  applied  to  prevent  readhesion. 

6.  Nursing  schedule: 

Intervals  Nursings 
during  the  between 


Nursings  day  6 a.m.  9 p.m.  and 

:_o4 


First  day 

in  24 
hours 

4 

to  9 p.  m. 
Hours 

6 

6 a.  m i.e. 
at  2 a.  m. 

1 

Second  day 

6 

4 

1 

Third  day  to  end  of 
4th  or  5th  month  . . 

7 

3 

1 

Fifth  to  13th  month. . 

6 

3 

0 

During  the  first  two  days,  if  the  baby 
cries  excessively,  give  a little  warm,  boiled 
water,  or  a very  dilute  solution  of  milk 
sugar  or  plain  sugar  (see  Infant  Feeding  in 
Part  1).  The  infant  is  to  be  mu’sed  until  it 
is  satisfied,  or  goes  to  sleep,  or  ceases  to  suck 
actively,  but  no  longer  than  twenty  minutes. 
Hold  the  child  upright  just  before  and  after 
nursing,  to  allow  of  the  escape  of  swallowed 
air.  Alternate  the  breasts  in  nursing. 

7.  Keep  the  windows  open  at  night  and, 
take  the  baby  out  for  an  airing  daily,  in  the 
warmest  part  of  the  day,  except,  of  course, 
in  very  hot  weather;  but  in  winter  not  until 
after  at  least  the  first  month. 

8.  Record  the  baby’s  weight  once  or 
twice  a week  (see  under  Infant  Feeding). 

The  nursing  woman  should  receive  an 
abundant,  plain  diet,  with  milk  at  bedtime. 


avoiding  tea,  coffee,  alcohol,  spices,  pastry, 
rich  cakes,  excessive  sweets,  and  all  indiges- 
tible articles.  Regular  hours  of  eating  and 
sleeping,  fresh  air  day  and  night,  adequate 
rest  and  exercise,  personal  cleanliness, 
a daily  bowel  movement,  and  freedom 
from  worry  are  important  for  both  mother 
and  child. 

9.  After  the  third  or  fourth  month,  sub- 
stitute for  the  breast  one  or  two  feedings  of 
bottle  milk  a day,  and  gradually  wean  the 
baby  between  the  ninth  and  fourteenth 
months.  The  milk  need  not  then  be  modi- 
fied, and  well-cooked  cereals  may  also  be 
given.  Withdraw  the  breast  at  the  rate 
of  one  adcUtional  daily  nursing  every 
two  or  three  weeks  until  the  breast  is 
abandoned  altogether. 

The  puerperium  extends  from  the  com- 
pletion of  labor  to  complete  involution  of 
the  uterus,  a period  of  six  weeks.  During 
this  period  the  patient  should  be  visited 
by  the  physician  once  or  twice  a day,  if 
possible,  for  the  first  five  days,  then  once 
every  day  or  two  until  she  is  out  of  bed, 
then  about  three  times  during  the  third  week, 
once  or  twice  in  the  fourth  week,  and  once 
again  at  the  end  of  the  sixth  week  (in  the 
country,  of  course,  this  is  not  always  pos- 
sible). At  each  visit  should  be  noted,  in 
the  mother,  the  pulse,  temperature,  odor, 
quantity  and  character  of  the  lochia,  action 
of  the  bladder  and  bowels,  size  of  the  womb 
ascertained  by  abdominal  palpation,  breasts 
and  nipples,  and  after-pains;  and,  in  the 
infant,  feeding,  digestion,  sleeping,  bowel  and 
bladder  movements,  lunbilicus,  eyes,  nose, 
mouth,  skin,  and  development  (see  the 
Schema  provided  in  the  Appendix,  following 
Part  4). 

The  upper  normal  temperature  limit  for 
the  puerperium  is  placed  at  100.4°  F.  If 
sepsis  has  not  developed  by  the  end  of  the 
fifth  day  it  is  not  likely  to  occur  (see  Puer- 
peral Fever,  for  the  various  causes  of  a 
puerperal  elevation  of  temperature  besides 
sepsis). 

The  normal  lochia  for  the  first  three  to 
five  days  after  labor  is  red  (lochia  rubra); 
from  then  until  about  the  tenth  day  it  is 
grayish  (lochia  serosa) ; and  after  that,  white 
(lochia  alba).  The  persistence  of  a reddish 
color  beyond  several  weeks  indicates  sub- 
involution {q.v.),  or  the  retention  of  secun- 
dines.  In  putrid  infection  the  lochia  is 
putrid;  in  streptococcic  infection  it  is  often 
odorless.  A marked  diminution  or  increase 
in  quantity  accompanies  the  onset  of  sepsis. 
Night  sweating  is  physiological. 


MASTITIS 


Suckling  the  infant  aids  involution  of  the 
uterus  and  increases  the  after-pains;  but  the 
latter,  as  a rule,  appreciably  subside  after 
twenty-four  hours.  For  the  treatment  of 
severe  after-pains,  see  After-Pains,  Severe. 

Should  the  uterus  be  found  retroposed, 
between  the  third  and  fourth  week,  replace 
it  (consult  Part  2,  Gynaecology,  Retrodis- 
placements),  and  have  the  patient  assmne 
the  knee-chest  po,sture  twice  a day  for  five 
minutes  at  a time.  This  is  very  effectual, 
says  Hirst.  A pessary  (see  Part  2)  may 
be  employed,  if  requh'ed,  in  the  sixth  week, 
not  before. 

Make  a careful  examination  at  the  end  of 
the  sixth  week.  Look  for  diastasis  of  the 
abdominal  muscles  {q.v.),  relaxed  vaginal 
outlet  (beginning  cystocele  or  retrocele,  etc.) , 
cervical  team  (see  below),  displacement  of 
the  uterus  {q.v.),  abnormal  uterine  mobil- 
ity and  tenderness,  prolapse,  subinvolution, 
endometritis,  and  a ruptured  coccygeal 
joint,  which  may  give  rise  to  coccygodynia 
(consult  Part  2,  Gynaecology,  for  the  treat- 
ment of  these  conditions). 

Perhaps  most  physicians  have  seen  the 
injurious  effects,  local  and  constitutional, 
of  unrepaired  cervical  tears.  A recent  tear, 
if  not  trivial,  may  be  repaired  as  follows; 
With  the  patient  in  the  lithotomy  position, 
and  the  parts  disinfected,  pull  down  the 
cervix  with  bullet  forceps  and  retract  the 
vaginal  walls  with  metal  retractors.  Now 
place  one  pah-  of  birllet  forceps  in  the  anterior 
lip,  and  another  pair  in  the  posterior  lip. 
With  a very  sharp  scalpel,  especially  sharp 
at  the  point,  denude  the  torn  surface  thor- 
orrghly  by  scraping  off  a superficial  film  of 
tis.sue,  paying  par-ticular  attention  to  the 
angles  of  the  tear,  but  scnrpirloitsly  avoiding 
the  mitcosa  of  the  cervical  canal.  Then 
with  a fitll-curved  needle  insert  No.  2 
chromic  catgirt  srrtures  (irsually  one  or  two 
on  each  side),  inchrding  the  entire  depth  of 
the  tear.  Bring  the  edges  of  the  tear- 
together  nicely  without  terrsion.  An  anres- 
thetic  may  often  be  dispensed  with.  The 
patient  may  be  allowed  aboirt  after 
the  operation,  arrd  no  after  treatment  is 
required.  Old  tears  which  contain  scar- 
tissue  require,  of  coirrse,  a more  extensive 
operation  (after  H.  J.  Boldt). 

If  the  infant  dies  or  rnirst  be  weaned, 
the  following  measures  for  drying  irp  the 
milk  secr-etion,  (proted  from  Edgar,  are 
commonly  employed : 

1.  “ The  application  of  a tight  well-fitting 
bi-east-binder  {q.v.),  after  the  breasts  have 
been  lightly  smeat-ed  with  a solution  of 
atropine  sulphate  in  glycer-ine  (gr.  i to  5i)- 


This  is  repeated  twice  in  the  twenty-four 
hours.” 

2.  “ The  cutting  down  of  the  liquid 
intake  to  a minimum.” 

3.  “ The  causing  of  free  watery  stools 
with  saline  cathartics  ” {q.v.  in  Part  11). 

4.  “ The  avoidance  of  all  massage  of  the 
breasts  or  the  use  of  breast-pimrps  if  pos- 
sible.” “Should  the  breasts  become  verj^ 
hard  and  painful,  the  application  of  hot 
flannel  stupes,  and  the  massaging  out  of  the 
milk  secretion  through  and  into  the  stupes 
is  permissible.” 

J.  W.  Williams,  however,  advocates  leav- 
ing the  breasts  absolutely  alone.  He  says: 
“ Within  twenty-four  hours  after  the  last 
nursing,  or  on  the  third  day  if  the  child 
has  not  been  suckled,  the  breasts  become 
greatly  engorged,  and  sometimes  quite 
painful.  But  if  they  are  not  touched,  the 
swelling  soon  subsides  and  the  pain  disap- 
pears within  a few  hours,  after  which  the 
breasts  gradually  become  smaller,  and  con- 
tain less  and  less  milk,  so  that  the  entire 
process  is  over  by  the  end  of  the  third 
day.”  “ A single  hypodennic  injection  of 
morphine  may  be  given  if  the  pain  is  severe.” 

Manual  Removal  of  the  Placenta. — L. 
ma'nus,  hand.  See  Adherent  Placenta. 

Mastitis. — Gr.  tiaaTos  breast  -t-  -tns 
inflammation. 

Etiology.— Uncleanliness;  sore  nipples;  skin 
pimples;  caking  of  the  breast;  stomatitis  in 
the  infant. 

Treatment. — Correct  engorgement  of  the 
breasts  (see  Caked  Breasts)  as  soon  as  it 
makes  its  appearance.  If  the  nipple  be- 
comes sore,  apply  hot  boric  acid  fomenta- 
tions, and  place  the  nipple  at  rest  by  the 
use  of  the  nipple  .shield. 

If  suppuration  threatens,  stop  suckling, 
withdraw  the  milk  by  means  of  the  breast 
pump  and  massage  toward  the  nipple 
through  hot,  moist  compresses,  cover  the 
breast  with  cotton,  and  compress  it  firmly 
with  a bandage. 

As  soon  as  fluctuation  or  a “ dusky-red 
hue  of  the  skin  with  oedema  and  fever  ” 
(Hirst)  appears,  make  a single  incision,  or  if 
need  be,  multiple  incisions  radiating  from 
the  nipple,  open  up  evei-j^  pocket  of  pus  with 
the  finger,  and  insert  for  drainage,  fenestrated 
rubber  tubes  or  gauze,  covered  with  gauze 
and  a firm  binder.  Change  the  dre.ss- 
ing  as  often  as  necessary  to  keep  the 
wound  tlry.  If  drainage  tubes  are  employed, 
they  should  be  replaced  with  gauze  as  soon 
as  feasible.  If  desired,  the  ca\-ity  may  be 
irrigated  daily  with  warm  sterile  nonnal  salt 
solution  (5i  ad  Oi),  or  boric  acid  solution, 


MULTIPLE  PREGNANCY 


5ii-iii  ad  Oi;  but  dry  or  moist  gauze  dres- 
sings alone  seem  preferable. 

For  milk  fistula,  employ  compression  of 
the  breast  and  injections  of  tincture  of  iodine, 
or  silver  nitrate,  2 per  cent.,  twice  a week  or 
oftener;  or  curette  the  fistulous  tract;  or 
dissect  it  out. 

In  submammary  abscess,  which  is  charac- 
terized by  high  fever,  deep-seated  pain,  and 
the  absence  of  reddening  of  the  overlying 
skin,  make  two  incisions  at  the  periphery 
of  the  gland,  one  at  the  most  dependent 
part  (the  patient  upon  her  back),  and  the 
other  a counter-opening,  on  the  opposite 
side.  Pass  fenestrated  drainage  tubes 
through  these  openings  with  long  dressing 
forceps,  and  irrigate  daily. 

Measurements,  Pelvic. — See  Contracted 
Pelves. 

Melaena  Neonatorum. — Gr.  fieXaLva  black, 
black  bile;  wos  new  -)-  L.  na'nts,  born.  See 
Hemorrhage,  General,  in  the  New-Born. 

Meningeal  Hemorrhage  in  the  New=Born. 
— Gr.  membrane.  See  Hemorrhage, 

Intracranial,  in  the  New-Born,  in  Part  1. 

Meningocele,  Cerebral.  — See  Part  1, 
General  Medicine  and  Surgery. 

Spinal. — See  Spina  Bifida,  Part  1. 

Mento=lliac  Presentations. — L.  men'tum, 
chin;  il'ium,  haunch-bone.  See  Face  Pres- 
entations. 

Metreurysis. — Gr.  iiypa  uterus  + evpv- 
v€Lv  to  stretch:  dilatation  of  the  cervical 
canal  with  an  inflatable  bag.  See  Prema- 
ture Labor,  Induction  of. 

Metrophlebitis. — Gr.  prjrpa  womb  -1-  4>\k4' 
vein  -1 — LT IS  inflammation.  See  Puerperal 
Infection. 

Micromelia. — See  Achondroplasia, 
in  Part  1. 

Micturition,  Absent. — L.  micturir'e,  to 
urmate.  See  Toxaemias  of  Pregnancy. 

Abundant. — See  Polyuria. 

Frequent. — See  Bladder  Irritability. 

Scanty. — See  Toxaemias  of  Pregnancy. 

Milk  Cyst. — See  Galactocele. 

Fistula. — L.  fis'tula,  pipe.  See  under 
Mastitis. 

Leg. — See  Phlegmasia  Alba  Dolens. 

Modified.  — See  Infant  Feeding,  in 
Part  1. 

Retention  Cyst. — See  Galactocele. 

Milk  Secretion,  Deficient. — L.  secre'tio, 
from  secer'nere,  to  separate. 

Causes.— Immaturity;  advanced  age;  poor 
glandular  development,  due  to  heredity, 
infantilism,  pressure  from  clothing,  or  fatty 
overgrowth;  general  ill-health;  overexer- 
tion; insufficient  nourishment;  acute  fevers; 
diarrhoea;  hemorrbage;  obesity;  emotion 
35 


(may  poison  the  milk) ; perhaps  nasal, 
pharyngeal,  or  bronchial  catarrh;  perhaps 
the  return  of  menstruation ; premature 
child-birth;  mastitis. 

Treatment.— Consider  the  cause.  If  the 
general  health  is  below  par,  prescribe  rest, 
an  abundance  of  good  food,  perhaps  a 
change  of  scene  and  tonics,  such  as  iron, 
nux  vomica,  calcimn,  hypophosphites,  or 
glycero-phosphates  (see  Part  11).  The  fol- 
lowing foods  are  recommended  as  milk  pro- 
ducers, viz.,  crabs,  lobsters,  shrimp,  oysters, 
clams,  fish,  beef,  eggs,  milk,  boiled  fresh 
beets  without  vinegar,  cereals,  especially 
oatmeal,  cocoa,  chocolate,  extract  of  malt 
(g.y.)  and  the  heavier  beers.  (Consult  also 
Infant  Feeding,  in  Part  1). 

Milk  Secretion,  Excessive;  Polygalactia. 
— Gr.  TToXus  much  + ydXa  milk.  Do  not  con- 
fuse this  condition  with  galactorrhoea  {q.v.). 

Employ  compression  and  support  of  the 
breasts  by  means  of  a firm  binder,  restriction 
of  the  diet  and  of  fluids,  laxatives,  and  if 
necessary,  evacuation  of  the  breasts  by 
massage  toward  the  nipple,  or  the  breast- 
pmnp. 

Miscarriage. — See  Abortion,  Miscarriage, 
and  Premature  Labor,  in  Part  2,  Gynaecology. 

Missed  Labor. — The  occurrence  of  uterine 
pains  at  term  which  disappear  without 
eventuating  in  the  birth  of  the  child,  the 
latter  soon  dying.  Some  form  of  obstruction 
may  be  causative.  Similar  symptoms  occur 
in  secondary  abdominal  (extra-uterine)  preg- 
nancy and  in  pregnancy  in  one  horn  of  a 
bicornute  uterus. 

Treatment.- — Induce  labor  (see  Premature 
Labor,  Induction  of)  as  soon  as  the  condition 
is  diagnosed.  Labor  should,  indeed,  always 
be  induced  when  pregnancy  continues  longer 
than  two  weeks  beyond  term. 

Modifed  Milk.-^ee  Infant  Feeding,  in 
Part  1. 

Mole,  Hydatidiform. — See  Hydatidiform 
Mole. 

Morbus  Maculosus  Neonatorum. — L. 

mor'bus,  disease;  ma'cula,  stain  or  spot;  Gr. 
veos  new  -|-  L.  na'tus,  born.  See  Hemor- 
rhagic Diseases  of  the  New-Born,  in  Part  1. 

Mother,  Care  of  the. — See  Management 
of  the  Puerperimn. 

Morning  Sickness. — See  Nausea  and 
Vomiting  of  Pregnancy. 

Multiple  Pregnancy.— L.  niuVtiplex;prceg'- 
nans.  Interference  is  called  for  at  the  time 
of  labor  in  about  twenty-five  per  cent,  of 
the  cases. 

Should  both  heads  attempt  to  engage  at 
one  time,  push  up  the  looser  head  and 
extract  the  other  with  forceps.  If  this 


NAUSEA  AND  VOMITING  OF  PREGNANCY 


proves  impossible,  insert  the  entire  hand 
into  the  uterus  and  investigate  matters. 
J.  W.  Williams  says:  “ Occasionally  it  will 
be  found  advisable  to  apply  forceps  to  the 
upixirmost  child  anti  attempt  to  drag  it 
past  the  other.”  Craniotomy  {q.v)  is  rarely 
demanded. 

If  the  cords  become  hopelessly  entangled, 
cut  one  or  both  between  ligaturas  and 
extract  the  children  hnmediately. 

In  interlocking  of  the  heatls  at  the  superior 
strait,  in  a head  and  breech  presentation, 
push  up  the  one  presenthig  by  the  head  and 
extract  the  other  at  om^e.  If  this  is  impos- 
sible, and  if  the  one  presenting  by  the  head 
can  not  be  dragged  past  the  other,  decapi- 
tate the  latter,  that  is,  the  one  presenting 
by  the  breech  (see  under  Craniotomy). 

If  both  children  present  by  the  breech, 
push  up  the  upper  and  extract  the  lower. 

As  soon  as  the  first  cliild  is  born,  cut  the 
cord  between  clamps  or  hgatures,  and  at 
once  ascertain  the  position  and  presentation 
of  the  second  child,  and  correct  any  abnor- 
mality discovered.  If  the  second  child  is  not 
born  in  thirty  mmutes,  extract  it. 

If  copious  hemorrhage  follows  the  expul- 
sion of  the  first  child  (due  to  separation  of 
its  placenta),  extract  the  second  child 
at  once. 

Should  hemorrhage  follow  the  budh  of 
the  children,  attempt  to  express  the  pla- 
centa at  once  by  Crede’s  method,  and,  if 
this  fails,  remove  it  manually  (see  Adherent 
Placenta) . 

Multiple  pregnancy  tends  to  inertia  uteri 
aiifl  resulting  post-partum  hemorrhage  {q.v., 
for  treatment). 

Myalgia  Uteri. — Gr.  nm  muscle  -f-  aXyos 
pain;  L.  u' tents,  womb.  See  Myometrial 
Rheumatism. 

Myoma  Uteri. — Gr.  ixvs  muscle  -p  -oofia 
tumor;  L.  u'terus,  womb.  See  Fibroid 
Tumors. 

Myometrial  Rheumatism  or  Myalgia. — 

Gr.  iJLvs  muscle  -|-  /xrjrpa  womb;  pevpanapos', 
aXyos  pain.  A very  painful  myalgia  of  the 
uterine  musculature,  aggravated  periodically 
by  the  intermittent  uterine  contractions 
of  Braxton  Hicks,  which  begin  about  the 
fourth  month,  and  the  pain,  not  the  con- 
traction, relieved  at  once  by  the  administra- 
tion of  salicylates  {q.v.  in  Part  11).  (Hirst.) 

Nagele’s  Obliquity. — L.  ohli'quus,  slant- 
ing. See  Ear  or  Parietal  Bone  Presentations. 

Nagele’s  Pelvis. — See  under  Contracted 
Pelves. 

Nausea  and  Vomiting  of  Pregnancy. — Gr. 

vavaia  seasickness;  L.  vornitar'e,  to  vomit; 
prcetj'nans,  with  child. 


Nausea  and  vomiting  of  pregnancy,  or 
“ morning  sickness,”  usually  first  appears 
about  the  sixth  or  seventh  week,  and  in- 
usually  disappears  by  the  fourth  month. 
It  occasionally  becomes  verj'  severe  and 
tractable  (pernicious  vomiting  of  pregnancy. 

Etiology — ^Hysteria  or  suggestion;  toxaemia, 
hepatic  or  nephritic;  prmiiparity,  especially 
in  an  elderly  woman;  mmioderate  sexual 
mtercourse;  reflex  m’itation,  due  to  uterine 
tUsplacement  {q.v.),  ovarian  tumor  or  cyst, 
salpingo-oophoritis,  appendicitis  {q.v.), 
chronic  metritis,  endometritis,  cervicitis 
and  endocervicitis,  rigid  ceiwix,  multiple 
pregnancy,  hycfiamnios  {q.v.),  splanchnop- 
tosis, chronic  gastritis,  gastric  ulcer  (may 
result  from  vomiting),  mtestinal  jjolypi, 
peritoneal  adhesions;  hypothyroichsm. 

Treatment. — Examine  carefully  into  the 
cause  of  the  trouble,  and  endeavor  to  cor- 
rect any  condition  found  that  may  be  of 
unportance  (consult,  if  need  be.  Part  2, 
on  Gynaecology,  and  Part  1,  on  General 
Medicine  and  Surgery).  An  abdominal  sup- 
port may  give  relief.  The  condition  is 
probably,  however,  usually  neurotic  or 
toxaemic  or  both.  Hypothyroichsm  as  a 
possible  cause  should  be  borne  in  mind. 
The  thyroid  should  normally  hjqiersecrete 
diu’uig  pregnancy.  It  increases  the  nitrog- 
enous output  in  the  urine. 

See  to  it  first  that  a correct  hygienic  regimen 
is  observed,  e.g.,  adequate  rest,  exercise,  and 
recreation,  regular  hours  of  eating  and 
sleepmg,  rest  before  and  after  eating,  fresh 
air  day  and  night,  frequent  bathmg,  and 
regulation  of  the  bowels. 

In  troublesome  cases,  prescribe  the  fol- 
lowing regimen : At  the  moment  of  awaken- 
mg,  before  raising  the  head  from  the  piUow, 
have  the  patient  eat  a hard,  chy  biscuit, 
or  chy  toast,  or  drink  hot  black  coffee. 
Beginning  at  8 a.  m.,  give  eveiy  two  hours, 
on  the  hour,  until  6 p.  m.,  concentrated, 
readily  digestible  foods  in  small  amounts, 
e.g.,  fresh,  clean  milk,  plain  or  diluted  with 
lune-water  or  soda-water,  or  barley-water, 
koumyss  {q.v.)  or  matzoon  {q.v.),  cream,  eggs 
raw^  or  boiled  thiee  minutes,  toast,  weak 
hot  tea  or  coffee,  clam  or  oyster  broth,  raw 
oysters,  ex]3ressed  beef-juice,  broiled  meats, 
crisply  fried  bacon,  somatose  {q.v.),  pano- 
pepton  {q.v.),  liquid  peptonoids  {q.v.),  a well- 
cooked  cereal  with  cream;  no  water  with 
meals.  If  certain  foods  are  strongly  craved, 
they  may  be  allowed  experimentally.  Have 
the  patient  lie  down  after  eating  for  half  an 
hour  or  longer.  Forbid  sexual  intercourse. 
Calcium  {q.v.)  may  be  prescribed  to  meet 
a supposed  calcium  deficiency.  Rest  and 


OCCIPITO-POSTERKm  PRESENTATIONS 


quiet  are  all-important,  and  a calmative 
may  be  required : 

Sodii  bromidi 3d  Oii  (gr-  x per  dose) 

Aqupp  camphorsB 
vel  aqu33  menthse 

piperifae 5 viii 

M.  Sig. — One  tablespoonful  four  times  a day. 

It  should  be  remembered  that  the  case 
may  be  chiefly  neurotic  or  hysterical  and 
amenable  to  suggestion  and  moral  suasion. 

The  symptomatic  remecUes  enumerated 
under  Vomiting,  in  Part  1,  may  be  of  service. 

In  obstinate  cases,  isolate  the  patient  in  a 
darkened  room,  in  bed,  administer  large 
doses  of  bromide  per  rectum  (gr.  xl-lx,  well 
diluted,  every  four  hours,  for  several  clays), 
and  allow  no  food  by  mouth,  but  substitute 
rectal  feeding  for  several  days  (see  Rectal 
Feeding,  in  Part  1). 

Serrnn  from  a bealthy  pregnant  woman 
may  be  tried. 

If  the  above-described  measures  are 
ineffectual,  or  if  the  case  is  acute  and  ful- 
minant from  the  beginning,  do  not  delay  in 
terminating  pregnancy  (see  Abortion;  and 
Premature  Labor,  Induction  of),  for  the 
mortality  from  exhaustion  in  these  evi- 
dently toxiemic  cases  is  high.  Employ 
ether,  or  better,  nitrous  o.xide  and  oxygen  as 
an  anaesthetic;  and  give  copious  enemata  of 
normal  saline  solution  (5i  ad  Oi)  after  the 
operation,  and  if  need  be,  wash  out  the 
stomach  and  leave  in  a pint  of  sodium 
bicarbonate  solution,  5 iss  ad  Oi. 

Nephritic  Toxaemia. — Gr.  ve(t>p6s  kidney. 
See  Toxaemias  of  Pregnancy. 

Neuritis  Complicating  Pregnancy. — Gr. 
vevpov  nerve  -ltls  inflammation.  See 
Paralyses. 

New=Born,  Care  of  the. — See  Manage- 
ment of  the  Puerperium. 

Diseases  of  the. — See  Diseases  of  the 
New-Born  Infant. 

Night  =Sweats. — Night  sweating  during 
the  puerperium  is  physiological. 

Nipple=Shield,  Use  of  the. — See  under 
Nipples,  Sore. 

Nipples,  Care  of  the. — See  Nipples,  Sore. 

Cracked. — See  Nipples,  Sore. 

Depressed. — L.  de,  down  -H  prem'ere, 
to  press.  See  Nipples,  Inverted. 

Fissured. — L.  fissu'ra.  See  Nipples, 
Sore. 

Inverted. — L.  in,  into  -|-  ver'tere,  to 
turn.  During  the  last  month  of 
pregnancy,  attempt  to  draw  the  nip- 
ples out  by  means  of  the  breast-pump. 
The  child  may  possibly  be  able  to 
nurse  by  means  of  the  nipple-shield. 


Nipples,  Retracted. — L.  re,  back  -1-  tra'- 
here,  to  draw.  See  Nipples,  Inverted, 
above. 

Sore. — Prophylaxis.— During  the  last  two 
or  three  months  of  pregnancy,  bathe  the 
nipples,  night  and  morning,  for  the  purpose 
of  hardening  them,  with  glycerol  of  tannin 
and  water,  equal  parts  (Hirst) ; or  compound 
tincture  of  lavender,  5h,  and  glycerine,  5ss 
(Edgar) ; or  lx)rax  or  boric  acid,  one  table- 
spoonful in  a tumbler  of  alcohol  and  water 
equal  parts  (J.  W.  Williams).  Some  condemn 
the  use  of  alcohol  as  too  drying  and  thereby 
tending  to  promote  cracking. 

Cleanse  the  nipples  with  plain  boiled 
water  before,  and  with  boric  acid  solution, 
gr.  X to  the  ounce,  followed  by  sterile  sweet 
oil,  after  each  nursing,  and  keep  them  cov- 
ered with  sterile  gauze  or  flannel.  Do  not 
touch  the  nipples  with  the  fingers. 

Treatment.— Employ  a nipple-shield  in 
nursing.  Place  the  shield  tightly  upon  the 
breast,  and  partly  fill  it  with  milk  expressed 
by  the  fingers  before  putting  the  child  to  it. 
After  each  nursing  take  the  nipple-shield 
apart,  cleanse  it  with  cold  water,  scakl  it, 
and  keep  it  immersed  in  a clean  tumbler  of 
saturated  boric  acid  solution  (4  per  cent.). 
The  best  nipple-shield  is  the  large  rubber 
one,  covering  almost  the  entire  breast. 

After  each  nursmg,  cleanse  the  sore 
nipple  with  boric  acid  solution,  dry  thor- 
oughly, and  apply  one  of  the  following  prep- 
arations, viz.,  bismuth  subnitrate  and  castor- 
oil,  equal  parts;  or  compound  tincture  of 
benzoin;  or  silver  nitrate,  gr.  x ad  5i;  or 
zinc  oxide;  or  orthoform  in  powder  or  alco- 
holic solution.  Expose  the  nipples  to  the  air. 

If  it  should  be  necessary  to  suspend 
nursing  from  the  breast,  express  the  milk  by 
means  of  massage  or  the  breast-pump. 

The  application  of  a 5 per  cent,  anaes- 
thesin  salve  to  the  fissure  just  before  nursing 
materially  mitigates  the  pain. 

Normal  Labor,  Management  of.  — See 
Conduct  of  Normal  Labor. 

Pregnancy,  Management  of.  — See 
Management  of  Pregnancy. 

Puerperium,  Management  of.  — See 
Management  of  the  Puerperium. 

Nursing. — See  Infant  Feeding,  in  Part  1. 
Obliquely  Contracted  Pelves. — L.  obli'- 
quus,  slanting.  See  under  Contracted  Pelves, 

Obstetrical  Outfit. — L.  ob,  in  front  of ; sto, 
I stand.  See  the  Appendix,  following  Part  4. 

Obstructed  Labor. — See  Dy.stocia. 

Occipito=Posterior  Presentations. — L.  oc'- 
ciput,  back  of  the  head;  poder'ius,  behind; 
prceesentn'tio.  Frequency. — 1.5  to  16.8  per 
cent.  In  1 to  7 per  cent,  of  these  cases  the 


OPHTHALMIA  NEONATORUM 


occiput,  during  labor,  rotates  into  the 
hollow  of  the  sacrum,  instead  of  normally 
toward  the  symphysis.  The  causes  of  such 
abnormal  rotation  are  as  follows:  weak 
expulsive  power,  due  to  abdominal  and 
uterine  inertia;  undue  resistance,  due  to  a 
small  pelvis,  particularly  the  kyphosis,  gen- 
erally contracted,  and  Nagele’s  pelvis,  and 
to  a large  head;  small  resistance,  as  in  a 
large  pelvis,  small  head,  or  a relaxed  pelvic 
floor;  hn perfect  flexion  of  the  head;  abnor- 
mal projection  of  the  lumbar  and  sacral 
vertebrje;  prolapse  of  the  hand  or  foot 
anteriorly,  preventing  forward  rotation. 

Treatment. — Spontaneous  delivery  is  the 
rule  in  occipito-posterior  presentations.  J. 
W.  Williams  does  “ not  consider  it  advisable 
to  attempt  to  convert  posterior  presenta- 
tions into  other  jwsitions  during  the  course 
of  labor,  except  when  the  forceps  is  to  be 
applied.”  He  says:  “ Even  when  the 

occiput  rotates  into  the  hollow  of  the 
sacrmn,  the  prognosis  is  not  bad,  as  in  the 
majority  of  cases  spontaneous  delivery 
occurs.”  His  practice  is  to  assist  labor  with 
forceps  only  “ when  convinced  that  the  best 
interests  of  the  mother  and  child  will  be 
subserved  by  prompt  delivery.”  “ On  the 
other  hand  when  the  head  is  arrested  at  the 
superior  strait  in  a posterior  position,  ver- 
sion (q.v.)  should  be  resorted  to  as  soon 
as  one  is  convinced  that  spontaneous 
advance  will  not  occur,  provided,  of  course, 
that  the  operation  is  not  contraindicated 
by  disproportion  between  the  size  of  the 
head  and  the  pelvis  ” (Williams).  Other 
contraindications  against  version  are  the 
draining  away  of  the  liquor  amnii,  tetanic 
contraction  of  the  upper  uterine  segment, 
and  dangerous  tliiiining  of  the  lower 
uterine  segment. 

If  it  is  deemed  advisable  during  labor  to 
take  active  steps  to  promote  anterior  rota- 
tion, have  the  patient  lie  on  that  side 
“ toward  which  the  fetal  back  is  directed, 
in  the  exaggerated  lateral  prone  position, 
with  a pad  under  the  lower  buttock,”  in 
order  “ to  secure  perfect  flexion  of  the  head.” 
If  the  pelvic  floor  does  not  furnish  sufficient 
resistance  to  maintain  flexion  of  the  head, 
insert  two  fingers  in  the  vagina,  or  a single 
blade  of  the  forceps,  “ imitating  the  shape 
and  direction  of  the  pelvic  floor  and  used 
as  a lever  to  pry  the  occiput  fonvard  ” 
(Hust).  One  may  also  press  upon  the  fore- 
head, during  a pain,  and  draw  down  the 
occiput.  A single  large  dose  of  quinine 
(gr.  xv),  or  a hypoderaiic  or  intramuscular 
injection  of  pituitrin  (0.5  c.c.)  may  be  useful 
in  increasing  the  expulsive  power. 


It  is  possible  in  some  cases  to  turn  the 
occiput  forward  with  the  hand  in  the  birth 
canal  while  an  assistant  rotates  the  shoulder 
externally  and  maintains  flexion  of  the  head 
by  pressure  upon  the  fundus.  If  the  occiput 
tends  to  slip  back  from  the  corrected  posi- 
tion, it  may  be  held  in  place  by  means  of 
a clamp  or  volsellum  forceps  affeed  to  the 
child’s  scalp.  Extraction  with  forceps 
(q.v.)  should  then  be  performed.  Rota- 
tion of  the  head  may  be  accomplished  by 
means  of  the  forceps,  which  are  applied  at 
first  as  though  the  occiput  were  anterior 
instead  of  posterior;  then,  after  rotation  to 
a transverse  or  anterior  position  has  been 
accomplished,  the  forceps  are  removed  and 
reapplied.  If  rotation  with  forceps  is  im- 
possible, extract  with  the  occiput  posterior. 

(Edema  of  the  Face. — Gr.  6i8r)fj.a  swelling. 
See  Toxaemias  of  Pregnancy, 
of  the  Feet. — See  Toxaemias  of  Preg- 
nancy; Phlegmasia  Alba  Dolens;  and 
Varicose  Veins  of  the  Legs, 
of  the  Vulva. — SeePart  2,  (jynaecology. 

(Edema  Neonatorum. — See  Part  5,  Skin 
Diseases. 

Oliguria. — Gr.  oXiyos  scanty  -p  ovpov 
urine.  See  the  Toxaemias. 

Ophthalmia  Neonatorum. — Gr.  6<j>0a\tJL6s 
eye;  Gr.  veSs  new  + L.  na'tus,  born.  Causative 
Agents.— Gonococcus,  colon  bacillus,  sta- 
phylococci, streptococci,  pneumococcus,  in- 
fluenza bacillus.  Purulent  conjunctivitis  in 
infants  is  due,  in  one-third  of  the  cases,  at 
least,  to  organisms  other  than  the  gonococ- 
cus. (Williams  and  Rosenberg.) 

Treatment.— Douche  the  eye  very  gently, 
three  or  four  times  daily  or  oftener  (taking 
great  care  not  to  abrade  the  corneal  epi- 
thelium), with  a warm  saturated  solution  of 
boric  acid  (gr.  xviii  to 
the  ounce),  or  potas- 
siiun  permanganate, 
1 : 5000,  or  bichloride 
of  mercmy,  1 : 10,000, 
or  cyanide  of  mer- 
cury', 1 : 5000,  using 
pledgets  of  absorbent 
cotton,  or  a fountain 
sjTinge  with  a bulbous- 
tipped  nozzle,  or  an  irrigating  bottle  (Fig. 
95) , or  a hollow  lid-retractor.  Once  or  twice 
daily,  apply  on  a cotton- wound  applicator  or 
camel’s-hair  brush,  or  drop  in  the  eye,  protar- 
gol,  10  to  20  per  cent.,  or  ar^Tol,  30  to  50  p>er 
cent.  Anoint  the  lid  margins  with  vaseline. 

For  cedema  of  the  lids,  apply  ice-water 
compresses  every  hour  or  two  for  ten  to 
thirty  minutes  until  the  swelling  subsides. 

Should  the  cornea  become  hazy  or  cloudy, 


PHLEGMASIA  ALBA  DOLENS;  MILK  LEG;  WHITE  LEG 


stop  the  ice  compresses  at  once,  and  apply 
here,  and  instil  once  or  twice  daily  a sterile 
solution  of  atropine,  gr.  i to  the  ounce. 
Should  ulceration  supervene,  employ  irri- 
gations of  formalin,  1 : 10,000,  and  keep  the 
pupil  dilated  with  atropine. 

As  convalescence  sets  in,  reduce  the 
strength  of  the  silver  solutions,  and  later 
substitute  astringents ; 


Zinci  sulphatis gr.  ss 

Acidi  borici gr.  x 

Aquaj  destillatae 5i 


M.  Sig. — ^Drop  into  the  eyes  t.i.d. 

Gonorrhoeal  ophthalmia  is  seldom  cured 
under  four  to  six  weeks.  Impairment  of 
vision  due  to  corneal  changes  results  in 
many  cases  in  spite  of  all  care. 

Prophylaxis.— Instil  into  the  eyes  immed- 
iately after  birth,  two  drops  of  a 5 per  cent, 
solution  of  protargol. 

Osteomalacia.-^ee  Part  1,  General  Medi- 
cine and  Surgery. 

Outfit,  Obstetrical. — See  the  Appendix, 
following  Part  4. 

Ovarian  Tumors  Complicating  Pregnancy 
and  Labor. — Ij.  ovar'ium,  ovary;  tu'mor, 
from  tu'mere,  to  swell.  If  diagnosed  before 
the  last  month  of  pregnancy,  remove  the 
tumor  through  the  abdomen;  but  if  first 
detected  during  the  last  month,  do  not 
interfere  until  term,  in  order  to  avoid  an 
abdominal  cicatrix  which  is  apt  to  rupture 
at  the  time  of  labor.  (J.  W.  Williams.) 

At  the  time  of  labor,  try  very  gently,  for 
fear  of  rupturing  the  cyst,  to  push  it  up  out 
of  the  pelvis.  If  this  fails,  perform  Caesarean 
section  (q.v.),  and  remove  the  tumor. 

Should  labor  terminate  successfully  with- 
out the  necessity  of  removing  the  tumor, 
watch  the  patient  carefully  during  the 
puerperium,  and  open  the  abdomen  on  the 
first  appearance  of  untoward  symptoms 
(torsion  of  the  pedicle;  gangrene).  In  any 
case,  remove  the  tumor  as  soon  as  feasible. 

Pains,  After,  Severe. — See  After-Pains, 
Severe. 

Palpitations  of  the  Heart. — L.  palpiia'tio. 
See  Cardiac  Disease. 

Paralyses,  Birth. — See  Birth  Palsies,  in 
Part  1. 

Paralyses  Complicating  Pregnancy. — Gr. 

TTCLpa  beside  -|-  Xueo'  to  loosen.  Cerebral  or 
spinal  hemorrhage  or  oedema  may  occur  as 
a result  of  toxaemia  and  eclampsia. 

Paraplegia  may  be  caused  by  spinal  dis- 
ease or  pressure  of  the  foetal  head  upon  the 
pelvic  nerves. 

Cerebral  embolism  may  follow  phlebitis 
of  the  lower  extremities  or  endocarditis. 


Cerebral  thrombosis  may  occur  as  a result 
of  infection. 

Neuritis  may  be  due,  possibly,  to  toxaemia. 

Deafness  may  occur  as  a result  of  paraly- 
sis of  the  auditory  nerve. 

Amblyopia  or  amaurosis  may  be  due  to 
renal  insufficiency,  or  to  reflex  contraction 
of  the  retinal  artery,  or  to  general  anaemia. 

Treatment.— Attend  to  the  cause.  For 
motor  paralysis  employ  strychnine  (q-v.), 
iron  (g.y.),  electricity,  and  massage.  It  may 
be  necessary  to  induce  labor,  following 
which  the  paralysis  may  disappear  (see  Pre- 
mature Labor,  Induction  of). 

Parametritis,  Pelvic  Cellulitis. — Gr.  -irapa 
near  -f-  prirpa  womb:  Inflammation  of  the 
cellular  tissue  about  the  uterus  (see  Puer- 
peral Infection). 

Parauterine  Phlebitis. — Gr.  irapa  near  -\- 
L.  u'terus,  womb;  Gr.  4>\e\p  vein  -trts 
inflammation.  See  Puerperal  Infection. 

Parietal  Bone  Presentations. — See  Ear  or 
Parietal  Bone  Presentations. 

Pelvic  Contraction. — L.  pel'vis,  basin. 
See  Contracted  Pelves. 

Deformity. — See  Contracted  Pelves. 

Cellulitis.— L.  cel'lula,  minute  cell  -f- 
Gr.  -LTLs  inflammation.  See  Puer- 
peral Infection. 

Joints,  Relaxation  of  the. — See  Relax- 
ation of  the  Pelvic  Joints. 

Rupture  of  the. — See  Rupture  of  the 
Pelvic  Joints. 

Measurements. — See  Contracted 
Pelves. 

Peritonitis. — Gr.  irtpL  around  + leiveLv 
to  stretch  J-  -ltls  inflammation.  See 
Puerperal  Infection. 

Pendulous  Abdomen.— See  Abdomen, 
Pendulous. 

Perineal  Tears. — Gr.  irtpivaiov.  See  under 
Conduct  of  Normal  Labor. 

Period  of  Pregnancy. — Gr.  irepL  around  -|- 
656s  way.  See  Stage  of  Pregnancy. 

Peritonitis,  Pelvic. — Gr.  irepL  around  + 
relveiv  to  stretch;  L.  pel'vis,  basin.  See 
Puerperal  Infection. 

Pernicious  Anaemia  Complicating  Preg= 
nancy. — L.  pernicio' sus.  See  Ansemia. 

Vomiting  of  Pregnancy. — See  Nausea 
and  Vomiting  of  Pregnancy. 

Phlebitis,  Crural. — Gr.  vein  -1 — tns 

inflammation;  L.  crus,  cru'ris,  leg. 
See  Phlegmasia  Alba  Dolens. 

Uterine  and  Parauterine. — Gr. 
vein  4-  -ltls  inflammation;  L.  u'terus, 
womb.  See  Puerperal  Infection. 

Phlegmasia  Alba  Dolens;  Milk  Leg; 
White  Leg. — Gr.  4>\eyp.aaLa  heat  inflamma- 
tion; L.  al'ba,  white;  do' lens,  painful.  The 


PLACENTA  PRiEVIA 


occuri’ence,  usually  during  the  puerperium, 
of  pain,  cedeina,  and  elevation  of  tempera- 
ture in  one  of  the  lower  extremities,  due  to 
venous  thrombosis. 

The  condition  usually  heals  in  several 
weeks  or  months,  but  suppuration,  gangrene, 
pyaemia,  pulmonary  embolism,  and  chronic; 
congestion  of  the  limb  are  possibilities. 

Etiology.— Uterine  infection;  local  infec- 
tion; mechanical  compression;  anaemia 
and  debility. 

Treatment. — See  Thrombosis,  Venous,  in 
Part  1,  General  Medicine  and  Surgery. 

Piles. — See  Hemorrhoids. 

Placenta,  Adherent. — L.  placen'ta  a flat 
cake.  See  Adherent  Placenta. 

Expression  of  the. — L.  expres'sio,  press- 
ing out.  See  Adherent  Placenta. 

Manual  Removal  of  the. — L.  vian'us, 
hand.  See  Adherent  Placenta. 

Placenta  Praevia. — L.  placen'ta  a flat 
cake ; prce-  before  vi'a,  way.  Implantation 

of  the  placenta  in  the  lower  uterine  segment, 
more  or  less  overlapping  the  internal  os; 
frequency,  about  one  in  160  to  1000. 

The  condition  is  usually  first  manifested 
after  the  seventh  month  of  pregnancy,  but 
sometimes  not  until  the  onset  of  labor,  by 
repeated  and  usually  copious  hemorrhages; 
and  internal  examination  usually  reveals  a 
patulous,  somewhat  dilated  cervical  canal, 
and  the  sponge-like,  boggy  or  gritty  maternal 
face  of  the  placenta  at  the  internal  os.  The 
cervix  should  be  dilated,  under  anaesthesia  if 
necessary,  to  palpate  the  better. 

Placenta  praevia  predisposes  to  abortion, 
malj)resentations,  uterine  inertia,  ailherent 
placenta,  and  infection. 

The  Prognosis  is  serious  for  both  mother 
and  child. 

Treatment. — Empty  the  uterus  as  soon  as 
the  condition  is  tliagnosed.  Shave  and 
cleanse  the  external  genitalia  and  neighbor- 
ing skin  thoroughly  with  castile  or  green 
soap  and  warm  water,  and  cleanse  the  vagina 
with  soap  and  water,  followed  by  bichloride 
solution,  1 :4000.  Cover  the  lower  limbs  and 
abdomen  with  sterile  sheets,  exposing  only 
the  vulva,  and  under  ether  <lilate  the  cervix 
gently  and  slowly  with  the  fingers  as  far  as 
convenient,  employing  Edgar’s  gentle  biman- 
ual dilatation,  if  desired.  Then  with  the 
two  fingers  of  the  right  hand  within  the 
cervix  push  the  presenting  head  away  while 
the  left  hand  on  the  abdomen  pushes  the 
upper  i^ole  of  the  foetus  around  toward  the 
pelvis  (bipolar  version  of  Braxton  Hicks). 
Now  }:)erf orate  the  membranes  beyond  the 
margin  of  the  placenta,  if  j)ossible,  other- 
wise through  the  placenta,  seize  and  bring 


down  a foot,  and  extract  it  “ until  the  knee 
appears  at  the  vulva  ”;  then  withdraw  the 
ana?sthetic.  Hemorrhage  is  controlled  by 
gentle  traction  upon  the  leg,  the  breech 
serving  as  a tampon.  Wait  patiently  for 
the  cervLX  to  dilate,  occasionally  exerting 
veiy  gentle  traction  upon  the  leg  to  hasten 
dilatation.  When  dilatation  is  practically 
complete,  not  before,  extract  the  child. 

In  the  absence  of  any  great  hemorrhage, 
the  child’s  interests  are  best  subserved  by 
the  employment  of  Voorhees’s  or  Champe- 
tier  do  Ribes’s,  or  Braun’s  metreurynter  of 
large  size  (500  c.c.),  with  a two-pound 
weight  attached.  The  ceiwix  is  first  dilated 
digitally  to  the  width  of  two  fingers,  the 
membranes  or  placenta  perforated,  and  the 
bag  placed  within  the  amniotic  sac  and 
filled  with  sterile  normal  salt  solution 
(5i  ad  Oi).  After  the  bag  is  expelled  or 
easily  removed,  forceps  are  applied  {q.v.) 
or  internal  podalic  version  {q.v.)  and  extrac- 
tion performed.  Shatz  regards  metreurynsis 
as  superfluous. 

If  the  cervix  is  exceptionally  rigid,  or  if 
the  condition  is  first  detected  during  labor 
by  a profuse  outpouring  of  blood,  and  the 
cervix  is  not  sufficiently  dilated,  one  may, 
under  strict  asepsis,  pack  the  cervix  anti 
vagina,  or  the  vagina  alone,  tightly  and 
fully  with  gauze  bandage.  Barn&s  advises 
separating  the  placenta  around  and  beyond 
the  internal  os  with  the  fingers  before  insert- 
ing the  pack.  After  a few  hours  the  os 
should  be  sufficiently  dilated.  Then  antes- 
thetize  the  patient  and  proceed  as  first 
directed.  The  tampon  should,  however,  be 
avoided,  because  of  the  increased  danger 
of  infection. 

If  during  labor  the  cervix  is  well  dilated 
when  hemorrhage  occurs,  one  may  per- 
forate the  membranes  and  bring  down  the 
head  with  forceps,  after  v/hich  the  latter 
may  be  removed.  If  this  is  not  feasible, 
resort  to  internal  podalic  version. 

If  hemorrhage  persists  after  the  birth  of 
the  child,  attempt  to  express  the  placenta 
by  Credo's  method,  and  if  this  is  not  quickly 
successful,  remove  it  manually  (see  Adher- 
ent Placenta).  Then  knead  the  uterus,  etc., 
(see  Hemorrhage,  Post-Partum).  Reynolds 
and  Newell  aclvocate  packing  the  uterus 
with  gauze  in  all  cases,  owing  to  the  ten- 
dency to  insufficient  contraction  of  the  lower 
uterine  segment.  The  pack  should  be  re- 
moved at  the  end  of  twelve  to  twenty-four 
hours,  and  the  uterus  irrigated.  The  pack 
greatly  increases  the  liability  to  infection. 

Pituitrin  {q.v.  in  Part  11)  may  be  of  value. 

The  above-described  treatment  is  that 


PREGNANCY,  ESTIMATION  OF  THE  DURATION  OF 


commonly  advised,  but  in  cases  in  which  the 
placenta  covers  the  entire  internal  os  and 
in  the  presence  of  a rigid  cervix,  the  classical 
CiEsarean  operation  (q.v.)  is  probably  best 
for  both  mother  and  child. 

Placenta,  Premature  Separation  of  the 
Normally  Situated. — See  Premature 
Separation  of  the  Normally  Situated 
Placenta. 

Previa. — See  Placenta  Pra?via. 

Removalof  the.— SeeAdherent  Placenta. 

Pneumonia  Complicating  Labor. — Gr. 

TTvevfjLuv  lung.  See  Adynamic  Diseases  Com- 
plicating Labor. 

Podalic  Version. — Gr.  -irovs  foot;  L.  ver'sio, 
turning.  Indications. — Transverse  presen- 

tations; floating  head  presentations  which 
do  not  promise  spontaneous  engagement  and 
delivery;  sometunes  ear,  brow,  or  face 
presentations;  usually  prolapse  of  the  ex- 
tremities or  cord;  often  placenta  prsevia; 
often  foetal  deformity;  perhaps  rupture  of 
the  uterus,  eclampsia,  and  hemorrhage. 

Contraindications. — Finn  engagement  of  the 
presenting  part;  marked  pelvic  contraction; 
hydrocephalus;  early  rupture  of  the  mem- 
branes and  draining  off  of  the  Liquor  amnii; 
tetanic  contraction  of  the  uterus  not  relieved 
by  anaesthesia;  dangerous  thinning  of  the 
lower  uterine  segment  as  evidenced  by  the 
high  position  of  Bandl’s  contraction  ring. 

I.  Internal  Podalic  Version. — Under  strict 
asepsis  (q.v.),  the  cervix  bemg  completely 
dilated,  rupture  the  membranes,  and  insert 
the  right  or  left  hand,  according  as  the  back 
of  the  child  is  directed  to  the  right  or  left. 
If  the  head  is  presenting,  attempt  to  grasp, 
if  possible,  the  anterior  foot.  In  transverse 
presentations,  seize  the  lower  foot  if  the 
back  is  directed  anteriorly,  the  upper  foot 
if  the  back  is  directed  jwsteriorly,  so  as  to 
bring  the  back  against  the  symphysis  pubis. 
If,  in  transverse  presentations,  an  arm  pro- 
lapses, attach  a fillet  to  it,  to  prevent  it  from 
becoming  extended  over  the  head  dur- 
ing extraction. 

During  extraction  an  assistant  should 
exert  firm  pressure  upon  the  fundus  uteri. 

II.  Combined  External  and.  Internal  Version 
(Braxton  Hicks  Bipolar  Method). — This  method 
may  be  employed  when  the  cervix  is  cUlated 
sufficiently  to  achnit  two  fingers,  and  the 
membranes  are  unruptured.  The  external 
hand  upon  the  abdomen  pushes  the  upper 
fetal  pole  toward  the  pelvis,  while  the 
internal  fingers  pusn  the  lower  pole  in  the 
opposite  direction.  Strict  asepsis  should 
be  observed. 

Polygalactia.  — See  Milk  Secretion,  Ex- 
cessive. 


Polyuria. — Gr.  ttoXvs  much  -|-  ovpov  urine. 
Polyuria  occurs  physiologically  in  preg- 
nancy. Sometimes  it  is  very  great. 

Posterior  Occipital  Presentations.  — See 
Occipito-Posterior  Presentations. 
Parietal  Bone  Presentations. — See  Ear 
Presentations. 

Post=Partum  Hemorrhage. — See  Hemor- 
rhage, Post-Partum. 

Posture,  Walcher’s  Hanging. — See  under 
Contracted  Pelves. 

Pre=Eclamptic  Toxaemia. — See  Toxaemias 
of  Pregnancy. 

Pregnancy,  Accidental  Complications  of. — 

See  Complications  of  Pregnancy 
Amaurosis  during. — L.  from  Gr. 

afxavpoeiv  to  darken;  blindness.  See 
Paralyses  Complicating  Pregnancy. 
Amblyopia  during. — Gr.  dg/eXus  dulled fi- 
unp  eye:  dimness  of  vision.  See  Par- 
alyses Complicating  Pregnancy. 
Anaemia  Complicating. — See  Anaemia 
Compheating  Pregnancy. 

Anorexia  Complicating. — See  Anorexia. 
Anteflexion  of  the  Uterus  in. — L.  an'te, 
before  fle'xio,  bend.  See  Displace- 
ments of  the  Pregnant  Uterus. 
Anteversion  of  the  Uterus  in. — L.  an'te, 
before  ver'sio,  turning.  See  Dis- 
placements of  the  Pregnant  Uterus. 
Appendicitis  Complicating.  — See  Ap- 
pendicitis. 

Cardiac  Disease  Complicating.  — See 
Cardiac  Disease. 

Chloasma. — See  Chloasma. 

Chorea  Complicating. — See  Chorea. 
Complications  of. — See  Complications 
of  Pregnancy. 

Constipation  Complicating. — See  Con- 
stipation. 

Deafness  Complicating. — See  Paraly- 
ses Complicating  Pregnancy. 

Dental  Caries  Complicating. — See  Den- 
tal Caries. 

Dermatitis  Herpetiformis  Complicat= 

ing. — See  Dermatitis  Herpetiformis, 
in  Part  5. 

Diagnosis  of. — See  Diagnosis  of  Preg- 
nancy. 

Diet  in. — See  Management  of  Preg- 
nancy. 

Displacements  of  the  Uterus  in. — See 

Displacements  of  the  PregnantUterus. 
Duration  of. — See  Stage  of  Pregnancy. 

Dyspepsia  Complicating.  — See  Dys- 
pepsia. 

Emphysema  Complicating.— See  Em- 
physema. 

Estimation  of  the  Duration  of. — See 

Stage  of  Pregnancy. 


PREMATURE  LABOR,  INDUCTION  OF 


Pregnancy,  Extra  = Uterine. — See  Extra- 
Uterine  Pregnancy,  in  Part  2,  Gynaj- 
cology. 

False. — See  Diagnosis  of  Pregnancy, 

Fibroid  Tumors  Complicating.  — See 

Fibroid  Tumors  Complicating  Preg- 
nancy. 

Gingivitis  Complicating.  — See  Gingi- 
givitis. 

Glycosuria  in. — See  Glycosuria. 

Gonorrhoea  Complicating. — See  Gonor- 
rhoea, 

Heart  Disease  Complicating. — See  Car- 
diac Disease. 

Hematuria  Complicating.— See  Hiema'- 
turia. 

Hemorrhage  During.  — See  Hemor- 
rhage, Ante-Partum. 

Hemorrhoids  Complicating. — See  Hem- 
orrhoids. 

Hepatic  Toxaemia  of. — See  Toxaemias 
of  Pregnancy. 

Hernia  of  the  Uterus  in. — See  under 
Disidacements  of  the  Pregnant  Ut- 
erus. 

Herpes  Qestationis  Complicating. — Gr. 

epTTTjs  creeping;  L.  gestat'io  pregnancy. 
See  Dermatitis  Herpetiformis,  in  Part 
5,  Skin  Diseases. 

Hygiene  of. — See  Management  of  Preg- 
nancy. 

Impetigo  Herpetiformis  Complicating. 

See  Impetigo  Herpetiformis,  in  Part  5. 

Icterus  in. — See  Icterus  in  Pregnancy. 

Indigestion  Complicating. — L.  in,  not  -f 
dis,  apart  -f-  ge'rere  to  carry.  See 
Dyspepsia. 

Insanity  of. — See  Insanity  of  Gestation. 

Jaundice  in. — See  Icterus  in  Pregnancy. 

Kidney  of. — See  Toxaemias  of  Preg- 
nancy. 

Leucorrhoea  in. — See  Vaginitis  in  Preg- 
nancy. 

Management  of. — See  Management  of 
Pregnancy. 

Multiple. — See  Multiple  Pregnancy, 

Nausea  and  V'omiting  of. — See  Nausea 
and  Vomiting  of  Pregnancy. 

Nephritic  Toxaemia  of. — See  Toxaemias 
of  Pregnancy. 

Neuritis  Complicating. — Gr.  vevpov  nei-ve 
+ -trts  inflammation.  See  Paralyses. 

Normal,  Management  of. — See  l\Ian- 
agement  of  Pregnancy. 

Para  lyses  Compl  icat  ing. — See  Paralyses . 

Pelvic  Joint  Relaxation  in. — See  Re- 
laxation of  the  Pelvic  Joints. 

Period  of. — See  Stage  of  Pregnancy. 

Pernicious  Anaemia  Complicating.-^ee 
Anaemia. 


Pregnancy,  Pernicious  Vomiting  of. — See 
Nausea  and  Vomiting  of  Pregnancy. 

Pre=Eclamptic  Toxaemia  of. — See  Tox- 
aemias of  Pregnancy. 

Prolapse  of  the  Uterus  in. — L.  pro, 
before  la'bi,  to  fall.  See  Dis- 
placements of  the  Pregnant  Uterus. 

Pruritis  in. — See  Pruritis. 

Ptyalism  Complicating.— See  Salivation. 

Pyelitis  and  Pyonephrosis  of. — See 
Pyelitis  and  Pyonephrosis  of  Preg- 
nancy. 

Relaxation  of  the  Pelvic  Joints  in. — See 
Relaxation  of  the  Pelvic  Joints. 

Retrod  isplacement  of  the  Uterus  in. — 

See  Displacements  of  the  Pregnant 
Uterus. 

Salivation  Complicating. — See  Saliva- 
tion. 

Signs  of. — See  Diagnosis  of  Pregnancy. 

Skin  Diseases  Complicating. — See  Skin 

Diseases. 

Stage  of. — See  Stage  of  Pregnancy. 

Symptoms  of. — See  Diagnosis  of  Preg- 
nancy. 

Syphilis  Complicating. — See  Syphilis 
Complicating  Pregnancy. 

Toothache  in. — See  Dental  Caries. 

Toxaemias. — See  Toxaemias  of  Preg- 
nancy. 

Tuberculosis  Complicating. — See  Tu- 
berculosis Complicating  Pregnancy. 

Twin. — See  Multiple  Pregnancy. 

Vaginitis  Complicating.— ^ee  Vaginitis. 

Valvular  Heart  Disease  Complicating. — 
See  Cardiac  Disease. 

Vomiting  of. — See  Nausea  and  Vomit- 
ing of  Pregnancy. 

Premature  and  Delicate  Infants,  Care  of. 

— See  Part  1,  General  Medicine  and 
Surgery. 

Detachment  of  the  Normally  Situated 
Placenta. — See  Premature  Separa- 
tion, etc. 

L a b o r. — See  Abortion,  Miscarriage, 
and  Premature  Labor,  in  Part  2, 
Gvmaecologj'. 

Premature  Labor,  Induction  of. — L.  in, 

in  + du'cere  to  lead.  The  artificial  termina- 
tion of  pregnancy  after  the  twenty-eighth 
week  or  sixth  month,  that  is,  when  the 
foetus  is  viable,  or  capable  of  living  outside 
the  uterus. 

Indications.— Placenta  prsevia;  premature 
detaclmient  of  the  nonnally  situated  pla- 
centa; mtractable  toxtemia  or  renal  insuf- 
ficiency; eclampsia;  broken  cardiac  com- 
pensation; grave  chorea;  grave  neuritis; 
grave  diabetes;  occasionally  pernicious 
anaemia  or  leukaemia;  pyelonephrosis; 


PREMATURE  SEPARATION  OF  THE  PLACENTA 


marked  hydramnios;  hydatidiform  mole;  the 
continuation  of  pregnancy  two  weeks 
beyond  term. 

Technique.— Shave  and  cleanse  the  external 
genitalia  and  neighboring  skin  thoroughly 
with  castUe  or  green  soap  and  warm  water, 
cleanse  the  vagina  with  soap  and  water, 
followed  by  bichloride  solution,  1 : 4000, 
and  cover  the  lower  luubs  and  abdomen  with 
sterile  sheets,  exposing  only  the  vulva. 
Cleanse  the  hands. 

Insert  into  the  cervix  and  high  up  into  the 
uterus  between  the  membranes  and  the 
uterine  wall,  several  stiff  bougies  (No.  17 
French  or  10  to  12  English),  or  thick  walled 
rubber  catheters  with  stylets.  Then  pack 
the  vagina  lightly  with  gauze  to  keep  the 
bougies  in  place.  The  bougies  are  sterilized 
by  prolonged  soaking  in  bichloride  solution. 
In  place  of  the  bougies  one  may  pack  the 
cervix  and  vagina  with  gauze  bandage. 

A quicker  method  is  as  follows:  Dilate 
the  cervix  to  a sufficient  width  by  means  of 
Hegar’s  or  Goodell’s  dilators  or  the  fingers. 
Then  introduce  a Champetier  de  Ribes, 
Voorhees,  Pomeroy,  Braun,  or  Barnes  rub- 
ber bag  smeared  with  sterile  vaseline  or 
glycerine.  The  Voorhees  bag  is  well  recom- 
mended. The  bag  is  rolled  up  and  grasped 
with  dressing  forceps.  The  left  index  and 
middle  finger  are  introduced  into  the 
vagina,  flexor  surface  up,  and  the  bag  is 
guided  to  the  cervical  opening  along  these 
fingers,  which  also  hold  the  bag  in  position 
"while  the  forceps  are  withch-awn.  With  the 
fingers  stiU  holding  the  bag  in  place,  an 
assistant  fills  the  bag  with  sterile  water,  or 
normal  salt  solution  (5i  ad  Oi),  or  lysol, 
0.5  per  cent.,  by  means  of  a piston  or  David- 
son syringe,  and  the  tube  is  clamped  with 
an  artery  forceps  or  tied  with  sterile  tape 
(R.  T.  La  Vake).  A two-pound  weight  may 
be  attached  to  hasten  dilatation,  but  the  risk 
of  tearing  the  cervix  is  thereby  increased. 
The  dangers  attendant  upon  the  use  of 
bags  are  (1)  sepsis,  (2)  cervical  laceration, 
and  (3)  displacement  of  the  presenting  part 
and  prolapse  of  the  cord. 

Bossi’s  four-branch  dilator  may  be  used 
in  place  of  the  bags,  if  greater  speed 
is  demanded;  or  Harris’s  method,  or 
Edgar’s  gentle  bimanual  dilatation  may 
be  practiced. 

In  the  presence  of  a rigid  cervix,  either 
vaginal  or  abdominal  Caesarean  section 
{q.v ) is  indicated.  The  former  operation 
(vaginal  hysterotomy)  is  performed  as 
follows;  Under  good  exposure  with  broad- 
bladed  specula,  the  cervix  is  drawn  to  the 
vulva  by  means  of  two  lateral  heavy  trac- 


tion sutures,  a median  longitudinal  incision 
is  made  through  the  anterior  vaginal  wall 
about  two  to  three  inches  long,  up  to  the 
utero-vaginal  junction,  the  bladder  is  sepa- 
rated entirely  from  the  anterior  surface  of 
the  uterus  with  the  gauze-covered  finger, 
up  to  the  level  of  the  internal  os,  where  the 
peritoneum  comes  in  sight,  the  peritoneum 
is  pushed  up,  and  the  anterior  cervix  is 
divided  with  stout  scissors  up  beyond  the 
internal  os  for  a distance  of  from  three  to 
four  and  a half  inches.  The  membranes  are 
now  ruptured  and  the  child  extracted.  One 
should  wait  for  the  spontaneous  loosening  of 
the  placenta,  unless  immediate  removal 
is  demanded. 

After  the  completion  of  delivery,  the 
wound  is  closed  from  above  downward  with 
deep  interrupted  and  superficial  continuous 
catgut  sutures. 

After  the  end  of  the  seventh  month  of 
pregnancy,  an  additional  posterior  cervical 
incision  is  required  (J.  W.  Williams).  The 
posterior  incision  is  made  first.  A trans- 
verse incision  is  first  made  at  the  utero- 
vaginal junction,  and  the  peritoneum  pushed 
back  from  the  uterus;  then  the  cervix  is 
divided  in  the  median  line  for  a distance  of 
about  two  inches. 

Premature  Separation  of  the  Normally 
Situated  Placenta. — Frequency.— One  in  118 

to  900  pregnancies. 

This  accident  usually  occurs  near  or  at 
the  time  of  labor.  There  are  severe  pain 
and  usually  external  bleeding.  In  some 
instances,  however,  the  hemorrhage  is  con- 
cealed, and  the  condition  is  then  manifested 
by  excruciating  pain,  hard  distention  of  the 
uterus,  rapid  pulse,  acute  anjemia,  and  shock. 

Placenta  prsevia  is  excluded  by  internal 
examination.  Rupture  of  the  uterus  is  dis- 
tinguished by  its  occurrence  late  in  labor, 
after  the  membranes  have  ruptured,  and  by 
recession  of  the  presenting  part  and  con- 
traction of  the  uterus. 

The  Prognosis  is  serious  for  both  mother 
and  child. 

Etiology. — Traumatism  (external  violence 
or  physical  exertion) ; emotion ; decidual  dis- 
ease; chronic  pelvic  congestion;  profound 
anaemia;  great  debility;  syphilis;  multipar- 
ity; uterine  abnormality,  such  as  uterus 
bicornis;  disease  and  death  of  the  fcetus; 
possibly  nephritis;  possibly  toxaemia;  possi- 
bly uterine  infection;  “ prolongation  of  preg- 
nancy with  irregular  uterine  contractions  ”; 
too  rapid  escape  of  amniotic  fluid  in  hydram- 
nios ; short  umbilical  cord ; partial  emptying 
of  the  uterus  in  the  birth  of  the  first  child 
of  a twin  pregnancy. 


PUERPERAL  DISPLACEMENTS  OF  THE  UTERUS 


Treatment.— Unless  the  hemorrhage  is 
slight,  the  uterus  should  be  emptied  as 
speedily  as  possible,  under  strict  asepsis 
iq.v.).  If  the  cervix  is  soft  and  patulous, 
it  may  be  tUlated  manually,  or  by  means 
of  rubber  Lags  (see  under  Premat  lire  Labor, 
Induction,  of),  or  Bossi’s  four-branch  dila- 
tor. Perform  internal  podalic  version  {q.v.) 
if  the  presenting  part  is  not  engaged.  If 
the  head  is  engaged,  try  forceps  (q.v.); 
but  if  rapid  delivery  can  not  thereby  be 
accomjilished,  perform  craniotomy  (q.v.). 
Have  an  assistant  follow  the  uterus  down 
during  labor  and  delivery.  Should  hemor- 
rhage follow  the  birth  of  the  child,  remove 
the  placenta  promptly  by  Crede’s  method 
or  manually  (see  Adlierent  Placenta),  and 
inject  ergot,  or  pituitrin  (see  Part  11).  For 
the  treatment  of  post-partmn  hemorrhage 
consult  Hemorrhage,  Post-Partum. 

“ If  labor  has  not  yet  set  in,  the  symi> 
toms  are  urgent,  and  the  patient  is  in  a 
hospital,  abdommal  (q.v.)  or  vaginal  (q.v.) 
Caesarean  section  should  be  performed  ” 
(J.  W.  Williams).  A rigid  cervix  is  another 
indication  for  vaginal  hysterotomy  or 
abdominal  Caesarean  section. 

Presentations,  Acromio=Iliac. — L.  proe- 
senta'tio;  Gr.  a/cpor  jx)int  cipos  shoulder; 
L.  il'ium,  haunch-bone.  See  Transverse 
Presentations. 

Anterior  Fontanelle. — L.  an'te,  before; 
Fr.  fontanelle,  little  fountain.  See 
Bregma  Presentations. 

Anterior  Parietal  Bone. — See  Ear  or 
Parietal  Bone  Presentations. 

Breech. — See  Breech  Presentations. 

Bregma. — See  Bregma  Presentations. 

Brow. — See  Brow  Presentations. 

Chin. — See  Face  Presentations. 

Ear. — See  Ear  Presentations. 

Face. — See  Face  Presentations. 

Fontanelle  (Anterior  or  Greater.)— Fr. 
fontanelle,  little  fountain;  L.  an'te, 
before.  See  Bregma  Presentations 

Mento=lliac. — L.  men' turn,  chin;  il'ium, 
haunch-bone.  See  Face  Presentations. 

Occipito=Posterior. — See  Occipito-Pos- 
terior  Presentations. 

Parietal  Bone. — See  Ear  or  Parietal 
Bone  Presentations. 

Posterior  Occipital. — See  Occipito-Po.s- 
t-erior  Presentations. 

Posterior  Parietal  Bone. — See  Ear  or 
Parietal  Bone  Presentations. 

Sacro=lliac.— L.  sa'crum,  sacred;  il'ium, 
haunch-bone.  See  Breech  Presenta- 
tions. 

Shoulder.  — See  Transverse  Presenta- 
tions. 


Presentations,  Transverse. — See  Trans- 
verse Presentations. 

Prolapse  of  an  Arm.  — See  Arm,  Pro- 
lapse of  an. 

Prolapse  of  the  Cord. — See  Cord,  Pro- 
lapse of  the. 

Parturient  Uterus. — See  Displacements 
of  the  Partm’ient  Uterus. 

Pregnant  Uterus. — See  Displacements 
of  the  Pregnant  Uterus. 

Puerperal  Uterus. — See  Displacements 
of  the  Puerperal  Uterus. 

Prolonged  Labor. — See  Dystocia. 

Pruritus  Complicating  Pregnancy. — L. 
prurir'e,  to  itch.  See  Part  2,  Gynaecology. 

Pseudocyesis. — Gr.  f/evdijs  false  -f-  kv7)(hs 
pregnancy.  See  Diagnosis  of  Pregnancy^ 

Ptyalism  Complicating  Pregnancy. — Gr. 
TTTuaW  spittle.  See  Salivation. 

Pubiotomy. — L.  pubis  + Gr.  TefiveLv 
to  cut.  Contraindications. — A conjugata 

vera  of  7 cm.  or  less;  infection;  dymg  or 
dead  child. 

Technique. — Empty  the  bladder  and  rec- 
tum, and  shave  and  cleanse  the  external 
genitalia  and  neighboring  skin  thoroughly 
with  Castile  or  green  soap  and  warm  water, 
and  cleanse  the  vagina  with  soap  and  water, 
followed  by  bichloride  solution,  1 : 4000. 
Dry  the  external,  parts  carefully,  and  apply 
tincture  of  iodine  to  the  site  of  operation. 
Cover  the  lower  limbs  and  abdomen  with 
sterile  sheets,  exposing  only  the  pubes. 

Under  ether  amesthesia,  make  a trans- 
verse incision,  about  one  inch  long,  over  the 
superior  margin  of  the  pubic  bone  in 
the  region  of  the  pubic  spine,  and  down  to 
the  bone  through  the  periosteum.  With  the 
fingers,  separate  the  contiguous  tissues  from 
the  posterior  surface  of  the  pubic  bone. 
Then  pass  down  a curved  artery  forceps, 
push  the  tip  out  beneath  the  bone,  and 
incise  the  slan  over  the  tip  of  the  forceps. 
Grasp  with  the  forceps  one  end  of  a Gigli 
saw  and  draw  it  tlirough  the  wound.  Saw 
through  the  bone.  After  withdrawing  the 
saw,  pack  the  wounds  with  gauze  to  control 
the  hemorrhage.  Then  extract  the  child  by 
forceps  (q.v.")  or  version  (q.v.),  an  assistant 
at  the  same  time  making  fii-m  pressure  upon 
the  thighs,  in  order  to  prevent  too  great 
separation  of  the  severed  ends  of  the  bone. 

Close  the  upjier  wound  and  drain  the 
lower.  Apply  a broad  adhesive  strip  around 
the  pelvis  and  upper  thighs.  Keep  the 
patient  in  bed  fourteen  days. 

Puerperal  Anaimia.  — L.  piier,  boy  -f 
par'ere,  to  bear.  See  Anaemia. 

Displacements  of  the  Uterus. — See  Dis- 
placements of  the  Puerperal  Uterus. 


PUERI’EIIAL  INFECTION 


Puerperal  Elevation  of  Temperature. — 

Soe  Puerperal  Fever. 

Endometritis. — Or.  ’ivSov  within  + 
firirpa  uterus  + -ms  inflammation. 
See  Puerperal  Infection. 

Fever. — L.  fe'bns.  Since  some  ele- 
vation of  temperature  during  the  puer- 
perium  appears  to  be  physiological,  the 
upper  limit  of  normal  is  placed  at  100.4°  F. 

Causes  of  a Puerperal  Elevation  of  Temperature 
— Infection;  constipation;  neuroses  (emo- 
tion, hysteria,  visitors);  overtUstention  of 
the  breasts;  caked  breasts;  sore  nipples; 
uterine  displacements;  cathartics;  colic; 
retention  of  urine;  exposure  to  cold;  tape- 
worm; cerebral  disease  (embolism  and  hem- 
orrhage in  particular);  eclampsia;  rupture  of 
the  uterus;  heat-stroke;  syphilis;  inter- 
current disease;  disease  contractecl  before 
pregnancy  or  the  puerperium,  e.g.,  phthisis, 
malaria,  etc.;  unknown  causes. 

Puerperal  Haematoma. — See  Hiematoma. 

Hemorrhage. — See  Hemorrhage,  Puer- 
peral. 

Infection.  — L.  infec'tio.  Puerperal 
infection  occurs  usually  about  the  third 
day.  It  is  commonly  ushered  in  by  a chill  or 
chilly  sensations  or  by  headache  or  nausea 
and  vomiting,  with  malaise,  furred  tongue, 
elevation  of  temperature,  and  rapid  pulse. 
In  the  less  serious  cases  of  putrid  infection 
or  saprsemia  (caused  by  saprophytic  organ- 
isms), the  discharge  is  putrid  and  abundant; 
whereas,  in  the  very  serious  septic  cases 
(caused  particularly  by  streptococci),  the 
discharge  is  odorless  and  scanty.  Mixed 
uifections  occur,  however,  with  intermediate 
lochial  characteristics. 

The  organisms  most  commonly  concerned 
in  puerperal  infection  are  saprophytes  of 
putrefaction,  streptococci,  staphylococci,  the 
bacillus  coli,  gonococcus,  and  pneumococ- 
cus. Other  organisms  occasionally  con- 
cerned are  the  bacillus  pyocyaneus,  bacillus 
diphtheria,  bacillus  tetani,  bacillus  aerogenes 
capsulatus  (gas  bacillus),  bacillus  typhosus, 
bacillus  tuberculosis,  etc.  (See  Puerperal 
Fever,  for  other  causes  of  a puerperal  ele- 
vation of  temperature.  A sudden  cessa- 
tion of  the  lochial  discharge  without  fever 
or  constitutional  symptoms  may  be  due  to 
the  blocking  of  the  internal  os  by  a clot, 
which  may  be  expelled  by  means  of  Credo’s 
manoeuvre  and  ergot) . 

Prophylaxis  embraces  thorough  cleanli- 
ness in  the  conduct  of  labor  and  the  sub- 
sequent ■ care  of  the  puerperal  woman,  as 
few  intra-vaginal  examinations  as  possible, 
the  immediate  repair  of  perineal  lacerations 
whenever  feasible,  and  the  use  of  the  long 


gauntlet  glove  reaching  to  the  elbow  for 
intra-uterine  manipulations. 

Prognosis.— Most  cases  of  puerperal  infec- 
tion, perhaps  about  95  per  cent.,  end  in 
recovery  after  an  illness  lasting  several 
weeks  or  months.  The  putrid  cases  are 
usually  quicldy  cured;  but  the  strepto- 
coccic cases  are  very  serious,  although 
about  80  j)er  cent,  or  more  of  the  latter 
rec;over  spontaneously. 

Treatment.— At  the  first  indication  of 
infection,  explore  the  genital  tract,  first 
shaving  and  cleansing  the  external  geni- 
talia and  neighboring  skin  thoroughly  with 
castile  or  green  soap  and  hot  water,  followed 
by  bichloride  solution  1 : 2000  to  4000,  and 
cleansing  the  hands.  Remove  the  stitches 
of  infected  lacerations,  touch  ulcers  and 
gray  patches  with  pure  carbolic  acid,  or 
tincture  of  iodine,  or  silver  nitrate,  5i  ad 
5i;  then  irrigate  and  clean.se  the  vagina  and 
mouth  of  the  ceiwix  thoroughly,  using  gauze 
sponges  and  the  fingers,  with  carbolic  acid 
solution,  2 to  3 per  cent.,  or  lysol,  0.5  to 
1 per  cent.,  or  bichloride,  1 : 4000,  jireceded 
by  tincture  of  green  soap  ami  hot  water. 
Then  examine  the  vagina  and  cervix  again, 
paying  particular  attention  to  the  presence 
of  cervical  lacerations,  and  again  cauterize 
ulcers,  etc.,  after  first  drying  the  parts.  A 
dusting  powder  of  iodoform  may  then  be 
applied,  if  desned. 

If  the  above  measures  prove  insufficient, 
one  may  take  a culture  from  the  uterus,  ami 
at  the  same  time  explore  the  uterine  cavity 
with  the  gloved  finger  with  the  least  ix>.ssible 
traumatism.  The  presence  of  a rough 
mucosa  suggests  putrid  endometritis; 
smooth  mucosa,  streptococcic  infection. 
Remove  thoroughly,  with  sjDecial  attention 
to  the  cornua,  any  debris  present,  using 
for  this  purpose  the  finger  or  large  dull 
wire  curette;  then  give  a copious  hot 
normal  saline  (oi  ad  Oi),  or  lysol  or  creolin 
(0.5  per  cent.)  nrigation  with  a double-way 
tube.  If  a single-way  tube  is  used,  it  should 
be  held  against  the  anterior  wall  of  the 
cervix  so  as  to  provide  a free  return  and 
avoid  entrance  of  the  fluid  into  the  tubes. 

Examine  the  appendages,  broad  liga- 
ments, etc.,  bimanually.  Involvement  of 
the  tubes  {X)ints  to  surface  or  gonococcic 
infection;  streptococci  invade  the  tissues. 

After  the  uterus  has  once  been  emptied, 
it  is  generally  conceded  that  it  should  be  left 
severely  alone.  The  Carossa  treatment, 
however,  seems  very  rational.  A catheter 
and  iodoform  gauze  are  packed  into  the 
uterus  and  allowed  to  remain  for  from  three 
days  to  two  weeks.  To  the  catheter  are 


PUERPERIUM,  COMPLICATIONS  OF  THE 


attached  rubber  tubing  and  a funnel, 
through  which  is  poured  every  hour,  day 
and  night,  two  or  three  tablespoonfuls  of 
alcohol  diluted  with  from  three  parts  to  one 
part  of  hot  sterile  water.  Everyone  knows 
how  readily  a septic  lymphangitis  of  an 
extremity  is  controlled  by  prolonged  soak- 
ing in  hot  bichloride  solution. 

If  a blood  or  uterine  culture  reveals  the 
presence  of  streptococci,  antistreptococcic 
serum  may  be  tried  in  large  doses,  20  c.c., 
t.i.d.,  hypodermically,  according  to  Edgar; 
80  c.c.  every  six  hours,  320  c.c.  during 
the  first  twenty-four  hours,  according  to 
J.  S.  Evans.  Its  action,  however,  is  uncer- 
tain. The  use  of  bacterins  is  evidently 
highly  irrational. 

Yeast  is  recommended  because  it  increases 
leucocytosis.  One-fourth  of  an  ordinary 
compressed  yeast-cake  may  be  given  three 
times  a day,  dissolved  in  a glass  of  water. 
Nuclein,  10  to  60  minims  of  a 5 per  cent, 
solution,  hypodermically,  is  also  recom- 
mended for  the  same  reason;  as  is  also 
Crede’s  ointment  (g.w.),  15  to  45  grs.,  rubbed 
into  the  skin  for  twenty  minutes,  once  to 
three  times  daily,  and  covered  with  rubber 
tissue;  or  daily  intravenous  injections  {q.v. 
in  Part  1,  General  Medicine  and  Surgery)  of 
argentum  colloidale,  gr.  xv,  in  a 2 per  cent, 
emulsion.  These  measures,  however,  are 
probably  of  little  value.  Formalin,  1 litre  of  a 
1 : 5000  solution,  intravenously,  is  advocated. 

Normal  saline  solution  (0.9  per  cent.), 
one  litre  every  six  hours,  subcutaneously,  or 
to  1 litre  every  three  to  six  hours  per  rec- 
tum by  the  Murphy  drop  method,  is  advised. 

Absolute  rest,  fresh  air,  the  Fowler  semi- 
sitting position,  hot  applications  to  the 
lower  abdomen,  an  initial  calomel  and 
saline  purge  {q.v.),  frequent  bathing  with 
warm  water,  or  alcohol  and  water,  equal 
parts,  the  withdrawal  of  the  child  from  the 
breast,  plenty  of  water  to  drink,  and  a nutri- 
tious soft  and  liquid  diet  are  essential.  The 
following  foods  are  appropriate,  viz.,  milk, 
koumyss  {q.v.),  broths,  eggs  beaten  up  with 
milk  or  with  broths,  beef-juice  and  pulp,  the 
hearts  of  raw  oysters,  panopeptone  {q.v.), 
beef  peptonoids  {q.v.),  well-cooked  gruels, 
flavored  gelatine  and  cream.  Give  as  much 
food  as  the  patient  can  assimilate. 

If  a cardiac  stimulant  is  required  (pulse 
above  110),  employ  strychnine,  or  caffeine, 
or  camphor.  Ergot,  or  quinine  (gr.  iii  twice 
daily)  or  pituitrin  may  be  administered  for 
the  purpose  of  contracting  the  uterus  (see 
Drugs,  Part  11). 

Should  parametritis  (pelvic  cellulitis)  or 
pelvic  peritonitis  develop,  and  a boggy 


induration  or  fluctuation  be  detected  by 
vaginal  palpation,  evacuate  the  accumula- 
tion of  pus  through  the  lateral  or  posterior 
vaginal  fornix,  open  up  pus  pockets  with  the 
finger,  and  drain  with  gauze.  Freely  mov- 
able pus  tubes  and  ovarian  abscesses  should 
be  removed  through  the  abdomen;  but  if 
they  are  adherent  to  and  involve  the  vaginal 
vault,  they  should  be  opened  and  drained 
per  vaginam.  If  the  uterus  itself  is  much 
involved,  a total  hysterectomy  would  seem 
indicated.  Abdominal  operations  should  be 
avoided  in  streptococcic  infections  because 
of  the  virulence  of  the  organisms. 

In  draining  abscess  cavities  through  the 
abdomen  with  gauze-surrounded  glass  or 
stiff  rubber  tubes,  suck  out  the  tubes  by 
means  of  a syringe  daily  for  three  or  four 
days;  then  remove  the  tube  and  withdraw 
the  gauze  gradually  day  by  day,  removing 
the  last  portion  in  eight  or  ten  days. 

In  cases  of  uterine  and  parauterine  phle- 
bitis (thrombosis,  possibly  phlegmasia  alba 
dolens,  pyaemia,  high  irregular  fever,  very 
rapid  pulse,  great  depression,  red  splotches 
on  the  body,  absence  of  local  signs),  main- 
tain absolute  rest,  administer  good  whiskey 
or  brandy  {q.v.)  freely,  and  concentrated 
liquid  food,  etc.,  and  consider  the  advisabil- 
ity of  excising  the  thrombosed  vessels  or 
ligating  them  distalward  to  the  thrombus, 
as  reported  by  J.  W.  Williams  in  five  cases 
with  four  recoveries.  If  hemorrhage  occurs 
in  metrophlebitis,  give  ergot  (see  Part  11)  in 
large  doses,  and  tampon  the  uterus  and 
vagina  for  twelve  to  twenty-four  hours, 
followed  by  a douche.  If  this  is  insufficient, 
try  hot  injections  of  acetic  acid,  2 to  6 per 
cent.,  and  as  a last  resort,  vaporization  or 
the  application  of  steam  at  a temperature 
of  100°  C.  for  thirty  to  forty  seconds. 

After  operations  (abdominal  or  vaginal) 
for  peritonitis,  raise  the  head  of  the  bed, 
and  employ  IMurphy’s  continuous  rectal 
instillation  of  nonnal  salt  solution  (5i 
ad  Oi). 

The  patient  should  be  kept  in  bed  for  at 
least  ten  days  after  the  temperature  has 
returned  to  normal,  to  avoid  a relapse. 

Puerperal  Insanity. — See  Insanity  of 
Gestation. 

Sepsis. — Gr.  arj^pLs  decay.  See  Puer- 
peral Infection. 

Temperature  Elevation. — See  Puer- 
peral Fever. 

Vaginitis. — L.  vagi'na,  sheath  -f  Gr. 
-ms  inflammation.  See  Puerperal 
Infection. 

Puerperium,  Complications  of  the. — See 

Complications  of  the  Puerperium. 


RUPTURE  OF  THE  UTERUS 


Puerperium,  Diet  in  the. — See  Manage- 
ment of  the  Puerperium. 

Duration  of  the. — See  under  Manage- 
ment of  the  Puerperium. 

Management  of  the. — See  Manage- 
ment of  the  Puerperium. 

Pyelitis  and  Pyelonephrosis  Complicating 
Pregnancy. — Gr.  vrOeXos  trough,  pelvis  -f 
ve4>p6s  kidney  -j-  -ins  inflammation.  This 
frequent  complication,  due  to  compression 
of  the  ureter  at  the  brim  of  the  pelvis  by 
the  pregnant  uterus,  occurs  usually  in  the 
latter  half  of  pregnancy.  It  is  manifested 
by  renal  pain,  tenderness  and  swelling,  fever, 
sometimes  with  chills,  and  pyuria.  An 
enlarged,  sensitive  ureter  may  perhaps  be 
palpated  per  vaginam.  Cystoscopy  and 
ureteral  catheterization  are  diagnostic 
aids  (see  Pyelonephritis,  in  Part  1,  on 
General  Medicine  and  Surgery,  for  extra 
information). 

Treatment.— Put  the  patient  to  bed,  and 
have  her  lie  upon  the  side  opposite  to  that 
affected.  The  bladder  may  be  distended 
with  sterile  boric  acid  or  normal  saline  solu- 
tion, 3i  of  either  to  the  pint,  for  the  purpose 
of  exciting  peristalsis  in  the  ureters.  An 
ice-bag  may  be  applied  to  the  affected  kid- 
ney. Prescribe  a light,  bland  diet,  con- 
sisting largely  of  milk  or  buttermilk,  and 
an  abundance  of  water,  four  to  six  pints  a 
day.  Appropriate  foods  are  well-cooked 
cereals,  oatmeal,  barley,  rice,  farina,  sago, 
tapioca,  macaroni,  apple  sauce,  baked  apple, 
orange,  grapefruit,  prunes,  junket,  custard, 
cream,  lettuce,  celery,  watercress,  mashed 
potatoes,  green  peas,  string  beans,  stale 
bread,  butter,  toast,  crackers,  zwieback. 
Open  the  bowels  freely.  Prescribe  urotropin 
and  salol,  aa  gr.  v,  every  four  hours.  The 
induction  of  premature  labor  (q.v.)  is  rarely 
required,  but  it  should  be  resorted  to 
promptly  should  serious  symptoms  arise. 

Pyelonephritis  of  Pregnancy. — See  Pye- 
litis, above. 

Pyelonephrosis  of  Pregnancy. — See  Pye- 
litis, above. 

Rachitic  Pelvis. — Gr.  paylrts  from  pax^s 
spine  -b  -tris  inflammation.  See  Con- 
tracted Pelves. 

Relaxation  of  the  Pelvic  Joints. — L. 

relaxa're  to  loosen;  -pel' vis,  basin.  The 
patient  complains  of  pain  and  difficult  or 
impossible  locomotion,  and  the  diagnosis  is 
made  by  holding  the  forefinger  in  the  vagina 
against  the  posterior  surface  of  the  symphysis 
pubis  and  the  thumb  against  the  front  of  the 
symphysis,  while  the  patient  takes  a few 
steps,  or  while  the  patient  lies  upon  her  back 
and  an  assistant  moves  her  thighs. 


Treatment.— Apply  a firm  bandage  or  can- 
vas or  leather  belt  or  adhesive  plaster,  about 
three  inches  wide,  about  the  hips,  between 
the  iliac  crests  and  the  trochanters,  or  just 
below  the  trochanters.  If  necessary,  the 
patient  should  be  kept  in  bed,  and  the  pelvis 
supported  by  means  of  sandbags.  Union 
usually  occurs  in  about  two  weeks;  but  the 
condition  sometimes  becomes  chronic.  A 
belt  should  be  worn  for  some  time  after 
child-birth.  Wiring  of  the  pubic  jomt  is 
rarely  called  for. 

Removal  of  the  Placenta. — See  Adherent 
Placenta. 

Respiration,  Artificial. — L.  respira'tio  a 
breathing;  a?’s, art  -|-  fac'ere  to  make.  See 
Asphyxia  Neonatorum. 

Retention  of  Urine. — See  Management  of 
the  Puerperium. 

Retrodisplacements  of  the  Parturient 
Uterus. — L.  re'tro  backward.  See  Dis- 
placements of  the  Parturient  Uterus. 

Pregnant  Uterus. — See  Displacements 
of  the  Pregnant  Uterus. 

Puerperal  Uterus. — See  Displacements 
of  the  Puerperal  Uterus. 

Rheumatism  of  the  Myometrium. — ^See 
Myometrial  Rheumatism. 

Rickets,  Congenital  or  Foetal. — See 
Achonch'oplasia,  in  Part  1. 

Rigidity  of  the  Cervix  Causing  Dystocia. — 
L.  rigid'itas  stiffness.  See  Atresia  of  the 
Cervix. 

Robert  Pelvis.— See  under  Contracted 
Pelves. 

Rupture  of  the  Pelvic  Joints,  the  Symphy= 
sis  Pubis,  or  Sacro=lliac  Joints. — L.  rup- 
tu'ra,  from  rump' ere  to  break;  pelv'is,  basin. 
The  bones  may  be  felt  to  give  way  at  the 
time  of  labor,  or  the  patient  later  may  com- 
plain of  local  pain  and  inability  to  sit  up 
or  walk. 

Treatment.— Apply  around  the  hips,  be- 
tween the  iliac  crests  and  the  trochanters, 
a broad,  firm  canvas  or  leather  belt,  or 
adhesive  plaster,  or  plaster-of-Paris  band- 
age, about  three  inches  wide;  support  the 
pelvis  with  sandbags,  and  keep  the  patient 
in  bed  for  six  to  twelve  weeks.  Silver  wire 
sutures  may  possibly  be  required. 

Open  and  drain  if  suppuration  occurs. 

The  Prognosis  is  good. 

Rupture  of  the  Uterus. — Rupture  of  the 
uterus  occurs  usually  during  labor,  but  it 
may  occur  earlier.  It  is  manifested,  as  a 
rule,  by  a sudden  sharp  pain  occurring  dur- 
ing the  course  of  a prolonged  obstructed 
labor  with  frequent  vigorous  pains  and 
Bandl’s  contraction  ring  high  up  near  the 
umbilicus;  but  it  may  occur  without  such 


SHOCK  AND  COLLAPSE 


warning  circumstances.  The  time  and 
manner  of  its  occurrence  depend,  of  course, 
upon  the  degree  of  weakness  of  the  uterine 
wall.  Following  the  sudden  pain,  the  uter- 
ine contractions  cease,  the  presenting  part 
recedes,  hemorrhage  occurs,  and  shock 
ensues.  If  the  rent  involves  the  lower 
uterine  segment,  which  it  usually  does,  it 
may  be  felt  by  internal  examination.  It  is 
termed  complete  if  the  peritoneum  is  opened, 
otherwise  incomplete. 

Rupture  may  oc(uir  without  any  very 
noticeable  symptoms  until  later  in  the 
puerperium,  when  symptoms  and  signs  of 
infection  make  their  appearance,  and  possi- 
bly prolapse  of  the  intestines. 

The  frequency  of  rupture  is  about  one 
in  500  to  1000. 

Etiology. — Obstructed  labor,  due  to  a con- 
tracted pelvis,  large  child,  malposition  or 
malpresentation  of  the  feetus,  hydrocephalus, 
stenosis  of  the  birth  canal,  pelvic  tumors, 
etc. ; lateral  displacement  of  the  uterus, 
resulting  in  undue  stretching  of  one  side  of 
the  lower  uterine  segment ; weakening  of  the 
uterine  wall,  due  to  previous  rupture. 
Caesarean  section,  myomectomy,  curettage, 
manual  removal  of  an  adherent  placenta,  a 
blow  or  a fall  during  j^regnancy,  fatty 
degeneration,  syiihilis,  soft  myoma,  carci- 
noma, placenta  praevia,  extensive  syncitial 
invasion  of  the  uterine  wall ; extensive  ceiwi- 
cal  laceration  due  to  too  rapid  manual  or 
instrumental  dilatation  of  the  cervix;  use 
of  ergot  before  deliveiy;  performance  of 
version;  Crede’s  method  of  expressing  the 
placenta;  manual  removal  of  the  placenta; 
curettage;  pregnancy  in  a bicornuate  or 
infantile  uterus. 

Treatment. — As  soon  as  rupture  is  sus- 
pected, extract  the  child  as  rapidly  as 
possible,  by  hiternal  podalic  version  {q.v.) 
forceps  iq.v.),  or  craniotomy  {q.v.)]  and 
extract  the  placenta.  If  the  tear  is  incom- 
plete, or  if  complete,  small  and  low  down  on 
the  posterior  wall,  and  little  or  no  foreign 
matter  has  entered  the  j^eritoneal  cavity, 
pack  the  rent  with  iodoform  gauze  to  con- 
trol hemorrhage  and  provide  drainage,  and 
apply  external  abdominal  pressure.  If  the 
child  or  placenta  has  jiassed  into  the  uterine 
cavity,  however,  or  if,  after  extra<ding  the 
child  and  {placenta,  the  tear  is  found  to  be 
extensive,  and  much  blood  or  liquor  amnii 
has  entered  the  peritoneal  cavity,  or  if  the 
tear  is  on  the  anterior  wall  or  at  the  fundus, 
or  if  the  chikl  is  unborn  and  the  cervix  not 
dilated,  perform  lajiarotomy  and  suj)ra- 
vaginal  or  total  hysterectomy  or  suture  of 
the  rent  with  deep  sutures  involving  the 


serous  and  muscular  coats,  and  superficial 
sutures.  Cleanse  the  peritoneum  of  all 
clots,  etc.,  best  with  gauze  pads,  or  if  need 
be,  by  irrigation  with  hot  normal  saline 
solution,  0.9  per  cent. 

Reynolds  and  Newell  advise  the  free  use 
of  saline  cathartics  {q.v.)  as  a preventive 
of  peritonitis  in  the  conservative  treatment 
of  rupture. 

R.  McPherson  reports  the  immediate 
marvelous  revival  and  subsequent  recovery 
of  a moribund  patient  by  means  of  blood 
transfusion  (consult  Part  1,  on  General 
Medicine  and  Surgery). 

Prophylaxis. — Consult  the  treatment  of  Con- 
tracted Pelves.  Pregnancy  occurring  in  a 
previously  ruptured  or  incised  uterus  should 
be  treated  by  Caesarean  section  {q.v.)  before 
the  onset  of  labor  (at  the  thirty-sixth  week). 

Sacro=Iliac  Joints,  Rupture  of  the. — L. 
sac'rum,  sacred ; il'ium,  haunch-bone. 
See  Rupture  of  the  Pelvic  Joints. 

Presentations. — See  Breech- Presenta- 
tions. 

Salivation  Complicating  Pregnancy. — L. 

sali'va,  spittle]  saliva' do.  Salivation  may  be 
due  to  reflex  irritation,  when  it  is,  of  course, 
intractable;  or  autointoxication,  when  it  is 
greatly  benefited  by  a rigorous  milk  diet 
(J.  W.  Williams);  or  to  hyperchlorhych’ia 
(see  Dyspepsia) ; or  to  gingivitis  {q.v.) ; or  to 
dental  caries  {q.v.)]  etc.,  (see  Pari  1 on 
General  IMedicine  and  Surgerj") . It  usually 
disappears  in  the  later  months  of  pregnancy. 

A mouth-wash  or  troches  of  tannic  acid 
{q.v.  in  Part  11),  and  the  bromides  {q.v.) 
may  be  of  service. 


Tinctura?  krameriu; S ss 

Aluininis 5i 

Aquae,  q.s.  ad oviii 


M.  Sig. — Mouth-wash. 

Sapraemia. — Gr.  aaivpos  rotton  aipa 
blood.  See  Puerperal  Infection. 

Sarcoma. — Gr.  aap^,  aapKos  flesh  + -copa 
tumor.  See  under  Atresia. 

Scanty  Urine. — See  Toxsemias  of  Preg- 
nancy. 

Schultze’s  Method  of  Artificial  Respira= 
tion. — See  Asphyxia  Neonatorum,  in  Part  1. 

Sclerema  Neonatorum. — See  Part  5,  Skin 
Diseases. 

Separation,  Premature,  of  the  Normally 
Situated  Placenta. — See  Premature  Separa- 
tion, etc. 

Sepsis,  Puerperal. — Gr.  o-rj^is  decay.  See 
Puerperal  Infection. 

Shock  and  Collapse. — Shock  or  collapse  is 
manifested  by  a rapid,  weak  pulse,  low  blood- 
pressure,  increased  frequency  of  resphation, 


SUBINVOLUTION  OF  THE  UTERUS 


subnormal  temperature,  muscular  relaxa- 
tion, pallor,  cold  clammy  respiration,  dimin- 
ished urinary  secretion,  and  weakening  or 
loss  of  consciousness. 

Etiology.— Strain  of  labor;  debility;  anajmia; 
severe  hemorrhage;  excessive  vomiting;  tox- 
aemia; emotion;  pain;  adynamic  diseases; 
forcible  attempts  to  expel  the  placenta;  com- 
pression of  an  ovary  in  performing  Crede’s 
manoeuvre;  rupture  of  the  uterus. 

Treatment.— Lower  the  head,  elevate  the 
foot  of  the  bed,  surround  the  body  with 
hot  water  bottles  wrapped  in  towels,  placed 
near  but  not  in  contact  with  the  skin,  and 
observe  absolute  quiet.  Administer  hot 
normal  saline  solution  (0.6  to  0.7  per  cent., 
or,  say,  gr.  xlvi  to  the  pint,  temperature 
102°  F.)  per  rectum  or  subcutaneously  or 
intravenously.  Give,  according  to  Crile,  no 
more  than  a pint  at  a time  (to  avoid  pul- 
monary oedema),  and  repeat  every  hour 
until  the  pulse  is  restored.  Adrenalin 
chloride,  15  minuns  of  a 1 : 1000  solution, 
may  be  added  to  the  pint  of  saline  solution. 
Give  the  infusion  very  slowly.  Gum  salt 
solution  (see  Part  11)  is  preferable.  Brandy 
digitalin,  strychnine,  camphor,  atropine, 
caffeme,  pituitrin,  and  moqjhine,  gr. 
to  34^,  may  be  of  some  service  (see  Drugs, 
Part  11). 

In  order  to  confine  the  blood  to  the  vital 
centres,  one  may  bandage  the  extremities 
and  abdomen  evenly  and  tightly  over  thick 
layers  of  non-absorbent  cotton,  for  one  or 
two  hours,  but  with  care  not  to  impede  the 
movements  of  the  diaphragm. 

Shoulder  Presentations. — See  Transverse 
Presentations. 

Signs  of  Pregnancy. — See  Diagnosis  of 
Pregnancy. 

Skene’s  Glands,  Abscess  of. — L.  glaris,  a 
cord.  See  Vulvitis. 

Skin  Diseases  Complicating  Pregnancy. — 

See  Chloasma;  Dermatitis  Herpetiformis,  or 
Herpes  Gestationis;  Impetigo  Herpetiformis; 
Pruritus. 

Sore  Nipples. — See  Nipples,  Sore. 

Sour  Eructations. — L.  eructa'tio,  belching. 
See  Dyspepsia. 

Spasm  of  the  Cervix  Causing  Dystocia. — 

Gr.  (Twaaixos.  See  Atresia  of  the  Cervix. 

Spondylolisthesis. — Gr.  (nr6v8v\os  verte- 
bra -t-  oXiffdaveip  to  slip.  See  under  Con- 
tracted Pelves. 

Stage  of  Labor. — See  Conduct  of  Normal 
Labor. 

Stage  of  Pregnancy. — The  fundus  uteri 
is  situated,  at  the  fourth  lunar  month,  just 
above  the  pelvic  brim;  fifth  lunar  month, 
midway  between  the  symphysis  pubis  and 


the  umbilicus;  sixth  lunar  month,  at  the 
level  of  the  umbilicus;  seventh  lunar  month, 
three  or  four  fingers’  breadth  above  the 
umbilicus;  eighth  lunar  month,  three  fingers 
above  that  of  the  seventh  month,  or  about 
midway  between  the  umbilicus  and  the 
xiphoid  cartilage;  ninth  lunar  month,  at  the 
xiphoid;  tenth  lunar  month,  at  the  same 
level  as  at  the  eighth  month,  owing  to  the 
engagement  of  the  presenting  part. 

Engagement  of  the  presenting  part,  which 
is  manifested  by  a sinking  of  tbe  womb,  or 
“ lightening,”  occurs,  in  primiparse,  about 
four  weeks  before,  ami  in  multipar®,  about 
two  weeks  or  less  before  the  onset  of  labor. 

The  date  of  confinement  is  estimated 
approximately  by  adding  seven  days  to  the 
first  day  of  the  last  menstrual  period  and 
then  counting  back  three  months  (Nsegle); 
thus,  if  the  last  menstruation  began 
on  July  6th,  add  seven  days,  making 
July  13th,  then  count  back  three  months, 
which  makes  April  13th,  the  approximate 
date  of  confinement. 

Stenosis. — See  Atresia. 

Sternocleidomastoid  Haematoma. — S e e 
Hsematoma,  of  the  Sternocleidomastoid,  in 
Part  1. 

Stone  in  the  Bladder. — See  Bladder  Cal- 
culus. 

Stridor. — L.  harsh  whistling  sound. — 
See  Part  1. 

Subinvolution  of  the  Uterus. — L.  sub, 
under  -f  involu'tio,  from  in,  into  J-  volv'ere, 
to  roll.  Imperfect  involution  of  the  uterus 
following  the  termination  of  pregnancy  is 
manifested  by  local  pain  or  discomfort  or  the 
sensation  of  heavmess,  backache,  a per- 
sistent profuse  red  lochial  chscharge,  and  a 
large  tender  and  soft  uterus.  The  normal 
lochia  for  the  first  three  to  five  days  after 
labor  is  red  (lochia  rubra);  from  then  until 
about  the  tenth  day  it  is  grayish  (lochia 
serosa);  and  after  that,  white  (lochia  alba). 
The  persistence  of  a reddish  color  beyond 
several  weeks  indicates  subinvolution  or  the 
retention  of  secundines.  The  fundus  uteri 
under  normal  conditions  should  be  at  the 
level  of,  or  a little  below  the  symphysis  pubis 
on  the  tenth  to  twelfth  day  after  childbirth. 

Etiology. — Getting  up  too  soon;  cervical 
laceration ; infection ; retention  of  secundines ; 
“imperfect  exfoliation  of  the  decidua”; 
uterine  displacement;  chronic  constipation; 
habitual  distention  of  the  bladder;  peri- 
uterine adhesions;  uterine  fibroids;  pelvic 
congestion  due  to  abdominal  tumors,  car- 
diac, renal,  hepatic  or  pulmonary  disease; 
great  shock;  puerperal  insanity;  sexual  inter- 
course too  soon. 


TOXEMIAS  OF  PREGNANCY 


Treatment.— Correct  any  possible  causal 
influence  {q.v.,  under  its  appropriate  title). 
If  no  other  cause  than  a chronic  metritis 
is  evident,  treat  the  condition  as  described 
under  Metritis,  in  Part  2,  on  Gynaecology. 

Submammary  Abscess. — L.  s'lih,  under  + 
mani'ma,  breast;  absces'sus,  a going  apart. 
See  Mastitis. 

Suburethral  Abscess.— L.  sub,  under  + 
Gr.  ovprjdpa  urethra.  See  Vulvitis. 

Superinvolution  of  the  Uterus. — L.  supper, 
above  + involu'tio,  from  in,  into  + vol'vere, 
to  roll.  A rare  condition,  diagnosed  by  the 
association  of  amenorrhcea  with  a small- 
sized uterus.  Ascribed  causes  are  anaemia 
from  uterine  hemorrhage,  overlactation, 
wasting  diseases,  reflex  irritation  incident  to 
nursing;  nervous  derangements,  e.g., 
puerperal  insanity,  chorea,  etc.;  local 
inflammation,  especially  ovarian;  and  a 
rapid  succession  of  labors. 

Treatment. — See  under  Amenorrhoea,  in 
Part  2,  on  Gynaecology. 

Sweating. — Night  sweating  during  the 
puerperium  is  physiological. 

Symphyseotomy. — Gr.  avv  together  -j- 
to  grow  + TkpvtLv  to  cut.  See,  instead, 
Pubiotomy. 

Symphysis  Pubis,  Rupture  of  the. — Gr. 

(jvv  together  4>vtLv  to  grow;  I;,  pu'bes,  pubic 
bone.  See  Rupture  of  the  Pelvic  Joints. 

Symptoms  of  Pregnancy.— See  Diagnosis 
of  Pregnancy 

Syncope. — Gr.  avyKoiri]  fainting.  SeeShock. 

Syncytioma  Malignum.  — See  Chorio- 
Epithelioma. 

Syphilis  Complicating  Pregnancy. — If 

either  parent  is  syphilitic,  treat  the  mother 
by  means  of  salvarsan,  mercury,  and  iodide, 
as  described  under  Syphilis,  in  Part  1,  General 
Medicine  and  Surgery. 

Tears,  Cervical. — L.  cer'vix,  neck.  See 
underManagementof  thePuerperium. 

Perineal. — Gr.  ■weplveiov.  See  under 
Conduct  of  Normal  Labor. 

Teeth,  Caries  of  the. — See  Dental  Caries. 

Temperature  Elevation,  Puerperal. — See 
Puerperal  Fever. 

Thrombosis,  Crural. — Gr.  6 p op. L. 

crus,  cru'ris,  leg.  See  Phlegmasia 
Alba  Dolens. 

Uterine  and  Parauterine. — Gr.  wapa 
near;  L.  u'terus,  womb.  See  under 
Puerperal  Infection. 

Toxaemias^  of  Pregnancy. — Gr.  to^ikov 
poison  -b  alpa  blood;  L.  prceg'nans,  with 
child.  The  so-called  hepatic  or  pre-eclamptic 
toxaemia  of  pregnancy,  presumably  occa- 
sioned by  hepatic  insufficiency,  or  the  inabil- 
ity of  the  liver  adequately  to  dispose  of  the 


toxines  arising  in  pregnancy,  usually  occurs 
late  in  pregnancy,  with  the  following  symp- 
toms, viz.,  lassitude,  headache,  perhaps 
jaundice  and  a tendency  to  hemorrhage, 
perhaps  vomiting,  rapid  feeble  pulse,  blood- 
pressure  normal  or  high  (125  to  150  or  over; 
115  mm.  of  mercury  during  pregnancy  is 
considered  normal) ; perhaps  loss  of  weight, 
sometimes  mental  disturbance,  perhaps 
some  oedema  and  a diminished,  albuminous 
urine,  and  failure  of  vision,  and  later  perhaps 
epigastric  pain,  somnolence,  coma,  and 
eclampsia. 

About  2 to  3 per  cent,  of  pregnant  women 
develop  symptoms  of  hepatic  toxaemia.  In 
early  pregnancy  it  may  be  manifested  by 
excessive  vomiting. 

The  so-called  nephritic  toxaemia  of  preg- 
nancy (kidney  of  pregnancy;  uraemia),  pre- 
sumably occasioned  by  renal  insufficiency, 
or  the  temporary  breakdown  of  a mildly  dis- 
eased or  weak  kidney  as  a result  of  the 
strain  of  pregnancy,  is  manifested  by  symp- 
toms similar  to  those  of  hepatic  toxaemia, 
but  especially  oedema,  a scanty  urine  con- 
taining much  albumen  and  casts  of  all  kinds, 
with  a markedly  diminished  nitrogen  excre- 
tion, and  high  blood-pressure.  Foetal  death 
and  premature  labor  often  ensue.  Nephritic 
toxaemia  is  said  to  be  much  less  frequent 
than  the  hepatic  type. 

J.  W.  Williams  saj^s:  “ It  would  appear 
that  one  attack  (of  hepatic  toxaemia)  con- 
fers a relative  immunity  upon  the  patient, 
just  as  in  eclampsia;  accordingly,  when  tox- 
aemia occurs  in  repeated  pregnancies,  it  may 
be  inferred  that  it  is  of  the  nephritic  type 
and  is  dependent  upon  the  existence  of  a 
chronic  nephritis.” 

The  Prognosis  of  pregnancy  toxaemia  is 
good  in  mild  cases;  verj^  bad  in  sudden,  ful- 
minating cases. 

(It  should  be  borne  in  mind  that  acute 
nephritis  may  occur  during  pregnancy  as  a 
result  of  exposure  to  cold  or  wet  or  draughts, 
or  of  overeating,  highly  seasoned  food, 
chemical  poisons,  infectious  diseases,  etc. 
It  seems  to  me,  in  view  of  the  deficiency  of 
our  present  knowledge,  that  the  assumption 
of  the  existence  of  two  distinct  varieties  of 
toxaemia  is  premature.) 

Treatment.— If  albumen  appears  in  the 
pregnant  woman’s  urine  (see  Urinalysis) 
prescribe  laxatives  (see  Part  11)  frequent 
warm  baths,  warm,  drj^  clothing,  and 
woolen  or  flannel  underwear,  and  light  diet 
consisting  chiefly  of  milk  and  plenty  of 
water,  best  in  the  form  of  cream  of  tartar 
lemonade  (q.v.).  Breatl  and  butter,  well- 
cooked  cereals,  lettuce,  celery,  apple  sauce, 


UMBILICAL  HERNIA 


oranges,  and  prunes  are  allowable;  but  meat, 
eggs,  fish,  and  very  nitrogenous  vegetables 
are  forbidden. 

Should  oliguria,  oedema,  and  urinary 
casts  appear,  or  the  excretion  of  urea  fall 
below  ten  grams  per  diem,  or  the  albumen 
rise  over  five  grams  per  litre  (see  Urinaly- 
sis), put  the  patient  to  bed,  clean  out  the 
gastro-intestinal  tract,  restrict  the  <liet 
chiefly  to  milk  or  milk  soups  (at  least  two 
quarts  of  milk  in  twenty-four  hours),  em- 
ploy warm,  hot,  or  sweat  baths  (see 
under  Uraemia  in  Part  1),  according  to  the 
severity  of  the  case,  every  other  day,  admin- 
ister normal  saline  solution  (0.6  per  cent.) 
per  colon  or  subcutaneously,  and  prescribe 
a diuretic  if  deemed  advisable,  e.g.,  potas- 
sium citrate  or  acetate,  buchu,  Basham’s 
mixture,  caffeine,  nitroglycerin  (see  Part  11). 

If  in  spite  of  these  measures  the  symptoms 
grow  worse,  if  obscurity  of  vision  occurs,  if 
the  albumin  steadily  or  suddenly  increases 
(according  to  J.  W.  Williams,  “ an  output  of 
eight  to  ten  grams  of  albumin  per  litre, 
irrespective  of  other  symptoms,  justifies 
interference),  the  blood -pressure  rises,  the 
quantity  of  urine  suddenly  diminishes,  the 
oedema  becomes  excessive,  the  headache 
intense,  if  somnolence  or  eclampsia  {q.v.), 
occurs,  the  uterus  should  be  emptied  at  once 
(see  Eclampsia). 

Transfusion  of  Blood. — See  Blood  Trans- 
fusion, in  Part  1,  General  Medicine  and 
Surgery. 

Transversely  Contracted  Pelvis. — L.  frans 
across  ver'fere,  to  turn.  See  Contracted 
Pelves. 

Transverse  Position  of  the  Head  at 
the  Pelvic  Outlet. — Frequency. — 0.9  per 
cent.  (Edgar.) 

Etiology. — Simple  flat  pelvis;  generally  con- 
tracted flat  pelvis;  masculine  or  funnel- 
shaped  pelvis;  very  small  head  descending 
precipitately;  congenital  double  dislocation 
of  the  hip;  large  head  with  broad  occiput; 
incomplete  flexion  of  the  head.  (Edgar.) 

Treatment.— Digital  rotation  may  be  tried, 
and  if  this  fails,  rotation  and  traction  with 
forceps(7.f .)  ;or  pubiotomy((/.t;.),  if  the  child  is 
alive;  craniotomy  (q.v.),  of  course,  if  it  is  dead. 

Transverse  Presentations;  Shoulder  Pres= 
entations. — E t i o I o g y. — Pendulous,  relaxed 
abdomen  and  uterus  of  multiparous  women; 
contracted  pelvis;  uterine  fibroids;  abdom- 
inal and  pelvic  tumors;  multiple  pregnancy; 
hydramnios;  large  child;  monstrosity;  pla- 
centa praevia;  jars  or  other  form  of  trauma- 
tism; tight  lacing  during  pregnancy;  foetal 
death;  premature  birth;  uterus  bicornis; 
broad  uterus  accompanying  a kyphotic 
36 


spine;  “ exces.sive  right  lateral  obliquity  of 
the  uterus.” 

Treatment.— I.  DURING  PREGNANCY. — If 

the  pelvis  is  markedly  contracted,  perform 
Caesarean  section  (q.v.)  at  term.  If  the  pelvis 
is  normal,  perform  external  cephalic  version, 
and  hold  the  foetus  in  place  by  means  of  an 
abdominal  binder  applied  over  two  long 
cylindrical  compresses  of  gauze  placed  at 
the  sides  of  the  uterus. 

II.  During  Labor. — A markedly  con- 
tracted pelvis  may  demand  C’aesarean  sec- 
tion (q.v.),  unless  infection  is  probably 
present.  If  considered  feasible,  and  pro- 
vided, of  course,  the  membranes  have  not 
ruptured,  one  may  perform  external  cephalic 
version,  and  hold  the  foetus  in  place  manu- 
ally until  engagement  occurs.  Internal 
podalic  version  (q.v.),  however,  is  usually 
the  only  practicable  procedure.  If  the  cervix 
is  slow  in  dilating,  one  may  perform  Hick’s 
bipolar  version  (q.v.),  then  bring  down  a 
foot,  and  exert  gentle  traction;  but  the 
child  should  not  be  extracted  until  com- 
plete cervical  dilatation  has  occurred. 

If  internal  podalic  version  is  contra- 
indicated (see  Podalic  Version),  or  the  shoul- 
der* is  tightly  impacted,  perform  decapita- 
tion (q.v.). 

For  the  treatment  of  prolapse  of  the  cord, 
see  the  latter  caption. 

Tuberculosis  Complicating  Pregnancy. — 
L.  luher'culum,  nodule.  Artificial  abortion 
(q.v.)  is  advised,  unless  pregnancy  is  far 
advanced.  After  the  fifth  month  it  is  prob- 
ably advisable  to  adopt  expectant  treatment 
and  to  induce  labor  two  weeks  before  term. 
Forceps  or  vemion  may  be  advisable  during 
labor. 

Tumor,  Ovarian,  Complicating  Pregnancy 
and  Labor.— See  Ovarian  Tumors,  etc. 

Tumors,  Fibroid,  Causing  Dystocia. — See 
Fibroid  Tumors  Causing  Dystocia. 

Complicating  Pregnancy. — See  Fi- 
broid Tumors  Complicating  Preg- 
nancy. 

Ovarian,  Complicating  Pregnancy  and 
Labor. — See  Ovarian  Tumors. 

of  the  Pelvis. — See  Contracted  Pelves. 

Vagina  or  Vulva  Causing  Dystocia. — 
See  Atresia  of  the  Vagina  and  Vulva. 

Twin  Pregnancy. — See  Multiple  Preg- 
nancy. 

Tympanites. — See  Part  1. 

Typhoid  Fever^Complicating  Labor. — Gr. 

Tv<t>os  stupor  -|-  elbos  form;  L.  fe'bris,  fever. 
See  Adynamic  Disea.scs. 

Umbilical  Hernia. — L.  umbili'eus;  her'nia. 
See  under  Displacements  of  the  Pregnant 
Uterus. 


VARICOSE  VEINS  OF  THE  LEGS 


Uraemia. — Gr.  ohpov  urine  + aipa  blood. 
See  Toxaemias  of  Pregnancy. 

Urinalysis. — See  Part  1,  General  Medicine 
and  Surgery. 

Urinary  Fistula. — See  Fistula,  Genito- 
urinary. 

Retention. — L.  uri'na  ; reten'tio.  See 
Management  of  the  Puerperium. 

Urination. — See  Micturition. 

Uterus,  Anteflexion  of  the  Pregnant. — L. 
u'terus,  womb;  an'te  -f-  fle'xio,  bend. 
See  Displacements  of  the  Pregnant 
Uterus. 

Atony  of  the. — ^Gr.  a priv.  -1-  tSvos  tone. 
See  Inertia  Uteri. 

Displacements  of  the. — See  Displace- 
ments. 

Fibroids  of  the. — See  Fibroid  Tumors. 

Inertia  of  the. — See  Inertia  Uteri. 

Inversion  of  the. — See  Inversion  of  the 
Uterus. 

Myalgia  of  the. — -See  Myometrial 
Rheumatism. 

Phlebitis  of  the. — Gr.  <p\e\p  vein  -LTIS 
inflammation . See  Puerperal  I nfection. 

Prolapse  of  the. — L.  pro,  before  -f- 
la'bi,  to  fall.  See  Prolapse. 

Retrodisplacements  of  the. — L.  re'tro, 
backward.  See  Displacements. 

Rheumatism  of  the. — See  Myometrial 
Rheumatism. 

Rupture  of  the. — ^See  Rupture  of  the 
Uterus. 

Subinvolution  of  the. — See  Subinvolu- 
tion. 

Superinvolution  of  the. — See  Superin- 
volution. 

Vaginal  Atresia. — L.  vagi'na,  a sheath. 
See  Atresia  of  the  Vagina. 

Caesarean  Section. — See  under  Pre- 
mature Labor,  Induction  of. 

Carcinoma. — Gr.  napKivos  crab  + -upa 
tumor.  See  Atresia  of  the  Vagina. 

Cysts  . — Gr.  KvffTis  cyst.  See  Vaginitis. 

Haematoma. — See  Haematoma. 

Hernia  of  the  Pregnant  Uterus. — L. 
her'nia.  See  under  Displacements  of 
the  Pregnant  Uterus. 

Hysterotomy. — Gr.  mrepa  uterus  -1- 
Topri  cut.  See  under  Premature 
Labor,  Induction  of. 

Laceration. — L.  lacera're,  to  tear.  See 
under  Conduct  of  Normal  Labor. 

Leucorrhoea  Complicating  Pregnancy. — 
Gr.  XevKos  white  + poLa  flow.  See 
Vaginitis  in  Pregnancy. 

Sarcoma. — Gr.  aap^,  aapKos  flesh  -j-  -upa 
tumor.  See  Atresia  of  the  Vagina. 

Stenosis. — Gr.  arevcoais.  See  Atresia  of 
the  Vagina. 


Vaginal  Tumors. — L.  tum'or,  swelling.  See 
Atresia  of  the  Vagina. 

Vaginismus. — See  Atresia  of  the  Vagina. 

Vaginitis  in  Pregnancy. — L.  vagi'na,  a 
sheath  -|-  Gr.  -trts  inflammation;  L.  prceg'- 
nans,  with  child.  A.  Granular  Vaginitis. — 
Vaginal  leucorrhoea  in  pregnancy  is  usually 
due  to  or  aggravated  by  the  congestion  of 
pregnancy.  “ The  best  treatment  of  vaginal 
leucorrhoea,”  says  Hirst,  “ is  a single  appli- 
cation to  all  parts  of  the  vagina  of  a 30  per 
cent,  solution  of  carbolic  acid  in  glycerine,” 
made  through  a cylindrical  or  skeleton  wire 
bivalve  speculum,  preceded  by  greasing  of 
the  vulva  with  vaseline,  and  followed  by  an 
alcohol  and  water  douche.  Silver  nitrate, 
gr.  XX  to  the  ounce,  followed  by  a saline 
douche  (3i  ad  Oi)  is  also  effectual.  Edgar 
reconnnends  one  of  the  following  supposi- 
tories, which  is  inserted  at  bedtime,  and  in 
the  morning  a douche  of  warm  boric  acid 
solution,  one  teaspoonful  to  the  pint,  or 
alum  solution,  one  teaspoonful  to  the 
quart,  given: 

R Hydrastininae  hydrochloridi gr.  i 

Zinci  boratis gr.  H 

Extract!  bclladonnse gr.  H 

Boroglycerini  et  olei  theobromatis,  q.s.  (Edgar.) 

R Extract!  belladonna} gx.  % 

Acid!  tannic! gr.  v-x 

Boroglycerini  et  ole!  theobromatis,  q.s.  (Edgar.) 

B.  Gonorrhoeal  Vaginitis. — Consult  Part  2, 
Gyntecology.  Intracervical  treatment,  how- 
ever, should  be  employed,  if  at  all,  with 
care  because  of  the  danger  of  provoking 
abortion. 

C.  Cystic  Vaginitis;  Colpohyperplasia  Cystica. — 
The  mucous  membrane  is  hypertrophied, 
and  contains  small  cysts.  The  latter  rarely 
contain  gas  (emphysematous  colpitis,  due 
possibly  to  the  gas-forming  bacillus) . 

Prick  the  vesicles  and  douche  with  boric 
acid  solution,  5Uiv  ad  Oi.  “ The  disease 
disappears  of  itself  after  deliverj^” 

D.  Venereal  Warts. — Skin-colored,  pink,  or 
purplish-red,  finger-like  vegetations,  resem- 
bling cauliflower,  cockscomb,  bunch  of 
grapes,  or  mulberries. 

Tre.\tment. — See  Part  2,  Gynaecology. 

Vaginitis,  Puerperal. — See  Puerperal  In- 
fection. 

Valvular  Heart  Disease  Complicating 
Pregnancy  and  Labor. — L.  val'va.  See 
Cardiac  Disease. 

Varicose  Veins  of  the  Bladder. — L.  varix; 
vena.  See  Haematuria. 

Varicose  \eins  of  the  Legs. — Employ 
elastic  bandages  or  stockings.  The  latter 
must  be  made  to  measure,  the  measure- 
ments being  taken  in  the  morning,  before 


YELLOW  ATROPHY  OF  THE  LIVER,  ACUTE 


the  patient  gets  upon  her  feet.  Frequent 
recumbency  and  the  avoidance  of  constipa- 
tion (q.v.)  should  be  enjoined.  A heart 
tonic  in  small  doses  may  sometimes  be  ser- 
viceable in  appropriate  cases.  For  itching, 
employ  the  following: 


CalaminsD, 

Zinci  oxidi,  aa oii~iv 

Acidi  borici o ii 

Glycerini ' ngxxx 

Acidi  carbolici 5ss~i 

Liquoris  calcis 3ii 

Aqua?  bullientis,  q.s.,  ad Sviii 


M.  Sig. — Shake  well,  and  apply  as  required 
for  itching. 

Should  thrombosis  occur,  treat  the  condi- 
tion as  described  under  Phlegmasia  Alba 
Dolens. 

Varicose  Veins  of  the  Vulva. — Regulate 
the  bowels  (see  Constipation),  support  the 
uterus  with  an  abdominal  binder,  and  the 
vulva  with  a compress  and  T-bandage,  pre- 
scribe hot  or  cold  lead  and  opium  wash 
(q.v.)  for  the  relief  of  itching,  and  enjoin 
frequent  recumbency.  Unguentum  gallaj 
(q.v.)  may  be  of  service.  Rupture  should  be 
guarded  against,  because  of  the  danger  of 
serious  hemorrhage.  The  condition  usually 
disappears  after  parturition. 

Accidental  hemorrhage  should  be  con- 
trolled by  means  of  firm  gauze  compresses 
or  deep  catgut  sutures. 

Venereal  Warts. — L.  vene'revs,  pertaining 
to  Venus.  See  under  Vaginitis  in  Pregnancy. 

Venous  Thrombosis,  Crural. — L.  ve'na, 
vein;  crus,  cru’ris,  leg;  Gr.  Spbu^os 
plug.  See  Phlegmasia  Alba  Dolens. 

Uterine.  — See  under  Puerperal  In- 
fection. 

Ventral  Hernia  of  the  Pregnant  Uterus. — 

L.  vent'er,  belly;  her'nia,  hernia.  See  under 
Displacements  of  the  Pregnant  Uterus. 


Version,  Bipolar,  of  Braxton  Hicks.— L. 

ver'sio,  turning;  bi,  two  -|-  pol'us, 
pole.  See  Cephalic  Version;  and  Po- 
dalic  Version. 

Cephalic. — See  Cephalic  Version. 

Combined  External  and  Internal. — See 
Cephalic  Version;  and  PodalicVersion. 

External. — See  Cephalic  Version. 

Internal  Podalic. — See  Podalic  Version. 

Podalic. — See  Podalic  Version. 

Vesical  Calculus. — L.  vesi'ea,  bladder. 
See  Bladder  Calculus. 

Vision,  Disturbance  of. — L.  vis'io,  vid'ere, 
to  see.  See  under  Paralyses  Complicating 
Pregnancy. 

Vomiting  of  Pregnancy. — See  Nausea  and 
Vomiting  of  Pregnancy. 

Vulval  Abscess. — L.  vul'va;  absces'sus,  a 
going  apart.  Consult  Vulvitis,  in  Part  2, 
on  Gynaecology.  Operations  are  best  per- 
formed during  the  last  month  of  pregnancy. 

Vulval  Atresia  Causing  Dystocia. — See 
Atresia  of  the  Vagina  and  Vulva. 

Carcinoma. — Gr.  napKivos  crab  -b  -wpa. 
tumor.  See  Atresia  of  the  Vagina 
and  Vulva. 

Haematoma. — See  Haematoma. 

(Edema. — See  (Edema  of  the  Vulva. 

Pruritis. — See  Pruritis  Vulvae. 

Sarcoma. — Gr.  <rap^,  aapKos  flesh  -1 — copa 
tumor.  See  Atresia  of  the  Vagina 
and  Vulva. 

Varices. — See  Varicose  Veins  of  the 
Vulva. 

Watcher’s  Hanging  Posture. — See  under 

Contracted  Pelves. 

Warts,  Veneral,  Complicating  Pregnancy. 

— L.  vene'reus,  pertaining  to  Venus.  See 
under  Vaginitis. 

White  Leg.— See  Phlegmasia  Alba  Dolens. 

Yellow  Atrophy  of  the  Liver,  Acute. — See 
Acute  Yellow  Atrophy  of  the  Liver  in  Part  1. 


APPENDIX 

Obstetrical  Record 


Name 

Singh  Married  (how  long) 

No.  and  ages  of  children 
Previous  jtregnancies 
Miscarriages 

Previous  labors 


Address 

Widow  (how  long) 

Age 

General  appearance 
Hygiene:  Rest 
Recreation 
Bowels 
Sexual  habits 
Alcohol 

amount 


No. 

Occupation 

Race 


Diet 

Ventilation 
Tea  and  coffee 
Digestion 

pain 


Exercise 
Sleep 


Baths 

Narcotics 

Appetite 


Expected  date  of  confinement 

Foetal  heart 


Amount  in  24  hours 
reaction 
albumin 


s.g. 

sugar 


Abdomen  (pendulous) 
Varicose  veins 
Frequency 
total  sohds 
sediment 


Previous  pxierperia 

Menstruation:  Intervals  duration 

Personal  history  (age  when  first  walked) 

Examination: 

Breasts  P’undus 

Presentation  and  position  of  fwtus 
Lungs,  heart,  bowels,  etc. 

Urinary  Analysis  (q.v.): 

Color 
Urea 

Renal  function 
Pelvic  measurements: 

Intercristal 
Interspinous 
Intertrochanteric 
External  conjugate 
Diagonal  conjugate 
True  conjugate 
Interischial  diameter 
Flexibihty  of  the  coccyx 
Abnormalities 

Present  pregnancy:  (Headache,  oedema,  vomiting,  visual  disturbance,  constipation,  hemorrhage) 

Labor 

Date 

Duration:  1st  stage  2d  stage  3d  stage 

Spontaneous 

Crede 

Presentation  and  position  of  child 

Hemorrhage 

Perineum 

Puerperium 


Mother:  Child: 


Perineum  ^’aginal  secretion 

Uterus  (size,  position,  mobility,  sensitiveness,  cervix) 

Child:  ' 


INSTRUMENTS  AND  MATERIAL  FOR  OPERATIVE  PROCEDURES  565 


The  Obstetrical  Outfit. — A special  leather- 
covered  box  or  valise  is  of  convenience  in 
out-patient  work.  J.  W.  Williams  recom- 
mends a rectangular  box  measuring  21  by 
83^  by  8 inches,  containing  a tin  box 
measuring  40  by  30  by  10  cm.,  with  a tin 
lid  and  wooden  handles,  to  boil  the  instru- 
ments in. 

The  obstetrical  valise  should  contain 
the  following: 

(a)  In  the  valise  proper:  Pelvimeter; 

nail-clippers;  nail-cleaner;  chloroform  and 
inhaler;  ether;  bichloride  tablets  or  lysol; 
castile  or  green  soap;  sterile  vaseline  in  a 
tin  salve-box,  in  which  it  may  be  sterilized 
on  the  stove  at  the  patient’s  residence  (for 
anointing  the  fingers  in  making  internal 
examinations);  ergotol,  ergotin,  or  fl.  ext. 
ergot;  spring  baby-scale;  tablets  of  sodium 
chloride  for  preparing  normal  salt  solution; 
hypodermic  syringe  and  tablets;  quinine 
in  5-gr.  capsules;  chloral  hydrate  in  15-gr. 
amounts;  pituitrin;  sterile  gown;  two  pack- 
ages, each  containing  six  sterile  towels;  one 
small  package  of  sterilized  absorbent  cot- 
ton; a dozen  or  more  small  packages  con- 
taining sterile  gauze  sponges;  one  package 
of  sterile  vulvar  pads  (absorbent  cotton  cov- 
ered with  gauze) ; three  sterilized  gauze 
bandages  for  packing  the  uterus;  sterile  cat- 
gpt  in  a glass  tube;  leg-holder;  Kelly  obstet- 
rical pad;  three-quart  fountain  syringe  with 
a glass  nozzle  for  intra-uterine  and  a hollow 
needle  for  subcutaneous  injections  of  normal 
salt  solution;  safety  razor;  clinical  thermome- 
ter; a sterilized  powder  shaker  containing 
boric  acid  powder  or  salicylic  acid,  1 
part,  and  starch,  8 parts;  boric  acid 
solution,  gr.  xv  to  the  ounce,  for  the  baby’s 
eyes;  argyrol,  25  per  cent.,  for  the  baby’s 
eyes;  bulbous  tipped  eye-dropper;  stetho- 
scope. 

(b)  In  the  tin  box:  Hand  brush;  soft  rub- 
ber and  glass  catheters;  silkworm-gut; 
bobbin  or  narrow  tape  for  tying  the  cord; 
glass  intra-uterine  nozzle;  transfusion  needle; 
rubber  gloves;  and  the  following  instru- 
ments: surgical  scissors;  umbilical  scissors; 
needle-holder;  assortment  of  needles,  chiefly 
large  curved;  four  artery  clamps;  two  tissue 
clamps  for  clamping  the  cord;  dissecting 
forceps;  long  dressing  forceps;  tenaculum 
forceps;  three-bladed  speculum;  Simon  spec- 
ulirni;  Tarnier  axis-traction  or  Simpson 
axis-traction  forceps;  safety  pins. 

Instruments  and  Material  for  Operative 
and  Miscellaneous  Procedures. — Simpson’s 
cranioclast;  Thomas’s  perforator;  Nagele’s 
perforator;  pubiotomy  instruments:  convex 
bistoury  and  Gigli’s  wire  saw  with  handles; 


ovum  or  placenta  forceps;  large  dull  wire 
curette;  Braun’s  cranioclast;  Dubois’s  scis- 
sors; Smellie’s  perforator;  set  of  Barnes’s 
cervical  dilators;  colpeurynter;  Arthur  Mill- 
er’s modification  of  Champetier  de  Ribes’s 
metreurynter;  Arthur  Miller’s  cervical  dila- 
tor; linen  tape,  34  inch  wide,  for  fillets; 
Olivier’s  fillet-carrier;  repositor  for  the  pro- 
lapsed cord;  double-current  uterine  irrigator; 
Champetier  de  Ribes’s  balloon;  Voorhees’s 
mbber  bags;  heavy  and  light  steel  cervical  di- 
lators; sharp  uterine  curettes;  metranoicter; 
Braun’s  colpeurynter;  uterine  sound ; probe- 
pointed  bistoury;  pulmotor;  adhesive  plaster, 
three  inches  broad;  uterine  bougies.  No.  17 
French,  or  10  or  12  English;  prostatic  ca- 
theter; Sims’s  speculum;  watch-spring  pes- 
sary; Smith-Hodge  pessary,  large  size; 
globe,  air,  or  water  pessary;  Bossi’s  four- 
branch  dilator;  Pomeroy’s  bag;  wet  cups; 
cylindrical  speculum;  stomach  tube;  Good- 
ell’s  dilators;  Hegar’s  dilators;  thermo- 
cautery; Smellie’s  scissors;  Blot’s  perforator; 
uterine  clamps;  Tarnier’s  basiotribe;  Simp- 
son’s basilyst-tractor;  rubber  tubing  and 
funnel;  a flexible  catheter  containing  a 
flexible  stylet  as  a fillet  carrier;  Momburg’s 
rubber  tubing;  scalpels;  plaster-of-Paris; 
chromic  catgut  No.  2;  linen  thread;  wire 
ecraseur  for  decapitation  of  the  foetus;  skele- 
ton wire  bivalve  speculum;  Braun’s  blunt 
hook;  Ramsbotham’s  sickle  knife;  curved 
arteiy  forceps ; Emmet’s  curettement  forceps ; 
Hank’s  cervical  metal  dilators,  coniform  and 
olive-shaped  (in  using  the  coniform  and 
olive-shaped  dilators  an  assistant  should 
exert  counter-pressure  on  the  fundus  uteri); 
Garrigues’s  olive-shaped  cervical  dilators, 
ten  in  number;  Goe let’s  expanding  dilator; 
weighted  vaginal  speculum;  forceps  for  carry- 
ing rubber  bags  into  the  uterus;  Braun’s  fillet- 
carrier;  Seeligmann’s  pubiotomy  needle; 
long  gauntlet  glove  reaching  to  the  elbow, 
for  performing  version  ; Teufel’s  abdominal 
supporter;  Patterson’s  abdominal  supporter; 
breast  pump;  nipple  shield;  hot- water  bags; 
five  basins;  large  pitcher,  douche-pan;  two  or 
three  quart  fountain  syringe  ; Davidson’s 
bulb  syringe  ; sterile  gauze  and  absorbent 
cotton;  cotton  batting;  rubber  sheeting  or  oil 
cloth,  two  pieces,  one  1 by  2 yards  and  one 
1 by  134  yards;  sanitary  bed-pads  made  of 
cotton  batting  and  absorbent  cotton;  waste 
bucket;  small  and  large  safety  pins;  blood- 
pressure  instrument;  unbleached  folded 
muslin  binder,  about  134  yards  long  and 
reaching  from  below  the  trochanters  to  the 
lower  ribs;  long  stockings,  canton-flannel 
for  winter,  thin  muslin  for  summer;  breast- 
binder. 


LOCAL  MEDICAMENTS  MENTIONED  IN  THE  TEXT 


Instruments  are  boiled  in  a solution  of 
washing  soda  (sodium  carbonate),  one  even 
tablespoonful  to  the  quart,  for  five  minutes. 

Urinary  Analysis  Outfit. — See  the  Appen- 
dix to  Part  1. 

Internal  Drugs  Mentioned  in  the  Text. — 

(a)  Purgatives  (L.  purgar'e,  to  cleanse). — 
Compound  laxative  pill,  contaming  aloin, 
strychnine,  ipecac,  and  belladonna;  aro- 
matic fluid  extract  cascara  sagrada; 
compound  licorice  powder;  aloin;  sulphur, 
effervescent  citrate  of  magnesia;  Rochelle 
salt;  castor-oil;  effervescent  sodium  phos- 
phate ; calomel ; croton  oil ; elaterium  tablets, 
gr.  34 ; Epsom  salt. 

(b)  Emmenagogues  (Gr.  en/iriva  memses  -j- 
ayeLv  to  lead).  — Ovarian  extract;  apiol; 
manganese  dioxide;  potassium  permangan- 
ate; iron;  tr.  puLsatilla;  salicylic  acid;  ext. 
vib.  prim.;  fl.  ext.  vib.  prun. 

(c)  Oxytocics  or  Ecbolics  (Gr.  o^vs  quick  -f- 
TOKos  childbu-th;  e/c/SoX  17  abortion) . — Pituitrin, 
qumine;  ergot;  enemata. 

(d)  Gastric  Sedatives  (L.  scdo,  I allay). — 
Cerium  oxalatej  carbolic  acid;  bismuth;  sil- 
ver nitrate;  cocame;  menthol;  pepsin;  vmum 
ipecac;  ihlute  hydrocyanic  acid. 

(e)  Antacids. — Magnesium  carbonate  in 
chalk  formj  sodium  bicarbonate;  milk  of 
magnesia;  ammonium  carbonate;  precipi- 
tated chalk;  potassiiun  bicarbonate;  lime- 
water;  ammonia. 

(f)  Digestants.— Essence  of  pepsin;  pan- 
creatin;  comp.  tr.  gentian;  tr.  mix  vomica; 
dilute  hydrocliloric  acid;  pepsin. 

(g)  Antirheumatics. — Sodium  salicylate; 
aspirin. 

(h)  Cardiovasculaj  Drugs. — Amyl  nitrite; 
champagne;  nitroglycerine;  spt.  glonoini; 
digitalis;  strychnine;  ammonia;  ammonium 
carbonate;  pituitrin;  whiskey. 

(i)  AJteratives  and  Tonics. — Calcium  chloride; 
Bland’s  piUs;  syy.  calc,  lactophosphate;  iron 
albuminate;  stryclmine;  codliver  oil;  syr. 
hypophosphites;  Fowler’s  solution;  potas- 


sium iodide;  oil  of  sandalwood;  sodium  ben- 
zoate; oxygen. 

(j)  Diuretics  (Gr.  8ta  through  -|-  oiipov 
urine). — Basham’s  mixture;  cream  of  tar- 
tar; potassium  chloride;  caffeine. 

(k)  Haemostatics  (Gr.  atyua  blood  ff-  aracns  a 
standing). — Pituitrin;  ergotol;  ergotin;  fl. 
ext.  ergot;  fl.  ext.  hydrastis;  hydrastinin. 

(l)  Astringents  (L.  ad,  to  -f-  stringere, 
to  bind). — Precipitated  chalk;  troches  of 
tannic  acid;  bismuth  subcarbonate 
and  subnitrate. 

(m)  Neuromuscular  Sedatives. — Bromides; 
morphine  and  atropine  hypo,  tablets;  chloral 
hydrate;  morphme;  ether;  chloroform;  tr. 
belladonna;  tr.  opii;  valerian;  ext.  hyoscya- 
mus;  cocaine;  paregoric;  atropine  sulphate; 
monobromide  of  camphor;  tr.  hyoscyami; 
asafoetida;  antipyrine;  codeine;  hyoscine 
hydrobromide;  tr.  veratrum  viride;  whiskey. 

Local  Medicaments  Mentioned  in  the 
Text. — (a)  Antiseptics  and  Astringents  (Gr.  avr'i 
against  -ff  (rr}\pLs  putrefaction). — Ung.  gall, 
comp.;  glyceritum  acicU  tannici  (one  of  tan- 
nic acid  to  four  of  glycerine);  comp.  tr. 
lavender;  comp.  tr.  benzoin;  tannic  acid; 
borjc  acid  powder;  bichloride  tablets;  lysol; 
creohn;  tr.  myrrh;  precipitated  chalk;  cas- 
tUe  soap;  green  soap;  peroxide  of  hydrogen; 
potassium  permanganate;  argyrol;  chromic 
acid;  carbolic  acid;  silver  nitrate;  acetic 
acid;  alcohol;  ung.  gall®;  lead  acetate; 
zinc  borate. 

(b)  Emollients;  Vehicles;  Protectives  (L.  emol'- 
lioy  I soften).- — Glycerine;  camphorated  oil; 
vaseline;  starch;  olive  or  cottonseed  oil; 
talcum;  bismuth;  boric  acid;  cold  cream; 
zinc  oxide;  ol.  theobrom®. 

(c)  Analgesics  (Gr.  av  without  -b  a\yos 
pain).— Orthoform;  ung.  stramonii;  ung. 
gall®  comp.;  ext.  belladonna;  lead  and 
opium  wash. 

(d)  Miscellaneous.— Picric  acid;  citric  acid; 
sodium  chloride  tablets  for  preparing  normal 
salt  solution. 


ACNE 


1.  - Acne  rosacea. 


2.  — 4cne  sebacea. 


N"  8 1 8.  D'  Guibout 


N®  498  O'"  Besnier. 


3.  — Acne  rosacea. 


4.  — Acne  keloid. 


N'’  730,  Fournier 


N'‘  1 1 I 4.  Bcsnier. 


St.  Louts  Hospital  Museum  Paris. 


LAROUSSE  MEDICAL. 


SKIN  DISEASES  : Varieties  of  acne. 


PART  5 

SKIN  DISEASES 


Abscess. — L.  absces'sus,  a going  apart. 
See  Furunculus. 

Acanthosis  Nigricans. — See  Keratosis  or 
Acanthosis  Nigricans. 

Acne. — Gr.  aKv-fj  point.  See  Acne  V ulgaris. 

Cicatricial. — L.  cica'trix,  scar.  See 

Dermatitis  Papillaris  Capilliti. 

Keloid. — Gr.  ktjXLs  scar  + el8os  form. 
See  Dermatitis  Papillaris  Capilliti. 

Necrotica. — Gr.  veKpos  dead.  See  Acne 
Varioliformis. 

Acne,  Pustular,  Sycosiform,  Cicatricial, 
Keloid,  Occurring  on  the  Nape  of  the  Neck. 

— L.  pus'tula,  pustule;  Gr.  amov  fig.;  L.  cica- 
trix, scar;  Gr.  KrfKis  scar  + etSos  form.  See 
Dermatitis  Papillaris  Capilliti. 

Acne  Rosacea. — Gr.  aKvrj  point;  L.  ros'a, 
rose.  A chronic  reflex  flushing  or  congestion 
of  the  nose  and  adjoining  cheeks,  sometimes 
incluchng  the  chin  and  forehead  in  the 
midline,  leading  to  permanent  vascular 
dilatation  (with  visible  dilated  capillaries), 
sebaceous  inflammation  (acne),  and  some- 
times tissue  hypertrophy  (rhinophyma:  Gr. 
pis  nose  fl-  (pupa  growth). 

Etiology. — The  causal  factors  are  those  in- 
fluences which  favor  habitual  facial  flushing 
and  venous  stasis,  viz.,  digestive  disturb- 
ances, constipation,  alcohol,  tea,  coffee,  hot 
drinks,  highly  seasoned  foods,  tobacco,  gout, 
intranasal  pressure  or  disease,  especially 
inflammation  of  the  hair  follicles  just  within 
the  nares,  cosmetics,  uncleanliness,  exposure 
to  cold  winds,  as  in  cabmen,  exposure  to 
great  heat,  exposure  to  the  sun’s  rays, 
seborrhoea,  feeble  circulation  due  to  cardiac, 
renal,  pulmonary,  or  hepatic  disease,  debil- 
ity, uterine  disorders. 

Prognosis. — Persistent  treatment  is  pro- 
ductive of  favorable  results. 

Treatment.— Attend  first  to  the  correction 
of  all  possible  causal  influences,  and  enjoin 
the  observance  of  a correct  hygienic  regimen, 
i.e.,  adequate  rest  and  exercise,  fresh  air  day 
and  night,  avoiding  draughts,  a daily  morn- 
ing tepid  bath  before  breakfast,  in  a warm 
room,  followed  by  a cold  spinal  douche  and 
brisk  rubdown  with  a coarse  towel,  regular 
hours  of  eating  and  sleeping,  early  rising, 
re.st  before  and  after  meals,  a light,  bland 
diet,  abstinence  from  tea,  coffee,  alcohol,  and 
tobacco,  and  regulation  of  the  bowels  (con- 
sult Dyspepsia,  in  Part  1 ; and  for  constitu- 


tional treatment.  Gastritis,  Chronic,  in 
Part  1).  The  treatment,  both  constitutional 
and  local,  is  the  same  as  that  of  acne  vul- 
garis, omitting  only  massage. 


Zinci  sulphatis, 

Potassii  sulphureti,  aa gr.  v-xx 

AquiB Bi 


M.  Sig. — Apply  in  sufficient  strength  and  fre- 
quency to  produce  some  irritation  and  desquama- 
tion. (Lotio  Alba.) 

Deodorized  benzine  is  recommended  by 
Bruck.  In  cleansing  the  parts  with  soap  and 
water,  which  should  be  done  daily,  use  not 
hot  but  tepid  water.  At  night,  the  following 
may  be  applied. 


Sulphuris  prsecipitati gr.  x-xxx 

Resorcini gr.  x-xx 

Paraffini  mollis,  q.s.,  ad.  . . . Bi 


M.  Sig. — Apply  at  bedtime.  (S.  E.  Dore.) 

Employ  electrolysis  frequently,  to  destroy 
the  telangiectases  of  dilated  vessels.  With 
a current  of  one-half  to  two  milliamperes,  and 
the  needle  attached  to  the  negative  pole, 
insert  the  latter  into  the  vessel,  and  keep  it 
there  until  there  is  an  “ appearance  of  dis- 
tinct blanching,  enlarging  to  the  size  of  a 
small  pea”;  this  occurs  within  thirty  sec- 
onds. Follow  each  seance  by  hot  water 
applications  for  a few  minutes,  (q.v.)  and 
then  cold  applications.  (Stelwagon.) 

In  the  oily  cases,  with  enlarged  glandular 
openings  and  slight  connective-tissue  hyper- 
trophy, one  may  employ  electrolysis  (cur- 
rent of  three  to  six  milliamperes,  for  twenty 
to  forty  seconds)  within  the  openings  and 
in  the  interspaces  eveiy  few  weeks;  or  fre- 
quent multiple  punctures  may  be  made,  and 
bleeding  favored  by  the  application  of  hot 
water  compresses,  these  to  be  followed 
later  by  cold  compresses. 

The  X-ray  is  well  recommended  for  bad 
cases  (see  Acne  Vulgaris). 

Rhinophyma  is  best  treated  by  decortica- 
tion with  the  scissors  or  knife,  the  parts 
being  trimmed  down  to  their  normal  size. 
Scarification,  freezing  with  carbon  dioxide 
snow.  X-ray  and  radium  therapy  (q.v.)  are 
other  measures  employed. 

Acne  Scrofulosorum. — L.  scroj'ula,  sow 
pig.  See  Acne  Varioliformis. 

Sycosiform,  Keloid. — Gr.  amov  fig;  Krjkis 
scar  -f  eibos  form.  See  Dermatitis 
Papillaris  Capilliti. 


ACNE  VULGARIS;  ACNE 


Acne  Varioliformis. — Gr.  aKvri  point;  L. 
vari'ola,  smallpox.  A chronic,  indolent, 
papulo-pustular  folliculitis,  which  predom- 
inates on  the  forehead,  temples,  and  scalp, 
although  it  may  occur  on  the  thorax,  and 
leaves  deep-pitted  scars  like  those  of  vac- 
cinia or  smallpox.  By  these  scars  it  is 
chiefly  characterized. 

Shnilar  lesions  occur  on  the  face,  trunk, 
or  extremities  in  tuberculous  subjects,  vari- 
ously designated  acne  scrofulosormn,  acnitis, 
and  folliclis. 

Prognosis.— Most  cases  yield  to  treatment, 
but  recurrences  are  almost  certain. 

Treatment.— Keep  the  affected  surface  clean 
with  soap  and  water,  and  perhaps  bichloride 
of  mercury,  1 : 4000  to  1000;  and  apply  one 
of  the  following  preparations  at  night,  to  be 
washed  off  in  the  morning  if  desired, 


R Hydrargyri  ammoniati gr.  xv-xxx 

Petrolati  mollis §i 

Cinnabaris, 

Sulphuris  prsecipitati,  aa gr.  xvi 

Petrolati  mollis §i 

(Sabouraud.) 


After  the  eruption  has  disappeared,  con- 
tinue the  observance  of  strict  cleanliness,  in 
order  to  prevent,  if  possible,  recurrence. 
Stelwagon  suggests  for  the  latter  purpose. 


1^  Resorcinolis gr.  xx-xc 

Acidi  borici gi’.  Ixxv 

Aquaj jiv 


The  internal  administration  of  codliver 
oil,  iron,  or  arsenic  (see  Part  11)  is  usually 
indicated.  Crocker  recommends  potassium 
iodide.  Good  hygiene,  of  course,  is  of  prime 
importance,  e.g.,  adequate  rest  and  exercise, 
fresh  air  day  and  night,  a daily  morning  warm 
bath  in  a warm  room,  before  breakfast, 
followed  by  a cool  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
meals,  a nutritious  cUet,  and  regulation  of 
the  bowels. 

In  rebellious  cases,  one  may  try  vaccines 
or  the  X-ray,  as  in  acne  vulgaris  {q.v.) 

Acne  Vulgaris;  Acne. — Gr.  d/o'i)  point;  L. 
vulgar'is,  common.  A common,  chronic, 
papulo-pustular,  sometimes  deep  nodular 
inflammation  of  the  sebaceous  glands  of  the 
face,  and  sometimes  the  shoulders  and 
chest,  due  at  least  partly  to  infection  of 
retained  secretion,  and  occurring  chiefly  in 
young  people. 

The  chief  causal  influence  is  an  irregular 
mode  of  life,  irregular  hours  of  eating, 
improper  food,  the  excessive  use  of  tea,  cof- 
fee, alcohol,  or  tobacco,  over-study,  unclean- 
liness, masturbation,  sedentary  habits,  etc.. 


leading  to  indigestion,  constipation,  intes- 
tinal toxaemia,  anaemia,  general  debility, 
menstrual  irregularities,  scurvy.  Other 
contributory  causes  are  dirty  atmosphere, 
exposure  to  cold  winds,  irritating  cosmetics, 
chlorine,  chrysarobin,  paraffin,  tar,  including 
tar  soap,  oils  and  fats,  bromides  and  iodides. 

Prognosis. — Well-directed  treatment  should 
be  effectual  in  the  course  of  several  months 
to  a year  or  longer,  according  to  the  obsti- 
nancy  of  the  case. 

Treatment. — Attend  first  to  the  general 
health,  and  enjoin  the  observance  of  a cor- 
rect hygienic  regimen,  e.g.,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  a 
daily  morning  warm  bath  before  breakfast, 
in  a warm  room,  followed  by  a cool  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
early  rising,  rest  before  and  after  meals,  a 
plain  but  nutritious  diet,  abstinence  from 
tea,  coffee,  alcohol,  and  tobacco,  and  regu- 
lation of  the  bowels.  The  dietetic  treatment 
is,  in  principle,  the  same  as  that  of  Gastritis, 
Chronic  (Part  1).  As  tonics,  one  may  con- 
sider the  use  of  stomachic  bitters,  such  as 
nux  vomica,  Blaud’s  pills,  elixir  ferri,  quininae, 
et  strychninae  phosphati,  Fowler’s  solution, 
and  codliver  oil.  Calcium  sulphide,  ichthyol, 
and  brewer’s  yeast  have  their  advocates 
(see  Part  11,  Drugs).  Saline  laxatives  are 
often  indicated,  and  it  is  well  to  prescribe  a 
glassful  of  Vichy,  or  of  hot  water  containing 
about  one-quarter  teaspoonful  of  sodium 
bicarbonate,  one-half  to  one  hour  before 
meals  and  also  between  meals. 

Remove  all  comedones  or  blackheads  by 
lateral  pressure  with  the  thumb-nails,  or 
with  a watch-key-like  instrument,  a comedo- 
extractor,  or  the  back  of  a broad  dermal 
curette.  Evacuate  all  pustules  and  touch 
the  base  with  carbolic  acid  or  alcohol  on  a fine 
probe.  Instruct  the  patient  to  wash  the  parts 
each  night  with  tincture  of  green  soap 
and  hot  water,  then  steam  or  sponge  with 
very  hot  water  for  five  to  ten  minutes,  then 
massage  with  a one-inch  cupping  glass,  wash 
and  rinse  again,  dash  with  cold  water,  wipe 
dry,  and  finally  apply  one  of  the  following 
medicaments,  which  should  be  allowed  to 
dry  on  the  face  and  be  washed  off  in  the 
morning  with  warm  water: 


Calcis 5 

Sulphuris  sublimati 5i 

Aquae  destillatae Sx 


M.  Boil  down  to  six  ounces  and  filter. 

Sig. — Dilute  at  first  with  about  ten  parts  of 
water,  and  bathe  the  skin  for  five  to  ten  minutes. 
Increase  the  strength  gradually  every  few  rughts, 
with  the  purpose  of  producing  some  irritation. — 
Liquor  calcis  sulphurate  or  Vleminckx’s  solution. 


ACTINOMYCOSIS 


Zinci  sulphatis, 

Potassii  sulphureti,  aa 3ss-iv 

Glycerini neiv-viii 

Aquai §iv 


M.  Sig. — Apply  two  or  three  times  daily? 
beginning  with  the  weaker  solution  and  gradually 
increasing  the  strength  until  some  irritation  and 
desquamation  are  produced.  (Lotio  alba.) 

Hydrargyri  bichloridi,  1 : 500 giv 

Sig. — Dilute  at  first  with  three  or  four  parts  of 
water,  and  gradually  increase  to  full  strength,  with 
the  object  of  producing  some  irritation. 

Do  not  employ  mercury  preparations 
too  soon  after  those  of  sulphur,  to  avoid 
the  formation  of  black  comedones  of  mer- 
curic sulphide. 


Sulphuris  praccipitati 3i-ii 

Adipis  benzoinati 5 i 

M.  Sig. — Apply  at  night  and  wash  off  in  the 
morning. 

Sulphuris  prsDcipitati 5ss-ii 

Ichthyohs 3i~ii 

Adipis  vel  petrolati  mollis 5 i 


In  extremely  sluggish  cases,  Stelwagon 
recommends  the  addition  to  each  ounce  of 
ointment  of  sapo  viridis,  3i“ih  or  salicylic 
acid,  gr.  x-xx.  Should  the  sulphur  prepara- 
tions be  without  effect,  he  advises  one  to 
wait  several  days,  and  then  prescribe  the 
following  two  preparations  alternately,  viz., 


Hydrargyri  chloridi  corrosivi.  . . gr.  ii-xii 

Zinci  sulphatis gr.  xx 

Tincturae  benzoini 3ii  i 

Aquae,  q.s.,  ad Siv 

Misce  et  filtra.  Sig. — Apply  three  times  daily. 

Hydrargyri  ammoniati gr.  xv-xlviii 

Petrolati 5 i 


M.  Sig.— Apply  night  and  morning. 

When  irritation  or  scaliness  ensues,  inter- 
mit the  treatment,  and  apply  cold  cream 
for  a few  days. 

More  radical  methods  of  treatment  are 
with  peeling  pastes: 


Resorcinolis 5 ss  + 

Zinci  oxidi 5i 

Terrae  siliceae gr.  xii 

Adipis  benzoinati,  q.s.,  ad 5i 

(Stelwagon.) 

R Beta-naphtholis 5ss-ii 

Sulphuris  praecipitati 5iv 

Saponis  viridis, 

Unguenti  aquae  rosae,  aa 3h 

(Lassar.) 


Apply  the  paste  at  night,  and  leave  it  on 
for  ten  to  thirty  minutes,  or  until  burning 
begins;  then  wipe  it  off  with  a cloth  moist- 
ened with  olive  oil,  wash  with  soap  and  warm 
water,  dry,  and  apply  cold  cream.  Repeat 
this  every  night  or  two  or  three  times  daily 


until  desquamation  occurs.  Then  wait,  and 
resume  the  treatment  as  soon  as  the  des- 
quamation ceases.  The  patient  should 
remain  indoors  during  the  treatment. 

Salicylic  ionization  (see  Ionic  Medication 
in  Part  1)  is  recommended  by  some. 

Rontgentherapy,  however,  is  considered 
the  most  effectual  method  of  treatment. 
The  eyes,  eyebrows,  and  scalp  should  be 
protected  by  a thin  covering  of  tin  or  lead 
foil.  Pusey  gives  one  to  three  exposures  a 
week,  “ of  five  minutes  duration,  with  the 
wall  of  the  tube  at  a distance  of  six  inches 
from  the  surface,  and  with  only  enough 
X-rays  to  produce  a faint  green  glow  in  the 
tube,”  and  the  exposures  are  continued  until 
effectual  (see  also  under  Eczema).  The 
X-rays  shoiild  be  used  cautiously  so  as  to 
avoid  atrophy  and  consequent  wrinkling  of 
the  skin  and  also  burns.  (See  Rontgenology 
in  Part  1.) 

For  acne  of  the  trunk,  which  may  be  more 
energetically  treated  than  that  on  the  face, 
Stelwagon  recommends  the  application  of 
formaline  “ of  sufficient  strength  to  produce 
considerable  irritation,”  followed  by  boric 
acid  as  a dusting  powder.  The  undershirt 
should  be  frequently  boiled. 

In  regard  to  vaccine  therapy,  Haldin 
Davis  says:  “ Vaccines  are  chiefly  of  value 
as  an  adjunct  to  other  measures.  An  autog- 
enous acne  bacillus  vaccine  in  doses  of  five 
to  ten  millions  and  upwards,  administered 
every  ten  days,  when  the  comedo  is  the 
predominant  feature  of  the  case,  and  autog- 
enous staphylococcus  vaccine  beginning 
with  about  200  millions,  when  there  is  much 
pustulation,  is  sometimes  productive  of 
good  results.” 

Acnitis. — Gr.  aKvij  point  -|-  -trts  inflamma- 
tion. See  Acne  Varioliformis. 

Acrodynia;  Epidemic  Erythema. — Gr. 
axpov  extremity  fi-  68vvr]  pain;  eirL  on  -f 
people;  kpbO-qiia  redness.  A rare,  epidemic, 
afebrile,  probably  toxic  disease,  occurring 
usually  among  the  unhygienic,  and  char- 
acterized by  nausea,  vomiting,  diarrhoea, 
pain  in  the  extremities,  with  hyperaesthesia 
and  parsesthesia,  followed  by  anaesthesia, 
and  an  erythemato-vesiculo-bullous  rash, 
terminating  usually  in  recovery  within  one 
or  two  months. 

Treatment.— This  is  symptomatic.  Coun- 
ter-irritation over  the  spine  is  gener- 
ally advised. 

Actinomycosis. — Gr.  d/crfs  ray  fl-  p.vK-ris 
fungus.  An  uncommon,  subacute  or  chronic 
infectious  disease,  caused  by  the  strepto- 
thrix  actinomyces  (Gr.  (XTpeTTTos  twisted  -|- 
dpi^  hair)  or  ray  fungus,  and  transmitted  by 


ALOPECIA;  CALVITIES;  BALDNESS 


plants  or  infected  animals,  principally  cattle. 
It  affects  the  head,  neck,  skin,  thoracic 
viscera  or  abdominal  viscera,  and  is  char- 
a(!terized  by  lumpy,  granulomatous  swell- 
ings, which  tend  to  suppurate,  with  the 
formation  of  sinuses  or  fistula;,  in  the  dis- 
charge from  which  pinhead-sized,  sulphur 
yellow  granules  may  be  demonstrated. 
Examined  microscopically,  these  granules 
reveal  radiating  bulbous  threads  ami  spores. 

Prognosis.— Bad  in  brain,  pulmonary,  and 
intra-abdominal  cases;  good  in  skin  cases. 

Treatment. — Complete  or  as  nearly  com- 
plete excision  as  possible,  followed  by  the 
application  of  the  Paquelin  cautery  and 
packing  with  iodine  or  iodoform  gauze,  is 
the  best  mode  of  treatment.  If  this  is  not 
feasible,  lay  wide  open  all  abscesses,  sinuses, 
and  fistula;,  curette,  remove  affected  bone, 
irrigate  thoroughly  with  bichloride  solution, 
1 : 1000,  and  pat;k  with  gauze  moistened 
with  silver  nitrate,  10  per  cent.,  Lugol’s 
solution  iq.v.),  tincture  of  iodine,  potas- 
sium iodicle,  10  per  cent.,  corrosive  subli- 
mate, 1 : 1000,  copper  sulphate,  1 per  cent., 
or  iodoform  gauze.  The  thermocauteiy 
may  be  applied  after  curretting.  Unre- 
movable granulomata  may  be  injected, 
every  few  days,  with  carbolic  acid,  5 per 
cent.,  or  tincture  of  iodine,  16  minims,  or 
20  per  cent.,  silver  nitrate  solution,  16 
minims,  or  1 to  2 c.c.  of  potassium  or  sodium 
iodide  and  iodine,  aa  1 gram,  in  10  granis 
of  tUstilled  water.  The  X-rays  (q.v.)  are  well 
recommended  for  both  cutaneous  and 
visceral  cases.  Relapses  should  be 
attacked  promptly. 

Achninister  potassium  iodide  (q.v.  in  Part 
11)  internally  in  as  large  doses  as  can  be 
borne,  and  over  a long  period  of  time,  with 
intervals  of,  say,  four  or  five  days  rest  after 
each  week  of  medication.  Says  Ochsner,  90 
grs.,  in  half  a pint  of  milk  followed  by  a pint 
of  hot  water,  every  eight  hours,  for  four  days, 
repeated  several  times  after  a week’s  inter- 
mission, cures  where  smaller  doses  fail. 

Bevan  proposes  the  internal  administra- 
tion of  copper  sulphate  (q.v.),  gr.  34  to  34> 
increased,  if  necessary,  to  gr.  i,  in  pill  form, 
t.i.d.,  and  the  use  of  the  1 per  cent,  solu- 
tion locally. 

Arsenic  is  also  recommended.  “Foderlhas 
cured  six  patients  with  hypodermatic  injec- 
tions of  cacodylate  of  sodium,”  writes  Forch- 
heimer,  who  adds:  “ This  is  conveniently 
prescril)ed  as  a 10  j)er  cent,  aqueous  solution, 
of  Which  0.5  c.c. , or  minims  viiss,  containing 
0.05  gm.,  or  gr.  niay  be  given  as  an  initial 
dose,  the  dose  to  be  incn'ased  daily  until 
physiological  effects  are  produced;  in  some  in- 


stances as  much  as  1 gm.  or  gr.  xv  may  be 
ultimately  administered.”  This  drug,  it 
should  be  borne  in  mind,  has  caused  per- 
manent optic  atrophy. 

Oil  of  eucalyptus  (q.v.)  is  claimed  to 
have  cured  a case  of  pulmonary  actinomy- 
cosis (J.  H.  Wright).  In  pulmonaiy  cases, 
one  may  try  the  injection  into  the  lung,  at 
the  point  of  greatest  dulness,  of  a half  dram 
of  potassium  iodide  solution,  1 per  cent., 
every  third  day.  (Sawyers.) 

Abdominal  cases  may  require  operative 
interference;  free  incision,  curettage,  effain- 
age;  excision  if  feasible. 

Lingual  involvement  calls  for  excision. 

Brain  cases  should  be  trephined. 

Fresh  air  and  a liberal  diet  should  be 
prescribed,  and  all  carious  teeth  should  be 
treated  or  removed  and  the  sockets  treated. 

(Nocardiosis  is  a very  rare  disease, 
caused  by  organisms  resembling  the  actino- 
niyces  bovis,  ami  simidating  pulmonary 
tuberculosis  or  cutaneous  actinomycosis.) 

Aden  Ulcer. — L.  ul’cus,  ulcer.  See  Phage- 
ilena  Tropica. 

Adenoma  Sebaceum. — Gr.  abiiv  gland  -f- 
-<o/ua  tumor;  L.  sebae'eus,  pertaining  to 
sebum.  Hyperplasia  of  the  sebaceous  glands, 
limited  for  the  most  part  to  the  middle  two- 
thirds  of  the  face,  beginning  in  early  life, 
usually  in  the  mentally  defective,  and  char- 
acterized by  jjinhead  to  split-pea  sized, 
waxy  to  reddish,  firm,  convex,  telangiectatic 
papules  imbedded  in  the  skin. 

Treatment.— Remove  each  lesion  by  electrol- 
ysis, the  knife,  curette,  or  galvanocautery. 
In  employing  electrolysis,  introduce  the 
needle,  attached  to  the  negative  pole,  into 
the  centre  of  the  growth,  and  allow  a cur- 
rent of  three  or  four  milliamperes  to  act  for 
five  to  thirty  seconds,  or  until  “ distinct 
blanching  enlarging  to  the  size  of  a small 
pea  ” occurs.  (Stel wagon). 

Ainhum  (African). — A disease  of  dark- 
skinned  races  of  warm  countries,  character- 
ized by  the  gradual  spontaneous  amputation 
of  one  or  more  of  the  toes  or  fingers,  usually 
the  little  toe. 

Treatment.— Divide  the  constricting  band 
freely,  if  there  is  any  possibility  of  saving 
the  toe;  otherwise  amputate  the  toe. 

Albinism. — L.  alb'us,  white.  Albinism  or 
congenital  leucoderma  is  the  congenital 
absence,  partial  or  complete,  of  the  pigment 
of  the  skin.  There  is  no  treatment. 

Aleppo  Boil. — See  Oriental  Sore. 

Alopecia;  Calvities;  Baldness. — Gr. 
aXwTTT?!  fox;  L.  calvi’ties,  baklness.  Baldness 
may  be  conveniently  dividetl  into  four  cate- 
gories: (1)  congenital  aloix;cia;  (2)  senile 


ALOPECIA  SEBORRHCEICA 


alopecia;  (3)  premature,  simple,  idiopathic 
or  symptomatic. alopecia,  inclutling  the  com- 
mon alopecia  seborrheica  {q.v.)]  and  (4) 
alopecia  areata  {q.v.) 

Alopecia  prematura  symptomatica  has  a 
varied  etiology,  viz.,  fevers  (typhoid  fever, 
secondary  syphilis,  etc.),  cachexias  (tubercu- 
losis, leprosy,  diabetes  mellitus,  myxoedema, 
or  hypothyroidism,  etc.),  chronic  eczema, 
psoriasis,  erysipelas,  lupus  erythematosus, 
folliculitis  decalvans,  tinea  or  ringworm, 
favus,  morphoea,  late  atrophic  or  ulcerative 
syphilodermata,  confluent  smallpox,  derma- 
titis seborrhoica  (the  commonest  cause  of 
baldness),  thallimn  acetate  administered 
for  excessive  sweating  in  tuberculosis, 
possibly  heredity. 

The  treatment  depends  upon  the  cause 
{q.v.,  in  its  appropriate  alphabetical  place). 

Alopecia  Areata. — Gr.  dXwTTTj^  fox;  bald- 
ness; L.  ar'ea,  a limited  space.  Alopecia 
areata  is  characterized  by  one  or  several, 
usually  sharply  circumscribed,  asymmetri- 
cally situated  patches  of  complete  baldness, 
“ unattended  by  any  apparent  alteration  in 
the  skin.”  There  are  recognized  a tropho- 
neurotic form  associated  with  trigeminal 
neuralgia,  worry,  anxiety,  nervous  shock, 
influenza,  leucodermia,  congenital  syphilis, 
tuberculosis,  the  menopause,  etc.,  and  a 
parasitic,  contagious  form,  the  so-called  true 
alopecia  areata,  with  the  marginal  diseased 
hairs  shaped  like  an  exclamation  point. 

Prognosis. — In  those  under  thirty,  and  in 
those  not  over  forty  or  forty-five  where  but 
several  patches  are  present,  the  outlook  is 
favorable.  In  the  generalized  cases  the 
prognosis  is  not  so  good.  If  no  downy 
growth  appears  in  the  course  of  a few 
months,  the  outlook  is  not  very  promising. 

Treatment.— Rub  into  the  skin,  over  an 
area  of  one  or  two  inches,  and  about  one- 
half  inch  beyond  the  border  of  the  patch, 
by  means  of  a cotton-tipped  matchstick, 
pure  liquid  carbolic  acid,  which,  in  children 
or  those  of  sensitive  skin,  or  upon  other  parts 
than  the  scalp,  may  be  cUluted  with  an  equal 
quantity  of  glycerine  or  alcohol.  Repeat 
the  application  at  intervals  of  a few  days. 

Instead  of  carbolic  acid,  one  may  use 
chrysarobin,  3i,  in  petrolatum,  §i,  which 
should  be  rubbed  in  energetically  night  and 
morning;  or  a saturated  solution  of  chrysa- 
robin in  chloroform  may  be  painted  on,  and 
the  resulting  film  covered  with  several  coat- 
ings of  flexible  collodion.  One  must  caution 
the  patient  against  carrying  the  chrysarobin 
to  the  eyes  and  clothing,  and  also  warn  him 
of  the  possible  occurrence  of  a 
general  erjdhema. 


Pilocarpine  {q.v.  in  Part  11)  is  recom- 
mended. 

As  a precaution  against  autoinfection  it  is 
well  to  bathe  the  whole  scalp  occasionally 
with,  say,  bichloride  of  mercury,  gr.  vus.s-xv, 
or  formaline,  3i~iii;  to  the  pint  of  alcohol 
(Pusey),  with  a shampoo  about  once  a week; 
and,  since  the  disease  is  sometimes  endemic, 
precaution  should  be  taken  against  its  chs- 
semination  by  means  of  combs,  hats,  etc. 

For  debility,  prescribe  codliver  oil,  together 
with  iron,  or  arsenic  (see  Part  11).  Enjoin 
an  outdoor  life,  free  from  worry.  Dental 
caries,  visual  and  other  defects  shoiild  re- 
ceive attention. 

Alopecia,  Cicatricial.  L.  cica'trix,  scar. 
See  Folliculitis  Decalvans. 

Idiopathica. — Gr.  Ulos  own  + irados  dis- 
ease. See  Alopecia. 

Alopecia  Seborrhoeica. — Gr.  aXuirri^  fox; 
L.  se'hum,  suet  -f-  Gr.  poia  flow.  This  is  the 
commonest  form  of  baldness.  It  is  associ- 
ated with  scaling  or  dandruff  and  hyper- 
secretion of  sebum  (seborrhoeic  dermatitis). 

Prognosis. — Further  loss  of  hair  may  be  pre- 
vented by  persistent  treatment;  and  if  the 
condition  has  not  been  too  long  neglected,  a 
regrowth  of  hair  may  occur. 

Treatment. — Rub  thoroughly  into  the  scalp 
every  night,  or  every  other  night,  or  less 
often,  as  deemed  requisite,  one  of  the  oint- 
ments given  below.  The  inunction  is  best 
performed  by  another  person,  and  should  be 
accompanied  by  vigorous  pinching  and  rub- 
bing of  the  scalp.  A cloth  may  then  be 
pinned  or  tied  about  the  head  in  the  form 
of  a nightcap.  In  the  morning,  shampoo 
the  head  thoroughly  with  hot  water  and 
castile  soap,  or  tar  soap,  or  tincture  of 
green  soap,  or  any  land  of  soap,  using  a 
hand-brush  if  desired,  rinse  and  dry  thor- 
oughly with  a clean  towel.  During  the  day, 
one  of  the  lotions  given  below  may  be 
applied,  with  flannel  or  sponge,  to  the  scalp : 


R Unguenti  hydrargyri  nitratis . . . . oi~iv 

Olei  cadini 3i 

Olei  olivaj 3ii 

Adipis  lanai  hydrosi  vcl  petrolati  3iv 

(Stelwagon.) 

Acidi  salicylic! gr.  x-xxx 

Sulphuris  pruicipitati 3 i-ii 

Petrolati  mollis,  q.s.,  ad 5i 

R Hydrargyri  chloridi  corrosivi ....  gr.  viiss 

Alcoholis (Ji-5iv 

(Solution,  1 : 1000  to  1 : 2.'50) 

R Formalin 3i~iii 

Alcoholis Oi 

R Resorcinolis 3i-ijrtii 

Acidi  salicylici.  3|“ii 

Alcoholis  seu  spiritus  myrcite  ...  5iv 


ANGIONEUROTIC  (EDEMA;  GIANT  URTICARIA 


Resorcinolis 3i-ii 

Olei  ricini 3ss 

Olei  tiglii i^jiv-xx 

Acidi  carbolici gr.  xx-xl 

Alcoholis  seu  spiritus  myrcia).  . . giv 


(S  tel  wagon.) 

In  those  of  white  or  gray  hair,  resorcin 
should  be  applied  only  to  the  scalp,  since  it 
may  unpart  a dirty  yellowish  tinge  to  the 
hair.  Croton  oil  should  be  used  very  cau- 
tiously, since  it  is  apt  to  produce  vesication. 


Tincturse  cantharidis 5ii“iv 

Tinctura;  cap.sici 3iv-viii 

AlcohoHs,  q.s.,  ad 5iv 

Pilocarpinse gr.  xx-xl 

Alcohol’s §iv 


Edgar  says:  “ AVhen  there  is  no  dandruff, 
pilocarpine  is  incomparably  the  best  rem- 
edy, thoroughly  rubbed  into  the  scalp 
every  day.” 

If  the  lotions  are  too  drying,  rub  a little 
almond  oil,  cold  cream,  or  vaseline  into  the 
scalp.  Should  irritation  or  soreness  super- 
vene in  the  coinrse  of  the  treatment,  intermit 
the  latter. 

After  an  apparent  cure,  occasional  use  of 
the  lotions  should  be  continued  indefinitely. 

Zinc  ionization  (see  Ionic  Medicine  in 
Part  1)  is  recommended. 

Treat  the  patient  constitutionally  as  indi- 
cated. Arsenic  may  be  given  for  a long 
period.  Sulphur  and  pilocarpine  may  be 
of  benefit  (see  Drugs,  Part  11). 

The  above  treatment  presupposes  that 
the  disease  is  due  to  a microorganism  residing 
deep  within  the  hair  follicles.  On  beginning 
the  treatment,  therefore,  the  patient  should 
buy  a new  hat.  After  each  shampoo  he 
should  go  over  that  part  of  the  inside  of  the 
hat  which  comes  in  contact  with  the  head 
with  alcohol,  ether,  or  chloroform.  He 
should,  after  each  shampoo,  boil  or  scrub 
with  soap  and  hot  water  his  brush  and 
comb,  and  he  should  carry  his  own  brush 
and  comb  with  him  in  barber  shops. 

Alopecia  Simplex  seu  Idiopathica. — L. 
sim’plex,  simple;  Gr.  Ulos  own  fi-  n-ados  dis- 
ease. Many  cases  of  so-called  simple  or 
idiopathic  alopecia  are  really  alopecia  sebor- 
rhoeica  (q.v.,  above).  The  treatment  is 
perhaps  the  same.  Pilocarpine  is  espe- 
cially indicated. 

Anal  Pruritis. — See  under  Pruritus. 

Anaphylaxis;  Anaphylactic  Shock. — See 
Part  i. 

Anatomic  Tubercle;  Verruca  Necrogen= 
ica;  Post  Mortem  Wart. — Gr.  av6.  apart  + 
Te^veLv  to  cut;  L.  tuber' culum,  nodule.  See 
Tuberculosis  Cutis. 


Angiokeratoma. — Gr.  ayyelov  vessel  + 
Kepas  horn  -|-  -copa  tumor.  A rare  affection, 
characterized  by  the  occurrence  on  the 
extremities  of  persons,  usually  children, 
with  a chilblain  circulation,  of  small,  wart- 
like excrescences  situated  upon  a purple, 
vascular  or  telangiectatic  base  (so-called 
telangiectatic  warts). 

Treatment. — Destroy  each  lesion  with  the 
galvanocautery  or  by  electrolysis.  Insert 
the  needle,  attached  to  the  negative  pole, 
into  the  base  of  the  lesion  and  employ  a 
current  of  two  to  five  milliamperes  for 
several  to  thirty  seconds,  or  until  pro- 
nounced blanching  occurs.  For  the  correc- 
tion of  the  underlying  vascular  atonicity, 
prescribe  adequate  hand  and  foot  covering 
in  cold  weather,  active  exercise,  fresh  air 
day  and  night,  a daily  morning  warm  bath 
before  breakfast,  in  a warm  room,  followed 
by  a cold  spinal  douche  and  brisk  rubdown 
with  a coarse  towel,  regular  hours  of  eating 
and  sleeping,  nutritious  food,  tonics,  rest 
before  and  after  meals,  and  regulation  of 
the  bowels. 

Angioma. — Gr.  ayytiov  vessel  -f-  -co/ia 
tmnor.  See  Nsevus  Vasculosus,  Telan- 
giectasis, and  the  following. 

Angioma  Cavernosum. — ^See  Naevus 
Vasculosus. 

Angioma  Serpiginosum. — Gr.  dyyeto;' ves- 
sel -f  -wyLia  tumor;  L.  ser'pere,  to  creep.  A 
very  rare  disease  of  infancy  and  early  child- 
hood, characterized  by  the  occurrence  of 
roundish  patches  of  minute,  red,  vascular 
points,  like  grains  of  cayenne  pepper,  which 
slowly  and  persistently  spread  peripherally 
with  central  clearing. 

Treatment.— Excision  and  cauterization 

have  been  unsuccessful.  Crocker  suggests 
the  employment  of  electrolysis  (see  under 
Acne  Rosacea)  along  the  border  of  the 
affected  area,  with  the  object  of  producing 
occlusion  of  as  many  vessels  as  possible. 

Angioneurotic  (Edema;  Giant  Urticaria. — 
Gr.  ayyetov  vessel  -}-  vevpov  nerve;  oLSrjpa 
swelling;  L.  urtic'a,  nettle.  A disease  re- 
lated, apparently,  to  urticaria  and  to  pur- 
pura, characterized  by  recurrent,  sudden, 
more  or  less  transient,  circumscribed,  white, 
oedematous  swellings,  occurring  usually  on 
the  face,  hands,  and  genitalia,  but  some- 
times affecting  the  legs,  pharj'nx,  tongue, 
larynx,  gastro-intestinal  tract,  etc.,  each 
attack  lasting  from  a few  hours  to  one  or 
two  days.  Colicky  pains,  nausea  and  vomit- 
ing may  accompany  the  attacks.  Fatal 
oedema  of  the  larynx  has  occurred. 

One  should  bear  in  mind  that  transitory 
swellings  occur  in  exophthalmic  goitre,  myx- 


ANTHRAX 


oedema,  and  organic  nervous  diseases,  e.g., 
tabes,  syringomyelia,  and  tumors  of  the  cord. 

Etiology.— Heredity  and  neurasthenia  are 
factors.  Nervous  fatigue,  emotional  dis- 
turbances, exposure  to  cold,  and  rarely  the 
diet  (coffee,  tea,  strawberries,  excessive 
meat)  are  provocative  influences.  Sensiti- 
zation to  certain  foreign  proteins,  e.g.,  egg 
white,  horse  dandruff,  pollen,  etc.,  may 
possibly  be  causative. 

Treatment.— During  an  attack,  administer 
saline  laxatives  (q.v.),  and  put  the  patient 
on  a barley  and  broth  diet  for  two  or  three 
days.  Calcium  lactate,  chloride,  or  bromide 
{q.v.  in  Part  11  )is  recommended.  For  colicky 
pains,  apply  a hot  water  bag  to  the  abdomen 
and  administer  a diffusible  stimulant,  such 
as  the  following: 

Spiritus  ammonise  aromatici, 

Spiritus  chloroformi, 

Syrupi  zingiberis, 

Tincturse  lavandula)  compositae,  aa. . 5ss 

M.  Sig. — One  or  two  teaspoonfuls  in  a glassful  of 
hot  water. 

Morphine  is  sometimes  required.  In 
great  oedema  of  the  tongue,  paint  the  tongue 
with  cocaine  solution,  5 per  cent.,  or  adrena- 
lin, 1 : 1000,  and  if  necessary,  make  several 
needle  punctures,  or  apply  leeches.  In 
oedema  of  the  larynx,  spray  the  latter  with 
cocaine,  2 per  cent.,  in  adrenalin,  1 : 2000; 
and  if  necessary,  make  multiple  punctures 
into  the  oedematous  tissues  (previously 
cocainized)  with  a laryngeal  lancet,  by  the 
aid  of  a laryngeal  mirror  and  reflected  light, 
with  the  tongue  pulled  forward  by  the 
patient.  The  application  of  ice  is  contra- 
indicated. If  these  measures  are  unsuccess- 
ful, perform  tracheotomy  or  intubation 
without  delay  (see  Part  1,  under  Diph- 
theria). 

Prescribe  an  invigorating  hygienic  regi- 
men, adequate  rest  and  exercise,  fresh  air 
day  and  night,  a daily  morning  tepid  bath 
before  breakfast,  in  a warm  room,  followed 
by  a cold  spinal  douche  and  brisk  rubdown 
with  a coarse  towel,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals,  a 
well-balanced  diet,  regulation  of  the  bowels, 
and  perhaps  tonics.  Osier  recommends 
strychnine  in  large  doses  for  nervous  anaemic 
patients.  Quinine,  arsenic,  atropine,  the 
nitrites  (sodium  nitrite,  nitroglycerine, 
erythrol  tetranitrate,  mannitol  hexanitrate), 
and  calcium  salts  are  variously  recom- 
mended. (See  Part  11,  Drugs.)  The  dose 
of  the  nitrites  should  be  gradually  in- 
creased until  flushing  and  headache  occur; 
then,  after  a rest  of  five  days,  the  drug 
should  be  continued  over  a prolonged  period 


in  the  proper  physiological  dose  for  periods 
of  ten  days  alternating  with  intervals  of 
five  days.  (Osier.) 

Anhidrosis. — Gr.  av  priv.  -f  idpws  sweat. 
An  abnormal  or  pathological  diminution  or 
suppression  of  the  sweat  secretion. 

Anhidrosis  occurs  in  diabetes,  nephritis, 
fevers,  malnutrition,  insufficient  washing, 
and  in  the  affected  areas  in  ichthyosis, 
anaesthetic  leprosy,  scleroderma,  psoriasis, 
cheloid  growths,  nerve  injuries,  and  some- 
times eczema  and  pityriasis  rubra  pilaris. 

The  treatment  is  that  of  the  under- 
lying cause. 

Anthrax. — Gr.  av9 pa  ^ coal,  carbuncle.  An 
acute  infectious  and  contagious  disease, 
caused  by  the  bacillus  anthracis,  and  trans- 
mitted from  infected  cattle,  sheep,  and 
horses  to  man,  in  whom  it  occurs  in  three 
forms:  cutaneous  (malignant  pustule 

and  malignant  oedema),  pulmonary,  and 
gastrointestinal . 

Malignant  pustule  is  marked  by  the 
appearance  of  a red,  itching,  painless, 
inflammatory  papule,  which  soon  becomes  a 
sanguineous  vesicle,  which  within  thirty-six 
hours  is  replaced  by  a gangrenous  eschar 
surrounded  by  a border  of  vesicles  and 
marked  brawny  oedema.  Cover-slip  prep- 
arations and  cultures  should  be  made  from 
the  lesion  and  a mouse  or  guinea-pig  inocu- 
lated. By  animal  inoculation  the  diagnosis 
is  made  in  two  days. 

Malignant  oedema  is  characterized  by  a 
diffuse,  flat,  oedematous  swelling,  which  is 
comparatively  painless,  and  without  red- 
ness, vesiculation,  or  fever.  Gangrene,  how- 
ever, soon  follows,  with  severe  constitutional 
symptoms  and  death. 

The  gastro-intestinal  form  of  anthrax 
resembles  “ ptomaine  poisoning.” 

Both  the  pulmonary  and  intestinal  forms 
are  rapidly  fatal;  the  malignant  pustule  is 
the  least  fatal.  Serum  therapy,  however, 
has  improved  the  prognosis. 

Anthrax  occurs  among  veterinarians, 
stablemen,  farmers,  shepherds,  brush-mak- 
ers, leather  workers,  tanners,  felt-makers, 
mattress-makers,  wool-sorters,  horn-work- 
ers, rag-pickers,  knackers,  butchers, 
and  plasterers. 

Treatment. — In  cutaneous  cases,  excise  the 
lesion  at  once  well  beyond  its  border,  fol- 
lowed by  the  actual  cautery  or  thorough 
swabbing  of  the  wound  with  pure  carbolic 
acid  or  caustic  potash;  or  perhaps  better, 
destroy  the  lesion  thoroughly  with  the 
actual  cautery  without  previous  excision. 

If  excision  or  the  use  of  the  actual  cautery 
is  not  feasible,  inject  pure  carbolic  acid. 


BEE  STING 


which  is  said  to  be  less  dangerous  than  the 
solution,  beneath  and  all  around  the  lesion, 
and  repeat  the  injection  every  four  hours. 
The  affected  parts  should  be  kept  absolutely 
at  rest. 

Since  ipecac  is  highly  recommended  as  a 
specific,  the  powder  may  be  used  locally  as 
a dressing,  and  given  internally  in  doses  of 
five  to  ten  grains  every  three  or  four  hours 
(see  Part  11).  Quinine  {q.v.)  in  large 
doses  is  also  recommended. 

Anti-anthrax  serum  is  productive  of  very 
good  results,  and  should  be  used.  An 
initial  dose  of  80  to  100  c.c.,  divided  ’in 
three  or  four  portions,  may  be  injected 
under  the  skin  at  different  points,  or  better, 
administered  intravenously  {q.v.  in  Part  1), 
and  repeated  in  twenty-four  hours,  if  no 
improvement  is  noted.  Daily  injections 
may  have  to  be  administered.  In  severe 
cases,  100  c.c.  may  be  injected  several  times 
a day.  It  is  said  to  be  harmless,  but  for  the 
ether  it  contains  (see  Anaphylactic  Shock, 
in  Part  1.) 

An  abundance  of  concentrated  nutri- 
ment should  be  given,  and  also  stimulants 
when  required.  In  the  intestinal  form, 
active  purgation  may  be  practiced  in  the 
beginning,  as  some  recommend,  but  so  far  as 
cleansing  the  bowel  of  bacilli  is  concerned, 
it  would  seem  futile. 

Prophylaxis  embraces  cleanliness,  the  pro- 
tection of  sores,  the  wearing  of  respirators 
and  gloves,  the  disinfection  of  hides,  hair, 
and  rags,  the  cremation  or  deep  biuying  (six 
feet)  of  infected  animals,  which  should 
first  be  covered  with  lime  or  petroleum,  and 
the  yearly  immunization  of  animals  by 
vaccination  with  attenuated  cultures  of  the 
anthrax  germ.  All  the  bed-clothing,  towels, 
etc.,  used  on  the  patient,  should  be  burned; 
and  feeding  utensils,  etc.,  should  be  sub- 
jected to  a prolonged  high  temperature,  in 
order  to  destroy  spores. 

Ant  Sting  . — ^See  Bites. 

Anus,  Pruritus  of  the. — L.  See  under 
Pruritus. 

Argyria. — Gr.  apyvpos  silver.  A slaty  dis- 
coloration of  the  skin  resulting  from  the 
prolonged  or  free  internal  administration  of 
silver  preparations.  It  is  incurable. 

Atheroma. — Gr.  adijpr]  ix)rridge  -j-  -copa 
tumor.  See  Sebaceous  Cyst. 

Atrophia  Cutis. — L.;  Gr.  a priv.  -f  Tpo<pT] 
nutrition ; L.  cu'tis,  skin.  A.  Atrophia  Cutis 
Senilis. — Senile  atrophy  or  old  age  of  the  skin 
is  characterized  by  thinning  and  the  forma- 
tion of  pigmented  spots  and  patches,  which 
may  become  greasy,  crusted  or  scaly,  and 
thickened,  with  the  development  of  flat 


warts  (keratosis  senilis),  which  display  a 
tendency  to  epitheliomatous  degeneration. 

Treatment. — Enjoin  the  observance  of 
good  hygiene,  e.g.,  adequate  rest  and 
exercise,  fresh  air,  frequent  bathing,  light 
nutritious  food,  regular  hours  of  eating  and 
sleeping,  and  regulation  of  the  bowels.  A 
little  almond  oil,  cold  cream,  or  vaseline 
should  be  occasionally  applied  in  order  to 
counteract  scurfiness  and  dryness.  The  oil 
may  be  rubbed  in  every  night  and  washed 
off  with  soap  and  warm  water  in  the  morn- 
ing, and  then  reapplied,  if  required. 

For  the  seborrhceic  spots,  keratoses,  or 
warts,  one  may  rub  in  the  following  ointment 
every  night: 


II  Sulphuris  prajcipitati gr.  v-xxx-1 

Acidi  salicylic! gr.  iii-xxx 

Unguenti  aqua;  rosa; Sss 

(Stelwagon.) 


The  ointment  should  be  of  such  strength 
as  just  to  stop  short  of  causing  irritation. 
Sabouraud  recommends  the  following: 


II  Potassii  chloratis gr.  xxiv 

Sulphuris  prajcipitati gr.  xlviii 

Resorcin! gr.  xvi 

Petrolati 51 


If  the  flat  warts  resist  the  above  ointment, 
Sabouraud  destroys  them  by  painting  with 
chromic  acid  solution,  10  per  cent.,  up  to  the 
concentrated  solution. 

The  X-rays  and  radium  are  effectual  in 
removing  both  senile  keratoses  and  result- 
ing epitheliomata  (q.v.).  The  cautery  or 
excision  may  also  be  employed.  Haldin 
Davis  prefers  the  use  of  carbon  dioxide 
snow,  a pencil  of  the  snow  being  pressed 
firmly  on  the  wart  until  the  latter  is  frozen 
to  the  lyase. 

B.  Atrophia  Cutis  Universalis  (Diffusa  Idio» 
pathica).— This  affection  is  not  confined  to  old 
age.  The  treatment  embraces  good  hygiene, 
tonics  (iron;  arsenic;  codliver  oil;  see  Part 
11),  and  the  local  use  of  cold  cream  or 
almond  oil  to  reduce  the  drjmess  and  harsh- 
ness. A cure  is  not  to  be  expected. 

Atrophia  Unguium. — L.;  Gr.  a priv.  -f 
Tpo<^’7  nutrition;  L.  ung'uis,  nail.  See  Nail 
Diseases. 

Bagdad  Boil. — See  Oriental  Sore. 

Baldness. — See  Alopecia. 

Barber’s  Itch. — See  Tinea  Sycosis. 

Beaded  Hair. — See  INIonilethrix,  under 
Hair  Diseases. 

Bed=bug  Bites. — See  Bites. 

Bed=Sore ; Decubitus. — See  Part  1,  Gen- 
eral IVIedicine  and  Surgery. 

Bee  Sting. — See  Bites. 


BROMIDROSIS 


Birthmark. — See  Nfevus  Vasculosus. 

Biskra  Button. — See  Oriental  Sore. 

Bites. — Insect  bites  are  characterized 
by  an  inflammatory  wheal,  resembling 
that  of  urticaria,  but  showing  a central, 
reddish  punctum. 

For  bed-bug,  mosquito,  and  flea  bites, 
and  for  bee,  wasp,  spider,  ant,  or  cater- 
pillar stings,  use  a strong  sodium  bicar- 
bonate solution,  or  diluted  ammonia  water, 
or  spirits  of  camphor,  or  a 1 to  3 per  cent, 
menthol  lotion  or  ointment,  or  a 5 per 
cent,  ichthyol  lotion,  or  camphor-chloral 
iq.v.),  1 to  2 per  cent,  in  vaseline,  or  one 
of  the  following: 


R CalaminsD gr.  xl 

Zinci  oxidi gr.  Ixxx 

Acidi  borici 3 i 

Glyccrini igjii-viii 

Acidi  carbolici m;viii-xxx 

Liquoris  calcis 5i 

Aqute,  q.s.,  ad 5iv 


(Calamine  lotion.) 


b Thymolis gr.  iv-viii 

Glycerini 3i 

Alcoholis 5i 

Liquoris  potasssB 3ss 

Aquce,  q.s.,  ad giv 

(Stelwagon.) 

Camphor-chlorali, 

Acidi  carbolici,  aa gr.  xx-lvii 

Mentholis gr.  x.x-xl 

Extracti  hamamclidis  destillati, 

Alcoholis,  aa gii 

(Pusey.) 


For  infection  with  the  Harvest  Bug  (Lep- 
tus),  use  the  above  calamine  lotion,  or 
the  following: 


R Sulphuris  sublimati, 

Balsami  Peruvian!,  aa 3ii~vi 

Adipis  benzoinati, 

Petrolati,  aa,  q.s.,  ad 3iv 


The  Jigger,  Chigre  or  Chigo,  or  Sand- 
flea  (Pulex  penetrans)  is  killed  by  inunction 
with  carbolized  oil  or  kerosine,  say  3 per 
cent.  Extract  the  parasite  with  a blunt 
needle;  but  (Author?)  warns  against  rup- 
turing the  sac,  as  “ liberation  of  the  eggs 
may  set  up  serious  and  even  fatal  inflam- 
mation.” After  the  extraction  of  the  para- 
site, employ  the  carbolized  calamine  lotion 
given  above. 

As  a prevention  against  fleas,  one  may 
pin  on,  at  different  parts  of  the  underwear, 
several  small,  loosely  woven  bags  containing 
camphor,  menthol,  or  pyrethrum  powder. 
The  essential  oils,  oils  of  eucalyptus,  penny- 
royal, and  cassia,  are  also  used. 

Before  attempting  to  remove  a wood-tick, 
fir.st  kill  it  by  the  application  of  kerosene, 
turpentine,  an  essential  oil,  or  tobacco-juice. 


For  the  treatment  of  snake-bite,  see  Part  1, 
under  Poisoning:  II. 

Blackhead  or  Comedo. — L.  come'do,  black- 
head. See  Acne  Vulgaris. 

Black=Tongue.^ — See  Tongue  Diseases. 

Blastomycosis;  Oidiomycosis;  Saccharo= 
mycosis. — Gr.  jSXao-ros  germ  -f  huktis  fungus; 
MOV  egg;  aaKxapov  sugar.  A rare,  very 
chronic,  yeast-fungus  disease,  affecting  usu- 
ally the  skin,  sometimes  the  blood  and 
viscera,  and  characterized  by  one  or  more 
well-elevated,  warty  or  papillary,  or  fungat- 
ing lesions,  studded  with  miliary  abscesses, 
with  ultimate  ulceration  and  scarring. 

The  disease  may  resemble  lupus  ver- 
rucosus or  vulgaris,  mycosis  fungoides,  coc- 
cidial  granuloma,  sporotrichosis,  carcinoma, 
or  syphilis. 

The  blastomycetes  is  demonstrated  by 
smearing  some  of  the  pus  or  teased  tissue 
on  a slide,  covering  it  with  a 20  to  30  per 
cent,  solution  of  potassium  hydroxide  and  a 
coverglass,  and  examining  the  specimen 
after  ten  to  sixty  minutes. 

Pulmonary  cases  resemble  pulmonary 
tuberculosis;  general  systemic  cases  re- 
semble pyaemia. 

Prognosis.— In  skin  cases,  the  prognosis 
under  treatment  is  good;  but  recurrence  is 
frequent.  Systemic  infection  is  fatal. 

Treatment.— Administer  potassium  or  sod- 
ium iodide  in  gradually  increasing  doses,  up 
to  gr.  xx-xxx  t.i.d.,  continued  for  a num- 
ber of  months,  with  intermissions  of,  say, 
four  or  five  days  after  each  week  of  medi- 
cation. See  Part  11. 

Employ  antiseptics  locally,  followed,  say, 
by  ichthyol  ointment  (q.v.).  Curettage  is 
perhaps  inadvisable,  owing  to  the  danger  of 
disseminating  the  disease. 

If  potassium  iodide  fails,  one  may  resort 
to  the  actual  cautery,  or  to  a wide  and  deep 
dissection,  followed  by  skin  grafting  (Walker 
and  Montgomery).  Bevan  suggests  the 
internal  administration  of  copper  sulphate, 
gr.  34,  increased  to  gr.  ss-i,  t.i.d.,  and  the 
local  use  of  a 1 per  cent,  copper  sulphate 
wash.  Copper  sulphate  should  be  tried  in 
systemic  cases,  since  the  iodides  have 
proved  ineffectual  in  these  cases. 

Boil. — See  Furunculus. 

Bromidrosis. — Gr.  /3pw^ios  stench  -|-  iSpcos 
sweat.  Stinking  sweat  may  be  general 
or  local. 

Etiology.— General  bromidrosis  may  occur 
in  rheumatic  fever,  smallpox,  cholera,  ty- 
phoid fever,  syphilis,  tuberculosis,  uraemia, 
anaemia,  scurvy,  nervous  conditions,  and 
after  the  ingestion  of  onions,  garlic,  asafoet- 
ida,  sulphur,  copaiba,  benzoic  acid,  musk,  etc. 


BURNS 


Local  bromidrosis  is  usually  an  accom- 
paniment of  hyperidrosis  {q.v.),  and  is  the 
result  of  bacterial  decomposition  of  the 
sweat. 

Prognosis. — The  treatment  of  stinking  feet 
is  always  beneficial  and  usually  curative,  if 
the  disease  is  acquired  and  not  of  too 
long  standing. 

Treatment. — Scrub  the  feet  thoroughly, 
twice  daily,  with  soap  and  hot  water,  rinse, 
bathe  in  an  antiseptic  solution,  such  as 
bichloride,  1 : 2000  to  1000,  or  formaline, 
1 ; 500  to  100,  or  potassium  permanganate, 
1 : 500  to  100,  or  boric  acid,  a heaping  table- 
spoonful to  the  pint,  or  alcohol,  full  strength 
or  diluted;  then  dry  the  feet  and  dust  them 
freely  with  boric  acid  powder,  to  which  may 
be  added  salicylic  acid,  gr.  xx-xlviii  to  the 
ounce,  or  else  anoint  them  with  salicylated 
lanolin  or  lard,  gr.  xiiad  5i-  Wear  a fresh 
pair  of  boiled  stockings  daily.  Shortly  after 
beginning  treatment,  buy  a new  pair  of 
easy-fitting  shoes,  and  keep  the  shoes  and 
stockings  dusted  with  boric  or  boric  and 
salicylic  powder.  It  is  well  to  change  and 
air  the  shoes  daily.  Hjnoeridrosis  {q.v.), 
should  receive  attention.  Sulphur  (see  Part 
11)  may  be  given  internally.  Prolonged 
standing  should  be  avoided. 

Bug=Bites. — See  Bites. 

Burns. — For  shock,  lower  the  head,  sur- 
round the  patient  with  hot  water  bottles 
wrapped  in  towels,  placed  near  but  not  in 
contact  with  the  skin,  and  observe  absolute 
quiet.  Administer  hot  norm,al  saline  solu- 
tion (gr.  xlvi  to  the  pint;  temp.  102°  F.) 
subcutaneously  very  slowly,  no  more  than 
a pint  at  a time,  according  to  Crile,  to  avoid 
pulmonary  oedema,  and  repeat  every  hour 
until  the  pulse  is  restored.  Gum-salt  solu- 
tion {q.v.  in  Part  11)  is  better.  Brandy, 
digitalin,  strychnine,  camphor,  atropine, 
caffeine,  and  pituitrin  may  be  of  some  service, 
especially  the  latter.  (See  Drugs,  Part  11). 
Morphine,  gr.  }/^  to  34;  is  of  value.  Matas 
injects  slowly  into  the  rectum — black  coffee, 
8 ounces,  panopepton,  1 ounce,  brandy  or 
whiskey,  1 ounce,  tincture  of  digitalis,  15 
minims,  and  laudanum,  10  minims,  which 
may  be  repeated  after  two  hours,  if  neces- 
sary. Anders’  favorite  formula  for  shock  is: 

li  Adrcnalini  chloridi  (1 : 1000) . . ('liv) 


Morphinse  hydrochloridi gr- 

Nitroglycerini  gr.  Mo 

Atropinae  sulphatis gr.  Mo 


If  respiration  ceases,  perform  rhydhmic 
thoracic  compression  (see  Asphyxia,  in 
Part  1),  with  the  head  low  and  the  tongue 
pulled  forward,  but  not  too  far.  The  con- 


tinuous hot-bath  is  recommended  for  the 
relief  of  pain  and  shock. 

A.  Former  Local  Treatment. — (a)  FiRST  DE- 
GREE Burn  or  Simple  Erythema. — Apply 
sterile  vaseline,  or  carron  oil  {q.v.),  or 
boric  acid,  talcum,  bismuth,  alum,  or  sodium 
bicarbonate  powder,  or,  for  pain,  one  of  the 
following  cold  solutions,  viz.,  sodium  bicar- 
bonate, gr.v-j- to  the  ounce;  boric  acid,  gr.v-t- 
to  the  ounce;  aluminum  subacetate,  gr.  x- 
XXV to  the  ounce;  Goulard’s  lead  lotion,  about 
half  strength;  picric  acid,  1 per  cent.  The 
lead  solution  or  picric  acid  should  not,  how- 
ever, be  applied  to  a large  surface,  for  fear 
of  ab.sorption. 

(b)  Second  Degree  Burn,  Showing 
Blebs. — Puncture  and  evacuate  the  blebs, 
and  apply  sterile  vaseline,  or  Squibb’s  com- 
pound alum  powder,  or  finely  powdered 
boric  acid,  or  silver  foil,  or  any  of  the  above 
powders  or  lotions.  Renew  the  dressing 
once  or  twice  daily. 

(c)  Third  Degree  Burn,  with  Skin 
Destruction  and  Sloughing.  Prolonged 
immersion  in  a hot  bath  may  be  employed 
at  first.  All  destroyed  tissue  that  is  not 
firmly  adherent  should  be  removed  and  the 
wound  treated  antiseptically  by  means  of 
powders  or  solutions.  Bichloride,  1 : 2000, 
may  be  used  in  the  presence  of  pus  and  a 
temperature.  Balsam  of  Peru  and  castor 
oil,  equal  parts,  is  of  service.  It  is  often 
advantageous  during  the  healing  process,  to 
alternate  the  application  of  finely  powdered 
boric  acid  with  boric  ointment,  10  per  cent., 
in  sterile  vaseline,  employing  the  powder  to 
suppress  the  exuberant  granulations  caused 
by  the  ointment.  If  flexor  surfaces  are 
involved,  the  parts  should  be  kept  extended 
to  prevent  flexion  deformity.  Thiersch 
grafts  may  be  later  required.  Early  passive 
and  active  motion  should  be  resorted  to. 

B.  Newer  Local  Treatment.  — Puncture  and 
evacuate  all  large  blisters,  cleanse  the  wound 
with  a mild  antiseptic  solution,  and  dry 
thoroughly  by  means  of  hot  pads  of  sterile 
gauze  or  lint,  aided  by  gentle  fanning.  Then 
apply  hot  (135°  to  145°  F.)  melted  paraffin 
wax,suchas  theStanolind  Surgical  Waxwhich 
is  declared  to  be  of  the  proper  melting  point, 
ductility,  and  plasticity.  The  melted  wax 
is  very  gently  “ patted,”  not  painted,  on  the 
wound  with  a fine,  one  or  two  inch,  camel’s- 
hair  varnish  brush,  and  is  carried  for  half  an 
inch  or  more  over  the  surrounding  healthy 
skin.  After  the  first  film  is  formed,  paint 
on  a fairly  heavy  coating  of  wax,  and  cover 
this  with  a snug  dressing  of  gauze  held  in 
place  by  a bandage. 

Redress  the  wound  once  daily  until  heal- 


CARBUNCLE 


ing  begins,  then  every  third  day.  In  remov- 
ing the  wax  dressing,  slit  it  through  with 
sharp  scissors,  avoiding  the  denuded  area, 
and  after  loosening  it  from  the  intact  skin, 
roll  it  back  and  remove  it  from  the  wound, 
from  which  it  is  separated  readily.  At  each 
dressing  all  easily  detachable  dead  tissue 
should  be  removed,  and  the  wound  flooded 
with  an  antiseptic  solution.  Bleeding  should 
be  strictly  avoided,  and  wiping  of  the 
wound,  therefore,  refrained  from. 

In  preparing  the  wax,  melt  it  in  a per- 
fectly dry,  covered  pot  over  a water  bath 
(preferably  a melted  sodium  acetate  bath), 
the  water  being  kept  boiling  until  the  wax 
is  entirely  -«ielted  and  has  reached  a temper- 
ature of  135°  to  145°  F.  No  water  should  be 
be  allowed  to  splash  into  the  melted  wax. 
(Frank  R.  Morton.) 

C.  Another  new  method  of  treating  burns 
is  by  means  of  dichloramine-T,  2 per  cent. 
(See  Part  11),  with  paresine-net  covering 
which  should  be  laid  on  very  smoothly  and 
changed  daily;  all  dead  tissue  to  be  removed 
gi-adually.  Burns  arc  best  exposed  to  the 
air  under  a blanket  or  tent  containing  elec- 
tric bulbs  or  other  device  to  prevent  irradi- 
ation of  the  body  heat. 

Paraffin  mesh  is  prepared  as  follows : 
Ordinary  large  mesh  (about  inch)  fly 
netting  may  be  used,  cut  into  4xG  inch  strips, 
and  sterilized  in  linen  wrappers.  Paraffin 
melting  at  45°C.  (paresine,  ambrine,  paraffin 
wax)  is  sterilized  over  boiling  water  for  at 
least  one-half  hom-.  One  end  of  the  netting 
is  grasped  with  forceps  and  the  netting 
dipped  into  the  melted  paraffin  over  a water 
bath.  It  is  then  suspended  until  it  drips 
clear;  or  a rubber  bulb  syringe  may  be  used  to 
blow  the  meshes  clear.  The  paraffin  hardens 
when  exposed  to  the  air.  The  hardened 
strips  should  be  placed  in  sterile  wrappers. 

Butterfly  Disease. — (See  Lupus  Erythe- 
matosus.) 

Callositas;  Callus.^ — L.,  callosity,  from 
cal'lus,  insensibility.  To  remove  callus,  (1) 
.soak  the  parts  for  half  an  hour  in  hot  soap- 
suds or  in  hot  water  containing  from  one- 
half  to  one  ounce  to  the  gallon  of  sodium 
carbonate,  bicarbonate  or  borate,  or  potas- 
sium carbonate,  and  then  pare  off  the  callus; 
or  (2)  dissolve  the  callus  gradually  by  paint- 
ing on  cautiously  every  few  minutes  a 10  to 
30  per  cent,  solution  of  caustic  potash  or 
pure  lactic  acid;  or  (3)  .soak  the  parts  in 
warm  oil,  followed  by  the  application  of  oil- 
soaked  flannel  during  the  night  (Hyde  and 
Montgomery) ; or  (4)  first  pare  off  the  callus, 
then  apply  for  several  days  or  a week  a 10 
to  25  per  cent,  salicylic  acid  rubber  plaster 
37 


or  plaster-mull,  or  a 10  per  cent,  solution 
in  flexible  collodion  or  in  ether  to  which 
a little  fat  is  added,  then  soak  the  parts  in  hot 
water  and  peel  or  scrape  off  the  softened 
mass.  (Stelwagon.) 

The  modified  papillary  layer  beneath  the 
callus  may  be  touched  with  the  Paquelin 
cautery  so  as  to  destroy  it.  (Crocker.) 

In  intractable  cases  associated  with  hyper- 
idrosis,  the  X-rays  {q.v.  in  Part  1)  should 
be  cautiously  applied  daily  until  the  hyperi- 
drosis  ceases  and  the  callosity  disappears. 

In  callosity  of  the  nail  matrix,  split  the 
nail  or  avulse  it,  and  remove  the  callus. 

Calvities. — L.  baldness.  See  Alopecia, 

Cancer  of  the  Skin. — L.  can'cer,  crab. 
See  Carcinoma  Cutis. 

Canities. — L.  See  Grayness  of  the  Hair, 
under  Hair  Diseases. 

Carbuncle. — L.  carhun'culus,  little  coal. 
An  acute  inflammatory  lesion  of  the  skin, 
characterized  by  a circumscribed,  flattened, 
brawny,  indurated  swelling,  with  multiple 
cribriform  perforations  exuding  pus.  It 
occurs  usually  on  the  nape  of  the  neck  or 
the  upper  part  of  the  back. 

Ill  health  from  any  cause  and  diabetes 
predispose  to  the  disease.  It  is  serious  if 
not  well  treated. 

Treatment.— One  may  insert  into  all  the 
openings,  carbolic  acid  crystals  (Crocker), 
or  solid  cau.st.ic  potash  (Phillips).  The  lat- 
ter is  left  in  for  about  twenty-five  minutes, 
or  until  cauterization  is  thorough,  after 
which  the  cavities  are  syringed  with  a weak 
solution  of  acetic  acid,  to  neutralize  the 
alkali,  and  a wet  dressing  of  carbolic  acid, 
1 : 40,  or  2)/^  per  cent,  applied  (from  Pusey) . 
This  method  of  treatment  is  well  praised. 

In  the  early  or  spreading  stage,  one  may 
inject  pure  carbolic  acid  (said  to  be  less 
dangerous  than  the  solution)  subcutaneously 
all  around  the  carbuncle,  in  oi’der  to  check 
its  extension,  and  apply  hot  compresses  wet 
with  a 1 : 30  solution  over  it.  A cupping- 
glass  or  one  of  Bier’s  glas.ses  may  be  used  to 
draw  out  the  pus  and  detritus,  and  crystals 
of  carbolic  acid  may  be  pushed  into  all  the 
openings,  after  syringing  them  out  with  the 
carbolic  acid  lotion.  Ichthyol,  pure  or 
(hinted  with  two  or  three  parts  of  water, 
may  be  applied.  Swabbing  the  cavities 
with  a cotton-wound  toothpick  soaked  in 
alcohol  is  efficacious,  if  persisted  in. 

As  soon  as  softening  occurs,  a bold  deep 
crucial  incision  shouhl  be  made,  and  the 
ends  of  the  incision  carried  well  beyond  the 
limits  of  the  inflammation.  The  four  skin- 
flaps  are  lifted  up  and  separated  from  the 
underlying  tissues,  well  beyond  the  area  of 


CARCINOMA  CUTIS;  EPITHELIOMA 


inflammation  (Kanavel),  all  detachable 
necrotic  tissue  is  removed  with  forceps,  and 
the  resulting  cavity  thoroughly  irrigated 
with  carbolic  acid  lotion,  1 ; 40,  and  packed 
with  hot  moist  gauze  wet  with  boric  acid 
solution,  3v  ad  Oi,  or  with  ichthyol.  Re- 
dress the  wound  every  day  at  first  and  later 
less  often  until  healing  occurs. 

Ionic  medication  {q.v.)  is  recommended. 
A zinc  positive  needle  is  inserted  into  the 
openings,  and  a current  of  20  to  30  milliam- 
peres  employed  for  thirty  minutes. 

At  the  onset  of  the  disease,  the  bowels 
should  be  opened  with  calomel  and  salines, 
and  they  should  be  kept  active.  Nourish- 
ing liquid  food  should  be  administered. 
Stiychnine  may  be  required.  Quinine,  gr. 
v-x,  in  capsule,  every  four  hours,  is  recom- 
mended; also  tincture  ferri  chloridi,  pss, 
well  diluted,  t.i.d.p.c.  The  elixir  ferri, 
quinmse,  et  strychninai  phosphati,  oi~ii, 
well  diluted,  t.i.d.p.c.,  is  a useful  tonic  (for 
formuke,  etc.,  .see  Part  11).  A carbohydrate- 
poor  diet  may  prove  curative. 

Carcinoma  Cutis  ; Epithelioma. — Gr. 
KapKLvos  crab  -f  -co/za  tumor;  L.  cu'tis,  skin; 
671 1 on  + dr]\7]  nipple.  Cancer  of  the  skin  is 
either  primary  or  metastatic.  It  begins  as 
a small,  superficial,  indurated  plaque  or 
tubercle,  or  as  a deep,  hard,  subcutaneous 
tubercle,  which  soon  develops  into  a firm, 
yellowish  or  pinkish,  waxy,  nodular  growth, 
with  dilated  blood  vessels  on  the  surface. 
When  the  lesion  ulcerates,  its  borders  pre- 
sent the  same  nodular,  hard,  waxy,  yellowish 
to  pinkish  appearance,  while  the  base  is 
nodular  and  red,  and  there  is  a tendency  to 
free  bleeding.  The  so-called  rodent  ulcer  is 
a superficial  form  of  epithelioma  in  which 
ulceration  predominates,  the  border  is  little, 
if  at  all  elevated,  and  there  is  practically  no 
tendency  to  metastasis. 

Etiology.— A (.Ivanced  age;  heredity;  trauma- 
tism; chronic  irritation;  the  actinic  light 
rays;  chronic  X-ray  burns;  irritation  caused 
by  soot,  dirt,  paraffiit,  coal-tar,  silver  nitrate; 
chronic  lesions,  e.g.,  senile  seborrhoeic  spots 
or  keratoses,  burns,  ulcers,  scars,  warts, 
moles,  callosities,  horns,  ntevi,  lupus 
vulgaris,  syphilis,  lupus  er^dhematosus, 
psoriasis,  arsenical  keratosis,  leucoplakia, 
blastomycosis,  etc. 

Prognosis.— Early  treatment  of  superficial 
epithelioma  is  almost  invariably  perma- 
nently successful,  and  even  the  deep-seated 
forms  may  be  cured  if  not  of  too  long 
standing.  Glandular  involvement,  of  course, 
renders  the  prognosis  more  .serious. 

Treatment. — Mucous  membrane  epithelio- 
mata  and  all  epitheliomata  with  glandular 


involvement  should  be  removed,  together 
with  their  glandular  connections,  by  a wide 
and  deep  excision,  followed  by  the  use  of  the 
X-rays  or  radium  (q.v.).  Cutaneous  epithel- 
iomata without  glandular  involvement  may 
be  destroyed  by  means  of  the  X-rays  or 
radium;  but  excision  followed  by  radiation 
is  considered  the  ideal  treatment,  where 
feasible.  The  parts  should  be  covered  by  a 
thin  lead-foil,  at  least  one-fiftieth  of  an  inch 
in  thickness,  with  a hole  large  enough  to 
expose  the  growth  to  the  X-rays  for  at 
least  one-half  an  inch  beyond  its  border,  or 
wider  than  this,  in  order  to  include  the 
lymphatic  distribution  of  the  affected  parts. 

Haldin  Davis  says:  “A  good  plan  is  to 
give  a pastille  dose  once  a week  for  three 
weeks  and  then  to  wait  for  three  weeks  to 
observe  the  result”;  but,  “in  cases  where 
there  is  a rapid  extension  of  ulceration  it  is 
legitimate  to  give  much  larger  doses  than 
this.”  Following  the  first  exposure,  a 
filter  should  be  used.  A preliminary 
curettage  may  be  desirable.  After  healing 
has  occurred,  continue  the  treatment 
every  several  weeks,  using  filters  and  a 
harder  tube,  in  order  to  reach  the  deeper 
tissues.  (Knox.) 

Radium  is  effective.  The  salt  may  be 
spread  upon  a flat  metal  plate  and  covered 
with  a layer  of  varnish  to  protect  it  against 
organic  fluids.  The  plate  is  fastened  in 
place  by  adhesive  plaster.  Full  strength 
doses  are  applied  without  a screen  for  from 
one  to  one  and  a half  hours.  “ The  full 
therapeutic  effect  of  a dose  is  not  seen 
until  six  weeks  after  its  administration.” 
Several  applications  are  sometimes  required 
(Haldin  Davis). 

Knox  has  obtained  excellent  results,  using 
two  small  tubes  of  platinum  about  2 cm. 
long  by  2 mm.  broad,  each  containing  30 
mgrms.  of  radium  bromide,  the  thickness  of 
the  wall  of  each  tube  being  mm.,  these 
tubes  being  placed  side  by  side  and  an  addi- 
tional filter  of  Yi  mm.  of  lead  usually  used. 
“ The  exposures  varied  from  one  to  four 
hours  to  any  particular  area,  and  when  a 
large  growth  or  ulcer  was  treated,  it  was 
divided  into  areas  each  receiving  the  same 
dose.”  But  variable  amounts  of  radium, 
periods  of  exposure,  and  repetitions  of  treat- 
ment are  required  in  different  cases. 

In  treating  the  eyelid,  the  eyeball  should 
be  protected  by  means  of  a sheet  of  lead, 
rubber,  or  lead  enclosed  in  gutta-percha 
tissue,  and  moulded  to  the  surface  of  the 
eyeball  under  the  lid  to  be  treated. 

Beads  and  nodules  of  growth  and  even 
ulcers  may  be  destroyed  by  firm  pressure  for 


CHILBLAIN;  PERNIO;  ERYTHExMA  PERNIO 


about  forty  seconds  with  a pencil  of  carbon- 
dioxide  snow.  The  resulting  crust  separates 
within  two  weeks. 

Perhaps  next  in  value  to  radiotherapy  in 
the  eradication  of  skin  cancers  which  show 
no  glandular  involvement  is  the  treatment 
by  caustics: 


R Farina}  tritici  (wheat  flour), 

Amyli,  aa gi 

Acidi  arsenosi  pulvcrLs gr.  viii 

Hydrargyri  sulphidi  riihri Oii 

Amrnoiiii  chloridi 0ii 

Hydrargyri  bichloridi  corrosivi ....  gr.  iv 

Zinci  chloridi  crystallLsati ^i 

Aqua}  fervida} iss 


(Bougard’s  pa.sto.) 

Separately  powder  the  first  six  ingredients 
and  then  mix  together.  Dissolve  the  zinc 
chloride  in  the  boiling  water,  to  which  may 
b(!  added  eucaine,  5 to  10  per  cent.  Add  this 
solution  slowly  to  the  powder  mixture  and 
stir  constantly  to  prevent  lumpiness.  “ The 
resulting  paste  is  firm  and  rather  stiff.”  It 
may  be  kept  indefinitely  in  a closed  jar. 


R Acacia}  pulvcris 1.0 

Acidi  arsenosi  pulveris 2.0 

or 

R Acacia}  pulveris, 

Acidi  arsenosi  pulveris,  aa 1.0 

Talci 10.0 


Mix  and  add,  at  the  time  of  using, 
enough  water  to  make  a thick,  firm  paste,  of 
the  consistency  of  stiff  butter  (Marsden’s 
Paste).  Ten  to  twenty  per  cent,  of  cocaine 
or  eucaine  niay  be  added,  if  desired. 

First  thoroughly  remove  with  the  curette, 
under  anaesthesia,  all  friable  epitheliornatous 
tissue;  or,  if  the  epidermis  is  unbroken, 
remove  the  latter  with  a solution  of  caustic 
potash  of  syrupy  consistency  api)lied  on  a 
glass  rod  or  cotton  swab.  Then  apply  the 
paste  thickly  over  an  area  no  larger  than  a 
square  inch.  On  each  successive  day  an 
additional  square  inch  may  be  covered  until 
the  whole  affected  surface  and  a little  beyond 
is  covered.  Leave  the  paste  on  for  from 
eight  to  twenty-four  hours,  or  until  a white 
eschar  is  produced.  If  any  part  of  the  tumor 
remains  undestroyed  after  the  removal  of 
the  paste,  reapply  it  immediately.  After 
removing  the  paste  treat  the  resulting 
wound  aseptically  until  healing  occurs.  The 
caustic  application  produces  considerable 
inflammatory  reaction  and  swelling,  but 
this  is  desirable  for  the  purpose  of  destroy- 
ing outlying  cancerous  radicles  not  actually 
reached  by  the  cau.stic  (chiefly  from  Pusey). 

Sherwell  .says  the  pre.sent  most  popular 
caustic  is  liquor  hydrargyri  nitratis;  pro- 


longed application  under  local  (see  cocaine 
in  Part  11)  or  general  anaesthesia,  following 
thorough  curettage. 

As  a further  assurance  one  may  ionize  the 
parts  (see  Ionic  Medication).  Use  a 2 per 
cent,  solution  of  zinc  chloride  or  10  per  cent, 
zinc  sulphate  and  a solid  zinc  positive  elec- 
trode ami  a current  of  2 to  3 milliamperes 
per  square  centimetre  for  ten  to  twenty  min- 
utes eveiy  two  weeks. 

Inoperable  and  metastatic  carcinoma  may 
be  treated  by  the  X-ray,  radium,  and  arsenic 
iq.v.)  internally  in  increasing  dosage.  The 
latter  is  reported  to  have  cured  cases 
Growths  apparently  inoperable  may  some- 
times b(}  rendered  operable  by  radiotherapy. 

Cataphoresis. — Gr.  Kara  across  -f-  4>6pr]cni 
bearing.  See  Ionic  Medication  in  Part  1. 

Caterpillar  Sting. — See  Bites. 

Chafing  . — See  Intertrigo. 

Chancre. — Fr.  See  Syphilis  in  Part  l._ 

Chancroid. — Fr.  chancre  d-  Gr.  eiSos 
form.  See  Part  2 or  Part  3. 

Chapping. — 


R Tincturac  henzoiiii oss 

Glycerini .^ii.s.s 

Aqua}  destillata} 3v 


Cheilitis  Exfoliativa. — Gr.  lip  + 

~LTLs  inflammation;  L.  ex,  out  Jolium,  leaf. 
See  Dermatitis  Seborrhocica. 

Cheilitis  Glandularis. — Gr.  xelXos  lip  -|- 
-irts  inflammation ; L.  (jlans,  a cord.  A rare 
chronic  inflammation  of  the  mucous  glands 
of  the  lower  or  both  lips,  characterized  by 
pinhead  or  larger  sized  dilatation  of  the 
mucous  glands  and  dilatation  of  the  open- 
ings, which  discharge  a mucous  or  muco- 
purulent secretion. 

The  disease  is  rebellious  to  treatment. 
Stelwagon  says:  “ Volkmann  (who  first 

described  the  disease)  cured  three  of  his 
cases  in  one  to  two  months  with  potassium 
iodide  internally,  gargles  of  potassium 
chlorate,  and  mild  cauterization  of  the  parts 
with  silver  nitrate.”  See  Part  11. 

Chelold. — See  Keloid. 

Chicken  Pox. — See  Varicella  in  Part  1. 

Chignon. — See  under  Hair  Diseases. 

Chigo,  or  Chigre,  or  Sand  Flea. — See  Bites. 

Chilblain;  Pernio;  Erythema  Pernio. — Jj. 
pernio,  chilblain;  L. ; Gr.  epWripa  redness. 
A bright  or  dusky  red  erythema  associated 
with  intense  itching,  occurring  on  the 
tenuous  parts  of  the  body,  such  as  the  heels 
and  borders  of  the  feet,  the  fingers,  ears,  and 
nose,  and  due  to  exposure  to  cold  and  damp. 
The  immediate  cause  is  possibly  a passive 
vascular  dilatation  due  to  paralysis  of  the 
vaso-constrictors.  The  wearing  of  rubberj 


CHLOASMA 


boots  is  a predisposing  cause,  as  is  also 
poor  health. 

Treatment.— The  following  local  applica- 
tions are  recommended  for  the  relief  of 
itching  and  burning: 

II  Calaminse gr.  xl 

Zinci  oxidi gr.  Ixxx 

Acidi  borici 5i 

Glyccrini 

Acidi  carbolici nijx-xxx-lx 

Liqiioris  calcis Ji 

Aqua',  q.s.,  ad giv 

(C'alamine  lotion.) 

Ment holi.s gr.  ii 

Acidi  borici  pulvcris gr.  xlviii 

Petrolati gi 

Immersion  in  cold  water  and  rubbing 
with  snow  or  ice  is  effectual. 

Later,  when  the  symptoms  are  less  acute, 
one  may  rub  on  every  night  or  every  two  or 
three  days,  one  of  the  following  stimulating 
preparations,  viz.,  tincture  of  iodine,  pure 
or  diluted  with  alcohol;  vasogen  iodine 
{q.v.  inParb  11),  or  unguentum  iodi  ((/.r.)  ;un- 
guentum  ichthyolis,  10  per  cent.;  menthol,  2 
per  cent. in  alcohol;  linimentum  saponis  {q.v.) 

Amnionii  chloridi,  5iv,  acidi  hydro- 
chlorici  diluti,  5i,  spiritus  vini  rectificati, 
5iss,  aquam  destillatam  ad  5iv  (R.  A. 
Bolam);  flexible  collodion,  several  coatings; 
tincture  iodi,  5i,  in  flexible  collodion,  5i; 

C'ollodii,  oi)  olei  ricini,  nyxx,  olei  tere- 
binthinae,  5i  (Stelwagon);  ichthyol  collod- 
ion, 10  per  cent.  Hot  salt  baths  are  also 
beneficial.  If  cracks  or  ulcers  are  present 
apply  a verv^  bland  ointment,  such  as  cold 
cream  or  boric  ointment. 

Electricity  is  also  recommended.  The 
galvanic  current  may  be  applied  for  ten 
minutes  three  times  a day,  or  three  or  four 
times  weekly,  the  positive  pole  being  applied 
to  the  affected  parts,  with  the  negative 
jK)le  near  the  truncal  nerve;  a current  of 
two  or  three  milliamperes  is  sufficient. 
Some  recommend  a strong  fararlic  current 
for  ten  minutes  three  times  a day;  some  an 
electric  bath  for  ten  to  fifteen  minutes 
daily,  given,  as  Pusey  quotes,  “ by  placing 
an  electrode  from  a static  machine  or  induc- 
tion coil  in  a foot  bath,  the  other  on  the 
patient’s  body  and  then  passing  a current 
not  strong  enough  to  be  disagreeable.” 

Crocker  recommends  nitroglycerine  {q.v.). 
Wright  recommends  calcivim  chloride,  gr.x- 
XX,  t.i.d.  {q.v.),  to  increase  an  alleged  defi- 
ciency in  the  coagulability  of  the  blood;  but 
Bolam  says  the  calcium  salts  are  “ often 
disappointing  in  their  action.” 

Prophylaxis.— The  hands  or  feet  should  be 
washed  dail}^  in  very  hot  water,  and  quickly 


and  carefully  dried  with  a soft  linen  towel 
They  shoidd  be  protected  with  warm,  dry, 
woolen  gloves  and  stockings,  and  thick, 
loose  shoes.  Active  exercise  and  good 
hygiene  are  to  be  enjoined,  e.g.,  adequate 
rest  of  mind  and  body,  fresh  air  day  and 
night,  a daily  warm  bath  in  a warm  room 
before  breakfast,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
rest  before  and  after  meals,  nutritious  food, 
and  regulation  of  the  bowels.  Tonics,  such 
as  Fowler’s  solution,  theelLxir  ferri,  quinina', 
et  strychninse  phosphati,  and  codliver  oil 
may  be  indicated  (see  Part  11). 

Treatment  of  Prolonged  Exposure  to  Severe 
Cold. — Place  the  patient  in  an  unheated 
room,  and  rub  the  body  with  cold  wet 
cloths.  Then  place  him  in  a bath  at  60.8°  to 
64.-1°  F.,  and  gradually  raise  the  tempera- 
ture of  the  bath  to  86°  F.  in  two  or 
three  hours.  Give  ether  or  camphor  {q.v.) 
hypodermically,  and  give  whiskey  or  brantly 
{q.v.)  as  soon  as  the  patient  can  swallow. 

Where  the  extremities  alone  are  affected, 
wrap  them  in  cold,  wet  cloths,  and  suspend 
them  to  relieve  the  pain. 

Second  and  third  degree  frost-bite  should 
be  treated  the  same  as  burns  {q.v.),  after 
the  normal  temperature  has  &’st  been 
gradually  restored.  ' 

Chloasma. — Gr.  xkoa^eLv  to  be  green. 
Diffuse  or  patchy,  yellowish,  brownish,  or 
blackish  pigmentation  of  the  skin  (so-called 
“ liver  spots  ”). 

Causes  of  Pigmentation  or  Discoloration  of  the 
Skin  in  General. — Utero-ovarian  disturbances; 
pregnancy;  ana'inia;  chronic  indigestion; 
chronic  gastric  ulcer;  chronic  gastrectasia; 
sluggish  liver  and  constipation;  hepatic 
cirrhosis;  anaemia;  cachexia;  neurasthenia; 
nervous  shock ; chronic  heart  disease ; arterio- 
sclerosis; syphilis;  tuberculosis  (abdominal); 
malaria;  Addison’s  disease;  ochronosis; 
arthritis  deformans;  pellagra;  leprosy;  hemo- 
chromatosis; exophthalmic  goitre;  innumer- 
able black  comedones  on  the  face;  local 
traumatism  or  irritation,  due  to  irritating 
drugs,  sinapisms,  the  sun’s  rays.  X-rays, 
heat,  great  cold,  scratching,  pressure  or 
friction;  abdominal  neoplasms;  melanotic 
cancer;  sarcoma;  arsenic;  varicose  veins  of 
the  legs;  pediculosis  corporis  (vagabond 
pigmentation) ; xeroderma  pigmentosum ; 
dermatitis  herpetiformis;  urticaria;  urticaria 
pigmentosa;  chronic  eczema;  endhema  exu- 
dativum;  lichen  planus;  tinea  versicolor; 
erythrasma;  Pinta  disease;  senile  atrophy 
of  the  skin;  scleroderma;  fibroma;  psoriasis; 
the  demodex  folliculorum ; argyria. 


CORN;  CLAVUS 


Pregnancy  and  utero-ovarian  disease  are 
the  commonest  causes  of  chloasma. 

Treatment  of  Chloasma.— The  underlying 
cause  must,  of  course,  be  removed,  if  possi- 
ble. One  of  the  following  peeling  lotions  or 
pastes  may  be  employed.  The  weaker 
strengths  should  first  be  employed  tenta- 
tively until  a branny  desquamation  or 
active  irritation  supervenes,  after  which 
cold  cream  may  be  applied  for  a day  or 
two,  and  active  treatment  again  resumed, 
if  necessary: 


Hydrargyri  chloridi  corro.sivi  gr.  iv-viii 


Tiiictura^  benzoin! 

3ii 

Zinci  sulphatis 

Alcoholis, 

gr.  xx-xl 

Aquae,  aa,  q.s.,  ad 

5iv 

M. 

Sig. — Apply  freely  and  often, 

as  directed. 

Acidi  lactic! 

1.0 

Aqua 

5.0-20.0 

M. 

Sig. — Apply  freely  and  often. 

as  directed. 

Acidi  salicylici 

gr.  xlviii-3ii 

Resorcinolis 

gr.  xxiv-xcvi 

AdipLs  benzoinati 

5i 

M.  Sig. — Apply  a.s  directed. 


As  long  as  the  underlying  cause  persists, 
recurrences  are  to  be  expected. 

Chromidrosis. — Gr.  xpwyaa  color  -f-  I8pws 
sweat.  Colored  sweat  and  sebum  are  most 
common  on  the  face.  Chronic  constipation, 
the  neurotic  temperament,  and  uterine  dis- 
orders are  cited  as  causes.  Green  or  bluish 
sweat  may  be  caused  by  the  ingestion,  inhal- 
ation, or  cutaneous  absorption  of  copper; 
pink  sweat  by  potassimn  iodide;  blue  sweat 
by  iron.  Red,  yellow,  and  blue  sweat  may 
be  caused  by  the  action  of  bacteria  upon  the 
sweat  after  its  excretion  (pseudo-chromi- 
drosis).  The  latter  occurs  in  the  axill®. 
One  must  bear  in  mind  the  possibility 
of  maUngering. 

Treatment. — Attend  to  any  possible  cause. 
Try  alcohol,  chloroform,  ether,  or  glycerine 
for  removing  the  discoloration.  Employ 
cleanliness  and  local  antiseptics  (bichloride, 
1 : 1000,  alcohol,  chlorofonn,  ether,  vinegar) 
for  pseudochromidrosis. 

Cicatricial  Alopecia. — L.  cica'trix,  scar; 
Gr.  dXwTTTj^  fox.  See  Folliculitis  Decalvans. 

Cicatrix. — L.  scar.  The  treatment  is  the 

same  as  that  of  Keloid,  q.v. 

Clavus. — L.  cla'mis,  nail.  See  Corn. 

Coccidial  Granuloma. — L.  cocdd'ium;  dim. 
of  Gr.  KOKKos  grain;  L.  granulum,  grain  -|- 
Gr.  -wAia  tumor.  A granulomatous  skin  dis- 
ease, resembling  blastomycosis,  due  to 
a sporozoan  protozoon,  the  coccidioides 
immitis.  It  has  been  observed  especially 
in  California. 


Cold,  Exposure  to. — See  under  Chilblain. 

Cold  Sore. — See  Herpes  Simplex. 

Colloid  Degeneration  of  the  Skin ; Colloid 
Milium. — Gr.  /coXXa  glue  4-  eL8os  fomi;  L. 
mil'iurn,  millet-seed.  A very  rare  disease, 
affecting  chiefly  the  upper  two-thirds  of  the 
face,  and  characterized  by  pinhead  to  small 
pea-sized,  glistening,  translucent,  lemon 
yellow,  flattened  papules,  deeply  embedded 
in  the  skin,  from  which,  when  punctured,  a 
little  gelatinous  material  or  a ch’oplet  of 
blood  may  be  expressed. 

Treatment. — The  nodules  may  be  removed 
by  electrolysis  (see  Adenoma  Sebaceum)  or 
the  curette. 

Comedo  or  Blackhead. — See  AcneVulgaris. 

Condyloma. — Gr.  k6p8v\os  knuckle  -| — copa 
tumor:  wart.  See  Verruca. 

Congenital  Leucoderma. — L.  con,  with  -\- 
ge'nitus,  born.  See  Albinism. 

Pemphigus.— See  Epidermolysis  Bullosa. 

Corn;  Clavus. — L.  clav'us,  nail.  After 
softening  the  corn  by  soaking  the  foot  in  hot 
soap-suds,  or  even  without  such  preparation, 
pare  down  the  callosity  with  a sharp  scalpel, 
and  carefully  dissect  out  the  core  without 
causing  bleeding.  The  resulting  cavity  may 
be  carefully  touched  with  a droplet  of  caustic 
potash  solution,  gr.  xxiv  ad  5i,  and  the 
latter’s  action  almost  inmiediately  neutral- 
ized with  dilute  acetic  acid  or  vinegar. 
Thereafter,  a perforated  felt  protector  with 
an  adhesive  side  should  be  worn  for  some 
time,  and  the  feet  should  be  cleansed  daily. 
Instead  of  the  above  treatment,  one  may 
employ  a keratoljdic  agent: 


B Acidi  salicyfici gr.  xxx-xl 

Extract!  cannabis  indiem gr.  x 

Collodii  flexilis 5 ss 

B Acidi  salicylici 3ss 

Extract!  opii 3ss 

Cerati  simplicis,  q.s.,  ad gss 


Apply  one  of  the  above  preparations  only 
to  the  corn,  and  reapply  as  often  as  it  wears 
off.  After  several  days,  soak  the  foot  in  hot 
water  and  scrape  the  corn  away. 

Hyde  and  Montgomery  recommend  that 
both  the  corn  and  adjacent  skin  be  covered 
with  narrow,  short,  smoothly  applied  strips 
of  adhesive  plaster,  or  that  Burgundy  pitch 
be  melted  and  painted  over  the  surface. 

Ionization  (q.v.)  with  zinc  is  also  recom- 
mended. The  hard  skin  is  first  removed  by 
means  of  pumice  stone;  then  the  corn  or 
callus  is  soaked  for  several  hours  under  a 
compress  wet  with  zinc  chloride  solution, 
1 per  cent. ; then  a current  of  2 to  3 milliam- 
peres  per  square  centimetre  is  applied  for 
thirty  minutes. 


DERMATITIS  EXFOLIATIVA  EPIDEMICA 


For  soft  corns,  which  usually  occur 
between  the  toes,  one  must  employ,  beside 
the  above  measures,  daily  bathing  of  the 
feet,  followed  by  the  application  of  a bland 
powder  and  the  insertion  of  wool  between 
the  toes.  Spirits  of  camphor  may  be  painted 
on  at  night. 

Properly  fitting  shoes  should  be  worn. 

Cornu  Cutaneum. — L.  co'rnu,  horn;  cu'tis, 
skin.  See  Horn,  Cutaneous. 

Cowpox. — See  Vaccinia,  in  Part  1. 

Crab=Lice. — See  Pediculosis  Pubis. 

Cracked  Lips. — See  under  Eczema. 

Craw=Craw. — A disease  of  doubtful  iden- 
tity, occurring  chiefly  on  the  west  coast  of 
Africa,  and  characterized,  according  to 
Emily,  by  small,  reddish-brown,  itching 
mucules,  which  develop  into  excavated 
itching  ulcers. 

Treatment. — The  skin  surrounding  the 
ulcers  should  be  shaved,  and  bathed  with  hot 
water  and  soap,  followed  by  bichloride  solu- 
tion. All  crusts  and  soft  tissue  should  be 
scraped  from  the  ulcers,  the  latter  irrigated 
and  dried  and  boric  acid  powder  applied 
freely,  followed  by  boric  ointment,  10  per 
cent.  (Emily).  The  disease  is  sa*id  to  be 
rebellious  to  treatment. 

Creeping  Eruption. — A very  rare  disease 
(excepting  in  southeastern  Russia),  caused 
by  the  minute,  migrating  larva  of  the  horse 
bot-fly,  which  traverses  the  skin,  producing 
an  irregular,  slightly  raised  line,  that  is  at 
first  reddish  and  later  becomes  vesicular  and 
crusted.  The  larva  is  one-quarter  of  an 
inch  or  more  in  advance  of  the  moving  end 
of  the  line. 

Treatment.— Excision  extending  one-half  an 
inch  beyond  the  advancing  part  may  be 
performed.  Stelwagon  cured  his  cases  in  a 
week  by  applying  “ cataphoretically  (q.v.) 
to  an  inch  and  a half  area  around  the 
advancing  end  of  the  burrow  a solution 
of  mercuric  chloride,  gr.  ii  to  the  ounce,  and 
a minute  quantity  of  nitric  acid  to  the  sus- 
pected site  of  the  parasite,  just  beyond  the 
extreme  end  of  the  line.”  “A  magnifying 
glass  should  be  employed  to  discover  this 
point,  as  it  is  slightly  in  advance  of  where  it 
appears  to  be  by  unaided  vision.”  The  cata- 
phoretic  applications  were  repeated  two  to 
four  times. 

Kirby-Smith,  who  has  seen  many  cases, 
gets  uniformly  good  results  by  cutting  the 
skin  over  the  furrows  with  a bistoury,  then 
applying  equal  parts  of  tincture  of  iodine 
and  phenol. 

Cystic  Epithelioma,  Multiple,  Benign. — 

See  Epithelioma,  Multiple,  Benign,  Cystic. 

Dandruff. — See  .\lopecia  Seborrhoeica. 


Decubitus. — L.,  a lying  down.  See  Bed 
Sore,  in  Part  1. 

Delhi  Sore. — ^See  Oriental  Sore. 

Dermatalgia. — Gr.  depfia  skin  -f  aXyos 
pain.  See  Neuralgia  of  the  Skin. 

Dermatitis  Exfoliativa. — Gr.  Sepfia  skin  + 
LTLs  inflammation;  L.  ex,  out  fl-  fol'ium,  leaf. 
A rare  inflammatory  disea.se,  involving 
usually  the  whole  surface  of  the  body,  and 
characterized  by  diffuse  redness  with  abund- 
ant, flaky  desquamation.  (See  also  the  fol- 
lowing two  diseases.) 

Etiology. — Eczema;  psoriasis;  lichen  planus; 
pityriasis  rubra  pilaris;  local  irritation 
caused  by  mercury,  chrysarobin,  iodoform, 
arnica,  etc.;  possibly  rheumatism,  gout, 
tuberculosis,  alcoholism,  cold,  quinine,  or 
some  form  of  toxsemia. 

Prognosis. — Those  cases  with  no  constitu- 
tional involvement  usually  recover  in  several 
weeks  or  months;  but  relapses  may  occur. 
Some  cases  persist  throughout  life  (Pityria- 
sis Rubra  of  Hebra). 

Treatment. — Put  the  patient  to  bed  in  a 
warm,  well-ventilated  room,  on  an  abundant, 
easily  dige.stible,  well-balanced  ration.  Sab- 
ouraud  advises  superalimentation  as  in 
tuberculosis  (see  Part  1).  Codliver  oil  may 
be  prescribed,  if  deemed  desirable  and  also 
iron  or  arsenic  (see  Part  11).  The  bowels 
should  be  cleared  out,  and  an  abundance  of 
water  and  diuretics  prescribed,  e.g.,  potas- 
sium bicarbonate,  gr.  xx,  in  a glassful  of 
water,  every  four  hours. 

All  that  is  required  locally  is  a bland, 
oily  application: 


B Calamin®, 

Zinci  oxidi,  aa 3 a 

Liquoris  calcis, 

Olei  oliva3,  aa Sii 


(Calamine  liniment.) 

Liquoris  calcis, 

Olei  olivae  seu  lini,  aa. 

(Carron  oil.) 

Olei  olivse, 

Petrolati  mollis,  aa. 

Dermatitis  Exfoliativa  Epidemica. — Gr. 

8epp.a  skin  fl-  -ins  inflammation;  L.  ex,  out 
fl-  joVium,  leaf;  Gr.  kir'i  on  -f  hgpos  people. 
A rare,  contagious,  usually  general,  exfolia- 
tive tlermatitis,  running  an  acute  course  of 
six  to  eight  weeks,  with  a mortality  of  ten  to 
twenty  per  cent. 

Treatment.— Apply  the  bland  oih^  prepara- 
tions recommended  in  dermatitis  erfoliativa 
(above).  The  constitutional  treatment  is 
supportive  and  symiptomatic.  In  a few 
cases  in  which  the  disease  began  as  a small 
patch,  Crocker  has  aborted  it  by  painting 
with  tincture  of  iodine  or  collodion. 


MEDICINAL  RASHES 


N'  2093.  D'  du  Castel. 


N"  2212.  D'-  Balzer. 


St.  Louis  Hospital  Museum,  Paris. 


LAROUSSE  MEDICAL. 


Medicinal  rashes  : Polymorphous  erythema. 


DERMATITIS  MEDICAMENTOSA 


Dermatitis  Exfoliativa  Neonatorum. — Gr. 

Sepfxa  skin  — itls  inflammation;  L.  ex,  out 
+ fo'lium,  leaf;  Gr.  veos  new  + L.  na'tus, 
born.  A rare,  general  exfoliative  dermatitis 
of  infants,  running  a course  of  one  to  three 
months,  with  a mortality  of  about  50 
per  cent. 

Treatment. — Anoint  the  child  with  a bland 
oil,  to  which  may  be  added  boric  acid  or 
ichthyol,  gr.  iiss-v  to  the  ounce,  and  wrap  it 
in  cotton  to  maintain  the  body  heat.  The 
crusts  at  the  corners  of  the  mouth  should  be 
softened  with  almond  or  olive  oil  and  gently 
removed,  so  that  the  child  can  nurse  with- 
out great  discomfort. 

Dermatitis  Qangrsenosa. — See  '^Gangrene 
of  the  Skin. 

Infantum.— See  Ecthyma  Gangrse- 
nosum. 

Herpetiformis. — Gr.  deppa  skin  -|-  itls 
inflammation;  Gr.  epweLV  to  creep;  herpetic 
means  the  occurrence  of  small  vesicles  in 
clusters.  A rare,  chronic,  relapsing,  multi- 
form, inflammatory  disease,  characterized 
by  a grouped,  erythiematous,  papular,  vesi- 
cular, pustular,  bullous,  or  mixed  eruption, 
accompanied  usually  by  intense  itching, 
and  with  resulting  pigmentation.  The 
disease  may  last,  with  exacerbations  and 
remissions  or  intermissions,  for  months  or 
years,  and  then  finally  disappear.  Most 
cases  get  well  in  a few  weeks  to  a few 
months,  but  recurrence  is  almost  certain. 
The  pregnancy  cases  (Herpes  Gestationis) 
offer  the  most  favorable  prognosis. 

Etiology. — Nervous  and  physical  stress  or 
breakdown;  pregnancy;  phimosis;  glycosuria; 
albuminuria;  exposure  to  cold;  septicsemia; 
vaccine;  drugs. 

Treatment. — An  endeavor  should  be  made 
to  ascertain  the  real  cause.  In  the  mean- 
time a correct  hygienic  regimen  should  be 
instituted,  e.g.,  physical  and  mental  rest, 
fresh  air  day  and  night,  but  the  avoidance  of 
cold,  regular  hours  of  eating  and  sleeping,  a 
plain  and  easily  digestible  but  generous  diet, 
the  avoidance  of  tea,  coffee,  alcohol,  and 
tobacco,  and  free  bowel  activity.  Such 
tonics  or  alteratives  as  arsenic,  strychnine, 
quinine,  and  codliver  oil  are  well  recom- 
mended, particularly  arsenic.  Crocker  rec- 
ommends salicin,  beginning  with  gr.  xv,  well 
diluted,  t.i.d.  and  increasing  rapidly  up  to 
gr.  XXV  and  xxx  t.i.d.;  and  he  adds,  “ if  the 
bowels  are  kept  open  there  is  rarely  head- 
ache or  other  disagreeable  symptoms.” 
Alkalies  and  diuretics,  such  as  potassium 
acetate  or  citrate  may  possibly  be  of  service. 
Potassium  iodide  should  not  be  given.  A 
milk  diet  and  eliminative  treatment  may 


be  effectual  in  pregnancy.  See  Part  1 1 for 
Drugs. 

For  the  relief  of  itching  and  burning,  are 
recommended  phenacetin,  antipyrine,  acetan- 
ilid,  bromides,  belladonna,  and  saline 
cathartics.  For  the  same  purpose  the  vesi- 
cles should  be  punctured  and  the  following 
soothing  and  healing  lotions  employed : 

Calaminse g>'-  xl 

Zinci  oxidi gr.  Ixxx 

Acidi  borici 3i 

Glycerini 

Acidi  carbolici njviii-xxx 

Liquoris  calcis Si 

Aquae,  q.s.,  ad 5iv 

(Calamine  lotion.) 

Thymolis gr.  iv-viii 

Glycerini 3i 

Alcoholis 5 i 

Liquoris  potassaj 3ss 

Aquae,  q.s.,  ad Siv 

Camphor-chlorali, 

Acidi  carbolici,  aa gr.  xx-lvii 

Mentholis gr.  x.x-xl 

Extracti  hamamelidis  destillati, 

Alcoholis,  aa Sh 

Also  (Stelwagon),  acidi  carbolici,  5i-iii, 
in  a saturated  solution  of  boric  acid  (3v), 
Oi;  liquoris  carbonis  detergens,  1 to  2 tea- 
spoonfuls or  more  in  a teacupful  of  water; 
liquoris  picis  alkalinus,  3i~iii  to  the  pint 
of  water,  applied  cautiously;  ichthyol,  2 to 
10  per  cent,  aqueous  solution;  resorcin,  1 to 
5 per  cent,  aqueous  solution. 

These  lotions  may  be  supplemented  with 
bland  dusting  powders  and  mild  ointments, 
e.g.,  cold  cream,  zinc  oxide  ointment  {q.v.), 
vaseline  containing  carbolic  acid,  gr.  vi,  or 
menthol,  gr.  i-x,  to  the  ounce.  For  vesico- 
bullous  and  pustular  lesions  in  particular, 
it  is  reconmiended  that  sulphur  ointment, 
gr.  x-xxx  (-3i-ii  cautiously)  to  the  ounce, 
be  rubbed  in  vigorously.  Indeed  rest,  arsenic, 
and  sulphur  are  reconmiended  as  a triad. 

Sulphur  or  alkaline  and  bran  baths  give 
great  relief,  especially  at  night:  (1)  potas- 
sium sulphide,  5ii~iv  to  thirty  gallons  of 
water;  (2)  lime,  5ss,  sublimed  sulphur,  5i, 
distilled  water,  5x,  boiled  down  to  six 
ounces  and  Altered, — 3 ii“iv  to  thirty  gallons 
of  water;  (3)  sodium  bicarbonate,  5ii-x, 
bran,  one  gallon,  to  thirty  gallons  of  water. 

Dermatitis  Medicamentosa  ; Drug  Erup= 
tions. — Gr.  Seppa  skin  -}-  -ltls  inflammation; 
L.  medicamen'tum,  drug;  L.  erup'tio,  a 
breaking  out.  Withtlrawal  of  the  drug  is,  of 
course,  the  first  step.  Copious  water  drink- 
ing and  alkaline  diuretics,  together  with 
laxatives  or  cathartics,  hasten  the  elimina- 
tion of  the  drug.  In  grave  cases  supporting 
treatment  may  be  required. 


DERMATITIS  VENENATA 


It  is  said  that  sodium  iodide  ^ives  rise  to 
skin  trouble  less  frequently  than  the  potas- 
sium salt.  The  ajjpearance  of  an  eruption 
when  using  iodides,  bromides,  etc.,  is  said 
to  be  inhibited  if  Fowler’s  solution  {q.v.  in 
Part  11)  and  potassium  bitartrate  {q.v.)  are 
achninistered  at  the  same  time  and  an  occa- 
sional laxative  is  given. 

Dermatitis  Papillaris  Capilliti;  Acne 
Keloid. — Gr.  b'epixa  skin  + -tns  inflamma- 
tion; L.  papilla,  nipple;  capil'lus,  hair;  Gr. 
aKvi]  point;  KrjKls  scar  e£5os  form.  An 
uncommon,  chronic,  pustular,  sycosiform, 
cicatricial,  cheloidal  acne  occurring  on  the 
nape  of  the  neck,  and  very  rebellious 
to  treatment. 

Treatment. — Thoroughly  scrape  away  gran- 
ulations and  pustules,  and  epilate  all  dis- 
ea.sed  hairs;  then  disinfect  the  surface  with 
pure  carbolic  acid  neutralized  with  alcohol. 
The  following  ointment  may  then  be  applied : 


Sulphuris  praicipitati oss-ii 

Ichthyolis 3i~ii 

Adipis  benzoinati 3 i 


Hot  boric  acid  solution,  5iv  ad  Oi,  or 
bichloride,  1 : 2000,  may  be  used  as  a wash. 

Rontgentherapy  {q.v.  in  Part  1)  is  said  to 
be  the  most  satisfactory  treatment. 

In  the  tumor  stage,  excision  may 
be  considered. 

Dermatitis  Psoriasiformis  Nodularis. — See 

Parapsoriasis. 

Dermatitis  Repens,— Gr.  heppa.  skin  + 
-iTis  inflaimnation ; L.  re’ pens  creeping. 
A rare,  superficial,  subepidermal,  spreading, 
seropurulent  inflammation,  starting  from  an 
injury,  usually  upon  the  hand.  The  picture 
is  that  of  a sharply  defined,  seropurulent 
undermining  of  the  epidermis.  The  staphy- 
lococcus albus  is  the  predominant  organ- 
ism found. 

Treatment.— Cut  away  with  scissors  the 
undermined  epidermis  flush  with  the  healthy 
skin,  taking  care  to  leave  no  concealed 
pockets.  Then  soak  the  extremity  in  a hot 
antiseptic  solution,  e.g.,  bichloride,  1 : 1000, 
for  about  thirty  to  sixty  minutes.  Redress 
the  wound  antiseptically  once  or  twice 
daily,  each  time  removing  thoroughly  any 
freshly  undermined  epidermis.  Balsam  of 
Peru  and  castor-oil,  equal  parts,  is  a good 
antiseptic  dressing.  The  disease  is  said  to 
be  very  rebellious  to  treatment. 

I have  seen  a number  of  cases  answei- 
ing  to  the  description  of  dermatitis  repens, 
and  they  all  responded  promptly  to  the 
above  treatment. 

Dermatitis  Seborrhoeica;  Eczema  Sebor= 
rhoeicum. — Gr  beppa.  skin  + -ms  inflamma- 


tion; to  boil  out;  L.  se'bum,  suet  fl-  Gr. 
po'ia  flow.  An  indolent,  evidently  contagious, 
slightly  itching  disease,  occurring  chiefly  on 
the  scalp,  eyebrows,  auricles,  face,  neck, 
sternal,  interscapular,  and  genito-crural 
regions,  axillae,  and  umbilicus,  ami  character- 
ized by  greasy,  scaly  patches,  usually  upon  a 
slightly  inflammatory  base.  The  patches 
are  often  circinate.  It  is  the  commonest 
cause  of  baldness  (see  Alopecia  Seborrhoeica) . 
It  rarely  involves  the  vermilion  border  of 
the  lips  (cheilitis  exfoliativa). 

Prognosis.— Upon  the  scalp  and  lips  the 
disease  is  very  tlLfficult  to  eradicate,  and 
tends  to  recur  repeatedly.  Ujjon  other  parts 
it  is  easily  cured,  but  is  apt  to  recur. 

Treatment. — Seborrhoeic  dermatitis  of  the 
scalp  is  con.«idered  under  Alopecia  Sebor- 
rhooica  {q.v.).  For  the  non-hairy  parts  the 
treatment  is  as  follows:  clean.se  the  parts 
ilaily  with  tincture  of  green  soap  and  hot 
water,  and  apply,  preferably  at  night,  the 
following  ointment: 


Acidi  salicylici gr.  x-xv 

Sulplmris  praecipitati gr.  x-lx 

Pulveris  amyli, 

Pulveris  zinci  oxidi,  aa 3iss 

Petrolati  mollis 5 iv 


This  may  be  washed  off  in  the  morning  if 
desired,  and  lotio  alba  applied  two  or  three 
tunes  during  the  day: 


Zinci  sulphatis, 

Sulphurts, 

Potassii  sulphnreti,  aa gr.  v-xv 

Aquae o i 

(Pu.sey.) 


If  any  irritation  is  produced  by  this 
treatment,  apply  cold  cream  for  a few  days. 

The  X-rays  (q.v.)  may  be  employed  for 
obstinate  patches:  exposures  every  several 
days  or  every  week,  of  two  to  five  minutes 
duration,  with  a soft  to  medium  tube,  at  a 
distance  of  eight  to  ten  inches.  (St  el  wagon.) 

The  lip  affection  is  treated  with  the  same 
sulphur  and  salicylic  ointment.  Stelw’agon 
recommends  for  stubborn  lip  cases,  the 
occasional  application  of  silver  nitrate  or 
resorcin,  2 to  20  per  cent.,  or  lactic  acid, 
10  to  20  + per  cent.,  with  mild  ointments 
in  the  intervals. 

In  the  “ milk  crust  ” of  infants,  first 
soften  the  crust  for  several  days  with  sterile 
olive  oil  or  vaseline,  then  remove  the  oil  and 
crusts  with  castile  soap  and  warm  water,  cut 
the  hair  short,  and  apply  on  linen  or  lint, 
resorcin,  gr.  xx,  in  vaseline,  h used  on 
the  face,  resorcin,  gr.  v ad  “i-  (Kerley.) 

Dermatitis  Venenata. — Gr.  bkppa  sldn  -|- 
-iTLs  inflammation ; L.  vene'nurn,  poison. 


ECTHYMA 


Under  this  heading  are  included  all  inflam- 
matory skin  diseases  caused  by  (1)  local 
chemical  irritants,  e.g.,  mustard,  arnica, 
cantharides,  mercurials,  iodine,  iodoform, 
orthoform,  benzene,  kerosene,  carbolic  acid, 
turpentine,  croton  oil,  arsenical  dyestuffs, 
tar  compounds,  resorcin,  alkalies,  acids, 
strong  soaps,  sugars,  flour,  chromic  acid  and 
its  salts,  polishing  material,  pastes,  tobacco, 
formaldehyde,  c h r y s a r o b i n,  pyrogallol, 
metol,  aniline,  etc.;  and  (2)  poisonous  plants, 
e.g.,  poison- ivy,  poison-oak,  poison  sumac, 
poison  dogwood,  primrose,  nettle,  cowhage, 
smartweed,  oleander,  balm  of  Gilead,  snow 
on  the  mountain,  rue,  etc. 

The  commonest  cause,  however,  is  poison 
iy^r  or  poison  oak,  which  produces  an 
intensely  itching,  vesicular  or  vesico- 
buUous  eruption  of  the  hands,  face,  and 
often  the  penis  and  scrotum,  with  some- 
tunes  much  swelling. 

Treatment  of  Ivy  or  Oak  Poisoning. — According 
to  Pfaff,  the  poisonous  jjrinciple  is  a fixed 
oil,  toxicodendrol,  soluble  in  alcohol  and 
precipitated  by  lead  salts;  and  the  following 
treatment,  based  upon  this  knowletlge,  is 
said  to  be  at  once  effective:  Fu'st  scrub  the 
affected  skin  with  soap  and  hot  water  and  a 
hand  brush,  and  then  bathe  repeatedly  with 
95  per  cent,  alcohol  in  order  completely  to 
remove  all  the  oil. 

Lead  and  opium  wash  (q.v.  in  Part  11), 
also  has  a good  reputation. 

Rhus  toxicodendron  (q.v.)  is  employed 
internally  by  the  homeopaths  with  prob- 
able success. 

Dermatitis,  X=ray. — See  X-ray  Dermatitis. 

Dermatolysis. — Gr.  Sepfia  skin  -|-  Xccns 
loosening.  Loose,  pendulous  skin,  of  un- 
known etiology. 

The  treatment  is  excision. 

Dhobie  or  Laundryman’s  Itch. — An  itch- 
ing, ringworm-like  dermatitis  of  the  genito- 
crural  and  axillary  regions  or  the  feet, 
occurring  in  tropical  countries. 

Treatment. — Tincture  of  iodine,  chrysa- 
robin  ointment,  5 to  10  per  cent.,  salicylic 
acid  ointment,  10  per  cent.,  ung.  epicarin, 
10  per  cent.,  and  bichloride  lotion,  to  1 
per  cent.,  have  been  variously  used;  but 
Adamson  says  they  may  now  be  discarded 
for  a cleanly  and  rapitlly  efficacious  oint- 
ment which  we  owe  to  Dr.  Arthur  Whitfield, 
as  follows: 


Acidi  salicylici gr.  x-xv 

Acidi  benzoici gr.  x-xv 

Olei  coea-nucis 3vi 

Petrolati  mollis,  q.s.,  ad §i 


The  underwear  should  be  frequently 
changed  and  boiled,  and  thorough  cleanli- 


ness practiced,  both  for  prophylactic 
and  curative  purposes.  The  disease  is 
readily  cured. 

Disinfection. — See  Part  1,  General  Medi- 
cine and  Sui’gery. 

Dracontiasis. — Gr.  bpaKovnov  (little 
dragon)  tapeworm.  A tropical  disease  of 
India,  Persia,  Arabia,  Africa,  the  We.st 
Indies  and  South  America,  caused  by  a 
nematode  worm,  the  dracunculus  metli- 
nensis  or  filaria  medinensis,  or  Guinea  worm. 
The  embryos  of  this  worm,  being  discharged 
into  water,  enter  the  bodies  of  the  fresh- 
water Cyclops,  a minute  crustacean,  where 
they  pass  the  larval  state,  and  in  which  they 
enter  the  human  stomach  with  the  drinking 
water.  Here  they  escape  from  the  cyclops, 
the  female  becomes  impregnated,  wanders 
into  the  tissues,  and  finally  reacflies  the  skin, 
usually  of  the  foot,  “ where  it  may  be  felt 
like  a coil  of  soft  string.”  The  parasite  may 
even  possibly  enter  the  body  through 
the  skin. 

The  mature  worm  is  two  to  three  feet  or 
more  in  length,  and  one-tenth  to  one 
fifteenth  of  an  inch  in  thickness.  When  the 
young  embryos  are  ripe  they  are  discharged 
through  a vesicle  in  the  skin,  and  the  mother 
worm  then  dies. 

Treatment. — Inject  into  the  body  of  the 
worm,  either  through  the  opening  in  the 
skin  or  through  the  unrupturetl  skin,  a few 
drops  of  bichloride  solution,  1 : 1000  (one 
minim  contains  gr.  Hooo  of  bichloride). 
This  kills  both  the  worm  and  its  embryos, 
which  may  become  absorbed;  or  the  worm 
may  be  wound  on  a stick  after  one  or  two 
days.  (Emily.) 

Another  plan  is  to  open  the  burrow  upon 
a grooved  director,  apply  lint  soaked  in  car- 
bolic acid  solution  (1  : 40),  and  cover  this 
with  oiled  silk,  wool,  and  a tight  bandage. 
This  is  changed  every  twenty-four  hours, 
until  in  three  or  four  days  the  worm  comes 
away  (Roth).  Do  not  bandage  a carbolic 
acid  compress  about  a finger  or  toe,  for  fear 
of  gangrene. 

“Asafoetida  in  full  doses  (q.v.  in  Part  11), 
is  said  to  kill  the  worm.”  (Osier.) 

Prognosis. — Boil  the  drinking  water;  and 
avoid  wading  or  bathing  in  infected  waters. 

Dracunculus  Medinensis. — L.  little 

dragon.  See  Dracontiasis. 

Drug  Eruptions. — See  Dermatitis  Medic- 
amentosa. 

Ecchymoses. — Gr.  tK  out  xvpo-  a flow. 
See  Purpura. 

Ecthyma. — Gr.  « out  -p  dhtiv  to  rush. 
Ecthyma  is  an  ulcerative  form  of  impetigo 
(q.v.).  It  is  characterized  by  one  or  more 


ECZEMA 


autoinoculable,  superficial,  crusted  ulcers, 
with  an  inflainmatoiy  areola. 

It  occurs  in  the  uncleanly  and  debilitated. 
The  bites  of  lice  and  bed-bugs  may  favor  the 
inoculation  and  spread  of  the  disease. 

Treatment. — This  is  the  same  as  that  of 
mipetigo  contagiosa.  Frequent  soap  washings 
are  necessary.  Good  hygiene  should  be 
enjoined.  The  cUsease  is  readily  cured. 

Ecthyma  Qangraenosum. — Gr.  e/c  out  + 
Oveiv  to  rush;  yayypaLva  mortification.  Syn= 
onym. — Dermatitis  gangrsenosa  infantum. 
A rare  eruption  of  gangrenous  lesions,  occur- 
ring spontaneously,  or  supervening  upon 
varicella  or  other  pustular  eruption,  chiefly 
in  debilitated  children. 

Treatment. — Carefully  remove  all  loose 
sloughs,  and  apply  gauze  wet  with  hot  boric 
acid  solution,  5v  ad  Oi,  or  ichthyol  solution, 
5 to  10  per  cent.,  or  liquor  sodse  chlorinatae 
iq.v.),  or  bichloride  solution,  1:5000  to  1000; 
or  apply  ichthyol  ointment,  10  per  cent.,  or 
unguentmn  hydrargj^ri  anmioniati,  5 ss  ad  5 i- 

Prescribe  a concentrated,  easily  digestible 
diet,  and  sthnulants  when  required.  Qui- 
nine, sodium  sulpho-carbolate,  and  sodium 
salicylate  are  recommended.  See  Drugs, 
Part  11. 

The  condition  is  serious,  but  most 
cases  recover.  _ 

Eczema. — Gr  to  boil  out.  A com- 

mon, acute,  subacute  or  chronic,  itching, 
catarrhal  inflammation  of  the  skin,  of  multi- 
form and  changing  character  (erythematous, 
papular,  vesicular,  pustular,  squamous), 
with  usually  a sticky  oozing  or  weeping,  or 
a history  of  such,  with  more  or  less  epidermic 
thickening,  and  a tendency  to  crust  or 
scale  formation. 

Etiology.— (a)  Constitutional  Factors. — 
Habitualovereating,possiblyproteinanaphy- 
laxis,  iq.v.)  dyspepsia,  constipation,  lithjemia, 
obesity,  defective  kidney  elimination,  gen- 
eral debility,  physical  or  mental  overwork, 
shock,  neurasthenia,  hysteria,  nerve  injury, 
hypothyroidism,  asthma,  reflex  irritation 
(dentition,  adherent  prepuce,  movable  kid- 
ney, uterine  disturbances,  etc.,  no  doubt 
giving  I'ise  to  nervous  irritability  and 
resulting  impairment  of  the  general  bocUly 
functions),  tuberculosis,  ana?mia,  nephritis, 
(habetes  mellitus  and  insipidus,  malaria, 
intesthial  parasites. 

(b)  Local  Factors. — Chemical  and  me- 
chanical mitants,  e.g.,  sulphur,  tar,  chrysa- 
robin,  turpentine,  mercurials,  iodoform, 
iodine,  benzine,  mustard  and  other  medicinal 
plastci’s,  lime,  paints,  dyes,  antiseptics,  pol- 
ishing materials,  pastes,  sugar,  hour,  tobacco, 
acids,  alkalies,  strong  soap,  the  excessive 
use  of  water  and  soap,  urine,  faeces,  decom- 


posing sweat  and  sebum,  parasites  (pediculi, 
fleas,  bed-bugs,  etc.,  and  the  parasites  of 
scabies,  ringworm,  etc.),  scratching,  friction 
and  pressure,  as  of  rough  woolen  underwear, 
cold,  heat,  sea  air,  winds,  sunlight,  vari- 
cose veins. 

Prognosis.—"  Eczema  is  always  amenable 
to  persevering,  judicious  treatment.” 
(Stelwagon.) 

Treatment. — Correct  hygiene  is  of  great 
unportance.  This  embraces  regular  hours  of 
eating  and  sleeping,  a proper  amount  of  rest 
and  exercise,  rest  before  and  after  meals, 
adequate  dry  clothing,  a plain  but  nutritious 
diet,  proper  bowel  activity,  and  the  correc- 
tion of  any  possible  causal  influence  (q.v., 
in  its  appropriate  place).  The  following 
articles  of  food  are  interdicted,  viz.,  pork  in 
any  form,  salted  meats,  cooked-over  meats, 
veal,  "gamy”  fowl, crabs,  lobsters,  fried  foods, 
gravies,  pastries  and  cakes,  hot  breads,  hot 
griddle  cakes,  sweets  and  confections,  s>Tups, 
soups,  sauces,  cheese,  pickles,  condiments, 
sweet  potatoes,  Irish  potatoes,  cabbage,  fried 
eggplant,  tomatoes,  oatmeal,  bananas, apples, 
tea,  coffee,  alcohol,  and  tobacco. 

The  diet  should  consist  chiefly  of  bread 
and  butter,  milk,  eggs,  fresh,  plainly  cooked 
vegetables,  cereals,  fresh  fish,  chicken  oc- 
casionally, with  other  meats  no  oftener  than 
once  or  twice  a week;  but  each  patient  may 
require  an  inchvidual  diet.  The  previous 
diet  of  the  patient  should  be  inquired  into, 
in  order  to  ascertain,  if  possible,  whether 
any  dietetic  idiosyncrasy  exists,  bearing  in 
mind  the  possibility  of  a special  protein 
hypersensibility  (see  tests  under  Asthma,  in 
Part  1).  A glassful  of  hot  water  or  Vichy 
should  be  drunk  one  hour  before  meals  and 
also  between  meals.  Sodimn  bicarbonate  or 
potassimn  acetate  or  citrate,  gr.  x,  t.i.d., 
may  be  added  to  the  water. 

In  infancy,  the  diet  of  the  mother  or  the 
baby  requires  special  attention  (see  Infant 
Feeding,  Part  1).  In  breast-fed  infants,  regu- 
late the  hours  of  nursing  and  the  quantity 
at  each  nursing;  correct  constipation  in  the 
mother,  and  enjoin  exercise;  regulate  the 
mother’s  diet  if  the  milk  is  high  in  fat  or 
proteid,  and  order  exercise;  prohibit  beer, 
tea,  and  coffee;  sochum  bicarbonate,  gr.  ii, 
in  water,  oil;  may  be  given  before  each 
nursing;  if  the  urine  is  highly  acid,  give 
potassium  citrate,  gr.  ii,  t.i.d.  In  bottle-fed 
infants,  reduce  experhnentally  first  the  sugar, 
then  the  fat,  then  the  proteid,  and  note  the 
effect  upon  the  eczema.  (Kerley.) 

In  older  children  with  gouty  or  rheumatic 
antecedents,  red  meat  and  cane  sugar,  even 
in  the  smallest  quantities,  may  produce 
eczema  and  cyclic  vomiting.  (Kerley.) 


ECTHYMA 


Ecthyma. 

N»  234.  D'  Lailler. 


2.  Seborrhceic  eczema. 

N-  2337.  D''  du  Castel. 


lakoussk  mkdical. 


N-  149.  D'  Lailler. 

3 and  4.  — Eczema  rubrum  of  both  surfaces  of  the  hand. 

Sf.  Louis  Hospital  Miiseiirji,  Paris. 
SKIN  DISEASES  : Ecthyma.  Eczema 


ECZEMA 


Following  is  a useful  laxative  prescription 
for  adults; 


Sodii  phosphatis 3 i 

Acidi  phosphorici  diluti 5v 

Synipi  zingiberis 5iss 

Aquae  menthae  piperitae,  q.s.,  ad 5vi 

M.  Sig. — A tablespoonful  in  a large  glass  of 
water  one  hour  before  meals.  (Pusey.) 


Says  Crocker:  “ Speaking  generally,  in  an 
acute  case,  seen  early,  saline  aperients  are 
good  treatment  at  fii'st,  and  later  on  tonics 
suited  to  the  patient’s  special  conditions; 
while  in  cases  of  long  standing  diiu’etics 
take  a high  place.” 

Local  Treatment. — Crusts  and  scales  should 
first  be  gently  removed  with  forceps  after 
softening  for  about  one  or  two  days,  if 
necessary,  with  liquid  paraffine  or  vaseline, 
almond  oil,  olive-oil,  or  cottonseed  oil, 
applied  on  strips  of  flamiel  or  lint.  The  use 
of  plain  water  and  of  soap  should  be 
avoided,  except,  perhaps,  in  chronic,  slug- 
gish cases.  After  the  affected  surface  has 
been  rendered  clean,  the  remedial  applica- 
tion is  made.  For  itching,  carbolic  acid  is 
added  to  the  latter,  5ss-ii  to  the  pint  of 
lotion,  and  gr.  ii-xxx  to  the  ounce  of  oint- 
ment (Stelwagon).  If  this  affords  no  relief, 
one  may  apply  very  hot  water  containing 
sodium  bicarbonate,  3^2  teasp.  to  the  pint. 

In  all  cases  of  eczema,  whether  acute  or 
chronic,  with  or  without  infiltration  or 
epidermic  thickening,  one  should  begin  with 
the  mild,  soothing  remedies  appropriate  for 
the  acute  type,  in  order  to  test  the  sensitive- 
ness of  the  skin,  stmiulating  applications 
being  later  employed  only  if  required.  This 
rule  is  all  important.  (Stelwagon.) 

Below  are  given  by  classes,  m the  order 
of  their  strength  or  stimulating  properties, 
the  remedies  employed.  The  mild  appli- 
cations are  used  in  all  acute  or  actively 
inflammatory  cases,  whether  any  epidermic 
thickening  is  present  or  not.  After  the 
inflammation  has  subsided,  stronger  appli- 
cations may  be  cautiously  employed  for 
the  purpose  of  removing  any  remaining 
infiltration.  For  the  thickly  indurated 
patches,  veiy  strong  stimulating  applications 
are  usually  requirecl. 

Class  I. — Mild,  soothing  remedies. 

II  LotionLs  nigra>. 

Aquae  calcis,  aa. 

(Up  to  full  strength  of  black  wash.) 


II  Calaminae, 

Zinci  oxidi,  aa 3ii-iv 

Acidi  borici 5ii 

Glycerini njjx-xxx 

Acidi  carbolici gr.  xv-5i 

Liquoris  calcLs 3 u 

Aquae,  q.s.,  ad Sviii 


(Calamine  lotion.) 


II  Liquoris  carbonis  detergentis.  . . oss-viii 
Aquae,  q.s.,  ad 5viii 

II  Ichthyolis 3ss-iii 

Aquae,  q.s.,  ad 3viii 

II  Acidi  borici 3 iiss 

Aquae  fervidae 5 viii 


Any  one  of  the  above  lotions  should  be 
dabbed  on  freely,  three  or  more  times  daily, 
after  first  wiping  off  the  parts  gently  with 
soft  linen  or  cotton  The  lotion  may  be 
allowed  partly  to  dry,  and  then  zinc  oxide 
ointment  or  cold  cream  may  be  applied  upon 
lint  or  linen  (Stelwagon),  or  the  following 
powder  dusted  on: 


II  Pulveris  acidi  borici gr.  xxx 

Talci, 

Zinci  oxidi,  aa 5ss 

(Stelwagon.) 


The  powder  is  particidarly  useful  in 
eczematous  intertrigo. 

II  Acidi  carbolici  seu  resorcinolis . gr.  viii-xvi 


Olei  amygdalae  dulcis, 

Liquoris  calcis,  aa 3iv 

(Useful  in  acute  scalp  cases.) 

II  Calaminae, 

Zinci  oxidi,  aa oiv 

Liquoris  calcis, 

Olei  olivae,  aa 3iv 

Acidi  carbolici gr.  xx-.\l 

Adipis  lanae  hydrosi 3 i 

II  Calaminae, 

Zinci  oxich,  aa gr.  xl 

Amyli 3i 

Acidi  salicylici gr.  iii-x 

AcicU  carbolici gr.  iii-xxx 

Petrolati  mollis,  q.s.,  ad 3i 


Haldin  Davis  recommends  the  following 
as  the  best  for  infantile  eczema: 


PI  Zinci  oxidi 3ii 

Amyli 3 ii 

Petrolati  mollis 3iv 


M.  Sig. — Spread  on  a ma.sk  of  butter  muslin. 
Enclose  the  arms  in  cardboard  splints  to  prevent 
scratching.  Change  once  or  twice  a day  in  weeping 
cases,  otherwise  once  in  forty-eight  hours. 


II  Zinci  oxidi 3i 

Adipis  lanae  hydrosi 3i 

Liquoris  calcis, 

Olei  olivae,  aa,  q.s.,  ad 3i 


M.  Sig. — A{)ply  twice  daily.  Later  when  exuda- 
tion ceases,  :idd  ichthyol,  3ss.  (Ilaldin  Daivis.) 

For  pustular  eczema  are  recommended  the 
following  two  ointments: 

II  IlydrargjTi  ammoniati  seu  oxidi 


flavi gr.  v-xx 

Lmguenti  zinci  oxidi  seu  aquae 
rosac 5 i 

II  lodoformi gr.  iii-x 

Unguenti  zinci  oxidi 5i 


ECZEMA 


For  eczema  of  the  scalp  and  of  the  external 
auditory  canal  the  following  ointment  is 
recommendetl.  The  auditory  canal  should 
also  be  syringed  occasionally  with  a warm 
solution  of  boric  acid  and  borax,  aa5ss 
to  the  pint: 


Resorcinolis gr.  v-xx 

Acitli  salicylici gr.  x-xx 

Acidi  carbolici gr.  ii-x 

Adijiis  lanaj  hydros!, 

Petrolati  mollis,  aa gss 


In  eczema  of  the  scrotum,  the  latter 
should  be  supported  as  high  as  possible  by  a 
suspensory  bag.  In  eczema  of  the  genitalia 
and  anus,  an  occasional  cleansing  with  a 
hot  solution  of  boric  acid,  oh,  and  borax, 
OSS,  to  the  pint,  is  necessary. 

Class  II. — Moderately  stimulating  reme- 
dies. 

The  stronger  jireparations  of  ichthyol  and 
liquor  carbonis  detergens  already  mentioned, 
come  in  this  class. 


II  Liqiioris  plumb!  suhacetatis ...  . oss-! 
Tiiictune  p!c!s  litiuidiD  composite  5ss-i 
Aqua?,  q.s.,  ad 5v!i! 

(Puscy.) 

II  Zinc!  o.xidi 3ii 

Licpioris  plumb!  subacetatis 

dilut! ov! 

Glycerin! oh 

Infus!  picis  liquida',  q.s.,  ad.  . . . giv 

(Stel  wagon.) 

II  Ole!  cadin! oi 

Ole!  amygdala?  rlulcis  sen  ole! 

olivac 5iii“i 

(Stelwagon.) 

II  Ilydrargyr!  ammoniat! gr.  x-lxxx 

Acid!  carbolic! gr.  v-x 

Unguent!  zinc!  oxid!  sen  Ung. 
aqua?  rosa? 5 ! 

II  Picis  liquidip m;x-xxx 

Zinc!  o.xidi oi 

Unguent!  aqua?  rosa?,  q.s.,  ad. . . 5i 

II  Liquoris  picis  carbonis oi 

Ilydrargyri  ammoniati gr.  x 

Petrolati  mollis,  q.s.,  ad 3i 

(Haldin  Davis.) 

II  Chrysarobini gr.  v-x 

Picis  liquida* ttjx 

IlydrargjTi  ammoniati gr.  x 

Adipis  benzoinati,  (j.s.,  ad 5i 

(Hutchinson.) 

II  Ichthyolis gr.  xivss 

Zinci  oxidi oi 

Glycerin! ohi 

Gelatin! oii 

Aqua? 5 vi 


Wdien  needed,  melt  over  a water  bath  (a 
double  oatmeal  boiler),  and  apply  with  a broad 
brush.  Before  the  gelatine  is  dry,  apply  a thin 
gauze  banilage.  Keej)  this  on  for  three  to  five 
days,  then  soften  and  remove  it  with  hot  water. 


and  apply  a fresh  dressing  (Stelwagon)  Gly- 
cerine is  said  to  be  preferable  to  vaseline  for 
most  fissured  lesions. 

Silver  nitrate,  gr.  v-xlviii  to  the  ounce  of 
water,  or  a saturated  solution  in  spirits  of 
nitrous  ether,  painted  on  every  five  to  ten 
days,  is  sometimes  useful  in  limited  areas, 
in  persistent  lip  cases,  in  eczema  of  the 
nails,  and  between  the  toes,  and  in  fissures 
of  the  breast.  The  mouth  should  be  opened 
widely  while  the  lips  are  being  painted. 
Tincture  of  benzoin,  painted  on  every  few 
hours,  is  also  useful  for  lip  and  breast  fis- 
sures, where  bland  ointments  fail.  Pusey 
says:  “ Where  the  fissures  are  deep  and  are 
constantly  broken  open  by  the  movements 
of  the  mouth,  they  can  be  cured  within  a 
day  or  two  by  painting  them  with  plain 
collodion,  which  should  be  renewed  as  soon 
as  it  loosens.” 

For  the  nails,  employ  unguentum  acidi 
salicylici,  gr.  xx-1  ad  5i,  with  an  occasional 
painting  with  silver  nitrate  in  obstinate  cases. 

Class  III. — Strongly  stimulating  remedies 
for  circumscribed  thickly  indurated  patches. 

Rub  in  thoroughly  twice  daily,  and  allow 
to  dry  on,  equal  parts  of  sapo  viridis,  pix 
liquida,  and  alcohol.  Continue  this  for  sev- 
eral days  or  longer,  if  no  irritation  ensues, 
and  then  soak  the  parts  in  hot  water  con- 
taining one  or  two  drams  of  borax  to  the 
quart,  wash  thoroughly  with  sapo  viridis, 
rinse  and  dry.  Continue  this  treatment 
until  effectual,  or  until  irritation  is  produced, 
when  mild  applications  may  be  made 
(Stelwagon).  A mild  ointment  such  as 
diachylon  ointment  {q.v.  in  Part  11)  maybe 
applied  thickly  upon  gauze  after  each 
cleansing. 

A quicker  method  of  removing  thick 
layers  of  horny  epidermis  is  by  rubbing  on 
liquor  potassse  {q.v.)  until  punctate  oozing 
occurs,  when  the  potash  is  washed  off  with 
vinegar,  ami  then  boric  acid  solution,  3iv 
ad  ()i,  and  a mild  ointment  applied. 

Salicylic  acid  plasters,  20  to  25  per  cent., 
may  be  applied  for  several  days  for  the 
same  purpose. 

One  may  scrub  the  hyperkeratotic  patches 
with  pumice  after  soaking  in  hot  water  con- 
taining salicylic  aciil,  10  per  cent.  Salic3'lic 
acid  is  a solvent  of  hornj'  epitlermis. 


II  Acidi  s.ilicylici gr.  xx-lxxx 

Adipis  lana?  hydros!. 

Petrolati  mollis,  aa 5ss 

II  Acidi  salicylici gr.  xv 

Ilydrargyri  ammoniati gr-  x 

Liquoris  picis  carbonis 5j 

Petrolati  mollis,  q.s.,  ad oi  . 


ELEPHANTIASIS 


Salicylic  ointment  is  valuable  for  the  dry, 
thickened  plantar  and  palmar  cases. 

For  intractable,  sluggish,  thickened  eases, 
the  X-rays  {q.v.)  may  be  employed.  Haldin 
Davis  uses  “ one-third  to  half  a pastille 
dose  for  a series  of  three  doses,  with  a 
rest  of  at  least  a week  after  each  dose.” 
Says  Knox,  “ The  first  dose  should  be  unfil- 
tercd  with  the  tube  fairly  soft  and  a three  to 
four  inch  spark-gap.  A Sabouraud  pastille 
should  be  colored  to  the  B tint,  its  distance 
from  the  skin  being  the  half  distance  of  the 
skin  from  the  anti-cathode.  Later  doses 
should  be  given  through  an  aluminum  screen 
of  .5  mm.  thickness,  which  allows  of  more 
frequent  exposures  and  a harder  ray  being 
used  when  deeper  than  superficial  effects  are 
necessary.  When  the  cure  begins  to  pro- 
gress, the  action  may  be  continued  by  a 
dose  once  in  three  weeks.” 

Eczema  Seborrhoeicum. — Gr.  eK^eiv  to  boil 
out.  See  Dermatitis  Seborrhocica. 

Elephantiasis.  — Gr.,  elephant  disease. 
Elephantiasis  lymphangitica  is  here  con- 
sidered. There  is  also  a lipomatous  form. 

Elejjhantiasis  lymphangitica  is  a chronic 
endemic  (tropical,  parasitic)  or  sporadic 
(non-parasitic)  disease,  characterized  by 
enormous  enlargement  and  deformity  of  a 
member  or  region  of  the  body,  due  to  hyper- 
trophy and  hypei’})lasia  of  the  skin  and 
subcutaneous  tissues  resulting  from  a block- 
ing of  the  Ijmiphatic  channels. 

Etiology.— The  immediate  cause  is  obstruc- 
tion of  the  lyitiphatics  or  veins.  Remote 
causes,  producing  such  obstruction,  are  the 
filaria  sanguinis  hominis  of  the  tropics 
(see  Filariasis),  intrapelvic  pressure,  as  in 
pregnancy,  giving  rise  to  phlegmasia  alba 
dolens  or  “ milk  leg  ” (see  Part  4), 
tumors,  ulcerations,  including  varicose 
ulcers,  chronic  erysipelatous  or  eczematous 
inflammation,  extensive  operative  removal 
of  the  inguinal  glands,  local  traumatism, 
extensive  chsease  of  the  inguinal  glands  and 
lymphatics  due  to  gonorrheea,  syphilis, 
chancroid,  lupus,  etc.,  wearing  of  a double 
truss,  frost-bite,  chronic  cedema  due  to 
thrombophlebitis  (see  Thrombosis,  and  Phle- 
bitis, in  Part  1),  or  to  cardiac  insufficiency, 
congenital  occlusion  of  the  lymph  channels. 

There  is  a congenital  or  inherited 
form  (elephantiasis  telangiectodes)  due, 
possibly,  to  overnutrition  resulting  from 
excessive  vascularity. 

Treatment. — During  febrile  attacks  (lym- 
phangitis or  elephantoid  fever,  following 
which  the  enlargement  increases),  admin- 
ister saline  aperients  and  quinine  (see  Part 
11),  and,  if  there  is  anaemia,  iron.  Locally, 


apply  on  lint,  and  change  once  to  thrice 
daily,  ichthyol  ointment  or  aqueous  solu- 
tion, 25  per  cent.;  or  bichloride  solution, 
1 : 4000  to  1 : 2000.  If  there  is  much  pain, 
fomentations  of  lead  water  and  laudanum 
iq.v.)  may  be  employed. 

To  open  any  turgid  lymphatics  incurs  the 
risk  of  infection  and  lymphorrhoea.  If  the 
disease  is  of  the  parasitic  variety,  the  patient 
should  be  removed  to  a non-infected  locality. 

In  the  intervals  between  acute  exacerba- 
tions, prescribe  a generous  diet,  codliver 
oil,  and  tonics,  such  as  iron,  arsenic,  and 
quinine.  Violent  exercise  and  exposure  to 
the  sun  should  be  avoided,  since  they  are 
apt  to  excite  elephantoid  fever.  The  iodides, 
thymol,  ichthyol,  methylene  blue,  and  gallic 
acid,  may  be  tried  experimentally.  Thomas 
recommends  calcium  sulphide,  gr.  i,  b.i.d.p.c., 
for  one  month,  then  gr.  iss,  and  later,  gr.  ii. 
Fibrolysin  is  recommended.  Alcohol  should 
not  be  taken.  Absolute  cleanliness  is  im- 
portant. See  Part  11  for  drug  formulje. 

For  offensive  discharge,  Stelwagon  recom- 
mends a powder  of  europhen,  one  part,  and 
boric  acitl,  three  parts;  or  where  there  is  a 
hard,  warty  covering,  europhen,  one  part, 
and  salicylic  acid,  three  parts. 

Palliation  is  afforded  by  rest,  elevation  of 
the  parts,  and  the  careful,  even,  and  firm 
application  of  a Martin  india-rubber  band- 
age by  day,  and  a light,  peiwieus  bandage 
by  night.  Under  this  treatment,  cases  due 
to  operative  removal  of  the  lymphatic 
glands  may  recover  in  several  months.  In 
vulval  cases  an  ointment  of  ichthyol,  10  to 
25  per  cent.,  iodine  (q.v.),  or  mercury 
iq.v.)  may  be  smeared  on  the  parts,  and 
pressure  applied  by  means  of  compresses 
and  a T-bandagc 

Under  strict  asepsis,  one  may  remove 
wedge-shaped  strips  of  skin  and  subcutan- 
eous tissue  from  time  to  time.  Adult 

filaria  may  be  removed  from  the  enlarged 
lymph  glands. 

The  scrotal  overgrowth  may  be  satis- 
factorily removed  with  the  knife.  First 
drain  the  parts  of  blood  for  some  hours. 
Then  apply  an  elastic  bandage,  and  at  the 
base  a ligature,  as  the  vascularity  is  very 
great.  Then  dissect  out  the  penis  and 
testicles  by  incisions  along  the  dorsum  of 
the  penis  and  along  the  course  of  the  cords, 
bearing  in  mind  that  hernia  is  apt  to  be 
present.  Take  away  the  whole  of  the 
affected  skin  to  obviate  recurrence. 

The  X-rays  (q.v.  in  Part  1)  may  be  of 
service. 

Prophylaxis  of  the  Filarial  Variety. — Boil  the 
drinkingwater,  andguardagainst  mosquitoes. 


EQUINIA 


Elephantiasis  Telangiectodes. — Gr.  reXos 
end  + ayyetov  vessel  + eKraais  dilatation. 
See  Elephantiasis,  above. 

Epidemic  Dermatitis  Exfoliativa. — See 
Dermatitis  Exfoliativa  Epidemica. 

Erythema. — -See  Acrodynia. 

Epidermolysis  Bullosa. — Gr.  hwLbepfxis  skin 
+ \vcns  loosening;  L.  bul'la,  large  blister.  A 
very  rare,  usually  congenital  and  hereditary 
(sometimes  acquired)  concUtion  of  the  skin, 
in  which  bull®  form  from  the  slightest 
injury.  The  tendency  usually  begins 
in  early  infancy  or  childhood,  and  per- 
sists indefinitely. 

There  is  no  other  treatment  than  the 
avoidance  of  pressure  and  friction. 

Epithelioma. — See  Carcinoma  Cutis. 

Adenoides  Cysticum. — Gr.  adr/v  gland 
-f  k8os  form.  See  Epithelioma, 
Multiple,  Benign,  Cystic. 

Multiple,  Benign,  Cystic. — Gr.  eir'  on 
d-  di]\rj  nipple  + -upa  tmnor;  Kucms  bladder. 
A very  rare,  usually  hereditary  disease, 
characterized  by  the  presence,  usually  on  the 
face,  ui;)per  trunk,  and  arms  of  multiple, 
small,  pinhead  to  pea-sized,  smooth,  glisten- 
ing, translucent  nodules  or  tubercles,  of  a 
pinkish,  pearly,  or  pale  yellowish  color. 

Malignant  degeneration  is  possible. 

Treatment. — Excision,  cinettage,  electrol- 
ysis (see  Adenoma  Sebaceum)  and  cauteri- 
zation are  mentioned.  Cautious,  repeated 
exposures  to  the  X-rays  (q.v.)  seem  the 
preferable  method  of  treatment. 

Equinia. — L.  e'quus,  horse.  An  infectious, 
contagious,  acute  or  chronic  disease,  caused 
by  the  bacillus  mallei,  derived  from  the 
horse,  mule,  and  ass,  and  characterized  by 
a pustular  or  deep-seated  nodular,  ulcerative 
eruption  in  the  skin  (farcy)  and  respira- 
tory mucous  membrane  (glanders),  together 
with  grave  constitutional  symptoms  resem- 
bling py®raia. 

The  acute  form  is  practically  always  fatal 
within  six  weeks.  The  chronic  form  is  remit- 
tent, with  about  fifty  per  cent,  of  recoveries. 

Mallein  may  be  used  in  the  same  way  as 
tuberculin  for  diagnostic  purposes.  If  a 
suspension  of  the  discharge  is  injected  into 
the  peritoneal  cavity  of  a male  guinea-pig, 
at  the  end  of  two  days  in  positive  cases  the 
testicles  will  be  swollen  and  the  skin  of  the 
scrotum  reddened. 

Treatment.— If  taken  within  an  hour  of 
inoculation,  excise,  if  possible,  the  infected 
area  with  its  neighboring  hmiphatics,  and 
mop  the  wound  with  pure  carbolic  acid  fol- 
lowed by  alcohol  or  tincture  of  iodine;  or 
open  and  thoroughly  cauterize  the  seat 
of  inoculation. 


In  established  cases,  open  the  farcy  buds 
before  they  break  down,  and  treat  the 
lesions  antiseptically.  Cauterize  nasal  ulcers 
with  chromic  acid  fused  on  the  end  of  a 
probe  (warm  the  probe,  dip  it  in  the  chromic 
acid  crystals,  and  warm  the  part  of  the 
probe  next  beyond  the  crystals  until  the 
latter  melt),  or  with  trichloracetic  acid, 
zinc  chloride,  or  the  actual  cautery,  and 
employ  a cleansing,  normal  saline  (5i  ad 
Oi)  or  alkaline  douche: 


B Sodii  bicarbonatis gr.  iii 

Sodii  biboratis gr.  iii 

Acidi  carboUci gr.  i 

Sacchari  albi gr.  v 

Aquae giii-iv 


When  irrigating  the  nose,  hold  the  head 
horizontally  over  a basin,  first  on  one  side, 
then  on  the  other,  and  insert  the  nozzle  each 
time  in  the  upper  nostril.  To  avoid  the 
entrance  of  fluid  into  the  Eustachian  tube 
and  middle  ear,  keep  the  mouth  wide  open 
during  the  irrigation,  breathe  through  the 
mouth,  and  refrain  from  swallowing.  In 
using  the  electro-cautery,  first  cocainize  and 
then  dry  the  parts  carefully.  Then  turn  on 
the  cm’rent  until  the  cautery  point  is  at  a 
cherry-red  heat.  A white  heat  causes  hemor- 
rhage, while  a dull  heat  causes  adlrerence  of 
the  point  to  the  charred  tissues.  Remove 
the  cautery  before  turning  off  the  current. 

The  following  drugs  may  be  tried:  qui- 
nine in  large  doses,  sulphur,  iodine,  sodium 
benzoate,  arsenic,  creosote,  but  St.  Clair 
Thomson  says : “Of  the  many  drugs  which 
have  been  employed,  mercury  is  the  onlj"  one 
which  can  claim  success  with  any  show  of 
reason.”  For  drug  dosage,  formul®,  etc., 
see  Part.  11. 

Mallein  may  be  given  hypodermically. 
Begin  with  one  milligram,  and  increase  the 
dose  in  the  course  of  sixteen  days  to  thirty 
milligrams.  In  one  chronic  case  it  was 
increased  from  one  milligram  to  a gram 
in-  the  course  of  a week,  with  recov- 
ery. (Crocker.) 

Fresh  air,  a concentrated  liquid  diet  con- 
sisting chiefly  of  milk  and  eggs,  and  sub- 
cutaneous and  rectal  infusions  of  normal 
salt  solution  (5i  ad  Oi)  are  important. 

It  is  advised  that  in  the  chronic  form, 
ulcers  should  not  be  curetted  or  rubbed 
with  antiseptics  for  fear  of  producing 
acute  s^miptoms. 

The  patient  should  be  isolated,  the  dress- 
ings and  discharges  destroyed,  and  con- 
taminated materials  of  value  either  boiled 
or  soaked  for  four  hours  in  a 2^2  cent, 
solution  of  carbolic  acid  (see  Disinfection, 


ERYSIPELOID 


in  Part  1) . Infected  animals  should  be  killed 
and  the  stables  thoroughly  disinfected. 

Erysipelas.— Gr.  epvdpos  red  + TreXXa  skin. 
A common,  contagious,  acute  infection  of 
the  lymphatic  spaces  of  the  corium  and  sub- 
cutaneous tissue  (sometimes  of  the  mucous 
membranes)  usually  affecting  the  face, 
caused  by  a streptococcus,  rarely  staphylo- 
cocci, and  characterized  by  a sharply  defined, 
swollen,  hot,  red,  shining,  tense,  oedematous 
area,  with  peripheral  spreading,  and  a 
tendency,  in  some  cases,  to  vesicle  and  bleb 
formation,  and  accompanied  by  pyrexia  and 
leucocytosis. 

Urinary  suppression,  oedema  of  the  glottis 
and  pyaemia  are  complications  to  be  feared; 
but  the  disea.se  usually  terminates  favorably 
in  about  a week  or  longer.  Suppuration, 
ulceration,  or  gangrene  rarely  occur,  but 
some  epidemics  have  been  reported  in  which 
suppuration  was  common.  The  disease  is 
serious  in  extensive  scalp  cases,  in  chronic 
alcoholism,  in  the  aged,  in  the  new-born,  in 
kidney  disease,  and  after  severe  injuries  or 
operations.  Gangrenous  cases  are  always 
fatal,  and  traiunatic  and  phlegmonous 
varieties  are  often  so. 

Etiology. — The  disease  usually  arises  from 
an  abrasion  or  local  infection  such  as 
a pustular  inflammation  just  inside  the 
nostril  orifice.  Poor  health,  alcoholism, 
chronic  nephritis,  old  age,  etc.,  j^redispose 
to  the  disease. 

Treatment. — Isolate  the  patient  (see  Disin- 
fection in  Part  1 ) . Open  the  bowels  with  calo- 
mel followed  in  six  hours  by  a saline.  Pre- 
scribe concentrated  liquid  nourishment : milk, 
egg-nog,  beef  juice,  beef  broth,  well-cooked 
farinaceous  gruels,  an  abundance  of  water. 
Employ  whiskey,  brandy,  ammonia,  cam- 
phor, and  strychnine  if  stimulation  is  re- 
quired (see  Drugs,  Part  11).  Iron  and  quinine 
are  classical  remedies,  but  the  former  is  apt 
to  upset  the  stomach: 


Tinctura;  ferri  chloridi 3ivss-§iss 

Quininse  sulphatis gr.  xxx-1 

Strychninte  sulphatis gr.  ss 

Syrupi,  q.s.,  ad 5iii 


M.  Sig. — Oneteaspoonful three  to  five  times  daily. 

Antistreptococcus  sermn  (obtained  from 
horses  immunized  with  the  streptococcus 
pyogenes)  is  of  doubtful  utility.  The  dose 
is  variously  given  as  10  to  20  to  50  c.c.,  sub- 
cutaneously, the  first  day,  followed  by  daily 
doses  of  10  to  25  c.c.  until  the  temperature 
fails.  Streptococcus  vaccine  may  be  tried, 
but  evidently  not  in  bactersemic  cases.  One 
may  begin  with  a daily  dose  of  one  to  five 
millions,  subcutaneously,  and  increase  to 


twenty-five  to  fifty  millions,  if  no  ill  effects 
are  shown.  Inunctions  of  Crede’s  ointment 
(q.v.)  are  recommended. 

Cut  the  hair  in  severe  scalp  cases.  Punc- 
tine  blebs  with  a sterile  needle.  Arneth, 
who  has  had  much  experience  in  the  treat- 
ment of  erysipelas,  paints  the  affected  skin 
three  or  four  tunes  a day  with  a five  per 
cent,  solution  of  carbolic  acid  in  oil,  and 
employs  no  covering.  He  has  never  obseiwed 
any  poisoning  from  its  use.  Other  commonly 
used  remedies  are  ichthyol,  10  to  25  to  50 
per  cent.,  in  vaseline  or  water,  the  weaker 
solutions  for  infants;  bichloride  of  mercury, 
1 : 4000  to  1 : 2000;  licjuor  aluminii  acetatis 
(g.r.);95  percent,  alcohol;  iodex.  The  solu- 
tions are  recommendecl  to  be  applied 
ice  cold,  on  lint  or  muslin,  covered  with 
gutta-percha  tissue  to  prevent  drying, 
and  changed  several  times  daily.  The 
bordering  skin  may  be  painted  an  inch  wide 
with  .strong  silver  nitrate  solution,  or  tincture 
of  iodine,  or  contractile  non-flexible  collo- 
dion (U.S.P.).  A half-inch-wide  strip  is 
painted  with  the  collodion  all  around  the 
affected  skin,  one  inch  from  the  latter,  and  the 
application  repeated  until,  when  dry,  the  col- 
lodion produces  a continuous,  deep  furrow, 
which  constricts  the  lymphatics  and  thereby 
prevents  the  spread  of  the  disease.  Multiple 
incisions  or  a fence  rail  incision  all  around 
the  infected  area,  followed  by  the  rubbing 
in  of  a 60  per  cent,  ichthyol-lanolin  oint- 
ment, or  soaking  with  hot  bichloride, 
1 : 1000,  is  recommended ; as  is  also  the  sub- 
cutaneous injection,  into  the  sensitive  por- 
tion beyond  the  border,  of  carbolic  acid, 
1 : 30,  or  biniodide  or  bichloride  of  mer- 
cury, 1 : 4000. 

During  convalescence,  gradually  replace 
the  liquitl  nourishment  by  a very  nutritious 
diet:  eggs  boiled  three  minutes,  beef,  well- 
cooked,  light  farinaceous  gruels  with  cream, 
mashecl  or  baked  potatoes,  custards,  blanc- 
mange, flavored  gelatine  and  cream,  cocoa, 
toast,  bread  and  butter,  baked  apple.  Tonics 
may  be  useful. 

After  recovery,  the  patient  should  take  a 
full  soap  and  water  bath,  followed  by  bichlor- 
ide, 1 : 5000;  and  the  clothing  and  bedding, 
etc.,  should  be  sterilized,  as  directed  under 
Disinfection  (in  Part  1). 

Erysipeloid. — Erysipelas  Gr.  d8os  form. 

A dermatitis  resembling  erysipelas,  except 
that  it  is  much  milder  and  with  little  or  no 
constitutional  disturbance,  caused  by  the 
entrance  of  infection,  derived  from  dead 
animal  matter  or  crab-bites,  through  abra- 
sions in  the  skin.  It  responds  rapidly 
to  treatment. 


EIlYTHExMA  MULTIFORME 


Treatment. — This  is  the  same  as  that  of 
erysipelas.  The  part  affected  must  be 
immobilized.  Gilchrist  recommends  the 
firm  application  for  three  days,  of  a 25  per 
cent,  salicylic  acid  plaster  extending  well 
beyond  the  border. 

Erythema  Autumnale. — L.,  from  Gr. 
epv9rjij.a  redness.  See  Harvest  Rash. 

Erythema  Elevatum  Diutinum. — L. ; Gr. 
epv9r]fj.a  redness;  L.,  elevar'e,  to  lift.  An  ex- 
tremely rare  disease,  affecting  chiefly 
young  females  with  a gouty  or  rheumatic 
tendency,  and  characterized  by  a more  or 
less  persistent  eruption  of  pea-  to  bean-sized, 
raised,  sharply  defined,  tlense,  pinkish  to 
purplish,  flattened  nodules  or  plaques. 

Treatment  has  been  unsatisfactory.  The 
X-rays  (q.v.)  may  be  tried. 

Erythema  Epidemica. — (See  Acrodynia). 

Erythema  Induratum. — L. ; Gr.  epv9r]pa 
redness;  L.  indura'tio,  hardness.  A rare 
chronic,  obstinate  disease,  occurring  almost 
exclusively  in  girls  and  women  who  are  much 
on  their  feet  and  who  have  a tubercular 
tendency,  and  characterized  by  bilaterally 
symmetrical,  multiple,  deep-seated,  red  or 
purplish,  gumma-like  nodules,  chiefly  in  the 
calves  of  the  legs,  of  slow  course,  with  a 
tendency  to  break  down  into  sluggish  ulcers. 

Treatment. — Of  the  first  hnportance  is  a 
correct  hygienic  regimen,  e.g.,  adequate 
rest,  fresh  air  day  and  night,  cleanliness, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  nutritious  food  and 
tonics,  codliver  oil  (q.v.  in  Part  11),  etc. 

If  there  is  no  ulceration,  apply  unguentum 
hydrargyri  bisiflphuretti,  gr.  v ad  5i,  ‘"i- 

firm,  evenly  applied  bandage  from  the  foot 
to  above  the  knee,  and  enjoin  moderate 
exercise  in  the  fresh  air. 

If  ulceration  is  present,  however,  enjoin 
rest  with  the  legs  elevated  and  treat  the 
ulcers  with  mild  antiseptics,  such  as  boric 
acid  solution,  3iv  ad  Oi,  or  hydrogen  per- 
oxide, half  strength,  or  boric  ointment, 
10  per  cent.,  or  unguentum  hydrargyri  oxidi 
rubri  (q.v.).  Rbntgentherapy,  “ half  a 
pa.stille  does  at  intervals  of  a week  ” (J.  H. 
Sequeira),  is  of  value. 

Where  rest  is  impracticable,  the  following 
plan  of  Stelwagon’s  may  be  tried:  wash  the 
leg  and  ulcers  daily  with  a saturated  solu- 
tion of  boric  acid  (5v  ad  Oi)  containing 
resorcin,  gr.  xlviii-clx  ad  Oi;  then  apply  to 
the  ulcer  finely  powtlered  boric  acid  or  the 
following  ointment : 

R Resorcinoli.s gr.  xxiv-xlviii 

Zinci  oxidi, 

Amyli,  aa oii 

Pctrolati.' 5iv 

(Stelwagon) 


Then  bandage  the  whole  leg  evenly  and 
firmly,  so  as  to  support  the  veins  and 
promote  the  circulation.  As  soon  as  the 
ulcers  have  become  clean  and  less  active, 
spray  them  with  hydrogen  peroxide,  and 
apply  a gelatine  dressing  containing  zinc 
oxide  and  ichthyol  (given  below),  leaving  a 
window  over  each  ulcer,  which  should  be 
treated  daily  with  the  powder  or  ointment 
above  mentioned.  The  gelatine  dressing 
should  be  renewed  every  three  or  fom’  days. 


IchthyolLs gr.  xivss 

Zinci  o.xidi 3 i 

Glycerini 5 iii 

Gelatini 3ii 

Aqua3 5 vi 


When  needed,  melt  over  a water  bath  (in 
a double  oatmeal  boiler),  and  apply  with  a 
broad  brush.  Apply  a thin  gauze  bandage 
before  the  gelatine  is  dry. 

Erythema  Infantum. — L.;  Gr  epWripia  red- 
ness; L.  in’ fans,  babe.  See  Miliaria. 

Intertrigo. — L.;  Gr.  epv9ripa  redness. 
See  Intertrigo. 

Iris. — Gr.  ipis  a rainbow  or  halo.  See 
Erythema  Multiforme. 

Migrans. — L.;  Gr.  ipv9r)pa  redness;  L. 
migrans,  migrating.  See  Geographic 
Tongue. 

Multiforme. — L ; Gr.  epv9r]pa  redness; 
L.  mid'tus,  many  fl-  for'ma,  form.  A not 
uncommon  acute  or  subacute  inflamma- 
tory disease,  characterized  by  the  occur- 
rence of  numerous  scattered  or  grouped, 
pinkish  to  purplish-red,  often  variegated 
macules,  slightly  raised,  flattened,  pea- 
sized papules,  and  tubercles,  occasionally 
becoming  vesicular  or  bullous,  and  showing 
a predilection  for  the  dorsal  surface  of  the 
hands  and  forearms,  the  tibial  aspect  of  the 
legs,  and  the  face.  The  eruption  sometimes 
assumes  an  annular,  a marginate,  or  a gyrate 
configuration.  Concentric  rings  may  pre- 
sent different  tints  of  coloring  (erythema 
iris;  herpes  iris). 

The  disease  may  possibly  be  related  to 
urticaria,  purpura,  and  erythema  nodosum. 
It  runs  its  course  in  two  to  four  weeks,  but 
recurrence  is  the  rule. 

Etiology.— Possible  causal  factors  are  intes- 
tinal toxines,  stale  food,  gout  or  rheumatism, 
antitoxin,  urethral  irritation,  uterine  dis- 
turbances, neuroses,  exposure  to  cold,  sea 
winds,  or  sunlight,  certain  drugs  (potassium 
iodide,  copaiba,  mercury,  coal-tar  drugs,  etc.) 

Treatment. — Open  the  bowels  by  means  of 
calomel  or  castor-oil  followed  by  salines.  If 
rheumatic  symptoms  are  present,  prescribe 
sodium  salicylate.  Quinine,  potassium  iodide, 
ergot,  and  arsenic  are  variously  recom- 


J^RYSIPELAS 


Measles. 


Scarlet  fever. 


Scarlet  fever. 


Erysipelas. 


Measles. 


LAROrSSE  MEDICAL. 


Erysipelas.  Measles.  Scarlet  fever. 


ERYTHROMELALGIA;  RED  NEURALGIA  OF  THE  EXTREMITIES 


mended  (see  Part  11,  for  Drugs).  Says 
Pusey:  “ Granville  McGowan  strongly 

advises  ten-drojr  doses  of  1 : 1000  solution 
of  adrenalin  chloride  every  two  hours  in 
erythema  multiforme  and  angioneurotic 
dermatoses.”  If  the  patient  is  debilitated, 
prescribe  a carefully  selected,  nutritious 
diet,  with  perhaps  codliver  oil  (q.v.)  and 
tonics.  In  stubborn,  recurrent  cases,  it  is 
well  to  put  the  patient  to  bed. 

Puncture  bullae  with  a sterile  needle,  and 
apply  one  of  the  following: 

Calamina' gr.  xl 

Zinci  oxidi gr.  Ixxx 

Acidi  borici 3i 

Glycerin! njii-viii 

Acidi  carbolic! injxx 

Liquoris  calcts gi 

Aquse,  q.s.,  ad 5iv 

(Calamine  lotion.) 

Mentliolis gr.  x 

Adipis  lanaj  hydros! 

Petrolati  mollis,  aa 3 ss. 

Erythema  Nodosum. — L. ; Gr.  epW-rjixa  red- 
ness; L.  nodosus,  nodose.  An  uncommon, 
acute  inflaimnatory  affection,  characterized 
by  the  occurrence  of  multiple,  tender  and 
painful,  erythematous,  roundish  or  oval, 
node-like  swellings,  varying  in  size  from  a 
large  nut  to  an  egg,  localized  chiefly  over 
the  tibiae  or  ulnae,  and  attended  by  slight 
fever,  malaise,  and  articular  pains.  The 
lesions  are  bright  red  at  first,  and  later 
undergo  the  color  changes  of  a bruise.  The 
swellings  become  semi-fluctuant,  but  never 
suppurate.  They  disappear  spontaneously 
in  from  one  to  eight  weeks. 

Etiology. — The  disease  is  toxic  or  infectious 
in  nature,  and  occurs  in  association  with 
articular  rheumatism,  anaemia,  malaria, 
tuberculosis,  bad  hygiene,  etc.  The  iodides 
and  antipyrine  have  caused  its  appearance. 
It  is  possibly  related  to  erythema  multiforme. 

Treatment. — Put  the  patient  to  bed  on  a 
plain,  bland  diet,  which  should  be  liquid  if 
fever  is  present,  and  restrict  the  use  of  red 
meats  and  cane  sugar.  Open  the  bowels 
with  calomel  followed  after  six  hours  by  a 
saline  (see  Part  11,  Drugs).  Elevate  the  legs. 
The  salicylates  and  quinine  are  recom- 
mended. Prescribe  iron  as  required. 

For  local  and  articular  pain,  apply  com- 
presses wet  with  lead  and  opium  wash 
(q.v.),  or  ichthyol  ointment,  10  per  cent., 
or  ether  and  alcohol,  aapiii,  with  ichthyol 
3ii-  The  nodes  may  be  painted  with  flexible 
collodion  (Jamieson).  The  joints  may  be 
enveloped  in  cotton  batting. 

Erythema  Pernio. — See  Chilblain. 

Scarlatinoides. — L.;  Gr.  epbOrtpa  red- 
ness; L.  scarlati'na,  scarlet;  Gr.  eidos  form. 
38 


A rare,  generalized,  macular  erythema, 
resembling  that  of  scarlet  fever,  associated 
with  slight  pyrexia,  but  no  throat  symptoms, 
and  followed  by  abundant  desquamation. 
It  may  run  its  course  in  one  or  two  weeks 
but  relapses  are  prone  to  occur. 

Etiology.— Some  form  of  intoxication,  e.g., 
intestinal  toxsemia,  septic  infection  (particu- 
larly from  pent-up  pus,  as  in  abscess,  car- 
buncle, empyema,  tuberculous  peritonitis), 
gonorrhoea,  uraemia,  rheumatism,  malaria, 
certain  drugs  and  foods,  such  as  diphtheria 
antitoxin,  copaiba,  quinine,  mercury,  bella- 
donna, salicylic  acid,  sewer-gas  shellfish, 
spoiled  meat. 

It  may  occur  following  an  enema,  an 
operation,  a mercury  inunction,  exposure  to 
great  heat,  the  prolapse  of  an  enlarged  ovary. 

Treatment. — Enjoin  rest  in  bed  in  a warm 
but  well-ventilated  room.  Attend  to  any 
possible  causal  influence.  Open  the  bowels 
with  calomel  followed  by  salines,  and  give 
water  to  drink  freely,  preferably  in  the  form 
of  cream  of  Tartar  lemonade,  made  by  dis- 
solving one  teaspoonful  of  cream  of  Tartar 
in  a pint  of  boiling  water,  and  serving  cool, 
flavored  with  a little  sugar  and  lemon  juice. 
Sodium  salicylate,  quinine,  or  tonics  may  be 
of  service  (see  Part  11,  Drugs).  Locally  a 
bland  oil  (almond  oil,  or  cottonseed  oil,  or 
liquid  vaseline),  or  dusting  powder  is  all 
that  is  reciuired.  The  former  relieves  the 
unj:)leasant  tension  and  stiffness. 

Erythrasma. — Gr.  epvdpbs  red.  A trivial, 
hyphomycetic  fungus  disease  of  the  skin, 
caused  by  the  microsporon  minutissimum, 
and  characterized  by  the  presence  of  reddish- 
brown  patches  in  the  axillary  and  genito- 
crural  regions. 

The  fungus  is  demonstrable  by  a micro- 
scopic examination  of  the  skin  scrapings, 
after  soaking  the  latter  for  fifteen  minutes 
in  liquor  potassae  (q.v.,  Part  11). 

The  treatment  is  the  same  as  for  tinea 
versicolor  (q.v.). 

Erythromelalgia;  Red  Neuralgia  of  the 
Extremities. — Gr.  epvdpbs  red  + geXos  limb 
-h  aXyos  pain.  A very  rare,  chronic,  intract- 
able disease,  characterized  by  flushing,  fever, 
swelling  and  pain  of  a limb,  aggravated 
when  the  latter  hangs  down. 

Etiology. — Central  or  peripheral,  organic  or 
functional  nervous  disease  or  disturbance; 
cervical  rib  (see  Part  1);  obliterative  endar- 
teritis (intermittent  claudication.  Part  1) 
Raynaud’s  disease  (q.v.). 

Treatment.— This  is  usually  only  palliative. 
For  the  relief  of  pain,  one  may  prescribe 
phenacetin,  antipyrine,  acetanelid,  cannabis 
indica,  aspirin  or  sodium  salicylate  (see 


FAVUS 


Part  11).  Menthol,  10  per  cent,  in  alcohol, 
oil  of  wintergreen,  wet  packs,  gentle  massage, 
if  well  borne,  faradization  or  galvanization 
may  be  employed  locally.  The  lunb  should 
be  elevated.  Overexertion  and  exposure  to 
heat  or  cold  should  be  avoided.  A pro- 
tracted rest  of  from  six  weeks  to  three 
months  is  advised. 

All  the  nerves  supplying  the  affected  part 
may  be  stretched  or  cut.  Amputation  is 
even  sometimes  demanded. 

Exfoliative  Dermatoses. — L.  ex,  out  + 
fo'lium,  leaf;  Gr.  Sepya  skin.  These  include 
dermatitis  exfoliativa,  dermatitis  exfoliativa 
epidemica,  dermatitis  exfoliativa  neonato- 
rum, erythema  scarlatinoides,  pityriasis  rubra 
pilaris,  and  scarlet  fever. 

Scaling  to  a slight  degree  occurs  also  in 
measles  and  rubella. 

Exfoliative  Glossitis. — Gr.  yXOiao-a  tongue 
+ -iTts  inflammation.  See  Geo- 
graphic Tongue. 

Glossodynia. — See  Glossodynia  Exfol- 
iativa. 

Eyebrows  Pale  and  Scanty. — 


Tincturae  jaborandi 3i 

Alcoholis 3 i 

Aeidi  acetici  glacialis t^x 

Spiritus  setheris  compositi 5 i 


Farcy. — ^See  Equinia. 

Favus. — h.fav'us,  honey-comb..  A chronic 
contagious,  hyphomycetic  fungus  disease, 
caused  by  the  achorion  Schonleinii  (L.  dim. 
of  Gr.  aycop  dandruff),  and  characterized  by 
the  presence,  chiefly  upon  the  scalp,  of 
friable,  sulphur-yellow,  saucer-shaped  crusts, 
with  a mousy  odor,  which  tend  “ sooner  or 
later  to  form  coalescent,  mortar-like  masses  ” 
(Stel wagon).  The  disease  is  followed  by 
atrophic  scarring  and  permanent  alopecia. 

The  fungus  is  demonstrable  microscopi- 
cally after  soaking  in  liquor  potassie  (see 
Part  11)  for  about  fifteen  minutes. 

The  disease  may  be  transmitted  by 
domestic  animals. 

Prognosis.— Favus  of  the  body  surface  is 
curable  in  from  one  to  eight  weeks.  Favus 
of  the  scalp  is  much  more  difficult  to  cure, 
from  six  months  to  one  or  two  years  being 
required  in  well-established  cases. 

Treatment. — First  crop  the  hair  closely 
over  the  entire  scalp,  and  keep  it  cropped. 
A paper  or  linen  skull  cap  should  be  worn 
inside  the  hat,  and  the  paper  cap  burned  or 
the  linen  cap  boiled  daily.  Remove  the 
crusts  with  a knife,  after  softening  them  for 
twelve  to  twenty-four  hours  or  longer  with 
carbolized  olive  oil,  gr.  v ad  oi-  Then 
cleanse  the  whole  scalp  with  hot  water  and 


green  soap,  shave  each  affected  patch, 
rinse  off  the  soap,  and  apply  a lotion  con- 
sisting of  carbolic  acid,  resorcin,  3i, 
boric  acid,  3iv,  and  water,  Oi  (Stel wagon). 
Now  apply  to  each  affected  patch  a depila- 
tory consisting  of  barium  sulphide,  3 hi,  zinc 
oxide  and  powdered  starch,  aa3hss,  to  which 
sufficient  water  is  added  to  make  a paste. 
The  paste  should  slightly  overlap  the  edges 
of  the  patch,  and  should  be  left  on  for  about 
ten  minutes,  or  until  a burning  sensation  is 
felt,  when  it  should  be  washed  off  thoroughly. 
Instead  of  using  the  depilatory  paste,  one 
may  epilate  a small  area  each  day  with 
forceps,  after  partially  desensitizing  the 
skin  with  a strong  solution  of  carbolic  acid. 

Each  day  the  whole  scalp  should  be 
cleansed  with  green  soap  and  hot  water, 
rinsed,  dried,  and  the  above  carbolic  lotion 
used.  One  of  the  following  parasiticides  is 
then  applied  to  each  patch: 


R Hydrargyri  chloridi  corrosivi . . . gr.  iv-xvi 
Aquae 5 iv 


Tincturae  iodi, 

Acidi  carbolici, 

Chlorali  hydrati,  aa 

(Cutler’s  Fluid.) 


1^  Acidi  pyrogallici 3ss-i 

Petrolati  mollis 3 i 

Chry.sarobini 3ss-i 

Petrolati  mollis 3 i 

(see  Chrysarobinum  in  Part  11.) 

R Acidi  carbolici 3i 

Unguenti  picis  liquidae, 

Ilnguenti  hydrargyri  nitratis,  aa  3ii 

Unguenti  sulphuris 3iv 

Make  this  up  fresh  once  weekly.  (Stelwagon.) 

Acidi  sulphurosi 3 i 

Use  pure  or  slightly  diluted. 


The  parasiticide  should  be  rubbed  in  thor- 
oughly, for  at  least  five  minutes,  at  bedtune 
or  twice  daily,  until  irritation  supervenes, 
when  it  should  be  discontinued  and  a bland 
ointment,  such  as  cold  cream  or  boric 
ointment,  used  until  the  irritation  has 
subsided.  The  depilatory  may  be  used 
every  five  to  ten  days  according  to  the 
rapidity  of  regroAvth.  It  should  never  be 
applied  to  an  actively  inflammatory  patch. 

After  three  or  more  months  of  this  treat- 
ment, it  should  be  discontinued  for  a week 
or  longer  in  order  to  observe  the  effect.  “ If 
there  are  no  signs  of  a return  of  scaliness, 
yellowish  points,  or  dulled,  lustreless  hair 
in  five  or  six  weeks  after  cessation  of  treat- 
ment, the  case  may  be  considered  as  cured  ” 
(Stelwagon).  “ The  treatment  and  neces- 
sary observation  require,  therefore,  at  least 
six  months.”  (Crocker.) 

For  favus  of  the  non-hairy  surface,  weaker 
parasiticides  are  employed; 


FOLLICULITIS  DECALVANS;  CICATRICIAL  ALOPECIA 


Hydrargyri  ammonia ti 5ss-i 

Petrolati  mollis 5i 

Sulphuris  prsecipitati 5ss-i 

Petrolati  mollis 5 i 

TinctursB  iodi 5i 

Acidi  sulphurosi 5 i 


Dilute  with  one  to  two  parts  of  water. 

Favus  of  the  nail  is  very  obstinate.  The 
nail  should  be  well  scraped,  and  then 
softened  by  applying  on  lint  under  oiled 
silk  or  a rubber  finger  stall,  for  fifteen  min- 
utes, a solution  of  potassium  iodide,  5ss, 
in  5ss  each  of  liquor  potassse  and  aqua 
destillata.  Then  at  once  is  applied  on  lint 
under  oiled  silk  a solution  of  hydrargyrum 
perchloridum,  gr.  iv,  in  spiritus  vini  rectifi- 
cati  and  aqua  destillata,  aa5ss.  At  the  end 
of  twenty-four  hours  the  nail  is  again 
scraped  and  washed  and  the  foregoing  pro- 
cedure repeated.  When  peeling  and  tender- 
ness of  the  skin  occur,  a solution  of  sodium 
hyposulphite  5 i,  in  water,  5 viii,  is  used  until 
these  symptoms  disappear.  (Stelwagon.) 

Another  method  of  treatment  is  by  means 
of  the  constant  application,  under  a rubber 
finger-stall,  of  absorbent  cotton  soaked  in  a 
solution  of  iodine,  gr.  xv,  and  potassium 
iodide,  gr.  xxx,  in  chstilled  water,  Oi.  The 
nail  may  be  first  avulsed.  (Stelwagon.) 

Favus  is  best  treated  by  means  of  the 
X-rays.  The  latter  are  applied  cautiously 
every  day  or  every  other  day  until  erythema 
is  produced  and  the  hair  falls  out.  They  are 
then  discontmued  imtil  the  reaction  has  sub- 
sided, when  they  may  be  repeated,  if  neces- 
sary. See  Ringworm  of  the  Scalp  for  the 
“ Kienbock-Adamson  ” technique. 

Fever  Bliste r. — See  Herpes  Simplex. 

Fibroma;  Fibroma  Molluscum;  Neuro= 
fibroma. — L.  fib'ra,  fibre  + Gr.  -wfxa  tumor; 
L.  molus'cum,  soft;  Gr.  vevpov  neiwe.  Syno= 
nym.— Von  Recklinghausen’s  Disease. 

A rare  hereditary  and  familial  disease  of 
the  skin,  characterized  by  the  presence  of 
one  or  more  abruptly  elevated,  sessile  or 
pedunculated,  soft  or  firm,  pea-  to  egg- 
sized or  larger,  painless,  connective-tissue 
tumors,  which  begin  to  appear  usually  in 
childhood.  Some  of  the  growths  may 
atrophy  and  leave  atrophic  areas  in  the 
corium;  patches  of  pigmentation  are  often 
present;  also  pseudo-neuromata  along  the 
course  of  the  nerves.  The  skin  may  hyper- 
trophy and  sag  in  places,  particularly  in  the 
scalp,  and  form  a pendulous  mass  which  may 
carry  down  attached  structures,  such  as  the 
ear.  The  patient  is  often  deficient  mentally 
and  physically. 


There  is  a fibroma  molluscum  gravidarum, 
which  disappears  post  partum. 

Treatment. — Pedunculated  tumors  may  be 
removed  by  means  of  ligation,  the  ecraseur, 
the  galvanocautery,  or  excision ; sessile  tum- 
ors by  excision,  or  if  small,  by  electrolysis 
(see  Adenoma  Sebaceum).  Removal  should 
be  complete  in  order  to  avoid  recurrence.  In 
performing  excision,  the  vessels  should  be 
secured  before  they  are  cut,  or  the  bleeding 
may  prove  very  formidable.  Sagging  masses 
of  skin  may  be  removed  by  a plastic 
operation. 

The  prolonged  achninistration  of  arsenic 
{q.v.  in  Part  11)  has  been  followed  by  good 
results. 

Fig  Wart  — See  Verruca. 

Filaria  Medinensis. — L.  fil'um,  thread. 
See  Dracontiasis. 

Sanguinis  Hominis. — L.  fil'um,  thread; 
san'guis,  blood;  ho'mo,  man.  See 
Filariasis,  in  Part  1. 

Filariasis. — L fil'um,  thread. — See  Part  1, 
General  Medicine  and  Surgery. 

Finger=Nail  Diseases.— See  Nail  Dis- 
eases. 

Fish=Skin  Disease. — See  Ichthyosis. 

Fissured  Lip.- — See  under  Eczema. 

Flea=Bite. — See  Bites. 

Folliclis. — See  under  Acne  Varioliformis. 

Folliculitis  Barbse. — L.  follic'ulus,  little 
bag  -1-  Gr.  -ms  inflammation;  L.  barb’ a, 
a beard.  See  Sycosis  Vulgaris. 

Folliculitis  Decalvans;  Cicatricial  Alo= 
pecia. — L.  follic'ulus,  little  bag  -b  Gr.  -trts 
inflammation;  L.  deca  v'ans,  destroying  hair; 
cica'trix,  scar;  Gr.  dXcoTrr?^  fox.  A chronic 
disease  of  hairy  parts,  characterized  by  a 
bald  cicatricial  spot  bordered  with  follicular 
inflammation.  The  disease  is  rebellious  to 
treatment,  but  it  can  be  cured.  The  bald- 
ness, however,  is  permanent. 

Treatment. — Clip  the  hair  surrounding  the 
patch,  and  epilate  the  border  hairs.  Cleanse 
the  entire  scalp  frequently  with  tincture  of 
green  soap  and  hot  water,  and  apply  daily 
to  the  entire  scalp,  an  aqueous  solution  of 
boric  acid,  qiv,  carbolic  acid  an<l 

resorcin,  5iss,  ad  Oi,  or  a 1 : 1000  solution 
of  bichloride  of  mercury  in  alcohol  or  alcohol 
and  water.  Once  daily,  rub  into  the  affected 
parts  one  of  the  following  preparations: 


B Hydrargyri  ammoniati gr.  x-5i 

Petrolati  mollis 51 

B Sulphuris  prsDcipitati gr.  x-3i 

Petrolati  mollis 31 

B Acidi  salicylici gr.  x-xx 

Resorcinolis gr.  vi-xx 

Petrolati  mollis 51 


FURUNCLE;  ABSCESS;  BOIL 


The  X-rays  are  recommended  (see  under 
Favus). 

Fordyce’s  Disease. — A not  very  rare  dis- 
ease of  the  oral  mucous  membrane  anfl  the 
lips,  characterized  by  the  permanent  presence 
of  abundant,  pinpoint  to  pinhead-sized,  dis- 
crete, aggregated,  whitish  or  yellowish 
bodies. 

Fragilitas  Crinium  - — L.  Jragil'itas,  brittle- 
ness; crin'is,  hair.  See  Hair  Diseases. 

Frambcesia;  Yaws. — L.  framboe'da,  rasp- 
beriy.  A tropical,  enflemic,  chronic  infec- 
tious and  contagious  disease,  caused  by  the 
si)irochseta  pertenuis,  transmitted  by  flies, 
and  characterized  by  an  incubation  periotl 
of  two  to  ten  weeks,  and  a febrile  ])eriod  of 
one  to  seven  or  more  days,  accompanied  by 
articular  jiains,  and  followed  by  the  appear- 
ance of  an  itching  eruption  of  papules  which 
usually  develop  into  fungoid  or  raspberry  or 
cauliflower-like,  reddish,  indolent  tvibercles, 
capped  by  a cheesy  crust  (Stelwagon). 

Spontaneous  recovery  is  the  rule;  but  if 
untreated,  the  eruption  continues  in  suc- 
cessive crops  for  months  or  years. 

Treatment. — Salvarsan  or  neosalvarsan,  ad- 
ministered as  in  syphilis  (q.v.,  in  Part  1),  is 
siiecific.  It  is  said  that  one  dose  generally 
effects  a complete  cure. 

During  the  febrile  stage,  the  patient 
should  be  kept  in  bed  on  a concentrated 
liciuid  diet,  with  plenty  of  water,  preferably 
in  the  form  of  cream  of  tartar  lemonade 
iq.v.)  Warm,  demulcent  drinks,  with  the 
patient  under  woolen  blankets,  should  be 
given  when  the  fever  subsides,  in  order  to 
hasten  the  rash.  After  the  rash  has  ap- 
peared, one  should  prescribe  an  abundance 
of  nutritious,  easily  digestible  food,  with 
codliver  oil  (q.v.)  if  deemed  advisable,  and 
iron  for  anaemia.  The  elixir  ferri,  quininae, 
et  strychninae  phosj^hati  is  a serviceable 
tonic.  Potassium  iodide  may  be  of  value, 
but  mercury  is  not  (see  Drugs,  Part  11). 

Thorough  cleanliness  is  important.  The 
skin  lesions  may  be  washed  with  bichloride 
solution,  1 : 2000,  and  iodoform  ointment 
(q.v.)  applied.  Touching  the  tubercles 
every  five  days  with  copper  sulphate  ciystals 
is  said  to  be  the  best  local  treatment.  Small 
chronic  growdhs  may  be  destroyed  by  curet- 
tage followed  by  the  ajii')lication  of  carlwlic 
acid.  To  got  at  troublesome  lesions  on  the 
soles  of  the  feet,  soak  the  latter  in  hot  soap- 
suds, and  pare  away  the  thick  epithelium. 

The  patient  should  be  segregated,  and 
thorough  disinfection  of  the  clothing,  house, 
etc.,  carried  out  iii  order  to  stamp  out  the 
disease  (see  Disinfection  in  Part  1).  Perfect 
cleanliness  is  preventive. 


Freckles;  Lentigo. — L.  lentig’o,  freckle. 
The  treatment  of  freckles  is  unsatisfactory, 
because  they  practically  always  recur  after 
removal.  They  are  best  removed  on  the 
approach  of  autiunn.  The  treatment  is  the 
same  as  that  of  chloasma  {q.v.)]  but  the 
stronger  applications  of  lactic  acid  should 
be  made  only  to  individual  lesions. 

Frost=Bite. — See  Chilblain. 

Furrowed  Tongue. — See  Tongue  Diseases. 

Furuncle;  Abscess;  Boil. — L.  fiirun'cidus, 
a petty  thief;  absces'sus,  a going  apart..  An 
acute,  usually  suppurative,  deep  folliculitis, 
affecting  usually  the  pilo-sebaceous  follicles, 
sometimes  the  sweat  glands.  Through 
autoinoculation  a multiplicity  of  furuncles 
may  appear  (furunculosis). 

Etiology.— Boils  arc  caused  by  pus  organ- 
isms, almost  always  the  staphylococci  aur- 
eus, albus,  and  citreus.  Predisposing  causes 
are  uncleanliness,  sweating  and  friction, 
dampness,  sewer  gas,  anaemia,  chronic  alco- 
holism, nephritis,  diabetes  mellitus,  dys- 
pepsia, the  gouty  or  rheiunatic  diathesis, 
menstrual  disorders,  working  in  paraffin 
oils,  petroleum  and  tar  products,  certain 
drugs,  particularly  potassium  iodide,  pruritic 
affections  (eczema,  scabies,  prurigo,  etc.), 
local  injury,  convalescence  from  acute  ill- 
nesses, particularly  tjqjhoid  fever. 

Treatment. — Endeavor  to  ascertain  the 
cause.  Enjoin  the  observance  of  correct 
hygiene,  e.g.,  adequate  rest  and  exercise, 
frequent  bathing,  fresh  air  day  and  night, 
a generous  dietary  (excepting  in  gouty 
cases  and  diabetes):  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals, 
perhaps  tonics,  such  as  Bland’s  pills,  elixir 
ferri,  quininae,  et  strychninae  phosphati,  Fow- 
ler’s solution,  syrup  of  hypophosphites,  and 
codliver  oil  (see  Part  11);  also  regulation  of 
the  bowels. 

Y^east  is  well  recommended:  fresh  brew- 
ers’ yeast,  a teaspoonful  to  a tablespoonful, 
t.i.d.a.c.;  or  the  ordinaiy  compressed  yeast 
cake,  one  to  two  teaspoonfuls,  t.i.d.a.c. 
(one-half  teaspoonful  daily  to  a child  of  two 
or  three  years  (Holt);  or  furunculin  (yeast 
I^owder);  or  ceridin  (yeast  fat;  see  Part  11). 

\"accine  therapy  is  well  recommended. 
Says  Holt:  “The  use  of  vaccines  is  alto- 
gether the  most  effective  treatment.”  “ In- 
jections should  be  repeated  every  three  or 
four  da}"s;  beginning  with  fifty  millions  (of 
dead  staphylococci),  the  dose  may  be 
increased  to  one  hundred  millions.” 

The  affected  skin  should  be  cleansed  daily 
with  soap  and  hot  water,  followed  by  a 
solution  of  bichloride,  1 : 4000  to  1 : 1000. 

A boil  may  somethnes  be  aborted  by 


GEOGIUPHIC  TONGUE 


injecting  into  its  base  five  drops  of  a five 
per  cent,  solution  of  carbolic  acid;  or  per- 
haps by  injecting  alcohol ; or  by  jjulling  out 
the  central  hair,  inserting  a fine  })rol)c  or 
cotton-wound  toothpick,  dipped  in  carbolic 
acid,  deep  into  the  follicle,  and  then  a])plying 
a drop  of  carbolic  acid  to  the  opening;  or  by 
painting  on  tincture  of  iodine  or  spirits  of 
camphor  three  or  four  times  daily;  or  by 
inserting  a zinc  positive  needle  of  a galvanic 
batteiy  into  the  furuncle,  and  employing  a 
current  of  twenty  to  thirty  milliamperes  for 
thirty  minutes;  or  by  applying  the  following 
ointment  covered  with  adhesive  plaster: 


Sulphuris  praecipitati oh 

Ichthyolis 5h 

Adipis  benzoinati 5i 


For  multiple  boils,  apply  a 25  per  cent, 
ointment  of  ichthyol. 

When  pointing,  which  may  be  hastened 
by  hot  applications,  has  occurred,  or  sooner 
if  desired,  incise  the  boil  freely,  and  gently 
remove  with  forceps  any  necrotic  tissue;  do 
not  curette  or  squeeze  the  abscess  walls. 
Then  pack  the  resulting  cavity  thoroughly, 
but  not  tightly,  with  sterile  gauze,  either 
dry,  or  moistened  with  bichloride  solution, 
1 : 1000;  and  renew  the  latter  daily  or  less 
often  according  to  the  discharge.  It  is 
often  recommended  that  the  abscess  cavity 
be  irrigated  with  hot  boric  acid  solution, 
3iv  ad  Oi,  or  normal  saline  solution,  3i  ad 
Oi,  or  carbolic  acid  solution,  5 per  cent.,  but 
experience  shows  that  the  dry  treatment 
is  usually  better. 

Qangosa;  Ogo;  Rhinopharyngitis  Muti= 
Ians. — See  Part  9,  Throat  Diseases. 

Gangrene  of  the  Skin;  Sphaceloderma. — 

L.  gangrcena;  Gr.  yayypaLva  mortification; 
Gr.  a<j)6LKe\os  gangrene  -f-  deppa  skin.  Gan- 
grene is  death  of  a part  en  masse  due  to  the 
complete  cutting  off  of  its  blood  supply. 

Causes.— Embolism;  thrombosis,  venous  or 
arterial,  occurring  in  syphilis,  senile  arterio- 
sclerosis, diabetes,  young  Hebrews,  etc.; 
vasomotor  constriction,  occurring  in  Ray- 
naud’s disease  and  in  ergotism  (sjmmietrical 
gangrene);  blood  extravasation  (purpuric 
gangrene)  pressure  from  an  inflammatory 
effusion;  pressure  from  a tumor;  destructive 
external  agencies,  such  as  heat  and  carbolic 
acid;  pressure  and  trophic  defects,  as  in  bed- 
sore; external  mechanical  compression;  trau- 
matism; infectious  disea.ses  (typhoid  fever, 
typhus  fever,  scarlet  fever,  measles,  variola 
varicella,  cerebrospinal  fever,  malaria,  etc.); 
nervous  diseases  (syringomyelia,  myelitis, 
tabes,  cord  tumor,  herpes  zoster,  neuritis, 
hemiplegia,  traumatism,  hysteria,  etc.); 


deliberate  self-infliction;  ecthyma  gangrae- 
nosum;  noma;  gango.sa. 

Buerger  gives  the  follow  ng  j)oints  of 
differentiation  between  thi-omboangitis 
obliterans  (occurring  chiefly  in  young  He- 
brews) and  Raynaud’s  angioneurosis : In 
thromboangitis  obliterans,  (1)  one  vessel,  at 
least,  is  permanently  pulseless;  (2)  inter- 
mittent claudication  is  usually  present;  (3) 
exacerbations  are  gradual  in  their  onset  and 
subsidence,  and  not  sudden  and  paroxysmal, 
as  in  Ra5maud’s  disease;  (4)  limbs  which 
are  red  or  blue  when  dependent,  become 
ischtemic  when  elevated;  (5)  migratoiy 
phlebitis  is  usually  associated;  (6)  males 
are  chiefly  affected,  not  females,  as  in 
Raynaud’s  disease. 

Treatment. — This,  of  course  depends  upon 
the  cause  {q.v , in  its  appropriate  alpha- 
betical place  and  part). 

In  thromboangitis  obliterans,  one  may 
administer  the  iodides  and  nitrites  (nitrogly- 
cerine, sodium  nitrite,  erythrol  tetranitrate, 
mannitol  hexanitrate  (see  Part  11),  and  apply 
warm  poultices.  A meat-free  and  salt-free 
diet  and  copious  water  drinking  are  advised. 
High  amputation  is  often  required. 

Geographic  Tongue.— Synonyms.— Ery- 
thema migrans;  wandering  rash;  exfoliative 
glossitis;  transitory  benign  plaques  of 
the  tongue. 

A rare,  chronic  disease,  mostly  of  young 
children,  characterized  by  the  appearance, 
commonly  on  the  lateral  portion  and  tip  of 
the  dorsum  of  the  tongue,  of  one  or  more  well- 
defined,  slightly  elevated,  superficial,  gray- 
ish, scaly  spots,  which  spread  peripherally, 
leaving  a reddened  and  slightly  scaly  central 
healing  area.  After  one  to  ten  days  cr 
longer  the  patch  disappears,  but  new  ones 
appear,  and  the  condition  may  continue 
indefinitely;  but  in  children,  it  usually  dis- 
appears altogether  in  from  a few  months  to 
rarely  a year.  There  are  no  marked  sub- 
jective symptoms  as  in  glossodynia  exfolia- 
tiva (q.v.). 

Poor  health,  gastro-intestinal  dis- 
orders, gout,  and  heredity  are  possible 
causal  factors. 

Treatment. — This  is  not  very  efficacious. 
Arsenic  is  recommended.  Iron  and  codliver 
oil  may  b(^  indicated.  Stelwagon  recommends 
an  occasii)iial  laxative  antacid,  such  as 
calcined  magnesia  (for  drug  formuhe,  etc., 
see  Part  11).  Kerley  does  not  treat  it  at 
all  in  children,  since  it  soon  disappears 
spontaneously. 

The  patches  may  be  painted  with  tincture 
of  myrrh  or  balsam  of  Peru.  The  intense 
burning,  says  Osier,  is  best  relieved  by 


GROUND  ITCH;  UNCINARIAL  DERMATITIS 


nitrate  of  silver  solution.  The  following  may 
be  employed  as  a mouth-wash  : 

II  Acidi  borici,  vel  sodii  biboratis,  vel 


sodii  bicarbonatis gr- 

Tinctura;  myrrhsD 3iv 

Aquae Sviii 


German  Measles. — See  Part  1,  General 
Medicine  and  Surgery. 

Giant  Urticaria. — See  Angioneurotic 

Qildema. 

Gila  Monster. — See  under  Snake  Bite, 
in  Part  1. 

Glanders. — See  Equinia. 

Glossitis  Acuta.- — Gr.  yXuaaa  tongue  -\- 
-LTLs  inflaimnation ; L acid’us,  sharp.  See 
Part  1. 

Exfoliative. — L.  ex,  out  -f-  joVium, 
leaf.  See  Geographic  tongue. 

Moeller’s. — SeeGlossodyniaExfoliativa. 

Papillaris. — L.  papil'la,  nipple.  See 
Glossitis  in  Part  1. 

Glossodynia  Exfoliativa;  Moeller’s  Glos= 

sitis. — Gr.  yXwaaa  tongue  + 68vvri  pain;  L. 
ex,  out  Jol'ium,  leaf.  Exfoliation  of  the 
corneous  layer  of  the  lingual  mucous  mem- 
brane associated  with  great  pain. 

Treatment. — “ Various  methods  of  treat- 
ment, including  cauterization  with  lactic 
and  chromic  acids  and  silver  nitrate,  and 
astringent  and  antiseptic  mouth  washes  hav 
all  been  futile.  Improvement  has  been 
recorded  in  a few  cases  after  anthelmintic 
treatment  ” (Harris).  Chewing  tar-rope 
daily  is  said  by  J.  Chalmers  DaCosta  to 
have  possibly  cured  a case  which  resisted 
other  methods  of  treatment. 

Glossy  Skin. — Local  atrophy  of  the  skin, 
tlue  to  disease  or  injury  of  the  nerve  supply- 
ing the  affected  area,  e.g.,  gunshot  injury, 
neuritis,  chronic  myelitis,  syringomyelia, 
herpes  zoster,  leprosy,  gout,  rhemnatism. 
The  condition  tends  to  cUsappear  spon- 
taneously in  the  course  of  several  weeks  to 
several  years,  and  “ only  requires  protect'on 
from  cold  and  other  injurious  influences  ” 
(Stel wagon).  The  affected  skin  may  be 
lubricated  with  cold  cream.  For  pain  em- 
ploy hot  or  cold  applications. 

Grain  Itch;  Straw  Itch. — A rare,  transi- 
tory, itching,  urticarial  skin  eruption,  caused 
by  a minute  arthropod,  the  pediculoides 
ventricosus,  which  lives  upon  the  grain-moth 
and  joint-worm  that  feed  upon  grain.  The 
mite  may  be  present  in  straw  mattresses. 

Treatment. — Take  a warm  soap  and  water 
bath,  and  apply  the  following  ointment  to 
the  eruption: 


II  Bota-naphtholis gr.  x.\x 

SulphurLs  pnecipitati gr.  xl 

Adipis  benzoinati § i 


Remember  that  beta-naphthol  has  pro- 
duced toxic  symptoms. 

Infested  mattresses  may  be  exposed  to 
steam  or  to  the  fumes  of  sulphur  or  formal- 
dehyde in  a vacuum  chamber.  Infected 
stubble  should  be  raked  up  in  the  spring 
and  burned. 

Granuloma  Annulare. — L.  gran'ulum, 

grain  Gr.  -coyua  tumor.  See  Lichen 
Annularis. 

Endemicum. — See  Oriental  Sore. 

Fungoides. — See  Mycosis  Fungoides. 

Inguinale  Tropicum. — L.  gran'ulum, 
grain  -|-  Gr.  -w/ra  tumor;  L.  ing'uen,  groin; 
Gr.  rpoTTCKos,  turning.  A chronic,  usually 
tropical,  linear  ulceration  in  the  groin  and 
neighboring  parts,  with  papillary  overgrowth. 

Treatment. — Thorough  curettement,  fol- 
lowed by  swabbing  with  carbolic  acid,  is 
curative.  (Crocker.) 

Pudendse  Ulcerosa. — L.  gran'ulum, 
granule  -j-  Gr.  -coga  tumor;  L.  pude're,  to  be 
ashamed;  ulc'us,  ulcer.  A chronic,  tropical, 
auto-inoculable,  recurrent  ulcerating  granu- 
loma, without  constitutional  symptoms. 

Treatment.— Curettage  and  cauterization 
may  be  employed;  but  it  is  probably  best  to 
excise  the  entire  growth  if  not  too  large. 
Large  doses  of  potassium  iodide  (see  Part  11) 
may  be  tried.  The  disease  is  difficult  to  cure. 

Granulosis  Rubra  Nasi. — L.  gran'ulum, 
granule;  ru'ber,  red;  nas'us,  nose  A rare, 
chronic,  cutaneous  disease  of  children, 
affecting  usually  the  nose,  characterized  by 
a reddish  hyperaemic  patch  “ dotted 
with  minute  macules  and  maculo-papules,” 
and  “ associated  with  hyperidrosis  and 
poor  peripheral  circulation.”  It  tends  to 
disappear  spontaneously  toward  adult 
life.  (Pusey.) 

Treatment. — Says  R.  A.  Bolam:  “ Good 

results  may  be  obtained  by  repeated  short 
applications  of  carbon  dioxide  snow  or 
resorcin  paste  of  medium  strength.  Marked 
benefit  is  also  seen  from  X-ray  treatment 
(q.v.)  Soon  after  puberty  the  condition 
begins  to  retrogress,  and  ultimately  will 
practically  clear  up,  even  if  no  treatment 
be  undertaken.” 

Gray  Hair. — See  under  Hair  Diseases. 

Ground  Itch;  Uncinarial  Dermatitis. — L. 

uncina'tus,  hooked;  un'cus,  hook;  Gr.  Seppa 
skin  -h  -ITS  inflammation.  An  itching, 
vesiculo-pustular  dermatitis,  occurring  usu- 
ally between  the  toes,  and  caused  by  the 
larva  of  the  hook-worm  (see  Ankylostomia- 
sis, Part  1). 

Treatment.— If  seen  in  the  very  beginning 
stage  of  reddish  spots,  apply  turpentine.  In 
the  later  stages  open  all  vesicles,  blebs  and 


HAIR  DISEASES 


pustules,  and  soak  the  parts  in  hot  bichlor- 
ide solution,  1 : 2000.  The  affection  is 
thereby  healed  in  about  twelve  days. 

As  a preventive  measure,  avoid  going 
barefoot  in  the  warm,  rainy  season. 

Quinea=Worm  Disease.-^ee  Dracontiasis. 

Gum  Rash. — See  Miliaria. 

Hair  Diseases. — I.  Baldness. — See  Alopecia. 

II.  Canities. — L.  See  V,  Grayness. 

III.  Chignon. — See  IX,  Piech’a. 

IV.  Fragilitas  Crinium  (L.,  brittleness  and 
splitting  of  the  hair). — Keep  the  hairs 
clipped  off  just  below  the  cleft  part;  or,  if 
the  splitting  or  brittleness  is  at  the  root 
ends  of  the  beard,  shave  constantly  for  a 
time.  Keep  the  scalp  or  face  and  hair 
clean  and  the  hair  very  slightly  oiled  by 
combing  with  a slightly  oiled  comb. 

V.  Qrayness. — Grayness  of  the  hah’  may  be 
congenital,  hereditary,  or  acquired.  Ac- 
quired grayness  may  occur  in  patches,  due 
to  nerve  disease  or  injury,  leukoderma,  or 
alopecia  areata;  or  it  may  be  general,  due  to 
senility,  exhausting  illness,  or  severe  nervous 
strain  or  shock. 

Treatment. — In  cases  due  to  exhau.sting 
illness,  nervous  strain,  or  nerve  lesions,  one 
may  try  careful  hygiene  and  tonics,  such  as 
arsenic,  and  strychnine  (see  Part  11).  Fara- 
dization with  the  wire  brush  electrode  and 
the  administration  of  pilocarpine  {q.v.  in 
Part  11)  may  be  of  service. 

Black  Dye: 


Argenti  nitratis gr.  l.xxv 

Plumbi  acetatis gr.  xv 

Aquai  cologniensis nj.xv 

Aquae  rosae,  q.s.,  ad Sviii 


M.  Sig. — ^Thoroughly  moisten  the  hair,  and  dry 
in  the  sunlight. 

Brown  Dye: 


Pyrogallol gr.  -xl 

Aquae  cologniensis tij1x.vv 

Aquae  rosae 3 ui 


(After  Stelwagon.l 

VI.  Hypertrichosis. — Gr.  iiirep  over  -ff  dpL^ 
hair.  For  the  removal  of  a moderate  growth  of 
facial  hair  in  women,  employ  elect  olysis. 
Do  not  operate  on  lanugo  hair,  as  the  growth 
of  the  hair  may  be  thereby  stimulated.  The 
surface  operated  upon  should  be  on  a level 
with  the  eyes;  a magnifying  lens  may  be 
used.  The  position  of  the  hair  papilla, 
except  under  the  chin,  is  usually  indicated 
by  the  chrection  of  the  hair  shaft.  The 
strength  of  current  required  is  from  34  to 
134  milliamperes  (Stel wagon);  2 to  5 milli- 
amperes  (Pusey).  A platinum  or  irido- 
platinum  needle  is  used;  and  needle  and 
holder  are  attached  to  the  negative  pole. 


There  should  be  no  interrupter  on  the 
needle-holder.  First  wipe  off  the  part  with 
alcohol.  Introduce  the  needle  into  the  hair 
follicle  alongside  of  the  hair  shaft  down  to 
the  papilla  (3-fe  to  34  inch).  The  current  is 
then  made  by  the  patient  touching  the  posi- 
tive electrode,  which  is  covered  with  a wet 
sponge.  The  current  is  allowed  to  act  until 
gas  bubbles  appear  (ten  to  thirty  seconds 
with  the  weaker  currents),  during  which  the 
needle  is  moved  about  a trifle  in  the  follicle. 
The  weakest  possible  current  should  be 
employed  on  the  upper  lip.  Before  the 
needle  is  witheffawn,  the  patient  should 
remove  her  hand  from  the  positive  electrode. 
The  hair  should  then  come  out  with  little  or 
no  traction  (Stelwagon).  Pusey  prefers  to 
have  the  current  on  continuously  during  the 
insertion  and  withdrawal  of  the  needle.  Do 
not  insert  the  needle  in  the  same  papilla 
twice  at  the  same  sitting,  and  avoid  neigh- 
boring hairs  within  a radius  of  3"^  inch,  in 
one  sitting.  Wipe  off  the  part  with  alcohol 
at  the  close  of  the  sitting.  The  patient 
should  apply  hot  water  for  several  minutes 
two  or  three  times  daily  during  the  ensuing 
two  days.  After  the  reaction  has  subsided 
(several  days  to  a week)  the  operation  may 
be  repeated.  Remember  that  the  careless 
use  of  electrolysis  produces  chsfiguring  scars. 

Other  measures  are  as  follows 

(a)  Rubbing  with  pumice  stone  every 
few  days. 

(b)  Bleaching  with  equal  parts  of 
hydrogen  peroxide  and  ammonia  water, 
frequently  repeated. 

(c)  The  use  of  depilatories: 

Barii  sulphidi  (freshly  made) 3ii~iv 

Zinci  oxidi, 

Amyli,  aa,  ad 5i 

M.  Sig. — Add  sufficient  water  to  make  a paste; 
apply  thickly,  and  allow  to  remain  on  for  one  to  two 
minutes,  or  until  a sensation  of  heat  is  produced; 
then  wash  off  and  apply  a dusting  powder  or  a little 
cold  cream.  Repeat  as  soon  as  the  hair  reappears 
(about  every  one  or  two  weeks). 

Crocker  does  not  sanction  the  use 
of  depilatories. 

(d)  The  X-rays  (q.v.  in  Part  1.)  Give  a suf- 
ficient dose,  through  a .5  imn.  aluminum 
filter,  to  ensure  depilation  at  the  end  of  a 
fortnight.  Then  give  a second  dose,  also 
through  a .5  mm.  filter.  The  latter  dose 
should  produce  permanent  alopecia  (Knox). 
It  should  be  remembered  that  telangiectasis 
sometimes  occurs,  even  as  long  as  three  years 
afterward,  in  cases  in  which  a reaction 
was  produced.  A large  dose  is  required  to 
produce  permanent  alopecia,  with  resulting 
damage  to  the  skin. 


HERPES  ZOSTER;  ZONA;  SHINGLES 


VII.  Lepothrix. — Gr.  Xeiros  scale  + dp'i^ 
hair.  Bacterial,  roughly  nodular  concre- 
tions upon  the  hairs  of  the  axillary  and 
inguinal  regions. 

'riiP^ATMP^NT. — Shave  the  partes,  wash  fre- 
quently with  soap  and  hot  water,  and 
apply  a solution  of  corrosive  sublimate  in 
alcohol,  1 : 500. 

VIII.  Monilithrix. — L.  moni'le,  necklace  -t-Gr. 
dpl^  hair.  Beatled  hair,  usually  congenital 
ami  hereditary.  Treatment  is  ineffectual. 

IX.  Piedra  (Sp.  for  stone). — A disease  of 
Colombia,  in  South  America,  characterized 
by  the  presence  of  hard,  pinhead  sized, 
nodular  concretions  on  the  hair  shaft  pro- 
duced by  a hyphomycetic  fungus. 

Treatoient. — Soften  the  nodules  with 
benzine  or  ether,  anti  comb  them  out  with  a 
fine-toothed  comb.  Wash  the  hair  fre- 
quently with  hot  bichloride  solution, 
1 : 1000.  The  latter  shoultl  be  hot  in  order 
to  soften  and  penetrate  the  nit-like  nodules. 

X.  Tinea  Nodosa. — L.  tinea,  moth;  nod'us, 
knot.  A hyi^homycetic  fungus  disease 
of  the  hairs  of  the  beartled  region, 
characterized  by  the  presence  of  irregular 
nodular  incrustations. 

Treatment. — Shave  or  clip  the  hair  fre- 
quently, and  apply  hot  bichloride  solu- 
tion, 1 : 2000. 

XI.  Trichiasis. — Gr.  rpcxio.o'LS  inverted  or 
ingrowing  hairs.  Irritation  and  jiruritus 
may  be  induced.  Epilate  the  hairs  or  des- 
troy their  papilte  by  electrolysis  (see  under 
Hy])crtrichosis,  VI). 

XII.  Trichorrhexis  Nodosa.  Gr.  6pi^  hair  -j- 
p/7 fracture;  L.  nod'us,  knot.  A rebellious 
disease,  characterized  by  the  jiresence  of 
m nute  whitish  swellings  along  the  hair 
shaft,  where  the  hair  has  swollen  and  burst, 
producing  the  appearance  of  two  small 
brushes  januned  together  end  to  end.  It  is 
seen  most  frequently  in  the  beard. 

'’1''reatment. — One  may  try  frequent  shav- 
ing and  the  use  of  hot  bichloride  solution, 
1 ; 2000  to  5000,  or  pxTOgallol,  1 jier  cent, 
ointment  or  2 j)er  cent,  aqueous  solution.  It 
is  recommendcHl  that  the  affected  hairs  be 
extracted,  and  the  jiarts  touched  daily  with 
tincture  of  cantharides,  pure  or  dijuted, 
a(“cording  to  the  sensitiveness  of  the  skin, 
until  the  hair  has  well  reappeared.  The 
general  health  should  receive  attention, 
('hange  of  climate  has  been  successful. 
(After  Stelwagon.) 

Harvest  Bug. — vSee  Bites. 

Harvest  Rash;  Erythema  Autumnale. — L., 
from  Gr.  tphO-ppa  redness.  A local,  itching, 
papula-vesicular  or  pustular  eruption,  o(!cur- 
ring  in  autumn  in  parts  of  England,  ami 


caused  by  a minute  larva  parasitic  upon  the 
harvest  spider. 

The  parasite  is  killed  by  benzine. 

Heat,  Prickly. — See  Miliaria. 

Rash. — See  Miliaria. 

Hemangioma. — Gr.  alpa  blood  -f-  ayyetov 
vessel  -|-  -ojpa  tumor.  See  Nsevus  Vascu- 
losus;  and  Telangiectasis. 

Henoch’s  Purpura. — See  Purpura. 

Herpes  Facialis. — Gr.  'IpireLv  to  creep;  L. 
facies,  face.  See  Herpes  Simplex. 

Qestationis. — L.  gestat'io,  pregnancy. 
See  Dermatitis  Herpetiformis. 

Iris. — Gr.  ipLs  a rainbow  or  halo.  See 
Erythema  Multiforme. 

Progenitalis. — Gr.  xpo  before  -(-  L. 
genital'is,  genital.  See  Herpes  Sim- 
pjex. 

Heipes  Simplex. — Gr.  'ipireiv  to  creep;  L. 
sim'plex,  simjile ; herpes  signifies  a cluster  of 
vesicles.  Aji  acute  inflaimnatory  affection, 
usually  of  the  muco-cutaneous  region  of  the 
face  (herpes  facialis)  or  genitals  (herpes  pro- 
genita’is),  characterized  by  the  sudden 
ajipearance  of  a cluster  of  small  vesicles, 
upon  an  inflaimnatoiy  base,  which  usually 
disappear  in  from  five  to  ten  days.  The 
affection  on  the  face  constitutes  the  familiar 
“ cold  sores  ” or  “ fever  blisters.” 

The  two  varieties  will  be  comsid- 
ered  separately. 

I.  Herpes  Facialis. — Etiology. — Acute  fe- 
brile affections,  e.g.,  catarrhal  fever,  bron- 
chitis, pneumonia,  influenza,  malaria,  acute 
miliary  tuberculosis,  ej)idemic  cerebrospinal 
meningitis,  the  exanthemata,  typhoid  fever; 
digestive  disturbances;  gout;  arsenical  poi- 
soning; dental  caries;  disease  of  the  fifth 
nerve;  facial  paralysis;  cold  winds;  sea  air; 
sunlight;  traumatism. 

Treatiient. — The  following  astringent 
applications  are  used,  e.g.,  spirits  of 
camphor;  cologne  water;  zinc  sulphate,  gr. 
i-iv  to  the  ounce  of  alcohol  and  water; 
tincture  or  compound  tincture  of  benzoin, 
the  latter  especially  where  fissures  have 
formed:  two  or  three  coatings  are  painted 
on  several  times  a day  and  allowed  to  drj' 
with  the  mouth  open.  Pusey  reconmiends 
the  aiiplication  of  collodion  for  persistent, 
deep  fissures.  When  crusting  occui’s,  apply 
cold  cream  or  camphor  ice.  Arsenic  (see 
Part  11)  is  recommended  in  {XT-sistent  and 
oft-recurring  cases.  The  underlying  cause 
should,  of  course,  be  searched  for. 

II.  Herpes  Progenitalis. — Consult  Part  2,  on 
G\ma?cology;  or  Part  3,  on  Male  Genito- 
urinary Diseiises. 

Herpes  Zoster;  Zona;  Shingles. — Gr. 
ep-rreiv  to  creep;  girdle;  L.  zo'na,  girdle 


HIDROCYSTOMA 


or  belt.  An  acute  interstitial  inflammation 
of  one  or  several  of  the  spinal  or  cranial 
sensory  root  ganglia,  manifested  clinically 
by  an  eruption,  consisting  of  groups  of 
large  papulo-vesicles  on  an  inflammatory 
base,  confined  to  the  cutaneous  distribution 
of  the  nerve  fibres  of  the  affecded  ganglia. 
The  eruption  is  usually  preceded  by  several 
days  of  fever  and  neuralgic  pams,  anti  the 
latter  may  persist.  The  vesicles  rupture 
after  a few  days  and  leave  dark  red  sjiots. 
The  thoracic,  lumbar,  and  supra-orbital 
regions  are  the  most  common  sites.  The  dis- 
ease runs  a course  of  from  two  to  eight 
weeks.  Persistent  neuralgia  or  paralysis 
rarely  follows.  If  the  eye  is  involved  it  may 
become  destroyed  (see  Keratitis  Neuro- 
pathica,  in  Part  G,  Eye  Diseases). 

Etiology. — Sudden  checking  of  the  perspira- 
tion (said  to  be  the  most  important  exciting 
cause);  damp,  changeable  weather;  neurotic 
predisposition;  severe  mental  emotion;  tlie- 
tary  indiscretions;  insufficient  food;  debility; 
diabetes;  acute  chorea;  peripheral  nerve 
injury  or  irritation,  due  to  a blow,  gunshot 
wound,  extraction  of  a tooth,  tumor 
pressure,  dental  caries,  a cold  draught; 
invasion  of  the  dorsal  root  ganglia 
by  tumors,  tuberculosis,  acute  cerebro- 
spinal meningitis,  tabes,  streptococci,  etc.; 
malaria;  pulmonary  disease;  intestinal 
parasites;  arsenic;  carbon  monoxide; 
spinal  manipulation. 

The  investigations  of  Rosenow  and  Ofte- 
dal  show  that  the  disease  may  be  caused  by  a 
selective  invasion  of  the  sensory  ganglia 
by  streptococci. 

Treatment. — Make  a careful  examination 
into  the  cause,  looking  particularly  for  some 
focus  of  mfection  in  the  throat,  etc.  Open 
the  bowels  by  means  of  calomel  or  castor-oil, 
followed  after  six  hours  by  a saline  (see  Part 
11,  for  drug  formulte,  etc.);  and,  if  there  is 
fever,  prescribe  a concentrated,  liquid  diet. 
If  there  is  much  pain,  give  phenacetin  or 
antipyrine,  or  aspirin,  or  aconitine,  gr. 
every  hour  for  three  or  four  doses,  or  until 
constitutional  symptoms  {q.v.  in  Part  11) 
appear,  then  every  three  or  four  hours  (Dench, 
who  says  it  “can  be  relied  upon  to  give  relief”). 
Other  pain-relieving  measures  are  (1)  light 
freezing  with  ethyl  chloride  over  the  spine  at 
the  exit  of  the  affected  nerve;  (2)  the  applica- 
tion of  the  galvanic  current,  one  to  five  milli- 
amperes,  for  five  to  ten  minutes,  once  or  twice 
daily,  with  the  positive  electrode  over  the 
main  nerve  supply,  and  the  negative  elec- 
trode gently  moved  to  and  fro  over  the  dis- 
ea.sed  area  (Author? );  (3)  Hypo- 

dermics of  morphine  over  the  affected  nerve. 


Local  applications,  protective,  anodyne, 
and  antiseptic  (to  be  covered  with  cotton 
and  a gauze  bandage),  are  the  following: 


L Mcntholis gr.  .x-xl 

Alcohohs o iv 

Acidi  carbolici gr.  x-xx 

Alcoholis 5iv 

Calamina», 

Zinci  oxidi,  aa oii 

Acidi  borici 3i 

Glycerini irjxxx 

Acidi  carbolici imxx 

Liquoris  calcLs 5 f 

Aquje,  q.s.,  ad 5iv 

Adrenalini  chloridi S'"- Y. 

Cocainse  chloridi gr.  .xii 

Aquae 5 i 

Acidi  carbolici  vel  Thymolis  ....  gr.  x 
Collodii  flexilis 5ii 

Zinci  oxidi,  partc.s 1 

Glycerini,  partes 3 

Gelatini,  partes 2 

Atiuae,  partes 4-6 


When  needed,  melt  over  a water  bath  (in  a 
double  oatmeal  boiler)  and  apply  with  a broad 
brush.  After  three  to  five  days,  soften  and  remove 
with  hot  water,  and  apply  a fresh  dressing. 
(Stelwagon.) 

Zinci  oxidi, 

Acidi  borici, 

Talci,  aa. 


Mentholis gr.  xw-xx 

Amyli 3|~ii 

Unguenti  zinci  oxidi 5 i 


(Stelwagon.) 

For  debility,  prescribe  a liberal  diet,  per- 
haps codliver  oil  {q.v.),  and  Fowler’s  solution 
{q.v.),  or  elixir  ferri,  quininse,  et  strychninse 
phosphati  {q.v.). 

Intractable  post-her]:)etic  neuralgia  may 
demand  section  of  the  affected  dorsal  spinal 
root  or  roots;  or,  in  trigeminal  neuralgia, 
extirpation  of  the  Gasserian  ganglion  or  its 
injection  with  alcohol. 

Hidebound  Skin. — See  Scleroderma. 

Hidrocystoma. — Gr.  tSpws  sweat  -|-  Kvans 
cyst  d-  -wpa  tumor.  An  uncommon  affection 
of  the  face,  characterized  by  the  formation 
of  deep-seated,  non-inflammatory,  sweat 
retention  cysts,  appearing  as  pinheafl  to 
pea-sized,  tense,  shining,  thin-walled  vesicles, 
which  disappear  in  the  course  of  two  weeks. 

Heat  and  steam  moisture,  as  over 
the  washtub  and  fire,  seem  to  be  the 
(iausal  factors. 

Treatment.— Puncture  the  vesicles  with  a 
sterile  needle;  and  apply,  twice  daily,  an 
alcoholic  solution  of  resorcin  (gr.  ixss 


HYPERIDROSIS 


ad  5i);  or  dust  with  equal  parts  of  zinc 
oxide  and  starch,  or  zinc  oxide,  boric  acid 
and  talcum,  or  bismuth  and  talcum. 

Hirsuties. — L.  hirsu'ius,  shaggy.  See 
Ilyjxjrtrichosis,  under  Hair  Diseases. 

Hives. — See  Urticaria. 

Hook=Worm  Dermatitis.— See  Ground 
Itch. 

Horn,  Cutaneous;  Cornu  Cutaneum. — L. 

cor'nu,  horn;  ad 'fs,  skin.  Excise  the  growth; 
or  break  off  and  dissect  the  horn  from  its 
base,  and  then  ajrply  caustic  potash,  or 
chloride  of  zinc  paste  (see  under  carcinoma 
cutis)  or  the  galvanocautery.  The  entire 
base  should  be  removed  for  fear  of  carcino- 
matous change. 

Hydroa  Vacciniforme;  Recurrent  Summer 
(rarely  Winter)  Eruption. — Gr.  vScop  water; 
L.  vaccinia,  cow-pox  + jor'ma,  form.  A 
rare,  recurrent,  inflammatory,  vesicular, 
scarring  eruption,  appearing  on  imcovered 
parts,  nearly  always  in  summer,  and  caused 
by  exposure  to  sunlight,  heat,  cold,  or  winds. 
The  affection  begins  to  manifest  itself  usu- 
ally during  the  second  or  third  year  of  life, 
nearly  always  in  males,  and  disappears,  as  a 
rule,  only  on  the  approach  of  adult  age,  so 
that  it  seems  to  indicate  a congenital  sus- 
ceptibility to  certain  forms  of  external  irri- 
tation, which  gradually  leads  to  immunity. 

Treatment. — The  exciting  causes  should,  of 
course  be  avoided.  Arsenic,  quinine,  bella- 
donna, and  the  salicylates  (see  Part  11)  are 
variously  reconmiended.  To  avoid  scarring, 
if  possible,  puncture  each  vesicle  as  soon  as 
possible,  anfl  apply  iodoform  j^owder  or  oint- 
ment, or  its  solution  in  ether.  Soften  and 
remove  crusts  with  carbolized  oil,  one  in  forty, 
anti  apply  an  antiseptic  ointment: 


R Acidi  borici gr.  xx 

lodofornii gr.  v 

CTeolini npv 

Adipis  benzoiimti 5i 

(Crocker.) 

R Ichthyolis ^ ii-iv 

Petrolati  inollis oi 

R Rcsorcinolis gr.  xv 

Petrolati  mollis 3 i 


Hyperidrosis. — Gr.  vwep  over  + 
sweat:  excessive  sweating.  A.  General  Hy= 
peridrosis. — CAUSES. — Debility;  neurasthenia 
or  nervous  temperament;  tuberculosis;  rheu- 
matic fever;  malaria;  septicaemia;  leukaemia; 
lithiasis;  cholelithiasis;  rickets;  alcoholism; 
incipient  exophthalmic  goitre;  obesity;  cen- 
tral nervous  lesion;  convalescence  from 
infectious  disease;  unknown  influences. 

Treatment. — Attend  to  any  possible 
etiological  influence.  For  debility,  pre- 


scribe rest,  fre.sh  air  day  and  night,  an 
abundance  of  nutritious,  easily  digestible 
food,  regular  hours  of  eating  and  sleeping, 
and,  if  need  be,  codliver  oil  and  tonics, 
such  as  Fowler’s  solution,  Blaud’s  pills,  elixir 
ferri,  quininae,  et  strychninae  phosphati,  sjTup 
of  hypophosphites,  or  the  mineral  acids 
and  nux  vomica  (see  Part  11). 

R Acidi  hydrochlorici,  vel 
sulphurici,  vel  nitro- 
hydrochlorici,  diluti.  . . 5iss  (irijxx  per  dose) 
Tincturaj  nucis  vomicae. . 3iv  (iiEvii  per  dose) 

Glycerini 5ii  (^IRxxvii  per  dose) 

Aquae,  q.s.,  ad 3vi 

M.  Sig. — One  teaspoonful  in  water  before  meals. 

For  night-sweats  due  to  debility,  give 
milk  at  bedtime,  to  which  may  be  added 
two  or  three  teaspoonfuls  of  whiskey  or 
brandy;  or  arouse  the  patient  two  hours 
before  the  expected  sweat  and  give  food. 

Special  internal  remedies  are  atropine 
or  belladonna,  pushed  to  the  physiological 
Imiit,  agaracinate  of  sodium  or  lithimn,  agar- 
acin,  muscarin,  picrotoxin,  salvia  or  sage, 
ergot,  camphoric  acid,  hydrastis,  nux  vomica, 
zinc  oxide,  bromural,  tellurate  of  sodium  or 
potassium,  quinine  in  full  dosage,  aromatic 
sulphuric  acid  (see  Part  11  for  drug  formula, 
etc.),  or  be.st  of  all,  in  Crocker’s  experience, 
precipitated  sulphur,  a level  teaspoonful 
in  milk,  twice  a day,  or  if  this  purges  too 
much,  the  following  combination : 


R Pulveris  cretaj  compositae 3vi 

Pulveris  cinnamomi  compositi 5ii 

Suli)huris  praecipitati 5 i 


M.  Sig. — A teaspoonful  twice  a day.  (Crocker.) 

Frequent  bathing  is  essential.  The  skin 
may  be  sponged  or  powdered  wdth  one  of  the 
followdng  preparations,  viz.,  vinegar;  alco- 
hol and  w'ater,  equal  parts;  alum  solution 
3iv  ad  Oi;  quinine,  gr.  Ixxx  ad  Oi;  formalin 
(40  per  cent.)  and  alcohol,  equal  parts; 
tannoform;  salicylic  acid,  gr.  v-xxx,  and 
boric  acid,  5i;  salicylic  acid  three  parts, 
wheat  starch,  ten  parts,  and  talcum,  87 
parts;  zinc  pero.xide,  5i,  and  talcmn,  5iss. 
The  formalin  is  said  to  be  very  efficacious, 
its  effect  lasting  usually  several  nights. 
Tannoform  is  also  well  reconmiended.  A 
flannel  nightgown  should  be  worn,  and  not 
too  much  bed-covering. 

B.  Local  Hyperidrosis. — CAUSES. — DebUity; 
rickets  (head  sweating);  affection  of  a cu- 
taneous nerve;  prolongeil  standing;  flaUfoot. 

Treatment. — The  best  treatment,  for 
lasting  results,  is  the  cautious  application, 
once  to  thrice  w’eekly,  of  the  X-raj^s  (q.v.) 
until  the  excessive  sweating  ceases,  repeating 
the  exposures  in  case  of  recurrence.  “ It  is 


IMPETIGO  CONTAGIOSA 


not  necessary  to  produce  an  erythema” 
(Pusey).  Knox  recommends  a full  pastille 
dose,  repeated  every  fourteen  days,  four 
applications  bein<;  usually  sufficient.  A 
.5  mm.  filter  should  be  used  after  the 
first  exposure. 

Palliative  local  measures  are  as  follows: 

(1)  After  scrubbing  the  j)arts  thoroughly 
with  soap  and  hot  water,  rinse,  and  sponge 
for  several  minutes,  twice  daily,  with  a solu- 
tion of  tannic  acitl,  alum,  or  zinc  sulphate, 
5i-viii  to  the  pint  of  water;  or  formalin, 
3iss  to  the  pint  of  water,  gradually  in- 
crea.sed  in  strength;  or  tincture  or  liniment 
of  belladonna  {q.v.  in  Part  11,  watch  for  toxic 
effects);  or  a strong  solution  of  extract  of 
pinus  canadensis.  Then  dry,  and  dust  on 
powdered  boric  acid,  with  or  without  sali- 
cylic acid,  gr.  v-xxx  ad  3 i-  Dust  the  stock- 
ings and  shoes  also  with  this  powder  (see 
Bromidrosis). 

(2)  Cleanse  and  dry  the  feet,  and  apply 
on  lint  followed  by  a bandage,  either  unguen- 
tum  diachylon  {q.v.)  or  tannic  acid,  3i-ii, 
in  sevum  praeparatum  and  petrolatum  molle, 
of  each  5ss-  After  twelve  hours,  rub  the 
parts  dry  with  boric  acid  powder  and  a 
cloth,  and  reapply  the  ointment.  Continue 
this  procedure  for  from  ten  days  to  two  weeks, 
or  until  free  desquamation  occurs;  then  em- 
ploy an  astringent  lotion  followed  by  the 
aforementioned  boric  and  salicylic  powder 
twice  daily  for  another  one  or  two  weeks, 
when  the  former  treatment  may  be  repeated, 
if  necessary  (Stelwagon). 

(2)  Faradic  and  galvanic  electricity. 

Hypertrichosis. — Gr.  virep  over  -j-  6pi^ 
hair.  Sec  under  Hair  Diseases. 

Hypertrophia  Unguium. — Gr.  hirkp  over  -f- 
Tpo4>q  nutrition;  L.  unguis,  nail.  See  Nail 
Diseases. 

Ichthyosis. — Gr.  ixQvo.  fish-skin.  Ichthyo- 
sis, or  fish-skin  disease,  is  a chronic  congeni- 
tal and  usually  hereditary  disease  of  the 
skin,  “ characterized  by  more  or  less  gen- 
eralized dryness  and  harshness  (xeroderma — 
Gr.  dry  -|-  bkppa  skin),  slight  to  plate- 

like scaliness,  ■ ancl  a variable  degree  of 
follicular  papulation  (ichthyosis  simplex), 
sometinies  warty  or  horn-like  (ichthyosis 
hystrix.  Gr.  iio-rpi^  hedgehog).”  (Stelwagon.) 

Prognosis.— Treatment  is  only  palliative, 
not,  as  a rule,  curative.  The  removal  of 
scaline.ss  and  the  maintenance  of  a soft  and 
pliable  condition  of  the  skin  arc  the  objects 
of  treatment. 

Treatment. — Pilocarpine  and  thyroid  ex- 
tract (the  latter  is  the  better)  are  only  of 
temporary  benefit.  The  treatment  is  local. 

The  patient  should  bathe  frequently. 


every  day  if  nece.ssary,  with  warm  or  hot 
water  and  green  soap,  followed  by  the  inunc- 
tion of  a bland  oil,  such  as  cold  cream; 
oil  of  sweet  almonds;  cottonseed  oil;  olive- 
oil;  benzoinated  lard;  vaseline  or  olive-oil, 
two  parts,  and  lanolin,  one  part;  emul- 
sion of  lanoline,  one  j:>art,  in  lime-water  or 
rose-water,  ten  parts;  glycerine,  3ss-ii,  and 
sodium  biborate,  gr.  xlviii,  ad  aquam,  5i 
(the  latter  two  especially  for  the  face 
and  hands). 

Where  the  hypei'keratosis  is  not  suffi- 
ciently influenced  by  the  above  treatment, 
Stelwagon  recommends  the  following  kera- 
tolytic  ointment,  which  should  be  well 
rubbed  in,  at  first  twice  a day,  and  later 
two  or  three  times  a week: 

Resorcinolis gr.  xv-xlviii-3iss 

Acidi  salicylic! gi'-  x-xlviii 

Glycerini njxx 

Adipis  lame  hydros! ph 

Adipis  benzoinati, 

Pctrdlati  mollis,  aa piu 

(Stelwagon.) 

To  remove  the  horny  accumulations  of 
ichthyosis  hystrix,  first  remove  the  horny 
caps,  then  paint  the  underlying  skin  with  a 
saturated  solution  of  salicylic  acid  in  alcohol, 
in  order  to  tlestroy  the  itapilla?  and  produce 
scarring.  To  the  latter  end,  one  may  also 
employ  the  knife,  curette,  or  galvano- 
cautery,  bearing  in  mind  that  the  keratosis 
is  deeper  than  it  appears.  The  daily  appli- 
cation of  a 10  to  25  per  cent,  salicylic  oint- 
ment, in  conjunction  with  hot  water  and 
green  soap  baths,  is  of  seiwice  in  dissolving 
and  removing  the  horny  caps  and  plates. 

Ichthyosis  of  the  Tongue. — Gr.  \xdva.  fish- 
skin.  See  Leucoplakia  Buccalis. 

Impetigo  Contagiosa. — L.  impetere,  to 
attack.  A common,  contagious,  superficial, 
l)yogenic  skin  disease  of  childhood,  usually 
observed  about  the  mouth,  chin,  nostrils, 
occijiital  region  and  fingers,  which  appears 
as  a flat  vesicle  or  pustule,  varying  in  size 
from  that  of  a pea  to  a finger-nail,  the  con- 
tents of  which  dry  into  a yellow  scab  which 
has  the  appearance  of  being  stuck  on  the 
surface;  other  discrete  lesions  soon  appear 
by  surface  inoculation;  there  is,  as  a rule,  no 
conspicuous  areola.  The  disease  is  an  infec- 
tion of  the  suj)erficial  layers  of  the  skin  by 
any  of  the  common  pus  organisms,  strepto- 
cocci or  staphylococci. 

It  is  readily  cured  in  a few  days. 

Treatment.— First  open  fresh  lesions  and 
remove  all  crusts  after  softening  with  sterile 
olive-oil  or  soap  and  hot  water.  Then  cleanse 
the  affected  surface  with  an  antiseptic 
lotion,  such  as  bichloride,  1 : 4000  to  2000, 


KELOID 


or  boric  acid  solution,  3iv  ad  Oi,  or  carbolic 
lotion,  gr.  v ad  5i,  or  creolin,  1 j^er  cent., 
and  rub  gently  but  thoroughly  into  the  l)a»se 
of  each  lesion,  two  or  three  times  daily, 
the  following  ointment: 


Ilydrargyri  ammoiiiati gr.  x-lx 

Petrolati  mollis 5i 


If  the  crusts  are  very  adherent,  they  may  be 
covered  with  the  white  precipitate  ointment 
until  they  become  softened. 

If  a large  surface  is  affected,  substitute 
bichloride  lotion  and  boric  ointment,  10  per 
cent.,  applied  on  lint  or  linen,  for  the  mer- 
cury ointment,  in  order  to  avoid  mercur- 
ial poisoning. 

Employ  boric  acid  solution  for  conjunc- 
tival lesions. 

In  scalp  cases,  look  for  pediculi. 

Impetigo  Herpetiformis. — L.  impetere,  to 
attack;  Gr.  epTrrjs  herpes  -|- L.  for'ma,  form. 
An  extremely  rare,  usually  fatal,  infectious 
disease,  occiming  usually  in  pregnant 
women,  and  characterized  by  the  appear- 
ance of  numerous,  closely  grouped,  periph- 
erally spreading,  pinhead-sized  pustules, 
associated  with  grave  constitutional  symj> 
toms,  viz.,  liigh  intermittent  fever,  chills, 
delirium,  vomiting,  diarrhoea,  ])rostration. 
The  closely  crowded  pustules  tend  to  00010" 
in  circular  groups. 

Treatment.  — Abortion  (see  Part  4)  is 
advised  when  the  disease  occurs  in  a preg- 
nant woman.  Mayer,  quoted  by  J.  W. 
Williams,  advises  the  intravenous  injection 
(see  Part  1)  of  small  amounts  of  blood  serum 
obtained  from  normal  pregnant  women 
(see  Blood  Transfusion,  in  Part  1).  Concen- 
trated liquid  nourishment,  brandy  or  whis- 
key, and  quinine  hydroc'hlorate,  gr.  v-x, 
every  four  hours,  (see  Part  11),  are 
recommended. 

Treat  the  local  condition  like  j>emphigus 
(q.v.). 

Insect  Bites. — See  Bites. 

Intertrigo. — L.  in'ter,  between  -|-  lerere,  to 
rub.  A readily  curable,  superficial  derma- 
titis, which  occurs  in  the  folds  of  the  body 
surface  as  a result  of  friction,  moisture,  and 
irritating  secretions. 

('ausal  influences  are  obesity,  uncleanli- 
ness or  the  reverse,  diarrhoea  in  infants, 
diabetes  mellitus,  acid  urine  in  gout. 

Treatment. — The  Jtarts  should  be  kept 
clean,  and  protected  against  friction  by 
means  of  lint  or  absorlx'iit  cotton  or  flat 
muslin  or  cheesecloth  bags,  filled  with  the 
dusting  j)owder  given  below,  and  (luilted  to 
prevent  shifting  of  the  powder. 

One  of  the  following  applications  may  be 
used  tw(j  or  three  times  daily: 


B Calaminop, 

Zinci  o.xidi,  aa oii 

Acidi  horici oi 

Acidi  carbolici igjxv 

Liquoris  calcis 5> 

Aqua?,  q..s.,  ad 5‘v 

Pulveris  acidi  borici 3i 

Pulveris  zinci  o.xidi 3d 

Pulveris  talci 3v 


For  the  buttocks,  in  infants,  one  may  use 
olive  oil  or  cold  cream,  or  zinc  oxide  ointment 
{q.v.  in  Part  11). 

Inverted  Hairs. — L.  in,  into  -f  ver'iere, 
to  turn.  See  Trichiasis  under  Hair  Diseases. 

Ionic  Medication. — Gr.  luv  going,  see 
Part  1,  General  Medicine  and  Surgery. 

Itch. — See  Scabies;  Tinea  Sycosis  or  Bar- 
ber’s Itch;  Grain  or  Straw  Itch;  Dhobie 
Itch;  and  Ground  Itch. 

Itching. — See  Pruritus. 

Ivy  Poisoning. — See  Dermatitis  Venenata. 

Jigger  or  Sand=FIea. — See  Bites. 

Keloid. — Gr.  scar;  xv^v  claw;  e'L8os 

form.  An  “ irregularly  shaped,  elevated, 
smooth,  firm,  pinkish  or  pale  reddish,  cica- 
triform  ” (Stelwagon),  connective-tissue 
new-growth  of  the  corium,  the  result  usually 
of  traumatism;  in  other  words,  an  “exuber- 
ant scar.” 

Treatment. — The  best  treatment  is  with 
radium  (q.v.)  or  the  X-rays  {q.v.).  Give 
a full  pastille  dose  without  a filter,  then  at 
the  end  of  fourteen  days,  a second  dose  with 
.5  mm.  of  aluminum  as  a filter,  followed  by 
exposures  at  regular  intervals  until  the 
desired  degree  of  flatness,  softness,  and 
flexibility  is  obtained.  (Knox.) 

Other  less  reliable  methods  of  treatment 
are  as  follows: 

(1)  Multiple,  deep,  criss-cross,  linear  in- 
cisions through  the  whole  thickness  of  the 
growth,  mincing  it  thoroughly,  remembering 
that  the  depth  below  the  skin  equals  the 
elevation  above  it;  the  scarification  to  be 
followed  immediately  by  a dry  or  wet  boric 
acid  dressing;  the  next  and  subsequent  days 
one  of  the  following  plasters  applied  con- 
tinuously, and  pressure  exerted  by  a pad 
and  bandage  or  adhesive  straps: 

.\cidi  salicylici gr.  x-xx 

Ichthyolis 3i~ii 

Emplastri  pluinbi, 

Emplastri  sajjonis,  .aa 3iii 

Petrolati,  cps.,  ad o* 

(Stelwagon.) 

E Empliistri  hydrargyri 5 i 

(2)  Electrolysis:  current  of  about  five 
milliamperes,  the  needle  inserted  at  various 
places  close  together,  and  thrust  in  from  the 
edge  slantingly  toward  the  centre;  several 
repetitions  are  necessarv. 


KELOID 


LAROUSSE  MEDICAL. 

SKIN  DISEASES  : Keloid.  Chloasma.  Dermatitis  herpetiformis  and  palmar  aiiliidrosis. 


3 Keloid. 


N“  1981  D’’  Bal/er 


7.  - Chloasma. 

N"  1514.  D‘‘  Fournier 


2.  — Palmar  anhidrosis. 

N”  1 883  D'  Fournier. 


KERATOSIS  PILARIS 


(3)  Injections  of  ten  to  twenty  inininis  of 
a 10  to  15  per  cent,  solution  of  thiosinainin 
in  equal  parts  of  water  and  glycerine,  fol- 
lowed by  massage. 

(4)  Injections  at  many  pf)ints  of  a 20  per 
cent,  solution  of  creosote  in  olive  oil  until 
the  gro\vth  becomes  pale;  repeated  when 
the  resulting  inflammation  and  sloughing 
have  healed. 

(5)  Chlorine  ionization  (see  Ionic  Med- 
ication, in  Part  1). 

(6)  Thyroid  extract,  or  arsenic  internally 
(see  Part  11). 

Keratoangioma. — See  Angiokeratoma. 

Keratosis  Follicularis  seu  Vegetans. — Or. 

Kepas  horn;  L.  Jolliadus,  little  bag;  veejetatio, 
growth.  An  e.xtremely  rare,  persistent, 
symmetrically  distributed,  abundant  eruji- 
tion,  usually  beginning  in  early  life,  and  as  a 
rule  on  the  face  or  scalp,  later  involving 
principally  the  neck,  sternal,  interscapular 
and  sacral  regions,  arms,  legs,  the  flexures 
and  mucous  orifices,  and  characterized  by  a 
hyperkeratosis  beginning  in  the  openings  of 
the  pilo-sebacoous  follicles  and  resembling 
keratosis  pilaris  (conical  horny  lesions  with 
a central  sebaceous  concretion  which  can 
be  squeezed  out),  later  spreading  beyond 
these  openings  and  forming  papular  and 
papillomatous  horny  masses. 

Treatment. — This  can  be  only  palliative. 
The  parts  may  be  bathed  daily  with  green 
soap  and  hot  water,  followed  by  the  thorough 
rubbing  in  of  one  of  the  following  ointments : 


R Acidi  salicylic! gr.  xv 

Sulphuris  pra3cipitati 3i 

Pulveris  amyli, 

Pulveris  zLiici  o.xidi,  aa. . . . 5iss 
Petrolati  molli.s 3 iv 

R Rc.sorcinolis gr.  xv-xlviii-3iss 

Acidi  salicylici gr.  x-.xlviii 

Glycerini t^jxx 

AdipLs  lanac  hydrosi 3ii 

Adipis  benzoinati, 

Petrolati,  aa 3iii 

(Stelwagon.) 


The  treatment  is  really  that  of  ichthyosis 
{q.v.).  The  thermocautery  (without  anaes- 
thetization)  is  well  recommended.  R-ontgen- 
therapy  {q.v.)  may  be  tried.  C'rocker  suggests 
the  trial  of  thyroid  extract  (see  Pait  11). 
For  the  offensive  secretions  from  the  axilte 
and  groins  are  recommended  europhen, 
{q.v.)  starch  powder  containing  formaline, 
TTpxv  to  the  ounce,  and  sulphur  baths 
etc.  (pot.  sulphide,  5ii-iv  to  30  gal.  water). 

Scalp  cases  are  treated  like  seborrhcsic 
dermatitis  {q.v.). 

Keratosis  Follicularis  Contagiosa. — Gr. 

Ktpas  horn;  L.  Jolliculus,  little  bag;  contdgio, 
contact  infection.  An  exceedingly  rare  dis- 


ease, resembling  keratosis  follicularis  seu 
vegetans  {q.v.,  above),  from  which  it  is  dis- 
tinguished by  the  absence  of  papillomatous 
masses,  greasincss,  and  offensive  odor,  its 
apparent  contagiousness,  and  its  ready 
res{)onsc  to  simple  softening  with  green 
soap  and  hot  water. 

Keratosis  Nigricans;  Acanthosis  Nigri= 
cans. — Gr.  Kepas  horn;  aKavda  prickle  or 
spine;  L.  nig'er,  black.  An  exceedingly  rare 
disease  of  the  skin  and  mucous  membranes, 
of  symmetrical  distribution,  characterized 
by  the  development  of  warty  growths  ami 
jiigmentation,  usually  secondary  t(j  visceral 
carcinoma.  Exposure  to  great  heat  has 
been  causative. 

The  condition  may  disappear  following 
the  removal  of  carcinoma.  (Otherwise  it 
is  not  amenable  to  treatment. 

Keratosis  Palmaris  et  Plantaris. — Gr. 
Kepas  horn;  L.  -palma,  j)alm;  planta,  .sole  of 
the  foot.  Hypertrophy  of  the  corneous 
layer  of  the  palms  and  soles  into  hard  plates. 
It  is  often  congenital  or  hereditary.  Arsenic 
is  rarely  the  cause. 

The  treatment  is  that  of  callositas  {q.v.). 

Keratosis  Pilaris. — Gr.  Kepas  horn;  L 
pU'us,  hair.  A common  affection,  character- 
ized by  an  accumulation  of  horny  cells 
(hypercornification)  about  the  mouths  of 
the  hair  follicles,  forming  small  corneous 
papules  or  plugs.  It  occurs  chiefly  on  the 
postero-lateral  aspect  of  the  arms  and  antero- 
lateral aspect  of  the  thighs,  and  imparts  to 
the  touch  the  sensation  as  of  running  the 
fingers  over  a nutmeg-grater. 

Infrequent  bathing  is  a frequent 
causal  factor. 

It  can  u.sually  be  removed  in  the  (bourse  of 
a few  weeks. 

Treatment.— Bathe  the  affected  parts  fre- 
quently with  warm  water  and  green  soap 
or  plain  soap,  followed  perhaps  by  the 
application  of  a little  almond,  olive,  or 
cottonseed  oil  or  cokl  cream.  Codliver 
oil  (see  Part  11)  internally  may  be  of  ser- 
vice. To  resistant  patches  may  be  applied 
salicylic  acid  ointment,  gr.  x-xxx  ad  5 i,  or  the 
following  strongly  keratolytic  preparation: 


R Acidi  salicylici, 

Resorcinolis,  aa gr.  xlviii 

Sulphuris  prmcipitati gr.  xii 

Glycerini  amyli §i 


(Sahouraud.) 

If  this  causes  much  smarting,  remove  it 
after  an  hour’s  time,  otherwise  leave  it  on 
for  several  hours  or  over  night.  Any  result- 
ing irritation  is  relieved  with  cold  cream 
or  zinc  oxide  ointment  {q.v.)  Continue  its 
use  until  exfoliation  occurs. 


LEPROSY 


Keratosis  Plantaris. — See  Keratosis  Pal- 
inaris  et  Plantaris,  above. 

Senilis. — See  Atrophia  Cutis  Senilis. 

Vegetans. — See  Keratosis  Follicularis 
seu  Vegetans. 

Kerion. — Gr.  KrjpLov  honey-comb.  See 
Ring-worm. 

Kraurosis  Vulvae.^ — Gr.  Kpavpos  diy;  L. 
vulv'a,  vulva.  Progressive  atrophy  and  con- 
traction of  the  \mlvar  cutaneous  tissues, 
associated  with  intense  itching,  and  followed 
by  narrowing  of  the  introitus.  Epithelio- 
matous  changes  sometimes  occur. 

Treatment. — Attend  to  any  vaginal  dis- 
charge (see  Leucorrhoea,  in  Part  2). 
Thickened  patches  of  leucoplakia  (Gr. 
\evKos  white  -|-  xXa^  plate)  may  be  removed 
with  the  curette,  followed  by  the  continuous 
application  of  a 0.5  to  2 per  cent,  solution  of 
salicylic  acid  alternately  with  a solution  of 
pyrogallol  of  the  same  strength ; this  treat- 
ment to  be  rejieated  if  the  conclition  recurs 
(Stelwagon).  Rontgentherapy  (q.v.)  is  valu- 
able. Excision  of  the  cUseased  parts  is 
curative. 

As  a palliative  measure,  one  may  paint 
the  affected  surface,  every  ten  days  or  less 
often,  with  silver  nitrate  solution,  10  to  50 
per  cent.,  or  tincture  of  iodine,  or  pure  car- 
bolic acid,  or  pure  ichthyol;  and  have  the 
patient  employ  at  home,  hot  compresses  wet 
with  creolin,  5 per  cent.,  or  carbolic  acid, 
3 to  8 per  cent,  in  water  containing  glycerine, 
5ii,  and  alcohol,  5i,  to  the  pint,  or  a 1 to  2 
per  cent,  solution  of  cocaine  in  equal  parts 
of  alcohol  and  water,  or  a solution  of  neu- 
tral acetate  of  lead  in  glycerine,  or  1 per  cent, 
yellow  oxide  of  mercury  ointment,  or  other 
antipruritic  applications  given  under  Pruritus. 

La  Perleche. — See  Perleche. 

Larva  Migrans.— L.  See  Creeping  Eruption. 

Laundryman’s  Itch. — See  Dhobie  Itch 

Leishmaniasis,  Dermal. — See  Oriental 
Sore. 

Lentigo. — See  Freckles. 

Lepothrix. — Gr.  Xtxos  scale  -h  6pL^  hair. 
See  under  Hair  Diseases. 

Leprosy. — L.  Icp'ra;  Gr.  XtTrpa  leprosy.  A 
chronic,  slowly  progressive,  infectious  and 
contagious,  endemic,  constitutional  disease, 
caused  by  the  bacillus  leprai,  which  shows  a 
predilection  for  cutaneous  and  nervous  tis- 
sue, producing,  in  the  cutaneous  type  of  the 
disease,  nodular  and  tubercular  infiltration, 
necrosis,  and  ulceration,  and  in  the  nervous 
type,  anaesthesia,  atrophy  and  deformity, 
etc.  The'  laiynx,  conjunctiva,  bones,  vis- 
cera, etc.,  may  also  become  involved.  “A 
leprous  ulceration  on  the  nasal  septum  is 
usually  the  first  sign  of  the  disease,”  and 


the  pharymx  is  often  early  involved.  Febrile 
exacerbations  associated  with  a patchy 
erythema  occur  at  the  onset.  The  bacilli 
are  demonstrable  in  the  secretions  and  in 
the  lesions. 

The  disease  occurs  as  well  in  cold  coun- 
tries, like  Norway  and  Iceland,  as  in  tropical 
and  temperate  countries. 

Prognosis.— The  disease  usually  terminates 
fatally  in  eight  to  twelve  years  or  more,  the 
anaesthetic  type  being  the  least  virulent,  the 
mixed  type  next,  and  the  tubercular  variety 
the  gravest. 

Treatment. — Lepers  should  be  segregated 
in  a non-leprous  district  and  placed  under 
the  best  hygienic  conditions:  open  air  life, 
fresh  air  at  night,  an  abundance  of  nutritious 
food,  with  perhaps  codliver  oil,  avoidance 
of  chills,  frequent  hot  baths,  preferably 
sulphur  baths  (potassium  sulphide,  5ii-iv 
to  thirty  gallons  of  water). 

Chaulmoogra  oil  (Oleum  gynocardiae),  ad- 
ministered both  mternally  and  externally,  is 
very  beneficial,  and  sometimes  curative;  but 
it  is  apt  to  irritate  the  stomach.  One  may 
begin  with  three  to  five  drops  in  capsule, 
emulsion,  or  milk,  three  times  a day,  before 
or  after  meals,  preferably  before  meals 
according  to  Dyer,  and  increase  the  dose  by 
one  or  two  drops  every  three  to  five  days, 
up  to  75  to  120  to  150  or  more  drops  t.i.d. 
At  the  same  time  give  daily  inunctions  of 
the  oil,  in  the  strength  of  25  to  50  per  cent, 
in  olive  oil,  cottonseed  oil,  cocoanut  oil,  or 
lard.  Before  each  inunction,  wash  the  skin 
with  soap  and  hot  water,  and  rub  the  oil 
into  the  lesions  thoroughly  for  one  or  two 
hours.  Crocker  records  the  case  of  a leper 
who  isolated  himself  in  the  mountains  and 
succeeded  in  increasing  the  dose  of  chaul- 
moogra oil  to  500  minims  daily,  and  was 
curecl.  Good  effects  are  observed,  as  a rule, 
only  after  large  doses  long  continued. 
Strychnine  or  nmx  vomica  (q.v.  in  Part  11) 
should  also  be  given  in  all  cases. 

Less  irritating  to  the  stomach  than  the 
oil  is  magnesium  or  sodium  gynocardate, 
gr.  ss,  gradually  increased  to  gr.  iii-xlv,  in 
capsule,  t.i.d.p.c.;  or  three  to  five  grain  cap- 
sules ten  to  twenty  times  daily. 

Other  remeches  are  as  follows : 

Balsam!  gurjunac  (Gurjun 

oil) oi  (ilRxv-x  per  dram) 

Liquori.s  calcis  vel  mucil- 

aginis  acaciic 5iii-v 

Miscc  et  fiat  emulsum. 

Sig. — One-half  to  two  to  four  drams  (5  to  10  -1- 
minims  of  the  oil),  two  or  three  times  daily.  At  the 
same  time  give  daily  inunctions  of  25  to  50  per  cent, 
of  the  oil  in  olive  oil,  for  one  to  two  hours  at  a time, 
into  the  lesions. 


LEUCOPLAKIA  BUCCALIS 


B Hoang-nan gr.  iii,  in  pill,  t.i.d. 

I)  Antivenini  (Calmette),  1 to  11  c.c.  hypodermi- 
cally every  day  or  every  other  day  (Dyer); 
20  to  30  c.c.  (Osier.) 

Hydra  rgjTi  sozoiodolatis  gr.  ]4, 

Sodii  iodidi gr.  M 

Aquaj  destillatse,  q.s. 

M.  Sig. — Inject  deeply  into  the  thigh  muscles 
twice  weekly. 

I^  Leprolin,  (a  toxin  obtained  from  lepra  bacilli), 
10  C.C.,  injected  deep  into  the  muscles  every 
ten  to  fourteen  days.  Keep  the  patient  in  bed 
and  administer  laxatives  during  the  follow- 
ing two  or  three  days  of  reaction.  At  the 
same  time,  apply  equal  parts  of  salt  and  vaseline 
to  the  ulcers  and  anaesthetic  areas,  and  administer 
one  ounce  of  salt  daily  with  the,  meals.  Pulmonary 
tuberculosis  and  albuminuria  contraindicate  the  use 
of  leprolin.  (Dyer.) 

Lepra  serum,  vaccine,  tuberculin,  Coley’s 
fluid  (see  Part  11),  nastin,  salvarsan,  snake 
venom,  ichthyol,  arsenic,  potassimn  chlorate, 
and  the  salicylates  are  reputed  to  be  of  some 
value;  but  the  list  is  su.spiciously  long. 

The  X-rays  and  radium  are  said  to  act 
favorably  upon  the  skin  lesions. 

Unna  recommends  inunctions  of  chrys- 
arobin  and  ichthyol,  eight  parts,  salicylic 
acid  two  parts,  and  vaseline  100  parts, 
substituting  pyrogallic  acid  for  chrysarobin 
on  the  face. 

Early  radical  removal  of  lesions,  followed 
by  cauterization,  is  said  to  arrest  the  disease. 
Ulcers  should  be  kept  cleansed  with  mild 
antiseptics,  such  as  boric  acid  solution, 
3iv  ad  Oi,  hydrogen  peroxide  half  strength, 
or  bichloride  solution,  1 : 4000  to  2000,  fol- 
lowed by  a protective  application,  e.g.,  bal- 
sam of  Peru  and  castor-oil,  equal  parts. 
Cleanse  the  nose  with  an  alkaline  lotion, 
e.g.,  sodium  bicarbonate,  3i  ad  Oi,  followed 
by  an  oily  spray,  e.g.,  liquid  albolene,  cos- 
moline,  benzoinol,  or  liquid  vaseline. 

In  the  anaesthetic  type,  the  application  of 
electricity  to  the  anaesthesic  areas,  and  nerve 
stretching  and  nerve  splitting  “ have  been 
found  useful  in  restoring  sensibility,  muscu- 
lar power,  and. healing  ulcers,  and  relieving 
pain.”  (Stelwagon.) 

Treatment  should  be  continued  at  inter- 
vals for  years  after  the  disappearance  of 
aU  symptoms. 

Leptus  or  Harvest  Bug. — Gr.  'Kewros 
slender.  See  Bites. 

Leucoderma;  Vitiligo;  Piebald  Skin. — 

Gr.  XevKos  white  -f-  depfxa  skin;  L.  vitilig'o, 
a leprous-like  skin  disease.  An  acquired 
patchy  pigmentation  of  the  skin,  character- 
ized by  the  occurrence  of  very  slowly  pro- 
gressive, milky-white  patches,  with  convex 


borders  surrounded  by  hyperpigmentation. 

Congenital  leucoderma  is  called  albinism 
{q.v.) 

Etiology.— Possible  causal  influences  are 
heredity,  emotion,  nerve  injury,  toxic  neu- 
ritis, migraine,  retinitis  pigmentosa,  pressure 
from  a truss,  etc.,  exophthalmic  goitre, 
tabes,  Addison’s  disease,  exposure  to  the 
sun  or  to  cold,  morphoea,  alopecia  areata, 
syphilis,  severe  illness,  hysterectomy,  etc. 

Treatment. — This  is  scarcely  effectual.  One 
may  try  local  stimulation  by  means  of 
mustard  plasters  or  cantharides  {q.v.  in  Part 
11),  or  the  negative  electrode  of  a galvanic 
battery,  with  a current  of  two  to  five  milliam- 
peres,  applied  for  only  one  to  several  minutes 
at  one  spot,  “so  as  only  to  produce  redness” 
(Stelwagon). 

The  hyperpigmentation  bordering  the 
white  spots  may  be  rendered  less  conspicuous 
by  the  means  used  in  the  treatment  of 
chloasma  {q.v.). 

Carbolic  acid,  pure  or  diluted  with  alcohol, 
may  be  painted  on  for  this  purpose. 

The  white  patches  on  exposed  parts  may 
be  masked  by  the  application  of  dilute 
walnut  juice,  chrysarobin,  or  extremely  weak 
tincture  of  iodine. 

Leucoderma,  Congenital. — L.  con,  with 
-f  genitus,  born.  See  Albinism. 

Leucoplakia  Buccalis.— Gr.  XevKos 
white  + 7rXa^  plate;  L.  bucca,  cheek. 
Synonyms.— Psoriasis  lingua;;  ichthyosis  lin- 
guae; .smokers’  patches. 

A slow,  persistent  hyperkeratosis  of  the 
mucous  membrane  of  the  mouth,  usually  the 
tongue,  characterized  by  the  presence  of 
somewhat  thickened  whitish  lines,  spots, 
or  patches. 

Cancerous  degeneration  sometimes  follows. 

Etiology. — Local  irritation  due  to  smoking, 
alcohol,  hot,  highly  seasoned  or  acid  foods, 
dental  caries,  or  gastric  or  gastro-intestinal 
catarrh  is  a contributory  cause. 

Treatment. — Remove  all  possible  sources  of 
irritation,  and  keep  the  teeth,  gums  and 
mouth  clean  with  brush,  soap,  and  warm 
water,  followed  perhaps  by  an  aqueous  solu- 
tion of  boric  acid,  borax,  or  sodium  bicar- 
bonate, 3iv  ad  Oi  (gr.  xv  ad  5i),  or  Dobell’s 
solution  {q.v.  in  Part  11).  To  destroy  the 
hyperkeratotic  patches,  employ  the  galvano- 
cautery  boldly  and  thoroughly,  or  better,  the 
X-rays  {q.v.)  or,  better  still,  radium,  using  a 
filter  (see  under  Eczema).  Says  Knox: 
“ The  employment  of  hard  tubes  and  ade- 
quate filtration  combined  with  frequent 
dosage,  may  lead  to  a rapid  improvement  in 
cases  where  no  improvement  had  taken 
place  under  the  lighter  doses  ”;  and  “ cases 


LICHEN  PI  ANUS 


which  show  no  iinj:)roveinent  are  j:)robal)ly 
cancerous.”  The  use  of  antisejjtics  astrin- 
gents, and  chemical  caustics  is  declared  to 
be  harmful.  (Riesman;  Pu.sey.) 

Leukonychia. — Gr.  \evKos  white  + ovv^ 
nail.  See  Atrophia  Unguium,  under  Nail 
Diseases. 

Lice. — See  the  Pediculoses. 

Lichen  Annularis  (Galloway). — Gr.  Xeix’7*' 
lichen  (papular  skin  disease);  L.  annulus, 
ring.  An  extremely  rare,  chronic  eruption, 
api^earing  ujinn  the  sides  and  back  of  the 
fingers,  and  characterized  by  an  aggregation 
of  lichen-planus-like  papules  or  nodules  into 
a ring,  which  enlarges  peripherally  while  it 
clears  centrally. 

Treatment. — Galloway’s  case  was  cured  ii 
six  months  by  the  ajiplication  of  a 2 to  10 
jter  cent,  salicylic  acid  ointment,  with  iron 
and  codlivcr  oil  (see  Part  11)  internally, 
and  improved  hygiene.  C'rocker  recom- 
mends parajDlast  hydrargyri,  containing 
mercury  fifty  parts,  and  carbolic  acid, 
seventy- five  parts  (paraplast  is  a plaster- 
base  of  caoutchouc,  lanolin,  rosin,  and 
dammar,  a resin).  Hyde  recommends  50 
per  cent,  aqueous  solution  of  ichthyol. 

Lichen  Pilaris  seu  Spinulosus. — Gr. 
lichen;  L.  pil'us,  hair;  sp^y^.a,  spine.  A rare, 
inflammatoiy  papulation,  occurring  at  the 
mouths  of  the  hair  follicles,  each  papule 
lieing  capped  by  a horny  spine. 

Treatment.— The  disease  is  readily  cured, 
by  thorough  scrubbing  with  green  soap  and 
hot  water.  Crocker  recommends  that  the 
following  prejiaration  be  rubbed  in  with  a 
piece  of  flannel,  following  the  bath: 

R Olei  cadini 5i 

Linimcnti  sapoiii.s  mollis, 

Spiritus  villi,  aa,  ad 5i 

Godliver  oil  and  iron,  or  arsenic  arc  usually 
indicated  (see  Part  11). 

Lichen  Planus.— Gr.  XeLxvp  lichen  (papu- 
lar skin  thsease)  ; L.  planus,  flat.  An 
uncommon,  chronic  (rarely  acute),  inflamma- 
tory (hsease,  characterized  by  pinhead  to 
small  pea-sized,  flattened,  glistening,  firm, 
pale-red  or  violaceous  papules  with  jioly- 
gonal  or  angular  outline,  and  often  a slight 
central  depression  or  umbilication,  the 
papules  tending  to  coalesce  into  patches  with 
a roughened,  slightly  scaly  surface.  The 
sites  of  predilection  of  the  eruption  are  the 
flexor  surfaces  of  the  wrists  and  forearms, 
the  inner  sides  of  the  knees,  and  the  lower 
parts  of  the  legs,  but  any  part  of  the  body, 
including  the  buccal  mucous  membrane  may 
become  affected.  The  eruption  is  usually 
itchy,  and  is  followed  by  pigmentation. 


Vesicles  and  blebs  appear  in  rare  instances. 

Etiology. — Bile  is  almost  invariably  present 
in  the  urine  (see  Urinalysis  in  Part  1). 
Some  form  of  gastric  or  duodenal  derange- 
ment is  possibly  the  underlying  cause. 
Worry,  overwork,  deficient  food,  neuras- 
thenia, etc.,  are  cited  as  predisposing  causes. 

Prognosis. — Improvement  under  treatment 
is  slow,  but  ultimate  recovery,  after  several 
months,  is  the  rule. 

Treatment. — Prescribe  a correct  hygienic 
regunen,  e.g.,  adequate  rest,  fresh  air  day 
and  night,  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals,  a 
well-balanced,  nutritious  ration,  perhaps  a 
glassful  of  hot  water  containing  one-quarter 
teaspoonful  of  sodium  bicarbonate  one  hour 
before  each  meal,  regulation  of  the  bowels, 
and  perhaps  codlivcr  oil,  quinine,  and  strj'ch- 
nine,  as  tonics.  Of  special  value  are  arsenic 
and  mercury  used  conjointly.  Salicin  is 
also  reconunended  (see  Part  11  for  drug 
formuhe,  etc.) 

Locally,  dab  on  twice  daily  or  oftener  if 
the  itching  demands  it,  compound  tincture 
of  coal  tar  (cpv.)  or  liquor  carbonis  detefgens, 
diluted  at  first  with  ten  to  fifteen  parts  of 
water,  and  later  gradually  stren^hened. 
Alkaline  and  bran  baths  (sodium  bicarbonate 
5ii-x,  bran,  one  gallon,  water,  thirty  gallons), 
every  day  or  two,  are  very  serviceable. 

Other  remedies  are: 


B Acidi  carbolic! gr.  xx 

Hydrargyri  bichloridi gr.  ii-v 

Ungiienti  zinci  oxidi 5i 

(Unn: 

Olei  nisei ngxx 

Unguenti  hydrargyri  ammoniati.  . §i 


For  thick,  hardened  areas,  apply  salicylic 
acid  ointment  or  rubber  plaster,  10  to  20 
per  cent.,  continuously,  until  irritation  is 
j:)roduced;  then  apply  cold  cream  or  zinc 
oxide  ointment  (q.v.). 

“ When  the  lesions  are  close  together  and 
jxatchy,  the  galvanic  current  of  four  to  ten 
milliamperes  may  be  applied  tlu'ee  or  four 
times  weekly.  The  app  ication  should  be 
rapidly  labile,  except  over  thickened  areas, 
where  the  electrodes  can  be  held  stationary 
for  one  to  two  minutes  ”;  or  the  static  cur- 
rent applied  with  the  roller  electrode,  or 
the  high-frequency  current  applied  with  the 
flat  vacuum  electrode  may  be  employed 
(Stelwagon).  The  cautious  application  of 
the  X-raj^s  may  be  employed,  as  in  eczema 

In  acute  inflaimnatory  and  in  irritable 
cases,  and  in  infants  and  children,  iisc 
calamine-zinc-oxide  lotion,  together  with 
the  aforementioned  baths: 


LENTIGO 


4.  — Lupus  erythematosus. 

N 1795.  Hallopcau. 


5.  --  Lichen  simplex. 

N"  1452.  Tenneson. 


St.  Louis  Hospital  Museum,  Paris. 


LAROUSSE  m^:dical. 


SKIN  DISEASES  : Lentigo.  Lichen.  Lupus. 


LUPUS  ERYTHEMATOSUS 


R Calaminsp, 

Zinci  oxidi,  aa 5ii-iv 

Acidi  borici 5u 

Glycerini i^x-xxx 

Acidi  carbolici i^xv-oi 

Liquoris  calcis 5ii 

Aqua?,  q.s.,  ad 5viii 


Lichen  Ruber  Acuminatus. — Gr.  'Ketxvv 
lichen;  L.  ruber,  red;  L.  acuminat’us,  sharp- 
pointed.  See  Pityriasis  Rubra  Pilaris, 

Lichen  Scrofulosus. — Gr.  XetxV  lichen 
(papular  skin  disease) ; L.  scrofula,  sow-pig. 
A chronic  inflammatory  disease,  occurring 
mainly  in  tuberculous  children,  characterized 
by  round,  pinhead-sized,  firm,  flat,  scaly, 
follicular  papules,  of  a red  color,  fading  to 
that  of  the  normal  skin,  disposed  in  closely 
set  groups  and  cu’cles. 

Treatment.— The  daily  administration  of 
codliver  oil  (q.v.  in  Part  11),  externally  and 
internally,  is  rapidly  curative.  The  oil  must 
be  rubbed  in  and  kept  constantly  applied. 
Other  oils  are  claimed  to  be  equally  efficient. 

Lichen  Spinulosus. — See  Lichen  Pilaris. 

Tropicus. — Gr.  Xetx’7''  lichen;  rpomKos 
turning.  See  Miliaria. 

Urticatus.^ — L.  ur'tica,  a nettle.  See 
Miliaria. 

Variegatus.— See  Parapsoriasis. 

Lingual  Affections. — L.  ling'ua,  tongue. 
See  Tongue  Diseases. 

Linguopapillitis. — L.  ling'ua,  tongue;  pa- 
pil'la,  nipple.  See  Glossitis,  in  Part  1. 

Lip  Diseases. — See  Cheilitis  Glandularis; 
Cheilitis  Exfoliativa,  under  Dermatitis  Se- 
borrhoeica;  Perleche;  and  Eczema. 

Liver  Spots. — See  Chloasma;  and  Tinea 
Versicolor. 

Loose  Skin. — See  Dermatolysis. 

Lousiness. — See  the  Pediculoses. 

Lupus  Erythematosus. — L.  lupus,  wolf; 
L.;  Gr.  kpvdrma  redness.  An  uncommon, 
chronic,  inflammatory  disease  of  adults, 
showing  a predilection  for  the  cheeks  and 
dorsum  of  the  nose  (butterfly  disease),  the 
eartips  and  scalp,  and  characterized  by 
superficial,  pink  to  red,  discoid,  sharply  cir- 
cumscribed, dry  scaly  patches,  with  a tend- 
ency to  atrophic  scarring.  The  presence  of 
gaping  follicles  plugged  with  sebum  is  a 
characteristic.  The  disease  may  even  occur 
in  the  mouth. 

Etiology. — The  following  are  possible  causal 
factors  e.g.,  nephritis,  gout,  dyspepsia, 
anajmia,  con.stipation,  uterine  disease,  tuber- 
culo.sis,  debility,  neurasthenia,  feeble  periph- 
eral circulation,  exposure  to  extreme  heat 
or  cold,  inflammatory  skin  diseases. 

Prognosis.— This  is  unfavorable  as  to 
cure,  but  benefit  can  be  expected  from 
judicious  treatment. 

39 


Treatment.— Attend  to  any  possible  etio- 
logical influence,  and  enjoin  the  observance 
of  a correct  hygienic  regimen,  e.g.,  adequate 
rest  and  exercise,  fresh  air  day  and  night, 
avoiding  draughts,  a daily  tepid  bath  in  a 
comfortable  room,  before  breakfast,  followed 
by  a cold  spinal  douche  and  brisk  rubdown 
with  a coarse  towel,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals, 
an  abundance  of  milk,  cream,  and  other 
fatty  foods  (Sequeira),  regulation  of  the 
bowels,  and  the  avoidance  of  anything 
which  tends  to  flush  the  face,  such  as  alco- 
hol, tea,  coffee,  tobacco,  hot,  rich  soups, 
constipation,  exposure  to  sun  or  wind, 
stooping,  and  great  exertion.  A warm,  dry 
climate  is  best.  Codliver  oil  (see  Part  11) 
and  tonics  are  often  useful.  The  salicylates, 
(q.v.),  gr.  x-xx,  t.i.d.,  well  diluted  and 
quinine  (q.v.),  beginning  with  gr.  iii-v, 
t.i.d.  are  especially  recommended,  par- 
ticularly quinine. 

In  the  local  treatment,  the  mildest  meas- 
ures are  the  best  recommended,  since  irri- 
tating measures  are  likely  to  make  the 
disease  spread.  Once  daily  the  affected  parts 
may  be  washed  with  green  soap  and  warm 
water,  and  one  of  the  following  mild  astrin- 
gent preparations  applied  frequently: 

Calaminae, 

Zinci  oxidi,  aa 5ii 

Acidi  borici 3i 

Glycerini * irjxxx 

Acidi  carbolici irgx 

Liquoris  calcis 5i 

Aqua;,  q.s.,  ad §iv 

(Calamine  lotion.) 

Calaminae, 

Zinci  oxidi,  aa 3ss 

Liquoris  calcis, 

Olei  oliva;,  aa 3iv 

Acidi  carbolici t^iii-v 

Adipis  lanae  hydrosi 3 i 

(Calamine  bniment.) 

II  Zinci  sulphatis, 

Potassii  sulphureti,  aa gr.  v-xv 

Glycerini irjviii 

Aqua; 3iv 

II  Sulphuris  prsecipitati 3ss-i 

Petrolati  mollis gi 

Should  these  preparations  prove  ineffec- 
tual, stronger  applications  may  be  cau- 
tiously made  to  limited  areas.  Every  seven 
to  ten  days,  liquor  potassse  (q.v.),  pure  or 
diluted,  may  be  applied,  allowed  to  dry^ 
then  covered  with  several  coats  of  collodion, 
and  allowed  to  remain  on  for  two  or  three 
days.  More  active  measures  are  (1)  vigor- 
ous scrubbing  with  green  soap ; (2)  painting 
with  pure  liquid  carbolic  acid  about  every 
seven  to  ten  days,  waiting  each  time  until 
the  film-like  crust  formed  has  fallen  off;  (3) 


LUPUS  VULGARIS 


painting  every  day  or  two  for  several  days 
with  salicylic  acid,  gr.  xx-lx,  to  collodion, 
5 i and  repeating  the  paintings  after  the  prev- 
ious film  has  fallen  off;  (4)  the  application 
twice  daily  of  pyrogallic  acid,  3i,  to  petro- 
latum, 5i- 

When  irritation  has  been  produced  by 
these  applications,  replace  them  for  a time 
by  such  soothing  applications  as  cold  cream 
boric  ointment,  or  calamine  lotion. 

Other  measures  which  are  sometimes  suc- 
cessful are  (1)  the  application  of  the  X-rays 
{q.v.),  pushed  to  the  point  of  producing  a 
mild  erythema;  (2)  radium  {q.v.)  applied  on  a 
flat  applicator  for  about  half  an  hour;  (3) 
ultra-violet  or  Finsen  light;  (4)  the  high  fre- 
quency current,  using  a flat,  hammer-shaped, 
vacuum  electrode,  applied  at  a distance  of 
to  3^  inch,  for  three  to  ten  minutes,  or 
“ sufficiently  long  to  bring  about  some  reac- 
tion,” and  “ repeated  every  five  to  ten  days, 
using  the  calamine-zinc-oxide  lotion  in  the 
intervals”  (Stel wagon);  “applied  daily  or 
every  other  day.”  (Pusey.) 

Pusey  thinks  that  freezing  with  solidified 
carbon  dioxide  or  liquid  air  is  the  most 
effective  treatment.  He  freezes  the  patches 
for  ten  to  twenty  seconds  (it  may  even  be 
continued  for  sixty  seconds)  at  intervals  of 
at  least  three  weeks. 

Lupus  Verrucosa. — L.  lupus,  wolf;  ver- 
ruca, wart.  See  Tuberculosis  Cutis. 

Lupus  Vulgaris, — L.  lupus,  wolf;  vulga'ris, 
common.  A chronic,  painless,  granulomatous 
disease  of  the  skin  and  mucous  membranes, 
caused  by  the  tubercle  bacillus,  and  character- 
ized by  the  appearance  of  brownish-red  or 
apple-butter  colored  nodules  or  tubercles  and 
infiltrated  patches,  which  either  ulcerate  or 
atrophy,  leaving  scars  and  disfigurement. 
Under  pressure  with  glass,  yellow  spots  are 
visible.  A positive  diagnosis  is  made  by 
microscopic  examination  and  animal  inocu- 
lation (see  Tuberculosis,  Pulmonary,  in 
Part  1). 

The  disease  usually  begins  in  early  life. 
It  is  rare  in  the  New  World,  but  common 
in  Europe. 

Prognosis. — The  disease  is  rebellious  to 
treatment,  but  usually  responds  eventually 
if  the  latter  is  persisted  in.  Recurrence 
however,  is  common.  X-ray  treatment 
is  effectual. 

Treatment.— A correct  hygienic  regimen  is 
of  the  first  importance.  This  embraces  ade- 
quate rest  and  exercise,  fresh  air  day  and 
night,  regular  hours  of  eating  and  sleeping, 
rest  before  and  after  meals,  and  an  abundant, 
nutritious  diet,  with  perhaps  codliver  oil 
and  tonics  (see  Tuberculosis,  Pulmonary, 


in  Part  1,  for  details).  Thyroid  extract  {q.v. 
in  Part  11)  is  well  recommended,  as  is  also 
tuberculin  (see  Part  1). 

The  best  local  treatment  is  with  the 
X-rays,  {q.v.),  rachum,  {q.v.),  or  the  Finsen 
ultraviolet  rays,  better  the  X-rays  or 
radium.  The  ultraviolet  rays  are  not  of  use 
where  there  is  ulceration,  or  in  lupus  of  the 
mucous  membranes. 

Give  a full  massive  dose  of  the  X-ray,  to 
produce  more  than  a mild  erythema,  and 
repeat  once  or  twice,  after  an  interval  of 
three  or  four  weeks.  For  deep  lesions,  em- 
ploy rays  of  greater  penetration  and  intensity 
through  a filter. 

While  employing  radiotherapy,  ulcers 
should  be  daily  cleansed  with  mild  anti- 
septics, such  as  boric  acid  solution,  3iv  ad 
Oi,  or  bichloride,  1 : 4000  to  2000,  and  con- 
tinuous wet  dressings  applied;  or  perhaps 
an  ointment  of  iodoform,  or  ammoniated 
mercury,  or  carbolic  acid  (see  Part  11)  may 
be  deemed  preferable.  Where  there  is  an 
associated  acute  inflammation,  calamine- 
zinc-oxide  lotion  may  be  applied  until  the 
inflammation  subsides: 


rj  Calaminffi, 

Zinci  oxidi,  aa 3i~ii 

Acidi  borici 3 i 

Glycerini igjxxx 

Acidi  carbolici tiex 

Liquoris  calcis 5i 

Aquae,  q.s.,  ad 5iv 


Where  rontgenotherapy  and  photo- 
therapy are  not  available,  or  sometimes  as 
an  adjuvant  to  radiotherapy,  the  following 
destructive  treatment  with  caustics  may 
be  employed : 

(1)  Pyrogallol 3ii-iii 

Petrolati  mollis  et  resinae  ceratae,  aa, 
q.s.,  ad oi 

Apply  this  closely  on  lint,  and  renew  twice 
daily,  each  time  wiping  off  gently  any  loose 
skin,  scale,  or  slough.  At  the  end  of  five  to 
eight  days,  apply  poultices  for  several  hours 
to  a day  or  longer,  to  soften  and  remove  the 
slough  that  has  formed.  Then  gently  wash 
with  soap  and  water,  rinse  and  wipe  dry, 
and  reapply  the  ointment,  and  so  on  until 
the  destructive  action  has  been  deemed  suf- 
ficient. This  requires  ten  days  to  two  or  three 
weeks.  After  removing  the  final  slough, 
apply  an  ointment  of  pyrogallol,  1 to  2 per 
cent.,  until  healing  takes  place.  (Stelwagon.) 

(2)  Paint  on  a 20  per  cent,  solution  of 
cocaine  in  order  to  benumb  the  cutaneous 
sensibility.  Then  apply  on  lint  as  much 
salicylic  acid  added  to  glycerine  as  will 


MEASLr:S,  GERMAN 


make  a paste.  To  tliis,  creosote  or  carbolic 
acid,  5ss  to  the  ounce,  inay  be  added  to  lessen 
the  f)ain.  (Jhanf^e  daily,  until  an  acute 
inflammatory  reaction  is  produc(\d,  then  u.sc 
bland  dressings  until  the  reaction  subsides. 

(3)  llydnirgyri  iK'.rcliloridi Ki'-  i~h 

Acjuii!  voi  {Kd.rolati 5* 

M.  Sif?. — Apply  continuously  until  an  acute 
reaction  is  produced.  (Wliite.) 

(4)  R ('ollodii  acidi  sali(;ylici,  10  to  20 

peu' cent ?)i 

Sig. — Api>ly  continuously  until  an  acute  reaction 
is  j)rodu<;ed. 

{.'))  R Acidi  salicylici  V(4  resorcinolis 5ii~i>i 

Petrolati 5i 

Sig. — Api)ly  continuously  until  an  acute  rca(d.ion 
is  produced. 

(0)  R Acidi  arsenosi Kr. 

(Jintuiharis pi 

Cocaina^  chloridi K''-  v-x 

Pctrolati  mollis 5i 

Apply  thickly  upon  lint,  cover  with  wax 
tissue,  and  bind  on.  Change  twice  daily. 
Continue  two  to  four  days.  Then  poultice 
until  the  slough  comes  awtiy,  and  then  apply 
a 1 to  2 per  cent,  pyrogallol  salve  until 
healing  ocimrs.  Considerable  inflammatory 
(edema  follows  this  treatment.  (Sttdwagon.) 

(7)  To  ulcers,  hud.ic  acid  may  be  a{)j)lied 
on  a wad  of  cotton  for  ten  to  thirty  minutes 
once  or  twi(^e  daily,  using  boric  ointment 
in  the  intervals.  (Stelwagon.) 

Operative  Measures.— (1 ) Thorough  curette- 
ment,  undei’  general  anaesthesia,  with  a small, 
sharp  spoon,  looking  well  after  the  edges,  fol- 
lowed by  the  application  of  pure  carbolic 
a(;id,  or’of  a 25  per  cent,  j^yrogallol  salve  for 
several  days,  as  descrilxed  under  caustic 
tneasures.  Crocker  recommends  that  thyroid 
extract  (q.v.  in  Part  11)  be  administened 
after  curetting,  and  that  reemrrent  nodules 
be  bored  out  with  a matchstic.k  dipped  in 
fuming  acid  nitrate  of  mercury. 

(2)  Ijinear  sc^arific^ation  under  general 
anaesthesia,  by  means  of  close  parallel 
incLsions,  to  inch  apart,  down  through 
the  disea.s(!(l  tissue,  cros.s-tra(;ked,  if  deemed 
advisable,  the  aim  Ixung  to  cut  off  the  blood 
supply.  Apf)ly  imitiediately  boroglyccride, 
further  to  deplete  the  tissues.  In  operating 
on  the  nose,  plug  the  nares  to  secure  a firm 
foundation.  Repeat  the  scarification  at 
intervals  of  one  to  two  weeks. 

Ionic  medication  (q.v.  in  Part  1 ) is  re(mm- 
mended.  First  rub  the  aff(H‘te,d  parts  with 
a pkxlgid.  of  cotton-wool  soakcxl  in  licpior 
IM)ta.ssai,  in  order  to  denude  the  nodules  of 
their  epilluflial  covering.  Then  wipe  dry,  and 
ionize,  using  a 2 per  cent,  solution  of  zinc 


chloride  or  10  per  cent,  zinc  sulphate  and  a 
current  of  two  to  three  milliamperes  per 
square  centimetre  for  ten  to  twenty  minutes. 
Repeat  the  treatment  every  two  weeks 
until  all  nodules  have  disappeanxl.  It  is 
also  dir(!cted  that  thirty  to  forty  grains  of 
potassium  iodide  be  given  by  mouth,  fol- 
lowed one  and  a half  to  two  hours  later  by 
the  introduction  into  the  nodules  of  an 
anodic  platinum  or  iridium  imedle,  and  the 
passage  of  a (airrent  of  three  to  four  milli- 
anqx'res  for  three  minutes.  Free  iodine  is 
lilxa’ated  around  the  needle. 

For  tliickened  scars  employ  repeated 
linear  scarific^ation  followed  by  the  applica- 
tion of  a mercurial  plaster.  Injections  of 
thiosinamin,  15  per  cent,  alcoholic  solution, 
iT^iv,  increa.sing  to  nyxv,  every  two  or  three 
days,  may  also  be  tried. 

(For  treatment  of  lupus  of  the  mucous 
membranes,  see  Lupus  of  the  Nose  and 
Throat,  in  ILirt  9) 

Lymphangiectodes. — L.  lymp'ha,  lymph  + 
Gr.  ayyeiov  vessel  -j-  e/crams  dilatation.  See 
Lymphangioma  Circumscriptum,  following. 

Lymphangioma  Circumscriptum;  Lym= 
phangiectodes. — L.  lymp'ha,  lymph  -f  Gr. 
ayytlov  vessel  -f  -co/xa  tumor;  kraerts  dilata- 
tion; L.  circum,  around  + .scrib'ere,  to  write. 
A rare,  circumscrilx'd  proliferation  of  lym- 
phatic vessels,  analogous  to  a vascular 
lucvus,  beginning  usually  in  early  life,  and 
characterized  by  an  aggregation  of  clo.sely 
crowded,  yellowish  or  reddish,  pinhead  to 
small  pea-sized,  tough  vesicles  containing 
lyni|)h,  and  resembling  somewhat  frog- 
spawn. 

Treatment. — Remove  immediately  by  a 
wide  excision,  by  cauterization,  or  by  the 
curette,  or  employ  radium  or  the  X-rays 
(q.v.),  or  treat  each  vesicle  separately  by 
electrolysis  (s'ee  Adenoma  Sebaceum).  Sur- 
gi(uil  removal  should  be  conqilete,  otherwise 
recurrence  is  almost  certain.  Skinner  rec- 
ommends deep  n’mtgenot.herapy  in  massive 
doses,  using  only  about  two  millimetres  of 
aluminum  filtration,  with  a lead  mask 
adapted  to  the  lesion,  or  conical  protection 
tube,  and  repeating  the  treatments  at  about 
two-month  intervals. 

Lymphangitis. — See  Part  1.  General  Medi- 
cine and  Surgery. 

Madura  Foot. — See  Mycetoma. 

Malabar  Ulcer. — See  Phagedena  Tropica. 

Malignant  QHdema. — L.  ynnlignam,  viru- 
lent; Gr.  otSiyga  swelling.  See  Anthrax. 

Pustule. — L.  pustula.  S(^e  Anthrax. 

Measles. — See  Part  1,  General  Medicine 
and  Surgery. 

Measles,  German. — See  Part  1. 


MYCETOMA;  MADURA  FOOT 


Melanoderma. — Gr.  fikXa^  black  + depfxa 
skin.  See  Chloasma. 

Miliaria  — L.  milium,  millet.  Synonyms.— 
Miliaria  rubra;  strophulus;  lichen  tropicus; 
lichen  urticatus;  erythema  infantum;  red 
giun;  prickly  heat;  heat-rash;  grun  or  teeth- 
ing rash. 

A common  acute  eruption  of  mildly  in- 
flamniatory,  pinpoint  to  pinhead-sized, 
closely  crowded  vesicles  and  papules,  at  the 
mouths  of  the  sweat  follicles,  accompanied 
by  burning,  prickling,  or  itching,  and  lasting 
from  several  days  to  several  weeks. 

It  is  caused  by  exposure  to  high  tempera- 
ture. 

Treatment. — Bathe  the  affected  skin  with 
dilute  alcohol,  followed  by  a bland  dusting 
powder,  such  as  equal  parts  of  boric 
acid,  zinc  oxide,  talcum,  and  starch;  or  if 
there  is  much  irritation,  by  one  of  the 
following  lotions: 

B Calaminac, 

Zinci  oxidi,  aa oii 

Acidi  borici 3i 

Glycerini i^x-xxx 

Acidi  carbolici Trjx-xxx 

Liquoris  calcis gi 

Aquae,  q.s.,  ad giv 

M.  Sig. — Shake  well,  and  dab  on  as  often  as 
desired  to  relieve  irritation. 

R Thymolis gr.  v 

Sodii  boratis gr.  iv 

Alcoholis 5 iv 

Aquae,  q.s.,  ad giv 

Prophylaxis.— Avoid  alcoholic  drinks  and 
overclothing.  Woolen  underclothing  is  pref- 
erable to  cotton,  says  Crocker.  Silk  or 
linen  is,  no  doubt,  best.  The  diet  should  be 
light,  and  the  bowels  should  be  kept  regular. 
In  infants,  restrict  carbohydrates;  forbid 
bananas,  potatoes,  and  sweets.  Bathe  fre- 
quently, followed  by  an  alcohol  rub  and  a 
bland  dusting  powder. 

Miliaria  Rubra. — L.  ru'her,  red.  See 
Miliaria,  above. 

Milium. — L.  milium,  millet-seed.  A pin- 
head-sized  or  larger,  whitish  or  yellowish, 
pearly,  sebaceous  retention  tumor,  without 
an  aperture  or  duct,  situated  just  beneath 
the  epidermis,  and  occurring  principally 
about  the  eyelids,  cheeks,  and  forehead, 
more  rarely  on  the  genitals.  It  sometimes 
consists  of  embryonic  epithelial  remnants 
instead  of  inspissated  sebum. 

Treatment. — In  infants  and  children,  the 
free  use  of  soap  and  water,  and  the  occasional 
inunction  of  unguentum  sulphuris  prsecipi- 
tati,  gr.  xx-xl  ad  5 b usually  suffices  to 
effect  a cure. 

In  adults,  the  milia  should  be  incised, 


their  contents  squeezed  out,  and  the  interior 
touched  with  carbolic  acid  or  tincture  of 
iodine  on  the  end  of  a probe;  or  electrolysis 
may  be  employed  (see  Adenoma  Sebaceum). 
Where  the  lesions  are  numerous  and  closely 
crowded,  one  may  try  a peeling  paste  (see 
under  Acne  Vulgaris). 

Milium,  Colloid.— See  Colloid  Degenera- 
tion of  the  Skin. 

M ilk=Crust. — See  DermatitisSeborrhoeica. 

Leg. — See  Thrombosis,  in  Part  1. 

Moller’s  Glossitis. — See  Glossodynia  Ex- 
foliativa. 

Moist  Wart. — See  Verruca. 

Mole.— L.  mol’es.  See  Nsevus  Pigmentosus. 

Molluscum  Contagiosum. — L.  molluscum, 
soft;  cantag'io,  contact  infection.  An  un- 
common, contagious  disease,  occurring  com- 
monly on  the  face,  breasts,  or  genitals, 
characterized  by  pinhead  to  pea-sized  or 
larger,  pinkish  or  pearly  white,  waxy,  firm, 
rounded,  globular  or  somewhat  flattened 
epithelial  tumors,  with  a central  umbilicated 
opening  filled  with  a cheesy  debris. 

Turkish  baths  and  birds  and  domestic 
fowls  are  frequent  sources  of  infection. 

The  disease  is  reacUly  cured. 

Treatment. — Incise  each  tumor  completely 
(unless  it  is  small,  when  an.  incision  may  not 
be  necessary),  press  out  the  contents  be- 
tween the  thumb  nail  and  the  handle  of  the 
scalpel,  and  touch  the  cavity  with  the  end  of 
a wooden  toothpick  dipped  in  pure  carbolic 
acid,  tincture  of  iodine,  strong  silver  nitrate, 
or  liquor  hydrargyri  nitratis,  {q.v.  in  Part  11), 
or  use  the  solid  silver  stick.  Pedunculated 
lesions  may  be  snipped  off  with  scissors 
or  grasped  with  mouse-tooth  forceps  and  cut 
off  with  a sharp  scalpel,  and  the  base  cauter- 
ized. With  small  lesions,  and  in  children,  the 
following  ointment  may  be  rubbed  in  vigor- 
ously once  or  twice  daily: 

Hydrargyri  ammoniati,  seu- 


sulphurus  preecipitati gr.  xx-xl 

Petrolati 5 i 


(Stehvagon.) 

Monilithrix. — L.  monile,  necklace  -f  Gr. 
dpi^  hair.  See  Hair  Diseases. 

Morphoea. — Gr.  pop4>ri  form.  Localized 
Scleroderms,  see  Scleroderma. 

Morvan’s  Disease. — See  S50'mgomyelia, 
in  Part  1. 

Mosquito  Bites. — See  Bites. 

Mother’s  Mark. — See  Naevus  Pigmento- 
sus; and  Naevus  Vascularis. 

Multiple,  Benign,  Cystic  Epithelioma. — 
See  Epithelioma,  Multiple,  Benign,  Cystic. 

Mycetoma;  Madura  Foot. — Gr.  guxTjs  fun- 
gus -f  -w/xa  tumor.  A slow,  chronic,  tropical 


MOLLUSCUM 


1.  — Vascular  neevus. 

N«  2588,  D'  Danlos 


2.  Sani6  face  (after  radium  treatment) 

N"  2597.  O'-  Danlos 


3.  --  Molluscum  contagiosum 

(varioliform  acne). 


4.  — NseVUS  (from  life). 


5.  Vascular  neevi.  N“  I772  Gaucher. 

S/.  Loin's  Hospital  Museum,  Paris. 


N**  774  O'"  Ollivier 


LAROUSSE  MEDICAL. 


SKIN  DISEASES  : Molluscum.  Naevi. 


IT^VUS  VASrULAEIS 


and  subtropical,  endemic  disease,  chiefly  of 
India,  commonly  involving  the  foot,  occa- 
sionally the  hand,  caused  by  the  streptothrix 
(or  actinomyces)  JMadura;  fungus,  and  char- 
acterized by  swelling  and  the  formation  of 
indolent  nodules  in  the  skin  and  subcutan- 
eous tissues,  which  break  down  with  the 
formation  of  sinuses.  There  is  a black 
variety  which  discharges  gunpowder-like 
granules,  a yellow  variety  which  discharges 
pale  yellowish  fish-roe-like  granules,  and  a 
rare  red  variety,  which  discharges  cayenne- 
pepper-like  granules. 

Treatment. — Remove  every  trace  of  the  chs- 
ease  with  the  knife,  followed,  perhaps,  by 
Carrel’s  method  of  treating  infected  wounds 
{q.v.  m Part  1).  In  advanced  cases,  ampu- 
tation well  above  the  diseased  part  is  the 
only  recourse.  Potassium  iothde  is  of 
no  avail. 

Mycosis  Fungoides.— Gr.  ixmrjs  (ungas;  L. 
jungus  -|-  Gr.  eL8os  form;  shaped  like  a toad- 
stool. A chronic,  malignant  disease  of  the 
skin,  characterized  in  the  beginning  by 
numerous  areas  of  circumscribed  erythema^ 
tous,  eczematous,  urticarial,  psoriatic,  or 
erysipelatous  dermatitis,  with  usually  in- 
tense itching  (sometimes  absent),  followed 
after  a period  of  months  or  years,  by 
the  appearance  of  pinkish  or  reddish,  ele- 
vated, irregular  nodules  and  plates,  which 
later  become  fungoidal  or  mushroom-like 
and  iflcerate. 

The  chsease  has  been  almost  invariably 
fatal  within  a few  months  to  fifteen  years. 

Treatment. — Arsenic  (q.v.  in  Part  11),  erysip- 
elas, and  apparently  continued  purgation  are 
reported  to  have  cured  cases.  Coley’s  mixed 
toxinesof  erysipelas  and  bacillus  prochgiosus 
(q.v.)  may  be  tried.  The  thorough  use  of  the 
X-rays  (g.y.)produces  asymptomatic,  possibly 
a permanent  cure.  It  also  relieves  the 
intense  itching. 

Myringomycosis;  Otomycosis. — L.  my- 

ringa,  drum-membrane;  Gr.  yvKys  fungus; 
ovs  ear.  See  Ear  Diseases,  Part  7. 

Naevus  Anaemicus. — L.  ncev'us,  mask;  Gr. 
au  neg.  -p  alfia  blood.  A rare,  congenital, 
sometimes  acquired  affection  of  the  skin, 
characterized  by  the  presence  of  small  white 
spots,  resembling  those  of  albinismus  par- 
tialis, which  are  rendered  distinct  by  any 
agency  that  causes  flushing  of  the  skin,  e.g., 
blushing,  friction,  cold,  heat,  or  exertion. 
Hairs  of  the  same  color  as  elsewhere  are 
present  over  the  affected  skin,  which  appears 
like  normal  skin,  except  for  the  color.  Sen- 
sation is  normal.  Firm  pressure  with  a glass 
causes  the  spots  to  disappear,  indicating  no 
lack  of  pigment  as  in  albinismus  or  leuco- 


derma.  The  condition  has  not  yet  been  con- 
clusively explained.  It  is  apparently  of  no 
pathological  significance. 

Naevus  Pigmentosus;  Mole. — L.  Ncev'u.s, 
mask;  pigmoitum,  paint;  mol'es,  fleshy  mass. 
Nsevus  pigmentosus  includes  the  simple 
pigmented  smooth  spot  (navus  spilus — Gr. 
amXos  spot),  the  hairy  mole  (nsevus  pilo.sus — 
L.  pil'us,  hair),  the  mamniillated  or  warty 
mole  (nsevus  verrucosus — L.  verruca,  wart; 
nsevus  papillomatosus — L.  papil'la,  nipple), 
and  the  type  with  excessive  fat  and  con- 
nective tissue  hypertrophy  (nsevus  lipo- 
matodes — Gr.  \Liros  fat  -f  -w/xa  tmnor). 
Some  nsevi  are  linear  and  horny.  They  are 
usually  congenital.  They  sometimes  develop 
into  malignant  melanotic  tmnors. 

Histologically,  a pigmented  mole  consists 
of  an  increase  of  pigment,  with  usually  a 
hyperplasia  of  the  other  skin  elements. 

Treatment. — Complete  excision  is  ordinar- 
ily the  best  method  of  removing  moles. 
They  may  be  picked  up  with  toothed  forceps 
and  snipped  off  below  their  base  with  a 
sharp  knife,  a fine  silk  suture  being  then  in- 
serted, if  necessary.  Local  anaesthesia  is 
superfluous.  Where  excision  may  leave  too 
disfiguring  a scar,  the  growth  may  be  thor- 
oughly frozen  with  carbon  dioxide  snow  or 
liquid  air.  The  X-rays  or  radium  (q.v.)  may 
also  be  employed.  Caustics  are  effectual, 
e.g.,  tri-chloracetic  acid,  glacial  acetic  acid, 
or  nitric  acitl,  applied  in  a thin  coating  to 
the  surface,  or  by  stippling. 

Nsevus  Lipomatodes. — See  Nsevus  Pig- 
mentosus, above. 

Papillomatosus. — See  Naevus  Pigmen- 
tosus. 

Pilosus. — See  Nsevus  Pigmentosus. 

Spider. — See  Telangiectasis. 

Spilus. — See  Naevus  Pigmentosus. 

Naevus  Vascularis. — L.  ncev'us,  mask; 
vasculum,  vessel.  Naevus  vascularis  is  a 
congenital,  circumscribed,  cutaneous,  vascu- 
lar hyperplasia,  consisting  of  anastomosing, 
dilated  capillaries.  It  includes  the  flat, 
superficial  “ port-wine  mark,”  the  hyper- 
trophic naevus  made  up  of  large  dilated 
vessels,  and  the  steadily  growing, 
globular  angioma  cavernosum  containing 
large  blood  spaces. 

Treatment. — The  following  methods  are 
available : 

(1)  Excision,  if  the  naevus  is  not  too  large, 
followed,  if  necessary,  by  Thiersch  skin  grafts. 

(2)  Compression  of  the  growth  by  means 
of  thick  and  repeated  paintings  with  collod- 
ion, continued  for  a few  weeks  or  longer, 
with  which  may  be  combined  punctures, 

to  34  iiich  apart,  with  a triangular-edged 


NAIL  DISEASES 


or  cataract  needle,  followed  immediately  by 
several  coatings  of  collodion;  applicable  only 
in  infants  under  two  or  three  months  of  age, 
during  which  period  there  is  a tendency  to 
spontaneous  disai)pearance. 

(3)  Punctures,  j-s  to  inch  apart,  with  a 
needle  or  wootlen  toothpick  dipped  in  car- 
bolic or  nitric  acid,  followed  by  compression; 
applicable  for  superficial  lesions. 

(4)  Electrolysis.  An  anaesthetic  is  usually 
required.  The  needle,  coated  with  shellac 
or  gutta  i^ercha  up  to  within  inch  of  the 
point,  is  attached  to  the  negative  or  positive 
electrode  (if  the  latter,  it  should  be  of  gold 
or  irido-j)latinum),  and  the  other  electrode, 
covered  with  a wet  sponge,  is  ajiplied  to 
any  convenient  part  of  the  body.  A cur- 
rent of  from  one  to  three  to  five  or  more 
milliamperes,  depending  upon  the  size  of  the 
grovrtli  is  used  (up  to  ten  to  twenty  milli- 
amperes for  hypertrophic  growths).  Make 
parallel,  slanting  punctures,  to  }/i  inch 
apart,  down  to  the  base  of  the  growth,  and 
allow  the  current  to  act  for  one-half  to  two 
or  three  minutes,  (seconds  ?),  or  until  a 
blanchetl  line  is  produced  in  its  course. 
Always  increase  and  break  off  the  current 
slowly  in  operating  about  the  head,  so  as  to 
avoid  dizziness,  etc.  The  needle  may  also 
be  inserted  at  to  34  inch  intervals,  just 
at  or  outside  the  edge  of  the  growth,  or  if 
the  growth  is  small,  it  may  be  inserted  at 
the  centre,  thrust  slantingly  toward  the 
edge,  allowed  to  act,  then  almost  completely 
withdrawn  and  thrust  in  another  direction, 
and  so  on.  Apply  pressure  for  several 
hours  or  longer  after  the  treatment  and 
reneat  the  treatment  every  one  to  three 
weeks.  (Stelwagon.) 

(5)  Thorough  freezing  with  solid  carbon 
dioxide  or  liquid  air,  perhaps  the  best 
method  of  treatment.  (Fordyce;  Pusey). 

(G)  Deep  rontgentherapy  in  massive 
doses,  using  only  about  two  millimetres  of 
aluminum  filtration,  with  a lead  mask 
adaj)ted  to  the  lesion  and  conical  protec- 
tion tube,  and  repeating  the  treatments  at 
about  two-month  intervals  (Skinner).  Stel- 
wagon says  the  exposures  should  be  pushed  to 
the  point  of  producing  a moderate  tlermatitis. 

(7)  Radium  therapy  (q.v.). 

(8)  Punctui’ing  with  the  galvanocautery 
needle,  combined  with  pressure. 

(9)  Passage  through  the  tumor  of  several 
asej)tic  silk  sutures  saturated  with  a solution 
of  pcrchloride  of  iron.  “ The  iron  coagulates 
the  blood,  and  the  threads  act  as  nuclei 
for  fhe  clot  formations.”  (Adam  Politzer.) 

Naevus  Verrucosus. — See  Naevus  Pig- 
mentosus. 


Nail  Diseases. — I.  Atrophia  Unguium.;  Gr. 
a priv.  +Tpo<f>r)  nutrition;  L.  Mw/'ms,  nail). — 
Thinness  and  brittleness  of  the  nails 
(onychorrhexis — Gr.  ovv^  nail  4-  frac- 

ture) occurs  in  glossy  skin,  gout,  syphilis, 
and  leprosy. 

Opaqueness  and  lack  of  lustre,  sometimes 
associated  with  a worm  eaten  appearance, 
may  be  congenital,  or  may  occur  with  vari- 
ous inflammatory  and  squamous  skin  dis- 
eases or  constitutional  disturbances. 

Transverse  furrows  occur  in  fevers,  local 
asphyxia,  etc. 

Spoon-shaped  nails  occur  in  wasting  dis- 
eases, etc. 

The  nails  may  become  friable  and  crumbly 
in  nervous  diseasses,  possibly  traumatism, 
poor  health,  chronic  indigestion,  and  favus 
or  ring-worm  of  the  nail. 

The  nails  may  be  shed  in  acute  infectious 
diseases,  syphilis,  diabetes  mellitus,  locomo- 
tor ataxia,  section  of  the  sciatic  nerve,  alo- 
pecia areata,  hysteria,  pemphigus  foliaceous, 
epidermolysis  bullosa,  impetigo  her- 
petiformis, dermatitis  exfoliativa,  scarlatina- 
form  erythema,  annual  keratolysis.  The 
tendency  may  be  congenital  or  hereditarj". 

White  spots  (leukonychia — Gr.  \evKos 
white  -f-  ovv^  nail)  may  follow  fevers  or 
nervous  disorders,  or  the  use  of  the  cuticle 
knife,  or  other  form  of  traumatism. 

Treatment. — Treat  the  underlying  cause. 
If  this  is  not  apparent,  arsenic  and  codliver 
oil,  or  precipitated  sulphur,  gr.  ii-iii,  t.i.d. 
may  be  tried  empirically  (see  Part  11). 
Boric  ointment  may  be  applied  locally. 
In  nail-splitting,  keep  the  nail  closely  filed 
and  enveloped  in  vaseline  and  a finger-cot. 
White  spots  may  be  concealed  by  touching 
them  with  a 5 to  10  per  cent,  resorcin 
lotion.  For  ring-worm  and  favus  atrophy, 
see  Vni,  p.  G15 — Onychomycosis. 

II.  Callosity  of  the  Matrix  (L.  call'us,  insensi- 
bility).— See  XI,  p.  G15 — Tylosis. 

III.  Hypertropliia  Unguium;  Onychauxis. — Gr. 
v-rrep  over  -f-  rpo</>4  nutrition;  L.  unguis,  nail; 
Gr.  6'vv^  nail  -|-  av’^eiv  to  increase. — Causes. 
— Congenital  anomaly,  chronic  pulmonary 
and  cardiac  disease,  tuberculosis,  ring-worm 
and  favus,  pressure  and  warmth,  lack  of 
care,  gout,  rheumatism,  leprosy,  acromegaly, 
syringomyelia  and  other  nervous  diseases, 
psoriasis,  eczema,  dermatitis  exfoliativa, 
pityriasis  rubra  pilaris,  ichthyosis. 

Treatment. — Treat  the  underljdng  cause. 
Arsenic  {q.v.  in  Part  1 1 ) is  recommended.  The 
nail  may  be  softened  by  soaking  in  hot  sodium 
bicarbonate  or  biborate  solution,  or  by  the 
use  of  salicylated  vaseline,  gr.  xx-lx  ad  5ii 
and  the- overgrowth  pared  or  filed  away,  and 


NEUROMA  OF  THE  SKIN 


subsequently  kept  down  with  a fine  file. 
“ Shoemaker  highly  recommends  an  oint- 
ment of  oleate  of  tin,  from  twenty  to  sixty 
grains  to  the  ounce  of  lard  ” (Pusey).  Ony- 
chogryphosis  (Gr.  nail -f-7pu7rwcrts  bend- 
ing: claw  or  ram’s  horn  deformity)  has  been 
cured  in  eighteen  sittings,  by  burning  away 
all  the  abnormal  accumulation  by  insinuat- 
ing a flat  platinum  knife  of  a Paquelin 
cautery  under  the  nail  ( Author?  ). 

IV.  Leukonychia. — Gr.  'KevKos  white  -|-  6'vv^ 
nail.  See  under  I,  Atrophia  Unguium. 

V.  Onychia;  Onychitis;  Paronychia.  Gr.  o'vv^ 
nail  -f-  -LTLs  inflammation;  irapa  near  or 
beside:  run-around). — Acute  or  chronic 
inflammation  of  the  nail  matrix,  due  to 
traumatism,  pyogenic  infection,  syphilis, 
tuberculosis.  Sabouraud  says  that  staphy- 
lococcic onychosis  is  always  due  to  inocu- 
lation from  the  saliva  by  biting  the  nails. 

Treatment. — Sterilize  the  parts  with 
tincture  of  iodine,  and  uiifler  cocaine  anaes- 
thesia, 0.1  per  cent.,  injected  just  beneath 
the  epidermis,  make  a dorsal,  median  longi- 
tudinal incision,  or  perhaps  better,  a lateral 
or  bilateral  longitudinal  incision  (Kanavel) 
as  shown  in  Fig.  96,  through  the  skin  over- 


Fio.  96  — I-ateral  incisions  in  paronychia  (Kanavel). 

lying  the  base  of  the  nail,  down  to  the  nail. 
Elevate  the  flap  of  cuticle,  and  cut  off  as 
much  of  the  root  of  the  nail  as  may  have 
become  separated  from  its  matrix,  leaving 
the  distal  portion  of  the  nail  still  attached. 
Then  insert  thin  strips  of  gauze  wet  with 
boric  acid  solution,  3iv  ad  Oi,  or  bichloride 
solution,  1 : 4000  to  2000,  and  soak  the  mem- 
ber for  an  hour  in  the  hot  solution ; or  else  use 
dry  gauze  packing  daily  until  healing  occurs. 

Rontgenotherapy  (q.v.)  may  be  of  service 
in  chronic  cases. 

Morrow  and  Lee  report  the  cure  of  chronic 
cases  of  paronychia  in  from  one  to  three 
weeks,  by  swabbing  the  affected  area 
beneath  the  plica  unguium  with  a satur- 
ated solution  of  chrysarobin  in  chloroform 
once  daily  until  there  is  no  longer  any 
pus  formation. 

VI.  Onychauxis.— See  III,  Hypertrophia 
Unguium. 

VII.  Onychogryphosis. — See  III,  under  Hyper- 
trophia Unguium. 

VIII.  Onychomycosis. — Gr.  6'vv^  nail  pvKTjs 

fungus.  A grayish,  friable  condition  of  the 


nail,  caused  by  the  ring-worm  orfavus  fungus. 
The  diagnosis  is  made  by  a microscopic 
examination  of  the  scrapings  after  soaking 
the  latter  in  liquor  potassae  for  one-quarter 
of  an  hour  to  twenty  hours. 

Treatment. — This  should  be  persistent; 
several  months  are  requned  for  a cure.  First 
avulse  the  nail,  or  scrape  it  well,  and  then 
soften  and  dissolve  it  for  about  fifteen  min- 
utes with  liquor  potassae.  Then  apply  on 
lint,  under  oiled  silk  or  a rubber  finger  stall, 
an  alcoholic  solution  of  bichloride  of  mer- 
cury, gr.  i-iv  to  the  ounce,  or  a solution  of 
sodium  hyposulphite,  3ii  to  the  ounce,  or 
iodine,  gr.  ii,  and  potassium  iochde,  gr.  iv  to 
the  ounce.  The  hyposulphite  solution  may 
be  used  when  the  others  cause  irritation.  The 
treatment  should  be  repeated  daily. 

Rontgenotherapy  is  effectual. 

IX.  Onychorrhexis. — See  I,  Atrophia  Unguium. 

X.  Paronychia. — See  Onychia. 

XI.  Tylosis. — Gr.  tvXoxjls  callosity;  Cal- 
losity of  the  Matrix.  Split  the  nail,  or 
avulse  it,  and  remove  the  callus. 

Natal  Boil. — See  Oriental  Sore. 

Nettlerash. — See  Urticaria. 

Neuralgia,  Red,  of  the  Extremities. — See 
Erythromelalgia. 

Neuralgia  of  the  Skin ; Dermatalgia. — Gr. 

j'eOpoJ' nerve ; 6epgaskin;  d'Xyoypain.  Causes. — 
Exposure  to  cold,  rheumatism,  gout,  chloro- 
sis, hysteria,  neuritis,  malaria,  syphilis,  dia- 
betes, locomotor  ataxia,  and  other  central  ner- 
vous diseases,  etc.  (see  Neuralgia  in  Part  1). 

Treatment. — Treat  the  underlying  cause. 
Palliative  and  remedial  local  measures  in- 
clude the  light  application  of  the  Paquelin 
cautery,  blisters  (see  Part  11,  Cantharides), 
heat,  unguentum  mentholis  (q.v.)  or  the 
menthol  cone,  tincture  of  iodine,  tincture  of 
aconite,  dilute  tincture  of  belladonna,  the  lini- 
ments of  belladonna,  chloroform,  and  turpen- 
tine (see  Part  11),  methyl  salicylate,  camphor 
and  chloral,  sprays  of  ether  and  ethyl  and 
methyl  chloride,  galvanism,  etc.  (see  Neural- 
gia, in  Part  1).  Applications  may  be  made 
over  the  painful  area,  or  over  the  spinal 
centre  from  which  the  affected  nerve  arises. 

Analgesic  drugs  include  aspirin,  salicylates, 
phenacetin,  antipyrine,  quinine,  etc.  (see 
Part  11  for  formulse,  etc.). 

The  pain  usually  disappears  spontaneously 
in  several  weeks. 

Neurofibroma. — See  Fibroma. 

Neuroma  of  the  Skin. — Gr.  vevpou  nerve  -f 
-wpa  tumor.  The  exceedingly  rare  occur- 
rence of  a single,  or  usually  multiple,  pin- 
head to  pea-sized  or  larger,  movable  or 
immovable,  firm,  sensitive,  sometimes  pain- 
ful fibrous  tumors  containing  nerve  elements. 


PEDICULOSIS  CAPITIS 


Neuromata  occur  sometimes  in  amputa- 
tion scars. 

Treatment. — Individual  tumors  may  be 
excised.  In  multiple  cases,  one  may  resect 
a portion  of  the  nerve  supply. 

Nevus. — See  Nsevus. 

Nocardiosis. — See  Actinomycosis. 

(Edema. — Gr.  oiSrjiJLa  swelling.  See  Part  1. 

Angioneuroti c. — See  Angioneurotic 
(Edema. 

Malignant. — See  Anthrax. 

(Edema  Neonatorum. — Gr.  6L5rnxa  swell- 
ing; veos  new  -|-  L.  na'tus,  born.  This  condi- 
tion develops  m the  first  few  days  of  life, 
and  begins  almost  invariably  m the  legs. 
The  skin  pits  on  j^ressure. 

Etiological  influences  mclude  premature 
birth,  cardiac  weakness,  atelectasis,  nephri- 
tis, hereditary  syphilis,  erysipelas,  infectioys 
disea.ses,  exposure  to  cold  immediately  after 
birth,  inconiplete  establishment  of  respira- 
tion, possibly  too  early  ligation  of  the  cord, 
ill-nourished  mother.  Most  cases  die. 

The  treatment  is  the  same  as  that  of 
sclerema  neonatorum  (q.v.). 

Ogo  . — See  Gangosa. 

Oidiomycosis. — L.  o'Ldium,  dim.  of  Gr. 
d)6v  egg  -f  ixmrjs  fungus.  See  Blastomycosis. 

Onychauxis. — Gr.  Spv^  nail  -|-  av^eiv  to 
increase.  See  under  Nail  Diseases. 

Onychia;  Onychitis. — Gr.  nail  + -tr« 

inflammation.  See  under  Nail  Diseases. 

Onychogryphosis. — Gr.  nail  -f 

ypviruais  bending.  See  under  Nail  Diseases. 

Onychomycosis. — Gr.  nail  -1-  fjLVKrjs 
fungus.  See  under  Nail  Diseases. 

Onychorrhexis. — Gr.  ow^  nail  -t- 
fracture.  See  under  Nail  Diseases. 

Oriental  Sore  or  Boil;  Dermal  Leishman= 
iasis. — A tropical,  endemic,  local,  con- 
tagious, auto-inoculable,  slow,  indolent  chs- 
ease,  due  to  the  Leislunania  Tropicum  (simi- 
lar to  the  Leislunania  Donovani;  see  Kala- 
Azar,  in  Part  1),  occurring  chiefly  on  the  face 
and  other  uncovered  parts,  and  characterized 
by  the  successive  formation  of  an  inflam- 
matory papule,  tubercle,  scab,  and  under  the 
latter,  a sharply  punched-out  ulcer.  The 
Central  and  South  American  sore  is  chaiac- 
terizcd  fjy  granulomatous  lesions  of  the  nose 
and  mouth  (resembling  syphilis,  tubercu- 
losis, or  leprosy:  Forest  Yaws)  associated 
with  lymphadenitis. 

Treatment.— This  is  effectual.  The  begin- 
ning lesions  may  be  excised,  or  treated  with 
tincture  of  iodine  or  unguentum  hydrargjTi 
(q.v.  in  Part  11)  or  methylene  blue,  lanolin 
and  vaseline,  aa.  In  older  lesions,  curettement, 
followed  by  cauterization  with  the  actual 
cautery,  silver  nitrate,  tincture  of  iodine,  or 


pure  carbolic  acid,  neutralized  with  alcohol, 
may  be  jjracticed.  Thereafter  the  ulcer  should 
be  sprayed  forcibly  once  or  twice  daily  with 
hot  boiled  water  or  boric  acid  solution,  5 iv  ad 
Oi,  followed  by  the  application  of  sterile,  dry 
gauze,  or  powdered  boric  acid,  or  iodoform. 

Rontgenotherapy  and  ionization  (q.v.)  may 
be  tried.  The  internal  administration  of 
quinineor  arsenic  is  recommended ; also  tartar 
emetic  intravenously  (see  Leishmaniasis  in 
Part  1).  It  is  stated  that  as  many  as  200 
injections  may  be  required  to  effect  a cure. 

Paget’s  Disease. — See  Carcinoma  Cutis. 

Papilloma. — L.  papil'la,  nipple  + Gr.  -coqa 
tumor.  See  Verruca. 

Parakeratosis  Variegata. — Gr.  irapa  be- 
sitle  -)-  Ktpas  horn.  See  Parapsoriasis. 

Parapsoriasis. — Gr.  rrapa  beside  -k  Psori- 
asis. A very  rare,  chronic,  exceedingly 
resistant,  generalized  eruption,  first  described 
by  Brocq  in  1912,  of  which  three  types  are 
recognized : 

(1)  “ Parapsoriasis  en  gouttes,  which 
appears  as  pinhead  to  lentil-sized,  pale  red 
or  redchsh-brown  papules,  which  are  slightly 
infiltratetl  and  covered  with  a dry,  slightly 
adherent  scale.  Removal  of  the  scales 
leaves  a fine  purpura,  without  bleeding 
points.  By  other  writers  this  type  has  been 
called  ‘ dermatitis  psoriaformis  nodularis  ’ 
and  ‘ pityriasis  lichenoides  chronica.’  ” 

(2)  “ Parapsoriasis  licheno'Lde,  which  is 
cUfferentiated  from  the  former  type  by  the 
more  marked  papular  character,  by  more 
infiltration,  and  by  less  scale  formation. 
The  papules  have  a tendency  toward  cen- 
tral depression  and  resemble  the  lichen 
papule.  They  are  disseminated  or  grouped 
in  a network  on  the  trunk  or  extremities. 
This  form  is  also  described  as  ‘ parakera- 
tosis variegata  ’ and  ‘ lichen  variegatus.’  ” 
Stelwagon  describes  it  as  a pinkish  yellow  to 
purplish,  maculo-papular,  slightly  scaly  con- 
dition of  the  skin,  with  a reticular  or  marble- 
like arrangement. 

(3)  “ Parapsoriasis  en  plaques,  which 
appears  as  sharply^  cu’ciunscribed,  yellow  or 
wine-red  areas,  with  little  or  no  scaling,  and 
as  a rule,  without  itching.” 

The  cause  is  unknown,  and  the  same  may 
be  said  concerning  treatment.  The  disease 
la.sts  for  y^ears. 

Paronychia. — Gr.  ■wapa  near  nail. 

See  Onychia,  under  Nail  Diseases. 

Pediculosis  Capitis. — L.  pedi'culus,  louse; 
ca'put,  head.  Nits  are  distinguished  from 
dandruff  by^  being  firmly  attached  to  the 
hair  shaft. 

Treatment.— One  of  the  following  methods 
may  be  chosen: 


PEMPHIGUS 


(1)  Soak  the  scalp  and  hair  for  twelve 
hours  with  equal  parts  of  kerosene  and  a bland 
oU,  such  as  cottonseed,  linseed,  or  olive  oil, 
or  liquid  vaseline,  or  vinegar  and  cover  the 
head  with  a cap  or  towel  (avoid  the  neighbor- 
hood of  flames) . At  the  end  of  twelve  hours, 
shampoo  the  head  and  hair  thoroughly  with 
soap  and  hot  water,  chy  with  a towel,  and 
repeat  the  treatment. 

(2)  After  a thorough  preliminary  shampoo 
with  soap  and  hot  water,  wet  the  scalp  and 
hair  thoroughly,  once  or  twice  daily  for  two 
or  three  days,  with  bichloride  solution, 
1 : 500  to  250,  preferably  a solution  in  vine- 
gar or  acetic  acid,  25  per  cent.,  to  dissolve 
away  the  nits : 


II  Acidi  acetici 3ii 

Hydrargyri  perchloridi gr.  iii-viiss 

Aquae,  q.s.,  ad 5viii 


The  hair  and  scalp  should,  at  the  same 
time,  be  shampooed  daily. 

Instead  of  bichloride  solution,  one  may 
use  tincture  of  cocculus  indicus,  diluted  with 
one,  two,  or  three  parts  of  water;  or  carbolic 
lotion,  1 : 40. 

If  acetic  acid  is  not  used,  the  nits  must  be 
removed  with  a fine-comb. 

Pediculosis  Corporis. — L.  pediculus,  louse; 
cor'pus,  body.  Hemorrhagic  specks  and  par- 
allel linear  scratch  marks  about  the  upper 
part  of  the  back  and  shoulders,  around  the 
waist,  over  the  sacrum  and  down  the  outside 
of  the  thighs  are  chagnostically  significant. 

Treatment. — The  body  clothing  and  bed 
clothing  should  be  thoroughly  baked,  boiled, 
or  gone  over  with  a very  hot  iron.  The  pedic  • 
ulus  vestimentorum  lives  in  the  seams  of 
the  clothing,  and  only  goes  to  the  body  to 
forage.  The  body  should  be  thoroughly 
scrubbed  with  soap  and  hot  water  and  a 
brush.  As  a pr  eventive  measure,  the  clothing 
may  be  lightly  dusted,  once  a week,  with 
washed  sulphur,  or  a mixture  of  talc,  20  gins., 
creosote,  1 c.c.,  and  sulphur,  0.5  gm. 

To  fumigate  quarters,  first  wash  the  walls 
with  kerosene  or  5 per  cent,  carbolic  acid, 
then  seal  the  room,  and  burn  5 pounds  of 
sulphur  for  every  1,000  cubic  feet  of  space. 
Keep  the  room  closed  for  six  hours.  Repeat 
in  ten  to  fourteen  days. 

Pediculosis  Pubis;  Crab=Lice. — L.  pedicu- 
lus,  louse;  puh'is,  pubes.  The  pediculus 
pubis  invades  the  pubic  region,  the  axillae,  the 
eyebrows  and  eyelashes,  rarely  other  parts. 

Treatment. — After  a thorough  shampoo  with 
soap  and  hot  water,  bathe  the  parts  twice 
daily  with  kerosene  and  vinegar,  equal  parts, 
or  a solution  of  bichloride,  1 : 500  to  250, 
in  vinegar  or  25  per  cent,  acetic  acid,  the 
latter  to  remove  the  nits: 


II  Hydrargyri  perchloridi gr.  iii-viiss 

Acidi  acetici 5ii,  , 

Aqua-,  q.s.,  ad Sviii 


In  place  of  the  lotion,  one  may  employ 
unguentum  hydrargyri  ammoniati,  5 to  10 
per  cent.,  or  equal  parts  of  Peruvian  balsam 
and  vaseline. 

In  involvement  of  the  eyelashes,  pick  off 
the  parasites  and  ova  with  small  forceps, 
sponge  the  eyelashes  with  carbolic  lotion, 
1 : 40,  to  kill  the  nits,  and  carefully  apply  to 
the  edge  of  the  lids  unguentmn  hydrargyri 
nitratis  diluti.  The  dead  nits  may  be 
removed  with  chlute  acetic  acid. 

Peliosis  Rheumatica. — Gr.  rreXios  livid; 
peOga  flux.  See  Purpura. 

Pellagra. — See  Part  1,  General  Medicine 
and  Surgery. 

Pemphigus. — Gr.  7reM</)t^  blister.  A very 
rare,  acute  or  chronic  disease,  characterized 
by  the  spontaneous  formation  of  bullae  in 
successive  crops. 

The  following  varieties  are  described: 

(1)  Pemphigus  Acutus  including  (a)  a form 
occurring  in  children  and  young  chlorotic 
girls,  which  may  or  may  not  be  epidemic, 
and  which  may  terminate  in  recovery;  (b) 
a very  rare  and  usually  fatal  form,  due  to 
the  Sites  of  animals,  or  to  animal  prod- 
ucts; (c)  a less  severe,  but  serious  and 
sometimes  fatal  form  following  rheumatic 
fever,  chphtheria,  the  exanthemata,  vac- 
cination, etc. 

(2)  Pemphigus  Chronicus  seu  Vulgaris  the  usual 
form.  Strong  emotion,  chill,  vaccine,  and 
drugs  are  cited  as  possible  causal  factors. 
It  may  or  may  not  end  in  recovery.  It  is 
usually  persistent  and  frequently  relapsing. 
The  pruriginous  form  is  the  most  chronic. 

(3)  Pemphigus  Foliaceous  very  rare,  distribu- 
tion of  rash  general,  almost  invariably  fatal. 
It  may  conunence  as  such,  or  it  may  follow 
the  acute  or  chronic  form.  It  sometimes 
follows  dermatitis  herpetiformis  or  general 
exfoliative  dermatitis.  Chill,  violent  emo- 
tion, or  local  infection  may  be  causal. 

(4)  Pemphigus  Vegetans  an  exceedingly  rare 
form,  in  which  fungoid  or  papillomatous 
vegetations  follow  upon  the  bullae.  It  is 
almost  invariably  fatal. 

Other  diseases  than  pemphigus,  in  which 
bullaj  may  occur,  are  dermatitis  herpeti- 
formis (possibly  a variety  of  pemphigus), 
erythema  multiforme,  urticaria,  impetigo 
contagiosa  (pemphigus  neonatormn,  a bul- 
lous infantile  variant  of  impetigo),  eczema, 
dermatitis  venenata,  herpes,  pompholyx, 
epidermolysis  bullosa  (congenital  pemphi- 
gus), varicella,  burns,  congenital  syphilis, 
leprosy,  organic  nervous  diseases,  hysteria. 


PERUVIAN  WART;  VERRUGA  PERUANA 


Prognosis. — “Almost  all  (acute)  cases  unat- 
tended by  temperature  elevation  or  other 
constitutional  symptoms  g;et  well  others 
are  very  serious.  “ The  prospect  in  children 
is  much  better  than  in  adults.”  The  chronic 
cases  are  usually  persistent  and  relapses  are 
not  uncommon.  Pemphigus  foliaceous  is 
usually  fatal,  sometimes  after  many  years. 
Pemphigus  vegetans  is  usually  fatal  in  from 
three  to  twelve  months.  (Stelwagon.) 

Treatment. — Correct  hygiene,  a generous 
diet,  with  perhaps  codliver  oil  (see  Part  1 1 for 
drug  formul®,  etc.),  change  of  scene  and 
climate,  and  tonics  are  indicated.  Arsenic  is 
recommended  in  increasing  doses  up  to  the 
point  of  tolerance,  and  continued  in  small 
do.ses  for  some  time  after  the  disease  has 
disappeared.  Dench  says  it  is  the  best 
prophylactic.  Strychnine  and  quinine  in  full 
doses  (gr.  v of  quinine,  t.i.d.)  may  be  advan- 
tageously given  with  the  ansenic.  Salicin,  gr. 
XV,  up  to  gr.  XXX,  well  diluted,  t.i.d.,  as  a 
substitute  for  arsenic  (Crocker),  iron  in  full 
do-ses,  linseed  meal,  pilocarpine,  atropine, 
and  small  doses  of  opium  (the  latter  espe- 
cially in  the  vegetative  form — Hutchinson) 
have  apparently  proved  of  advantage  in 
some  cases.  Potassium  iodide  should  not 
be  given. 

The  blebs  should  be  punctured  as  soon  as 
they  appear  and  the  collapsed  sacs  painted 
with  flexible  collodion.  The  best  results, 
says  Dench,  are  obtained  by  this  treatment. 
Calamine  liniment  and  bland  ointments, 
such  as  those  of  zinc  oxide  and  boric  acid,  are 
useful  soothing  applications.  For  itching, 
atld  carbolic  acid,  gr.  ii-xxx  to  the  ounce 
of  ointment,  5ss-ii  to  the  pint  of  lotion 
(Stelwagon). 

II  Calamina!, 

Zinci  oxidi,  aa 3iv 

Liquoris  calcis, 

Olei  olivse,  aa giv 

Acidi  carbolici tqjxx-xl 

Adipis  Ian®  hydro.si gi 

(Calamine  liniment.) 

R Pulveris  acidi  borici gss 

Talci, 

Zinci  o.xidi,  aa gss 

Sulphur  or  alkaline  and  bran  baths  are 
useful:  (1)  Potassium  sulphide,  5ii~iv,  to 
thirty  gallons  of  tepid  water;  (2)  Lime,  5ss, 
sublimed  sulphur,  5i>  tlistilled  water,  5^, 
boiled  down  to  six  ounces  and  filtered, 
5ii-iv  to  thirty  gallons  of  water;  (3)  Sodium 
bicarbonate,  5ii~x,  bran,  one  gallon,  to 
thirty  gallons  of  water.  Follow  the  bath 
by  the  application  of  an  ointment.  In 
pemphigus  vegetans,  with  offensive  dis- 
charge, apply  lint  soaked  in  carbolized  oil. 


1 : 40,  dust  the  papillary  growths  freely  with 
iodol,  rinse  the  mouth  frequently  with 
liquor  sod®  chlorinat®  (q.v.  in  Part  11),  and 
use  a spray  of  dilute  potassium  permanganate 
solution  several  tunes  daily.  (Crocker.) 

Denudation  and  resulting  cicatrization  of 
the  mucous  membrane  of  the  conjunctiva, 
nose,  mouth,  and  throat  may  occur  in  pem- 
phigus. For  xerophthalmus  (Gr.  ^p6$  dry 
-f-  6<t>da\fx6s  eye)  instil  into  the  conjunctival 
sac,  milk,  glycerine,  or  mucilaginous  sub- 
stances, such  as  mucilago  semenum  cydoni- 
orum.  (Fuchs.) 

In  extensive  cases  a water-mattress  should 
be  used.  See  also  Dermatitis  Herpetiformis. 

Penjdeh  Sore. — See  Oriental  Sore. 

Perforating  Ulcer  of  the  Foot. — A trophic, 
painless  affection,  due  to  diabetes,  chronic 
alcoholism,  arteriosclerosis,  thromboangitis 
(see  Gangrene),  and  degenerative  neiwous 
diseases,  c.g.,  tabes,  general  paresis, 
syringomyelia,  Friedreich’s  ataxia,  hemi- 
plegia, myelitis,  progressive  muscular  atro- 
phy, spina  bifida,  cord  injury,  as  in  fracture 
of  the  spine,  cord  tumor,  multiple  neuritis, 
division  of  the  peripheral  nerves. 

Treatment. — See  Ulcer,  Cutaneous. 

Perleche. — Fr.  perlecher,  to  lick.  A con- 
tagious affection  (impetigo,  says  Sabouraud) 
of  the  commissures  of  the  lips,  occurring 
almost  exclusively  in  infants  and  young 
children,  characterized  by  a blanched  and 
sodden  appearance  of  the  epithelium,  re- 
sembling mucous  patches,  and  a tendency 
to  cracking  and  crusting  at  the  mouth  angles. 

The  disease  runs  a course  of  several  weeks 
to  several  months,  and  tends  to  recur. 

Treatment.— Keep  the  lips  cleansed  with, 
say,  a warm  solution  of  boric  acid,  gr.  xv  ad 
5i,  and  apply  an  ointment  of  zinc  oxide 
or  boric  acid,  10  per  cent.  The  occas- 
ional application  of  silver  nitrate,  5 per 
cent.,  or  zinc  sulphate,  1 per  cent.,  may  be 
of  service.  In  view  of  the  contagiousness 
of  the  cfisease,  attend  to  the  nursing 
bottles,  etc. 

Pernio. — See  Chilblain. 

Perspiration. — See  Sweat. 

Peruvian  Wart;  Verruga  Peruana. — Sp. 
Verruga  Peruana,  Peruvian  wart.  A chronic, 
infectious,  inoculable  disease,  endemic  only 
in  certain  valleys  of  the  Pacific  slope  of  the 
Peruvian  Andes,  probably  caused  by  Yzqui- 
erdo’s  bacillus,  and  characterized  by  an 
incubation  period  of  eight  to  forty  days,  a 
prodromal  febrile  period  of  one  to  eight 
months,  or  longer,  with  irregular  fever, 
an®mia,  articular  and  muscular  pains,  and 
painful  enlarged  liver  and  spleen,  followed 
by  an  eruption  of  pinhead  to  pear-sized  to 


PITYRIASIS 


LAKOUSSE  MEDICAL. 

SKIN  DISEASES  : Pityriasis  Prurigo.  Psoriasis.  Purpura. 


1.  — Pityi-iasis  rosea  of  Gilbert. 

N ' 2101.  D'  Hallopeau. 


4.  - Hebra’s  prurigo. 

N 863.  O'"  Bcsnier. 


5.  — Purpura. 

N"  1068  D'  Lailler, 


8.  — Acute  purpura. 

N ' 853.  D'  Guibout. 


St.  Louis  Hospital  Museum.  Paris. 


2.  Arthropathic  psoriasis. 

N»  2336.  O'-  du  Castel 


PITYRIASIS  RUBRA  PILARIS 


orange-sized,  reddish,  granulomatous,  wart- 
like nodules,  which  also  occur  in  the  mucous 
membranes  aiwl  internal  organs. 

About  10  per  cent,  of  the  patients  die 
before  the  appearance  of  the  eruption.  After 
the  appearance  of  the  eruption,  the  disease 
lasts  from  four  to  six  months  to  two  years, 
and  ends  usually  in  recovery. 

Treatment.— The  patient  should  be  removed 
from  the  infected  region  to  the  coast.  The 
eruptive  tendency  should  be  encouraged,  as 
it  were,  by  warm  baths  and  hot  drinks. 
Stimulants  may  be  required.  The  treat- 
ment, indeed,  is  symptomatic.  Tonics, 
especially  iron,  arsenic,  and  quinine,  are 
inchcated  (see  Part  11). 

Petechia. — L.  A small  hemorrhagic  spot 
in  the  skin.  See  Purpura. 

Phagedena  Tropica;  Aden  Ulcer;  Malabar 
Ulcer. — Gr.  (^ayeiv  to  eat;  tpotlkos  turning. 
A chronic,  sjrreading  gangrenous  or  slough- 
ing ulcer  of  the  skin  and  underlying  tissues 
starting  from  a slight  injury,  and  occurring 
in  cachectic  individuals  in  hot  countries. 

Treatment. — Isolate  the  patient  (see  Disin- 
fection in  Part  1),  and  prescribe  rest,  a gen- 
erous, well-balanced,  diet  and  quinine  and 
other  tonics  (see  Part  11). 

Scrape  the  ulcer  thoroughly,  removing  all 
diseased  tissue,  and  cauterize  with  the 
actual  cautery,  or  else  swab  with  jxire  car- 
bolic acid,  followed  by  alcohol,  and  a dusting 
powder  of  iodoform,  aristol,  or  boric  acid 
Continuous  irrigation  with  hot  boric  acid 
solution.  5iv  ad  Oi,  or  Dakin’s  fluid  (q.v. 
in  Part  11),  may  be  of  service. 

Phlegmasia  Alba  Dolens. — Gr.  (pXeypaaLa 
heat  inflammation;  L.  alb'us,  white;  dol'ens, 
painful.  See  Thrombosis,  in  Part  1. 

Piebald  Skin. — See  Leucoderma. 

Piedra. — Sp.  stone.  See  under  Hair  Dis- 

eases. 

Pigmentation  of  the  Skin. — L.  pigmentum, 
paint.  See  Chloasma. 

Pinta  Disease. — Sp.,  pinta,  or  pinto 
painted.  A very  chronic,  contagious  dis- 
ease of  tropical  America,  due  to  several 
hyphomycetic  fungi,  and  characterized  by  the 
occurrence,  mostly  on  exposed  parts,  of  vari- 
ously sized  and  shaped  scaly  discolorations. 

Treatment. — This  is  the  same  as  that  of 
ring-worm  or  of  tinea  versicolor.  Tincture 
of  iodine,  pure  or  diluted,  may  be  applied  to 
recent  patches,  and  chrysarobin  to  chronic, 
obstinate  patches. 

Pityriasis  Capitis. — Gr.  ttItvpov  bran;  re- 
ferring to  branny  scales;  L.  cap'ut,  head. 
See  Dermatitis  Seborrhoeica. 

Lichenoides  Chronica. — Lichen  -1-  Gr. 
eiSos  form.  See  Parapsoriasis. 


Pityriasis  Rosea. — Gr.  wirvpov bran;  L.  rosa, 
rose.  A rare,  “mildly  inflammatory  affection, 
characterized  by  discrete  and  frequently 
confluent,  plain  or  circinate,  salmon-tinted, 
pinkish  or  pale  red,  variously  sized,  scaly 
efflorescences,  seen  most  abundantly  upon 
the  trunk.”  (Stelwagon.) 

Prognosis.— Recovery  occurs  in  from  several 
weeks  to  several  months. 

Treatment.— Salicin  (q.v.  in  Part  11),  gr.  xv, 
t.i.d.  and  an  occasional  laxative,  are 
recommended. 

A daily  half-hour  bath  containing  two  or 
three  teaspoonfuls  of  a strong  solution  of 
potassium  permanganate,  followed  by  the 
application  of  a 3 to  5 per  cent,  salicylic  acid 
ointment,  is  advised  (Jamieson).  A dusting 
powder  of  equal  parts  of  boric  acid,  zinc 
oxide,  and  starch  or  talcum  may  be  useful. 
For  itching,  the  following  lotion  may 
be  used : 


R Calainina>, 

Ziiici  oxidi,  aa 3iv 

Acidi  borici 3ii 

Acidi  carbolici 3ss-i 

Glycerini 3ss 

Liquoris  calcis 5 a 

Aqua;,  q.s.,  ad Sviii 


Pityriasis  Rubra. — Gr.  wLtvpov  bran;  L. 
ruh’er,  red.  See  Dermatitis  Exfoliativa. 

Rubra  Pilaris. — Gr.  irLrvpov  bran;  L. 
ruber,  red;  piVus,  hair.  A rare,  very  chronic, 
generalized  skin  eruption  of  years,  duration, 
characterized  by  the  formation  around 
the  hair  follicles,  of  firm,  yellowish  to 
deep-red,  subacute  inflammatory,  acuminate, 
spiny  papules,  presenting  a nutmeg-grater- 
like appearance  and  feel,  and  in  places 
coalescing  to  form  diffuse,  thickened,  scaly 
plaques.  It  is  rebellious  to  treatment. 

Treatment.— Enjoin  the  observance  of  a 
correct  hygienic  regimen,  e.g.,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  a well-balanced,  nutritious  diet, 
and  plenty  of  water,  tonics,  including  cod- 
liver  oil,  and  regulation  of  the  bowels. 
Arsenic  in  large  doses,  protiodide  of  mercury, 
and  thyroid  extract  may  be  tried  (see 
Drugs,  Part  11).  Warm  weather  and 

sweating  have  a favorable  effect,  there- 
fore daily  exercise  and  frequent  hot  baths 
are  recommended,  with  perhaps  pilocarpine 
(q.v.  in  Part  11).  Following  the  bath,  and 
once  or  twice  daily,  the  skin  .should  be 
anointed  with  the  keratolytic  unguentum 
acidi  salicylici,  gr.  x-lx  ad  gi.  Thickened 
patches  may  be  treated  with  a 10  to  20  per 
cent,  salicylic  acid  plaster,  or  a 2 to  10  per 
cent,  solution  in  collodion.  Rbntgenother- 


PRURIGO 


apy  iq.v.)  is  recommended,  “ carried  to  the 
point  of  producing  the  first  evidences  of 
reaction.”  (Pusey.) 

Plaques  of  the  Tongue,  Transitory,  Be= 
nign. — Fr.,  a flat  patch.  See  Geographic 
Tongue. 

Poison=Ivy;  Poison=Oak. — See  Dermati- 
tis Venenata. 

Pomphyx. — Gr.  Tron4>okv^  bubble.  A rare, 
acute  inflammatory,  deep-seated,  vesicular 
and  bullous  eruption,  limited  to  the  hands 
and  feet,  disappearing  spontaneously  in  ten 
days  to  two  weeks,  but  showing  a tendency 
to  recur,  especially  in  summer. 

Treatment.— General  ill  health  and  nervous 
debility  are  factors  in  its  etiology,  therefore 
a careful  examination  should  be  made,  and 
any  discoverable  derangements  corrected,  if 
possible,  and  a correct  hygienic  regimen 
instituted,  e.g.,  adequate  rest  and  exercise, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  fresh  air  day  and 
night,  a well-balanced,  nutritious  diet,  regu- 
lation of  the  bowels,  care  of  the  skin,  and 
tonics,  such  as  codliver  oil,  arsenic,  iron, 
quinine,  and  strychnine  (see  Part  11). 

The  following  daily  astringent  applica- 
tions are  recommended: 


B CalaminiE, 

Zinci  oxidi,  aa 3ii~iv 

Acidi  borici 3ii 

Acidi  carbolici  (for  itching) i^xv-3i 

Liquoris  calcis 5ii 

Aqu£E,  q.s.,  ad Sviii 


M.  Sig.— Shake  well,  and  apply  frequently. 

Do  not  bandage  a finger  or  toe  on  which 
carbolic  acid  is  used,  for  fear  of  gangrene. 


Mentholis gr.  ii 

Acidi  salicylici gr.  x 

Emplastri  pluinbi, 

Emplastri  saponis,  aa 3iss 

Petrolati 3v 

(Stelwagon.) 

Zinci  oleatis 3i 

Ccrati  plumbi  subacetatLs 5i 


The  ointments  should  be  applied  thickly 
on  strips  of  linen  or  lint,  each  finger  being 
done  up  separately. 

Porokeratosis.— Gr.  rcDpos  callus  wpas 
horn.  A very  rare,  hereditary  disease, 
occurring  upon  the  exposed  parts,  but  some- 
times affecting  the  feet  and  mucous  mem- 
branes, characterized  by  the  presence  of  one 
or  more,  slowly  spreading,  coin-sized  or 
larger,  annular  or  gyu’ate  patches,  presenting 
a slightly  atrophic  centre  and  an  abruptly 
projecting,  blackish,  horny  border,  repre- 
senting spreading  hypertrophy  of  the  stratum 
corneurn  followed  by  its  central  atrophy. 


Treatment.— Thorough  excision  and  elec- 
trolysis (see  under  Nsevus  Vascularis)  are 
the  only  effectual  curative  measures  to  date. 

Port=Wine  Mark. — See  Nsevus  Vascularis. 

Post=Mortem  Wart. — See  Tuberculosis 
Cutis. 

Powder  Stains,  Removal  of. — If  the 

marks  can  not  be  picked  out,  remove  them 
by  means  of  a cutaneous  trephine  of 
extremely  small  calibre.  Place  the  punch 
over  the  powder  speck  and  give  a slight 
rotary  motion,  “ pressing  firmly,  but  not 
going  down  to  unnecessary  depth;  the  little 
disc  of  skin  tends  to  jut  out,  can  be  snipped 
off,  and  the  minute  cavity  filled  with  pow- 
dered subsulphate  of  iron  or  with  a paste  of 
tincture  of  benzoin  and  boric  acid,  or  one 
part  acetanilid  and  seven  parts  boric 
acid.”  (Stelwagon.) 

Another  method  is  the  application  of  a 
concentrated  solution  of  hydrogen  dioxide, 
continued  until  a white  zone  appears 
around  and  under  the  grains,  and  until 
bubbling  has  fairly  ceased,  after  which  the 
grains  may  be  readily  removed  with  a pointed 
instrument;  or  one  part  glycerine  and  three 
parts  hydrogen  dioxide  may  be  applied 
freely  on  lint,  if  not  irritating.  (Stelwagon.) 

“A  certain  amount  of  anaesthesia  may  be 
obtained  by  the  application  of  small  quan- 
tities of  weak  cocaine  solution  or  by  the 
use  of  an  ointment  of  10  to  20  per  cent,  ortho- 
form in  lanolin.”  (Pusey.) 

Prickly  Heat. — See  Miliaria. 

Prurigo. — L.  prurire,  to  itch.  A chronic 
disease,  common  in  Europe  but  rare  in 
America,  associated  with  poor  food  and  bad 
hygiene,  beginning  in  infancy,  and  marked 
by  the  development  of  constantly  recurring, 
intensely  itching,  discrete,  small,  hard,  pale 
red,  deeply  seated,  only  slightly  raised 
papules,  most  abundant  on  the  extensor 
surfaces,  especially  of  the  legs,  and  usually 
associated  with  enlarged  Ijonphatic  glands, 
usually  the  inguinal.  The  skin,  even  where 
not  affected,  is  harsh  and  d^v^ 

Prognosis.— Mild  cases  achnit  of  cure,  but 
relapses  are  common.  Severe  cases  are 
incurable,  although  relief  can  be  afforded 
by  treatment. 

Treatment.— Put  the  patient  to  bed,  if 
practicable,  in  a well-ventilated  room,  and 
prescribe  a liberal,  well-balanced  diet,  with 
perhaps  codliver  oil,  and  iron  (see  Part  11), 
if  indicated.  For  the  intense  itching, 
Crocker  recommends  tincture  of  cannabis 
indica,  ti^v,  graduall}^  increased  even  to 
TTjxxx,  t.i.d.p.c.,  for  a child  of  eight  or  ten 
years.  About  every  six  weeks,  it  should  be 
intermitted  for  two  weeks.  Antip}T’ine, 


PRURITUS 


beginning  with  two-grain  doses,  also  gives 
relief.  Thyroid  extract  {q.v.)  may  be  tried. 

After  healing  by  mild  applications  any 
eczema  or  ecthyana  that  may  be  present, 
prescribe  inunctions  of  unguentum  olei 
cadini,  3 i ad  5 i,  alternating  with  unguentum 
acidi  saUcyUci,  3i  ad  5i,  twice  daily,  and  a 
prolonged  warm  bath  every  second  or  third 
night.  Daily  hot  prolonged  alkaline  or  sul- 
phur baths  (sodium  bicarbonate  or  potas- 
sium sulphide,  two  to  four  ounces  to  the 
bath),  lasting  one-half  hour,  and  followed  by 
the  aforementioned  inunction,  are  of  ser- 
vice. The  tar  ointment  should  be  used  only 
for  short  periods  at  a time.  Kaposi  recom- 
mends beta-naphthol  ointment,  1 to  2 per 
cent,  for  children,  5 per  cent,  for  adults,  but 
its  use  is  attended  with  the  risk  of  poisoning. 

X-ray  treatment,  as  employed  for  eczema 
may  be  of  benefit.  A dose  of  one-third  or 
one-half  pastille,  administered  through  a 
filter  of  1 mm.  or  more,  once  a week,  may 
be  continued  for  long  periods  of  time  without 
producing  an  observable  reaction  on  the  skin. 
(Knox.) 

Pruritus. — L.  prurir'e,  to  itch.  A.  General= 
ized  Pruritus  Without  Visible  Changes  in  theSkin. — 
Causes. — Congenital  hypersesthesia;  ner- 
vous disorders,  functional  and  organic, 
nervous  strain,  worry,  and  other  emotional 
disturbances;  the  climactery;  thyroidismus; 
toxic  influences,  due  to  gastro-intestinal  dis- 
turbances, constipation,  the  gouty  or  rheu- 
matic diathesis,  nephritis,  chabetes,  jaundice, 
toxsemia  of  pregnancy,  Hodgkin’s  disease, 
certain  foods  and  drugs,  e.g.,  opium,  iodine, 
iodoform,  alcohol,  tea,  coffee,  tobacco,  and 
ingesta  which  cause  urticaria,  etc.;  senile 
degeneration  of  the  .skin;  varicose  veins; 
winter  season;  suimner  season;  bathing. 

Treatment. — Attend  to  the  cause.  Pre- 
scribe a bland  diet,  excluding  spices,  condi- 
ments, pickles,  acids,  tomatoes,  straw- 
berries, gooseberries,  cabbage,  cauliflower, 
sauces,  sweets,  pastry,  hot  liquids,  fried 
foods,  meat,  cheese,  tea,  coffee,  alcohol, 
chocolate  and  any  other  food  that  may  prove 
causal,  and  also  tobacco.  Water  should  be 
drunk  in  abundance.  The  bowels  should  be 
kept  active.  An  occasional  saline  (see  Part 
11)  one  hour  before  breakfast,  and  Vichy, 
or  sodium  bicarbonate,  one-quarter  of  a 
teaspoonful  in  a tumbler  of  water  one  hour 
before  meals,  may  be  useful.  The  under- 
wear should  be  of  cotton,  lisle  thread,  linen 
or  silk,  instead  of  wool.  Too  much  soaping 
and  bathing  is  apt  to  aggravate  the  itching. 
Alkaline  baths  (sodium  bicarbonate,  two  to 
four  ounces  to  the  bath)  lasting  ten  to 
thirty  minutes,  followed  by  a bland  oil,  such 


as  cottonseed,  olive,  or  almond  oil,  liquid 
vaseline,  or  cold  cream,  and  following  this 
a bland  du-sting  powder,  such  as  rice-flour, 
or  cornstarch,  or  talcum,  repeated  every  two 
or  three  days,  may  be  of  service.  In  bath 
prm-itus,  the  bath  should  be  tepid,  as  brief 
as  possible,  the  skin  dried  by  tapping,  not 
by  rubbing,  and  a bland  oil  or  powder 
applied.  The  bath  should  not  be  taken 
just  before  retiring. 

Antipruritic  internal  remedies  include 
cannabis  indica,  pilocarpine,  gelsemimn,  anti- 
mony for  senile  pruritus,  carbolic  acid  in 
liberal  doses,  antipyrine,  phenacetin,  acetan- 
elid,  lactophenin,  bromide,  valerian,  chloral, 
sulphonal,  belladonna,  strychnine,  lupulin, 
calcium  chloride,  arsenic,  quinine  in  large 
doses  (see  Part  11  for  drug  formulae,  etc.) 

Antipruritic  applications : 


II 


II 


II 


II 


II 


Calaminae, 

Zinci  oxidi,  aa 3iv 

Acidi  carbolici  seu  mentholis . . gr.  xx-xl 
Olei  olivffi, 

Liquoris  calcis,  aa ^iv 

(Calamine  liniment.) 

Calaminac 3 iss 

Zinci  oxidi 3iii 

AcicU  borici 3d 

Glycerini itjv-xv 

Acidi  carbolici ngxv-3i 

Liquoris  calcis 5 ii 

Aquae,  q.s.,  ad Sviii 


(Calamine  lotion) 


Tragacanthae .... 

Glycerini 

Acidi  borici 

Acidi  carbolici . . . 

Olei  rosae 

Olei  lavandulae . . . 
Olei  bergamot . . . 
Aquae,  q.s.,  ad . . . 

Acidi  carbolici . . . 

Glycerini 

Alcoholis 

Aquae,  q.s.,  ad . . . 

Acidi  carbolici . . . 

Thymolis 

Resorcini 

Sodii  boratis .... 

Glycerini 

Alcoholis 

Aquae,  q.s.,  ad . . . 

Mentholis 

Spiritus  rosmarini 
Aquae,  q.s.,  ad . . . 


3iss-iii 

3v 

3v 

gr.  Ixxx-clx 


W 

Wn 

in,v 

Oi 

(Pusey,  not  greasy.) 


3i-iu 

3ii 

5i 

Oi 

(Stelwagon.) 

3d 

gr.  xvi 

3ss-i 

3ss 

3d 

5i 

Oi 

(Stelwagon.) 


gr.  xvi-lxxx 

5d 

Sviii 


Other  local  remedies  are  olive,  cottonseed, 
or  almond  oil,  vaseline,  liquid  vaseline,  cold 
cream  or  zinc  oxide  ointment,  containing 
carbolic  acid,  gr.  v-xx  to  the  ounce,  or 
menthol  or  thymol,  gr.  v-xxiv  to  the 
ounce,  or  salicylic  acid  or  resorcin,  gr. 
v-x  to  the  ounce;  liquor  carbonis  deter- 


PSORIASIS 


gens,  5ii,  ad  aquam,  5viii;  camphor 
chloral,  aa,  pure  or  diluted;  acetic  acid,  one 
part,  to  twenty,  thirty,  or  more  parts  of 
water;  dusting  powders,  either  alone  or  fol- 
lowing the  lotions. 

General  galvanization  may  be  beneficial. 

B.  Pruritus  Ani. — CAUSES. — Hepatic  de- 
rangement; constipation;  gouty  diathesis; 
dial)etes;  nephritis;  jaundice;  certain  foods 
and  drugs  (morphine,  iodine,  iodoform, 
aicohol,  tea,  coffee,  tobacco,  etc.);  heat; 
cold;  neurosis;  hemorrhoids;  intestinal  ca- 
tarrh ; catarrhal  jtroctitis  or  sigmoiditis ; anal 
fissure;  anal  fistula;  rectal  tumors;  rectal 
stricture;  rectal  foreign  body;  intestinal 
worms;  uncleanliness;  too  frequent  cleans- 
ing; blind  sinuses  frequently  originating  in 
ulcers  at  the  bottom  of  the  crypts  of  Mor- 
gagni; minute  fissures  at  the  bottom  of  the 
anal  folds. 

Treatment. — First  cleanse  the  anal  ori- 
fice and  canal  thoroughly  with  castile  soap 
and  hot  water,  and  rinse.  This  often  suffices 
in  itself  to  stop  the  itching.  If  not,  one  may 
then  bathe  the  parts  with  carbolic  acid  solu- 
tion, 3ss  ad  5iv,  or  saturated  boric  acid 
solution,  gr.  Ixxv  ad  5iv,  or  bichloride, 
1 : 4000,  followetl  perhaps  by  one  of  the 
following  ointments,  and  this  in  turn  by  a 
dusting  powder: 


Hydrargyri  amnioniati gr.  xx 

Acidi  carbolici gr.  x 

Adipis  benzoinati 3 i 


Instead  of  the  carbolic  acid  one  may  use 
creo.sote,  rrpxv,  or  camphor,  3ss,  cum  spt. 
rectificati,  q.s. 


Acidi  carbolici  seu  nientholis. ...  gr.  v-x.xx 
Petrolati  mollis  seu  petrolati 
liquidi oi 


Other  local  remedies  are  ung.  hydrargyri 
nitratis,  pure  or  diluted;  ichthyol,  5 per 
cent,  lotion,  or  10  per  cent,  ointment;  com- 
pound tincture  of  benzoin;  chloral,  gr.  xv,  in 
glycerine,  5ss;  chloroform,  5ss-i,  ad  ceratum 
vel  petrolatum,  5i;  cocaine,  gr.  i-x,  to  the 
ounce  of  ointment  or  lotion;  chloral  and 
camphor,  aa5ss-i,  rubbed  together  until  an 
oil  is  formed,  and  added  to  ceratum  or 
petrolatum,  5i;  Peruvian  balsam  rubbed  up 
with  a little  vaseline;  ung.  picis  liquidiB  (q.v. 
in  Part  11).  Tar  jn-eparations  should  be  con- 
tinued for  only  four  or  five  days  at  a time, 
followed  by  zinc  oxide  ointment  for  one  or 
two  days,  before  resuming  the  tar. 

If  simple  measures  are  not  effectual, 
search  for  ami  correct  the  underlying  cause, 
especially  the  opening  up  of  blind  sinuses, 
using  a general  anaesthetic,  if  necessary. 


For  external  piles,  inject  hazeline  or  apply 
ung.  gallae  et  opii. 

A small  blister  (see  Part  11)  over  the  lower 
lumbar  region  is  sometimes  effectual.  Light 
X-ray  {q.v)  exposures  with  a hard  tube,  every 
one  to  three  days,  are  highly  recommended. 
Says  Tidy;  “A  half  Sabouraud  dose  may 
be  given  at  the  first  exposure,  and  if  not 
successful  a full  dose  three  or  four  days  later.” 

If  all  other  measures  fail,  it  is  advised 
that  all  the  sensory  nerves  to  the  part  be 
resected  (consult  Earle,  Diseases  of  the 
Anus,  Rectum,  and  Sigmoid). 

C.  Pruritus  Vulvae. — See  Part  2,  Gynaecology. 

D.  Pruritus  Scroti. — See  Part  3,  Genito- 
Urinary  Diseases. 

E.  Pruritus  Meati  Urinarii. — CAUSES. — Ure- 
thritis; urethral  stricture;  stone;  cystitis. 

Pseudochromidrosis. — Ulr.  f/evhiis  false. 
See  under  Chromidrosis. 

Psoriasis. — Gr.  ipeopa  itch.  A common, 
acute  or  chronic,  recurrent,  inflammatoiy 
chsease  of  the  skin,  characterized  by  the 
occurrence  of  variously  sized,  rounded, 
sharply  defined,  dry,  reddish  patches,  cov- 
ered with  silvery-white,  imbricated,  adher- 
ent scales,  which  when  scraped  off,  reveal 
minute  bleeding  points.  It  occurs  especially 
upon  the  extensor  surface  of  the  knees  and 
elbows,  at  the  hair  border  of  the  scalp,  and 
on  the  trunk. 

Etiology.— This  is  unknown.  Possible  cau  • 
sal  influences  are  heredity,  the  gouty 
diathesis,  nitrogen  retention,  arthritis  defor- 
mans and  other  arthropathies,  tonsillitis, 
(hgestive  and  metabolic  chsturbances,  defec- 
tive kidney  elimination,  the  intemperate  use 
of  tea,  coffee,  alcohol,  or  tobacco,  debility, 
neurasthenia,  mental  depression. 

The  question  of  its  contagiousness  is  not 
definitely  decided. 

Prognosis.— This  is  good  for  any  one  attack, 
but  recurrences  are  almost  certain.  In  mod- 
erate cases  the  eruption  maj^  be  made  to 
cUsappear  in  from  three  to  twelve  weeks, 
but  it  recurs.  Exceptionally  the  disease 
develops  into  a general  exfoliative  dermatitis. 

Treatment.— A low  protein  (low  nitrogen) 
diet  has  a very  favorable  influence  upon  the 
eruption.  The  salicylates  (see  Part  11)  may 
be  of  benefit  in  acute  cases.  Arsenic  (q.v.)  is 
of  especial  value  in  chronic  cases,  but  is  con- 
traindicated in  acute  cases.  It  should  be 
continued  for  about  a month  or  two  after 
the  disaj^pearance  of  f!ie  eruption.  In  such 
a disease  of  unknown  etiology',  one  should 
make  a careful  search  for  abnormalities,  and 
direct  the  treatment  against  any  such  that 
may  be  found. 

In  the  local  treatment,  first  remove  the 


PURPURA 


accumulation  of  scales  by  means  of  thrice 
weekly  or  daily,  warm,  alkaline  baths 
(sodium  bicarbonate,  sodimn  biborate,  or 
ammonium  chloride,  two  to  six  ounces  to  the 
thirty-gallon  bath,  duration,  twenty  to 
thirty  minutes),  or  the  home  cabinet  steam 
bath,  and  scrubbing  with  soft  soap  and 
hot  water,  followed  by  the  inunction,  twice 
daily,  of  unguentum  acidi  salicylici,  gr. 
xx-xl  ad  5i-  Rubber  cloth  underwear  may 
also  be  worn  for  several  hours  daily. 

After  the  scales  have  been  removed,  em- 
ploy the  salicylic  ointment  as  a general  appli- 
cation, and  treat  individual  patches  with  one 
of  the  following  stimulating  preparations, 
named  in  the  order  of  their  effectiveness: 


Chrysarobini oi-ii 

Chloroformi 5i 

M.  Sig. — Shake  and  paint  on  two  or  three  coat- 
ings; then  paint  on  a few  coatings  of  flexible  collod- 
ion. Renew  when  the  film  becomes  loose. 

Chrysarobini 5i 

Acidi  salicylici gr.  x 

Collodii  flexilis,  q.s.,  ad... §i 

Chrysarobini gr.  x-lx 

Adipis  benzoinati, 

Petrolati  mollis,  aa 3ss 

M.  Sig. — Rub  in  vigorously  once  or  twice  daily) 


wipe  off  the  excess,  and  dust  over  with  rice  flour, 
cornstarch,  or  talcum. 

Chrysarobin  stains  the  skin  and  clothing, 
the  latter  indelibly,  sometimes  causes  an 
itching  erythema  and  toxic  symptoms  (see 
Part  11),  and  should  not  be  used  on  the  face 
or  scalp  for  fear  of  being  conveyed  to  the 
eyes  and  setting  up  a conjunctivitis. 

R Picis  liquidse,  olei  cadini,  olei 
rusci,  seu  tinct.  comp,  picis 


anthracis 5 ss-ii 

Acidi  salicylici gr.  x 

Unguenti  zinci  oxidi 5 i 


M.  Sig. — Rub  in  freely  twice  daily,  wipe  off  the 
excess,  and  apply  a dusting  powder. 

Liq.  picis  carbonis,  painted  on  pure,  or  com- 
bined with  vaseline,  3ii  ad  5i- 


Hydrargyri  ammoniati 3ss-i 

Acidi  salicylici gr.  x-xx 

Petrolati  mollis 3i 


M.  Sig. — ^ Apply  daily  to  the  scalp,  and  shampoo 
the  latter  thoroughly  every  few  days  with  green 
soap  and  hot  water. 


Beta-naphtholis gr.  xx-lx 

Petrolati  mollis 3 > 

R Sulphuris  praccipitati 3ss-i 

Acidi  salicylici gr.  x-xx 

Petrolati  mollis ji 


In  the  rare  acutely  inflammatory  cases, 
use  only  mild  applications,  e.g.,  acidi  sali- 


cylici, gr.  iii-iv  to  the  ounce  of  petrolatum, 
or  calamine  liniment: 


R Calaminac, 

Zinci  oxidi,  aa 3iv 

Acidi  carbolici ig;iv-xl 

Liquoris  calcis, 

Olei  olivsG,  aa 5 iv 


(Stelwagon.) 

The  best  method  of  treatment  of  chronic 
psoriasis  is  with  the  X-rays,  using  the  same 
technique  as  that  for  eczema.  Says  S.  E. 
Dore:  “A  Sabouraud  pa.stille  do.se,  or  half 
this  amount  repeated  two  or  three  times,  is 
usually  sufficient  for  a single  area.”  Knox 
admini.sters  one-third  or  half  a pastille  dose 
once  a week  for  three  or  four  weeks  to  large 
areas,  later  once  in  three  weeks. 

Psoriasis  of  the  Tongue. — See  Leuco- 
plakia  Buccalis. 

Pulex  Penetrans,  or  Sand=Flea. — L. 

pulex,  flea.  See  Bites. 

Purpura. — L. ; Gr.  7rop<^upeos  purple.  Pur- 
pura designates  hemorrhage  into  the  skin. 
The  smaller  or  pinhead-sized  hemorrhages 
are  called  petechiae,  the  larger  patches, 
ecchymoses.  They  do  not  disappear  on 
pressure  as  do  erythematous  lesions.  They 
often  occur  in  successive  crops,  and  in  pur- 
pura haemorrhagica  are  accompanied  by 
bleeding  from  the  mucous  membranes.  Pur- 
pura is  not  congenital  or  hereditary,  as  is 
haemophilia.  The  frequent  association  of 
purpura,  urticaria,  erjd;hema  multiforme, 
erythema  nodosum,  and  angioneurotic 
cedema,  suggests  an  intimate  relationship 
between  these  affections. 

Etiology. — Skin  hemorrhages  sometimes 
occur  in  the  following  conditions,  viz., 
acute  infectious  diseases  (typhus  fever, 
typhoid  fever,  bubonic  plague,  scarlet  fever, 
measles,  influenza,  smallpox,  cerebrospinal 
meningitis,  septicopyaemia,  ulcerative  endo- 
carditis, relapsing  fever,  vaccinia,  intestinal 
anthrax,  malaria,  syphilis);  cachectic  states 
(nephritis,  heart  disease,  severe  anaemia, 
cancer,  tuberculosis,  leukaemia,  Hodgkin’s 
disea.se,  scurvy,  icterus  gravis,  enterocolitis 
in  children,  chronic  alcoholism,  senility,  etc.) ; 
poisoning  (iodides,  mercury,  copaiba,  qui- 
nine, antipyrine,  belladonna,  ergot,  benzol, 
snake  venom,  cholaemia,  blood  sera,  pos.si- 
bly  salicylates,  etc.);  neuroses  (severe  neu- 
ralgia, locomotor  ataxia,  particularly  follow- 
ing lightning  pains,  acute  myelitis, 
transverse  myelitis,  multiple  sclerosis,  hemi- 
plegia, the  purpura  occurring  on  the 
paralyzed  side,  hysteria,  severe  emotional  di.s- 
turbances);  mechanical  influences  (epileptic 
fit,  whooping-cough  paroxysm,  tight  band- 
aging); haemophilia;  thermic  fever. 


PURPURA  ANNULARIS  TELANGIECTODES 


Besides  these  many  conditions  in  which 
skin  hemorrhages  sometimes  occur,  there 
are  five  clinical  entities  in  which  purpura  is 
a prominent  sjmiptom,  viz. 

1.  Purpura  Simplex. — A mild  form,  with 
perhaps  slight  articular  symptoms,  seen 
most  commonly  in  children,  lasting  from 
one  to  six  weeks,  rarely  a year  or  longer  in 
chronic  cases. 

2.  Purpura  (Peliosis)  Rheumatica  or 
Schonlein’s  Disease. — An  acute  form  asso- 
ciated with  iiolyarthritis,  fever,  often 
sore  throat,  and  often  urticaria,  eiythema 
multiforme,  and  erythema  nodosum,  of 
good  prognosis. 

3.  Henoch’s  Purpura. — Characterized 

by  recurrent  attacks,  lasting  several  days, 
or  purpura  associated  with  abdominal  colic, 
sometimes  vomiting,  diarrhoea,  melsena, 
and  arthritic  symptoms,  usually  splenic 
enlargement,  often  urticaria,  erythema 
multiforme,  and  angionemotic  oedema, 
frequently  nephritis. 

4.  Purpura  H.emorrhagica. — Purpura 
associated  with  hemorrhages  from  the  mu- 
cous membranes,  lastmg  from  one  to  eight 
weeks,  sometimes  complicated  with  nephri- 
tis. Exclude  scurvy,  leukaemia,  and  anaemia. 

5.  Purpura  Fulminans. — A rapidly  fatal 
form  with  extensive  ecchymoses  but  no 
mucous  membrane  hemorrhages. 

Treatment.— Rest  in  bed,  mental  repose, 
fresh  air,  smooth  sheets,  and  gentleness  in 
handling  the  patient,  so  as  to  avoid  pro- 
ducing ecchymoses,  are  important  considera- 
tions. The  cUet  should  be  light  at  first,  and 
later  gradually  increased.  Foods  rich  in 
iron  are  advised,  such  as  spinach,  egg-yolk, 
asparagus,  beef,  apples,  carrots,  beans, 
jwtatoes,  rice,  named  in  the  order  of  their 
iron  content,  also  acids  and  fruit  juices. 
The  food  should  not  be  hot,  and  no  stimu- 
lants, such  as  alcohol,  coffee,  or  tea  should 
be  allowed.  For  constipation,  prescribe 
oranges  for  breakfast,  and  baked  apple  or 
ajiple  sauce,  preserved  fruits,  honey,  and  if 
necessary  cascara  sagrada,  castor-oil,  (see 
Part  11),  or  enemas;  no  salines.  Fowler’s 
solution  iq.v.)  is  recoimnended  in  gradu- 
ally increasing  doses  until  physiological 
effects  are  obtained.  Peliosis  rheumatica, 
says  Kerley , ‘ ‘ usually  yields  readily  to  treat- 
ment for  rheumatism,”  viz.,  salicylates, 
alkalies,  aiul  restriction  of  red  meats  and 
cane  sugar.  MacGowen  strongly  advocates 
the  hypodermatic  or  internal  administration 
of  adrenalin  solution,  1 : 1000,  ten  drops  every 
two  hours  for  forty-eight  hours  and  then 
smaller  doses,  in  purpura,  urticaria  and 
erythema  multiforme  (see  Part  11,  Drugs). 


For  arthritic  symptoms,  raise  the  parts, 
and  envelop  the  affected  joints  in  cotton. 
Warm  applications  of  lead  and  opium  wash 
iq.v.)  or  wet  compresses  covered  with 
oiled  silk  afford  relief. 

To  check  bleeding,  secure  rest  and  anal- 
gesia by  means  of  morphine,  if  necessary, 
and  prescribe  oleum  terebinthinse,  or  dilute 
or  aromatic  sulphuric  acid,  or  fluid  extract  of 
ergot,  or  fluid  extract  of  hydrastis,  or  calcimn 
lactate,  or  atropine  hj-podermically,  or 
Merck’s  sterilized  gelatine  solution,  10  per 
cent.,  or  the  swallowing  of  bits  of  ice,  or  for 
hsematemesis,  acffenalin,  1 : 1000,  5i  every 
hour  for  several  hours.  Calcium  lactate  is 
reputed  to  be  the  best  remedy. 

For  epistaxis,  employ  adrenalin,  1 : 1000 
(see  also  Epistaxis  in  Part  8,  Nose  Diseases). 

Blood  transfusion  (see  Part  1)  may  be 
practiced  in  serious  cases,  or  in  lieu  of  this, 
hypodermic  injections  of  antidiphtheritic  or 
antistreptococcic  serum,  avoiding  the  risk  of 
inducing  anaphylactic  phenomena  (see  Ana- 
phylactic Shock  in  Part  1.) 

During  convalescence  prescribe  iron. 

The  dangers  in  purpura  are  acute  nephri- 
tis and  cerebral  hemorrhage. 

Purpura  Annularis  Telangiectodes. — Jj 
'pur’pura  purple ; annulus,  ring ; Gr . reXos  end 
-|-  ayyeiov  vessel  eKTaais  dilatation.  An 
extremely  rare,  bilateral  and  usually  sym- 
metrical eruption,  of  slow  evolution,  requir- 
ing several  weeks  or  months  to  attain  its 
maximum  development,  and  of  equally  slow 
involution,  the  total  eruptive  period  rang- 
ing from  several  months  to  a year  or  more, 
frequently  preceded  by  rheumatic  or  neu- 
ralgic pains,  especially  in  the  knees,  and 
characterized  by  (1)  lentil-sized,  well-defined, 
rose-or  red-colored  macules,  composed  of  a 
fine  network  of  dilated  capillaries  revealed 
by  the  diascope  (telangiectatic  stage),  w'hich 
(2)  slowly  enlarge  by  peripheral  extension  to 
the  size  of  a dime,  or  even  to  that  of  a silver 
half  dollar,  while  at  the  same  time,  minute, 
dark  red,  hemorrhagic  puncta  appear 
throughout  the  lesion,  but  especially  at  the 
margin;  as  the  lesion  enlarges  it  clears  in 
the  centre,  leartng  the  latter  pigmented 
yellow  to  brown  (hemorrhagic  pigmentary 
stage);  finally,  after  a more  or  less  pro- 
tracted period  of  quiescence,  (3)  involution 
occurs,  and  the  lesions  slowlj'-  fade  away, 
leaving  usually  but  not  always,  atrophy  and 
alopecia  in  the  centre  (atrophic  stage).  All 
three  stages  are  sometimes  present  at 
one  time. 

The  essential  histological  features  consist 
of  an  endarteritis  and  an  endophlebitis 
obliterans,  with  hyaline  degeneration  of  the 


RHINOSCLEROMA 


blood-vessels  and  the  formation  of  tiny- 
aneurysmal  sacculations,  which  rupture, 
with  resulting  hemorrhage  and  pigmentation. 

The  etiology  is  unknown.  (After  MacKee.) 

Pustula  Maligna. — L.  See  Anthrax. 

Raynaud’s  Disease. — An  uncommon  an- 
gioneurotic affection  (arteriospasm)  of  the 
fingers,  toes,  tip  of  the  nose,  internal  parts, 
etc.,  characterized  by  periodic,  paroxysmal 
attacks  of  local  ischaemia  or  syncope,  in 
which  the  part  affected  appears  dead-white 
and  cold,  followed  after  several  minutes  to 
an  hour  or  longer,  by  local  asphyxia  or 
cyanosis,  which  is  later  replaced  by  active 
hypersemia,  redness,  throbbing,  and  pain. 
Eight  or  ten  of  these  attacks  may  occur  in 
one  day;  or  the  one  attack  may  be  the  last; 
or  several  attacks  may  occur  at  intervals  of 
six  months  or  a year.  In  severe  cases  the 
local  asphyxia  or  cyanosis  may  persist,  with 
severe  pain,  for  a number  of  days,  and 
necrosis  or  gangrene  occur.  Ha^moglobi- 
nuria  sometimes  occurs,  sometimes  abflomin- 
al  colic,  rarely  transient  aphasia,  transient 
hemiplegia,  transient  amblyopia  due  to 
spasm  of  the  retinal  vessels,  or  convulsions. 

For  other  causes  of  gangrene,  which  should 
be  excluded,  see  Gangrene  of  the  Skin. 

Etiology. — Syphilis  is  said  to  be  the  under- 
lying cause  in  the  majority  of  cases.  Hered- 
ity may  be  a factor.  A neuropathic 
dispo.sition  predisposes.  Nervous  .shock, 
emotion,  and  exposure  to  damp  cold  may 
bring  on  an  attack. 

Treatment.— For  severe  local  asphyxia,  the 
following  measures  may  be  tried:  (1)  nitro- 
glycerin (see  Part  11  for  drug  formulae, 
etc.);  (2)  calcium  lactate;  (3)  galvanism  with 
the  part  immersed  in  tepid  salt  water,  place 
the  positive  electrode  over  the  spine  and  the 
other  in  the  water;  use  as  strong  a current  as 
can  be  borne,  and  make  and  break  the  current 
frequently — Barlow) ; (4)  a tourniquet  to  the 
arm  in  the  fomi  of  the  arm-band  of  a blood- 
pressure  instmment,  cutting  off  the  arterial 
circulation  for  several  minutes  several  times 
a day — Cushing;  (5)  massage  for  half  an 
hour  twice  daily;  (6)  alternate  hot  and  cold 
douches,  or  wrapping  in  cold  wet  cloths. 
Phenacetin,  antipyrine,  or  morphine  may  be 
required  for  the  pain.  Should  gangrene  occur, 
keep  the  parts  antiseptic,  and  employ  surgical 
measures  when  required.  Pota.ssium  iodide 
may  cause  healing  of  the  gangrene. 

Enjoin  the  observance  of  a correct  hygi- 
enic regimen,  e.g.,  adequate  rest  and  exer- 
cise, freedom  from  v/orry,  fresh  air  day  and 
night,  regular  hours  of  eating  and  sleeping, 
re.st  before  and  after  meals,  a liberal,  well- 
balanced  bland  diet,  with  perhaps  codliver 
40 


oil,  and  tonics,  free  bowel  activity,  a 
daily  morning  tepid  bath  in  a warm  room, 
before  breakfa.st,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  warm,  dry  feet  and  hands  in  cold 
weather,  and  if  possible,  wintering  in 
Florida,  Southern  California,  or  Egypt. 

Anastomosis  of  the  afferent  artery  with 
the  efferent  vein  (reversal  of  the  circulation) 
has  been  done  with  success. 

Recklinghausen’s  Disease. — See  Fibroma. 

Recurrent  Summer  Eruption. — L.  recur'- 
rens,  returning.  See  Hydra  Vacciniforme. 

Red  Qum.-^ee  Miliaria. 

Red  Neuralgia  of  the  Extremities. — See 
Erythromelalgia. 

Rhinopharyngitis  Mutilans. — See  Gan- 

gosa. 

Rhinophyma. — Gr.  pis  nose  -1-  <f>vpa 
growth.  See  Acne  Rosacea. 

Rhinoscleroma. — Gr.  pis  nose  + <xK\r]p6s 
hard  -f  -copa  tumor.  A very  rare,  chronic, 
slowly  progressive,  local  affection,  due  to  the 
bacillus  rhinoscleroma,  involving  usually  the 
anterior  nares  and  adjacent  parts,  and  char- 
acterized by  the  occurrence  of  red,  smooth, 
soft,  painless  but  tender,  usually  non-ulcera- 
tive  nodules  or  plaques,  which  soon  become 
shrunken,  pale,  or  grayish-white,  and  of 
ivory-like  hardness.  It  may  continue  for 
many  years,  and  always  remains  local, 
although  it  may  involve  the  pharynx,  larynx, 
and  even  the  bronchi.  It  eventually 
causes  steno.sis.  It  occurs  most  frequently  in 
Austria,  Russia,  Central  America,  and  Brazil. 

Histologically,  the  growths  are  made  up 
of  newly  formed  granulation  tissvie  with  old 
and  new  fibrous  tissue  and  very  many  small 
round  and  oval  cells,  and  in  the  deeper 
parts,  the  larger  round  or  irregular  Mikulicz 
or  foam  cells,  and  hyaline  masses  (“  Russel 
bodies  ”).  In  sections  of  tissue  stained 
according  to  Gram  (see  Part  3,  under  Gonor- 
rhoea), there  can  be  seen  in  the  Mikulicz  cells 
and  in  the  lymph  spaces  surrounding  them, 
the  small,  oval,  capsulated  diplobacilli  des- 
cribed first  by  Frisch  in  1882.  These  do  not 
retain  the  stain,  and  resemble  morphologi- 
cally and  culturally  the  diplobacilli  of  Fried- 
lancler.  They  are  almost  always  found  in 
pure  culture.  (Kaempfer.) 

Prognosis. — This  has  heretofore  been  unfav- 
orable; but  recent  experience  with  the 
X-rays  and  radium  has  given  encourag- 
ing results. 

Treatment.— TheRontgenrays,  <7.?;. (“twenty- 
three  gentle  applications,  each  lasting  six 
minutes  ”)  and  radium  bromide  (“  seven 
applications  of  sixty  mg.,  each  lasting 
twenty  minutes  ”)  are  well  recommended 


RINGWORM;  TINEA  TRICHOPHYTINA 


( Author  ? ).  Alderson  has  obtained  good 
results,  using  a Coolidge  tube,  with  five- 
inch  spark  gap,  the  target  ten  inches  from 
the  lesions,  an  aluminum  filter,  1 mm.  thick, 
interposed,  and  fifty-two  milliampere  min- 
utes administered,  with  a repetition  of  the 
treatment  at  the  end  of  six  weeks.  Tracheal 
scleroma  is  exposed  to  the  X-rays  through 
a tracheotomy  wound. 

The  knife  and  curette  and  the  galvano- 
cautery  have  been  resorted  to  in  order 
to  preserve  the  patency  of  the  air  passages, 
but  the  growths  have  invariably  recurrecl 
after  operation. 

Internal  and  local  drugs  and  vaccine 
therapy  have  proved  ineffectual. 

Ringworm;  Tinea  Trichophytina, — L. 
tinea,  moth;  Gr.  0pL^  hair  -(-  4>vt6v  plant.  A 
common,  local,  contagious  disease  of  the 
skin,  produced  by  several  varieties  of  tri- 
chophyton fungi.  It  is  often  contracted 
from  animals.  Ringworm  of  the  general 
surface  (tinea  cfrawota — L.  cir' cuius,  ring)  is 
characterized  by  rounded,  sharply  circmn- 
scribefl,  slightly  elevated,  inflamed,  red, 
scaly  patches,  which  tend,  by  clearing  up  in 
the  centre,  to  assume  a ring-like  aspect. 
Ringworm  of  the  scalp  (tinea  tonsurans — L. 
tonsu'ra,  shaving)  is  characterized  by 
rounded,  sharply  circiunscribed,  pinkish  to 
grayish,  bald,  scaly  patches,  showing  broken 
hair,  hair  stumps  and  black  dots,  and  often 
prominent  follicles.  It  occurs  almost  ex- 
clusively in  children.  Ringworm  of  the 
beardetl  region  (tinea  sycosis  seu  barbae — Gr 

avKov  fig;  L.  barba  ) may  be 

superficial,  resembling  tinea  ch’cinata,  or 
deep,  lumpy,  and  nodidar,  with  follicular 
inflammation  and  hair  destruction.  Tinea 
cruris  et  axillaris  is  accompanied  by  acute 
inflammatory  symptoms.  On  the  volar  and 
interdigital  surfaces  of  the  hands  and  feet, 
ringworm  may  produce  atj'pical  vesciular, 
scaling  or  desquamating  areas  in  which  it 
may  require  several  examinations  to  demon- 
strate the  presence  of  fungi. 

Sometimes  a pustular  folliculitis,  called 
kerion  (Gr.  Ktipiov  honey-comb)  is  produced 
by  the  ringworm  fungus. 

A positive  diagnosis  of  ringworm  is  made 
by  the  microscopic  examination  of  an 
extracted  hair  in  liquor  potass*,  after  allow- 
ing it  to  soak  for  fifteen  minutes. 

Treatment.— A.  RiNGWORM  OF  THE  GEN- 
ERAL Surface. — Curable  generally  in  a 
week  or  two. 

Keep  the  patches  free  from  scaliness 
with  green  soap  and  hot  water,  and  rub  in 
thoroughly,  once  to  thi’ice  daily,  the 
following  parasiticide: 


R Acidi  .salicylic! gr.  xxx 

Acidi  benzoici 5i 

Petrolati  mollis 3 i 


(Whitfield.) 

Other  eligible  but  inferior  preparations 
are  tincutre  of  iodine,  pure,  or  perhaps 
better,  diluted  with  an  equal  quantity  of 
alcohol;  sodimn  hyposulphite,  3i  ad  aquam 
5i;  carbolic  acid,  gr.  xv-xxiv  ad  5i;  bichlor- 
ide, 1 : 500  to  2.50;  sulphur,  sublim.,  3ss, 
acidi  carbolici,  itpxx,  adipis  Ian*  hydrosi, 
5vi,  olei  oliv*,  pii;  hydrargyri  oxidi  flavi, 
vel  hy(lrargyri  ammoniati,  3i,  lanolin  cum 
oleo,  5i;  ung.  picis  liquid*.  Ionization  with 
iodine  or  mercury  ions  is  recommended 
(see  Ionic  Aledicine  in  Part  1). 

For  infants  use  a weak  preparation,  e.g., 
acidi  salicylici,  gr.  x-xv,  ackh  benzoici,  gr. 
x-xx,  lanolin,  5i;  or  hyclrargyri  ammoniati, 
gr.  xxx,  ad  lanolin,  5i- 

When  acute  dermatitis  is  produced,  em- 
ploy a bland  application,  e.g.,  acidi  carbolici, 
sue  hydrargyri  ammoniati,  gr.  v-x, 
ad  unguentum  zinci  oxidi,  ov,  or  cala- 
mine lotion: 


Calaminae, 

Zinci  oxidi,  aa 5i~ii 

Acidi  borici 3 i 

Glycerini in^x 

Acitli  carbolici ngx-xxx 

Liquoris  calcis 5i 

Aquae,  q.s.,  ad 5iv 


After  the  disease  is  apparently  cured, 
continue  mild  applications  daily  for  several 
weeks  to  guard  against  relapse.  The  under- 
wear should  of  course,  be  frequently 
changed  and  boiled,  and  thorough  cleanliness 
practiced,  both  for  prophylactic  and 
curative  purposes. 

B.  Ringworm  of  the  Genitocrural  and 
Axillary  Regions. — Curable  in  several 
weeks  to  several  months. 

First  employ  soothing  applications,  if  - 
necessaiy,  such  as  those  given  above.  The 
same  parasiticides  may  be  emplo3*d  as  for 
tinea  circinata,  but  the  older  ones,  sa3^s 
Adamson,  may  now  be  discarded  for  a 
cleanly  and  rapidly  efficacious  ointment 
which  we  owe  to  Dr.  Arthur  Whitfield 
as  follows: 


,\cidi  salicj-lici gr.  x-xv 

Acidi  benzoici gr.  x-xv 

Olei  coca-nucis 3vi 

Petrolati  mollis,  q.s.,  ad Si 


C.  Ringworm  of  the  Scalp. — Curable  in 
a few  months  to  a 3*ar. 

Shave  the  hair  for  an  inch  around  the 
patch,  and  keep  the  hair  of  the  entire  scalp 
short.  Shampoo  the  whole  scalp  every 
second  or  third  day  with  green  soap  and 


RINGWORM;  TINEA  TRICHOPHYTINA 


hot  water,  rinse  thoroughly,  and  apply  a 
lotion  of  aoidi  carbolici,  3ii>  resorcinolis,  pi 
acich  borici,  3iv,  in  water,  Oi  (Stelwagon). 
Use  the  latter  daily.  A paper,  muslin,  linen, 
or  oiled  silk  skull-cap  should  be  worn  inside 
the  hat,  and  the  paper  caji  burned  or  the 
others  boiled  daily.  Treat  the  diseased 
patch  as  follows:  Fir.st  gently  curette,  and 
then  apply  the  following  depilatory,  over- 
lapping slightly  the  edge  of  the  patch: 
barimn  sulphide,  3iii,  zinc  oxide  and  pow- 
dered starch,  aa3iiss,  water  sufficient  to 
make  a paste.  Leave  on  until  a burning 
sensation  is  felt,  about  ten  minutes,  then 
wash  off  thoroughly.  Use  the  depilatory 
every  five  to  ten  days,  according  to  the 
rapidity  of  regrowth  of  the  hair.  Never 
apply  it  to  an  actively  inflamed  patch. 

After  depilation,  rub  in  thoroughly  for 
five  or  ten  minutes,  twice  daily,  one  of  the 
following  parasiticides: 

Acidi  salicylici 5ss 

Acidi  beiizoici oi 

Petrolati  mollis 5 i 

(Whitfield.) 


Sulphuri.s  prwcipitati 

Adipis  lame  hydro.si 

5i 

Ilydrargj^’i  perchloridi 

gr.  X 

Alcoholis,  q.s. 

Olei  olivaj. 

Keroseni,  aa 

(Highly  praised  by  Holt.) 

Ilydrargyri  ammoniati oi 

Adipis  lanaj  hydrosi 5 i 

Hydrargyri  biniodidi  seu  bichloridi  gr.  i-iii 

Tincturaj  iodi oi 

M.  Sig. — -Paint  on  twice  daily  two  or  three  coat- 
ings each  time,  until  the  film  cracks  or  loosens  or 
the  area  becomes  tender;  then  apply  a mild  salve 
and  pick  off  the  film  as  soon  as  it  becomes  detach- 
able. Then  resume  the  paintings.  (Stelwagon.) 

Acidi  carbolici, 

Tincturae  iodi, 

Chlorali  hydrati,  aa.  (Cutler’s  Fluid.) 

The  salicylic,  sulphur,  and  mercury  oint- 
ments are  applicable  to  large  areas;  the 
iodine  to  small,  circumscribed  areas. 

Intermit  the  treatment  if  irritation  occurs, 
and  apply  bland  ointments.  A kerion  shoukl 
not  be  incised. 

To  obstinate  patches,  no  larger  than  one 
inch  in  cUameter  (never  in  chikh’en),  one 
may  apply  croton  oil,  two  or  three  times 
daily,  diluted  at  first  with  three  parts  of 
olive  oil  and  gradually  strengthened  up  to 
the  pure  oil,  if  neces.sary.  The  action  of  the 
croton  oil  may  be  delimited  by  means  of  a 
border  of  vaseline.  Two  or  three  days  are 
required  to  bring  about  the  desired  amount 
of  inflammatory  reaction.  As  soon  as  slight 


swelling  and  minute  pustulation  appear,  dis- 
continue the  oil,  and  poultice  repeatedly 
until  pronounced  inflammation  is  pro- 
duced. (Stelwagon.) 

Says  Stelwagon:  “After  .several  weeks  or 
a few  months  discontinue  all  treatment  for 
the  purpose  of  noting  the  progress  made.” 
“As  long  as  stmnps  are  to  be  seen,  and  a 
tendency  to  scaliness  persists,  a cure  has 
not  been  effected.”  To  guard  against 
relapse,  parasiticide  applications  should  be 
continued  for  several  weeks  after  the  dis- 
ease is  apparently  cured. 

Vaccine  therapy  combined  with  local 
treatment  has  been  proved  to  be  advantage- 
ous. Stock  or  autogenous  vaccine,  0.5  to 
2.0  to  4.0  C.C.,  may  be  injected  hypodermi- 
cally every  five  or  six  days  (Strickler). 
Striclder  gives  the  following  tecbnique  for 
preparing  the  vaccine:  “ Infected  hairs  are 
soaked  in  absolute  alcohol  for  from  fifteen 
to  twenty-five  minutes,  then  iimnersed  in 
sterile  salt  solution,  and  transplanted  by 
sterile  forceps  to  ‘ French  j)roof  agar  ’ mecl- 
iuni  contained  in  Erlenmeyer  flasks.  All  the 
steps  in  the  procedure  are  carried  out  under 
the  usual  laboratory  technique.  The  cotton 
stoppers  of  the  flasks  are  paraffined,  and  the 
flasks  placed  on  top  of  the  incubator  and 
allowed  to  grow  for  twenty-fom’  days.  The 
growth  is  then  removed  with  a sterilized 
platinum  spade,  care  being  taken  to  remove 
as  little  of  the  culture  medium  as  po.ssible, 
and  treated  for  from  ten  to  fifteen  minutes 
with  crystals  of  chemically  pure  sochum 
chloride.  To  this  enough  sterilized  distilled 
water  is  added  to  make  a normal  saline 
solution.”  “ From  the  growth  on  an  onh- 
nary  Erlenmeyer  flask,  about  500  c.c.  of 
vaccine  is  made  up;  and  this  is  heateil  for 
one  hour  at  G0°  C.,  to  kill  the  growth.” 
Controls  for  living  fungi  are  made  on 
‘ French  proof  agar,’  and  for  pyogenic  organ- 
isms on  plain  agar.”  “ The  vaccine  is  pre- 
served by  the  addition  of  sufficient  phenol 
to  bring  it  up  to  0.25  per  cent.  It  is  then 
tubed  in  sterile  vials,  and  is  ready  for  use.” 

By  far  the  best  treatment  of  ringworm  of 
the  hairy  regions  (excepting  perhajDS  vaccine 
therapy)  is  by  means  of  rontgenotherapy 
(q.v.).  H.  G.  Adamson  describes  the  treat- 
ment as  follows:  “ If  there  be  only  one 
to  three  patches  of  ringworm,  each  patch 
may  be  treated  separately  by  exposure 
through  a circular  hole  cut  in  a sheet  of 
lead,  and  large  enough  to  include  a good 
margin  of  healthy  hair;  or  a lead-glass 
cylindrical  localizer  may  be  u.sed.  When 
tliere  are  more  than  three  patches  it  is  gen- 
erally advisable  to  depilate  the  whole  scalp. 


SCABIES 


This  is  done  most  conveniently  by  the 
“ five-exposure  ” or  “ Kienbock-Adamson  ” 
methotl.  By  this  method  the  forepart  of 
the  scalp,  the  crown,  the  occiput  and  sides 
of  the  head,  each  receive  in  turn  a single 
Sabouraud  pastille  dose  of  X-rays.  In 
order  that  there  may  be  an  even  radiation 
of  the  whole  scalp,  it  is  necessary  to  aim  the 
five  doses  at  five  equidistant  points,  and 
these  jioints  are  to  be  carefully  marked  on 
the  clipped  or  shaven  scalp  with  a blue 
skin  pencil.  The  first  point  is  in  the  middle 
line,  an  inch  or  two  behind  the  anterior 
margin  of  the  hairy  scalp.  Five  inches  are 
measurcfl  backward  from  this  point  to 
mark  the  second  point  on  the  crown,  and 
again  five  inches  for  the  point  on  the  occiput. 
The  two  lateral  points  are  marked  just 
above  each  ear,  so  that  they  are  five  inches 
from  each  of  the  three  central  points.  The 
applications  are  best  made  with  the  patient 
lying  down.  The  X-ray  tube  is  enclosed  in 
a lead-lined  box  shield  which  has  a circular 
aperture  of  three  to  four  inches  in  diameter, 
through  which  the  rays  pass  towards  the 
scalp.  Around  the  aperture  there  are  fixed 
three  slender  converging  wooden  pegs,  the 
ends  of  which  rest  on  the  scalp  and  keep  the 
shield  and  the  contained  tube  at  a fixed 
distance  from  the  skin.  The  box  must  be 
so  arranged  that  the  blue  pencil  mark  on 
the  scalp  is  exactly  in  the  middle  of  the 
points  of  the  three  pegs.  The  anticathode 
of  the  X-ray  tube  should  be  Q}/2  inches  from 
the  skin,  and  the  Sabouraud  pastille  exactly 
midway  between  the  skin  and  the  target  or 
anti-cathode.  The  five  exposui’es  are  given 
at  one  ‘ sitting,’  and  the  whole  procedure 
occupies  from  an  hour  and  a quarter  to  two 
hours.  After  the  exposures  no  visible 
change  occurs  until  the  beginning  of  the 
third  week.  During  the  thircl  week  after  the 
treatment,  the  hair  falls,  both  healthy  and 
diseased.  The  fungus  is  not  destroyed,  but 
merely  conies  away  with  the  hair  upon 
which  it  feeds.  For  six  weeks  or  longer  the 
parts  which  were  exposed  to  the  rays 
remain  absolutely  bald,  and  then  the  new 
and  healthy  hail’  begins  fo  grow.  In  the 
course  of  a few  weeks  it  may  be  an  inch  or 
so  long.  A mild  antiseptic  ointment  (ung. 
hydrargyri  aimn.  chlor.  dil.)  or  lotion 
(tinctime  iodi,  one  ounce,  spirit,  vini 
merhyl,  seven  ounces)  is  applied  to  the 
whole  scalp  daily  tluring  the  treatment  in 
order  to  tlisinfect  the  skin  itself.  The  child 
isfi  •ee  from  infection  as  soon  as  the  hair  has 
completely  fallen.”  An  overdose  of  the 
X-rays  may  cause  permanent  baldness,  and 
even  in  rare  instances  a minimum  dose  in 


Fig 


in 

se- 


hypersusceptible  individuals.  An  irritated  or 
septic  condition  of  the  skin  should  be  allayed 
before  X-ray  treatment  is  begun.  Fair-haired 
individuals  should  be  given  rather  smaller 
doses  than  those  with  dark  hair. 

During  the  exposure  of  the  front  of  the 
vertex  the  forehead  and  eyes  should  be 
shielded  by  lead  or 
rubber,  and  the  ears 
and  face  should  be 
likewise  shielded  du- 
ring exposure  of  the 
sides  of  the  head,  and 
also  the  neck  during 
exposure  of  the  lower 
occiput. 

D.  Ringworm  of 
THE  Bearded  Re- 

97  —Diagram  showing  GION. Curable 

centres  of  area  to  be  rayed.  ^ ^ 

(Schaii)  several  weeks  to 

veral  months. 

Use  an  ointment  of  salicylic  and  benzoic 
acids,  sulphur,  or  mercury,  as  in  tinea 
tonsurans.  Keep  the  face  shaved  and  the 
hairs  of  the  affected  area  extracted.  Adam- 
son recommends  oleate  of  mercury,  5 per 
cent.,  containing  resorcin,  gr.  xv  ad  5i- 

E.  Ringworm  of  the  Nail. — See  Ony- 
chomycosis, under  Nail  Diseases. 

Rodent  Ulcer. — See  Carcinoma  Cutis. 

Rosacea. — See  Acne  Rosacea. 

Rubella;  Rotheln. — See  German  Measles, 
in  Part  11. 

Run-around. — See  Onychia,  under  Nail 
Diseases. 

Sand-Flea. — See  Bites. 

Sarcoma  Cutis. — Gr.  aapj,  <japKm  flesh  -f 
-w/na  tumor;  L.  cu'tis,  skin.  Primary  sar- 
comata of  the  skin  usually  begin  in  old  skin 
lesions,  such  as  moles,  warts,  nsevi,  scars, 
sebaceous  cysts,  etc.  If  not  completely 
removed  a fatal  issue  is  to  be  expected  in 
from  a few  months  to  several  years  or  more. 

Treatment. — Remove  the  growths  by  a wide 
excision,  followed  by  “ vigorous  X-ray  (q.v.) 
exposures  carried  up  to  the  point  of 
acute  reaction,  and  this  followed  by  sub- 
sequent but  somewhat  less  vigorous  expos- 
ures at  intervals  of  a few  months  for  a year  or 
more  ” (Pusey).  At  the  same  time  give 
arsenic  {q.v.  in  Part  11)  h^q^odermically. 
Injections  of  erysipelas  and  prodigiosus 
toxines  (Coley’s  fluid  q.v.),  may  also  be  tried. 

Scabies. — L.,  from  scab’ ere,  to  scratch.  A 
common  contagious  disease,  due  to  the 
acarus  scabei  (L.,  Gr.  a/capt  mite),  the  female 
of  which  burrows  in  the  epidermis,  producing 
a minute,  slightly  elevated,  black-dotted  line 
consisting  alternately  of  eggs  and  excrement, 
and  causing  itching  and  an  acute  papular 


SCABIES 


1.  — Herpes. 


N"  1956.  O'"  Fournier. 


2.  — Impetigo  rodens. 

N " 2513.  D'  Gaucher. 


3.  - Scabies. 

N ' 2077.  D"  Hallopcau. 


4.  Hydroa. 

N*  1563.  D'  Vidal. 


Sf.  Louis  Hospital  Museum,  Paris. 


LAROUSSE  MEDICAL. 


SKIN  DISEASES  : Scabies.  Herpes.  Hydroa.  Impetigo. 


SCLERODERMA 


or  papulo-pustular  dermatitis,  “ predomi- 
nantly upon  the  fingers,  hands,  wrists, 
axillary  folds,  lower  abdomen,  and  genital 
and  anal  regions.”  It  is  readily  cured. 

Treatment.— A hot  soap  bath  with  thorough 
rubbing  with  a coarse  washcloth  or  brush, 
to  open  up  the  burrows  and  other  lesions, 
should  be  taken.  One  of  the  following  para- 
siticides is  then  rubbed  in  vigorously  over 
the  affected  area,  if  limited  in  extent,  or 
else  over  the  entue  surface  below  the  chui 
line,  night  and  morning,  for  three  or  four 
days,  the  same  underwear  being  worn  con- 
tinuously. Ten  or  twelve  hours  after  the 
last  application  a bath  is  taken  and  the 
underwear  and  bed  linen  changed.  The 
underclothing  and  bed  linen  should  be  boiled, 
or  if  of  wool,  baked,  and  the  outer  clotliing 
baked  or  ironed  with  a very  hot  iron. 


Sulphuris  sublimati, 

Balsami  Peruviani,  aa 3ii~vi 

Adipis  benzoinati,  q.s.,  ad giv 


Lard  and  not  vaseline  should  be  used  as 
the  base. 

For  adults,  Stelwagon  adds  beta-naphthol, 
5i-ii,  to  the  above,  and  Osier  prescribes 
naphthol,  5i  to  the  ounce;  but  the  drug  may 
become  absorbed  and  produce  toxic  symp- 
toms, and  is  therefore,  perhaps,  better  left  out. 

Pusey  prefers  the  following: 

Sulphuris  prsecipitati, 

Balsami  Peruviani, 


Crffitae  preparatse, 

Saponis  viridis,  aa gr.  xx-xl 

Petrolati,  q.s.,  ad 5i 

(Pusey.) 


The  writer  has  always  used  with  success 
equal  parts  of  balsam  of  Peru  and  alcohol. 

It  should  be  remembered  that  toward 
the  last  rubbing  slight  itching  may  again 
appear  as  a result  of  irritation  caused 
by  the  parasiticide. 

Where  one,  for  instance  a lumberman,  is 
constantly  exposed  to  contagion,  he  may 
keep  his  underclothing  dusted  with  a small 
quantity  of  washed  sulphur. 

Scar. — See  Keloid. 

Scarlatinaform  Rash. — See  Eiythema 

Scarlatinoides. 

Scarlet  Fever;  Scarlatina. — See  Part  1, 
General  Medicine  and  Surgery. 

Schonlein’s  Disease. — See  Purpura. 

Sclerema  Neonatorum. — Gr.  u/cXrjp6s  hard; 
Gr.  vk>s  new  -f-  L.  ndtus,  born.  An  uncom- 
mon, diffuse,  hard,  stiff,  leathery  condition 
of  the  skin,  occurring  at  or  soon  after  birth, 
associated  with  subnormal  temperature  and 
depression  of  the  respiration  and  pulse,  and 
usually  terminating  fatally.  Theskin  does  not 
pit  on  pressure  as  in  oedema  neonatorum  (q.v.). 


Premature  birth,  diarrhoea,  cardiac  weak- 
ness, atelectasis,  pneumonia,  bad  hygiene, 
and  improper  feeding  are  causative. 

Treatment. — Treat  the  infant  as  directed 
under  Premature  and  Delicate  Infants  (in 
Part  1).  The  child  cannot  suck,  so  must 
be  fed  by  gavage.  Very  gentle  friction 
of  the  bocly  and  limbs  with  oil  toward  the 
heart  is  useful.  “ The  most  important  and 
beneficial  measure,”  says  Kerley,  is  the 
injection,  subcutaneously  and  rectally,  of 
hot  normal  saline  solution  (0.8  per  cent.), 
three  times  a day. 

Scleroderma. — Gr.  o-/cX??p6j  hard  -|-  5epna 
skin.  An  uncommon,  chronic  disease,  char- 
acterized (1)  by  localized,  circiunscribed 
patches  or  bands  of  yellowish  or  pinkish, 
ivory-like  induration,  surrounded  by  faint 
lilac  borders,  and  sometimes  followed  by 
atrophy  (circmnscribed  scleroderma  or 
morphoea — Gr.  pop^i)  form),  or  (2)  by  a 
diffuse,  symmetrical,  usually  pigmented, 
wax-like,  rigid,  stiffened,  indurated,  or 
hide-bound,  sometimes  oedematous  condition 
of  the  skin,  occasionally  followed  by  atrophy 
(generalized  scleroderma) . 

Etiology. — Possible  causal  influences  are 
exposure  to  the  sun,  or  to  cold  and  wet, 
tramnatism,  exhaustion,  neiwous  depression, 
infectious  diseases,  particularly  acute  rheu- 
matism and  erysipelas,  Raynaud’s  disease, 
thyroid  disease,  local  arterial  disease. 

The  anatomical  cause  is  a “ sclerosis  of  the 
small  arterioles  of  the  skin,  together  with  a 
general  arteriosclerosis.”  (A.  G.  Gibson.) 

Prognosis. — The  outcome  is  uncertain.  The 
circumscribed  form  disappears  after  several 
months,  or  it  may  last  for  years.  The  diffuse 
type  is  often  fatal,  although  recovery 
may  occur. 

Treatment. — This  has  been  unsatisfactory. 
A correct  hygienic  regunen  should  be 
observed,  e.g.,  adequate  rest  and  exercise, 
well-ventilated  apartments,  but  the  avoid- 
ance of  cold  and  draughts,  flannel  clothing, 
care  of  the  skin  and  bowels,  regular  hours  of 
eating  and  sleeping,  rest  before  and  after 
meals,  nutritious  food,  with  perhaps  cod- 
liver  oil,  and  tonics  (see  Drugs,  Part  11) 
Meats  should  be  reduced  to  a minimmn. 
A daily  hot  shampoo  and  massage  with 
bland  oils  is  recommended  to  restore  the 
circulation.  General  and  local  galvanism 
may  be  of  some  benefit.  Electrolysis  (see 
under  Nsevus  Vascularis),  or  the  X-rays  (q.v.) 
may  be  tried.  Thiosinamin  is  said  to  be 
worthless.  Thyroid  extract  (q.v.  in  Part  11) 
is  of  doubtful  utility.  One  may  start  with 
gr.  twice  daily,  and  gradually  increase 
the  dose  to  gr.  v,  twice  daily,  if  practicable, 


SUMMER  ERUPTION,  RECURRENT 


not  allowing  the  pulse,  with  the  patient  at 
rest,  to  rise  above  100.  (Gibson.) 

Scorpion  Bites. — See  Bites. 

Scrofuloderma. — L.  scrof'iila,  sow-pig  + 
Gr.  8epiJ.a  skin.  See  Tuberculosis  Cutis. 

Scrotal  Pruritus. — L.  scrotum,  bag.  See 
under  Pruritus. 

Sebaceous  Cyst. — L.  seb'um,  suet;  Gr. 
Kvaris  cyst.  The  treatment  is  excision  under 
local  cocaine  or  novocaine  (see  Part  1 1 ) 
anajsthesia,  followetl  by  closure  of  the  skin 
incision  with  a fine  silk  subcutaneous  suture. 

Seborrhoea. — L.  seb’um,  suet;  -j-  Gr.  poLa 
flow.  Sebaceous  hypersecretion,  affecting 
commonly  the  nose,  forehead,  and  scalp. 

Possible  etiological  influences  are  general 
debility,  anaemia,  phthisis,  severe  constitu- 
tional diseases,  especially  the  exanthemata, 
dyspepsia,  intranasal  pressure  (causing  nasal 
seborrhma),  contagion  (see  Dermatitis  Sebor- 
rhoeica) 

Treatment. — Attend  to  any  possible  causal 
influence.  Bathe  the  affected  skin  frequently 
with  soaj:)  and  hot  water,  and  employ  one  of 
the  following  applications; 

Zinci  sulphatis, 

Potassii  sulpliureti,  aa gr.  v-xx 

Aqiuc o i 

M.  Sig. — Apply  in  sufficient  strength  and  fre- 
quency to  produce  some  irritation  and  desquama- 
tion. (Lotio  alba.) 

4 Resorcinolis gr.  v-lx 

Alcoholis 5iv 

B Sulphuris  pnecipitati 1.0 

Pulveris  talci 4. 0-5.0 

For  infants,  employ  oil  followed  by 
warm  water  and  soap  for  the  removal  of 
ailherent  crusts,  and  apply  one  of  the 
following  ointments: 

B Re.sorcinolis gr.  x 

Adipis  lanjB  hydros! ji 

B Sulphuris  prmcipitati 3i 

Adipis  lana;  hydros! 5 i 

Seborrhoea  Sicca.  — Ij.  sie'eus,  dry.  See 
Dtu’matitis  Seborrhoeica. 

Seborrhoeic  Alopecia. — See  Alopecia  Se- 
borrhoeica. 

Dermatitis.  — See  Dermatitis  Sebor- 
rhoeica. 

Senile  Skin  Changes. — Sec  Atrophia 
Cutis  Senilis. 

Shingles. — See  Herpes  Zoster. 

Sloughing  Phagedena,  Tropical.  — See 

Phagedena  Troj)ica. 

Smallpox;  Variola. — See  Part  1,  General 
Medicine  and  Surgery. 

Smoker’s  Patches.  — See  Leucoplakia 
Buccalis. 

Snake=Bite. — See  under  Bites. 


Sphaceloderma. — SeeGangreneof  the  Skin. 

Spider  Naevus.  — L.  nce'vus,  mask.  See 
Telangiectasis. 

Sting  . — See  Bites. 

Sporotrichosis. — ^Gr.  awopos  seed  + 6pi^ 
hair.  A chronic  nodular  or  granulomatous, 
suppurative,  ulcerative  affection  of  the  skin 
and  subcutaneous  tissues,  sometimes  with 
involvement  of  the  mucous  membranes, 
muscles,  bones,  etc.,  due  to  several  forms 
of  hypomycetic  fungus  belonging  to  the 
sporothrix  grouj).  The  nodules  are  sub- 
cutaneous lymphatic  abscesses.  The  affec- 
tion may  be  contracted  from  aniiiials, 
especially  the  horse. 

The  clisease  is  distinguished  from  tuber- 
culosis, syphilis,  and  actinomycosis  by  cul- 
ture of  the  organism  and  by  the  specific 
agglutinating  and  fixation  properties  of  the 
patient’s  serum.  To  obtain  cultures,  trans- 
fer aseptically  some  of  the  light  yellow  pus 
to  gluco.se-,  maltose-,  or  blood-agar,  and  keep 
at  room  temperature.  Circular  growThs 
with  marked  striation  develop  in  ten  to 
twelve  days,  which  later  may  become  black. 
Smears  from  these  show  branched  mycelial 
filaments  with  terminal  or  lateral  budtled 
spores.  In  the  living  tissues  these  branched 
filaments  are  not  found,  but  in  their  place 
elongated  or  oval  bodies,  often  with  budding 
processes.  (Webster.) 

Treatment.— Abscesses  may  be  thoroughly 
ojjened  and  cleansed,  and  the  lesions  treated 
with  an  aqueous  solution  of  iodine  and 
potassium  iodide,  gr.  xv  of  the  former  and 
5iiss  of  the  latter  to  the  pint,  wdiile  potas- 
sium iodide  (q.v.  in  Part  11)  is  given  inter- 
nally, as  in  actinomycosis.  Adamson  says 
that  surgical  treatment  is  “inadvisable.” 

The  disease  may  be  cmed  in  from  four 
to  six  weeks. 

Stings. — See  Bites. 

Stomatitis. — Gr.  aropa  mouth  -ltl$ 
inflammation.  See  Part  1. 

Straw=Itch. — See  Grain-Itch. 

Strophulus. — L.  See  Miliaria. 

Sudamen. — L.  siida're,  to  sweat.  An  ephem- 
eral, non-inflammatory,  abundant  eruption 
of  sweat  vesicles  resembling  dew-di’ops. 

Sudamina  occur  often  near  the  tennina- 
tion  of  acute  febrile  disorders,  e.g.,  tj^ihoid, 
typhus,  rheumatic,  puerperal,  and  septic 
fevers,  and  also  in  conditions  of  depressed 
vitality,  as  in  tuberculosis. 

Tn'atment  is  scarcely  required.  The 
body  may  be  sponged  with  equal  parts  of 
alcohol  and  water,  dried,  and  dusted  with  a 
bland  powder,  such  as  starch  or  talcum. 

Summer  Eruption,  Recurrent.  — See  Hy- 
droa  Vacciniforme. 


SKBORRHCEA 


LAROUSSE  MEDICAL. 

Seborrhoea.  Sporotrichosis.  Favus.  Tricophytosis. 


7.  — Seborriicea  (seborrhoeic  eczema). 


4.  -Sporotrichosis. 

N'^  2531  O'"  dc  Beurman, 


1944.  D'  Fournier 


3.  — Favus. 


N'^  548.  D''  Besnier. 


2.  --  Circinate  tricophytosis. 

N“  2516.  D'  Hallopeau. 
St.  Louis  Hospital  Museum,  Paris. 


TATOO  :\rAUKS,  REMOVAL  OF 


Sunburn. — Both  for  the  prevention  and 
treatment  of  sunburn  and  eczema  solare,  one 
may  use  pui’e  calamine  powder  or  calamine- 
zinc-oxide  lotion: 


Calamina', 

Zinci  oxicli,  aa oji 

Acidi  borici 5i 

Glycerini i^xv 

Liquoris  ealcis 5 1 

Aqua>,  q.s.,  ad 5iv 


Sweat,  Colored. — See  Chromidrosis. 

Diminished. — See  Anhidrosis. 

Excessive. — See  Hyperidrosis. 

Stinking. — See  Broniidrosis. 

Suppression. — See  Anhich’osis. 

Vesicles.- — L.  vesic'ula,  dhn.  of  vesi'ca, 
bladder.  See  Sudamen. 

Sycosis  Vulgaris. — Gr.  avKoais,  avKov  fig; 
L.  vulgar'is,  conunon.  An  obstinate,  chronic 
pustular  folliculitis  of  the  bearded  and  mus- 
tache regions,  each  pustule  being  pierced  by 
a hair  which  is  easily  extracted. 

Etiology.— The  staphylococci  aureus  and 
albus  are  the  usual  infecting  agents.  Con- 
tamination from  a nasal  catarrh  and 
ill  health  from  any  cause  are  sometunes 
causal.  “Alcohol,  inchgestible  foods,  tobacco, 
excessive  tea  or  coffee,  and  bromine- 
containing  ch’ugs,  all  have  a damaging 
tendency.”  (Stel  wagon.) 

Treatment.— Enjoin  the  observance  of  a 
correct  hygienic  regmien,  e.g.,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  a 
daily  morning  tepid  bath  before  breakfast, 
in  a warm  room,  followed  by  a cold  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
rest  before  and  after  meals,  a sunple,  nutri- 
tious, well-balanced  ration,  free  bowel  activ- 
ity, and  tonics,  if  indicated. 

The  face  should  be  shaved  every  day  or 
two,  and  all  crusts  removed.  Before  the 
antiseptic  applications  are  made,  any  acute 
inflannnatory  action  should  be  reduced  by 
soothing  remedies,  such  as  cold  cream, 
zinc  oxide  ointment  or  calamine  lotion: 


b Calaminie, 

Zinci  oxicli,  aa 

Acidi  borici 5i 

Acidi  carbolici tijx 

Liquoris  calcis 5 i 

Aquas,  q.s.,  ad 5iv 


M.  Sig. — Shake  well,  and  dab  on  frequently. 

After  all  inflammatory  action  has  sub- 
sided, rub  in  morning  and  night,  following  a 
hot  .soap  and  water  bath,  one  of  the  follow- 
ing ointments: 


b Hydrargyri  ammoniati gr.  x-3i 

Adipis  lana;  hydros! 5i 


Sulphuris  praeeipitati gr.  x-xlviii 

Adipis  lana;  hydros! 5 i 

b Resorcinohs gr.  xxiv-xlviii 

Adipis  kina' hydros! 3* 

1^  Acidi  carbolici, 

Tincturai  ioch, 

Chlorali  hydrati,  aa 3> 


M.  Sig. — Pull  out  each  affected  hair,  and  touch 
each  lesion  with  the  solution. 

Under  this  method  of  treatment,  the  dura- 
tion of  the  chsease  is  from  two  to  twelve 
months.  Shaving  and  cleanliness  should  be 
persistently  practiced  for  months  after  an 
ajjparent  cure,  in  order  to  prevent  a relapse. 

Ionic  medication  {q.v.  in  Part  1)  is  recom- 
mended. A zinc  positive  electrode  may  be 
inserted  into  the  pustule,  and  a current  of 
twenty  to  thh’ty  milliamperes  employed  for 
thirty  minutes  (see  under  Hypertrichosis). 
Ehrmann  recommends  the  introduction  of 
pyoktanin  (10  per  cent,  solution)  into  the 
diseased  follicles  by  cataphoresis : the  anode, 
soaked  in  the  solution,  is  applied  to  the  part, 
and  the  cathode  is  held  in  the  hand,  or,  per- 
haps, placed  on  the  back  of  the  neck. 

Rajiid  ami  satisfactory  results  are  obtained 
with  the  X-rays  (q.v.),  non-diseased  parts 
being  protected  with  lead  foil.  Give  an 
erythema  dose,  unfiltered,  at  three  or  four 
weeks’  intervals,  although  one  thorough  dose 
is  generally  sufficient  (Knox).  The  hairs 
fall  out,  but  reappear  after  some  months. 
C’are  should  be  taken  against  the  production 
of  a permanent  alopecia.  No  active  local 
treatment  should  be  employed  during  the 
X-ray  treatment. 

Syphilis. — See  Part  1. 

Tattoo  Marks,  Removal  of. — The  various 
methods  employed  are  here  described  in  the 
probable  orcler  of  their  usefulness. 

1.  Cover  the  areas,  to  no  larger  extent 
than  one  or  two  square  inches  at  a time, 
with  a concentrated  solution  of  tannin. 
Tattoo  this  in  with  punctures  close  together, 
then  rub  the  surface  firmly  with  the  silver 
nitrate  stick.  After  several  minutes  wipe 
off  the  silver  nitrate.  An  eschar  forms 
which  eventually  drops  off  leaving  a slight 
scar.  (Variot.) 

2.  Cleanse  the  part  thoroughly;  then 
tattoo  in  a solution  of  tlih'ty  parts  of  zinc 
chloride  in  forty  parts  of  water.  Treat 
no  larger  .surface  than  one  or  two  square 
inches  at  a time.  An  eschar  forms  which 
eventually  drops  off,  leaving  a slight 
.scar.  (Brault.) 

3.  Punch  the  skin  with  a cutaneous 
trephine  or  punch,  cut  off  the  projecting 
disc  of  skin,  and  transplant  a slightly  larger 


TONGUE  DISEASES 


disc  of  healthy  skin  made  by  a larger  tre- 
phine. If,  however,  the  area  to  be  removed 
is  large,  use  the  jjimch  on  several  parts  of 
its  surface,  and  apply  a ch’essing  of  one  part 
acetanelid  and  seven  parts  boric  acitl.  After 
healing  has  occurred,  treat  new  areas  in  the 
same  nranner. 

4.  Electrolysis,  applicable  only  to  small 
sjX)ts,  because  of  the  resulting  scarring. 

Introduce  the  needle,  attached  to  the 
negative  pole  of  a galvanic  battery,  from 
the  eilge  of  the  spot  slantingly  toward  the 
centre,  at  intervals  of  about  one-eighth  of  an 
mch  apart.  A current  of  one,  to  four,  to 
five,  to  ten  milliamperes  is  allowed  to  act 
for  one-half  to  one  minute,  or  a trifle  longer 
at  each  insertion  of  the  needle.  If  any  pig- 
ment remains  after  the  crust  has  been  cast 
off,  repeat  the  jn'ocess. 

5.  Excision. 

Teething  Rash. — See  Miliaria. 

Telangiectasis. — Gr.  reXos  end  -f  ayyeiov 
ves.sel  -b  eKraais  dilatation.  Telangiectases 
are  acquired  cutaneous  capillary  dilatations 
or  angiomata.  The  so-called  spider  naevus 
presents  the  apj^earance  of  a red  dot  with 
radiatmg  cUlated  capillaries.  The  very  com- 
mon and  interesting  “ papillary  ectases  ” 
are  jiinhead  to  small  pea-sized,  crimson  to 
purplish  red,  flattenecl  or  rounded,  raised 
angiomata.  They  occur  in  depraved  condi- 
tions of  health,  and  may  be  found  in  chil- 
dren as  well  as  m adults,  in  the  obese  as 
well  as  in  the  thin  and  emaciated.  Telangi- 
ectasis occurs  in  acne  rosacea,  morphoea, 
lujjus  erythematosus,  lupus  vulgaris,  syph- 
ilis, angiokeratoma,  xeroderma  pigmentosum, 
the  senile  skin.  X-ray  dermatitis,  purpura 
aimularis  telangiectodes. 

Treatment. — Electrolysis  is  usually  employed 
(see  Acne  Rosacea.)  The  chlated  capillaries 
may  also  be  slit  up  with  a sharp  knife  and 
cauterized  with  carbolic  acid. 

Thromboangitis  Obliterans. — Gr.  dpbufios 
clot  -b  ayyeiov  vessel  -b  -trts  inflaimnation. 
See  under  Gangrene  of  the  Skin. 

Tinea  Axillaris. — L.  tinea,  moth;  axil'la, 
arm-pit.  See  under  Ringworm. 

Barbae. — See  under  Ringworm. 

Circinata. — L.  circulus,  ring.  See  Ring- 
worm.) 

Cruris. — L.  mis,  crur'is,  leg.  See  under 
Ringworm;  and  Dhobie  Itch. 

Tinea  Imbricata. — L.  tinea,  moth;  imbri- 
cdtus  overlajjping,  from  imb'rcx,  tile.  A 
tropical,  local,  contagious,  fungus  disease, 
chara(‘terized  by  the  formation  of  brown 
patches  in  the  shape  of  concentric,  imbri- 
cated scaly  rings. 

The  mycelial  fungus  may  be  demon- 


strated by  microscopic  examination  after 
soaking  for  fifteen  minutes  in  liquor  potassse. 

Treatment. — After  removal  of  the  scales  by 
scrubljing  with  hot  water  and  soap,  or  by 
means  of  alkaline  baths  (sodimn  bicarbon- 
ate, two  to  six  ounces  to  the  thirty-gallon 
bath),  rub  in  petroleum  once  or  twice  daily 
for  fourteen  days,  no  bath  being  taken  dur- 
ing this  time;  or  paint  on  linimentum  iodi 
(see  Part  11)  to  a limited  area  each  day;  or 
try  Whitfield’s  salicylic  and  benzoic  ointment 
(see  Ringworm)  which  is  highly  praised  for 
ringworm.  The  underwear,  etc.,  should  be 
disinfected  by  boiling.  The  disease  is  read- 
ily cured,  but  strict  cleanliness  must  be  ob- 
served in  order  to  guard  against  relapse. 

Tinea  Nodosa. — L.  nod'us,  knot.  See  under 
Hair  Diseases. 

Sychosis. — Gr.  avKov  fig.  See  Ringworm. 

Tonsurans. — L.  tonsur'a,  shaving.  See 
Ringworm. 

Trichophytina. — See  Ringworm. 

Tinea  Versicolor. — L.  ver'sio,  turning  -b 
color,  tint.  A common,  trivial,  persistently 
recurring,  slightly  contagious,  local  fungus 
disease,  occurring  chiefly  on  the  trunk, 
characterized  by  brownish  yellow,  furfurace- 
ous,  macular  patches. 

The  mycelial  fungus  may  be  demon- 
strated by  soaking  the  scales  in  liquor 
potas.S£B  for  fifteen  minutes  and  examining 
microscopically. 

Treatment.— Scrub  the  affected  area  daily 
with  soap  and  hot  water,  in  order  to  remove 
the  scales;  then  dry,  and  rub  in,  twice  daily, 
sochmn  hyposulphite  solution,  5i~h  ad  5i> 
either  alone,  or  followed  inmiediately  by 
tartaric  acid  solution,  gr.  xv  ad  5i-  The 
latter  causes  the  liberation  of  nascent  sul- 
phur and  sulphm’ous  acid  in  the  skin.  Sul- 
phur {q.v.  in  Part  1 1)  may  be  given  internally. 
The  underwear,  etc.,  should  be  boiled,  baked, 
or  soaked  in  the  hyposulphite  solution. 

After  an  apparent  cure,  continue  to 
apply  the  parasiticide  once  or  twice  a week 
for  two  or  three  months  in  order  to  guard 
against  recurrence. 

The  chsease  is  usually  cured  in  one  to 
three  months. 

Toe=Nail  Affections. — See  Nail  Diseases. 

Tongue  Diseases. — 1.  Atrophy,  due  to 
hypoglossal  neiwe  paralj'sis,  occurring  in 
bulbar  paralysis  {q.v.  in  Part  1),  and  some- 
times in  tabes,  meningitis,  plumbism, 
trauma,  tumors,  scars,  bone  disease. 

2.  Black  Tongue. — A rare  affection,  due 
to  hyerkeratosis  of  the  lingual  papillae, 
which  usually  disappears  spontaneously  after 
a jieriod  of  weeks,  months,  or  years.  Treat- 
ment is  of  no  avail. 


UR  TIC  ARIA 


LAKOUSSE  MEDICAL. 

Urticaria.  Vitiligo.  Zona. 


2.  — He/'pes  zoster  ophthalmicus. 

N”  187',  D''  Danlos 


Vitiligo. 

N“  itiO.  U''  Lallicr. 


St.  Loins  Hospital  Museum,  Paris. 


— Zona. 

N»  85.  D'  Lallier. 


4.  Urticaria. 

N ■ 237  O'-  Lallier. 


URTICARIA 


3.  Furrowed  Tongue. — Cleanliness  is  all 
that  is  required. 

4.  Geographic  Tongue  (q-v.) 

5.  Glossitis  Acuta  (see  Part  1). 

6.  Glossitis  Exfoliativa  (see  Geographic 
Tongue) . 

7.  Glossitis,  Moeller’s  (see  Glossodynia 
Exfoliativa). 

8.  Glossitis  Papillaris  (see  Glossitis,  in 
Part  1). 

9.  Glossodynia  (see  Part  1). 

10.  Glossodynia  Exfoliativa  (q.v.) 

11.  Hypertrophy  or  Macroglossia  (q.v.  in 
Part  1). 

12.  Leucoplakia  (q.v.) 

13.  Lingual  Tumors  and  Cysts  (see 
Part  1 ). 

14.  Macroglossia  (see  Part  1). 

15.  Plaques,  Transitory,  Benign  (see 
Geographic  Tongue). 

16.  Psoriasis  Linguae  (see  Leucoplakia). 

17.  Ulcers  (see  Glossitis,  in  Part  1). 

Transitory  Benign  Plaques  of  the  Tongue. 

— See  Geographic  Tongue. 

Trichiasis. — Gr.  rpixia-cn^  inverted  hairs. 
See  under  Hair  Diseases. 

Trichophytia.— See  Ringworm. 

Trichorrhexis  Nodosa. — Gr.  6pL^  hair  + 
fracture;  L.  nod' us,  knot.  See  under 
Hair  Diseases. 

Tropical  Sloughing  Phagedena.  — See 

Phagedena  Tropica. 

Tropical  Sore. — See  Oriental  Sore. 

Tubercle,  Anatomic. — See  Tuberculosis 
Cutis. 

Tuberculides.^ — A group  of  skin  eruptions 
which  occur  in  association  with  systemic 
tuberculosis.  They  are  described  under  Acne 
Varioliformis.  Lichen  Scrofulosus  and  Ery- 
thema Induratum. 

For  local  skin  tuberculosis,  see  Tubercu- 
losis Cutis. 

Tuberculosis  Cutis. — L.  tuber' culum,  no- 
dule; cutis,  skin.  Tuberculosis  of  the  skin 
includes  (1)  the  extremely  rare  Tubercu- 
losis Ulcerosa,  or  miliary  tuberculous  ulcers 
or  nodules  of  the  skin,  occurring  almost 
exclusively  about  the  mucous  outlets  in 
those  with  internal  tuberculosis;  (2)  The 
uncommon  Tuberculosis  vel  Lupus  Verru- 
cosa (Anatomic  Tubercle;  Post-Mortem 
Wart;  Verruca  Necrogenica),  occurring  usu- 
ally on  the  back  of  the  hand  in  autopsy  per- 
formers, and  characterized  by  a warty 
development  on  an  infiltrated  but  not 
nodular  base;  (3)  the  more  common  Scroful- 
oderma, a suppurating  dermatitis  usually 
pre.senting  sinuses  and  secondary  to  tuber- 
culous adenitis  or  other  subcutaneous 
tuberculous  process;  and  finally,  (4)  Lupus 
Vulgaris,  characterized  by  deep,  brownish 


red  or  apple-butter-colored  nodules  and  infil- 
trated patches. 

Treatment.— This  is  fully  considered  under 
Lupus  Vulgaris.  The  treatment  of  Scrofu- 
loderma, however,  is  chiefly  surgical. 

Tylosis. — Gr.  tvXuchs  callosity.  See  Ca’- 
lofsitas. 

Ulcerating  Granuloma  of  the  Pudenda. — 

L.  ulcus,  ulcer;  granulum,  granule  + Gr. 
-wpa  tumor;  L.  ptidere,  to  be  ashamed.  A 
tropical,  auto-inoculable,  chronic  recurrent, 
ulcerating  granuloma,  without  constitu- 
tional symptoms. 

Treatment.— It  is  probably  best  to  excise 
the  entire  growth,  if  it  is  not  too  large. 
Scraping  and  the  application  of  chemical 
caustics  or  the  actual  cautery  may  be  em- 
ployed. Tartar  emetic  is  probably  a speci- 
fic. Give  it  intravenously  (q.v.  in  Part  1), 
every  second  day,  beginning  with  5 c.c.  of  a 
1 per  cent,  solution  (sterilized  by  filtering 
cold  through  a Berkefeld  filter),  and  increas- 
ing to  10  to  12  c.c.  Twenty  or  more  injec- 
tions are  said  to  be  required  for  a cure; 
but  occasionally  there  is  recurrence. 
Vicente  Pardo  reports  cures  after  about 
five  injections. 

Ulcers,  Cutaneous. — See  Part  1,  General 
Medicine  and  Surgery. 

Ulcers,  Lingual. — L.  ling'ua,  tongue.  See 
Glossitis,  in  Part  1. 

Mouth. — See  Stomatitis,  in  Part  1. 

Tongue. — See  Glossitis,  in  Part  1. 

Uncinarial  Dermatitis. — See  Ground-Itch. 

Urticaria. — L.  ur'tica,  a nettle.  A com- 
mon, acute  or  chronic  inflammatory  affec- 
tion of  the  skin,  characterized  by  the  sudden 
occurrence  of  various  sized,  usually  evanes- 
cent wheals,  of  a pink  or  reddish  color,  or 
white  with  a pinkish  areola,  and  accom- 
panied by  itching.  A wheal  is  a circumscribed 
oedema  of  the  corium.  Giant  urticaria  is  also 
called  angioneurotic  oedema  (q.v.). 

Etiology. — A special  idiosyncrasy  is  the 
important  predisposing  cause.  The  exciting 
causes  are  many:  bites  or  poisoning  or  irri- 
tation produced  by  wasps,  bees,  mosquitoes, 
fleas,  pediculi,  bed-bugs,  scabies,  jelly-fish, 
certain  kinds  of  caterpillars,  stinging  nettle, 
formalin,  scratching,  poulticing,  galvaniza- 
tion, sudden  chilling,  rarely  sun  heat;  cer- 
tain foods,  oysters,  clams,  lobsters,  crabs, 
shrimps,  mussels,  fish,  pork,  sausage,  veal, 
mutton,  eggs,  cheese,  butter,  mushrooms, 
strawberries,  tomatoes,  cucumbers,  oatmeal, 
buckwheat,  nuts;  certain  drugs,  copaiba, 
cubebs,  opium,  salicylates,  iodides,  mercury, 
arsenic,  quinine,  chloral,  turpentine,  valer- 
ian, coal-tar  products,  formalin,  antitoxines 
or  sera;  certain  odors;  intestinal  worms, 
intestinal  catarrh,  dyspepsia;  gout  and 


VERUCCA;  WART' 


rheumatism;  cholelithiasis;  jaundice;  album- 
inuria; g;lycosuria;  purpura;  malaria;  utero- 
ovarian  disease;  neuralgia,  locomotor  ataxia, 
hysteria,  emotional  disturbances,  emigra- 
tion; asthma;  eye-strain;  surgical  opera- 
tions; anaemia;  hydatid  fluid  absorption; 
tapping  a pleuritic  effusion;  phimosis;  focal 
infection,  etc.  The  affection  may  be  a 
manifestation  of  anaphylaxis  {q.v.  in  Part  1). 

Prognosis. — Acute  urticaria  is  transitory, 
but  recurrences  are  common.  The  progno- 
sis in  chronic  urticaria  depends  upon  the 
ability  to  discover  and  remove  the  cause. 

Treatment. — Acute  urticaria  probably  usu- 
ally has  its  origin  in  the  gastro-intestinal 
tract,  so  that  a brisk  calomel  and  saline 
purge  is  indicated,  followed,  as  is  advised,  by 
large  doses  of  sodium  bicarbonate  (see  Part 
11  for  drug  dosage  and  formulse). 

Chronic  urticaria  calls  for  a searching 
investigation  into  the  cause.  The  diet 
should  be  simple  and  bland,  tea,  coffee, 
alcohol,  and  all  possibly  provocative  foods 
being  avoided.  Large  quantities  of  water, 
eight  to  ten  glasses  a day  between  meals, 
should  be  drunk.  A glass  of  water  contain- 
ing s(xlium  bicarbonate  may  be  taken  one 
hour  before  each  meal  and  also  between 
meals.  The  bowels  should  be  kept  active. 
A daily  hot  bath  of  from  ten  to  thirty  min- 
utes duration,  especially  alkaline  baths 
which  relieve  itching  (sodium  bicarbonate 
or  sodium  biborate  or  ammonium  chloride, 
one  or  two  ounces  to  the  thirty-gallon 
bath),  is  beneficial.  Nervous  sedatives  are 
sometimes  of  value,  e.g.,  bromides,  phena- 
cetin,  antipyrine,  acetanelid,  sulphonal, 
trional,  chloral,  etc.  (see  Part  11). 

Empirical  remedies,  so  called,  are  pilo- 
carpine, calcium  chloride;  yeast  prepara- 
tions, quinine,  atropine,  strychnin,  arsenic. 
Pusey  prefers  pilocarpine  in  doses  sufficient 
to  procluce  a very  slight  increase  of  the  per- 
spiration (see  Part  11). 

Local  antipruritic  remetlies  follow: 


Acidi  carbolic! 3ss-i 

Glycerini ,3ss 

Alcoholis 5i 

Aqiuc,  q.s.,  ad Sviii 

(Stelwagon.) 

TliymolLs gr.  viiss-xv 

Glycerini 3ji 

Alcoholis 5ji 

Li()uoris  potassai 5i 

Aqua',  q.s.,  ad Sviii 

(Stelwagon.) 

Mentholis gr.  xx-xl 

Cainphor-chlorali, 

Acidi  carbolici,  aa gr.  xx-lx 

Ext.  hainainclidis  de.stil. 

Alcoholis,  aa 3ii 


Calamina;, 

Zinci  o.xidi,  aa 3i~ii 

Acidi  borici 5i 

Glycerini iqjx 

Acidi  carbolici i^.xv-xxx 

Liqiioris  calcis gi 

Aqua',  q.s.,  ad giv 

(Calamine  lotion.) 

1^  Pul veris  acidi  borici 3ss-i 

Pulveris  zinci  o.xidi,  seu  talci, 
seu  ainyli,seu  zinci  stearatis . gi 

Pulveris  acidi  salicylic!,  seu  re- 


sorcinolis,  seu  thymolLs gr.  v-xx 

Pulveris  zinci  oxidi,  seu  talci, 
seu  ainyli g i 


Apply  the  powders  after  the  bath 
or  lotion. 

Urticaria,  Giant. — -See  Angioneurotic 
Oedema. 

Urticaria  Pigmentosa. — L.  ur’tica,  nettle; 
pigynen'ium,  paint.  A very  rare,  urticaria- 
like,  itching,  recurring  eruption  of  wheals 
(circumscribed  oedema  of  the  coriiun),  fol- 
lowed by  persistent  pigmented  macules  or 
nodules,  which  can  be  changed  into  wheals 
by  rubbing. 

It  occurs  as  a rule  in  infants,  and  usually 
subsides  as  puberty  is  approached;  but  it 
may  come  on  at  puberty,  or  even  later. 

Treatment. — The  disease  may  be  treated 
experimentally  like  urticaria,  but  little 
except  the  relief  of  itching  can  usually 
be  accomplished. 

Vaccinia;  Cow=Pox;  Vaccination.- — See 
Part  1. 

Varicella;  Chicken-Pox. — See  Part  1. 

Variola. — See  Smallpox,  in  Part  1. 

Venereal  Wart. — L.,  ven'us.  See  under 
Verruca. 

Verruca;  Wart. — L.  verru'ca  wart..  A 
wart  consists  of  hypertrophietl  epidermis 
and  papillae. 

Classification.— 1.  Verruca  Vulgaris,  the  or- 
dinary wart  or  simple  papilloma,  probably 
mildly  contagious. 

2.  Verruca  Plana  Juvenilis,  multiple  flat 
warts,  re.sembling  somewhat  lichen  planus. 

3.  Verruca  Senilis,  the  pigmented,  flat, 
greasy  wart  of  old  people  (see  Atrophia  Cutis 
Senilis). 

4.  Verruca  Acuminata. — Pointed  condy- 
loma, venereal  wart,  moist  wart,  fig  wart, 
cauliflower  excrescences,  vegetations — con- 
tagious, skin-colored,  pink  or  purplish 
red,  finger-like  vegetations,  resembling 
cauliflower,  cockscomb,  bunch  of  grapes, 
or  mulberries. 

Causes.— Uncleanliness,  irritating  dis- 
charges, congestion  and  leucorrhoea  of  preg- 
nancy, gonorrhoea,  syphilis,  etc. 

5.  Flat  Condyloma  or  moist  painile  of 


(Pusey.) 


VON  RECKLINGHAUSEN’S  DISEASE 


secondary  syphilis — modified  mucous  patch: 
“ soft,  grayish,  with  a broad  base.” 

6.  Verruca  Telangiectatica  or  Angiokera- 
toma (q.v.). 

Treatment.— 1 . Verruca  Vulgaris. — To 

remove  isolated  warts,  one  of  the  following 
methods  may  be  selected: 

(a)  Pick  up  the  w'art  with  toothed  forceps, 
and  cut  it  off  below  the  base  with  a sharp 
knife;  suture  the  skin  with  catgut,  or  cauter- 
ize the  wound  with  pure  carbolic  acid  or 
silver  nitrate  applied  with  a matehstick. 

(b)  First  freeze  the  wart  with  ethyl  chlor- 
ide, then  snip  it  off  with  curved  scissors,  or 
curette  it  thoroughly,  and  after  the  bleecling 
has  ceased,  paint  the  base  with  jxire  car- 
bolic acid  followed  by  a light  application  of 
nitric  acid;  or  cauterize  the  base  lightly 
with  zinc  chloride. 

(c)  Freeze  the  wart  with  carbon  dioxide 
snow  or  liquid  air  Press  a pencil  of  carbon 
dioxide  snow,  of  the  same  diameter  as  the 
wart,  firmly  on  the  latter  until  it  is  frozen 
to  its  base.  This  may  be  repeated,  if  neces- 
sary, every  two  or  three  weeks. 

(d)  Employ  electrolysis;  with  the  needle 
attached  to  the  negative  pole  and  the  mois- 
tened positive  electrode  applied  near-by, 
make  one  or  two  insertions  into  the  base  of 
the  wart,  allowing  the  current  to  act  for 
one-half  to  one  or  two  minutes,  accorihng 
to  the  size  of  the  growth  and  the  strength  of 
the  current,  the  latter  varying  between  one 
and  four  or  five  milliamperes;  or  ionization 
may  be  employed  with  a zinc-positive  needle, 
the  latter  being  inserted  into  the  deep  layers 
of  the  epidermis,  not  into  the  true  skin  or 
corium  or  dermis,  and  a current  of  one  or 
two  milliamperes  employed  for  one  to 
six  minutes. 

(e)  Curette  warts  occurring  beneath  the 
nail,  and  then  cauterize  with  the  Paquelin 
or  galvanocautery. 

(f)  Pedunculated  and  filiform  warts  may 
be  ligatured  with  silk,  or  snipped  off,  and 
silver  nitrate  applied  to  the  base.  The  gal- 
vanocautery, however,  is  safer  in  large  pedun- 
culated warts  owing  to  their  vascularity. 

(g)  Employ  the  high  frequency  current 
(g.v.  in  Part  1,  under  Medical  Electricity). 

(h)  Employ  radium  (q.v.:  10-30  min.  ex- 
posure) or  the  X-ray  (two  or  three  thorough 
exposures  of  the  latter,  q.v.). 

(i)  After  paring,  scraping,  or  sandpaper- 
ing the  wart  down,  and  protecting  the 
surrounding  skin  with  vaseline,  apply  repeat- 
edly and  cautiously  with  a matehstick  or 
glass  pen  or  rod,  a strong  cau.stic,  e.g., 
liquor  potassse  (q.v.  in  Part  11),  salicylic  acid, 
10  to  20  per  cent,  in  collodion,  glacial  acetic 


acid,  chromic  acid,  nitric  acid,  zinc  chloride, 
lactic  acid,  acid  nitrate  of  mercury,  etc. 
This  treatment  is  not  as  satisfactory  as  the 
preceding  methods. 

2.  Multiple  Flat  Warts  or  Verruca 
Plana  Juvenilis. — ^Multiple  small  flat 
warts  may  be  ionized  with  magnesium  sul- 
phate, 5 per  cent,  solution,  using  a carbon 
anode  and  a current  of  ten  milliamperes  for 
fifteen  minutes;  or  a rod  of  metallic  mag- 
nesium may  be  used  as  the  anode  for 
individual  warts  (see  Ionic  Medication,  in 
Part  1).  The  warts  should  first  be  pricked 
with  a needle.  They  disappear  in  three  to 
four  weeks  after  a single  treatment. 

Radiotherapy  (“  a few  applications 
of  moderate  intensity  ” — Piisey)  may 

be  employed  (see  Rontgenology  in  Part  1). 

Hyde  and  Montgomery  recommend  the 
daily  inunction  of  Vleminck.x’s  solution : 


II  Calcii  hydroxitli gss 

Sulphuris  subliniati §i 

Aqu®  destillatae 5x 


Boil  down  to  .six  ounces  and  filter. 

S.  E.  Dore  says:  “ Multiple  flat  warts  on 
the  face  are  best  treated  with  an  ointment 
of  sulphur  and  salicylic  acid.” 


II  Sulphuris  prsecipitati 3 i-iss 

Acidi  salicylici gr.  x-  3 i 

Petrolati  mollis, 

Adipis  lanaj  hydrosi,  aa 3ss 


Individual  warts  may  be  snipped  off  with 
scissors  and  pure  carbolic  acid  applied  to  the 
base  with  a match. 

Certain  internal  drugs  have  been  reputed 
to  be  curative,  e.g.,  magnesium  sulphate, 
gr.  ii-iii,  t.i.d.,  for  children,  5ss,  t.i.d.,  for 
adults;  liquoris  potassii  arsenitis,  -f  for 
children,  irgii-v  for  adults,  t.i.d.a.c.,  well 
diluted;  nitrohydrochloric  acid  (q.v.  in  Part 
11);  tincture  of  thuja  ttjv  in  water,  t.i.d.; 
thjToid  extract  (q.v.);  lime-water  (q.v.);  but 
C.  J.  White  has  in  recent  years  obtained 
much  more  certain  results  with  the  achninis- 
tration  of  protiodide  of  mercury  in  pill  form, 
gr.  34,  t-i-fl-  One  recalls  the  value  of  mercury 
in  the  treatment  of  lichen  planus. 

3.  Verruca  Acuminata. — See  Part  2, 

Gynaecology. 

4.  Condyloma  Syphilitica  — Employ 
local  anti.septics  and  specific  internal  medi- 
cation (see  Syphilis,  in  Part  1). 

Verruca  Necrogenica. — L.  verruca,  wart; 
P€Kpos  corpse  J-  ytwav  to  jjroduce.  See 
Tuberculosis  Chitis. 

Verruga  Peruana. — See  Peruvian  Wart. 

Vitiligo. — L.  See  Leucoderma. 

Von  Recklinghausen’s  Disease. — See  Fi- 
broma. 


ZOSTER 


Vulvar  Pruritus  — L.,  vulv'a.  See  under 
Pruritus. 

Wandering  Rash  of  the  Tongue. — See 

Geographic  Tongue. 

Wart. — See  \'erruca. 

Peruvian. — See  Peruvian  Wart. 

Post=Mortem. — See  Tuberculosis  Cutis. 

Senile. — See  Atrophia  Cutis  Senilis. 

Venereal. — See  under  Verruca. 

Wasp=Sting. — See  Bites. 

Wen. — See  Sebaceous  Cyst. 

White=Leg. — See  Thrombosis  in  Part  1. 

Xanthoma;  Xanthelasma. — Gr.  ^avdos  yel- 
low + -una  tumor;  eXaafia  plate.  A fibro- 
fatty  neoplasm,  appearing  as  soft,  pinhead 
to  wheat-grain  to  bean-sized,  chamois-yellow 
plates  or  nodules  embedded  in  the  corium. 

Two  varieties  are  recognized,  viz.,  xan- 
thoma planum,  occurring  usually  about  the 
eyelids,  and  xanthoma  tuberosum  sen  tuber- 
culatum seu  multiplex,  which  is  somewhat 
general  in  chstribution. 

Etiology.— Heredity,  migraine,  and  jaundice 
bear  some  relation  to  the  disease. 

Prognosis. — The  disease  is  usually  persist- 
ent, and  recm’rence  after  apparent  removal 
is  common. 

Treatment. — The  following  methods  of 
treatment  are  available: 

1.  Electrolysis  (for  xanthoma  palpebra- 
rum). With  the  needle  attached  to  the 
negative  pole  of  a galvanic  battery,  and  the 
moistened  positive  pole  applied  near-by, 
puncture  the  growth  superficially,  at  several 
points  if  large,  using  a current  of  one  to 
five  milliamperes,  for  one-half  to  one  or 
two  minutes,  accorcUng  to  the  size  of  the 
growth  and  the  strength  of  the  current. 
Treat  but  a j^ortion  of  the  growth  at  a time 
if  it  is  very  large.  The  treatment  may  have 
to  be  repeated  at  intervals  of  two  to  four 
weeks.  (Stelwagon.) 

2.  The  application  of  trichloracetic  or 
monochloracetic  acid,  cautiously,  in  scant 
quantity,  only  to  a portion  of  the  growth 
at  a time  if  large.  A second  or  third  applica- 
tion may  be  required. 

3.  A series  of  punctures,  at  intervals  of  one 
or  two  millimetres,  with  a fine  galvano- 
cautery  needle,  repeated  every  two  weeks 
until  cured.  (Sabouraud.) 

4.  Rontgenotherapy  (q.v.  in  Part  1). 

5.  The  high  frequency  current  (see  Med- 
ical Electrolysis  in  Part  1). 


6.  Deep  freezing  under  pressure  for  ten  or 
fifteen  seconds  with  liquid  air  or  solid  car- 
bon dioxide.  (Suggested  by  Pusey.) 

7.  Excision. 

8.  The  continued  application  of  a 25  per 
cent,  salicylic  acid  plaster,  or  salicylated 
collodion,  5i  ad  5i,  for  several  days,  or 
until  the  nodules  are  so  softened  that  they  can 
be  curetted  out,  (for  xanthoma  multiplex). 

Xanthoma  Diabeticorum. — Gr.  ^avdos  yel- 
low -f-  -ufjLa  tmnor.  A verj^  rare,  slightly 
itching  eruption,  of  sudden  evolution,  ob- 
served usually  in  diabetics,  characterized  by 
multiple,  pinhead  to  pea-sized,  inflamma- 
tory, red,  papular  or  nodular  elevations,  the 
most  of  which  present  a central,  chamois 
yellow,  fatty  tip. 

Prognosis. — The  eruption  usually  disap- 
pears spontaneously  in  a few  months 
or  years. 

Treatment.— Treat  the  causal  diabetes  {q.v. 
in  Part  1).  For  itching,  prescribe  some 
one  of  the  antipruritic  remedies  given  under 
Pruritus. 

Xeroderma. — Gr.  ^p6s  dry  -f-  8eppa  skin. 
See  Ichthyosis. 

Xeroderma  Pigmentosum. — Gr.  ^p6s  dry 
-(-  deppa  skin;  L.  pi.gynefituni,  paint.  A very 
rare,  congenital  disease  of  the  skin,  pre- 
dominantly of  the  exposed  parts,  beginning 
usually  in  early  childhood,  and  character- 
ized by  the  appearance  of  numerous  freckles, 
which  become  interspersed  with  atrophic 
white  spots  and  crimson  telangiectases,  fol- 
lowed by  keratoses  and  ulcerations,  and 
finally,  after  ten  to  thirty  years,  epithelio- 
matous  or  cancerous  tumors.  It  nearly 
always  occurs  in  several  children  of  a family. 

Prognosis. — This  is  very  bad,  but  death  may 
be  delayed  many  years. 

Treatment.— Protect  the  exposed  parts  of 
the  body  against  sun  and  wind,  which  are 
probably  exciting  causes  of  the  affection. 
Employ  boric  acid  solution  for  the  ej^es, 
gr.  X ad  5 i,  and  cleanliness  and  bland  oint- 
ments, such  as  boric  ointment,  10  per  cent., 
for  ulcers.  Epitheliomata  may  be  excised 
or  otherwise  destroyed  as  described  under 
Carcinoma  Cutis. 

Yaws. — See  Frambesia. 

Zona. — L.,  girdle,  or  belt.  See  Herpes 
Zoster. 

Zoster. — Gr.  ^wa-ritp  girdle.  See  Herpes 
Zoster. 


APPENDIX 


The  Skin  Armamentarium. — I.  Office 
and  Operating  Room  Equipment. — Electrolysis 
outfit  with  platinum  or  iridoplatinum 
needle;  X-ray;  radium;  scissors;  knives; 
comedo-extractor;  dermal  curette;  fine 
probe;  one-inch  cupping-glass;  tin  or  lead 
foil,  at  least  3^o  inch  in  thickness,  for  pro- 
tecting skin  in  X-ray  work;  Paquelin  caut- 
ery; gauze;  curette;  galvano-cautery;  gal- 
vanic, faradic,  and  high-frequency  currents, 
with  rheostat  and  milliamperemeter;  static 
electricity;  metallic  brush  or  comb  attached 
to  faraclic  battery;  hot  water  bags;  air 
cushions;  cotton  wool;  water-bed;  rubber 
rings;  silver  foil;  flannel;  rubber  plaster 
for  making  medicated  plasters;  Bier’s  cup- 
ping glasses;  glass  rod;  adhesive  plaster; 
linen;  hnt;  grooved  director;  oiled  silk; 
bandages;  wool;  forceps;  gauze  bandage; 
scrotal  suspensory  bag;  Martin  india-rubber 
bandage;  gutta-percha  tissue;  double  oat- 
meal boiler  for  water  bath;  broad  brush  for 
applying  gelatine  preparations  ; crepe  (elastic) 
bandage;  epilating  forceps;  absorbent  cotton; 
ecraseur;  magnifying  lens;  ultraviolet  or 
Finsen  light;  triangular-edged  cataract 
needle;  needle-holder,  needles,  fine  silk,  cat- 
gut; silkworm-gut;  chromicized  catgut;  fine 
file;  cutaneous  trephines;  cxirved  scissors; 
self-retaining  cutaneous  retractor;  mouse- 
toothed forceps;  artery  clamps. 

Ionization  Outfit. — See  Ionic  Medi- 
cation, in  Part  1. 

Skin  Grafting  Instruments.  — Razor; 
broad-bladed  spatula;  teasing  needles. 

2.  Internal  Drugs  Mentioned  in  the  Text. — (a) 
Tonics  and  Alteratives  (L.  to'nus,  tone; 
altera're,  to  change). — Codliver  oil;  iron; 
arsenic;  potassium  iodide;  ferrum  sulphate; 
sulphuric  acid,  dilute;  tincture  of  nux  vom- 
ica; infus.  gent,  comp.;  ac.  nitro-hydrochl. ; 
dil.  sodium  benzoate;  tincture  of  cardamom; 
Fowler’s  solution;  Blaud’s  pills;  elixir  ferri, 
quininae,  et  strychninse  phosphati;  sodium 
cacodylate;  strychnine;  gold  chloride;  tr. 
ferri  chloridi;  salicin;  sodium  salicylate;  cal- 
cium sulphide;  fibrolysin;  creosote;  binio- 
dide  of  mercury;  Asiatic  pills;  syrup  of 
hypophosphites ; fresh  brewer’s  yeast  or 
ordinary  yeast  cake;  furunculin  (yeast 
powder);  ceridin  (yeast  fat);  thyroid  ex- 
tract; quinine  sulphate;  quinine  hydro- 
chlorate; thiosinamin;  chaulmoogra  oil  (olei 
gynocardise) ; magnesium  sen  sodium  gyno- 
cardatis;  balsam  seu  ol.  jejunae;  hoang-nan; 


sodium  iodide;  hydrarg.  sozoiodol.;  proti- 
odide  of  mercury;  vinum  antimon.;  sodium 
or  ammonium  benzoate;  ammonium  chlor- 
ide; iodothyrin;  tartaric  acid;  tincture  of 
thuja;  creosote;  syrup  of  ipecac;  ext.  pinus 
canadensis;  urotropin. 

(b)  Diuretics  (Gr.  5ta  through  4- 
oupof  urine). — Potassium  acetate,  citrate; 
and  bicarbonate;  cream  of  Tartar, 
Basham’s  mixture. 

(c)  Diaphoretics  (Gr.  5td  through  -|- 
(f>opeiv  to  carry). — Pilocarpine  hydrochloride; 
spt.  seth.  nitrosi;  liq.  ammonii  acetatis. 

(d)  Antacids. — Sodium  bicarbonate;  cal- 
cined magnesia  or  magnesium  oxide;  lime- 
water;  Vichy. 

(e)  Purgatives  (L.  purga're,  to  cleanse). 
— Rochelle  salt;  Friedrichshall  water;  Hun- 
jadi  Janos  water;  magnesium  sulphate;  pulv. 
rhei;  fl.  ext.  cascara  sagrada;  castor-oil; 
calomel;  colchicum;  aromatic  fl.  ext.  cas- 
cara; liq.  mag.  citratis. 

(f)  Vehicles  and  Flavors. — Aq.  menth. 
pip.;  spt.  menth.  pip.;  infus.  aurantii  amari 
corticis  comp.;  ac.  phosphor,  dil.;  syr.  zingi- 
beris;  sacchar.  alb.;  liq.  Hoffmannii;  syrup 
of  raspberry;  aq.  laurocerasi;  aq.  camphone; 
syr.  simplicis;  syrup  of  orange;  cinnamon 
water;  syr.  tolutani;  ol.  sesami;  ol.  hinonis 
comp.  tr.  lavand. 

(g)  Nervous  Sedatives  (L.  sedo,  I allay). 
— Morphine;  tr.  belladonna;  ext.  cannabis 
indica;  ext.  opii;  bromides;  asafoetida;  ace- 
tanelid;  antipyrine;  phenacetin;  tr.  opii; 
ether;  chloral  hydrate;  aspirin;  atropine; 
tr.  cannabis  indica;  tr.  gelsemii;  lactophen; 
sulphonal;  lupulin;  trional;  codeine; 
paregoric;  Dover’s  powder;  whiskey;  spirits 
of  chloroform. 

(h)  Cardiovascular  Drugs. — Nitrogly- 
cerine; nitrites;  ammonia;  strychnine;  atro- 
pine; adrenalin;  calcium  lactate,  chloride, 
and  bromide;  ergot;  ether;  aconitin;  tr. 
aconite;  brandy;  whiskey;  aromatic  spirits 
of  ammonia. 

(i)  Acids. — Dilute  hydrochloric,  sul- 
phuric, and  nitro-hydrochloric  acids. 

(j)  Anhidrotics  (Gr.  av  without  -f-  vdwp 
water). — Atropine;  tr.  belladonna;  agaraci- 
nate  of  sodium  or  lithium;  agaracin;  cam- 
phoric acid;  muscarin;  picrotoxin;  fl.  ext. 
hydrastis;  fl.  ext.  ergot;  bromural;  infus. 
sal  vise  (sage);  fl.  ext.  salviie;  aromatic  sul- 
phuric acid;  sodium  or  potassium  tellurate; 
tr.  cocculus  indicus. 


THE  SKIN  ARMAMENTARIUM 


(k)  Vaccines  and  Sera. — Vaccine  virus; 
diphtheria  antitoxine;  mallein;  leprolin; 
Sclavo’s  serum;  antistreptococcus  serum; 
antistaphyloccus  sermn;  Moser’s  serum  for 
scarlet  fever;  tuberlin  R (T.R.);  antivenene; 
Coley’s  mixed  toxines  of  erysipelas  and  bacil- 
lus prothgiosus. 

3.  Local  Medicaments  Mentioned  in  the  Text. — 
(a)  Antiseptics;  Parasiticides;  Astrin- 
gents; Stimulants. — Benzoic  acid;  zinc  sul- 
phate; potass,  sulphuret.;  deodorized  ben- 
zine; bicliloride  of  mercury;  ammoniated 
mercury;  cinnabar;  sulphiu’  prsecipitat. ; 
resorcinol;  boric  acid;  carbolic  acid;  tincture 
of  green  soap;  lime;  sublimed  sulphur; 
ichthyol;  salicylic  acul;  tr.  benzoin;  beta- 
naphthol;  formalin;  tincture  of  iodine; 
iodoform;  silver  nitrate;  copper  sulphate;  liq. 
iodi  comp.  (Lugol’s  solution);  iodine;  oil  of 
eucalyptus;  alcohol;  chiysarobin ; liq. 
amnion,  fortis;  spt.  rosmarini;  castile  soap; 
tar  soap;  thymol;  ung.  hycRarg.  nitratis; 
oil  of  cade;  spt.  myrcite;  ether;  caustic 
potash;  potassium  clilorate;  clu-omic  acid; 
comp.  tr.  benzoin;  iodol;  aristol;  peroxide  of 
hydrogen;  balsam  of  Peru;  spirits  of  cam- 
phor; ext.  hamamelidis  destil;  kerosene; 
pyrethrum  powder;  pemiyroyal  oil;  oil  of 
cassia;  oil  of  turpentine;  calcium  hypo- 
chlorite; potassimn  permanganate;  alum 
acetate;  picric  acid;  Squibb’s  compound 
alum  powder;  boric  ung.;  sodium  carbonate ; 
sothiun  borate;  potassium  carbonate;  lactic 
acid;  carbolic  acid  crystals;  acetic  acid; 
radimn;  acidi  arsenosi  pulveris;  hytlrarg. 
sulph.  rub.;  ammon.  chi.;  zinc  chloride;  tr. 
benzoin;  nitric  acid;  liq.  carbonis  tletergens; 
ung.  epicarin;  liq.  sodie  chlorinatie;  sodium 
benzoate;  sodium  sulpho-carbolate ; lotio  ni- 
gra, or  black  wash;  hytdarg.  oxidi  flavi; 
liq.  plumbi  subacetatis;  comp.  tr.  picis 
liquidse;  pix  liquida;  liq.  plumbi  subacet. 
dil.;  infus.  picis  liq.;  diachylon  ointment; 
gallic  acid;  methylene  blue;  europhen; 
trichloracetic  acid;  liq.  alum,  acet.;  biniodide 
of  mercuiy;  hycRarg.  bisulphuret. ; oil  of 
wintergreen;  pyrogallic  acid;  ung.  sulphuris; 
ung.  picis  liquida;;  spt.  vini  rectif.;  sod. 
hyposulphite;  myrrh;  ung.  iodofornii;  tr. 
alum;  tr.  jaborandi;  plumb,  acet.;  benzine; 
pyrogallol;  creolin;  tannoform;  zinc  per- 
oxide; yellow  oxide  of  mercury  ointment; 
neutral  acetate  of  lead;  Dobell’s  solution; 


glycerite  of  tannic  acid;  liq.  hydrarg.  nitratis; 
spt.  vini;  ol.  rusci;  glacial  acetic  acid;  nitric 
acid;  oleate  of  tin;  ung.  hydrarg.;  ung. 
hydrargyri  nitratis  dil.;  lime;  liq.  soda; 
chloratus;  absolute  alcohol;  tr.  eucalyptus; 
liq.  antisepticus;  tr.  krameria;  tr.  myrrh; 
fuming  nitric  acid;  oleate  of  zinc;  ceratum 
plumbi  subacetatis;  subsulphate  of  iron;  ung. 
gallic  et  opii;  hazeline;  oleate  of  mercury; 
pyoktanin;  liniment  iodi;  glyc.  of  tannic 
acid;  thymol;  Loeffler’s  solution;  ung.  Crede; 
lysol;  comp,  chalk  powder;  comp,  cinnamon 
powder;  taimic  acid;  emplast.  plumbi; 
emplast.  saponis;  emplast.  hydrarg.;  per- 
chloride  of  iron. 

(b)  Emollients;  Protectives;  Vehicles 
(L.  emol'lio,  I soften). — 01.  coca-nucis;  pe- 
trolatum molle;  glycerine;  benzoinated  lard; 
adeps;  cold  cream;  liq.  gutta-percha;  zinc 
ox  cle;  terra  silicea;  olive-oil;  cotton-seed 
oil;  paraffin  wax  (Stanolind  surgical  wax); 
flexible  collodion;  petroleum  jelly;  lanolin; 
sweet-almond  oil;  castor- oil;  sevum  praepar.; 
starch;  talcum;  liquid  albolene;  cocoa  butter; 
bismuth;  calamine;  linseed  oil;  wheat  flour; 
rice- flour;  pulv.  acacia;  zinc  stearate;  zinc 
oxide  ointment;  resin  cerat.;  bran;  liquid 
vaseline;  glycerinum  amylum;  mucilago 
seminmn  cydoniorum;  gelatine. 

(c)  Counter  Irritants. — Vlustard;  tinc- 
ture of  iodine;  croton  oil;  tr.  cantharidis; 
tr.  capsici;  lin.  saponis  (camph.);  cata- 
plasma  kaolini. 

(d)  Analgesics  and  Antipruritics  (Gr. 
av  without  -f  aXyos  pain;  avrL  against  fl-  L. 
pruri're,  to  itch). — ^lenthol  cone;  menthol 
crystals;  powdered  camphor;  camphor- 
chloral;  spirits  of  camphor;  liq.  calcis;  sod- 
ium bicarbonate;  liq.  potassie;  carbolic  acid; 
alcohol;  thymol;  lead  water;  lead  water  and 
huulanum;  cocaine;  eucaine;  orthoform;  lin. 
belladonnai;  camphor  ice;  orthoform  loz- 
enges, gr.  i;  salicylic  acid;  resorcin;  liq.  car- 
bonis detergens;  acetic  acid. 

(e)  Freezing  Agents. — Ethyl  chloride; 
solidified  carbon  dioxide;  liquid  air. 

(f)  Depilatories  (L.  de,  away  -[-  pil'ns, 
hail’). — Barium  sulphide. 

(g)  Perfumes.— Aq.  rosse;  aq.  cologniensis; 
ext.  violet;  ol.  rosse;  ol.  lavand.;  ol.  bergamot. 

Miscellaneous.— Distilled  water;  walnut 
juice;  pumice  stone;  Burgundy  pitch;  pulv. 
ipecac:  sodium  chloride. 


THE  EYE 


Cul  de-Sac  oft 
IheConjunct?!. 
\ Cellular^, 
^ tissue 
•A  Orbicularisls 
\ muscle 'r 


Supenol 

redus 

Bulbar 

capsule 


Ora 

serrata  Levator 
palp  Sup- 


Tendon 

ofsuperidr. 

oblique 


Tendon  ofT 
j thelavatqi^ 
/ palFLSu^i 

'^Orbicu^'-^ 
ftscia^  5? 


Ciliary 

arteries 


Iridocorneal 


Ciliary  zone 
and  processes 

lent  of  lens 


Suspensory  ligami 

Posterior 

chamber 


-.Z'  Tarsal  P .rjj^ 
plate^'^ 

FUNDUS  OF  THE  NORMAL 

C o n c t i V a — iPTij 
'bowman's 
membrane' ^ ;j 


Ciliary  nerve^J 
iliary  arteries^  ^ 

Layer  of  the  | 
great  vessels^ 


Anterior 

capsule 


Anterior! 

chamber| 

Cornea 


vitreous 


Posterior 

capsule 


Ay  Descemetj 
\\niembrai| 


Optic  nerve__ 

Central  excavation 
of  the  optic  disc 
Central  artery offhe  retina'^ 
Lamina  cribrosa^ 
i Hyaloid  membrane*^ 
Sclera^  /M 

Retina — 

Layer  of  rods  ! A 


FUNDUS  OF  THE  EYE  IN  A MYOPE  ■ 

Macular  choroiditis  ir , 

Retinal  Lash ^*^  4 

detachmeni''^ 


Posterior  chamber 


Ciliary  processes 
Capsule 
op'  Tenon 


Ciliary 
muscre 
- Ciliar’ 
arterid 
Ciliary 
nerves  / 


Inferior'’! 
s.  tarsal  i 
\ plate 


/ rectus' 
muscle 
inr 
oblique 
muscle 


Ora 

serrata 


Tarsal 
I muscle 

fy  Orbiculari: 
palpebrarum 

Conjundival'’ 
Cul  de  SacV 


M.  rC55£«Tf;lflt. 


RIGHT  TYMPANIC  lYlEMBRANE 

Acute  otitis 
mediR  ^ 

Large  exudative 
sac  bulging  inLo 
the  canal 


Processus  bre> 
ofthe  malleus 

Normal  / 
condition/ 
Manubntrrrr  y 
of  malleus  ' 


Chrome 

otorrhaea 


Large  perforation 
of  the  membrane 


Air  cells 

communicating  with 
the  middle  ear 


Space  leading  to  the  middle  cerebral  fossa 


Roof  ofthe  tympan 

Openi nq  for  the 
1 I audil'ory  nerve 


Semi  circular  canals 
Superiopcanal 
Posterior  canal 
External  canal 

Ampoulesof  the  semi- circular  canals 


Uppef'A 
part  ' y 
of  middlee^l 


^ Cochlea  ^ 
iCochlear  canal 


Cavil  oMr' 
concha'^K 

Wall  of 
epi^mpanic 
space  \j 

External' 
auditory  cam 


Eustachian  tube 


^cial  nerv^  ; - 

Dcessus  orbicu- / j 
'isofincus_.  / 
Stapes  ' 

Lovyer  part 
of  middle  ear 


Round  window 
and  border 
of  tympanum 


Tympanic  ' 
membrane  L- 


Skin  . The  arrows  indicatethe  progress  of  the 
infection  starting  from  the  Naso  pharynx  and  from 
theadenoids  to  successively  invade  the  Eustachian 
tube,  the  tympanum  .middle  ear,  vesObule . theau 
diiory  canal,  fheaircells  .middle  fossa, meninges, 
brain,  or  the  semi-circular  canals 


Opcning''^'^k 
ofthe  Eustachiair 
tube 


Naso- 

pharynx 


LAROUSSE  MEDICAL 


Section  of  eye,  and  fundus. -Ear  and  diseases  ofthe  ear. 


V 


,i’y*  J . ‘ 


jf.  t 


* h 


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•-  / 


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‘.V  . V •> 


-t»  '■  f 
-jk‘'K 
^ . 

;,  ; ■ . 


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,.**  i"'  * 


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I * I ' < » » 

;t ' V ‘ 

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■■  • . ■*••■.  * - • , 


PART  6 

EYE  DISEASES 


Abducens  Paralysis. — L.  ah,  from  + 
ducere,  to  draw;  Gr.  wapa  beskle  + \veLV  to 
loosen.  See  Muscular  Anomalies. 

Ablatio  Retinae. — L.  ablat'io  ablation;  L. 
ret'ina.  See  Detachment  of  the  Retina. 

Abscess  of  the  Cornea. — L.  abscessus,  a 
going  apart;  L.  coriieus,  horny.  See 
Keratitis  Ulcerosa. 

Eyeball. — See  Panophthahnitis  Puru- 
lenta. 

Eyelid. — See  Hordeohun. 

Lachrymal  Gland. — L.  lacrima,  tear; 
glans,  a cord.  See  Dacryoadenitis. 

Lachrymal  Sac. — L.  saccus;  Gr.  aaKKos. 
See  Dacryocystitis. 

Orbital. — L.  orb'ila,  track.  See  Orbital 
Cellulitis. 

Subperiosteal. — L.  sub,  under  + Gr. 
Trept  around  + barkov  bone.  See 
Orbital  Periostitis  and  Osteitis. 

Accommodation  Anomalies. — L.  accom- 
moddre,  to  fit  to ; Gr.  avupaXLa  abnormal.  The 
function  of  accoimnodation,  or  adjustment 
of  the  eye  for  various  chstances,  resides  in 
the  lens  and  ciliary  muscle.  Faulty  accom- 
modation is  manifested  by  a diminution  of 
the  power  of  near  vision,  whereby  near 
work  is  rendered  difficult  or  impossible 
(except  perhaps  in  myopes  or  old  people 
with  sclerosed  lens),  with  resulting  symp- 
toms of  eye-strain  (see  A.sthenopia). 

Etiology. — Diminished  elasticity  and  flatten- 
ing of  the  lens  due  to  advancing  age  (pres- 
byopia Gr.  7rpeo-/3cs  old  -|-  <b\{/  eye,  or 
old-sigh tedness) ; congenital  inelasticity  of  the 
lens;  luxation  of  the  lens;  removal  of  the 
lens;  paresis  or  paralysis  of  the  ciliary  muscle 
(cycloplegia)  due  to  paralysis  of  the  third 
nerve  (q.v.),  diphtheria  (the  paralysis  ap- 
pears in  two  to  four  weeks  following  cure 
of  the  cUphtheria),  influenza,  atropine  and 
other  mydriatics,  intestinal  mtoxication, 
diabetes,  syphilis,  tabes,  general  paresis  and 
other  central  nervous  diseases,  contusion  of 
the  eyeball,  prodromal  stage  of  glaucoma, 
severe  constitutional  diseases;  “ congenital 
inefficiency  of  the  ciliary  muscle,”  consti- 
tuting what  Theobald  designates  “ sub- 
normal accommodative  power”;  spasm  of 
the  ciliary  muscle  (revealed  by  finchng  the 
myopia  higher  in  the  subjective  test  with 
glasses  than  in  the  objective  test  with  the 
ophthalmoscope  or  the  shadow  test),  due  to 
continual  near  work,  refractive  errors. 


reflex  dental  irritation,  the  action  of  niio- 
tics,  hysteria. 

Treatment.— This  depends,  of  course,  upon 
the  cause  {q.v.,  in  its  alphabetical  place). 

In  weakness  or  paralysis  of  the  ciliary 
muscle,  prescribe  general  rest  and  rest  of 
the  eyes,  good  food,  fresh  air  day  and  night, 
care  of  the  skin  and  bowels,  and  perhaps  a 
tonic,  such  as  the  elixir  ferri,  quininae,  et 
strychninse  phosphati,  or  nux  vomica,  or 
Fowler’s  solution  (see  Drugs,  Part  11).  Local 
galvanization  may  be  employed  provided  no 
acute  symptoms  are  present.  The  cathode 
is  placed  over  the  closed  lid,  and  the  anode 
over  the  temple,  and  a very  weak  current  (1 
to  Ij/^mUli-amperes)  applied  for  five  minutes 
daily.  Instil  pilocarpine  solution,  1 per  cent, 
or  eserine  solution,  0.25  per  cent.,  one  drop 
twice  a day,  for  its  stimulating  effect  upon 
the  ciliary  muscle. 

The  prognosis  in  paralytic  cases  is  usually 
favorable,  except  in  diseases  of  the  central 
nervous  system.  Post-chphtheritic  paralysis 
usually  disappears  spontaneously  in  from 
four  to  eight  weeks. 

In  spasm  of  the  ciliary  muscle,  attend  to 
any  possible  etiological  influence.  Make  a 
precise  correction  of  any  errors  of  refraction, 
as  determined  under  atropinization. 

For  presbyopia,  prescribe  appropriate 
convex  glasses. 

Accommodation,  Paralysis  of  the. — Gr. 

Trapa  beside  -f-  \i>ecv  to  loosen.  See 
Accommodation  Anomalies,  above. 

Spasm  of  the. — Gr.  airaapos.  See  Ac- 
coimnodation Anomalies,  above. 

Adenitis,  Lachrymal.— L.  lacrnna,  tear. 
See  Dacryoadenitis. 

Amaurosis. — Gr.  apavpbeiv,  to  darken; 
complete  blindness.  See  Blinchiess. 

Amaurotic  Cat’s  Eye. — Gr.  apavpbtLv  to 
darken.  Luminosity  of  the  pupil,  resembling 
that  of  the  cat,  occurs  when  the  retina  is 
pushed  forward,  as  in  glioma  retinae,  (q.v.), 
whereby  emerging  light  rays  diverge  in- 
stead of  being  | focussed  to  a point  straight 
in  front  of  the  pupil.  It  is  also  present  in 
albinos’  eyes,  due  to  lack  of  pigment  in  the 
choroid,  ami  when  the  lens  has  been  re- 
moved. A yellow  reflection  in  the  vitreous 
(pseudo-glioma)  occurs  in  panophthalmitis 
purulenta  (q.v.). 

Amaurotic  Family  Idiocy. — See  Part  1, 
General  Medicine  and  Surgery. 


ASTHENOPIA;  EYE-STRAIN 


Amblyopia  and  Amaurosis  without  Oph= 
thalmoscopic  Change. — Gr.  a.fx^'Kvs  dulled  -1- 
(ot^eye;  dfxavpoeiv  to  darken;  6(/>0aX/x6s  eye 
(TKoireiv  to  see.  Amblyopia  means  diminished 
vision,  and  amaurosis,  complete  blindness. 

Etiology. — Congenital  deficiency  of  sight; 
non-use  of  the  eye  from  earliest  youth,  due 
to  opacities  of  the  cornea  or  lens,  a pupillary 
membrane,  or  squint  (with  suppression  of 
vision  in  the  squinting  eye);  sinus  obstruc- 
tion producing  monocular  blindness;  malnu- 
trition; uraemia;  glycosuria;  malaria;  severe 
hemorrhage;  refractive  errors;  accommoda- 
tion anomalies;  muscular  anomalies;  cer- 
tain poisons  (see  Toxic  Amblyopia);  hys- 
teria; prolonged  exposure  to  bright  light, 
as  in  snow-blindness;  shock;  severe  injuries 
to  the  head;  occipital  injury;  neurasthenia; 
henuopia,  due  to  a central  lesion;  migraine; 
excessive  physical  or  mental  exertion ; strain- 
ing of  the  eyes ; dazzling  light ; great  hunger. 

In  hysterical  impairment  of  vision,  “ the 
field  for  led  and  green  is  often  larger  than 
that  for  white,”  “ the  limits  for  red  are  usu- 
ally wider  than  those  for  blue,”  which  is  the 
reverse  of  normal,  there  is  “ concentric  con- 
traction of  the  visual  field,”  which  changes 
frequently,  perhaps  an  annular  scotoma, 
etc.,  and  other  hysterical  phenomena  (see 
Hysteria,  in  Part  1,  on  General  Medicine 
and  Surgeiy). 

In  neurasthenia,  “ the  visual  field  gets 
smaller  and  smaller  the  longer  the  patient 
is  tested  with  the  perimeter  ” (reaction  of 
exhaustion;  see  also  Asthenopia). 

Snow-blindness  is  accompanied  by  swollen 
lids,  photophobia,  conjunctivitis,  corneal 
erosions,  and  possibly  chorioretinitis. 

The  Prognosis  is  favorable  in  the  above 
cases,  excepting  congenital  amblyopia  and 
glyc'osuria.  In  the  latter  instance,  optic 
atrophy  (q.v.)  usually  ensues.  Optic  neuritis 
(q.v.)  and  atrophy  may  also  follow  great  loss 
of  blood  and  the  action  of  certain  toxic 
agents.  Hysterical  amblyopia  or  amaurosis 
sometimes  la.sts  for  years. 

Treatment. — In  congenital  amblyopia,  any 
correctible  defect  present,  such  as  an  error 
of  refraction,  should  be  remedied,  even 
though  good  vision  rarel}^  results. 

Visional  defects  in  childhood,  such  as 
cataract,  pupillary  membrane,  or  squint, 
should  be  corrected  as  early  as  possible,  in 
order  to  prevent  amblyopia  from  disuse. 

In  hysterical  cases,  inject  strychnine  (Part 
11)  near  the  eye,  and  employ  massage,  gal- 
vanization (see  below),  tinted  glas.ses,  and 
correct  hygiene,  e.g.,  adequate  mental  and 
physical  rest,  daily  exercise  in  the  fresh  air, 
agreeable  occupation,  fresh  air  day  and 


night,  a morning  warm  bath  before  breakfast 
in  a warm  room,  followed  by  a cool  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  regular  hours  of  eating  and  sleeping, 
rest  before  and  after  eating,  an  abundant 
bland  diet  (exclucUng  alcohol,  tea,  coffee,  and 
tobacco)  regulation  of  the  bowels,  and 
wholesome  companionship  with  others.  Iron 
or  arsenic  (see  Part  11)  may  be  prescribed 
as  a tonic,  if  deemed  advisable  (see  also 
Hysteria,  in  Part  1,  on  General  Medicine 
and  Surgery).  In  employing  local  galvaniza- 
tion, place  the  cathode  over  the  closed  lid  and 
the  anode  over  the  temple  and  employ  a cur- 
rent of  from  one  to  one  and  a half  milliam- 
peres  for  five  minutes  daily. 

In  snow-blindness,  keep  the  patient  in  a 
dark  room,  apply  heat  to  the  eyes,  and  instil 
atropine,  gr.  ii-iv  to  the  ounce,  one  or  two 
drops  once  or  twice  a day,  or  often  enough 
to  keep  the  pupil  dilated. 

Other  causal  conditions  should  be 
treated  as  described  under  their  respective 
captions  (see  Part  1,  on  General  Medicine 
and  Surgery). 

Amblyopia,  Toxic. — See  Toxic  Amblyopia. 

Ametropia. — Gr.  a neg.  perpov  measure 

Siyp  eye:  refractive  imperfection  of  the 
eye,  embracing  myopia,  hypermetropia,  and 
astigmatism.  See  Refractive  Anomalies. 

Ansesthesia  Retinae. — Gr.  ds^not  +a’icdr](7is 
sensation. 

Aneurysm.— Gr.  avevpvapa  w’idening.  See 
Exophthalmos. 

Angioma  Conjunctivae. — Gr.  dyyetoc  vessel 
-f  -co/xa  tumor.  See  Conjunctival 
Tumors. 

Orbital. — See  Orbital  Tumors. 

Anisocoria  or  Unequal  Pupils. — Gr.  avuros 
unequal  Koprj  pupil.  Causes. — Action  of  a 
mych'iatic  in  one  eye;  marked  difference  in 
the  refraction  of  the  two  eyes;  unilateral 
blindness;  aortic  aneurysm;  apical  tuber- 
culosis; dental  disease;  local  traumatism; 
disease  of  the  nervous  system,  e.g.,  tabes, 
general  jmresis,  multiple  sclerosis. 

The  condition  may  occur  in  health. 

Anisometropia.- — Gr.  avLcos  unequal 
p'tTpov  measure  -|-  eye,  a difference  in  the 
refractive  power  of  the  two  eyes.  See  Re- 
fractive Anomalies. 

Anomalies,  Accommodation. — See  Ac- 
commodation Anomalies. 

Muscular. — See  Muscular  Anomalies. 

Refractive. — See  Refractive  Anomalies. 

Arcus  Senilis. — L.  arcus,  arc  or  bow; 
senilis,  senile.  See  Corneal  Opacities. 

Asthenopia;  Eye=Strain. — Gr.  a priv.  -f 
adivos  strength  -j-  vision.  Asthenopia 
or  ej^e-strain  signifies  fatigue  of  the  ocular 


BLACK  EYE;  ECCHYMOSIS 


muscles,  either  the  intrinsic  or  ciliary  (ac- 
commodation asthenopia),  or  the  extrinsic 
(muscular  asthenopia),  with  the  resulting 
manifold  symptomatology,  e.g.,  “ failure  of 
near  vision  after  use  of  the  eyes  (relaxed 
accommodation)”;  “temporary  blurring  of 
distant  vision  (spasm  of  accommodation)”; 
“ great  discomfort  when  attempting  to 
watch  moving  objects,”  also  “ inability  to 
gaze  attentively  at  stationary  objects,”  also 
intermittent  blurring  of  vision  which  may 
be  attended  by  chplopia,  and  “ eccentric 
poses  of  the  head,”  even  torticollis  (muscular 
asthenopia  or  heterophoria,  relieved  at  once 
by  closing  one  eye);  rapid  fatigue  after  use 
of  the  eyes,  contraction  of  the  field  of 
vision,  “rapid  disappearance  from  view  of  any 
object  wliich  is  fixed,”  “ diminution  of  cen- 
tral vision,”  “ sudden  attacks  of  obscura- 
tion of  vision  and  processions  of  scotomas,” 
“ visual  hallucinations,”  and  general  neu- 
rasthenic symptoms  (nervous  or  neuras- 
thenic or  hysterical  asthenopia);  local  pain; 
precordial  and  back  pain;  headache;  mi- 
graine; vertigo;  anorexia;  indigestion,  nausea 
and  vomiting;  car  siclmess;  constipation; 
palpitation  of  the  heart;  ch’owsiness;  insom- 
nia; facial  and  other  spasms,  particularly 
tonic  blepharospasm  and  twitching  of  the 
lids;  photophobia;  conjunctival  hyperemia; 
blepharitis  marginalis;  eczema  of  the  lids; 
styes;  muscse  volitantes;  neurasthenia;  night- 
terrors;  melancholia;  hysteria;  pseudo- 
chorea; chorea;  epilepsy;  etc.  Continual 
straining  of  the  eyes  at  near  work  tends  to 
the  production  of  myopia. 

Etiology.— The  unmediate  or  exciting  causes 
of  asthenopia  are  over-use  of  the  eyes,  and 
impairment  of  the  general  health,  due  to 
debilitating  diseases,  dyspepsia,  utero-ovar- 
ian  disease,  antemia,  insomnia,  the  exce.ssive 
use  of  alcohol,  tobacco,  tea  or  coffee,  etc. 
The  remote  or  predisposing  causes  are 
refractive,  accommodative,  or  muscular 
(especially  heterophoria)  anomaUes,  and 
neurasthenia  or  hysteria. 

Nasal  disease  is  said  to  cause  asthe- 
nopic  symptoms. 

Treatment.— Attend  to  the  cause.  Correct 
any  existing  refractive,  (g.?^.),  accommodative, 
iq.v.),  or  muscular  (q.v.)  anomaly,  prohibit 
the  use  or  abuse  of  alcohol,  tobacco,  tea,  or 
coffee,  and  treat  any  existing  dyspepsia,  con- 
stipation, utero-ovarian  disease,  ansemia,  in- 
somnia, etc.,  as  described  in  Part  1 on  General 
Medicine  and  Surgery,  and  Part  2,  on  Gynae- 
cology. 

Treat  conjunctival  hyperaemia  (g.t^.), bleph- 
aritis (q.v.),  and  .styes  (q.v.),  if  present. 
For  insufficient  nervous  tone,  prescribe 
41 


ascending  doses  of  strychnine,  or  mix  vomica 
(see  Drugs,  Part  11). 

“ Large  doses  of  tincture  of  hyoscyamus 
are  of  distinct  advantage  in  cases  of  spas- 
mocfic  heterophoria.”  (De  Schweinits.) 

For  headache,  one  may  apply  very  hot  or 
cold  fomentations  by  means  of  a folded  towel 
held  at  the  ends  in  both  hands  and  pressed 
over  the  forehead  and  lids;  or  the  forehead 
and  temples  may  be  rubbed  with  one  of  the 
following  preparations : 

Spirit-us  lavandukD, 

Alcoholis,  aa 5iii 

Spiritus  camphorae 5 i 

M.  Sig — Apply  to  the  forehead  and  temples 
every  two  or  tliree  hours.  (Wood  and  W oodruff.) 

II  Chloroformi 5i 

Camphorae 3ii 

Tincturae  aconiti 3ii 

Olei  menthce  piperitae gtt.  xx 

Alcoholis, 5ii 

M.  Sig. — Shake  well  and  apply  every  two  or 
three  hours.  (Wood  and  Woodruff.) 

A weak  galvanic  current,  3 to  5 milli- 
amperes,  with  the  positive  pole  to  the  nape 
of  the  neck  and  the  negative  pole  (prefer- 
ably a double  eye  electrode)  to  the  closed 
lids,  applied  for  two  to  ten  minutes  at  a 
time,  may  afford  temporary  relief.  (Wood 
and  Woodruff.) 

ly  Chloretone  gm.  0.10 

Sodii  bihoratis gm.  0..'i0 

Aquae  destillata; c.c.  30.00 

M.  Sig. — Instil  into  the  eyes  a few  drops  every 
hour  or  two.  (W'ood  and  W'oodruff.) 

I^  Sodii  biboratis gr.  xv 

Acidi  borici gr.  xv 

Aquae  camphorae ou 

Adrenalini  chloridi  (1  : 1000), 
q.s.,  ad 5i 

M.  Sig. — Instil  a few  drops  every  hour  or  two. 

Astigmatism. — Gr.  a priv.  -f  (TTiyiia  point: 
“ a defect  in  which  light-rays  in  different 
meridians  are  not  brought  to  the  same  focus 
by  the  eye.”  (Borland.)  See  Refrac- 
tive Anomalies. 

Atresia  of  the  Canaliculi. — Gr.  a neg.  d- 
Tprjats  a boring;  L.  cannlic'ulus,  little 
canal.  See  Epiphora. 

Lachrymal  Puncta. — L.  lac’rima  tear; 
punc'tum,  point.  See  Epiphora. 

Atrophy  of  the  Optic  Nerve.-^ee  Optic 
Atrophy. 

Black  Eye;  Ecchymosis. — Gr.  e/c  out  -f- 
XCMo  a flow.  If  seen  at  once,  apply  cold 
cloths,  or  cloths  wet  with  a solution  of 
liquor  plumbi  subacetatis,  5i,  alcohol,  5i, 
and  water,  Oi;  or  apply  leeches;  or  make 
several  small  transverse  incisions  or  punc- 
tures and  press  the  extravasated  blood  out. 

Later,  employ  hot  compresses,  pres,sure, 
and  massage  with  a bland  oil.  The  discol- 


BLINDNESS 


oration  may  be  concealed  with  flesh-colored 
(water  color)  paint. 

Blennorrhoea.—Gr./3Xewos  mucus  d-pota  flow. 

Blepharitis  Marginalis. — Gr.  ^\e<papov  eye- 
lid d — trts  inflaimnation;  L.  niarg'o,  margin. 
Squamous,  crusted,  or  ulcerous  inflaimna- 
tion of  the  lid  margin. 

Etiology. — Malnutrition,  e.g.,  anaemia  and 
tuberculosis  (the  blepharitis  is  often  accom- 
panied by  eczema,  phlyctenular  conjuncti- 
vitis, or  otorrhoea);  chronic  conjunctivitis; 
ectropion;  lagophthalmus ; epiphora;  lachry- 
mal disease  (the  blepharitis  is  likely  to  be 
unilateral  in  these  unilateral  affections); 
chronic  rhinitis;  eye-strain;  exposure  to  bad 
air,  wind,  dust,  smoke,  heat,  etc. ; late  hours 
and  debauchery;  eczema;  eczema  seborrhoei- 
cum,  seborrhoea,  acne. 

Prognosis.— A ciu’e  may  require  several 
months,  and  recurrence  is  usual. 

Treatment.— Aim  to  remove  the  cause  {q.v. 
under  its  appropriate  heading).  Enjoin  ade- 
quate rest  and  exercise,  fresh  air  day  and 
night,  a daily  morning  warm  bath  in  a warm 
room,  before  breakfast,  followed  by  a cool 
siiinal  douche  and  brisk  rubdown  with  a 
coarse  towel,  regular  hoiu’s  of  eating  and 
sleeiting,  an  abundance  of  wholesome  food, 
rest  before  and  after  eating,  and  regulation 
of  the  bowels.  A tonic  may  be  prescribed, 
e.g.,  iron,  strychnine,  codliver  oil,  arsenic  (see 
Drugs,  Part  11). 

Remove  loose  eyelashes,  open  abscesses 
and  epilate  the  involved  cilia  by  means  of 
cilium  forceps,  cut  off  wards  aird  cauterize 
their  base  with  the  silver  stick,  and  massage 
callosities  (tylosis)  with  the  aid  of  w'hite 
precipitate  oirrtrnent,  1 to  2 per  cent.  • 

Instruct  the  patient  to  sponge  the  lid- 
margiirs  orrce  or  twice  daily,  itr  order  to 
remove  all  crrrsts  and  scales,  with  warm 
water,  or  a solirtion  of  sodiirm  carbonate, 
gr.  V to  the  ounce,  or  bicarbonate  or  biborate 
of  sothrurr,  gr.  viii  to  the  ouirce,  or  soapsuds 
(with  the  lids  gently  closed),  and  then 
apply  one  of  the  followiirg  ointirrents: 


B Hydrargyri  oxidi  flavi gr.  v 

Adipis  lansc  hydros!. 

Pet  rolati  mollis,  aa o ii 

B Hydrargyri  oxidi  flavi gr.  viii 

Unguenti  aquse  rosse,  vel  cerati 
flavi,  1.0  ct  petrolati  mollis,  4.0  Jss 

(Theobald.) 

B Acidi  salicylic! gr.  v 

Adipis  lana'  hydros!, 

Petrolati  mollis,  aa 5i> 

B Acidi  borici gr.  v-xxiv 

Adijjis  lame  hydros!, 

Petrolati  mollis,  aa pi* 

B Hydrargyri  ammoniati gr.  v 

Adipis  lame  hydros!, 

Petrolati  mollis,  aa 3ii 


Salicylic  ointment  is  especially  indicated 
for  scaly  conditions,  the  yellow  oxide  of 
mercury  for  ulceration,  and  the  boric  and 
white  precipitate  ointments  for  the  promo- 
tion of  healing. 

A warm  boric  acid  lotion  (2  to  4 per  cent.) 
may  be  applied  several  times  during  the  day. 

In  obstinate  cases,  the  physician  may 
touch  the  lid  margin  lightly  with  a pointed 
crayon  of  silver  nitrate,  or  silver  nitrate 
solution,  gr.  v ad  5i,  or  protargol,  5 to  20 
per  cent.,  or  argyrol,  25  per  cent. 

Blepharochalasis. — Gr.  p\e(t>apov  eyelid  -|- 
xakaaLs  relaxation.  A very  rare  condition 
of  relaxation  or  looseness  of  the  skin  of 
the  eyelid,  due  to  atrophy  of  the  connec- 
tive tissue  (dermatolysis)  occurring  in 
early  childhood. 

Blepharospasm. — Gr.  p\k(f)apov  eyelid  + 
airaapos  spasm.  Tonic  or  clonic  spasm 
of  some  or  all  the  fibres  of  the  orbic- 
ularis muscle. 

Etiology. — Ocular  irritation  due  to  a foreign 
body,  inflammation,  blepharitis,  trichiasis, 
and  eye-strain;  reflex  irritation  from  the 
teeth,  nose,  throat,  ear,  accessory  sinuses, 
phimosis,  worms,  etc.;  central  irritation,  as 
in  hysteria,  habit  spasm  or  tic  convxilsif, 
trigeminal  neuralgia,  mental  strain,  worry,  or 
shock,  debility,  nerve  tiunor,  brain  lesion,  etc. 

Treatment. — Aim  to  correct  the  cause.  Re- 
move all  possible  sources  of  reflex  irritation. 
Enjoin  the  observance  of  correct  hj^giene, 
e.g.,  adequate  rest  and  recreation,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  frequent  bathing,  fresh  air  day 
and  night,  regulation  of  the  bowels,  and  a 
bland,  nutritious  diet,  together  with  such 
tonics  as  uon,  arsenic,  strychnine,  and  qui- 
lune  (see  Drugs,  Part  11.)  interchet  tea  and 
coffee.  Encourage  the  patient  to  inhibit  the 
movements. 

Pressure  upon  certain  points  sometimes 
affords  relief.  Galvanism  or  the  hjT>odermic 
injection  of  morphine  at  these  points  may 
be  effectual;  also  the  application  of  cocaine, 
2 to  4 per  cent.,  to  the  conjimctiva;  or  gal- 
vanism to  the  closed  lids.  In  the  latter 
instance,  employ  a weak  current  of  from 
tluee  to  five  milliamperes,  with  the  positive 
pole  to  the  nape  of  the  neck  and  the  nega- 
tive pole  to  the  closed  lids,  for  about  ten 
minutes  at  a sitting.  The  antispasmodics, 
conium  and  gelsemium  (see  Part  11),  pushed 
to  the  physiological  lunit,  may  perhaps  be 
tried  in  certain  cases. 

Blindness. — Partial  or  complete  loss 
of  vision. 

Consult:  Accommodation  anomalies ; 
amaurotic  cat’s-eye;  amaurotic  family  idiocy; 


CATARACT 


amblyopia  and  amaurosis  without  ophthal- 
moscopic change;  cataract;  choroiditis;  color- 
blindness; corneal  opacities;  corneal  staphy- 
loma; detachment  of  the  retina;  dislocation 
of  the  lens;  glaucoma;  glioma  of  the  retina; 
hemeralopia;  hemianopia;  hemorrhage  into 
the  vitreous;  iritis;  keratoconus;  keratoma- 
lacia; muscular  anomalies;  nyctalopia;  opaci- 
ties in  the  vitreous;  optic  atrophy;  optic 
neuritis;  panophthalmitis;  refraction  anom- 
alies; retinitis;  scleral  staphyloma;  scleritis; 
scotomata;  sympathetic  ophthalmia;  toxic 
amblyopia. 

Blindness,  Color. — See  Color-Blindness. 

Day. — See  Hemeralopia. 

Night  . — See  Nyctalopia. 

Snow.- — See  Amblyopia  ancl  Amaurosis. 

Bodies,  Foreign,  in  the  Eye. — See  For- 
eign Bodies  in  the  Eye. 

Bruise. — See  Black  Eye,. 

Bullous  Keratitis. — L.  tml'la,  large  blister. 
See  Keratitis  Vesiculosa. 


Buphthalmus. — Gr.  /3o0s  ox  + 6ct>eaXn6s 
eye.  Buphthalmia.  See  under  Glaucoma. 

Burns  of  the  Eye. — See  Injuries  of  the  Eye. 

Calcareous  Concretions,  Meibomian. — L. 
calcdrea,  lime ;co7icreiio,  from  am,  together, -h 
crescere,  to  grow.  See  Lithiasis  Conjunctivie. 

Calculus,  Lachrymal. — L.  calculus,  peb- 
l)le;  lacrima,  tear.  See  Epiphora. 

Canaliculus,  Obstruction  of  the  — L.  little 
canal;  obstructio.  See  Epiphora. 

Canthotomy. — L.;  Gr.  savdos  -1-  Gr. 
to  cut.  See  Conjunctivitis  Gonorrhceica; 
and  Conjunctivitis  Trachomatosa. 

Carcinoma  Conjunctivae. — L.  cancer,  Gr. 

KapKivos  crab  -1 — wpa  tumor. 

See  Conjunctival  Tumors. 
Orbital.-SeeOrbital  Tmnors. 

Cataract. — L.  cataract'a, 
from  Gr.  Karaprivywai  to  rush 
down.  Opacity  of  the  lens  or 
its  capsule  or  both. 

A cataract  is  either  general 
(total)  or  partial.  A general 
or  total  cataract  may  be 
white  (juvenile,  soft,  occur- 
ring before  the  age  of  forty), 
or  it  may  be  yellowish  or 
amber-colored,  gray  or  black 
(senile,  hard) . “Underthe  age 
of  thirty-fiveall  cataracts  are 
soft.”  (De  Schweinitz.) 

Partial  cataracts  areclassi- 
fied  by  Fuchs  as  follows : 

(a)  Zonular,  lamellar,  or 
perinuclear  cataract,  in  which  the  layers  of 
the  lens  situated  between  the  nucleus  and 
cortex  are  opaque  while  the  latter  are  both 
transparent  (Fig.  98) . It  occurs  congenitally 


Fig.  98. — Lamellar 
Cataract  in  Cross 
Section.  Schematic. 
Magnified  2XL  The 
layers  «,  placed  be- 
tween nucleus  and 
cortex,  are  opaque, 
but  the  acfjacent 
layer  is  so  only  in 
the  equatorial  re- 
gion, r,  so  that  riders 
are  formed. 


Fig.  99. — Posterior 
Polar  Cataract.  Mag- 
nified 2X1. 


Fig.  100. — Posterior 


or  in  early  childhood,  rickets  and  convulsions 
bearing  a causal  relation. 

(b)  Anterior  polar  cataract.  It  occurs 
congenitally,  or  m small  children  as  the 
result  of  a central  perforating  gonorrhoeal 
ulcer  of  the  cornea,  with  adhesion  to 
the  lens. 

(c)  Posterior  polar  cat- 
aract, extracapsular  and 
congenital,  due  to  remains 
of  the  hyaloid  artery. 

(d)  Other  congenital  cir- 
cumscribed forms. 

(e)  Anterior  and  po.ste- 
rior  cortical  cataracts,  usually  following  dis- 
ease of  the  deep  structures  of  the  eye,  but 
also  caused  by  injury  of  the  lens  and  certain 
skin  affections.  The  posterior  cortical  cat- 
aract, with  its  stellate  or 
rosette-shaped  opacity, 
should  be  distinguished 
from  the  posterior  polar 
variety  with  its  round  dot 
(see  Figs.  99  and  100). 

After  remaining  stationary  Cortical  Cataract, 
for  many  years,  the  cortical  2x1. 

opacities  eventually  become  total. 

The  occurrence  of  cataract  is  marketl  by 
a gradual  impairment  of  vision,  usually 
binocular;  monocular  diplopia  or  polyopia 
may  occur.  The  decline  of  presbyopia,  or 
second-sight,  is  an  early  sign  of  approaching 
cataract.  Light  perception  is  retained  in 
uncomplicatecl  cataract;  if  lost,  retinal  or 
optic  degeneration  is  present,  which  renders 
operation  useless.  The  pupil  reacts  to 
light  in  uncomplicated  cataract;  it  does  not 
in  optic  atrophy. 

In  examining  the  eye  for  cataract,  first 
dilate  the  pupil  with  an  evanescent  mydri- 
atic, i.e.,  homatropine  hydrobromate,  1 jx?r 
cent.;  or  euphthalmin  hydrochlorate,  5 per 
cent.  (Theobald),  and  employ  both  oblique 
illumination  (q.v.)  and  the  ophthalmoscope. 
Hold  the  latter  twelve  inches  from  the  eye : 
the  cataractous  parts  appear  dark  against  a 
red  background. 

Etiology.— Senility  (the  commonest  cause; 
according  to  T.  Barth,  opacities  occur  in 
96  per  cent,  of  all  persons  above  sixty,  but 
they  usually  remain  slight  anti  of  no  patho- 
logical importance);  lenticular  traumatism; 
diabetes;  nephritis;  gout;  malaria;  cholera; 
influenza;  meningitis;  congenital  syphilis; 
tuberculosis;  rickets;  infantile  convulsions; 
tetany;  arteriosclerosis;  heat;  electricity; 
lightning-stroke ; bronchocele ; hookworm  dis- 
ease; extensive  skin  affections;  pellagra; 
naphthalin  or  naphthol;  ergot;  raphania; 
hereditary  predisposition;  congenital  anoma- 


CHOROIDITIS 


lies;  disease  of  the  deep  eye  structures 
(uveal  tract  diseases,  “ unchecked  inflamma- 
tory glaucoma,”  “ lifelong  accommodative 
strain,  ’ ’ due  to  uncorrected  errors  of  refraction 
producing  a choroido-retinitis  g.v.,  myopia 
of  high  degree,  retinitis  pigmentosa,  corneal 
suppuration,  detachment  of  the  retina). 

Treatment. — Soft  cataracts  may  be  needled; 
hard  cataracts  must  be  extracted. 

A zonular,  lamellar,  or  perinuclear  cata- 
ract should  be  operated  upon  only  when  the 
vision  is  quite  bad.  If  the  cataract  is  not 
progressing,  and  the  transparent  periphery 
of  the  lens  is  broad  enough  to  furnish  suf- 
ficient \nsion  as  determined  with  atropine, 
do  an  iridectomy;  if  the  transparent  periph- 
ery is  not  broad  enough,  extract  the  lens. 
If  the  cataract  is  progressing,  do  a dis- 
cission in  young  people,  an  extraction  in 
older  ones  with  a hard  nucleus.  (Fuchs.) 

Anterior  polar  cataract,  in  rare  cases, 
calls  for  an  iridectomy. 

Posterior  polar  cataract  and  other  congeni- 
tal circumscribed  forms  requh’o  no  treatment. 
A general  congenital  cataract,  however,  should 
be  removed  during  the  early  weeks  of  life,  to 
prevent  lack  of  development  of  the  retina. 

A general,  hard  cataract  :s  not  ready  for 
operation  until  it  is  matirre,  that  is,  until 
no  transparent  portions  remain.  To  deter- 
mine whether  the  cataract  is  “ ripe  ” for 
operation,  the  pupillary  space  is  illuminated 
obliquely.  “ If  the  opacity  is  complete,  the 
opaque  lens,  covererl  by  its  capsule,  is  level 
with  the  margin  of  the  pupil,  and  there  is  no 
shadow  (of  the  iris  in  the  lens);  if  not,  the 
major  portion  of  the  opacity  ;s  at  a level 
posterior  to  the  plane  of  the  pupil,  or  in 
other  words,  a clear  or  partly  clear  space  is 
present  between  the  iris  and  the  opaque 
portion,  and  a dark  semicircle  appears  upon 
the  opacity  at  the  side  from  winch  the  light 
comes.  This  is  the  shadow  of  the  iris. 
Shining  sectors  or  the  transmission  of  a red 
glai’c  indicate  immaturity,  even  if  the  shadow 
is  absent.  In  hyj:>crmature  cataract  the 
shadow  is  visible  (not  visible  says  Fuchs), 
but  the  surface  of  the  lens  is  flat  ” (De 
Schweinitz).  In  hypermature  cataract,  says 
Fuchs,  “ the  surface  of  the  lens  appears 
quite  homogeneous  (in  the  case  of  lique- 
faction), or  shows  irregular  dots  and  spots 
in  place  of  the  radial  markings  of  the  lens- 
star.”  It  may  take  from  one  to  three  years 
or  longer  for  a senile  cataract  to  become 
mature.  In  traumatic  cataract,  wait  until 
the  cataract  is  complete  before  operating. 

Before  every  cataract  operation  or  iridec- 
tomy, the  tear  passages  should  be  carefully 
examined  for  evidences  of  infection,  and 


their  patency  tested  by  injecting  liquid 
through  them  (see  Dacryocystitis).  The 
presence  of  local  or  near-by  mfection  contra- 
indicates operation. 

When  a cataract  is  seen  in  its  incipiency, 
one  should  try  the  daily  instillation  of  chonin, 

4 per  cent,  (it  causes  an  mdematous  reaction  at 
first) , or  subcon  j uncti  val  inj  ections  of  mercuric 
cyanate,  1 :4000,  10  to  20  minims,  containing 
1 per  cent,  of  acoin  for  the  relief  of  pain.  The 
injections  cause  marked  pain  and  oedema. 

Catarrhal  Conjunctivitis. — L.  catar'rhus, 
from  Gr.  Karappeiv  to  flow  down.  See  Con- 
junctivitis Catarrhalis. 

Catarrh,  Dry. — See  Conjimctival  Hyper- 
semia. 

Spring. — See  Conjunctivitis  Vernalis. 

Cat’s=Eye,  Amaurotic.  — See  Amaui’otic 
Cat’s-Eye. 

Cellulitis,  Orbital. — L.  cel'lula,  dim.  of 
cel'la,  cell  -}-  Gr.  -tns  inflaimnation.  See 
Orbital  Cellulitis. 

Centres,  Optic. — See  Optic  Chiasma, 
Tract,  and  Centres. 

Cephalocele,  Orbital. — Gr.  head  -f 

K7]\7]  tumor.  See  Orbital  Tumors. 

Chalazion. — Gr.  xakaj'a  hailstone.  A re- 
tention (yst  cf  a tarsal  or  Aleibomian  gland. 

Blepharitis  marginalis  and  eye-strain  are 
cited  as  precUsposing  causes. 

Treatment.— Anaesthetize  the  conjunctiva 
by  several  ajtplications  of  cocaine,  4 per 
cent.,  in  adrenalin,  1 ; 1000;  and  excise  tliQ 
cyst  through  the  conjunctiva.  A Desmarre  or 
a chalazion  clamp  may  be  used  to  hold  the 
lid  and  control  the  bleeding  while  operating. 

Instead  of  excising  the  cyst,  one  may  in- 
cise it  by  means  of  a crucial  incision  through 
the  conjunctiva,  evacuate  the  contents, 
curette  the  wall  thoroughly  to  prevent  recur- 
rence, and  cauterize  with  silver  nitrate  fused 
on  a silver  probe.  A transitory  inflammatory 
reaction  follows  cauterization.  Excision  of 
the  cyst  is,  however,  to  be  preferred.  It  is 
better  surgery,  and  obviates  recurrence. 

Chiasma,  Optic. — See  Optic  Chiasma. 

Choked  Disc. — L.  (discus,  a circular,  flat 
plate.  See  Optic  Neuritis. 

Chorioretinitis. — See  Choroiditis,  _below. 

Choroiditis. — Gr.  sldn -f  h5os  form 

-trts  inflammation.  Choroiditis  is  char- 
acterized, anatomically,  by  the  presence  of 
isolated,  yellowish,  imhstinctly  outlined 
spots  of  exudate  beneath  the  retinal  vessels, 
and  an  altered,  veil-like  appearance  of  the 
retina.  \'"ision  is  impaired  as  a result  ef 
cloudiness  and  opacities  of  the  vitreous  (the 
latter  may  cause  floating  specks  before  the 
eyes),  hyperremia  of  the  retina,  and  the 
isolated  retinal  inflammatory  foci  (producing 


C’lLIARY  BODY,  INFLAMMATION  OF 


scotomata)  situated  over  the  corresponding 
choroidal  spots  (choroido-retinitis).  Distor- 
tion of  images,  alterations  in  the  apparent 
size  of  images,  and  “ sj)arks  and  balls  of 
fire  ” before  the  eyes  may  occur. 

Says  Theobald:  “ Disease  of  the  choroid 
and  retina  is  to  be  suspected  when  the  pupil 
is  enlarged  and  responds  imperfectly  to  light. 


Fio.  101. — Recent  Chorioiditis.  (After  Ocller.) 

and  when,  glaucoma  having  been  excluded, 
distant  as  well  as  near  vision  is  impaired, 
and  is  growing  progressively  worse.” 

After  healing  has  occurred,  the  yellowish, 
hazily  outlined  choroidal  spots  appear  as 
white,  sharply-outlined  cicatricial  spots, 
often  surrounded  with  black  pigment  or  cov- 
ered with  black  spots.  (Figs.  101  aiul  102). 


Fig.  102. — Senile  Guttate  Chorioiditis  (Tay  and 
Hutchinson).  (After  Weeks.) 


Etiology.— Syphilis  (congenital  or  acquired) ; 
tuberculosis;  pneumococcus,  streptococcus, 
and  other  infections,  tonsillitis,  influenza, 
typhoid  fever,  pyorrhoea  alveolaris,  pelvic 
disease,  disease  of  the  nasopharynx  and 
acce.ssory  sinuses,  gonorrhoea,  rheumatism; 
intestinal  toxaBinia;  con.stitutional  or  nutri- 


tional disorders,  such  as  anaemia,  gout,  dia- 
betes, tuberculosis,  nephritis,  liver  disorders, 
menstrual  disorders  and  the  climacterimn ; 
traumatism;  eye-strain;  progressive  myopia 
flue  to  posterior  staphyloma. 

Prognosis. — This  is  unfavorable,  as  a rule, 
except  perhaps  in  syphilis.  The  affection  is 
chronic,  with  a tendency  to  recurrence. 
Atrophy  of  the  retina  and  optic  nerve  and 
also  cataract  ensue  in  obstinate  cases.  Glau- 
coma or  cataract  may  follow  the  choroido- 
retinitis  due  to  eye-strain. 

Treatment.— Attend  to  any  possible  etio- 
logical influence,  and  enjoin  the  observance 
of  correct  hygiene,  e.g.,  adequate  rest  and 
exercise,  fresh  air  day  and  niglit,  frequent 
bathing,  regulation  of  the  bowels,  a bland, 
simple,  but  nutritious  diet,  rest  before  and 
after  eating,  and  regular  hours  of  eating  and 
sleeping.  “Codliver  oil  (see  Part  11)  and 
iron  are  specially  indicated  in  childi’en,” 
says  Randolph.  The  eyes  should  be  pro- 
tected with  dark  glasses. 

In  order  to  hasten  resorption  of  the 
inflammatory  exudate,  administer,  to  begin 
with,  an  active  calomel  purge,  gr.  ii-vui,  at 
bedtime,  followed  by  salts  in  the  morning, 
one  hour  before  breakfast  (see  Part  11); 
then  institute  a course  of  potassiiun  iodide 
and  mercury,  even  in  non-syphilitic  cases, 
together  with  energetic  diaphoresis,  practiced 
every  day  or  every  other  day  by  means  of 
sodiiun  salicylate  or  aspirin,  gr.  xx  dissolved 
in  hot  linden  flower  or  elder  tea  or  lemonade, 
with  the  patient  well  wrapped  in  blankets;  or 
by  means  of  pilocarpine,  gr.  3^  to  every 
other  night;  or  a hot  bath  followed  by  woolen 
blankets;  or  hot  bricks  covered  with  wet 
cloths  sprinkled  with  alcohol;  and  give  also 
subconjunctival  injections  of  normal  salt 
solution  (0.6  to  0.9  per  cent ),  or  cyanide  of 
mercury,  1 : 5000,  or  bichloride  of  mercury, 
1 : 4000  to  2000. 

Should  iritis  supervene,  as  indicated  by 
the  occm’rence  of  pericorneal  injection,  pain, 
photophobia,  and  lachrymation,  instil  atro- 
pine, as  described  under  Iritis. 

For  the  relief  of  pain  and  irritability, 
bandage  to  the  lids,  coinjiresses  wet  with 
hot  water  or  with  ext.  opii,  gr.  x-xv,  in 
aquam,  5iv  (Theobald),  or  ext.  belladonnse, 
gr.  XV,  in  aquam,  §iv.  The  application  of 
six  or  eight  leeches  or  the  Heurteloup  arti- 
ficial leech  (1  to  2 cylinderfuls)  to  the  temple 
or  mastoid  process  is  also  of  service  in  reduc- 
ing the  inflammatory  symptoms. 

Choroidoretinitis. — See  Choroiditis. 

Ciliary  Body,  Inflammation  of  the. — L. 
cil’iuvi,  hair-like  body;  inflamma're,  to 
set  on  fire.  See  Cyclitis. 


CONJUNCTIVAL  TUMORS 


Ciliary  Muscle,  Paralysis  of  the. — L. 

musculus;  Gr.  -rrapa  beside  + \ueiv 
to  loosen.  See  Accomniodation 
Anomalies. 

Spasm  of  the.  — Gr.  cnraapos.  See 
Accommodation  Anomalies. 

Coloboma. — L.;  Gr.  KoXo^copa  mutilation 
or  defe(d.  A fissure  or  defect,  usually  con- 
^;enital,  of  any  part  of  the  eye. 

Color=Blindness. — Color  blindness  is  either 
(1)  congenital  and  incurable,  occurring  in 
3 to  4 per  cent,  of  males,  or  (2)  acquired,  due 
to  affections  of  the  light-perceiving  appara- 
tus (retina,  optic  nerve  and  visual  centres), 
e.g.,  tobacco  and  alcohol  amblyopia,  hysteria, 
optic  atrophy,  etc. 

Red-green  blindness  is  the  commonest 
type.  Blue-yellow  blindness  and  total  color 
blindness  are  rare. 

In  test  ing  for  color  blindness,  set  a Holm- 
gren colorecl  worsfi'd  before  the  patient,  and 
ask  him  to  place  with  it  all  the  worsteds 
that  look  like  it  or  that  approximate  it 
in  shade. 

Concomitant  or  Ordinary  Squint. — L. 

cimi,  together  -j-  coni'es,  companion.  See 
Muscular  Anomalies. 

Concretions,  Mebiomian. — L.  cum,  to- 
gether + crescere,  to  grow;  H.  Meibom 
(1638-1700).  See  Lithiasis  Conjunctivte. 

Conical  Cornea. — Gr.  Kwros;  L.  co'nus, 
cone;  L.  cor'neus  horny.  See  Keratoconus. 

Conjunctival  Burns. — L.  See  Injuries  of 
the  Eye. 

Catarrh. — See  Conjunctivitis  Catar- 
rhalis. 

Cysts. — Gr.  Kvans  bladder.  See  Con- 
junctival Tumors. 

Diphtheria. — See  Conjunctivitis  Diph- 
therica. 

Dryness. — See  Xerosis;  Xerophthal- 
mos. 

Conjunctival  Hypersemia;  Dry  Catarrh. — 

Gr.  vwep  over  + oTpa  blood;  L.  catar'- 
rhus,  from  Gr.  Karappeiv  to  flow  down. 
Simple  hjq:>er8eniia  is  distinguished  by  red- 
ness without  discharge  other  than 
increased  lachr^nnation. 

Etiology.— 1.  Acute  or  Transient. — For- 
eign body;  exposure  to  wind,  cold,  heat, 
light,  irritating  gases,  smoke,  etc.;  pro- 
longed use  of  the  eyes;  crjdng;  acute  rhinitis 
(coryza,  hay  fever);  facial  neuralgia;  acute 
exanthematous  fevers,  onset  of  inflamma- 
tion; potassium  iodide;  arsenic. 

2.  Chronic. — Eye-strain;  chronic  rhini- 
tis; inflammation  of  the  lachrymal  appara- 
tus; trichiasis;  late  hours;  alcoholism;  gout; 
imligestion;  blepharitis  marginalis. 

Treatment.— Remove  the  cause. 


B Zinci  sulphatis gr. 

Acidi  borici gr.  x 

Aquaj  destillatac g i 


M.  Sig. — In.stil  several  drops  into  the  eye,  t.i.d. 
(After  Theobald.) 

Conjunctival  Inflammation. — L.  inflam- 
ma're,  to  set  on  fire.  See  Conjuncti- 
vitis. 

Injuries. — See  Injuries  of  the  Eye. 

Lithiasis. — See  Lithiasis  Conjunctivae. 

Traumatism. — Gr.  rpavpa  wound.  See 
Injuries  of  the  Eye. 

Conjunctival  Tuberculosis. — L.  tuber' cu- 
luni,  nodule.  Tuberculosis  of  the  conjunctiva 
is  characterized  by  the  presence  of  localized, 
slowly  advancing  ulceration  and  thickening, 
grayish-red  granulations  and  nodules,  swell- 
ing of  the  preauricular  Ijnnph-glands,  and 
the  demonstration  of  giant  cells  and  tub- 
ercle bacilli  in  removed  bits  of  tissue.  Sporo- 
trichosis is  excluded  by  the  absence  of  the 
fungus  on  microscoiiic  examination. 

Treatment. — If  not  secondary  to  nasal 
tuberculosis,  a cure  may  be  hoped  for  by  the 
complete  excision  of  the  ulcer,  or  thorough 
curettage  followed  by  thorough  cauteriza- 
tion. If  the  disease  is  too  extensive,  how- 
ever, to  permit  of  these  measures,  one  may 
try  tuberculin  injections  or  phototherapy, 
and  treat  the  lesions  with  iodoform  powder 
or  ointment,  10  to  20  per  cent.  (Fuchs). 
Axenfeld  claims  success  with  lactic  acid,  50 
per  cent,  solution,  followed  by  irrigation 
with  saline  solution,  5i  ad  Oi.  Correct 
hygiene  and  an  abuntlance  of  good  food  are, 
of  course,  of  the  greatest  importance  (con- 
sult Tuberculosis,  Pulmonary,  in  Part  1,  on 
General  Mechcine  and  Surgery,  for  impor- 
tant details  in  regard  to  the  constitutional 
treatment) . 

Conjunctival  Tumors. — L.  tu'mor,  from 
tu'mere,  to  swell.  1.  Epithelioma. — (Gr.  ewL  on 
-f  dr]\rj  nipple;  -upa  tumor). — -A  superficial 
membrane-like,  vascular,  malignant  gro\ydh, 
with  a tendency  to  ulceration.  If  small, 
thorough  excision  may  be  practiced,  followed 
by  cauterization  with  the  actual  cauteiy;  if 
large,  the  eye  may  have  to  be  removed. 
Treacher  Collins  removed  a growth  10  mm. 
in  diameter  by  means  of  radium  bromitle, 
10  mg.  of  which,  on  a circular  disc,  1 cm. 
in  (fiameter,  unscreened,  was  held  contin- 
ually over  the  growth  for  fifty  minutes  by  a 
relay  of  assistants.  “ The  growth  dis- 
appeared completely  in  a fortnight,  and 
after  five  months  nothing  could  be  seen 
except  a smooth  grayish  scar  ” 

2.  Sarcoma  Gr.  aap^,  aapKos  flesh). — A pro- 
minent, mushroom-like,  malignant  growdh. 
Treat  the  same  as  epithelioma. 


CONJUNCTIVITIS  CATARRHALIS  SEU  SIMPLEX 


3.  Papilloma  (L.  papil'la,  nipple). — A nodu- 
lated, raspberry-liJce  gro\vth.  Make  a thor- 
ough excision,  in  order  to  obviate  recurrence, 
followed  by  the  actual  cautery. _ 

4.  Dermoid  (Gr.  depfxaskin  -f-  et5os  form). — 
A congenital  cyst  containing  skin,  hair,  per- 
haps teeth,  etc.,  situated  partly  in  the  cornea 
and  partly- in  the  conjunctiva.  It  should  be 
carefully  excised,  and  the  denuded  area  cov- 
ered with  conjunctiva. 

5.  Cysts  (Gr.  KvarLs  bladder). — Varieties: 
Dermoid,  hydatid,  lymphangiectatic,  trau- 
matic, congenital.  Excise  the  cyst,  and 
cover  the  denuded  area  with  conjunctiva. 

6.  Lipoma  Subconjunctivale  (Gr.  Xittos  fat;  L. 
sub,  under). — A benign,  yellowish,  fatty 
growth,  situated  beneath  the  conjunctiva, 
upon  the  upper  and  outer  surface  of  the 
eyeball.  If  large,  it  may  be  removed  in 
whole  or  in  part. 

7.  Polypi  (L. ; Gr.  toXvs  many  -{-  ttoOs 

foot). — Small,  pedunculated  fibromata.  Ex- 
cise the  growth,  and  cauterize  the  base  with 
silver  nitrate.  ^ 

8.  Haemangioma  (Gr.  aipa  bloocl  -|-  ayye'tov 
vessel.) — A rare,  usually  congenital  anas- 
tomosing network  of  chlated  and  tortuous 
capillaries.  Remove  the  growth  with  the 
actual  cautery,  if  small;  if  large,  employ 
electrolysis.  With  the  positive  pole  of  a 
galvanic  battery,  in  the  form  of  a plate  cov- 
ered with  a wet  sponge,  upon  the  temple, 
plunge  the  negative  needle,  which  is  coatecl 
with  shellac  or  gutta-percha  up  to  within 
one-eighth  inch  of  the  point,  into  the  timior, 
and  turn  on  a current  of  from  one  to  three  or 
more  milliamperes,  according  to  the  size  of 
the  growth.  Allow  the  current  to  act  until  a 
blanched  line  is  produced  along  the  needle’s 
course.  Make  parallel  slanting  punctures, 
about  one-eighth  inch  apart,  down  to  the 
base  of  the  growth.  Always  increase  and 
break  off  the  current  slowly.  Several  sit- 
tings, at  intervals,  of  one  to  three  weeks 
are  always  required. 

9.  Pigmented  Moles  (L.  mo'les,  mass),  fibro- 
mata (L.  fi'bra,  fibre),  myxomata  (Gr.  pv^'os 
mucus),  cylindromata  (Gr.  kvXlvSpos  cylin- 
der), lymphangiomata  (L.  lym'pha,  lymph  -f- 
Gr.  ayyaov  vessel)  are  very  rare. 

Conjunctival  Wounds.  — See  Injuries  of 
the  Eye. 

Xerosis. — ^See  Xerosis. 

Conjunctivitis  Catarrhalis  seu  Simplex. — 

L.  catar'rhus,  from  Gr.  Karappeiv  to  flow 
down;  L.  simp'lex,  simple.  Simple  catarrhal 
conjunctivitis  is  characterized  by  conjuncti- 
val injection,  a muco-purulent  discharge, 
and  gumming  of  the  eyelashes  during  sleep. 
The  injected  vessels  are  superficial,  brick- 


red  in  color,  coarse,  tortuous,  and  movable, 
as  distinguished  from  the  deep,  pinkish,  fine 
pericorneal  injection  of  keratitis  and  uveitis. 
The  conjunctival  surface  is  smooth  in  the 
acute  form.  The  disease  is  usually  binocular. 

Etiology.— 1.  Acute  Inflammation. — Irri- 
tation caused  by  smoke,  dust,  wind,  cold, 
heat,  gases,  foreign  bodies,  etc.;  acute 
rhinitis  (coryza,  hay  fever);  bronchitis,  pul- 
monary disorders;  trichiniasis;  facial  ery- 
sipelas; impetigo  contagiosa;  eczema;  acute 
infectious  diseases  (measles,  scarlet  fever, 
smallpox,  typhus  fever,  typhoid  fever,  rheu- 
matic fever,  influenza,  yellow  fever) ; blepha- 
ritis. Bacterial  agents  are  the  Koch- Weeks 
bacillus,  diplobacillus  of  Morax-Axenfeld, 
diplobacillus  liquifaciens  of  Petit;  pneumo- 
coccus, influenza  bacillus,  streptococci,  sta- 
phylococci, micrococcus  catarrhalis,  colon 
bacillus,  hsemoglobinophilic  bacilli,  von 
Prowazeck  inclusion  bodies,  etc.  One  should 
remember  that  the  normally  present  xerosis 
bacillus  resembles  the  bacillus  diphtherise. 

2.  Chronic  Inflammation. — Prolonged 
or  frequently  repeated  acute  inflammation; 
late  hours;  alcoholism;  eye-strain;  blephari- 
tis marginalis;  disease  of  the  lachrymal  ap- 
paratus (epiphora);  ectropion;  chronic  rhini- 
tis; infection  of  the  Meibomian  glands;  lag- 
ophthalmus;  prominent  eyeballs;  prolonged 
bandaging;  bad  hygiene. 

Says  Webster,  “ The  most  common  bac- 
terial cause  of  chronic  conjunctivitis  is  the 
bacillus  of  Morax-Axenfeld.” 

Treatment.— Prescribe  a laxative,  such  as 
castor-oil,  calomel,  compound  laxative  pill, 
compound  licorice  powder,  or  cascara  (see 
Drugs,  Part  11),  and  one  of  the  following 
collyria: 


R Zinci  sulphatis 

Acidi  borici 

Aqua;  bullientis 

M.  Sig. — Drop  into  the  eyes  t.i.d. 

. . . gr.  ss 
. . . gr.  X 

. . . oi 

1^  Sodii  boratis 

Aqua;  camphorse 

Aqua;  destillatae,  q.s.,  ad. . . . . . 

. . . gr.  X 
. ..  3ii 
...  Si 

M.  Sig. — Drop  into  the  eyes  t.i.d. 

R Zinci  sulphatis 

Sodii  biboratis 

Aqua;  camphora;. 

Aqua;  bullientis,  aa 

Misce  et  filtra. 

. . . gr.  i 
• ■ ■ gr.  IV 

. . . 3iv 

Sig. — -Drop  into  the  eyes  t.i.d. 

Frequent  irrigation  with  warm  boric  acid 
solution,  two  to  four  teaspoonfuls  to  the 
pint  is  very  useful.  At  bedtime  the  lid- 
margins  may  be  , anointed  with  boric  oint- 
ment. 

If  prompt  improvement  does  not  follow 


FOLLICULARIS 


the  above  treatment,  substitute  for  the  zinc 
solution,  argyrol,  5 to  10  to  25  per  cent., 
protargol,  2 to  5 to  20  per  cent.,  or  silver 
nitrate,  0.5  to  1 to  2 per  cent.  The  latter  is 
applied  with  a camel’s-hair  brush,  avoicUng 
the  cornea,  every  one  or  two  days,  followed 
by  normal  salt  solution  ( 3 i ad  Oi) ; but  it  is 
probably  better  replaced  by  the  other  silver 
preparations. 

In  severe  cases,  one  may  employ  bichlor- 
ide solution,  1 : 10,000  to  8000. 

For  chplobacillary  conjunctivitis,  L.  K. 
Wolff  recommentls  the  insufflation  of  finely 
pulverized  fluorescin-zinc  (made  from  potas- 
sium fiuorate  and  zinc  sulphate,  soluble  in 
water  only  in  1 to  1000  solution,  and  con- 
taining 15.8  per  cent,  of  zinc),  followed  by 
light  massage.  One  or  two  applications  are 
curative  in  from  twenty-four  to  forty- 
eight  hours. 

For  chronic  conjunctivitis,  employ  the 
above  zinc  collyria.  “ Boric  acid  in  lanolin 
(2  per  cent.)  is  useful  if  the  conjimctival 
surface  is  too  dry  ” (De  Schweinitz).  The 
cause,  of  coiu’se,  should  be  sought  and  cor- 
rected. A tonic  may  be  indicated,  and  cor- 
rect hygiene  enjoined.  See  also  Conjuncti- 
val Hy])ersemia. 

Conjunctivitis  Catarrhalis  Epidemica. — 

Gr.  kirL  on  8r}iMs  people.  See  Conjuncti- 
vitis Catarrhalis. 

Conjunctivitis  Crouposa  seu  Membranosa 
seu  Diphtheritica. — L.  memhrdna,  mem- 
brane; Gr.  dL4>depa  membrane.  This  type  of 
conjunctivitis  is  characterized  by  the  forma- 
tion of  a membrane  of  exudate  with  (diph- 
theritic) or  without  (croupous)  underlying 
necrosis.  It  may  occur  in  any  variety  of 
conjunctivitis  as  well  as  in  diphtheria,  and 
also  as  a' result  of  burns,  strong  or  too  fre- 
quently repeated  silver  nitrate  applications, 
the  too  frequent  application  of  jequirity 
infusion,  poor  health,  etc.  There  is  a seri- 
ous streptococcus  form  which  occurs  usually 
in  smallpox,  measles,  or  scarlet  fever. 

The  prognosis  in  diphtherial  cases  is  serious. 
The  comUtion  in  any  case  is  rebellious 
to  treatment. 

Treatment.— Irrigate  the  eye  very  gently, 
three  or  four  times  daily  (taking  great  care  not 
to  abrade  the  corneal  epithelium),  with  warm 
saturatetl  boric  acid  solution  (gr.  xviii  to  the 
ounce),  or  bichloride  of  mercuiy,  1 : 10,000 
to  8000,  or  cyanide  of  mercuiy,  1 : 5000, 
using  pledgets  of  absorbent  cotton,  or  a 
fountain  syringe  with  a bulbous-tipped 
nozzle,  or  an  irrigating  bottle,  or  a hollow 
lid-retractor.  Warm  compresses  may  be 
bandaged  on  the  lids,  soaked  in  hot  water, 
or  in  Theobald’s  opium  lotion: 


b Extract!  opii gr.  x 

Acidi  borici gr.  xl 

Aquae jiv 


“ Iodoform  powder  or  salve  (see  Part  11) 
may  be  freely  applied  within  the  conjunctival 
sac.”  (De  Schweinitz.) 

If  ciliary  injection  is  present,  instil 
atropine  (see  Keratitis  Ulcerosa).  Corneal 
necrosis  is  veiy  liable  to  occur  in  diph- 
therial infection.  If  the  lids  become  very 
tense,  a free  canthotomy  may  be  neces- 
sary in  order  to  relieve  pressure  on  the 
cornea.  An  incision  is  made  at  the  external 
angle  of  the  eye,  “ from  without  down 
to  the  bone,  as  far  as  the  margin  of  the 
orbit,  but  leaving  the  conjunctiva  unin- 
jured.” Canthotomy  may  be  practiced 
only  in  adults. 

After  the  membrane  has  been  thrown  off, 
apply  protargol,  2 to  4 to  10  per  cent.,  or 
silver  nitrate,  1 per  cent.,  once  a day,  or  on 
alternate  days.  The  latter  is  applied  with  a 
camel’s-haii'  brush,  avoiding  the  cornea,  and 
is  followed  with  normal  saline  solution  (3i 
ad  Oi).  If  necrosis  and  sloughing  of  the  con- 
junctiva has  occurred,  endeavor  to  prevent 
the  formation  of  adhesions  between  the  eye- 
ball and  the  lids  by  inserting  a pledget  of 
cotton  soaked  in  castor-oil  between  the  two, 
and  by  frequently  drawing  the  lids  away 
from  the  eyeball. 

A tonic,  such  as  the  elixir  ferri,  quininse, 
et  stiyclminse  phosphati  (Part  11)  is  usually 
indicated. 

In  diphtherial  cases,  the  sound  eye  should 
be  protected  with  a Buller’s  shield  or  watch 
crystal  fastened  with  adhesive  plaster,  open 
on  the  temporal  side  for  ventilation,  but 
sealed  on  the  nasal  side  with  collodion.  The 
patient  should  be  isolated,  and  the  dressings 
burned.  Diphtherial  antitoxin  should,  of 
course,  be  achninistered  (see  Diphtheria, 
in  Part  1,  on  General  IMedicine  and  Surgerj'). 

Conjunctivitis  Diphtherica. — See  Con- 
junctivitis Crouposa. 

Eczematosa. — Gr.  kK^e7v  to  boil  out. 
See  Conjunctivitis  Phlyctemilosa. 

Follicularis. — L.  folliculus,  little  bag.  An 
acute  or  chronic,  contagious  affection  of  the 
conjunctiva,  occurring  usually  in  poor  school 
childi’en  as  a result  of  uncleanliness  and 
bad  hvgiene,  and  characterized  by  the 
presence  in  the  superior  and  inferior  retro- 
tarsal  folds,  usually  in  parallel  rows,  of  pin- 
head sized,  oval,  translucent  nodules  or 
follicles  consisting  of  hypertrophied  Ijunphoitl 
tissue.  The  prognosis  is  good.  The  follicles 
tend  to  disappear  in  time. 

The  disease  may  be  caused  by  non-sterile 
atroj)ine.  Eye-strain  predisposes. 


CONJUNCTIVITIS  GONORRHffilCA 


Treatment.— Prescribe  a tonic,  such  as  the 
elixir  ferri,  quinina',  et  strychnina;  phos- 
phati  (Part  11),  and  enjoin  the  observance  ot 
correct  hygiene,  e.g.,  adequate  rest  and  exer- 
cise, fresh  air  day  and  night,  cleanliness, 
wholesome  food,  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals,  and 
regulation  of  the  bowels. 

The  ocal  treatment  is  antiseptic: 


Zinci  sulphiitis gr.  i 

Sodii  biboratis gr-  >v 

Aquae  camphorae. 

Aquae  bullicntis,  aa 5‘v 

Misce  et  Ultra. 


Sig. — Drop  into  the  eyes  t.i.d. 

Ilydrargvri  chloridi  corro.sivi, 

1 : 12,000  to  8000 

Sig. — Instil  into  the  eyes  t.i.d. 


Protargol,  10  per  cent “ss 

Sig. — -Drop  into  the  eyes  t.i.il. 

Argyrol,  25  ix'r  cent 5ss 

Sig. — Drop  into  the  eyes  t.i.d. 

Argcnti  nitratis,  2 per  cent oii 


Sig. — Apply  with  a cainel’s-hair  brush,  avoiding 
the  cornea,  once  a day  or  on  alternate  days,  followed 
by  normal  saline  solution  (pi  ad  Oi). 

The  silver  salts  are  ajtproj^riate  in 
a.cute  cases. 


Ilydrargj'ri 7.00 

Acidi  nitrici 17. .50 

Olei  morrhuae  (brown  or  unrcfineil) . . 70.00 


Dissolve  the  mercury  in  the  acid  and  mix  with 
the  oil;  then  add  and  mix  to  00  parts  of  this  40 
parts  of  refined  codlivcr  oil. 

Sig. — Place  the  ointment  in  the  lower  cul-<le-sac 
every  other  day,  and  massage  for  one  to  three  min- 
utes through  the  upper  lid  with  the  eyeball  rotated 
downward;  then  through  the  lower  lid  with  the 
eyeball  rotated  upward.  (Wood  and  Woodruff.) 

Express  the  follicles  as  in  trachoma  {q.v.). 

Conjunctivitis  Qonorrhoeica. — Gr.  yovrj 

semen  peN  to  flow.  An  acute  jiurulent, 
contagious  inflammation  of  the  conjunctiva 
caused  by  the  gonococcus  of  Neisser. 

Gram’s  method  of  staining  is  as  follows 
(Webster) : Place  a drop  of  the  pus  on  one 
end  of  a clean  dry  slide,  and  with  a second 
slide  held  at  an  angle  of  4.5°  to  the  first  one, 
touch  the  drop  of  pus,  and  when  the  latter 
has  spread  out  by  capillarity  along  the  edge 
of  the  second  slide,  draw  the  latter  along 
the  first  slide,  still  maintaining  the  angle 
of  45°,  and  exerting  very  little  pressure.  A 
cigarette  paper  may  also  be  used  as  a 
spreader.  Fix  the  smear  thus  made  by 
passing  it  several  times  through  the  flame, 
allow  it  to  cool,  then  cover  with  a solution 
consisting  of  84  c.c.  of  aniline  water  (water 


saturated  with  aniline  and  filtered)  and  1(5 
c.c.  of  a saturated  alcoholic  solution  of  gen- 
tian violet.  After  one  to  three  minutes,  pom- 
off  the  stain,  wash  in  water,  and  without 
drying,  cover  with  a solution  consisting  of 
one  gram  of  iodine  and  two  grams  of  potas- 
sium iochde  dissolved  in  300  c.c.  of  water. 
After  one-half  to  one  minute,  wash  in  water, 
and  treat  with  95  per  cent,  alcohol  until  all 
the  color  is  removed.  Now  wash  in  water, 
and  cover  with  a dilute  aqueous  solution  of 
safranin  as  a contrast  stain.  Allow  the 
latter  to  act  for  only  a few  seconds,  then 
wash  off  with  water,  tlry  between  folds  of 
filter-j;)aper,  and  examine  under  an  oil- 
immersion  lens.  Gram-positive  organisms, 
i.e.,  tho.se  not  decolorized  (tubercle  b., 
smegma  b.,  diphtheria  b.,  pneumococcus, 
streptococxais,  staphylococcus,  and  various 
saprojihjdic  cocci)  are  stained  deep  blue, 
while  the  Gram-negative  organisms  (gono- 
coccus, meningococcus,  micrococcus  catar- 
rhalis,  influenza  b.,  typhoitl  b.,  colon  b., 
Kock-Weeks  b.,  and  the  VIorax-Axenfehl  b.) 
and  the  bodies  of  the  jnis  cells  take  the  red 
safranin  stain.  (Webster.) 

Treatment.— Enjoin  rest,  keep  the  bowe's 
open,  and  prescribe  a light  bland  diet,  with 
plenty  of  water  between  meals.  Interchct 
alcohol,  tea,  coffee,  ginger  ale,  carbonated 
beverages,  lemonade,  fruit,  sour  foods, 
pickles,  sauces,  salads,  spices,  condiments, 
mustartl,  pepper,  horseradish,  i-adishes,  to- 
matoes, asparagus,  salty  foods,  smoked  and 
salted  meats,  preserved  fish,  herring,  shell- 
fish, cheese,  greasy  or  fried  foods,  tobacco 
in  excess.  Burn  the  dressings.  Protect  the 
sound  eye  with  a Buller’s  shield  or  watch 
crystal  fastened  with  adhesive  plaster,  open 
on  the  temporal  side  for  ventilation,  but 
sealed  with  collodion  on  the  nasal  side. 

Douche  the  eye  very  gently,  three  or  four 
times  daily,  or  even  every  hour  or  half  hour 
if  tleemed  advisable  (taking  great  care  not 
to  abrade  the  corneal  epithelium),  with  a 
warm  saturated  solution  of  boric  acid  (gr. 
xviii  to  the  ounce),  or  potassium  permanga- 
nate, 1 : 5000,  or  bichloride  of  mercury, 
1 : 10,000,  or  cyanide  of  mercury,  1 : 5000, 
or  iced  jiliysiologic  salt  solution,  5i  iid  Oi 
(Heckel),  using  pledgets  of  absorbent  cotton, 
or  a fountain  sju-inge  with  a bulbous- 
tipped  nozzle,  or  an  irrigating  bottle 
(Fig.  98),  or  a hollow  lid-retractor. 

Once  daily,  apply  on  a cotton-wound 
applicator  or  camel’s-hair  brush,  silver 
nitrate,  2 per  cent,  (condemned  by  Derby 
and  otliers),  or  protargol,  40  per  cent.;  or 
apply  protargol,  10  to  20  jicr  cent.,  twice 
daily,  or  argyrol,  30  to  50  jier  cent.,  three 


CONJUNCTIVITIS  PHLYCTENULOSA  SEU  ECZEMATOSA  SEU  SCROFULOSA 


times  daily,  or  oftener.  >Some  (Myles  Stand- 
ish  and  Bruns)  recoimnend  that  the  con- 
junctival sac  be  kept  constantly  flooded  with 
arjryrol  solution,  25  per  cent.  The  white 
film  formed  by  the  application  of  the  silver 
nitrate  should  be  irrigated  away  completely 
by  normal  salt  solution,  3i  ad  Oi  (De 
Schweinitz;  Horwitz).  Anoint  the  lid  mar- 
gins with  vaseline. 

For  oedema  of  the  lids,  apply  ice-water 
compresses,  every  hour  or  two  for  ten  to 
twenty  minutes  in  infants,  almost  continu- 
ously in  adults,  changing  every  half  hour  or 
less  often,  until  the  swelling  subsides;  then 
discontmue  them. 

Should  the  lids  become  so  swollen  and 
tense  as  to  prevent  the  proper  opening  of  the 
palpebral  fissure,  and  also  as  to  endanger  the 
cornea  by  their  pressure,  widen  the  fissure 
at  the  external  angle  with  scissors;  or  with 
a scalpel,  cut  “ from  without  down  to  the 
bone,  as  far  as  the  margin  of  the  orbit,  but 
leavingthe  conjunctiva  uninjured”  (canthot- 
omy).  Canthotomy  is  admissible  only  in 
adults. 

Should  the  cornea  become  hazy  or  cloudy, 
stop  the  ice  compresses  at  once  and  apply 
heat,  and  instil  once  or  twice  daily,  a sterile 
solution  of  atropine,  gr.  iv  to  the  ounce  for 
adults,  gr.  i to  the  ounce  for  infants.  Should 
ulceration  supervene,  employ  Rrigations  of 
formaline,  1 : 10,000  to  5000.  The  actual 
cautery  is  advised  for  commencing  ulcera- 
tion (see  Keratitis  ulcerosa) . In  unfavorable 
cases  the  chscharge  may  become  thin  and 
watery  and  a membrane  form  with  danger 
of  corneal  necrosis.  Theobakl  recommends 
in  these  instances  quinine  in  liberal  doses. 
(See  Part  11). 

As  convalescence  sets  in,  reduce  the 
strength  of  the  silver  solutions,  and  later 
substitute  astringents : 


Zinci  sulphatis gr.  ss-i 

Acidi  borici gr.  x 

Aqua)  bullientis gi 


M.  Sig. — Droj)  into  the  eyes  t.i.d. 

Hydrochlorate  of  optochin  (ethyl-hych’o- 
cupreine)  is  a newgonococcocide  that  is  highly 
praised.  Puscarin  reports  rapid  cure  (within 
a few  days  to  two  weeks)  by  instillations  of 
a 1 ]x;r  cent,  solution  every  hour,  and  2 per 
cent,  every  two  hours,  after  previous  removal 
t)f  all  discharge  with  lotions  of  boracic  acid. 

P.  von  Szily  reports  equally  favorable 
results  by  vaccine  therapy.  A culture  is 
made  on  human  serum  agar,  and  from  this  a 
vaccine  is  made  twenty  hours  later.  A heat 
of  ()0°  C.  is  used  for  killing  the  organisms. 
The  finst  injection  is  of  300  million  and  is 


folknved  on  the  next  day  by  double  the  dose. 
Daily  injections  are  made,  increasing  the 
do.sage  100  million  each  tmie,  for  five  or  six 
days.  The  maximum  dose  contains  800 
million  killed  organisms. 

Ionic  methcation  {q.v.  in  Part  1)  also  has 
its  advocates.  Cotton  wool  wet  with  a 2 
l)cr  cent,  solution  of  zinc  sulphate  is  placed 
witliin  the  lids,  and  a current  of  0.5  Ma. 
passed  for  three  minutes.  The  treatment  is 
repeated  twelve  hours  later. 

Under  the  usual  mode  of  treatment,  gon- 
orrhoeal opthahnia  is  “ seldom  cured  under 
four  to  six  weeks.”  Impairment  of  vision 
due  to  corneal  changes  results  in  many 
cases  in  spite  of  all  care. 

Prophylaxis  in  Infants. — Instil  into  the  eyes, 
immechately  after  birth,  two  ch’ops  of  a 
10  per  cent,  protargol,  or  25  per  cent,  argyrol 
solution. 

Conjunctivitis  Granulosa. — L.  gran'ulum, 
grain.  See  Conjunctivitis  Tracho- 
matosa. 

Membranos  a. — See  Conjunctivitis 
Crouposa. 

Conjunctivitis  Phlyctenulosa  seu  Eczema= 
tosa  seu  Scrofulosa. — L.  phlyctaeYiula-,  Gr. 
(fkvKTaLva  blister;  Gr.  e/cfeir  to  boil  out;  L. 
scrofula,  “sow  pig  ”;  tuberculosis.  A local- 
ized, usually  monocular  kerato-conjrmcti- 
vitis,  characterized  by  the  occurrence  of  one 
or  more  minute  yellowish-red,  translucent 
vesicles  or  ulcerated  nodules  on  or  in  the 
vicinity  of  the  corneal  border,  about  which 
the  conjunctival  injection  is  focalized,  ac- 
companied by  photophobia,  lachrymation, 
and  blepharospasm. 

The  phlyctenules  may  be  absent  and  the 
coiuUtion  resemble  simple  catarrhal  con- 
junctivitis, but  the  presence  of  blepharitis 
marginalis  or  facial  eczema  or  other  mani- 
festation of  poor  health  will  intlicate  the 
diagnosis,  especially  if  the  disease  is  monocu- 
lar. If  in  doubt,  treat  the  affection  as 
strumous  conjunctivitis,  since  astringents 
are  harmful.  (Theobald). 

The  disease  responds  well  to  treatment. 

Etiology.— Poor  health;  tuberculosis; 
infectious  diseases,  particular!}'  the  exan- 
themata and  influenza;  naso-pharyngeal 
disease;  bad  hygiene. 

Treatment.— .Mtend  fir.st  of  all  to  the  gen- 
eral health.  Enjoin  the  observance  of  cor- 
rect hygiene,  e.g.,  fresh  air  day  and  night, 
adequate  rest  and  exercise,  rest  before  and 
after  meals,  a daily  morning  tepid  bath, 
before  breakfast,  in  a comfortable  room,  fol- 
lowed by  a cool  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  personal  and 
household  cleanliness,  an  abundance  of 


EYE 


LAROUSSE  MEDICAL. 


Diseases  of  the  eye. 

From  life  and  wax  models  of  Mr.  Jumelin.  (Tramond-Rouppert.) 


CONJUNCTIVITIS  TRACHOMATOSA 


simple,  wholesome  food,  regular  hours  of 
eating  and  sleeping,  and  regulation  of  the 
bowels.  (See  the  dietary  advised  under  Ec- 
zema of  the  Lids.)  In  the  beginning,  purge 
the  patient  with  broken  doses  of  calomel 
followed  by  a saline.  Prescribe  a tonic,  such 
as  the  elixir  ferri,  quininte,  et  strychnina; 
phosphati,  syrupus  ferri  ioditli,  hypophos- 
phites,  glycerophosphates,  Fowler’s  solution, 
codliver  oil  (see  Drugs,  Part  11).  Theobald 
advises  liberal  doses  of  quinine  in  the  pres- 
ence of  deep  ulceration  (see  Keratitis  Ulcer- 
osa). The  patient  should  wear  tinted  glasses. 


Atropinsc gr.  i-ii-iv 

Acidi  borici gr.  x 

Aquae  bullienti.s 5> 


M.  Sig. — Instil  into  the  eye  t.i.d.,  or  often 
enough  and  in  sufficient  strength  to  keep  the  pupil 
well  dilated,  and  to  prevent  photophobia,  lachrynia- 
tion,  and  blepharospasm. 

Warn  the  patient  that  atropine  some- 
times sets  up  a marked  conjunctivitis  with 
oedema  of  the  lids. 


Hydrargyri  oxidi  ffavi gr.  i 

Petrolati  mollis 3i 


M.  Sig. — Apply  with  a wooden  toothpick  or 
camel’s-hair  brush  in  the  morning  after  instilling  the 
drops.  (Theobald.) 

The  ointment  is  used  only  in  the  presence 
of  ulceration. 

De  Schweinitz  says  that  where  there  is 
much  secretion,  the  use  of  a 10  per  cent, 
solution  of  argyrol  is  “of  signal  service,” 
employed  in  conjunction  with  frequent 
flashings  with  a concentrated  solution  of 
boric  acid  (gr.  xviii  to  the  ounce). 

The  application  of  hot  moist  compresses 
to  the  closed  lids  affords  relief  from  pain  in 
the  acute  stage. 

For  the  blepharitis,  apply  nightly,  white 
precipitate  ointment  (ung.  hydrargyri  ani- 
moniati),  1 to  2 per  cent.;  and  rub  this  also 
into  any  eczematous  lesions  present,  and 
into  the  nasal  passages  as  far  as  possible,  if 
rhinitis  is  present,  (Fuchs,  see  Part  8,  on 
Nose  Diseases).  Adenoids  should  be  re- 
moved. For  moist  eczema  of  the  face, 
Fuchs  well  recommends  the  application  of 
silver  nitrate  solution,  5 to  10  per  cent., 
after  the  removal  of  crusts,  the  application 
to  be  matle  at  first  daily,  and  later  less  often. 

Conjunctivitis  Purulenta. — L.  -pus,  gen. 
pur'is;  purulen'tus. 

Scrofulosa. — See  Conjunctivitis  Phlyc- 
tenulosa. 

Simplex. — See  Conjunctivitis  Catar- 
rhal is. 

Spring. — See  Conjunctivitis  Vernalis. 


Conjunctivitis  Squirrel  Plague. — See  Con- 
junctivitis Tulai’ensis. 

Strumosa. — L.  strumo'sus,  scrofulous. 
See  Conjunctivitis  Phlyctenulosa. 

Toxic. — Gr.  to^lkov  poison. 

Causes.— Mydriaticand myotic  drugs;  chrys- 
arobin;  du.st  of  aniline  dyes;  menthol  fumes; 
formaline  fumes;  artificial  fertilizers;  calomel, 
when  an  ioditle  is  athninistered  internally, 
causing  the  local  formation  of  iodide  of  mer- 
cury; insect  bites;  caterpillar  hairs  (causing 
ophthalmia  or  keratitis  nodosa);  X-rays; 
potassium  iodide  internally;  arsenic  inter- 
nally, etc. 

Treatment. — Irrigate  the  eye  frequently 
with  warm  boric  acid  solution,  3i  ml  Oi,  or 
normal  saline  solution,  qi  ml  Oi. 

Conjunctivitis  Trachomatosa. — L. ; Gr. 
Tpaxo^fJrO.,  -Tpaxvs  rough  + -copa  tumor.  A 
chronic  contagious  disease  of  the  conjunc- 
tiva, due  possibly  to  the  so-called  trachoma 
bodies  of  Prowazek-Greef,  anil  characterized 
by  hypertrophy  of  the  paijilla?  of  the  tarsal 
conjunctiva  (granular  lids)  and  the  occur- 
rence of  translucent,  gray  elevations,  resem- 
bling boiled  sago  grains  (enlargetl  follicles) 
in  the  conjunctiva  of  the  tarsus  and  in  the 
retro-tarsal  folds,  accompanied  by  a puru- 
lent secretion,  and  eventuating  in  atrophy, 
cicatricial  contraction  with  the  production 
of  entropion  and  trichiasis,  the  presence  of 
cicatricial  striae  upon  the  conjunctival  sur- 
face of  the  upper  lid,  and  pannus. 

Treatment. — In  recent,  acute  inflammatory 
cases  with  much  secretion,  apply  once  daily 
or  on  alternate  days,  to  the  everted  lids  and 
retrotarsal  folds  and  superior  and  inferior 
cul-de-sacs,  silver  nitrate,  2 jicr  cent.,  or 
jtrotargol,  40  per  cent.,  using  for  the  purpose 
a cotton-wound  applicator,  or  camel’s-hair 
brush.  The  white  film  formed  by  the  silver 
nitrate  may  be  irrigated  away  completely 
with  normal  saline  solution,  qi  ml  Oi.  The 
eye  should  be  flooded  by  the  patient,  three 
or  four  times  daily,  with  boric  aidd  solution, 
2 to  4 per  cent.,  or  bichloride,  1 : 8000,  or 
formaline,  1 : 5000  to  3000,  or  freshly  pre- 
pared chlorine  water,  50  per  cent,  officinal 
(Part  11);  or  protargol  solution,  10  to  20  per 
cent.,  may  be  instilled  twice  daily.  Should 
ulceration  of  the  cornea  occur,  instil,  t.i.d., 
atropine,  gr.  ii-iv  to  the  ounce  (see  Keratitis 
Ulcerosa). 

After  the  acute  inflammatory  symptoms 
have  disappeared  and  the  secretion  has 
materially  diminished,  which  may  require 
several  weeks,  discontinue  the  silver  applica- 
tions, and  institute  the  following  treatment: 

Instil  a drop  of  4 per  cent,  solution  of 
cocaine  hydrochloride  in  the  conjunctival 


CONJ  UXCTiVlTIS  TRACHOMATOSA 


sac,  and  repeat  in  four  minutes.  After  a 
few  minutes,  apply  powdered  cocaine  to  the 
everted  lids  with  a dampened  cotton-wound 
ap])licator,  with  particular  attention  to  the 
conjunctiva  of  the  retixjtarsal  folds  and  the 
uiferior  cul-de-sac.  In  from  one  and  a half 
to  two  minutes  anaesthesia  is  practically 
complete.  Now  evert  the  upper  lid,  anti 
place  one  blade  of  Knapp’s,  Rust’s,  Noyes’s, 
or  Prince’s  roller  expression  forceps  in  the 
fornix  and  the  other  over  the  tarsal  plate, 
and  with  firm  pressure  strip  the  granules 
from  then-  betl.  Then  grasp  the  superior 
margin  of  the  tarsal  plate  with  Prince’s 
forceps,  and  make  a second  eversion,  asking 
the  patient  to  look  down,  and  thus  expose 
to  view  the  entire  retrotarsal  conjunctiva, 
from  which  every  visible  granule  should  be 
removed.  After  wijjing  away  the  debris 
with  a pledget  of  cotton,  look  for  any  gran- 
ules that  may  have  been  missed,  especially 
in  the  outer  canthus,  and  use  Dewey’s 
trachoma  burr  to  remove  those  gi'anules 
which  are  inaccessible  to  the  roller  forceps. 
Now  turn  to  the  lower  lid  and  express  the 
granules  m the  same  manner,  using  j:>articu- 
larly  the  Dewey  burr,  with  a rubbing  and 
half  turn  of  the  instrument,  while  the 
thumb  nail  is  placed  firmly  against  the  outer 
wall  of  the  lid  in  order  to  steady  the  narrow 
tarsal  jdate.  The  cornea  should  be  kept 
flooded  with  a warm  saturated  solution  of 
boric  acid  (gr.  xviii  to  the  ounce)  during 
the  operation. 

After  every  granule  has  been  removed, 
cleanse  the  conjunctival  sac  with  warm 
boric  acid  solution,  instil  one  droji  of  acRena- 
lin,  1 : 1000,  and  one  of  argyrol,  25  per  cent., 
place  the  patient  upon  a couch,  and  aj^ply 
moist  compresses  as  hot  as  can  be  borne, 
until  the  patient  is  free  from  j:>ain,  which 
lasts  from  one-half  to  one  or  two  hours. 

Thereafter,  for  a week,  the  patient  should 
flush  the  eye  three  or  four  times  a day  with 
warm  boric  acid  solution,  and  instd  a drop 
of  argyrol  solution,  25  per  cent.,  t.i.cl. 
(.\fter  C.  H.  Dewey). 

After  the  inflanmiatory  reaction  has  sub- 
sided, begin  the  copper  sulphate  treatment, 
at  first  once  daily,  then  every  other  day, 
and  so  on,  “ until  eveiy  trace  of  hyjx^rtrophy 
has  vanished  and  the  conjunctiva  has 
be(;ome  free  from  congestion  and  smooth 
throughout  ” (F’uchs).  This  may  take 
months  and  even  years.  The  copj^er  sul- 
phate is  applied  lightly  to  the  tarsal  plates 
and  fornices  in  the  form  of  a pencil,  pre- 
ceded by  one  or  two  drops  of  a 4 |x'r  cent, 
cocaine  solution  (for  a few  weeks  only),  and 
followed  by  irrigation  with  warm  boric  acid 


or  normal  saline  solution,  5i  ad  Oi.  “ When 
there  is  great  cicatricial  contraction  of  the 
conjunctiva,”  replace  the  blue  stone  by  a 
1 to  2 per  cent,  ointment  of  ammoniated 
mercury,  or  1 per  cent,  yellow  oxide  of  mer- 
cury, which  should  be  massaged  into  the 
conjunctival  sac  (Fuchs).  The  milder  alum 
pencil  may  be  later  substituted  for  the 
copper.  Wood  and  Woodruff  recommend  a 
solution  of  copper  sulphate  in  glycerine, 
gr.  xc  ad  5 i,  at  first  one  drop  to  fifteen  drops 
of  water,  the  strength  to  be  gradually 
increased.  The  conjunctiva  is  first  dried 
before  applying  the  glyceride,  which  should 
be  apjjlied  to  all  parts  with  a cotton-wound 
stick.  The  eye  should  be  kept  cleansed 
with  warm  boric  acid  solution,  employed  by 
the  patient  three  or  four  times  daily.  When 
the  disease  is  well  under  control,  the  patient 
may  be  given  an  ointment  of  copper  sul- 
lihate,  0.5  to  1 per  cent.,  or  of  copper  citrate 
5 to  10  per  cent.,  or  of  thiosinamine,  15  per 
cent.,  to  be  massaged  into  the  conjunctival 
sac  by  himself  two  or  three  times  a day. 

Recent  pannus  (membrane-like,  super- 
ficial vascularization  of  the  cornea,  com- 
monly limited  to  the  upper  half)  will  disap- 
pear of  itself.  When  present,  instil  atropine 
occasionally,  m order  to  keep  the  pupil 
dilated,  since  a slight  iritis  with  danger  of 
posterior  synechiae  is  often  associated  with 
it.  If  the  upper  lid  is  tense  and  exei’ts 
pressure  and  friction  upon  the  cornea,  thus 
favoring  the  development  of  pannus,  do  a 
canthotomy  as  described  by  Theobald: 
“ With  a pair  of  straight  scissors  the  external 
canthus,  at  one  cut,  is  divided  horizontally 
outwanl  for  adistanceof  SorlOimn.  (/-3I0M2 
inch).  The  upper  lid  is  then  put  upon  the 
stretch,  and  the  superior  half  of  the  external 
canthal  ligament,  which  is  thus  made  tease, 
is  cut  through  with  the  scissors,  the  points 
of  which  are  inserted  vertically  beneath  the 
upper  lip  of  the  skin  wound.  The  finst 
incision  will  have  divided  both  skin  and  con- 
junctiva, ami  the  final  step  of  the  operation 
consists  in  attaching  the  edges  of  the  con- 
junctival wound  to  those  of  the  skin  wound 
by  several  fine  silk  sutures,  so  that  the  cut 
edges  of  the  skin  shall  not  miite  one  with 
the  other.” 

If  fresh  granules  appear,  they  should  be 
expressetl  or  squeezetl  out  by  means  of  the 
roller  forceps  or  Dewey’s  burr,  or  punctured 
individually  with  a sharp  knife  and  then 
squeezed  out.  Some  prefer  the  grattage 
operation  to  the  use  of  the  expression  forceps. 
The  lids  are  held  completely  everted  by 
means  of  Darier’s  forceps,  and  a horn 
spatula  is  inserted  beneath  the  lid,  to  pro- 


COJ^JUXCTIVITIS  VEllNALIS ; SPRING  CATARRH 


tect  the  cornea.  The  conjunctiva  is  then 
thoroughly  scarified  by  means  of  a special 
tri-bladed  scarificator  or  scalpel,  and  then 
scrubbed  with  a stiff  tooth-brush  which  has 
been  steeped  in  bichloride  solution,  1 ; 1000 
(Dr.  Coover  uses  sandpaper  which  has  been 
soaked  in  bichloride).  After  scrubbing,  the 
parts  are  washed  with  bichloride  solution, 
1 ; 1000.  The  subsequent  treatment  is  the 
same  as  previously  described. 

In  intractable  forms  of  trachoma,  Casey 
A.  Wood  warmly  advocates  removal  of  the 
diseased  tarsus. 

Rontgenotherapy,  the  high  frequency 
current,  and  ionic  medication  {q.v.  in  Part  1) 
are  recommended  for  trachoma.  In  employ- 
ing ionization,  cotton  wool  wet  with  a 2 per 
cent,  solution  of  zinc  sulphate  is  placed  within 
the  lids,  and  a current  of  1 to  2 -|-  milli- 
amperes  passed  for  two  minutes. 

Subconjunctival  injections  of  cyanide  of 
mercuryq  1 : 4000,  10  to  20  minims,  are  well 
recommended  for  pannus.  To  clear  up  a 
very  old  pannus,  the  jequirity  treatment 
may  be  employed;  but  there  is  danger  of  its 
producing  corneal  necrosis.  Use  Rbmer’s 
jequiritol  and  jequiritol  serum  (Merck). 
“ Jequiritol  comes  in  four  different  degrees 
of  strength.  A single  drop  of  No.  1 is 
instilled  into  the  conjunctival  sac  by  means 
of  a capillary  tube.  If  no  severe  reaction 
follows,  the  dose  must  be  daily  increased 
until  a typical  jequiritol  inflammation  devel- 
ops. Occasionally  no  reaction  occurs  until 
No.  2 is  used,  when  the  acute  inflaimnation 
is  finally  reduced,  and  subsides  in  a few 
days.  Subsequently  the  eye  will  endure  a 
still  stronger  dose.  Immunity  is  obtained 
after  a number  of  inflammatory  attacks, 
and  at  last  the  stronge.st  dose  produces  no 
effect.  If  twenty-four  hours  after  the 
employment  of  a dose  the  inflammation 
appears  to  be  too  severe,  several  drops  of 
the  jequiritol  serum  should  be  instilled  into 
the  eye  frequently  during  the  day.” 

For  the  treatment  of  entropion  and  tri- 
chiasis, see  these  headings.  Good  hygiene 
and  tonics  should  not  be  neglected. 

The  application  of  radium  {q.v.  in  Part  1) 
in  a glass  tube  or  very  thin  metal  filter  for  a 
few  minutes  (the  tune  increased  if  necessary) 
is  of  great  value. 

Conjunctivitis  Tuberculosa. — See  Con- 
junctival Tuberculosis. 

Tularensis. — A very  rare,  acute,  severe 
inflammation  of  the  conjunctiva,  caused  by 
infection  with  the  bacillus  tularense  of 
squirrel  and  rabbit  plague,  and  characterized 
by  the  occurrence  of  multiple,  discrete, 
deep,  round,  golden-yellow  necrotic  ulcers, 


great  swelling  of  the  lids,  enlargement  of 
the  pre-auricular  and  neighboring  lymph 
glands,  elevation  of  temperature,  and 
constitutional  disturbance. 

Vaccine  therapy  has  been  employed  with 
good  results. 

Conjunctivitis  Vernalis;  Spring  Catarrh. — 

L.  vernal'iSyOi  the  spring;  Gr.  Karapppelv  to 
flow  down.  A rare,  clironic  affection  of  the 
bulbar  ami  tarsal  conjunctivse,  character- 
ized by  the  presence  of  yellowish-brown, 
velvety  looking,  gelatinous,  slightly  raised, 
flattened,  papilliform  granulations,  present- 
ing the  appearance  of  a “ pavement  of 
cobblestones  ” covered  with  a milky  film, 
and  accompanied  by  constant  itching.  The 
affection  may  last  for  from  three  to  ten  or 
more  years,  with  spring  and  suimner  exacer- 
bations (being  symptomless  in  fall  and 
winter  and  in  cool  weather),  and  may 
then  disappear. 

Both  vernal  conjunctivitis  and  the  con- 
junctivitis of  hay  fever  are  accompanied  by 
an  eosinophilia,  so  that  the  two  conditions 
may  have  a common  cause.  (Pu.sey.) 

Treatment. — The  following  measures  may 
relieve  the  distressing  symptoms: 

B Zinci  .sulpliatis gr.  ss 

Acidi  borici gr.  x 

Aquaj  bullientis 3i 

M.  Sig. — Drop  into  the  eyes  t.i.d. 

R Ilydrargyri  chloridi  corrosivi . . 0.004  gin. 

Sodii  chioridi 0.030  gm. 

Aquae  destillatai 30.000  c.c. 

M.  Sig. — Drop  into  the  eyes  t.i.d. 

R Acidi  acetici  diluti gtt.  xv-xx 

Aquae 5 i 

M.  Sig. — Instil  into  the  eyes  frequently  for  the 
relief  of  itching. 

B Acidi  salicylici gr.  v 

Aquae 5 i 

M.  Sig. — Drop  into  the  eyes  t.i.d. ; and  massage 
into  the  conjunctival  sac,  once  daily,  ung.  acidi 
sahcylici,  gr.  iii  ad  5ss.  (Randolph.) 

Antipyrinaj gr.  xlviii 

Aqua? 5 i 

M.  Sig. — Drop  into  the  eyes  as  required. 

B Protargol,  2 to  3 per  cent 5 i 

Sig. — Instil  into  the  eyes  three  or  four  times 
a day. 

I^  Adrenalini  chloridi,  1 : 1000.  . . 5ss 

Sig. — One  drop  in  the  eye,  as  required.  (Fuchs.) 

R Glyceriti  boroglycerini gi 

Sig. — Apply  to  the  everted  lid  by  means  of  a 
cotton-wound  applicator.  (De  Schweinitz.) 

I^  Solutionis  acidi  borici,  2 to  4 

per  cent 5 iv 

Sig. — Instil,  warm,  t.i.d.;  and  apply  ung.  hydrarg 
ox.  flav.,  gr.  i ad  3i,  twice  a day. 


CORNEA,  TRAUMATISM  OF  THE 


Smoked  glasses  may  be  worn.  Cold  com- 
presses applied  frequently  afford  relief.  The 
patient  should  keep  as  cool  as  possible, 
iirsenic  (see  Part  11)  internally  may  be  tried. 
Radium  and  the  X-ray  employed  as  in  tra- 
choma (q.v.)  are  said  to  be  curative.  The 
roller  forceps  may  be  employed  in  the  pal- 
pebral type  (see  Trachoma). 

Contraction  of  the  Pupil. — L.  contraciio; 
pupil'la,  girl.  See  Myopia. 

Contusion  of  the  Eyeball. — L.  contusio, 
from  contundere,  to  bruise.  See  Injuries  of 
the  Eye. 

Convergence,  Latent  or  Esophoria. — L. 

con,  together  + ver'gere,  to  incline;  lat'ens, 
hidden;  Gr.  ecrco  inward  -}-  <j>kpnv  to  bear. 
See  Muscular  Anomalies. 

Cornea,  Abscess  of  the. — L.  cor'neus, 
horny;  absces'sus,  a going  apart.  See 
Keratitis  Ulcerosa. 

Burns  of  the. — See  Injuries  of  the  Eye. 

Conical. — L.  co'nus;  Gr.  kuvos  cone. 
See  Keratoconus. 

Dryness  of  the. — See  Xerosis;  Xeroph- 
thalmos. 

Fistula  of  the. — L.  fiklula,  pipe.  See 
under  Keratitis  Ulcerosa. 

Foreign  Bodies  in  the. — See  Foreign 
Bodies  in  the  Eye. 

Herpes  of  the. — L.  ; Gr.  tpirris]  herpetic 
means  vesicular.  See  Keratitis  Neu- 
ro}iathica. 

Inflammation  of  the. — L.  injlammdre,  to 
set  on  fire.  See  Keratitis. 

Injuries  of  the. — See  Injuries  of  the  Eye. 

Opacities  of  the. — L.  opac'itas.  The 
causes  are  corneal  inflammation,  severe 
iritis  and  uveitis,  and  corneal  traimiatism. 
Arcus  senilis,  “ the  ring  of  degeneration  seen 
about  the  corneal  perijilieiy  in  aged  persons  ” 
(Borland),  occurs  spontaneously  and  is  of 
no  therapeutic  importance. 

The  following  untoward  consequences  may 
obtain,  viz.,  obstruction  of  vision,  refractive 
errors  and  resulting  asthenopia,  myopia, 
strabismus,  nystagmus.  “ Incarceration  of 
the  iris  in  the  corneal  scar  entails  two  dan- 
gers— mcrease  of  tension  (glaucoma)  and 
purulent  inflammation  of  the  interior  of 
the  eye.”  (Fuchs.) 

Treatment.— Recent,  slight  opacities  may 
be  improved  by  systematic,  gentle  massage 
of  the  cornea  through  the  eyelid,  after  the 
introduction  of  ung.  hjalrargyri  oxidi  flavi, 
gr.  i ad  pi  of  vaseline  or  cosmoline  or  liquid 
albolene,  into  the  conjunctival  sac.  The 
massage  inust  be  persisted  in  for  months  or 
even  years,  if  necessary.  The  instillation  of 
one  drop  of  dionin  solution,  5 per  cent., 
thrt'c  or  four  times  daily,  is  of  additional 


service.  It  produces  an  cedematous  reac- 
tion at  first.  Subconjunctival  injections  of 
chonin,  4 to  5 per  cent.,  or  salt  solution, 
1 to  5 per  cent.,  or  cyanide  of  mercury, 
1 : 4000,  10  to  20  minims,  are  also  advo- 
cated. Chlorine  ionization  may  be  tried 
(see  Ionic  Medication  in  Part  1).  The 
negative  electrode  is  placed  over  the  closed 
lids,  the  lachrjnnal  secretion  containing  the 
requisite  sodium  chloride,  and  a current  of  1 
to  2 + milliamperes  is  passed  for  two  or 
three  minutes. 

Where  the  opacity  involves  only  the  epi- 
thelium, the  result  of  irritation  in  trichiasis 
or  of  the  imbedding  of  lead,  lime,  or  powder 
grains,  remove  the  affected  epithelium  with 
the  knife.  Such  superficial  opacities,  how- 
ever, are  rare. 

Where  the  opacity  overlies  the  pupil,  an 
u-idectomy  should  be  perfonned. 

Wdiere  a part  of  the  pupillary  area  of  the 
cornea  is  clear  and  another  part  cloudy, 
causing  confused  vision  and  interfering  with 
reading,  stenopoeic  glasses  (Gr.  orerds  narrow 
b-wi]  opening)  may  be  used,  the  aperture 
behig  held  in  front  of  the  transparent  por- 
tion of  the  cornea. 

Dense  opacities  may  be  rendered  less  con- 
spicuous by  tattooing  with  India-ink;  or 
better,  according  to  Verhoeff,  by  the  injec- 
tion of  India-ink  suspended  in  normal  saline 
solution,  using  a hypodermic  syringe,  taking 
care  not  to  force  the  suspension  past  the 
scar  margin. 

G)rnea,  Protrusion  of  the. — See  Cornea, 
Staphyloma  of  the. 

Softening  of  the. — See  Keratomalacia. 

Staphyloma  of  the. — Gr.  crra^cX^  grape 
-j — wpa  tumor;  crra</)uXct)ga.  Protrusion  of 
the  cornea  and  iris,  caused  by  a penetrating 
wound  or  deejD  corneal  necrosis  and  ulcera- 
tion, usually  gonorrhoeal. 

Treatment.— If  seen  in  its  incipiency,  ajiply 
a jiressure  bandage  continuously,  but  not  too 
tightly,  and  enjoin  absolute  quiet,  the  avoid- 
ance of  straining  at  stool,  etc.  If  deemed 
advisable,  a paracentesis  may  be  performed 
anti  repeated  if  necessaiyq  or  in  clean  cases 
an  iridectomy,  or  Knapp’s  operation  of 
‘‘partial  abscission,”  or  Elliot’s sclero-corneal 
trephining.  Do  not  operate,  however,  “ if 
in  a partial  staphyloma  (t.e.,  one  confined  to 
a limited  area  of  the  cornea)  the  vision  is 
good,  and  there  is  no  tendency  to  an  in- 
crease of  the  ectasia.”  In  total  staphyloma, 
on  the  other  hand,  “enucleation  of  the  eye 
is  commonly  indicated,”  to  forestall  infec- 
tion (chiefly  after  Theobald). 

Cornea,  Traumatism  of  the. — Gr.  rpavpa 
wound.  See  Injuries  of  the  Eye, 


DACRYOCYSTITIS 


Cornea,  Tuberculosis  of  the. — See  Con- 
junctival Tuberculosis. 

Ulcer  of  the. — See  Keratitis  Ulcerosa. 

Wounds  of  the. — See  Injuries  of  the  Eye. 

Corneitis. — See  Keratitis. 

Cross=Eyes. — -See  Squint. 

Croupous  Conjunctivitis. — See  Conjunc- 
tivitis Crouposa. 

Crystalline  Lens. — Gr.  KpuoraXXos  ice. 
See  Lens. 

Cyclitis. — Gr.  kukXos  ring  + -trts  inflaimna- 
tion.  Inflammation  of  the  ciliary  body  is 
usually  but  a part  of  inflaimnation  of  the 
uveal  tract  (iris,  ciliary  body,  and  choroid). 
Tenderness  (on  palpation  with  the  end  of  a 
probe)  in  the  ciliary  region  is  an  unportant 
diagnostic  sign.  Consult  Iritis  for  symp- 
tomatology, etiology,  and  treatment. 

Cycloplegia. — Gr.  kvkXos  circle  -t-  Tr\riy^ 
stroke.  See  Accommodation  Anomalies. 

Cylindroma  Conjunctivae. — Gr.  KvXivdpos 
cylintler  H — copa  tumor.  See  Conjunctival 
Tumors. 

Cyst,  Conjunctival. — Gr.  Kvans  bladder. 
See  Conjunctival  Tumors. 

Cyst,  Lachrymal  Qland;  Dacryops. — L. 

lacrima,  tear;  glans,  a cord;  Gr.  8a.Kpv 
tear  + '■'V  eye.  See  (Orbital  Tumors. 

Meibomian. — H.  Meibom  (1638-1700). 
See  Chalazion. 

Orbital. — ^See  Orbital  Tumors. 

Tarsal. — Gr.  rape- 6s  foot.  See  Chalazion. 

Dacryoadenitis. — Gr.  ddKpv  tear  -|-  d8r/v 
gland  + -LTLs  inflaimnation.  Inflammation 
of  the  lachrymal  gland  is  either  acute 
or  chronic.  The  acute  form  may 
resemble  orbital  cellulitis  (q.v.) ; the  chronic 
form  is  marked  by  enlargement  and 
tenderness. 

Etiology.— Traumatism;  “ cold  ”;  influenza; 
mumps;  smallpox;  syphilis;  tuberculosis; 
gonorrhoea;  leuktemia;  rheumatism;  gout; 
conjunctivitis,  and  keratitis. 

Treatment.— Treat  acute  cases  the  same  as 
cellulitis  (q.v.).  In  chronic  cases,  prescribe 
mercury  and  iodide,  internally,  and  ung. 
hydrargyri  or  ung.  iodi  externally  (see  Drugs, 
Part  11.)  Excise  the  gland  if  it  is  very  large. 

Dacryocystitis. — Gr.  SdKpv  tear  -t-  /cuems 
sac  H — LTLS  inflammation.  I.  Acute  Suppura= 
tive  Inflammation  of  the  Lachrymal  Sac. — ETIOL- 
OGY.— Ghronic  dacryocystitis;  entrance  of 
irritating  fluids;  traumatism;  exanthematous 
fevers  (measles,  scarlet  fever,  smallpox); 
caries  of  the  lachrymal  bone  (very  rare). 

Treatment. — Open  the  bowels  with  cal- 
omel, followed  by  a saline,  or  with  castor-oil, 
and  administer,  according  to  Theobald, 
sodium  pyrophosphate  (see  Drugs,  Part  11). 
Apply  moist,  hot  compresses,  and  irrigate  the 


nose  on  the  affected  side,  using  a fountain 
syringe,  with  hot  normal  saline  solution  (5  i ad 
Oi),  in  the  hope  that  the  abscess  may  break 
into  the  inferior  meatus,  which  it  may  be  ex- 
pected to  do  unless  cicatricial  stenosis  of  the 
nasal  duct  is  present.  In  irrigating  the  nose, 
place  the  patient’s  face  horizontally  over  a 
basin  and  instruct  hmi  to  breathe  through  the 
mouth  and  to  refrain  from  swallowing,  in 
order  to  avoid  the  entrance  of  fluid  into  the 
eustachian  tube. 

If  the  abscess  can  not  be  evacuated 
through  the  nose,  owing  to  cicatricial  steno- 
sis of  the  nasal  duct,  continue  the  local 
application  of  heat,  and  as  soon  as  fluctua- 
tion appears,  incise  the  lachrymal  sac  down- 
ward and  outward,  evacuate  the  contained 
pus,  and  insert  a gauze  drain.  Renew  the 
latter  each  day  until  the  inflaimnation  has 
disappeared;  then,  before  the  fistula  is 
allowed  to  close,  restore  the  patency  of  the 
nasal  duct  by  means  of  sounds,  as  described 
under  chronic  dacryocystitis,  following.  If 
the  fistula  does  not  then  close,  cauterize  the 
edges  or  refresh  and  suture  them. 

If  the  patency  of  the  duct  can  not  be 
maintained,  resort  to  a dacryocystorhinos- 
tomy (see  below). 

II.  Chronic  Inflammation  of  the  Lachrymal  Sac.— 
Chronic  dacryocystitis  is  manifested  by  the 
presence  of  epiphora,  or  tear-drop,  and  more 
or  less  fulness  in  the  region  of  the  lachrymal 
sac,  pressure  upon  which  causes  a muco- 
purulent or  tliin,  Ihnpid  mucous  fluid  to 
issue  from  the  puncta.  Acute  inflamma- 
tory exacerbations  are  prone  to  occur. 

Etiology. — Obstruction  of  the  nasal  duct, 
due  to  (1)  inflanmiatory  turgescence  of  the 
mucous  membrane  occurring  in  chronic 
rhinitis;  (2)  cicatricial  stenosis  occurring  as 
a result  of  ozoena  or  ulceration  (syphilitic  or 
tuberculous) ; (3)  tumors,  usually  polypi ; (4) 
traumatism;  (5)  persistence  in  the  newborn 
of  the  “ thin  diaphragm  of  mucous  mem- 
brane which  in  the  foetus  closes  the  lower 
orifice  of  the  nasal  duct.”  Other  causes  of 
dacryocystitis  are  local  trachoma,  tubercu- 
losis, and  traumatism.  A flattened  or  saddle- 
back nose  predisposes. 

Treatment. — A cicatricial  stricture  of 
the  nasal  duct  requires  gradual  dilatation  by 
means  of  Theobald’s  probes.  Theobald’s 
procedure  is  as  follows:  Instil  several  times, 
alternately,  into  the  inner  corner  of  the  eye, 
cocaine  solution,  4 per  cent,  (or  holocaine, 
1 per  cent.),  and  adrenalin,  1 : 1000  (or  three 
drops  of  adrenalin  may  be  added  to  each 
c.c.  of  5 per  cent,  cocaine  solution).  Then 
probe  the  lower  canaliculus  with  a No. 
followed  by  a No.  2 probe.  If  a stricture  is 


DETACHMEiXT  OE  THE  liETlEA 


encountered  which  these  probes  cannot 
pass,  use  the  straight,  sharp-pointed  probe 
and  bore  through  the  stricture  into  the  lachry- 
mal sac.  Then  slit  the  canaliculus  up  into  the 
sac  as  described  under  Epiphora.  Now 
attempt  to  pass  through  the  nasal  duct  into 
the  nose  as  large  a probe  as  possible,  usually  a 
No.  5,  first  lubricating  it  with  sterile  vaseline. 
Standing  behind  the  patient,  and  keeping 
the  lower  lid  upon  tlie  stretch,  pass  the 
probe  horizontally  along  the  canaliculus 
until  the  sac  is  entered,  then  turn  the  probe 
vertically,  and  pass  it  slowly  through  the  duct 
to  the  floor  of  the  nose,  cUrecting  its  point 
to  the  furrow  between  the  ala  of  the  nose 
and  the  cheek.  At  the  end  of  ten  to  twenty 
minutes  withdraw  the  probe. 

If  neither  a No.  5 nor  a No.  4 probe  can 
be  made  to  enter  the  stricture,  use  the  “ sup- 
plementary probe,”  and,  if  this  fails,  wait 
forty-eight  hours  and  try  again.  If  then 
unsuccessful,  bore  through  the  stricture 
with  the  straight,  sharp  probe,  or  divide  it 
with  a narrow-bladed,  Sichel  cataract  knife. 

Repeat  the  jjrobing  every  other  day,  pass- 
ing each  time,  if  possible,  a larger  size  probe, 
until  a No.  16  can,  if  possible,  be  passed, 
considerable  force  being  sometimes  recpiired. 

After  the  duct  has  been  thus  thoroughly 
dilated,  gradually  diminish  the  frequency  of 
the  probings,  first  to  every  three  or  four  days, 
then  once  a week,  two  weeks,  a month,  two 
months,  and  cease  when  the  duct  no  longer 
tends  to  recontract.  Eight  to  ten  months 
may  be  required  for  a cure.  After  the  duct 
has  been  thoroughly  dilated,  the  patient  may 
be  given  a probe  for  occasional  use  at  home. 

During  the  treatment,  havethe  patient  press 
out  the  contents  of  the  sac  thrice  daily,  and 
drof)  into  the  inner  corner  of  the  eye,  bichlo- 
ride of  mercury,  1 : 12,000  to  8000,  in  sodium 
chloride  solution,  1 per  cent. ; or  alum,  gr.  i-ii, 
and  boric  acid,  gr.  x,  in  water,  5 i ! oi’  J^rotar- 
gol,  2 jier  cent.  If  nasal  catarrh  is  present,  have 
him  spray  the  nose  thrice  daily,  by  means  of 
a hand  atomizer,  with  the  following: 


R Hydrargyri  ohloridi  corrosivi  . . gr.  .s.s 

Sodii  chloridi gr.  xv 

GlywTiiii oss 

Aqua.'  dost  illata* 5 ivss 


Ammonium  chloride  in  doses  of  gr.  x may 
be  administered  internally  (after  Theobald). 

If  a cure  by  sounds  cannot  be  accom- 
plished, one  may  bore  a hole  through  the 
internal  wall  of  the  lachr\mial  sac  into  the 
nasal  cavity  by  means  of  a dental  burr,  after 
ojiening  the  sac  by  an  incision  starting  at 
the  upper  canaliculus  (J.  A.  Pratt);  or  a more 
extensive  daciyo-cysto-rhinostomy  may  be 


performed,  either  from  above  or  below. 
Formerly  the  lachrymal  sac  was  extirpated, 
and  later,  if  epiphora  was  troublesome,  the 
inferior  lachrymal  gland  was  removed. 

Dacryolith. — Gr.  daKpvov  tear  -f  X10os 
stone.  See  Epiphora. 

Dacryops;  Cyst  of  the  Lachrymal  Gland. — 
Gr.  dcLKpv  tear  -j-  eye;  Gr.  Kvans  cyst;  L. 
lac'rima,  tear;  (jlans,  a cord.  See  Orbital 
Tumors. 

Day=Blindness. — See  Hemeralopia. 

Dendritic  Keratitis. — Gr.  bkvbpov  tree.  See 
Keratitis  Neuropathica;  Keratitis  Ulcerosa. 

Dermatolysis  of  the  Eyelid. — Gr.  bkppa. 
skin  -f-  Xuens  loosening.  See  Blepharochalasis. 

Dermoid  of  the  Conjunctiva. — Gr.  bkppa. 
skin  -f-  €t5os  form.  See  Conjunctival  Tumors. 

Orbital. — See  Orbital  Tumors. 


Fig.  103. — Serous  Detachment  of  the  Retina  in  Myopia 

A woman  of  sixty-two,  having  previously  been  very  my- 
opic, had  for  four  years  suffered  from  a cataract  in  the  right 
cye.s  After  the  removal  of  the  cataract  by  operation,  the 
lower  half  of  the  retina  proved  to  be  detached,  thrown  into 
folds  and  tremulous.  The  upper  border  of  the  detached 
retina  lay  upon  the  lower  border  of  the  papilla,  and  concealed 
it.  To  the  outer  side  the  detachment  is  sharply  demarcated 
from  the  normal  fundus,  while  to  the  inner  side  it  spreads  out 
quite  gradually  into  t wo  or  three  flat  folds.  On  the  crests  of 
the  folds  the  detached  retina  looks  lighter  than  in  the  depres- 
sions between  them.  The  retinal  vessels  running  downward 
from  the  papilla  soon  after  they  start  disappear  behind  the 
overhanging  edge  of  the  detached  portion  of  the  retina,  and 
are  apparently  interrupted  at  this  spot.  In  their  subsequent 
course  they  are  distinguished  by  the  remarkably  sharp  bends 
they  make  and  which  follow  the  folds  of  the  detached  retina. 
The  outer  side  of  the  optic  disk  is  bordered  by  a white  atro- 
phic crescent,  which  is  about  half  the  width  of  the  papilla, 
and  is  attributable  to  the  myopia  pre-existing  in  the  eye. 
The  outlines  both  of  this  papilla  and  the  crescent  are  hazy. 
The  rest  of  the  lundiis  is  tessellated — i.  e.,  displays  the  chori- 
oidal  vessels  and  the  dark  intravascular  spaces. 

Descemetitis. — Inflammation  of  Desce- 
met’s  membrane,  the  posterior  lining  mem- 
brane of  the  cornea.  See  Iritis. 

Detachment  of  the  Iris. — See  Injuries  of 
tlie  Eye,  under  Penetrating  Wounds. 

Retina.—  Retinal  detachment  is  charac- 
tc'rized  clinically  by  limitation  of  the  field  of 


DISLOCATION  OF  THE  LENS 


vision,  the  appearance  as  of  a dark  cloud  or 
curtain  veiling  parts  of  objects,  and  perhaps 
“ flickering  and  confusion  of  sight.”  The 
ocular  tension  is  usually  subnormal,  unless 
an  intra-ocular  growth  is  present,  when 
it  is  increased. 

The  Prognosis  is  serious,  but  operative  treat- 
ment is  not  infrequently  curative.  (Fig.  103.) 

Etiology.— Traumatism;  chronic  uveitis; 

hemorrhage  from  the  choroid;  intra-ocular 
tmnors  and  cysts;  high  myopia;  senility. 

The  unmecUate  cause  may  be  a fall,  blow, 
violent  coughing,  vomiting,  heavy  lifting,  etc. 

Treatment.— It  is  perhaps  best  to  operate 
as  soon  as  practicable,  and  remove  a small 
scleral  button  from  under  a conjunctival 
flap  over  the  site  of  the  detachment,  by 
means  of  the  Elliot  trephine.  The  choroid 
which  then  protrudes  may  be  grasped  and 
clipped  away  with  ciu’ved,  fiat  scissors,  so 
that  the  retina  may  be  forced  into  the  open- 
ing of  the  choroid  and  there  become  aclher- 
ent  (Tiffany).  The  conjunctival  flap  is 
sutured  with  fine  siik,  and  a moderate 
pressure  bandage  applied.  The  patient  is 
then  returned  to  bed,  and  atropine  drops 
(gr.  ii-iv  ad  5 i)  instilled.  If  the  retina  does 
not  fall  back  into  place,  push  the  needle  of 
an  aspirating  syringe  through  the  conjunc- 
tiva and  the  trephine  opening  and  draw  off 
the  subretinal  fluid.  The  patient  should  be 
kept  in  bed  for  a few  days. 

A subretinal  hydatid  cyst  may  be  success- 
fully extracted  tfu’ough  the  sclera. 

If  surgical  treatment  is  not  feasible,  one 
may  try  the  dubious  plan  of  confining  the 
patient  to  bed  for  several  weeks,  instilling 
atropine,  applying  a moderate  pressure 
bandage,  administering  laxatives,  and  pro- 
moting diaphoresis  by  means  of  pilocarpine, 
followed  later  by  potassium  iodide  (see  Dmgs, 
Part  11),  this  treatment  to  be  persisted  in 
for  several  weeks  if  improvement  occurs. 
Subconjunctival  injections  of  sterile  salt 
solution  are  also  advised,  the  injections  to 
be  given  every  two  or  three  days,  increasing 
the  strength  from  2 to  5 per  cent.,  and  the 
quantity  from  15  to  25  minims;  but  H.  W. 
Woodruff  declares  that  they  have  not  been 
proven  of  any  value  in  this  affection. 

Dilatation  of  the  Pupil. — L.  pupil'la,  girl. 
See  Mydriasis. 

Diphtherial  Conjunctivitis. — See  Con- 

junctivitis Crouposa. 

Diplopia. — Gr.  SltXoos  double  -f-  o\pis 
vision.  I.  Binocular  Diplopia  — Diplopia  pres- 
ent only  in  binocular  vision,  disappearing 
when  one  eye  is  shut,  is  due  to  a deviation  of 
one  of  the  eyeballs  whereby  the  images  of  an 
object  fall  upon  non-corresponding  parts  of 
42 


the  two  retinae,  as  in  strabismus,  displacement 
of  one  eyeball  by  a tumor,  and  limitation  of 
the  excursions  of  the  eye  by  a symblepharon 
or  pterygium.  The  “ true  ” image  is  more  dis- 
tinct than  the  “ false  ” or  displaced  unage. 

Binocular  diplopia  is  “ homonymous  ” 
when  the  displaced  image  is  on  the  side  of 
the  affected  eye,  as  in  convergent  squint, 
which  may  be  ascertained  by  closing  one 
eye,  then  the  other,  and  asking  the  patient 
which  image  in  each  instance  disappears.  It 
is  “ heteronjauous  ” or  crossed  in  divergent 
squint,  in  which  the  left  image  belongs  to  the 
right  eye  and  the  right  image  to  the  left  eye. 

The  two  images  are  on  a different  level 
when  the  axes  of  the  two  eyes  are  not  on  the 
same  horizontal  plane;  and  they  are  inclined 
in  relation  to  each  other  when  one  eye  is 
rotated  about  its  sagittal  axis. 

Squint  may  be  present,  however,  without 
diplopia,  as  when  one  eye  is  blind,  or  when 
vision  in  the  squinting  eye  is  suppressed  or 
psychically  ignored.  To  determine  in  squint 
whether  binocular  vision  is  present  or 
whether  one  of  the  images  is  suppressed, 
place  a prism,  base  downward,  before  one 
of  the  eyes.  If  two  unages  are  not  now 
seen,  one  of  the  images  is  being  suppressed. 
Binocular  vision  may  also  be  tested  by  holding 
a ruler  vertically  a few  centuuetres  in  front  of 
the  patient’s  nose,  with  the  edge  of  the  ruler 
toward  the  nose,  and  then  ascertaining  if  the 
patient  can  read  without  moving  his  head  to 
one  side  or  the  other  of  the  printed  page. 

II.  Monocular  Diplopia.— Diplopia  present 
when  one  eye  (the  sound  eye)  is  shut  is 
caused  by  the  following  conditions,  viz., 
irregular  astigmatism;  subluxation  of  the 
lens;  incipient  cataract;  a double  pupillary 
opening  (as  in  iridodialysis,  perforation  of 
the  iris,  and  division  of  the  pupil  into  two 
parts  by  an  opaque  strand,  etc.) ; “ irregular 
cramp  of  the  ciliary  muscle  “ complete  or 
partial  constriction  of  the  eyelids,  by  which 
they  are  made  to  impinge  on  the  cornea”; 
hysteria;  “ organic  disease  of  the  brain  or  its 
membranes,  associated  with  abducens  paral- 
ysis.” Sunulation  should  be  excluded. 

Dislocation  of  the  Lens. — L.  dis,  apart; 
locar'e,  to  place;  lens,  lentil.  In  examining  the 
eye,  first  dilate  the  pupil  with  an  evanescent 
mydriatic,  i.e.,  homatropine  hydrobromate, 
1 per  cent.,  or  euphthalmine  hydrochlorate, 
5 per  cent.,  and  employ  both  oblique  ilhun- 
ination  (g.w.)  and  the  ophthalmoscope. 
Tremulousness  of  the  iris  nearly  always 
occurs  when  the  lens  is  dislocated  backwards. 

Etiology. — Congenital  anomaly;  trauma; 
hydrophthalmus;  staphylomata;  chorioidi- 
tis; myopia  of  high  degree;  detachment  of 


ECZEMA  OF  THE  LIDS 


the  retina;  iiypermature  cataract  with 
stretching  and  atropliy  of  the  zonula. 

Treatment  —Perform  an  iridectomy,  as 
broad  as  need  be,  anti  extract  the  lens.  If  the 
lens  is  dislocated  into  the  vitreous,  lift  it 
out,  under  good  illumination,  by  slipping  a 
Knapp’s  loop  behind  it,  or  by  seizing  it  with 
Stevens’  hook,  raising  it  up  to  the  incision, 
and  passing  a Smith  spatula  behind  it,  after 
which  it  is  sUd  out  by  pressure  applied  from 
the  outside  of  the  cornea — pushed,  not 
lifted  out.  (Howard  S.  Paine.) 

If  extraction  of  the  lens  is  not  feasible,  and 
no  inflaimiiatory  symptoms  (irido-cyclitis; 
glaucoma)  are  present,  prescribe  suitable 
glasses  for  the  correction  of  the  visual  dis- 
turbance. If  irido-cyclitis  or  glaucoma  is 
present,  an  iridectomy  should  be  performed 
in  order  to  combat  the  inflammation  or 
increase  of  tension;  but  the  lens  should  also 
be  extracted,  if  possible.  Always  perform 
extraction  in  dislocation  into  the  anterior 
chamber,  as  otherwise  the  eye  is  lost  (Fuchs). 
If  the  inflamed  eye  is  blind,  enucleate  it,  to 
avert  sympathetic  ophthalmia  in  theothereye. 

Distichiasis. — -Or.  dis  twice  arixos  row. 
See  Trichiasis. 

Divergence,  Latent,  or  Exophoria. — L. 

dis,  apart  -f-  ver'gere,  to  tend;  Idtens,  hidden; 
Gr.  e|w  out  -j-  4>opeiv  to  bear.  See  Muscular 
Anomalies. 

Double  Vision. — L.  vis'io,  vid'ere,  to  see. 
See  Diplopia. 

Drooping  of  the  Upper  Lid.— See  Ptosis. 

Dry  Catarrh. — See  Conjunctival  Hyper- 
temia. 

Dryness  of  the  Conjunctiva  and  Cornea. — 

See  Xerosis;  Xerophthalmos. 

Ecchymosis. — See  Black  Eye. 

< Ectasia  Corneae. — Gr.  e/c  out  TtiveLv  to 
stretch.  See  Cornea  Staphyloma  of  the.  ' 
Sclerae. — -See  Sclera,  Staphyloma  of  the. 

Ectropion. — -Gr.  U out  + rpeweLv  to  turn. 
Eversion  of  the  Eyelid. 

' Etiology. — Blepharospasm;  senile  relaxa- 
tion of  the  lids;  paralysis  of  the  orbicularis 
muscle  (seventh  nerve;  see  Part  1) ; cicatricial 
contraction,  due  to  burns,  ulcers,  wounds,  or 
orbital  caries;  chronic  inflammation  of  the  lid 
and  conjunctiva,  with  hypertrophy;  eczema 
of  the  lid  and  cheek;  stye  or  tumor  of  the  lid. 

Senile  relaxation  and  seventh  nerve  paral- 
ysis affect  only  the  lower  lid. 

Treatment.— In  slight  cases  in  which  the 
resulting  epiphora  is  the  most  annoying 
symptom,  merely  slit  the  lower  canaliculus, 
as  described  uiKler  Epiphora. 

In  spasmodic  ectropion,  correct  the  ever- 
sion and  apply  coni|)ression  with  a bandage 
for  two  or  three  da.ys.  If  this  fails,  introduce 
a silk  thread  through  each  lid,  and  tie  it  on 


the  outside  over  a piece  of  small  rubber 
tubing,  tight  enough  to  bring  the  margins 
of  the  lids  back  into  their  proper  position. 
Remove  the  thread  at  the  end  of  four  days. 

The  application  of  a bandage  at  night 
may  give  relief  in  senile,  spasmodic,  and 
paralytic  cases. 

For  marked  cases  of  ectropion  a plastic 
operation  is  required. 

Eczema  of  the  Conjunctiva. — ^Gr.  eK^elv  to 
boil  out.  See  Conjunctivitis  Phlyct- 
enulosa. 

Lids. — An  acute,  subacute,  or  chronic, 
itching,  catarrhal  inflammation  of  the 
skin,  of  variable  character  (erythematous, 
papular,  vesicular,  pustular,  squamous), 
with  usually  a sticky  oozing  or  weeping, 
or  a histoiy  of  such,  and  with  more  or  less 
epidermic  thickening  and  a tendency  to  crust 
or  scale  formation. 

Etiology. — (a)  Constitutional : Habitual 

overeating,  dyspepsia,  constipation,  obesity, 
lithaemia,  defective  kidney  elimination,  gen- 
eral debility,  improper  or  insufficient  food, 
physical  or  mental  overwork,  irregular 
habits,  shock,  neurasthenia,  hysteria,  nerve 
injuries,  asthma,  reflex  irritation  (dentition, 
adherent  prepuce,  movable  kidney,  uterine 
disturbances,  etc.,  no  doubt  giving  rise  to 
nervous  irritability  and  resulting  impan- 
ment  of  the  general  bodily  functions),  tuber- 
culosis, anaemia,  nephritis,  diabetes  mellitus 
and  insipidus,  malaria,  intestinal  parasites. 

(b)  Local:  Epiphora;  dacryocystitis;  con- 
jimctivitis;  eye-strain;  chronic  rhinitis; 
chemical  irritants,  e.g.,  sulphur,  tar,  chiysa- 
robin,  tm’pentine,  mercurials,  iodoform,  ben- 
zine, lime,  paints,  dyes,  antiseptics,  polishing 
materials,  pastes,  sugar,  flour,  tobacco,  acids, 
alkalies,  strong  soap,  the  excessive  use  of 
water  and  soap,  etc.;  mechanical  irritants, 
e.g.,  parasites  (pediculi,  fleas,  bed-bugs,  etc.), 
scratching,  cold,  heat,  sea  air,  winds,  sunlight. 

Treatment.— Enjoin  the  observance  of  cor- 
rect hygiene,  e.g.,  adequate  rest  and  exercise, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  a plain  but  nutri- 
tious diet,  proper  bowel  activity,  fresh  air 
day  and  night,  avoiding  draughts,  and  ade- 
quate dry  clothing.  The  following  articles 
of  food  should  be  avoided,  viz.,  pork  in  any 
form,  salted  meats,  cooked-over  meats,  veal, 
“ gamy  ” fowl,  crabs,  lobsters,  fried  foods, 
gravies,  pastries  and  cakes,  hot  breads,  hot 
griddle  cakes,  sweets  and  confections,  sjTups, 
soups,  sauces,  cheese,  pickles,  condiments, 
spices,  sweet  ]-)otatoes,  Irish  potatoes,  cab- 
bage, fried  eggplant,  tomatoes,  oatmeal, 
bananas,  apples,  tea,  coffee,  alcohol,  and 
tobacco.  The  diet  should  consist  chiefly  of 
bread  and  butter,  milk,  eggs,  fresh,  plainly 


ENUCLEATION  AND  EVISCERATION  OF  THE  EYEBALL 


cooked  vegetables,  fresh  fish,  chicken  occa- 
sionally, with  other  meats  no  oftener  than 
once  or  twice  a week.  A glassful  of  hot  water 
containing  soda  bicarbonate,  gr.  xv,  or 
Vichy  should  be  drunk  one  hour  before 
meals  and  between  meals.  Potassium  ace- 
tate or  citrate,  gr.  x,  t.i.d.,  may  be  added. 

In  acute  cases,  apply  mild,  soothing  lo- 
tions until  the  swelling  subsides,  e.g., 

Calaminae, 

Zinci  oxidi,  aa 3i~ii 

Acidi  borici 3i 

Glycerini irjv-xv 

Acidi  carbolici i^viii-xxx 

Liquoris  calcLs 5i 

Aquae,  q.s.,  ad 3iv 

M.  Sig. — Shake  well,  and  apply  as  often  as 
required  to  effect  relief. 

Lotionis  nigrac. 

Aquae  calcis,  aa 5ii 

M.  Sig. — Shake  well,  and  apply  frequently.  (Full 
strength  of  black  wash  may  be  used.) 

Solutionis  aluminii  acetatis  (Part 

11) 3iv 

M.  Sig. — -Dab  on  freely  three  or  more  times  daily. 

When  the  acute  symptoms  have  subsided, 
gently  remove  all  crusts  after  softening  with 
a bland  oil  (olive,  cottonseed  or  almond), 
and  apply  one  of  the  following  ointments: 


Hydrargyri  ammoniati gr.  v-x 

Adipis  lanae  hydros!, 

Petrolati  mollis,  aa §ss 

Zinci  oxidi gr.  x-xl 

Adipis  Ian®  hydros!, 

Petrolati  mollis,  aa 5 ss 

Hydrargyri  oxidi  flavi gr.  x 

Adipis  Ian®  hydros!, 

Petrolati  mollis,  aa gss 

Acidi  salicylic! gr.  x 

Adipis  Ian®  hydros!, 

Petrolati  mollis,  aa 5ss 


In  vesicular  eczema,  apply  a drying  pow- 
der consisting  of  about  equal  parts  of  starch, 
zinc  oxide,  and  camphor. 

In  chronic  cases,  try  the  above  mild  reme- 
dies, and  if  these  prove  insufficient,  resort 
to  the  stronger  preparations  following: 


Picis  liquid® tnjx-xxx 

Zinci  oxidi 3i 

Unguenti  aqu®  ros®,  q.s.,  ad 3i 

Acidi  salicylic! gr.  xv 

Hydrargyri  ammoniati gr.  x 

Liquoris  picis  carbonis .3i 

Petrolati  mollis,  q.s.,  ad 3i 


Applications  of  silver  nitrate  solution, 
5 to  10  per  cent.,  after  the  removal  of 
crusts,  are  very  useful. 


Eczematous  Conjunctivitis.  — See  Con- 
junctivitis Phlyctenulosa. 

Edema  of  the  Lids. — See  Qildema  of  the 
Lids. 

Enchondroma,  Orbital. — Gr.  ev  in  -t- 

xovbpos  cartilage  + -w/xa  tumor.  See  Orbital 
Tumors. 

Endothelioma,  Orbital. — Gr.  'ivbov  within  + 
017X77  nipple+'W^a  tumor.  See  Orbital  Tumors. 

Entropion. — Gr.  kv  in  + Tpeiruv  to  turn. 
Inversion  of  the  Eyelid.  Occurring  in  the 
upper  lid,  it  causes  trichiasis  {q.v.). 

Causes. — Blepharospasm;  senile  relaxation  of 
the  lid ; shrunken  or  absent  eyeball ; bandag- 
ing the  eye  after  operations;  cicatricial  con- 
traction, due  to  trachoma,  diphtheria,  pem- 
phigus, conjunctival  burns,  traumatism,  etc. 

Treatment. — Slight,  non-cicatricial  cases 
may  be  benefited  by  painting  contractile 
collodion  on  the  lid  every  two  or  three  days 
after  cleansing  the  skin  with  alcohol  or  ether. 
If  this  is  ineffectual,  an  operation  is  required 
as  for  the  cicatricial  variety. 

Enucleation  and  Evisceration  of  the  Eye= 
ball.— 

I.  Enucleation. — Sever  the  conjunctiva 
close  to  the  cornea  with  scissors  or  a curved 
bistoury  with  blunt  point.  Open  the  capsule 
of  tenon  in  order  to  get  at  the  muscle 
attachments  to  the  sclera.  With  the  point 
of  the  hook  in  constant  contact  with  the 
sclera  introduce  it  beneath  the  rectus  mus- 
cle tendons,  and  cut  the  latter  close  to  the 
sclera,  excepting  the  internal  or  external 
rectus,  which  is  left  so  as  to  have  something 
to  grasp  in  rotating  the  eyeball.  Rotate  the 
latter  far  outward,  introduce  scissors  above 
the  nerve,  bring  them  down  until  they  touch 
the  nerve,  then  open  them  and  slide  the 
blades  around  the  neiwe  and  sever  it.  Then 
sever  the  oblique  muscles.  Apply  digital 
compres.sion  with  gauze  over  the  lids  until 
hemorrhage  ceases.  The  conjunctiva  or 
muscles  need  not  be  sewn. 

II.  Evisceration. — Evisceration  leaves 
a better  stump  for  an  artificial  eye  than 
enucleation.  There  is  no  danger  of  subse- 
quent sympathetic  ophthalmia.  In  panoph- 
thalmitis it  is  preferable  to  enucleation 
because  of  the  avoidance  of  meningitis. 

Sever  the  conjunctiva  close  to  the  cornea 
with  scissors  or  a blunt-pointed  curved  bis- 
toury. With  a sharp  knife  puncture  the 
sclera  about  2.5  mm.  from  the  cornea,  push 
the  knife  blade  through  the  eye  and  make  a 
corresponding  counter  incision  on  the  oppo- 
site side,  then  cut  a flap  above,  and  remove 
the  rest  of  the  front  of  the  eyeball  with 
scissors.  Now,  with  a bone  curet,  scrape 
out  all  of  the  choroid  down  to  the  white 
sclera.  The  choroid  is  firmly  attached  at 


EPISCLERITIS 


the  optic  nerve  and  anteriorly  in  the  ciliary 
region.  No  sewing  is  required.  An  artificial 
eye  may  be  inserted  in  four  weeks. 

Epiphora;  Tear  Drop. — Gr.  kTncj>opa  down- 
flow. An  abnormal  overflow  of  tears  down 
the  cheek.  Chronic  conjunctivitis,  blephari- 
tis, and  eczema  are  possible  consequences. 

Etiology. — Local  irritation,  due  to  foreign 
bodies  (q.v.),  inflammation,  smoke,  wind, 
irritation  of  the  retina  by  intense  light,  eye- 
strain  (q.v.)  neuralgia  of  the  first  and  second 
branches  of  the  trigeminus,  and  rhinitis; 
lagophthalmus  (q.v.);  ectropion  {q.v.),  entro- 
pion (q.v.) ; abnormal  position  or  enlargement 
of  the  caruncle;  atresia  of  the  lachrymal 
puncta,  either  congenital  or  due  to  burns,  or 
inflammation,  or  desiccation,  as  in  blephar  tis 
comphcated  by  ectropion;  atresia  of  the 
canahculi,  either  congenital  or  due  to  trau- 
matism, ulceration,  polypi,  dacryoliths  or 
tear  stones  (due  sometimes  to  a form  of 
strep tothrix),  or  foreign  bodies,  especially 
eyelashes;  small  or  deeply  set  eye;  dacryo- 
cystitis (q.v.);  stricture  of  the  nasal  duct 
{q.v.);  neurasthenia;  tabes  dorsalis;  exoph- 
thalmic goitre;  senility. 

Treatment.— Attend  to  the  cause  {q.v.,  in 
its  alphabetical  place). 

Canalicular  stenosis  due  to  swelling  of  the 
lining  membrane  may  be  relieved  by  the 
injection  of  astringents  through  an  Anel 
syringe,  e.g.,  zinc  sulphate,  gr.  i-ii,  and  boric 
acid,  gr.  xv,  in  water,  5i- 

Openastenosedpunctum  by  means  of  agold 
or  silver  pin  or  dilator  or  Theobald’s  sharp- 
pointed  probe;  then  test  the  patency  of  the 
lachrymal  duct  by  injecting  boric  acid  solu- 
tion, 3 per  cent.,  through  an  Anel  syringe. 

In  all  malpositions  of  the  puncta,  slit  the 
corresponding  canaliculus  (almost  always 
the  lower).  First  anjEsthetize  with  cocaine, 
4 per  cent,  solution,  and  dilate  the  canal 
with  a small  probe.  Then  standing  behind 
the  patient  and  holding  the  lower  lid  upon 
the  stretch,  introduce  the  straight,  probe- 
pointed  canaliculus  knife,  anointed  with 
sterile  vaseline,  vertically  into  the  punctum, 
then  horizontally  up  to  the  junction  with 
the  sac;  then,  with  the  blade  turned  upward 
and  slightly  backward,  raise  the  handle  of 
the  knife  and  so  divide  the  canaliculus. 
Separate  the  cut  edges  every  forty-eight 
hours,  to  prevent  closure,  with  a probe 
anointed  with  vaseline.  (After  Theobald.) 

In  atresia  of  the  canaliculus,  pass  probes 
and  slit  the  canaliculus.  If  the  latter  is 
obliterated,  make  an  artificial  opening  into 
the  lachrymal  sac,  following  the  usual  course 
of  the  canaliculus. 

The  canaliculus  may  have  to  be  divided 
in  removing  tear-stones  or  polypi. 


Eyelashes,  if  they  project  through  the 
puncta,  may  be  removed  with  forceps ; other- 
wise the  canaliculus  may  have  to  be  slit. 

For  senile  epiphora,  prescribe  an  astrin- 
gent collyrium. 


R Zinci  sulphatLs gr.  i-ii 

Acidi  borici gr.  xv 

Aquae  bullient is gi 


M.  Sig. — Drop  into  the  eyes,  t.i.d. 

Episcleritis. — Gr.  kwi  upon;  a K\rip 6s  hard; 
fi-  -iTLs  inflammation.  Subconjunctival  or 
superficial  scleritis,  as  cUstinguished  from  the 
deep  form  of  scleritis,  which  see. 

Episcleritis  is  characterized  by  a dusky- 
red  or  violet-hued,  circumscribed  elevation 
of  the  sclera,  which  persists  for  several 
weeks,  and  is  prone  to  recur.  It  is  not 
movable  on  the  wall  of  the  sclera,  as  is  a 
conjunctival  lesion.  Vision  is  not  affected. 

The  so-called  “ hot  eye  ” is  a “ fugaceous 
periodic  episcleritis,”  of  sudden  onset,  last- 
ing from  two  to  eight  days,  and  recurring  at 
intervals  of  several  weeks  or  months,  often 
associated  with  gout  or  rheumatism. 

The  treatment  of  episcleritis  is  not 
very  satisfactory. 

Etiology.— Gout;  rheumatism;  enterogenous 
or  auto-intoxication;  infectious  diseases  (influ- 
enza, tuberculosis,  etc.) ; exposure  to  inclem- 
ent weather;  sinusitis;  menstrual  disorders 

Treatment. — Attend  to  any  possible  etio- 
logical influence,  and  enjoin  the  observance 
of  correct  hygiene,  e.g.,  adequate  rest  and 
daily  exercise,  frequent  bathing,  an  occa- 
sional Turkish  bath  if  the  heart  is  good, 
fresh  air  day  and  night,  adequate  dry,  warm 
clothing,  regular  hours  of  eating  and  sleep- 
ing, rest  before  and  after  meals,  free  bowel 
activity  (a  morning  saline,  if  need  be,  such 
as  sodium  phosphate,  or  Carlsbad  salts. 
Part  11),  copious  water  drinking,  temper- 
ance in  eating,  and  avoidance  of  woriy. 
The  following  foods  are  interdicted  (the 
most  of  them  because  of  their  rich  purin 
content,  some  because  of  indigestibility  or 
of  acidity) : alcohol,  game,  sweetbreads, 

liver,  kidney,  brain,  sausages,  .smoked  meats, 
meat  extracts,  meat  soups,  broths,  gravies, 
salt  fish,  fish  roe,  caviar,  crabs,  lobsters, 
sharp  cheeses,  mushrooms,  peas,  beans, 
lentils,  oatmeal,  celeiy,  onions,  garlic,  rad- 
ishes, asparagus,  cucumbers,  sorrel,  toma- 
toes, cabbage,  hot  breads,  corn  breads, 
pastries,  candies,  jireserves,  much  salt, 
vinegar,  condiments,  spices,  tea,  coffee, 
cocoa,  bananas,  strawberries,  cherries,  dates. 
The  following  foods  are  allowed:  milk, 

buttermilk,  koumyss  (see  Part  11.),  junket, 
cream,  butter  (2^  to  3)4  ounces  a day — 
Ebstein),  eggs,  custard,  mild  cheese,  olive  oil, 


EYE  INJURIES 


white  bread,  rice,  macaroni,  tapioca,  sago, 
potatoes,  spinach,  sprouts,  beet  tops,  cauli- 
flower, lettuce,  chicken,  crisp  bacon,  fresh 
fish,  oysters,  white  and  red  meat  in  modei  a- 
tion,  pears,  green  figs,  mild  oranges. 

In  an  acute  attack,  open  the  bowels  thor- 
oughly with  calomel,  gr.  ii-viii,  followed  by 
a saline  (Part  11)  and  prescribe  wine  or  tinc- 
ture of  colchicum,  npxv-xxx,  in  water,  every 
two  hours  for  eight  or  ten  doses,  then  every 
four  hours  for  three  or  four  days,  or  until 
the  condition  is  relieved  or  symptoms  of 
poisoning  occur,  e.g.,  nausea,  vomiting,  diar- 
rhoea, and  cardiac  depression.  Colchicine 
or  colchicine  salicylate,  gr.  3=50,  every  four 
hours,  may  be  used  instead,  if  desired. 

If  colchicum  affords  no  relief,  try  sodium 
salicylate  or  aspirin,  gr.  x-xx  every  two  to 
four  hours,  or  phenacetin  or  antipyrine  (see 
Part  11;  see  also  Gout  in  Part  1). 

For  the  relief  of  pain,  apply  hot  fomenta- 
tions to  the  lids,  every  two  hours,  or  Theo- 
bald’s opium  and  boric  acid  lotion: 


Extract!  opii gr.  x 

Acid!  boric! gr.  xl 

Aqua) §!v 


Burnet  says:  “ Heat  is  the  best  local 
remedy.”  The  application  of  six  to  ten 
leeches,  or  a Heurteloup  artificial  leech  to 
the  temple  also  affords  relief. 

For  pain,  photophobia,  lachrymation,  and 
ciliary  irritation,  instil  atropine: 


Atropin® gr.  !-!!-!v 

Acid!  boric! gr.  x 

Aqu®  bullientis 3 ! 


M.  Sig. — Instil  one  drop,  warmed,  every  three 
or  four  hours  (the  strength  should  depend  upon  the 
de^ee  of  photophobia,  lachrymation,  and  ciliary 
irritation  present). 

Smoke-tinted  glasses  should  be  worn. 
De  Schweinitz  says:  “ Dionin  is  of  distinct 
service  ” : one  drop  of  a 4 to  5 per  cent,  solu- 
tion, t.i.d.  Subconjunctival  injections  of 
normal  saline  solution  (0.6  to  0.9  per  cent.), 
or  better,  cyanide  of  mercury,  1 : 4000, 
10  to  20  minims,  are  of  value. 

In  chronic  cases  (not  in  acute,  painful 
cases)  ung.  hydrargyri  oxidi  flavi,  gr.  i ad 
3i,  may  be  inserted  within  the  conjunctival 
sac  and  the  eyeball  massaged  through  the 
closed  lids.  Ionic  medication  (q.v.  in  Part  1) 
is  also  recommended.  Cotton  wool  wet  with 
a solution  of  sodium  salicylate  or  sodium 
chloride  is  placed  within  the  lids,  and  a cur- 
rent of  5 to  10  milliamperes  employed  over 
the  closed  lids  for  five  to  fifteen  minutes, 
thrice  weekly. 

Any  accommodative,  muscular,  or  refrac- 
tive anomaly  should  be  corrected  (Theobald.) 


Epithelioma  Conjunctivse. — Gr.  eirL  on  4- 
07jXr)  nipple  + -wjjLa  tumor.  See  Con- 
junctival Tumors. 

Orbital. — See  Orbital  Tumors. 

Esophoria  or  Latent  Convergence. — Gr. 
eaw  inward  -)-  4>epeLP  to  bear;  L.  Idtens,  hid- 
den; con,  together  + verg'ere,  to  incline. 
See  Muscular  Anomalies. 

Eversion  of  the  Eyelid. — L.  ever'sio,  a 
turning  outward.  See  Ectropion. 

Examination  of  the  Eye. — See  the  Ap- 
pendix, following  Part  6. 

Exophoria  or  Latent  Divergence. — Gr. 
out  (jiepeLv  to  bear;  L.  Idtens,  hidden;  dis, 
apart  -|-  verg’ere,  to  incline.  See  Muscular 
Anomalies. 

Exophthalmos. — Gr.  out  4-  6(pda\p.6s 
eye.  Abnormal  protrusion  of  the  eyeball. 

Causes.— Hyperthyroidism  (exophthalmic 
goitre);  acromegaly;  brain  tumors;  hydro- 
cephalus; oxycephaly  (tower  or  steeple 
head);  panophthalmitis  purulenta  {q.v.); 
orbital  cellulitis  (q.v.);  tumors  of  the  eye- 
ball; orbital  tumors  (q.v.);  orbital  cephalo- 
cele;  orbital  meningocele;  traumatic  or 
spontaneous  communication  between  the 
carotid  artery  and  cavernous  sinus  (arterio- 
venous aneurysm);  aneurysm  of  the  internal 
carotid;  aneurysm  of  the  ophthalmic  artery; 
orbital  haematoma;  polypi  from  the  nose  or 
accessory  sinuses. 

Pulsating  exophthalmos  is  usually  due  to 
traumatic,  rarely  to  spontaneous  rupture  of 
the  carotid  artery  into  the  cavernous 
sinus;  very  rarely  to  aneurysm  of  the 
internal  carotid  or  ophthalmic  artery  or  to 
intracranial  affections. 

Treatment.— This  depends,  of  course,  upon 
the  cause  (q.v.,  in  its  alphabetical  place). 
Ligation  of  one  or  both  of  the  common 
carotids,  or  of  the  dilated,  pulsating  orbital 
veins,  may  cure  a pulsating  exophthalmos. 

Exostosis,  Orbital. — Gr.  out  -f  dareov 

bone.  See  Orbital  Tumors. 

Eye,  Amaurotic  Cat’s. — See  Amaurotic 
Cat’s-Eye. 

Eyeball,  Contusion  of  the. — L.  contusio, 
bruise.  See  Injuries  of  the  Eye. 

Injuries  of  the. — See  Injuries  of  the  Eye. 

Penetrating  Wounds  of  the. — L.  imi'e- 
trans.  See  Injuries  of  the  Eye. 

Protrusion  of  the. — See  Exophthalmos. 

Eye,  Black. — See  Black  Eye. 

Burns  of  the. — See  Injuries  of  the  Eye. 

Cat’s. — See  Amaurotic  Cat’s-Eye. 

Cross — See  Squint. 

Foreign  Bodies  in  the. — See  Foreign 
Bodies  in  the  Eye. 

Hot. — See  Episoleritis. 

Injuries. — See  Injuries  of  the  Eye. 


GLAUCOMA 


Eye,  Pink.— See  Conjunctivitis  Catarrhalis. 

Strain — See  Asthenopia. 

Traumatism — Gr.  rpadna,  wound.  See 
Injuries  of  the  Eye. 

Wounds. — See  Injuries  of  the  Eye. 

Eyelid,  Abscess  of  the. — L.  abscessus,  a 
going  apart.  See  Hordeolum. 

Adherent  to  the  Eyeball. — See  Sym- 
blepharon. 

Dermatolysis  of  the. — Gr.  Seppa  skin  + 
Xfiats  loosening.  See  Blepharochalasis. 

Drooping  of  the  Upper.— See  Ptosis. 

Eczema  of  the. — ^ee  Eczema  of  the 
Lids. 

Eversion  of  the. — L.  ever'sio,  a turning 
outward.  See  Ectropion. 

Granular. — L.  gran'ulum,  grain.  See 
Conjunctivitis  Trachomatosa. 

Inversion  of  the. — L.  in,  into  + ver'tere, 
to  turn.  See  Entropion. 

(Edema  of  the. — See  (Edema  of  the  Lids. 

Spasm  of  the. — See  Blepharospasm. 

Eyes,  Cross. — See  Squint. 

Eye=Strain  . — See  Asthenopia. 

Facial  Paralysis. — L.  fac'ies,  face;  Gr. 
■wapa  beside  + \vkv  to  loosen.  Paralysis  of 
the  orbicularis  muscle,  due  to  facial  nerve 
paralysis,  causes  lagophthalmos  {q.v.),  epi- 
phora, conjunctivitis,  and  sometimes  keratitis 
e lagophthahno.  See  Part  1,  General  Medi- 
cine and  Surgery, 

Family  Idiocy,  Amaurotic. — See  Amau- 
rotic Family  Idiocy,  in  Part  1. 

Far=Sightedness.  — See  Accommodation 
Anomalies  and  Hypermetropia. 

Fibroma  (tonjunctivas. — L.  ji'hra,  fibre  -f 
Gr.  -w/xa  tmnor.  See  Conjunctival 
Tumors. 

Orbital. — See  Orbital  Tumors. 

Fields  of  Vision.- — vSee  the  Ocular  Exam- 
ination in  the  Appendix  following  Part  6. 

Fistula  of  the  Cornea. — L.  fis'tula,  pipe. 
See  under  Keratitis  Ulcerosa. 

Lachrymal  Gland. — L.  fis’tula,  pipe; 
lac'rirna,  tear;  glans,  a cord. 

Etiology. — Congenital  anomaly;  traumatism; 
dacryo-ailenitis;  carious  upper  canine  tooth. 

Treatment  —Connect  the  fistula  with  the 
conjunctival  sac  by  Bownan’s  operation. 
Insert  a threaded  needle  a short  distance 
into  the  fistula,  and  bring  it  out  on  the  con- 
junctival surface  of  the  lid  by  passing  it 
through  the  latter.  Now  pass  a second 
needle  attached  to  the  other  end  of  the 
thread  through  the  lid  at  a point  close  to 
the  orifice  of  the  fistula,  tie  the  two  ends 
tightly,  anil  leave  the  thread  to  cut  its  way 
out.  Freshen  the  edges  of  the  external 
fistula  in  order  to  hasten  its  closure. 
(From  Theobald.) 


Follicular  Conjunctivitis. — See  Conjunc- 
tivitis Follicularis. 

Foreign  Bodies  in  the  Eye. — A foreign 
body  that  is  producing  symptoms  is  either 
beneath  the  upper  lid  or  upon  the  cornea, 
rarely  within  the  eyeball. 

To  remove  a foreign  body  from  beneath 
the  upper  lid,  lUrect  the  patient  to  look 
strongly  down,  then  grasp  the  eyelashes 
with  the  fingers  of  the  left  hand,  pull  the 
lid  downward  and  away  from  the  eyeball, 
and  with  a rounded,  smooth  instrument, 
such  as  a crochet-needle  or  pen-holder  or 
wooden  toothpick  used  as  a fulcrum  against 
the  tarsal  cartilage,  evert  the  lid.  Remove 
the  body  with  a cotton-covered  toothpick. 

To  remove  a foreign  body  from  the  cornea 
first  anaesthetize  the  eye  by  means  of  a 
5 per  cent,  solution  of  cocaine,  holocaine,  or 
alypin;  then  carefully  lift  out  or  scrape  away 
the  body  with  a boiled  wooden  toothpick, 
spud,  or  knife.  Then  flood  the  eye  with 
sterile  boric  acid  solution,  3 per  cent.  If  a 
keratitis  is  present,  instil  atropine  (see 
Keratitis). 

To  remove  a foreign  body  that  has  passed 
through  anil  lies  beneath  the  conjunctiva, 
lift  the  body  with  forceps,  and  snip  off  the 
part..  Grains  of  powder  may  be  removed 
in  this  way,  or  by  electrolysis,  or  they  may 
be  allowed  to  remain. 

A foreign  body  within  the  eyeball,  if  not 
removed,  will  cause  a destructive  inflamma- 
tion of  the  eye,  and  probably  sympathetic 
inflammation  of  the  other  eye  (q.v.).  The 
diagnosis  is  made  from  the  history,  by  means 
of  oblique  illumination  (q.v.)  ophthalmoscopy, 
the  electro-magnet,  the  X-ray,  or  the  result- 
ing symptoms  of  irritation  and  inflammation. 
The  boily  should  be  removed,  if  possible, 
and  the  eye  treated  with  atropine,  etc.,  as 
described  under  Iritis.  If  the  body  can  not 
be  removed,  do  not  ilelay  over  two  or  three 
weeks  in  removing  the  eye,  if  the  inflamma- 
tory sjnnptoms  do  not  improve  within  that 
time,  because  of  the  danger  of  sympathetic 
ophthalmia  developing  in  the  other  eye. 

Fourth  Nerve  Paralysis. — L.  ner'vus;  Gr, 
irapa  beside  -f-  Xvav  to  loosen.  See  IMuscu- 
lar  Anomalies. 

Fugaceous  Periodic  Episcleritis.  — See 

Episcleritis. 

Glaucoma.— Gr.  yXavKos  green.  Abnor- 
mal increase  in  the  intra-ocular  tension,  as 
iletermineil  by  pressure  with  the  fingers 
through  the  upix*!’  lid  with  the  eye  looking 
downwaril,  or  by  means  of  the  tonometer. 
Use  the  index  fingers  of  both  hands  and 
make  alternate  pressure  first  with  one  finger 
then  the  other.  The  usual  upper  limit  of 


GLAUCOMA 


normal  is  25  millimetres.  The  condition  is 
seldom  met  with  below  the  age  of  thirty  years. 

Three  varieties  of  glaucoma  are  dis- 
tinguished, viz.,  (1)  prhnary  inflanmiatory 
glaucoma;  (2)  primary  non-inflanunatory  or 
simple  glaucoma;  and  (3)  secondary  glau- 
coma. These  three  varieties  will  be  con- 
sidered in  the  order  named. 

(1)  Glaucoma  Inflammatorium;  Glaucoma  with 
Exacerbations. — This  form  of  glaucoma  is 
characterized  by  periodic,  more  or  less  fre- 
quent, increasingly  severe  attacks  of  pain, 
obscuration  of  vision  (contraction  of  the 
field  beginning  on  the  nasal  side),  and  the 
appearance  of  a rainbow  halo  about  a flame, 
associated  with  pericorneal  and  general  con- 
junctival injection,  dilatation  of  the  pupil, 
steaminess  and  ana3sthesia  of  the  cornea,  a 
shallow  anterior  chamber,  and  increased 
intra-ocular  tension.  The  attacks  last  at 
first  usually  several  hours.  In  the  intervals 
between  attacks,  ophthalmoscopic  examina- 
tion reveals  cupping  of  the  optic  disc. 

Etiology.- — (a)  Predisposing  Causes:  Eye- 
strain  with  resulting  choroido-retinitis; 
rheumatism;  gout;  arteriosclerosis;  chronic 
constipation ; chronic  bronchitis ; feeble  heart 
action  producing  venous  congestion;  the 
menopause;  syphilis,  influenza,  and  other 
febrile  diseases;  heredity. 

(b)  Exciting  Causes:  Emotion;  exposure 
to  inclement  weather;  trauma;  insomnia; 
late  hours;  a hearty  meal;  neuralgia  of  the 
fifth  nerve;  use  of  a mydriatic. 

Treatment. — In  severe  cases,  the  sight 
may  be  destroyed  in  forty-eight  to  twenty- 
four  hours,  therefore  the  necessity  for  prompt 
treatment.  Instil  a solution  of  e.serin  sul- 
phate or  pilocarpine  hydrochlorate,  gr.  iv  to 
the  ounce  of  distilled  water,  one  or  two 
drops  every  hour  or  two,  or  three  or  four 
tunes  in  the  twenty-four  hours,  until  the 
pupil  is  well  contracted  and  relief  is  ob- 
tained. The  adchtional  use  of  dionin,  5 per 
cent.,  one  drop  in  the  eye,  t.i.d.,  is  of  service. 
Apply  hot  fomentations  of  opium  to  the  lids : 


Extracti  opii gr.  x 

Acidi  borici gi'.  xl 

Aquae 5iv 


(Theobald.) 

Six  to  ten  leeches  may  be  applied  to 
the  temple. 

Give  at  once  an  energetic  mercurial 
purge,  e.g.,  calomel,  gr.  ii-viii,  followed  by  a 
saline  (Part  11).  Sodium  salicylate,  aspirin, 
phenacetin,  antipyrine,  or  morphine  (see 
Drugs,  Part  11),  may  be  prescribed  for  the 
relief  of  pain. 

If  the  above  mea.sures  are  not  followed 


by  prompt  relief,  perform  a broad  superior 
iridectomy,  extending  to  the  ciliary  margin 
through  a scleral  incision.  If  iridectomy 
fails,  and  the  sight  is  lost,  perform  enuclea- 
tion (q.v.)  to  save  the  other  eye. 

Even  should  the  u.se  of  myotics  prove 
effectual,  an  iridectomy  should  be  per- 
formed as  early  as  possible,  in  order  to 
ensure  a permanent  cure. 

To  prevent  the  development  of  glaucoma 
in  the  other  eye,  correct  any  refractive 
accommodative,  or  muscular  anomalies  pres- 
ent, and  enjoin  the  ob.servance  of  correct 
hygiene,  e.g.,  adequate  rest  and  daily  exer- 
cise, frequent  bathing,  fresh  air  day  and 
night,  adequate  dry,  warm  clothing,  regular 
hours  of  eating  and  sleeping,  rest  before 
and  after  meals,  free  bowel  activity  (a  morn- 
ing saline,  if  need  be,  such  as  sodium  phos- 
phate, or  Carlsbad  salts,  temperance  in  eat- 
ing, and  the  avoidance  of  mental  stress. 
Employ  eserin  upon  the  first  api:>earance  of 
symptoms;  and  in  the  latter  event  do  an 
early  iridectomy. 

(2)  Glaucoma  Simplex. — A chronic,  non-in- 
flammatory  affection  of  elderly  people,  char- 
acterized by  a gradual,  bilateral  failure  of 
vision  (contraction  of  the  field  beginning 
on  the  nasal  side),  slight  increase  of  intra- 
ocular tension,  and  cupping  of  the  optic 
disc,  which  is  surrounded  with  a halo-like 
ring.  The  condition  occurs  usually  in  those 
past  forty-five  years  of  age;  but  it  is  some- 
times met  with  in  young  people.  It  should 
be  distinguished  from  optic  atrophy  (q.v.). 

Etiology. — Gout,  rheimiatism,  arterio- 
sclerosis, mfluenza,  etc.,  may  be  causative. 

Treatment. — Prescribe  eserin  sulphate, 
gr.  to  34  to  the  ounce  of  sterile,  distilled 
water,  or  pilocarpine  hydrochlorate,  gr.  34 
to  the  ounce  of  sterile  distilled  water,  freshly 
prepared,  one  drop  in  each  eye,  two  to  four 
times  a day.  The  strength  of  the  jiilocarpine 
solution  may  be  gradually  increased  in  three 
years  to  about  six  grains  to  the  ounce  (De 
Schweinitz).  Before  each  instillation  the 
eye  should  be  irrigated  freely  with  boric  acid 
solution,  3 per  cent.,  and  the  eyeball  mas- 
saged through  the  closed  lids. 

Correct  any  refractive,  accommodative,  or 
muscular  anomaly  that  may  be  present,  at- 
tend to  any  other  possible  etiological  influ- 
ence, and  enjoin  the  observance  of  correct 
hygiene,  e.g.,  adequate  rest  and  daily  exer- 
cise, frequent  bathing,  fresh  air  day  and 
night,  adequate  dry,  warm  clothing,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  free  bowel  activity,  temperance 
in  eating,  and  the  avoidance  of  mental  stress. 
Potassium  iodide  (Part  11)  may  be  tried. 


HETEROPHORIA,  OR  LATENT  SQUINT 


The  employment  of  myotics  should  be 
persisted  in  for  the  remainder  of  life,  or  as 
long  as  the  intraocular  pressure  is  con- 
trolled; but  should  the  pressure  rise,  as 
shown  by  the  tonometer,  or  the  visual  field 
and  central  vision  decline,  an  iridectomy 
should  be  performed.  It  is  rarely  unsuccess- 
ful in  checking  the  progress  of  the  disease, 
and  rarely  harmful,  but  it  can  not  be 
expected  to  improve  the  vision,  although 
it  may. 

(Hych’ophthalmos  or  buphthalmus  or  ox 
eye  is  an  unnaturally  big  eye,  with  usually 
increased  tension,  occurring  congenitally  or 
in  the  first  year  of  life,  heredity  being  an 
important  factor.  It  may  spontaneously 
cease  to  increase  or  it  may  increase 
and  total  blindness  result.  An  iridectomy 
is  indicated.) 

(3)  Secondary  Glaucoma. — Increased  intra- 
ocular tension  consequent  upon  other  dis- 
ease of  the  eye,  viz.,  corneal  staphyloma, 
scleral  staphyloma,  uveitis,  seclusio  pupillte, 
or  adherence  of  the  iris  to  the  lens  at  the 
pupillary  margin,  lens  injuries  causing  swell- 
ing or  dislocation,  cataract  extraction  or 
discission  with  resulting  prolapse  of  the 
iris,  etc.,  intra-ocular  tumors,  retinal  hem- 
orrhage, detaclmient  of  the  retina,  choroido- 
retinitis,  high  myopia,  penetrating  and 
contused  wovmds,  ulcerative  diseases,  ne- 
glected iritis,  cataract  formation. 

Treatment. — Attend  to  the  cause  {q.v., 
in  its  alphabetical  place).  Combat  the 
increase  of  tension  by  means  of  myotics  and 
(honin,  and  if  necessary,  by  paracentesis  of 
the  cornea,  (applicable  in  transient  cases  of 
increased  tension,  as  in  swelling  of  the  lens 
and  serous  iritis  [Fuch.s]),  or  iridectomy. 

Glioma  of  the  Retina. — Gr.  yXia  glue  -b 
-co/za  tumor.  A malignant  sarcomatous 
growth  affecting  the  neuroglial  or  con- 
nective tissue  of  the  retina,  occurring  con- 
genitally or  in  early  childhood,  usually 
within  the  first  three  to  five  years,  and 
manifested  by  impairment  of  vision  and 
slight  enlargement  and  sluggishness  of  the 
pupil,  which  presents  a yellow-white  reflex 
(amaurotic  cat’s-eye,  q.v.).  An  ophthalmos- 
copic examination  should  be  made. 

Swelling  and  jmin  soon  occur,  the  eyeball 
ruptures,  and  the  tumor  appears  externally. 
Unless  promptly  eradicated  the  disease  is 
fatal  in  several  years.  Metastases  occur 
very  early. 

Treatment.— Enucleate  the  eye  at  once,  and 
divide  the  optic  nerve  as  far  back  as  possi- 
ble. If  the  orbit  is  invaded,  remove  its 
whole  contents.  After  enucleation  or  orbital 
exenteration,  employ  the  X-rays  or  radium 


{q.v.  in  Pait  1)  to  destroy  any  remaining 
tumor  cells. 

Gonorrhoeal  Ophthalmia. — Gr.  64>6a\ixds 
eye.  See  Conjunctivitis  Gonorrhoeica. 

Granular  Lids. — L.  granulum,  grain.  See 
Conjunctivitis  Trachomatosa. 

Gumma,  Orbital. — L.,  gummy  tumor. 
See  Orbital  Tumors.  ^ 

Haemangioma  Conjunctivse. — Gr.  alna 

blood  ayyeiov  vessel  -f-  -cojua  tumor. 
See  Conjunctival  Tumors. 

Orbital. — See  Orbital  Tumors. 

Haematoma,  Orbital. — Gr.  aifia  blood  -f 
-w^a  tumor.  See  Orbital  Tumors. 

Hemeralopia;  Day  Blindness. — Gr.  riixepa 
day  -|-  akads  blind  -f-  uxp  eye.  Improvement 
of  vision  when  the  illumination  is  diminished. 

Etiology. — Central  opacities  in  the  cornea, 
pupil,  or  lens;  central  scotoma,  particularly 
in  tobacco  amblyopia. 

Hemianopia. — Gr.  rtpi-  half  -f  av  priv.  -|- 
o\pLs  vision.  See  Optic  Chiasma,  Tract, 
and  Centres. 

Hemorrhage  into  the  Retina. — Gr.  aipa 
blood  -j-  prjypwaL  to  burst  forth.  See  untler 
Retinitis. 

Hemorrhage  into  the  Vitreous. — L.  vit'- 
reus,  glassy.  Impairment  of  vision  occurs 
anti  continues  until  the  hemorrhage  is 
absorbed.  Ophthalmoscopic  examination 
reveals  a black  or  reddish-black  or  misty-red 
reflex,  or  “ ill-defined,  opaque  masses.” 

Etiology.— Traiuna;  choroidal  or  retinal 
disease;  arteriosclerosis;  gout;  diabetes; 
nephritis;  anaemia;  haemophilia;  delayed 
menstruation;  myopia;  glaucoma. 

Treatment. — Enjoin  rest  of  the  eyes  and 
body,  open  the  bowels,  and  prescribe 
potassimn  iodide. 

Solutionis  potassii  iodidi  conccntrati,  gss 
(gr.  i to  each  min.) 

Sig. — Minims  five  to  ten,  well  diluted  in  milk  or 
water,  t.i.d. 

Merciu’y  and  pilocarpine  (see  Part  11) 
also  serve  to  promote  absorption,  as  well  as 
subconjunctival  injections  of  salt  solution 
every  two  or  three  days,  increasing  the 
strength  from  2 to  5 per  cent.,  ami  the 
quantity  from  15  to  25  minims. 

Attend  to  the  cause. 

Herpes  Febrilis  Cornese. — Gr.  'ipwris  blis- 
ter; L.  feb'ris,  fever.  See  Keratitis 
Neuropathica. 

Zoster  Ophthalmicus. — Gr.  ("axTr^p  gir- 
dle; 64>da\fids  eye.  See  Keratitis 
Neuropathica. 

Heterophoria,  or  Latent  Squint. — Gr. 

erepos  other  -|-  </>op6s  bearing;  L.  lai'ens,  hid- 
den. See  Muscular  Anomalies. 


INJURIES  OF  THE  EYE 


Heterotropia,  or  Manifest  Squint. — Gr. 

erepos  other  + Tpowos  turn.  See  Muscular 
Anomalies. 

Hordeolum;  Stye. — L.  horde' olum,  barley- 
corn. Acute,  localized  inflanunation  of  a 
ciliary  sebaceous  gland,  at  the  edge  of  the 
lid  (hordeolum  externum),  or  a Meibomian 
gland,  at  the  posterior  surface  of  the  lid 
(hordeolum  mternum).  The  chsease  tends 
to  recur. 

Etiology.  — Eye-strain  (q  v.) ; blepharitis 
marginalis  iq.v.)',  poor  health  (ansemia, 
tuberculosis,  etc.);  habitual  constipation. 

Treatment. — Attend  to  the  cause.  Enjoin 
adequate  rest  and  exercise,  fresh  air  day 
and  night,  a daily  morning  warm  bath  in  a 
warm  room,  before  breakfast,  followed  by  a 
cool  spinal  douche  and  brisk  rubdown  with 
a coarse  towel,  regular  hours  of  eating  and 
sleeping,  an  abundance  of  wholesome  food, 
rest  before  and  after  eating,  and  regulation 
of  the  bowels.  Prescribe  a tonic,  e.g.,  iron, 
strychnine,  codliver  oil,  or  arsenic  (see  Drugs, 
Part  11).  The  elixir  ferri,  quininse,  et  strych- 
ninte  phosphati  is  a good  tonic. 

As  an  abortive  measure,  one  may  extract 
the  eyelash  with  epilation  forceps,  and 
apply  every  half  hour,  on  a “ few  fibres  of 
absorbent  cotton  ” (Theobald),  a solution  of 
zinc  sulphate,  gr.  xxx  to  the  ounce,  taking 
care  not  to  get  any  m the  eye;  or  one 
may  apply: 


R Hydrargyri  oxidi  flavi gr.  iiss 

Adipis  lana' hydros! 3i 

Petrolati  mollis 5 i 


or  paint  the  lid  margin  with  collodion;  or 
puncture  the  affected  follicle  with  a sharp 
toothpick  dipped  in  pure  carbolic  acid. 

If  abortive  treatment  is  not  feasible, 
apply  hot  boric  acid  compresses,  and  as 
soon  as  pus  appears,  make  an  incision  paral- 
lel to  the  lid  margin.  Continue  the  hot 
apphcations,  and  after  the  pain  and  dis- 
charge have  ceased,  apply  yellow  oxide  of 
mercury  ointment  in  order  to  prevent  the 
development  of  other  styes. 

Hot  Eye  . — See  Episcleritis. 

Hydatid  Cyst,  Orbital  . — Gr.  vSaTLS',  KVffTLS 
bladder.  See  Orbital  Tumors. 

Hydrophthalmos. — Gr.  i;5wp  water  + 
6(f)9a\p6s  eye.  See  under  Glaucoma. 

Hyperaemia  of  the  Conjunctiva. — See 
Conjunctival  Hypera;mia. 

Hypermetropia. — Gr.  vrep  over  -|-  perpov 
measure  + onj/  eye;  far-sightedness;  the 
focussing  of  parallel  rays  behind  the  retina 
See  Refraction  Anomalies. 

Hyperopia. — Gr.  v-n-kp  over  -|-  f'V^ye.  See 
Hypermetropia,  under  Refraction  Anomalies. 


Hyperostosis,  Orbital. — Gr.  iiwep  over  -1- 
oarkov  bone.  See  Orbital  Tumors. 

Hyperphoria. — Gr.  vwep  over  -f-  <t>op6s  bear- 
ing or  tending;  the  elevation  of  the  visual 
axis  of  one  eye  above  that  of  the  other. 
See  Muscular  Anomalies. 

Hypertrophy  of  the  Lachrymal  Gland. — 
Gr.  inrep  over  -j-  Tpocj>i]  nutrition.  See  Orbi- 
tal Tumors. 

Hypopyon. — Gr.  v-wb  under  -|-  irvov  pus: 
an  accumulation  of  a purulent  exudate  at 
the  bottom  of  the  anterior  chamber.  See 
Iritis,  and  Keratitis  Ulcerosa. 

Idiocy,  Amaurotic  Family. — See  Amau- 
rotic Family  Idiocy  in  Part  1. 

Illumination,  Oblique. — See  Oblique  Il- 
lumination. 

Imbalance  of  the  Eye  Muscles. — L.  in,  not 
-b  bil'anx,  balance.  See  Muscular  Anomalies. 

Inequality  of  the  Pupils. — See  Anisocoria. 

Inferior  Oblique,  Paralysis  of  the. — L. 

infe'rior,  lower;  obliq'uus,  oblique;  Gr.  irapa 
beside  -b  \vuv  to  loosen.  See  Muscular 
Anomalies. 

Injuries  of  the  Eye. — A.  Conjunctival  and 
Corneal  Injuries. — First  antesthetize  the  eye 
with  cocaine  solution,  4 per  cent.,  two  or 
three  drops  every  three  minutes;  then 
remove  all  foreign  material  by  means  of 
forceps  or  pledgets  of  cotton  and  copious 
irrigation  with  warm  boiled  boric  acid  solu- 
tion, 3 per  cent.  (5iv  ad  Oi),  or  normal 
saline  solution  (pi  ad  Oi),  or  mercury 
bichloride  or  oxycyanate,  1 : 10,000. 
Cleanse  the  skin  of  the  lid  and  adjacent 
field  by  gently  washing  with  soap  and  water, 
followed  by  benzene  (Lloyd  Mills).  Con- 
tinue the  boric  acid  irrigations  three  or  four 
tunes  a day,  or  oftener,  until  healing  occurs. 
For  pain  and  swelling,  apply  Theobald’s 
opium  and  boric  aciil  lotion  to  the  closed  lids : 


Extract!  op!i gr.  x 

Ackli  bone! gr.  xl 

Aqua; % 'w 


In  corneal  injuries,  with  photophobia  and 
lachrymation,  instil  atropine,  gr.  i-iv  to  the 
ounce,  or  holocaine  hydrochlorate,  gr.  i-ii 
to  the  ounce,  one  or  two  drops  several  times 
a day,  for  the  purpose  of  keeping  the  pupil 
dilated.  Holocaine  is  tiseful  for  its  anaes- 
thetic properties,  and  it  is  also  antiseptic. 
Dionin,  in  5 per  cent,  solution,  one  drop 
three  or  four  times  a day,  is  an  analgesic 
and  lymphagogue,  and  favors  healing. 
Tinted  glasses  should  be  worn. 

If  the  wound  is  infected,  cauterize  it 
carefully  with  pure  carbolic  acid  by  means 
of  a sharp-pointed,  wooden  toothpick  wound 
with  a few  fibres  of  absorbent  cotton,  after 


INSUFFICIENCY,  MUSCULAR,  LATENT 


having  first  anaesthetized  the  eye  with 
cocaine  solution,  5 per  cent.  Follow  the 
cauterization  after  a few  nionients  with 
boric  acid  irrigation.  The  cauterization 
may  be  repeated  after  twenty-four  hours, 
if  required.  Bichloride  of  mercury, 
1 : 10,000,  cyanide  of  mercury,  1 : 2000, 
and  chlorine  water,  full  strength  and 
freshly  prepared  (see  Part  11)  are  of  service 
in  infected  cases  (see  also  Keratitis  LTlcerosa). 

In  simple  corneal  erosion,  bandage  the 
eye  (Duane  advises  both  eyes  bandaged) 
night  and  day  for  one  or  two  weeks,  or 
until  the  epithelimn  is  regenerated.  Some- 
times the  erosion  recurs  weeks  or  months 
after  it  has  healed,  due  probably  to  “ lack 
of  firm  adhesion  of  the  regenerated  epithel- 
ium to  its  bed  ” (Fuchs).  To  prevent  recur- 
rence, Fuchs  advises  massage  of  the  cornea 
tlu’ough  the  lids,  with  yellow  oxide  of  mer- 
cury ointment  (gr.  i ad  oL,  “ for  some 
time  ” after  the  erosion  has  healed.  “ For 
jiain  which  recurs  at  night,”  he  advises  the 
introduction  into  the  conjunctival  sac, 
before  retiring,  of  “ some  fatty  substance, 
e.g.,  boric  acid  ointment  ” (Part  11),  and 
great  caution  in  opening  the  eyelids  if  the 
patient  should  happen  to  awake  during 
the  night.  If  relap.ses  occur  in  spite  of  the 
above  measures,  he  advises  that  the  loosely 
adherent  epithelium  be  scrapetl  off  and  the 
denuded  area  painted  with  tincture  of  iodine. 

B.  Burns. — Neutralize  acid  burns  with  sod- 
ium bicarbonate  solution,  pi  ad  Oi,  and  alka- 
line burns  with  hydrochloric  acid,  1 : 2000, 
or  acetic  acid,  gtt.  xx  of  the  dilute  acid  to 
one  ounce  of  water.  Remove  all'  foreign 
material  by  means  of  forceps  or  pledgets  of 
cotton  and  copiously  irrigate  with  boric 
acid  or  normal  saline  solution,  5i  ad  Oi. 
'Then  instil  the  following  collyrium: 


H Atroi>ina‘ gr-  iv 

Olei  ricini 5* 


Apply  iced  cloths  continuously  until  the 
burning  pain  ceases,  and  irrigate  the  eye 
frequently  with  boric  acid  solution.  Guard 
against  adhesions  between  the  eyeball  and 
the  lids  by  the  free  use  of  vaseline,  or  by 
means  of  pledgets  of  cotton  soaked  in 
castor-oil,  anti  by  repeatedly  drawing  the 
lids  away  from  the  eyeball. 

Permanent  opacities  are  apt  to  follow 
lime  burns  due  to  the  deposition  of  calcium 
(carbonate.  To  clear  the  cornea  in  these 
cases,  Zur  Nedden  advises  bathing  the 
eye,  after  cocainization,  “ several  times  a 
day  for  half  an  hour  at  a time  in  a ten  per 
cent,  solution  of  neutral  ammonium 
tartrate.”  (Fuchs.) 


C.  Penetrating  Wounds  of  the  Eyeball. — Cleanse 
the  eye  with  bichloritle  or  oxycyanate  of 
mercury,  1 : 10,000.  Use  the  X-ray  (Sweet’s 
apparatus)  or  the  ophthalmoscope  to  locate 
foreign  bodies,  which  should  be  removed,  if 
possible.  The  electro-magnet  may  prove 
useful  in  the  extraction  of  magnetizable 
bodies  (see  Foreign  bodies).  Remove  or 
rejjlace  displaced  structures.  If  the  iris 
prolapses,  draw  the  prolapsed  portion  for- 
ward as  far  as  possible  with  forceps,  after 
freeing  it  from  the  wound  margin,  and  cut 
it  off  flush  with  the  surface.  Close  gaping 
wounds,  whether  of  the  cornea  or  con- 
junctiva, with  fine  silk  sutures  or  with  con- 
junctival flaps.  After  five  or  six  days  the 
flaps  may  be  allowed  to  slip  back  by  cutting 
the  stays.  Close  scleral  wounds  with  con- 
junctival sutures.  Instil  atropine,  gr.  iv  ad 
5i  (or  eserine,  gr.  iv  ad  5i,  E the  intra- 
ocular tension  is  increased),  put  the  patient 
to  bed,  apply  moderate  compression  with 
a bandage  over  gauze  and  cotton,  and  en- 
join absolute  rest,  the  avoidance  of  straining 
at  stool,  etc.  (see  also  Staphyloma).  Partial 
detachment  of  the  iris  at  its  periphery 
(iridodialysis)  calls  for  atropine.  Inject 
anti-tetanus  serum  in  military  wounds.  See 
Dislocation  of  the  Lens,  for  this  complication. 

Should  cyclitis  develop,  manifested  by 
ciliary  pain  and  sensitiveness,  photophobia, 
lachrymation,  pericorneal  congestion  and 
hyperaemia  of  the  iris,  or  should  vision 
gradually  decline,  or  the  eye  become  grad- 
ually soft,  perform  enucleation  or  evi.scera- 
tion  (g.v.)  at  once,  in  order  to  avoid  the 
occurrence  of  sympathetic  ophthalmitis  (g.v.) 
in  the  other  eye.  In  severe  destructive  in- 
juries remove  the  eye  promptly  for  the  same 
reason.  Sympathetic  ophthalmia,  however, 
does  not  develop  earlier  than  ten  to  four- 
teen days,  and  rarely  before  three  weeks, 
so  that  one  has  at  least  a week  to  decide 
the  fate  of  the  injured  eye. 

D.  Contusion  of  the  Eyeball. — The  pupil  is  tii- 
lated  and  inactive. 

Put  the  patient  to  bed.  Shade  the  eyes, 
apply  cold  compresses  and  instil  a solution 
of  jtilocarpine  hytlrochloride  or  eserine  sul- 
phate or  salicylate,  gr.  iv  to  the  ounce  of 
distilled  water,  one  or  two  drops  three  or 
four  times  a day,  until  the  pupil  is  well  con- 
tracted. Eserine  may  jtroduce  a feeling  of 
great  tension  in  the  eye,  with  headache  and 
nausea,  so  that  pilocarpine,  although  less 
effectual  as  a myotic,  had  better  be  tried  first. 

Insufficiency,  Muscular,  Latent. — L.  in, 
not  + sufficiens,  sufficient;  muscu- 
liis,  muscle ; lat'ens,  hidden.  See 
Muscular  Anomalies. 


IRITIS 


Insufficiency,  Manifest. — See  Muscular 

Anomalies. 

Internal  Rectus,  Paralysis  of  the. — L. 

inter’nits;  rect'us,  straight;  Gr.  irapa  beside  + 
\veiv  to  loosen.  See  Muscular  Anomalies. 

Interstitial  Keratitis. — See  Keratitis  In- 
terstitialis. 

Inversion  of  the  Eyelid. — L.  in,  into  + 
vert'ere,  to  turn.  See  Entropion. 

Ionic  Medication. — See  Part  1,  General 
Medicine  and  Surgery. 

Irido=Choroiditis,  Non=Suppurative. — See 

Iritis. 

Suppurative. — L.  sub,  under  + pus, 
pur'is,  pus.  See  Panophthalmitis 
Purulenta. 

Irido=Cyclitis. — See  Iritis. 

Iridodialysis. — Gr.  Ipts  iris  + 5La  through 
+ \vtLv  to  loosen : separation  of  the  iris  from 
its  attachment.  See  Penetrating  Wounds 
of  the  Eyeball,  under  Injuries  of  the  Eye. 

Iris,  Detachment  of  the. — Gr.  ipts  iris. 
(See  Penetrating  Wounds  of  the  Eye- 
ball, under  Injuries  of  the  Eye. 

Inflammation  of  the. — L.  inflamma’re,  to 
set  on  fire.  See  Iritis. 

Prolapse  of  the. — L.  pro,  before  -f-  lab'i, 
to  fall.  See  Penetrating  Wounds  of 
the  Eyeball,  under  Injuries  of  the 
Eye;  and  Keratitis  Ulcerosa. 

Iritis.—Gr.  Ipts  iris  -| — trts  inflammation. 
Iritis  (usually  irido-cyclitis)  is  either  acute 
or  chronic.  Acute  iritis  is  manifested  by 
pain  (sometimes  absent),  photophobia,  lach- 
rymation,  a fine,  pinkish,  pericorneal,  sub- 
conjunctival injection  (ciliary),  a contracted 
sluggish  or  immobile,  irregular  pupil  (due 
to  adhesions,  and  brought  out  by  dilating 
with  atropine,  gr.  ss-i,  or  homatropine,  gr. 
iv,  or  euphthalmine,  gr.  iii,  to  the  ounce), 
swelling,  change  of  color,  and  dull,  lustreless 
appearance  of  the  iris,  and  in  severe  cases, 
grayish  opacity  of  the  pupil  due  to  exudate 
upon  the  anterior  capsule  of  the  lens  and  to 
turbidity  of  the  aqueous.  Hypopyon  (q.v.) 
may  occur.  Tenderness  in  the  ciliary 
region  is  an  inchcation  of  cyclitis.  The  dis- 
ease runs  a course  of  four  weeks  or  longer. 
Chronic  iritis  (irido-cyclitis  and  irido-choroi- 
ditis  or  uveitis)  is  characterized  by  few  or 
no  symptoms  of  inflammation,  but  by  defec- 
tive vision  due  to  synechia?  and  a pupillary 
membrane,  deposits  upon  the  posterior 
surface  of  the  cornea  (keratitis  punctata), 
and  opacities  in  the  vitreous  (so-called 
“ serous  iritis,”  a confusing  term  which 
should  be  dropped).  Chronic  iritis  may 
last  for  years. 

Etiology.— Septic  or  toxic  states,  e.g.,  syphi- 
lis, tuberculosis,  gonorrhoea,  acute  infectious 


diseases,  pyorrhoea  alveolaris,  alveolar  ab- 
scess, tonsillitis,  naso-pharyngitis,  sinusitis, 
otitis  media,  bronchitis,  gastro-intestinal 
intoxication,  pelvic  disease,  menstrual 
disortlers,  prostatitis,  aniemia,  cachexia, 
diabetes,  gout,  “ rheumatism,”  arthritis 
deformans,  etc.;  keratitis  or  other  ocular 
disease;  traumatism;  trophic  nerve  disturb- 
ances, as  in  reflex  dental  and  uterine 
irritation,  herpes  zoster  ophthalmicus,  post- 
malarial  iritis,  sympathetic  iritis  due  to 
uveitis  in  the  other  eye,  etc. 

According  to  Theobald,  syphilis  is  the 
cause  in  about  50  per  cent,  of  the  cases, 
“rheumatism,”  (probably  focal  infection),  in 
about  25  per  cent. 

Prognosis. — Iritis  is  almost  always  amenable 
to  early  treatment.  Trophic  iritis  is  rather 
intractable.  Sympathetic  iritis  or  uveitis 
(q.v.)  usually  leads  to  destruction  of  the 
eye,  even  though  the  offending  fellow  eye 
is  removed.  Relapses  are  frequent  in 
sypliilitic,  rheumatic,  and  gouty  cases. 
Untoward  sequelae  include  closure  of  the 
pupil  by  an  organized  membrane  (occlusio 
pupillae),  acUierence  of  the  iris  to  the  lens  at 
the  pupillary  margin  (seclusio  pupillae), 
adherence  of  the  iris  to  the  lens  throughout 
its  entire  extent,  and  sympathetic  inflamma- 
tion of  the  other  eye  (q.v.). 

Treatment. — Attend  to  the  cause  (q.v.  in  its 
alphabetical  place  and  appropriate  part). 
Administer,  at  the  outset,  an  active  calomel 
purge,  gr.  ii-vui,  followed  by  a saline 
(Part  11),  confine  the  patient  to  bed  on  light 
diet,  excluding  alcohol  and  condhnents,  in 
acute  cases,  jjrotect  both  eyes  against  the 
light  by  .smoked  glasses  (No.  2 London 
smoke),  and  prescribe  aspirin  phenacetin, 
antipyrine,  codeine,  or  morphine  for  the 
relief  of  pain  (see  Drugs,  Part  11). 

Treat  the  condition  locally  as  follows. 
Keep  the  pupil  well  dilated  by  means 
of  atropine: 


AtropiruD  sulphatis gr-  iv 

Acidi  borici gr.  x 

Aquae  destillata; ji 


M.  Sig. — Drop  into  the  eye  four  to  .six  tirne.s 
daily  at  first,  and  later  only  often  enough  to  keep 
the  pupil  dilated. 

If  it  is  desired  to  break  up  recent  pupillary 
adhesions,  the  atropine  may  be  employed 
every  hour  or  half-hour  (Theobald).  Look 
out  for  toxic  constitutional  symptoms,  e.g., 
flushing  of  the  face,  dryness  of  the  throat, 
acceleration  of  the  pulse,  nau.sea,  mental 
excitement,  tremor,  motor  incoordination, 
and  finally  unconsciousness  (combat  these 
effects  with  morphine  hypodermically,  and 


KERATITIS  INTERSTITIALIS  SEU  PARENCHYMATOSA 


the  free  achninistration  of  water.  Atropine 
may  also  cause  conjunctival  catarrh.  In 
cyclitis  or  uveitis  it  should  be  used  with 
care  for  fear  of  glaucoma  (q.v.).  Should 
the  tension  become  elevated,  the  atropine 
should,  of  course,  be  discontinued,  and 
if  necessary,  pilocarpine  or  eserine,  gr.  iv 
to  the  ounce  of  distilled  water  instilled. 
Atropine  should  be  suspended  whenever  it 
produces  an  increase  of  pain.  If  atropine 
does  not  produce  mydriasis,  or  if  it  causes 
conjunctivitis,  substitute  scopolamine  (hyo- 
scine)  hydrobromide  or  duboisine  sulphate, 
gr.  ii  to  the  ounce,  three  or  foiu-  times 
daily  (look  out  for  constitutional  effects: 
see  Part  11),  or  euphthalmine,  2 per  cent.,  or 
eumydrin,  1 per  cent.,  or  Komatropine 
hydrobromide,  1 per  cent. 

Dionin,  5 per  cent,  solution,  one  drop  in 
the  eye  three  tunes  a day,  is  advantageously 
used  in  conjunction  with  atropine.  It 
is  an  analgesic  and  lymphagogue,  and  pro- 
motes healing. 

For  the  relief  of  pain  in  severe  cases, 
apply  to  the  closed  lids  for  thirty  minutes, 
several  times  a day,  very  hot  compresses 
wet  with  water  or  with  ext.  opii  or  ext. 
belladonnae,  gr.  xv.,  in  water,  %'w.  For 
nocturnal  pains  a blister  (cantharidal  col- 
lodion or  cerate:  .see  Part  1 1)  may  be  applied 
above  the  brow  and  to  the  temple,  “ about 
noon,  so  that  full  vesication  is  obtained 
about  7 p.  M.”  (Wood  and  Woodruff).  The 
application  to  the  temple  of  from  three  to 
ten  leeches,  or  a Heurteloup  artificial  leech, 
is  also  useful  in  diminishing  the  inflamma- 
tory symptoms. 

Subconjunctival  injections  of  normal  salt 
solution,  0.6  to  0.9  per  cent.,  or  bichloride 
of  mercury,  1 : 5000,  or  cyanide  of  mercury, 
1 : 3000  to  1500  tt\^xxv,  are  “exceedingly  val- 
uable,” says  De  Schweinitz.  Novocaine, 
gr.  may  be  added  to  render  the  injection 
almost  painless  (Melville  Black). 

General  measures  for  the  purpose  of  com- 
bating the  inflannnation  and  promoting  the 
absorjDtion  of  exudate,  no  matter  what  may 
be  the  cause  of  the  iritis,  are  (1)  energetic 
thaphoresis,  practiced  every  day  or  every 
other  day,  by  means  of  sodium  salicylate  or 
aspirin,  gr.  xx,  clis.solved  in  hot  linden  flow'er 
or  elder  tea  or  lemonade,  with  the  patient 
well  wrapped  in  blankets;  or  by  means  of 
pilocarpine,  gr.  3^  to  ]/^,  every  other  night; 
or  a hot  bath  followed  Ijy  woolen  blankets; 
or  hot  bricks  covered  with  wet  cloths  sprin- 
kled with  alcohol;  and  (2)  mercury,  by 
mouth  or  inunction,  and  {wtassiiun  iodide 
(see  Drugs,  Part  11).  Donovan’s  solution 
{q.v.)  is  useful. 


In  purulent  ophthalmitis,  the  eye  should 
be  promptly  removed.  See  enucleation. 

In  occlu.sio  or  seclusio  pupillae,  perform  a 
broad  peripheral  iridectomy,  and  extract  the 
lens  if  it  is  opaque. 

Keratitis  Bullosa. — Gr.  Kkpas  horn  -f  -ms 
inflammation;  L.bul'la,  blister.  See 
Keratitis  Vesiculosa. 

Dendritica. — Gr.  bkvhpov  tree.  See 
Keratitis  Neuropathica  and  Keratitis 
Ulcerosa. 

Interstitialis  seu  Parenchymatosa.— L. 

inter,  between  -f  sistere,  to  set;  Gr. 
irapkyxvfj.a.  A chronic  inflammatory 
affection  of  the  substantia  propria  of  the 
cornea,  occurring  usually  in  young  people, 
characterized  by  a “ ground-glass  ” appear- 
ance of  the  cornea,  a fine,  pinkish,  peri- 
corneal, subconjunctival  injection  (ciliary), 
pain,  photophobia,  lachrymation,  and  bleph- 
arospasm. Uveitis  is  almost  always  present. 

The  disease  may  persist  for  many  months, 
but  the  ultimate  prognosis  is  usually  good, 
and  the  opacities  clear  up.  Relapses 
are  frequent. 

Etiology  — In  young  people : inherited  syph- 
ilis; rarely  tuberculosis;  possibly,  but  rareR" 
rickets;  malaria;  myxoedema;  poor  nutrition. 

In  those  above  thirty:  gout;  rheumatism; 
tuberculosis;  the  climacterium;  syphilis. 

Treatment. — 


Atropina; gr.  iv 

Acidi  borici gr.  x 

Aquae  destil  late 5i 


M.  Sig. — Instil  one  or  two  drops,  three  or  four 
times  a day,  or  often  enough  to  keep  the  pupil 
well  dilated. 

Smoke-tinted  glasses  should  be  worn,  and 
the  near  use  of  the  eyes  prohibited. 

After  the  photophobia  has  subsided,  and 
mydriasis  is  established,  use  the  atropine 
twice  daily.  Dionin,  5 per  cent.,  one  drop 
in  the  eye,  t.i.d.,  “ is  of  distinct  ser\dce  ” 
(De  Schweinitz) . Apply  hot  fomentations  to 
the  closed  lids  for  fifteen  minutes,  three 
times  a day  or  oftener,  until  the  pain  and 
irritation  subside. 


R Extracti  opii gr.  x 

Addi  borici gr.  xl 

Aquae o*v 


M.  Sig. — Apply  to  the  closed  lids  for  the  relief 
of  pain.  (Theobald.) 

If  atropine  sets  up  a conjunctivitis,  sub- 
stitute scopolamine  (hyoseme)  hydrobro- 
mide or  duboisine  sulphate,  gr.  ii  to  the 
ounce  (look  out  for  constitutional  effects, 
see  Part  11),  or  euphthalmine,  2 per  cent., 
or  eumydrin,  1 per  cent.,  or  homatropine, 
1 per  cent. 


KERATITIS  PARENCHYMATOSA 


Should  the  intraocular  tension  become 
elevated,  discontinue  the  use  of  myotics, 
and  if  necessary,  use  pilocarpine  or  eserine, 
gr.  iv  to  the  ounce  of  distilled  water.  An 
iridectomy  is  rarely  required.  Subconjunc- 
tival injections  of  cyanide  of  mercury, 
1 : 4000,  10  to  20  minims,  may  be  of  value. 

Open  the  bowels  at  the  outset  with  calo- 
mel, prescribe  fresh  air,  a nutritious  diet, 
(excluding  condiments,  spices,  and  alcohol), 
tonics  such  as  iron,  arsenic  and  codliver  oil, 
(see  Part  11),  and  otherwise  treat  the 
patient  according  to  the  cause,  which  is 
usually  syphilis. 

After  all  symptoms  of  irritation  have  dis- 
appeared, have  the  patient  practice  syste- 
matic, gentle  massage  of  the  cornea  through 
the  eyelid,  after  the  introduction  of  ung. 
oxidi  flavi,  gr.  i ad  3i  of  vaseline  or  cosmo- 
line  or  liquid  albolene,  into  the  conjunc- 
tival sac,  with  the  object  of  hastening  the 
absorption  of  opacities  {q.v.,  for  additional 
treatment). 

After  healing  has  occurred,  glasses  are 
usually  required  for  the  correction  of  corneal 
astigmatism  produced  by  the  inflammation. 

Keratitis  Neuroparalytica. — Gr.  vtvpov 

nerve;  irapa  beside;  \veiv  to  loosen. 
(See  Keratitis  Neuropathica,  below.) 

Neuropathica. — Gr.  veopov  nerve  + irados 
disease.  Corneal  ulceration,  perhaps  pre- 
ceded by  vesiculation,  due  to  a disturbance 
of  the  corneal  nerve  supply,  i.e.,  the 
trigeminal  nerve,  Gasserian  ganglion,  or 
ophthalmic  ganglion.  Under  the  above 
caption  are  included  keratitis  neuro-para- 
lytica,  due  to  paralysis  of  the  fifth  nerve, 
herpes  zoster  ophthalmicus,  due  to  a lesion 
of  the  Gasserian  ganglion,  herpes  cornese 
febrilis  and  keratitis  dendritica,  due  to 
“ cold,”  influenza,  naso-pharyngitis,  bron- 
chitis, pneumonia,  malaria,  typhoid  fever, 
whooping-cough,  syphilis,  rheumatism,  gout, 
and  reflex  dental  irritation.  Keratitis  den- 
dritica is  usually  due  to  malaria.  A non- 
neuropathic  keratitis  vesiculosa  et  bullosa 
occurs  in  irido-cyclitis,  interstitial  keratitis, 
and  glaucoma. 

Prognosis. — This  is  good,  under  treatment, 
in  herpes  febrilis;  usually  good  in  herpes 
zoster  (a  spontaneous  cure  usually  occurring 
in  two  or  three  weeks,  see  Part  10);  very 
serious  in  paralysis  of  the  fifth  nerve,  in  which 
the  cornea  is  apt  to  be  left  densely  opaque. 


Treatment. — 

H Atropina; gr.  iv 

Acidi  borici gr.  x 

Aqua)  de.stillata) § i 


M.  Sig. — Instil  one  or  two  drops,  three  or  four 
times  a day  at  first,  later  twice  a day,  or  often 
enough  to  keep  the  pupil  well  dilated. 


In  using  atropine  in  herpes  zoster  one 
should  bear  in  mind  that  this  disease  pre- 
disposes to  glaucoma,  so  that  the  tension  of 
the  eyeball  should  be  constantly  observed. 

Holocaine  hydrochlorate,  gr.  i-ii  to  the 
ounce  (analgesic  and  antiseptic),  and  dionin, 
5 per  cent,  (lymphagogue),  one  drop  in  the 
eye  three  or  four  times  a day,  may  be  used 
in  conjunction  with  atropine,  the  former 
during  the  stage  of  irritation.  Dionin,  says 
De  Schweinitz,  “ is  of  signal  service.” 
Apply  hot  fomentations  for  the  relief  of 
pain,  and  keep  the  eyelids  closed  by  means 
of  a bandage.  Aspirin,  phenacetin,  anti- 
pyrine,  codeine,  or  morphine  (see  Part  11), 
may  be  required  for  the  relief  of  pain. 
Every  two  or  three  hours  irrigate  the  con- 
junctival sac  with  warm  boric  acid  solution, 
3 percent.,  or  bichloride  of  mercury,  1 : 10,000, 
or  cyanide  of  merciny,  1 : 2000,  or  chlorine 
water  freshly  prepared  and  of  full  strength 
(see  Part  11),  or  instil  argyrol,  25  per  cent., 
t.i.d.  (See  also  Keratitis  Ulcerosa  for  addi- 
tional instructions.) 

Give  at  the  outset  an  energetic  calomel 
purge,  gr.  ii-viii,  followed  by  quinine,  gr. 
iii,  in  capsule,  four  or  five  times  a day,  and 
strychnine,  gr.  34o  to  t.i.d.  Potassium 
iocUde,  gr.  v-x,  well  diluted,  t.i.d.p.c.  (see 
Part  11),  is  also  recommended.  Salicylate 
of  sodium,  says  De  Schweinitz,  “ is  a most 
valuable  remedy.”  Prescribe  iron,  or  arsenic, 
if  indicated,  and  also  fresh  air  and  nutri- 
tious food,  excluding  spices,  conchments,  and 
alcohol.  For  the  skin  eruption  in  herpes 
zoster,  employ  one  of  the  following  protective, 
anodyne,  and  antiseptic  applications: 

R Calamina), 

Zinci  o.xidi,  aa 5ii 

Acidi  borici 3i 

Glycerini nifxxx 

Acidi  carbolici t^jxx-xxx 

Liquoris  calcLs 5 j 

Aquae,  q.s.,  ad 5iv 

M.  Sig. — Shake  well,  and  apply  as  often  as 
required  to  obtain  relief. 

R Mentholis,  (vel  ac.  carb.,  gi'. 

x-xx) gr.  x-xl 

Alcoholis  ethylis 3iv 

R Acidi  carbolici  vel  thymolis gr.-.  ^ 

Collodii  flexilis 5ii 

R Zinci  oxidi, 

Acidi  borici, 

Talci,  aa 


R Mentholis gr.  xy-xx 

Amyli 5 Pi* 

Ungtienti  zinci  oxidi 5i 


(Stelwagon.) 

Keratitis  Parenchymatosa. — See  Kera- 
titis Interstitialis. 


KERATITIS  ULCEROSA 


Keratitis,  Phlyctenulosa. — See  Conjuncti- 
vitis Phlyctenulosa. 

Punctata. — L.  point.  See  Iritis. 

Ulcerosa. — L.  ul'cus,  ulcer.  Ulceration 
of  the  cornea  is  accompanied  by  a fine, 
pinkish,  subconjunctival,  pericorneal  zone 
of  injection,  pain,  photophobia,  lachry- 
mation,  and  blepharospasm:  Hypopyon 

ig.v.)  and  iritis  may  occur.  The  ulcer  may 
be  outlined  by  staining  (green)  with  the 
following  dye;  fluorescein,  gr.  viii,  and  liquor 
jwtassse,  3 i,  in  distilled  water  up  to  5 i,  the 
excess  to  be  washed  off  with  water. 

Corneal  ulcers  usually  heal  readily  under 
treatment.  Resulting  opacities,  however,  if 
central,  interfere  seriously  with  vision. 

Etiology.— Traumatism,  due  to  a foreign 
body,  misplaced  cilia,  burns,  papillary 
growths  on  the  free  borders  of  the  lids,  etc., 
complicated  by  bacterial  infection;  any  form 
of  conjunctivitis;  kerato-conjunctivitis, 
phlyctenular  (q.v.);  daciyocystitis ; lagoph- 
thalmos (q.v.),  causing  desiccation  of  the 
cornea;  lowered  vitality,  as  after  typhoid 
fever,  influenza,  measles,  scarlet  fever,  small- 
pox, hepatic  cirrhosis,  hepatic  carcinoma,etc.  ; 
senility;  gastro-intestinal  intoxication  and 
other  toxic  and  septic  states,  such  as  dental 
caries,  naso-pharyngeal  disease,  gout,  etc.; 
glaucoma;  cUsturbances  in  the  corneal  nerve 
supply  (see  Keratitis  Neuropathica) ; local 
tuberculosis  (q.v.);  niptured  vesicles  (see 
Keratitis  Vesiculosa  etBullosa) ; oldcicatrices. 

Treatment. — Attend  to  any  possible  etio- 
logical influence,  remove  foreign  bodies, 
epilate  misplaced  cilia,  remove  papillaiy 
growths  on  the  lid  margins,  etc.  An  ener- 
getic calomel  purge,  gr.  ii-viii,  should  be 
given  at  the  outset,  followed  by  quinine, 
gr.  iii,  in  capsule,  four  or  five  times  a day 
(Theobald).  Fresh  air  and  nutritious  food, 
exclucUng  spices,  condiments,  and  alcohol, 
are  of  unportance,  and  tonics,  such  as  iron 
or  arsenic  (Part  11),  if  indicated.  Protective 
tinted  glasses  should  be  w’orn  or  the  eye 
bandaged,  as  directed  below: 


II  Atropin® gr.  i-ii-iv 

Acidi  borici gr.  x 

Aqu®  bullicntis 5i 


M.  Sig. — Instil  one  or  two  drops  into  the  eye 
once  or  twice  daily  or  often  enough  and  in  sufficient 
strength  to  keep  the  pupil  well  dilated,  and  to  pre- 
vent photophobia,  lachrymation,  and  blepharospasm. 

Atropine  sometimes  sets  up  a marked 
conjunctivitis  with  oedema  of  the  lids.  If 
this  should  occur,  substitute  scopolamine 
(hyoscine)  hydrobromide  or  duboisine  sul- 
phate, gr.  ii  to  the  ounce,  or  euphthalmine, 
2 per  cent.,  or  eumydrin,  1 per  cent.,  or 
homatropine,  1 per  cent. 


II  Hydrargyri  oxidi  flavi gr.  i 

Petrolati  mollis 3i 

M.  Sig. — Apply  with  a wooden  toothpick  or 
camel’s-hair  brush  in  the  morning  after  instilling  the 
drops.  (Theobald.) 

II  Unguenti  iodoformi,  10  per  cent 3i 

Sig. — Apply  with  a wooden  toothpick  or  camel’s- 
hair  brush.  Fine  calomel  or  iodoform  powder  may 
be  dusted  on  the  idcer,  but  not  calomel  if  iodine  is 
being  taken  internally,  because  of  the  local  forma- 
tion of  mercury  iodide. 

Holocaine  hydrochlorate  (analgesic  and 
antiseptic),  gr.  i-ii  to  the  ounce,  and  dionin 
(Runphagogue  and  analgesic),  5 per  cent., 
one  drop  three  or  four  times  a day,  may  be 
advantageously  used  in  conjunction  with 
the  atropine.  Subconjunctival  injections  of 
cyanide  of  meremy,  1 : 4000,  10  to  20  min- 
ims, are  also  recommended. 

Every  two  or  three  hours  the  conjunctival 
sac  should  be  flushed  or  irrigated  with  warm 
boric  acid  solution,  3 per  cent.,  or  bichloride 
of  mercury,  1 : 10,000  to  8000,  or  cyanide  of 
mercury,  1 : 2000,  or  chlorine  water,  freshly 
prepared  and  of  full  strength  (see  Part  11), 
or  formaline,  1 : 10,000. 

For  the  relief  of  pain,  apply  to  the 
closed  lids  hot  fomentations  of  water,  or 
the  following: 


II  Extract!  opii gr.  x 

Acidi  borici gr.  xl 

Aqu® 3iv 


(Theobald.) 

Spray  the  nasal  passages  frequently  with 
Dobell’s  solution  (Part  11)  while  treating 
corneal  ulcer. 

If  the  floor  of  the  ulcer  shows  a tendency 
to  bulge,  employ  moderate  compression  by 
means  of  a soft  gauze  and  cotton  pad  and 
bandage,  and  keep  the  patient  quiet  in  bed 
to  avoid  sudden  perforation  with  prolapse  of 
the  iris.  Caution  the  patient  against  strain- 
ing at  stool,  coughing,  etc.,  and  prescribe 
if  need  be,  laxatives  for  the  former  and  seda- 
tives for  the  latter. 

In  pronounced  bulging,  with  threatened 
perforation,  perform  paracentesis  through 
the  floor  of  the  ulcer,  holding  the  needle 
flatwise,  with  the  point  well  forv’ard,  so  as  to 
avoid  wounding  the  lens.  If  a paracentesis 
needle  with  a shoulder  is  used,  it  is  inserted 
at  an  angle  of  45°. 

If  perforation  occurs  and  the  iris  pro- 
trudes, one  may  try  to  replace  it  under 
cocaine  ana'sthesia  (5  per  cent,  solution). 
If  unsuccessful  (and  Fuchs  sa}'s  that 
attempts  at  permanent  replacement  are 
always  unsuccessful),  draw  the  prolapsed 
portion  forward  with  forceps  as  far  as 
possible,  after  freeing  it  from  the  wound 


LACHRYMAL  ABSCESS 


margin,  and  cut  it  off  flush  with  the 
corneal  smface. 

In  foul,  spreading  ulcers  (ulcus  serpens, 
due  to  the  pneumococcus),  one  may  curette 
the  ulcer  carefully,  under  cocaine  anaesthesia, 
at  the  same  time  spraying  the  ulcer  with 
boric  acid  solution,  then  apjjly,  by  means  of 
a sharp-pomted  wooden  toothpick,  wound 
with  a few  fibres  of  absorbent  cotton,  pure 
carbolic  acid,  or  trichloracetic  acid,  or 
tincture  of  iodine,  or  formalme  (1  : 60),  or 
silver  nitrate,  gr.  xx  to  the  ounce,  taking 
great  care  not  to  touch  the  healthy  portions 
of  the  cornea.  After  a few  moments,  flush 
the  cornea  with  normal  saline  solution  (3i 
ad  Oi)  or  boric  acid  solution.  If  necessary, 
the  cauterization  may  be  repeated  after 
twenty-four  hoiu’s.  If  no  improvement 

follows,  one  may  employ,  under  cocainiza- 
tion,  and  with  extreme  care,  the  galvano- 
cautery  or  the  end  of  a knitting-needle 
heated  white  hot.  Prince’s  pasteurizer, 

however,  had  better  be  tried  first.  The 
point  of  the  egg-shaped  instrument  is  heated 
red-hot  in  the  flame  of  an  alcohol  lamp,  and 
is  then  held  about  three-sixteenths  of  an 
inch  from  the  cocainized  ulcer,  w'hile  the 
lids  are  separated  by  the  first  and  second 
fingers,  and  the  patient  chrected  to  look  so 
as  to  brmg  the  ulcer  into  the  middle  of  the 
palpebral  apertiu-e.  To  learn  how  close  to 
approach  the  ball  to  the  ulcer,  it  is  well  to 
approximate  the  heated  end  to  the  bulb  of 
a thermometer.  The  temperature  should 
not  register  more  than  150°  F.  Of  recent 
years,  ethyl  hydrocupreine  or  optochin  (a 
quinine  alkaloid),  in  1 per  cent,  aqueous 
solution,  every*  two  hours,  is  advanced  as  a 
specific  for  ulcus  serpens  due  to  the  pneiuno- 
coccus. 

If  a corneal  abscess  is  “ extending  later- 
ally and  shows  no  disposition  to  reach  the 
surface,”  make  a vent  by  means  of  the 
curette,  and  apply  carbolic  acid  or  the 
galvano-cautery.  (Theobald.) 

Ionic  mechcation  {q.v.  in  Part  1)  is 
recommended  for  corneal  ulcer.  The  cornea 
is  cocainized.  A fine  tuft  of  cotton  wool  is 
placed  on  the  end  of  a zinc  rod  which  is  then 
moistened  with  zinc  sulphate  solution,  1 per 
cent.,  and  a current  of  1 -f  milliamperes  is 
passed  for  two  to  three  -j-  minutes. 

Should  a corneal  fistula  occur,  it  is  essen- 
tial to  healing  to  keep  the  tension  in  the 
anterior  chamber  low.  To  this  end  put  the 
patient  to  bed,  in.stil  eserine  or  pilocarpine 
(see  Glaucoma),  and  bandage  both  eyes 
lightly.  If  these  measures  fail,  a conjunc- 
tival flap  may  be  sewn  over  the  fistula  after 
scraping  the  latter;  or  the  fistula  may  be 


excited  by  means  of  the  corneal  trephine 
and  an  equally  large  piece  of  healthy  cornea 
implanted  in  the  opening. 

Keratitis  Vesiculosa  et  Bullosa. — L.  vesi- 
c'ula,  a small  sac  or  blister;  bul'la,  a large 
bhster.  Corneal  vesicles  occur  in  keratitis 
neuropathica  (q.v.),  and  in  iridocyclitis  (see 
Iritis),  interstitial  keratitis  (q.v.),  phlycten- 
ular keratoconjunctivitis  (q.v.),  and  glau- 
coma (q.  V.). 

Keratoconjunctivitis. — See  Conjunctivitis 
Phlyctenulosa. 

Keratoconus;  Conical  Cornea. — Gr.  Kkpas 
horn  + K(7)Vo%  cone;  L.  co'nus,  cone;  cor'neus, 
horny.  A very  rare  anomaly.  A high 
grade  of  myopia  and  astigmatism  are  pro- 
duced, for  which  glasses  should  be  prescribed. 
Duane  pomts  out  the  great  usefulness, 
in  selected  cases,  of  discs  with  steno- 
poeic  holes  or  slits,  their  size  and  shape 
determined  by  careful  experiment.  The 
hydrodiascope  (Gr.  vSup  water  -}-  Sia 
through  -f  aKOTretv  to  look)  may  also  be 
of  seiwice. 

If  the  condition  is  extreme,  the  apex  of 
the  cone  should  be  cauterized  with  the 
galvano-cautery,  using  extreme  care  to 
avoid  perforation;  and  this  should  be 
repeated  several  times  until  a sufficient 
flattening  is  produced.  An  iridectomy  for 
a new  pupil  may  then  be  required,  and  the 
corneal  scar  tattooed  in  order  to  lessen 
the  dazzling. 

^ Keratomalacia. — Gr.  Kepas  horn  -|-  paXaKia 
softening.  Necrotic  softening  of  the  cornea, 
occurring  usually  in  childi'en  debilitated  by 
some  exhausting, disease,  such  as  meningitis, 
smallpox,  scarlet  fever,  measles,  typhus 
fever,  herecUtary  syphilis,  and  severe  diar- 
rhoea, or  by  insufficient  or  unproper  food. 
It  is  ushered  in  by  night-blindness  and  con- 
junctival and  corneal  desiccation  or  xerosis, 
with  scarcely  any  symptoms  of  irritation. 
In  this  early  stage,  careful  treatment  may 
possibly  prevent  the  loss  of  sight,  but  the 
prognosis  is  usually  extremely  bad. 

Treatment.— Apply  hot  fomentations  to  the 
lids,  and  instil,  every  two  or  three  hours,  a 
warm  saturated  solution  of  boric  acid  (4  per 
cent.),  or  freshly  prepared  chlorine  water  of 
full  strength  (see  Part  11),  together  with  the 
use  of  atropine  in  weak  solution,  gr.  i-ii  to 
the  ounce.  Keep  the  eyes  closed  by  means 
of  a bandage  Administer  concentrated 
liquid  nourishment  (milk,  eggs,  and  beef 
juice),  stimulants,  and  quinine  (see  Part  11) 
in  liberal  doses.  (Theobald.) 

Lachrymal  Abscess. — L.  lacrima,  tear; 
abscessus,  a going  apart.  See  Dacry- 
ocystitis. 


MIOSIS 


Adenitis. — See  Dacryoadenitis. 

Calculus. — L.  calc'ulus,  pebble.  See 
Epiphora. 

Duct,  Stricture  of  the. — L.  ductus,  from 
ducere  to  lead;  strictu'ra.  See 
Dacryocystitis. 

Gland,  Cyst  of  the.— L.  glans,  a cord; 
Gr.  KVffTis  bladder.  See  Orbital 
Tumors. 

Fistula  of  the. — See  Fistula  of  the 
Lachrymal  Gland. 

Inflammation  of  the. — L.  inflammdre, 
to  set  on  fire.  See  Dacryoadenitis. 
Hypertrophy  of  the. — Gr.  v-n-tp  over  + 
Tpo4>rj  nutrition.  See  Orbital  Tum- 
ors. 

Puncta,  Atresia  of  the. — L.  punctum, 
point;  Gr.  a neg.  + rprjaLs  a boring. 
See  Epiphora. 

Sac,  Inflammation  of  the. — L.  saccus, 
bag;  inflammdre,  to  set  on  fire.  See 
Dacryocystitis. 

Stone.— -See  Epiphora. 

Lagophthalmos. — Gr.  Xayws  hare  + 

6<t>6a\p.ns  eye.  Inability  to  close  the  lids 
completely,  resulting  in  chronic  conjunctival 
catarrh  and  epiphora,  and  possibly  keratitis, 
due  to  desiccation. 

Etiology.— Congenital  anomaly;  notching  of 
the  border  of  the  lid;  ectropion  (g.r.); 
paralysis  of  the  orbicularis  muscle,  supplied 
by  the  seventh  or  facial  nerve  (q.v.);  loss 
of  tissue  due  to  burns,  ulcers,  traumatism, 
or  operations;  staphyloma  cornese  (q.v.)] 
extreme  myopia;  unconsciousness  or  pros- 
tration; enlargement  of  the  eyeball;  exoph- 
thalmos {q.v.) 

Treatment. — The  treatment  is  causal. 
Meanwhile,  protect  the  eye  against  drying 
by  uniting  the  lids  with  adhesive  plaster 
and  applying  a bandage  over  a gauze- 
covered  cotton  pad.  In  light  cases  it  may 
only  be  necessary  to  do  this  at  night.  If  the 
lids  cannot  be  approximated,  cover  the  eye 
hermetically,  by  means  of  adhesive  plaster 
and  collocUon,  with  a watch  crystal  contain- 
ing moist  cotton.  In  appropriate  cases,  a 
tarsorrhaphy  may  be  performed,  to  shorten 
the  palpebral  fissure. 

Latent  Convergence  or  Esophoria. — L. 

Idtens,  hidden;  cmi,  together 
vcrg'cre,  to  incline;  Gr.  ecrw  inward  -(- 
<f)€peiv  to  bear.  See  IMuscular  Anoma- 
lies. 

Divergence  or  Exophoria. — L.  dis 

apart  4-  verg’ere,  to  tend;  Gr. 
out  -|-  d>epttv  to  bear.  See  Muscular 
Anomalies. 

Latent  or  Suppressed  Squint— L.  suppres- 
sio.  See  Muscular  Anomalies. 


Lens,  Dislocation  of  the. — L.  lens,  lentil. 
See  Dislocation  of  the  Lens. 

Opacity  of  the. — L.  opaciias.  See 

Cataract. 

Lid,  Adherent  to  the  Eyeball. — See  Sjnn- 
blepharon. 

Drooping  of  the  Upper. — See  Ptosis. 

Lids,  Eczema  of  the. — See  Eczema  of  the 
Lids. 

Edema  of  the  — See  Oedema  of  the 
Lids. 

Everted. — L.  ever'sio,  a turning  out- 
ward. See  Ectropion. 

Inverted. — L.  in,  into  ver'tere,  to 
turn.  See  Entropion. 

Granular. — L.  granulum,  grain.  See 
Conjunctivitis  Trachomatosa. 

QEdema  of  the. — See  ffidema  of  the  Lids. 

Open. — See  Lagophthalmos. 

Spasm  of  the.-^ee  Blepharospasm. 

Light  Sense. — See  the  Ocular  Examina- 
tion, in  the  Appendix,  following  Part  6. 

Lipoma,  Orbital. — Gr.  XIttos  fat  -|-  -w/xa 
tmnor.  See  Orbital  Tumors. 

Subconjunctivale. — Gr.  XIttos  fat  -|-  -wga 
tumor;  L.  sub,  under.  See  Conjunctival 
Tumors. 

Lithiasis  Conjunctivae. — Gr.  \L6os  a 

stone.  The  occurrence  of  white,  calcareous 
(gouty)  concretions  in  the  acini  of  the  i\Iei- 
bomian  glands. 

Cocainize  (using  4 to  5 per  cent,  cocaine), 
incise,  and  remov^e  each  concretion  with 
a needle. 

Luxation  of  the  Lens. — L.  luxdtio,  dislo- 
cation. See  Dislocation  of  the  Lens. 

Lymphangioma  Conjunctivae.^ — L.  lytn'pha, 
water  or  IjTiiph;  Gr.  ayytiov  vessel 
-w/xa  tumor.  See  Conjunctival  Tum- 
ors. 

Orbital. — See  Orbital  Tumors. 

Manifest  Muscular  Insufficiency  or  Mani= 
fest  Squint. — See  IMuscular  Anomalies. 

Meibomian  Concretions. — H.  Meibom 
(1638-1700);  L.  cum,  together  -j- 
crescere,  to  grow.  See  Lithiasis 
Conjunctivse. 

Cyst. — Gr.  /cucrrxy  bladder.  See  Chala- 
zion. 

Gland  Inflammation. — L.  glans,  a cord; 
inflammdre,  to  set  on  fire.  See 
Hordeolum. 

Membranous  Conjunctivitis. — See  Con- 
junctivitis Crouposa. 

Meningocele,  Orbital. — Gr.  pf/VLy^  mem- 
brane -f-  KriX-q  tumor.  See  Orbital  Tumors. 

Mikulicz’s  Disease. — See  Part  1,  General 
IMedicine  and  Surgery. 

Miner’s  Nystagmus. — See  Nystagmus. 

Miosis. — See  Myosis. 


MUSCULAR  ANOMALIES 


Mole,  Conjunctival. — L.  mol'es,  mass. 
See  Conjunctival  Tumors. 

Mucous  Cysts,  Orbital. — L.  mucus]  Gr. 
KxxjTLs  bladder.  See  Orbital  Tumors. 

Muscse  Volitantes. — L.  flitting  flies.  See 
Opacities  in  the  Vitreous. 

Muscle,  Ciliary  or  Intrinsic,  Paralysis  of 
the. — L.  musculus;  cilium,  hair;  in- 
trinsecus,  inside;  Gr.  Trapd  beside + 
to  loosen.  See  Accommodation 
Anomalies. 

Spasm  of  the. — Gr.  airaaiius.  See 
Accommodation  Anomalies. 

Extrinsic,  Paralysis  of. — L.  extrinsecus, 
outside.  See  Muscular  Anomalies. 

Spasm  of  the. — See  Muscular  Anom- 
alies 

Orbicularis,  Paralysis  of. — L.  orbicu- 
la'ris,  circular  or  rounded.  See 
Facial  Paralysis  in  Part  1. 

Spasm  of. — See  Blepharospasm. 

Muscular  Anomalies.^ — Gr.  avu/j-aXia  ab- 
normality. 

Classification.—!.  Muscular  Insufficiency: 

A.  Manifest  (“cross  eyes”;  squint;  stra- 

bismus; heterotropia) : 

(a)  Paraljdic  squint. 

(b)  Concomitant  or  ordinary  squint. 

B.  Latent  (suppressed  or  latent  squint; 

heterophoria) : 

1.  Esophoria;  latent  convergence; 
suppressed  inclination  to  inward 
deviation. 

2.  Exophoria;  latent  divergence; 
suppressed  inclination  to  outward 
deviation. 

3.  Hyperphoria;  latent  vertical 
squint;  suppressed  inclination  to 
vertical  deviation. 

II.  Muscular  spasm,  causing  concomitant 
heterotropia  or  heterophoria. 

III.  Nystagmus  (q.v.). 

In  heterotropia,  binocular  vision  is  lost. 
The  squinting  eye  soon  becomes  amblyopic, 
because  the  images  formed  in  this  eye  are 
constantly  suppressed  to  prevent  double 
vision  (see  Diplopia,) ; therefore  the  necessity 
for  early  treatment. 

In  heterophoria,  binocular  vision  is  main- 
tained by  a constant  effort,  which  may  lead 
to  marked  asthenopia  symptoms  (see  Asthen- 
opia,) or  to  manifest  (concomitant)  squint. 

A.  (a)  Paralytic  or  Paretic  Squint. — 
In  paralytic  squint,  the  latter  increases 
when  the  eye  is  turned  toward  the  paralyzed 
muscle,  whereby  it  is  distinguished  from  the 
ordinary  (concomitant)  squint,  due  usually 
to  refractive  anomalies,  in  which  the  squint- 
ing eye  follows  all  the  movements  of  the 
fixing  eye,  maintaining  always  the  same 
43 


angle  with  it.  Paralytic  squint  of  long 
duration,  however,  in  which  the  antagonist 
of  the  paralyzed  muscle  is  contractured, 
can  scarcely  be  distinguished  from  con- 
comitant squint.  “ Indeed,”  says  Duane, 
“many  cases  of  concomitant  squint  are 
without  doubt  paralytic  in  origin.” 

Etiology  of  Paralysis  oj  the  Ocular  Muscles. 
— (1)  Acide. — Poisoning  with  alcohol,  to- 
bacco, lead,  sulphuric  acid,  gelsemium, 
conium,  chloral,  carbon  monoxide,  fish,  and 
meat;  acute  infectious  diseases,  e.g.,  diph- 
theria, influenza,  “cold,”  tonsillitis,  measles, 
whooping-cough,  herpes  zoster,  acute  polio- 
myelitis, mumps,  basal  meningitis  (tuber- 
cular or  epidemic);  orbital  cellulitis; 
tenonitis;  sinusitis;  fracture;  basal  hemor- 
rhage; basal  abscess;  cerebral  hemorrhage; 
cerebral  injury. 

(2)  Chronic. — Syphilis;  tabes  dorsalis  (fre- 
quently ushered  in  by  transitory  and  recur- 
rent ocular  paresis);  dementia  paralytica; 
disseminated  sclerosis;  myasthenia;  exoph- 
thalmic goitre;  orbital  periostitis;  tumors; 
basal  hemorrhage,  meningitis,  abscess, 
thrombosis,  or  aneurysm;  cavernous  sinus 
disease;  otitic  disease;  progressive  muscular 
atrophy;  bulbar  paralysis;  gout;  rheuma- 
tism; diabetes;  hysteria. 

Paralysis  of  the  third  or  oculomotor  nerve 
(which  supplies  the  levator  palpebrae  super- 
ioris,  the  superior,  internal,  and  inferior 
recti,  the  inferior  oblique,  the  ciliary  muscle, 
and  the  constrictor  iridis),  producing  down- 
ward and  outward  squint,  diplopia,  and 
ptosis,  with  or  without  semi-dilatation  of 
the  pupil  and  impairment  of  near  vision 
(due  to  cycloplegia:  see  Accommodation 
Anomalies),  is  usually  due  to  syphilis 
or  “rheumatism.” 

Paralysis  of  the  fourth  or  trochlear  nerve 
(which  supplies  the  superior  oblique),  pro- 
ducing squint  more  marked  on  looking  down 
and  diplopia  on  looking  down,  and  paralysis 
of  the  siiffh  or  abducens  nerve  (which  sup- 
plies the  external  rectus),  producing  inward 
squint,  inability  to  turn  the  eye  outward, 
and  diplopia  on  looking  outward,  are  usually 
due  to  “ cold  ” (Theobald) ; to  the  rheumatic 
poison  or  diabetes  (Wood  and  Woodruff); 
often  to  influenza. 

Periodic  ocular  paralysis  with  headache 
and  often  vomiting  (ophthalmoplegic  mi- 
graine) may  be  due  to  hysteria,  to  arterio- 
spasm  (see  Migraine,  in  Part  1,  on  General 
Medicine  and  Surgery),  or  to  a circumscribed 
exudate  or  small  tumor  at  the  base  of  the 
brain,  pressing  upon  the  nerve  tract. 

Conjugate  paralyses,  manifested  by  ina- 
bility to  look  with  both  eyes  conjointly  to 


MUSCULAR  ANOMALIES 


the  right  or  left,  or  up  or  down,  etc.,  are  due 
to  lesions  (usually  cerebral  hemorrhage, 
sometimes  hysteria)  involving  the  centres 
for  the  associated  movements  of  the  eyes 
(in  conjugate  spasm,  although  the  eyes  are 
strongly  deviated  in  one  direction,  they  can 
be  moved  in  the  opposite  direction). 

Treatment  of  Ocular  Paralysis. — In  acute 
cases  with  pain,  apply  to  the  temple  heat, 
counter  irritation,  or  leeches,  or  the  Heurte- 
loup  artificial  leech.  Where  “ cold  ” or 
“ rheumatism  ” is  the  supposed  cause,  pre- 
scribe potassium  iodide,  gr.  v-x,  well  diluted, 
t.i.d.p.c.  (see  Drugs,  Part  11),  or  sodium 
salicylate.  Diaphoresis  should  be  encouraged 
by  means  of  blankets,  hot  bottles,  and 
copious  hot  drinks. 

Syphilitic  cases  call  for  specific  treatment. 

Arsenic  is  recommeiuled,  no  matter  what 
the  cause. 

In  order  to  obviate  the  annoying  diplopia 
and  resulting  dizziness,  cover  the  affected 
eye  with  an  opaque  glass,  or  u.se  prisms. 

After  the  acute  symptoms  have  subsided, 
prescribe  strychnine,  or  mix  vomica,  in 
ascending  doses;  and  employ,  if  desired,  the 
galvanic  current,  the  cathode  over  the  closed 
lid  and  the  anode  over  the  temple,  using  a 
very  weak  current,  1 to  1)^  milliamperes,  for 
five  minutes  ilaily. 

If  the  paralysis  proves  incurable,  perfonn 
tenotomy  of  the  opposing  muscle,  or 
atlvancement  (resecting  a large  portion 
of  the  tendon)  of  the  paralyzed  muscle, 
or  both. 

The  prognosis  in  both  syphilitic  and  rheu- 
matic cases  is  favorable. 

A.  (b)  Concomitant  or  Ordinary 
Squint.- — In  this  form  of  strabismus,  the 
squinting  eye  follows  all  the  movements  of 
the  fixing  eye,  maintaining  always  the  same 
angle  with  it,  whereas  in  paraljdic  strabis- 
mus the  squint  increases  when  the  ej^e  is 
turned  toward  the  paralyzed  muscle  (but 
see  also  Paralytic  Squint,  preceding). 

The  squint  may  be  convergent,  divergent, 
or  vertical;  constant,  periodic,  or  intermit- 
tent. It  may  shift  from  one  eye  to  the  other. 
Says  Theobald,  “ It  is  never  bilateral,  and 
diplopia  is  rarely  complained  of.”  “ It 
usually  develops  in  early  cliildhood.” 

Etiology. — Refractive  anomalies  (the  usual 
cause) ; marked  difference  in  the  acutene.ss  or 
refraction  of  the  two  eyes;  total  blindness; 
defective  fusion  faculty  (see  “ cover  test” 
below) ; congenital  or  acquired  muscular  de- 
ficiencies (“  muscle  too  long  or  too  short, 
too  much  or  too  little  developed,  imper- 
fectly or  unduly  innerv^ated  ”:  see  Muscular 
Spasm). 


The  “ cover  te.st  ” is  performed  as  follows: 
Have  the  patient  regard  fixedly  a small 
candle-light  upon  a black  background  five 
or  six  metres  chstant,  and  cover  the  left  eye 
with  a screen.  Then  pass  the  screen  rapid- 
ly in  front  of  the  right  eye  and  note  the 
movement  of  this  eye  behind  the  screen. 
Outward  deviation  indicates  exophoria;  in- 
ward deviation,  esophoria;  and  vertical  devi- 
ation, h5q3crphoria. 

Convergent  concomitant  squint  occurs 
usually  in  early  childhood  as  a result  of  hyper- 
metropia,  exceptionally  in  high  grade  myopia. 
Divergent  concomitant  squint  usually 
develops  in  adults  as  a result  of  myopia. 

Treatment. — Correct  errors  of  refraction 
by  means  of  appropriate  glasses,  with  per- 
haps esophoric  or  exophoric  prisms.  Exer- 
cise the  eyes  in  binocular  vision,  several 
times  a day,  for  a few  minutes  at  a time,  by 
producing  diplopia  with  prisms  or  the 
stereoscope  or  amblyoscope,  and  training 
the  eyes  to  fuse  the  double  images  (orthop- 
tic training:  Gr.  6p06s  straight  -|-  otttlkos 
optic).  Encourage  vision  in  the  affected 
eye  by  shading  or  atropinizing  the  good  eye 
or  by  “ bar  reading,”  that  is,  holding  a ruler 
vertically  a few  centimetres  in  front  of  the 
patient’s  nose,  with  the  edge  of  the  ruler 
toward  the  nose,  and  practicing  him  in 
reading  wdthout  moving  his  head  to  one 
side  or  the  other  of  the  printed  page.  Em- 
ploy, also,  general  tonic  treatment,  e.g., 
adequate  rest  and  exercise,  fresh  air  day 
and  night,  a daily  morning  tepid  bath  in  a 
comfortable  room,  before  breakfast,  followed 
by  a cool  spinal  douche  and  brisk  rubdown 
with  a coarse  towel,  regular  hours  of  eating 
and  sleeping,  nutritious  food,  abstention 
from  alcohol,  tea,  coffee,  and  tobacco,  rest 
before  and  after  meals,  regulation  of  the 
bowels,  and  perhaps  a tonic,  such  as  the 
elixir  ferri,  quininse,  et  strj'chninse  phosphati ; 
(Part  11);  and  correct  any  associated  dis- 
order, particularly  intranasal  disease  (see 
Part  8 on  Nose  Diseases). 

If  the  above  measures  are  insufficient, 
operate.  In  convergent  squint,  advance  the 
external  rectus,  with,  if  required,  tenotomy 
of  the  internal  rectus.  In  divergent  squint, 
advance  the  internal  rectus  and  tenotomize 
the  external  rectus,  ^’el’tical  squint  is  rare; 
tenotomy  of  the  superior  or  inferior  rectus 
is  usuall}^  demanded. 

B.  Heterophoria. — Have  the  patient 
fixate  with  both  eyes  an  object  30  cm.  dis- 
tant, then  cover  one  eye  with  a screen.  If, 
on  removing  the  screen,  the  covered  eye 
moves  in  order  to  fixate  the  object  again,  it 
indicates  a latent  muscular  insufficiency. 


MYDRIASIS,  DILATATION  OF  THE  PUPIL 


Heterophoria  (less  often  actual  squint) 
may  cause  marked  asthenopia,  intermittent 
blurring  of  vision  which  may  be  attended 
by  chplopia,  eccentric  attitudes  of  the  head, 
even  torticollis,  “ great  discomfort  when 
attempting  to  watch  moving  objects,” 
“ inabihty  to  gaze  attentively  at  stationary 
objects,”  etc.  (see  Asthenopia).  These 
symptoms  are  reheved  at  once  by  closing 
one  eye. 

Etiology. — Muscular  weakness  or  paresis, 
either  congenital  or  due  to  anaemia,  nervous 
debihty,  pelvic  disortlers,  intranasal  disease, 
malaria,  rheumatism,  refractive  errors,  faulty 
attachment  of  the  muscle,  excessive  action  of 
the  opposing  muscles,  insufficient  innerva- 
tion, etc.;  muscular  spasm  {q.v.). 

Treatment. — Enjoin  the  observance  of  cor- 
rect hygiene  in  order  to  improve  the  nervous 
and  muscular  tone — adequate  rest  and  exer- 
cise, fresh  air  day  and  night,  a daily  morn- 
ing tepid  bath  in  a warm  room  before  break- 
fast, followed  by  a cool  or  cold  spinal  douche 
and  brisk  rubdown  with  a coarse  towel, 
regular  hours  of  eating  and  sleeping,  simple, 
wholesome  diet,  abstention  from  alcohol, 
tea,  coffee,  and  tobacco,  rest  before  and 
after  meals,  regulation  of  the  bowels,  and  if 
indicated,  iron,  arsenic;,  calciiun,  glycerophos- 
phates, or  hypophosphites,  cociliver  oil,  and 
strychnine  (see  Drugs,  Part  11).  Strychnine 
or  nux  vomica  is  given  in  ascending  doses. 
Any  associated  disorder,  particularly  nasal 
disease,  should  of  course  be  attended  to.  In 
spasmodic  heterophoria,  says  De  Schweinitz, 
“large  doses  of  tincture  of  hyoscyamus  are  of 
distinct  advantage”  (see  Muscular  Spasm.) 

In  latent  cUvergence,  treat  the  condition 
only  when  causing  asthenopia  or  when 
strabismus  is  threatened.  In  slight  cases, 
employ  prisms  for  both  eyes,  with  the  bases 
inward,  to  assist  defective  convergence; 
with,  if  required  for  myopia,  concave  glasses. 
In  markecl  cases,  advance  the  internal  rec- 
tus, with,  if  required,  tenotomy  of  the 
external  rectus. 

SPASM 

The  absolute  excursion  of  the  faster  moving  eye  in 
the  given  direction  is  greater  than  normal;  that 
of  the  other  eye  is  normal. 

The  total  excursion  of  the  faster  moving  eye  in  the 
given  direction  and  in  the  direction  opposite  is 
greater  than  normal — i.e.,  the  field  of  foation  is 
excessively  large  in  one  of  its  diameters. 

Fixation  is  usually  performed  by  the  slower  moving 
eye. 

The  amount  of  deviation  may  show  great  and 
sudden  changes  from  time  to  time. 

If  false  projection  is  present,  it  occurs  when  the 
faster  moving  eye  is  used  for  fixation  (the  other 
being  closed),  and  the  patient  undershoots  the 
mark  he  is  trying  to  touch. 


In  latent  convergence,  treat  the  condition 
only  when  strabismus  is  threatened.  Em- 
ploy convex  glas.ses  for  hypermetropia. 

Hyperphoria  is  rare.  Employ  prisms.  Oper- 
ation is  required  only  rarely  in  severe  cases. 

H.  Muscular  Spasm.- — Muscular  spasm 
is  characterized  by  excessive  movement  of 
the  affected  muscle  and  false  projection  or 
orientation  of  objects,  with  perhaps  diplopia, 
vertigo,  etc.  It  is  a cause  of  latent  or  mani- 
fest strabismus.  Fuchs  shows  its  differentia- 
tion from  paralysis  in  the  table  below. 

Etiology. — Excessively  strong  and  over- 
developed muscle ; over-close  insertion  to  the 
cornea;  excessive  innervation,  as  m menin- 
gitis or  other  irritative  affection  of  the  brain, 
hysteria,  tetanus,  increased  labjTinthine 
pressure,  reflex  irritation  from  dental  caries, 
intranasal  di.sease,  etc.;  overaction  of  the 
associate  to  the  paralyzed  muscle  in  the 
sound  eye  when  the  paretic  eye  fixes;  over- 
action of  a synergic  muscle  in  the  same  eye 
with  the  paralyzed  muscle;  irregular  con- 
traction of  the  opponents  of  the  paralyzed 
muscle;  contracture  of  the  opponent  of 
the  paralyzed  muscle. 

In  conjugate  spasm,  due  to  lesions  involv- 
ing the  centres  for  the  associated  movements 
of  the  eyes,  although  the  eyes  are  strongly 
deviatecl  in  one  chrection,  they  can  be  moved 
in  the  opposite  clffection,  thus  chstinguishing 
the  conffition  from  conjugate  paralysis. 
Muscular  Imbalance. — L.  in,  not,  bilanx, 
balance.  See  Muscular  Anomalies. 

Insufficiency,  Latent. — L.  in,  not,  -|- 
siifficiens,  sufficient;  Miens,  hidden. 
See  Muscular  Anomahes. 

Insufficiency,  Manifest.^ — See  Muscu- 
lar Anomalies. 

Paralysis  or  Paresis.^ — Gr.  napa.  beside 
-f-  \veLv  to  loosen;  Tapeais  relaxation. 
See  Muscular  Anomalies. 

Spasm, — Gr.  (nraffpos.  See  Muscular 
Anomalies. 

Mydriasis,  Dilatation  of  the  Pupi'. — Gr. 

pvdpiaaLs.  Causes. — Paralysis  of  the  third  or 

PARALYSIS 

The  absolute  excursion  of  the  faster  moving  eye  is 
normal  in  the  given  direction ; that  of  the  other 
eye  is  subnormal. 

The  total  excursion  of  the  faster  moving  eye  is 
normal,  that  of  the  other  eye  is  subnormal — i.e., 
the  field  of  fixation  of  the  latter  is  contracted  in 
one  of  its  diameters. 

Fixation  usually  performed  by  the  faster  mov- 
ing eye. 

The  amount  of  deviation  remains  constant  or 
changes  slowly  and  progressively. 

False  projection  occurs  when  the  slower  moving 
eye  is  used  for  fixation,  and  the  patient  overshoots 
the  mark  he  is  trying  to  touch. 


NYSTAGMUS 


oculomotor  (autonymic  or  para-sympathetic) 
nerve,  which  innervates,  among  other  mus- 
cles, the  sphincter  iricUs  (see  under  Muscular 
Anomalies,  for  causes  of  oculomotor 
paralysis) ; paralysis  of  the  terminal  end 
of  the  oculomotor  nerve  in  the  sphincter 
iridis,  due  to  the  mydriatic  drugs:  atropine, 
homatropine,  methyl-atropine,  euphthal- 
mine,  eumydrin,  ephedrine,mydrol,atroscine, 
scopolamine  or  hyoscine,  hyoscyamine,  dex- 
trohyoscyamine,  duboisine;  paralysis  of  the 
oculomotor  centre,  due  to  meat,  fish,  mussel, 
cheese,  or  sausage  poisoning;  retinal  or 
optic  nerve  paresis  or  paralysis;  glaucoma; 
amblyopia  or  amaurosis;  neurasthenia  or 
depressed  nervous  tone;  low  mental  devel- 
opment; anaemia;  stimulation  of  the  (sym- 
pathetic) dUator  irichs,  due  to  brain, 
meningeal,  and  spinal  irritation,  emotion, 
fright,  vomiting,  forced  respiration,  syncope 
or  coma,  many  fevers,  irritation  of  the  cervical 
sympathetic  due  to  scratching  the  skin 
of  the  neck,  apical  tuberculosis,  aortic 
insufficiency,  etc.,  and  stimulation  of  the 
sympathetic  nerve-endings  by  epinephrine 
and  cocaine;  adhesion  of  the  iris  to  the 
lens  capsule. 

Myopia. — Gr.  fxvHv  to  shut  + eye-  See 
Refractive  Anomalies. 

Myosis;  Contraction  of  the  Pupil. — ^Gr. 
/uetoxrts,  pieioiv  less.  Causes.— Local  or  reflex 
irritation  of  the  sphincter  iridis,  due  to 
iritis,  injury  of  the  iris,  uveitis,  keratitis,  or 
a foreign  body  in  the  eye ; stimulation  of  the 
oculomotor  (autonymic  or  para-sympathetic) 
nerve  endings  in  the  sphincter  iridis  caused 
by  pilocarpine;  augmentation  of  the  excita- 
bility of  the  oculomotor  (autonymic)  nerve 
enchngs  in  the  sphincter  irichs,  caused  by 
phy.sostigmine ; opium;  chloral;  nicotine; 
brain,  meningeal  and  high  spinal  lesions 
(tabes,  general  paresis,  etc.),  causing  paraly- 
sis of  the  sympathetic  dilator  nerves ; paraly- 
sis of  the  cervical  sympathetic  due  to  aort^ic 
aneurysm ; paralysis  of  the  fifth  or  trigeminal 
nerve;  certain  fevers  and  toxaemias;  mitral 
disease;  plethora;  venous  obstruction;  long 
sustained  efforts  of  accommodation;  hys- 
teria; onset  of  an  epileptic  attack;  old  age. 

Myxoma  Conjunctivae. — Gr.  iiv^os  mucus 
+ -co/ca  tumor.  Sec  Conjunctival  Tumors. 

Nasal  Duct,  Stricture  of  the. — L.  nasa'lis; 
duc'tus,  from  chi' cere,  to  lead;  sirictu'ra.  See 
Dacryocystitis. 

Near=Sightedness. — See  Myopia,  under 
Refractive  Anomalies. 

Neuritis,  Optic. — See  Optic  Neuritis. 

Neuroparalytic  Keratitis. — -Gr.  vevpov 
nerve;  irapa  beside  + \vtiv  to  loosen.  See 
Keratitis  Neuropathica. 


Neuropathic  Keratitis. — See  Keratitis 

Neuropathica. 

Night=Blindness. — See  Nyctalopia,  below. 

Nyctalopia;  Night=Blindness.  — Gr.  vv^ 

night  + dXaos  bhnd  + a>\{/  eye.  Imperfection 
of  vision  when  the  illumination  is  diminished. 

Etiology.—"  Torpor  retinte  ” due  to  mal- 
nutrition (insufficient  or  improper  food, 
scurvy,  pregnancy,  chronic  alcoholism,  ma- 
laria, jauncUce);  keratomalacia;  atrophy  of 
the  retina  following  retinitis,  choroiditis, 
glaucoma,  etc. ; retinitis  pigmentosa;  "periph- 
eral opacities  of  the  cornea  and  lens”; 
" diffuse  opacities  distributed  uniformly 
over  the  entire  cornea,”  causing  dazzling 
when  the  pupil  is  dilated;  errors  of  refrac- 
tion; heredity;  congenital  anomaly;  hysteria; 
sun-blinding. 

Night  blindness  due  to  torpor  retinse  is 
usually  associated  with  xerosis  of  the  bulbar 
conjunctiva.  It  usually  disappears  spon- 
taneously in  a few  weeks  or  months,  but 
tends  to  recur  in  the  spring  or  summer. 

Nyctalopia  is  sometimes  a family  disease. 

Treatment. — Attend  to  the  cause.  In  tor- 
por retinal,  prescribe  a generous  diet,  cod- 
liver  oil,  a tonic  containing  strychnine  (see 
Part  11),  fresh  air,  etc.,  and  protect  the  eyes 
with  dark  glasses,  or  in  severe  cases,  keep 
the  patient  in  a dark  room  for  .several  days. 

Nystagmus. — Gr.  wara^uv  to  nod.  An 
involuntary,  rhythmical  oscillation  of  the 
eyeball,  horizontal,  vertical,  rotary,  or 
mixed,  usually  bilateral. 

Nystagmus  is  either  ocular  or  vestibular. 

In  ocular  ny.stagmus,  the  to-and-fro 
movements  are  equally  rapid,  whereas  in 
vestibular  nystagmus,  there  is  a quick  com- 
ponent in  one  direction  and  a slow  com- 
ponent in  the  opposite  direction.  Ocular 
nystagmus  is  never  rotary. 

The  quick  component  in  vestibular  nys- 
tagmus is  toward  the  affected  ear  as  long  as 
a labjTinth  is  functioning.  As  soon  as  com- 
plete destruction  of  the  lab\Tinth  occurs, 
the  quick  component  swings  to  the  other 
side,  where  it  remains  for  three  or  four  days, 
after  which  it  gradually  disappears,  unless 
some  complication,  such  as  meningitis, 
occurs,  when  it  will  again  move  toward  the 
affected  side.  (Ballenger.) 

A pseudo-nystagmus  may  occur  when 
both  eyes  are  turned  far  in  one  direction. 

Causes  of  Nystagmus. — Bilateral  amblyopia, 
either  congenital  or  acquired,  usually  in 
early  childhood  (gonorrhoeal  ophthalmia 
neonatorum  producing  corneal  opacities  or 
anterior  polar  cataract,  congenital  opacities, 
marked  refractive  errors,  albinism,  retinitis 
pigmentosa,  disease  of  the  retina,  optic 


OPACITIES  IN  THE  VITROUS 


nerve  or  choroid,  color  blindness  with  small 
central  scotomas) ; central  nervous  affec- 
tions— -disseminated  sclerosis,  syringomyelia, 
herecUtary  ataxia,  chronic  hydrocephalus, 
cerebral  concussion,  hemorrhage,  degenera- 
tion, inflammation,  or  tumor  of  the  men- 
inges, cord,  or  brain,  especially  the  cere- 
bellum; hysteria;  heredity;  poisoning  with 
ether,  alcohol,  cocaine,  sulphonal,  arsenic, 
lead,  quinine,  ergot,  sewer-gas;  “ constant 
strain  of  the  eyesight  due  to  poor  illumina- 
tion or  muscular  strain  or  both,”  occurring 
in  adult  life,  in  miners,  compositors,  paper- 
makers,  metal  rollers,  etc.,  and  also  in  high 
astigmatism  and  traumatic  cataract;  rickets; 
ocular  traumatism,  tenotomy,  etc.,  produc- 
ing a transient  ny.stagmus;  labyrinthine 
(semicircular  canal)  disease  or  irritation, 
occurring  in  auditory  neuritis,  labyrinthitis, 
otitis  media,  intracranial,  especially  cere- 
bellar disease  (abscess,  tumor,  meningitis, 
hemorrhage,  etc.),  neurasthenia,  sea-sick- 
ness, alcohol,  tobacco,  or  intestinal  intoxica- 
tion, probing,  application  of  the  galvanic 
current,  rapid  rotation  of  the  body,  or 
syringing  of  the  ear.  (I  do  not  possess 
sufficient  data  to  be  able  accurately  to 
separate  the  above  causes  into  ocular  and 
vestibular.) 

Turning  about  ten  times  in  twenty  sec- 
onds, causes  normally  a primary  nystagmus 
in  the  direction  of  the  turning,  and  a second- 
ary nystagmus  after  the  turning,  in  the 
opposite  direction.  If  the  labyrinth  of  the 
ear  toward  which  the  turning  is  done,  is 
affected,  two  turnings  alone  will  produce 
nystagmus.  (Ballenger.) 

The  introduction  of  cold  or  hot  water  in 
the  external  auditory  canal,  with  the  head 
upright,  causes  a nystagmus  toward  the 
other  ear  if  cold  is  used,  toward  the  same 
ear  if  hot  is  used.  The  nystagmus  does  not 
occur  if  the  vestibular  apparatus  or  nerve  is 
destroyed  or  paralyzed.  (Ballenger.) 

Treatment.— Attend  to  the  cause.  Operate 
upon  a cataractous  lens,  make  a careful  cor- 
rection of  refractive  errors,  correct  strabis- 
mus, perform  iridectomy  for  a new  pupil, 
if  need  be,  etc.  Treatment  in  infantile 
nystagmus,  however,  is  usually  of  little 
avail.  Occupational  nystagmus  is  relieved 
by  a change  of  occupation. 

Oblique  Illumination. — See  the  Ocular 
Examination  in  the  Appendix,  fol- 
lowing Part  6. 

Muscles,  Paralysis  of  the. — See  Mus- 
cular Anomalies. 

Obstruction  of  the  Canaliculi. — L.  ob- 

strua'io;  canaliculus,  little  canal. 
See  Epiphora. 


Obstruction  of  the  Nasal  Duct. — L. 

nasa'lis;  duct' us,  from  ducere,  to  lead. 
See  Dacryocystitis. 

Puncta  Lachrymalia. — L.  pufictum, 
point;  lacrima,  tear.  See  Epiphora. 

Occlusio  Pupillae. — L.  See  under  Iritis. 

Ocular  Examination. — See  the  Appen- 
chx,  following  Part  6. 

Ocular  Muscles,  Abnormal  Balance  of 
the. — L. oculus,eye;  musculus,  muscle; 
bi'lanx,  balance;  ah,  from  + norm' a, 
rule.  See  Muscular  Anomalies. 

Latent  Insufficiency  of  the. — L.  in, 
not  + sufficiens,  sufficient;  lat'ens, 
hidden.  See  Muscular  Anomalies. 
Manifest  Insufficiency  of  the. — See 
Muscular  Anomalies. 

Paralysis  of  the.— See  Accommodation 
Anomalies  and  Muscular  Anomalies. 
Spasm  of  the. — See  Accoimnodation 
Anomalies  and  Muscular  Anomalies. 

Tension. — See  the  Ocular  Examination 
in  the  Appendix,  following  Part  6. 

Oculomotor  Paralysis. — L.  oculus,  eye; 
motor,  moving;  Gr.  irapa  beside  fl-  \veiv  to 
loosen.  See  Muscular  Anomalies. 

(Edema  of  the  Lids. — Gr.  oiSripa  swelling. 

Causes.— Local  or  nearby  infection;  erysipe- 
las; trichiniasis;  measles;  whooping-cough; 
anaemia;  nephritis;  arsenical  poisoning;  angi- 
oneurotic oedema;  a debauch;  orbital  cellu- 
litis; orbital  periostitis  and  osteitis;  panoph- 
thalmitis purulenta. 

Old  Sightedness;  Presbyopia. — Gr.  wpea^vs 
old  -f-  eye.  See  Accommodation  Anomalies. 

Opacities  of  the  Cornea. — L.  opacitas 
See  Cornea,  Opacities  of  the. 

Lens. — L.  lens,  lentil.  See  Cataract. 

Opacities  in  the  Vitrous. — L.  vit'reus, 
glassy.  Opacities  in  the  vitreus  are  mani- 
fested by  diminution  of  the  visual  acuity 
and  the  presence  of  floating  specks,  which 
are  observed  subjectively  and  with  the 
ophthalmoscope  (direct  the  patient  to  move 
the  eye  quickly  in  all  directions  and  then 
hold  it  still,  when  the  opacities  may  be  seen 
to  move  in  the  vitreous). 

“ Muscse  volitantes  ” are  not  ordinarily 
due  to  opacities,  but  suggest  “ accommoda- 
tive or  muscular  strain.”  (Theobald.) 

Etiology  — The  presence  of  unabsorbed  exu- 
date following  uveitis  or  retinitis,  or  of 
unabsorbed  hemorrhage  into  the  vitreous. 

Prognosis.— Only  recent  opacities  which  are 
not  too  large  may  be  absorbed. 

Treatment.— Measures  to  promote  absorp- 
tion are  employed,  viz.,  (1)  energetic  dia- 
phoresis, practiced  every  day  or  every  other 
day,  by  means  of  sodium  salicylate  or  aspirin, 
gr.  XX,  dissolved  in  hot  linden  flower  or  elder 


OPTIC  NEURITIS 


tea  or  lemonade,  with  the  patient  well 
wrappetl  in  blankets;  or  by  means  of  pilo- 
carpine, gr.  }/g  to  every  other  night;  or  a 
hot  bath  followed  by  woolen  blankets;  or 
hot  bricks  covered  with  wet  cloths  sj^rinkled 
with  alcohol;  (2)  mercury,  by  mouth  or  in- 
unction, and  potassium  iodide  (see  Drug's, 
Part  11);  (3)  saline  purgatives;  (4)  subcon- 
junctival injections  of  salt  solution,  5 to  10 
per  cent.,  one-half  to  one  syringeful;  or  of 
cyanide  of  mercury,  1 ; 4000  10  to  20  min- 
ims; and  (5)  galvanism. 

Pilocarpine  in  doses  even  too  small 
to  produce  sweating  (gr.  to  Jfo  oi’  l^ss) 
is  recommended. 

Ophthalmia  Neonatorum. — See  Part  4, 
Obstetrics. 

Sympathetic. — See  Sympathetic  Oph- 
thalmia. 

Ophthalmoplegia  Externa. — Gr.  64>6a\iJL6s 
eye  -f  ■n-'Kriyri  stroke;  L.  exter'nus,  out- 
side. See  Muscular  Anomalies. 

Interna. — L.  inter  hus,  inside.  See 
Accommodation  Anomalies. 

Ophthalmoplegic  Migraine.— See  under 
Muscular  Anomalies. 

Optic  Atrophy. — L.  op'ticus,  visional;  L. 
from  Gr.  a neg.  -|-  Tpo<j>rj  nourishment : wast- 
ing. Optic  nerve  atrophy  is  usually  bilateral. 
It  is  manifested,  clinically,  by  impairment  of 
vision  and  tUlatation  and  sluggishness  of  the 
pupil  (except  in  certain,  spinal  conditions 
in  which  the  pupil  may  be  contracted : 
spinal  myosis).  The  cause  is  not 
always  ascertainable. 

There  are  two  types  of  optic  atrophy: 

I.  Primary,  Simple,  Non=Inflammatory. — The 
papilla  becomes  progressively  paler,  and 
eventually  white  or  bluish-white,  and  sharply 
defined,  with  the  lamina  cribrosa  plainly 
visible  as  gray  dots. 

Etiology. — Tabes  dorsalis  (the  common- 
est cause;  prognosis  bad);  dementia  para- 
lytica; multiple  sclerosis  (prognosis 
relatively  good);  Friedreich’s  ataxia;  chronic 
myelitis;  paralysis  agitans;  spastic  spinal 
paraly.sis;  bulbar  paralysis;  compression  of 
the  nerve  liy  tumor,  dilated  sclerosed  arter- 
ies, periosteal  thickening,  fracture,  etc.; 
amaurotic  family  itliocy;  skull  deformities; 
heredity;  arteriosclerosis;  syphilis;  venereal 
excesses;  methyl  or  wood  alcohol;  lead; 
chronic  malaria;  diabetes;  excessive  hemor- 
rhage; menstrual  disturbances;  imperfect 
nutrition ; cold. 

Treatment. — This  is  causal.  Strychnine 
in  increasing  doses,  nitroglycerin  (see  Part 
11),  local  galvanism,  and  the  high-fre- 
quency current  are  employed,  but  usually 
with  but  little  avail. 


II.  Secondary,  Inflammatory. — The  papilla  is 
white,  but  the  margins  are  ill-defined,  and 
the  lamina  cribrosa  not  visible. 

Etiology. — Optic  neuritis;  retinitis  (in- 
cluding embolism  or  thrombosis  of  the  cen< 
tral  artery  or  vein);  compression  of  the 
optic  nerve,  chiasma,  optic  tract,  thalamus, 
lateral  geniculate  body,  anterior  quadri- 
geminal body,  posterior  part  of  the  internal 
capsule,  optic  rachation,  or  cuneus  of  the 
occipital  lobe,  due  to  bulging  of  the  lateral 
ventricles,  tumors,  exostoses,  aneurysm, 
meningitis,  traumatism. 

Treatment.^ — This  is  causal.  To  pro- 
mote the  absorption  of  exudates,  employ 
the  measures  described  in  the  treatment  of 
optic  neuritis.  Strychnine  in  ascending  closes, 
nitroglycerin,  local  galvanism,  and  the  high- 
freciuency  current  are  also  indicated. 

The  Prognosis  is  somewhat  better  than 
in  the  primary  type. 

Optic  Centres.-^ee  Optic  Chiasma,  Tract, 
and  Centres,  below. 

Chiasma,  Tract,  and  Centres. — L.  chi- 
as’ma;  Gr.xiac/ua  crossing;  L.  trac'tus, 
tract;  L.  cen'trum;  Gr.  Kkvrpov.  See 
Brain  Localization,  in  Part  1. 

Optic  Neuritis. — Gr.  vevpov  nerve  -f  -it is 
inflammation.  Two  forms  of  optic  neuritis 
are  distinguished,  an  intraocular  form  (papil- 
litis or  choked  disc)  and  a retrobulbar  form. 
The  disease  is  manifested  by  impairment  of 
vision  (not  always  present,  however,  in 
choked  disc),  some  dilatation  and  sluggish- 
ness of  the  pupil,  and  characteristic  opthal- 
moscopic  changes  in  the  intraocular  form, 
but  few  or  none  in  the  retrobulbar  fonn. 
The  opthalmoscopic  changes  are  a deepening 
of  color  of  the  optic  disc,  due  to  congestion, 
a gradual  loss  of  outline  or  blurring  and 
marginal  striation,  narrow  arteries  and  dis- 
tended, tortuous  veins.  Papillitis  may  be 
simulated  by  simple  hyperiemia  of  the  disc 
(increased  redness,  hazy  outlines,  dilatation 
and  tortuosit}'  of  the  retinal  vessels),  occur- 
ring congenitally  and  as  a result  of  eye- 
strain,  iritlo-cyclitis,  choroiditis  retinitis, 
and  arteriosclerosis. 

Optic  neuritis  maybe  followed  by  atro- 
phy, or  more  or  less  vision  may  be  restored, 
according  to  the  cause  and  severity  of 
the  neuritis. 

Intraocular  neuritis  is  usually  bilateral, 
and  of  serious  prognosis. 

Retrobulbar  neuritis  is  either  acute  or 
chronic,  and  is  generally  of  good  prognosis. 
The  acute  variety  is  usually  unilateral,  fre- 
quently accompanied  by  retrobulbar  tender- 
ness, and  always  by  central  obscuration  of 
vision,  which  progresses  in  from  one  to 


ORBITAL  CELLULITIS 


eight  days  to  more  or  less  complete  blind- 
ness, with  a tendency  to  recovery.  The 
chronic  variety  (toxic  amblyopia)  is  com- 
monly bilateral,  and  is  accompanied  by 
central  obscuration  of  vision  and  central, 
egg-shaped,  syimnetrical  color  scotomas, 
especially  for  red  and  green.  If  taken  in 
time,  the  prognosis  is  also  usually  good. 

I.  Intraocular  Neuritis,  Papillitis,  or  Choked  Disc. 
— Etiology.  — Intracranial  new  growths; 
acromegaly;  syphilis;  meningitis,  acute  and 
chronic,  especially,  in  children,  tuberculous 
meningitis;  abscess  of  the  brain;  sinus  throm- 
bosis; hydrocephalus;  hemorrhagic  pachy- 
meningitis; cerebritis;  head  injuries;  cerebral 
hemorrhage,  embolism,  thrombosis,  oedema, 
or  aneurysm;  skull  deformities;  rarely  acute 
myelitis,  general  paresis,  epilepsy,  dissem- 
inated sclerosis,  or  tetany;  orbital  inflamma- 
tion or  new  growth;  sinusitis;  dental  caries; 
acute  infectious  fevers;  toxic  agents  (lead, 
atoxyl,Felix’smass,alcohol,iodoform) ; nephri- 
tis; diabetes  ; gout;  menstrual  disorders;  preg- 
nancy; lactation;  anaemia,  especially  that  due 
to  severe  hemorrhage ; myxoedema ; sunstroke ; 
exposure  to  cold;  lightning  stroke;  violent 
exertion  and  injuries;  congenital;  heredity. 

Treatment. — ^This  is,  of  course,  causal 
(consult  the  appropriate  part  and  caption). 
In  choked  disc  due  to  brain  lesions  (includ- 
ing meningitis  serosa,  cerebral  oedema,  infec- 
tions, intracranial  hemorrhage,  new-growths, 
etc.),  cerebral  decompression  should  be  done 
early  in  order  to  save  the  sight. 

To  promote  local  absorption,  the  following 
measures  are  employed,  sometimes  with 
benefit,  e.cj.,  rest  of  the  eyes,  purgation,  mer- 
cury and  potassium  iodide  (see  Part  11)  in 
large  doses,  leeches  or  the  artificial  Heurte- 
loup  leech  to  the  mastoid  process,  and  dia- 
phoresis practiced  every  day  or  every  other 
day  by  means  of  the  Turkish  bath  followed 
by  woolen  blankets,  or  the  hotair  bath, 
using  a lamp  and  two  chairs  covered  with 
rubber  sheeting,  or  hot  bricks  surrounchng 
the  patient  beneath  blankets,  the  bricks 
being  covered  with  wet  cloths  sprinkled  with 
alcohol,  or  sodium  salicylate  or  aspirin,  gr. 
XX,  dissolved  in  hot  peppermint  tea  or 
lemonade,  with  the  patient  well  wrapped  in 
blankets,  or  the  use  of  pilocarpine,  gr.  to 
34;  eveiy  other  night. 

Harry  Gifford  prescribes  sodium  salicy- 
late, gr.  XV,  well  diluted  in  water  and 
brandy,  eight  to  twelve  times  a day  for  about 
a week.  Then,  if  no  decided  sweating  is 
produced,  he  changes  to  large  doses  of 
potassium  iodide,  together  with  pilocarpine, 
gr.  34  to  34  (very  large  doses;  pilo- 
carpine is  a dangerous  heart  depressant),  in 


a glassful  of  hot  whiskey  and  water,  adding 
15  grains  of  sodium  salicylate  if  the  pilo- 
carpine does  not  produce  free  diaphoresis. 

11.  Retrobulbar  Neuritis. — (a)  AcUTE  RETRO- 
BULBAR Neuritis. — E tiology. — Syphilis; 
rheumatism;  gout;  diabetes;  acute  infectious 
diseases;  sudden  suppression  of  the  men- 
strual flow;  exposure  to  wet  and  cold; 
rhinitis;  sinusitis;  orbital  cellulitis,  periostitis, 
syphilis,  etc. ; overwork;  prolonged  eye-strain; 
multiple  sclerosis;  myelitis;  alcohol;  tobacco; 
lead;  methyl  or  wood  alcohol ; heredity. 

Treatment. — This  is  causal.  To  promote 
absorption,  employ  the  measures  described 
under  Intraocular  Neuritis,  and  prescribe 
strychnine  in  ascending  doses,  beginning 
with  gr.  34o,  t.i.d.p.c.,  and  increasing 
gradually  to  five  or  six  times  this  amount 
(see  Part  11  for  toxic  effects). 

(b)  Chronic  Retrobulbar  Neuritis; 
Toxic  Amblyopia. — Etiology. — Alcohol  and 
tobacco  (the  conmionest  causes) ; nitro- 
benzol;  carbon  disulphide  (“employed  in  vul- 
canizing rubber”);  arsenic;  lead;  iodoform; 
stramonium;  cannabis  inchca;  chloral; opium; 
atoxyl;  diabetes;  rheumatism,  gout;  expos- 
ure to  wet  and  cold,  etc.  (There  is  a special 
form  of  retrobulbar  neuritis,  a family 
disease  coimnonly  known  as  hereditary 
nerve  atrophy.) 

Treat?nent. — Withdraw  the  poison,  or 
remove,  if  possible,  the  source  of  intoxica- 
tion, administer  water  in  copious  amoimts, 
and  employ  the  measures  for  promoting 
absorption  described  under  Intraocular  Neu- 
ritis. Strychnine  in  ascending  doses  is 
recommended,  beginning  with  gr.  34o> 
t.i.d.p.c.,  and  increasing  gradually  to  five 
or  six  times  this  amount  (see  Part  11,  for 
toxic  effects;  see  also  Toxic  Amblyopia.) 

Optic  Tract. — See  Optic  Chiasma,  Tract, 
and  Centres. 

Orbicularis  Muscle,  Paralysis  of  the. — L. 

orbicular' is,  circular  or  rounded. 

See  Facial  Paralysis,  in  Part  1. 
Spasm  of  the. — See  Blepharospasm. 

Orbital  Abscess. — L.  orh'ita,  track;  ab- 
scessus,  a going  apart.  See  Orbital 
Cellulitis,  below. 

Cellulitis. — L.  ceVlula,  little  cell  -|-  Gr. 
-LTi%  inflammation.  Inflammation  of  the 
orbital  cellular  tissue  may  be  acute,  sub- 
acute, or  chronic.  It  is  manifested,  accord- 
ing to  the  degree  of  intensity  of  the  infection, 
by  local  pain  and  tenderness,  conjunctival 
injection  and  chemosis,  redness  and  oedema 
of  the  lids,  exophthalmos  and  resulting 
diplopia,  pyrexia,  etc. 

Etiology.— Traumatism;  orbital  operations; 
facial  infection  (erysipelas,  etc.);  sinusitis-, 


PANOPHTHALMITIS  PURULENTA 


dental  caries;  orbital  periostitis  and  osteitis 
{q-v.)\  panophthalmitis  {q.v-)',  meningitis; 
pyaemia,  “ cold,”  influenza,  scarlet  fever, 
typhoid  fever,  etc. 

Treatment.— Open  the  bowels  by  means  of 
castor-oil  or  calomel  followed  by  a saline 
(see  Drugs,  Part  11).  To  combat  the 
infection,  Theobald  recommends  the  admin- 
istration of  sodiimi  p}Tophosphate,  or  qui- 
nine, in  full  doses,  or  sodium  salicylate,  or 
fractional  doses  of  calomel.  Apply  hot 
fomentations  for  the  purpose  of  promoting 
the  reaction  of  inflammation,  and  perhaps  six 
to  ten  leeches  or  the  artificial  Heurteloup 
leech  to  the  temjjle.  When  it  is  evident  that 
pus  has  formed,  make  a free  incision  through 
the  lifl  or  conjunctiva,  as  .seems  best,  and  in- 
sert a gauze  drain.  Renew  this  every  day,  or 
less  often,  as  required,  until  healing  occurs. 
Antiseptic  irrigations  (using  hot  boric 
acid  solution,  3 to  4 jier  cent.,  or  bichlor- 
ide, 1 : 8000  to  1 : 4000,  two  or  three  times 
daily,  or  less  often)  are  probably  better 
omitted,  as  a rule.  Experience  favors  simple 
gauze  drainage. 

Orbital  Osteitis. — (See  Orbital  Periostitis 
and  Osteitis,  below.) 

Periostitis  and  Osteitis. — Gr.  irtpl 
around  4-  dareov  bone  -|-  -trts  inflammation. 
The  inflammatory  jjrocess  may  be  acute  or 
chronic.  The  symptoms  resemble  those  of 
orbital  cellulitis  (q.v.).  - A sinus  may  ensue. 

Etiology.— Syphilis;  tuberculosis;  rheuma- 
tism; sinusitis;  traumatism. 

Treatment.— Attend  to  the  cause;  otherwise 
treat  the  infection  locally  and  constitution- 
ally, the  same  as  orbital  cellulitis  (q.v.). 
Dead,  detached  bone  should  be  removed. 
For  the  purpose  of  dissolving  diseased 
bone,  there  is  recommended  syringing  with 
hydrocliloric  acid  solution,  2 to  4 per 
cent.,  cautiously  increased  to  20  to  25  per 
cent.,  if  well  borne,  or  the  direct  application, 
on  a cotton-wound  probe,  of  hydrochloric 
acid  (c.p.)  diluted  with  three  or  four  parts, 
and  later  equal  parts  of  water. 

Orbital  Tumors. — L.  tu'mor,  swelling. 

Benign.— Fibroma,  lipoma,  angioma,  lym- 
phangioma, osteoma,  enchondroma,  lym- 
phoma, gumma,  dermoid  cyst;  hydatid 
cyst,  cysticercus  cyst,  sebaceous  cyst, 
exostosis,  hyperostosis,  cephalocele  and 
meningocele  (fluctuating,  transparent  promi- 
nence on  the  inner  side  of  the  orbit), 
lupus  from  the  face,  aneury^sm,  mucous 
cysts  (which  may  communicate  with  the 
nose),  polypi  from  the  nose  or  accessory 
sinuses,  haematoma,  cyst  of  the  lachrymal 
gland  (either  congenital  or  due  to  occlusion 
of  the  excretory  ducts),  hypertrophy  of  the 


lachrymal  gland  (congenital  or  syphilitic, 
or  Mikulicz’s  disease.  Part  1). 

Malignant.— Carchioma,  sarcoma,  epitheli- 
oma, endothelioma. 

Displacement  of  the  eyeball  is  common  to 
all  orbital  tumors  (see  Exophthalmos). 

Treatment. — Benign  tumors  may  be  excised, 
excepting  deep-seated  cysts,  which  should  be 
opened  and  their  walls  destroyed  with 
tincture  of  iodine  or  silver  nitrate.  If  it  is 
impracticable  to  excise  an  angioma,  it  may 
be  destroyed  by  electrolysis.  In  employing 
electrolysis,  an  anaesthetic  is  usually  re- 
quired. The  needle  is  attached  to  the  nega- 
tive electrode,  and  the  positive  electrode, 
covered  with  a wet  sponge,  is  applied  to  any 
convenient  part  of  the  body.  A current  of 
from  one  to  five  or  more  milliamperes, 
depending  upon  the  size  of  the  growdh,  is 
used.  Parallel  punctures,  to  3^  inch 
apart,  are  made,  down  to  the  base  of  the 
growth,  and  the  current  allowed  to  act  for 
from  one-half  to  two  or  three  minutes,  or 
until  a blanched  line  is  produced  in  its  course. 
The  current  should  be  increased  and  broken 
off  slowly.  The  treatment  is  repeated  every 
one  to  three  weeks. 

In  cyst  of  the  lachrymal  gland,  establish 
an  opening  between  the  cyst  and  the  con- 
junctival sac  by  tying  a silk  thread  tightly 
in  the  wall  of  the  cyst  and  leaving  it  to  cut 
its  way  out. 

In  hypertrophy  of  the  lachrymal  gland, 
if  the  enlargement  is  not  extreme,  one  may 
administer  potassimu  iodide  (see  Part  11) 
internally,  and  apply  unguentum  hydrargjTi 
vel  iodi  locally;  otherwise  the  gland  should 
be  removed. 

Pulsating  exophthalmos  is  sometimes  cured 
by  ligation  of  one  or  both  common  carotids, 
or  the  dilated,  pulsating  orbital  veins. 

Malignant  tumors  demand  radical  extirpa- 
tion, followed  by  radium  or  the  X-ray  (q.v. 
in  Part  1). 

Ordinary  or  Concomitant  Squint. — L. 

cum,  together  -|-  co'mes,  companion.  See 
Muscular  Anomalies. 

Osteitis  and  Periostitis  of  the  Orbital 
Walls. — See  Orbital  Periostitis  and  Osteitis. 

Osteoma,  Orbital. — Gr.  dcTeov  bone  -f 
-wjua  tumor.  See  Orbital  Tumors. 

Overflow  of  Tears,  Abnormal. — See  Epi- 
phora. 

Ox=Eye. — See  Glaucoma. 

Pannus. — L.  cloth.  See  under  Conjuncti- 
vitis Trachomatosa. 

Panophthalmitis  Purulenta. — Gr.  ttSs  all  -|- 
6<t)da\p6s  eye  -ctls  inflammation;  L.  puru- 
lent'us,  purulent.  Suppurative  inflammation 
of  the  eyeball  (suppurative  irido-choroiditis) 


PTERYGIUM 


Ls  manifested  by  the  presence  of  exophthal- 
mos, chemosis  of  the  conjunctiva,  oedema  of 
the  lids,  haziness  of  the  cornea,  a yellow 
reflection  in  the  vitreous  (pseudo-glioma), 
loss  of  vision,  pain,  tenderness,  and 
pyrexia. 

Etiology.— Traumatism;  perforating  corneal 
ulcer;  entrance  of  bacteria  through  a thin 
corneal  cicatrix;  uveitis;  retinitis;  septico- 
pysemia,  or  bacteraemia,  such  as  may  occur  in 
puerperal  infection,  erysipelas,  inflanunation 
of  the  mnbilical  vein,  thrombosis  of  the 
orbital  veins,  dysentery,  bronchitis, 
whooping-cough,  influenza,  thphtheria,  pneu- 
monia, anthrax,  Weil’s  disease  (infectious 
jaundice),  measles,  scarlet  fever,  smallpox, 
cerebro-spinal  meningitis,  basic  meningitis, 
typhoid  fever. 

Treatment. — Open  the  bowels  thoroughly 
by  means  of  castor-oil,  or  calomel  followed 
by  a saline  (see  Dings,  Part  11).  For  the 
purpose  of  combating  the  infection,  one  may 
administer  sodium  pyrophosphate  (Theo- 
bald), or  quinine  in  full  doses,  or  sodium 
salicylate,  or  fractional  doses  of  calomel. 
Apply  hot  fomentations  for  the  purpose  of 
promoting  the  reaction  of  inflammation,  and 
perhaps  six  to  ten  leeches  or  the  artificial 
Heurteloup  leech  to  the  temple.  Morphine 
may  be  required  for  the  pain.  Give  subcon- 
junctival injections  of  cyanide  of  mercury, 
I : 4000,  10  to  20  niinims. 

Remove  the  eye  (see  Enucleation)  as  soon 
as  it  “is  evident  that  there  is  no  hope  of  pre- 
serving sight”  (Theobald) . In  fully  developed 
cases  of  suppuration,  however,  it  is  safer,  in 
order  to  avoid  the  risk  of  secondary  menin- 
gitis, to  evacuate  the  pus  by  a free  incision 
of  the  sclera  (Fuchs),  and  enucleate  the  eye 
later,  after  the  infection  has  been  destroyed, 
or  should  the  shrunken  eye  become  inflamed, 
which  is  exceptional.  Meningitis  is  much  less 
likely  to  follow  evisceration  than  enucleation. 

Papillitis. — L.  papil'la,  nipple  Gr.  -ltis 
inflammation.  See  Optic  Neuritis. 

Papilloma  Conjunctivae. — L.  papiVla,  nip- 
ple -f  Gr.  -oiixa  tumor.  See  Conjunctival 
Tumors. 

Paralysis,  Abducens. — Gr.  -wapa  beside  -f 
\viLv  to  loosen;  L.  ah,  from  du'cere, 
to  draw.  See  Muscular  Anomalias. 

Accommodation. — See  Accommodation 
Anomalies. 

Ciliary  Muscle. — L.  cil'ium,  hair  or 
lash;  mus'auliis,  muscle.  See  Accom- 
modation Anomalies. 

Facial. — See  Facial  Paralysis,  in  Part  1. 

Fourth  Nerve. — See  Muscular  Anomalies. 

Oculomotor. — L.  oc'ulus,  eye  -f-  mo'ior, 
mover.  See  Muscular  Anomalies. 


Paralysis,  Orbicular  Muscle. — L.  orhicu- 
la’ris,  cncular  or  rounded.  See  Facial 
Paralysis,  in  Part  1. 

Sixth  Nerve. — See  Muscular  Anomalies. 

Sphincter  Pupillae. — Gr.  a4>LyKTi]p  bind- 
er; L.  pupil'la,  girl.  See  Accommo- 
dation Anomalies. 

Third  Nerve. — See  Muscular  Anomalies, 

Parenchymatous  Keratitis. — See  Kerati- 
tis Interstitialis. 

Parinaud’s  Conjunctivitis. — See  Conjunc- 
tivitis, Parinaud’s. 

Penetrating  Wounds  of  the  Eyeball. — See 
Injuries  of  the  Eye. 

Periodic  Episcleritis. — See  Episcleritis. 

Periostitis  and  Osteitis  of  the  Orbital 
Walls. — See  Orbital  Periostitis  and  Osteitis. 

Phlyctenular  Keratoconjunctivitis.  — See 
Conjunctivitis  Phlyctenulosa. 

Photophobia. — Gr.  4>w  light  -j-  4>6^os  fear. 
Abnormal  mtolerance  of  light,  occmring  in 
keratitis  and  uveitis. 

Pigmented  Mole  of  the  Conjunctiva. — L. 

pigmmtum,  paint;  mo'les,  fleshy  mass.  See 
Conjunctival  Tumors. 

Pinguecula. — L.  pinguis,  fat.  A yellow- 
ish, colloidal  (Gr.  KoWd^S-gs  glutinous),  ridge- 
like elevation  upon  the  interpalpebral 
conjunctiva,  on  either  side  of  the  cornea,  due 
probably  to  irritation  caused  by  winds, 
dust,  etc. 

If  unsightly,  it  may  be  removed  with 
curved  scissors,  the  adjoining  conjunctiva 
slightly  undermined,  and  its  cut  edges 
united  by  fine  silk  sutures,  which  should  be 
removed  at  the  end  of  three  days.  (Theobald.) 

Pink=Eye  . — See  Conjunctivitis  Catarrhalis. 

Polyopia. — Gr.  ttoXus  many  -j-  d\J/L^  vision. 
See  Diplopia. 

Polypi  Canaliculorum. — Gr.  iroXvs  many  -1- 
TTovs  foot;  L.  canaliculus,  little  canal. 
See  Epiphora. 

Conjunctivae. — S ee  Conjunctival 
Tumors. 

Orbital. — See  Orbital  Tumors. 

Presbyopia;  01d=Sight. — Gr.  irpka^vs  old 
-f  (uyp  eye.  See  Accommodation  Anomalies. 

Prolapse  of  the  Iris. — L.  pro,  before  -f- 
Idbi,  to  fall.  See  Keratitis  Ulcerosa;  and 
Penetrating  Wounds  of  the  Eyeball. 

Protrusion  of  the  Cornea  and  Iris. — See 
Cornea,  Staphyloma  of  the. 

Eyeball  . — See  Exophthalmos. 

Protrusion  of  the  Sclera. — See  Sclera, 
Staphyloma  of  the. 

Pseudo=Qlioma. — Gr.  \pevbgs  false.  See 
Panophthalmitis  Purulenta. 

Pterygium. — Gr.  irTtphyiov  wing.  A med- 
ian, transverse,  wedge-shaped,  slow-growing 
hypertrophy  of  the  conjunctiva,  the  apex  of 


RECTUS  MUSCLES,  PARALYSIS  OF  THE 


tlie  wedge  approaching  or  encroaching  upon 
the  cornea,  and  the  base  extending  toward 
the  inner  cantlms.  It  should  be  distin- 
guished from  a similar  “ pseudo-pterygium  ” 
arising  from  an  ulcer  or  wound  of  the 
corneal  margin. 

Etiology.— Exposure  of  the  eyes  to  heat, 
winds,  dust,  etc.;  probably  also,  according 
to  Theobald,  insufficiency  of  the  internal 
recti  muscles  (exophoria). 

Treatment. — Correct  any  existing  accom- 
modative, muscular,  or  refractive  anomaly. 
Says  Theobald,  excise  the  growth  if  it  is 
“ narrow  and  well  defined,”  or  if  it  is  grow- 
ing, even  though  “ broad  and  ill-defined,” 
or  if  it  is  encroaching  upon  the  cornea.  Mc- 
Reynold’s  operation  is  perhaps  the  best: — 

The  neck  of  the  pterygium  is  grasped  in 
its  entirety  with  strong  but  naiTow  fixation 
forceps,  a Graefe  knife  is  passed  beneath  it, 
as  close  to  the  globe  as  possible,  with  its 
cutting  edge  toward  the  cornea,  and  the 
growth  is  comiiletely  and  smoothly  shaved 
off  from  the  cornea.  With  the  pterygium 
still  held  in  the  grasp  of  the  fixation  forceps, 
the  conjunctiva  is  divided  with  slender 
straight  scissors  down  to  the  scelera  along 
the  lower  oblique  margin  of  the  ptery- 
gium. The  latter  is  now  separated  with  a 
blunt  instrument  from  the  sclera,  and  then 
the  conjunctiva  is  well  .separated  from  the 
underlying  sclera  from  the  oblique  incision 
downward  and  halfway  around  the  inferior 
border  of  the  cornea.  A small  curved 
needle  carrying  a black-silk  thread  is  now 
passed  through  the  ape.x  of  the  pterygium, 
near  its  upper  margin  from  within  outward 
(or  behind  forward)  and  then  back  again 
near  its  lower  margin  from  without  inward, 
and  the  tail  end  of  the  silk  is  then  threaded 
through  another  small  cuiwed  needle.  Both 
needles  are  now  carried  downward  be- 
neath the  loosened  lower  conjunctiva  to  the 
lower  fornix  of  the  eyeball  and  are  pushed 
out  or  fomard  through  the  conjunctiva  at 
a distance  apart  from  each  other  of  about 
bs  t-o  3^4  of  inch.  Then  the  loosened 
conjunctiva  is  lifted  up  with  forceps  and 
traction  exerted  upon  the  needles  so  as 
to  draw  the  pterygium  down  beneath  the 
conjunctiva.  The  threads  are  now  tight- 
ened and  tied.  They  are  removed  after 
union  ha.s  occurred.  No  incision  should 
be  made  along  the  upper  border  of  the 
pterygium. 

F^tosis. — Gr.  tttCxjls  fall.  Drooping  of  the 
ui^fx'r  eyelid. 

Etiology. — C'ongenital,  often  hereditary, 
usually  bilateral  absence  or  imperfect  devel- 
opment of  the  levator  palpebrse  superioris 


muscle ; oculomotor  or  third  nerve  paralysis 
due  to  syphilis,  tabes  dorsalis,  general 
paresis,  disseminated  sclerosis,  basal  hemor- 
rhage, meningitis,  abscess,  thrombosis,  or 
aneurysm,  cerebral  injury  or  hemorrhage, 
cavernous  sinus  (hsease,  bulbar  palsy,  orbital 
periostitis,  orbital  cellulitis,  sinusitis,  frac- 
ture, tmnors,  otitic  disease,  gout,  rheumatism, 
chabetes,  hysteria,  diphtheria,  influenza, 
“ cold,”  tonsillitis,  measles,  whooping- 
cough,  herpes  zoster,  acute  poliomyelitis, 
minnps,  poisoning  with  alcohol,  tobacco, 
lead,  sulphuric  acid,  gelsemiiun,  conium, 
chloral,  carbon  monoxide,  fish,  and  meat 
(sjonptoms  of  oculomotor  paralysis,  besides 
l^tosis,  are  dowmward  and  outward  squint, 
diplopia,  with  or  without  semi-chlatation  of 
the  jjuj)il  and  impairment  of  near  vision); 
myasthenia  gravis;  exophthalmic  goitre; 
nem'asthenia;  migraine;  cervical  sj'mpathetic 
paralytic  lesions  (producing  moderate  ptosis 
of  an  eye,  with  retraction  of  the  eyeball, 
miosis,  and  flushing  of  the  affected  side  of 
the  face);  injury  to  the  lid;  increased  weight 
of  the  licl  due  to  chronic  conjunctivitis,  tar- 
sitis,  hypertrophic  blepharitis,  and  tumors; 
relaxed  condition  of  the  skin  of  the  lid; 
primary  atrophy  of  the  muscle  developing 
without  known  cause  in  middle-aged 
women;  debility  (a  transient  ptosis  occurs 
in  weak,  delicate  women,  particularly  in 
the  morning). 

Syphilis  is  the  commonest  cause  of  ptosis. 
“ The  cases  of  isolated  ptosis  without  any 
other  signs  of  oculomotor  paralysis  are 
caused  mainly  by  central  chsease,”sa3"s  Fuchs. 

Treatment.— This  is  causal.  Blisters  (see 
Part  11)  to  the  forehead  and  temples  may  be 
of  service  in  appropriate  cases.  Galvanism 
and  strychnine  (Part  11)  may  be  of  serrtce 
after  the  acute  symjrtoms  have  subsided. 

For  congenital  ptosis  and  chronic  ptosis 
that  does  not  respond  to  constitutional 
treatment,  operate. 

Puncta  Lachrjmalia,  Stenosis  of  the, — L. 

punctum,  point;  lacrima,  tear;  Gr.  artvoai^ 
narrowing.  See  Epiphora. 

Pupil,  Contraction  of  the.^ — L.  pupil' la 
girl ; con,  together  -f-  trdhere,  to  draw. 
See  Myosis. 

Dilatation  of  the. — See  IMydriasis. 

Occlusion  of  the. — L.  occlusio.  See 
under  Iritis. 

Seclusion  of  the. — L.  seclusio.  See 
under  Iritis. 

Unequal. — See  Anisocoria. 

Purulent  Panophthalmitis, — See  Panoph- 
thalmitis Purulenta. 

Rectus  Muscles,  Paralysis  of  the. — L. 

rectus,  straight.  See  Muscular  Anomalies. 


RETINITIS 


Refraction  Anomalies. — L.  refring'ere,  to 
break  apart;  Gr.  avoonaXLa  abnormality. 
Uncorrected  errors  of  refraction  are  apt  to 
cause  eye-strain  with  its  manifold  train  of 
disturbances  (see  Asthenopia). 

I.  Myopia;  Near-  or  Short=Sightedness  (Gr. 

uveiv  to  shut  -1-  eye). — In  myopia,  parallel 

rays  come  to  a focus  in  front  of  the  retina, 
requiring  for  its  correction  concave  glasses. 
In  adults,  divergent  concomitant  squint 
(see  Muscular  Anomalies)  may  lesult.  In 
children,  convergent  squint  is  a rare  result 
of  high  grade  myopia. 

Causes  of  Myopia. — Increased  corneal 
curvature,  due  to  staphyloma  or  keratoco- 
nus;  increase  curvature  of  the  lens,  due  to 
luxation  or  cUiaiy  spasm;  increased  density 
of  the  lens  in  approaching  senile  cataract; 
posterior  staphyloma,  rarely  congenital,  but 
usually  acquired  in  youth  as  a result  of 
habitual  straining  of  the  eyes  at  near  work 
with  poor  illumination,  aided  by  an  anatomi- 
cal or  hereditary  predisposition  to  myopia 
(the  commonest  cause). 

II.  Hypermetropia;  Far-Sightedness  (Gr.  imep 

over  fitTpov  measure  4-  eye). — In  hyper- 

metropia, parallel  rays  come  to  a focus 
behind  the  retina,  requiring  for  its  correction 
convex  glasses.  In  children,  convergent  con- 
comitant squint  may  result  (see  Muscular 
Anomalies). 

Causes  of  Hypermetropia. — Flattening 
of  the  cornea,  due  to  cicatrization;  dimin- 
ished refractive  power  of  the  lens,  due  to 
advanced  age;  complete  luxation  or  opera- 
tive removal  of  the  lens;  protrusion  of  the 
retina  into  the  vitreous,  due  to  inflamma- 
tory exudation,  hemorrhage,  or  tumors; 
congenital  shortening  of  the  eyeball  (the 
common  cause). 

III.  Astigmatism  (Gr.  a priv.  -{-  aHypa 
point).- — In  astigmatism  the  different  merid- 
ians of  the  refracting  mecha  (ordinarily  the 
cornea)  refract  differently,  owing  to  differ- 
ences in  their  curvature. 

(a)  Regular  Astigmatism,  in  which, 
while  the  curvatures  of  the  different  merid- 
ians differ  one  from  another,  the  curvature 
of  each  meridian  is  regular.  It  is  corrected 
by  cyUndrical  glasses. 

Causes  oj  Regular  Astigmatism. — Congeni- 
tal, perhaps  hereditary,  irregularity  of  the 
corneal  curvature  (almost  always  the  cause) ; 
rarely  keratitis,  or  operations  upon  the 
cornea,  or  subluxation  of  the  lens. 

(b)  Irregular  Astigmatism,  in  which 
the  curvature  of  each  meridian  is  irregular,  so 
that  different  portions  of  the  same  meridian 
have  different  refracting  powers.  Reading 
may  be  aided  by  means  of  stenopoeic  glasses. 


Causes  of  Irregular  Astigmatism — Incipi- 
ent cataract;  subluxation  of  the  lens;  corneal 
ulceration,  flattening,  or  ectasia. 

IV.  Anisometropia  (Gr.  artaos  unequal  -|- 
perpov  measure  4-  w\p  eye). — In  anisome- 
tropia, the  refraction  differs  in  the  two  eyes. 

Retina,  Detachment  of  the. — See  De- 
tachment of  the  Retina. 

Glioma  of  the. — See  Glioma  of  the 
Retina.  _ 

Hemorrhages  in  the. — Gr.  alpa  blood  4- 
prjyvwat.  to  burst  forth.  See  Retini- 
tis, below. 

Retinitis. — L.  ret'ina  4-  Gr.  -ltls  inflamma- 
tion. Retinitis  is  characterized,  clinically, 
by  impaiiTiient  of  vision,  and  enlargement 
and  sluggishness  of  the  pupil,  no  pain;  and 
ophthalmoscopically  by  retinal  opacity  or 
loss  of  transparency,  which  “ may  manifest 
itself  as  a faint,  diffuse  haze,  a circumscribed 
opacity  and  swelling  (exudate),  or  as  streaks 
of  white  infiltration,  especially  along  the 
lines  of  the  larger  vessels  ” (De  Schweinitz). 
Retinal  hemorrhages  are  apt  to  occur.  These 
form  dark  red  patches,  which,  if  the  hemor- 
rhage is  in  the  nerve-fibre  layer,  are  striate 
or  flame-shaped.  (Simple  retinal  hemor- 
rhage is  also  here  included.) 

Nephritic  retinitis  is  characterized  by  the 
presence  of  “ whitish,  degenerative  patches 
arranged  in  stellate  fasliion  about  the 
macula  ” (Wood  and  Woodruff).  Uraemic 
amaurosis,  however,  is  cerebral  in  origin. 

Retinal  arteriosclerosis  is  characterized  by 
increased  tortuousness  of  the  arteries,  cork- 
screw appearance  of  the  arterial  twigs, 
“ silver  wire  ” appearance  of  the  arteries, 
variation  in  calibre,  indention  of  veins  by 
sclerosed  arteries,  congested  appearance 
of  the  optic  disc,  hemorrhages,  oedema, 
and  exudates. 

Embolism  or  thrombosis  of  the  central 
artery  of  the  retina  is  characterized  by  the 
occurrence  of  sudden  blindness,  and  opthal- 
moscopically  by  the  appearance  of  arterial 
anaemia  and  a “ cherry  spot,”  rarely  a 
“ coal-black  ” spot  in  the  macula  lutea. 

Thrombosis  of  the  central  vein  is 
characterized  by  great  (hstention  of  all 
the  retinal  veins,  while  the  arteries  are 
scarcely  visible,  together  with  the  presence  of 
retinal  hemorrhages. 

There  is  an  atrophic  “ retinitis  pig- 
mentosa,” which  occurs  in  childhood,  or  is 
congenital,  and  is  early  made  manifest  by 
night-blindness,  and  is  frequently  associated 
with  nystagmus. 

Etiology.— Syphilis;  nephritis;  diabetes; 

gout;  arteriosclerosis;  plumbism;  phosphorus 
poisoning;  extensive  cutaneous  burns;  leuk- 


SCLEKA,  STAl^lIYLOMA  OF  THE 


aemia;  scurvy;  purpuni;  grave  autemias;  tox- 
seiuia  of  pregnancy;  oxaluria;  jaundice;  sup- 
pressed inensi  uation;  the  cliinactery;  sep- 
sis; typhoid  fever;  relapsing  fever;  malaria 
with  anaemia;  ocular  inflaimnation  (uveitis, 
optic  neuritis,  etc.);  exposure  to  excessive 
light;  exposure  to  cold;  “ prolonged  accom- 
modative strain  ”;  cardiac  disease  (causing 
passive  hypersemia  and  hemorrhage);  trau- 
matic rupture  of  blood  vessels,  as  in  com- 
pression of  the  skull  during  parturition; 
iridectomy  for  glaucoma;  embolism  of  the 
central  retinal  artery,  due  usually  to  valvular 
heart  disease,  also  to  aneurysm,  arterio- 
sclerosis, Bright’s  disease,  pregnancy,  chorea; 
tlirombosis  of  the  central  artery,  tlue  to 
endarteritis,  blood  alterations,  severe  hemor- 
rhage; compression  of  the  central  artery,  due 
to  hemorrhage  or  inflannnatoiy  infiltration 
in  the  optic  nerve;  thrombosis  of  the  central 
vein,  due  to  organic  heart  disease,  artei’io- 
sclerosis,  syphilis,  excessive  hemorrhage, 
orbital  disease,  disease  of  the  cavernous 
sinus,  facial  erysipelas,  blood  alterations; 
atropine  retinitis  i)igmentosa,  due  to  hered- 
ity, parental  consanguinity,  etc. 

Prognosis. — Retinitis  runs  a slow  course, 
usually  extentling  over  several  months,  with 
permanent  impairment  of  vision,  except  in 
light  cases,  in  which  vision  may  be  com- 
pletely restored.  Atrophy  of  the  retina  with 
resulting  blindness  may  follow  severe  or 
recurrent  attacks. 

After  the  appearance  of  nephritic  retinitis, 
the  patient  seldom  lives  longer  than  two  years. 

The  outlook  in  retinitis  pigmentosa  is 
unfavorable,  but  complete  blindness  does 
not  ordinarily  supervene  imtil  the  sixth 
decade  or  later.  (Fuchs.) 

Treatment.— Attend  to  the  cause.  Correct 
any  existing  accommodative,  muscular,  or 
refractive  anomaly.  Have  the  patient  wear 
smoke-tinted  glasses,  and  enjoin  absolute 
rest  of  the  eyes.  Open  the  bowels  by  means 
of  calomel  or  castor-oil  (see  Part  11);  and 
in  early  cases  apply  hot  fomentations  to 
the  closed  lids,  and  perhaps  from  six  to  ten 
leeches  or  the  artificial  Heurteloup  leech  to 
the  temple,  unless  the  patient  is  antemic. 
Instil  atropuie,  gr.  ii-iv  to  the  ounce,  one  or 
two  tlrops,  once  or  twice  a day,  or  often 
enough  to  keep  the  j^upil  dilated. 

To  promote  absorption  of  the  exudate, 
athnuiister  sahne  purgatives,  mercury,  and 
potiissium  iodide  (see  Part  11),  and  pmctice 
iliaphoresis  every  day  or  every  other  day, 
by  means  of  the  Turkish  bath  followed  by 
woolen  blankets,  or  the  hot-air  bath,  using 
a lamp  and  two  chairs  covered  with  rub- 
ber sheeting,  or  hot  bricks  surrounding  the 


patient  beneath  blankets,  the  bricks  being 
covered  with  wet  cloths  sprinkled  with 
alcohol,  or  sochiun  salicylate  or  aspirin,  gr. 
XX,  dissolved  in  hot  peppennint  tea  or 
lemonade,  with  the  patient  well  wrapped  in 
blankets,  or  the  use  of  pilocarpine,  gr.  ^ to 
34  every  other  night.  Every  day  or  alternate 
day,  positive  galvanism  may  be  applied  to 
the  closed  lids,  using  a current  of  one  nulli- 
ampere  for  ten  minutes.  (Ziegler.) 

In  embolLsm  of  the  central  artery,  massage 
the  eye  energetically  and  faithfully,  and 
have  the  patient  inhale  amyl  nitrite  for  the 
purpose  of  dislodging  the  embolus,  “.so  that 
it  may  find  its  way  into  one  of  the  sub- 
divisions of  the  artery,  where  the  ill  conse- 
quences of  its  presence  will  be  of  less 
moment  ” (Theobald).  Fuchs  advises  par- 
acentesis of  the  cornea  for  the  purpose  of 
producing  a sudtlen  diminution  of  intra- 
ocular tension,  followed  by  an  influx  of 
blootl  which  may  i)ush  the  embolus  for- 
ward. 

In  thrombosis  of  the  central  vein,  en- 
ergetic catharsis  followed  by  potassium 
iodide  is  advised,  but  treatment  is  of  little 
avail. 

In  retinitis  pigmentosa,  the  eyes  should 
be  used  ve^  moderately.  Refractive, 
acconnnodative,  and  muscular  anomalies 
should  be  corrected.  Galvanism,  strychnine 
and  potassium  iodide  are  reconnnended,  but 
any  benefit  from  their  use  is  apt  to  be  only 
transitory. 

Retinochoroid  itis. — See  Choroiditis. 

Retrobulbar  Neuritis. — L.  re'lro,  back  -(- 
bul'hus,  bulb.  See  Optic  Neuritis. 

Sarcoma  Conjunctivae. — Gr.  erdp^,  aapKos 
flesh  d-  -copa  tumor.  See  Conjunctival 
Tumors. 

Orbital. — See  Orbital  Tumors. 

Scars  of  the  Cornea. — See  Cornea,  Opaci- 
ties of  the. 

Sclera,  Inflammation  of  the. — L.  inflam- 
ma’re,  to  set  on  fire.  See  Episcleritis, 
and  Scleritis. 

Protrusion  of  the. — Gr.  aK\r)pbs  hard. 

See  Sclera,  Staphyloma  of  the. 
Staphyloma  of  the. — Gr.  aK\r]p 6s  hard; 
(TTa<pv\6s  a bunch  of  graj^es.  Local  or  general 
protrusion  of  the  sclera,  anteriorly,  equator- 
ially,  or  posteriori}'-,  in  the  latter  case  not 
visible,  but  inferretl  from  the  presence  of 
a high  grade  of  myopia  {q.v.,  under  Refrac- 
tive Anomalies)  . 

Etiology.— Chronic  glaucoma  (q.v.),  scleral 
inflammation,  traumatism,  and  new-gro\rths, 
malignant,  syphilitic,  or  tuberculous. 

Prognosis.— In  untreated  cases  of  anterior 
and  equatorial  staphyloma,  ultimate  loss 


SYliELEPHiUiON 


of  sight  results  from  increased  intra- 
ocular tension. 

Treatment.— Do  an  iridectomy  if  the  intra- 
ocular tension  is  increased  (see  Glaucoma). 
Remove  the  eye  if  it  is  useless  (see  Enuclea- 
tion). 

Scleritis,  Deep. — Gr.  aK\r)p6s  hard  -f-  -itls 
inflammation.  Scleritis  is  characterized  by  a 
bluish-red  injection  of  the  sclera  presenting 
focal  or  diffuse  elevations.  The  cornea, 
uveal  tract,  and  other  parts  of  the  eye 
become  or  are  primarily  involved  in  the 
inflammation  (in  distinction  to  episcleritis, 
q.v.),  so  that  the  {prognosis  is  grave.  Thin- 
ning and  ectasia  follow  cicatrization. 

Etiology.— Rheimiatism;  gout;  gonorrhoea; 
menstrual  disorders;  exposure  to  cold; 
syphilis;  tuberculosis. 

Treatment. — This  is  the  .same  as  that  of 
Episcleritis  iq.v.). 

Scleritis,  Subconjunctival.— See  Episcleritis. 

Superficial. — See  Episcleritis. 

Scotomata. — Gr.  aKOTu/ia,  from  ckotos 
darkness.  A scotoma  is  a blind  or  partially 
blind  area  in  the  visual  field.  It  is  called 
positive  if  it  is  perceptible  to  the  patient  as 
a dark  spot,  negative  if  it  is  not  per- 
ceptible. 

Causes. — Focal  retinitis  or  choroidoretinitis; 
senile  changes;  retrobulbar  neuritis  (toxic 
amblyopia);  opacities  in  the  cornea,  lens, 
and  vitreous. 

Opacities  in  the  refracting  media  and  in 
the  retina  (exudate  or  hemorrhage  in  the 
retina)  cause  positive  scotomata. 

Scintillating  scotoma  or  teichopsia  (Gr’ 
reixos  wall  -fi  oypLs  vision)  is  a luminous 
appearance  before  the  eyes  with  a 
zigzag  outline,  and  often  foreruns  an 
attack  of  migraine.  It  is  also  called 
fortification  spectrum. 

Scrofulous  Ophthalmia. — L.  scrojula,  sow 
pig;  Gr.  64>da\fi6s  eye.  See  Conjunctivitis 
Phlyctenulosa. 

Sebaceous  Cyst,  Orbital. — L.  seh'urn,  suet; 
Gr.  KV(7TLs  cy.st.  See  Orbital  Tumors. 

Seclusio  Pupillae. — L.  See  under  Iritis. 

Second  Sight. — See  Cataract. 

Serous  Iritis. — L.  ser'um,  whey.  See 
Iritis. 

Cyclitis. — See  Uveitis. 

Short=Sightedness. — See  Myopia,  under 
Refraction  Anomalies. 

Sight,  Far  . — See  Hypermetropia,  under 
Refraction  Anomalies. 

Lost. — Amaurosis;  see  Blindness. 

Near. — See  Myopia  under  Refraction 
Anomalies. 

Old. — See  Accommodation  Anomalies. 

Second. — See  Cataract 


Short. — See  Myopia  under  Refraction 
Anomalies. 

Weak. — Amblyopia;  see  Blindness. 

Simple  Conjunctivitis. — See  Conjuncti- 
vitis Catarrhalis. 

Sixth  or  Abducens  Nerve,  Paralysis  of  the. 

— See  Muscular  Anomalies. 

Snow=Blindness.  — See  Amblyopia  and 
Amaurosis  without  Ophthalmoscopic  Change. 

Softening  of  the  Cornea. — See  Kerato- 
malacia. 

Spasm,  Accommodation. — Gr.  airaapos. 
Sec  Accommodation  Anomalies. 

Ciliary. — See  Accoimnodation  Anomalies. 

Eyelid  . — See  Blepharospasm. 

Muscular. — See  Muscular  Anomalies. 

Sphincter  Pupillee,  Paralysis  of  the. — Gr. 
<T(j>tyKTr]p  binder;  L.  pupil'la,  girl.  See 
Mydriasis. 

Spring  Catarrh. — See  Conjunctivitis  Ver- 
nalis. 

Squint. — See  Muscular  Anomalies. 

Squirrel  Plague  Conjunctivitis. — See  Con- 
junctivitis Tularensis. 

Staphyloma  of  the  Cornea. — See  Cornea, 
Staphyloma  of  the. 

Sclera. — See  Sclera,  Staphyloma  of  the. 

Stenosis  of  the  Canaliculi. — Gr.  arkvooL^ 
narrowing.  See  Epiphora. 

Nasal  Duct. — See  Dacryocystitis. 

Puncta  Lacrymalia. — See  Epiphora. 

Stones,  Tear.— ^ee  Epiphora. 

Strabismus. — Gr.  arpa^KTuds  squint.  See 
Muscular  Anomalies. 

Strain,  Eye. — See  Asthenopia. 

Stricture. — L.  strictura.  See  Stenosis. 

Strumous  Conjunctivitis. — L.  struma, 

scrofula.  See  Conjunctivitis  Phlyctenulosa. 

Stye. — See  Hordeolum. 

Subconjunctival  Scleritis. — L.  suh,  under. 
See  Episcleritis. 

Subluxation  of  the  Lens. — L.  suh,  under 
-f-  luxdtio,  dislocation.  See  Dislocation  of 
the  Lens. 

Subperiosteal  Abscess. — See  Orbital  Per- 
iostitis and  Osteitis. 

Superficial  Scleritis. — See  Episcleritis. 

Superior  Oblique  Muscle,  Paralysis  of  the. 
— L.  supe'rior,  higher;  obliq'uus,  slant- 
ing. See  Muscular  Anomalies. 

Rectus  Muscle,  Paralysis  of  the. — L. 
rectus,  straight.  See  Muscular  Anom- 
alies. 

Suppressed  or  Latent  Squint. — See  Mus- 
cular Anomalies. 

Suppurative  Iridochoroiditis. — L.  sub,  un- 
der + -pus,  puris,  pus.  See  Panophthal- 
mitis Purulenta. 

Symblepharon. — Gr.  <rvv  together  + 
ffke^apov  lid.  Adhesion  of  the  lid  to  the 


TOXIC  AMBLYOPIA 


eyeball,  the  result  of  purulent,  croupous, 
diphtheritic,  or  trachomatous  conjuncti- 
vitis, burns,  pemphigus,  traumatism,  or 
rarely  a congenital  anomaly.  The  treat- 
ment is  operative. 

Sympathetic  Ophthalmia. — Gr.  aw  with  -|- 
7ra0os  disease;  d(f)da\fjL6s  eye.  Inflammation 
of  the  uveal  tract  of  one  eye,  originating 
from  traumatic  inflammation  of  the  uveal 
tract  of  the  other  eye.  It  usually  sets  in 
about  two  to  eight  weeks  after  the  onset  of 
the  chsease  in  the  injured  eye,  almost  never 
before  the  expiration  of  two  weeks.  It  is 
ushered  in  by  photophobia,  lachrymation, 
blurring  of  the  vision  for  near  work,  and  the 
occurrence  of  tender  spots  in  the  ciliary 
region,  which  may  be  picked  out  with  the 
end  of  a probe  (De  Schweinitz).  Then  a 
pericorneal  zone  of  injection  appears,  etc. 
(see  Iritis).  The  disease  may  eventually 
subside,  or  the  eye  may  finally  be  destroyed. 
“The  patient  cannot  be  considered  cured, 
however,  until  at  least  a year  has  elapsed.” 
(De  Schweinitz). 

Preventive  Treatment. — An  eye  with  a pene- 
trating wound  in  the  ciliaiy  region  or  con- 
taining an  irremovable  foreign  body  should 
be  removed. 

Remedial  Treatment. — Emicleate  (q.v.)  the 
offending  fellow-eye  only  if  the  latter  is  blind 
or  practically  so,  but  not  if  there  is  a possi- 
bility of  the  retention  of  a “u.seful  degree  of 
vision  ” in  this  eye,  for  the  excitmg  eye  may, 
in  the  end,  prove  the  most  serviceable  eye. 

Absolute  rest  and  darkness  should  be 
enjoined.  Six  to  ten  leeches  or  the  artificial 
Heurteloup  leech  may  be  applied  to  the 
temple,  and  hot  fomentations  to  the  lids. 
Heat  is  a valuable  agent  for  promoting  the 
reaction  of  inflammation.  Atropine  gr.  ii-iv 
to  the  ounce  of  boiled  water,  one  drop  in  the 
eye  once  or  twice  a day,  or  often  enough  to 
keep  the  pupil  dilated,  may  be  used  guard- 
edly, and  discontinued  if  the  intraocular 
tension  should  increase  (see  Glaucoma). 
“Dionin,  5 per  cent.,  should  be  used,”  one 
drop  in  the  eye,  t.i.d.  (De  Schweinitz);  also 
subconjunctival  injections  of  cyanide  of  mer- 
cury, 1 : 4000,  10  to  20  minims. 

Open  the  bowels  thoroughly  in  the  begin- 
ning with  calomel,  and  administer  mercury 
liberally  by  mouth  and  inunction,  or  sodium 
salicylate  in  large  doses,  or  quinine  freely; 
and  later,  after  the  acute  symptoms  have 
sub-sided,  prescribe  jwtassium  iodide  (for 
drug  formulae,  etc.,  see  Part  11). 

Nutritious  food,  fresh  air,  and  tonics,  if 
indicated,  are  of  importance. 

Synechia  Iridis. — Gr.  awexeio.  connexion; 
Gr.  Ipis  a rainbow  or  halo.  Adhesion 


of  the  iris  to  the  cornea  or  to  the  lens  (see 
Iritis). 

Tarsal  Cyst. — Gr.  rape 6s  foot;  kvcttls  cyst. 
See  Chalazion. 

Tarsitis. — Chronic  (rarely  acute)  inflam- 
mation of  the  tarsus  with  thickening. 

Etiology. — Syphilis  (the  commonest  cause); 
blepharitis;  conjunctivitis;  trachoma. 

Treatment. — Treat  the  condition  locally  as 
in  blepharitis  (q.v.)  and  constitutionally  as 
indicated. 

Teardrop. — See  Epiphora. 

Tear=Duct  Disease. — See  Dacryocystitis. 
Gland  Disease.  — See  Dacryoadenitis 
and  Orbital  Tumors. 

Sac  Disease. — See  Dacryocystitis. 

Tears,  Overflow  of,  Abnormal.  — See 
Epiphora. 

Tearstones. — See  Epiphora. 

Teichopsia. — Gr.  retyos  wall  fl-  o\pLs  vision. 
See  Scotomata. 

Tension,  Ocular. — See  the  Ocular  Exam- 
ination in  the  Appendix,  following  Part  fe. 

Tests,  Ocular. — See  the  Ocular  Examina- 
tion in  the  Appendix,  following  Part  6. 

Third  Nerve  or  Oculomotor  Paralysis. — 
See  Muscular  Anomalies. 

Toxic  Amblyopia. — Gr.  to^ikSv  poison; 
apIS'Kvs  dull  -f-  eye.  Causes.— Tobacco  and 
ethyl  alcohol  (the  commonest  causes;  pro- 
ducing central  scotomas  for  red  and  green) ; 
quinine  (producing  spasm  of  the  vessels  of 
the  retina  and  optic  nerve) ; methjd  or  wood 
alcohol  (Columbian  spirits,  Jamaica  ginger, 
bay  nun,  shellac,  etc.);  lead;  Felix’s  mass; 
salicylic  acid;  pomegranate-root  bark;  stra- 
monium; chloral;  iodoform;  iodides;  thiuret; 
thyreoidin;  carbon  disulphide;  aniline;  nitro- 
benzol;  arsenic;  atoxyl;  cannabis  indica; 
silver  nitrate;  potassium  chlorate;  mercuiy; 
antipjTine;  osmic  acid;  opium;  optochin; 
ptomaines  (may^  also  cause  paralysis  of  the 
intrinsic  and  extrinsic  eye  muscles);  coffee: 
tea;  diabetes;  uraemia;  intestinal  parasites; 
shock;  etc.  (see  also  Optic  Neuritis,  Optic- 
Atrophy  and  Retinitis). 

Treatment.— Attend  to  the  cause.  Promote 
elimination  of  the  poison  by  means  of 
purgation,  copious  water  drinking,  and  dia- 
phoresis, the  latter  practiced  everj^  day  or 
eveiy  other  day  by  means  of  the  Turkish 
bath,  or  the  hot-air  bath,  using  a lamp  and 
two  chairs  covered  with  rubber  sheeting,  or 
hot  bricks  surrounding  the  patient  beneath 
blankets,  the  bricks  being  covered  with  wet 
cloths  sprinkled  with  alcohol,  and  the  hypo- 
dermic injection  of  pilocarpine,  gr.  twice 
a week.  Potassium  iodide  (see  Part  11)  may 
be  of  service  as  an  eliminant. 

Strychnine  is  advised  in  ascending  doses, 


VISION,  ACUTENESS  OF 


beginning  with  gr.  ^o>  hypoclennically, 
t.i.d.,  and  increasing  the  dose  until  muscular 
twitching  occurs,  then  continuing  for  several 
weeks  one-fourth  of  the  toxic  dose.  Strych- 
nine should  not  be  given,  however,  if  active 
inflammation  is  present. 

Nutritious  food,  fresh  air,  and  tonics,  if 
indicated,  are  of  importance. 

In  quinine  blindness,  prescribe  nitro- 
glycerine and  inhalations  of  amyl  nitrite 
followed  by  ascending  doses  of  strychnine 
(see  Drugs,  Part  11). 

In  lead  poisoning,  small  doses  of  magnesium 
sulphate  are  administered,  besides  the  elim- 
inative measures  above  described. 

Prognosis.— If  taken  in  time,  the  prognosis 
is  usually  good,  but  optic  atrophy  is  a 
possible  consequence  in  some  cases.  In 
tobacco  and  ethyl  alcohol  amblyopia,  a cure 
may  usually  be  expected  in  from  one  to  three 
months.  Optic  atrophy  is  apt  to  follow 
poisoning  with  wood  alcohol. 

In  quinine  blindness,  vision  is  usually 
restored  in  several  hom’S  or  days,  but  atrophy 
may  result. 

In  lead  poisoning,  the  outlook  is  favorable 
in  early  cases,  but  not  when  optic  neuritis 
and  atrophy  have  set  in. 

Toxic  Conjunctivitis. — See  Conjunctivitis, 
Toxic. 

Trachoma. — See  Conjunctivitis  Tracho- 
matosa. 

Tract,  Optic  . — See  Optic  Chiasma,  Tract, 
and  Centres. 

Traumatism,  Ocular. — Gr.  rpadfia  wound; 
L.  oculus,  eye.  See  Injuries  of  the  Eye. 

Trichiasis. — Gr.  rpixicuns;  dpL^  hair.  A 
turning  inward  of  the  eyelashes  against  the 
eyeball.  A rare  congenital  anomaly  is  the 
presence  of  two  rows  of  cilia  (distichiasis 
(Gr.  twice  -f-  <xtLxos  row),  with  the  po.s- 
terior  row  directed  backward. 

Etiology. — Cicatricial  contraction,  due  to 
trachoma,  cUphtheria,  pemphigus,  conjunc- 
tival burns,  traumatism,  etc.;  blepharitis; 
styes;  bandaging  the  eye  after  operations; 
blepharospasm. 

Treatment. — Wliere  only  a few  cilia  are  mis- 
directed, they  may  be  extracted  by  means  of 
epilation  forceps  as  often  as  necessary;  or 
better,  the  cilium  follicles  may  be  destroyed 
by  electroly.sis.  Under  local  cocaine  anaes- 
thesia (5  per  cent.),  with  the  positive  plate 
(wet  sponge)  of  a galvanic  battery  on  the 
temple,  introduce  the  negative  pole  in  the 
form  of  a fine  sewing  needle,  into  the  follicle 
down  to  its  base.  Then  close  the  circuit. 
After  an  action  of  about  one  minute,  using  a 
current  of  from  14  to  l}/2  milliamperes,  the 
cilium  should  be  easily  drawn  out.  The 


current  should  be  increased  and  broken  off 
slowly,  to  avoid  dizziness.  The  part  should 
be  cleansed  with  alcohol  both  before  and 
after  the  operation.  Do  not  re-insert  the 
needle  in  the  same  papilla  at  the  same  sitting, 
and  avoid  neighboring  cilia  at  one  sitting. 
The  patient  should  apply  hot  boric  acid 
solution  (3  per  cent.)  for  several  minutes 
two  or  three  times  daily  during  the  ensuing 
two  days.  After  the  reaction  has  subsided, 
i.e.,  after  several  days  or  a week,  the  opera- 
tion may  be  repeated.  Remember  that  the 
careless  use  of  electrolysis  produces  dis- 
figuring scars. 

Snellen’s  operation  may  sometimes  be 
preferred. 

In  extensive  cases  an  entroj:)ion  operation 
is  demanded  (see  also  Entropion). 

Trochlear  Nerve  Paralysis. — L.  tro'chlea, 
pulley.  See  Aluscular  Anomalies. 

Tuberculosis  of  the  Conjunctiva. — See 
Conjunctival  Tuberculosis. 

Tumors  of  the  Conjunctiva. — See  Con- 
junctival Tumors. 

Orbit.— See  Orbital  Tumors. 

Tylosis. — Gr.  tvXos  knot : a callo.sity . See 
Blepharitis  Marginalis. 

Ulcer  of  the  Cornea. — See  Keratitis 
Ulcerosa. 

Unequal  Pupils. — See  Anisocoria. 

Uveitis. — L.  u'vea  -f-  Gr.  -trts  inflammation. 
Inflammation  of  the  uveal  tract,  consisting 
of  iris,  ciliary  body,  and  choroid,  forming  the 
pigmentary  layer  of  the  eye  (irido-choroidi- 
tis,  practically  synonymous  with  serous 
cyclitis,  serous  iritis,  descemetitis,  and 
keratitis  punctata;  consult  Iritis,  for  symp- 
tomatology, etiology,  and  treatment). 

Vernal  Conjunctivitis. — See  Conjuncti- 
vitis Vernalis. 

Vertigo. — (See  Part  1,  General  Aledicine 
and  Surgery. 

Vesicular  Keratitis. — See  Keratitis  Vesi- 
culosa. 

Vision,  Acuteness  of. — See  the  Ocular 
Examination,  in  the  Appendix,  following 
Part  6. 

Dimness  of;  Amblyopia. — L.  vis'io;  Gr. 
apjSXvs  dulled  -j-  ^ eye.  See  Blind- 
ness. 

Disturbances  of,  without  Ophthalmo= 
scopic  Change. — See  Amblyopia  and 
Amaurosis  without  Ophthalmoscopic 
Change. 

Double. — See  Diplopia. 

Fields  of. — See  the  Ocular  Examina- 
tion, in  the  Appendix,  following 
Eye  Diseases. 

Loss  of;  Amaurosis. — Gr.  ap.avp6av  to 
darken.  See  Blindness. 


XEROSIS;  XEROPHTHALMOS 


Obscured  or  Weak;  Amblyopia. — Gr. 

afx^Xvs  dulled  + eye.  See  Blindnes,s. 

Tests  of. — See  the  Ocular  Examination, 
in  the  Appendix,  following  Part  6. 
Vitreous,  Hemorrhage  into  the. — See 
Hemorrhage  into  the  Vitreous. 
Opacities  in  the. — See  Opacities  in  the 
Vitreous. 

Weak  Sight,  Amblyopia  — Gr.  afi^Xvs 
dulled  + eye.  See  Blindness. 

Wounds,  Ocular. — L.  oc'ulus,  eye.  See 
Injuries  of  the  Eye. 

Xerophthalmos. — See  Xerosis,  below. 


Xerosis;  Xerophthalmos. — Gr.  ^p6s  dry 
+ 64>da\iMs  eye.  Dryness  of  the  conjunctiva 
or  cornea. 

Causes.— Scarring  of  the  conjunctiva  foUow- 
trachoma,  burns,  croupous  or  diphtheritic 
inflammation,  pemphigus,  traumatism,  etc.; 
ectropion;  lagophthalmos;  malnutrition  (see 
Nyctalopia) ; keratomalacia. 

Treatment.— Correct  any  remediable  cau.sal 
influence.  In  incurable  cases,  employ  milk, 
glycerine,  codliver  oil  emulsion,  or  mucilage 
of  acacia  or  tragacanth,  for  the  purpose  of 
diminishing  the  sense  of  dryness. 


APPENDIX 

Schema  for  the  Ocular  History  and  Examination 


Name 

Single  Married  (how  long) 

No.  and  ages  of  children 
Complaint  and  history 
of  Present  Illness 


Previous  Ocular  and  General  II istory 


Address 

Widow  (how  long) 

Age 

General  appearance 


No. 

Date 

Occupation 

Race 


Height  Weight 

Appropriate  or  proper  weight  {g.v.  in  Part  1). 
II ygiene:  Rest  Exercise 

Recreation  Diet  Sleep 

Bowels  Ventilation  Baths 

Sexual  habits  Tea  and  coffee 
Narcotics  Alcohol  Tobacco 


Family  History 

Examination  (see  below) 

Lids  Ciliary  borders 

Selene  Corneai 

Orbits  Irides 

Anterior  Chambers  Eyeballs 

Pupillary  reaction  to  light  and  ac-  Visual  fields 

commodation  and  consensual  Ophthalmoscopic  picture 
light  reflex  Light  sense 

Visual  acuity  Other  Organs  and  tissues  (ears, 

Accommodation  (using  Jaiger’s  nose,  mouth,  throat,  heart, 

type)  blood  vessels,  kidneys,  lungs, 

etc. 

Diagnosis: 

Treatment  (including  dates  and  whether  at  office  or  home) : 


Conjimctiva 
Lachrymal  apparatus 
Tension 

Mobihty  of  globes 
Balance  of  the  external  eye-mus- 
cles (see  Muscular  Anomalies) 
Color  sense  (see  Color  Blindness) 


The  Ocular  Examination. — Examine  the 
cornea,  anterior  chamber  (depth,  pus,  blood), 
iris,  and  lens,  etc.,  by  means  of  oblique 
illumination  in  a darkened  room.  Place  a 
lamp  about  two  feet  to  the  side  and  some- 
what in  front  of  the  patient.  With  the 
right  hand,  focus  the  light  upon  the  eye  by 
means  of  a biconvex  lens  of  two  or  three 
inch  focal  chstance,  and  examine  the  eye 
through  a magnifying  lens  of  the  same  focal 
distance,  or  through  a Jackson  or  Berger 
binocular  loupe. 

The  presence  of  senechiie  is  shown  by  the 
appearance  of  pupillary  irregularity  on  the 
instillation  of  a transient  mydriatic,  such  as 
homatropine  or  euphthalmine,  (see  Part  11). 

The  sensibility  of  the  cornea  is  tested  by 
means  of  a wisp  of  cotton  twisted  to  a point. 

The  fields  of  vision  for  both  light  and 
color  are  measured  by  means  of  a self- 
registering perimeter.  Look  for  concentric 
contraction,  imilateral  contraction,  hemi- 
anopia,  reentering  angles,  and  scotomata. 
A rough  test  may  be  made  in  the  following 
manner:  The  physician  s'ts  directly  facing 
the  patient,  about  three  feet  away.  If  the 
patient’s  right  eye  is  to  be  tested,  his  left 
eye  and  the  physician’s  right  eye  are  closed. 
Both  look  directly  into  each  other’s  open 
44 


eyes.  Then  the  examiner  slowly  moves  his 
shaking  finger  inward,  at  an  equal  distance 
between  himself  and  the  patient,  and  tells 
the  patient  to  indicate  by  saying  “ Now,” 
when  the  finger  is  first  seen.  If  this  occurs 
at  the  same  instant  that  the  finger  is  seen 
by  the  examiner,  the  patient’s  field  of  vision 
is  normal.  The  normal  order  for  color  per- 
cept'on  is,  from  without  inward,  blue,  yel- 
low, red,  and  green. 

To  test  the  acuteness  of  vision,  place  the 
patient  twenty  feet  from  Snellen’s  test  card. 

20,  or  the  distance  of 

, , the  point  from  the  card 

Visual  acuteness  = r^— ; — ^ 

JNo.  of  type,  which  is 

the  distance  at  which 
it  should  be  read. 

If  the  largest  type  cannot  be  read  at  anj”- 
distance,  ascertain  the  distance  ad  which 
the  patient  can  count  fingers.  If  the 
vision  is  too  poor  for  this  test,  see  if  the 
moving  hand  can  be  detected.  If  not,  test 
for  light  perception. 

Test  near  vision  or  accommodation  by 
means  of  Jaeger’s  test  types,  testing  each 
eye  separately.  J.  No.  1 = type  No.  1 read 
at  the  usual  reading  or  sewing  distance. 

The  light  sense  is  tested  by  means  of 


THE  OCFLAE  ARMAMEXTAPJUM 


Forster’s  photometer.  The  patient  should 
remain  for  ten  minutes  with  the  eyes 
bandaged  in  a perfectly  dark  room  before 
making  the  test.  The  object  of  the  test  is 
to  determine  the  smallest  amount  of  light 
that  will  render  an  object  just  visible. 

Corneal  inequalities  are  detected  by 
means  of  Placido’s  disc  or  keratoscope,  or  by 
the  appearance  of  broken  images  of  the 
window  bars  on  moving  the  cornea  in  differ- 
ent directions.  In  using  the  keratoscope, 
place  the  patient  with  his  back  to  the  light, 
and  hold  the  instrument  30  cm.  from  the 
eye.  Look  through  the  central  aperture 
and  note  if  the  reflections  of  the  circles  from 
the  cornea  are  broken  or  cUstorted. 

Ocular  tension  is  recorded  as  follows: 
Tn  = tension  normal;  T -1-  1,  -|-  2,  -|-  3 = 
degrees  of  high  tension;  T — 1,  — 2,  — 3 = 
degrees  of  low  tension;  T g = tension 
doubtful. 

Look  for  opacities  in  the  several  media 
by  means  of  the  ophthalmoscope. 

In  using  the  pupdlometer  make  the  mea- 
surements under  a uniformly  strong  light. 

The  Ocular  Armamentarium. — 1.  Office 
and  Operating  Room  Equipment. — Argand  gas 
burner  or  oil  lamp  mounted  upon  a hinged 
bracket;  glass  or  metal  fountain  syringe, 
with  bulbous  tipped  nozzle  for  irrigating  the 
conjtmctival  sac;  Llewellyn’s  flask  for  ster- 
ilizing collyria;  hypodermic  syringe;  Sweet’s 
skiagraphy  apparatus  for  localizing  foreign 
bodies  in  the  eye;  magnet:  Johnson’s, 

Haab’s;  galvanic  battery  and  electrolytic 
needles;  liigh-frequency  current;  Maddox 
rod;  Risley’s  rotary  prism;  trial  case  of 
lenses  for  testing  the  refraction  of  the  eyes; 
spectacle  frames  for  placing  test  lenses 
before  the  eyes;  ophthalmometer  for  meas- 
uring the  amount  of  corneal  astigmatism; 
phorometer  for  measm’ing  muscular  insuf- 
ficiency or  heterophoria;  amblyoscope;  Stev- 
ens’s tropometer;  colored  worsteds  for  test- 
ing the  color  sense;  stereoscope;  esophoric 
and  exophoric  prisms;  Placido’s  disc  or  kerat- 
oscope ; ophthalmoscope ; water  distiller; 
funnel;  filter  paper;  soft  camel’s-hair  brush; 
adhesive  plaster;  absorbent  cotton;  pupil- 
lometer;  self-registering  perimeter;  Forster’s 
photometer;  biconvex  lenses  of  two  or  three 
inch  focal  chstance;  Jackson’s  or  Berger’s 
binocular  loupe;  cream-colored  test-type 
card  of  Snellen;  Jaeger’s  test-types;  scales 
for  weighing  drugs;  cilium  forceps;  Knapp’s 
ild-clamp;  Desmarre’s  clamp;  Graefe  Inear 
cataract  knife;  chalazion  clamp;  fine  scalpel; 
fine  needles  and  needle-holder ; fixation  forceps ; 
lid  plate;  scissors:  enucleator,  iris,  curved, 
straight,  and  strabismus;  spring  speculum; 


strabismus  hooks;  vulcanite  spatula ;Knapp’s 
roller  forceps;  silver  probe;  chalazion  curette; 
narrow-bladed  Sichel  cataract  knife;  hand 
nasal  atomizer  for  spraying  nose;  Noyes’s 
trachoma  forceps;  Rust’s  trachoma  forceps; 
three-bladed  scarifier;  grattage  forceps; 
lance-knife;  spud  and  needle  for  removing 
foreign  boclies;  paracentesis  needle;  galvano- 
cautery  with  set  of  eye-tips;  tattooing 
needles  for  corneal  scars;  evisceration  scoop; 
Beer’s  knife;  dissecting  forceps;  curv'ed  iris 
forceps;  Mathieu’s  iris  forceps;  grooved 
spatula  and  probe;  Tyrrell’s  blunt  hook; 
De  Weeker’s  pince-ciseaux;  stenopoeic 
glasses;  hycLrodiascope;  gold  or  silver  pin 
for  opening  a stenosed  lachrjmial  point; 
cystotomes,  right  and  left;  Daviel’s  spoon; 
wire  loop  curved  like  a spoon;  discission  or 
knife  needle;  Prince’s  advancement  forceps; 
canaliculus  knives,  beak-pointed  and  probe- 
pointed;  lachi-jnnal  probes,  Theobald’s  and 
Bowman’s;  lid  retractors,  solid  and  hollow; 
ring  forceps;  Heurteloup’s  artificial  leech; 
fine  silk  thread  and  needles;  wooden  tooth- 
picks; Anel’s  lachi’jmial  syringe;  keratome; 
syringe  for  removing  soft  cataract  by  suc- 
tion; irrigating  bottle;  tinted  goggles;  eye- 
shades;  Buller’s  shield  or  watch  crj'stals; 
bulbous-tipped  eye-droppers;  Ziegler’s  canal- 
iculus cUlators;  capsule  forceps  ;T}Trell’s  sharp 
hook  for  tearing  the  capsule;  iris  spatula; 
cross-bar  entropion  forceps;  Wilder’s  double 
knife;  artificial  eyes;  Thomas’s  stricturotome; 
Stilling’s  stricturotome;  Elliott’s  trephine; 
curved,  flat  scissors;  Prince’s  roller  expres- 
sion forceps ;Dewey’s  trachoma  burr;  Darier's 
forceps;  horn  spatula;  ionic  outfit:  galvanic 
battery  with  milliamperemeter,  copper  and 
zinc  electrodes;  Knapp’s  loop;  Stevens’s 
hook;  Smith’s  spatula;  Prince’s  pasteurizer 
for  heating  corneal  ulcers;  adhesive  plaster. 

2.  Laboratory  Equipment. — IMicrOSCOpe;  slides; 
cover  glasses;  stains:  saturated  aniline  water, 
filtered;  saturated  alcoholic  solution  of 
gentian  violet;  iodine;  potassium  iodide; 
alcohol,  95  per  cent.;  safranin;  alcohol  lamp 
or  Bunsen  burner;  drug  scales;  spatulas; 
mortar  and  pestle;  capsules.  L’rinarj"  Analy- 
sisoutfit  (see  Appendix  to  Part  1). 

3.  Internal  Drugs  Mentioned  in  the  Text. — (a) 
Tonics  and  Alterati\'es  (L.  to'nus,  tone; 
alterar'e,  to  change). — Quinine;  elixir  ferri, 
quininte  et  stiychninte  phosphati;  sjt.  ferri 
iodidi;  Inyiophosphites;  Fowler’s  solution; 
codliver  oil ; stiA-chnine ; potassium  iodide ; 
sodium  salicylate;  mere,  protiodide;  Dono- 
van’s solution;  hydrarg.  salicylate;  hydrarg. 
biniodide;  tr.  nucis  vomicse. 

(b)  Purgatives  (L.  piirga're  to  cleanse). 
— Castor-oil;  calomel;  magnesium  sulphate; 


THE  OCULAPt  AR]\rAj\IENTARITJM 


sodium  sulphate;  sodium  phosphate;  Ro- 
chelle salt. 

(c)  Neuromuscular  Sedatives  (L.  sed'o, 
I allay). — Ext.  opii;  morphine;  tr.  hyoscy- 
ami;  chloretone;  croton  chloral  hydrate; 
potassimn  bromide;  ext.  belladonna;  alco- 
hol; ether;  antipyrine;  brandy;  whiskey;  tr. 
aconite;  conium;  fl.  ext.  gelsemii. 

(d)  Hemostatics  (Gr.  alfia  blood  -|- 
cTaTLKos  standing). — Ergot. 

(e)  Vasodilators  (L.  vas,  ve.ssel). — Ni- 
troglycerme;  amyl  nitrite. 

(f)  Antilithics  (Gr.  avrL  against  -|-  Xidos 
stone). — Cream  of  tartar;  colchicum;  lith- 
ium salicylate;  colchicine;  linden  flower  or 
elder  tea. 

4.  Local  Preparations  Mentioned  in  the  Text. — 
(a)  Antiseptics  and  Astringents  (Gr.  avrL 
against  ctt]\Pls  putrefaction;  L.  ad,  to  + 
sirin' gere,  to  bind). — Zinc  sulphate;  boric 
acid;  soclimn  biborate;  argyrol;  protargol; 
silver  nitrate;  sodium  chloride;  mercury 
bichloride;  glycerol  of  tannin,  gr.  x ad  5i; 
tannin;  ung.  hydrarg.  nitratis;  potassium 
permanganate;  mercurj^  cyanide;  formaline; 
alum  crystals;  copper  sulphate  crystals; 
copper  citrate;  white  precipitate;  iodoform; 
hydrarg.  oxidi  flavi;  boroglyceride;  carbolic 
acid;  tr.  iodi;  Dobell’s  solution;  ichthyol; 
soda  bicarbonate;  blue  ointment;  aluminum 
acetate;  lotio  nigra;  calamine  lotion;  sodium 
carbonate;  collyrium  astringens  luteum  or 
Horst’s  eye  water;  compound  iodine  oint- 
ment; liq.  plumbi  subacetatis ; Haab’s  discs  or 
rods  of  iodoform;  Finsen  (ultra  violet)  rays 
for  tuberculosis  of  the  conjunctiva;  castile 
soap. 

(b)  Caustics  (Gr.  koIuv  to  burn). — Car- 
bolic acid;  trichloracetic  acid;  silver  stick; 


hydrochloric  acid,  c.p.;  copper  sulphate 
pencils;  alum  pencils;  copper  citrate; 
liq.  potassae. 

(c)  Styptics  (Gr.  aTv4>ei.v  to  contract). — 
Adrenalin,  1 : 1000. 

(d)  Mtoriatics  (Gr.  iiuSpiaais). — Atro- 
pine; cocaine;  homatropine  hydrobromide; 
euphthalmine  hydrochloride ; eumydrin ; 
hyoscyamine  hydrobromate ; duboisine  sul- 
phate; daturine;  scopolamine  hydrobromide. 

(e)  Miotics  (Gr.  puecv  to  close). — Pilo- 
carpine hydrochloride;  eserine  sulphate 
or  salicylate. 

(f)  Analgesics  (Gr.  dr  neg.  -f  oKyos 
pain). — Cocaine;  holocaine  hydrochlorate; 
alypin;  chloroform;  spt.  camphorac;  aq.  cam- 
phorae;  spt.  lavendulae;  camphor;  ol. 
menth.  pip. 

(g)  Emollients  and  Protectives  (L. 
ernol'lio,  I soften). — Ung.  aquae  rosae;  yellow 
wax;  glycerine;  lanolin;  vaseline;  refined 
codliver  oil ; brown  or  unrefined  codliver  oil ; 
collocUon;  albolene;  olive  or  cottomseed  oil; 
ung.  zinci  oxidi;  emulsion  of  codliver  oil. 

(h)  Skin  Medicaments. — Salicylic  acid; 
diachylon  ointment;  starch  powder;  pix 
liquida;  oil  of  cade;  lanolin;  vaseline. 

(i)  Lymphagogue  (L.  lym'pha,  lymph  -|- 
Gr.  ayw  I carry  off). — Dionin. 

(j)  Counter-Irritant. — Cantharidal  col- 
lodion. 

Miscellaneous. — Flesh-colored,  water-color 
paint;  antigonococcus  serum;  diphtheria 
antitoxin;  tuberculin;  neutral  ammon.  tar- 
trate; dilute  acetic  acid;  jequiritol  (Romer); 
jequiritol  serum  (Merck);  distilled  water; 
fluorescein,  Griibler’s;  liq.  potassae;  India 
ink;  ammonium  chloride;  sodium  pyro- 
phosphate; thiosinamin  ung.,  15  per  cent. 


PART  7 

EAR  DISEASES 


Abscess,  Auricular. — L.  abscessus,  a going 
apart ; auric'ula,  the  pinna.  See 
Perichondritis  Auricute. 

Brain. — See  under  Otitis  Media  Puru- 
lenta;  Labyrinthitis,  and  Mastoidi- 
, tis  Interna. 

Epidural. — Gr.  kirL  on  + L.  dur'a,  hard. 
See  Abscess,  Brain,  above. 

External  Auditory  Canal. — L.  audir'e,  to 
hear ; canal' is  canal.  See  Otitis 
Exderna  Circmuscripta  Acuta. 

Extra=Dural. — L.  ex'tra,  outside.  See 
Abscess,  Brain,  above. 

Acoustic  Nerve  Inflammation. — Gr.aKoceu' 
to  hear;  vevfx>v  nerve;  L.  inflammar'e,  to  set 
on  fire.  See  Acoustic  Nerve  Paralysis,  below. 

Acoustic  Nerve  Paralysis. — ^Gr.  xapa  be- 
side -h  \veiv  to  loosen.  The  symptoms  of 
acoustic  nerve  disease  are  as  follows,  viz: 
labyrinthine  or  nerve  deafness,  partial  or  com- 
plete (see  Deafness),  and  tinnitus  (cochlear 
symptoms) ; nausea,  dizziness,  staggering 
gait,  and  nystagmus  (vestibular  symptoms). 
The  nystagmus  is  rotary  and  horizontal  (see 
Nystagmus,  for  important  desiderata).  The 
cochlear  symptoms  in  auchtory  neuritis  are 
usually  the  first  to  appear.  The  onset  in 
neuritis  is  sudden,  and  the  symptoms  vary 
in  degree  from  day  to  day. 

Etiology.— (1)  Neuritis. — Syphilis  (the 
commonest  cause);  influenza;  scarlet  fever; 
typhoid  fever;  rhemnatism;  polyneu- 
ritis; meningitis;  tuberculosis;  alcoholism; 
quinine;  salicylates. 

(2)  Atrophy. — Neuritis;  aneurysm  of  the 
ba.silar  artery;  tumor  in  the  cerebello-pontine 
fissure;  hydrocephalus;  contraction  of  the 
basilar  and  internal  auditory  arteries;  men- 
ingitis; purulent  ependymitis;  hemorrhage 
or  inflammation  in  the  region  of  the  nucleus 
and  roots  of  the  acoastic  nerve;  otosclerosis; 
long-continued  pressure  on  the  labyrinth 
in  chronic  otitis  media;  professional  sound 
concussion;  tabes  dorsalis;  nephritis;  maras- 
mus; senility. 

(3)  Functional  Paralysis. — Hysteria; 
angioneurosis  (an  exceedingly  rare,  transi- 
tory acoustic  paralysis,  “ characterizes  1 by 
sudden  pallor  of  the  face,  nausea,  dizziness, 
tinnitus,  and  hardness  of  hearing,  which  dis- 
appear entirely  within  a few  minutes  with 
the  ndurn  of  the  former  normal  color  of  the 
face,  and  without  leaving  the  slightest  di.s- 
turbance  of  hearing.”)  (Politzer.) 


Treatment. — Attend  to  the  cause.  In  acous- 
tic neuritis,  enjoin  rest  and  freedom  from 
noise.  Promote  the  elimination  of  toxines 
by  means  of  purgation,  copious  water  drink- 
ing, and  thaphoresis,  the  latter  practiced 
every  day  or  every  other  day  by  means  of  the 
Turkish  bath;  or  the  hot  air-bath,  using  a 
lamp  and  two  chairs  covered  with  rubber 
sheetmg;  or  hot  bricks  surrounding  the 
patient  beneath  blankets,  the  bricks  being 
covered  with  wet  cloths  sprinkled  with 
alcohol;  and  the  hypodermic  injection  of 
pilocarpine,  gr.  }y-g,  twice  a week,  or  gr. 
by  mouth,  twice  or  thrice  daily,  the  dose  or 
its  frequency  to  be  increased  until  a slight 
increase  of  perspiration  and  saliva  occurs, 
the  {ihysiological  dose  being  continued,  if 
necessary,  for  two  months  or  longer.  (Dench.) 
Potassium  or  sodiiun  iodide  is  a useful 
eliminant.  Tincture  of  iodine,  or  vesicants 
or  six  to  ten  leeches,  or  the  artificial  Heurte- 
loup  leech  to  the  mastoid  process,  and  mus- 
tard foot-baths  are  advised  (for  diugs,  vesi- 
cants, etc.,  see  Part  11), 

After  all  inflaimnatory  symptoms  have 
subsided  and  tinnitus  is  absent,  strychnine 
may  be  prescribed  in  ascending  doses,  begin- 
ning with  gr.  3-^0)  hypodermically,  t.i.d.,  and 
increasing  the  dose  until  muscular  twitching 
occurs,  then  continuing  for  several  weeks 
one-fourth  of  the  toxic  dose. 

Nutritious  food,  fresh  air,  and  tonics,  if 
indicated,  are  of  importance. 

In  angioneurotic  paralysis,  Politzer  has  em- 
ployed galvanization  of  the  sympathetic  nerve 
of  the  neck  for  several  months  with  success. 

Acoustic  Neuritis. — See  Acoustic  Nerve 
Paralysis,  above. 

Paralysis.— See  Acoustic  Nerve  Paraly- 
sis, above. 

Adhesions  of  the  External  Auditory 

Canal. — See  Stricture  of  the  External 
Auchtory  Canal. 

Aids  to  Hearing,  Artificial. — See  under 
Otitis  Media  Catarrhalis  C-hronica,  and 
Otitis  Media  Purulenta  Chronica. 

_ Anaemia  of  the  Labyrinth. — Gr.  av  neg.  -f 
aijjLa  blood;  \a^vpiv6os. — Causes. — (a)  General 
Anasmia  (see  Part  1,  on  General  Medicine 
and  Surgery,  for  its  many  causes). 

(b)  Local  Anaemia  or  Ischaemia,  due  to 
angiosiiasm  (extremely  rare) ; obstruction  of 
the  internal  auditory  artery,  as  in  aneurysm 
of  the  basilar  artery,  neoplasms  growing  into 


AUDITORY  NEURITIS 


the  internal  meatus,  and  embolism  and 
sclerosis  of  the  artery;  chronic  otitis  media, 
in  which  pressure  is  exerted  upon  the  laby- 
rinthine structures  through  the  round  and 
oval  windows. 

Symptomatology. — In  acute  anaemia,  as  in 
cases  of  sudden  severe  hemorrhage  and  in 
the  angioneurotic  form,  there  occur  marked 
facial  pallor,  marked  timiitus,  deafness, 
dizziness,  nausea  or  vomiting,  and  perhaps 
faint  iig.  In  the  very  rare  angioneurotic 
form,  these  symptoms  disapjiear  entirely 
within  a few  minutes. 

In  chronic  anaemia,  tinnitus  and  deafness 
are  the  main  symptoms.  The  deafness  is, 
of  course,  labyrinthine,  that  is,  it  is  especially 
marked  for  high-pitched  and  sharp  sounds, 
and  bone  conduction  is  reduced  (see  Tests). 

An  improvement  in  the  symptoms  follow- 
ing the  athninistration  of  amyl  nitrite 
(Part  11)  is  of  diagnostic  significance. 

Treatment. — Attend  to  the  cause  (consult 
Part  1 on  General  Mctlicine  and  Surgery). 
In  angiospasm,  Politzer  has  employed  gal- 
vanization of  the  sympathetic  nerve  of  the 
neck  for  several  months  with  success. 

Apoplexy,  Labyrinthine. — Gr.  aTOTr'k-q ^la. 
See  Labyrinthine  Hemorrhage. 

Artificial  Aids  to  Hearing. — L.  ars,  art  -|- 
fae'ere,  to  make.  See  under  Otitis  Media 
C’atarrhalis  Chronica ; and  Otitis  Media 
Purulenta  C’hronica. 

Atresia  of  the  External  Auditory  Canal. — 

Gr.  a neg.  -f-  rpqaLs  a boring.  Imperforation 
or  absence  or  complete  closure  of  the  canal, 
as  distinguished  from  partial  closure  (for 
which  see  Stricture). 

Etiology  — Atresia  is  either  congenital  or 
acquired.  Acquired  atresia  is  produced  by 
the  apposition  of  denuded  surfaces  or  granu- 
lations due  to  traumatism  (including  frac- 
tures, and  poorly  performed  mastoiil  opera- 
tions), burns,  cauterizations,  extension  from 
without  of  a phlegmonous  inflammation, 
ulcerations,  chronic  suppurative  otitis  media, 
caries  and  necrosis  of  the  mastoid  process 
and  walls  of  the  meatus. 

Treatment. — Congenital  atresia  is  usually 
associated  with  rudimentarj'  or  absent  inter- 
nal structures,  so  that  in  such  cases,  even  if 
an  artificial  meatus  could  be  successfully 
formed,  which  is  very  exceptional,  the  opera- 
tion would  be  futile.  Therefore,  before  an 
oj)eration  is  attempted,  wait  until  the  patient 
is  okl  enough  to  make  it  possible  to  ascertain 
if  the  internal  ear  is  functionally  intact  (see 
Examination  of  the  Ear). 

An  artificial  canal  is  made  as  follows: 
Make  a curved  incision  just  behind  the 
attachment  of  the  pinna,  which  is  usually 


deformed  (see  C'ongenital  Malformations  of 
the  Auricle),  through  the  skin  and  peri- 
osteum to  the  bone,  and  turn  the  flap, 
including  the  periosteum,  forward.  Then 
search  for  a rudimentary  meatus,  which  if 
found  should  be  enlarged  by  means  of  chisels 
or  burrs,  the  latter  ch'iven  by  an  electric 
motor  or  dental  engine.  If  no  rudimentary 
meatus  is  found,  make  a canal  where  a 
normal  canal  should  be.  In  either  case,  take 
great  care  not  to  injure  important  adjacent 
structures.  After  forming  a canal,  make  a 
crucial  incision  in  the  overlying  portion  of 
the  skin  and  periosteal  flap,  and  when  the 
latter  has  been  replaced,  insert  into  the 
canal  the  four  small  triangular  flaps  thus 
formed,  and  insert  a gauze  pack  to  mamtain 
the  four  flaps  in  position.  After  a few  days, 
replace  the  gauze  packing  with  an  aluminum 
or  rubber  tube.  Dench  suggests  “Thiersch’s 
method  of  skin  grafting  as  soon  as  healthy 
granulations  spring  up,”  in  order,  if  possible, 
to  prevent  cicatricial  contraction  of  the 
canal.  The  patency  of  an  artificial  canal  can 
hardly  be  maintained. 

Acquired  atresia  is  usually  fibrous,  rarely 
bony.  Probe  carefully  to  ascertain  which 
variety  is  present,  and  if  the  former,  whether 
it  is  a membranous  septum  or  a cliff  use  growth. 
Siegle’s  speculmn  will  help  in  the  clifferen- 
tiation.  Test  the  hearing  (see  Examina- 
tion). “ In  those  cases  in  which  whispered 
speech  is  understood  through  the  hearing 
trumpet  (the  latter  is  employed  to  ob\’iate 
cranial  bone  transmission),  it  is  quite  prob- 
able that  the  septum  is  veiy  thin.”  Opera- 
tive removal  of  the  atresia  in  such  cases  is 
justifiable.  “ In  those  patients,  however, 
where  speech  is  not  understood  by  the  aid 
of  the  hearing  trumpet,  in  other  words,  where 
we  are  dealing  with  an  extensive  atresia,  the 
operative  procedure  of  cutting  through  the 
same  (with  knife  or  galvanocautery),  and  the 
introduction  of  cannulas,  as  well  as  leaden 
plugs,  remain  fruitless.”  (Knapp.) 

In  the  latter  instances,  and  also  in  osseous 
atresias,  one  may  resort  to  Jansen’s  opera- 
tion, as  described  under  Stricture  of  the 
External  Auditory  Canal,  provided  the 
auditoiy  nerve  is  intact,  as  ascertained 
by  the  tuning  fork  tests  (see  Examination), 
and  the  tennpanum  is  not  involved,  as  ascer- 
tained by  observing  whether,  by  ausculta- 
tion and  eustachian  catheterization  {q.v ), 
air  can  be  heard  to  enter  the  t\nnpanic  cavity. 

Auditory  Canal,  E.xternal. — See  Exiernal 
Auditory  Canal. 

Neuritis. — L.  midir'e,  to  hear;  Gr. 
vtvpov  nerve  -|-  -tns  inflammation.  See 
Acoustic  Neiwe  Paralysis. 


AURAL  POLYPI  AND  GRANULATIONS 


Auditory  Paralysis.— See  Acoustic  Nerve 
Paralysis. 

Aural  Catarrh,  Acute. — L.  au'ris,  ear;  Gr. 
KaTappetv  to  flow  down.  See  Otitis 
IVIedia  Catarrhalis  Acuta. 

Chronic. — See  Otitis  Media  Catar- 
rhalis Chronica. 

Cerumen. — L.  ceru'men,  ear-wax.  See 
Wax,  Inspissated. 

Cholesteatoma. — Gr.  xoX^  bile  -|-  aTtap 
fat  -f-  -co/xa  tumor.  See  under  Otitis 
Mecha  Purulenta  Chronica. 

Eczema. — See  Eczema  Auris. 

Examination. — L.  au'ris,  ear.  See  Exam- 
ination of  the  Ear. 

Exostoses. — See  Exostoses  and  Hyper- 
ostoses of  the  External  Auditory  Canal. 

Fistula,  Congenital. — L.  fis'tula,  pipe. 
See  Auricle,  Congenital  Malforma- 
tions of  the. 

Foreign  Bodies. — See  Foreign  Bodies 
in  the  Ear. 

Furunculosis. — h.  furun' cuius,  boil.  See 
Otitis  Externa  Circumscripta  Acuta. 

Granulations. — See  Aural  Polypi  and 
Granulations. 

Haematoma. — See  Haematoma  Auris. 

History. — See  Schema  for  the  Aural 
History  and  Examination,  in  the  Ap- 
pendix, following  Part  7. 

Hyperostose  s. — See  Exostoses  and 
Hyperostoses  of  the  External  Audi- 
tory Canal. 

Aural  Polypi  and  Granulations. — L.  au'ris, 
ear;  Gr.  ttoXus  much  ttovs  foot;  L.  gran'ulum 
grain.  An  inflammatory  polypus  is  a pedun- 
culated granulation.  Polypi  usually  have 
their  origin  in  the  tympanic  cavity  in  purulent 
otitis  media;  but  they  sometimes  arise  in  the 
external  auditory  canal  as  a result  of  chronic 
otorrhoea,  caries,  furunculosis,  desquamative 
inflammation,  traumatism,  or  poulticing. 

Treatment. — Locate  the  root  of  the  polypus 
with  a blunt  probe  curved  to  a right  angle 
at  the  end. 

If  the  polypus  arises  in  the  external 
meatus,  it  may  be  avulsed,  or  constricted,  or 
cut  off  with  Blake’s  cold  wire  snare,  after 
the  canal  has  been  cleansed  with  bichloride 
of  mercury,  1 ; 3000,  in  equal  parts  of  warm 
alcohol  and  water,  and  anaesthetized  with  a 
warm  10  per  cent,  solution  of  cocaine  or 
with  powdered  cocaine  applied  on  the  moist 
end  of  a probe.  In  children,  a general 

I'  anaesthetic  is  required.  Hemorrhage  is 
arrested  by  inserting  cotton-wool  dipped  in 
powdered  alum  or  in  adrenalin  solution, 
1 : 3000-1000.  Then  the  parts  are  dried, 
and  the  base  or  stump  of  each  polypus  cau- 
I terized  with  chromic  acid  or  silver  nitrate 


fused  on  the  end  of  a probe  by  dipping  the 
red-hot  probe  in  the  powdered  caustic.  Then 
a minute  quantity  of  finely  powdered  boric 
acid  is  insufflated. 

Granulations  may  be  cauterized  with 
liquor  ferri  chloridi  or  with  a 10  per  cent, 
solution  of  trichloracetic  acid,  using  a probe, 
or  small  brush  or  a ball  of  cotton-wool,  and 
taking  extreme  care  not  to  touch  any  other 
parts  but  the  granulations,  and,  in  the  tym- 
panum, to  avoid  the  promontory  (the 
prominence  formed  by  the  first  turn  of  the 
cochlea).  The  cauterization  should  not  be 
repeated  until  after  the  crust  or  eschar  has 
fallen  off  and  is  syringed  fronr  the  ear. 

The  galvanocautery  may  be  used  to  re- 
move polyjri  from  the  external  meatus  and 
drum  membrane  (not  from  the  tympanum), 
and  is  preferred  by  Politzer  to  chemical 
caustics.  The  parts  are  first  anaesthetized 
with  powdered  cocaine  applied  on  the  moist- 
ened end  of  a probe.  “ The  circuit  should  be 
closed  only  when  the  cauteiy  is  in  contact 
with  the  growth;  and  before  each  cauteriza- 
tion the  point  must  be  thoroughly  heated.” 

Intra-tympanic  polypi  should  not  be 
avulsed  for  fear  of  tearing  out  the  ossicles. 
To  remove  them,  the  perforation  in  the 
drum  membrane  may  have  to  be  enlarged. 
Small,  soft  polypi  and  granulations  may  be 
removed,  after  cocainization,  by  means  of 
small  sharp  spoons,  sharp  curettes,  or  ring- 
knives,  the  latter  being  made  to  encircle  the 
polypus.  These  instruments  are  also  useful 
in  scraping  necrosed  bone,  which  is  fre- 
quently concealed  by  large  flabby  granula- 
tions. After  curetting,  check  the  resulting 
hemorrhage  with  acfienalin,  1 : 1000,  applied 
on  a pledget  of  cotton.  Then  dry  the  parts, 
and  cauterize  the  base  or  stump  of  each 
granulation  with  silver  nitrate  or  chromic 
acid  fused  on  the  end  of  a probe. 

Polypi  in  the  attic  may  sometimes  be 
tliagnosed  by  means  of  a small  tympanic 
mirror,  and  removed  with  a small  curette 
bent  at  a right  angle  with  the  handle. 

When  operative  measures  are  not  feasible, 
or  are  refused,  alcohol  instillations  may  be 
employed.  The  alcohol,  because  of  its 
dehydrating  properties,  causes  the  granula- 
tions to  shrink.  First  cleanse  and  dry  the 
ear,  then  pour  in  warmed  alcohol  and  water, 
equal  parts.  To  avoid  pain,  pour  in  two  or 
three  drops  at  first,  and  the  rest,  about 
thirty  drops,  a half  to  one  minute  later. 
Allow  it  to  remain  in  the  ear  twenty  or 
thirty  minutes.  Repeat  the  instillations 
two  or  three  times  daily,  and  gradually 
increase  the  strength.  Boric  acid,  gr.  xx  to 
the  ounce,  or  carbolic  acid,  gr.  xv  to  the 


I 


CONCUSSION  OF  THE  LABYRINTH 


ounce,  may  be  added.  Two  to  six  or  more 
weeks  of  the  alcohol  treatment  are  rc- 
Cjuired  t(j  cause  the  polypi  comj)letely  to 
disapixjar.  Alcohol  is  contraimlicated  in 
acute  inflaimnation  and  in  bone  caries. 

Chronic  ear  suppuration  with  the  extensive 
formation  of  granulation  tissue  is  slowly 
amenable  to  radium  therapy  {q.v.  in  Part  1). 

Aural  Seborrhoea. — See  Seborrhoea  Anris. 

Vertigo.— See  Vertigo  in  Part  1. 

Wax. — See  Wax,  Inspissated. 

Auricle,  Abscess  of  the. — L.  auricula,  the 
pinna;  abscesms,  a going  apart.  See  Peri- 
chondritis AuriculiE. 

Auricle,  Congenital  Malformations  of  the. 

— L.  con,  together  + genitus,  born;  mdlus, 
evil  + format' io,  a forming.  A plastic  opera- 
tion in  infancy  may  be  appropriate  in  many 
instances.  Wiere  the  deformity  is  great, 
however,  it  is  better  to  remove  the  deformed 
member  entirely,  and  replace  it  with  an 
artificial  auricle. 

In  microtia,  the  external  meatus  is  usually 
absent,  and  the  internal  structures  usually 
either  rudimentary  or  absent,  so  that  the 
formation  of  an  artificial  meatus,  even  if 
successful,  is  usually  futile.  Before  such  an 
operation'  is  attempted,  one  should  wait 
until  the  patient  is  old  enough  to  permit  of 
an  examination  of  the  functional  capacity 
of  the  internal  ear  (see  Atresia  of  the  Exter- 
nal Auditory  Canal). 

For  protruding  ears  in  early  chikUiood, 
strap  the  ear  to  the  head,  or  apply  collodion 
to  the  head  and  to  the  apposing  posterior 
aspect  of  the  auricle.  In  adults,  remove  an 
elliptical  segment  of  the  posterior  auricular 
integument  and  approximate  the  cut  edges. 

Congenital  (blind)  fistulae  require  no 
treatment,  unless  a retention  cyst  should 
form  as  a result  of  blocking  of  the  orifice  of 
the  fistula,  when  the  cyst  shoukl  be  opened 
and  curetted. 

Auricle,  Eczema  of  the.— See  Eczema  Auris. 

Haematoma  of  the. — See  Hasmatoma 
Auris. 

Inflammation  of  the. — L.  inflammdre,  to 
set  on  fire.  See  Perichondritis  Auriculae. 

Malformations,  Congenital,  of  the. — 
See  Auricle,  Congenital  Malforma- 
tions of  the. 

Perichondritis  of  the. — See  Perichon- 
dritis Auriculae. 

Bodies,  Foreign,  in  the  Ear. — See  Foreign 
Bodies  in  the  Eair. 

Boil  in  the  External  Auditory  Canal. — 

See  Otitis  Externa  Circumscripta  Acuta. 

Brain  Abscess. — See  under  Labyrinthitis, 
Otitis  Media  Purulenta ; and  Mastoidi- 
tis Interna. 


Caloric  Test. — L.  cdlor,  heat.  See  Ex- 
amination of  the  Ear. 

Canal,  External  Auditory. — See  External 
Auditoiy  Canal. 

Catarrh,  Aural,  Acute. — Gr.  Karappeir  to 
flow  down ; L.  aur'is,  ear.  See  Otitis 
Media  Catarrhalis  Acuta. 

Chronic. — See  Otitis  Aledia  Catar- 
rhalis Chronica. 

Eustachian.^ — B.  Eustachi,  d.  1574.  See 
Otitis  Media,  Catarrhalis  Acuta; 
and  Chronica. 

Tubo=Tympanic. — L.  m'ha,  a tube;  tym'- 
panum,  drum.  See  Otitis  Media 
Catarrhalis  Acuta;  and  Chronica. 

Catheterization  of  the  Eustachian  Tube. — 
Gr.  Kaderyp.  See  Inflation  of  the  kliddle  Ear. 

Cerebellar  Abscess. — L.  dim.  of  cer'ebrum, 
brain.  See  Abscess,  Brain. 

Cerebral  Abscess. — L.  cer'ebrum,  brain. 
See  Abscess,  Brain. 

Cerumen,  Impacted. — L.  ceni'men,  ear- 
wax  ; impactus,  closely  lodged.  See  Wax, 
Inspissated. 

Cholesteatoma. — Gr.  xoby  bile  -|-  arkap 
fat  + -upa  tumor.  See  under  Otitis  Media 
Purulenta  Chronica. 

Chronic  Aural  Catarrh. — See  Otitis  Aledia 
Catarrhalis  Chronica. 

Circumscribed  Acute  External  Otitis. — 
See  Otitis  Externa  Circumscripta  Acuta. 

Closure  of  Perforations  of  the  Drum 
Membrane. — See  imder  Otitis  Media  Puru- 
lenta Chronica. 

Concussion  of  the  Labyrinth. — L.  con- 
cussio,  violent  jar  or  shock;  Gr.  \a0vpiv6os. 
Concussion  of  the  labyrinth  may  be  caused 
by  an  explosion,  the  report  of  a gun,  a box 
on  the  ear,  or  fracture  of  the  petrous  portion 
of  the  temporal  bone.  The  membrana 
tympani  is  apt  to  be  ruptured  (see  Injuries 
of  the  Membrane  Tympani).  Sudden  un- 
consciousness and  deafness  may  occur,  or 
the  patient  may  stagger  and  become  dazed 
for  a time,  and  suffer  with  more  or  less 
tinnitus  and  deafness  (q.v.),  and  possibly 
nausea  or  vomiting  and  nystagmus  (q.v.). 

Treatment.— Absolute  rest  in  bed  in  a quiet 
room  is  important.  For  the  relief  of  pain, 
the  artificial  leech  may  be  applied  to  the 
mastoid,  and  al)out  two  to  four  ounces  of 
blood  abstracted.  Distressing  tinnitus  may 
be  relieved  by  the  atlministration  of  sodium 
bromide  (see  Part  11  for  diug  formulae,  etc.) 

Aftt'r  the  acute  sjmiptoms  have  subsided, 
potassium  iodide  or  j)ilocarpine  may  be 
prescribed  for  the  purpose  of  hastening  the 
absorption  of  a {wssible  exudate.  In  pre- 
scribing pilocarpine,  Dench  administers  gr. 

iiiouth,  twice  or  thrice  daily, 


DIPHTHERITIC  OTITIS  EXTERNA 


gratliially  increases  the  dose  until  a light 
increase  of  perspiration  and  saliva  occurs, 
and  continues  the  latter  dosage  for  two 
months  or  longer,  if  necessaiy. 

Congenital  Fistulas — L.  con,  together  + 
gmitus,  born  ;fisi'tila,  pipe.  See  Auricle, 
Congenital  Malformations  of  the. 

Malformations  of  the  Auricle. — See  Au- 
ricle, Congenital  Malformations  of  the. 

Congestion,  Labyrinthine. — L.  conge'- 
rere,  to  heap  together.  See  Hyper- 
semia  of  the  Labyrinth. 

Tubal  — L.  tu'ba,  tube.  See  Otitis 
Media  Catarrhalis. 

Tubo=Tympanic. — L.  tym'panuni,  drum. 
See  Otitis  Media  Catarrhalis. 

Croupous  Otitis  Externa. — See  Otitis 
Externa  Membranosa. 

Deaf=Mutism. — Deaf-mutism  is  either 
congenital  or  acquired.  Congenital  deaf- 
mutism  may  be  due  to  parental  (leaf-mutism, 
parental  consanguinity,  maternal  shock  dur- 
ing intra-uterine  life,  or  hereditary  syphilis. 
Acquired  deaf-mutism  is  a result  of  deafness 
{q.v.  for  causes),  before  the  age  of  seven 
years.  The  deafness  need  not  be  complete. 

The  Prognosis  is  more  favorable  in  the  con- 
genital than  in  the  acquired  form. 

Treatment. — Endeavor  to  correct  any  pos- 
sible etiological  factor  (g.w.  under  Deafness). 

Turn  the  child  over  early  to  a reputable 
institution  where  deaf-mutes  are  trained. 
The  child  should  be  at  least  seven  years  of 
age  before  such  instruction  is  begun.  Seven 
or  eight  years  of  instruction  are  required. 

Of  the  two  methods  of  education  of  deaf- 
mutes,  the  pure  oral  method,  of  lip  reading 
and  articulation  (German  method),  is,  of 
course,  better  than  the  sign  and  gesture,  or 
French  method. 

Gorham  Bacon  says:  “ When  a child  has 
suddenly  become  deaf  from  some  general 
disease,  such  as  scarlet  fever  or  diphtheria, 
it  is  important  for  the  patient  himself  to 
read  aloud  for  an  hour  or  two  each  day  in 
order  not  to  lose  the  art  of  speech.” 

An  important  preventive  measure  is  the 
timely  incision  of  a bulging  drum-membrane 
in  acute  otitis  media  complicating  the  acute 
infcKjtious  diseases  (see  Otitis  Media  C'atar- 
rhalis  Acuta). 

Deafness. — Etiology.— I.  External  Audi- 
tory Ganal  Affections. — Ceruminous  or 
epithelial  plugs  {q.v.)]  otomycosis  {q.v.)] 
foreign  bodies  {q.v.)]  furunculosis  (g. f.); 
otitis  externa  chffusa  {q.v.)]  atresia  {q.v.)] 
stricture  {q.v.) ; exostosis  or  hyperostosis 
{q.v.)  ] polypi  and  granulations  {q.v.) ; senile 
collapse  of  the  cartilaginous  meatus  {q.v.)] 
seborrhoea  auris  {q.v.). 


II.  Drum  Membrane  Affections. — Per- 
foration {q.v.)]  inflammation  (g.y.);  thicken- 
ing {q.v.)]  adhesions  {q.v.)]  herpes  {q.v.)] 
fracture  of  the  handle  of  the  malleus  {q.v.)] 
atrophy  {q.v.). 

HI.  Middle  Ear  Affections. — Otitis 
media,  acute  or  chronic,  catarrhal  or  suppu- 
rative {q.v.)]  tubal  congestion  or  catarrh 
{q.v.)]  tubal  stricture  {q.v.)]  adenoids  and 
enlarged  tonsils;  paralysis  of  the  stapedius 
and  tensor  tympani  muscles  (usually  asso- 
ciated with  facial  paralysis). 

IV.  Labyrinth,  Acoustic  Nerve  and 
Brain  Affections. — Labyrinthitis  (g.  v.) ; 
labyrinthine  sclerosis  following  inflamma- 
tion; anaemia  of  the  labyrinth  {q.v.)]  con- 
cussion of  the  labyrinth  {q.v.)]  labyrinthine 
hemorrhage  {q.v.)]  Meniere’s  disease  {q.v.)] 
nephritis;  diabetes,  tuberculosis;  syphilis; 
rickets;  traumatism;  fright;  lightning  stroke; 
sunstroke ; sudden  immersion  in  water ; 
degeneration  and  atrophy  of  the  organ  of 
Corti  due  to  constant  noise,  as  in  copper- 
smiths and  boilermakers  (the  damage  comes 
through  air  conduction,  not  bone  conduc- 
tion, therefore  the  prophylactic  value  of 
an  air-free  stopper,  e.g.  a moist  pledget  of 
cotton  in  the  external  meatus) ; quinine, 
salicylate,  or  gas  poisoning;  infectious  dis- 
eases; congenital  defects  (due  to  parental 
consanguinity,  parental  deaf-mutism, 
maternal  shock  during  intra-uterine  life, 
congenital  syphilis) ; acoustic  nerve  paralysis 
{q.v.)]  hysteria;  neurasthenia;  lesions  of 
the  superior  convolution  of  the  temporal  lobe 
(word-deafness,  or  loss  of  memory  of  the 
meaning  of  words  heard,  results  from  de- 
struction of  the  superior  temporal  gyrus  on 
the  left  side),  internal  capsule,  corpora  qiiadri- 
gemina  and  geniculate  bodies,  and  pons,  e.g., 
tabes,  multiple  sclerosis,  hydrocephalus,  men- 
ingitis, hemorrhage,  traumatism,  aneurysm, 
inflammation,  and  tumors,  especially  tumors 
in  the  cerebello-pontine  recess;  senility, 
producing  sclerosis  of  the  auditory  artery  or 
nerve  atrophy. 

Diagnosis. — In  labyrinthine  and  nerve  deaf- 
ness, hearing  for  high-pitched  and  sharp 
sounds  is  impaired,  and  both  air  and  bone 
conduction  are  diminished,  the  latter  being 
usually  lost.  In  middle  ear  deafness,  air 
conduction  is  diminished  and  bone  conduc- 
tion increased  (consult  Examination  of  the 
Ear,  for  Hearing  Te.sts,  etc.). 

Deformed  Ears. — See  Auricle,  Congenital 
Malformations  of  the. 

Diffuse  Otitis  Externa. — See  Otitis  Ex- 
terna Diffusa. 

Diphtheritic  Otitis  Externa. — See  Otitis 

Externa  Membranosa. 


ECZEMA  AURIS 


Dizziness. — See  Verti{?o  in  Part  1. 

Drum  Membrane. — See  Membrana  Tym- 
j)ani. 

Dry  Type  of  Chronic  Aural  Catarrh. — Sec 

Otitis  Media  Catarrhalis  (Aironiea. 

Earache. — Causes.  — 1 . Inflammatory 
Earache — Otitis  media  acuta;  myringitis; 
otitis  externa;  otomycosis. 

2.  Non-Inflammatory  Earache;  Otal- 
gia.— “ Cold;  anaemia;  hyperaemia;  hysteria; 
neurasthenia;  sexual  derangements;  jieri- 
neuritis;  exostoses  in  the  interior  of  the 
cranium;  new  growths  and  inflammation  of 
the  Gasserian  ganglion;  trigeminal  neuralgia 
associated  with  herpes  zoster  of  the  face; 
Iirain  tumor;  caries  of  the  cranial  bones; 
caries  of  the  cervical  vertebrae;  carcinoma  in 
the  suiierior  maxilla,  the  retropharyngeal 
rc'gion  (the  tonsils,  the  laiynx),  or  the  tongue; 
carious  teeth,  and  eruption  of  the  molars 
(common  causes  in  children);  ulcers  in  the 
larynx,  and  in  the  neighborhood  of 
the  pharyngeal  orifice  of  the  eustachian 
tube  ; severe  noise ; possibly  syphilis  ” 
(Politzer);  qumsy. 

Otalgia  is  distinguished  from  an  inflam- 
matory earache  by  the  absence  of  inflam- 
matory phenomena. 

Treatment. — Consider  the  cause  {q.v.  in  its 
appropriate  alphabetical  place  and  part). 
Local  remedial  measures  embrace  vesicant 
applications  to  the  mastoid  process  (see 
under  Cantharides  in  Part  11);  belladonna 
p aster;  inunctions  of  opium  or  veratrum 
ointment;  galvanization  (the  anode  to  the 
ear  and  the  cathode  to  the  neck) ; repeated 
massage  “ in  those  cases  in  which  the  pain 
is  increased  upon  jrressure  between  the 
ramus  of  the  jaw  and  the  mastoid  process,” 
the  site  of  the  cartilaginous  portion  of  the 
eustachian  tube;  and  massage  of  the  tym- 
panic membrane  by  means  of  Lucae’s  probe 
(“highty  praised.”)  (Politzer.) 

Neuralgia  of  the  mastoid  may  be  due  to 
an  osteosclerosis  following  a chronic  middle 
ear  suppuration,  or  a successful  radical 
ojieration,  and  is  in  such  cases  relieved  by 
chiseling  away  a wedge-shajied  portion  of  the 
mastoid  bone.  (Politzer.) 

Politzer  mentions  as  possible  internal 
remedies  (see  Part  11  for  formulae,  etc.), 
(luinine,  sodium  or  potassium  iodide,  iodo- 
form, salicylates,  arsenic,  iron,  oil  of  turpen- 
tine, atropine,  zinc  oxide,  valerian,  asafadicla, 
hyoscyamus,  bromide,  antipyrine,  phena- 
cetin,  galbanum,  wines,  etc. 

Ear  Deformity. — See  Auricle,  Congenital 
Malformations  of  the. 

Examination  of  the. — See  Examination 
of  the  Ear. 


Ear,  External. — See  External  Auditory 
Meatus;  and  Auricle. 

Foreign  Bodies  in  the. — See  Foreign 
Bodies  in  the  Ear. 

Internal. — See  Labyrinth. 

Middle. — See  Otitis  Media. 

Protruding. — See  under  Auricle,  C'on 
genital  Malformations  of  the. 

Ringing  in  the. — See  Tinnitus  Aurium. 

Small. — See  Auricle,  Congenital  (Mal- 
formations of  the. 

Syphilis  of  the  External. — See  Otitis 
Externa  Syphilitica. 

Eczema  Auris. — Gr.  to  boil  out;  L. 

au'ris,  ear.  Eczema  is  an  acute,  subacute,  or 
chronic,  itching,  catarrhal  inflammation  of 
the  skin,  of  variable  character  (ei’ydhematous 
jiapular,  vesicular,  pustular,  squamous), 
with  usually  a sticky  oozing  or  weeping,  or  a 
history  of  such,  and  with  moi’e  or  less  epi- 
deiinic  thickening  and  a tendency  to  crust 
or  scale  formation. 

Etiology.— (a)  Constitutional:  Habitual 

overeating,  improper  or  insufficient  food, 
dyspepsia,  constipation,  obesity,  litha'inia, 
irregular  habits,  tuberculosis,  rickets, 
antemia,  general  debility,  physical  or  mental 
overwork,  shock,  neurasthenia,  hysteria, 
nerve  injuries,  asthma,  reflex  irritation  (den- 
tition, adherent  prepuce,  movable  kidney, 
uterine  disturbances,  etc.,  no  doubt  giving 
rise  to  nervous  irritability  and  resulting  im- 
pairment of  the  general  bodily  functions), 
nephritis,  diabetes  mellitus  and  insipidus, 
malaria,  intestinal  parasites. 

(b)  Local:  Irritating  applications,  cold, 

heat,  sea  air,  winds,  sunlight,  scratching, 
covering  the  ears,  pediculosis  capitis,  sebor- 
rlima  (q.v.),  otomycosis  (q.v.),  otorrhoea, 
chemical  irritants,  e.g.,  sulphur,  tar,  chrj'sa- 
1‘obin,  turpentine,  mercurials,  iodoform, 
benzine,  mustard,  lime,  paints,  dyes,  anti- 
sejitics,  polishing  materials,  pastes,  sugar 
flour,  tobacco,  acids,  alkalies,  strong  soap,  the 
excessive  use  of  water  and  soap,  etc. 

Treatment. — Enjoin  the  observance  of  cor- 
rect hygiene,  e.g.,  adequate  rest  and  exercise, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  a plain  but  nutrit'ous 
diet,  proper  bowel  activity,  fresh  air  day  and 
night,  avoiding  draughts,  and  adequate,  diy 
clothing.  The  following  articles  of  food 
should  be  avoided,  viz.,  jiork  in  any  fonn, 
salted  meats,  cooked-over  meats,  veal, 
” ganw  ” fowl,  crabs,  lobsters,  fried  foods, 
gravies,  pastries  and  cakes,  hot  breads,  hot 
griddle  cakes,  sweets  and  confections,  syrups, 
soups,  sauces,  cheese,  pickles,  condiments, 
spices,  sweet  potatoes,  Irish  jiotatoes,  cab- 
bage, fried  eggplant,  tomatoes,  oatmeal, 


EXAMIXATIOX  OF  THE  EAR  ' 


bananas,  apples,  tea,  coffee,  alcohol,  and 
tobacco.  The  diet  should  consist  chiefly  of 
bread  and  butter,  milk,  eggs,  fresh,  plainly 
cooked  vegetables,  fresh  flsh,  chicken  occa- 
sionally, with  other  meats  no  oftener  than 
once  or  twice  a week.  A glassful  of  hot 
water  containing  soda  bicarbonate,  gr.  xv, 
or  Vichy  shoukl  be  drunk  one  hour  before 
meals  and  between  meals  Potassium  ace- 
tate or  citrate,  gr.  x,  t.i.d.,  may  be  added. 

Soften  crusts  and  scales  with  a bland  oil 
(olive,  cottonseed,  or  almond)  for  a day  or 
longer,  and  remove  them  gently  with  the 
curette  or  forceps;  avoid  the  use  of  water. 
Then  apply  the  following  ointment: 


Acidi  salicyli gr.  vii-xii 

Adipis  lanse  liydrosi, 

Petrolati  mollis,  aa 5ss 


M.  Sig. — Apply  as  directed. 

In  chronic,  squamous  cases,  paint  the 
canal  or  external  skin  with  silver  nitrate 
solution,  10  to  20  per  cent.  Dench  recom- 
mends, for  clu’onic,  indurated  cases,  frequent 
but  cautious  applications  of  acetum  can- 
tharichs,  with  a cotton  mop,  until  the  indu- 
ration has  disappeared. 

Embolism,  Labyrinthine.— Gr.  eg/3oXos  plug. 
See  Labyrinthine  Hemorrhage,  at  the  end. 

Epidural  Abscess. — Gr.  kwi  on;  L.  dur'a, 
hard.  See  Abscess,  Brain. 

Epithelial  Plugs. — Gr.  Lri  on  + d-qXi] 
nipple.  See  Wax,  Inspissated. 

Eustachian  Catarrh.  — B.  Eustachi,  d. 
1574;  Gr.  Karappeiv  to  flow  down.  See 
Otitis  Media  Catarrhalis 
Catheterization.- — Gr.  Kaderrip.  See  In- 
flating the  Middle  Ear. 

Congestion. — L.  congerere,  to  heap 
together.  See  Otitis  Media  Catar- 
rhalis. 

Examination  of  the  Ear.^ — In  making  an 
otoscopic  examination,  straighten  the  canal 
by  pulling  the  auricle  outward,  backward 
and  upward  in  adults,  downward  in  infants 
and  children. 

Ascertain  the  mobility  of  the  mem- 
brane and  ossicles  by  means  of  Siegle’s  pneu- 
matic speculum. 

Hearing  and  Labyrinthine  Tests. — I.  Voice 
and  Watch  Tests.— In  performing  the  voice 
and  watch  tests,  blindfold  the  patient,  close 
the  ear  not  being  tested,  and  approach  the 
watch  or  voice  to  the  ear  until  it  is  heard. 
In  the  voice  test,  use  whispered  numbers  of 
two  figures,  producing  the  voice  sounds  with 
the  “ reserve  air  ” remaining  in  the  lungs 
after  a forced  inspiration  followed  immedi- 
ately by  a normal  expiration. 

Whisper  = ^o  means  whispered  voice 


heard  at  four  feet,  normal  hearing  distance, 
ten  feet. 

H.  W.  = means  watch  heard  at  twelve 
inches;  normal  distance,  forty  inches.  One 
may  use  the  Politzer  acoumeter  instead  of 
the  watch. 

H.  means  watch  heard  on 

40 

contact  with  the  auricle. 

H.  W.  = means  watch  heard  on 

40 

pressure  upon  the  auricle. 

If,  in  the  hearing  tests,  the  same  results 
are  obtained  when  both  ears  are  stopped  as 
when  only  the  sound  ear  is  stopped,  then  the 
defective  ear  is  totally  deaf. 

II.  Range  of  Hearing. — Ascertain  the  limits 
between  which  musical  notes  are  perceived, 
by  means  of  Dench’s  low-pitch  tuning  fork 
and  the  Galton  whistle.  The  normal  range 
of  hearing  is  from  about  16  to  about  48,000 
double  vibrations  per  second.  After  fifty 
years  of  age  the  upper  limit  is  reduced. 
Impairment  of  the  conducting  apparatus 
results  in  impairment  or  loss  of  hearing  for 
the  lower  tones  of  the  scale.  Impairment  of 
the  percejition  apparatus  results  in  loss  of 
hearing  for  the  high  tones. 

III.  Weber’s  Test. — A vibrating  tuning  fork 
(no  higher  than  C"),  ])laced  with  its  handle 
upon  the  teeth,  cliin,  or  cranium,  midway 
between  the  two  ears,  in  a case  of  unilateral 
deafness,  is  heard  best  in  the  deaf  ear  if  the 
disease  is  due  to  disease  of  the  conducting 
mechanism,  e.g.,  wax,  eustachian  occlusion, 
otitis  mecha,  etc.;  but  it  is  heard  best  in  the 
sound  ear  if  the  deafness  is  due  to  labyrin- 
thine or  nerve  chsease. 

IV.  Rinne’s  Test. — Normally  the  duration 
of  air  conduction  is  about  double  that  of 
bone  conduction. 

If  a vibrating  tuning  fork  (preferably  a'), 
placed  over  the  ma.stoid  process,  just  behind 
the  external  meatus,  until  it  is  no  longer 
heard,  is  then  at  once  placed  before  and  close 
to  the  ear,  with  a reappearance  of  the  sound, 
any  impairment  of  hearing  in  the  ear  tested 
is  located  in  the  internal  ear.  If  the  sound  is 
heard  best  by  bone  conduction,  the  impair- 
ment of  hearing  is  due  to  disease  of  the  con- 
ducting mechanism. 

Rinne-|-2^Q  means  tuning  fork  heard  for 
twenty-five  seconds  upon  the  mastoitl,  and 
fifty  seconds  close  to  the  meatus. 

Rinne — means  tuning  fork  heard  for 
thirty  seconds  upon  the  mastoid,  and  ten 
seconds  close  to  the  meatus. 

V.  Schwabach’s  Test. — Use  the  tuning  forks, 

C-'  (26  to  64  V.S.),  C (128  v.s.),  C'  (256  v.s.), 
C"  (512  V.S.),  C"  ' (1024  V.S.),  (2048  v.s.) 


EXOSTOSES  AND  HYPEROSTOSES 


In  the  normal  car  and  in  nerve  deafness, 
air  conduction  is  louder  than  bone  conduc- 
tion. In  disease  of  the  conducting  apparatus, 
the  reverse  is  true,  excepting  with  the  tuning 
fork  C^'',  when  the  two  are  about  equal.  The 
following  illustrative  tables,  taken  partly 
from  Alderton,  are  of  value  as  a diagnostic 
guide,  and  show  how  a record  should  be  made : 

C-'  C C'  C"  C”  ' C*'’ 

A. C.  22  25  15  33  32  22  seconds 

B. C.  12  13  7 13  13  14  seconds 

Average  normal  ear  (A.C.  = air  conduc- 
tion; B.C.  = bone  conduction). 

C-i  C C'  C"  C" ' C'lv 

A. C.  0 ' 8 8 13  15  13  seconds 

B. C.  14  14  11  17  16  14  seconds 

Typical  of  obstructive  trouble  in  the  con- 
ducting apparatus. 

C-i  P P'  P"  P"  ' Piv 

A. C.  12  17  18  21  15  10  seconds 

B. C.  4 6 7 6 4 2 seconds 

Typical  of  trouble  in  the  perceiving 
apparatus. 

VI.  The  Turning  Test. — The  patient,  wear- 
ing opaque  glasses,  is  seated  erect  upon  a 
revolving  chair,  and  turned  twice  toward  the 
ear  under  examination.  If  the  labyrinth  of 
this  ear  is  affected,  a prunary  nystagmus  will 
occur,  during  the  turning,  toward  the 
affected  ear.  In  the  normal  ear,  about  ten 
turnings  in  about  twenty  seconds  are  re- 
quired to  produce  this  reaction. 

The  quick  component  is  toward  the  af- 
fected ear  as  long  as  the  labyrinth  is  still 
functioning;  but  as  soon  as  complete  de- 
struction of  the  labyrinth  occurs,  the  quick 
component  swings  to  the  other  side,  where  it 
remains  for  three  or  four  days,  after  which 
it  gradually  disappears,  unless  some  com- 
plication such  as  meningitis  occurs,  when 
it  will  again  move  toward  the  affected 
side.  (Ballenger.) 

VII.  The  Caloric  Test. —The  introduction 
of  cold  or  hot  water  in  the  external  auditory 
canal,  with  the  head  upright,  causes  a 
nystagmus  toward  the  other  ear  if  cokl  is 
used,  toward  the  same  ear  if  hot  is  used.  The 
nystagmus  does  not  occur  if  the  vestibular 
api^aratus  or  nerve  is  destroyed  or  paralyzed. 

VIII.  The  Galvanic  Test. — One  electrode 
should  be  about  two  inches  square  and  fiat, 
and  the  other,  a small  ball  electrode,  about  a 
quarter-inch  in  diameter.  Both  electrodes 
should  be  wrapped  vsnugly  in  moist  cotton  or 
gauze.  The  patient  should  first  be  examined 
JPor  the  presence  of  a spontaneous  nystagmus. 


The  large  flat  electrode,  moistened  with 
warm  salt  solution,  is  held  in  either  hand  of 
the  patient,  while  the  ball  electrode,  also 
moistened  with  salt  solution,  is  applied  to 
the  tragus,  and  the  latter  pushed  into  the 
external  meatus.  The  patient  is  directed  to 
look  straight  ahead.  The  current  is  then 
slowly  applied. 

In  normal  ears,  about  four  milliamperes 
are  required  to  produce  nystagmus.  The 
cathode  produced  nystagmus  to  the  same 
side,  and  the  anode  to  the  opposite  side. 
(G.  W.  MacKenzie.) 

IX.  The  Fistula  Symptom. — Compression  of 
air  in  the  external  auditory  canal  produces 
nystagmus  and  vertigo  in  the  presence  of 
fistula  of  the  labyrinth,  and  also,  at  times,  in 
acute  middle  ear  inflammation  in  the  absence 
of  fistula. 

(See  the  Appendix  to  Part  7 for  a Schema 
for  the  Aural  History  and  Examination.) 

Exostoses  and  Hyperostoses  of  the  Ex= 
ternal  Auditory  Canal. — Gr.  out;  inrep  over; 

oarkov  bone.  Clinically,  a hyperostosis  is  a 
diffuse  bony  growth,  whereas  an  exostosis  is 
a circumscribed,  tumor-like  growth. 

Etiology. — Chronic  periostitis  secondary  to 
a long-standing  otorrhoea;  fracture;  caries; 
syphilis;  gout;  rheumatism;  sea-bathing; 
heredity.  The  cause,  however,  is  most  often 
not  ascertainable. 

Treatment. — When  the  only  consequence  of 
the  bony  stricture  is  deafness,  an  attempt 
should  be  made  to  open  the  canal  through 
pressure  by  the  long-continued  wearing  of  a 
metal  rod  between  the  growth  and  the  wall 
of  the  canal. 

To  remove  ceruminous  and  epidermic 
accumulations  from  behind  the  growth, 
insert  the  point  of  a small  tympanic  catheter, 
and  mject  by  means  of  a Pravaz  syringe 
about  ten  drops  of  a warm  solution  of  sodium 
bicarbonate,  gr.  xxv,  and  glycerine,  3i,  in 
water,  5 i-  The  next  day  syringe  with  warm 
water  through  the  catheter,  and  instil  a 
warm  alcoholic  solution  of  boric  acid,  gr.  xl 
to  the  ounce,  unless  acute  (not  chronic) 
inflammation  or  bone  caries  is  present, 
which  contraindicates  the  use  of  alcohol. 
For  the  removal  of  granulations,  see  Aural 
Polypi  and  Granulations. 

When  the  growth  causes  serious  retention 
of  pus,  it  should  be  removed.  The  auricle  is 
displacetl  forward,  the  lining  of  the  posterior 
wall  of  the  canal  dissected  away,  the  growth 
removed  with  the  mallet  and  chisel,  or  gouge, 
or  burr  driven  by  a dental  engine  the  hemor- 
rhage controlled,  the  retroauricular  wound 
sutured,  and  the  canal  filled  with  a strip  of 
iodoform  or  boric  acid  gauze.  A complicat- 


HEMATOMA  AUlllS 


ing  chronic  middle-ear  suppuration  calls  for 
the  radical  mastoid  operation. 

External  Auditory  Canal,  Abscess  in  the. 
— L.  exter'nus,  outside;  audir'e,  to 
hear;  candlis;  adhcer'ere,  to  stick 
to.  Sec  Otitis  Externa  Circum- 
scripta Acuta. 

Adhesions  of  the. — See  Stricture 
of  the  External  Auditory  Canal. 

Atresia  of  the. — See  Ati’esia  of  the 
External  Aiuhtoiy  Canal. 

Cerumen  in  the. — L.  ceru'men,  ear- 
wax.  See  Wax,  Inspissated. 

Eczema  of  the. — See  Eczema  Auris. 

Epidermal  Plugs  in  the. — Gr.  ewi 
ujxjn  + 5epiJ.a  skin.  See  Wax, 
Inspissated. 

Exostoses  of  the.^ — See  Exostoses 
and  Hyj)erostoses. 

Foreign  Bodies  in  the. — See  For- 
eign Bodies  in  the  Ear. 

Fungus  Invasion  of  the. — L.fung'us 
See  Otomycosis. 

Furunculosis  of  the. — L.  furuncu- 
lus,  a boil.  See  Otitis  Externa 
Circumscripta  Acuta. 

Granulations  in  the.  — See  Aural 
Polypi  and  Granulations. 

Hyperostoses  of  the. — Gr.  hwkp 
over  + barkov  bone.  See  Exos- 
toses and  Hyperostoses. 

Inflammation  of  the. — L.  inflam- 
ma're,  to  set  on  fire.  See  Otitis 
Externa. 

Mycosis  of  the.^ — See  Otomycosis. 

Occlusion  of  the. — L.  ocdu'sio, 
closure.  See  Atresia  of  the 
External  Auditory  Canal. 

Polypi  in  the. — See  Aural  Polypi 
and  Granulations. 

Seborrhoea  of  the.  — See  Sebor- 
rhoea  Auris. 

Stricture  of  the. — See  Stricture  of 
the  External  Auchtory  Canal. 

Syphilis  of  the.  — See  Otitis  Ex- 
terna Syphilitica. 

Wax  in  the. — See  Wax,  Inspissated. 

External  Mastoiditis.  — See  Mastoiditis 
Externa. 

Meatus. — L.  medhis,  passage.  See 
External  Auditory  Canal. 

Otitis. — See  Otitis  Externa. 

Extra=Dural  Abscess. — L.  ex'tra,  outside; 
dur'a,  hard.  See  Abscess,  Brain 

Facial  Paralysis. — L.  facies,  face ; Gr.  xapa 
I^eside  + \vtiv  to  loosen.  See  under  Otitis 
Media  Pur ulenta  Acuta;  and  Chronica;  and 
Mastoiflitis  Interna. 

Fistula,  Congenital. — L.  fist'ula,  pipe.  See 
Auricle,  Congenital  Malformations  of 
the. 


Fistula  Symptom. — See  Examination  of 
the  Ear. 

Foreign  Bodies  in  the  Ear. — If  much  in- 
flammation and  swelling  are  present,  first 
reduce  it  by  irrigations  with  warm  boric  acid 
solution,  etc.,  as  directed  under  Otitis 
Externa  Diffusa,  before  attempting  to 
remove  the  foreign  body.  If  the  latter  is 
likely  to  swell  (pea,  bean,  etc.),  pour  warm 
oU,  or  glycerine,  or  alcohol  into  the  canal 
before  syringing.  Insects  should  fii’st  be 
killed  by  drowning  in  oil;  maggots  by  a 
50  per  cent,  solution  of  chloroform. 

Place  the  patient  in  the  recumbent  posi- 
tion, with  the  head  hanging  somewhat  over 
the  edge  of  the  table,  draw  the  auricle  back- 
ward and  upward,  and  direct  a stream  of 
warm  water  between  the  foreign  body  and 
the  wall  of  the  canal. 

If  swinging  fails,  a fine  camel’s-hair  brash 
thpp,.-d  in  glue  may  be  brought  in  contact 
wffh  the  foreign  body,  which  has  first  been 
dried,  the  brush  left  in  place  until  the  glue 
has  hardened,  and  then  withdrawn. 

If  instrumentation  is  necessary,  try  first 
the  traction  hook  (it  can  be  made  from  a 
steel  hau'pin),  before  resorting  to  forceps. 
Employ  instruments  with  great  care, 
under  good  illumination.  An  anaesthetic  may 
be  required. 

The  galvano-cautery  has  sometimes  been 
employed  to  divide  the  foreign  body  before 
extracting  it. 

In  very  rare  instances  it  may  be  necessary 
to  detach  the  auricle  and  posterior  wall  of 
the  cartilaginous  canal  by  an  incision  behind 
the  pinna  close  to  the  canal. 

Fungus  Invasion  of  the  External  Auditory 
Canal. — L.  fun'gus;  in,  into  + vad'ere,  to  go. 
See  Otomycosis. 

Furunculosis  of  the  External  Auditory 
Canal.  — L.  Jurunculus,  boil.  See  Otitis 
Externa  Circumscripta  Acuta. 

Galvanic  Test. — A.  Galvani,  1737-1762. 
See  Examination  of  the  Ear. 

Granulations.  — See  Aural  Polypi  and 
Granulations. 

Haematoma  Auris.  ^ — Gr.  alpa  blood  -f 
-wpLa  tumor;  L.  aur'is,  ear.  A sudden  effusion 
of  blood  between  the  auricular  cartilage  and 
the  overlying  perichondrium,  due  to  trauma- 
tism, or  at  times  occurring  spontaneously 
(q)  in  the  insane.  It  is  opaque  by  trans- 
mitted light. 

Treatment.— Apply  ice-bags  or  a Leiter’s 
coil  until  the  pain  subsides,  then  apply 
liquor  plumbi  subacetatis  or  Burow’s  solu- 
tion (see  Part  11),  until  healing  occurs;  or 
paint  with  contractile  collodion  in  order  to 
exert  compression;  or  paint  with  cantharidal 
collodion  to  promote  absorption  (warmly 


INFLATING  THE  MIDDLE  EAR 


recommended  l)y  Hearder) ; or  employ  com- 
pression by  means  of  a bandage,  together 
with  massage;  or,  if  deemed  best,  make  an 
incision  under  local  cocaine  or  novocaine 
anaesthesia  (see  Part  11),  turn  out  the  clot, 
irrigate  with  sterile  normal  saline  solution 
(5i  ad  Oi)  or  boiled  boric  acid  solution 
(3iAv  ad  Oi),  and  suture,  leaving  a narrow 
gauze  drain  in  the  lower  angle  of  the  wound 
for  about  twenty-four  hours. 

Gentle  massage  may  be  employed  after 
healing  has  set  in. 

Hearing,  Artificial  Aids  to. — See  under 
Otitis  Media  Catarrhalis  Chronica; 
and  Otitis  Media  Purulenta  Chronica. 

Defective. — See  Deafness. 

Tests. — See  Examination  of  the  Ear. 

Hemorrhage,  Labyrinthine. — See  Laby- 
rinthine Hemorrhage. 

Hemorrhagic  Otitis  Externa. — See  Otitis 
Externa  Htemorrhagica. 

History,  Aural. — See  Schema  for  the 
Aural  History  ami  Examination,  in  the 
Appendix,  following  Pait  7. 

Hyperaemia  of  the  Labyrinth. — Gr.  bivkp 
over  -b  a'ya  blood;  \aj3vpLv9os.  Labyrinthine 
hyperremia  or  congestion  is  diagnosed  from 
the  following  association  of  symptoms,  viz., 
“ tinnitus,  dizziness,  a feeling  of  fullness  in 
the  ears  and  tightness  in  the  head,  nausea, 
unsteady  gait,  and  congestion  of  the  vessels 
along  the  handle  of  the  malleus.”  (Politzer.) 
It  is  tlistinguished  from  Meniere’s  disease 
iq.v.,)  by  the  rapid  subsidence  of  the 
symptoms  without  any  residual  disturbances 
of  hearing.  Irritation  of  the  acoustic  centre 
in  the  brain  produces  the  same  symptoms  as 
labyrinthine  hypertemia,  but  the  former 
condition  is  not  necessarily  associated  with 
hypenemia  of  the  drum  membrane. 

Etiology.— Acute  otitis  media;  the  exanthem- 
ata and  other  acute  infections,  e.g.,  typhoid 
fever,  pneumonia,  meningitis,  puerperal  in- 
fection, mumps,  encephalitis;  congestion  of 
the  head  in  goitre,  heart,  lung,  and  kidney 
affections;  tumors  at  the  base  of  the  brain 
causing  j^ressure  upon  the  veins  coming 
from  the  internal  meatus;  venous  throm- 
bosis; arteriosclerosis;  angioneurotic  conges- 
tion of  the  cranial  vessels;  rheumatism;  gout; 
severe  coughing,  sneezing,  or  blowing  of  the 
nose;  sudden  lowering  of  the  head;  mountain 
climbing;  sudden  overexertion;  exposure  to 
inclement  weather;  alcoholism;  a blow  on 
the  ear,  or  an  explosion ; prolonged  exposure 
to  sharp  sounds;  certain  drugs,  e.g.,  quinine, 
salicylates,  amyl  nitrite. 

Treatment.— C'orrect  the  cause,  if  possible. 

Rest  in  bed  with  the  head  raised,  purga- 
tion, diuresis,  cold  applications  to  the  head. 


alcoholic  embrocations  behind  the  ear,  the 
extraction  of  about  four  ounces  of  blood 
from  the  mastoid  by  means  of  the  artificial 
leech,  or  a wet-cup  (q.v.  in  Part  1)  to  the  nape 
of  the  neck,  and  warm  foot-baths  are  bene- 
ficial in  acute  cases.  In  chronic  cases,  the 
mastoid  may  be  painted  wdth  tincture  of 
iodine.  Pilocarpine,  gr.  3^  to  3^  by  mouth, 
twice  or  thrice  daily,  increased  until  a slight 
increase  of  the  cutaneous  and  salivarj'  secre- 
tions occurs,  is  recommended;  as  is  also 
potassium  iodide,  gr.  x,  well  diluted,  t.i.d. 
See  Part  11  for  all  drug  fonnulse,  etc. 

Strychnine  in  full  closes,  by  stimulating 
the  heart  and  blood  vessels,  is  useful  in 
relieving  local  venous  congestion. 

The  bromides  in  large  doses  are  useful 
for  the  relief  of  a distressing  tinnitus. 

In  the  angioneurotic  form  of  conges- 
tion, the  application  of  the  galvanic  cur- 
rent to  the  sympathetic  nerve  of  the  neck 
is  recommended. 

Enjoin,  as  prophylactic  measures,  a simple 
diet,  regulation  of  the  bowels,  regular  hours, 
daily  exercise  in  the  fresh  air,  frequent  bath- 
ing, and  the  avoidance  of  tea,  coffee,  alcohol, 
and  tobacco. 

Hyperostosis  of  the  External  Auditory 
Canal. — See  Exostoses  and  Hyperostoses. 

Hyperplastic  Aural  Catarrh. — Gr.  virkp 
over  -)-  TrXdcrts  formation.  See  Otitis  Media 
Catarrhalis  Chronica. 

Hypertrophic  Aural  Catarrh. — Gr.  virep 
over  -b  Tpo(j)r,  nutrition.  See  Otitis  Media 
Catarrhalis  Chronica. 

Impacted  Cerumen. — L.  impacius,  wedged; 
ceni'men,  ear-wax.  See  Wax,  Inspissated. 

Inflammation  of  the  Auricle. — L.  inflam- 
mdre,  to  set  on  fire.  See  Perichon- 
dritis Auriculae. 

Eustachian  Tube. — See  Otitis  IMedia 
Catarrhalis. 

External  Auditory  Canal. — See  Otitis 
E.xterna. 

Labyrinth. — See  Labjuinthitis. 

Mastoid. — See  Mastoiditis. 

Membrana  Tympani. — See  IMyringitis. 

Middle  Ear. — See  Otitis  Media. 

Inflating  the  Middle  Ear. — l.  Valsalva’s 
Method.— Close  the  mouth  and  nose  and  then 
attempt  to  blow  through  the  closed  nose. 

2.  Politzer’s  Method.— Have  the  patient  take 
a small  quantity  of  tvater  in  the  mouth,  and 
then  hold  the  nozzle  of  a Politzer  bag  in  one 
nostril  while  closing  the  other  with  the 
finger.  Then  tell  the  patient  to  swallow, 
and  as  soon  as  the  laiynx  is  seen  to  rise, 
quickly  compress  the  bag. 

3.  Catheterization  of  the  Eustachian  Tube. — 
Pass  the  catheter  along  the  floor  of  the  nose^ 


LABYRINTHINE  HEMORRHAGE  OR  APOPLEXY 


beak  downward,  until  the  latter  touches  the 
posterior  wall  of  the  pharynx;  then  rotate 
it  inward  through  an  angle  of  45  degrees, 
draw  it  forward  until  the  beak  impinges 
upon  the  posterior  edge  of  the  septum,  then 
rotate  it  outward  through  an  angle  of  a little 
over  90  degrees,  when  it  should  be  at  the 
mouth  of  the  Eustachian  tube. 

Another  method  is  as  follows:  Introduce 
the  catheter,  beak  downward,  close  to  the 
septum  and  gently  hugging  the  floor  of  the 
nose,  until  the  beak  is  felt  to  slip  down  over 
the  soft  palate.  Then,  avoiding  forward 
traction,  rotate  the  catheter  until  the  ring 
points  toward  the  outer  canthus  or  pupil 
of  the  eye,  when  it  should  be  at  the  mouth 
of  the  Eustachian  tube. 

It  may  be  best  to  precede  the  catheteriza- 
tion by  a spray  of  cocaine,  4 per  cent.  The 
catheter  should  be  warmed  and  lubricated 
with  sterile  vaseline  before  insertion. 

By  means  of  the  auscultation  tube,  one 
end  of  which  is  placed  in  the  physician’s  ear 
and  the  other  end  in  the  ear  under  examina- 
tion, there  is  heard,  during  inflation  of  the 
normal  ear,  a soft,  dry,  blowing  sound  with 
a metallic  click  or  snap.  If  fluid  is  present, 
crackling  rales  are  heard.  If  the  drum 
membrane  is  perforated,  a whistling  sound 
is  heard. 

Injuries  of  the  Labyrinth. — See  Concus- 
sion of  the  Labyrmth. 

Injuries  of  the  Membrana  Tympani. — 

Etiology. — Fracture  of  its  supporting  bone; 
foreign  bodies,  such  as  pins,  wood,  ear- 
spoons,  instrmnents,  etc.;  caustics;  hot 
fluids;  violent  coughing,  vomiting,  or  sneez- 
ing; violent  inflation  of  the  tympanima  by 
Politzer’s  method;  Siegle’s  otoscope;  box 
on  the  ear;  explosion;  diving;  sea  bathing. 

The  prognosis  is  good  if  the  labyrinth  is  not 
involved  (see  Concussion  of  the  Labyrinth), 
and  if  infection  does  not  supervene. 

Treatment.— Some  advise  that  a sterile  cot- 
ton or  gauze  tampon  be  placed  in  the  meatus, 
and  the  patient  kept  absolutely  quiet  on  a 
low  cUet  for  a few  days,  no  drops  or  syringing 
being  employed.  Dench,  however,  advises 
syringing  with  warm  bichloride  solution, 
1 : 6000,  at  first  every  two  hours,  and  later 
less  often  as  the  sero-sanguinolent  discharge 
diminishes.  See  Concussion  of  the  Laby- 
rinth, for  the  symptoms  and  treatment  of 
this  complication. 

Inspissated  Wax. — See  Wax,  Inspissated. 

Internal  Ear. — L.  inter' nus.  See  Laby- 
rinth. 

Mastoiditis. — See  Mastoiditis  Interna. 

Ionic  Medication. — See  Part  1,  General 
Medicine  and  Surgery. 


Ischsemia,  Labyrinthine. — Gr.  tcrxeu/  to 
hold  back  + ai/xa  blood.  See  Anaemia  of 
the  Labyrinth. 

Keratosis  Obturans. — Gr.  Ktpas  horn;  L. 
ob'mrans,  obstructing.  See  Wax,  Inspissated. 

Labyrinthine  Anaemia. — Gr.  \a^vpivdos. 
See  Anaemia  of  the  Labyrinth. 

Apoplexy. — Gr.  aTro-irXri  ^ia.  See  Laby- 
rinthine Hemorrhage. 

Concussion. — See  Concussion  of  the 
Labyrinth. 

Congestion. — L.  congestio,  from  con- 
ger'ere,  to  heap  together.  See  Hyper- 
aemia  of  the  Labyrinth. 

Embolism  and  Thrombosis. — Gr. 

ep^oXos  plug;  dpop^os  clot.  See  Laby- 
rinthine Hemorrhage. 

Labyrinthine  Hemorrhage  or  Apoplexy. — 
Gr.  aipa  blood  + ppyvvvai  to  burst  forth  ; 
anoTrXri^La  stroke.  Labyrinthine  hemorrhage 
may  occur  in  any  condition  which  produces 
labyrinthine  hyperaemia  (q.v.),  in  infectious 
diseases,  pachyineningitis  haemorrhagica, 
anaemia,  leukaemia,  nephritis,  diabetes,  gout, 
rheumatism,  arteriosclerosis,  cranial  fracture 
or  concussion,  a sudden  loud  sound  or  ex- 
jilosion,  embolism  of  the  internal  auditory 
artery,  sudden  exertion,  forcible  inflation  of 
the  middle  ear,  severe  coughing  or  sneezing, 
holchng  the  breath  overlong,  lowering  the 
head  too  long,  mobilization  or  removal  of 
the  stapes. 

It  is  manifested  by  the  sudden  occurrence 
of  marked  giddiness,  nausea,  tinnitus,  and 
labyrinthine  deafness  (see  Deafness),  some- 
times unconsciousness. 

More  or  less  restoration  of  function  may  be 
looked  for,  but  also  recurrences  of  the  hemor- 
rhage, which  should  be  guarded  against. 

Treatment.— Absolute  rest  in  bed  in  a quiet 
rooni,  with  the  head  raised,  and  an  ice-cap 
applied,  is  imperative.  Open  the  bowels 
freely  by  means  of  calomel  followed  by 
a saline  (see  Part  11),  and  extract  at  least 
four  ounces  of  blood  from  the  mastoid  by 
means  of  the  artificial  leech  or  wet-cup  (q.v. 
in  Part  1),  unless  the  patient  is  anaemic. 

After  the  acute  symptoms  have  subsided, 
aim  to  promote  absorption  by  the  adminis- 
tration of  pilocarpine  by  mouth,  gr.  3^  to  3-^ 
twice  or  thrice  daily,  increased  rapidly  until 
slight  sweating  and  salivation  are  produced, 
and  then  continued  for  two  or  more  months, 
if  necessary.  Potassium  iochde,  gr.  x,  well 
diluted,  t.i.d.  may  be  given  subsequently. 
Tincture  of  iodine  or  vesicants  may  be  aj> 
plied  to  the  mastoid.  (See  Drugs,  Part  11). 

Enjoin,  prophylactically,  a simple  chet, 
regulation  of  the  bowels,  regular  hours, 
daily  exercise  in  the  fresh  air,  frequent  bath- 


MASTOIDITIS  EXTERNA 


ing,  and  the  avoidance  of  tea,  coffee,  alcohol, 
and  tobacco. 

(Embolism  or  thrombosis  of  the  labyrinth- 
ine vessels  occurring  in  septicaemia  is  treated 
the  same  as  hemorrhage.) 

Labyrinthine  Hyperaemia.  — See  Hyper- 
aemia  of  the  Labyrinth. 

Inflammation. — L.  inflamrna're  to  set 
on  fire.  See  Labyrinthitis. 

Injuries. — See  Concussion  of  the  Laby- 
rinth. 

Ischaemia. — Gr.  I'crxeu'  to  hold  back  -f- 
atna  blood.  See  Anaemia  of  the 
Labyrinth. 

Thrombosis. — Gr.  dpon^os  clot.  See 
Labyrinthine  Hemorrhage. 

Traumatism. — Gr.  rpavpa  wound.  See 
Concussion  of  the  Labyrinth. 

Labyrinthitis. — Gr.  Xa^vpivOos  d — ltls  in- 
flammation. Acute,  prunary  labyrinthitis 
occurs  in  children  in  scarlet  fever,  measles, 
chphtheria,  mumps,  typhoid  fever,  typhus 
fever,  variola,  vaccinia,  chicken-pox,  influ- 
enza, erysipelas,  dysentery,  whooping-cough, 
pneumonia,  cerebrospinal  meningitis,  ma- 
laria, rheumatic  fever,  etc. 

It  “ arises  suddenly  with  fever,  marked 
redness  of  the  face,  and  vomiting,  which  are 
soon  followed  by  unconsciousness,  delirium, 
and  convulsions.”  “ These  symptoms  dis- 
appear completely  within  a few  days  (as 
distinguished  from  meningitis),  but  total 
deafness,  tinnitus,  and  a staggering  gait 
remain  for  some  tune  ” (Politzer).  Syphilis 
is  also  a cause  of  primary  labyrinthitis, 
which  may  appear  suddenly  with  tinnitus, 
dizziness,  and  marked  deafness,  but  no 
vomiting  or  severe  vertigo,  and  slight  or 
absent  tlisturbance  of  equilibrium. 

Secondary  labyrinthitis,  supijurative  or 
non-suppurative,  occurs  in  acute  and  chronic 
suppurative  and  non-suppurative  otitis 
media.  It  is  commonest  in  children.  The 
s,\miptoms  are  sudden  giddiness,  tinnitus, 
nystagmus  (q.v.),  and  deafness  (ui:)per  tone 
Ihnit  lowered;  bone  conduction  diminished 
or  absent,  see  Hearing  and  LabjTinthine 
Tests,  under  Examination  of  the  Ear). 

Suppurative  labyrinthitis  may  be  dis- 
tinguished from  cerebellar  abscess  as  follows : 
In  sup[)urative  labjuinthitis,  “ the  nystag- 
mus becomes  less  and  less  marked,  and 
finally  (hsappears  as  the  suppuration  ex- 
tends; while  in  cerebellar  abscess  it  increases 
as  the  disease  progres.ses.”  “ In  suppura- 
tion of  the  labyrinth,  nystagmus  occurs  in 
the  beginning,  when  the  eye  is  turned  toward 
the  diseasetl  side;  whereas  the  strabismus 
may  disappear  and  the  nystagmus  still  be 
present  when  the  eye  is  turned  to  the 


unaffected  side.”  “In  cerebellar  abscess  the 
conditions  are  reversed,  and  the  nystagmus 
is  fir.st  observed  when  the  quick  component 
is  to  the  normal  side,  and  is  later  to  the  dis- 
eased side.”  “ When  this  form  of  nystag- 
mus is  observed  a positive  diagnosis  of 
cerebellar  abscess  may  be  made.”  “ The 
diagnosis  may  be  made  in  many  cases  with- 
out the  foregoing  objective  signs  by  the 
presence  of  pronounced  deafness,  tinnitus, 
vertigo,  and  headache.”  (Ballenger.) 

See  also  Hearing  and  Labyrinthine  Te.sts. 

Treatment. — In  the  early  stage  of  acute, 
non-suppirrative  labyrinthitis,  enjoin  abso- 
lute rest  in  bed  in  a quiet  room,  with  the 
head  raised,  and  an  ice-cap  or  Leiter’s  coil 
applied;  extract  about  two  to  four  ounces 
of  blood  from  the  mastoid  region  by  means 
of  the  artificial  leech  or  wet-cup  (q.v.  in 
Part  1),  and  achninister  divided  doses  of 
calomel  followed  by  a saline  (see  Part  11). 
Syphilis,  of  course,  calls  for  specific  treat- 
ment (see  Syphilis,  in  Part  1,  on  General 
Medicine  and  Surgery). 

After  the  acute  symptoms  have  subsided, 
administer  pilocarpine  by  mouth,  gr.  Ve  to 
3^,  twice  or  thrice  daily,  and  increase  the 
dose  imtil  a slight  increase  of  perspiration 
and  saliva  occurs;  then  continue  the  physio- 
logical dose  for  two  months  or  longer,  with 
the  object  of  promoting  absorption  of  the 
inflanmiatory  exudate.  Potassium  iochde, 
gr.  X,  well  chluted,  t.i.d,  may  be  given  sub- 
sequently. Strychnine  should  be  given  in 
full  doses,  gr.  3^o  t.i.d.,  increased  to  gr.  3^o 
fo  Hsj  t.i.d.  (see  Drugs,  Part  11),  when 
the  acute  sjanptoms  have  disappeared. 
Apply  also,  by  inunction,  unguentum  iodi 
(q.v.)  to  the  mastoid  region.  Forbid  the 
excessive  use  of  alcohol  and  tobacco,  qui- 
nine, salicylates,  overeating,  and  fatigue. 
As  a form  of  massage,  Dench  recommends 
reading  distinctly  to  the  patient  for  ten  to 
fifteen  minutes  twice  daily,  or  the  use  of 
the  phonograph,  vibrophone,  or  vibrometer. 
For  distressing  tinnitus,  prescribe  bromides. 

Suppurative  lab^'rinthitis  demands  the 
radical  meato-mastoid  operation. 

Prognosis.— The  prognosis  in  regard  to  hear- 
ing is  not  very  favorable  in  meningitic  cases ; 
it  is  more  favorable  in  other  cases;  it  is  bad 
in  suppurative  cases.  In  children,  proper 
measures  should  be  taken  against  deaf- 
mutisni  (q.v.). 

Malformations,  Congenital,  of  the  Auricle. 

— See  Auricle,  Congenital  Malformations 
of  the. 

Mastoiditis  Externa. — ^Gr.  paaros  breast 
-|-  ddos  form  + -ins  inflammation;  L. 
exier'nus,  outside.  Primary  acute  inflamma- 


MASTOIDITIS  INTERNA 


tion  of  the  mastoid  periosteum  is  very  rare. 
The  hearing  is  usually  normal,  which  dis- 
tinguishes the  affection  from  mastoiditis 
externa  due  to  otitis  media. 

Etiology.—"  Cold  furunculosis  of  the  ex- 
ternal meatus;  etc. 

Treatment  — Apply  the  artificial  leech  in 
the  early  stage  of  the  inflammation,  followed 
by  the  ice-bag  or  Leiter  cold  coil.  If  no 
relief  ensues,  make  a free  incision  down  to 
the  bone.  If  the  latter  is  carious,  remove 
the  dead  bone  with  chisels  and  gouges. 

Mastoiditis  Interna. — Gr.  /xacrTos  breast  + 
eldos  form  fi-  -trts  inflammation;  L.  inter' nus 
inside.  The  occurrence  of  internal  mas- 
toiditis as  a primary  affection,  due  to  " cold,” 
influenza,  pnemnococcus  infection,  tubercu- 
losis, syphilis,  traumatism,  otitis  externa, 
etc.,  is  very  rare;  it  is  nearly  always  second- 
ary to  acute  or  chronic  suppurative  otitis 
media.  Normal  hearing  would  point  to 
primary  mastoid  disease. 

Symptomatology. — Pain,  persistent  or  remit- 
tent, somethnes  not  a prominent  sjnnptom; 
tenderness  (in  pressing  upon  the  mastoid  to 
elicit  tenderness,  do  not  touch  the  auricle, 
for  in  otitis  externa  the  auricle  is  very  sensi- 
tive; remember  also  that  pressm’e  just 
beneath  the  mastoid  tip  produces  pain  in 
normal  individuals);  distinct  periosteal 
thickening  (osteitis),  revealed  by  touch; 
local  elevation  of  temperature ; general  eleva- 
tion of  temperature,  often  low ; local  swelling 
sometimes;  marked  bulging  of  the  drum 
membrane,  or  if  the  latter  is  perforated,  often 
a nipple-like  projection  in  the  posterior 
superior  quadrant;  bulging  perhaps  of  the 
posterior  superior  wall  of  the  bony  meatus 
(an  absolute  indication  for  opening  the  mas- 
toid cells) ; profuse  mucopurulent  aural  dis- 
charge; sudden  cessation  or  diminution  of  the 
aural  discharge;  facial  paralysis  sometimes. 

Possible  Consequences. — Spontaneous  recov- 
ery; abscess  formation;  carionecrosis  of  bone; 
spontaneous  perforation  through  the  external 
cortex;  extradural  abscess,  manifested  by 
localized  headache,  moderate  elevation  of 
temperature,  perhaps  choked  disc,  no  ce- 
phalic rigidity,  vomiting,  or  photophobia; 
brain  abscess,  manifested  by  headache,  men- 
tal torpidity,  asthenia,  constant  low  tem- 
perature, perhaps  motor  or  other  focal 
sjTnptonis  of  irritation  or  destruction, 
perhaps  vomiting  and  choked  disc;  menin- 
gitis, manifested  by  intense  headache,  photo- 
phobia, constant  high  temperature,  rapid 
pulse,  rigichty  of  the  neck,  nausea  and  vomit- 
ing, choked  disc,  and  local  paralyses,  particu- 
larly strabismus;  sigmoid  sinus  phlebitis, 
manifested  by  a septic  temperatm-e,  with 
45 


wide  fluctuations,  sweats,  prostration,  per- 
haps choked  disc,  tenderness  and  swelling 
along  the  internal  jugular  vein  if  the  latter 
becomes  involved;  burrowing  of  pus  be- 
neath the  deep  fascia  of  the  neck,  giving 
rise  to  septico-pysemia  or  a post-pharyngeal 
abscess;  septico-pysemia. 

Several  of  the  above  complications 
may  occur  together;  they  demand  unme- 
diate operation. 

Prognosis.— This  is  usually  favorable  in 
simple,  micom plicated  cases;  less  favorable 
in  those  cases  associated  with  influenza, 
measles,  scarlet  fever,  diphtheria,  typhus 
fever,  streptococcus  infection,  tuberculosis, 
syphilis,  and  diabetes. 

Treatment. — A.  When,  in  the  course  of  an 
acute  otitis  media,  the  drmn  membrane 
appears . greatly  congested,  swollen,  and 
bulging,  and  there  is  pain  and  tenderness  .in 
the  mastoid  region,  the  membrane  should  be 
freely  incised,  as  directed  under  Otitis 
Media  Pm’ulenta  Acuta,  and  the  ear 
should  be  frequently  irrigated  with  warm 
bichloride  solution,  1 : 8000  to  4000,  or 
saturated  boric  acid  solution  (4  per  cent.). 
It  is  customary,  in  the  first  or  hypersemic 
stage  only,  to  apply  cold  to  the  mastoid  con- 
tinuously, preferably  by  means  of  siphonage 
through  a Leiter’s  coil.  The  coil  should  be 
kept  on  no  longer  than  from  thirty-six  to 
forty-eight  hours,  since  it  may  mask  im- 
portant symptoms;  audit  should  never 
be  reapplied  after  having  been  removed. 
Gleason  advocates  the  application  of  heat 
instead  of  cold.  It  is  also  commonly  ad- 
vised that  not  less  than  four  ounces  of 
blood  be  extracted  by  means  of  the  artificial 
leech  applied  over  the  antrum  and  tip  of  the 
mastoid  (the  antrum  is  just  above  and 
behind  the  external  meatus).  Theobald  and 
Dench,  among  others,  think  little,  however, 
of  blood-letting  and  cold  applications. 

The  patient  should  be  kept  in  bed,  on 
liquid  diet,  and  calomel  should  be  admin- 
istered in  small,  frequently  repeated  doses 
followed  by  a saline  (see  Part  11  for  all 
drugs).  Theobald  has  great  faith  in  sodium 
pyrophosphate  (q.v.)  as  an  anti-suppurant, 
and  also  recommends  mercury  for  its  con- 
stitutional effects,  viz.,  calomel,  gr.  34  fo  3^ 
every  hour  or  two,  and  inimctions  of 
unguentum  hydrarg;yTi  (q.v.).  Mercury 
should  not  be  given,  however,  to  cachectic 
or  strumous  patients.  Tincture  of  aconite, 
in  one-drop  doses  (see  Part  11),  is  also  advo- 
catetl  for  the  early  stage,  when  the  pulse  is 
hard  and  full.  Bier’s  hyperaemic  treatment 
is  still  sub  judice. 

By  these  measures  the  mastoid  inflamma- 


MENIERE’S  disease 


tion  may  possibly  be  checked  in  from  three 
to  eight  days.  In  cases  of  influenza,  diph- 
theria, scarlet  fever,  tuberculosis,  and  syph- 
ilis, however,  abscess  formation,  it  is  said, 
can  seldom  be  checked,  and  the  mastoid  cells 
should  be  opened  early,  before  extensive 
destruction  of  bone  occurs. 

If,  after  several  days’  trial  (about  eight 
days — Politzer),  the  antiphlogistic  treat- 
ment proves  of  no  avail,  “ if  the  profuse 
otorrhoea,  pain  in  the  mastoid,  and  fever 
continue,  and  especially  if  the  evening  ex- 
acerbations of  fever  do  not  cease,  or  symp- 
toms of  a labyrinthine  (nausea,  vomiting, 
dizziness,  disturbance  of  equilibriiun,  nystag- 
mus) or  meningeal  irritation  (nausea,  vom- 
iting, severe  headache),  or  chills  occur  ” 
(Politzer),  the  mastoid  process  must  immedi- 
ately be  opened.  A complete  operation 
with  obliteration  of  all  of  the  mastoid  cells 
should  be  done  in  every  case. 

“ Wlien  the  temperature  remains  elevated 
after  the  mastoid  cells  have  been  opened,  one 
can  be  fairly  confident  that  some  complication 
exists,  possibly  a pneumonia,  or  thrombosis 
‘of  the  .sigmoid  sinus,  or  other  intracranial 
chsease,  or  erysipelas.”  (Gorham  Bacon.) 

It  should  be  borne  in  mind  that  the  diag- 
nosis of  mastoiditis  does  not  necessarily  call 
for  a mastoidectomy.  The  latter  operation 
is  indicated  only  when  it  is  quite  clear  that 
the  mastoid  inflammation  has  gone  on  into 
abscess  formation. 

B.  In  chronic,  persistent  middle  ear  sup- 
puration, the  inchcations  for  the  radical 
meato-mastoid  or  Stacke-Schwartze  opera- 
tion are,  according  to  Politzer,  the  following: 

Caries  of  the  temporal  bone;  fistula?  on 
the  mastoid  process,  in  the  osseus  meatus, 
or  at  the  posterior -superior  margin  of  the 
membrana  tympani  associated  with  per- 
sistent antral  suppuration;  persistent  fetid 
middle  ear  suppuration;  recurrent  polyposis 
arising  from  the  attic  and  antrum;  persistent 
cholesteatoma  in  the  middle  ear ; intractable 
stricture  of  the  external  meatus ; facial  nerce 
paresis;  persistent  pyrexia  or  a septic  fever; 
inter-current  acute  abscess  formation  in  the 
mastoid ; the  occurrence  of  severe  headache, 
nausea  and  vomiting,  pointing  to  cerebral 
involvement;  choked  optic  disc;  the  occur- 
rence of  dizziness,  nystagmus,  nausea,  stag- 
gering gait,  profound  deafness  (see  Hearing 
and  Labyrinthine  Tests),  indicative  of  laby- 
rinthine suppuration ; persistent  or  oft-recur- 
ring pains  and  localized  headaches.  (Mastoid 
neuralgia  may  be  caused  by  osteosclerosis, 
following  chronic  mastoiditis,  and  is  relieved 
by  the  removal  of  a wedge  of  bone  from  the 
m astoid  process . — Schwar tze) . 


The  radical  meato-mastoid  or  Schwartze- 
Stacke  operation  aims  to  convert  the  “cavum 
tympani,  the  attic,  and  the  antrum  into 
one  common,  smooth-edged,  open  cavity  by 
the  removal  of  the  posterior  superior  wall 
of  the  osseous  meatus  and  the  external  attic 
wall,  and  furthermore  to  induce  the  surface 
of  the  wound  to  become  covered  with  epi- 
dermis and  to  cicatrize  by  proper  after- 
treatment.”  (Politzer.) 

The  hearing  frequently  gets  worse  after 
the  operation. 

Meatus, — L.  for  passage.  See  External 
Auditory  Canal. 

Mechanical  Aids  to  Hearing. — See  under 
Otitis  Media  Chronica,  Catarrhalis,  et 
Purulenta. 

Membrana  Tympani,  Inflammation  of  the. 

— L.,  membrane  of  the  drum.  See 

Myringitis. 

Injuries  of  the. — See  Injuries  of  the 
Membrana  Tjunpani. 

Perforations,  Closure  of. — See  under 
Otitis  Media  Purulenta  Chronica. 

Membranous  Otitis  Externa. — See  Otitis 
Externa  Membranosa. 

Meniere’s  Disease. — IMeniere’s  disease  is 
due  to  an  exudation  into  the  semicircular 
canals,  and  is  characterized  by  sudden 
momentary  loss  or  impairment  of  conscious- 
ness, labjTinthine  deafness  {q-v.),  usually 
bilateral,  severe  tinnitus,  nausea,  vomiting, 
vertigo,  and  a staggering  gait.  No 
other  paralyses  than  that  of  the  au(htorj' 
nerve  terminals  are  observ'ed,  which 
eluninates  apoplexy. 

An  increase  of  pressure  in  the  labjTinthine 
fluid,  resulting  from  the  forcing  inward  of 
the  stapes  due  to  intermittent  closure  of  the 
Eustachian  tube  in  middle  ear  disease,  or 
resulting  from  the  pressure  of  cerumen 
against  the  drumhead,  is  manifested  by 
vertigo,  disturbance  of  equilibrium,  nausea, 
tinnitus,  and  some  deafness,  but  such  cases 
are  perhaps  not  properly  classified  under 
IMeniere’s  disease  (see  also  Vertigo.) 

Assigned  Causes.— Intense  heat;  nephritis; 
gout;  diabetes;  pernicious  anaemia;  leu- 
kaemia; purpura;  chlorosis;  arteriosclerosis; 
thyroid  intoxication;  intestinal  intoxication; 
syphilis;  chemical  poisons:  alcohol,  tobacco, 
arsenic,  quinine,  salicylates;  acute  infectious 
diseases:  influenza,  mumps,  meningitis, 

etc.;  labjTinthitis;  cranial  traumatism; 
hereditarx'  malformation  of  the  internal  ear; 
tabes  dorsalis,  multiple  sclerosis,  tmnors, 
abscess,  and  other  diseases  of  the  central 
nervous  system;  angioneurotic  oedema  {q.  v.). 

Prognosis.— This  is  unfavorable  in  regard  to 
the  deafness.  The  dizziness  gradually  dis- 


MYRINGITIS 


appears  within  a few  weeks  or  months.  The 
tinnitus  and  staggering  gait  may  or  may  not 
persist  for  years.  Relapses  may  occur. 

Treatment.— Put  the  patient  to  bed  in  a 
quiet  room  with  the  head  moderately  raised, 
and  an  ice-cap  or  Leiter’s  coil  apphed.  Paint 
tinctime  of  iochne  behind  the  ears,  or  apply 
blisters  (see  Part  11).  Open  the  bowels  with 
calomel,  in  small,  frequently  repeated  doses 
followed  by  a saline.  Prescribe  a restricted, 
liquid  diet,  and  forbid  tea,  coffee,  and  alco- 
hol. For  the  relief  of  the  head  symptoms, 
prescribe  bromides,  gr.  xx,  well  diluted,  t.i.d. 
(see  Drugs,  Part  11).  Babinski  recommends 
lumbar  puncture  {q.v.  m Part  1,  on  General 
Medicine  and  Simgery). 

After  the  acute  symptoms  have  subsided 
(in  the  second  or  third  week  of  the  attack, 
says  Politzer)  give  pilocarpine,  gr.  to  % 
by  mouth,  twice  or  thrice  daily,  and  increase 
the  dose  rapidly  until  a slight  increase  of 
perspiration  and  saliva  is  produced,  then 
continue  the  physiological  dose  for  two 
months  or  longer,  for  the  purpose  of  pro- 
moting absorption  of  the  exudate  (Dench). 
Potassium  iodide,  gr.  x,  well  diluted,  t.i.d. 
may  be  subsequently  prescribed.  Stiych- 
nine  should  be  given  in  full  doses,  gr. 
t.i.d.,  increased  to  gr.  3^q  fo  t.i.d. 
after  the  acute  symptoms  have  subsided. 

Four  to  ten  drops  of  a warm  sterile  2 per 
cent,  solution  of  pilocarpine,  or  eight  to 
ten  drops  of  a warm  solution  of  potassium 
iodide,  0.3  : 20.0,  may  be  injected  into  the 
tympanic  cavity  through  the  Eustachian 
catheter  {q.v.)  every  second  day  for  three 
or  four  weeks;  and  unguentum  iodi  applied 
by  inunction  to  the  mastoid  process. 
(Politzer.) 

“ Rarefaction  of  the  air  in  the  external 
meatus  is  an  important  therapeutic  meas- 
ure.” (Politzer.) 

Politzer  recommends,  in  those  cases  in 
which  Meniere’s  symptoms  appear  in  par- 
oxysms with  warning  signs,  that  the  patient 
carry  about  with  him  a “ rubber  tube  one- 
third  metre  long,  the  one  end  of  which  can 
be  hermetically  introduced  into  the  external 
meatus;  when  the  patient  has  the  sensation 
of  an  approaching  attack,  he  can  take  the 
other  end  of  the  tube  in  his  mouth,  and  by 
repeatedly  aspirating  he  can  rarify  the  air 
in  the  external  meatus.” 

Any  possible  etiological  influence  should 
be  combated;  nasal  and  ocular  defects 
should  be  treated  (consult  the  appropriate 
part  and  caption). 

Meningitis. — Gr.  iivr/Ly^  membrane  -|-  -tm 
inflammation.  See  under  Mastoiditis  In- 
terna. 


Microtia. — Gr.  tuKpos  small  -\-  ovs  ear. 
See  Auricle,  Congenital  Malformations  of  the. 

Middle  Ear  Diseases. — See  Otitis  Media. 

Middle  Ear,  Inflating  the. — See  Inflating 
the  Middle  Ear. 

Moist  Type  of  Chronic  Aural  Catarrh. — 

See  Otitis  Media  Catarrhalis  Chronica. 

Mycosis  of  the  External  Auditory  Canal. — 

See  Otomycosis. 

Myringitis. — L.  miringa,  ch-um-membrane 
-f  Gr.  -LTLs  inflanunation.  Myringitis  is 
manifested  by  pain  and  the  objective  signs 
of  tympanic  inflammation,  but  the  pres- 
ence of  only  slight  deafness  {q-v.)  chstin- 
guishes  it  from  otitis  media.  Acute 
myringitis  lasts  usually  about  three  or  four 
days. 

Etiology. — Traumatism;  exposure  to  cold 
air  or  cold  water;  extension  of  inflam- 
mation from  the  external  meatus  or 
from  the  tympanmn. 

Treatment.— Open  the  bowels  by  means 
of  castor-oil  or  calomel  followed  by  a 
saline  (see  Drugs,  Part  11);  insufflate  a 
minute  quantity  of  finely  powdered  boric 
acid,  or  boric  acid  and  zinc  oxide,  equal  parts; 
and  apply  heat,  and  perhaps  the  artificial 
leech  to  the  mastoid  process,  or  in  front  of 
and  close  to  the  tragus.  Open  painful 

abscesses  with  the  paracentesis  needle, 
taking  care  that  not  more  than  one-half 
of  the  point  is  mserted  into  the  membrane. 

Should  the  disease  become  chronic,  which 
very  rarely  happens  (one  should  take  care  to 
exclude  otitis  media  by  testing  for  perfora- 
tion of  the  drmn  membrane  by  means  of 
inspection  and  inflation,  q.v.),  syringe  away 
the  secretion  gently  with  warm  boiled 
boric  acid  solution  (5i-iv  ad  Oi)  or  normal 
saline  solution  (oi  ad  Oi) ; then  dry  the  parts 
with  sterile  cotton  on  the  end  of  a probe,  and 
insufflate  a minute  quantity  of  equal  parts 
of  boric  acid  and  zinc  oxide  powders.  If, 
after  several  days  of  such  treatment,  the 
secretion  does  not  diminish,  instil  15  to  20 
drops,  two  or  three  drops  at  a time,  of  a 
warm  solution  of  boracic  alcohol,  1 ; 20,  or 
carbolic  alcohol,  1 : 30,  and  allow  the  solu- 
tion to  remain  in  the  ear  for  half  an  hour 
(Politzer);  or  instil  a warm  solution  of  zinc 
sulphate,  copper  sulphate,  or  lead  acetate, 
gr.  iv  to  the  ounce  of  water.  (Bacon.) 

In  particularly  obstinate  eases,  apply  a 
warm  concentrated  solution  of  silver  nitrate 
(gr.  xxxviii  ad  5i),  and  then  neutralize  the 
latter  by  syringing  the  meatus  with  warm 
salt  solution.  Repeat  the  silver  applications 
only  after  the  crust  previously  formed  has 
been  thrown  off ; three  applications  a week  for 
three  or  four  weeks  usually  suffice.  (Politzer.) 


OTITIS  EXTERNA  DIFFUSA 


Treat  the  desquamative  forms  of  myringi- 
tis with  continued  instillations  of  alcohol; 
ulcers  with  iodoform  insufflations. 

For  the  removal  of  granulations  and  ])olypi, 
consult  Aural  Polypi  and  Granulations. 

Nerve,  Acoustic,  Neuritis  of  the. — Gr. 
pevpov  nerve  -R  -tns  inflaimnation. 
See  Acoustic  Nerve,  Paralysis  of  the. 

Paralysis  of  the. — See  Acoustic 

Nerve,  Paralysis  of  the. 

Noises,  Subjective. — See  Tinnitus  Aurium. 

Nystagmus. — See  Part  6,  Eye  Diseases. 

Otalgia. — Gr.  ocs  ear  -1-  dXyos  pain.  See 
Earache. 

Othaematoma. — Gr.  ovs  ear  + aifxa  blood 
+ -wpLa  tumor.  See  Hsematoma  Auris. 

_ Otitis  Externa  Circumscripta  Acuta.— Gr. 
ovs  ear  ltls  inflammation;  L.  exter'nus, 
external;  cir'cum  around  + scribere,  to 
write;  acu'tus  sharp.  Furunculosi.s  affects, 
as  a rule,  only  the  cartilagmous  portion  of 
the  external  auchtory  canal,  very  exception- 
ally the  osseous  portion.  The  symptoms 
are  pain,  swelling,  and  tenderness  on  pres- 
sure (using  a cotton- wound  probe),  followed 
later  by  deafness  should  the  canal  become 
occluiled.  The  auricle  is  extremely  sensitive 
to  manipulation.  The  disease  is  subject 
to  recurrences. 

Etiology. — Boils  are  caused  by'  pus  organ- 
isms, almost  always  the  staphylococci  aur- 
eus, albus,  and  citreous.  Contributory^ 
causes  are  a chronic  otorrhoea,  chronic 
eczema,  frequent  syringing,  irritatmg  appli- 
cations, such  as  the  prolonged  use  of  alum 
etc.,  scratching,  foreign  bodies,  dust,  un- 
cleanliness, sewer-gas,  dampness,  aniemia, 
chronic  alcoholism,  nephritis,  diabetes  mel- 
litus,  dyspepsia,  gouty  or  rheumatic  dia- 
thesis, menstrual  disorders,  poor  health. 

Treatment.— Attend  to  any  possible  etio- 
logical influence,  and  enjoin  the  observance 
of  correct  hygiene,  e.g.,  adequate  rest  and 
exercise,  fresh  air  day  and  night,  cleanli- 
ness (cotton  in  the  ears  for  those  who  work 
in  a dusty  atmosphere),  frequent  bathing, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  a generous  dietarv, 
regulation  of  the  bowels,  and  tonics,  if 
indicated,  viz.,  Bland’s  pills,  elixir  ferri, 
quinin*,  et  strychninae  phosphati,  syTup  of 
hypophosphites.  Prowler’s  solution  of  arsenic. 
P'resh  brewer’s  y'cast,  or  the  ordinaiy  com- 
pressed yeast  cake,  or  furunculin,  or  ceriilin 
is  well  recommended,  (see  Drugs,  Part  11). 
“ The  use  of  vaccines  is  altogether  the  most 
effective  treatment,”  says  IPolt.  “ Injections 
should  be  repeated  every  three  or  four  days : 
beginning  with  fifty  millions,  the  dose  may 
be  increased  to  one  hundred  millions.” 


The  local  treatment  is  as  follows:  To 
abort  the  inflammation  in  the  early  .stage, 
that  is,  in  the  first  thirty^  hours,  apply  the 
artificial  or  natural  leech  or  wet  cup  {q.v.  in 
Part  1)  in  front  of  the  tragus,  or  to  the 
mastoid  region,  according  to  the  site  of  the 
furuncle  (place  cotton  in  the  ear  if  using  the 
natural  leech),  and  insert  into  the  meatus  a 
tampon  of  cotton  soaked  in  warm  carbolized 
glycerine,  2)^  to  5 to  10  per  cent.,  or  men- 
thol solution,  10  to  20  per  cent.,  in  albolene 
or  olive  oil  or  alcohol.  Keep  the  tampon  in 
place  for  twenty-four  hours,  if  possible. 
Warm  instillations  of  Burow’s  solution  (see 
Part  1)  are  also  said  to  be  often  abort al. 

If  the  inflaimnation  can  not  be  aborted, 
apply  dry^  heat,  and  as  soon  as  deemed 
advisable,  make  a free  incision  at  the  most 
tender  place,  down  through  the  perichond- 
rium, scrape  out  the  contents  of  the  abscess 
cavity,  and  syringe  the  canal  with  a warm, 
boiled  solution  of  boric  acid,  3iv  ad  Oi. 
Frequent  springing  should  be  employed  by 
the  patient  until  healing  occurs. 

For  the  relief  of  itching  which  is  apt  to 
follow  the  subsidence  of  acute  symptoms, 
instruct  the  patient  to  paint  the  canal  with 
a warm  solution  of  carbolic  acid  in  glycerine, 
2}/2  per  cent. 

Otitis  Externa  Crouposa. — See  Otitis 
Externa  Membranosa. 

Otitis  Externa  Diffusa. — L.  dis,  apart  -f 
fun'dere,  to  pour.  Diffuse  inflammation 
of  the  external  auditory  canal,  of  favor- 
able ])rognosis. 

Etiology.  — Irritating  applications  — oils, 
caustics,  etc.;  scratching  with  pins,  ear- 
spoons,  etc.;  furunculosis;  foreign  bodies; 
otomy'cosis;  middle  ear  suppuration;  expos- 
ure to  cold;  sea-bathing;  infectious  diseases; 
dental  caries;  poor  health. 

Treatment. — Open  the  bowels  by'  means  of 
calomel,  followed  by'  salines  (see  Part  11). 
If  seen  early,  at  least  two  oimces  of  blood 
may  be  extracted  by'  the  application  of  the 
artificial  leech  close  to  the  tragus.  A hot-  or 
cold-water  bag  or  Leitcr’s  coil  may'  then  be 
applied.  The  canal  should  be  irrigated  fre- 
quently, by  means  of  a fountain  syTinge, 
with  warm,  bo  led,  saturated  boric  acid  solu- 
tion (4  per  cent.),  or  bichloride,  1 : 8000.  If 
the  pain  is  severe,  one  may'  instil  four  or 
five  drops  of  warm  cocaine  solution,  4 per 
cent.,  and,  if  necessary',  administer  a hypo- 
dermic of  morphine,  gr.  3^  to  34. 

If  the  canal  becomes  very  narrow,  or  if 
the  acute  symptoms  do  not  abate  after  the 
lap.se  of  twenty'-four  hours,  it  is  recom- 
mended that  long,  free  incisions  be  made 
through  the  skin  and  periosteum,  followed 


OTITIS  MEDIA  CATARRHALIS  ACUTA 


by  syringing  with  warm  boric  acid  solution 
every  two  to  four  hours.  Ballenger  removes 
the  secretions  with  a cotton-wound  appli- 
cator soaked  in  hydrogen  peroxide,  followed 
by  the  instillation,  two  or  three  times 
daily,  of  a 12  per  cent,  carbol-glycerine  mix- 
ture, cotton-wool  being  kept  in  the  cartilag- 
inous canal. 

After  the  acute  symptoms  have  subsided, 
remove  all  pus  and  scales  by  means  of  the 
syringe  and  curette,  and  insufflate  a minute 
quantity  of  finely  powdered  boric  acid,  or 
zinc  oxide,  or  equal  parts  of  each,  or  bismuth 
subnitrate  or  subgallate.  Cauterize  per- 
sistent ulcers  with  a strong  solution  of  silver 
nitrate,  90  per  cent. 

In  chronic  cases,  especially  with  granula- 
tions, instil  a warm  alcoholic  solution  of 
boric  acid,  gr.  xx  to  the  ounce.  The  granu- 
lations may  be  cauterized  with  silver  nitrate 
or  with  chromic  acid  fused  on  the  end  of  a 
probe  (see  also  Aural  Polypi  and  Granula- 
tions). Where  bone  is  bared  it  should 
be  scraped. 

Otitis  Externa  Diphtheritica. — Gr.  bi4>dtpa 
membrane.  See  Otitis  Externa  Membrauo^a. 

Otitis  Externa  Haemorrhagica. — Gr.  aipa 
blood  -f  p-qjvvvat  to  bm'st  forth.  A rare, 
acute  inflammatory  affection  of  the  external 
auditory  canal,  usually,  but  not  always, 
secondary  to  influenzal  otitis  media,  char- 
acterized by  the  appearance  of  hemor- 
rhagic vesicles,  usually  in  the  osseous  canal, 
associated  with  intense  local  pain,  fever, 
and  prostration. 

The  Prognosis  is  favorable,  recovery  occur- 
ring in  one  or  two  weeks. 

Treatment.— Keep  the  patient  in  bed  on 
liquid  diet  for  several  days,  and  open  the 
bowels  with  castor-oil  or  calomel  followed  by 
salines.  Morphine  may  be  demanded  for 
the  pain. 

After  anaesthetizing  the  parts,  if  necessary, 
by  the  instillation  of  a 10  per  cent,  sterile, 
aqueous  solution  of  cocaine,  and  waiting 
twenty  minutes,  puncture  and  evacuate  the 
vesicles,  dry  the  canal  with  sterile  absorbent 
cotton  on  a probe,  and  insufflate  a minute 
amount  of  finely  powdered  boric  acid,  the 
latter  to  be  repeated  until  the  canal  remains 
perfectly  dry  for  twenty-four  hours. 

Otitis  Externa  Membranosa. — L.  mem- 
brdna,  membrane.  Membranous  inflamma- 
tion of  the  external  auditory  canal  occurs  in 
funmculosis  of  the  meatus  and  in  influenzal, 
scarlatinal,  and  diphtheritic  otitis  media.  i 

The  Prognosis  in  furuncular  and  influenzal 
cases,  in  which  the  white,  fibrinous  mem- 
brane is  detachable  without  bleeding  (croup- 
ous inflammation)  is  good;  but  in  scarlatina 


and  tliphtheritic  cases,  in  which  the  mem- 
brane is  firmly  attached  and  leaves  an  excori- 
ated, bleechng  surface  when  removed  (diph- 
theritic inflammation)  serious  necrosis  may 
result,  and  the  labyrinth  may  become 
involved,  with  resulting  deafness. 

Treatment.— In  the  croupous  type  of  inflam- 
mation, remove  the  false  membrane  by 
syringing  with  warm  hydrogen  peroxide  or 
lime  water,  or  by  the  application  of  a full 
strength  solution  of  ferric  sulphate,  together 
with  the  use  of  forceps.  Then  dry  the  canal, 
paint  it  with  a warm  solution  of  silver 
nitrate,  5i  ad  5i,  and  insufflate  a minute 
amount  of  finely  powdered  boric  acid,  or 
equal  parts  of  boric  acid  and  iodoform,  by 
means  of  a powder  blower.  Repeat  the 
insufflations  once  or  twice  daily. 

This  method  of  treatment  is  also  advo- 
cated for  the  diphtheritic  type  of  inflamma- 
tion, but  Politzer  says,  Dench  concurring, 
that  “ mechanical  removal  of  the  diph- 
theritic membrane  hastens  the  process  of 
healing  just  as  little  as  cauterization  with 
silver  nitrate.” 

In  chphtheritic  cases,  Politzer  recommends 
that  the  affected  parts  be  occasionally 
touched  with  warm  carbolic-glycerine,  1 : 15, 
or  carbolic-alcohol,  1 : 20,  and,  in  addition, 
the  meatus  filled  several  times  a day  with  a 
warm  alcoholic  solution  of  boric  acid,  1 : 10, 
or  salicylic  acid,  1 : 100,  or  corrosive  subli- 
mate, 0.05  : 50.0.  The  occasional  applica- 
tion of  ferric  sulphate  in  full  strength  solu- 
tion, and  syringing  with  warm- lime  water, 
are  also  recommended.  Antitoxine  shoukl, 
of  course,  be  administered  (see  Diphtheria, 
in  Part  1,  on  General  Medicine  and  Surgery). 

Otitis  Externa  Syphilitica. — Besides  con- 
stitutional treatment  (see  Syphilis,  m Part  1 , 
on  General  Medicine  and  Surgery),  the  ear 
should  be  S3ninged  with  warm  bichloride 
solution,  1 ; 3000,  and  all  scales,  etc.,  removed 
with  forceps  and  a cotton  wound  probe. 
Then  warm  lotio  nigra  (see  Part  11) 
may  be  instilled,  or  a minute  quantity 
of  iodoform  powder  insufflated.  Ulcers 
may  be  painted  with  tincture  of  iodine,  or 
treated  with  calomel  powder  or  yellow  oxide 
of  mercury  ointment  (q.v.  in  Part  11).  Gum- 
mata,  if  very  large,  and  condylomata  should 
be  cauterized  with  a concentrated  solution 
of  chromic  acid. 

Otitis  Interna. — See  Labyrinthitis. 

Otitis  Media  Catarrhalis  Acuta. — Gr.  ovs 

ear  -|-  -trts  inflammation;  Karappeiv  to  flow 
down;  L.  me'dius,  middle;  acu'tus,  sharp. 
Acute,  catarrhal  inflammation  of  the  middle 
ear  is  manifested  by  pain,  deafness  (q.v.), 
and  reddening  of  the  drum-membrane, 


OTITIS  MEDIA  CATARRHALIS  ACUTA 


especially  along  the  handle  of  the  malleus. 
Fluid  may  sometimes  be  seen  behind  the 
membrane.  Tinnitus  and  vertigo,  due  to 
increased  intra-tympanic  pressure,  are  some- 
tunes  present.  Bubbling  and  snapping 
sounds  may  be  evident  to  the  patient  when 
he  blows  his  nose.  There  may  be  some 
retraction  of  the  driun-membrane  and  con- 
sequent foreshortening  of  the  malleus  handle, 
due  to  congestion  and  closure  of  the  eus- 
tachian  tube  and  resulting  rarefaction  of 
air  in  the  tympanum. 

The  duration  of  the  disease  is  from  one  or 
two  days  to  one  to  six  weeks.  Relapses  may 
occur,  and  the  condition  may  become  chronic 
{q.v.)  or  purulent  {q.v.).  Streptococcic  and 
pneumococcic  cases  are  severe  and  tend  to 
become  purulent  and  to  involve  the  mastoid 
cells;  staphylococcic  and  other  infections 
are  usually  mild. 

Etiology.— Naso-pharyngitis;  tonsillitis;  the 
exanthemata  and  other  acute  infectious  dis- 
eases; erysipelas;  nasal  and  epipharyngeal 
ob-struction,  due  to  hypertrophic  rhinitis, 
deflected  septum,  adenoids,  enlarged  tonsils, 
adhesive  bands  in  Rosernniiller’s  fossa,  eth- 
moiditis  and  sphenoiditis;  dental  caries; 
dentition;  exposure  to  cold  and  wet;  the 
nasal  douche,  and  sniffing  up  salt  water,  also 
sea-bathing  and  diving;  injury  to  the  drum 
membrane;  heredity;  poor  health:  ansemia, 
rickets,  nephritis,  diabetes,  tuberculosis, 
syphilis,  gout,  and  rheumatism. 

Politzer  says  that  labyrinthine  involvement 
(see  Labyrinthitis)  is  suggestive  of  syphilis. 

Treatment.— Put  the  patient  to  bed  on  light 
diet,  with  plenty  of  water,  say  in  the  form 
of  lemonade,  and  open  the  bowels  by  mean 
of  small,  frequently  repeated  doses  of  cal- 
omel, followed  by  a saline  or  castor-oil  (see 
Drugs,  Part  li).  Prohibit  alcohol  and 
tcjbacco.  If  the  pulse  is  full  and  hard, 
aconite  may  be  prescribed.  Aspirin,  salol, 
or  socUum  salicylate  is  recommended  for  the 
promotion  of  diaphoresis.  The  nose  and 
nasojjharynx  should  receive  attention  (see 
Part  8,  on  Nose  and  Throat  Diseases). 

For  the  local  pain  and  conge.rtion,  em- 
ploy one  of  the  following  preparations: 


R Atropinae gr.  i 

Cociiimc gr.  ii 

Olei  amygdala!  dulcis oii_ 

M.  Sig. — Instil  six  to  ten  drops,  warmed,  into  the 
ear,  three  or  four  times  during  the  twenty-four 
hours. — Theobald. 

R Atropinaj  sulphatis gr.  i 

Morphinae  sulphatis gr.  ii 

Cocaina'  hydrochloratis gr.  vi 

Aqua;  destillataj 5i 


M.  Sig. — Pour  into  the  ear  from  a spoon  previously 
dipped  into  hot  water,  five  or  six  drops,  or  less  if 
perforation  is  present. — H.  G.  Miller. 


R CocainsB gr.  iiss 

Aquae  camphorae. 

Aqua;  destillataj,  aa pi 


M.  Sig. — Instil  five  drops,  warmed,  into  the 
ear. — Kerley. 

R Acidi  carbolic!, 

Glycerini, 

Cocaina;  hydrochloratis,  aa 
M.  Sig. — Several  drops  in  the  ear — ^Ballenger. 

li  Acidi  carbolici gr.  iii-vii 

Glycerini 3i 

M.  Sig. — Five  or  six  drops  in  the  ear. — Andrews. 

R Liquoris  aluminii  acetatis 3iii 

Plumbi  acetatis gr.  xxv 

Aquae 5i 

M.  Sig. — Instil,  warmed,  three  or  four  times  dailyi 
and  allow  to  remain  in  the  ear  for  twenty  to  thirty 
minutes  each  time. — Burow’s  solution. 

R Chlorofomii pii 

Sig. — Blow  the  fumes  into  the  ear  through  a pipie- 
■ — -Ballenger. 

Keep  a loose  pledget  of  cotton  in  the 
meatus;  and  apply  hot  water  or  hot  salt 
bags.  In  the  early,  hyperaemic  stage,  many 
apply  the  artificial  leech  in  front  of  and  close 
to  the  tragus,  or  make  scarifications  and 
apply  the  cupping  glass  {q.v.  in  Part  1),  and 
extract  from  two  to  four  otmces  of  blood. 

Should  the  drum-membrane  bulge,  or 
should  the  pain  and  fever  persist  over 
twelve  hours  in  spite  of  the  foregoing 
analgesic  and  antiphlogistic  treatment,  in- 
cise the  membrane  freely  by  means  of  a 
crucial  or  V-shaped  incision  at  the  most 
bulging  portion,  or  a curv'ed  incision,  poster- 
ior to  the  malleus  handle,  parallel  with  the 
margin  of  the  membrana,  and  down  to  the 
bottom  of  the  meatus.  Where  there  is 
bulging  in  the  upper  and  posterior  quadrant, 
carry  the  knife  well  up  into  the  attic,  and 
incise  to  the  bone,  then  carry  the  knife  back- 
ward to  the  periphery  of  the  drum-mem- 
brane, and  out  for  one-quarter  inch  along 
the  posterior  wall  of  the  bony  meatus,  down 
to  the  bone  (Bacon),  but  some  do  not  advise 
this  for  fear  of  extending  the  infection, 
especially  in  streptococcus  cases.  Before 
incising  the  drum  membrane,  syringe  the 
meatus  with  warm  bichloride  solution, 
1 : 5000,  dry  with  sterile  absorbent  cotton, 
and  anaesthetize  the  membrana  with  the 
following  preparation,  viz.,  equal  parts  of 
cocaine  crystals,  carbolic  acid  crj'stals,  and 
menthol  crj^stals,  rubbed  together  in  a mor- 
tar into  a s\Tupy  fluid  and  applied  warm 
(anaesthetization  is  produced  in  twenty 
minutes);  or  administer  chloroform,  ether, 
or  nitrous  oxide  gas.  In  using  the  otoscope 
or  ear  speculum,  straighten  the  canal  by 
pulling  the  auricle  outward,  backward  and 


OTITIS  MEDIA  CATARRHALIS  ACUTA 


upward  in  adults,  downward  in  infants 
and  children. 

After  the  incision,  Politzer  inserts  a sterile 
gauze  wick  for  drainage,  which  is  changed 
twice  daily;  he  avoids  syringing.  Dench,  on 
the  other  hand,  employs  frequent  irrigations, 
at  two  hourly  intervals,  with  warm  bichlor- 
ide solution,  I : 6000,  or  boric  acid  solution, 
3i-iv  ad  Oi,  or  warm,  boiled  water,  in  order 
to  encourage  bleeding. 

As  soon  as  pain  has  subsided  commence 
inflations  of  the  tympanum  by  Politzer’s 
method  or  by  catheterization  of  the  eustach- 
ian  tube  {q.v.),  with  the  object  of  (1) 
separating  inflamed  surfaces,  and  thus  pre- 
venting or  breaking  down  adhesions;  (2) 
draining  the  t3rmpanmn;  and  (3)  maintaining 
the  patency  of  the  eustachian  tube,  thus 
preventing  or  relieving  congestion  of  the 
aural  mucous  membrane  due  to  rarefaction 
of  air  within  the  tympanic  cavity.  Employ 
inflation  at  first  every  one  to  three  hours, 
gently,  and  later  once  a day,  then  every  other 
day,  and  so  on,  as  required.  For  a few  min- 
utes before,  and  also  during  inflation,  incline 
the  patient’s  head  strongly  forward  and  a 
little  toward  the  opposite  side,  so  as  to 
favor  drainage  from  the  tulx'.. 

Pneumomassage,  by  means  of  Siegle’s 
otoscope,  the  Delstanche  masseur,  or  a 
rubber  tube,  “ through  which  alternating 
compression  and  rarefaction  may  be  pro- 
duced with  the  mouth  ” (Ballenger),  may 
also  be  employed,  for  the  purpose  of  lessen- 
ing vascular  engorgement  and  preventing 
ankylosis  of  the  ossicles. 

Where  the  improvement  in  hearing,  fol- 
lowing inflation,  is  only  of  short  duration, 
the  drum  membrane  should  be  incised,  and 
inflation  continued,  at  first  two  or  three 
times  a week,  later  every  eight  to  fourteen 
days,  xmtil  a cxire  results.  In  such  cases  a 
pledget  of  sterile  cotton  should  be  placed  in 
contact  with  the  membrane  at  each  inflation 
to  catch  and  hold  the  secretion  as  it  is 
forced  through  the  perforation.  Or,  one 
may  employ  Blake’s  middle-ear  syringe,  and 
a warm  saturated  solution  of  boric  acid  (4 
per  cent.)  to  wash  out  the  middle  ear;  and 
if  the  tympanic  mucous  membrane  is  thick- 
ened, as  revealed  by  inspection,  one  may 
instil,  through  the  syringe  or  a glass  middle- 
ear  pipette,  a few  drops  of  a solution  of  silver 
nitrate,  2 per  cent.,  or  zinc  sulphate,  4 per 
cent.  If  the  secretion  is  tough  and  stringy, 
it  may  be  necessary  to  inject  into  the  middle 
ear,  through  the  drumhead  incision,  or 
through  the  eustachian  catheter  (see  Inflating 
the  Tympanum)  a very  weak  (1  per  cent.) 
warm,  sterile  solution  of  sodium  bicarbonate. 


In  order  to  “ hasten  the  absorption  of 
residual  fluid,”  vapors  may  be  forced  through 
the  eustachian  catheter  into  the  middle  ear, 
using  Roosa’s,  Lucse’s,  Dayt.on’s,  or  Dench’s 
middle-ear  vaporizer,  and  tincture  of  ben- 
zoin, oil  of  eucalyptus,  menthol,  camphor, 
or  oil  of  cloves,  3i  of  any  of  the  preceding  to 
oi  of  alcohol,  or  of  tincture  of  iodine,  or  oil 
of  eucalyptus  and  pine-needle  oil,  equal 
parts;  or  alcohol;  or  tincture  of  iodine;  or 
chloroform;  or  ether,  the  latter  in  very  small 
quantities,  because  it  is  h’ritating. 

For  obstinate  swelling  of  the  tube,  employ 
local  medication.  After  administering  an 
air  douche,  inject  into  the  eustachian 
catheter,  with  a Pravaz  syringe,  eight  to 
ten  drops  of  one  of  the  following  solutions, 
viz.,  solut.  zinci  sulphatis  concent.,  injiii,  ad 
aquam  3hss;  Burow’s  solution  (see  Part  11), 
1 ad  aquam  5;  solut.  ac.  tannici,  1 to  2 per 
cent. ; zinc-olein,  ir^v  ad  sterilized  liquid 
vaseline,  5i;  iodi  puri,  gr.  ivss,  potassii 
iodicU,  gr.  xlv,  glycerini  puri,  oii'^s-v.  Sev- 
eral injections  of  sodium  bicarbonate,  3 : 10 
to  20,  may  have  to  be  made  preceding  the 
above  applications.  A good  plan  is  to  give 
the  air  douche  and  medicated  applications 
on  alternate  days.  (Politzer.) 

When  inflation  is  difficult,  as  ascertained 
by  means  of  the  diagnostic  tube,  introduce 
medicated  bougies  into  the  tube.  Politzer 
employs  the  thinnest  catgut  violin  strings, 
impregnated  with  a concentrated  solution  of 
silver  nitrate  (1  : 10).  “ These  are  dried 

and  pushed  through  the  catheter  as  far  as 
the  isthmus  tubse  (about  one  inch),  where 
they  are  allowed  to  remain  three  to  five 
minutes.”  This  is  repeated  eveiy  two  or 
three  days,  and  “ often  after  the  third  or 
fourth  introduction,  air  may  be  forced 
through  the  eustachian  tube  by  Politzeriza- 
tion.” (See  also  Dench’s  method  of  dilating 
the  tube,  described  under  Otitis  Media 
Catarrhalis  Chronica.)  Employ  also  mas- 
sage of  the  neck  between  the  ramus  of 
the  inferior  maxilla  and  the  mastoid  proc- 
ess, for  two  or  three  minutes  at  a time. 

Energetic  sweat  cures  and  a change  to  a 
dry  climate  are  recommended  for  very 
obstinate  cases  (see  also  Otitis  Media 
Catarrhalis  Chronica,  the  moist  form). 

For  the  relief  of  persistent  and  distressing 
tinnitus,  which  will  eventually  disappear,  pre- 
scribe the  bromides  (Part  11)  in  large  doses. 

Prophylaxis  Against  Aural  Catarrh. — Fresh  air 
day  and  night,  avoiding  draughts,  best  an 
out-of-door  life;  adequate  clothing,  includ- 
ing woolen  under-garments,  dry  stockings 
and  good  shoes;  the  avoidance  of  over- 
heated rooms;  sponging  of  the  neck  and 


OTITIS  MEDIA  CATARRHALIS  CHRONICA 


chest  every  morning  witli  cold  water  (while 
standing  in  warm  water  in  a warm  room), 
followed  by  vigorous  rubbing  with  a coarse 
towel;  the  correction  of  all  possible  etiologi- 
cal factors,  especially  adenoids  in  children; 
the  avoidance  of  large  doses  of  quinine; 
stojrping  the  ears  with  absorbent  cotton 
saturated  with  vaseline  when  bathing  in 
the  sea. 

Otitis  Media  Catarrhalis  Chronica. — L. 

chronicus,  from  Gr.  xpovos  time.  The  char- 
acteristic symptoms  of  chronic  aural  catarrh 
are  deafness  (q.v.)  and  tinnitus,  without 
pain,  of  gradual  and  insidious  onset,  except 
when  following  acute  otitis  media. 

'There  arc  two  distinct  types  of  the  dis- 
ease: (1)  a moist,  or  exudative,  or  hyper- 
trophic ty])c,  with  hypertemia  and  swelling 
of  the  mucous  membrane,  which  may  be 
followed  by  the  formation  of  adhe.sions  and 
ankylosis  of  the  ossicles,  and  which  com- 
monly occurs  in  males  between  the  ages  of 
fifteen  and  thirty-five  years;  and  (2)  a dry 
or  hyperplastic,  or  sclerotic  tj'pe  (otoscler- 
osis), with  fibrous  interstitial  changes, 
“ usually  limited  to  the  neighborhood  of  the 
fenestra  ovalis  and  rotunda,”  but  which 
may  begin  in  the  labyrinth  and  which  com- 
monly occurs  in  females  between  the  ages  of 
forty  and  fifty  years. 

In  the  moist  type,  the  chronic  hypersemia 
and  turgescence  involve  the  eustachian  tube 
and  cause  its  closure,  with  resulting  rare- 
faction of  air  in  the  tympanic  cavity  and 
retraction  of  the  drum  membrane.  The 
latter  appears  lustreless  and  thickened,  and 
may  contain  chalky  deposits;  the  long 
hamlle  of  the  malleus  appears  foreshortened, 
the  short  process  and  posterior  fold  promi- 
nent, and  the  cone  of  light  distorted. 

In  the  sclerotic  type,  on  the  other  hand, 
the  eustachian  tube  is  patent,  and  may 
even  be  abnormally  wide,  and  atrophy  of 
the  mucous  membrane  is  also  commonly 
present.  Occasional  pain  may  occur.  As  a 
rule,  the  patient  hears  better  in  a noise. 

Employ  Siegle’s  otoscope  and  the  probe 
to  test  the  mobility  of  the  drum-membrane 
and  for  the  presence  of  adhesions;  and 
employ  Politzerization  (q.v.)  and  the  diag- 
nostic tube  to  determine  the  permeability 
of  the  eustachian  tube. 

Etiology.— Chronic  moist  catarrh  of  the 
middle  ear  may  follow  the  acute  form  (q.v., 
for  causes),  or  it  may  develop  insidiously 
as  a consequence  of  frequent  “colds,”  alco- 
holism, or  poor  health.  In  otosclerosis, 
heredity  is  perhaps  an  important  etiological 
factor;  it  may  follow  the  hypertrophic  form 
of  catarrh,  rarely  {)urulent  otitis  media; 


physical  and  mental  debility  and  psychic 
shock  may  be  factors;  also  altered  ductless 
gland  secretion,  or  focal  infection. 

Prognosis. — The  prognosis  under  treatment 
in  cases  which  show  even  a very  slight 
improvement  following  inflation  of  the 
middle  ear  (moist  type)  is  favorable;  the 
prognosis  in  the  sclerotic  type  is  unfavorable. 

Treatment  of  the  Hypertrophic  Variety  of  Chronic 
Aural  Catarrh. — Attend  to  the  general  health 
and  to  the  nose  and  throat  (see  Parts  8 and 
9 on  Nose  and  Throat  Diseases).  Remove 
all  obstructions  to  breathing,  e.g.,  adenoids, 
enlarged  tonsils,  hypertrophy  of  the  turbi- 
nates, deviation  of  the  septum,  etc.  When 
prescribing  gargles,  instruct  the  patient  to 
lie  upon  the  back  so  as  to  allow  the  fluid  to 
enter  the  epipharynx.  Remove  any  granu- 
lation tissue  or  adhesive  bands  in  Rosen- 
miiller’s  fossa  with  the  finger  nail.  Silver 
nitrate,  5i  ad  5 b applied  upon  a cotton- 
tipped  probe  to  the  epipharynx  through  the 
anterior  nares,  following  cocainization  (4  per 
cent.),  is  also  effectual  in  removing  granula- 
tions or  adenoids  (Dench).  Restrict  or  pro- 
hibit the  use  of  alcohol  or  tobacco. 

Treatment  of  the  moist  variety  of  chronic 
aural  catarrh  auns  at  the  restoration  of  the 
normal  patency  of  the  eustachian  tube,  the 
relief  of  turgescence  within  the  tympanum 
and  tube,  and  the  prevention  or  breaking 
down  of  adhesions. 

Practice  inflation  of  the  tympanum  by 
Politzerization  or  catheterization  (see  In- 
flating the  Middle  Ear),  followed  by  the 
introduction  of  various  antiseptic  and  stimu- 
lating vapors  into  the  middle  ear  and  tube. 
If  catheterization  is  employed,  drop  about 
five  or  six  minims  of  the  medicament  into  the 
Politzer  bag,  and  connect  the  latter  with  the 
catheter  (always  before  the  latter’s  introduc- 
tion into  the  eustacliian  tube) , by  means  of 
rubber  tubing  at  least  a foot  long;  or  employ 
Roosa’s,  Lucse’s,  Dayton’s,  or  Dench’s  mid- 
dle ear  vaporizer,  in  which  is  placed  a pledget 
of  cotton  saturated  with  the  medicament.  If 
Politzerization  is  emploj^ed,  pour  the  drops 
on  absorbent  cotton  in  a glass  inhaler 
attached  to  the  Politzer  bag.  The  following 
vaporising  mixtures  are  recommended,  \iz., 
tincture  of  benzoin,  oil  of  eucalyptus,  men- 
thol, camphor,  or  oil  of  cloves,  pi  of  any  one 
of  the  preceding  to  5 i of  alcohol  or  of  tinc- 
ture of  iodine;  oil  of  eucalyptus  and  pine- 
needle  oil,  equal  parts;  alcohol;  tincture  of 
iodine;  chloroform;  ether  (in  veiy  small 
quantities,  because  it  is  irritating) ; tincture 
of  iodine,  gt..  xv,  chloroform  and  alcohol, 
aa  5ss;  menthol  and  camphor,  aa  3i,  'vith 
tincture  of  iodine  ad  3 i- 


OTITIS  MEDIA  CATARRH ALIS  CHRONICA 


Employ  inflation  at  first  daily,  and  later 
three  times  a week,  for  about  six  weeks, 
followed  by  a period  of  rest.  But  little 
force  should  be  used  at  first  for  fear  of  rup- 
turing an  atrophic  drum  membrane.  For  a 
few  minutes  before  and  also  during  inflation, 
have  the  patient’s  head  inclined  strongly 
forward  and  a little  toward  the  opposite  side, 
so  as  to  favor  drainage  from  the  tube. 

Pneumomassage  by  means  of  Siegle’s 
otoscope,  the  Delstanche  rarefacteur  or 
masseur,  the  electromotor  masseur  (see 
under  Treatment  of  the  Hyperplastic  Vari- 
ety), or  a rubber  tube,  “ through  which 
alternating  compression  and  rarefaction  may 
be  produced  with  the  mouth  ” (Ballenger), 
may  also  be  employed,  for  the  purpose  of 
lessening  vascular  engorgement  and  pre- 
venting ankylosis  of  the  ossicles.  These 
instruments  should  be  used  cautiously  and 
judiciously,  under  inspection  of  the  drum- 
head, when  atrophic  changes  are  present 
in  the  latter. 

Massage  of  the  middle  ear  may  also  be 
practiced  by  the  patient  several  times  a day, 
using  the  moistened  finger  tip,  with  the  nail 
posterior,  like  a piston.  This  is  useful  for 
the  relief  of  tinnitus,  etc.  Reading  to  the 
patient  for  five  to  fifteen  minutes  at  a sitting 
is  a method  of  massage  advocated  by  Dench. 

Where  the  unprovement  in  hearing  follow- 
ing inflation  is  only  of  short  duration,  incsie 
the  drum  membrane  and  continue  the  infla- 
tions. In  such  cases  a pledget  of  sterile 
cotton  should  be  placed  in  contact  with  the 
membrane  at  each  inflation  so  as  to  catch 
and  hold  the  secretion  as  it  is  forced  through 
the  perforation.  If  the  mucus  is  tough  and 
stringy,  first  inject  into  the  tympanic  cavity 
through  the  drum  head  incision  a very  weak 
(1  per  cent.),  warm,  sterile  solution  of  sodium 
bicarbonate,  or  irrigate  the  middle  ear 
through  the  eustachian  catheter,  with  warm, 
sterile  normal  salt  solution  (3i  ad  Oi).  The 
latter  procedure,  however,  may  excite  a 
purulent  otitis  media. 

One  may  employ  Blake’s  middle  ear 
syringe  and  a warm,  saturated  solution  of 
boric  acid  (4  per  cent.)  to  wash  out  the 
iniddle  ear;  and  if  the  tympanic  mucous 
membrane  is  thickened,  as  revealed  by 
inspection,  one  may  instil,  through  the 
syringe  or  a glass  middle  ear  pipette,  a few 
(Irops  of  a solution  of  silver  nitrate,  2 per 
cent.,  or  zinc  sulphate,  4 per  cent. 

Liquid  vaseline,  or  albolene,  or  a 2 per 
cent,  solution  of  pilocarpine,  or  the  two 
latter  combined,  or  the  following  mixture, 
viz.,  sodium  bicarbonate,  gr.  x,  glycerine, 
njviii,  and  distilled  water,  q.s.,  ad  3i 


(Politzer),  may  be  injected  into  the  middle 
ear  through  a catheter  two  or  three  times  a 
week,  only  when  the  drum  membrane  is  per- 
forated. Five  to  eight  drops  of  the  warmed, 
sterile  fluid  is  first  injected  into  the  sterilized 
eustachian  catheter,  which  is  clamped  in 
place.  The  fluid  is  then  forced  into  the  mid- 
dle ear  by  means  of  the  Politzer  bag,  care 
being  taken  to  keep  the  patient’s  head  erect 
during  the  inflation.  Always  inflate  the 
tympanum  with  air  two  or  three  times 
before  injecting  the  fluid. 

For  obstinate  swelling  of  the  tube,  employ 
local  medication;  After  administering  an 
air- douche,  inject  into  the  eustachian  cathe- 
ter, with  a Pravaz  syringe,  ten  drops  of  one 
of  the  following  solutions,  viz.,  solut.  zinci 
sulphatis  concent.,  Tn>iii  ad  3hss;  Burow’s 
solution  (see  Part  11),  1 : 5;  solut.  ac. 
tannici,  1 to  2 per  cent.;  zinc-olein,  njv,  add 
sterilized  liquid  vaseline,  5i;  iodi  puri,  gr. 
ivss,  pot.  iochdi,  gr.  xlv,  glycerini  puri, 
3iiss-v.  Several  injections  of  sodium  bicar- 
bonate solution,  3 : 10  to  20,  may  have  to 
be  made  preceding  the  above  applications 
(Politzer).  Dench,  before  employing  local 
medication,  first  cleanses  the  pharyngeal 
orifice  of  the  tube  by  irrigation  with  Dobell’s 
solution  (Part  11)  or  boric  acid  or  sodium 
bicarbonate  solution,  3 i~iv  ad  Oi,  through  a 
eustachian  catheter  with  closed  extremity 
and  lateral  perforations;  or  by  means  of  a 
pledget  of  cotton  upon  an  applicator  curved 
like  the  eustachian  tube.  He  then  touches 
the  pharyngeal  orifice  of  the  tube  with  silver 
nitrate,  gr.  x-xxx  ad  5i;  or  comp,  tincture 
of  iodine  and  glycerine,  equal  parts.  A good 
plan,  says  Politzer,  is  to  give  the  air-douche 
and  medicated  applications  on  alternate  days. 

When  inflation  is  difficult,  as  ascertained 
by  means  of  the  diagnostic  tube,  introduce 
medicated  bougies  into  the  tube.  Dench 
employs  the  following  device:  a No.  5 
piano  wire  is  bent  and  flattened  upon  itself 
at  one  extremity  for  a distance  of  about 
He  inch.  The  wire  is  then  passed  through 
the  eustachian  catheter  until  the  bent 
extremity  protrudes  IH  inches  (the  average 
length  of  the  eustachian  tube).  The  prox- 
imal end  of  the  wire  is  then  bent  at  a right 
angle  to  prevent  its  passing  farther  through 
the  catheter.  “A  little  cotton  is  then  wound 
tightly  about  the  doubled  extremity  of  this 
wire,  which  is  then  drawn  backward  into  the 
catheter,  so  that  the  cotton-tipped  end  pro- 
trudes just  beyond  the  mouth  of  the  instru- 
ment. The  catheter  is  then  introduced  into 
the  mouth  of  the  tube  in  the  ordinary  way, 
and  the  cotton-tipped  bougie  is  gradually 
passed  through  the  eustachian  canal  until 


OTITIS  MEDIA  CATARRHALIS  CHRONICA 


it  is  felt  to  enter  the  tympanum.”  Resist- 
ance is  felt  when  the  bougie  has  been  intro- 
duced about  an  inch  (the  istlmius  tubee  lies 
here),  but  “ a moderate  amount  of  pressure 
forces  the  instrument  through  the  bony 
portion  of  the  tube  and  into  the  tjanpanum.” 
“ Great  care  should  be  used  in  the  final  stage 
of  the  operation.”  “ It  is  sometimes  nece.s- 
sary  to  carry  the  mstrmnent  a little  further 
(than  l}/2  inches)  in  order  to  be  certain  that 
it  has  entered  the  tympanum.”  This  event 
is  recognized  by  the  sense  of  touch.  The 
cotton  pledget  may  be  saturated  with  a 
solution  of  silver  nitrate,  gr.  x-lx  ad  5i- 
using  bougies,  take  care  not  to  lacerate  the 
tissues  and  thereby  produce  an  intensti- 
tial  emphysema. 

Politzer  employs  the  thinnest  catgut 
violin  strings,  iinjiregnated  with  a concen- 
trated solution  of  silver  nitrate.  These  are 
drietl  and  jmshed  through  the  catheter  as 
far  as  the  isthmus  tubac,  where  they  are 
allowed  to  remain  three  to  five  minutes.” 
Tlfis  is  repeated  every  two  or  three  days, 
and  “ often  after  the  third  or  fourth  intro- 
duction, ah’  may  be  forced  through  the 
eustac'hian  tube  by  Politzerization.”  Em- 
ploy also  massage  of  the  neck  between  the 
ramus  of  the  inferior  maxilla  and  the  mastoid 
process,  for  two  or  three  minutes  at  a 
time.  Massage  of  the  eustachian  tube 
may  also  be  accomplished  by  means  of  the 
Weaver  masseur. 

Remember  that  “ to  continue  the  treat- 
ments longer  than  improvement  of  the  hear- 
mg  chstance  increases  often  leads  to  ill 
effects.”  Indeed,  Dench  and  others  believe 
that  the  measures  designed  to  increase  the 
mobility  of  the  ossicles  probably  only 
stretch  the  drum-membrane  and  do  harm. 

Such  operations  as  tenotomy  of  the  tensor 
tjanpani  muscle;  cUvision  of  a tense  posterior 
fold  of  the  drum  membrane  (plicotomy), 
repeating  several  times,  if  necessary,  cUvision 
of  interossicular  and  ossiculo-t>mipanic  ad- 
hesions; the  separation  from  the  internal  wall 
of  the  tympanum  of  an  adherent  drum  mem- 
brane; the  establishment  of  a permanent 
opening  in  the  drum  membrane  when  the 
latter  alone  is  at  fault  (such  an  oj>ening  is 
very  (Ufficult  to  maintain);  and  the  restora- 
tion of  the  tension  of  a relaxed  drum- 
membrane  by  appljfing  a moistened,  thin 
paper  cUsk  over  the  relaxed  area,  are  effectual 
only  in  rare  cases. 

Where  other  measures  fail,  and  the  laby- 
rinth is  not  greatly  involved  {i.e.,  no  marked 
lowering  of  the  upper  tone-limit  is  present: 
see  Hearing  Tests),  Dench  practices  and 
ach’oeates  an  exploratory  tympanotomy. 


under  local  ana?sthesia,  carrj-dng  out  hearing 
tests  during  the  exploration.  He  turns  down 
a large  flap  of  the  posterior  superior  segment 
of  the  membrana  vibrans.  If  the  opening 
causes  no  great  improvement  in  the  hearing, 
he  cUsarticulates  the  incudo-stapedial  joint. 
If  no  improvement  follows,  he  cUvides  the 
stapecUus  tendon  and  any  adhesions  present 
in  the  oval  niche,  by  means  of  stellate 
inci.sions,  in  order  to  free  the  stapes.  He 
also  divides  adhesions  in  the  rouncl  window 
by  means  of  stellate  incisions.  If  liberation 
of  the  stapes  improves  the  hearing,  he  removes 
the  membrana  tympani,  malleus,  and  incus 
to  secure  improvement.  If  the  stapes,  as 
tested  with  a cotton-tipped  probe,  is  fixed, 
Dench  removes  it  by  means  of  a sharp  spoon 
or  a small  conical  burr,  “ so  guarded  as  to 
prevent  its  entering  the  labjuinth  more 
than  a millimetre,  when  the  foot  plate  is 
perforated  ”;  or  he  leaves  the  stapes  and 
removes  the  malleus,  incus,  and  drum  mem- 
brane, and  tries  later  several  times  to  mobil- 
ize the  stapes  by  the  division  of  adhesions 
about  the  stapes  and  the  round  window. 
Should  the  drum  membrane  reform,  it 
should  be  removed  until  it  ceases  to  reform. 

For  distressing  tinnitus,  one  may  prescribe 
dilute  hydrobromic  acid,  gtt.  xv-lx,  in  water, 
t.i.cL,  or  fluid  extract  of  ergot,  gtt.  x,  in 
water,  t.i.d. 

Artificial  aids  to  hearing,  in  the  form  of 
ear  tnunpets  (the  small  London  hearing 
horn  is  a good  one),  or  the  ear  telephone 
with  pocket  battery,  are  used  chiefly  in 
incorrectible  senile  cases. 

Treatment  of  the  Hyperplastic  Variety  of  Chronic 
Aural  Catarrh. — One  may  employ  gargles, 
inflation,  vaporization,  pnemnomassage,  etc., 
as  described  in  the  treatment  of  the  hyper- 
trophic form.  JMassage  of  the  eustachian 
tube  by  means  of  a tube  introduced  as  far 
as  the  isthmus  (see  under  Inflating  the 
Middle  Ear)  and  then  moved  in  and  out 
like  a piston  for  a few  seconds,  may  be  of 
benefit.  The  long  continued  administration 
of  strj’chnine,  gr,  t.i.d.,  gradually 

increased  to  gr.  four  tunes  daily,  (see 
Part  11)  is  said  to  be  valuable  in  neurasthenic 
and  senile  cases.  Potassimn  iodide  is 

recommended.  For  distressing  tinnitus, 
employ  tlilute  hydrobromic  acid,  gtt.  xv-lx, 
in  w’ater,  t.i.d.  For  labjuinthine  involve- 
ment is  recommended  pilocarpine,  gr.  % 
to  two  or  three  tunes  daily,  bj"  mouth, 
the  dose  to  be  gradually  increased  by  one 
drop  at  a time  until  a moderate  increase  of 
perspiration  and  saliva  follows  each  dose 
(the  patient  being  warned  to  avoid  (h’aughts 
for  134  hours  after  each  dose).  The  pilo- 


OTITIS  MEDIA  PURULENTA  ACUTA 


oarpine  should  be  continued  for  two  months, 
and  if  some  improvement  is  then  noted, 
it  should  be  continued  for  four  to  six 
months.  (Dench.) 

In  cases  in  which  the  labyrinth  is  not 
materially  involved,  and  in  which  the  use 
of  vapors,  massage,  etc. , causes  no  improve- 
ment within  four  to  six  weeks,  one  may 
resort  to  Dench’s  exploratoiy  operation 
referred  to  under  the  hypertrophic  form. 

The  “ typical  otosclerosis,”  accorcUng  to 
Politzer,  is  primarily  a disease  of  the  laby- 
rinthine capsule,  resulting  in  bony  ankylosis 
of  the  foot-plate  of  the  stapes,  and  is  not 
necessarily  associated  with  middle-ear  ca- 
tarrh. Its  treatment,  therefore,  is  nearly 
hopeless.  The  only  treatment,  says  Politzer, 
that  promises  results,  and  these  only  tem- 
porary, is  pneumo-massage  by  means  of  the 
electro-motor  masseur,  in  the  early  stages  of 
the  disease.  “ The  massage  must  be  given 
only  from  a half  to  one  minute,  and  two  .or 
three  times  a week  for  a period  of  four  or 
five  weeks,  which  must  be  followed  by  a 
rest  of  several  months.”  “ The  vibrations 
must  follow  each  other  with  great  rapidity, 
but  their  amplitudes  must  be  slight  and  the 
motion  of  the  piston  must  be  1 nun.,  and  not 
more  than  4 nun.” 

The  small  London  hearing  horn  and  the 
ear  telephone  with  pocket  battery  are  useful 
in  incurable  cases. 

Otitis  Media  Purulenta  Acuta. — L.  pus, 
pur' is,  pus;  purulefiius,  purulent.  The  symp- 
toms of  acute  suppurative  otitis  media  are 
more  intense  than  those  of  the  catarrhal 
form.  There  are  intense  pain,  pyrexia, 
headache,  constipation,  deafness,  and  per- 
haps tinnitus  and  vertigo,  due  to  increased 
intratympanic  pressure.  Except  in  tuber- 
culosis, the  driun-head  is  markedly  con- 
gested (before  inspection,  remove  any  white, 
dead  epithelium  from  the  drum-head  with  a 
cotton-tipped  probe),  and  perforation  soon 
occurs,  followed  by  a purulent  discharge. 
In  tuberculosis  the  discharge  is  “ apt  to  be 
thin  and  watery  ”;  in  influenza,  “ sticky  and 
sero-sanguinolent  ” (Bacon).  The  presence 
of  a perforation  may  usually,  but  not  alw'ays, 
be  detected  by  the  whistling  sound  heard 
through  the  diagnostic  tube  during  inflation 
of  the  middle  ear;  the  normal  sound  is  soft  and 
blowing.  Siegle’s  otoscope  and  the  Valsalva 
method  of  inflating  the  middle  ear  {q.v.) 
may  also  be  used  to  detect  a perforation. 

The  affection  may  terminate  in  cure  in 
from  three  or  four  weeks  to  several  months, 
or  be  followed  by  chronic  aural  catarrh, 
adhesive  proces.ses,  chronic  suppuration, 
caries  and  necrosis  of  the  tympanic  walls 


and  ossicles,  mastoiditis,  labju-inthitis,  sinus 
thrombosis,  septicaemia,  meningitis,  extra- 
dural or  brain  abscess  (see  uiuler  Mastoiditis 
Interna). 

“ Six  weeks  of  daily  inspection  and  appro- 
priate treatment  will,  in  most  cases,  result 
in  a complete  cure,”  says  Ballenger. 

Etiology.— This  is  the  same  as  that  of 
the  catarrhal  form  {q.v.).  Colds,  measles, 
scarlet  fever,  and  influenza  are  particularly 
important  causes  (see  Prophylaxis).  Other 
causes  are  paracente.sis  of  the  ch-um- 
head,  caustic  applications,  improper  instru- 
mentation, irrigation  of  the  tympanum, 
blows  on  the  ear,  operations  on  the  nose,  etc. 

The  disease  may  be  suppurative  at  the 
start,  or  it  may  develop  upon  an  acute 
catarrhal  inflammation.  The  following  germs 
are  causal;  streptococci,  staphylocci,  pneu- 
mococci, Vincent’s  spirillum,  bacillus  coli, 
bacillus  pyocyaneus,  bac.  diphtheriae,  bac. 
tuberculosis,  Friedlander’s  bac.,  etc.  Strep- 
tococcic and  pneumococcic  cases  are  severe, 
and  tend  to  invasion  of  the  mastoid  cells; 
staphylococcic  and  other  Infections  are  usu- 
ally mild. 

Treatment.— Put  the  patient  to  bed  on  I ght 
diet  with  plenty  of  water,  say  in  the  form  of 
lemonade,  and  open  the  bowels  by  means  of 
small,  frequently  repeated  doses  of  calomel, 
followed  by  a saline  or  castor-oil.  If  the 
pulse  is  full  and  hard,  aconite  (see  Part  11 
for  all  drugs)  is  prescribed  by  many.  If 
there  is  a profuse  nasal  or  naso-phaiyngeal 
chscharge  (coryza),  Gorham  Bacon  pre- 
scribes tincture  of  pulsatilla  in  drop  doses 
alternately  with  the  tincture  of  aconite. 
Aspirin,  salol,  or  sodiimi  salicylate  is  recom- 
mended for  the  promotion  of  diaphoresis. 
Codeine  or  phenacetm  may  be  given 
for  the  relief  of  pain,  together  with 
instillations  of  one  of  the  analges  c and 
antiphlogistic  preparations  given  under  Otitis 
Media  Catarrhalis  Acuta;  or  the  ear 
may  be  douched  every  hour  or  two  with 
a warm  solution  of  boric  acid,  3iOv  ad 
Oi.  The  nares  and  nasopharynx  should, 
of  coirrse,  receive  attention  (see  Part  8 and  9 
on  Nose  and  Throat  Diseases).  Instruct 
the  patient  to  gargle  in  the  sirpine  position, 
with  the  head  low,  so  that  the  flrrid  will 
reach  the  epipharynx.  Apply  hot -water 
or  hot  salt  bags  to  the  ear.  In  tbe  early  con- 
gestive stage,  some  apply  the  artificial  leech 
in  front  of  and  close  to  the  tragus,  or,  m 
mastoid  involvement,  over  the  antrum  or 
the  mastoid  tip,  and  extract  two  to  four 
ounces  of  blood. 

Incise  the  drum-head  as  soon  as  brrlging  is 
apparent,  or  when  the  pain  and  fever  persist 


OTITIS  MEDIA  PURULENTA  CHRONICA 


after  twelve  hours  in  spite  of  the  above 
analgesic  and  antiphlogistic  treatment.  Pdrst 
syringe  the  meatus  with  warm  bichloride 
solution,  1 : 5000,  dry  with  sterile  absorbent 
cotton,  and  anajsthetize  the  membrana  with 
the  following  preparation,  viz.,  equal  parts 
of  crystals  of  cocaine,  carbolic  acid,  and 
menthol,  rubbed  together  in  a mortar  imtil  a 
syrupy  fluid  is  formed,  and  applied  warm 
(anaesthesia  is  produced  in  twenty  minutes) ; 
or  administer  chloroform,  ether,  or  nitrous 
oxide  gas.  Incise  the  membrane  freely,  by 
means  of  a crucial  or  V-shaped  incision  at 
the  most  biflging  portion,  or  a curved  incision 
posterior  to  the  malleus  handle,  parallel 
with  the  margin  of  the  membrana,  and  down 
to  the  bottom  of  the  meatus.  Where  there 
is  bulging  in  the  upper  and  posterior  quatl- 
rant,  cany  the  knife  well  up  into  the  attic, 
and  incise  to  the  bone,  then  carry  the  knife 
backward  to  the  periphery  of  the  thnini- 
membrane,  and  out  for  one-quarter  inch 
along  the  posterior  wall  of  the  bony  meatus, 
down  to  the  bone  (Bacon,  Dench),  but  some 
do  not  advise  this  for  fear  of  extending  the 
infection,  especially  in  streptococcus  cases. 
In  using  the  otoscope  or  ear  speculum, 
straighten  the  canal  by  pulling  the  amide 
outward,  backward,  and  uj^ward  in  adults, 
downward  in  infants  and  children. 

Where  spontaneous  perforation  has  oc- 
curred, it  is  advisable  to  enlarge  the  opening. 

John  Guttman  has  lately  devised  a special 
trephine  for  opening  the  drum-membrane, 
made  by  E.  B.  Meyrowitz,  New  York.  With 
one  or  two  turns  of  the  trephine,  a hole  is 
pierced  through  the  lower  posterior  quad- 
rant, no  matter  where  the  drum-membrane 
may  be  bulging.  After  incising  the  dnim- 
head,  douche  the  ear  eveiy  hour  or  two  with 
warm,  sterile  nonnal  saline  solution  (5i  ad 
Oi),  or  boric  acid  solution,  5ii  ad  Oi,  or 
bichloride  solution,  1 : 5000,  the  latter  if  the 
infection  is  virulent,  followed  each  time  by 
the  insertion  of  a strip  of  boric  acid  or  iodo- 
form or  plain  sterile  gauze  down  to  the  mem- 
brana tympani.  If  the  discharge  is  thick 
and  tenacious,  syringe  the  meatus  with  a 
warm,  st(;rile  solution  of  sodium  bicarbonate, 
aided  by  suction  with  Siegle’s  otoscope,  and 
cautious  inflation  (q.v.).  The  perforation 
in  the  drum-head  shoukl,  however,  be  large 
before  the  latter  is  attempted.  Politzer 
recommends  daily  Politzerization,  beginning 
on  the  third  or  fifth  day  after  the  discharge 
has  made  its  appearance,  the  nares  and 
pharynx  being  first  cleansed  each  time  with 
normal  saline  solution.  After  the  more  ac\ite 
symptoms  have  subsided,  continue  to  sjTinge 
the  meatus  several  times  a day,  and  gently 


wijx;  away  all  discharge  with  a cotton-wound 
probe;  a 5 per  cent,  aqueous  solution  of 
liyth'ogen  peroxide  may  be  poured  into  the 
ear  to  break  up  the  discharge,  after  which 
it  is  more  readily  wiped  away.  Then  instil 
a warm,  boiled,  saturated  solution  of  boric 
acid  (4  per  cent.);  or  insufflate  a minute 
quantity  of  finely  powdered  boric  acid. 

If  the  discharge  persists,  instil  twice  a 
day  15  to  20  drops  of  zinc  sulphate,  2 to 
4 per  cent.,  or  copper  sulphate,  10  to  15 
grains  to  the  ounce,  or  lead  acetate,  3 to  8 
grains  to  the  ounce,  or  persulphate  of  iron, 
cUluted  or  full  strength,  and  allow  the 
astringent  fluid  to  remain  in  the  ear  fifteen 
minutes;  or  irrigate  the  tympanum  through 
the  eustachian  tube  (q.v.)  daily  by  means 
of  a fountain  syringe  under  low  preasimi 
with  a warm,  boiled  solution  of  boric 
acid,  5i-iv  ad  Oi,  followed  by  Politzerization. 
For  the  treatment  of  granulations  and 
polypi,  see  Aural  Polypi  and  Granulations. 

The  treatment  of  facial  paralysis  due  to 
suppurative  otitis  media  is  that  of  the 
primary  affection. 

After  the  perforation  has  closed,  have  the 
patient  wear  a small  pledget  of  cotton  in  the 
meatus  for  a time,  and  inflate  the  tjnn- 
panum  several  times  a week  until  the  hear- 
is  entirely  restored.  A tonic  may  be  given, 
if  deemed  advisable,  and  the  patient  shoukl 
be  cautioned  against  catching  cold. 

Prophylaxis. — Fresh  air  day  and  night, 
avoiding  draughts,  best  an  out-of-door  life; 
adequate  clothing,  including  woolen  under- 
garments, dry  stockings  and  good  shoes; 
the  avoidance  of  overheated  rooms;  sponging 
of  the  neck  and  che.st  every  morning  with 
cold  water  (while  standing  in  warm  water 
in  a warm  room),  followed  by  vigorous 
rubbing  with  a coarse  towel;  the  correction 
of  all  possible  etiological  factors,  especially 
adenoids  in  children;  the  avoidance  of  large 
doses  of  quinine;  stopping  the  ears  with 
absorbent  cotton  satm’ated  with  vaseUne 
when  bathing  in  the  sea. 

In  the  acute  infectious  diseases,  particu- 
larly measles,  scarlet  fever,  and  influenza, 
the  naso-pharynx  should  be  sprayed  wdth  a 
solution  of  boric  acid,  5i~iv  ad  Oi,  or  car- 
bolic acid,  gi’.  V ad  5i,  or  Dobell’s  solution 
(Part  11),  or  bichloride,  1 : 5000,  and  an  early 
free  incision  of  the  drimi-head  made,  should 
the  middle  ear  become  infected  (see  Otitis 
kledia  Catarrhalis  Acuta). 

Otitis  Media  Purulenta  Chronica. — An 
aural  discharge  lasting  three  months  means 
the  existence  of  a chronic  suppurative  otitis 
media.  The  latter  may  be  present,  however, 
without  the  appearance  of  a discharge,  in 


OTITIS  MEDIA  PURULENTA  CHRONICA 


cases  in  which  the  discharge  is  so  slight  as  to 
dry  up  before  reaching  the  external  meatal 
orifice.  Perforation  of  the  drum  membrane, 
which,  of  course,  is  always  present,  can 
usually,  but  not  always  be  detected  by  the 
high  and  hissing  sound  (“  perforation 
whistle  ”)  heard  tt^ough  the  diagnostic  tube 
during  inflation  of  the  middle  ear,  performed 
either  by  Valsalva’s  or  Politzer’s  method,  or 
by  catheterization  (see  Inflating  the  Middle 
Ear).  The  normal  sound  is  soft  and  blowing. 
If  fluid  is  present,  moist  rales  may  be  heard. 
Siegle’s  otoscope  may  also  be  employed  to 
detect  the  presence  of  perforation.  By  its 
use,  a small  drop  of  pus  may  possibly  be 
seen  exuding  through  the  perforation.  This 
instrument  is  also  useful  for  the  detection 
of  adhesions.  After  thoroughly  cleansing 
the  meatus  and  deeper  parts  with  cotton 
pledgets,  use  a probe  to  explore  for  adhesions, 
granulations,  and  rough,  necrosed  bone. 

The  causes  of  chronic  middle  ear  suppura- 
tion are  the  same  as  those  of  the  acute  catar- 
rhal or  suppmative  forms  {q.v,),  from 
which  the  chronic  form  develops.  Adenoids 
are  of  special  etiological  hnportance.  Tuber- 
culosis and  syphilis  are  sometimes  causal. 

Prognosis.— The  disease  may  eventuate  in 
(1)  cure  with  complete  restoration  of  hear- 
ing; (2)  more  or  less  deafness  due  to  adhe- 
sions and  thickening  of  the  mucous  mem- 
brane; (3)  cholesteatoma  formation;  (4) 
bone  necroses  and  their  sequelae,  viz.,  con- 
tinuous discharge,  mastoiditis,  labyrinthitis, 
meningitis,  extradural  or  brain  abscess, 
sinus  thrombosis,  septico-pyaemia,  hemor- 
rhage from  the  internal  carotid  artery  or 
internal  jugular  vein  (see  under  Mastoiditis 
Interna).  The  prognosis  is  favorable  in 
healthy  individuals,  and  in  cases  with  a central 
perforation,  no  granulations,  a permeable 
eustachian  tube,  and  a moderate,  non-fetid, 
purulent  discharge.  It  is  less  favorable  in  the 
contrary  cases,  in  those  secondary  to  scarlet 
fever,  measles,  influenza,  typhoid  fever, 
tuberculosis,  syphilis,  diabetes,  leukaemia 
and  other  cachexias,  and  in  those  associated 
with  chronic  nasopharyngeal  affections, 
stricture  of  the  external  meatus,  choleste- 
atoma, and  paresis  or  paralysis  of  the  facial 
nerve. 

Treatment.— The  general  health  should,  of 
course,  receive  attention.  Prescribe  a nutri- 
tious diet,  fresh  air  day  and  night,  regula- 
tion of  the  bowels,  adequate  rest  and  exer- 
cise, adequate  clothing,  a daily  morning 
warm  bath  before  breaMast  in  a warm  room, 
followed  by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  and  tonics 
(iron,  arsenic,  codliver  oil,  hypophosphites, 
potassium  iodide,  etc.),  as  indicated  (see 


Drugs,  Part  11).  Interdict  the  use  of  alcohol 
and  tobacco. 

Endeavor  to  correct  any  possible  etio- 
logical influence,  such  as  adenoids,  hypertro- 
phied tonsils,  hypertrophied  timbinates,  septal 
deflection,  disease  of  the  posterior  ethmoidal 
or  sphenoidal  sinuses,  etc.  (see  Nose  and 
Throat  Diseases).  Treat  an  epipharyngitis 
with  weak  silver  solutions. 

A marginal  perforation  generally  inchcates 
bone  necrosis;  a central  perforation,  a shnple 
suppurative  process,  probably  of  tubal 
original.  “If  the  tubal  infection  is  due  to  a 
constriction  at  the  isthmus  of  the  tube  (as 
evidenced  by  the  absence  of  a perforation 
whistle,  although  a perforation  is  invisible), 
the  tube  should  be  dilated  with  bougies, 
and  astringent  and  antiseptic  solutions 
forced  through  it  with  a Weber-Liel 
catheter.”  (Ballenger.) 

Two,  three,  or  four  times  a day,  if  the  chs- 
charge  is  profuse,  otherwise  once  a day, 
inflate  the  middle  ear  per  tubam  by  means 
of  Politzer’s  or  Valsalva’s  method  or  the 
catheter  (see  Inflating  the  Middle  Ear),  and 
produce  rarefaction  of  the  air  in  the  ex- 
ternal meatus  by  means  of  Siegle’s  oto- 
scope, for  the  purpose  of  expelling  and 
aspirating  the  secretion  from  the  middle 
ear.  Follow  this  procedure  by  gently  syring- 
ing the  canal,  or  if  need  be,  the  middle 
ear  directly,  the  latter  by  means  of  Blake’s 
middle-ear  cannula,  with  warm,  boiled  water, 
or  sterile  normal  saline  solution  (3i  ad  Oi), 
or  boric  acid  solution,  3i~iv  ad  Oi,  or  alumi- 
num acetate,  2 to  3 per  cent.,  or  lysol,  10  to 
15  drops  to  the  half  piut,  or  formalin  10  to 
15  drops  to  the  quart  or  litre  of  boiled  water, 
or  potassium  permanganate,  1 : 2000,  or 
bichloride,  1 : 8000  to  1 : 5000.  The  latter  is 
used  in  virulent  cases,  e.g.,  scarlet  fever, 
diphtheria,  influenza,  etc.,  and  should  be 
used  with  care,  especially  in  children,  since 
the  fluid  may  escape  into  the  pharynx; 
therefore  employ  little  force  in  syringing, 
and  incline  the  patient’s  head  toward  the 
affected  side.  If  the  discharge  is  profuse  or 
blenorrhoeic,  Politzer  uses  oil  of  turpentine, 
4 to  5 drops  to  0.3  litre  of  warm  boiled  water. 

In  syringing  or  performing  other  manipu- 
lations within  the  canal,  straighten  the  latter 
by  drawing  the  auricle  upward,  backw^ard, 
and  outward  in  adults,  and  in  children  out- 
ward and  downward.  Insert  the  nozzle  of 
the  syringe  within  the  canal  as  far  as  possi- 
ble, and  direct  it  toward  the  tip  of  the  nose 
in  adults,  and  upward  and  inward  in  chil- 
dren. If  the  syringing  is  done  by  the  patient, 
supply  him  with  a soft  rubber  ball-syringe. 

After  syringing  the  canal,  cleanse  it 
further  by  means  of  small,  sterile  cotton 


OTITIS  MEDIA  PURULENTA  CHRONICA 


pledgets  on  a cotton-carrier,  pushing  the 
cotton  down  to  the  membrane  and  rotating 
it,  so  that  a clear  view  of  the  membrana 
tympani  may  be  obtained.  Then  fill  the 
external  meatus  with  warm  hydrogen  per- 
oxide, to  which  may  be  added  alcohol  or 
boric  acid.  Now  introduce  into  the 
meatus  the  nozzle  of  a rubber  tube  at- 
tached to  a small  rubber  air-bag,  and  by 
alternately  rarefying  and  condensing  the  an- 
witluri  the  canal,  drive  the  antiseptic  fimd 
into  all  parts  of  the  tympanic  cavity;  or, 
with  the  external  meatus  filled  with  the  anti- 
septic fluid,  and  the  head  inclined  to  the 
opposite  side,  inflate  the  tympanum  by 
Politzer’s  method;  or  press  the  tragus  over 
the  external  meatus  and  inward,  so  as  to 
force  the  fluid  into  the  middle  ear.  If  the 
perforation  is  in  the  anterior  portion  of  the 
membrana,  incline  the  head  a little  back- 
ward as  well  as  to  the  opposite  side. 

By  this  treatment  the  suppiu’ation  may 
often  be  arrested  in  one  or  two  weeks  in 
uncomplicated  cases. 

If  no  decided  lessening  of  the  discharge  is 
noted,  insufflate  daily,  or  every  other  day, 
through  a speculum,  with  a powder-blower, 
a minute  quantity,  never  large  amounts,  of 
finely  powdered  boric  acid,  or  zinc  oxide,  or 
equal  parts  of  each,  or  boric  acid  and  ahun, 
equal  paiis,  or  iodoform,  or  boric  acid  and 
iodoform,  equal  parts.  Powders  are  not  so 
good,  however,  where  there  is  rnirch  rnitcus, 
where  caries  or  gr’anulations  are  present,  or 
where  there  is  marked  desquamation  in  the 
exteriral  meatus.  Indeed,  granulations 
shoirld  be  destroyed  before  beginning  any 
other  treatrnerrt;  After  cleansing  the  canal 
and  cocainizing  the  gr'anirlations  with  a 
warm  4 to  10  per  cent,  solution  of  cocaine, 
or  powdered  cocaine  applied  on  the  mois- 
tened end  of  a probe  (in  children  administer 
ether  or  chloroform),  apply  liquor  ferri 
chloridi,  or  a 10  per  cent,  solution  of  tri- 
chloracetic acid,  on  a probe,  a small  brush, 
or  a ball  of  cotton-wool,  taking  extreme  care 
not  to  touch  any  other  parts  but  the  granu- 
lations, and  to  avoid  the  promontoiy.  The 
cauterization  should  not  be  repeated  until 
after  the  eschar  has  fallen  off.  Politzer  pre- 
fers the  galvanocautery  to  chemical  caustics, 
but  it  should  not  be  used  in  the  t^mipanum. 
The  parts  are  first  anaesthetized  with  {X)w- 
dered  cocaine  applied  on  the  moistened  end 
of  a probe.  “ The  circuit  should  be  closed 
only  when  the  cautery  is  in  contact  with  the 
growth;  and  befoi’e  each  cauterization  the 
point  must  be  thoroughly  heated.”  Small 
shai'p  spoons,  sharp  curettes,  or  ring-knives 
may  be  employed,  after  applying  powdered 
cocaine  on  the  moistened  end  of  a probe,  and 


locating  the  root  of  the  polypus  with  a blimt 
probe  cuiwed  at  the  end  at  a right  angle. 
These  instnnnents  are  also  useful  in  scraping 
necrosed  bone,  which  is  often  concealed  by 
large,  flabby  granulations.  After  curetting, 
apply  adrenalin  solution,  1 : 1000,  on  a 
pledget  of  cotton,  to  check  hemorrhage. 
Then  dry  the  parts,  and  cauterize  the  base 
or  stmnp  of  each  granulation  or  polypus  with 
silver  .nitrate  or  chromic  acid  fused  on  the 
end  of  a probe  by  (Upping  the  red-hot  probe 
in  the  powdered  caustic.  Then  insufflate  a 
minute  quantity  of  finely  powdered  boric 
acid  and  zinc  oxide,  equal  parts.  It  may 
be  necessary  to  enlarge  the  perforation  in 
the  drum  membrane  in  order  to  reach  intra- 
tympanic  polypi.  Polypi  in  the  attic  may 
sometimes  be  diagnosed  by  means  of  a 
small  tympanic  mirror,  and  removed  with  a 
small  curette  bent  at  a right  angle  with  the 
handle.  Large  granulations  and  polypi  may 
be  removed  with  Blake’s  cold  wire  snare. 

Of  particular  value  where  there  are  granu- 
lations, and  where  the  discharge  is  curdy,  is 
the  instillation,  two  or  three  times  daily,  of 
warm  alcohol.  By  virtue  of  its  dehydrating 
qualities  it  causes  the  granulations  to  shrink. 
It  should  at  first  be  cUluted  with  an  equal 
quantity  of  water,  and  its  strength  gradually 
increased.  To  avoid  pain,  pom’  in  two  or 
thi’ee  ch’ops  first,  and  the  rest,  about  thirty 
drops,  one-half  to  one  minute  later;  allow 
it  to  remain  in  the  ear  twenty  to  thirty  min- 
utes. Boric  acid,  gr.  xx  to  the  ounce,  or  car- 
boUc  acid,  gr.  xv  to  the  oimce,  may  be  added. 
Before  instilling  the  alcohol,  the  ear  should 
be  cleansed  and  dried.  The  alcohol  treat- 
ment is  valuable  when  operative  measures 
are  not  feasible  or  are  refused.  Two  to  six 
weeks  or  longer  of  this  treatment  are  required 
to  cause  the  polj’pi  completely-to  disappear. 
Alcohol  is  contraindicated  in  bone  caries 
and  in  acute  intercurrent  inflammation. 

When,  following  any  form  of  treatment, 
the  discharge  becomes  scanty,  allow  a week’s 
rest,  in  order  to  see  if  the  discharge  will  not 
cease.  In  other  words,  do  not  overtreat 
the  case. 

In  cases  in  which  the  discharge  is  scanty 
and  not  fetid,  the  di’y  treatment  may  be 
tried.  The  tjunpanum  is  first  mflated  with 
air  so  as  to  drive  the  secretion  into  the 
external  meatus,  from  which  it  is  removed 
with  a sterile  cotton-wound  applicator.  A 
strip  of  sterile  gauze,  which  may  be  impreg- 
nated, if  desired,  with  boric  acid,  salic3dic 
acid,  bichloride  of  mercury,  tannin,  or  iodo- 
form, etc.,  is  then  introduced  with  forceps 
into  the  Umijianic  cavity,  if  possible,  and 
changed  aseptically  from  one  to  three  times 
daily,  accorciing  to  the  amount  of  discharge, 


OTITIS  MEDIA  PURULENTA  CHRONICA 


the  canal  being  wiped  out  each  time.  The 
diy  treatment  is  contraindicated  “ when 
there  is  a septic,  curdy  secretion,  in  desqua- 
mative processes,  polypi,  caries,  and  great 
irritability  of  the  lining  membrane  of  the 
canal  and  middle  ear.”  (Politzer.) 

Where  there  is  a large  perforation,  the 
caustic  treatment  may  be  tried.  After  care- 
fully syringing  the  canal,  wipe  it  out  with 
sterile  cotton,  and  instil  5 per  cent,  cocaine 
solution.  Wipe  this  out,  and  then  instil 
15  to  20  drops  of  warm,  concentrated  silver 
nitrate  solution.  After  two  or  three  minutes, 
syringe  with  warm  boiled  water.  To  pre- 
vent discoloration  of  the  external  meatus, 
it  may  be  painted  with  a solution  of  potas- 
sium iodide.  The  caustic  treatment  is 
contraindicated  in  cases  with  extensive 
granulations,  desquamation,  caries,  and  a 
fetid  secretion,  and  a small  perforation. 

Where  other  methods  seem  insufficient, 
one  may  try  astringents,  e.g.,  zinc  sulphate, 
lead  acetate,  or  copper  sulphate,  gr.  iii-viii, 
with  glycerine,  5i  and  if  desired,  boric  acid, 
gr.  XV  to  the  ounce  of  water;  or  silver  nitrate, 
gr.  V to  the  ounce  at  first,  increasing  the 
strength  if  necessary;  or  Burow’s  solu- 
tion (Part  11).  Urbantschitsch  recommends 
(Bacon)  thigenol,  two  to  four  parts,  with 
glycerine  and  alcohol,  ten  parts  of  each. 

In  obstinate  cases,  try  washing  out  the 
tympanic  cavity,  per  tubam  (see  Inflating 
the  Middle  Ear)  with  warm  normal  saline 
solution  (5i  ad  Oi),  or  boric  acid  solu- 
tion, 5ii-iii  ad  Oi,  employing  only  mod- 
erate, gradually  increasing  pressme.  If  this 
is  impossible,  fill  the  external  meatus 
with  the  warmed  saline  solution,  after  air- 
douching  and  syringing;  then  tightly  insert 
the  olive-shaped  tip  of  the  air-bag  tube  into 
the  external  orifice  of  the  ear,  and  drive  the 
solution  through  the  tube  into  the  pharynx 
by  compressing  the  air-bag.  (Politzer.) 

Zinc  ionization  is  recommended:  After 
cleansing  the  ear,  fill  it  with  a warm  solution 
of  zinc  sulphate,  2 to  4 per  cent.,  and  aspirate 
the  air  with  a fine  cannula  in  order  to  allow 
the  solution  to  enter  the  middle  ear.  Now 
introduce  an  anodic  wire  wrapped  in  cotton- 
wool wet  with  the  zinc  solution,  and  employ 
three  or  four  rmlliamperes  of  current  for  six  to 
ten  minutes  (see  Ionic  Medication  in  Part  1). 

Where  Sharpnell’s  membrane  is  perfor- 
ated, and  no  neighboring  caries  can  be  dis- 
covered, treat  tentatively  for  a month  or 
so,  as  follows:  After  cleansing  and  drying 
the  canal,  and  cocainizing  the  drum  mem- 
brane by  placing  against  it  for  several  min- 
utes a pledget  of  cotton-wool  soaked  in  10 
per  cent,  cocaine  solution,  slowly  inject  into 
the  attic,  through  a Hartmann  or  an  elastic 


cannula,  connected  by  means  of  a rubber 
tube  30  cm.  long  with  a No.  3 air  bag,  or  by 
means  of  Hewitt’s  apparatus,  or  Blake’s 
middle-ear  syringe,  a solution  of  hydrogen 
peroxide,  one  part,  in  alcohol  and  glycerine, 
one  part  each.  Retain  this  for  fifteen 
minutes,  with  the  head  tilted  toward  the 
opposite  side.  Then  dry  the  canal,  and  in- 
sert a pledget  of  cotton  soaked  in  a strong 
solution  of  iodine-potassium-iodide-glycerine 
down  to  the  drum  membrane,  and  pack 
the  canal  with  gauze.  Repeat  this  treatment 
in  ten  days,  if  necessary.  (Haug.) 

If  no  improvement  follows  remove  the 
carious  ossicles  and  scrape  the  attic  very 
cautiously,  first  carefully  probing  to  ascer- 
tain whether  the  diu’a  is  exposed.  The 
Schwartze-Stacke  meato-mastoid  operation 
may,  however,  be  demanded. 

If  three  or  four  weeks  of  conservative 
treatment  of  a chronic  purulent  otitis  media 
does  not  materially  lessen  the  discharge,  and 
if,  too,  granulations  reappear  several  days 
after  their  removal,  then  bone  caries  or 
necrosis  is  presumably  present.  The  diag- 
nosis is  made  by  the  rough  feeling  imparted 
when  the  diseased  bone  is  touched  with  a 
probe  (use  extreme  care  in  probing  the  mid- 
dle ear),  or  when  sequestra  are  seen  in  the 
meatus  or  deeper  parts. 

Dead  bone  must  be  removed.  After 
syringing  the  canal  and  middle  ear  with 
antiseptic  solutions,  extract  the  malleus  and 
incus,  scrape  the  carious  bone  thoroughly, 
but  with  extreme  care,  and  remove  any 
loose  sequestra  with  forceps.  Bear  in  mind 
the  proximity  of  the  facial  nerve  and  dura 
mater  above,  the  internal  ear,  the  carotid 
artery  in  front,  and  the  jugular  bulb  below. 
Do  not  cmette  the  promontorJ^  After 
removing  the  dead  bone,  syringe  the  middle 
ear  with  bichloride  solution,  1 : 5000,  dry 
with  sterile  cotton,  insufflate  iodoform,  or 
iodoform  and  boric  acid,  equal  parts,  and 
inserta  stripof  boric  acid  gauze  in  the  meatus. 

Where  there  is  necrosed  bone  that  is 
inaccessible  to  the  curette,  Gleason  instils 
enzymol  (containing  pepsin)  twice  a day, 
after  syringing  with  warm  water.  The  enzy- 
mol is  allowed  to  remain  in  the  tympanum 
several  hours  so  as  to  digest  the  dead  tissue. 

If  no  cure  follows  the  above  treatment,  the 
radical  meato-mastoid  or  Stacke-Schwartze 
operation  is  demanded. 

A discharge  may,  of  course,  occur  at  any 
time,  following  ossiculectomy  and  curettage 
of  the  tympanum,  as  a result  of  “ cold,”  as 
pointed  out  by  Dench,  but  it  is  stopped  in  a 
few  days  by  bichloride  (1  : 8000)  irrigations 
followed  by  the  instillation  of  a few  drops 
of  an  alcoholic  solution  of  boric  acid,  gr.  xx 


OTITIS  MEDIA  PUHULENTA  CHRONICA 


to  the  ounce.  The  presence  of  vegetable 
moulds  may  also  be  responsible  for  a sub- 
s('quent  discharge. 

During  the  course  of  any  form  of  treat- 
ment, a light  pledget  of  cotton  should  be 
kept  in  the  external  meatus.  After  the  su{> 
j)uration  has  ceased,  instruct  the  jiatient  to 
instil  every  eight  to  fourteen  days  a warm 
solution  of  equal  parts  of  hydrogen  peroxide 
and  water,  or  increasing  strengths  of  warm 
alcohol,  the  latter  especially  in  the  presence  of 
adhesive  connective  tissue  formation;  and 
have  him  keep  a loose  plug  of  cotton-wool  in 
the  external  meatus,  ami  avoid  the  entrance 
of  water  mto  the  car  while  bathing. 

As  a sequel  of  chronic  suppuration  in  the 
middle  ear,  the  epithelium  of  the  external 
meatus  and  middle  ear  may  desquamate  and 
form  “ structureless,  incoherent  masses  ” 
and  “ circumscribed  tumors  composed  of 
concentric  stratified  lamella',”  mixed  with 
fat  globules  and  crystals  of  cholesterin 
(cholesteatoma).  The  accumulations  are 
whitish-yellow,  and  impart  a doughy  feeling 
on  probing;  they  possess  a foul  odor;  fre- 
quently, small,  gi’itty  lumps  or  large,  whitish- 
yellow  strings  a]ipear  in  the  water  after 
syringing.  I’hey  may  be  found  in  any  part 
of  the  middle  ear  spaces,  particularly  the 
mastoid  cells.  They  may  even  be  forced 
into  the  Haversian  canals,  which  may  possi- 
bly explain  their  frequent  recurrence  after 
oj^erative  removal.  A cholesteatoma  may 
undergo  spontaneous  expansion  with  conse- 
quent pressure  necrosis  of  the  surrounding 
parts.  It  may  cause  death  through  j^ygemia, 
meningitis,  epidural  and  brain  abscess,  or 
sinus  phlebitis. 

When  the  gritty  Imnps  of  cholesteatoma 
ai)i)ear  in  the  aural  discharge,  associated 
with  frequently  recurring  pain  in  the 
mastoid,  the  latter  contains  cholesteatoma, 
and  shoidd  be  opened  uj)  by  means  of  the 
radical,  or  Stack-Schwartze  meato-mastoid 
operation.  This  operation  is  urgently  indi- 
cated when  headache,  dizziness,  and  pysemic 
symptoms  occur. 

In  the  absence  of  mastoid  s^nniitoms, 
endeavor  forcibly  to  syringe  out  the  chole- 
steatomatous  masses,  after  first  loosening 
them  with  a blunt  probe.  If  the  perforation 
in  the  drum  membrane  is  too  small,  it  should 
b('  enlarged.  A fine  cannula  is  attached  to  a 
s^■ring(^,  and  is  introduced  into  the  deeper 
))arts  of  the  meatus,  or  into  the  middle  ear. 
If  the  meatus  is  narrowed,  an  elastic  t\an- 
})anic  catheter  should  be  pushed  through 
the  .stricture  into  the  deejier  j:)arts;  but 
operative  measures  are  usually  required 
in  these  cases.  The  Hartmann  can- 
nula, in  conjunction  with  spoons  bent 


to  a right  angle  at  the  end,  may  be 
employed,  using  air  and  fluid  injections,  to 
remove  cholesteatomata  from  the  attic. 
Slowly  washing  out  the  middle  ear  per 
tubam  with  warm,  sterile  normal  saline  solu- 
tion (5i  ad  Oi)  may  also  be  resorted  to. 

If  the  foul-smelling  tUscharge  continues 
after  several  months  of  treatment,  the 
malleus  and  incus  may  be  extracted  (in  the 
absence  of  indications  for  a radical  meato- 
mastoid  operation),  to  permit  freer  access 
to  the  attic;  and  if  necessary,  as  much  as 
possible  of  the  margo  tympanicus  and  pos- 
terior upper  wall  of  the  bony  meatus  may  be 
chiseled  away  “ in  order  to  gain  ready  access 
to  the  attic,  aditus,  and  if  necessary,  the 
mastoid  antrum.”  The  operation  is  per- 
formed through  the  external  meatus  w'ithout 
detaching  the  auricle,  and  either  general  or 
local  periosteal  anaesthesia  is  employed. 
The  operation  is  described  on  p.  480  in 
Politzer;  the  method  of  producing  periosteal 
anaesthesia  is  described  on  p.  534. 

After  removing  the  epidermic  masses, 
instruct  the  patient  to  irrigate  the  ear  once 
or  twice  a week  with  normal  saline  solution, 
after  instilling  diluted  glycerine  to  soften  up 
the  masses,  and  then  to  instil  hydrogen 
peroxide,  1 : 10,  and  report  to  the  physician 
for  examination  everj'  three  or  four  months 
(Politzer).  For  indications  for  the  radical 
meato-mastoid  operation,  see  under  Mas- 
toiditis Interna. 

In  considering  the  advisability  of  closing 
a perforation  of  the  drum  membrane,  first 
stop  it  with  a drop  of  thin  glycerine  on  the 
end  of  a probe,  if  the  perforation  is  small,  or 
with  a piece  of  moistened  paper,  if  it  is  large ; 
and  then  test  the  hearing;  for  the  closure  of 
the  perforation  maj'  increase  the  deafness. 

To  close  the  perforation,  first  cocainize  the 
drum  membrane  by  means  of  a piece  of  cot- 
ton soaked  in  10  per  cent,  sterile  cocaine 
solution,  which  is  allowed  to  act  ten  min- 
utes; then  diji  a silver  probe  covered  with  a 
thin  layer  of  cotton  into  a concentrated  solu- 
tion of  trichloracetic  acid,  wipe  off  the  excess 
of  ac'id  with  cotton,  and  touch  the  edges  of 
the  perforation,  after  drying  the  latter. 
Repeat  this  every  four  to  eight  days  (Gom- 
perz).  One  may  also  apply  to  the  perfora- 
tion, upon  a cotton-tipped  probe,  a paper 
disc  moistened  in  bichloride  solution 
1 : 1000,  and  repeat  the  application  when- 
ever the  disc  is  (hsplaced,  that  is,  about 
every  four  days  to  two  weeks. 

Closure  of  the  perforation  is  contra- 
indicated when  the  membrana  is  defective 
in  its  entire  extent,  in  perforation  of  Sharji- 
nell’s  membrane,  ami  in  cachectic  imli- 
viduals.  (Politzer.) 


OTOMYCOSIS 


A small  ball  of  sterile  cotton,  impregnated 
with  boric  or  salicylic  acid,  or  dipped  in 
sterilized  Liquid  vaseline,  may  be  employed 
as  an  artificial  driun  membrane.  It  is  best 
inserted  by  the  patient  himself,  with  Hassen- 
stein’s  forceps,  after  showing  him  how.  It 
should  be  worn  only  half  an  hour  for  the 
first  four  or  five  days,  thereafter  increasing 
the  time  by  one-half  hour  every  foui'th  or 
fifth  day.  It  should  be  changed  eveiy  day, 
and  should  be  worn  only  when  needed  for 
j)urpose  of  conversation,  its  daily  applica- 
tion not  to  exceed  six  or  eight  hours.  If  a 
chscharge  is  present,  the  ear  should  be 
syringed  before  each  fresh  insertion  and  after 
each  removal,  and  boric  acid  occasionally 
insufflated  or  a medicated  lotion  instilled. 
It  should  never  be  used  in  children. 

If  marked  deafness  or  intense  tinnitus  and 
dizziness,  not  associated  with  labyrinthine 
disease  (see  tests  under  Examination  of 
the  Ear),  develops  subsequently  to  the 
cessation  of  suppuration  (otitis  media 
purulenta  residua),  employ  the  same  treat- 
ment as  that  of  clu’onic  aural  catarrh, 
i.e.,  good  hygiene;  the  correction  of  nasal 
and  naso-pharyngeal  obstructions;  topical, 
mildly  astringent  applications  to  the  tym- 
panum; inflation  of  the  tympanum,  and 
the  use  of  stimulating  vapors;  the  use  of 
bougies  to  restore  the  patency  of  the  eustach- 
ian  tube;  the  cauterization  of  granulations; 
the  removal  of  crusts  in  the  upper  posterior 
quach’ant  with  forceps,  curette,  or  syringe; 
pneumo-massage  by  means  of  Delstanche’s 
or  the  electro-motor  masseur.  Politzeration 
may  first  be  tried,  combined  with  pneiuno- 
massage.  Politzerize  the  ear  two  or  three 
times  a week  for  four  or  five  weeks,  then 
allow  an  intermission  of  two  or  three  weeks, 
and  resume,  and  so  on. 

If  these  measures  are  insufficient,  an  intra- 
tympanic  operation  should  be  resorted  to. 
Such  operations  as  tenotomy  of  the  extensor 
tympani  muscle;  division  of  a tense  posterior 
fold  of  the  drum  membrane  (plicotomy), 
repeating  several  times,  if  necessary;  cUvision 
of  interossicular  and  ossiculo-tympanic  ad- 
hesions; the  separation  from  the  internal 
wall  of  the  tympanum  of  an  adherent  drum 
membrane;  the  establishment  of  a permanent 
opening  in  the  drum  membrane  when  the 
latter  alone  is  at  fault  (such  an  opening  is  very 
chfficult  to  maintain) ; and  the  restoration  of 
the  tension  of  a relaxed  drum  membrane  by 
applying  a moistefied,  thin  paper  disc  over 
the  relaxed  area  are  effectual  only  in  rare  cases. 

Where  other  measures  fail,  and  the  laby- 
rinth is  not  greatly  involved  {i.e.,  no  marked 
lowering  of  the  upper  tone  limit  is  present: 
see  Hearing  Tests),  Dench  practices  and 
46 


advocates  an  exploratory  tympanotomy, 
under  local  cocaine  anaesthesia,  carrying  out 
hearing  tests  during  the  exp  oration.  He 
turns  down  a large  flap  of  the  posterior- 
superior  segment  of  the  membrana  vibrans. 
If  the  ojiening  causes  no  great  improvement 
in  the  hearing,  he  disarticulates  the  incudo- 
stapechal  joint.  If  no  improvement  follows, 
he  divides  the  stapedius  tendon  and  anj' 
adhesions  present  in  the  oval  niche,  by 
means  of  stellate  incisions,  in  order  to  free 
the  stapes.  He  also  divides  adhesions  in  the 
round  window  by  means  of  stellate  incisions. 
If  liberation  of  the  stapes  improves  the  hear- 
ing, he  removes  the  membrana  tjnnpani, 
malleus,  and  incus  to  secure  permanent  im- 
provement. If  the  stapes,  as  tested  with  a 
cotton-tipped  j^robe,  is  fixed,  Dench  removes 
it  by  means  of  a sharp  spoon  or  a small  conical 
burr,  “ so  guarded  as  to  prevent  its  entering 
the  labyrinth  more  than  a nrillimetre,  when 
the  foot-plate  is  perforated  ”;  or  he  leaves 
the  stapes,  and  removes  the  malleus,  incus, 
and  drum  membrane,  and  tries  later  several 
times  to  mobilize  the  stapes  by  the  chvision 
of  adliesions  about  the  stapes  and  the  round 
window.  Should  the  drum  membrane  re- 
form, it  should  be  removed  until_it  ceases 
to  reform. 

Operative  measures  should  not  be  imder- 
taken  too  soon  after  the  suppurative  process 
has  ceased,  for  fear  of  provoking  a relapse. 

The  treatment  of  facial  paralysis  due  to 
suppurative  otitis  media  is  that  of  the 
primary  affection. 

Otitis  Media  Purulenta  Residua. — L.  re-, 
back  + si'dere,  to  sit.  See  under  Otitis 
Media  Purulenta  Chronica,  above. 

Otomycosis. — Gr.  ear  -f  /xkijs  fungus. 

Fungus  invasion  of  the  external  auchtory 
canal,  causing  itching,  and  possibly  pain, 
tinnitus,  and  deafness.  On  inspection,  the 
walls  of  the  canal  are  seen  to  be  studded 
with  blackish  spots,  or  a whitish  or  yellowish 
powdery-looking  material,  or  thin,  moist 
flakes  or  scales,  according  to  the  variety  of 
fungus  present. 

Soak  the  deposit  in  liquor  potassse  for 
fifteen  ininutes  and  examine  microscopically. 

The  disease  is  quickly  curable. 

Treatment. — After  syringing  the  ear  with 
warm  water  or  a 4 per  cent,  solution  of  sod- 
ium bicarbonate,  and  the  use  of  the  curette, 
forceps,  and  cotton  pledgets,  to  remove  the 
greater  part  of  the  growth,  instruct  the 
patient  to  fill  the  canal  three  times  a day, 
for  at  least  four  days,  and  thereafter  occa- 
sionally for  several  weeks,  allowing  the  fluid 
to  remain  in  at  least  fifteen  minutes,  with  a 
warm  solution  of  bichloride  of  mercury  in 
50  per  cent,  or  pure  alcohol,  1 : 3000;  or  a 2 


STRICTURE  OF  THE  EXTERNAL  AUDITORY  CANAL 


per  cent,  solution  of  salicylic  acid  in  alcohol; 
or  a saturated  alcoholic  solution  of  boric 
acid;  or  sodium  hyposulphite,  1 per  cent, 
solution.  The  alcoholic  solutions  must  be 
in.stilled  drop  by  drop,  because  of  the  pain 
produced.  Instead  of  fluids,  one  may  insuf- 
flate veiy  small  amounts  of  finely  divided 
boric  acid  and  zinc  oxide,  equal  parts;  or 
boric  acid  and  salicylic  acid,  20  : 1.  Oils 
favor  the  growth  of  the  fungus. 

Otorrhoea. — Gr.  ovs  ear  -f  pe7i>  to  flow. 
See  Otitis  Media  Piu-ulenta. 

Otosclerosis. — Gr.  ovs  ear  -f-  cr/cXrjpos  hard. 
See  Otitis  Media  Catarrhalis  Chronica. 

Paralysis  of  the  Acoustic  Nerve. — Gr.  Tapd 
beside  4-  Xueiy  to  loosen.  See  Acous- 
tic Nerve  Paralysis. 

Facial  Nerve. — L.  facies,  face;  Gr. 
vevpov  nerve.  See  Otitis  Media  Puru- 
lenta  Acuta;  and  Chronica;  and  Mas- 
toiditis Interna. 

Perforations  of  the  Drum  Membrane, 
Closure  of. — See  imder  Otitis  Media  Puru- 
lenta  Clironica. 

Perichondritis  Auriculae. — Gr.  Trepl  around 
-p  xdvdpos  cartilage  -f  -ltls  inflammation; 
L.  auricula,  auricle  or  pinna.  Open  the 
bowels  by  means  of  castor-oil,  or  calomel  fol- 
lowed by  a salme  (see  Part  11).  Cleanse  the 
amide  with  soap  and  warm  water.  If  the 
symptoms  are  of  less  than  twenty-four  hours’ 
duration,  one  may  apply  leeches,  followed  by 
the  ice-bag  or  hot-water  bag,  with  the  object 
of  aborting  the  inflanunation;  or  hot  com- 
presses wet  with  bichloride  solution,  1 : 1000, 
or  boric  acid  solution,  5iv  ad  Oi,  or  lead 
and  opium  lotion  (see  Part  11)  may  be 
applied,  and  covered  with  a hot-water  bag 
or  Leiter’s  coil. 

As  soon  as  fluctuation  appears,  make  a 
free  incision,  scrape  the  cartilage  thoroughly 
with  a dull  curette,  irrigate  with  hot  boric 
acid  solution,  and  pack  with  iodofonn  or 
plain  gauze.  Repeat  the  brigation  and 
gauze  packing  daily. 

Some  have  practiced  the  withch’awal  of  the 
septic  fluid  by  means  of  a hypodermic  needle, 
followed  by  the  mjection  of  a mixture  of 
tincture  of  iodine,  one  part,  with  water,  two 
parts,  to  be  withch-awn  after  a few  moments. 

After  heahng  has  set  in,  employ  gentle 
massage. 

Pinna. — L.  'pinna,  whig.  See  Auricle. 

Plugs,  Ceruminous  or  Epidermal.  — L. 
ceru'men,  car-wax;  Gr.  e-rt  on  -f  Seppa  skin. 
See  Wax,  Inspissated. 

Politzerization.  — See  Inflating  the  Mid- 
dle Ear. 

Polypi,  Aural. — See  Aural  Polypi. 

Protruding  Ears. — See  Auricle,  Congeni- 
tal Malformations  of  the. 


Purulent  Inflammation  of  the  Middle 
Ear. — See  Otitis  Media  Purulenta  Acuta; 
and  Chronica. 

Range  of  Hearing. — See  under  Examina- 
tion of  the  Ear. 

Ringing  in  the  Ears. — See  Tinnitus  Aurium. 

Rinne’s  Test  . — See  under  Examination 
of  the  Ear. 

Salpingitis. — Gr.  caXTriy^  tube  -| — ins  in- 
flammation. See  Otitis  Media  Catarrhalis. 

Schwabach’s  Test. — See  under  Examina- 
tion of  the  Ear. 

Sclerotic  Type  of  Chronic  Aural  Catarrh. — - 

Gr.  aKkrjpos  hard.  See  Otitis  Media  Catar- 
rhalLs  Chronica. 

Seborrhoea  Auris. — L.  se'bum,  suet  + Gr. 
po'ia  flow;  L.  aur'is,  ear.  Seboirhoea  of  the 
external  meatus  is  associated  with  sebor- 
rhoea of  the  nose,  forehead,  and  scalp.  It 
causes  itching,  and  may  give  rise  to  some 
tinnitus  and  deafness. 

Possible  etiological  influences  are  general 
debility,  anaemia,  phthisis,  severe  constitu- 
tional diseases,  especially  the  exanthemata, 
dyspepsia,  and  contagion. 

Treatment. — Attend  to  any  possible  causal 
influence.  After  removing  scales  and  other 
accmnulations,  as  described  tmder  Wax, 
Inspissated,  insufflate  a minute  quantity 
of  finely  powdered  boric  acid  and  zinc 
oxide,  equal  parts;  or  precipitated  sul- 
phur and  talcum,  1:4  to  5;  or  apply  an 
ointment  of  ammoniated  mercury,  gr.  x-xxx 
to  the  ounce. 


K Hydrargyri  ammoniati gr.  x-xxx 

Adipis  lanae  hydros!  

Petrolati  mollis,  aa oss 


Sigmoid  Sinus  Phlebitis. — Gr.  ai'ypa  letter 
s 4-  dbos  form;  L.  si'hus,  cavity;  Gr.  ^Xh/- 
vein  -|-  -LTLs  inflanunation.  See  Otitis 
Media  Pmulenta  and  Mastoiditis  Interna. 

Sinus  Thrombosis. — Gr.  dpbp^os  plug. 
See  Otitis  Mecha  Pm’ulenta  and  Mastoiditis 
Interna. 

Stenosis  of  the  External  Auditory  Canal. — 

Gr.  arhoais  narrowing.  See  Stricture  of  the 
External  AucUtory  Canal,  below. 

Stricture  of  the  External  Auditory  Canal. 
— L.  strictu'ra,  narrowing.  Etiology. — Fibrous 
thickening  or  cicatricial  rings  or  bands 
resulting  from  otitis  externa,  chronic  sup- 
purative otitis  media,  or  chronic  eczema, 
rarely  syphilis,  diphtheria,  or  the  action  of 
caustics;  exostoses  and  hyperostoses  (g.r.); 
senile  atrophy  and  shrivelhig  of  the  cartilage; 
congenital  anomaly. 

Temporary'  stricture  is  caused  by  acute 
otitis  externa  and  by  bulging  of  the  posterior- 
superior  wall  of  the  deep  meatus  in  mas- 
toid suppuration. 


TINNITUS  AURIUM 


For  complete  closure  of  the  canal,  see 
Atresia. 

Examine  with  a probe,  in  order  to  ascer- 
tain whether  the  stricture  is  due  to  mem- 
brane or  to  bone. 

A damming  back  of  pus  sometimes  gives 
rise  to  alarining  cerebral  symptoms  (see 
under  Exostoses,  for  Politzer’s  method 
of  syringing  behind  strictures). 

Treatment.— First  reduce  any  inflammation 
present  by  the  measures  described  under 
Otitis  Externa  Diffusa.  If  the  swelling 
is  not  thereby  sufficiently  reduced,  dilate  the 
canal  by  inserting  plugs  of  absorbent  cotton 
soaked  in  carbolic  acid  solution,  1 : 40,  or 
boric  acid  solution,  4 per  cent.  Do  not  leave 
the  plugs  in  too  long. 

The  canal  may  be  gradually  dilated  by 
inserting  conical,  resistant  plugs  of  Charpie, 
of  graduated  sizes;  or  by  means  of  hard 
rubber,  sUver,  or  soft  rubber  tubes,  the 
latter  containing  a quill  toothpick;  or  by 
sterilized,  compressed  sponge  tents,  which 
should  be  allowed  to  remain  until  moderate 
pain  is  produced  by  their  swelhng.  Several 
parallel  longitudinal  incisions  may  be  made 
before  introducing  the  dilators.  The  canal 
should  always  be  irrigated  with  warm 
boric  acid  solution,  5i~iv  ad  Oi,  before 
inserting  dilators. 

Electrolysis  may  be  employed  to  reduce 
fibrous  strictmes.  The  needle  is  attached 
to  the  cathode,  while  the  anode  is  con- 
nected with  a large  sponge,  for  application 
to  the  body  surface.  Employ  a current  of 
“25  to  50  milliamperes,  of  five  to  twenty 
minutes  duration,  according  to  the  amount 
and  density  of  the  fibrous  tissue  ”;  “ five  or 
six  sittings  are  required.” 

The  obstructing  scar  tissue  may  be  ex- 
cised, after  detaching  the  auricle  and  pos- 
terior wall  of  the  cartilaginous  meatus,  and 
replaced  by  a pedunculated  skin  flap  from 
the  mastoid  region.  (Jansen.) 

The  radical  meato-mastoid  operation  is 
indicated  where  the  stricture  is  complicated 
with  a chronic  middle  ear  suppuration. 

Subjective  Noises. — See  Tinnitus  Aurium. 

Syphilis  of  the  External  Ear. — See 
Otitis  Externa  Syphilitica. 

Tests  for  Hearing. — See  under  Examina- 
tion of  the  Ear. 

Thrombosis,  Labyrinthine. — Gr.  dpofi^os 
plug.  See  Labyrinthine  Hemorrhage. 

Sinus. — See  Otitis  Mecfia  Purulenta, 
and  Mastoiditis  Interna. 

Tinnitus  Aurium. — L.  tinnitus,  a tinkling; 
aur'is  ear.  Causes.— Ceruminous  or  epi- 
derm'c  plugs  in  the  external  meatus;  sebor- 
rhoea  auris;  otomycosis;  granulations  and 
polypi;  cholesteatoma;  otitis  externa;  otitis 


media,  acute  or  chronic,  catarrhal  or  sup- 
purative; closure  of  the  eustachian  tube  in 
tubal  congestion  or  catarrh  or  in  acute  or 
chronic  catarrhal  otitis  media;  labyrinthine 
affections  (anaemia,  in  wliich  the  tinnitus  is 
relieved  by  lying  down,  hypersemia,  hemor- 
rhage, embolism  occurring  in  septicaemia, 
and  thrombosis  occurring  in  purulent  otitis 
media,  both  producing  sudden  tinnitus, 
labyrinthitis,  concussion,  Meniere’s  disease, 
vasomotor  palsy  of  the  labyrinthine  vessels) ; 
acoustic  nerve  neuritis  or  paralysis;  abnor- 
mal pulsation  in  the  carotid  artery,  relieved 
by  compressing  the  artery;  intra-cranial 
aneurysm;  loud  or  continuous  sounds;  hys- 
teria; neurasthenia;  arteriosclerosis;  high 
blood  pressure;  anaemia;  migraine;  epilepsy 
(aura);  gout;  congestion  of  the  turbinates, 
relieved  by  the  application  of  cocaine  or 
adrenalin;  quinine,  salicylates,  etc. 

A clicking  tinnitus  is  described,  due  prob- 
ably to  “ spasmodic  contraction  of  one  or 
more  of  the  palate  muscles,  whereby  the 
mouth  of  the  eustachian  tube  is  opened  and 
shut,  particularly  if  the  mucous  membrane 
is  sticky  from  the  presence  of  mucous  ” 
(Bacon);  or  possibly  due,  as  some  believe, 
to  clonic  spasm  of  the  tensor  tympani  or 
stapedius  muscle. 

Politzer  says:  “ Ringing  in  the  cars  with- 
out chfficulty  in  hearing  (see  Hearing  Tests,) 
must  be  regarded  as  a pure  neurosis.” 

Treatment.— Tliis  depends,  of  course,  upon 
the  cause,  (q.v.,  in  its  appropriate  alphabeti- 
cal place).  Inflation  of  the  tympanum  and 
rarefaction  of  the  air  in  the  external  meatus 
are  particularly  effectual  in  middle  ear  chs- 
eases.  Counter-irritation  behind  the  ear  in 
the  form  of  alcoholic  compresses  or  blisters 
(see  Part  11)  may  afford  relief.  Quinine  bi- 
sulphate may  be  applied  to  the  parts  exposed 
by  vesication.  The  cartilaginous  meatus 
may  be  painted  with  a mixture  of  tr.  Valeri- 
anae, 2.0,  aetheris  acetici,  1.5,  and  glycerini 
puri,  30.0  (Politzer).  Sodium  bromide 
and  dilute  hydrobromic  acid  (see  Drugs, 
Part  11)  afford  relief.  Potassium  iochde,  gr. 
V,  t.i.d.,  and  inunctions  of  unguentum 
iodi  into  the  skin  of  the  mastoid  proc- 
ess are  recommended  in  otosclerosis  and 
syphilis.  “ When  the  noises  are  of  a pul- 
sating character,  with  or  without  an  affec- 
tion of  the  heart,”  tincture  of  digitalis,  six 
to  ten  drops,  well  diluted,  t.i.d.,  or  tincture 
of  strophanthus,  five  drops,  well  diluted, 
t.i.d.,  may  diminish  them  (Politzer).  In 
functional  nervous  disorders,  employ  gal- 
vanism, using  the  anode  as  the  active  pole. 
Treat  embolism  and  thrombosis  of  the 
labyrinthine  vessels  the  same  as  labyrinthine 
hemorrhage  (q.v.).  For  clicking  tinnitus. 


WOUNDS 


treat  any  existing  naso-pharyngeal  and 
tubal  catarrh,  and  administer  tonics,  espe- 
cially strychnine  (q.v.).  Galvanization  of 
the  soft  palate,  and  massage  of  the  region 
between  the  ramus  of  the  inferior  maxilla 
and  the  mastoid  process  may  also  be  tried. 

For  persistent  tiimitus  as  well  as  for  per- 
sistent vertigo  of  labyrinthine  (not  central) 
origin,  the  auditory  nerve  has  been  divided 
with  success.  “According  to  W.  S.  Bryant, 
the  most  promismg  cases  are  those  with 
marked  loss  in  an-  conduction  with  preserva- 
tion of  bone  conduction,  cases  of  definite 
cochlear  lesions  in  which  the  tinnitus  is  low- 
pitched  and  of  varying  character.  High- 
pitched  and  musical  tinnitus,  with  complete 
deafness  in  both  air  and  bone  conduction,  he 
regards  as  contramdications.”  (Dench.) 

Good  hygiene,  regulation  of  the  diet  and 
bowels,  adequate  rest  and  exercises,  fresh 
air,  regular  hours  of  eating  and  sleeping, 
frequent  bathing,  residence  in  high  altitudes, 
and  the  avoidance  of  noises,  fatigue,  alcohol 
and  tobacco,  are  of  importance. 

Prognosis. — Where  the  cause  is  removable, 
the  tinnitus  is  curable.  The  condition  is 
rarely  benefited  in  hyperplastic  otitis  media, 
otosclerosis,  unpermeability  of  the  eustach- 
ian  tube,  labyrinthine  and  brain  affections. 
The  prognosis  is  particularly  unfavorable 
when  the  tinnitus  has  lasted  for  months 
or  years. 

Trauma. — Gr.  rpavfxa  woimd.  See  Injuries. 

Tubal  Catarrh. — L.  tuba,  tube;  Gr. 
KarappeXv  to  flow  down.  See  Otitis 
MecUa  Catarrhalis. 

Congestion. — L.  con,  together  gerere, 
to  heap.  See  Otitis  Mecha  Catarrhalis. 

Tubo=Tympanic  Catarrh. — ^See  Otitis 
Media  Catarrhalis. 

Congestion.  — See  Otitis  Media  Catar- 
rhalis. 

Turning  Test  . — See  under  Examination  of 
the  Ear. 

Tympanic  Membrane.  — See  Membrana 
Tym[)ani. 

Tympanum. — Iv.  tym'panum,  drum.  See 
Otitis  Media. 

Valsalva’s  Method  of  Inflating  the  Middle 
Ear. — See  Inflating  the  Middle  Ear. 

Vertigo. — See  Part  1,  General  hledicine 
and  Surgeiy. 

Voice  Test. — See  Examination  of  the  Ear. 

Watch  Test. — See  Examination  of  the  Ear. 

Wax,  Inspissated. — L.  in,  in  -f  spissa're, 
to  thicken.  The  accumulation  of  wax  in  the 
ear  may  be  due  to  (1)  hypersecretion  result- 
ing from  local  hjqierai'mia  occurring  in 
eczema,  seborrhoea,  otitis  externa,  and 
catarrhal  otitis  media;  or  to  (2)  interference 


with  the  normal  escape  of  cerumen  from  the 
ear  resulting  from  stricture  of  the  meatus, 
foreign  bodies,  hairs  about  the  tragus,  mixed 
cermnen  and  soap  pushed  back  into  the 
canal  in  attempts  to  dry  it  with  the  end  of  a 
towel,  scaly  conchtions  of  the  wall  of  the 
canal,  eczema,  and  otitis  externa. 

Plugs  of  desquamated  epidermis  give  rise 
to  the  same  symptoms  as  ceruminous  plugs. 

Prognosis. — The  hypersecretion  of  cerumen 
is  often  associated  with  middle  ear  catarrh 
or  labywmthine  disease,  therefore  the  prog- 
nosis for  hearing  is  favorable  only  when  the 
deafness  is  of  sudden  onset,  indicating  un- 
complicated wax  inspissation. 

Recurrences  after  removal  are  to  be 
expected. 

Treatment. — If  the  plug  is  hard,  first  soften 
it  by  instilling  a warm  solution  of  sodium 
bicarbonate,  gr.  xxv,  and  glycerine,  3i,  in 
water,  5i-  After  fifteen  minutes,  S3ringe 
with  a warm  solution  of  sothum  bicarbonate, 
one  teaspoonful  to  the  pmt,  or  bichloride  of 
mercury,  1 ; 8000  to  1 : 5000,  directing  the 
stream  between  the  plug  and  the  walls  of 
the  canal,  and  using  very  little  force.  Very 
adlierent  masses  may  be  carefully  loosened, 
under  good  illumination,  with  a round-ended 
probe  or  with  forceps.  If  desired,  the  soften- 
ing solution  of  sodium  bicarbonate  and 
glycerine  may  be  instilled  three  or  four 
times  daily  for  about  three  days  before 
employing  the  S3Tinge. 

Epithelial  plugs  should  first  be  gently 
separated  from  the  walls  of  the  meatus  with 
a flat  applicator,  and  then  the  stream  di- 
rected between  the  plug  and  the  canal  wall. 
The  mass  may,  however,  have  to  be  removed 
piecemeal  with  a probe  or  forceps,  an  anaes- 
thetic being  required  for  children. 

After  removing  the  plug,  dry  the  canal 
with  a cotton-wound  probe,  and  to  guard 
against  subsequent  infection,  insufflate  a 
very  small  quantity  of  finely  powdered  boric 
acid  and  zinc  oxide,  equal  parts;  or  have  the 
patient  instil  a solution  of  boric  acid,  gr.  xl, 
or  salicylic  acid,  gr.  x,  in  alcohol,  5h  twice 
daily.  A strong  solution  of  silver  nitrate, 
3i-iii  ad  5i,  left  in  for  fifteen  or  twenty 
minutes,  and  then  sjwinged  out  with  warm 
water,  is  highly  recommended  in  oases  of 
desquamative  inflammation  (epithelial  plugs 
due  to  eczema,  seborrhoea,  otitis  externa). 

After  clearing  out  and  cleansing  the 
canal,  inflate  the  middle  ear  by  Politzer’s 
method  {q.v.),  and  insert  a loose  plug  of 
absorbent  cotton  in  the  meatus,  to  be 
removed  the  next  day. 

Weber’s  Test. — See  Examination  of  the  Ear. 

Wounds. — vSee  Injuries. 


APPENDIX 

Schema  for  the  Aural  History  and  Examination 


Name  Address 

Occupation  Age 

General  appearance 


Complaint  and  history  of  present  illness: 
Previous  history: 

Family  History: 

Examination: 

Hearing:  Whisper — H.  W. — 

Upper  tone  limit — Weber — ■ 

Schwabach : 


Hygiene:  Rest 
Recreation 
Bowels 
Sexual  habits 
Narcotics 
Other  drugs 


No. 

Date 

Race 

Exercise 
Diet  Sleep 

Ventilation  Baths 

Tea  and  coffee 
Alcohol  Tobacco 


Acoumeter — Lower  tone  limit 

Rinne — 


C' 

C" 

C'" 

C>v 

A.C. 

seconds 

B.C. 

seconds 

A.C.  louder,  equal  to,  or  less  than  B.C.: 

Auricles  Mastoids  External  meati 

Drum  membranes  Eustachian  tubes  Nasopharjmx 

Pharynx  Mouth  Nose 

Other  Organs  and  Tissues : 

Diagnosis: 

Treatment  (including  dates  and  whether  at  office  or  home ) : 


The  Aural  Armamentarium. — 1.  Office  and 
Operating  Room  Equipment. — Two  piano  stools; 
adjustable  gas  bracket;  head  mirror  and 
black  leather  head-band  (Gleason’s);  light 
concentrator  with  reflector,  the  latter  to 
replace  the  head  mirror;  Champion  or  Little 
Wonder  pump  for  furnishing  compressed  air 
for  atomizers;  sink  with  foot-lever  spigots; 
swinging  water  spittoon,  galvanic  battery 
and  ionization  outfit;  galvanocautery  and 
aural  points;  dental  engine  or  electric  motor 
for  driving  burrs;  microscope;  fountain 
syringe;  hot- water  bag;  hypodermic  sjTinge; 
revolving  chair. 

Dench’s  low-pitch  tuning  fork;  spoons 
bent  to  a right  angle  at  the  ends;  elastic 
tympanic  catheter;  Galton  whistle;  opaque 
glasses;  Politzer  acoumeter;  Hassenstein’s 
forceps;  blunt  ear- probe  curved  to  a 
right  angle  at  the  end;  foreign  body 
forceps;  polyp  forceps;  Politzer’s  ear 
forceps;  mastoid  curette;  rongeur  forceps 
of  various  sizes;  hand  gouge;  Allport’s 
middle-ear  forceps;  mastoid  chisels  and 
gouges;  middle  ear  probe;  aural  ice-bag; 
aural  Loiter  coil;  polypus  snare;  Toynbee’s 


artificial  ch'um-head;  sharp  aural  polyp 
curette;  Hai’trnann’s  ear  forceps;  dentist’s 
tooth  syringe;  Lucse’s  probe;  metal  ear- 
spout;  Dench’s  modification  of  the  Galton 
whistle;  Bacon’s  scarificator;  vibrophone; 
vibrometer;  artificial  leech;  middle  ear 
vaporizer;  soft  rubber  bulb  ear  s3Tinge;  ear 
specula,  full  set:  Gruber’s  and  Boucheron’s; 
Siegle’s  pneumatic  speculum;  Delstanche’s 
rarefactor  or  masseur.’  electro-motor  mas- 
seur; cotton  carriers;  blunt  hook;  Gross  ear- 
scoop  and  hook;  De  Vilbiss  atomizers,  with 
set  of  tubes,  some  for  introduction  through 
the  nose  into  the  post-nasal  space;  magic 
atomizers;  nasopharyngeal  syringes  (piston 
and  bulb)  with  post-nasal  tips;  Blake’s 
middle  ear  syringe  and  cannula,  straight  and 
curved;  eustachian  catheters,  several  sizes; 
eustachian  bougies;  Clevenger’s  instrument 
for  medicating  the  eustachian  tube;  aural 
auscultation  tube;  paracentesis  needle;  pow- 
der-blower; Allport’s  retractor;  ear  basins; 
trays;  Politzer  bag;  Bezold-Edelmann  set  of 
tuning  forks  and  w’histles;  McKay’s  ear 
forceps;  Dench’s  cutting  forceps;  aural 
gauze  packer;  Allport/s  bone-crushing  for- 


THE  AURAL  ARMAMENTARIUM 


ceps;  circular  trephines;  metal  rods  for 
enlarging  lumen  of  auditoiy  canal  in  exos- 
tosis; Pravaz  syringe;  Siegle’s  otoscope; 
ether  inhaler;  ear-trumpets;  ear  telephone; 
the  small  London  hearing  horn  with  pocket 
battery;  pronged  retractors;  mallet;  dissect- 
ing forceps;  probe  director;  Weber-Liel 
eustachian  catheter;  small  camel’s-hair 
brushes;  needle-holder;  needles,  assorted;  silk, 
silk  worm-gut,  catgut;  scalpels;  arteiy  forceps. 

Intratym panic  instruments angled 
knives;  Ludwig’s  incus  hooks;  dilatation 
knives;  synechia  knives;  Sexton’s  forceps; 
blunt  and  sharp  hooks;  sharp  curettes;  sharp 
spoons,  straight  and  angular;  ring  knives; 
sharp  and  probe-pointed  knives,  straight  and 
curved;  Dench’s  set  of  instruments;  Dench’s 
middle  ear  scissors;  Hartmann’s  tenotome; 
ossiculectomy  knives;  ring  curettes  for 
removing  the  malleus;  tympanic  catheter; 
small  tympanic  mirror; 

Periosteum  elevators;  straight  scissors; 
Hartmann’s  middle-ear  cannula;  curved  scis- 
sors; Jansen  rongeur  forceps;  wet  cup; 
Stacke’s  angular  knives;  blunt  dissector; 
Hewitt’s  apparatus;  Riverdin  needle;  burrs; 
Blake’s  cold  wire-snare;  Ballance’s  instru- 
ments for  skin  grafting:  razor,  pipettes,  teas- 
ing needles,  blunt  packer,  broad  spatulse. 

Wliiting’s  encephaloscope;  Delstanche’s 
nose-clamp  for  holding  the  eustachian  cath- 
eter in  place;  absorbent  cotton;  flat  aural 
applicator;  gauze;  iodoform  gauze;  glue; 
steel  hairpin;  Charpie’s  plugs  of  graduated 
sizes;  aural  tubes  of  silver  or  hard  rubber 
for  dilating  strictures  of  external  auditory 
canal;  compressed  sponge  tents  for  the  same; 
electrolytic  needle;  aluminum  aural  tubes; 
glass  middle  ear  pipette;  Roosa’s  or  Lucse’s 
or  Dayton’s  or  Dench’s  middle  ear  vaporizer; 
No.  5 piano  wire;  thinnest  catgut  violin 
strings;  Weaver  masseur;  artificial  leech; 
Guttmann’s  drum-membrane  trephine,  made 
by  E.  B.  Meyrowitz,  New  York. 

Instrument  case  with  drawers;  cupboard; 
operating  table;  stands;  basins;  pitchers; 
hand-brushes;  soap;  Rochester  sterilizer  for 
dressings;  instrument  sterilizer  (fish-kettle); 
operating  gowns,  caps,  nose  and  mouth  pro- 
tectors; sheets;  towels;  rubber  gloves;  safety 
pins;  adhesive  plaster;  tongue  forceps. 

2.  Internal  Drugs  Mentioned  in  the  Test. — 
(a)  Alteiiatives  and  Tonics  (L.  al'ero,  I 
change;  ton'us,  tone). — Iron;  Fowler’s  solu- 
tion; quinine;  hypophosphites ; codliver  oil; 
tr.  pulsatilla;  sodium  lyrophosphate;  strych- 
nine; galbanum;  potassium  iodide. 

(b)  Purgatives  (L.  purga're,  to  cleanse). 


— Calomel;  castor-oil;  Rochelle  salt;  sodium 
phosphate ; sodium  sulphate;  pul  V.  scammony. 

(c)  Cardiovascular  Drugs. — Tr. 
digitalis;  tr.  strophanthus;  strychnine; 
nitroglycerine;  amyl  nitrite;  ergot; 
adrenalin;  atropine. 

(d)  Diaphoretics  (Gr.  Slo.  through  + 
4>opeLV  to  carry). — Pilocarpine;  salol. 

(e)  Neuromuscular  Sedatives  (L.  sedo, 
I allay). — Morphine;  ether;  chloroform; 
nitrous  oxide  gas;  tr.  opii;  fl.  ext.  gelsemium; 
tr.  aconite;  codeine;  phenacetin;  asafoetida; 
tr.  valerian;  dilute  hydrobromic  acid;  isopral; 
atropine;  ext.  and  tr.  hyoscyami;  radix 
valerian;  bromides;  antipyrine. 

3.  Local  Preparations  Mentioned  in  the  Text. — 
(a)  Antiseptics  and  Astringents  (Gr. 
avri  against  arj\pis  putrefaction;  L.  ad, 
to  strin'gere,  to  bind). — Sodium  bicar- 
bonate; boric  acid;  mercury  bichloride; 
alcohol;  silver  nitrate;  iodoform;  carbolic 
acid;  liq.  alum,  acetatis;  plumbum  acet.; 
liq.  plumbi  subacetatis;  sodium  chloride; 
sodium  hyposulphite;  hydrogen  peroxide; 
lime-water;  ferric  sulphate;  bismuth  sub- 
nitrate; dermatol;  tr.  iocfi;  lotio  nigra;  yel- 
low oxide  of  mercury  ung. ; ammoniated- 
mercury;  zinc  sulphate;  lead  acetate;  tr. 
benzoin;  tannic  acid;  zinc  olein;  iodine; 
Dobell’s  solution  ; comp.  tr.  iodi ; iodine 
ung.;  lysol;  formalin;  potassium  perman- 
ganate; Merck’s  perhydrol  (pm-e  30  per 
cent,  solution);  hyclrogen  peroxide;  Burow’s 
solution;  Thigenol;  balsam  of  Peru;  iodol; 
enzymol;  ung.  hydrarg.  salicylic  acid;  ol. 
eucalyptus;  camphor  water;  pine-needle  oil; 
spt.  vini  rectificati. 

(b)  Caustics  (Gr.  /caTeip  to  burn). — Silver 
nitrate  stick  and  crystals;  chromic  acitl; 
copper  sulphate;  zinc  sulphate;  alum;  liq. 
ferri  sesquichloridi;  potassium  hydroxide; 
liq.  ferri  chloriili;  trichloracetic  acid;  car- 
bolic acid  crystals. 

(c)  Anodynes  (Gr.  av  without  4-  68wri 
pain). — Cocaine  crystals,  alkaloid  and 
salts;  menthol  crystals;  alypin;  eucaine; 
camphor;  oil  of  cloves;ung.veratri;  lead  and 
opium  lotion. 

(d)  Emollients  and  Protectives  (L. 
emol'lio,  I soften). — Glycerine;  zinc  oxide; 
olive-oil;  petrolatum;  albolene;  oil  of  sweet 
almonds;  liquid  vaseline;  lanolin;  con- 
tractile collodion. 

(e)  Counter  Irritants. — Mustard;  oil 
of  turpentine;  tr.  iodi;  acetum  cantharidis; 
cantharides  plaster. 

Miscellaneous.— Sodium  acetate ; sodium  cit- 
rate; aq.  destill.;  diphtheria  antitoxine. 


NOSE 


Cribriform  plate 
of  the  ethmoid 


^ Frontal  sinus 
_ Olfactory  cleft 
_ Superior  turbinate 
^up^meatus 
Ethmoidal  smus 
_ Middle  turbinate 

Orifice  of  the 
maxiT 


llary  sinus 
. Middle  meatus 

Deviated  septum 
~ Septum  of  the 
nasal  foss$ 

Lowertiirbinate 
Lower  meatus 


Granulating 

tissue 


'Mucous  poljp  Y 
j Hypertrophied bwerturb 


Taxillarv 

sinus 


Suppura  iivesinusiiis 


Vaull  of  the  palate 
Buccal  cavH^- 


Carwus  tooth 


Molar 

tooth 


VERTICAL  SECTION  WITH  VARIOUS  LESIONS 

SEEN  FROM  IN  FRONT 

Uvula 

Linqual  V Palatine 


NORWAL  VERTICAL  SECTION 

SEEN  FROM  IN  FRONT 


vegetations 


Adenoid 


Pharyngeal  ton: 


Lingual 
tdnsll  ■ 


Opening  of  the 
^stachian 
tube 

tMid  turbinate 
Lowerturbinate 


Hypertrophiei^ 
I lingual  tonsil 


Openingofth? 

iustachiantube 


Vestibule 
of  larynx- 


Openutg  oF  tfi^ 
Eustachian  tube 


POSTERIOR  OPEMNG 
OF  NASAL. FOSS/E 
Normal  condition 

( Arrow  A i 


^ VERTICALSECTION  OFPROFILOF  NOSE 

tSv  Cribriform  plate  ^ 


PHARYNX  FROM  BEHIND 
FORWARD 
[ Arrow  B i 


Frontal  sinus- 


Ethmoidal 

cells 


Sup**  turbinate 
Sup*?  meatus 
Mid  turbinate 


Mid  fheatus- 
Mucous—^ 
polyps  / 


Adenoids 


Opening  of 
Eustachian  tube 


Inf  meatus 


Tooth 


Palatine  tonsi 


Base  of  the  tongue 


Lowerjaw, 


Vestibule 
of  larjnx 


LAROUSSE  MEDICAL 


The  nose  and  diseases  of  the  nose 


V 


PART  8 

NOSE  DISEASES 


Abscess,  Cuticular. — L.  absces'sus,  a going 
apart;  L.  cu'tis,  skin.  See  Furunculo- 
sis Nasi. 

Abscess  of  the  Septum. — L.  scep'tum,  sep- 
tum. Abscess  of  the  nasal  septum  is  mani- 
fested by  the  presence  of  a painful,  tender, 
bilateral,  fluctuating,  inflammatory  swelling, 
and  resulting  nasal  obstruction. 

Etiology. — Haematoma  of  the  septum;  trau- 
matism; extension  of  inflammation  from 
an  upper  incisor  tooth;  infectious  diseases. 

Treatment.— Make  a free,  unilateral,  hori- 
zontal incision,  as  low  down  as  possible, 
remove  any  loose  fragments  of  cartilage  that 
may  be  present,  and  insert  a loose  gauze 
drain,  which  should  be  changed  daily  until 
healing  occurs. 

Accessory  Sinus  Disease. — L.  accessor'ius, 
supplementary.  See  Sinusitis. 

Adenoma  Nasi. — Gr.  ad-qv  gland  + w/xa- 
tumor;  L.  na'ms,  nose.  See  Tumors  of 
the  Nose. 

Adhesions  of  the  Septum. — L.  adhoe'sio, 
from  adhce'rere,  to  stick  to;  scep'tum,  septum. 
Adhesions  between  the  nasal  septum  and 
adjacent  structures  may  occur  as  a result  of 
traumatism,  syphilis,  lupus,  diphtheria, 
measles,  scarlet  fever. 

Treatment  is  indicated  only  in  the  pres- 
ence of  nasal  obstruction. 

Treatment. — Divide  fibrous  adhesions  with 
scissors,  bony  synechiac  with  the  file-saw, 
and  apply  sterile  vaseline  freely,  or  insert 
a white  celluloid  plate  cut  in  the  shape  of 
a Lake’s  splint.  Any  septal  or  turbmal 
deformity  present  should  be  corrected. 

Cleanse  the  nose  daily  with  a mild 
alkaline  lotion: 

Sodii  bicarbonatis, 


Sodii  biboratis, 

Sodii  chloridi, 

Sacchari  albi,  aa gr.  v 

Aquae 3iii-iv 


M.  Sig. — Warm  and  spray  into  the  nose  several 
times  a day.  St.  Clair  Thomson. 

Touch  exuberant  granulations  with 
chromic  acid  solution,  20  per  cent. 

Alae  Nasi,  Collapse  of  the.  — See 

Alar  Collapse. 

Alar  Collapse. — L.  al'a,  wing;  collapsus, 
falling  in.  Collapse  of  the  alee  nasi,  with 
sliClike  anterior  nares,  is  due  to  non-use  of 
the  nose  in  breathing. 


Treatment. — Correct  the  nasal  obstruction 
(q.v.)  Then  enjoin  nasal  breathing,  and 
employ  local  massage  and  faradism.  A Fels- 
bach  or  Francis  dilator  or  a rubber  tube 
may  be  worn  at  night,  if  required. 

Alternating  Stenosis. — Gr.  arkvocns  nar- 
rowing. See  Rhinitis,  Sunple  Chronic. 

Anaemic  Rhinitis  — Gr  dr  neg.  + at/xa 
blood;  Gr.  pLs  nose  + -ltls  inflammation. 

Synonyms . — Rhinitis  Sicca;  Chronic 
Rhinitis  with  Collapse  of  the  Erectile  Tissue. 

A chronic,  bilateral,  anaemic  condition  of 
the  nasal  mucous  membrane,  due  to  general 
or  constitutional  anaemia,  characterized  by 
paleness  and  collapse  of  the  mucous  mem- 
brane, dryness  and  capaciousness  of  the 
nasal  chambers,  and  the  absence  of  crusts, 
ulceration,  ozoena,  and  anosmia,  whereby 
it  is  chstmguished  from  atrophic  rhinitis. 

Treatment. — This  is  directed  to  the  correc- 
tion of  the  constitutional  anaemia  {q.v.,  in 
Part  1,  on  General  Medicine  and  Surgery). 

Anaesthesia,  Nasal. — -Gr.  av  not  -f  aiadtjcns 
sensibility.  See  Nasal  Neuroses. 

Angioma  Nasi. — Gr.  dyyeiov  vessel  -)-  -w/xa 
tumor;  L.  nasus,  nose.  See  Trunors  of 
the  No.se. 

Anosmia. — Gr.  dv  neg.  -j-  hutip  smell. 
Loss  of  the  sense  of  smell  is  nearly  always 
bilateral.  Test  each  no.stril  separately  with 
oil  of  cloves,  wintergreen,  asafoetida,  valer- 
ian, otto  of  roses,  musk,  oil  of  peppermint, 
alcohol,  ether;  avoid  pungent  substances  like 
vinegar  and  aimnonia,  which  act  upon  the 
fifth  nerve. 

Causes.— Destruction  of  the  alse  nasi, 
whereby  the  insph’ed  air  passes  along  the 
floor  of  the  nose,  and  does  not  reach  the 
olfactory  region;  alar  collapse;  facial  paraly- 
sis; rhinitis;  nasal  polypi;  septal  deviations; 
nasal  tumors;  nasal  obstruction;  nasal  sup- 
puration; adhesion  of  the  soft  palate  to  the 
pharynx;  habit  of  sniffing  up  cold  water, 
cocaine,  snuff  or  nasal  lotions,  especially 
tho.se  containing  carbolic  acid  and  astring- 
ents; congenital  absence  of  the  olfactory 
bulbs  and  nerves;  neuritis  due  to  influenza, 
plumbism,  tobacco,  or  malaria;  dementia 
paralytica;  tabes  dorsalis;  basal  fracture  of 
the  skull;  compression  of  the  nerves  by 
meningeal  lesions,  bone  caries,  or  tumors; 
senile  atrophy;  increased  intracranial  pres- 


ATROPHIC  RHINITIS 


sure;  disease  of  the  uncinate  gyrus;  paralysis 
of  the  fifth  nerve,  causing  anosmia  on 
the  affected  side,  due  to  interference  with 
the  secretion;  reflex  inhibitory  influences 
due  to  an  intranasal  or  other  operation; 
hysteria;  exhausting  diseases  (chiefly  from 
St.  Clair  Thomson). 

Treatment. — This  depends  upon  the  cause 
{q.v.  in  its  appropriate  place) ; but  treatment 
is  unsatisfactory. 

Antrum  Disease. — L.;  Gr.  avrpov  cave. 
See  Sinu.sitis. 

Asthma. — Gr.  aadfia  panting.  See  Asthma, 
in  Part  1,  on  General  Medicine  and  Surgery. 

Atrophic  Rhinitis. — Gr.  a neg  + Tpo4>i] 
nourishment;  pk  nose  + -ltis  inflammation. 

Synonyms. — Ozoena;  Coryza  Foetida;  Scle- 
rotic Rhinitis;  Dry  Catarrh. 

A chronic  affection,  characterized  by 
atrophy  and  sclerosis  of  the  nasal  mucous 
membrane  and  underlying  bone,  abnormal 
patency  of  the  nasal  passages,  and  a fetid, 
muco-purulent  chscharge  which  tends  to 
chy  into  crusts. 

The  absence  of  ulceration  or  necrosis  dis- 
tinguishes it  from  syphilis  and  lupus.  It 
should  also  be  distinguished  from  foreign 
botly,  rhinoliths,  suppurative  sinusitis,  and 
suppurating  adenoids. 

Atrophic  nasopharyngitis,  atrophic  laryn- 
gitis, dyspepsia,  anaemia,  etc.,  may  result 
from  or  accompany  the  cUsease. 

Treatment  heretofore  has  been  only  pallia- 
tive, but  recent  cures  have  been  claimed  by 
the  use  of  vaccines. 

Etiology.— The  coccobacillus  foetidus  ozenae 
of  Perez  may  be  the  causal  agent.  Possible 
etiological  factors  may  be  a local  or  adja- 
cent chronic  suppuration  (ethmoidal  or 
siihenoidal,  rarely  frontal  or  maxillary  sinu- 
sitis, purulent  rhinitis  secondary  to  one  of 
the  exanthemata  or  to  adenoids,  membran- 
ous or  chphtheritic  rhinitis),  long  continued 
hypertrophic  rhinitis,  or  constitutional  dis- 
ease, such  as  syphilis,  tuberculosis,  etc. 

The  affection  occurs  mostly  in  females. 
“ Most  cases  begin  between  the  ages  of 
seven  and  twelve,  and  few  originate  after 
twenty-five.”  (Treitel). 

Treatment. — C'orrect  hygiene  is  of  fore- 
most importance  This  embraces  ade- 
quate rest  and  exercise,  regular  hours  of 
eating  and  sleeping,  rest  before  and  after 
meals,  adequate  clothing,  fresh  air  day  and 
night,  a daily  morning  warm  bath  before 
breakfast  in  a warm'  room,  followed  by  a 
cokl  spinal  douche  and  brisk  rubdown  with 
a coarse  towel,  regulation  of  the  bowels, 
wholesome  food,  and  the  avoidance  of  tlust, 
tobacco,  and  alcohol.  Tonics  may  be  in- 


dicated, e.g.,  iron,  arsenic,  hypophosphites, 
codliver  oil  (see  Drugs,  Part  11).  The  sea- 
side is  recommended. 

J.  W.  MacKenzie  says:  “As  little  liquid 
nourishment  should  be  taken  as  is  com- 
patible with  the  comfort  of  the  inchvidual.” 
Gleason  prescribes  potassiiun  iocUde,  gr.  ii-x, 
well  diluted,  t.i.d.,  (see  Part  11),  “to  in- 
crease secretions  and  (Uminish  reflex  action,” 
“ if  pharyngitis  sicca  and  reflex  laryngeal 
symptoms  are  very  annoying.”  Each  case 
should  be  treated  according  to  imhca- 
tions.  In  po.st-diphtherial  cases  it  is  ad- 
vised that  antitoxin  be  given  hypoder- 
mically and  bichloride,  1 : 4000  to  2000, 
used  locally.  Any  associated  nasal  or  con- 
stitutional affection  should,  of  course,  re- 
ceive attention. 

As  often  as  necessary  for  the  prevention 
of  crust  formation,  the  patient  should 
syringe  the  nose  forcibly,  by  means  of  a 
fountain  syringe,  or  a two-ounce  hard  rubber 
syringe,  or  a rubber  bulb  syringe,  or  a 
three  or  four  ounce  pear-shaped  syringe, 
or  a dental  bulb  syringe  with  post-nasal 
tip,  with  as  hot  a solution  as  can  be 
borne  of  sochum  chloride,  bicarbonate,  or 
biborate,  one  teaspoonful  to  the  pint.  The 
addition  of  thjanol,  1 : 10,000,  or  resorcin, 
1 : 200,  renders  it  more  pleasant  (St.  Clair 
Thomson) . 

Instruct  the  patient  as  follows:  In  irri- 
gating the  nose,  hold  the  head  horizontally 
over  a basin,  first  on  one  side,  then  on  the 
other,  and  insert  the  nozzle  of  the  syringe 
each  time  in  the  upper  nostril.  To  avoid 
the  entrance  of  fluid  into  the  eustachian 
tube  and  middle  ear,  keep  the  mouth  wide 
open  during  the  irrigation,  breathe  through 
the  mouth,  and  refrain  from  swallowing. 
After  each  injection,  clear  the  nose  of  crusts 
and  pus  by  blowing. 

Adherent  crusts  may  be  detached  by  a 
preliminary  softening  with  peroxide  of  hydro- 
gen or  perhytlrol,  3 per  cent.,  or  equal  parts 
of  Dobell’s  solution  (Part  11)  and  pero.xide  of 
hydrogen,  or  by  the  wearing  of  Gottstein’s 
cotton  plugs  in  the  nose  (Fig.  104);  the 


plugs  may  be  moistened  with  olive  oil;  they 
are  changed  every  eight  to  twelve  hours), 
or  by  j)acking  the  nose  with  cotton-wool 
saturated  with  a 10  per  cent,  aqueous  solu- 
tion of  ichthyol  or  with  coal  oil,  which  is 
allowed  to  remain  in  {)lace  for  about  thirty 
minutes,  when  the  crusts  are  detached  by 


Fig.  104. 


CEREBROSPINAL  RHINORRIKEA 


blowing  the  nose,  or  by  the  use  of  a cotton- 
wound  probe. 

After  each  cleansing  process,  one  of  the 
following  oily  preparations  should  be  thor- 
oughly sprayed  or  brushed  into  all  nooks 
and  corners: 


Lignol, 

Olei  olivye,  aa §i 

(Gleason.) 

Thymol gr.  i 

Menthol gr.  x 

Eucalyiitol npi 

Parafhni  liquidi 5i 

(Thonuson.) 

lodi  purl gr.  vi 

Potassii  iodidi gr.  xx 

Olei  menthse  piperita* njv 

Glycerini 5 i 

Antiseptic  and  stimulant  paint.  (Mandl.) 

Ichthyol 3i 

Coumarini gr.  ii 

Unguenti  parafhni ov 


Antiseptic  and  sedative.  (Thom.son.) 

The  following  solution  may  be  carried 
about  by  the  patient  and  used  frequently 
during  the  day : 


R Sodii  bicarbonatis gr.  xx 

Acidi  borici OSS 

Acidi  carbolici mjiv 

Glycerini 5i 

Aquae,  q.s.  ad 5viii 


M.  Sig. — Dilute  with  an  equal  volume  of  water, 
and  use  in  an  atomizer  as  a nasal  spray.  (Dench.) 

Massage  by  means  of  the  electrical  vibra- 
tor or  by  “ titillating  the  parts  with  a probe 
armed  with  a pledget  of  cotton,”  and  dipped 
in  balsam  of  Peru,  is  recommended  as  a 
stimulative  measure.  A one  per  cent,  solu- 
tion of  formaline  occasionally  sprayed  or 
painted  on  under  cocaine  anaesthesia  (4  per 
cent.)  is  also  recommended  for  the  same 
purpose  (Thomson).  Dench  recommends, 
in  some  cases,  the  insufflation  of  a stimulat- 
ing powder,  viz.,  Pulveris  sanguinariae, 
3ss,  Pulveris  lycopochi,  q.s.,  ad  5i-  It 
causes  pain  and  a profuse  watery  discharge. 
It  should  be  discontinued  after  the  tendency 
to  crust  formation  has  been  checked.  Sum- 
mers recommends  a 25  to  35  per  cent,  pow- 
der of  citric  acid  with  sugar  of  milk.  In 
insufflating  powders,  have  the  patient  first 
take  a deep  breath,  and  then  exhale  after 
the  powder  has  been  blown  in. 

Horn  and  Victors  report  remarkable 
re.sults  from  the  use  of  a polyvalent  vaccine 
made  from  the  Perez  bacillus,  which  is 
obtained  preferably  from  the  anterior  end 
of  the  middle  turbinate  after  the  removal  of 
crusts.  The  organism  is  incubated  in  a 
bouillon  tube  for  just  twelve  hours;  then 
one  drop  of  the  bouillon  culture  is  spread 


over  from  three  to  five  agar  Petri  dishes, 
and  these  are  incubated  for  twenty-four 
hours,  when  the  i.'^iolated  colonies  are  trans- 
ferred to  agar  slants.  'Fhe  initial  dose  of 

50.000. 000  to  125,000,000  is  increased  by 

100.000. 000  every  third  or  fourth  or  seventh 
day  until  a reaction  is  obtained,  when  the 
injections  are  given  every  five  to  ten  days 
and  the  dose  gradually  increased  to  one  to 
two  billion.  The  virulence  of  the  germ  is 
sustained  by  animal  passage  and  a fresh 
vaccine  prepared  every  three  or  four  weeks. 
While  cures  are  reportetl,  there  is,  however, 
a tendency  to  relapse  after  treatment 
is  suspended. 

Consult  also  Atrophic  Nasopharyngitis,  in 
Part  9,  Throat  Diseases. 

Bad  Odor,  Abnormal  Perception  of  a. — 

See  Cacosmia. 

Bleeding  from  the  Nose. — See  Epistaxis. 

Bodies,  Foreign,  in  the  Nose.— ^ee  For- 
eign Bodies  in  the  Nose. 

Cacosmia. — Gr.  xa/cos  bad  -|-  6ajj.r)  smell. 
Perception  of  a bail  odor. 

Causes.— Local  nasal  disease;  sinusitis,  espe- 
cially maxillary ; foreign  body;  parosmia  (q.v.) 

Calculus,  Nasal. — L.  cal'ailus,  pebble; 
nahis,  nose.  See  Foreign  Bodies  in  the  Nose. 

Cancer  of  the  Nose. — L.  cancer-,  Gr. 
KapKLvos  crab.  See  Tumors  of  the  Nose. 

Caseous  Rhinitis;  Nasal  Cholesteatoma. — 
L.  caseus,  cheese;  Gr.  pLs  nose  -tns  in- 
flammation; L.  nasus,  nose;  Gr.  xoXi)  bile  -|- 
(TTeap  fat  H — w/xa  tumor.  A rare,  unilateral 
accumulation  of  putrefying  pus  in  the  form 
of  a fetid,  cheesy  mass,  occurring  as  a result 
of  sinusitis,  polyposis,  the  presence  of  a 
foreign  body,  tumors,  or  na.sal  stenosis.  As 
a result  of  pressure,  bony  ulceration  anil  {jer- 
foration  may  occur. 

Treatment. — The  chee.sy  mass  is  removed 
by  means  of  a bent  probe  or  curette  and  the 
post-nasal  injection,  or  injection  through  the 
opposite  nostril  (see  Nasal  Technique),  of  a 
warm  alkaline  solvent,  e.g.,  sodium  bicarbo- 
nate and  biborate,  aa  gr.  viii,  ad  aquam,  5 i. 

Catarrhal  Fever. — L.  catarr'hus,  from  Gr. 
Karappeiv  to  flow  down;  Ij.jehris,  fever.  See 
Rhinitis  Acuta. 

Catarrh,  Dry. — See  Atrophic  Rhinitis. 

Nasal,  Acute. — See  Rhinitis  Acuta. 

Chronic.  — See  Rhinitis,  Simple 
Chronic ; and  Hypertrophic  Rhinitis. 

Dry  . — See  Atrophic  Rhinitis. 

Cerebrospinal  Rhinorrhoea. — L.  cer'ebrum, 
brain;  spina,  spine;  Gr.  pLs  nose  poia  flow. 
A rare  affection,  characterized  by  the  escape 
of  cerebrospinal  fluid  into  the  nose,  due  to 
injuries  to  the  base  of  the  skull,  brain 
tumoi-,  chronic  hydrocephalus,  syphilitii^ 


EPISTAXIS 


pachymeningitis,  or  to  no  apparent  cause. 
An  embryonal  cleft  may  connect  the  anterior 
horn  of  a lateral  ventricle  with  the  nose. 
The  fluid  is  clear  and  watery,  reduces  Fehl- 
ing’s  solution  (see  Urinalysis,  in  Part  1),  and 
contains  no  mucin  (mucin  is  precipitated  by 
acetic  acid).  The  discharge  is  constant  (see 
Nasal  Hydrorrhoea,  for  the  points  of  dis- 
tinction between  the  two  affections). 

There  is  no  known  treatment. 

Cholesteatoma,  Nasal.  — See  Caseous 

Rhinitis. 

Cold  in  the  Head. — See  Rhinitis  Acuta. 

Collapse  of  the  Alae  Nasi. — See  Alar 
Collapse. 

Erectile  Tissue. — See  Ansemic  Rhinitis. 

Concretions,  Nasal. — L.  concretio,  from 
cum,  together  -t-  crescere,  to  grow.  See 
Foreign  Bodies  in  the  Nose. 

Coryza,  Acute.  ^ — L.;  Gr.  Kopv^a.  See 
Rhinitis  Acuta. 

Chronic. — See  Rhinitis,  Simple 
Chronic;  and  Hypertrophic  Rhinitis. 

Foetida. — L.  foe'tidus.  See  Atrophic 
Rhinitis. 

Cysts,  Nasal. — Gr.  kvctls  bladder;  L. 
nasus,  nose.  See  Tumors  of  the  Nose. 

Deflection  of  the  Septum. — See  Deformi- 
ties of  the  Septum. 

Deformities  of  the  Septum. — A septal 
deformity  should  be  corrected  only  when  it 
is  productive  of  symptoms  of  nasal  obstruc- 
tion, viz.,  mouth-breathing,  intermittent 
turgescence,  hyjiertrophic  rhinitis,  si- 
nusitis, post-nasal  catarrh,  chronic  neur- 
algia and  headache,  sense  of  fulness,  nasal 
timbre  of  the  voice,  perhaps  epistaxis,  per- 
haps asthma. 

The  treatment  consists  in  a thorough  sub- 
mucous resection  of  the  septum. 

Deviations  of  the  Septum. — L.  devidre,  to 
turn  aside.  See  Deformities  of  the  Sep- 
tum, above. 

Diathermy.— See  Part  1,  General  Medicine 
and  Surgery. 

Diphtheria,  Nasal. — See  Part  1. 

Dry  Catarrh. — See  Atrophic  Rhinitis. 

Edema  of  the  Septum. — See  Qildema  of 
the  Septum. 

Empyema. — Gr.  ev  within  ttvov  pus. 
See  Sinusitis. 

Enchondroma  Nasi — Gr.  tv  in  -f  xovSpos 
cartilage;  L.  naJius,  nose.  See  Tumors  of 
the  Nose. 

Epipharyngeal  Affections. — Gr.  kwi  on  + 
4>dpvj^  phaiynx.  See  ddiroat  Diseases, 
Part  9. 

Epistaxis. — Gr.  tTrLara^Ls  nosebleed.  The 
hemorrhage  may  occur  from  any  part  of  the 
nasal  mucosa,  but  arises  almost  invariably 


from  the  anterior  {X)rtion  of  the  septum,  the 
so-called  “ site  of  predilection.” 

Etiology. — (a)  Local  Causes. — Deflection 
of  the  anterior  portion  of  the  septum,  favor- 
ing drying,  infection,  and  erosion  of  the 
mucous  membrane  (dry  crusts  form  in  the 
hollow  of  the  septum,  and  give  rise  to  bleed- 
ing when  removed  by  the  finger  nail  or  by 
violent  blowing  of  the  nose) ; multiple 
telangiectases  or  varicosity  of  vessels  in  the 
anterior  portion  of  the  septmn;  traumatism; 
violent  blowdng  of  the  nose,  or  sneezing; 
irritating  inhalations;  acute  rhinitis;  hay 
fever;  chronic  turgescent  rhinitis;  adenoids-, 
tumors;  syphilis;  tuberculosis;  poly7X)sis; 
glanders;  leprosy;  separation  of  crusts  in 
atrophic  rhinitis;  traumatic  abrasion,  ulcera- 
tion, or  perforation  of  the  septum;  foreign 
bodies,  incluchng  maggots,  worms,  and 
leeches;  fracture  of  the  base  of  the  skull. 

(b)  Constitutional  Causes. — High  ar- 
terial tension,  as  in  arteriosclerosis,  hepatic 
sclerosis,  chronic  interstitial  nephritis,  the 
climacteric,  great  or  prolonged  mental  or 
physical  exertion  or  excitement,  extremes  of 
heat  and  cold,  sexual  excess,  overeating  and 
general  plethora,  gout,  alcoholism,  hj^per- 
thyi’oichsm,  acromegaly;  high  venous  pres- 
sure, as  in  vahailar  heart  disease,  congenital 
heart  tlisease,  emphysema,  bronchitis, 
whooping-cough,  pneumonia,  compression  of 
the  veins  from  the  head  and  neck  by  a 
thoracic  aneuiysm,  mediastinal  tumors, 
goitre  and  other  tumors  in  the  neck;  blood 
dyscrasias,  as  in  jaundice,  the  acute  infec- 
tious diseases  (tj^phoid  fever,  smallpox, 
whooping-cough,  measles,  scarlet  fever,  vari- 
cella, typhus  fever,  erysipelas,  pneumonia, 
malaria,  diphtheria.  Rocky  Mountain  spot- 
ted fever,  rheumatic  fever,  miliary  fever, 
yellow  fever,  relapsing  fever,  ephemeral 
fever,  influenza,  acute  nephritis,  syphilis, 
etc.),  in  wliich  epistaxis  occurs  usually  at 
the  onset,  the  various  anaemias  (pernicious 
anaemia,  chlorosis,  post-hemorrhagic  anae- 
mia, leukaemia,  malaria,  etc.),  and  the 
hemorrhagic  diseases  (haemophilia,  purpura, 
scurvy,  etc.);  rapid  ascent  to  high  altitudes; 
suppression  of  the  menstrual  flow;  sudden 
suppression  of  a hemorroidal  hemorrhage; 
vicarious  menstruation;  pregnancy;  neur- 
asthenia; certain  drugs,  viz.,  phosphorus, 
salicylates,  chloralamide,  quinine. 

Treatment.— Have  the  patient  sit  erect, 
holding  a finger  bowl  under  the  cliin.  Ex- 
plore tile  nose  carefully,  under  good  illum- 
ination, using  pledgets  of  cotton,  either 
unmedicated  or  saturated  with  adrenalin 
solut  ion,  1 : 2000  to  1 : 1000,  or  adrenalin  and 
10  per  cent,  cocaine,  equal  parts,  or  anti- 


EPISTAXIS 


pyrine  solution,  5 to  10  per  cent.,  for  the 
purpose  of  checking  hemorrhage.  If  the 
bleeding  point  is  found,  apply  to  it  silver 
nitrate,  or  pure  carbolic  acid,  or  trichlor- 
acetic acid,  or  chromic  acid  fused  on  the  entl 
of  a probe  (first  warm  the  probe,  dij)  it  in 
the  chromic  acid  crystals,  then  warm  the 
part  of  the  probe  next  beyond  the  crystals 
until  the  latter  melt),  or  best,  the  galvano- 
cautery  heated  to  a cherry-red,  or  a silver 
probe  at  a dull  red  heat,  simply  singeing  the 
mucous  membrane  lightly.  Then  apply 
sterile  vaseline  or  boric  ointment,  and  cau- 
tion the  patient  against  blowing  the  nose 
until  the  eschar  has  separated.  The  patient 
may  be  given  an  ointment  to  apply  once  or 
twice  daily  until  the  separation  has  occurred 
and  the  wound  has  healed. 

Angiomata  or  telangiectases  may  be 
removed  with  the  snare  or  forceps,  and  the 
base  touched  with  chromic  acid;  or  electrol- 
ysis, under  cocaine  aiuesthesia  (6  per  cent.) 
may  be  employed;  “the  galvanocautery  is 
apt  to  produce  profuse  hemorrhage.”  In 
employing  electrolysis,  the  needle,  coated 
with  shellac  or  gutta  percha  up  to  within 
one-eighth  inch  of  the  point,  is  attached  to 
the  negative  or  positive  pole  of  a galvanic 
battery  (if  to  the  positive  pole  it  should  be 
of  gold  or  irido-platinum),  and  the  other 
electrode,  covered  with  a wet  sponge,  is 
applied  to  any  convenient  part  of  the  body. 
A current  of  from  one  to  five  milli- 
amperes,  depending  upon  the  size  of 
the  growth,  is  used  and  allowed  to  act  for 
one-half  to  two  or  three  seconds,  or  until 
a blanched  line  is  produced.  The  current 
should  be  increased  and  broken  off  slowly, 
so  as  to  avoid  dizziness,  etc.  Parallel,  slant- 
ing punctures,  to  inch  apart,  may 
be  made,  if  required,  down  to  the  base 
of  the  growth  (see  also  under  Tumors  of 
the  Nose). 

If  the  bleeding  point  can  not  be  found, 
remove  blood-clots,  and  spray  the  nose  with 
adrenalin  solution  (1  : 1000  in  adults, 
1 : 10,000  in  children);  or  insert  pledgets  of 
cotton  saturated  with  adrenalin  solution, 
and  leave  the  latter  in  place  for  a few  min- 
utes, or,  if  need  be,  for  twelve  to  twenty- 
four  hours. 

Other  measures  are  as  follows:  (1)  syring- 
ing (see  Nasal  Technique)  with  very  hot  or 
cold  salt  water  (3i  ad  Oi;  temperature  112° 
to  130°  P\),  or  alum,  4 per  cent.,  or  anti- 
pyrine,  8 to  10  per  cent.,  or  gelatine,  10  per 
cent.,  or  hydrogen  peroxide,  10  vols.  strength 
or  full  strength,  or  perhydrol,  3 per  cent.,  or 
dilute  solution  of  hamamelis;  (2)  insufflation 
(see  Nasal  Technique)  of  powdered  anti- 


pyrine,  ahun,  or  tannic  acid;  (3)  compression 
of  the  septum  l\y  pinching  the  nose  for 
about  fifteen  minutes;  or  the  insertion 
and  dilatation  of  the  finger  of  a rubber 
glove  with  rubber  tube  and  stopcock 
attachment  (Osier);  (4)  affusions  of  cold 
water  to  the  forehead,  face,  and  nape  of 
the  neck;  (5)  digital  compression  of  the 
facial  artery;  (6)  the  reciunbent  posture 
with  the  arms  over  the  head,  and  clothing 
light  and  loose;  (7)  morphine,  if  required, 
as  a calmative. 

As  a last  resort,  tampon  the  nasal  cavity 
with  Bernay’s  comjjressed  sponge,  or  with 
ribbon  gauze  (one-half  to  one  inch  wide  and 
one  yard  long),  either  dry  or  squeezed  out  of 
adrenalin  solution,  or  hydrogen  peroxide,  or 
antipyrine  solution,  or  dilute  solution  of 
hamamelis,  or  trichloracetic  acid  solution, 
1 ; 1000.  Cocaine,  5 per  cent.,  may  first  be 
applied.  Employ  a nasal  specuhmi,  nasal 
dressing  forceps,  and  good  illumination. 
Pack  in  the  gauze  in  successive  loops  nearly 
to  the  posterior  nares,  from  below  upward 
and  from  behind  forward,  until  the  whole 
chamber  is  packed  to  the  anterior  nares. 
Gleason  employs  absorbent  cotton,  which 
is  wrapped  loosely  about  an  Allen’s  probe 
“ so  that  it  forms  a cone  three  inches  in 
length  and  one  inch  in  diameter  at  its 
proximal  extremity  ” (see  Fig.  105).  The 


cotton  is  saturated  with  peroxide  of  hy- 
drogen and  introduced  along  the  floor  of 
the  nose  to  the  epipharyiix,  and  the  probe 
is  withdrawn  while  the  cotton  is  hekl  in 
place  with  the  finger  tip.  Several  more 
plugs  are  then  inserted.  If,  after  a minute  or 
two,  some  blood  oozes  through  the  cotton, 
it  is  touched  with  perchloride  of  iron.  After 
five  or  six  hours  the  first  plug  is  removed 
extremely  slowly  and  gently,  and  after 
twelve  to  twenty-four  hours  the  remaining 
plugs.  No  packing  in  the  nose  shoukl 
be  allowed  to  remain  longer  than  forty- 
eight  hours,  for  fear  of  sepsis  and  result- 
ing meningitis.  Ballenger  insufflates  sub- 
nitrate of  bismuth  before  introducing  the 
tampon. 

In  severe  cases,  and  where  packing  of  the 
anterior  nares  is  insufficient,  {)ack  also  the 
posterior  nares  by  means  of  a Bellocq  (‘an- 
nula,  or  a soft  gum  catheter,  which  is  passed 
through  the  nostril  into  the  pharynx,  and 
then  fastened  to  a cotton  dossil  by  a thread, 
the  free  end  of  which  is  left  long.  The  dossil 
is  brought  up  into  the  choana  by  traction 


Fia.  105. 


FOREIGN  BODIES  IN  THE  NOSE 


on  the  catheter,  and  the  nasal  and  mouth 
ends  of  the  thread  are  tied  over  the  upper 
lip.  The  anterior  nares  is  then  packed.  All 
the  {)acking  should  be  removed  within 
twenty-four  to  forty-eight  hours,  and  the 
nose  irrigated  with  a warm  solution  of  sod- 
ium chloride,  pi  ad  Oi. 

In  severe  operative  hemorrhage,  Ballenger 
employs  ice-water,  “only  two  or  three  injec- 
tions of  four  ounces  each,  for  fear  of  shock.” 

St.  Clair  Thomson  regards  as  antiquated 
the  use  of  ergot  (fluid  extract,  twenty  tlrops 
in  water  every  two  hours),  gallic  acid  (gr.  x 
every  two  hours),  and  dilute  sulphuric  or 
(utric  acid  (gtt.  v-x,  every  hour  for  three 
doses),  internally,  and  iron,  alum,  tannic 
acid,  and  other  astringents  externally.  Gal- 
cium  lactate,  gr.  xxx  in  a half  tumbler  of 
water,  twice  daily  for  six  doses,  is  recom- 
mended (to  a child  of  five  years,  “ at  least 
thirty  or  forty  grains  a day,”  says  Holt). 
Nitrogl3^ceiin  (see  Part  11)  may  be  given  if 
the  l)lood-pressure  (g.w.,  in  Part  1),  is  high. 

Any  causal  influence  should,  of  course, 
receive  attention  (consult  the  appropriate 
caption  and  part). 

Equinia. — See  Skin  Diseases,  Part  5. 

Ethmoiditis. — Gr.  sieve  -|-  eiSos  form 

-|-  -LTLs  inflammation.  See  Sinusitis. 

Exostosis  Nasi. — Gr.  e^out  -T  darkov  bone; 
L.  nasus,  nose.  See  Tumors  of  the  Nose. 

Fetid  Coryza. — L.  jce'tidus;  Gr.  Kopv^a. 
See  Atrophic  Rhinitis. 

Fibrinous  or  Membranous  Rhinitis. — L. 
fib'ra,  fibre;  menihrdna,  membrane;  Gr.  pts 
nose  + -LTLS  inflammation.  An  inflamma- 
toiy  nasal  affection  of  children,  character- 
ized by  a membranous  exudation,  associated 
generally  with  the  presence  of  the  Klebs- 
Loffler  bacillus,  sometimes  with  the  strep- 
toco(Tus,  staj^hylococcus  aureus,  or  pneu- 
mococcus, with  slight  nasal  obstruction  and 
catarrh,  and  little  or  no  constitutional  symp- 
toms, and  with  spontaneous  recoveiy  in 
from  one  week  to  three  months. 

Bad  hygiene  is  a factor.  IMeasles,  scarlet 
fever,  and  influenza  may  be  causative.  The 
affection  may  also  follow  intranasal  opera- 
tions, especially  when  the  galvanocauter\' 
is  used. 

Treatment.— Keep  the  nose  clean  by  means 
of  the  following  bland,  alkaline  lotion,  fol- 
lowed by  a spraj"  or  instillation  of  albolene, 
benzoinol,  or  paroline, 

B .Sodii  hicarbonati.s, 


.Sxlii  hiboratis, 

Sodii  chloridi, 

Sacchari  all)i,  aa gr.  v 

Aqua; 5iii-iv 


M.  Si}j. — W'arm,  and  spray  into  the  nose 
(Thomson. ) 


St.  Clair  Thomson  .says:  “ It  is  useless 
to  remove  the  membrane  forcibly,  and  the 
local  employment  of  strong  antiseptics  can 
onl}^  be  harmful.”  “ The  injection  of  diph- 
theritic antitoxin  does  no  good.” 

Kjdc,  however,  advises  the  following 
measures:  First  douche  the  nose  (see  Nasal 
Technique)  with  a warm  solution  of  sodium 
bicarbonate  and  biborate,  aa  gr.  viii  to  the 
ounce;  then  apply,  by  means  of  spray,  douche, 
f)r  cotton  pledget,  equal  parts  of  hydrogen 
peroxide  (15  vols.  strength)  and  cinnamon 
water.  Remove  all  caseous  material  by  means 
of  a probe,  loosely  wrapped  with  cotton, 
repeat  the  alkaline  douche,  dry  the  surface 
carefully,  and  apply,  on  a cotton  carrier,  one 
of  the  following  preparations: 


B Toluol .36.0 

Alcoholis  absoluti 60.0 

Liquoris  ferri  sesquichloridi . . . 4.0 

M.  Sig. — Apply  not  oftener  than  three  times  daily. 
(Loffler’s  solution.) 

B Olei  eucalypti gtt.  ii 

Acidi  carbolici gtt.  i 

Olei  cassiae gtt.  iv 

Alboleni  liquidi 5 i 


Open  the  bowels  and  prescribe  elixir 
ferri,  quinin®,  et  stiychninte  phosphati 
(see  Part  11). 

Fibroma  Nasi. — L.  fib'ra,  fibre  -f  Gr.  -wga 
tumor;  L.  nasus,  nose.  See  Tumors  of 
the  Nose. 

Foreign  Bodies  in  the  Nose. — These 
incluile  calculi  or  concretions  (rhinoliths) , 
maggots,  screw-worms,  leeches,  centipedes, 
ascarides,  earwigs,  etc. 

A chronic,  unilateral  discharge,  usually 
fetid,  is  very  suggestive  of  the  presence  of  a 
foreign  bodj'.  Examine  the  nose  with  a 
probe,  under  good  illumination. 

Treatment. — Remove  the  foreign  body  bj" 
syringing  through  the  opposite  nostril  (see 
Nasal  Teclmique)  or  through  the  posterior 
nares  with  warm  normal  saline  solution 
(oi  ad  Oi),  or  by  means  of  special  forceps,  or 
a strabismus  or  ear  hook,  or  snare.  If  it  can 
not  be  removed  anteriorljq  it  maj^  possibly  be 
pushed  back  into  the  throat,  where  it  should 
be  caught  before  it  can  enter  the  larjmx. 
Local  cocaine  antesthesia  (5  per  cent.)  may 
be  required  in  adults,  and  general  antesthesia 
in  children. 

After  removing  the  foreign  body,  cleanse 
the  nose  twice  daily  with  a warm,  bland, 
alkaline  wash:  1}  Sodii  bicarbonatis,  Sodii 
biboratis,  Sodii  chloridi,  Sacchari  albi,  aa 
gr.  V,  ad  aquam  5iii-iv  (Thomson),  followed 
bv  the  application  of  Camphorie,  gr.  i, 
Tlnunol,  gr.  i,  (Menthol,  gr.  ii,  Gosmolini 
liquidi,  5i  (Kyle),  until  healing  occurs. 


HYPERTROPHIC  RHINITIS 


Where  the  foreign  body  is  animate,  e.g., 
larvae,  anaesthetize  the  patient  with  chloro- 
form, and  inject  into  the  nose  equal  parts  of 
chloroform  and  water,  or  a bland  oil,  such 
as  olive  oil  or  liquid  vaseline.  Then  remove 
the  dead  larvae  and  cleanse  the  nasal  cavities 
as  described  before.  Touch  any  ulcers  pres- 
ent with  zinc  chloride,  3 per  cent,  solution; 
and  for  h’ritation,  apply  night  and  morning 
the  following: 


R Acetanilid  S''-  v 

Salol sr.  iv 

Menthol gr.  v 

Ungiienti  petrolati, 

Unguenti  zinci  oxidi,  aa oiv 

(Kyle.) 


Should  the  larvae  get  into  the  sinuses, 
operative  interference  may  be  demanded. 

Fractures  of  the  Nose. — See  Part  10. 

Frontal  Sinusitis. — L.  Jronidlis,  pertaining 
to  the  forehead.  See  Sinusitis. 

Furunculosis  of  the  Nose. — L.  furunculus, 
lx)il.  Etiology.— Boils  are  caused  by  pus 
organisms,  almost  always  the  staphylococci 
aureus,  albus,  and  citreus.  Contributory 
causes  are  chronic  eczema,  u-ritating  appli- 
cations, scratching,  dust,  uncleanliness, 
sewer-gas,  dampness,  anaemia,  chronic  alco- 
holism, nephritis,  diabetes  mellitus,  dys- 
pepsia, gouty  or  rhemnatic  diathesis,  men- 
strual disorders,  poor  health. 

Treatment.— A boil  may  often  be  aborted 
by  the  application,  on  a pledget  of  cotton, 
of  a 50  per  cent,  solution  of  ichthyol,  or  10 
per  cent,  solution  of  carbolic  acid  in  glycer- 
ine. After  pus  has  formed,  incise  the  abscess 
from  within^the  nose,  whenever  feasible. 

Attend  to  any  possible  causal  influence, 
and  enjoin  the  observance  of  correct  hygiene, 
e.g.,  adequate  rest  and  exercise,  fresh  air 
day  and  night,  frequent  bathing,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  a generous  dietary,  regulation 
of  the  bowels,  and  tonics  if  indicated,  viz., 
Blaud’s  pills,  elixir  ferri,  quininse,  et  strych- 
ninae  phosphatum,  syrup  of  hypophosphites, 
Fowler’s  solution  of  arsenic  (see  Drugs, 
Part  11). 

Fresh  brewer’s  yeast,  or  the  ordinary 
compressed  yeast  cake,  or  finmnculin,  or 
ceridin  (see  Part  11)  is  well  recommended 
for  furunculosis.  “ The  use  of  vaccines  is 
altogether  the  most  effective  treatment,” 
says  Holt.  “ Injections  should  be  repeated 
every  three  or  four  days;  beginning  with 
fifty  millions,  the  dose  may  be  increased  to 
one  hundred  millions.”  (See  Vaccines  in 
Part  11.) 

Glanders;  Equinia. — L.  equus,  horse.  See 
Part  5,  Skin  Diseases. 


Haematoma  of  the  Septum. — Gr.  aifxa 
blood  + -coyua  tumor;  L.  sep'tum,  septum. 
Septal  haematoma  is  characterized  by  the 
presence  of  a bilateral,  rounded,  smooth 
swelling,  and  resulting  obstruction  to  breath- 
ing, following  injury. 

Treatment. — If  small,  leave  alone;  if  large, 
or  if  suppurating,  make  a free,  unilateral, 
horizontal  incision  as  low  down  as  possible. 

Hallucinations  of  Smell. — L.  hallucinai'io. 
See  Parosmia. 

Hay=Fever. — See  Part  1,  General  Medicine 
and  Surgery.  ^ 

Hemorrhage,  Nasal. — Gr.  ai^a  blood  -f- 
prtyvvvaL  to  burst  forth.  See  Epistaxis. 

Hydrorrhcea,  Nasal. — See  Nasal  Hycffor- 
rhcea. 

Hypersesthesia,  Nasal. — Gr.  virtp  over  + 
aiadrjcTLs  sensibility.  See  Nasal  Neuroses. 

Hyperosmia. — Gr.  virkp  over  -|-  dcrpi] 
smell.  Exaggerated  sense  of  smell. 

Causes. — Hysteria;  mania;  hypochondria; 
irritative  lesions  of  the  olfactory  bulbs 
and  centre. 

Hypertrophic  Rhinitis. — Gr.  vivkp  over  + 
Tpo<t>r^  nutrition;  pLs  nose  + -trts  inflamma- 
tion. A chronic,  hypertrophic  affection  of 
the  inferior  turbinal,  and  perhaps  the  anter- 
ior extremity  of  the  middle  turbinal,  giving 
rise  to  partial  nasal  obstruction  and  an 
abundant,  thick,  nasal  or  postnasal  dis- 
charge, and  caused  by  the  same  conditions 
that  produce  chronic  turgescent  rhinitis 
iq.v.).  Gleason  says:  “It  is  invariably  the 
result  of  long-continued  simple  chronic 
(intumescent)  rhinitis.”  The  surface  of  the 
turbinal  appears  nodular,  or  polypoid,  or 
rugose,  and  is  firm  to  the  touch  of  the 
j)i’obe.  Cocaine  and  adrenalin  do  not  con- 
tract the  tissues  as  in  chronic  turges- 
cent rhniitis. 

The  Prognosis  imder  treatment  is  favorabh'. 
The  possible  sequelae  are  the  same  as  those 
of  simple  chronic  rhinitis  (q.v.).  Atrophy 
may  also  result. 

Treatment. — Attend  to  any  existing  consti- 
tutional derangement,  and  enjoin  the  observ- 
ance of  correct  hygiene  (see  the  etiology  and 
prophylaxis  of  Simple  Chronic  Rhinitis). 

Prescribe,  for  cleansing  purposes  at  home, 
one  of  the  following,  to  be  used  as 
often  as  retjuired,  until  all  inflammation 
has  subsided : 

Sodii  bicarbonatis, 


Sodii  biboratis, 

Sodii  chloridi, 

Sacchari  albi,  aa gr.  v 

Aqua; 5 iii-iv 


M.  Sig. — ^Use  warm  as  a spray  or  douche  (see 
Nasal  Technique).  (Thomson.) 


INTUME8CENT  RHINITIS,  CHRONIC 


R Sodii  bicarbonatis gr.  xxx 

Sodii  biboratis gr.  xvl 

Acidi  carbolici irpvi 

Glycerin  i 5i 

Aqua;  destillata; 


M.  Sig. — Use  warm  as  a spray. 

Follow  each  cleansing  process  by  a spray 
of  liquid  albolene  or  vaselin,  benzoinol,  or 
paroline. 

After  the  inflammation  has  disaj^peared, 
resorti  to  surgery  for  the  removal  of  hyper- 
trophied masses  aiul  obstructive  lesions, 
such  as  spurs,  septal  deflections,  adenoids, 
and  enlarged  tonsils.  Hypertrophied  masses 
are  removed  (under  local  cocainization,  6 
per  cent.,  and  adrenalization,  1 : 1000,  or 
under  general  anaesthesia)  with  the  cold- 
wire  snare  (Jaiwis’  needles  and  snare;  the 
Krause,  Blake,  or  Lock  snare,  threaded 
with  No.  5 piano  wire),  saw,  spoke- 
shave,  or  swivel  knife.  When  employing 
the  snare  to  remove  the  enlarged  anter- 


upon  the  septum,  it  is  best  to  give  a 
general  anaesthetic,  and  after  adrenalizing 
the  parts  thoroughly,  to  remove  the  hyper- 
trophied part  in  one  mass,  with  sharp,  nar- 
row, curved  nasal  scissors,  or  saws,  or 
spoke-shave,  or  swivel  knife.  Then  apply 
cotton  saturated  with  adrenalin  for  five  or 
ten  minutes;  then  paint  the  cut  surface 
with  collochon. 

In  employing  the  snare  or  punch  forceps 
for  the  removal  of  the  posterior  end  of  the 
inferior  turbinal,  the  left  forefinger  is  used 
in  the  post-nasal  space  as  a guide. 

St.  Clair  Thomson  first  grasps  the  mass 
firmly  with  the  snare,  then  waits  “ some 
minutes  to  allow  of  blood-clotting,”  then, 
with  a quick  movement,  avulses  the 
mass  instead  of  cutting  through  it,  thus 
removing  it  more  thoroughly  and  with 
less  hemorrhage. 

Hemorrhage  is  checked  by  the  same 
measures  detailed  under  Epistaxis,  viz.. 


ior  end  of  the  inferior  or  middle  turbinate, 
first  make  a cut  with  scissors  at  the  attach- 
ment of  the  turbinal  to  the  outer  nasal  wall, 
lighten  the  screw  slowly  and  intermittently 
so  as  to  avoid  hemorrhage.  After  removing 
the  mass,  insufflate  iodol  upon  the  cut  sur- 
face, or  cauterize  the  cut  surface  with  the 
galvanocautery  or  with  chromic  ac^id  fused 
on  the  end  of  a probe  (first  warm  the  probe, 
dip  it  in  the  chromic  acid  crystals,  then  warm 
the  part  of  the  probe  next  beyond  the  crys- 
tals until  the  latter  melt).  Warn  the  patient 
not  to  clear  the  nostril  for  forty-eight  hours. 
At  the  end  of  this  period,  the  nose  is  clearetl 
of  clots  and  mucus  by  blowing,  and  an  alka- 
line lotion  followed  by  an  oily  spray  is  pre- 
scribed until  healing  occurs. 

The  punch  forceps  are  useful  for  the  pur- 
pose of  removing  the  enlarged  anterior 
end  of  the  middle  turbinal  and  the  posterior 
end  of  the  inferior  turbinal  (under 
g('ueral  anaesthesia). 

\\’hen  the  whole  inferior  border  of  the 
turbinal  is  hypertrophied  and  presses  firmly 


closure  of  the  nostrils  with  thumb  and  fore- 
finger; ice  externally  and  in  the  mouth;  the 
horizontal  posture;  syringing  of  the  nose 
with  very  cold  or  very  warm  normal  salt 
solution,  3 i ad  Oi ; the  introduction  of  pledg- 
ets of  cotton  soaked  in  hydrogen  peroxide, 
10  vols.  strength;  packing  with  ribbon  gauze 
or  cotton  as  a last  resort. 

The  operator  should  aim  to  leave  at  least 
one-half  of  the  turbinal  body  behind  so  as 
to  avoid  the  development  of  a dr>'  rhinitis, 
phaiyngitis,  and  laryngitis. 

For  diffuse  turgidity  and  hj-pertrophy, 
gradual  pressure  with  soft  rubber  splints  or 
malleable  silver  tube  (Fig.  103)  is  well 
recommended.  The  silver  tube  is  worn 
only  one  or  two  hours  at  a time  at  first,  and 
the  pressure  and  the  duration  of  its  applica- 
tion are  graduall}"  increased. 

Injuries  of  the  Nose. — See  Fractures  of 
the  Nose,  in  Part  10. 

Intumescent  Rhinitis,  Chronic. — L.  in- 
nmiescens,  swollen.  See  Rhinitis,  Simple 
Chronic. 


NASAL  NEUROSES 


Ionic  Medication. — See  Part  1,  General 
Medicine  and  Surgery. 

Lipoma  Nasi. — Gr.  XIttos  fat  + -to/ua  tumor; 
L.  nasus,  nose.  See  Tmnors  of  the  Nose. 

Loss  of  Smell. — See  Anosmia. 

Lupus  of  the  Nose  and  Throat. — See  Part 
9,  Throat  Diseases. 

Lymphoma  Nasi. — L.  lym'pha,  lymph  + 
Gr.  -icfia  tumor;  li.  nasus,  nose.  See 
Tumors  of  the  Nose. 

Maxillary  Sinusitis. — L.  maxil'la,  jaw- 
bone. See  Sinusitis. 

Membranous  Rhinitis. — See  Fibrinous  or 
Membranous  Rhinitis. 

Mucocele  of  the  Accessory  Sinuses. — L. 

mucus  -|-  Gr.  (07X77  tumor.  See  under 
Sinusitis. 

Nasal  Abscess. — L.  nasus,  nose;  absce's- 
sus,  a going  aj^art.  See  Furuncu- 
losis Nasi. 

Adenoma. — Gr.  abijv  gland  + -wm® 
tumor.  See  Tumors  of  the  Nose. 

Alae,  Collapse  of  the.  — See  Alar 
Collapse. 

Anaesthesia. — Gr.  av  not  -f-  olaQ-qais 
sensation.  See  Nasal  Neuroses. 

Calculus. — L.  calculus,  pebble.  See 
Foreign  Bodies  in  the  Nose. 

Catarrh,  Acute. — L.  catar'rhus,  from 
Gr.  narappelv  to  flow  down; 
L.  acui'us,  sharp.  See  Rhinitis 
Acuta. 

Chronic.  — See  Rhinitis,  Sim- 
ple Chronic;  and  Hypertrophic 
Rhinitis. 

Cholesteatoma. — See  Caseous  Rhinitis. 

Collapse. — See  Alar  Collapse. 

Concretions. — L.  concretio,  from  cum 
together  -)-  crescere,  to  grow.  See 
Foreign  Bodies  in  the  Nose. 

Cysts. — Gr.  /cuo-rts  bladder.  See  Tum- 
ors of  the  Nose. 

Edema,  Acute. — See  QHdema  of  the 
Septum. 

Enchondroma. — Gr.  h within  -|-  x^Spos 
cartilage  -co/xa  tumor.  See  Tum- 
ors of  the  Nose. 

Exostosis. — Gr.  ef  out  -1-  oareov  bone. 
See  Tumors  of  the  Nose. 

Fibromatosis. — L.  fib'ra,  fibre  -f-  Gr. 
-upa  tumor.  See  Tumors  of  the 
Nose. 

Foreign  Bodies. — See  Foreign  Bodies 
in  the  Nose. 

Fractures, — See  Part  10. 

Furunculosis. — See  Furunculosis  of  the 
Nose.  _ 

Hemorrhage. — Gr.  aipa  blood  + 
prjyvvvaL  to  burst  forth.  See  Epistaxis. 

Nasal  Hydrorrhoea. — L.  nasus,  nose;  Gr. 


vSosp  water  -f  poLa  flow.  A rare  and  obscure 
nasal  affection,  characterized  by  a more  or 
less  abundant,  viscid,  slightly  opalescent, 
mucinous  discharge,  varying  from  a few 
ounces  to  a pint  or  more  in  the  twenty-four 
hours,  and  without  marked  visible  local 
changes,  e.g.,  hypertrophies,  polypi,  septal 
spurs,  neoplasms,  sinusitis,  etc.,  and  not 
associated  with  trigeminal  neuritis. 

It  is  distinguished  from  cerebrospinal 
rhinorrhoea  (q.v.,)  by  the  presence  in  the 
secretion  of  mucin,  which  is  precipitated 
by  acetic  acid,  and  the  absence  of  a reducing 
substance,  as  demonstrated  by  Fehling’s 
test  (see  Urinalysis  in  Part  1) . The  secretion 
usually  flows  from  both  nostrils;  whereas  cere- 
bro-spinal  rhinorrhoea  is  unilateral.  Malaise 
begins  with  the  discharge  and  only  ends 
with  the  cessation  of  the  discharge;  whereas 
in  cerebrospinal  rhinorrhoea,  headache,  etc., 
are  relieved  by  the  discharge.  Nasal  hydror- 
rhoea is  frequently  irshered  in  with  sneez- 
ing, photophobia,  and  lachrymation, 
whereas  no  photophobia  or  lachrymation 
accompanies  cerebrospinal  rhinorrhoea.  The 
discharge  in  the  former  affection  rarely 
continues  during  sleep,  in  the  latter 
it  does. 

Treatment. — The  treatment  is  the  same 
as  that  of  hay-fever  (q.v.):  cauteriza- 

tion of  sensitive  areas;  correction  of  nasal 
and  sinus  lesions;  adrenalin  sprays,  1 : 20,000 
to  1 :1000,  repeated  as  required;  atropine,  gr. 
HoO)  every  three  or  four  hours,  to  lessen 
secretion;  zinc  chloride  solution,  3 per  cent., 
twice  daily,  to  lessen  secretion  (Kyle) ; 
acicU  gallici,  gr.  x,  ad.  vaseline  5i,  with 
menthol,  gr.  i-ii  (Gleason);  olei  myrti,  gtt. 
V,  olei  santali,  gtt.  v,  alboleni  liquidi,  5i, 
or,  camphoriE,  gr.  i,  mentholis  gr.  iv,  ben- 
zoinolis,  5 i,  to  lessen  local  irritation  (Kyle) ; 
the  constant  current  (Babes) ; calcium  chlor- 
ide, gr.  xxx-xlv  a day,  (see  Part  11),  for  two 
weeks.  (Lake.) 

Nasal  Hyperaesthesia. — Gr.  virkp  over  -t- 
a'Lad-qcns  sensibility.  See  Nasal  Neu- 
roses. 

Injuries. — See  Fractures  of  the  Nose 
in  Part  10. 

Lipoma. — Gr.  XIttos  fat  + -oipa  tumor. 
See  Tumors  of  the  Nose. 

Lupus. — See  Lupus  of  the  Nose  and 
Throat,  in  Part  9. 

Lymphoma. — L.  lym'pha,  lymph  -1-  Gr. 
-wpa.  tumor.  See  Tumors  of  the 
Nose. 

Neoplasms. — Gr.  vko<i  new  -|-  ir'Kaapa 
formation.  See  Tumors  of  the  Nose. 

Nasal  Neuroses. — Gr.  vevpov  nerve.  Nasal 
neuroses  embrace  anosmia,  hyperosmia. 


NASAL  TECHNIQUE 


parosmia,  cacosmia,  aneesthesia  (caused  by 
hysteria,  chronic  nasal  disease,  or  rarely 
intracranial  growths  or  syphilitic  pachy- 
meningitis), hypersDsthesia,  and  possibly  hay- 
fever  and  asthma. 

Nasal  Obstruction. — 

Nasal  CEdema,  Acute. — See  (Edema  of 
the  Septum. 

Nasal  Osteoma. — Gr.  dareov  bone  + -cofxa 
tumor.  See  Tumors  of  the  Nose. 

Papilloma. — L.  papil'la,  nipple  -f-  Gr. 
-(A>fxa  tumor.  See  Tumors  of  the  Nose. 

Nasal  Polypus. — L.  nams,  nose;  Gr. 
irokvs  many  -(-  ttoOs  foot.  Nasal  polypi  con- 
sist of  exuberant  granulation  tissue,  and 
arise  as  a result  of  chronic  inflammation, 
e.g.,  sinusitis  (especially  necrosing  or  rare- 
fying ethmoiditis),  simple  chronic  rhinitis, 
hypertrophic  rhuiitis,  sejDtal  spurs  and 
deviations,  foreign  bodies,  traumatism,  new- 
gi-owths,  nasal  hydrorrhoea,  cerebrospinal 
rhinorrhoea,  etc.  The  sjanptoms  are  those 
of  nasal  obstruction  together  with  a dis- 
charge. The  affection  is  common. 

Nasal  ix)lypi  arise  almost  invariably  from 
the  inferior  surface  of  the  middle  turbinate, 
or  from  the  etlunoidal  cells;  very  rarely  from 
the  septum,  the  inferior  turbinate,  or  the 
accessory  sinuses  (mostly  the  maxillary). 

In  the  examination,  always  employ 
cocaine  (4  per  cent.)  and  the  probe. 
Polypi  do  not  bleed  readily  like  malignant 
growths. 

Prognosis. — The  prognosis  is  good  if  all 
the  polypi  are  removed  together  with  theii’ 
cause. 

Treatment.— St.  Clair  Thomson  says:  “ In 
operating  on  nasal  polypus,  two  facts  should 
be  kept  in  mind.  The  first  is  that,  with  few 
exceptions,  nasal  polypi  spring  from  the 
middle  turbinal  and  the  neighborhood  of  the 
middle  meatus;  the  second  is  that,  when 
numerous,  rapidly  recurrent,  or  associated 
with  suppuration,  they  will  be  found  to  be 
dependent  on  jtus  in  one  or  more  of  the 
accessory  sinuses. 

In  simple  cases,  in  which  the  cause  is  a 
slight  local  inflammation,  the  use  of  the 
cold  wire  snare  is  effectual.  Fii’st  cleanse  the 
nose  by  irrigation  (see  Nasal  Technic)  with 
warm,  boiled,  normal  saline  solution  (pi  aci 
()i);  then  apply  to  the  accessible  mucous 
membrane,  particularly  that  of  the  septum, 
sterile  cotton  jiledgets  saturated  with  4 to 
10  per  cent,  cocaine  and  1 : 2000  adrenalin 
solution.  After  waiting  seven  minutes,  pass 
the  wire  loop  over  the  polypus  to  its  base, 
tighten  the  loop  until  the  pedicle  is  snugly 
grasped,  then  tear  the  polypus  from  its 
attachment  by  a “ quick  movement  of 


avulsion.”  As  many  polypi  should  be 
removed  at  one  sitting  as  practicable.  The 
toothed  forceps  may  be  useful  in  bringing 
down  the  polypus  into  a more  accessible 
position;  or  this  may  be  accomplished  by 
the  patient  blowing  through  the  nose.  Kyle 
prefers  a modified  Sajous  snare,  or  scissors, 
or  alligator-jaw,  biting  forceps.  St.  Clair 
Thomson  prefers  a simple  Krause  or  Blake 
snare,  threaded  with  No.  5 piano  wire. 

The  left  forefinger  in  the  post-nasal  space 
is  of  assistance  when  the  polypus  presents  in 
this  region. 

If  the  bleeding  is  severe,  apply  an  8 to 
10  per  cent,  solution  of  aliunnol,  or  pack 
the  nose  lightly  with  gauze  or  cotton  pled- 
gets moistened  with  hydrogen  peroxide 
(see  Epistaxis);  but  remove  the  packing 
as  soon  as  possible,  within,  at  the  most, 
twelve  hours. 

After  twenty-four  or  forty-eight  hours, 
the  nose  should  be  cleansed  two,  three,  or 
four  times  a day  with,  say. 


Sodii  biboratis gr.  ,xv 

Acidi  carbolic! gr.  ii 

Aqiiffi  cinnamomi oil 

Aquae,  q.s.  ad Si 

(Kyle.) 

or  B Sodii  bicarbonatis, 

Sodii  biboratis, 

Sodii  chloridi, 

Sacchari  albi,  aa gr.  v 

Aqua? Siii-iv 

(Thomson.) 


Where  the  ethmoid  bone  or  an  accessory 
sinus  is  diseased,  more  extensive  operative 
measures  are  required  (see  the  standard 
special  textbooks). 

“ In  the  aged  or  the  infirm,  however,  it  is 
usually  inadvisable  to  recommend  measures 
more  radical  than  the  simple  removal  of  the 
polypi,  as  the  danger  from  shock  and  acute 
infection  is  greater  in  these  subjects  ” 
(Ballenger).  Ballenger  says  that  the  injec- 
tion into  the  polypus  with  a hypodermic 
sjTinge  of  a few  minims  of  a saturated  solu- 
tion of  zinc  sulphate  or  tannic  acid  will 
cause  it  to  shrink  and  slough  awa}'. 

Nasal  Septum.^ — See  Septum. 

Suppuration. — L.  sufe,  under  -f-  pus, 
pur'is,  pus.  See  Purulent  Rhinitis. 

Technique. — In  irrigating  the  nose,  hold 
the  head  horizontally  over  a basin,  first 
on  one  side,  then  on  the  other,  and  insert 
the  nozzle  each  time  in  the  upper  nostril. 
To  avoid  the  entrance  of  fluid  into  the 
eustachian  tube  and  middle  ear,  keep 
the  mouth  wide  open  during  the  irrigation, 
breathe  through  the  mouth,  and  refrain 
from  swallowing. 


PAROSMIA 


In  insufflating  powders,  have  the  patient 
first  take  a deep  breath  and  exhale  after  the 
powder  has  been  blown  in. 

In  fusing  chromic  acid  on  the  end  of  a 
probe,  first  warm  the  probe,  dip  it  in  the 
chromic  acid  crystals,  and  warm  the  part 
of  the  probe  next  beyond  the  crystals  until 
the  latter  melt. 

In  using  the  electrocautery,  first  co- 
cainize and  then  dry  the  parts  carefully. 
Then  turn  on  the  current  until  the  cautery 
point  is  at  a cherry-red  heat.  A white  heat 
causes  hemorrhage,  while  a dull,  heat  causes 
adherence  of  the  point  to  the  charred  tis- 
sues. Remove  the  cautery  before  turning 
off  the  current. 

Nasal  Traumatism. — Gr.  rpadfia  wound. 
See  fractures  of  the  Nose,  in  Part  11. 

Tuberculosis. — -See  Lupus  of  the  Nose 
and  Throat  in  Part  9. 

Tumors. — See  Trnnors  of  the  Nose. 

Nasal  Ulcers. — L.  nasus,  nose;  ulcus, 
ulcer.  Causes.— Nasal  catarrh;  herpes;  ec- 
zema; foreign  bodies;  paresis  or  paral- 
ysis of  the  fifth  nerve  (neuroparalytic 
or  trophic  ulcer);  scurvy;  diabetes;  vari- 
cose veins;  excess  of  sulpho-cyanides  and 
ammonium  salts  in  the  salivary  and  nasal 
secretions  (Kyle);  malignant  neoplasms; 
tuberculosis;  syphilis;  leprosy;  glanders; 
membranous  rhinitis,  croupous  or  diph- 
theritic; acute  infectious  diseases  (measles, 
scarlet  fever,  typhoid  fever,  typhus  fever, 
smallpox,  rheumatism,  influenza,  diph- 
theria); irritating  fumes  (chromic  acid, 
copper-arsenic  green);  traumatism  (picking 
at  the  nose);  the  galvano-cautery  or  other 
caustic;  septal  haematoma;  septal  abscess; 
deposition  of  dust  or  discharge  over  the 
bleeding  area  of  the  septum  in  those  subject 
to  epistaxis  (see  Ulceration  and  Perforation 
of  the  Septum). 

Treatment. — Attend  to  the  cause.  Cleanse 
the  nose  and  soften  scabs  by  means  of  a 
warm,  alkaline  lotion,  viz.,  ^ Sodii  bicar- 
bonatis,  sodii  biboratis,  sodii  chloridi,  et 
sacchari  albi,  aa  gr.  v,  in  aquam,  5iii~iv; 
or  I^  Hydrogeni  peroxidi  et  aquae  cinna- 
momi,  aa;  applied  frequently  during  the  day. 
Then  gently  remove  scabs  and  apply  a mild 
mercurial  ointment,  e.g.,  I)  Hydrargyri  am- 
moniati,  gr.  x,  petrolati  mollis,  5i;  or  the 
following,  Tr.  benzoini  comp,  et  boro- 
glyceridi  (50  per  cent.),  aa. 

If  the  ulcer  is  very  sluggish,  it  may  be 
very  gently  curetted,  and  a weak  caustic 
applied  only  occasionally,  e.g.,  silver  nitrate, 
gr.  v-xx  ad  5i;  or  chromic  acid,  gr.  v-x  ad 
5 i;  or  formaline,  3 per  cent. ; or  zinc  chloride, 
3 per  cent.;  or  Loffler’s  solution  (toluol,  36 
47 


parts,  absolute  alcohol,  60  parts,  liquor  ferri 
sesquichloridi,  4 parts. 

Kyle  recommends  the  local  application  of 
bovinine  to  trophic  ulcers.  The  ulcers  of 
leprosy  are  treated  with  chaulmugra  oil,  one 
part  to  five  or  six  parts  of  lard;  those  of 
glanders  with  carbolic  acid,  1 : 60,  on  lint. 
Tubercular  ulcers  should  be  thoroughly  re- 
moved with  the  knife  or  cautery,  followed 
by  the  application  of  lactic  acid,  50  per 
cent,  solution,  and  insufflations  (see  Na.sal 
Technic),  of  pyoktanin  or  aristol  (Kyle). 
Syphilitic  ulcers  should  be  touched  every 
other  day  with  acid  nitrate  of  mercury, 
one  part  to  four  parts  of  water;  or  if  this 
is  too  painful,  silver  nitrate,  gr.  lx  ad  5i- 
(Gleason.) 

Zinc  ionization  (q.v.)  is  recommended — 
a current  of  eight  milliamperes  being 
applied  for  fifteen  minutes,  and  repeated  in 
one  week. 

Naso=Pharynx.  — See  Throat  Diseases, 
Part  9. 

Neoplasms  of  the  Nose. — Gr.  veos  new  -|- 
7rXd(T/xa  formation ; L.  nasus,  nose.  See 
Tumors  of  the  No-se. 

Neuroses,  Nasal. — ^See  Nasal  Neuroses. 

Nose,  Affections  of  the. — ^See  Nasal 
Affections. 

Nose=Bleed. — See  Epistaxis. 

Obstruction,  Nasal. — L.  obstructio;  nasus, 
nose.  See  Nasal  Obstruction. 

Odor,  Bad,  Abnormal  Perception  of  a. — 

See  Cacosmia. 

CEdema  of  the  Septum;  Acute  QEdema= 
tous  Rhinitis. — Gr.  swelling;  L.  scep'- 

turn;  acutus,  sharp;  Gr.  pLs  nose  -j — trts  in- 
flammation. Causes. — Traumati-sm;  the  gal- 
vanocautery  and  other  escharotics;  irritating 
fumes;  inhalation  of  steam;  dental  caries; 
perichondritis;  typhoid  and  other  infec- 
tious fevers. 

Treatment. — Apply  astringents,  e.g.,  adren- 
alin, 1 : 1000,  or  a 0.1  per  cent,  solution  of 
formaldehyde  in  5 per  cent,  cocaine  solu- 
tion, or  6 per  cent,  sulpho-carbolate  of  zinc, 
or  3 per  cent,  chloride  of  zinc.  If  the  swell- 
ing is  excessive,  puncture  the  oederha- 
tous  tissues. 

(Edematous  Rhinitis,  Acute. — See  CEdema 
of  the  Septum,  above. 

Osteoma,  Nasi. — Gr.  darkov  bone  -|-  -wpa 
tumor;  L.  nasus,  nose.  See  Tumors  of  the 
Nose 

Ozoena. — Gr.  o^rj  stench.  See  Atrophic 
Rhinitis. 

Papilloma  Nasi. — L.  papil'la,  nipple  -j-  Gr. 
-wpa  tumor;  L.  nasus,  nose.  See  Tumors  of 
the  Nose. 

Parosmia. — Gr.  irapa  beside  -f-  oapi]  smell. 


RHINITIS,  ACUTE 


Subjective  perversion  of  the  sense  of  smell, 
or  olfactory  hallucinosis. 

Causes.— Hysteria;  epilepsy;  insanity;  hy- 
pochondriasis; injury  of  the  head;  rarely 
tumors  in  the  hippocampi ; influenza. 

Perforation  of  the  Septum.^ — See  Ulcera- 
tion and  Perforation  of  the  Septum. 

Perversion  of  the  Sense  of  Smell. — L.  per 
through  + ver'sio,  a turning.  See  Parosmia. 

Polypus,  Nasal. — See  Nasal  Polypus. 

Post=Nasal  Affections. — See  Throat  Dis- 
eases. 

Purulent  Rhinitis. — L.  pus,  pur' is,  pus; 
Gr.  pis  nose  -|-  -ins  inflammation.  Causes.— 
Acute  coryza  in  the  later  stages;  the  specific 
exanthematous  fevers;  syphilis;  tuberculosis; 
gonorrhoea;  mixed  nasal  infections;  foreign 
bodies;  suppurative  sinusitis. 

Treatment. — Attend  to  the  cause.  In  sim- 
ple purulent  rhinitis,  first  blow  out  the 
mucus  and  pus  from  each  nostril  (in  children 
using  the  rubber  bulb  ear  syringe),  then 
cleanse  the  nose  very  gently,  twice  daily, 
by  means  of  the  rubber  bulb  syringe  (see 
Nasal  Technic)  with  Dobell’s  solution  (see 
Par!  11),  or  hydrogen  peroxide,  15  vols. 
strength,  or  equal  parts  of  hydrogen  peroxide 
and  cirmamon  water,  or,  in  infants,  tepid 
milk  containing  three  grains  of  sodium 
chloride  to  the  ounce,  followed  by  tepid 
boric  acid  solution  of  the  same  strength. 
Then  dry,  and  apply  with  a brush  a small 
quantity  of  an  astringent  preparation,  viz., 
zinc  sulphocarbolate  gr.  xx,  to  water  one 
ounce  ; or  ichthyol,  50  per  cent,  solution; 
or  camphor,  gr.  i,  menthol,  gr.  iii,  and  car- 
bolic acid,  gtt.  ii,  in  liquid  albolene  one 
ounce;  or  in  infants,  two  or  three  drops  *of 
liquid  albolene  or  cosmoline. 

Rhinal  Hydrorrhoea. — Gr.  pis  nose.  See 
Nasal  Hydrorrhoea. 

Rhinitis,  Acute. — Gr.  pis  nose  -ltls  in- 
flammation; L.  acid' us,  sharp.  Synonyms. — 
Acute  coryza;  acute  nasal  catarrh;  cold  in 
the  head;  acute  catarrhal  fever. 

An  acute  inflammatory  affection  of  the 
nasal  mucous  membrane,  lasting  from  four 
to  fourteen  days  or  longer,  characterized  by 
the  occurrence  of  malaise,  lassitude,  slight 
fever,  chilly  sensations,  perhaps  headache, 
perhaps  slight  sore  throat,  sneezing,  lachry- 
mation,  dryness  and  stuffiness  of  the  nose 
(first  stage  or  stage  of  onset),  followed  by  a 
profuse,  watery,  acrid  discharge  (second 
stage),  which  later  becomes  mucopurulent 
or  {)urulent  (third  stage). 

The  inflammation  may  extend  to  any  part 
of  the  respiratory  tract,  and  also  to  the 
accessory  sinuses,  eustachian  tube,  middle 
ear,  and  retropharyngeal  glands. 


Etiology.— A variety  of  microorganisms  may 
be  demonstrated,  e.g.,  the  staphylococus 
aureus,  streptococci,  pneumococci,  bacil- 
lus influenzae,  micrococcus  catarrhalis, 
and  bacillus  rhinitis  of  Tunnicliff;  but  the 
last  named  is  probably  the  common  cause. 
Contributory  influences  are  sudden  tempera- 
ture changes;  automobiling,  or  exposure  to 
cold,  or  wet,  or  draughts;  damp  feet;  insuf- 
ficient or  too  much  clothing;  overheated 
rooms;  vitiated  air,  dust  and  irritating  inhal- 
ations; spring  and  fall;  depressing  mental 
and  physical  states,  e.g.,  fatigue,  hunger, 
etc.;  constipation;  hepatic  torpidity;  defec- 
tive urinary  excretion;  gout;  rheumatism; 
diabetes;  infantile  scurvy;  anaemia;  digestive 
disturbances;  sexual  excesses;  violent  exer- 
cise; alcohol,  tobacco, iodide,  arsenic,  etc. ; hay 
fever;  asthma;  traumatism;  nasal  obstruc- 
tion, due  to  adenoids,  septal  deviations,  poly- 
pi, etc.;  foreign  bodies;  chronic  rhinitis;  infec- 
tious diseases  (“  cold  ” or  catarrhal  fever,  influ- 
enza, measles,  scarlet  fever,  whooping-cough, 
typhoid  fever,  typhus  fever,  rheumatic  fever, 
syphilis,  tuberculosis,  smallpox,  chicken  pox, 
diphtheria,  erysipelas,  glanders,  gonorrhoea). 

Treatment. — 1.  First  or  Dry  Stage.— 
Enjoin  rest  indoors,  preferably  in  bed,  in  a 
comfortable,  well-ventilated  room,  free  from 
draughts,  for  one  or  two  or  three  days. 
Open  the  bowels  with  castor-oil,  or  calomel  in 
divided  doses,  followed  by  a saline.  For  drug 
formulae,  etc.,  see  Part  11.  Prescribe  liquid 
diet  and  copious  hot  drinks,  e.g.,  lemonade, 
barley  water,  linseed  tea,  or  whiskey  and 
water,  and  a hot  mustard  foot-bath  (about 
one  tablespoonful  to  the  gallon),  or  a full  hot 
bath,  if  it  can  be  taken  without  danger  of 
subsequent  exposure.  Tincture  of  aconite 
is  well  recommended,  one  drop  in  water 
every  fifteen  minutes  for  several  hours,  or 
until  dryness  of  the  throat  or  tingling  of  the 
fingers  is  produced.  At  bedtime,  one  may 
administer  Dover’s  powder,  gr.  v-x,  or 
bromide  of  quinine,  gr.  v,  or  fluid  extract  of 
pilocarpine,  njjx-xlv,  according  to  age. 

Kyle  recommends  the  insertion  into  each 
nostril  of  a tablet  containing  sodium  chlor- 
ide, gr.  • 3^,  for  the  purpose  of  inducing  a 
copious  flow  of  mucus  and  serous  exudate, 
to  be  followed,  every  two  hours,  by  the 
instillation  of  a few  drops  of  the  following 
protective:  Olei  cassiae,  Olei  santali,  aa 

gtt.  vi,  Alboleni  liquidi,  oi;  or  the  applica- 
tion on  a cotton- wound  probe  of  a slight 
astringent:  Tr.  benzoini  comp,  et  boro- 

glycerini  (50  per  cent.),  aa. 

Parker  recommends  cinnamon  for  abor- 
tive purposes:  “ ol.  cinnamomi,  20  minims, 
in  milk  every  hour  for  three  doses,  then 


RHINITIS,  ACUTE 


15  minims  every  other  hour  for  two  doses, 
and  then  10  minims  every  three  or  four 
hours.”  “ This  may  effect  a cure  in  thirty- 
six  to  forty-eight  hours.”  (Allen;  Thomson.) 

Spiess  recommends  the  free  insufflation  of 
orthoform  into  the  postnasal  space,  to  abort 
an  acute  catarrh. 

The  following  combination  is  much  used: 


II  Pulveris  camphorsc gr.  ss 

Extract!  belladonnae gX-  H 

Quininae  bromidi gr.  i 


M.  et  fiat  capsula  No.  1;  mitte  tails  8. 

Sig. — One  capsule  with  plenty  of  water  eveiy  hour 
for  three  or  four  doses,  or  until  dryness  of  the 
throat  is  noticed;  then  intermit  for  three  or  four 
hours.  (Kyle.) 


I^  Pulveris  camphora; gr.  M 

Fluidextracti  bclladonnie 

Quininae  bromidi gr.  U 


M.  et  fiat  tabella  una;  mitte  tails  8. 

Sig. — One-half  tablet  every  hour,  to  a child  of 
five  years.  (Holt.) 

For  the  relief  of  stuffiness  and  headache, 
and  also  to  promote  the  reaction  of  inflam- 
mation, apply  heat  in  the  form  of  a hot 
water  bag  or  a hot  towel,  or  by  holding  the 
face  over  a basin  of  steaming  water,  to 
which  may  be  added  conipouncl  tincture  of 
benzoin,  5i,  or  spirits  of  camphor,  5ss,  to 
the  pint  (protect  the  upper  lip  with  vase- 
line). The  face  steaming  may  be  repeated 
every  hour,  if  desired,  and  a small  piece  of 
the  following  menthol  ointment  may  be 
placed  in  the  nostrils  and  snuffed  up:  R 
Mentholis,  gr.  i,  acidi  borici,  gr.  v,  olei 
gaultherise,  TTiji,  adipis  lanse  hydros!,  5ii, 
petrolati  mollis,  5vi  (St.  Clair  Thomson). 
The  fluid  extract  of  hamamelis  may  be 
snuffed  from  the  hand  every  two  or  three 
hours.  Ballenger  recommends  the  applica- 
tion of  the  leucodescent  lamp  (500  candle 
power)  for  twenty  to  thirty  minutes,  over 
the  closed  eyes,  at  a distance  of  eighteen  to 
twenty  inches  from  the  face.  He  also  advo- 
cates the  establishment  of  free  ventilation 
and  drainage  by  means  of  the  application 
of  cocaine,  4 per  cent.,  or  adrenalin,  1 : .5000 
to  2000,  or  antipyrine,  10  per  cent.,  to  the 
turgid  erectile  boches,  whenever  required 
(by  spray  or  cotton  pledgets) ; and  the 
administration  of  stiychnine  and  arsenious 
acid  in  tonic  doses  (see  Part  11),  and 
alcohol  rubs,  “ to  maintain  the  tonicity  of 
the  vasomotor  nervous  system.” 


II  Cocainu!  hydrochloratLs gr.  ii 

Camphorac gr.  i 

Olei  rosae  geranii gtt.  i 

Alboleni  liquid! §i 


M.  Sig. — Two  or  three  drops  in  each  nostiil  night 
and  morning.  (Kyle.) 


I^  Cocaina- hydrochloratis gr.  iv 

Mentholis gr.  i 

Sodii  bicarbonatis gr.  ii 

Magnesii  carbonatis  levis gr.  iii 

Sacchari  lactis 3 iss 


M.  Dispense  in  a tightly  corked  vial. 

Sig. — Use  a pinch  as  .snuff  every  two  or  three 
hours.  (Gleason.) 

Cocaine  furnishes  only  temporary  relief, 
and  is  followed  by  increased  turgescence. 
It  may  cause  faintness,  so  that  aromatic 
spirits  of  ammonia  should  be  kept  on  hand. 

Where  the  patient  cannot  remain  strictly 
indoors,  one  may  prescribe,  as  a mild  dia- 
phoretic, the  following: 

I^  Codeinte gr.  i (gr.  per  dose) 

/Vmmonii  carbonatis  gr.  .xxiv  (grs.  1’^  per  do.se) 
Syrupi  tolutani ....  5vi  (lUJXX  per  dose) 

Glycerin! oiv  (iriixiii  per  dose) 

Aqu»,  q.s.  ad 3 iii 

M.  Sig. — Teaspoonfiil  every  hour  for  four 
doses,  then  every  two  hours.  (Modified  from 
C.  W.  Richardson.) 

The  bowels,  too,  should  be  kept  atdive, 
in  these  outdoor  cases,  by  means  of  effer- 
vescent sodium  phosphate,  one  tablesj^oonful 
one  hour  before  breakfa.st;  and  relief  from 
the  stuffiness  may  be  obtained  by  smelling 
dry  menthol  or  camphor,  or  a saturate(l 
solution  of  camphor  in  alcohol,  or  carbolic 
smelling  salts. 

For  headache  or  general  discomfort,  one 
may  prescribe  phenacetin,  gr.  v-x,  or 
aspirin,  gr.  x,  or  salol,  gr.  x,  with  phenace- 
tin, gr.  V. 

In  infants,  instil  into  each  nostril,  every 
hour,  three  drops  of  a solution  of  menthol, 
gr.  ss,  in  liquid  albolene,  5i-  In  older 
children,  spray  the  nose  every  two  or  three 
hours  with  a solution  of  menthol,  gr.  i,  in 
liquid  albolene,  5 i- 

2.  Second  Stage,  or  Stage  of  Flux. — 
Irrigate  (see  Nasal  Technique)  the  nasal 
passages  occasionally  with  quite  warm  nor- 
mal saline  solution  (3i  ad  Oi),  or  employ 
inhalations  of  medicated  .steam,  or  one  of 
the  following  sprays  or  douches,  about  every 
three  hours,  warmed: 


I^  Sodii  bibonitts, 

Sodii  bicarbonatis,  aa gr.  v 

Aqua? 5i 


I^  Sodii  bicarbonatis. 


Sodii  biboratis, 

Sodii  chloridi, 

Sacchari  albi,  aa gr.  v 

Aqua; 3iii-iv 


(St.  Clair  Thomson.) 


RHINITIS,  SIMPLE  CHRONIC 


R Mentholis gr.  i 

Olei  eucalypti t^iii 

Olei  gaultheriffi itgiii 

Sodii  bicarbonatis gr.  xv 

Sodii  boratis gr.  xv 

Glycerini 5 iii 

Aquce,  q.s.  ad 3i 


M.  Sig. — One  teaspoonful  to  one  ounce  of  warm 
water,  as  a spray.  (Casselberry.) 

Spray  the  solution  luitil  it  reaches  the  throat. 

Follow  the  above  cleansing  process  by  one 
of  the  following  oily  sprays  or  instillations: 


Mentholis gr.  xxv 

Cainphorre gr.  vii 

lodi gr.  ss 

Benzoinolis,  vel, 

AJbolcni  liquidi 3i 

M.  Sig. — Use  with  an  oil  atomizer,  twice 
daily.  (Richardson.) 

Mentholis gr.  i 

Olei  pini  pumilionis rnjv 

Olei  gaultheria' irpiii 

Olei  eucalypti irifiii 

Benzoinolis 5ss 

Olei  vaselini,  q.s.  ad 5i 


M.  Sig. — Use  with  a double-bulb  (Davidson) 
atomizer.  (Casselberry.) 


R Olei  eucalypti gtt.  ii 

Olei  cassia; gtt.  iv 

Alboleni ji 


M.  Sig. — Instil  a few  drojjs  with  a medicine 
dropper  every  few  hours.  (Kyle.) 

Where  the  secretion  is  jn’ofuse  and  thin, 
and  in  protracted  cases,  one  may  employ 
astringents,  e.g.,  silver  nitrate,  1 per  cent.; 
zinc  cliloride,  1 to  2 per  cent.;  formaline, 
2 per  cent.;  or  the  following,  I^  Ext.  hama- 
melidis  aq.,  Ext.  hych-astic  aq.  (colorless), 
5iv,  Aquae  destillatae,  q.s.,  ad  5ii,  a few 
drops  in  each  nostril  two  or  three  tunes 
daily. 

Internally  one  may  prescribe: 

Ammonii  chloridi . 5ii  (gr-  vii  per  dose) 
Tinctunc  opii  dc- 


odorati gtt.  xl-lx  (gtt.  ii-iii  per  dose) 

Sacchari 5iv 

Aqua;  camphora;, 
q.s.  ad 5 iii 


M.  Sig.^ — One  teaspoonful  every  two  hours  for 
four  doses,  then  every  three  hours  as  long  as  re- 
quired. (Kyle.) 

Iodine  (see  Part  11)  is  recommended 
internally. 

Ballenger  recommends  aconite  or  bella- 
donna for  the  purpose  of  lessening  the  secre- 
tion in  the  second  stage;  but  St.  Clair  Thom- 
son condemns  the  use  of  these  agents. 

In  infants,  cleanse  the  nostrils  with  an 
alkaline  solution  by  means  of  an  eye- 
dropper; after  which,  instil  a few  drops  of  a 


one  per  cent,  solution  of  camphor  in  ben- 
zoinol  or  albolene. 

Prophylaxis. — This  embraces  fresh  air  day 
and  night,  daily  exercise  in  the  fresh  air, 
clothing  neither  too  light  nor  too  heavy,  dry 
stockings,  heavy-soled  shoes,  linen-mesh 
underwear,  rubbers  in  wet  weather,  no  neck 
protectors,  frequent  warm  baths  in  a com- 
fortable room,  followed  by  a moderately  cool 
sponge  and  brisk  rubdown  with  a coarse 
towel,  proper  house  ventilation,  avoidance 
of  overheated  rooms,  dust,  dietetic  errors, 
the  excessive  use  of  alcohol  and  tobacco, 
etc.,  and  the  correction  of  nasal  defects 
(spurs,  septal  deflection,  chronic  rhinitis, 
adenoids,  etc.). 

Rhinitis,  Anaemic. — See  Anaemic  Rhinitis. 

Atrophic.— See  Atrophic  Rhinitis. 

Caseosa. — See  Caseous  Rhinitis. 

Chronic,  with  Collapse  of  the  Erectile 
Tissue. — L.  chronicus,  from  Gr. 
xpovos  time.  See  Anaemic  Rhinitis. 
Hypertroph  ic.  — See  Hypertrophic 
Rhinitis. 

Intumescent. — L.  intumescens,  swol- 
len. See  Rhinitis,  Simple  Chronic. 
Simple.  — See  Rhinitis,  Simple 
Chronic. 

Turgescent. — L.  turgescens,  swelling. 

See  Rhinitis,  Simple  Chronic. 
Vasomotor. — L.  vas,  vessel  -f-  mot' or, 
mover.  See  Rhinitis,  Shnple 
Chronic. 

Edematous,  Acute. — See  Qildema  of 
the  Septum. 

Fibrinous. — See  Fibrinous  or  Mem- 
branous Rhinitis. 

Hypertrophic.  — See  Hypertrophic 
Rhinitis. 

Intumescent,  Chronic. — L.  intumescens, 
swollen.  See  Rhinitis,  Simple 
Chronic. 

Membranous. — See  Fibrinous  or  Mem- 
branous Rhinitis. 

(Edematous,  Acute.  — See  (Edema  of 
the  Septum. 

Purulent. — See  Purulent  Rhinitis. 

Sclerotic. — Gr.  <rxXi7pcoo-ts  hardness. 
See  Atrophic  Rhinitis. 

Sicca. — L.  siccus,  diy.  See  Anaemic 
Rhinitis. 

Rhinitis,  Simple  Chronic. — Gr.  pis  nose  -|- 
-LTis  inflammation;  L.  sim'plex,  simple; 
chronicus,  from  Gr.  xporos,  time.  Synonyms. — 
Chronic  coryza;  chronic  nasal  catarrh; 
chronic  iifliunescent  rhinitis;  chronic  rhinitis 
with  turgescence;  chronic  vasomotor  rhini- 
tis ; alternating  stenosis. 

X chronic  inflammatory  affection  of  the 
nasal  mucous  membrane,  characterized  by 


RHINITIS,  SIMPLE  CHRONIC 


fugitive  turgescence  of  the  erectile  tissue  of 
the  inferior  turbinates,  with  resulting  inter- 
mittent nasal  obstruction,  worse  after  meals 
and  at  night,  etc.,  associated  with  a thick, 
mucous,  nasal  or  postnasal  chscharge.  The 
sm’face  of  the  inferior  turbinals  is  smooth 
and  boggy,  and  tlie  swollen  tissues  shrink  on 
the  application  of  cocaine  (4  per  cent.)  or 
adrenalin  (1  : 2000) ; whereas,  in  hyper- 
trophic rhinitis  {q.v.),  the  turbinal  mucous 
membrane  is  rugose  and  firm,  and  is  not 
contracted  by  cocaine  or  adrenalin. 

Hypertrophy,  however,  eventually  results 
in  imtreated  cases,  and  sometimes  atrophy. 

Possible  sequelae  include  dyspepsia, 
chronic  intoxication,  anaemia,  affections  of 
the  accessory  sinuses,  brain,  eustachian 
tube,  middle  ear,  eye,  and  skin  (acne 
rosacea,  eczema,  eiysipelas),  descenchng 
respiratoiy  affections,  and,  in  children, 
deformities  of  the  chest  and  spine.  The 
treatment  of  simple  clrronic  rhinitis  is 
very  satisfactory. 

Etiology. — The  causes  of  acute  rhinitis 
q.v.)]  habitual  exposure  to  dust  and  irri- 
tating inhalations;  habitual  use  of  cocaine; 
an  infection  (syphilis,  tuberculosis,  etc.); 
foreign  bocUes;  septal  deviations;  adenoids; 
sinusitis  (etlmioiditis) ; constitutional  de- 
rangements (pregnancy,  dyspepsia,  malnu- 
trition, lithsemia,  chronic  nephritis,  diabetes, 
constipation,  anaemia,  neurasthenia,  etc.). 

Adenoids  and  septal  deformities  are 
probably  the  coimnonest  causes. 

Treatment.— Attend,  first  of  all,  to  any 
possible  etiological  influence,  local  or  con- 
stitutional; and  enjoin  the  observance  of 
correct  hygiene,  e.g.,  adequate  rest  and 
exercise,  rest  before  and  after  meals,  fresh 
air  day  and  night,  avoiding  draughts,  ade- 
quate clothing,  neither  too  light  nor  too 
heavy,  preferably  linen-mesh  underwear, 
dry  stockings,  heavy-soled  shoes,  rubbers 
in  wet  weather,  no  neck  protectors,  proper 
house  ventilation,  avoidance  of  over-heated 
rooms,  dust,  dietetic  errors,  alcohol  and 
tobacco,  a daily  morning  warm  bath  in  a 
comfortable  room,  before  breakfast,  followed 
by  a cold  spinal  douche  and  brisk  rubdown 
with  a coarse  towel,  regulation  of  the  bowels, 
and  a simple,  bland,  nutritious  diet.  Tonics 
containing  strychnine  and  arsenic  (see  Part 
1 1 ) and  general  ma.ssage  are  of  value. 

Instruct  the  patient  to  cleanse  the  nasal 
passages  night  and  morning,  only  so  long 
as  any  discharge  or  stagnant  secretion  is 
present,  with  sodium  chloride,  bicarbonate, 
or  biborate,  one  teaspoonful  to  the  pint  of 
hot  water,  using  for  the  purpose  a fountain 
syringe,  or  a two-ounce  hard  rubber  syringe, 


or  a rubber-bulb  syringe,  or  a three  or  four 
ounce  pear-shaped  syringe,  or  a dental 
bulb  syringe  with  postnasal  tip.  Give  the 
following  directions:  In  irrigating  the  nose, 
hold  the  head  horizontally  over  a basin, 
first  on  one  side,  then  on  the  other,  and 
insert  the  nozzle  of  the  syringe  each  time  in 
the  upper  nostril.  To  avoid  the  entrance  of 
fluid  into  the  eustachian  tube  and  imdcUe 
ear,  keep  the  mouth  wide  open  during  the 
irrigation,  breathe  tlirough  the  mouth,  and 
refrain  from  swallowing.  After  each  injec- 
tion, clear  the  nose  of  mucus  by  blowing. 

Following  is  a selection  of  prescriptions  in 
common  use: 

Sodii  bicarbonatis. 


Sodii  biboratis, 

Sodii  chloridi, 

Sacchari  albi,  aa gT-  v 

Aqua; giii-iv 


M.  Sig. — Use  warmed  night  and  morning, 
with  atomizer  or  Birmingliam  nasal  douche. 
^St.  Clair  Thomson.) 


Sodii  biboratis, 

Sodii  bicarbonatis, 

Sodii  chloratis, 

Potassii  bicarbonatis,  aa gr.  xv 

Aquffi 5 ii 

M.  Sig. — ^Use,  warmed,  night  and  morning,  as  a 
spray  or  douche.  (Kyle.) 

Sodii  bicarbonatis, 

Sodii  biboratis,  aa oi 

Acidi  carbolici 3ss 

Glycerini §i 

Aqua;,  q.s.  ad oiv 


M.  Sig. — Add  to  one  quart  of  warm  water  and 
use  as  an  irrigation.  (Gleason.) 

Follow  the  cleansing  of  the  nasal  chambers 
with  a spray  or  instillation  of  liquid  albo- 
lene,  liquid  vaseline,  benzoinol,  or  cosmoline. 

St.  Clair  Thomson  says  that  carbolic  acid 
“ should  not  be  ordered  in  chronic  cases,  for 
fear  of  injuring  the  sense  of  smell.”  He  also 
deprecates  the  use  of  astringents,  such  as 
zinc  and  alum,  and  of  powders,  as  irritating 
and  deleterious  to  the  sense  of  smeU. 

Kyle,  Gleason,  and  Richardson,  how- 
ever, have  the  patient  rejwrt  to  the  office 
every  other  day,  when  after  cleansing  and 
drying  the  nasal  mucous  membrane,  and 
perhaps  the  nasopharynx  and  pharynx,  they 
apply,  by  means  of  a cotton-wound  applica- 
tor inserted  as  high  as  possible,  one  of  the 
following  preparations  (“  until  the  tissues 
are  sufficiently  retracted  ”),  viz., 

Solut.  aq.  ichthyol,  20-40  per  cent.  (Kyle.) 

Solut.  aq.  alcoholLs,  25  per  cent.  (Kyle.) 

Acidi  tannici gr.  xl 

Glycerini Si 

(Gleason.) 


SEPTUM,  HEMATOMA  OF  THE 


lodi gr.  V 

Potassii  iodidi gr.  xv 

Glycerini ji 

(Gleason.) 

Mentholi.s gr.  xxv 

Camphors gr.  vii 

lodi gr.  ss 

Benzoinolis 5i 

(Bichardson.) 

lehthyol gr.  ii 

(more  or  less  according  to  irritation) 
Petrolati  mollis 3ss 


Later,  zinc  ointment  or  boric  ointment  (J. 
Biernacki.) 

In  plethoric  individuals,  Kyle  advises  the 
u.se  of  stronger  astringents,  e.g.,  silver 
nitrate,  4 to  8 per  cent.;  zinc  sulphocarbo- 
late,  2 to  5 per  cent.;  zinc  chloride,  3 to  5 
pt'f  cent.  Follow  the  astringent  application 
with  the  following  spray: 


II  Mentholis gr.  v 

Camphora) gr.  xx 

Alboleni  li(juidi ,3ii 

(Gleason) 


Gleason  says  that  a cure  may  be  effected 
by  this  form  of  treatment  in  three  to  six 
weeks. 

In  cases  uninfluenced  by  the  above  treat- 
ment, cauterization  of  the  turgid  parts  is 
available.  Richardson’s  technique  is  as  fol- 
lows: First  dry  the  mucous  membrane  thor- 
oughly; then  exsanguinate  and  cocainize  the 
parts  by  the  application  of  a 5 per  cent,  solu- 
tion of  cocaine  on  cotton  pledgets,  which  are 
allowed  to  remain  in  place  five  to  ten  minutes. 
Then  collect  a few  crystals  of  chromic  acid 
on  the  warmed  enrl  of  a probe,  and  heat  the 
part  of  the  probe  just  beyond  the  crystals 
until  the  latter  melt ; on  cooling  they  form  a 
red  coating.  Now  dry  the  mucous  mem- 
brane again,  and  make  a “ number  of 
minute  points  of  cauterization  ” in  the  turgid 
areas,  wherewith,  “ as  it  were,  to  pin  down 
the  mucous  membrane  to  the  periosteum.” 
Monochloracetic  acid  or  the  galvanocautery, 
with  a finely  pointed  electrode,  may  be  used 
in  the  same  way  making  four  to  six  minute, 
deep  (not  linear)  cauterizations.  Afterward 
wash  out  the  nasal  cavity  with  an  alkaline 
solution,  say  the  following: 


II  Sodii  bicarbonatis gr.  x.xx 

Sodii  biboratis gr.  xlv 

.\citli  carbolic! mjvi 

Glycerini 3i 

A(iuic  destillatac ovi  (M.) 


Dench  cauterizes  an  area  about  the  size  of 
a split  pea  over  the  most  turgid  {lart  of  the 
inferior  turbinate,  and  repeats  the  pro- 
cedure elsewhere  after  the  slough  from  the 


first  cauterization  has  separated  (five  to  ten 
days),  and  so  on,  until  the  patency  of  the 
canal  is  re.stored. 

Chemical  caustics,  too,  may  be  applied  in 
a single  line  along  the  inner  border  of  the 
inferior  turbinal ; or  a fine  needlelike  electrode 
may  be  pushed  backwards  beneath  the 
mucous  membrane. 

Electrolysis  (bipolar,  with  a double  elec- 
trol3d,ic  needle),  employing  a current  of  five 
to  ten  milliamperes,  gradually  introduced 
for  two  to  five  minutes,  and  gradually  with- 
ilrawn,  is  effectual,  says  Kyle. 

Great  conservatism  should  be  exercised  in 
f he  employment  of  caustics  so  as  to  destroy 
as  little  as  po.ssible  of  the  secreting  surface. 

For  diffuse  turgidity  ami  hypertrophy, 
gratlual  [pressure  with  soft  rubber  splints 
or  a malleable  silver  tube  (see  Fig.  103)  is 
well  recommended.  The  silver  tube  is 
worn  only  one  or  two  hours  at  a time  at 
first,  and  the  pressure  and  the  duration  of 
its  application  are  gradually  increased. 

Rhinitis,  Suppurative. — L.  sub,  under  -f- 
pus,  pur'is,  pus.  See  Purulent  Rhinitis. 

Turgescent,  Chronic. — L.  turges'cens, 
swelling.  See  Rhinitis,  Simple 
Chronic. 

Vasomotor,  Chronic. — L.  vas,  vessel  -|- 
mo'tor,  mover.  See  Rhinitis,  Sim- 
ple'Chronic. 

Rhinolith. — Gr.  pis  nose  + stone. 

See  P’oreign  Bodies  in  the  Nose. 

Rhinopharyngeal  Affections. — Gr.  pis  nose 
-)-  4>apvy^  pharjmx.  See  Throat  Diseases, 
Part  9. 

Rhinorrhoea,  Cerebrospinal. — See  Cere- 
brospinal Rhinorrhoea. 

Spasmodic. — Gr.  pis  nose  -1-  poia  flow’; 
(jiraapbs  spasm.  See  Hay-Fever. 

Rhinoscleroma. — See  Skin  Diseases, 
Part  5. 

Saddle=Back  Nose. — Try  a tibial  or  rib 
transplant. 

Sarcoma  Nasi. — Gr.  aap^,  aapKos  flesh  -|- 
-coyua  tumor;  L.  nas'iis,  nose.  See  Tumors  of 
the  Nose. 

Scleroma. — See  Rhinoscleroma  in  Part  5. 

Sclerotic  Rhinitis. — Gr.  crxXi^paxns  hard- 
ness. See  Atrophic  Rhinitis. 

Septum,  Abscess  of  the. — L.  seep' turn 
septum.  See  Abscess  of  the  Septum. 

Adhesions  of  the. — See  Adhesions  of 
the  Septum. 

Deformities  of  the. — See  Deformities 
of  the  Septum. 

Edema  of  the. — See  Qildema  of  the 
Septum. 

Haematoma  of  the. — See  Haematoma  of 
the  Septmn. 


SINUSITIS 


Septum,  (Edema  of  the. — See  (Edema  of 
the  Septum. 

Perforation  of  the. — See  Ulceration  and 
Perforation  of  the  Septum. 

Synechiae  of  the. — Gr.  (jwexeia  con- 
tinuity. See  Adlresions  of  the  Septum. 

Ulceration  of  the. — See  Ulceration  and 
Perforation  of  the  Septmn. 

Simple  Chronic  Rhinitis. — See  Rliinitis, 
Simple  Chronic. 

Sinusitis. — L.  sinus,  cavity  + Gr.  -ltls 
inflammation.  Frontal  headache,  most 
severe  upon  awaking  in  the  morning,  as 
contrasted  with  ocular  headache,  which 
occm’s  during  the  day  from  using  the  eyes, 
dizziness  aggravated  upon  stooping,  and 
present  when  the  eyes  are  closed,  in 
distinct  on  from  ocular  vertigo,  sense  of 
pressure  between  the  eyes,  tenderness  on 
pressure  with  the  finger  tip  directed  upward 
and  well  under  the  roof  of  the  orbit  at  its 
inner  angle,  avoiding  the  supraorbital  nerve, 
all  sugge.st  frontal  sinusitis. 

Tenderness  on  pressure  toward  the  med- 
ian line  “ a little  above  the  inner  canthus 
of  the  eye  and  a little  deeper  in  the 
orbital  cavity  than  the  canthus,”  points 
to  ethmoiditis. 

Tenderness  on  pressure  over  the  canine 
fossa,  painful  teeth,  and  the  absence,  in  the 
transillumination  test  (performed  by  hold- 
ing an  electric  bulb  in  the  closed  mouth),  of 
a “ red  pupillary  reflex,  a crescent  of  light 
corresponding  to  the  position  of  the  lower 
eyelid,  a sense  of  light  in  the  eye  when 
closed,”  and  a translucent  sclerotic,  noted 
on  depressing  the  lower  eyelid,  point  to 
maxillary  sinusitis.  The  transillumination 
test,  however,  is  not  infallible. 

In  sphenoidal  sinusitis,  the  headache  is 
usually,  but  not  always,  felt  in  the  occipital 
region  on  the  affected  side. 

Other  signs  and  symptoms  of  sinusitis  are 
face-ache  or  neuralgia,  mental  dulness  and 
depre.ssion,  nasal  obstruction,  nasal  or  post- 
nasal catarrh,  rapidly  recurring  polypi, 
caseous,  hypertrophic,  or  atrophic  rhinitis, 
parosmia,  anosmia,  or  cacosmia,  localized 
inflammatory  oedema  and  tenderness,  and  a 
cloudy  appearance  of  the  sinus  area  on  the 
skiagraphic  plate. 

Suppm-ative  sinusitis  is  accompanied  by  a 
unilateral,  purulent,  nasal  discharge.  The 
ptosterior  ethmoidal  and  the  sphenoidal 
sinuses  drain  posteriorly  into  the  superior 
meatus;  while  the  frontal,  anterior  ethmoidal 
and  maxillary  sinuses  drain  anteriorly  into 
the  middle  meatus.  The  nasal  (tear)  duct 
drains  into  the  inferior  meatus.  Aid  in 
ascertaining  the  origin  of  the  pus  is  given  by 


Sondermann’s,  or  Brawley’s  modification  of 
Sondermann’s  suction  apparatus.  The  nose  is 
first  carefully  wiped  out  with  pledgets  of 
cotton-wool  moistened  with  a 2 to  5 per 
cent,  solution  of  cocaine.  With  the  nasal 
tips  of  the  suction  apparatus  in  position  in 
each  nostril,  and  the  tap  water  turned  on, 
the  patient  is  told  to  say  a j)rolonged  “ hick,” 
whereat  the  pus  is  drawn  from  the  affected 
sinuses,  and  may  be  seen  in  the  various 
characteristic  locations  upon  subsequent 
examination  of  the  nose. 

Fraenkel’s  test  for  maxillary  sinusitis  is  as 
follows;  The  patient  bends  the  head  “ well 
forward  between  the  knees,  with  the  affected 
side  uppermost.”  When  he  again  raises  his 
head,  inspection  will  reveal  pus  in  the 
middle  meatus,  if  the  maxillary  antrum 
is  affected. 

The  above  tests  are  best  made  in 
the  morning  before  the  sinuses  have 
become  emptied. 

In  chronic  cases  in  which  it  is  uncertain  as 
to  which  sinus  or  sinuses  are  affected,  one 
may  resort  to  exploratory  puncture,  first  of 
the  maxillary  antrum.  St.  Clair  Thomson’s 
method  of  procedure  is  as  follows:  First 
tuck  a pledget  of  cotton-wool,  soaked  in 
equal  parts  of  adrenalin  and  20  per  cent, 
cocaine,  well  under  the  inferior  turbinal, 
one  to  one  and  a half  inches  from  the  nasal 
orifice;  and  anaesthetize  also  the  anterior 
part  of  the  septum.  After  ten  to  thirty 
minutes,  remove  the  cotton  pledgets,  and 
direct  a hollow  needle,  either  straight  (Licht- 
witz),  or  curved  (Schmidt;  Myles),  high  up 
imder  the  inferior  turbinal,  about  one  to 
one  and  a half  inches  from  the  orifice  of  the 
nose,  and  towards  the  outer  canthus  of 
the  eye.  Then  attach  a Politzer  bag  to  the 
hollow  needle  and  pump  air  through  the 
cavity.  Foul  pus  and  air  bubbles  may  then 
appear  below  the  middle  turbinal.  Then 
forcibly  syringe  through  the  hollow  needle  a 
warm,  sterile,  normal  saline  or  boric  acid 
solution  (5i  ad  Oi),  and  receive  the  wash  in 
a black  vulcanite  tray  in  order  that  the  pres- 
ence of  pus  or  debris  may  be  detected. 
Afterward  blow  out  all  fluid  from  the  antrum 
by  means  of  the  Politzer  bag  connected  with 
the  exploring  needle. 

Small  quantities  of  pus  may  be  detected 
by  the  effervescence  produced  by  the  injec- 
tion of  hydrogen  peroxide. 

If,  however,  there  is  a carious  bicuspid  or 
first  molar  tooth  on  the  suspected  side  it 
should  be  removed,  under  general  anaes- 
thesia, and  by  means  of  a large  sized  hand- 
drill,  a perforation  into  the  antrum  should 
be  made,  preferably  through  the  inner 


SINUSITIS 


socket  of  the  tooth.  When  the  patient  has 
recovered  from  the  anaesthesia,  the  same 
procedure  as  described  above  should  be 
pursued.  The  opening  may  be  maintained, 
if  desired,  by  means  of  a rubber  obturator. 

If,  on  waiting  for  ten  to  twenty  mmutes 
after  exploring,  washing  and  blowing  out  the 
maxillary  antriun,  pus  is  again  found  in  the 
middle  meatus,  it  has  evidently  come  from 
the  frontal  sinus  or  the  anterior  ethmoidal 
cells,  usually  both.  The  maxillary  antrum 
may  even  serve  as  a reservoir’  for  this  pus. 

To  distinguish  chronic  frontal  from  anterior 
ethmoidal  sinusitis,  the  fi’ontal  sinus  should 
be  catheterized,  washed  and  blown  out,  after 
amputating  the  anterior  end  of  the  mid- 
dle turbinal. 

If  clu’onic  sphenoidal  sinusitis  is  suspected 
(in  sjrhenoidal  and  posterior  ethmoidal 
sinusitis  pus  appears  anteriorly  in  the  olfac- 
tory cleft,  although  it  may  be  found  also  m 
empyema  of  the  other  sinuses;  the  discovery, 
on  jx)st  rhinoscopic  examination,  of  pus  on 
top  of  the  middle  turbinate,  or  of  pus  and 
crusts  in  the  vault  of  the  epipharynx,  points 
to  posterior  ethmoidal  and  sphenoidal  dis- 
ease), the  sinus  should  be  catheterized,  after 
the  removal  of  the  middle  tiu’binal,  if  neces- 
sary, and  its  cavity  washed  and  blown  out 
(the  standard  textbooks  should  be  consulted 
for  the  teclmique  of  these  latter  procedures). 

The  {X)ssible  complications  and  sequelae  of 
sinusitis  are  as  follows:  eustachian  catarrh; 
otitis  media;  ocular  disease  (optic  neuritis, 
orbital  celluUtis,  osteitis  and  periosteitis, 
retrobulbar  abscess,  conjunctivitis,  marginal 
blepharitis,  keratitis,  errors  of  refraction  or 
accommodation,  asthenopia,  choroiditis,  u’i- 
docyclitis,  neuroretinitis,  restricted  field  or 
loss  of  vision,  scotomata,  photophobia, 
lachr>nnation,  epiphora,  blepharospasm, 
ptosis,  cataract,  hemorrhagic  retinitis,  glau- 
coma, mydi’iasis);  cough;  pharyngitis;  ton- 
.shlitis;  laryngitis;  asthma;  chronic  bron- 
chorrhoea;  recurrent  broncho-pneumonia; 
gastro-intestinal  indigestion;  anaemia;  extra- 
thiral  and  brain  abscess;  meningitis;  sinus 
thrombo.sis  (suiierior  longitudinal  and  cav- 
ernous); pyaemia. 

Etiology.— Acute  infectious  diseases  (influ- 
enza, scarlet  fever,  measles,  pneumonia, 
typhoid  fever,  cerebrosjDinal  meningitis, 
(liphtheria,  smallpox,  erysipelas,  glamlers, 
miunps,  gonorrhoea);  acute  rhinitis;  nasal 
stenosis  (chronic  turgescent  rhinitis,  hyper- 
tropliic  rhinitis,  septal  deformities,  ade- 
noids); atrophic  rhinitis;  foreign  bodies, 
including  larva;,  vomitus,  etc.;  syphilis; 
tuberculosis;  nasal  gonorrhoea;  nasal  douch- 
ing; intranasal  tamponing;  intranasal  ojjera- 


tions;  use  of  the  galvanocautery  in  the  nose; 
external  traumatism;  diving  into  water  feet 
foremost ; dental  mfection  (the  upper  second 
bicusihd  and  first  and  second  molars  are 
situated  close  beneath  the  floor  of  the  maxil- 
lary sinus);  malignant  tumors;  mercury, 
phosphorus,  and  lead  poisoning;  extension  of 
inflammation  from  one  sinus  to  another. 

Treatment — A.  AcuTE  Sinusitis. — The 
aims  of  treatment  are  to  promote  the  reac- 
tion of  inflammation  and  to  reduce  the  swell- 
ing of  the  nasal  mucous  membrane,  so  as  to 
open  the  ostia  of  the  sinuses,  and  thereby 
secm-e  ch-ainage. 

The  patient  should  be  put  to  bed,  and 
calomel  administered  in  divided  doses  (fol- 
lowed by  a saline  (see  Part  11)  ; the  diet 
should  be  liquid.  The  reaction  of  inflamma- 
tion is  promoted  by  the  application  to  the 
forehead,  nose,  and  cheek  of  a hot -water 
bag,  or  hot,  moist  compresses;  also  by  pass- 
ing “ back  and  forth  before  the  closed  eyes, 
at  a distance  of  twelve  to  eighteen  inches, 
for  twenty  to  tturty  minutes,”  the  500 
candlepower  leucodescent  lamp  (Ballenger). 
The  patency  of  the  ostia  of  the  sinuses  is 
established  by  spraying  the  nose  wdth  ach’en- 
alin,  1 ; 10,000  to  1 : 5000,  evei’y  two  hours,  or 
whenever  the  nose  feels  stuffy  or  the  head- 
ache or  sense  of  pressure  returns.  Every  two 
or  tbree  hours,  a spray  of  menthol,  gr.  iii 
ad  5i  of  albolene,  benzoinol,  cosmoline,  or 
olive-oil,  should  be  applied  by  means  of  a 
nebulizer.  Once  a day  the  physician  may 
cocainize  the  middle  meatus  by  placing 
withm  it  a pledget  of  absorbent  cotton 
saturated  with  4 per  cent,  cocauie  solution, 
followed  by  a spray  of  antipyi’ine  solution, 
4 to  10  per  cent.,  and  a solution  of  menthol 
in  oil,  to  prolong  the  ischsemic  effects  of  the 
adrenalin  and  cocame.  Kyle  recommends 
the  application  of  40  per  cent,  ichthyol  in 
lanolin  to  the  middle  meatus  or  high  up  in 
the  nasal  tract.  Thomson  recommends  nasal 
inhalations  of  mentholized  steam  for  five  or 
six  minutes  every  hour: 


B Mentholis gr.  x 

Alcoholis oi 


M.  Sig. — A teaspoonful  in  a pint  of  steam- 
ing water. 

Antiseptic  gargles  and  sprays  are  advis- 
able. 

Slow  irrigation  of  the  nose  with  quite 
warm  normal  salme  solution  from  a fountain 
stTinge  (see  Nasal  Technique)  would  seem 
to  be  \'ery  useful,  if  the  patient  takes  proper 
precautions  against  the  entrance  of  the  fluid 
into  the  middle  ear,  be.,  bj"  holding  the  head 
horizontally  over  a basin,  by  ojx'iiing  the 
mouth  wide  and  breathing  through  the 


TUMORS  OF  THE  NOSE 


mouth,  and  by  refraining  from  swallowing; 
but  Thomson  condemns  it. 

Sondermamds  suction  apparatus  may  be 
used;  or  suction  may  be  accomplished  by 
the  patient  holding  his  nose  and  then 
expanding  the  chest. 

Gleason  recommends  inflation  of  the 
sinuses  by  means  of  Politzer’s  air  bag.  The 
procedure  is  as  follows:  First  cocainize  the 
middle  meatus ; then  have  the  patient  lie  upon 
the  unaffected  side,  puff  out  his  cheeks,  and 
close  the  external  auditory  meati  with  his' 
finger  tips,  so  as  to  jirevent  overinflation  of 
the  tyinpaniuu.  Now  fill  the  Politzer  bag 
with  iocUne-chloroform  or  menthol-chloro- 
form vapor,  by  insertmg  the  nose-piece  of 
the  compressed  bag  into  a bottle  containmg 
the  vapor  above  a solution  of  the  iodine  or 
menthol  in  chloroform,  and  then  allowing 
the  bag  to  expand.  Now  insert  the  nozzle 
into  the  nostril,  and  suddenly  compress 
the  bag. 

For  the  nem-algic  pains,  give  jihenacetin, 
antipyrine,  or  aspirin  (see  Part  11).  Any 
affected  teeth  should  be  removed. 

The  above  measures  usually  bring  about 
resolution  in  three  or  four  days.  If  resolu- 
tion, however,  does  not  occur,  and  if  external 
swelling,  orbital  cellulitis,  or  cerebral  symp- 
toms (delirimu,  convulsions,  coma,  rigors) 
occur,  operative  measures  should  be  resorted 
to,  e.g.,  incision  of  external  swellings;  per- 
foration and  irrigation  of  the  maxillary  sinus, 
if  involved;  simple  opening  of  the  frontal 
sinus  and  enlargement  of  the  fronto-nasal 
duct,  if  the  frontal  sinus  is  affected;  opening 
and  irrigation  of  the  sphenoidal  sinus,  rf 
affected  (consult  the  standard  textbooks  for 
the  technique  of  these  operative  procedures) . 

B.  Chronic  Sinusitis. — Chronic  maxil- 
lary sinusitis  is  best  treated  by  nasal  lavage 
through  an  opening  through  the  antronasal 
wall  in  the  inferior  meatus,  in  which  it  is 
usually  necessary  to  amputate  the  anterior 
end  of  the  inferior  turbinal.  Inveterate 
cases,  however,  require  the  Caldwell-Luc 
operation,  in  which  an  opening  is  made  both 
through  the  canine  fossa  and  the  antronasal 
wall.  Buccal  lavage  through  a tooth  socket, 
where  such  is  available,  is  not  usually 
efficacious  (consult  the  standard  textbooks 
for  the  technique  of  these  operations,  and 
for  the  treatment  of  chronic  disease  of  the 
other  sinuses). 

Conservative  methods  of  treatment  should 
be  given  the  preference.  These  embrace  the 
establishment  of  drainage  and  ventilation 
by  the  correction  of  septal  deformities  and 
turbinal  hypertrophies,  the  reduction  of 
turgescence,  the  removal  of  polypi,  adenoids. 


and  an  enlarged  middle  turbinate,  and  if 
need  be,  the  introduction  of  a cannula  into 
the  involved  sums  and  the  injection  of,  say, 
10  per  cent,  argyrol. 

Mucocele  (L.  mu'cus,  -|-  Gr.  /C17X77  tumor) 
of  a nasal  accessory  sinus  Ls  a cystic  disten- 
tion of  the  sinus  with  mucus,  characterized 
by  an  elastic  swelling  which  sometimes 
crackles  like  parclunent  on  palpation,  and 
Avhich  is  non-inflamiriatory  unless  the  con- 
tents of  the  sac  become  infected.  The 
treatment  is  surgical  (for  which  consult  the 
standard  textbooks). 

Smell,  Absent. — See  Anosmia. 

Bad. — See  Cacosmia. 

Increased  Sense  of. — See  Hypcrosmia. 

Loss  of. — See  Anosmia. 

Perverted  Sense  of. — See  Parosmia. 

Sneezing,  Paroxysmal. — Gr.  Trapo^v(Tn',s. 
See  Hay  Fever. 

Spasmodic  Rhinorrhcea.  — Gr.  airacr^os 
spasm;  pb  nose  + poia  flow.  See  Hay  F'ever. 
_ Sphenoidal  Sinusitis. — Gr.  wedge  -p 

ei5os  form.  See  Sinusitis. 

Stenosis,  Alternating. — Gr.  arkvocns  nar- 
rowing. See  Rliinitis,  Simple  Chronic. 

Suppuration,  Nasal. — L.  suh,  under  + 
pus,  pur'is,  pus.  See  PiuTilent  Rhinitis. 

Synechise,  Septal. — Gr.  <rurtxeta  continu- 
ity. See  Adliesions  of  the  Septum. 

Syphilis. — See  Part  1,  on  General  Medi- 
cine and  Sm-gery. 

Technique,  Nasal. — See  Nasal  Technique. 

Traumatism,  Nasal. — Gr,  rpavpa  wound. 
See  Fractures  of  the  Nose  in  Part  10. 

Tuberculosis,  Nasal. — L.  tuher'culum,  no- 
dule. See  Lupus  of  the  Nose  and  Throat  in 
Part  9. 

Tumors  of  the  Nose. — L.  tumor,  from 
tu'mere,  to  swell.  A.  Benign  Tumors.— (1)  PAP- 
ILLOMA (L.  papiVla,  nipple  -f-  Gr.  -wpa  tumor) 
is  a very  rare,  smooth  or  corrugated,  red  or 
gray,  pediculated  growth,  generally  spring- 
ing from  the  septum,  more  rarely  from  the 
imier  or  inferior  surface  or  the  posterior  end 
of  the  inferior  turbinal.  It  should  be  com- 
pletely removed  (following  cocainization  of 
the  surrounding  tissues  with  a 5 to  10  per 
cent,  solution  of  cocaine  applied  on  pledgets 
of  cotton)  with  the  snare  or  nasal  scissors. 
The  base  should  then  be  mopped  dry,  and 
well  cauterized  with  chromic  acid  fused  on 
the  end  of  a probe  (first  warm  the  probe, 
(hp  it  in  the  chromic  acid  ciystals,  and 
warm  the  part  of  the  probe  next  beyond  the 
crystals  until  the  latter  melt),  or  cauter'zed 
with  the  galvanocautery.  A very  large 
growth  may  require  an  external  operation, 
e.g.,  that  of  Moure  or  of  Rouge. 

(2)  Fibroma  (L.  fib'ra,  fibre)  is  a very 


ULCERATION  AND  PERFORATION  OF  THE  SEPTUM 


rare,  firm  and  smooth  growth,  which  gen- 
erally arises  from  the  posterior  extremity  of 
the  middle  turbinal,  less  often  from  the 
posterior  extremity  of  the  inferior  turbinal, 
the  septum,  or  the  floor  of  the  nose.  When 
small,  it  may  be  removed  with  the  snare, 
cutting  forceps,  or  Ballenger’s  turbinotome. 
When  large,  it  may  bo  removed  piecemeal 
with  cutting  forceps.  When  it  invades  the 
surrounchng  structures,  a temporary  resec- 
tion of  the  superior  maxilla  or  a Rouge  opera- 
tion may  be  required  to  remove  it. 

(3)  Angioma  (Gr.  ayyelov  vessel)  is  a dark 
red,  vascular  growth,  which  usually  arises 
from  the  cartilaginous  septum,  rarely  from 
the  adjoining  floor  of  the  nose  or  the  anterior 
end  of  the  inferior  turbinal.  After  apply- 
ing cocaine  and  adrenalin,  strangulate  the 
growth  at  its  base  very  slowly  with  the  cold 
wire  or  galvanocautery  loop.  If  the  growth 
is  sessile,  place  the  loop  in  position,  and 
transfix  the  tumor  with  a needle  so  as  to 
hold  the  wh’e  in  place;  or  make  two  elliptical 
incisions  around  it;  or  ligate  the  tumor 
in  sections  with  a number  of  silk  ligatures. 
After  removal,  scrape  the  base  thoroughly 
with  a sharp  spoon,  and  then  sear  with  the 
galvanocautery.  Apply  sterile  vaseline,  and 
warn  the  patient  not  to  blow  the  nose 
violently.  Keep  the  patient  under  observa- 
tion and  cauterize  thoroughly  any  recur- 
rences. Bijxilar  electrolysis  may  also  be 
employed  (see  under  Epistaxis). 

(4)  Adenoma  (Gr.  adrjv  gland)  grows  from 
the  septum  or  ethmoidal  region.  It  bleeds 
very  readily  when  touched,  and  shows  a 
tendency  to  malignant  degeneration.  It 
should  be  completely  removed  and  its  base 
cauterized  or  curetted  to  prevent  recurrence. 

(5)  Cysts  (Gr.  Kvarcs  bladder)  occur  on 
the  floor  of  the  nose.  Small  cysts  may  be 
merely  incised,  repeating  the  incision  if 
necessary.  Larger  ones  may  have  to  be  dis- 
sected out  through  an  inci.sion  in  the 
gingivo-labial  fold. 

(6)  Osteoma  (Gr.  ooreor  bone),  enchon- 
droma  (Gr.  h in  + xovSpos  cartilage), 
lymphoma  (L.  lym'pha,  l>nnph),  lipoma  (Gr. 
XtTTos  fat),  and  exostoses  (Gr.  out  + bareov 
bone)  occur.  If  they  can  not  be  removed 
intranasally,  an  external  operation  (Rouge’s 
or  Moure’s)  may  be  required. 

B.  Malignant  Tumors. — Carcinoma  (Gr. 
KapKims,  L.  can'cer,  crab)  and  sarcoma  (Gr. 
<rdp$,  aapKos  flesh)  are  not  common,  but 
they  are  much  more  common  than  benign 
tumors.  The  s>nnptoms  of  a malignant 
nasal  growth  are  a unilateral  fetid  discharge, 
hemorrhage,  increasing  obstruction,  and 
ulceration,  and  later,  pain,  external  deform- 


ity, and  enlarged  glands.  Remove  a piece 
of  the  growth  remote  from  any  ulcerated 
area  for  microscopic  examination.  Exclude 
syphilis,  tuberculosis,  rhinoscleroma,  be- 
nign tumors,  and  foreign  bodies.  Complete 
extirpation  is,  of  com-se,  to  be  accomplished, 
if  possible;  by  the  mternal  route,  if  feasible, 
otherwise  by  the  external  route,  employing 
Mom-e’s  operation  through  the  side  of  the 
nose  where  the  growth  is  situated  in  the 
ethmoidal  or  sphenoidal  region;  or  employ- 
ing Rouge’s  operation,  or  both  combined, 
or  the  combined  Rouge  and  Caldwell-Luc 
operation.  In  operating  within  the  nose,  a 
subsequent  examination  should  be  made,  and 
any  visible  remnant  of  the  tumor  removed. 
The  base  of  the  growth  should  always  be 
subsequently  cauterized  with  the  galvano- 
cautery (St.  Clair  Thomson).  It  is  advised 
not  to  operate  unless  the  growth  is  in  an 
early  stage. 

In  inoperable  cases,  apply  orthoform 
powder  to  relieve  pain.  To  ulcerations 
apply  dilute  hydrochloric  acid,  or  formaline 
(5  per  cent,  solution),  every  other  day,  to 
arrefst  their  progress.  The  X-ray  or  radium 
(see  Part  1)  may  possibly  retard  the  growth 
of  the  tumor.  Employ  gauze  plugs  to 
check  hemorrhage.  Coley’s  fluid  (mixed 
toxins  of  erysipelas  and  bacillus  prochgiosus) 
and  arsenic  (see  Part  11)  may  be  tried 
for  inoperable  sarcoma.  Liebemnann  re- 
ports a cure  of  sarcoma  of  the  nasophaiynx 
by  the  introduction  of  a silver  tube  con- 
taining 53.5  mg.  of  mesotherium,  the  tube 
being  wrapped  in  cotton  and  rubber  tissue, 
which  was  placed  in  the  retronasal  space 
and  left  in  situ  for  forty-eight  hours  on 
two  occasions,  once  at  the  end  of  Decem- 
ber and  again  during  the  early  part  of 
January.  By  the  middle  of  iMarch  the 
process  was  brought  to  a standstill,  and  the 
entire  growth  disappeared  {Practical  Medi- 
cine Series,  1917). 

In  nasal  sarcoma,  O.  J.  Stein  applied  100 
mg.  of  radium  uninterruptedly  for  five  hours 
for  three  consecutive  days,  repeated  the 
treatment  after  nineteen  days,  again  thirty 
days  later  and  again  after  sixty  days,  with 
cure;  4100  milligram  hours  were  used  in  the 
nose,  and  2125  mg.  hours  to  the  enlarged 
glands. 

Diathermy  (see  Part  1)  may  be  of  value. 

Turgescent  Rhinitis,  Chronic. — L.  turges- 
cens,  swelling.  See  Rhinitis,  Shnple  Chronic. 

Ulceration,  Nasal. — See  Nasal  Ldeers. 

Ulceration  and  Perforation  of  the  Septum. 
— L.  uVeus,  ulcer;  perforate,  to  pierce 
through;  seep' turn,  septum.  Etiology.— De- 

position of  dust  or  discharge  over  the  bleeding 


VASOMOTOR  RHINITIS,  CHRONIC 


area  in  persons  who,  are  subject  to  epis- 
taxis  iq.v.,);  irritating  fumes  (chromic 
acid,  copper-arsenic  green);  septal  deform- 
ity; tramnatism  (picking  at  the  nose);  the 
galvanocautery  or  other  caustics;  haematoma 
of  the  septum;  abscess  of  the  septum;  acute 
infectious  diseases  (diphtheria,  measles, 
smallpox,  scarlet  fever,  typhoid  fever,  typhus 
fever,  rheumatism) ; congenital  anomaly 
(extremely  rare);  syphilis  (rare);  tubercu- 
losis (rare). 

Treatment.— In  the  ulcerative  stage,  first 
soften  the  scab  by  means  of  a warm  alka- 
line lotion,  such  as  Dobell’s  or  Seller’s  (see 
Part  11)  solution,  applied  frequently  during 
the  day.  Then  gently  remove  the  scab  and 
apply  a mild  mercurial  ointment : Hydrar- 

gyri  ammoniati,  gr.  x,  ad  petrolatum  molle, 
,^i.  If  the  ulcer  is  sluggish,  curette  it  very 


gently,  and  apply,  but  only  very  occasion- 
ally, a weak  caustic:  silver  nitrate,  gr.  v-x-xx 
ad  5i;  or  chromic  acid,  gr.  v-x  ad  5i;  or 
formalin,  3 per  cent.;  or  zinc  chloride, 
3 per  cent. 

After  healing  has  occurred,  instruct  the 
patient  to  avoid  picking  or  violently  blowing 
the  nose,  and  advise  the  occa-sional  use  of  a 
mild  alkaline  lotion  and  inunction  of  the 
parts  at  bedtime  with  vaseline. 

If  perforation  occurs,  treat  the  inflamed 
margins  as  before,  and  apply  an  occa.sional 
mild  caustic,  until  healing  occurs.  If  bare 
cartilage  projects  beyond  the  margin  of  the 
perforation,  remove  it  after  first  reflecting 
the  overlying  mucosa. 

Vasomotor  Rhinitis,  Chronic. — L.  vas, 
vessel  mo'tor,  mover.  See  Rhinitis,  Simple 
Chronic. 


APPENDIX 

Schema  for  the  Nose  and  Throat  History  and  Examination 


Name.  Address 
Smgle  Married  (how  long) 

No.  ami  ages  of  children 
Complaint 

To  what  does  the  patient  attribute  his  illness: 


Date 


No. 


Widow  (how  long)  Occupation 

Age  Race 

General  appearance 
Height  Weight 

Appropriate  or  proper  weight  (see  Part  1) 
Hygiene:  Rest  Exercise 

Recreation  Diet  Sleep 

Bowels  Ventilation  Baths 

Sexual  habits  Tea  and  coffee 

Narcotics  Alcohol  Tobacco 


Preiiom  History 
Family  History 
Examination: 

External  nose  (skin,  nasal  bones,  alae  nasi) 

Mouth  (lips,  cheeks,  tongue,  teeth,  gums,  floor  of  mouth) 
Fauces  and  tonsils 

Pharynx  Larynx 

Ears  Eyes 

(Rher  organs  and  tissues 
Diagnosis: 

(On  other  side  of  jiage) 

Treatment  ( including  dates  and  whether  at  office  or  home) : 


Internal  nose 
Palate  and  uvula 
Nasopharynx 
Sinuses 

Cervical  lymph  glands 


The  Nasal  Armamentarium. — 1.  Office  and 
Operating  Room  Equipment. — X-ray  machine; 
straip;lit  back  revolving  chair  with  adjusta- 
able  back  and  head-rest;  two  piano  stools; 
table;  cabinet;  swinging  fountain  cuspidor; 
cupboard  for  sterile  goods;  Rochester  sterilizer 
for  dressings;  instrument  sterilizer  (fish 
kettle);  kerosene,  gas  (argand  burner)  or 
50  candlepower  electric  lamp;  Mackenzie 
condenser;  folding  portable  lamp  for  laryn- 
goscopy, etc.;  head  mirror  with  Gleason’s 
black  leather  head-band;  sink  with  foot- 
lever  spigots;  Kirstein  head  lamp;  C’hampion 
or  Little  Wonder  pmnp  for  furnishing  com- 
pressed air  for  atomizers;  Pynchon  and  Hub- 
bard regulating  air  tanks;  Sondermann’s,  or 
Brawley’s  modification  of  Sondermann’s  suc- 
tion ai^paratus;  nasal  specula;  Myles’s,  Glea- 
son’s, Allen’s,  Hartmann’s  bivalve,  Bos- 
worth’s  open  wire;  DeVilbiss  atomizers  with 
set  of  tubes,  some  for  introduction  through 
the  nose  into  the  post-nasal  space;  magic 
atomizers;  nasopharyngeal  sjTinges  (piston 
and  bulb)  with  post-nasal  tips;  long  nasal 
probe;  applicators  with  corrugated  tips; 
frontal  sinus  probe;  palate  retractor;  Jarvis’s 
needles  and  snare;  Krause,  Blake,  or  Lack 
snare,  threaded  with  No.  5 piano  wire; 
Griinwald’s  or  Luc’s  punch  forceps;  Bos- 
worth’s  nasal  saw;  Holbrook  Curtis  saw; 
Lake’s  rubber  nasal  sj^lint;  Kyle’s  saw; 
Zwaardemaker’s  olfactometer;  Seiler’s  septo- 
meter ; Yeo’s  inhaler ; transillumination 
lamps;  nasal  dre.ssing  forceps;  Hartmann’s 
frontal  sinus  cannula;  Krause’s  or  Myles’s 
curved  antrum  trocar  with  obturator;  Hajek’s 
straight  trocar  and  cannula;  file  saw;  Fels- 
bach  dilator  ; soft  rubber  obturators  and 


hard  Auilcanite  obturators  for  maintaining 
patency  of  opening  in  maxillary  alveolus; 
Gottstein’s  cotton  plugs;  toothed  forceps; 
fountain  syringe  (metal  or  glass) ; two-ounce 
hard  rubber  syringe;  rubber  bulb  syringe; 
three-  or  four-ounce  pear-shaped  sjTinge; 
dental  bulb  syringe  with  post-nasal  tip; 
Asch’s  hollow  splint,  various  sizes;  IMayer’s 
hollow  splint,  various  sizes ; antrum  drainage 
tubes;  silver  infundibulum  irrigation  tube; 
Roe’s  metallic  form  for  fracture  of  nose; 
Adam’s  nasal  truss;  strabismus  hook;  Roe’s 
intra-nasal  spring ; malleable  silver  tube ; 
straight  hollow  needle  (Lichtwitz);  curced 
hollow  needle  (Schmidt,  Alyles);  six-flask 
Globe  multinebulizer;  powder  blower;  Politzer 
bag;  galvanocauterj"  with  tips;  ^"anSant’s  hot 
air  apparatus;  black  Auilcanite  tray;  Bunsen 
burner  or  alcohol  lamp;  Goldstein’s  chromic 
acid  aj^plicator  for  submucous  cauterization; 
Beckmann’s  serrated  scissors;  Bellocq’s  post- 
nasal tampon  cannula;  Casselberrj'’s  scissors; 
Holmes’s  middle  turbinal  scissors;  large 
sized  hand  drill  for  perforating  the  antrum 
through  the  tooth  socket;  BaUenger’s  turb- 
inal knife,  ethmoid  curette,  right-angle 
knife,  swivel  knife,  \"-ghaped  septum  gouge, 
mucosa  knife,  and  mucosa  swivel  knife; 
Andrews’s  sphenoidal  probe,  cannula  and 
knives;  Halle’s  frontal  sinus  drills  with 
handle;  Good’s  rasj)  and  guide;  Ingal’s 
pilot  burr  and  guide;  Ostrum’s  localizer  for 
the  pulley  of  the  superior  oblique  muscle; 
\Ail’s  antrum  saw;  Corwin’s  antrum  chisel; 
Ostrum’s  forward-cutting  antrum  forceps; 
Well’s  trocar  cannula  rasp;  Nobel-Cordes 
forceps;  Asch’s  straight  and  curv'ed  scissors; 
Asch’s  septmn  forceps;  Weber’s  siphon  nasal 


THE  NASAL  ARMAMENTARIUM 


douche;  Fetterolf’s  file  saw;  Hajek-Ballenger 
muco-perichondrial  elevators,  sharp  and 
blunt;  Foster  septum  speculum;  Ballenger- 
Foster  perpendicular-plate  bone  forceps; 
Hurd’s  bone-septum  forceps;  Simpson’s  nasal 
sponge  splint;  Ivillian’s  chisels;  Gleitsman 
powder  blower;  ulcer  curette;  Yankauer’s 
intranasal  suture  instrument;  Birmingham 
nasal  douche;  Volkmann  spoon  or  ring  knife; 
Hawley’s  spray  tube;  leukodescent  thera- 
peutic lamp,  500  candlepower;  modified 
Sajous  snare;  vacuum  aspirator;  Bos- 
worth’s  saw;  alligator-jaw  biting  forceps; 
Choleway’s  spoke-shave;  Lombard’s  bone 
forceps;  Meyer’s  vulcanite  nasal  splints; 
Gitelli’s  bone  forceps;  Roe’s  septum 
forceps;  Stein’s  antrum  gouge;  Hajek’s 
sphenoidal  forceps;  Ballenger’s  turbinotome, 
angular  ethmoid  knife,  and  hook  ethmoid 
knife;  Beck’s  paraffin  screw-syringe;  Halle’s 
antrum  trocar,  cannula,  and  obturator; 
Myles’s  alligator  nasal  cutting  forceps; 
Griinwald’s  cutting  forceps;  Gottstein’s  nasal 
curette;  Lowenburg’s  postnasal  forceps; 
Emil  Mayer’s  pharyngeal  curette;  Schroe- 
ter’s  forceps;  electric-motor  drills;  finger 
bowl;  galvanic  battery;  hiPinostatic  forceps; 
Bernay’s  compressed  sponge;  Allen’s  probe; 
Bellocq’s  caimula;  soft  gum  catheter;  Fara- 
dic  current;  Felsbach  clilator;  Francis  dila- 
tor; hot-water  bag;  eye-droppers;  oil  atom- 
izer; Davidson  double-bulb  atomizer;  sterile 
cotton;  sterile  gauze  (one-half  to  one  inch 
wide  ribbon  gauze). 

Internal  Drugs  Mentioned  in  the  Text. — (a) 
Alteratives  and  Tonics  (L.  alterar'e,  to 
change;  L.  to'nus,  tone). — Potassium  iodide; 
arsenious  acid;  arsenious  iodide;  double  sul- 
phide of  arsenic;  quinine  bromide;  com- 
pound wine  of  iodine;  strychnine;  elixir  ferri, 
quininae  et  strjThninai  phosphati;  syr.  ferri 
iodith ; codliver  oil  ; syrup  of  hyjDophos- 
phites;  bovinine;  dilute  nitric  acid;  dilute 
hych’ochloric  acid. 

(b)  Neuro-Muscular  Sedatives  (L. 
sedo,  I allay). — Ether;  chloroform;  whiskey; 
morphine;  pulv.  opii;  Dover’s  powder;  deod. 
tr.  opii;  codeine;  rhinitis  or  coryza  tablets 
containing  morphine,  belladonna,  and  qui- 
nine; fl.  ext.  belladonna;  ext.  belladonna; 
atropine;  aq.  lam-ocerasi;  phenacetin;  aspi- 
rin; acetanelid;  pyramidon;  valerian;  asa- 
fmtida;  jxitassium  bromide;  musk. 

(c)  Purgatives  (L.  purga're,  to  cleanse). 
— Calomel;  mag.  carb.  levis;  sod.  phos. 
efferves.;  sod.  sulph;  Rochelle_salt. 

(d)  Hemostatics  (Gr.  ai/xa  blood  -f 
arariKos  standing). — Gelatine;  fl.  ext.  ergot; 
gallic  acid;  dilute  sulphuric  acid;  lactate  and 
chloride  of  calcium. 

(e)  Flavors. — 01.  menth.  pip;  attar  of 


roses;  spiritus  menthse  piperitse;  citric  acid; 
ol.  rosse  geranii. 

(f)  Vasodilators  (L.  vas,  vessel). — Ni- 
troglycerin; sodium  nitrite. 

(g)  Diaphoretics  (Gr.  8m  through 
4>opeiv  to  carry). — Fl.  ext.  pilocarpine;  tr. 
aconite;  salol;  aspirin;  Dover’s  powder. 

(h)  Respiratory  Stimulants  and  Ex- 
pectorants (L.  ex,  out,  -|-  pec'tus,  brea.st). — 
Ammonium  carbonate;  ammonium  chloride; 
syr.  tolutani;  eucalyptol;  ol.  eucalypti; 
toluol;  tr.  eucalypti;  pulv.  sanguinariae. 

Miscellaneous. — Chaulmoogra  oil;  Fehling’s 
solutions;  pollantin;  distilled  water;  potas- 
sium bicarbonate ; diphtheria  antito.xin ; cou- 
marin;  Coley’s  fluid  (mixed  toxines  of  ery- 
sipelas and  bacillus  prodigiosus). 

Local  Preparations  Mentioned  in  the  Text. — 
(a)  Antiseptics  and  Astringents  (Gr.  clptL 
against  + arixpis  putrefaction;  L.  ad,  to  -|- 
strin'gere,  to  bind). — Boric  acid;  .sodium 
chloride;  aristol;  alum;  hydrogen  peroxide; 
perhydrol;  tannic  acid;  ung.  hydrarg.  dil.; 
ung.  ac.  pyrogal.;  bismuth  subnitrate;  lead 
acetate ; pyoktannin ; comp,  tincture  benzoin ; 
boroglyceride;  alcohol;  sodium  bicarbonate; 
sodium  biborate;  iodine;  formaline;  aq.  ext. 
hamamelidis;  aq.  ext.  hydrastis  (colorle.ss) ; 
ichthyol;  zinc  sulphocarbolate;  Dobell’s  solu- 
tion; Seiler’s  solution;  bichloride;  thymol; 
resorcin;  balsam  of  Peru;  absolute  alcohol; 
ammoniated  mercury;  zinc  stearate;  alum- 
nol;  zinc  sulphate;  spt.  vini  rectificati;  iodol; 
sodium  chlorate;  radium;  sanitas  oU. 

(b)  Emollients,  Protectives,  and  Men- 
strua (L.  ernoVlio,  I soften). — Vaseline; 
lanolin;  liquid  albolene;  glycerine;  mucil. 
acaciae;  sacchar.  lactis;  sacchar.  albi;  ben- 
zoinol;  paroline;  zinc  oxide;  collochon;  olive 
oil;  lignol;  liquid  paraffin;  ung.  paraffini; 
lycopodium;  cosmoline;  ung.  zinci  oxidi. 

(c)  Styptics  (Gr.  gtv4)uv  to  contract). — 
Adrenalin,  1 : 1000;  cocaine;  antipyrine; 
gelatine;  fl.  ext.  hamamelidis;  perchloride  of 
iron;  gallic  acid;  liq.  ferri  sesquichloridi. 

(d)  Caustics  (Gr.  HaUw  to  burn). — 
Chromic  acid;  silver  nitrate;  trichloracetic 
acid;  carbolic  acid;  zinc  chloride;  mono- 
chloracetic  acid;  acetic  acid;  piu’e  concen- 
trated hydrochloric  acid;  pure  nitric  acid; 
lactic  acid;  acid  nitrate  of  mercury. 

(e)  Mucous  Membrane  Stimulants. — 
Tablets  of  sodium  chloride,  gr.  J-g;  ol.  cassiie; 
ol.  santali;  camphor;  spt.  camphor;  menthol; 
ol.  gaultherim;  carbolic  smelling  salts;  ol. 
cinnamomi;  ol.  eucalypti;  ol.  pini  pumilionis; 
aq.  camphor;  eucalyptol;  oil  of  cloves;  ol. 
niyrti;  tr.  eucalypti;  spt.  menth.  pip. 

(f)  Local  Anodynes  (Gr.  av  without  -fi 
bhvvri  pain). — Orthoform;  cocaine. 

(g)  Counter  Irritant. — Mustard. 


LARYNX 


^tpiglottis 
■^Upper  vocalcord 
Lowepvocal  cord 


Polyp  of  the  right  vocal  cord 


Tuberculosis  of  the  larynx 


NORMAL  LARYNX  FROM  ABOVE 


Base  of  the  tongue 


Acute 


Upper  vocal  cord 

/ 

Ventricle  of 
ij^orgagni 

I-n  teraryte  n o i d 


Tuberculous  infilirati 
of  the  larynx 


Xower  vocal 
\ cord 


Edema  of  the  upper  vocal  cords 


Cricoid 

cartilage 


Syphilitic  laryngitis 
iMucous  patches! 


(t-fTrachea 


ANTERO-POSTERIOR  SECTION 
OF  NORMAL  LARYNX  I RIGHT  SIDE . ) 


Granular  laryngitis 


Syphilitic  laryngitis 

I Gumma  oftbe  left  lower  vocal  cord ) 


Chronic  catarrhal  larynqitis 
(With  tumefaction  of  the 
upper  vocal  cord ) 


Module  ofthe  vocal  cords 


Tumors  ofthe  larynx 
(Papillomata) 


Acute  stridulous  laryngitis 


I.AnOUSSE  MEDICAL 


Larynx  and  diseases  ofthe  larynx. 


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PART  9 

THROAT  DISEASES 


Abductor  Paralysis. — L.  ab,  from  + 
du'cere,  to  draw;  Gr.  Trapa  beside  + \veiv  to 
loosen.  See  Aphonia. 

Abscess,  Lingual, — L.  absces'sus,  a going 
apart.  See  Lingual  Tonsillitis,  Acute. 

Peritonsillar. — See  Peritonsillar  Ab- 
scess; Quinsy. 

Retropharyngeal.  — See  Retropharyn- 
geal Abscess. 

Adductor  Paralysis. — L.  ad,  to  -|-  du'cere, 
to  draw;  Gr.  Trapa  beside  -|-  \vtiv  to 
loosen.  See  Aphonia. 

Spasm,  Rhythmical  Clonic. — L.  ad- 
duc'ere,  to  draw  toward;  Gr.  aTrautios] 
pvdfios;  kXovos  turmoil.  See  Neuroses 
of  the  Larynx. 

Tonic. — L.  to'nus;  Gr.  tovos  tone. 

See  Laryngismus  Stridulus. 

Adenitis,  Retropharyngeal,  Suppurative. — 
Gr.  abi\v  gland  + -ltls  inflammation;  L.  sub, 
under  -|-  pus,  puris,  pus.  See  Retropharyn- 
geal Abscess. 

Adenoids. — Gr.  abi]v  gland  -f  eibos  form. 
Adenoids  are  better  felt  with  the  finger 
(with  the  patient  supine  and  the  head 
retracted)  than  seen  with  the  aid  of  the 
post-rhinoscopic  mirror,  and  retraction  of 
the  soft  palate,  or  by  dh-ect  inspection 
through  the  nose.  The  presence  of  enlarged 
tonsils  m children  always  mchcates  the 
presence  of  adenoids.  The  latter  tend  to 
atrophy  as  puberty  approaches,  but  they 
are  often  found  in  adults.  The  following 
symptoms  and  sequete  occur,  viz.,  nasal 
obstruction  and  mouth  breathing,  collapse 
of  the  ala?  nasi  and  narrowness  of  the 
nasal  passages,  septal  deviation,  turgescent 
and  hypertrophic  rhinitis,  postnasal  catarrh, 
eustachian  catarrh,  otitis  media,  deafness, 
arched  palate  and  crowded  teeth,  snoring, 
“ dead  voice,”  gingival,  dental,  pharyngeal, 
laryngeal,  bronchial,  pulmonary,  and  gastric 
infection,  deformity  of  the  chest  walls,  vomit- 
ing, laryngismus  stridulus,  convulsions,  night- 
terrors,  night-sweats,  peevishness,  enuresis, 
reflex  cough,  facial  twitching,  stammering, 
stuttering,  asthma,  hay-fever,  emphysema, 
chorea,  epilepsy,  anaemia,  cyanosis,  false 
croup,  epistaxis,  discharging  or  dry  nose, 
ocular  inflammation,  enlarged  cervical  glands, 
glandular  fever,  headache,  physical  and 
mental  backwardness,  lack  of  concentration 
of  attention  (aprosexia,  from  Gr.  a priv. 
-)-  irpoaex^Lv  to  heed),  etc. 


Treatment.— The  growths  should  be  re- 
moved under  ether  anaesthesia  by  means  of 
various  sizes  and  curves  of  the  Gottstein 
curette,  preceded,  if  need  be,  by  the  finger. 
Dangerous  bleetUng  is  very  rare;  neverthe- 
less one  had  better  have  at  hand  hydrogen 
peroxide,  full  strength,  and  adrenalin  solu- 
tion, 1 : 1000,  one  or  two  drams  of  either 
being  injected,  if  need  be,  into  the  naso- 
pharynx through  the  nostrils.  If  these  fail 
to  check  the  hemorrhage,  the  posterior  nares 
and  rhinopharynx  may  be  plugged. 

If  mouth  breathing  at  night  ]:>ersists  after 
the  adenoids  have  been  removed,  apply  a 
chin  strap.  Increase  the  chest  capacity  by 
breathing  exercises.  Less  than  two  per  cent, 
of  cases  show  recurrence  after  removal. 

Adenoma. — Gr.  abrjv  gland  -|-  -co/xa  tumor. 
See  Tumors  of  the  Naso-Pharynx  and 
Pharynx,  and  Tumors  of  the  Larynx. 

Air  Passages,  Foreign  Bodies  in  the. — 
See  Foreign  Bodies  in  the  Air  Passages. 

Amyloid  Tumor  of  the  Larynx. — Gr.  apvXov 
starch-(-et5os  form.  See  Tumors  of  the  Larynx. 

Anjesthesia  of  the  Larynx. — Gr.  ar  not  -f 
cLLuOrjaLs  sensation.  See  Neuroses  of 
the  Larynx. 

of  the  Pharynx. — See  Neuroses  of  the 
Pharynx. 

Angina,  Ludwig’s. — L.  an'gina,  anguish. 
See  Ludwig’s  Angina  in  Part  1. 

Membranous. — L.  membrana,  mem- 
brane. See  Tonsillitis  Acuta. 

Vincent’s. — See  Part  1. 

Angioma. — Gr.  ayjeiov  vessel  4-  -oipa 
tumor.  See  Tumors  of  the  Na.so-Pharynx 
and  Pharynx,  and  Tumors  of  the  Laiynx. 

Angioneurotic  CEdema. — Consult  Part  1, 
on  General  Medicine  and  Surgery. 

Aphonia. — Gr.  a priv.  -p  4Mvr]  voice. 
Aphonia,  or  loss  of  voice,  may  be  myopathic 
(myo-paretic),  neuropathic  (neuro-paralytic) 
or  psychopathic  (hysterical). 

I.  Bilateral  Adductor  Paralysis  or  Paresis. — 
This  form  of  paralysis  of  the  vocal  cords  is 
marked  by  incomplete  closure  of  the  glottis 
on  attempted  phonation.  It  is  usually 
hysterical  in  origin,  but  may  be  myopathic 
and  due  to  laryngitis,  incipient  tuberculosis, 
syphilis,  typhoid  and  typhus  fevers,  cholera, 
diphtheria,  gout  or  rheumatism,  local  neo- 
plasms, anaemia,  general  debility,  overuse  or 
misuse  of  the  voice,  phosphorus,  copper, 
arsenic,  or  lead  poisoning. 


APHONIA 


Hysterical  aphonia  is  a bilateral  adductor 
paralysis  of  sudden  onset  and  as  sudden 
termination,  and  is  probably  chiefly  due  to 
some  emotional  disturbance,  viz.,  shock, 
grief,  worry,  anger,  chagrin,  fright,  joy,  etc., 
which  causes  a temporary  dissociation  of  the 
adductor  nervous  mechanism  from  the 
cerebral  volitional  centres.  Laryngeal  ex- 
amination reveals  incomplete  closure  of  the 
glottis  on  attempted  phonation,  but  closure 
on  coughing,  which  is  diagnostic.  More- 
over, paralysis  of  the  adductors  alone 
is  always  functional.  Organic  paralysis 
affects  first  the  abductors  and  then 
the  adductors. 

For  the  treatment  of  hysterical  aphonia 
aiifl  hysteria  in  general,  consult  Part  1,  on 
General  Medicine  anrl  Surgery. 

II.  Paralysis  of  the  Superior  Laryngeal  Nerves. — 
These  nerves  sujiply  the  crico-thyroid  mus- 
cles, whose  function  is  to  as.sist  in  rendering 
tense  the  vocal  cords  during  phonation.  The 
effect  of  this  paralysis  is  shown  in  the 
accompanying  pictures  (Figs.107,  108,  109.). 


may  be  necessary  to  feed  the  patient 
through  a stomach  tube  (see  Part  1,  under 
Dyspepsia,  for  the  technique). 

III.  Paralysis  of  the  Recurrent  Laryngeal  Nerves 
— These  nerves  supply  all  the  muscles  of  the 
larynx  except  the  crico-thyroid.  Their 
paralysis  (which  is  the  commonest  form  of 
laryngeal  paralysis  met  with)  results  in  palsy 
first  of  the  abductors,  and  finally  the  adduc- 
tors. 

Paralysis  of  the  adductors  alone  is  always 
functional  and  not  organic.  One  should  bear 
in  mind  that  inflammatory'  infiltration  of  the 
abductor  muscles,  due  to  cancer,  tuberculosis, 
syphilis,  or  traumatism,  and  also  anky'losis  of 
the  crico-arytenoid  articulation  both  produce 
a resemblance  to  true  paralysis. 

The  causes  of  recurrent  laryngeal  paraly- 
sis are  as  follows:  Pressure  on  the  vagus  or 
recurrent  laryngeal  nerve  from  aneurysm, 
goitre,  pericardial  effusion,  pleimal  thicken- 
ing at  the  apex  of  the  lung,  dilated  left 
auricle,  pneumonoconiosis,  large  pleural  effu- 
sions, cancer  of  the  pleura  with  effusion, 


Fig.  107 


Paralysis  of  crico-thyroid  muscle 
on  left  side,  as  seen  during  respir- 
ation. 


Paralysis  of  crico-thyroid  muscle 
on  left  side,  as  seen  during  phona- 
tion. 


Paralysis  of  crico-thyroid  muscle; 
appearance  of  bilateral  paralysis  as 
seen  during  phonation. 


Anaesthesia  of  the  larynx  may  co-exist, 
resulting  in  the  danger  of  food  entering 
the  lungs. 

The  causes  of  this  extremely  rare  form  of 
paralysis  are  as  follows:  Injury  or  section  of 
the  nerve;  “ cold  overuse  of  an  inflamed 
larynx;  involvement  of  the  nerve  in  a new- 
growth  or  enlarged  gland;  and  diphtheria. 

The  Prognosis  is  usually  good.  Recovery 
occurs  in  from  one  to  tliree  months  in 
dipththeritic  cases;  sometimes  a year  in 
traumatic  cases. 

The  Treatment  embraces  local  counter- 
irritation by  means  of  iodine  or  mustard 
plasters,  massage,  galvanism  or  faradism  for 
five  to  ten  minutes  daily,  strychnine  in  full 
dosage  (see  Part  11),  and  re.st  of  the  voice. 
Where  laryngeal  anjesthesia  is  present,  it 


enlarged  bronchial  glands,  cancer  of  the 
oesophagus,  mediastinal  tumors,  inflamma- 
tory or  neoplastic,  cervical  growths  or  phleg- 
mon; traumatism;  bulbar  lesions:  hemor- 
rhage, thrombosis,  embolism,  disseminated 
sclerosis,  tabes,  general  paresis,  syphilis, 
glossio-labio-laryngeal  paralysis,  aneurj’sm, 
tumors,  abscess,  amyotrophic  lateral  sclero- 
sis, syringomyelia,  diphtheria;  peripheral 
neuritis,  due  to  exposure  to  cold  winds, 
infectious  diseases  (typhoid  and  typhus 
fevers,  rheumatic  fever,  influenza,  diph- 
theria, pneumonia,  puerperal  infection,  er>'- 
sipelas,  scarlet  fever,  measles,  gonorrhoea), 
lead,  arsenic,  potassium  iodide,  iodoform, 
antimony,  copper,  potassium  cyanide,  phos- 
phorus, alcohol,  morphine,  atropine,  canna- 
bis indica,  cocaine. 


ATROPHIC  LARYXGITIS 


The  treatment  is  that  of  the  cause.  A 
bilateral  abductor  paralysis  may  at  any  time 
be  complicated  by  a sudden  fatal  dyspnoea, 
therefore  it  is  advisable  to  do  a precautionary 
tracheotomy  {q.v.  in  Part  1)  in  these  cases. 

IV.  Paralysis  of  the  Arytaenoidaeus  Muscle. — 
This  rare  paralysis,  Fig.  110,  may  occur  in 

hysteria,  neurasthenia, 
and  in  myopathic 
conditions,  e.g.,  laryn- 
gitis, etc.  (see  under 
Bilateral  Adductor 
Paralysis). 

The  treatment  em- 
braces removal  of  the 
cause,  vocal  rest,  daily 
local  galvanism  or 
muscle  faradism  tor  nve  to  ten 

minutes,  strychnine  in  full  dosage,  tonics, 
good  hygiene,  fresh  air  day  and  night,  and 
’ nourishing  food. 

V.  Paralysis  of  the  Internal  Tensors,  the  Thyro= 
arytenoidei  Interni  and  Externi. — This  rare  paral- 
ysis (Fig.  Ill)  is  due  to  hysteria,  neurasthe- 
nia, laryngitis,  overuse 
or  misuse  of  the  voice, 
anaemia,  general  de- 
bility, local  neoplasms, 
incipient  tuberculosis, 
diphtheria,  recurrent 
laryngeal  paralysis,  etc. 

The  treatment  em- 
braces removal  of  the 
cause,  vocal  rest,  daily 
local  galvanism  or 
faradism  for  five  to  ten  minutes,  strychnine 
in  full  dosage,  tonics,  good  hygiene,  fresh  air 
day  and  night,  and  nutritious  food. 

Arytaenoidaeus  Paralysis. — Gr.  aphraiva  jug 
or  pitcher  + ct5os  form.  See  Aphonia. 

Atrophic  Laryngitis. — Gr.  a neg.  + Tpo4>ij 
nourishment;  \apvy^  larynx  -)-  -ltls  in- 
flammation. Synonyms. — Laryngitis  sicca; 
dry  laryngitis. 

A chronic  inflammatory  affection  of  the 
laryngeal  mucous  membrane,  secondary  to 
rhinal  suppuration,  e.g.,  suppurative  sinu- 
sitis, ozocna,  syphilis,  tuberculosis,  and 
adenoids,  and  characterized  by  atrophy  and 
the  presence  of  crusts,  with  resulting  hoarse- 
ness, painful  phonation,  hawking  and  cough- 
ing, relieved  by  the  expulsion  of  the  crusts. 

The  prognosis  depends  upon  the  ability  to 
remove  the  cause. 

Treatment. — Remove  the  cause.  Prescribe, 
as  glandular  stimulants  or  alteratives,  potas- 
sium iodide,  gr.  v-x,  t.i.d.  (see  Drugs,  Part 
11) ; or  iodi,  gr.  phosphori,  gr.Koo,  bro- 
mini,  gr.  vini  xerici,  3i,  well  diluted,  t.i.d. 
(Kyle) ; or  terpin  hydrate,  gr.  iii-v,  three  or 
48 


Paralysis  of  the  internal 
tensors. 


four  times  daily;  or  ammonium  chloride  and 
cubebs ; or  granular  effervescent  sodium  phos- 
phate, one  tablespoonful  morning  and  night; 
or  lozenges  of  ammonium  chloride  or  carbolic 
acid  (gr.  J^jwith  menthol,  gr.  made  with 
“ glycogelatine  ” or  “ fruit  paste  ” as  a base. 
Spray  or  syringe  out  the  larynx  frequently 
with  a cleansing  alkaline  lotion,  viz.,  R 
Sodii  bicarbonatis,  sodii  biboratis,  sodii 
chloridi,  sacchari  albi,  aa  gr.  v,  with  or 
without  acidi  carbolici,  gr.  i,  in  aquam 
5iii-iv;  or  hydrogen  dioxide  and  Dobell’s 
solution,  aa,  followed  by  a spray  of  albolene, 
benzoinol,  cosmoline,  paroline,  liquid  vaseline, 
or  olive  oil,  containing  menthol,  gr.  vad  5i; 
or  thymol,  gr.  i,  menthol,  gr.  x,  and  eucalyp- 
tol,  TTgi,  aci  5 i (Thomson) ; or  ol.  santali,  gtt. 
vi  ad  5 i-  The  larynx  is  syringed  under  good 
illumination,  with  the  patient  holding  his 
own  tongue.  He  is  instructed  to  take  a long 
breath  and  then  say  a prolonged  E,  during 
which  the  fluid  is  injected  against  the  vocal 
cords.  At  the  conclusion  of  the  treatment 
the  patient  should  close  his  mouth  and  take 
deep  breaths  through  the  nose,  in  order  to 
avoid  laryngeal  spasm. 

Richardson  does  not  advocate  the  use  of 
mentholated  oily  solutions.  He  first  removes 
all  crusts  and  scabs  by  means  of  an  anti- 
septic, alkaline  spray,  aided  if  necessary  by 
medicated  steam  inhalations,  viz.,  zinc 
sulpho-carbolate,  gr.  v,  or  carbolic  acid, 
gr.  i-iii,  or  compound  tincture  of  benzoin, 
5i,  and  chloroform,  gtt.  x,  in  a pint  of  boiling 
water  over  an  alcohol  lamp.  He  then 
applies  on  a cotton  swab,  as  a local  stimu- 
lant, zinc  chloride  or  silver  nitrate,  1 to  3 
per  cent,  aqueous  solution.  The  excess  of 
fluid  is  removed  from  the  cotton  and  the 
application  is  made  quickly,  just  at  the  end 
of  a full  inspiration.  Mandl’s  solution  may 
also  be  used.  R Iodi  puri,  gr.  vi,  potassii 
iodidi,  gr.  xx,  Olei  menthae  piperitse,  n^v, 
glycerini,  5i.  The  benzoin  and  chloroform 
inhalations  and  a spray  of  antipyrine  solu- 
tion, 2 per  cent.,  are  useful  for  the  relief 
of  irritation. 

It  is  advised  by  Kyle  that  crude  petroleum 
be  rubbed  in  externally  at  night,  and  the 
larynx  then  covered  with  a saturated  flannel 
cloth  to  be  worn  all  night. 

The  observance  of  correct  hygiene  is 
essential.  This  embraces  adequate  rest  and 
exercise,  regular  hours  of  eating  and  sleep- 
ing, rest  before  and  after  meals,  adequate 
clothing,  fresh  air  day  and  night,  a daily 
morning  warm  bath  before  breakfast,  in  a 
warm  room,  followed  by  a cold  spinal  douche 
and  brisk  rubdown  with  a coarse  towel, 
regulation  of  the  bowels,  wholesome  food. 


CATARRH,  TONSILLAR 


and  the  avoidance  of  dust,  tobacco,  and 
alcohol.  Tonics  may  be  indicated,  e.g.,  iron, 
arsenic,  hypophosphites,  codliver  oil  (see 
Part  11).  A warm,  moist  climate  is  desirable 
(see  also  Atropliic  Rhinitis,  in  Part  8, 
Nose  Diseases). 

Atrophic  Naso=Pharyngitis  and  Pharyn= 
gitis. — Gr.  a neg.  + rpo^^  nourishment;  L. 
na'sus,  nose;  Gr.  4>apvy^  pharynx  + -trts 
inflammation.  Synonym. — Pharyngitis  sicca; 
dry  pharyngitis. 

A chronic  inflammatory  affection  of  the 
pharyngeal  mucosa,  characterized  anatom- 
ically by  atrophy  and  resulting  increased 
capaciousness  of  the  pharynx,  and  clinically 
by  dryness  of  the  throat  and  the  eventual 
appearance  of  dried  mucous  scabs. 

Etiology.— Chi'onic  catarrhal  or  hyper- 
trophic pharyngitis;  atrophic  rhinitis; 
suppurative  sinusitis;  syphilis;  tuberculosis; 
adenoids;  mouth-breathing;  a too  complete 
turbinotomy;  Rritating  inhalations;  cyanotic 
congestion  secondary  to  cardiac,  hepatic, 
renal,  or  pulmonary  chsease;  diabetes  melli- 
tus;  chronic  nephritis;  gastro-intestmal  dis- 
orders; senility;  antemia. 

Prognosis.— This  depends  upon  the  remedi- 
ability  of  the  cause  and  the  extent  of  fibrous 
contraction  present.  A year’s  treatment  of 
the  pharyngeal  conchtion  may  be  required 
after  the  cause  is  removed. 

Treatment. — Attend  first  to  the  correction 
of  the  cause.  Every  day  or  every  other 
day,  or  as  often  as  required,  remove  the 
dried  secretions  by  swabbing  with  equal 
parts  of  hydrogen  peroxide  and  cimramon  or 
peppermint  water,  or  by  means  of  steam 
medicated  with  creosote  (about  10  to  15 
drops  of  creosote  to  one  pint  of  boiling 
water  over  an  alcohol  lamp),  or  by  means  of 
boroglycerine  applied  with  a brush.  Follow- 
ing the  removal  of  the  crusts,  and  also  two 
or  three  tunes  a day,  spray  or  syringe  the 
pharynx  and  nasophaiynx  (using  a post- 
nasal syringe  for  the  latter),  with  a hot 
alkaline  wash; 


Sodii  bicarbonatis, 

Sodii  biboratis, 

Sodii  chlorati.s, 

Potassii  bicarbonatis,  aa gr.  xv 

Aquaj 5ii. 

(Kyle.) 


Then  dr>^  the  surface  with  pledgets  of 
absorbent  cotton,  and  apply  one  of  the 
following  mildly  stimulating  lotions,  viz., 
(1)  lanolin  and  ichthyol,  aa;  (2)  refined  or 
crude  petroleum  (Kyle);  (3)  oil  of  mustard, 
gtt.  ss-i,  or  oil  of  cassia,  gtt.  ii,  ad  albolene 
or  liquid  vaseline,  pi  (Kyle);  (4)  silver 
nitrate,  gr.  v-xv  ad  o i;  (5)  spray  of  paroline. 


cosmoline,  albolene,  benzoinol,  or  liquid 
vaseline,  alone  or  containing  ol.  gaultherise, 
gtt.  i,  and  menthol,  gr.  v-x,  ad  5i,  or  ol. 
cassiiB  and  ol.  santali,  aa  gtt.  vi  ad  §i;  (6) 
iodi  puri,  gr.  vi,  potassii  iodidi,  gr.  xx,  ol. 
menth.  pip.,  t^v,  glycerini,  Si- 

Massage  of  the  mucous  membrane,  accom- 
plished by  rubbing  with  cotton  or  a sponge, 
is  beneficial. 

The  achninistration  of  potassium  iodide  in 
small  doses  (see  Part  11),  may  be  of 
occasional  service  for  the  purpose  of  loosening 
crusts;  as  may  also  Kyle’s  “tonic  alterative” : 


R Phqsphori gr.  Koo 

Iodi  puri gr. 

Bromini gr. 

Vini  xerici 5i 


M.  Sig. — One  dram  in  one-quarter  glass  of  water, 
t.i.d.p.c.  (Kyle.) 

The  observance  of  correct  hygiene  is  of 
importance.  This  embraces  adequate  rest 
and  exercise,  regular  hours  of  eating  and 
sleeping,  rest  before  and  after  meals,  ade- 
quate clothing,  fresh  air  day  and  night,  a 
daily  morning  warm  bath,  before  breakfast, 
in  a comfortable  room,  followed  by  a cold 
spinal  douche  and  brisk  rubdown  with  a 
coarse  towel,  regulation  of  the  bowels, 
wholesome  food,  and  the  avoidance  of  du.st, 
tobacco,  and  alcohol.  Tonics  may  be  indi- 
cated, e.g.,  iron,  arsenic,  strychnine,  sodium 
phosphate,  5h“iv,  two  or  three  times  dail}", 
stomachic  bitters  (see  also  Atrophic  Rhinitis, 
in  Part  8,  Nose  Diseases). 

Atrophic  Pharyngitis. — See  Atrophic 

Naso-Pharyngitis  and  Pharyngitis. 

Bodies,  Foreign. — See  Foreign  Bodies. 

Breath,  Holding  the. — See  Larjmgismus 
Stridulus. 

Bronchi,  Foreign  Bodies  in  the.— Gr. 

0POJXOS  bronchus.  See  Foreign  Bodies  in 
the  Air  Passages. 

Bulbar  Paralysis. — Consult  Part  1,  on 
General  Medicine  and  Surgerj". 

Cancer  of  the  Larynx. — L.  ca/icer;  Gr. 
KapKivos  crab.  See  under  Tumors  of 
the  Larynx. 

Naso=Pharynx. — See  Tumors  of  the 
Naso-Pharjmx  and  Pharjux. 

(Esophagus.— See  Part  1. 

Pharynx. — See  Tumors  of  the  Naso- 
pharynx and  Phar>mx. 

Catarrh,  Laryngeal. — L.  cata'rrhus,  from 
Gr.  Karappelv  to  flow  down.  See 
Laryngitis. 

Naso=Pharyngeal. — See  Naso-Pharjm- 
gitis. 

Pharyngeal. — See  Pharyngitis. 

Post=Nasal. — See  Naso-Pharyngitis. 

Tonsillar. — -See  Tonsillitis. 


ELONGATION  OF  THE  UVULA 


Cellulitis  Cervical. — L.  ceVlula,  minute 
cell;  cer'vix,  neck;  Gr.  -ins 
inflammation.  See  Ludwig’s  Angina, 
in  Part  1. 

Submaxillary. — L.  sub,  under  + maxil'la 
jaw.  See  Ludwig’s  Angina,  in 

Part  1. 

Child=Crowing. — See  Laryngismus  Stri- 
dulus,. 

Chondritis  and  Perichondritis  of  the 
Larynx. — Gr.  xovbpos  cartilage;  wepi  around; 
-ins  inflammation.  An  acute  or  subacute 
inflammation  of  the  perichondrium  of  the 
thyroid  and  cricoid  cartilages,  of  grave 
import,  leading  usually  to  abscess  form- 
ation, and  necrosis  ancl  exfoliation  of  the 
cartilage. 

Etiology.— Syphilis;  tuberculosis;  carcinoma, 
traumatism ; foreign  bodies  in  the  oesophagus 
or  larynx;  neighboring  sepsis;  overu.se  of  an 
inflamed  larynx;  “pres.sure  of  the  plates  of 
the  cricoid  against  the  vertebrae  in  bed- 
ridden patients”  (bed-sore)  ; gout  or 
rheumatism;  exposure  to  cold  and  damp; 
typhoid  fever,  typhus  fever,  smallpox,  diph- 
theria; actinomycosis;  glanders. 

Treatment.— In  acute  cases,  apply  the  ice- 
bag  and  give  the  patient  ice  to  suck.  Blood 
may  be  extracted  by  means  of  the  artificial 
leech.  For  oedema  of  the  glottis,  employ  a 
spray  of  cocaine,  2 per  cent.,  in  adrenalin, 
1 : 1000;  but  perform  tracheotomy  (q.v.  in 
Part  1)  at  once  should  suffocation  threaten. 
As  soon  as  suppuration  is  evident,  apply  ex- 
ternal heat  and  incise  the  abscess  freely 
either  from  within  or  without  the  larynx. 
An  internal  incision  is  made  with  a laryngeal 
lancet  under  cocaine  anaesthesia,  with  the 
patient  in  a sitting  posture.  The  cocaine, 
10  to  20  per  cent,  solution,  is  applied  repeat- 
edly with  Sajous’s  forceps.  When  operating 
from  without,  curette  away  granulations 
and  softened  cartilage,  and  remove  necrosed 
cartilage.  It  is  advised  that  lactic  acid,  50 
to  75  per  cent.,  be  then  rubbed  in  every 
second  or  third  day.  Later,  laryngeal 
bougies,  intubation  tubes  or  tracheal  tubes 
may  be  required  to  overcome  strictures. 

The  cause  of  the  trouble,  must,  of  course, 
be  considered.  A foreign  body  must  be 
removed  (see  Foreign  Bodies  in  the  Air 
Passages,  and  in  the  QHsophagus).  The 
treatment  of  tuberculosis  and  cancer  can 
only  be  palliative;  tracheotomy,  when  re- 
quired, should  be  done  as  low  down  as 
possible.  Syphilis  calls  for  vigorous  specific 
treatment  (see  Syphilis,  in  Part  1,  on  General 
Medicine  and  Surgery).  Indeed,  potassium 
iodide  (Part  11)  should  be  tried  in  all  doubt- 
ful cases. 


Chondroma  of  the  Larynx. — Gr.  xovbpos 
cartilage  + -wpa  tumor.  See  Tumors  of 
the  Larynx. 

Choreic  Movements  of  the  Larynx. — L. ; 

Gr.  xopeia  dance.  See  under  Neuroses  of 
the  Larynx. 

Clergyman’s  Sore  Throat. — See  Pharyn- 
gitis, Chronic  Hypertrophic. 

Clonic,  Rhythmical  Spasm  of  the  Adduc= 
tors. — Gr.  kXopos  turmoil;  pvdpSs',  airaapos]  L. 
adduc'ere,  to  draw  toward.  See  Neuroses  of 
the  Larynx. 

Constrictors  of  the  Pharynx,  Paralysis  of 

the. — L.  con,  together  string' ere,  to  draw. 

See  Neuroses  of  the  Pharynx. 

Cords,  Vocal,  Paralysis  of  the. — Gr. 

Xop5rf  cord;  L.  vocal' is,  from  vox,  voice; 

Gr.  irapcL  beside  -f-  Xceir  to  loosen. 

See  Aphonia. 

Spasm  of  the. — Gr.  (nraapos.  See 
Neuroses  of  the  Laiynx,  and 
Laryngismus  Stridulus. 

Cough  and  Cry,  Nervous  Laryngeal. — See 
Neuroses  of  the  Larynx. 

Croup,  False. — See  Laryngitis  Acuta  in 
Children,  and  Laryngismus  Stridulus. 

Membranous. — See  Diphtheria,  in 

Part  1. 

Non=Membranous. — See  Laryngitis 

Acuta  in  Children. 

Spasmodic. — See  Laryngitis  Acuta  in 
Children,  and  Laiyngismus  Stridulus. 

Cry,  Nervous  Laryngeal. — See  Neuroses 
of  the  Larynx. 

Cystoma  of  the  Larynx. — Gr.  kvcttis  cyst  -h 
-upa  tumor.  See  Tumors  of  the  Larynx. 

Cysts  of  the  Nasopharynx  and  Pharynx. — 
See  under  Tumors  of  the  Naso-Pharynx 
and  Pharynx. 

Defects  of  Speech. — See  Speech  Defects. 

Dermoid  Cyst  of  the  Throat  . — Gr.  beppa 
skin  -h  eibos  form;  Kvans  bladder.  See 
Tumors  of  the  Naso-Pharynx  and  Pharynx. 

Diathermy. — -See  Part  i.  General  Medi- 
cine and  Surgery. 

Dilatation  of  the  (Esophagus. — ^SeePart  1. 

Diphtheria. — See  Part  1. 

Diverticulum  of  the  Pharynx. — See  (Eso- 
phageal Diverticula  in  Part  I. 

(Esophagus. — See  Part  I. 

Dry  Laryngitis. — See  Atrophic  Laryngitis. 

Pharyngitis. — See  Atrophic  Naso- 

pharyngitis and  Pharyngitis. 

Dysphagia. — See  Part  1. 

Dysphonia  Spastica. — Gr.  Sus  ill  -f  4>wvri 
voice;  awaapds  spasm.  See  under  Neuroses 
of  the  Larynx. 

Edema. — See  (Edema. 

Elongation  of  the  Uvula.  — L.  uv'ula, 
little  grape.  The  condition  does  not 


FOREIGN  BODIES  IN  THE  LARYNX 


re(}uire  treatment  unless  it  is  productive  of 
symptoms,  e.g.,  sensation  of  a foreign 
body,  constant  hawking,  nausea  and  vomit- 
ing, alteration  of  voice,  laryngeal  spasm, 
paroxysmal  cough. 

Causes.  — Congenital  anomaly  ; chronic 
inflammation  ; naso-pharyngitis  ; antemia; 
diphtheritic  paralysis;  improper  use  of  the 
voice;  etc. 

Treatment. — Attend  to  the  cause.  Treat 
any  existing  antemia,  gastro-intestinal  dis- 
order, or  local  inflammation.  Paint  the 
enlarged  uvula  every  second  or  third  day 
with  silver  nitrate,  5 to  10  per  cent.,  or 
chromic  acid,  10  to  20  per  cent.  Lozenges  of 
krameria  may  also  be  useful. 

If  the  above  measures  fail,  resort  to  uvu- 
lotomy.  Under  the  anaesthetic  and  haemo- 
static action  of  a 10  per  cent,  solution  of 
cocaine  in  1 : 1000  adrenalin,  seize  the  tip 
of  the  uvula  with  forceps,  without  exerting 
traction,  and  amputate  a portion  of  it, 
never  the  whole  uvula,  with  scissors,  in  such 
a way  that  the  cut  surface  is  oblique  ami 


directed  posteriorly,  viz.. 


If  too  much 


of  the  uvula  is  severed,  severe  hemorrhage 
may  ensue.  Prescribe  cold,  bland,  soft  food, 
cracked  ice,  and  a carbolic  lozenge  (ac.  carb., 
gr.  3<^  ol.  cinnamomi,  in;  }io,  with  “ gly co- 
gelatine ” or  “ fruit  paste  ” as  a basis — 
Thomson)  until  healing  occurs.  If  required, 
the  throat  may  be  syringed  with  warm  alka- 
line lotions,  as  given  under  Tonsillitis  Acuta. 

Enlarged  Faucial  Tonsils. — See  Tonsillitis. 
Chronic  Lacunar,  and  Tonsillectomy. 

Lingual  Tonsil.— See  Hyperpla.sia  of 
the  Lingual  Tonsil. 

Epithelioma  of  the  Larynx. — Gr.  ext  on  + 
9r]\r]  nipple  -f-  -toyua  tumor.  See  Tumors  of 
the  Larynx. 

Erythematous  Tonsillitis. — L.;  Gr.  epWijyua 
redness.  See  Tonsillitis  Acuta. 

Esophageal  Affections. — See  Oesophageal 
Affections. 

False  Croup. — See  Laryngitis  Acuta  in 
Children,  and  Laryngismus  Stridulus. 

Fibroma. — L.  fib'ra,  fibre  -h  Gr.  -wga 
tumor.  See  Tumors  of  the  Naso-Pharynx 
and  Pharynx,  and  of  the  Larynx. 

Follicular  Pharyngitis. — L.follic'ulus,  little 
bag.  See  under  Pharyngitis  Catar- 
rhalis  Chronica. 

Tonsillitis. — See  Tonsillitis  Acuta. 

Foreign  Bodies  in  the  Air  Passages. — If 
the  symptoms  are  urgent,  inv'ert  the  patient, 
and  at  the  same  time  rapidly  explore  the 
pharyngo-larynx  with  the  finger.  If  this  is 
not  immediately  successful,  do  a tracheot- 
omy {q.v.)  at  once,  and  attempt  to  remove 


the  body,  if  hi  the  larynx,  with  curved 
laryngeal  forceps,  under  good  illumination. 
Should  this  fail,  try  to  push  the  body  up 
through  the  glottis  or  draw  it  down  through 
the  tracheotomy  wound.  If  the  foreign  body 
is  below  the  tracheotomy  wound,  it  is  usually 
expelled  as  soon  as  the  severed  tracheal 
rings  are  retracted;  if  it  is  not  expelled, 
titillate  the  tracheal  mucous  membrane  to 
induce  coughing,  or  invert  the  patient 
and  slap  the  back  smartly;  if  this  fails, 
search  with  a probe  or  with  cystoscopic 
forceps  through  a cystoscope,  or  with 
forceps  guided  by  the  fluoroscopic  shadow 
of  the  foreign  body,  or  best,  if  available, 
a tracheo-bronchoscope. 

If  the  symptoms  are  not  urgent,  examine 
carefully,  under  good  illumination  and 
cocaine  anaesthe.sia,  the  po.st-nasal  space, 
jiharynx,  tonsils,  base  of  the  tongue,  ami 
pharyngolarynx;  the  finger  or  a probe  may 
also  be  used.  Suspension  larjmgoscopy  (in 
which  the  patient  is  susixjnded  head  down  by 
means  of  a special  apparatus)  is  a new 
method  of  inspection  introduced  by  Killian 
and  perfected  by  Lynch.  In  children  a gen- 
eral anaesthetic  is  nece.ssary.  The  X-ray  is 
invaluable  for  the  location  of  metallic  bodies. 
It  may  be  necessary,  in  view  of  the  danger 
of  sudden  and  fatal  laryngeal  spasm,  to  do  a 
tracheotomy  before  attempting  to  remove 
through  the  mouth  an  impacted  body  in 
the  larynx. 

IGllian’s  direct  method,  by  means  of 
Ivillian’s  tubes,  with  perhaps  Briining’s 
modifications,  is  the  ideal  method  for  the 
removal  of  bodies  from  the  trachea  and 
bronchi.  When  this  method  is  not  av'ailable, 
perform  tracheotomy,  and  if  titillation  of 
the  tracheal  mucous  membrane,  coughing, 
inversion  and  succussion  are  of  no  avail,  one 
may  search  for  the  body  under  cocaine  anaes- 
thesia, with  the  aid,  if  practicable,  of  an 
X-ray  screen.  It  should  be  borne  in  mind 
that  immediate  removal  of  the  foreign  body 
is  very  rarely  necessary;  therefore,  one  should 
take  the  tune  and  pains  to  secure  the  most 
skilful  service  obtainable  (Consult  Chev’alier 
Jackson  on  bronchoscopy  in  Musser  and 
Kelly’s  Practical  Treatment,  Vol.  Ill,  page 
216,  et  seq.;  and  the  Journal  of  the  American 
Medical  Association,  Januaiy  27,  1917). 

Thoracotomy  is  to  be  considered  only 
in  abscess  formation,  after  bronchoscopy 
has  failed 

Foreign  Bodies  in  the  Bronchi. — Gr. 

^poyxos  bronchus.  See  Foreign 

Bodies  in  the  Air  Passages. 

Larynx. — Gr.  Xapvy^  larjmx.  See 

Foreign  Bodies  in  the  Air  Passages. 


HYPERPLASIA  OF  THE  LINGUAL  TONSIL 


Foreign  Bodies  in  the  Naso=Pharynx.— 

L.  nas'us,  nose;  Gr.  4>apvy^  pharynx.  See 
Foreign  Bodies  in  the  Air  Passages. 

Foreign  Bodies  in  the  OEsophagus. — 
Killian’s  direct  oesojihagostoiny  is  the  ideal 
method.  The  application  of  ach’enalin  to 
reduce  local  swelling  is  helpful.  If  oesopha- 
gostomy  is  not  available,  employ  the  um- 
brella probang  for  fish-bones  and  other  small 
bodies,  the  coin-catcher  for  coins  and  small 
bodies,  or  forceps  guided  by  an  X-ray  screen, 
or  if  the  body  is  soft,  an  oesophageal  bougie 
to  push  it  into  the  stomach.  Aforphine 
may  be  achninistered  to  relax  the  oesoph- 
ageal musculature. 

The  chinking  of  strong  brandy  may  cause 
some  foreign  boches  to  shi'ink.  DUute 
hydi’ochloric  acid  and  pepsin  or  papain 
(consult  Part  11)  are  also  employed  m suit- 
able cases  for  the  purpose  of  artificial 
chgestion. 

(Esophagotomy  or  gastrotomy  is  per- 
formed only  as  a last  resort,  or  in  cases  of 
perforation  or  severe  hemorrhage. 

Foreign  Bodies  in  the  Pharynx.^Gr. 
<^apvy^.  See  Foreign  Bodies  in  the 
Air  Passages. 

Trachea. — Gr.  rpaxeta.  See  Foreign 
Bodies  in  the  An-  Passages. 

Fracture  of  the  Hyoid  Bone. — See  Part  10. 

Larynx. — See  Part  10. 

Trachea. — See  Part  10. 

Fungus  Disease  of  the  Throat. — L.  See 
Pharyngomy  cosis . 

Qangosa;  Rhinopharyngitis  Mutilans. — 

See  Rhinopharyngitis  Mutilans. 

QIosso=Labio=Laryngeal  Paralysis. — Gr. 
yXwffo-a  tongue;  L.  lab'ium,  lip;  Gr.  Xapvy^ 
larynx;  irapa  beside  -j-  Xveiv  to  loosen.  See 
Part  1. 

Glottis,  Congenital  Stenosis  of  the. — Gr. 

yXcoTTLs;  L.  congen'itus,  born  together;  Gr. 
arepoa is.  See  Obstruction  of  the  Larynx. 

CEdema  of  the. — See  (Edema  of  the 
Larynx. 

Spasm  of  the. — Gr.  (nratrum.  See 
Laryngismus  Stridulus. 

Stenosis,  Congenital  of  the. — Gr. 
aTtvoais;  L.  congen'itus,  born  together. 
See  Obstruction  of  the  Larynx. 

Granular  Pharyngitis. — L.  grari'ulum 
grain.  See  Pharyngitis  Catarrhalis  Chronica. 

^Haematoma,  Laryngeal  Submucous.— Gr. 
alpa  blood  + -ccifia  tumor.  See  Submucous 
Laryngeal  Hemorrhage. 

Hemorrhage,  Laryngeal  Submucous. — 
See  Submucous  Laryngeal  Hemorrhage. 

Herpes  of  the  Throat. — L.;  Gr.  ep'xTjs 
creeping.  An  acute,  usually  imilateral, 
febrile  affection  of  about  eight  to  sixteen 


days  duration,  characterized  by  an  itching, 
burning  eruption  of  vesicles,  which  rapidly 
rui^tiue  to  form  ulcers  that  soon  become 
coveretl  with  a membranous  exudate.  A 
tendency  to  recurrence  is  manifested.  Physi- 
cal and  mental  debility  are  causal  factors. 

Treatment.— Open  the  bowels,  and  pre- 
scribe a tonic,  such  as  Fowler’s  solution 
(see  Part  11  for  all  drugs),  or  elixir  ferri, 
quininte,  et  strychninae  phosphati.  Codliver 
oil  may  be  indicated.  For  the  neuralgic  pains 
prescribe  aspirin,  phenacetin,  or  antipyrine. 
Each  ulcer  may  be  touched  with  a pencil 
of  silver  nitrate.  As  a local  sedative,  the 
following  may  be  applied  once  daily  on  a 


cotton-wound  probe : 

Mentholis gr.  v 

Cocainae gr.  v 

Acidi  carbolic! njxv 

Petrolati  mollis 3 i 

The  following  may  be  prescribed  as 
a gargle: 

Thymolis gr.  iv 

Mentholi.s 3i 

Acidi  borici 3 i 

Aquae 5 iv 


M.  Sig. — Mix  with  an  equal  amount  of  water  as 
a gargle. 

Holding  = the  = Breath. — See  I^aryngismus 
Stridulus. 

Hyoid  Bone  Fracture. — See  Fracture  of 
the  Hyoid  Bone  in  Part  10. 

Hyperaesthesia  of  the  Larynx. — Gr.  vn-ep 
over  -f  atV^Tjcrts  sensibility.  See  Neuroses 
of  the  Larynx. 

Hyperaesthesia  of  the  Pharynx. — See 

Neuroses  of  the  Pharynx. 

Hyperkeratosis  of  the  Tonsils  and 
Pharynx. — See  Keratosis  Pharyngis. 

Hyperplasia  of  the  Lingual  Tonsil. — Gr. 

virkp  over  -f-  7rXd(ns  formation;  L.  lin'gua 
tongue;  tonsil'la,  tonsil.  The  mouth  and 
teeth  should  be  kept  clean,  the  diet  should 
be  plain,  bland,  and  moderate,  constipation 
should  be  corrected,  and  alcohol  and  tobacco 
strictly  avoided.  If  symptoms  of  u-ritation 
are  troublesome,  the  enlargement  may  be 
reduced  by  means  of  caustics  applied  on  a 
corrugated,  cotton-wound  applicator,  every 
fourth  day,  e.g.,  chromic  acid,  20  per  cent.; 
zinc  chloride,  3 per  cent. ; dilute  hydrochloric 
acid.  All  excess  of  caustic  fluid  should  be 
expressed  from  the  applicator  before  making 
the  application.  This  is  very  essential.  The 
galvanocautery  may  also  be  used  at  a dull 
red  heat,  five  or  six  punctures  (not  deep) 
being  made  at  each  sitting,  at  weekly  inter- 
vals. (Jne  may  cut  away  the  enlarged  glantl 
with  Kirkpatrick’s  scissors,  punch  forceps, 
or  a lingual  tonsillotome,  taking  care  not  to 
injure  the  epiglottis. 


LARYNGEAL  PARALYSES 


Hypertrophic  Laryngitis. — Gr.  inrkp  over 
+ Tf>o4>rj  nutrition.  See  Laryngitis, 
Chronic  Catarrhal. 

Pharyngitis. — See  Pharyngitis  Catar- 
rhalis  Chronica. 

Hypertrophied  Tonsils. — See  Tonsillitis, 
Chronic  Lacunar,  and  Tonsillectomy. 

Hysterical  Aphonia. — Gr.  mrkpa  womb. 
See  Aphonia. 

Infants,  Congenital  Laryngeal  Stridor  in. 

— L.  in' fans;  congen'itus,  born  together; 
stri'dor.  See  Obstruction  of  the  Larynx. 

Influenza. — See  Part  1,  General  Medicine 
and  Surgery. 

Intubation. — L.  in,  into  + tu'ba,  tube. 
See  under  Diphtheria  in  Part  1. 

Keratosis  Pharyngis. — Gr.  Kepas  horn; 
4>a.pvy^  pharynx.  Synonym.— Hyperkeratosis 
of  the  tonsils  and  pharynx. 

A chronic  affection  of  the  tonsils  and  phar- 
ynx of  variable  duration  (weeks  to  years), 
occurring  mostly  in  young  adults,  and  charac- 
terized by  the  presence  of  “discrete  horny 
outgrowths  of  cornified  epithelial  cells.” 

Treatment. — If  uTitation  is  complained  of, 
destroy  three  or  four  of  the  horny  masses 
each  week  with  the  electro-cautery,  includ- 
ing a margin  of  healthy  tissue. 

Since  the  affection  seems  to  occur  com- 
monly in  those  who  are  physically  or  men- 
tally depressed,  the  patient  should  be  en- 
joined to  observe  the  rules  of  hygiene,  which 
embrace  mental  and  physical  relaxation, 
fresh  air  day  and  night,  nutritious  food,  rest 
before  and  after  meals,  regular  hours  of  eat- 
ing and  sleeping,  frequent  bathing  followed 
by  the  cold  spinal  douche,  regulation  of  the 
bowels,  and,  if  indicated,  tonics,  i.e.,  sto- 
machic bitters,  strychnine  or  mix  vomica, 
iron,  arsenic,  etc.  (See  Drugs,  Part  11). 

Keratosis  Tonsillse. — L.  tonsiVla,  tonsil. 
See  Keratosis  Pharyngis,  above. 

Lacunar  Tonsillitis,  Acute. — L.  lacu'na,  a 
small  pit.  See  Tonsillitis  Acuta. 
Chronic. — See  Tonsillitis,  Chronic 
Lacunar. 

Laryngeal  Adenoma. — Gr.  Xapvy^  larjmx; 
adr]p  gland  -f-  -copa  tmnor.  See 
Tumors  of  the  Larynx. 

Amyloid  Tumor. — Gr.  apvXov  starch  -|- 
eidos  form.  See  Tumors  of  the  Larynx. 

Anaesthesia. — Gr.  av  not  + aiadgcns  sen- 
sation. See  Neuroses  of  the  Lar3uix. 

Angioma. — Gr.  ayyeioi>  vessel  -|-  -upa 
tumor.  See  Tumors  of  the  Laiynx. 

Cancer. — L.  can'cer;  Gr.  Kapsivos  crab. 
See  Tumors  of  the  Larvnx. 

Chondritis  and  Perichondritis.  — See 
Chondritis  and  Perichomlritis  of  the 
Larvnx. 


Laryngeal  Chondroma. — Gr.  xbvbpo%  car- 
tilage -wpa  tumor.  See  Tumors 
of  the  Larynx. 

Choreic  Movements. — L. ; Gr.  xopda 
dance.  See  Neuroses  of  the  Larynx. 

Clonic  Spasm. — Gr.  kXopos  turmoil; 
airaapos  spasm.  See  Neuroses  of  the 
Larynx. 

Cough,  Nervous. — See  Neuroses  of  the 
Larynx. 

Cry,  Nervous. — See  Neuroses  of  the 
Larynx. 

Cystoii.a. — Gr.  kvcttls  cyst  -f-  -copa 
tumor.  See  Tumors  of  the  Larymx. 

Edema.  See  Oedema  of  the  Larynx. 

Epithelioma. — Gr.  ewL  on  -|-  driXri  nipple 
-o)pa  tumor.  See  Tmnors  of  the 
Larjmx. 

Fibroma. — L.  fib'ra,  fiber  -f  Gr.  -<j)pa 
tmnor.  See  Tumors  of  the  Larjmx. 

Foreign  Bodies. — See  Foreign  Bodies 
in  the  Air  Passages. 

Fracture. — See  Fracture  of  the  Larjmx 
in  Part  10. 

Hemorrhage,  Submucous. — See  Sub- 
mucous Laryngeal  Hemorrhage. 

Hyperaesthesia. — Gr.  vpep  over  aLad- 
7](TLs  sensibility.  See  Neuroses  of  the 
Larynx. 

Hypertrophy. — Gr.  vpep  over  -1-  rpo<i>ri 
nutrition.  See  Lar>mgitis,  Chronic 
Catarrhal. 

Inflammation. — L.  inflammar'e,  to  set 
on  fire.  See  Lar^mgitis,  beginning. 

Lipoma. — Gr.  XLiros  fat  -|-  wpa  tumor. 
See  Tumors  of  the  Larynx. 

Lupus. — See  Lupus  of  the  Nose  and 
Throat. 

Lymphoma. — L.  lympha,  Ijonph  4-  Gr. 
-<A)pa  tmnor.  See  Tumors  of  the 
Larynx. 

Myxoma. — Gr.  pv^os  mucus  -|-  -eopa 
tumor.  See  Tumors  of  the  Larjmx. 

Neuroses. — See  Neuroses  of  the  Larjmx. 

Obstruction. — L.  obstruc'tio.  See  Ob- 
struction of  the  Larjmx. 

(Edema. — See  (Edema  of  the  Laiynx. 

Osteoma. — Gr.  oareov  bone  -f-  -wpa 
tumor.  See  Tumors  of  the  Laiynx. 

Pachydermia. — Gr.  Traycs  thick  -f-  b'eppa 
skin.  See  Laryngitis,  Chronic  Catar- 
rhal. 

Papilloma. — L.  papil'Ia,  nipple  4-  Gr. 
-o)pa  tumor.  See  Tumors  of  the 
Larvnx. 

Paraesthesia. — Gr.  irapa  beside  4- 
rjats  sensation.  See  Neuroses  of  the 
Ijar^mx. 

Paralyses. — Gr.  irapa  beside  4-  XveLv  to 
loosen.  See  .\phonia. 


LARYNGISMUS  STRIDULUS 


Laryngeal  Perichondritis. — See  Chondritis 
and  Perichondritis  of  the  Larynx. 

Sarcoma. — Gr.  (rap^,  crapKos  flesh  + 
-cjpa  tumor.  See  Tiunors  of  the 
Larynx. 

Spasm,  Clonic. — Gr.  kKovos  turmoil; 
aTraapds  spasm.  See  Neuroses  of 
the  Larynx. 

Tonic. — L.  to'nus  Gr.  topos  tone.  See 
Laryngismus  Stridulus. 

Stenosis. — Gr.  arevoa-is  narrowing.  See 
Obstruction  of  the  Larynx. 

Submucous  Hemorrhage. — See  Sub- 
mucous Laryngeal  Hemorrhage. 

Thyroid  Gland  Tumor. — Gr.  dvpeSs 
shield  -f  eidos  form;  L.  glans,  a cord. 
See  Tumors  of  the  Larynx. 

Tuberculosis. — See  Tuberculosis  of  the 
Larynx. 

Tumors. — See  Tumors  of  the  Larynx. 

Laryngismus  Stridulus. — L.;  Gr.  \apvj- 
yLo-pds  a whooping;  L.  strid'ulus,  attended 
with  stridor.  Synonyms.— Spasm  of  the  glottis; 
spasmodic  croup;  spasmodic  laryngitis;  false 
croup;  child-crowing;  holding-the-breath. 

A relatively  rare,  chronic  affection,  lasting 
from  several  days  to  several  weeks  or  months, 
occurring  usually  in  young  children  of  a 
feeble  constitution,  i.e.,  in  children  affected 
with  rickets,  or  with  malnutrition  resulting 
from  improper  thet  and  bad  hygiene,  char- 
acterized by  the  sudden  occurrence,  usually 
at  night  and  without  fever,  of  an  adductor 
spasm  of  the  glottis,  with  arrested  breathing 
of  from  fifteen  to  thirty  seconds  duration, 
followed  by  a crowing,  inspiratory  stridor. 
Carpo-pedal  spasm  and  convulsions  often 
occur.  Mild  attacks  are  often  designated 
by  the  parents  as  “ passion  fits,”  or  “ holding 
the  breath.” 

M.  H.  Fussell  says:  “ Larjmgismus  stri- 
dulus can  be  surely  diagnosed  by  the  chron- 
icity  of  the  case,  the  usual  presence  of 
rickets  in  the  child,  and  frequently  by  the 
presence  of  Trousseau’s  sign,  namely,  the 
appearance  of  contraction  of  the  finger  and 
hand  when  firm  pressure  is  made  along  the 
large  vessels.”  The  affection  is  rare  in 
adults. 

Causes  of  Spasm  of  the  Glottis. — Adenoids; 
enlarged  faucial  tonsils,  enlarged  lingual 
tonsuls;  chronic  nasal  disease  (rhinitis, 
polypi,  septal  deformities) ; gastro-intestinal 
disturbances  (catarrh,  constipation,  worms) ; 
dentition;  whooping  cough;  measles;  diph- 
theria; ear  le.sions;  faucial  or  laryngeal  irr - 
tation  due  to  a foreign  body,  inflammation,' 
ulceration,  tuberculosis,  syphilis,  neoplasm, 
an  elongated  uvula,  traumatism,  or  the 
action  of  caustics;  uterine  lesions;  lithiasis; 


sexual  excess;  cerebral  or  spinal  irritation; 
tabes  (laryngeal  crises) ; caries  of  neighboring 
vertebrae;  hydrophobia;  tetanus;  epilepsy; 
pressure  upon  the  pneiunogastric  or  laryn- 
geal nerves  by  a goitre,  aneuiysm,  enlarged 
thymus  gland,  enlarged  lymphatic  glands, 
mediastinal  and  cervical  tumors  or  absce&s, 
retro-oesophageal  abscess,  cancer  of  the 
oesophagus,  tubercular  pleuritic  adhesions 
over  the  right  pulmonary  apex;  morphine 
or  cocame  habit;  rickets;  malnutrition; 
neurotic  temperament;  hysteria;  heredity; 
cold;  emotion. 

Treatment.— A.  During  the  Attack. — 
Explore  the  pharynx  and  larynx  at  once  for 
a foreign  body,  and  incidentally  induce  gag- 
ging with  the  finger.  Loosen  the  patient’s 
clothing  and  open  the  windows  for  plenty  of 
fresh  air,  dash  cold  water  on  the  face,  neck, 
and  chest,  or  apply  hot  water  or  a mustard 
plaster  to  the  nape  of  the  neck  or  to  the 
front  of  the  neck  and  sternum,  or  place  the 
feet  in  a mustard  bath  (about  one  table- 
spoonful of  mustard  to  the  gallon)  at  95°  F., 
or  immerse  the  patient  up  to  the  chin  in 
water  as  hot  as  can  be  borne  and  then  dash 
cold  water  over  the  face  and  head,  slap  the 
back,  rub  the  lips  with  a dry  towel,  place 
smelling  salts  to  the  nose  or  give  a few 
whiffs  of  ether  or  chloroform,  or  employ 
rhythmic  traction  upon  the  tongue,  fifteen 
to  eighteen  times  to  the  minute;  should  the 
jaws  be  set,  make  traction  by  deep-seated 
pressure  with  the  fingers  under  the  angle 
of  the  jaw. 

An  emetic  may  be  given,  e.g.,  warm  salt 
water,  or  syrup  of  ipecac,  20  to  60  drops 
every  twenty  to  thirty  minutes  until  vomit- 
ing occurs;  in  children  over  three  years  of 
age,  an  equal  amount  of  syrup  of  squills 
may  be  combined  with  the  ipecac. 

Intubation  (q-v.)  or  tracheotomy  (q-v.)  is 
rarely  demanded. 

After  the  attack  is  over  it  may  be  wise  to 
give  calomel  in  divided  doses,  followed  by 
a saline  (see  Part  11). 

Spasm  of  the  laiynx  in  adults,  says  Kyle, 
“ can  be  frequently  controlled  by  the  appli- 
cation of  bland  oils  to  the  nasopharynx.” 

If  the  spasm  is  due  to  nerve  pressure, 
spray  the  larynx  with  a 2 per  cent,  solution  of 
cocaine  and  menthol,  or  employ  inhalations 
of  tincture  of  benzoin  and  paregoric,  of  each 
one  teaspoonful  to  the  pint  of  boiling  water. 
St.  Clair  Thomson  prescribes  glass  ampoules 
containing  chloroform,  npx,  menthol,  gr.  3^, 
and  ethyl  iodide,  irpv,  to  be  broken  at  the 
time  of  an  attack  and  the  contents  inhaled. 
Pearls  of  amyl  nitrite  may  also  be  used.  He 
says:  “The  patient  should  be  ordered  to 


LARYNGITIS  ACUTA 


keej)  the  mouth  closed  and  to  breathe  quietly 
through  the  nose.” 

Ammonia  to  the  nose  and  cold  affusions 
are  recommended  in  hysterical  cases. 

E.  Between  Aitacks. — First  remove,  if 
possible,  all  sources  of  reflex  irritation  (see 
Causes).  Then  strengthen  the  patient’s 
physical  and  nervous  stamina  by  the  appli- 
cation of  the  rules  of  hygiene,  e.g.,  fresh 
air  tlay  and  night,  daily  exercise  out  of  doors, 
adequate  but  not  too  much  clothing,  plain, 
nutritious  food  at  regular  hours  (see  Infant 
Feeding,  in  Part  1,  on  General  Medicine  and 
Surgery),  frequent  bathing  (two  or  three 
times  daily  place  the  child  in  a warm  bath, 
and  sponge  the  back  and  chest  with  colcl 
water,  followed  by  friction),  and,  if  indi- 
cated, codliver  oil,  iron,  arsenic,  or  phos- 
phorus (see  Drugs,  Part  11). 

Chloral,  antipyrine,  and  the  bromides  are 
recommended  for  neiwous  hypersensitive- 
ness (see  Laryngitis  Acuta,  for  Kerley’s 
formulas),  but  good  hygiene  is  to  be  preferred. 
Forchheimer  jjrai.sed  the  bromides.  To  a child 
of  one  year  may  be  given  sotlium  bromide, 
gi’.  V,  and  chloral,  gr.  i,  every  three  or  four 
hours  until  the  attacks  are  controlled,  then 
three  times  a day.  (Holt.)  Holt  prefers,  how- 
ever, antipyi-me, — to  a child  of  one  year,  gr. 
i-ii  every  four  hoiu’s,  the  dose  to  be  gradually 
diminished  as  the  symptoms  improve.  Cal- 
cium Chloride,  says  Holt,  is  sometimes  very 
effectual  and  sometimes  not;  to  a child  of  one 
year  he  gives  gr.  vi,  four  or  five  tmies  a day. 

St.  Clah’  Thomson  recommends  in  mild 
cases  in  infants  a few  drops  of  a solution  of 
resorcin,  gr.  ii-v,  in  normal  saline  solution 
or  olive  oil,  one  ounce,  into  the  nostrils 
several  times  a day.  He  also  quotes  Eustace 
Smith  as  warmly  recommending,  as  an  anti- 
spasmotlic,  “10  to  30  drops  of  liquid  extract 
of  grindelia,  in  water  flavored  with  the  liquid 
extract  of  liquorice  and  well  sweetened  with 
glycerine,  every  four  hours.” 

Laryngitis  Acuta. — Gr.  \apvj^  larynx  -|- 
-LTLs  inflammation;  L.  acu'tus,  sharp.  An 
acute  catarrhal  inflammation  of  the  laryn- 
geal mucosa,  of  about  three  to  twelve  days 
duration,  characterized,  in  adults,  by  hoarse- 
ness or  aphonia,  local  irritation  and  desire  to 
deal’  the  throat,  and  sometimes  a metallic 
cough.  In  children,  the  affection  is  more 
serious  than  in  adults,  because  the  glottis  is 
narrower,  the  tendency  to  laryngeal  spasm 
marked,  aiifl  the  danger  of  suffocation  con- 
se(iuently  greater.  It  is  characterized,  in 
chihUen,  by  a spasmodic,  barking  cough, 
hoarseness,  and  attacks  of  d.yspnoea  (form- 
erly called  false,  non-membranous,  or  spas- 
modic croup). 


Etiology.— Exjx)sure  to  cold  and  wet  and  to 
draughts;  poor  ventilation;  indoor  life  and 
sedentary  habits;  dust  and  irritating  inha- 
altions  and  aiDplications;  swallowed  hot  or 
corrosive  liquids;  traumatism;  mouth  breath- 
ing; poor  health;  contiguous  inflammation; 
gastro-intestinal  irregularities;  violent  cough- 
ing; overuse  and  improper  use  of  the  voice; 
excessive  use  of  tobacco;  alcoholism;  foreign 
body;  acute  infectious  diseases  (catarrhal 
fever,  influenza,  measles,  whooping  cough, 
smallpox,  chicken-pox,  rotheln,  scarlet  fever, 
diphtheria,  typhoid  fever,  erysipelas);  hay- 
fever;  syphilis;  tuberculosis;  persistent  vom- 
iting and  retching;  passionate  cr>dng  or 
sobbing;  lithiasis. 

A.  Treatment  in  Adults. — In  the  early 
dry  or  congestive  stage,  enjoin  rest  indoors, 
preferably  in  bed,  in  a comfortable,  well- 
ventilated  room,  free  from  draughts,  at  a 
temperature  of  65°-70°  F.,  and  with  the  air 
surcharged  with  steam.  Rest  of  the  voice 
should  also  be  enjoined.  Open  the  bowels 
with  castor-oil  or  calomel  (see  Part  11). 
Prescribe  liquid  tliet,  copious  hot  drinks, 
e.g.,  lemonade,  barley  water,  linseed  tea,  or 
whiskey  and  water,  and  a hot  mustard  foot- 
bath (about  one  tablespoonful  to  the  gallon) , 
or  a full  hot  bath,  if  it  can  be  taken  without 
danger  of  subsequent  exposmu.  Apply  to 
the  neck,  over  the  larynx  and  trachea  to  the 
middle  of  the  stenuun,  cold  or  warm  applica- 
tions, a turpent me  fomentation  (see  Part  11), 
mustard  poultice  (q.v.),  tincture  of  iodine, 
or  imguentiun  capsici  (q.v.).  Massage  of 
the  neck  by  stroking  the  jugulars  toward  the 
heart  is  beneficial.  Eveiy  one,  two,  or  three 
hours,  have  the  patient  inhale  for  five  to 
fifteen  minutes  or  longer,  steam  medicated 
with  compound  tincture  of  benzoin,  pi  to  the 
pmt  of  boiling  water  over  an  alcohol  lamp, 
to  which  may  be  added  a teaspoonful  of 
paregoric ; or  steam  medicated  with  creosote, 
gtt.  x-xv. 

Tuicture  of  aconite,  one  drop  in  water 
every  fifteen  minutes  for  several  hours,  or 
until  thyness  of  the  throat  or  tingling  of  the 
fingers  is  produced,  is  well  recommended. 
Some  achninister  an  effervescent  pilocarpine 
tablet  (gr,  Hoo)  every  horn  for  three  or  four 
doses.  Kyle  says  that  relief  may  be  obtained 
in  a few  hours,  in  the  early  stage,  by  the 
ailministration  of  dilute  nitric  acid,  5 to  10 
drops  in  water,  at  first  every  half  hour,  aiul 
later  every  hour  for  two  or  three  doses;  or, 

Acidi  nitrici  diluti,  TTgih,  tr.  opii  deodorati, 
nEiii,  cocainie  jihenati,  gr.  y^o,  every  hour  for 
three  or  four  doses. 

For  distressing  cough,  prescribe  codeine, 
gr-  yi‘2~yi~}4:,  every  three,  four,  or  six  hours 


LARYNGITIS  ACUTA 


until  relieved;  or  heroin,  gr.  ^2!  or  mor- 
phine, gr.  ys~}4r',  or  the  following: 


R Menthol 5ss 

Eucalyptol 5 i 

Olei  mentha*  piporit® 3ss 


M.  Sig. — Inhale  five  drops  from  a respirator  for 
twenty  minutes,  every  four  hours.  (Birkett.) 

Adrenalin,  1 : 5000  to  1 : 2000,  applied  in 
the  form  of  a spray  several  times  daily, 
may  be  of  service. 

Should  oedema  occm,  apply  ice-bags  to 
the  neck  for  forty  minutes,  followed  by  the 
application  of  two  leeches  on  each  side  of  the 
neck,  give  the  patient  ice  to  suck,  open  the 
bowels  freely  by  means  of  calomel  and  salines, 
employ  free  diaphoresis  by  means  of 
Dover’s  powder,  or  pilocarpine,  gr.  3"^, 
hypodermically,  and  hot  lemonade,  and 
spray  the  larynx  every  one,  two,  or  three 
hoirrs  with  a solution  of  cocaine,  2 per  cent., 
in  adrenahn,  1 : 2000.  Multiple  punctures 
(do  not  scarify)  may  be  made  into  the 
swollen  tissues,  jjreviously  cocainized  with  a 
10  per  cent,  solution  of  cocaine,  with  a 
laryngeal  lancet,  by  the  aid  of  a laryngeal 
mirror  and  reflected  light  (see  Throat 
Technique),  followed  perhaps  by  the  appli- 
cation of  ichthyol,  20  to  30  per  cent,  aqueous 
solution,  or  liquor  ferro  persulphatis,  gtt. 
v-x  ad  5i)  or  silver  nitrate,  gr.  ii-v  ad  5i. 
Immediate  tracheotomy  (q.v.)  may,  however, 
be  demanded. 

After  the  acute  stage  has  subsided  and  the 
secretion  has  become  established,  replace  the 
steam  inhalations  by  sprays  of  liquid  vase- 
line, albolene,  cosmoline,  paroline,  or  ben- 
zoinol,  either  plain  or  medicated  with  ol. 
santali,  gtt.  iv-vi,  and  ol.  picis  liquid!,  gtt. 
i-iii,  to  the  ounce;  or  camphor  menthol 
(equal  parts  rubbed  together  until  liquefied), 
gr.  v-x  to  the  ounce ; or  apply  by  means  of  a 
syringe,  atomizer,  or  cotton-wound,  corru- 
gated applicator  (see  Throat  Technique), 
a solution  of  silver  nitrate,  1 to  2 per 
cent.,  or  zinc  chloride  or  sulphate,  1 to  3 per 
cent.  Richardson  says:  “ I wish  to  mi  press 
upon  my  readers  the  importance  of  thorough 
cleansing  of  the  nasal,  pharyngeal,  and  laryn- 
geal mucous  membrane  (with  a warm  alka- 
line lotion  : see  Rhinitis  Acuta,  in  Part 
VTII,  on  Nose  Disea.ses)  before  making  top- 
ical applications  to  the  laiynx.” 

For  persistent  huskiness  is  recommended 
sodium  benzoate,  gr.  v,  or  compound  elixir 
of  terpin  hydrate  (Llewellyn’s),  3i,  three  or 
four  times  a day,  together  with  a spray  of 
tannin  or  alum,  gr.  v-x  to  the  ounce. 

In  cases  of  obscure  origin  the  iodides 
(Part  11)  are  usually  beneficial. 


Prophylaxis. — This  embraces  fresh  air  day 
and  night,  daily  exercise  in  the  fresh  air, 
clothing  neither  too  light  nor  too  heavy,  dry 
stockings,  heavy-soled  shoes,  linen-mesh 
underwear,  rubbers  in  wet  weather,  no  neck 
protectors,  frequent  warm  baths  in  a com- 
fortable room,  followed  by  a moderately  cool 
sponge  and  brisk  rubdown  with  a coarse 
towel,  proper  house  ventilation,  avoidance 
of  overheated  rooms,  dust,  dietetic  errors, 
the  excessive  use  of  alcohol  and  tobacco,  etc., 
and  the  correction  of  nasal  defects  (spurs, 
septal  deflection,  clironic  rhinitis,  adenoids, 
etc.). 

B.  Treatment  in  Children. — Admin- 
ister,  in  the  beginning,  calomel,  gr.  i-ii  in 
divided  doses,  followecl  by  a saline  (see  Part 
11),  or  castor-oil,  one  to  three  teaspoonfuls. 
Place  the  child’s  feet  or  the  whole  body  in 
hot  mustard  water  (a  heaping  tablesixionful 
of  mustard  to  six  gallons)  for  fifteen  minutes, 
then  put  to  bed  and  cover  with  woolen 
blankets.  Keep  the  room  properly  venti- 
lated, at  a temperature  of  about  70°  F.,  and 
the  air  surcharged  with  steam.  Rub  the 
neck  vigorously  with  camphorated  oil,  or 
linhnentiun  saponis  (Part  11)  or  equal  parts 
of  lard  and  turpentine.  Hot  applications 
over  the  larynx  (from  ear  to  ear)  are  useful. 
In  older  children,  cold  compresses,  applied 
every  thirty  minutes,  may  be  preferable. 
Several  times  a day,  or  as  often  as  desired, 
employ  for  twenty  or  thu*ty  minutes  at  a 
time,  inhalations  of  steam  medicated  with 
creosote,  gtt.  x,  or  compound  tincture  of 
benzoin,  3i,  or  a solution  of  menthol,  gr.  x, 
in  one  ounce  of  tr.  eucalypti  or  spt.  vini 
rectificati,  one  teaspoonful  in  a pint  or  quart 
of  steaming  water  contained  in  a Holt  croup 
kettle  or  saucepan  over  an  alcohol  lamp,  and 
under  a sheet  supported  by  an  umbrella. 

For  distressmg  cough,  prescribe  paregoric, 
Dover’s  powder,  codeine  (see  Part  11) 
or  antipyi-ine  and  sodimn  bromide  (see 
below) : 

R Ammonii  broinidi 

Ammonii  carbonati.s .... 

Tincturae  aconiti 

Glycerini 

Aqu®,  q.s.  ad 

M.  Sig. — Two  drains 
(C.  W.  Richardson.) 

R Tinctur®  opii  eamphor- 

at® iTpxxxii  (TTijii  per  dose) 

Tinctnr®  belladonn®.  . . TTjixvi  (irgi  per  do.se) 

Ammonii  bromidi gr.  Ixxx  (gr.  v per  dose) 

SjTiipi  tolutani 5i  (3ss  per  dose) 

Aqu®,  q.s.  ad 5ii 

M.  Sig. — One  dram  every  hour  until  relieved 
(for  a child  two  years  of  age).  (M.  H.  Fussell.) 


gr.  xvi  (gr.  ii  per  dose) 
gr.  xvi  (gr.  ii  per  dose) 
T^viii  (tiji  per  dose) 

3ii  ( iTExv  per  dose) 

5ii 

every  two  hours. 


LARYNGITIS,  CHRONIC  CATARRHAL 


For  tlie  relief  of  dyspnoea,  sedative  drugs 


are  effectual : 

1 year 

2 years  3 to  0 yra 

Antipyrina* 

. gr.  ss 

gr.  i 

gr.  ii 

Sodii  bromidi 

• gr.  ii- 

111  e;!*.  ii-iu 

gr.  IV 

Syrupi  ipecacuanhas. 

. TT^ii-iii  nijiii 

TIPUI 

Aquas,  q.s.  ad 

■ 5i 

3i 

5i 

M.  Sig.— One  dram 

every 

two  hours- 

-eight 

doses  in  twenty-four  hours.  (Kerley.) 


Holt  gives  one  grain  of  antipyrine  every 
two  hours  to  a child  of  one  year.  It  may 
have  to  be  given  only  at  bedtime  for  three 
or  four  successive  nights.  Forchheimer 
praised  the  bromides. 

If  there  is  much  mucus  in  the  throat, 
give  an  emetic,  e.g.,  wine  or  syrup  of 
ipecac,  one  or  two  teaspoonfuls,  rei^eated  in 
twenty  minutes,  if  necessary;  or  one  tea- 
spoonful every  thirty  or  sixty  minutes  until 
vomiting  occurs. 

Intubation  (q-v.)  or  tracheotomy  (q.v.)  is 
rarely  demanded.  Wliere  intubation  has 
been  performed,  the  tube  may  usually  be 
removed  in  two  or  three  days. 

Prophyla.\is.— Tliis  embraces  fresh  air  day 
and  night,  adequate  clothing,  diy  stockings 
and  good  shoes,  a daily  bath  with  momentary 
cold  sponging  of  the  neck  and  chest  followed 
by  friction,  a liberal,  bland  diet  at  regular 
hours  (see  Infant  Feeding,  in  Part  1,  on 
General  Medicine  and  Surgery),  the  removal 
of  enlargetl  tonsils  and  adenoids,  and,  if 
indicated,  codliver  oU,  maltine,  iron,  or 
arsenic  (see  Part  11). 

Laryngitis,  Atrophic. — See  Atrophic 
Laryngitis. 

Laryngitis,  Chronic  Catarrhal. — Gr.  Xapvy^ 
larynx  + -trts  inflammation;  xpo^os  time; 
KarapptLv  to  flow  down.  A chronic  catarrhal 
inflammation  of  the  laryngeal  mucosa, 
(characterized  clinically  by  impairment  and 
alteration  of  the  voice,  manifested  by  lower- 
ing of  the  tone  and  hoarseness  or  huskiness, 
and  increased  secretion,  manifested  by 
frequent  clearing  of  the  throat  and  slight 
expectoration;  and  anatomically  by  con- 
gestion in  the  simple  catarrhal  form,  more 
or  less  generalized  thickening  in  the  hyper- 
tropliic  form,  and  localized  thickening  of  the 
vocal  cords  (singer’s  or  teacher’s  nodules) 
in  the  nodular  form. 

There  is  a rare,  intractable  form  of  hyper- 
trophic laryngitis,  called  pachydermia  laryn- 
gis,  characterized  by  more  or  less  SAunmetri- 
cal  thickenings  of  the  epithelium  and  sub- 
(‘pithelium  over  the  posterior  ends  of  the 
vocal  cords,  with  resulting  hoarseness  and 
.sometimes  dysphagia. 

Etiology.— Repeated  attacks  of  acute  laryn- 
gitis iq.v.);  disorders  of  the  nose  naso- 


phar^mx,  pharjmx,  and  mouth  (mouth 
breathing,  chronic  turgescent  or  hyper- 
trophic rhinitis,  septal  (leformities,  polypi, 
sinusitis,  adenoids,  nasal  suppuration,  en- 
larged faucial  or  lingual  tonsils,  elongated 
uvula,  dental  caries,  pyorrh(£a  alveolaris, 
etc.);  chronic  tracheitis  and  bronchitis; 
pulmonary  tubercidosis ; asthma;  hay  fever; 
chronic  cough;  constant  exposure  to  dust  or 
other  irritating  inhalations;  local  tubercu- 
losis or  lupus;  leprosy;  neoplasms;  syphilis; 
paralysis;  frequent  fits  of  weeping;  overuse 
or  faulty  use  of  the  voice;  excessive  use  of 
alcohol,  tobacco,  or  condiments;  arsenic; 
potassium  iodide;  lithiasis;  gastro-intestinal, 
hepatic,  cardiac,  or  renal  disease,  especially 
chronic  constipation;  perhaps  menstrual 
disorders;  perhaps  anaenua. 

The  exciting  cause  of  singer’s  or  teacher’s 
nodules  is  overuse  or  misuse  of  the  voice. 

Prognosis.— This  is  fairly  good,  and  depends 
upon  the  stage  of  development  of  the  disease 
and  the  eradicability  of  its  cause.  Three  to 
six  months  of  treatment  may  be  required  for 
the  hypertrophic  form. 

Treatment. — First  direct  the  attention  to 
the  correction  of  any  and  all  possible  causal 
factors,  and  impress  upon  the  patient  the 
importance  of  obseiwing  good  hygiene,  ade- 
quate rest  and  exercise,  fresh  an  day  and 
night  with  the  avoidance  of  draughts,  ade- 
quate clothing,  but  not  too  heavy,  dry 
stockings,  heavy-soled  shoes,  rubbers  in  wet 
weather,  a daily  warm  bath  in  a warm  room 
before  breakfast,  followed  by  a moderately 
cold  douche  and  brisk  rubdown  with  a 
coarse  towel,  proper  house  ventilation, 
avoidance  of  overheated  rooms,  dust,  alco- 
hol, tobacco,  dietetic  errors,  etc.,  regular 
hours  of  eating  and  sleeping,  and  regulation 
of  the  bowels. 

Rest  of  the  voice,  as  nearly  absolute  as 
possible,  is  important.  Three  or  four  times 
daily,  the  larynx  and  also  the  nose  and 
pharynx,  if  affected,  may  be  cleansed  by 


means 

of  a warm  alkaline  spray. 

viz. . 

R 

Mentholis 

Sodii  bicarbonatis 

■ gr.  ii 

Sodii  biboratis,  aa 

. gr.  V 

Aquae 

. 5i 

i; 

Sodii  bic.arbonatis, 
Sodii  biboratis, 
Sodii  cldoridi, 

Sacchari  albi,  aa 

■ gr.  V 

Acidi  carbolici 

. . gr.  viii 

Aquae 

5iv 

After  thus  cleansing  the  larynx,  emploj^  a 
spray  of  liquid  vaseline  (cosmoline),  albo- 
lene,  benzoinol,  or  paroline,  either  plain  or 
medicated  with  menthol,  gr.  v-xxx  ad  5i> 


LINGUAL  TONSILLITIS,  ACUTE 


or  camphor-menthol  (equal  parts  rubbed 
together  until  liquefied),  gr.  v-x  ad  5h  or 
ol.  santali,  TTjiv-vi,  and  ol.  picis  liquidae, 

nEi-iii,  ad  5i- 

Medicated  steam  inhalations  are  also 
beneficial,  but  they  should  not  be  employed 
when  the  patient  is  going  about  out  of  doors. 
The  inhalations  may  be  taken  through  an 
improvised  paper  cornucopia  or  under  a 
sheet,  the  water  being  heated  in  a tin 
over  an  alcohol  lamp,  and  medicated  with 
creosote,  gtt.  x-xv  ad  Oi,  or  tinctme  of 
benzoin,  3i  ad  Oi. 

Eucalyptol,  ol.  pini  sylvestris,  or  terebene, 
five  drops,  alone  or  m combination,  may  be 
inhaled  from  a respirator  for  twenty  minutes 
three  times  a day. 

In  inveterate  cases,  employ  every  other 
day  to  once  a week,  astringent  applications: 
zinc  chloride,  gr.  ii-xxx  ad  5i;  silver  nitrate, 
gr.  ii-c  ad  5i;  zinc  sulphate,  gr.  v-xv  ad  5u 
iron  perchloride,  gr.  iii-xxx  ad  3 b'  copper 
sulphate,  gr.  ui-x  ad  5i;  ailing,  gr.  xxx  ad  5i,‘ 
alumnol,  gr.  xv  ad  Si;  lactic  acid,  gr.  x ad  Si. 
The  stronger  solutions  are  employed  in 
hypertrophic  laryngitis.  The  solution  may 
be  applied  in  the  form  of  a spray,  or  with 
the  laryngeal  brush,  or  on  cotton,  with 
Sajous’s  forceps,  the  excess  of  fluid  always 
being  squeezed  from  the  cotton  before  the 
application  is  made.  Says  Sajous,  the  infra- 
glottic  region  should  always  be  included  in 
the  application.  For  supracordal  applica- 
tions, the  tongue  should  be  held  out  and  the 
patient  told  to  sound  a ; for  subcordal 
applications,  the  tongue  is  held  out  and  the 
application  made  during  a deep  inspiration. 
Shou.d  spasm  of  the  laryngeal  muscles  be 
excited  by  the  application,  “ instruct  the 
patient  to  take  a niunber  of  deep  breaths  in 
rapid  succession.”  (Ballenger.) 

For  profuse  but  tenacious  secretions  is 
reconunended  sodium  benzoate,  gr.  v-xv 
(see  Part  11),  three  or  four  times  daily;  or 
fl.  ext.  hydrastis,  gtt.  v-xxx,  in  water,  three 
or  four  tunes  daily. 

For  scanty  secretions  and  dryness  is 
recommended  potassium  iodide,  gr.  v-x  (see 
Part  11),  t.i.d.;  or  I^  lodi,  gr.  }^,  phosphori, 
gT;  Koo,  . bromini,  gr.  vini  xerici, 

3i  M.  Sig.  One  dram  well  diluted, 
t.i.d.  (Kyle.) 

Potassium  iodide,  gr.  v,  t.i.d.,  with  per- 
haps protoiodide  of  mercury,  and  a ferrugin- 
ous tonic  (see  Part  11  for  all  drugs)  are  val- 
uable for  the  promotion  of  absorption  in 
hypertrophic  laryngitis,  as  well  as  for  any 
associated  bronchitis.  Saline  cathartics  in 
small  doses  may  also  be  useful. 

In  nodular  laryngitis,  absolute  rest  of  the 


voice  is  most  important.  Says  St.  Clair 
Thomson:  “ It  may  require  months  of  abso- 
lute dumbness  in  some  cases  before  the 
nodules  will  completely  disappear.”  When 
quicker  results  are  important,  or  conserva- 
tive treatment  fails,  large  nodules  may  be 
removed  with  intralaryngeal  forceps  and 
small  or  sessile  ones  may  be  very  care- 
fully touched  with  a fine  galvanocautery 
point.  Suspension  laryngoscopy  (with  the 
Killian-Lynch  apparatus)  affords  easy  ap- 
proach to  all  parts  of  the  larynx.  Correct 
anaemia,  if  present  (consult  Part  1).  Faulty 
use  of  the  voice  should,  of  course,  be  corrected. 

After  the  most  important  changes  induced 
by  a chronic  laryngitis  have  been  corrected, 
“ any  remainmg  paresis  of  the  cords  may  be 
met  by  the  administration  of  strychnine, 
the  use  of  faradism,  or  a coin-se  of  static 
electricity.”  (St.  Clair  Thomson.) 

Laryngitis,  Diphtherial. — See  Diphtheria, 

Dry  . — See  Atrophic  Laryngitis. 

Edematous. — See  (Edema  of  the  Larynx. 

Hypertrophic. — Gr.  virkp  over  -|-  Tpo4>r/ 
nutrition.  See  Laryngitis,  Chronic 
Catarrhal. 

Nodular. — L.  nod'ulus,  little  knot.  See 
Laryngitis,  Chronic  Catarrhal. 

(Edematous. — See  (Edemaof  the  Larynx. 

Sicca. — L.  sie'eus,  dry.  See  Atrophic 
Laryngitis. 

Simple  Chronic.  — L.  sim'plex.  See 
Laryngitis,  Chronic  Catarrhal. 

Spasmodic. — Gr.  a-iraands  spasm.  See 
Laryngitis  Acuta;  and  Laryngismus 
Stridulus. 

Tuberculous. — See  Tuberciflosis  of  the 
Larynx. 

Larynx,  Affections  of  the. — See  Laryngeal 
Affections. 

Lingual  Abscess. — L.  lin'gua,  tongue;  ab- 
sces'sus,  a going  apart.  See  Lingual 
Tonsillitis,  Acute. 

Quinsy.  — Fr.  cynan'che,  sore  throat. 
See  Lingual  Tonsillitis,  Acute. 

Tonsil,  Hyperplasia  of  the. — See  Hy- 
perplasia of  the  Lingual  Tonsil. 
Inflammation  of  the. — L.  inflamma're 
to  set  on  fire.  See  Lingual  Tonsil- 
litis, Acute. 

Lingual  Tonsillitis,  Acute. — L.  lin'gua, 
tongue  ; tonsil'la,  tonsil  ; acu'tus,  sharp. 
Synonyms.— Preglottic  tonsillitis;  lingual  ab- 
scess; lingual  quinsy. 

The  symptoms  are  similar  to  those  of 
acute  faucial  tonsillitis,  with  the  difference 
of  location;  the  lingual  tonsil  being  situated 
at  the  base  of  the  tongue  behind  the  circum- 
vallate  papillae  and  in  front  of  the  epiglottis. 

The  prognosis  is  good. 


NASO-PHARYNGEAL  LUPUS 


Treatment.— Open  tlie  bowels  with  pow- 
dered calomel,  followed  by  a saline.  Employ 
the  same  lo(;al  measures  as  for  acute  faucial 
tonsillitis  {q.v.).  If  an  abscess  forms,  it 
should  be  incised. 

Lipoma. — Gr.  XIttos  fat  -f-  -cojua  tumor. 
See  Tumors  of  the  Naso-Pharynx  and 
Pharynx;  and  Tumors  of  the  Larynx. 

Loss  of  Voice. — See  Aphonia. 

Ludwig’s  Angina. — See  Part  1,  General 
Medicine  and  Surgery. 

Lupus  of  the  Nose  and  Throat. — L.  lu'pus, 
wolf.  Lupus,  as  contrasted  with  the  ordi- 
nary form  of  tuberculosis,  is  characterized  by 
the  occurrence  of  numerous,  slow-growing, 
indolent  or  painless,  minute,  discrete,  mud- 
brown  or  apple-butter-brown  nodules,  (rend- 
ered distinct  by  the  aj^plication  of  cocaine  or 
adrenalin),  with  but  slight  secretion,  no 
o?dema,  and  of  good  prognosis. 

The  orchnary  form  of  tuberculosis  is 
characterized  by  the  occurrence  of  diffuse 
infiltration,  proneness  to  cedema,  greater 
secretion,  sensitiveness  and  often  pain,  a 
progressive  course,  and  more  serious  prog- 
nosis. It  is  very  rare  in  the  nose  and  pharynx 
but  not  in  the  larynx  (see  Tuberculosis  of 
the  Laiynx). 

Lupus  in  the  nose  occurs  mostly  on  the 
cartilaginous  septum,  the  floor,  and  the 
anterior  end  of  the  inferior  turbinal;  in  the 
larynx  it  occurs  mostly  on  the  epiglottis. 
Ulceration  is  prone  to  occur,  followed  by 
scarring  and  retraction. 

Treatment. — Good  hygiene,  adequate  rest 
and  exercise,  fresh,  jjure  air  day  and  night, 
a daily  morning  warm  bath  in  a warm  room 
followed  by  a cold  spinal  douche,  regular 
hours  of  eating  and  sleeping,  rest  before  and 
after  meals,  a plain  but  abundant  diet,  ade- 
quate clothing,  personal  cleanliness,  (the 
avoidance  of  dust,  tobacco,  and  alcohol)  and 
perhaps  codliver  oil,  hypophosphites,  creo- 
sote, arsenic,  or  strychnine  (see  Drugs  Part 
11),  is  of  the  first  importance. 

A single  lupus  tumor  of  the  septum  should 
be  completely  excised.  In  more  extensive 
cases,  the  centre  of  each  intact  nodule  should 
be  penetrated  with  a fine  galvanocautery 
point,  and  each  ulcer  should  be  thoroughly 
cauterized,  and  then  treated  with  lactic 
acid,  ()0  per  cent.,  or  a mixture  of  iodine,  5i, 
jM)tassium  iodide,  oii,  and  distilled  water, 
oii,  or  unguentum  ac.  jnTogallici,  10  to  20 
per  cent.,  or  unguentum  hydrargyri  dilutum, 
oi,  ad  petrolatum  mollem,  5h  the  applica- 
tion to  be  renewed  daily. 

Exdensive  cases  first  require  thorough 
scraping,  under  general  antesthesia,  with  a 
Volkmann  spoon  or  ring-knife,  the  posterior 


nares  being  first  plugged.  To  prevent  sub- 
sequent contraction,  Meyer’s  vulcanite 
splints  smeared  with  mercury  ointment 
should  be  worn  in  the  no.strils.  The 
scraping  may  have  to  be  repeated  ever}" 
few  weeks  until  the  cfiseased  tissue  is 
all  destroyed. 

The  parts  shoukl  be  kept  cleansed  with  an 
alkaline  lotion  (see  under  Rhinitis  Acuta), 
followed  by  a spray  of  liquid  vaseline,  albo- 
lene,  paroline,  cosmoline,  or  benzoinol. 

For  the  relief  of  irritation  and  for  the 
purpose  of  softening  crusts,  one  may  apply 
the  following  on  tampons:  R Resorcinolis, 
balsami  Peruvianse  et  mucilaginis  acaciae, 
aa  (Fordyce.) 

For  laryngeal  lupus,  St.  Clair  Thomson 
well  recommends  the  galvanocautery  (under 
cocaine  anaesthesia,  10  to  20  per  cent., 
repeatedly  applied).  He  uses  a fine-pointed 
electrode,  “brought  almost  to  a white  heat,” 
and  “ firmly  thrust  through  the  diseased 
area  until  its  arrest  shows  that  healthy 
tissue  has  been  reached.”  “ Several  cauter- 
izations are  carried  out  at  one  sitting, 
which  is  repeated  every  ten  to  twenty  tlays 
until  complete  healing  takes  place.”  Chro- 
mic acid  fused  on  the  end  of  a probe  (first 
warm  the  probe,  dip  it  in  the  chromic 
acid  crystals,  then  w"arm  the  part  of  the 
probe  next  beyond  the  crystals  until  the 
latter  melt),  may  also  be  used.  Fungating 
masses  may  first  be  cut  off  with  punch 
forceps  before  using  the  cautery.  Suspen- 
sion laryngoscopy  (with  the  Killian-Lynch 
apparatus)  affords  easy  approach  to  all  parts 
of  the  larjmx. 

Watch  for  and  attack  recurrences. 

Lymphoma  Laryngis. — L.  ly?n'pha,  Hnnph 
-b  Gr.  tumor.  See  Tiunors  of  the 

Larynx. 

Membranous  Non=Diphtherial  lnflamma= 

tion. — See  Tonsillitis  Acuta. 

Mogiphonia. — Gr.  fiSyis  difficulty  -|- 
voice.  See  Phonic  Spasm,  under  Neuroses 
of  the  Larynx. 

Mycosis  of  the  Throat. — See  Phar}Tigo- 
niycosis. 

Myxoma  Laryngis. — Gr.  pv^os  mucus  ■+■ 
-co/ua  tumor.  See  Tumors  of  the  Larjmx. 

Naso=Pharyngeal  Catarrh. — L.  nas'us, 
nose;  Gr.  4>apvy^  pharynx;  Karappeiv 
to  flow  tlown.  See  Naso-Pharyngitis 
Acuta,  and  C’hronica. 

Foreign  Bodies. — See  Foreign  Bodies 
in  the  Air  Passages. 

Inflammation. — L.  inflamma're,  to  set 
on  fire.  See  Naso-Phaiyngitis. 

Lupus. — See  Lupus  of  the  Nose  and 
Throat. 


NA80-PHARYNGITIS  CHRONICA;  CHRONIC  POST-NASAL  CATARRH 


Naso=Pharyngeal  Tumors. — See  Tumors 
of  the  Naso-Pharynx  and  Pharynx. 

Naso=Pharyngitis  Acuta;  Acute  Post= 
Nasal  Catarrh. — L.  nas'us,  nose;  Gr.  4>apvy^ 
-p  -LTis  inflammation;  L.  acu'tus,  sharp;  post, 
behind;  Gr.  Karapptlv  to  flow  down.  This 
affection  occurs  usually  as  an  accompani- 
ment of  acute  rhinitis  {q.v.,  in  Part  8)  or 
acute  pharyngitis  {q.v.). 

Treatment.— Achninister  calomel  in  divided 
doses  followed  by  a saline  (see  Part  11). 
By  means  of  a post-nasal  syringe,  or  a 
fountain  syringe,  or  a catheter  attached  to  a 
rubber  bulb  and  passed  through  the  nose, 
cleanse  the  naso-pharynx  three  or  four  tunes 
daily,  with  a very  warm  normal  saline  or 
alkaline  antiseptic  solution,  .sodium  chloride, 
or  bicarbonate,  or  biborate,  one  teaspoonful 
to  the  pint.  When  irrigating  the  throat, 
keep  the  mouth  wide  open,  breathe  through 
the  mouth,  and  refrain  from  swallowing,  in 
order  to  avoid  the  entrance  of  fluid  into  the 
eustachian  tube.  Inhalations  of  .steam  medi- 
cated with  compound  tincture  of  benzoin, 
5i  ad  Oi,  are  also  .serviceable. 

The  following  antiseptic  and  astringent 
preparations  applied  on  a cotton  swab,  are 
effectual:  (1)  silver  nitrate,  gr.  x-xxx ad  5i; 
(2)  iodine,  gr.  vi,  potassium  iodide,  gr.  xv-xx, 
carbolic  acid,  igjii,  or  ol.  menth.  pip.,  njv,  and 
glycerine,  5i;  (3)  resorcin,  gr.  v,  borogly- 
ceride,  §i;  (4)  argyrol,  25  per  cent,  solution; 
(5)  boroglyceride,  50  per  cent.,  and  comp.  tr. 
benzoin,  equal  parts;  (6)  ol.  eucalypti,  gtt.  ii, 
ol.  cassiae,  gtt.  ii,  ext.  pini  canadensis,  gtt.  x, 
tr.  benzoin,  q.s.  ad  5i,  to  which  may  be 
added  cocaine,  3 per  cent.  (Kyle.) 

In  the  early,  dry  stage,  Kyle  recommends 
the  administration  of  a granular  effervescent 
pilocarpine  tablet,  gr.  Hoo,  to  be  dissolved 
slowly  in  the  mouth  every  hour,  until  the 
secretions  are  established. 

For  headache,  prescribe  phenacetin,  gr. 
v-x,  and  repeat  the  dose  if  necessary. 

Should  the  eustachian  orifice  become 
blocked,  and  earache,  tinnitus,  and  deafness 
supervene,  catheterize  the  eustachian  tube 
{q.v.,  in  Part  7)  and  draw  off  the  accumu- 
lated secretions. 

To  keep  the  nasal  passages  free,  apply  a 
spray  of  adrenalin,  1 : 5000,  followed  by  a 
spray  of  camphor,  gr.  vii,  and  menthol, 
gr.  XXV,  in  liquid  albolene,  5 i. 

Naso=Pharyngitis  Atrophica. — See  Atro- 
phic Na.so-Pharyngitis  and  Pharyngitis. 

Naso=Pharyngitis  Chronica;  Chronic  Post= 
Nasal  Catarrh. — L.  na'sus,  nose;  Gr.  4>apvy^ 
-LTLs  inflammation;  xpows  time;  L.  post, 
behind;  Gr.  Karappelv  to  flow  down.  Chronic 
post-nasal  catarrh  is  characterized  by  local 


irritation  and  the  dropping  or  hawking 
of  mucus.  It  is  sometimes  rebellious 
to  treatment. 

Etiology.— Repeated  attacks  of  acute  naso- 
pharyngitis; remains  of  only  partially  atro- 
phied adenoids;  neighboring  nasal  or  pharyn- 
geal disease;  sinusitis;  nasal  ob-struction,  as 
well  as  wide  nasal  passages;  irritating  vapors 
and  dust;  irritating  medication;  overuse  of 
the  voice,  damp,  variable  climate;  improper 
clothing;  tobacco;  alcohol;  ga.stro-intestinal 
intoxication;  gouty  or  rheumatic 
tliathesis;  poor  health  from  any  cause; 
infectious  diseases  (influenza,  scarlet  fever, 
tliphtheria,  etc.). 

Treatment. — ^Attend  to  the  cause,  and 
enjoin  the  observance  of  correct  hygiene, 
e.g.,  fresh  air  day  and  night  with  the  avoid- 
ance of  draughts,  adequate  but  not  too 
heavy  clothing,  linen-mesh  underwear,  dry 
stockings  and  heavy-soled  shoes,  rubbers  in 
wet  weather,  proper  house  ventilation, 
adequate  rest  and  exerci.se,  a daily  warm 
bath  in  a comfort.able  room  before  breakfast, 
followed  by  a moderately  cold  douche  and 
brisk  rubdown  with  a coar.se  towel,  avoid- 
ance of  overheated  rooms , dust , alcohol, 
tobacco,  dietetic  errors,  etc.,  regular  hours 
of  eating  and  sleeping,  and  regulation  of 
the  bowels. 

Remove  completely  any  diseased  remains 
of  adenoids  by  means  of  small  curettes,  the 
postnasal  forceps,  galvanocautery,  chromic 
acid,  or  lactic  acid,  3 i ad  5 i-  In  employing 
cauterization,  use  a palate  retractor  and 
post-nasal  mirror,  and  first  apply  cocaine, 
20  per  cent.,  on  a cotton  carrier. 
Take  care  not  to  touch  healthy  tissue  with 
the  caustic. 

By  means  of  a post-nasal  syringe,  or  a 
fountain  syringe,  or  a catheter  attached  to  a 
rubber  bulb  and  passed  through  the  no.se, 
cleanse  the  naso-pharynx  daily,  with  a very 
warm  normal  saline  or  alkaline  antiseptic- 
solution,  viz.,  sodium  chloride  or  bicarbonate 
or  biborate,  one  teaspoonful  to  the  pint. 
When  irrigating  the  throat,  keep  the  mouth 
wide  open,  breathe  through  the  mouth,  and 
refrain  from  swallowing,  in  order  to  avoid 
the  entrance  of  fluid  into  the  eustachian  tube. 

Follow  the  cleansing  proce.ss  by  a bland, 
oily  spray,  viz.,  liquid  albolene,  benzoinol, 
liquid  vaseline,  cosmoline,  or  paroline,  to 
which  may  be  added  menthol,  gr.  v-xxx  ad 
,3i.  Employ  a weak  solution  of  potas.sium 
permanganate  if  there  is  fetor. 

Three  times  a week,  or  oftener,  the  parts, 
including  the  posterior  part  of  the  soft 
palate,  may  be  sprayed  or  swabbed  by  means 
of  a curved,  cotton-wound  applicator,  with 


XEUEOSES  OE  THE  PIIARYXX 


one  of  the  following  antiseptic  astringent 
solutions,  viz.,  silver  nitrate,  gr.  x-xxx  ad 
5i;  argyrol,  25  per  cent.;  zinc  chloride,  2 to 
5 {rer  cent. ; zinc  sulphocarbolate.  gr.  viii  ad 
5i;  trichloracetic  acid,  1:2000;  iodine,  gr. 
vi,  potassium  iodide,  gr.  xx,  carbolic  acid, 
irpii,  or  ol.  menth.  pip.,  t^_v,  and  glycerine, 
5i;  resorcin,  gr.  v,  boroglyceride,  5i;  boro- 
glyceride,  50  per  cent.,  and  comp.tr.  benzoin, 
equal  parts;  ol.  eucalypti,  gtt.  ii,  ol.  cassia?, 
gtt.  ii,  ext.  pini  canadensis,  gtt.  x,  tr. 
benzoini,  q.s.  ad  oi-  (Kyle.) 

One  should  remember  that  too  prolonged 
local  treatment  is  in  itself  mritating. 

Ionic  medication  {q.v.  in  Part  1)  is 
recommended. 

Naso=Pharyngitis  Mutilans. — (See  Phino- 
pharyngitis  Mutilans. 

Nervous  Laryngeal  Cough. — Gr.  vevpov 
nerve.  See  Neuroses  of  the  Larynx. 

Cry  . — See  Neiu’oses  of  the  Larynx. 

Neuralgia  of  the  Pharynx. — Gr.  vevpov 
nerve  -t-  dXyos  pain.  See  Neuroses  of  the 
Pharynx. 

Neuroses  of  the  Larynx. — Gr.  vevpov 
nerve;  Xdpcy^  laiynx.  Neuroses  of  the 
larynx  embrace  ana-sthesia;  hyperipsthesia ; 
parsesthesia;  tonic  adductor  spasm,  or  laryn- 
gismus stridulus  (q.v.,);  clonic  rhythmical 
adductor  spasm;  phonic  adductor  spasm; 
paralysis,  functional  or  organic  (see  Aphonia) ; 
nervbus  laryngeal  cough  or  cry;  and  choreic 
movements. 

(a)  Anassthesia. — The  laryngeal  mucosa,  on 
one  side  or  both,  is  insensitive  to  the  touch 
of  the  probe.  As  a result  of  this  insensitive- 
ness, food  is  apt  to  be  asph-ated  into  the  lungs. 

Causes. — Paralysis  of  the  superior  laryn- 
geal nerve,  due  to  diphtheria,  influenza, 
pneumonia,  t>q)hoid  fever,  tj^phus  fever, 
cholera,  traimiatism,  railway  spine,  pressure 
from  a tumor,  tabes,  general  paresis,  glosso- 
labio-laryngeal  jiaralysis,  s5Tingomyelia, 
multiple  sclerosis,  syphilis,  hemorrhage; 
hysteria;  antemia;  old  age;  local  ana?sthetics 
(cocaine  and  its  congeners,  orthoform,  anscs- 
thesin,  menthol,  ice,  morphine,  bromides, 
chloral,  ethyl  chloride,  chloroform). 

Treatment. — This  embraces  re.st,  strychnine 
in  full  dosage,  external  farachsm, and  mas.sage. 
Marked  cases  may  require  feeding  with  the 
stomach  tube  (for  the  technique  consult 
Part.  1,  under  Dyspepsia;  care  is  required  in 
order  to  avoid  inserting  the  tube  into  the 
trachea).  In  po.st-diphtheritic  cases,  recov- 
ery occurs  in  from  one  to  six  weeks. 

(b)  Hypera'sthesia  and  Paraesthesia. — The 
manifestations  are  pain,  itching,  burning, 
pricking,  rawness,  tightness,  the  feeling  of  a 
foreign  body,  cough. 


Causes. — Hysteria;  neurasthenia;  hypo- 
chondriasis; fatigue,  general,  physical,  vocal, 
or  mental;  anaemia;  dyspepsia;  alcoholism; 
the  menopause;  gout  or  rheumatism;  early 
tabes;  reflex  nasal,  pharyngeal,  aural,  buccal, 
dental,  and  tonsillar  disorders;  larjmgitis; 
incipient  tuberculosis. 

Treatment. — This  embraces  the  removal 
of  the  cause,  good  hygiene  (adequate  rest 
and  exercise,  fresh  air  day  and  night,  regular 
hours  of  eating  and  sleeping,  nutritious  food, 
rest  before  and  after  meals,  regulation  of  the 
bowels,  and  a daily  morning  warm  bath, 
before  breakfast,  in  a warm  room,  followed 
by  a cold  spinal  douche  and  bri.sk  rubdown 
wdth  a coarse  towel),  local  external  galvan- 
ism and  massage,  sprays  of  ice-water,  or  of 
menthol,  gr.  v-x  to  the  ounce  of  benzoinol 
liqiiid  albolene,  liquid  vaseline,  cosmoline,  or 
paroline,  and  tonics  of  arsenic  and  iron 
(Part  11). 

(c)  Clonic  Rhythmical  Spasm  of  the  Adductors. 
— This  affection  is  said  to  occur  in  “ paraly- 
sis agitans,  after  meningitis,  in  syphilis  of 
the  brain,  in  pressure  on  the  medulla  from 
tumors  of  the  cerebellum,  and  in  disease  of 
the  medulla  in  the  neighborhood  of  the 
accessory  nucleus.”  (St.  Clair  Thomson.) 

(d)  Phonic  Spasm;  Dysphonia  Spastica;  Mogi= 
phonia.— This  is  an  adductor  spasm  occurring 
in  “ professional  voice-users  of  nervous  tem- 
perament ” on  attempted  phonation,  and  is 
analogous  to  writer’s  cramp. 

Treatment. — This  embraces  absolute 
rest  of  the  voice,  massage,  tonics,  and  the 
removal  of  nodules,  if  present  (see  Larjm- 
gitis.  Chronic  Catarrhal). 

(e)  Nervous  Laryngeal  Cough  or  Cry. — This 
includes  the  “ barking  cough  of  puberty.” 
It  is  a form  of  “tic  commlsif  ” (q.v.,  in 
Part  1). 

Treatment. — This  embraces  the  correc- 
tion of  all  possible  reflex  influences,  such  as 
adenoids,  diseased  tonsils,  aural  cerumen, 
etc.,  external  faradism,  tonics  (iron,  arsenic, 
codliver  oil;  see  Part  11),  and  good  hygiene 
(q.v.,  under  (b)). 

(f)  Choreic  Movements. — These  may  occur 
in  multiple  sclerosis  and  in  chorea. 

Neuroses  of  the  Pharynx. — Gr.  vevpov 
nerve;  <()apvy^  phanmx.  Neuroses  of  the 
pharynx  embrace  antesthesia;  hypertesthesia ; 
para?sthesia ; neuralgia;  pharyngeal  spasm, 
both  tonic  and  clonic;  and  paralysis,  func- 
tional or  organic,  of  the  soft  palate  or  the 
l)haryngeal  constrictors. 

(a)  Anesthesia.— Ansesthesia  of  the  phar^mx 
is  of  moment  in  itself  only  when  it  is  so 
marked  as  to  pennit  of  food  entering  the 
larynx.  It  is  caused  bj’’  hysteria,  diphtheria, 


(EDEMA  OF  THE  LARYNX 


bulbar  or  glosso-labio-laryngeal  paralysis, 
general  paresis,  and  pressure  on  the  glosso- 
pharyngeal nerve. 

(b)  Hyperaesthesia  and  Parsesthesia. — The 

causes  are  hysteria,  hypochondriasis, 

the  climacteric,  gout,  ansemia,  dyspep- 

sia, alcoholism. 

(c)  Tonic  Pharyngeal  Spasm. — The  cause  is 
usually  hysteria;  other  causes  are  bulbar 
tumors,  tabes,  hydrophobia,  tetanus,  acute 
local  inflammation. 

(d)  Clonic  Spasmodic  Contractions. — The 

causes  are  hysteria,  reflex  irritation,  and 
organic  brain  disease. 

(e)  Paralysis.— Paralysis,  practically  always 
of  the  soft  palate,  is  usually  due  to  diph- 
theria, rarely  to  influenza,  syphilitic  or 
malignant  basal  meningitis,  bulbar  or  glosso- 
labio-laryngeal  paralysis,  bulbar  hemorrhage 
or  embolism,  bulbar  tumors,  tabes,  syringo- 
myelia affecting  the  bulb,  hysteria,  cervical 
tumors  or  tuberculous  glands. 

It  is  manifested  by  a cleft-palate  voice, 
regurgitation  of  fluids  through  the  nose, 
inability  to  whistle,  suck,  blow  out  the 
cheeks,  or  say  “wrong,”  limp  pendancy  of  the 
soft  palate  downwards  and  forwards,  and 
immobility  of  the  same  on  saying  “ah”  and 
on  touching  it  with  a probe.  One  should 
remember  that  regurgitation  of  fluids  through 
the  nose  may  also  occur  in  injury  or  inflam- 
mation of  the  soft  palate,  in  quinsy,  oesoph- 
ageal stricture,  and  affections  of  the  pharynx, 
larjmx,  and  base  of  the  tongue  which  cause 
pain  on  swallowing. 

Treatment. — This  embraces  tonics  of 
strychnine  and  iron  (see  Part  11),  perhaps 
faradism,  and  goocl  hygiene  (adequate 
rest  and  exercise,  fresh  air  day  and  night, 
regular  horns  of  eating  and  sleeping,  nutri- 
tious food,  rest  before  and  after  meals, 
regulation  of  the  bowels,  and  a daily  morn- 
ing bath,  before  breakfast,  in  a warm  room, 
followed  by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel). 

Nodular  Laryngitis. — L.  nod'ulus,  little 
knot.  See  Laryngitis,  Chronic  Catarrhal. 

Nodules,  Singer’s  and  Teacher’s. — See 
LarjTigitis,  Chronic  Catarrhal. 

Non=DiphtheriaI,  Membranous,  Inflam= 
mation. — See  Tonsillitis  Acuta. 

Non=Membranous  Croup. — See  Laryn- 
gitis Acuta. 

Obstruction  of  the  Larynx. — Laryngeal 
obstruction  is  manifested  by  dyspnoea,  dur- 
ing which  the  patient  sits  up  and  throws  the 
head  backward  (in  tracheal  obstruction  he 
holds  the  head  slightly  forward  with  the 
chin  somewhat  depressed),  stridor,  and 
alteration  or  loss  of  the  voice. 


Etiology.— I.  Acute  Obstruction. — Acute 
catarrhal  laryngitis;  laryngismus  stridulus; 
membranous  laryngitis;  diphtheria;  oedema 
of  the  larynx;  foreign  boflies;  traumatic 
laryngitis,  due  to  irritating  gases,  .steam, 
corrosive  fluids  or  powders;  retropharyn- 
geal abscess. 

II.  Chronic  Obstruction  (of  gradual 
onset). — Syphilis;  tuberculosis;  perichondri- 
tis; injuries;  new  growths,  benign  and  malig- 
nant; leprosy;  scleroma;  adhesions  between 
the  cords;  recurrent  laryngeal  nerve  paraly- 
sis; too  high  tracheotomy;  chronic  subglottic 
laryngitis  or  ulceration  caused  by  wearing  an 
intubation  tube;  ankylo.sis  of  the  crico- 
arytenoid joint  (manifested  by  fixation  of 
the  vocal  cord  resembling  recurrent  nerve 
paralysis),  due  to  rheumatism,  gout,  syphilis, 
tuberculosis,  pachydermia,  traumatism, 
acute  local  inflammation,  and  long-standing 
recurrent  nerve  paralysis;  laryngeal  compli- 
cations of  typhoid  fever,  diphtheria,  or 
smallpox;  very  rare  congenital  webs;  very 
rare  congenital  laryngeal  stridor,  which 
tends  to  disappear  during  the  second  year. 

Treatment. — The  treatment  is  that  of 
the  cause  (q.v.  in  its  appropriate  alphabeti- 
cal place). 

Cicatricial  stenosis  is  treated  by  the 
prolonged  wearing  (for  two  to  six  years)  of 
a dilating  intubation  tube  or  a T-shaped 
tracheotomy  tube.  Scar  tissue  may  first 
have  to  be  divided.  Laiyngofissure  is 
sometimes  required,  and  often  tracheo- 
tomy iq-v.). 

Suspension  laryngoscopy  (with  the  Killian- 
Lynch  apparatus)  affords  ea.sy  appi’oach  to 
all  parts  of  the  larynx. 

(Obstruction  of  the  Trachea. — See  Part  1, 
General  Medicine  and  Surgeiy. 

(Edema  of  the  Glottis. — Gr.  6L5r]fxa  swel- 
ling; yXwTTts.  See  (Edema  of  the  Larynx, 
following. 

(Edema  of  the  Larynx. — Gr.  0L8r]iJ.a  swel- 
ling; \apvy^  larynx.  Laryngeal  oedema, 
which  practically  always  affects  the  aryteno- 
epiglottidian  folds  and  epiglottis,  and  not 
the  glottis  or  vocal  cords,  as  the  designation, 
“ oedema  glottidis,”  would  imply,  is  charac- 
terized by  marked  dyspnoea,  stridor,  and 
hoarseness,  and  marked  swelling  of  the 
epiglottis  and  laryngeal  structures  on  laryn- 
goscopic  or  digital  examination. 

Etiology.— (a)  Inflammatory  Causes. — 
Acute  catarrhal  laryngitis,  acute  infectious 
diseases;  syphilitic  laryngitis;  tuberculous 
laryngitis;  neighboring  inflammation — peri- 
tonsillar abscess,  lingual  quinsy,  retropharyn- 
geal abscess,  Ludwig’s  angina,  cancer  of  the 
oesophagus,  chondritis,  erysipelas. 


PERITONSILLAR  ABSCESS,  QUINSY 


(b)  Non-inflammatory  Causes. — Im- 
paction of  a foreign  l>ody;  traumatism; 
violent  use  of  the  voice;  irritating  inhalations 
(.steam,  ammonia,  bromine,  smoke,  etc.); 
irritating  ingesta  (scalding  or  corrosive 
fluids);  caustic  applications;  carcinoma  of 
the  larynx;  ^passive  laryngeal  congestion 
due  to  venous  compression  caused  by  a 
goitre,  mediastinal  growths  or  enlargetl 
bronchial  glands;  ch'opsy  due  to  cardiac, 
renal,  hepatic,  or  pulmonary  disease;  ne- 
phritis; diabetes;  myxoedema;  angioneurotic 
oedema;  hydrophobia;  potassium  iodide; 
antitoxin. 

Prognosis. — This  is  always  serious. 

Treatment.— Put  the  patient  to  bed  in  a 
warm  room,  with  the  air  surcharged  with 
steam  (compound  tincture  of  benzoin  may 
be  adtled  to  the  boiling  water).  Apply  ice- 
bags  to  the  neck  for  forty  minutes,  followed 
by  two  leeches  on  each  side  of  the  neck.  Open 
the  bowels  freely  by  means  of  calomel  and 
salines  (see  Part  11  for  all  Drugs),  and  employ 
free  diaphoresis  (by  means  of  blankets,  hot 
bricks  covered  with  wet  cloths  sprinkled 
with  alcohol,  hot  lemonade,  Dover’s  powder, 
or  pilocarpine,  gr.  hypodermically). 

Have  the  patient  suck  ice.  Spray  the  laiynx 
every  one,  two,  or  three  hours,  with  a solu- 
tion of  cocaine,  2 per  cent.,  in  adrenalin, 
1 : 2000.  Multiple  punctures  may  be  made 
into  the  oedematous  tissues  (previously 
cocamized  with  a 10  per  cent,  solution  of 
cocaine)  with  a laryngeal  lancet,  by  the  aid 
of  a larjmgeal  mirror  and  reflected  light, 
followed  perhaps  by  the  application  of  a 20  to 
30  per  cent,  aqueous  solution  of  ichthyol. 

In  angioneurotic  oedema  and  that  due  to 
potassium  iodide,  administer  sodium  bicar- 
bonate freely.  Ice  is  contraindicated  in 
angioneurotic  oedema. 

Tracheotomy  (q.v.)  is  sometimes  de- 
manded; intubation  is  useless. 

CEdema  of  the  Uvula.— See  Uvulitis 
Acuta  et  (Edema  Uvulae. 

(Esophageal  Carcinoma. — Gr.  oLaeiv  to 
carry  -|-  (payrjfxa  food ; KapKivos  crab  + 
-ojpa  tumor.  See  Part  1,  General 
Medicine  and  Surgery. 

Dilatation. — See  Part  1. 

Diverticula. — See  Part  1. 

Foreign  Bodies. — See  Foreign  Bodies 
in  the  (Esojihagus. 

Inflammation. — 1>.  inflnmmor'e,  to  set 
on  fire.  See  (Esophagitis  in  Part  1. 

Stricture. — See  Pai  t 1. 

(Esophagitis. — See  Part  1. 

Ogo  . — See  Rhinopharyngitis  Mutilans. 

Osteoma  Laryngis. — (ii\  bcTtov  bone  + 
-o}p.a  tumor.  See  Ikimors  of  the  Larynx. 


Pachydermia  Laryngis. — Gr.  Trayus  thick 
+ bkppa  skin.  See  Laryngitis,  Chronic 
Catarrhal. 

Palate,  Soft,  Paralysis  of  the.— L.  pala'tmn 
palate;  Gr.  Trapd  beside  + \veiv  to  loosen. 
See  Neuroses  of  the  Pharynx. 

Papilloma. — L.  papill'a,  nipple  Gr.-copa 
tumor.  See  Tumors  of  the  Larynx,  and  of 
the  Naso-pharynx  and  Pharynx. 

Paraesthesia  Laryngis. — Gr.  irapa  beside 
-f  aiadrjffLs  sensibility.  See  Neuroses 
of  the  Laiynx. 

Pharyngis. — See  Neuroses  of  the 

Pharynx. 

Pa.>*alysis,  Abductor. — Gr.  irapa  beside  -|- 
\vtiv  to  loosen ; L.  ad,  from  -f  due' ere, 
to  draw.  See  Aphonia. 

Adductor. — L.  ad,  to  + due' ere,  to  draw. 
See  Aphonia. 

Arytenoideus.— Gr.  apvTmva  jug  or 
pitcher  + eiSos  form.  See  Aphonia. 

Bulbar. — Consult  Part  1,  on  General 
MecUcine  and  Surgery. 

of  the  Constrictors  of  the  Pharynx. — L. 
con,  together  + sirin' gere,  to  draw. 
See  Neuroses  of  the  Pharynx. 

Cords. — Gr.  cord.  See  Aphonia. 

Glosso=Labio=Laryngeal. — Gr.  yXCiaaa 
tongue;  L.  lab' turn,  lip.  See  Bulbar 
Paralysis,  in  Part  I. 

Larynx. — See  Aphonia. 

Palate. — L.  pala'tum.  See  Neuroses  of 
the  Pharynx. 

Pharyngeal  Constrictors. — L.  con,  to- 
gether -f  strin'gere,  to  draw.  See 
Neuroses  of  the  Pharynx. 

Recurrent  Laryngeal  Nerve. — L.  recur' - 
rens,  returning.  See  Aphonia. 

Soft  Palate. — L.  pala'tum.  See  Neuro- 
ses of  the  Pharynx. 

Superior  Laryngeal  Nerve.— See 

Aphonia. 

Thyroarytenoidei  Muscles. — Gr.  depths 
shield;  apvraiva  jug;  eihos  form.  See 
Aphonia. 

Vocal  Cords. — L.  voca'lis,  from  vox, 
voice;  choi-'da,  cord.  See  Aphonia. 

Parenchymatous  Tonsillitis. — Gr.  irapiy- 
xma  essential  or  functional  portion  of  an 
organ  as  chstinguished  from  its  stroma.  See 
Tonsillitis  Acuta. 

Perichondritis  Laryngis. — See  Cdiomhitis 
and  Perichondritis  of  the  Larynx. 

Peritonsillar  Abscess,  Quinsy. — Gr.  irepi 
around;  L.  tonsil'la,  tonsil;  absces'su.s,  a going 
apart;  Fr.  ajnan'che,  sore  throat.  Quinsy  is 
characterized  by  local  pain  and  swelling  or 
bulging,  coated  tongue,  offensive  breath, 
lock-jaw,  dysphagia,  fever,  chills,  malaise 
and  anorexia.  It  is  usually  unilateral,  and 


PHARYNGITIS  ACUTA 


often  passes  from  one  side  to  the  other.  It 
may  follow  acute  tonsillitis,  or  it  may  occur 
as  a primary  affection.  Recurrent  quinsy 
is  usually  the  result  of  a chronic  lacunar 
tonsillitis.  The  duration  of  an  attack  is 
from  five  to  ten  days,  unless  relieved  by 
operative  interference. 

Treatment.— Open  the  bowels  thoroughly 
with  powdered  calomel  followed  by  a saline 
(see  Part  11);  and  for  pain  prescribe  the 
remedies  given  under  Tonsillitis  Acuta. 
Salol  is  particularly  recommended. 

Apply  heat  externally,  and  syringe  or 
irrigate  the  throat  frequently,  at  least  every 
hour,  with  tepid  normal  saline  or  an  alkaline 
solution,  e.g.,  sodium  chloride,  biborate,  or 
bicarbonate,  one  teaspoonful  to  the  pint. 
When  irrigating  the  throat,  keep  the  mouth 
wide  open,  breathe  through  the  mouth,  and 
refrain  from  swallowing,  in  order  to  avoid 
the  entrance  of  fluid  into  the  eustachian  tube. 
A fountain  syringe  is  best  for  the  purpose. 

As  soon  as  bulging  or  fluctuation  about  the 
faucial  pillar  is  evident  (this  is  sometimes 
best  determined  by  palpation),  or  earlier  if 
the  symptoms  are  intense,  incise  the  abscess 
where  it  points  with  a straight,  narrow- 
bladed  tenotome;  or,  in  the  absence  of 
pointing,  pull  the  tonsil  medianward  and 
forward  by  means  of  forceps,  separate  the 
tonsil  from  the  anterior  pillar,  as  in  the  oper- 
ation of  tonsillectomy,  and  thus  reach  the 
abscess  cavity;  or  make  the  incision  through 
the  anterior  pillar. 

After  the  pus  has  been  evacuated,  con- 
tinue the  warm  irrigations. 

Pharyngeal  Anaesthesia. — Gr.  (f>apvy^;  av 
not  + aiadriais  sensation.  See  Neu- 
roses of  the  Pharynx. 

Diverticulum. — L.  diverticuV are,  to  turn 
aside.  See  (Esophageal  Diverticula, 
in  Part  1. 

Foreign  Bodies. — See  Foreign  Bodies  in 
the  Air  Passages. 

Fungus  Disease. — L.  fun'gus.  See 
Pharyngomycosis. 

Herpes. — See  Herpes  of  the  Throat. 

Hyperaesthesia. — Gr.  virkp  over  + 
aicrdrjaLs  sensibility.  See  Neuroses  of 
the  Pharynx. 

Hyperkeratosis. — See  Keratosis  Phar- 
yngis. 

Inflammation. — L.  inflamma're,  to  set 
on  fire.  See  Pharyngitis. 

Keratosis. — See  Keratosis  Pharyngis. 

Lupus. — See  Lupus  of  the  Nose  and 
Throat. 

Mycosis. — See  Pharyngomycosis. 

Neuralgia. — Gr.  vevpov  nerve  -f  (1X705 
pain.  See  Neuroses  of  the  Pharynx. 

49 


Pharyngeal  Neuroses. — See  Neuroses  of 
the  Pharynx. 

Paraesthesia. — Gr.  Trapa  beside  + alad- 
■qais  sensibility.  See  Neiu’o.ses  of  the 
Pharynx. 

Paralysis. — Gr.  Trapa  beside  + \vtLv  to 
loosen.  See  Neuroses  of  the  Pharynx. 

Spasm. — Gr.  oTrao-pos.  See  Neuroses  of 
the  Phaiynx. 

Tumors. — (See  Tumors  of  the  Pharynx, 

Pharyngeal  Ulcers. — L.  ul'cus,  ulcer. 

Etiology. — Chroniccatarrh  (follicularulcers) ; 
syphilis;  tuberculosis  or  lupus;  carcinoma; 
diphtheria  and  other  pseudo-membranous 
inflammations;  typhoid  and  other  fevers. 

Pharyngitis  Acuta. — Gr.  cfyapvy^  pharynx 
+ -1T6S  inflammation;  L.  acu'tus,  sharp.  An 
acute  inflammatory  affection  of  the  pharyn- 
geal mucosa,  of  from  several  days  to  one  or 
two  weeks  duration,  characterized  by  sore 
throat,  fever,  headache,  malaise,  anorexia, 
and  constipation.  The  initial  stage  of  the 
disease  is  marked  by  congestion  and  dryness, 
which  is  later  followed  by  increased  secretion. 

Etiology.— Exposure  to  cold  and  wet;  sud- 
den thermic  changes;  bad  hygiene;  sedentary 
occupation;  intemperance  in  eating  and  in 
the  use  of  alcohol  and  tobacco;  acute  indi- 
gestion; lithiasis;  certain  ingesta,  which  are 
eliminated  through  the  mucous  membrane, 
e.g.,  onions,  garlic,  phosphorus,  mercury, 
antimony,  arsenic,  iodine,  bromine;  local 
traumatism  produced  by  hot  fluids,  hot 
spices,  raw  spirits,  corrosives,  ffritating 
vapors,  foreign  bodies,  or  operations;  mouth 
breathing;  adjacent  infection,  e.g.,  tonsillitis, 
adenoiditis,  rhinitis,  sinusitis,  quinsy,  laryn- 
gitis, pyorrhcea  alveolaris;  acute  infectious 
diseases,  e.g.,  catarrhal  fever,  influenza, 
scarlet  fever,  measles,  German  measles, 
small-pox,  diphtheria,  typhoid  fever,  typhus 
fever,  erysipelas,  syphilis;  milk  from  cows 
affected  with  strejjtococcus  mastitis. 

The  bacteria  usually  found  are  staphylo- 
cocci, streptococci,  pneumococci,  and  bacil- 
lus influenzae. 

Treatment. — Open  the  bowels  with  pow- 
dered calomel,  followed  by  a saline  (see  Part 
11  for  all  ch'ug  formulae,  etc.),  and  have  the 
patient  drink  freely  of  Vichy  water  or  hot 
water  containing  sodium  chloride  and  bicarb- 
onate, aa  gr.  v-xv  to  the  tumblerful.  The 
diet  in  the  acute  stage  should  be  liquid  or 
soft:  milk,  eggs,  cereals,  milk  toast,  cool 
lemonade  (no  beef  extracts  or  beef  tea, — 
Knapp.)  The  salicylates  are  considered 
“almost  specific” : sodium  salicylate,  or  salol 
or  aspirin,  or  salophen,  gr.  x every  two  hours 
until  relieved.  Add  phenacetin  or  antipy- 
rine  for  the  relief  of  headache. 


PHARYNGITIS  CATARRHALIS  CHRONICA 


An  old  and  useful  remedy  is  the  tincture 
of  iron: 

Tincturse  ferri  chloridi.  3iss  (TTjjvii-xv  per  dose) 

Glycerini 3iv 

Syrupi  aurantii,  q.s.  ad.  §ii 

M.  Sig. — One  or  two  teaspoonfuls,  well  diluted, 
every  three  or  four  hours,  best  taken  through  a glass 
tube,  followed  by  rinsing  and  brushing  of  the  teeth. 

Cold  or  heat  may  be  employed  externally. 
A wet  towel  around  the  neck,  covered  with  a 
dry  towel  and  left  on  overnight,  may  prove 
beneficial.  Massage  of  the  neck  by  stroking 
the  jugulars  toward  the  heart  is  of  service. 

The  application  of  strong  silver  nitrate 
solution  on  a cotton-wound,  corrugated 
applicator,  or  on  cotton  pledgets  held  with 
haemostatic  forceps,  from  which  the  excess 
of  fluid  has  been  expressed,  may  prove 
abortive  if  employed  early. 

In  the  early,  dry  stage,  the  patient  may 
dissolve  slowly  in  the  mouth,  every  hour,  for 
three  or  four  doses,  an  effervescent  pilocar- 
pine lozenge,  gr.  Koo-  Potassium  chlorate 
lozenges  or  troches  {q-v.)  are  also  recom- 
mended in  this  stage.  For  the  rawness  and 
irritation  are  recommended  inhalations  of 
steam  medicated  with  comp.  tr.  benzoin,  one 
tablespoonful  to  the  pint  of  boiling  water; 
al.^o  lozenges  of  camphor  and  menthol,  of 
krameria,  of  catechu,  and  of  red  gum. 
Guaiacum  lozenges  are  recommended  for  the 
gouty.  Cracked  ice  may  be  sucked. 


R Resin®  guaiaci gr.  iss 

Acidi  tannici gr.  M 


M.  Sig. — One  lozenge  slowly  dissolved  on  the 
tongue  every  one  or  two  hours. 

The  throat  should  be  cleansed  frequently 
by  syringing,  gargling,  or  spraying  with 
warm  normal  saline  or  an  alkaline  antiseptic 
solution,  e.g.,  sodium  chloride,  biborate,  or 
bicarbonate,  one  teaspoonful  to  the  pint;  or 
with  potassium  chlorate,  1 to  3 per  cent. ; or 
almn,  3 to  5 per  cent. ; or  one  of  the  following: 


R Sodii  biboratis gr.  xxiv 

Glycerini i5!xxiv 

Tincturse  myrrhse rjxxiv 

Aquse  destillatse,  q.s.  ad gi 

M.  Sig. — Use  every  hour  as  a gargle.  (Parker.) 

R Sodii  bicarbonatis, 

Sodii  biboratis,  aa gr.  xv 

Acidi  carbolici ti^v 

Glycerini t^xIv 

Aqu®,  q.s.  ad gi 


M.  Sig. — Use  frequently  as  a spray  or  gargle. 

R Potassium  chloratis,  vel  sodii 
chloridi,vel  ammonii  chloridi. 


Sodii  biboratis, 

Sodii  bicarbonatis,  aa gss 

Sacchari  albi gi 


M.  Sig. — One  level  teaspoonful,  dissolved  in  half 
a glass  of  water  and  used  as  a gargle. 


R Tinctur®  krameri® i^x 

Tinctur®  myrrh® i^x 

Tinctur®  lavandul®  composit®  ajv 

Glyceriti  boroglycerini gi 

Aquam,  ad gi 


M.  Sig. — Use  frequently  as  a mouth-wash 
and  gargle. 

R Extract!  hamamelidis  aquosi, 

Aqu®  cinnamomi, 

Aqu®  menth®  piperit®,  aa. 

M.  Sig. — Throat  gargle  to  be  used  every  hour  for 
dryness  of  the  throat.  (Kyle.) 


R Glyceriti  acidi  tannici gii 

Sig.^ — One  teaspoonful  to  a glass  of  warm  water  as 
a gargle.  (Knapp.) 

R Camphor® gr.  ii 

Mentholis gr.  ii 

Olei  santali gtt.  iv 

Olei  eucalypti gtt.  ii 

Alboleni  liquidi gi 


M.  Sig. — Throat  spray.  (Kyle.) 

For  excessive  secretion  in  the  second  or 
exudate  stage,  is  recommended  atropine  or 
aconitine,  gr.  34oo  to  3^oo  every  three  or 
four  hours,  to  the  point  of  a beginning 
physiological  effect  (see  Part  11). 

An  cedematous  uvula  may  be  freely  punc- 
tured and  sprayed  with  adrenalin,  1 : 2000; 
ice  too  may  be  sucked. 

Ulcerated  areas  may  be  touched  with 
silver  nitrate,  gr.  xxx  ad  5 i,  or  zinc  chloride, 
gr.  XV  ad  5 i- 

Pharyngitis  Atrophica.  — See  Atrophic 
Naso-pharjmgitis  and  Pharyngitis. 

Pharyngitis  Catarrhalis  Chronica. — Gr. 
4>apvy^  -j-  -tris  inflammation;  Karappeiv  to 
flow  down;  xpovos  time.  A chronic,  usually 
obstinate,  inflammatory  affection  of  the 
pharyngeal  mucosa,  characterized  clinically 
by  local  sensitiveness  and  discomfort,  fre- 
quent desire  to  clear  the  throat,  cough,  and 
weak  voice;  and  anatomically  by  congestion, 
swelling,  and  a duskj'-red,  velvety  appear- 
ance (simple  chronic  or  catarrhal  pharjm- 
gitis),  with  perhaps  the  presence  of  small, 
reddish  or  yellowish  elevations,  consisting  of 
lymphatic  tissue  (granular  or  follicular 
pharyngitis),  or  enlarged,  dull-red  folds 
behind  the  posterior  faucial  pillars  (pharyn- 
gitis hypertrophica  lateralis). 

Etiology.  — Recurrent  or  long-continued 
acute  attacks;  overuse  and  improper  use  of 
the  voice  (clergjTnan’s  sore  throat);  dyspep- 
sia; lithiasis;  alcoholism;  anaemia;  constipa- 
tion; diabetes;  narcotic  addiction;  sexual 
excesses  ; tuberculosis  ; sy^Dhilis  ; cyanotic 
congestion  secondary  to  cardiac,  renal, 
hepatic,  or  pulmonary  disease;  tobacco; 
irritating  vapors  and  dust;  mouth-breathing; 
adjacent  inflammation  and  growths:  ade- 

noids, diseased  and  enlarged  tonsils,  rhino- 


PHARYNGOMYCOSIS 


pharyngitis,  rhinitis,  laryngitis,  dental  caries, 
pyorrhoea  alveolaris;  “slanting  pharynx”; 
infectious  diseases  (influenza,  scarlet  fever, 
measles,  diphtheria). 

Prognosis.— This  depends  upon  one’s  success 
in  removing  the  cause. 

Treatment  — First  search  carefully  for  any 
and  all  possible  etiological  influences,  and 
eradicate  them  as  far  as  possible.  Granular 
effervescent  phosphate  or  sulphate  of  sodium 
5i-iv,  or  granular  effervescent  citrate  of 
lithium,  gr.  v,  with  j)lenty  of  water,  in  the 
morning  one  hour  before  breakfast  or  before 
each  meal,  is  often  useful.  St.  Clair  Thom- 
son says:  “ The  various  alkaline  mixtures 

with  vegetable  bitters  are  frequently  of 
more  benefit  than  any  topical  treatment 
and  he  recommends,  where  there  is  dyspepsia 
the  following: 


Pulveris  rhei gr-  v 

Ammonii  carbonatis gr.  v 

Inf usi  quassia; 5ss 


Aquae  nientha;  piperitae,  q.s.  ad  5i 

M.  Sig.— T)ne  ounce  (two  tablespoonfuls)  before 
meals.  (Thomson.) 

Adequate  rest  and  recreation,  warm  cloth- 
ing, dry  stockings  and  good  shoes,  rubbers  in 
wet  weather,  fresh  air  day  and  night,  proper 
house  ventilation,  regular  hours  of  eating 
and  sleeping,  rest  before  and  after  meals,  a 
daily  morning  warm  bath  before  breakfast, 
in  a warm  room,  followed  by  a moderately 
cold  spinal  douche  and  brisk  rubdown  with 
a coarse  towel,  the  avoidance  of  overheated 
rooms,  dust,  dietetic  errors,  alcohol,  and 
tobacco,  and  tonics,  particularly  arsenic  (see 
Part  11),  are  important. 

For  voice  strain,  absolute  rest  of  the  voice 
should  be  enjoined;  and  later  the  patient 
should  be  instructed  in  proper  methods  of 
respiration  and  elocution.  All  unnecessary 
hawking  should  be  forbidden. 

The  throat  should  be  cleansed  frequently 
by  irrigating,  syringing,  or  spraying,  with 
quite  hot  normal  saline  or  an  alkaline  solu- 
tion, e.g.,  sodium  chloride,  bicarbonate,  or 
biborate,  5i  ad  Oi;  or  sodium  bicarbonate  or 
biborate,  gr.  xv  ad  5 i;  or  sodium  bicarbonate 
sodium  biborate,  sodium  chloride,  and  sac- 
chari  albi,  aa  gr.  v-x  ad  5 i-  If  much  irrita- 
tion remains,  a gargle  of  camphorated  tinc- 
ture of  opium,  one  teaspoonful  to  the  ounce 
of  water,  or  a menthol  lozenge,  may  be 
employed.  For  cough  and  irritation  are  pre- 
scribed codeine,  gr.  }{2  fo  three  or  four 
times  daily,  or  sodium  bromide,  gr.  x-xv,  well 
diluted,  after  meals  and  at  bedtime  (Part  11). 

Once  or  twice  a week  the  pharynx  may  be 
mopped  or  painted  with  silver  nitrate,  gr. 
x-xxx  ad  5i;  sulphate  or  chloride  of  zinc, 
gr.  ii-v-xv  ad  5 i ; copper  sulphate,  gr.  x-xx 


ad  5i;  tannic  acid,  gr.  xl  ad  glycerine,  5i;  or 
iodine,  gr.  v,  potassium  iodide,  gr.  xv,  glycer- 
ine, §i.  Throat  paints  should  not  be 
“ rubbed  in.” 

In  granular  or  follicular  pharyngitis,  touch 
each  follicle  with  chromic  acid  fused  on  the 
end  of  a probe  (warm  the  probe,  dip  it  in 
the  chromic  acitl  crystals,  then  warm  the 
part  of  the  probe  next  beyond  the  crystals 
until  the  latter  melt),  or  with  a 20  per  cent, 
chromic  acid  solution  on  a finely  pointed, 
cotton-wound  applicator,  the  excess  of  caus- 
tic being  first  removed,  and  the  surface  of 
the  pharynx  mopped  dry;  or  the  entire 
surface  may  be  mopped  every  other  day 
with  the  following: 

I^  Olei  pini  sylvestris. 


Olei  eucalypti,  aa gtt.  v 

Mentholis gr.  iv 

Tincturse  benzoini §i  (Kyle.) 


In  pronounced  cases  the  galvanocautery 
may  be  used  (under  cocaine  anaesthesia, 
10  per  cent.).  The  needle  should  be  fine- 
pointed,  and  inserted  at  a white  heat,  not 
too  deeply.  Four  or  five  follicles  may  be 
destroyed  at  a sitting  at  intervals  of  five 
or  six  days.  The  patient  should  continue 
the  daily  use  of  alkaline  cleansing  solutions. 
The  follicles  may  be  curetted  at  a single 
sitting  with  an  E.  Mayer  curette.  (Gleason.) 

If  the  uvula  is  elongated,  it  may  be 
amputated  (see  Elongation  of  the  Uvula). 

Pharyngitis,  Dry. — See  Atrophic  Naso- 
pharjmgitis  and  Pharyngitis. 

Follicular.— L./oWtc'itZus,  little  bag.  See 
Pharyngitis  Catarrhalis  Chronica. 

Granular. — L.  gran'ulum,  grain.  See 
Pharyngitis  C’atarrhalis  Chronica. 

Hypertrophica  Lateralis. — Gr.  vwep  over 
-}-  rpo4>r]  nutrition;  L.  la'tus,  side. 
See  Pharyngitis  C’atarrhalis  Chronica. 

Sicca. — L.  sic'cus,  dry.  See  Atrophic 
Naso-pharyngitis  and  Pharyngitis. 

Pharyngomycosis.— Gr.  <t>apvy^  pharynx 
d-  pvKTjs  fungus.  An  affection  of  the  throat 
caused  by  the  LeptothrLx  fungus  and  char- 
acterized by  the  presence  of  white  masses 
upon  an  inflamed  surface.  Examine  the 
white  material  under  the  microscope. 

Treatment.— Remove  the  growth  with  the 
curette  or  forceps,  and  apply  tincture  of 
iodine  or  silver  nitrate  (3i  ad  5i),  twice 
daily.  Keep  the  mouth  cleansed  with  hot 
boric  acid  solution,  3 i~iv  ad  Oi.  Attend  to 
the  teeth  and  to  any  existing  gastro- 
intestinal derangement,  and  interdict  sweets. 

If  these  measures  prove  ineffectual,  em- 
ploy the  galvanocautery.  Lise  a very  small 
platinum  wire  at  a white  heat,  and  touch 
only  a few  patches  at  each  sitting. 


SPASMODIC  LARYNGITIS 


Pharynx,  Affections  of  the. — See  Pharyn- 
geal Affections. 

Phonasthenia. — Gr.  4>oivrt  voice  -f-  a priv. 
+ adtvos  strength.  See  under  Speech  De- 
fects. 

Phonic  Spasm. — Gr.  4>avri  voice;  a-n-aufids 
spasm.  See  Neuroses  of  the  Larynx. 

Polypus. — Gr.  woXhs  many  -f-  ttoDs  foot. 
See  Tumors  of  the  Naso-pharynx  and 
Pharynx. 

Post=nasal  Catarrh,  Acute. — L.  post,  be- 
hind; nas'us,  nose;  Gr.  Karappeiv  to 
flow  down.  See  Naso-pharyngitis 
Acuta. 

Chronic. — See  Naso-]Dharyngitis 
Chronica. 

Inflammation. — L.  inflamnia're,  to  set 
on  fire.  See  Naso-pharyngitis. 

Preglottic  Tonsillitis. — L.  prce,  before  -j- 
Gr.  jXcottLs  glottis.  See  lingual  Tonsillitis, 
Acute. 

Pseudolalia. — Gr.  \{/ev8^s  false  -f  XaXeZv  to 
babble.  See  Speech  Defects. 

Quinsy,  Faucial. — Fr.  cynan'che,  sore 
throat;  L.  fau'ces.  See  Peritonsillar 
Abscess. 

Lingual. — L.  ling'ua,  tongue.  See  Lin- 
gual Tonsillitis,  Acute. 

Recurrent  Laryngeal  Nerve  Paralysis. — 
L.  reair'rens,  returning.  See  Aphonia. 

Retropharyngeal  Abscess. — L.  rei'ro,  back 
-|-  Gr.  (papvy^;  L.  absces'sus,  a going  apart. 

Synonym.— Suppurative  retropharyngeal 

adenitis. 

Acute  retropharyngeal  abscess  occius 
nearly  always  in  feeble  infants  as  a compli- 
cation of  nasal,  buccal,  pharymgeal,  or 
middle  ear  inflammation,  or  of  the  acute 
infectious  diseases.  Chronic  abscess  occurs 
practically  always  as  a result  of  cervical 
Pott’s  disease. 

The  manifestations  are  as  follows,  viz.: 
retraction  of  the  head,  cough,  noisy  tlysp- 
ncea,  altered  voice,  chfliculty  in  swallowing, 
and  the  presence  of  a rounded  swelling,  best 
revealed  by  digital  examination. 

The  comlition  is  serious. 

Treatment. — In  acute  cases,  make  hot  appli- 
cations until  fluctuation  is  detected,  then 
incise  the  abscess  vertically  with  the  child 
inverted  (without  anaesthesia),  and  with  the 
finger  as  a dull  curette,  explore  and  enlarge 
the  abscess  cavity.  Holt  opens  the  abscess 
with  the  finger  nail  sharpened  k)  a point. 

If  the  abscess  jx)ints  towards  the  neck, 
make  the  incision  along  the  posterior  border 
of  the  upper  third  of  the  sterno-cleido- 
mastoid  muscle,  and  carry  the  dissection 
behiiul  the  large  vessels  of  the  neck  and  in 
front  of  the  prevertebnil  muscles. 


An  iron  tonic  (see  Part  11)  may  then  be 
given.  Recovery  is  usually  rapid. 

A tuberculous  abscess  is  preferably  opened 
externally  because  of  the  resulting  sinus 
which  may  persist  for  many  months. 

Retropharyngeal  Adenitis,  Suppurative. — 
Gr.  adfiv  gland  -h  -ltis  inflammation;  L.  stib, 
under  -f-  pus,  pur'is,  pus.  See  Retropharyn- 
geal Abscess. 

Rhinopharyngitis  Mutilans;  Qangosa; 

Ogo. — Gr.  pts  nose;  </)api/y^  pharynx  -|-  -ltls 
inflammation;  L.  mut'ilans,  mutilating;  8p. 
gangosa,  muffled  voice.  A tropical,  ulcera- 
tive, destructive  affection  of  the  rhino- 
phaiymx  or  soft  palate,  extending  to  adjacent 
parts,  and  resistant  to  treatment. 

Treatment. — Cauterize  the  ulcers  with  the 
silver  nitrate  stick,  chromic  acid  solution, 
20  per  cent.,  or  the  actual  cautery,  the  parts 
being  first  mopped  dry  and  anaesthetized 
with  cocaine,  10  per  cent.  Prescribe  a 
cleansing,  alkaline,  antiseptic  spray  or 
douche,  e.g.,  sodium  bicarbonate  or  biborate, 
3i-iv  ad  Oi.  Applications  of  tincture  of 
iodine  are  well  recommended. 

Prescribe  an  abundance  of  good  food, 
outdoor  exercise,  and  tonics.  Potassium 
iodide  (see  Part  11)  may  be  tried. 

Rhinopharynx. — See  Naso-phaiyngeal 

Affections. 

Rhythmical  Clonic  Spasm  of  the  Adduc= 

tors. — Gr.  pvdpbs]  kXopos  turmoil;  crTracrpos; 
L.  addu'cere,  to  draw  toward.  See  Neuroses 
of  the  Larynx. 

Scarlet  Fever. — Consult  Part  1,  on  Gen- 
eral Medicine  and  Surgerj'. 

Singer’s  Nodules.— L.  nod'ulus,  little  knot. 
See  Laryngitis,  Chronic  Catarrhal. 

Soft  Palate  Paralysis. — L.  pala'ium;  Gr. 
wapa  beside  Xv€lv  to  loosen.  See  Neuroses 
of  the  Pharynx. 

Spasm,  Clonic,  of  the  Adductors. — Gr. 

anaapos',  kXovos  turmoil.  See  Neu- 
roses of  the  Laiynx. 

Glottic. — Gr.  yXwTTis.  See  Laiyngis- 
mus  Stridulus. 

Laryngeal. — See  Larjmgismus  Stri- 
dulus. 

Pharyngeal. — See  Neuroses  of  the 

Pharynx. 

Phonic. — Gr.  (j>uvr]  voice.  See  Neiuoses 
of  the  Larynx. 

Rhythmical  Clonic,  of  the  Adductors. — 

Gr.  pvdpos',  kXopos  turmoil;  L.  ad.  to  -F 
due'ere,  to  draw.  See  Neuroses  of  the 
Larynx. 

Spasmodic  Croup. — See  Larjmgitis  Acuta, 
and  Laryngismus  Stridulus. 

Laryngitis. — See  Larymgitis  Acuta,  and 
Lar>mgismus  Stridulus. 


SUBMUCOUS  LARYNGEAL  HEMORRHAGE 


Speech  Defects. — A.  stammering  and  Stut- 
tering.—CAUSES. — Heredity,  the  male  sex, 
nervous  temperament,  eye-strain,  glandular 
enlargements  in  the  pharynx,  adenoids,  en- 
larged tonsils,  intranasal  intumescence, 
hypertropliies,  polypi  and  septal  deformities, 
and  thymic  enlargement  (Browning)  are 
cited  as  predisposing  causes,  and  nervous 
shock  as  an  exciting  cause. 

Treatment.— This  embraces  perfect  hygiene 
(see  below),  the  correction  of  all  possible 
etiological  factors,  and  instruction  in  proper 
diaphragmatic  breathing  and  the  voluntary 
control  of  the  speech  muscles,  the  patient 
being  trained  to  speak  in  a state  of  relaxa- 
tion, calmly,  slowly,  and  in  syllables,  and  to 
lengthen  and  strengthen  the  principal  vowels. 
Browning  reix»rts  success  in  the  treatment  of 
stammering  by  the  application  of  the 
X-rays  over  the  thymus.  From  two  to  four 
treatments  are  given  at  intervals  of  from 
five  to  fifteen  days,  after  which  there 
should  be  a pause  of  several  weeks  (see 
Rontgenology  in  Part  1). 

B.  Phonasthenia  or  Weak  Voice. — (Gr.  (pufr] 
voice  + a priv.  + cd'evos  strength.). — Voice 
fatigue  is  characterized  by  a weak,  unsteady 
voice,  which  tends  to  break  and  to  slide  off 
the  pitch  into  a lower  key,  also  huskiness, 
tendency  to  clear  the  throat  constantly, 
pain  in  the  sides  of  the  neck,  and  pain 
on  swallowing. 

Causes. — Faulty  voice  placement  (too 
high  pitching),  submucous  laryngeal  hem- 
orrhage {q.v.),  antemia,  debilitating  diseases, 
convalescence  from  typhoid  and  in- 
fluenza, pregnancy,  menstruation,  chronic 
tonsillitis,  chi*onic  hypersecretion,  nasal 
affections. 

Treatment. — Rest  of  the  voice  is  of  first 
importance.  Any  possible  causal  influence 
should  be  corrected,  and  perfect  hygiene 
observed,  e.g.,  adequate  rest,  exercise,  and 
recreation,  fresh  air  day  and  night,  a daily 
morning  tepid  bath  in  a comfortable  room, 
before  breakfast,  followed  by  a (^old  spinal 
douche  and  brisk  rubdown  with  a coarse 
towel,  massage,  if  practicable,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
meals,  plain,  wholesome  food,  regulation  of 
the  bowels,  and  if  indicated,  tonics,  iron, 
arsenic,  strychnine  (see  Part  11). 

Warm  apphcations  for  pains,  and  a men- 
thol spray  (gr.  v-xxx  ad  liquid  albolene, 
5i),  for  its  cooling,  analgesic  effect,  may 
be  prescribed. 

After  the  physical  and  nervous  stamina 
has  been  restored,  the  patient  should  be 
instructed  in  the  proper  use  of  the  voice. 
“The  speech  must  be  slow,  fairly  light,  with 


good  lip  and  tongue  action.”  “ The  voice 
should  be  directed  forward  against  the  upper 
teeth  and  hard  palate,  and  increased  and 
chminished  in  a monotone.”  “ Certain 
syllabic  exercises  such  as  the  no,  na,  nu,  ni, 
na,  and  co,  ro,  mo,  varieties  sung  with 
moderate  strength  in  middle  voice  are 
helpful.”  “ During  these  exercises  special 
attention  must  be  paid  to  the  breathing” 
(after  Voorhees). 

C.  Pseudolalia. — (Gr.  \j/evbi]s  false  + \a\eiv 
to  babble). — Pseudolalia  means  the  “ decapi- 
tation, decaudation,  and  mutilation  of 
syllables.”  It  is  treated  the  same  as  stam- 
mering. Any  possible  mechanical  cause 
should  be  removed  and  syllabication 
taught. 

Stammering. — See  Speech  Defects. 

Stenosis  of  the  Larynx. — ^Gr.  aremcns  nar- 
rowing. See  Obstruction  of  the  Larynx. 

Stenosis  of  the  Trachea. — See  Part  1. 

Stricture  of  the  (Esophagus. — See  Part  1, 
General  Medicine  and  Surgery. 

Stridor. — See  Part  1. 

Stuttering. — See  Speech  Defects. 

Submaxillary  Cellulitis. — ^L.  svh,  under  -|- 
maxil'la,  jaw;  cel'lula,  minute  cell  -j-  Gr.  -irts 
inflammation.  See  Ludwig’s  Angina,  in 
Part  1. 

Submucous  Laryngeal  Hemorrhage. — L. 

sub,  under  + mu'cus,  mu'cus;  Gr.  \apvy^; 
aipa  blood  + pr)yvhvaL  to  burst  forth.  An 
extravasation  of  blood  beneath  the  mucous 
membrane  of  the  vocal  cords,  due  usually  to 
a sudden  vocal  strain,  as  in  screaming, 
singing,  talking,  coughing,  or  sneezing,  or 
due  to  heavy  lifting,  during  which  the  glottis 
is  closed.  Other  rarer  causes  are  acute 
inflammation,  tuberculosis,  syphilis,  benign 
and  malignant  neoplasms,  and  the  following 
constitutional  affections:  cardiac  dilatation, 
hepatic  cirrhosis,  nephritis,  anaemia,  mal- 
nutrition, phthisis,  diabetes,  haemophilia, 
leukaemia,  variola,  typhoid  fever,  yellow 
fever,  vicarious  menstruation,  and  pregnancy . 

The  manifestations  are  sudden  hoarseness, 
pain,  and  vocal  fatigue,  and  the  appearance 
of  red  patches  of  hemorrhage  on  the  cords, 
which  are  not  dislodged  by  coughing 
or  manipulation. 

Treatment. — Excepting  absolute  rest  of  the 
voice,  no  treatment  may  be  required,  and 
spontaneous  recovery  usually  occurs  within 
several  weeks. 

If  desired,  however,  one  may  prescribe 
astringent  sprays,  with  the  object  of  pro- 
moting absorption,  viz.,  alumnol  solution, 
3 to  10  per  cent.;  or  aluminis,  gr.  vi,  acidi 
tannici,  gr.  iii,  aquae  destillatae,  ad.  5i; 
or  zinc  chloride,  3 to  5 per  cent.  For 


TONSILLECTOMY 


cough,  prescribe  codeine,  gr.  every  hour 
until  effectual. 

Superficial  Tonsillitis.  — L.  See  Tonsil- 
litis Acuta. 

Superior  Laryngeal  Nerve  Paralysis. — ■ 

See  Aphonia. 

Swallowing,  Difficult  or  Painful.  — See 

Dysphagia  in  Part  1. 

Syphilis.  — Consult  Part  1,  on  General 
Medicine  and  Surgery. 

Teacher’s  Nodules. — L.  no'dulus,  little 
knot.  See  Lar3mgitis  Chronic  Catarrhal. 

Technique. — In  making  a laryngoscopic 
examination  with  the  mirror,  the  tongue  is 
covered  with  a cloth  and  tlrawn  out  ami 
held  by  the  patient.  The  surface  of  the 
mirror  is  first  heated  and  the  temperature  of 


its  metallic  back  tested  on  the  hand  before 
in.sertion  in  the  throat. 

Medicated  solutions  may  be  applied  to 
the  larynx  in  the  form  of  a spray,  or  with 
the  laryngeal  brush,  or  on  cotton,  with 
Sajous’s  forceps,  the  excess  of  fluid  always 
being  squeezetl  from  the  cotton  before  the 
application  is  made.  For  supracordal  appli- 
cations, the  tongue  should  be  held  out  and 
the  patient  told  to  sound  a ; for  subcordal 
applications,  the  tongue  is  held  out  and  the 
application  made  during  a deep  inspiration. 
Should  spasm  of  the  laryngeal  muscles  be 
excited  by  the  application,  “ instruct  the 
patient  to  take  a number  of  deep  breaths  in 
rapid  succession.”  (Ballenger.) 

The  larynx  is  syringed  under  good  illumi- 
nation, with  the  patient  holding  his  own 
tongue.  He  is  instructed  to  take  a long 


breath  and  then  say  a prolonged  E,  during 
which  the  fluid  is  injected  again.st  the  vocal 
cords.  At  the  conclusion  of  the  treatment 
the  patient  should  close  his  mouth,  and  take 
deep  breaths  through  the  nose,  in  order  to 
avoid  laryngeal  spasm. 

In  insufflating  powders,  have  the  patient 
first  take  a deep  breath,  and  then  exhale 
after  the  powder  has  been  blown  in. 

Throat  paints  should  not  be  “ rubbed  in.” 
Easy  access  to  the  larynx  is  obtained  by 
means  of  suspension  laryngoscopy. 

In  fusing  chromic  acid  on  the  end  of  a 
probe,  first  warm  the  probe,  dip  it  in  the 
chromic  acid  crystals,  and  then  warm  the 
part  of  the  probe  next  beyond  the  crystals 
until  the  latter  melt. 


Fig.  1 13 

In  using  the  electro-cautery,  first  cocain- 
ize and  then  dry  the  parts  carefully.  Then 
turn  on  the  current  until  the  cautery'  point 
is  at  a cherry-red  heat.  A white  heat  causes 
hemorrhage,  while  a dull  heat  causes  ad- 
herence of  the  point  to  the  charred  tissues. 
Remove  the  cautery  before  turnmg  off 
the  current. 

Thyro=arytenoidei  Muscles,  Paralysis_of 
the. — Gr.  dupe's  shield;  apUTaiva  jug;  eibos 
form.  See  Ajihonia. 

Thyroid  Gland  Tumor  of  the  Larynx. — 

Gr.  dvpeos  shield  -f  tibos  form;  L.  glam,  a 
cord.  See  Tumors  of  the  Laiynix. 

Tonsillectomy. — L.  tonsiVla,  tonsil  -f  Gr. 
eKTopir,  excision. 

Indications  for  Tonsillectomy  and  Adenectomy. 
-Mouth-breathing;  chronic  rhinitis;  deaf- 
ness; otitis  media;  recurrent  tonsillitis; 


TONSILLITIS  ACUTA 


recurrent  quinsy;  chronic  tonsillitis ; enlarged 
cervical  glands;  harboring  of  diphtheria 
germs;  and  systemic  conditions  probably 
due  to  tonsillar  infection,  e.g.,  rheumatism, 
chorea,  endocarditis,  pleuritis,  pericarditis, 
tuberculosis,  gastric  ulcer,  appendicitis, 
gastro-intestinal  trouble,  goitre,  asthma,  etc. 

The  Operation. — Many  operators  prefer  the 
guillotine.  St.  Clair  Thomson  prefers  Heath’s 
modification  of  Mackenzie’s  pattern,  with  a 
small  fenestra  (three-quarter  inch)  through 
which  the  tonsil  must  be  threaded.  Wilfred 
Harris  prefers  Elphick’s  modification  of  Bal- 
lenger’s  instrument.  The  lower  or  right  ton- 
sil is  removed  first  (see  Figs.  112  and  113). 

Enucleation  of  the  tonsil  from  above 
downward  with  the  finger,  after  first  dividing 
the  mucous  membrane  above  the  upper  pole 
with  curved,  blunt-pointed  scissors,  is  done 
by  many.  The  tonsil  usually  remains 
attached  below,  and  is  then  divided  with 
scissors  or  a wire  snare.  It  is  well  to  keep 
punch  forceps  on  hand  to  perform  morcella- 
tion  when  the  tonsil  proves  soft  and  friable. 

A good  method  of  removing  the  tonsils  is 
the  following:  Under  ether  anaesthesia, 

carried  on  by  means  of  a crooked  hollow 
metal  tube  curving  around  the  cheek  and 
attached  to  a syringe  containing  ether,  open 
the  mouth  by  means  of  a combination 
mouth-gag  and  tongue  depressor,  and  bring 
the  patient’s  head  over  the  edge  of  the  oper- 
ating table  so  that  the  tonsillar  region  may 
be  viewed  from  behind  the  head.  Grasp  the 
tonsil  with  forceps  and  separate  it  from  the 
faucial  pillars  with  a cutting  hook.  Then 
remove  the  tonsil  with  a cold-wire  snare, 
slowly  tightened  so  as  to  avoid  hemorrhage. 
Bleeding  points  may  be  caught  with  forceps, 
applied  vertically  and  ligated  with  silk. 

Other  measures  for  checking  excessive 
bleeding  are  as  follows:  (1)  syringing  with 
ice  cold  water;  (2)  syringing  with  hot  water; 
(3)  pressure  for  ten  to  twenty  minutes  with 
lint  dipped  in  hydrogen  peroxide  or  adrenalin 
solution,  1 : 2000  to  1 : 1000;  (4)  the  applica- 
tion of  a special  forceps,  with  one  blade 
against  the  tonsillar  fossa  and  the  other 
outside  the  neck;  (5)  clamping  the  two  pil- 
lars of  the  fauces  together  with  forceps;  (6) 
sewing  the  two  pillars  over  a roll  of  lint  wet 
with  a styptic,  using  a long  curved  needle 
or  Michael’s  hooks,  for  which  special  instru- 
ments are  required. 

In  order  to  lessen  reaction  and  soreness, 
one  may  apply  a 25  per  cent,  solution  of 
tincture  of  iodine  to  the  tonsillar  fossae 
immediately  after  the  operation.  Atropine 
(Part  11)  may  be  administered  before  the 
operation  to  lessen  secretion. 


Light,  soft  diet  is  required  for  several 
days  following  a tonsillectomy.  Ice  may 
be  sucked. 

If  tonsillectomy  is  not  feasible,  the  tonsils 
may  be  burned  (following  cocainization, 
5 per  cent.)  with  the  galvanocautery 
every  five  or  six  days,  until  they  are  suffi- 
ciently reduced. 

Tonsil,  Lingual,  Abscess  of  the. — L. 

absces'sus,  a going  apart.  See 
Lingual  Tonsillitis,  Acute. 

Hyperplasia  of  the. — See  Hyper- 
plasia of  the  Lingual  Tonsil. 

Inflammation  of  the. — L.  infiamma're, 
to  set  on  fire.  See  Lingual  Tonsil- 
litis, Acute. 

Tonsillitis  Acuta. — L.  tonsil'la,  tonsil  + 
Gr.  -trts  inflammation;  L.  acii'ius,  sharp.  An 
acute  infection  of  the  tonsils,  of  about  a 
week’s  duration,  characterized  clinically  by 
sore  throat,  fever,  malaise,  anorexia,  fetid 
breath,  coated  tongue,  headache,  backache, 
and  pains  in  the  limbs;  and  anatomically  by 
inflammatory  hypersemia  and  swelling  in  the 
catarrhal  form  or  stage,  the  presence  of  dis- 
crete, white,  gray,  or  yellow  patches  of 
exudate  in  the  follicular  or  lacunar  form, 
and  marked  swelling,  oedema,  and  focal  sup- 
puration in  the  parenchymatous  form. 

Complications  to  be  feared  are  endo- 
carditis, pericarditis,  pneumococcic  peri- 
tonitis, pneumonia,  acute  nephritis,  arth- 
ritis, and  otitis  media. 

Quinsy  (q-v.)  and  chronic  enlargement 
may  ensue. 

Vincent’s  angina  is  an  uncommon,  non- 
virulent,  subacute,  ulcerative,  pseudo-mem- 
branous inflaimnation  which  occurs  in  debili- 
tated and  unsanitary  subjects,  and  is  due  to 
Vincent’s  anaerobic  bacillus.  Diphtheria  and 
syphilis  are  to  be  excluded. 

The  tonsillitis  of  diphtheria  is  associated 
with  less  pain  and  fever  than  the  ordinary 
acute  tonsillitis,  the  false  membrane  more 
often  spreads  over  the  faucial  pillars,  soft 
palate  and  uvula,  rhinorrhoea  and  albumi- 
nuria are  frequent,  involvement  of  the 
larynx,  manifested  by  hoarseness,  stridor,  or 
a croupy  cough,  commonly  occurs,  the  Klebs- 
Loffler  bacilli  are  demonstrable,  and  paraly- 
ses or  cardiac  disturbance  is  prone  to  follow. 

Etiology.— Sudden  climatic  and  thermic 
changes;  exposure  to  cold  and  wet;  poor 
health;  irritating  inhalations  (bad  air,  sewer 
gas,  coal  gas,  etc.);  mouth-breathing;  ton- 
sillar hypertrophy  and  chronic  tonsillitis; 
suppurative  sinusitis; intra-nasal  operations; 
impaction  of  a foreign  body;  infectious 
diseases  (catarrhal  fever,  influenza,  scarlet 
fever,  measles,  diphtheria,  secondary  syph- 


TONSILLITIS,  CHRONIC  LACUNAR 


ills);  gastro-intestinal  disorders;  gouty  or 
rheumatic  diathesis;  septic  conditions  of  the 
mouth  and  teeth;  milk  from  cows  infected 
with  streptococcus  mastitis. 

The  bacteria  usually  present  are  strepto- 
cocci, sometimes  staphylococci,  pneumo- 
cocci, Vincent’s  bacillus,  etc. 

Treatment.— In  doubtful  cases  the  patient 
should  be  isolated  and  the  advisability  of  ad- 
ministering diphtherial  antitoxin  considered. 

Open  the  bowels  in  the  beginning  with 
castor-oil  or  powdered  calomel  followed  by  a 
saline,  and  order  liquid  or  soft  diet  with 
plenty  of  lemonade. 

For  the  relief  of  pain  and  fever,  prescribe 
powdered  salol,  gr.  v-x,  with  phenacetin, 
gr.  v-x,  repeated  if  nec^essary;  or  aspirin, 
gr.  v-x,  with  or  without  phenacetin,  gr.  v; 
or  sodium  salicylate,  gr.  xw-xx,  with  or 
without  antipyrine,  gr.  iii-v;  or  quinine 
bromide,  gr.  ii,  and  antipju-ine,  gr.  iii,  in 
capsule,  eveiy  three  hours  until  the  fever  is 
abated;  or  tinct.  guaiaci  aimnoniati,  gtt. 
xv-xx;  or  guiacol  carbonate,  gr.  v,  in  wine 
or  milk,  every  two  hours;  or  tinct.  aconiti, 
gtt.  i,  every  hour  or  two  imtil  the  fever  and 
pain  are  reduced  (consult  Part  11  for  the 
proper  doses  for  children).  The  salicylates 
are  regarded  by  some  as  almost  specific. 

Cold  or  heat  may  be  applied  externally  in 
the  form  of  a wet  towel  around  the  neck  from 
ear  to  ear,  covered  with  a dry  towel.  A silk 
covered  cotton  collar  is  grateful. 

Ballenger  says:  “One  application  of  a 

50  to  90  per  cent,  solution  of  nitrate  of  silver, 
made  during  the  first  twenty-four  hours'’of 
the  disease,  will  in  nearly  every  instance 
abort  the  attack.”  The  application  is  made 
by  means  of  a cotton-wound  corrugated 
probe  or  a cotton  pledget  held  in  htemostatic 
forceps,  from  which  all  excess  of  the  caustic 
fluid  is  expressed,  so  that  none  of  it  may  run 
down  into  the  larynx  and  jiroduce  alarming 
spasm  of  the  glottis. 

Some  advise  mopping  the  tonsils  once  or 
twice  a day  with  silver  nitrate,  5 i ad  3 i,  or 
argyrol,  25  per  cent.,  or  carbolized  glycerine, 
gr.  V ad  5i)  or  pure  guaiacol,  or  tr.  ferii 
chloridi,  pi,  in  glycerine  q.s.  ad  5i-  Others 
prefer  frecpient  gargling  or  spraying,  or  better, 
syringing  of  the  throat  with  a hot  solution 
of  sodium  chloride,  bicarbonate,  or  biborate, 
3i  ad  Oi;  or  boric  acid  solution,  3i~iv  ad  Oi, 
with  or  without  carbolic  acid,  3i;  or 
hych’ogen  peroxide,  half  strength,  or  one  of 
the  following: 


R Hydrogeni  peroxidi. 

Extract!  hamainelidis  aquosi. 

Aquae  cinnamomi,  aa 5 i 

Chloral!  hydrat! gr.  x 

(Kyle.) 


R Acid!  salicylic! 5! 

Sodi!  chlorld! 3x 

Sodi!  blcarbonatls 5uss 

M.  Slg. — Half  a teaspoonful  dissolved  in  a 
tumblerful  of  tepid  water.  (Lemioyez.) 

R Acid!  carbollcl gr.  1 

Sodi!  blboratls 3 i 

Potas.sll  brornldl 31 

Splrltus  mentha;  piperita; gss 

Glycerin!,  q.s.  ad 5iv 


M.  Slg. — ^A  teaspoonful  In  half  a tumblerful  of 
tepid  water.  (St.  Clair  Thomson.) 

Instruct  the  patient,  when  syringing  the 
throat,  to  keep  the  mouth  wide  open,  to 
breathe  through  the  mouth,  and  to  refrain 
from  swallowing,  in  order  to  prevent  the 
entrance  of  fluid  into  the  eustachian  tube. 

Lozenges  of  guaiacum,  of  carbolic  acid, 
gr.  and  menthol,  gr.  Ho)  and  of  formalin 
gr.  Ig,  made  with  “ glyco-gelatine  ” or  “ fruit 
paste  ” (Thomson)  are  useful. 

Thomson  says:  “ In  small  or  fractious 

children  the  following  should  be  given, 
undiluted  ”: 


R Tincturae  ferrl  chloridi 3h 

Glycerini,  q.s.  ad gii 


M.  Sig.^L)  ne-halfdrameveryhour.  (St. 
Clair  Thomson.) 

Where  there  is  much  oedema,  relief  is 
afforded  by  multiple  punctures,  followed  by 
irrigation  of  the  throat  with  hot  normal 
saline  or  boric  acid  solution  (3i  ad  Oi)  and 
the  application  of  heat  externally.  Adrena- 
lin, 1 : 1000,  and  medicated  vapors  (comp, 
tr.  benzoin,  one  tablespoonful  to  a pint  of 
steaming  water  over  an  alcohol  lamp)  are 
also  of  benefit  in  these  cases. 

During  convalescence,  prescribe  rest,  fresh 
air,  nourishing  diet,  and  tonics,  e.g.,  the 
elbdr  ferri,  quininse,  et  strychninae  phosphati, 
Fowler’s  solution,  Blaud’s  pills,  freshly  pre- 
pared, or  sjTupus  ferri  iodidi  (consult  Part 
11).  Rest,  fresh  air,  nourishing  food,  tonics, 
cleanliness  of  the  mouth,  and  the  local 
application  of  silver  nitrate,  2 per  cent,  or 
pure  tincture  of  iodine  after  cleansing  with 
hydrogen  peroxide,  half  strength,  consti- 
tute the  treatment  of  Vincent’s  angina. 

Tonsillitis,  Catarrhal. — Gr.  Karappeiv  to 
flow  down.  See  Tonsillitis  Acuta. 

Chronic  Lacunar. — L.  lonsiVla,  tonsil; 
Gr.  xpovos  time;  L.  lacuna,  a small  pit.  A 
chronic  affection  of  the  tonsils,  character- 
ized by  the  presence  of  fetid,  caseous  plugs 
in  the  tonsillar  crypts  or  lacunae. 

Treatment. — Remove  the  tonsils  (see  Tonsil- 
lectomy), or  slit  open  the  crj’pts,  remove 
the  cheesy  material,  and  apply  peroxide  of 
hydrogen  through  a s\Tinge  with  a small 
cannula  attached;  or  appljq  by  means  of  a 
long,  thin  applicator  wound  with  a minute 


MOUTH 


Granular  angina 


Tonsillitis 


Scorbutus 


Tonsillar 

abscess 


Papular 

sypfiilide 


Papular  s^phi lide  - Lingual  leukoplasia. 


Diphtheritic  angina. 


LAROUSSE  MEDICAL 


Mouth  diseases 


TUBERCULOSIS  OF  THE  LARYNX 


amount  of  cotton,  a 20  per  cent,  solution  of 
trichloracetic  acid,  or  40  to  80  per  cent,  silver 
nitrate  solution,  or  iodine  and  potassium 
iodide,  aa  5 iss  ad  5 i ; or  employ  the  galvano- 
cautery  in  several  sittings. 

Tonsillitis,  Diphtherial. — See  Diphtheria, 
in  Part  1. 

Erythematous. — L. ; Gr.  kpvdrma  red- 
ness. See  Tonsillitis  Acuta. 

Follicular. — L.  folli'culus,  little  bag. 
See  Tonsillitis  Acuta. 

Hypertrophic. — Gr.  v-irkp  over  Tpo4>r^ 
nutrition.  See  Tonsillitis,  Chronic 
Lacunar;  and  Tonsillectomy. 

Lacunar,  Acute. — L.  lacu'na,  a little  pit. 
See  Tonsillitis  Acuta. 

Chronic.  — See  Tonsillitis,  Chronic 
Lacunar. 

Lingual,  Acute. — (See  Lingual  Tonsil- 
litis, Acute. 

Parenchymatous. — Gr.  Trapeyxvpa  the 
essential  or  functional  portion  of  an 
organ,  as  distinguished  from  its 
stroma.  See  Tonsillitis  Acuta. 

Preglottic.  — L.  proe,  before  -f-  Gr. 
yXwTTis  glottis.  See  Lingual  Tonsil- 
litis, Acute. 

Superficial. — L.  See  Tonsillitis  Acuta. 

Ulcerative. — L.  ul'cus,  ulcer.  See  Ton- 
sillitis Acuta. 

Tonsils,  Enlargement  of  the. — See  Tonsil- 
lectomy. 

Hyperkeratosis  of  the. — See  Keratosis 
Pharyngis. 

Hypertrophied. — Gr.  vwep  over  + Tpo<t>rj 
nutrition.  See  Tonsillectomy. 

Inflammation  of  the. — L.  inflarnma're,  to 
set  on  fire.  See  Tonsillitis. 

Keratosis  of  the.  — See  Keratosis 
Pharyngis. 

Removal  of  the. — See  Tonsillectomy. 

Tumors  of  the. — See  Tumors  of  the 
Naso-pharynx  and  Pharyn.x. 

Tracheal  Foreign  Bodies. — L.;  Gr.  rpaxeia 
rough.  See  Foreign  Bodies  in  the 
Air  Passages. 

Fracture. — See  Fracture  of  the  Trachea, 
in  Part  10. 

Inflammation. — L.  inflarnma're,  to  set 
on  fire.  See  Bronchitis,  in  Part  1. 

Obstruction. — See  Part  1. 

Tumors. — See  Obstruction  of  the  Tra- 
chea in  Part  1. 

Tracheitis. — See  Bronchitis,  in  Part  1. 

Tracheotomy. — Gr.  rpaxeia  trachea  -f- 
TepvHv  to  cut.  See  under  Diphtheria  in  Part  1. 

Tuberculosis  of  the  Larynx. — L.  tuber' - 
culum,  nodule;  Gr.  \apvy^  larynx.  Laryn- 
geal -tuberculosis  is  secondary  to  pulmonary 
tuberculosis.  It  almost  always  first  attach 


the  arytenoid  and  interarytenoid  regions. 
The  prognosis  is  serious,  but  not  necessarily 
hopeless.  A cure  is  possible,  but  early 
diagnosis  and  treatment  are  essential. 

Treatment. — Correct  hygiene  (adequate  re.st 
and  exercise,  prolonged  absolute  rest  of  the 
voice,  constant  pure,  fresh  air,  nutritious 
food,  regular  hours  of  eating  and  sleeping, 
rest  before  and  after  meals,  adequate 
clothing,  a daily  morning  warm  bath  in  a 
warm  room,  followed  by  a cold  spinal 
douche,  personal  cleanliness,  the  avoidance 
of  dust,  tobacco,  and  alcohol) ; and  perhaps 
codliver  oil,  maltine,  hypophosphites,  creo- 
sote, arsenic,  or  strychnine,  (see  Drugs,  Part 
11),  is  of  the  first  importance  (consult  Tuber- 
culosis, Pulmonary,  in  Part  1,  on  General 
Medicine  and  Surgery). 

The  larynx  should  be  kept  cleansed  by 
means  of  an  alkaline,  antiseptic  spray,  viz., 
1^  Sodii  bicarbonatis  et  sodii  biboratis,  aa 
gr.  iiij  acidi  carbolici,  gr.  i,  sacchari  albi, 
gr.  V,  aquam  ad  5~iv;  or  I^  Sodii  bicarbon- 
atis et  sodii  biboratis,  aa  gr.  x,  ad  aq.  ext. 
hamamelidis  et  aquam,  aa  5ss  (Kyle);  fol- 
lowed by  an  oily  spray,  viz. 


R 

Mentholis 

gr.  v-xxx 

Alboleni  liquidi 

5i 

R 

Mentholis 

gr.  xiv 

Camphorse 

gr.  xiv 

Chloreton 

gr.  V 

Olei  cinnamomi 

iiKiii 

JParaftini  liquidi 

Si 

(Thomson.) 

R 

Creosoti 

Olei  picis  liqiiida) 

gtt.  XX 

Alboleni  liquidi 

....  Sss  (Kyle.) 

Ballenger,  after  cleansing  the  larynx, 
insufflates  powdered  saccharated  suprarenal 
gland,  gr.  iii-vi,  and  after  a few  minutes, 
instils  with  a laryngeal  syringe  the  following: 


R Mentholis gr.  xv-ccxxv 

Olei  amygdala)  dulcis.  . oviiss 

Vitelli  ovorum 3vi  njxv 

Orthoformi oiii  gr.  viiss 


Misce  et  fiat  emulsio. 

When  insufflating  powder,  have  the 
patient  first  take  a deep  breath,  and  then 
exhale  after  the  powder  has  been  blown  in. 
When  swinging  the  larynx,  have  the’patient 
hold  his  own  tongue,  and  employ  good 
illumination.  Instruct  the  patient  to  take  a 
long  breath,  and  then  say  a prolonged  E, 
during  which  the  fluid  is  injected  against  the 
vocal  cords.  At  the  conclusion  of  the  treat- 
ment the  patient  should  close  his  mouth  and 
take  deep  breaths  through  the  nose,  in  order 
to  avoid  laryngeal  spasm. 


TUMORS  OF  THE  LARYNX 


The  patient  may  wear  a perforated  zinc 
inhaler  containing  a sponge  moistened  with 
the  following: 


Acidi  carbolic! 3ii 

Creosoti 3ii 

Tincturae  iodi 3i 

Spiritus  a;tlieris 3i 

Spiritus  chlorofonni 3ii 


M.  Sig. — Six  to  eight  drops  on  the  inhaler  every 
hour.  (D.  R.  Lees.) 

For  laryngeal  cough  and  irritation  are 
recommended  lozenges;  R Mentholis,  gr.  }-g; 
ext.  glycerrhiz®,  gr.  ii;  R Mentholis,  gr.3^o; 
acidi  carbolici,  gr.  3^.  (St.  Clair  Thomson.) 

To  mitigate  the  pain  of  swallowing,  the 
patient  may  lie  prone  upon  a couch  and  suck 
his  nouri.shment  through  a glass  tube  from 
a cup  on  the  floor;  or,  cocaine,  3^  to  4 per 
cent.,  may  be  sprayed,  or  orthoform  or 
anasthesin,  gr.  iii-v,  may  be  insufflated,  one 
hour  before  the  taking  of  food. 

Injection  of  the  laryngeal  nerves  with 
alcohol  is  of  the  greatest  value  for  the  relief 
of  pain.  B.  A.  Vanderhoof’s  technique  is  as 
follows:  With  the  patient  recumbent  and 

the  head  slightly  thrown  back  so  as  to  put 
the  neck  muscles  on  a stretch,  press  with  the 
finger  nail  just  above  the  upper  edge  of  the 
thyroid  cartilage  and  about  three  centi- 
metres from  the  incisura  thyroidse.  If  the 
finger  nail  is  directly  over  the  nerve,  there 
will  be  a sensation  of  pain.  Sterilize  the  skin 
with  iofline,  pick  it  up  between  the  thiunb 
and  forefinger,  and  insert  a sterile,  dull, 
hypodermic  needle,  with  syringe  attached, 
containing  2 c.c.  of  a 50  per  cent,  solution  of 
alcohol.  Insert  the  needle  with  a slow  push- 
ing anti  twisting  movement,  and  after  it  has 
passed  thi'ough  the  skin,  slowly  push  it 
1.5  cm.  perpenthcularly  to  the  skin  and  move 
the  point  slowly  around  in  all  directions  until 
the  patient  complains  of  a sharp  pain  in  the 
ear  or  sometimes  in  the  jaw.  Inject  the 
solution  slowly,  talcing  about  five  minutes 
to  inject  the  whole  amount,  and  at  the 
same  time  move  the  point  of  the  needle 
about  a little  in  all  directions.  After  with- 
drawing the  needle,  seal  the  puncture  with 
flexible  collodion. 

Fungating  masses  may  be  cut  off  with 
punch  forceps  a!id  the  curette;  ulcers  may 
l)e  cauterized  evers"  one  to  three  weeks 
(waiting  each  time  for  the  slough  to  separ- 
ate), by  means  of  an  acid  aiiplicator  with 
lactic  acid,  60  per  cent.,  or  a combination 
of  formaline,  7 per  cent.,  pure  carbolic  acid, 
10  per  cent.,  and  lactic  acid,  50  per  cent. 
(Lake) ; or  chromic  acid  fused  on  the  end  of 
a probe  (first  warm  the  probe,  dip  it  in  the 


chromic  acid,  then  warm  the  part  of  the 
probe  next  beyond  the  crystals  until  the 
latter  melt) ; or  best  of  all,  the  galvanocaut- 
ery  (all  employed  under  cocaine  anaesthesia, 
10  per  cent.,  repeatedly  applied). 

St.  Clair  Thomson  uses,  for  tuberculous 
deposits  as  well  as  for  ulcers,  a fine-pointed 
electrode,  “ brought  almost  to  a white  heat,” 
and  “ firmly  thrust  through  the  diseased 
area  until  its  arrest  shows  that  healthy 
tissue  has  been  reached.”  “ Several  cauter- 
izations are  carried  out  at  one  sitting,  which 
is  repeated  every  ten  to  twenty  days  until 
complete  healing  takes  place.”  Suspension 
laryngoscopy,  by  means  of  the  Killian- 
Lynch  apparatus,  affords  ea.sy  approach  to 
the  larynx. 

Tumors  of  the  Larynx. — L.  tu'mor,  from 
tu'mere,  to  swell;  Gr.  \a.pvy^.  Benign 
tumors,  while  uncommon,  are  commoner 
than  malignant  tumors.  First  in  frequency 
is  papilloma;  then  comes  fibroma; 
rarer  growths  are  cystoma,  myxoma, 
angioma,  lipoma,  adenoma,  lymphoma, 
chondroma,  osteoma,  thyroid  gland  tumor, 
anti  amyloid  tumor. 

Malignant  tumors  are,  first  in  frequency, 
epithelioma,  rarely  medullaiy  or  encephaloid 
cancer,  glandular  cancer,  or  sarcoma. 

Laryngeal  neoplasms  are  almost  always 
supraglottic,  and  are  usually  situated 
upon  the  vocal  bands.  The  most  frequent 
variety,  papilloma,  is  usually  single  and  non- 
recurrent in  adults,  but  multiple  and  recur- 
rent in  children. 

Treatment.— A.  Benign  Tumors. — Symp- 
tomless  grovdhs  may  best  be  let  alone.  To 
remove  a growth,  first  cleanse  the  throat  and 
larynx  with  an  alkaline  spray,  say  Dobell’s 
.solution  (see  Part  11),  and  then  spray  into 
the  larynx  a 4 per  cent,  solution  of  cocaine 
muriate,  and  mop  the  uvula,  pillars,  pos- 
terior pharyngeal  wall  and  epiglottis  with 
the  same  solution.  The  head  being  steadied 
by  a nurse,  have  the  patient  hold  out  the 
tongue  with  a napkin,  or  have  an  assistant, 
in  case  the  epiglottis  is  in  the  way,  use  an 
Escat  epiglottis  lifter.  Train  the  patient  to 
use  the  vowel  sound  A,  changing  to  E with- 
out moving  the  tongue.  The  A changing  to 
E brings  the  cords  on  the  highest  plane 
possible,  and  gives  the  best  view  of  them  in 
their  fullest  extent.  Then  without  dropping 
the  cords  and  in  the  E emission,  at  the  com- 
mand “ Now,”  the  patient  should  be  taught 
to  take  a deeji  breath  suddenly  without 
making  any  sound  or  body  movement,  and 
with  complete  relaxation.  At  that  instant 
the  laryngeal  serrated  forceps  (Mackenzie’s, 


UVULA,  ELONGATION  OF  THE 


Dundas  Grant’s,  etc.)  are  introduced  and 
the  growth  is  grasped  and  avulsed.  This 
applies  to  subglottic  growths  and  those  on 
the  border  of  the  cords.  Growths  situated 
on  the  upper  surface  are  removed  (.luring  the 
E emis.sion  (after  E.  H.  Curtis.) 

Suspension  laryngoscopy,  however,  by 
means  of  the  Killian-Lynch  apj^aratus, 
affords  easier  approach  to  the  larynx, 
especially  in  children. 

After  the  operation,  absolute  rest  of  the 
voice  should  be  observed  until  healing 
occurs. 

An  intra-laryngeal  spray  of  absolute 
alcohol,  repeated  “ several  times  daily  ” 
(Richardson),  or  “ at  intervals  of  ten  days  ” 
(Kyle),  may  possibly  cause  papillomatous 
growths  to  atrophy,  and  may  also  prevent 
their’  recurrence. 

Kyle  says  that  papillomata  in  children 
may  be  made  to  disa[)pear  by  not  using  the 
voice  for  from  one  to  three  weeks.  Papillo- 
mata have  been  successively  treated  with 
radium  {q.v.  in  Pai’t  1). 

B.  Malignant  Tumors. — Radical  oper- 
ative procedures  include  thyrotomy  or 
laryngo-fissure,  partial  laryngectomy,  sub- 
hyoid or  transhyoid  pharyngotomy,  anti 
complete  laryngectomy  with  the  insertion 
of  a Braun’s  artificial  larynx. 

Palliative  measm-es  in  inoperable  cases 
embrace  (1)  strict  cleanliness  of  the  teeth 
and  mouth;  (2)  the  use  of  antiseptic,  alkaline 
sprays  and  irrigations  (permanganate  sprays, 
2 per  cent.,  to  lessen  the  disagreeable  odor), 
followed  by  the  insufflation  of  an  antiseptic 
powder,  iodoform,  aristol,  europhen,  etc. 
(see  Tuberculosis  of  the  Larynx,  for 
formulae  and  technique);  (3)  for  the  relief 
of  pain,  orthoform  insufflations,  cocaine 
sprays,  5 to  10  per  cent.,  and  morphine; 
(4)  for  hemorrhage,  adrenalin,  1 : 2000  to 
1 : 1000;  (5)  lozenges  of  formaline  (gr.  3^0, 
carboUc  acid  (gr.  ^),  or  menthol  (gr.  l'2o), 
or  the  latter  two  combined;  (6)  removal  of 
obstructive  tissue  with  the  galvanocautery, 
snare,  or  forceps;  (7)  low  tracheotomy;  (8) 
gastrostomy;  (9)  rachum;  (10)  the  X-rays 
{q.v.  in  Part  l).  Diathermy,  by  means  of 
a powerful  high-frequency  current,  should 
be  of  great  value  (see  Diathermy  in 
Part  1). 

Tumors  of  the  Naso^pharynx  and  Pharynx. 

— L.  tu'mor,  from  tu'mere,  to  swell;  na'sus, 
nose;  Gr.  4>apvy^.  A.  Benign  Tumors  of  the 
Naso=pharynx.— These  are  rare.  Papillomata, 
adenomata,  cysts,  and  polypi  (the  latter 
originate  in  the  maxillary  antrum)  are 
usually  removable,  under  cocaine  anaes- 


thesia, 5 per  cent.,  by  means  of  a cold  wire 
snare  introduced  through  the  nose  aided 
with  the  left  forefinger  in  the  post-nasal 
space;  or  by  means  of  the  post-nasal  forceps 
or  adeno'd  curette.  In  using  the  wire  snare, 
do  not  cut  through  the  pedicle  of  the  growth, 
but  grasp  it  firmly  with  the  snare  and 
avulse  the  pedicle. 

Naso-pharyngeal  fibroma  is  a very  rare, 
hard,  vascular,  usually  small  based,  progres- 
sively growing  neoplasm  of  serious  import, 
which  usually  undergoes  spontaneous  invo- 
lution at  about  the  age  of  twenty-three 
years.  The  treatment  is  radical  removal, 
(consult  the  standard  textbooks).  Dia- 
thermy (q.v.  in  Part  1)  may  be  applicable. 

B.  Benign  Tumors  of  the  Tonsils  and  Pharynx. — 
These  are  also  rare.  They  embrace  papil- 
loma, adenoma,  fibroma,  lipoma,  angioma, 
dermoid  cyst,  and  mixed  tumor.  Peduncu- 
lated growths  may  be  removed  with  forceps 
and  scissors;  encysted  growths  by  incision 
down  to  the  cyst  and  enucleation;  angio- 
mata by  incising  beyond  the  growth  to  avoid 
hemorrhage.  Diathermy  should  prove  of 
value. 

C.  Malignant  Tumors. — Sarcoma  and  carci- 
noma tlemand  thorough  removal,  if  feasible. 
In  inoperable  sarcoma,  give  arsenic  (see 
Part  11). 

Palliative  measures  in  inoperable  cases 
embrace  (1)  strict  cleanliness  of  the  teeth 
and  mouth;  (2)  the  use  of  alkaline,  antiseptic 
mouth  washes,  such  as  Dobell’s  solution 
(Part  11);  (3)  lozenges  of  formalin  (gr.  )-^), 
carbolic  acitl  (gr.  menthol  (gr.  |^o),  the 
latter  two  combined,  or  iodoform;  (4)  for 
hemorrhage,  adrenalin  1 : 2000  to  1 : 1000; 
(5)  for  pain,  orthoform  insufflations,  cocaine 
sprays,  5 to  10  per  cent.,  and  morphine;  (6) 
local  applications  of  arsenous  acid  (1  : 1.50 
to  1 : 50)  in  water  and  alcohol,  aa,  to  retard 
growth;  (7)  tracheotomy;  (8)  gastrostomy; 
(9)  radium;  (10)  the  X-rays. 

Diathermy  is  of  value. 

Tumors  of  the  Pharynx. — See  Tumors  of 
the  Naso-pharynx  and  Pharynx. 

Tonsils. — See  Tumors  of  the  Naso- 
pharynx and  Pharynx. 

Trachea.— See  Obstruction  of  the 
Trachea,  in  Part  1. 

Ulcerative  Tonsillitis. — L.  ul'ais,  ulcer. 
See  Tonsillitis  Acuta. 

Ulcers  of  the  Pharynx. — See  Pharyngeal 
Ulcers. 

Uvula,  Edema  of  the. — See  Uvulitis 
Acuta  et  (Edema  Uvulse. 

Elongation  of  the. — See  Elongation  of 
the  Uvula. 


VOICE,  WEAK 


Uvula,  Inflammation  of  the. — L.  inflam- 
ma're,  to  set  on  fire.  See  Uvulitis. 

CEdema  of  the. — See  Uvulitis  Acuta  et 
(Edema  Uvulae,  below. 

Uvulitis  Acuta  et  (Edema  Uvulae. — L. 
u'vula,  little  grape  + Gr.  -itl%  inflammation ; 
oUrjua  swelling;  L.  acu'tus,  sharp.  Etiology.— 
Traumatism ; very  hot  or  otherwise  irritating 
ingesta;  excessive  vocal  effort;  neighboring 
inflammation;  chgestive  disorders;  profound 
anaemia;  debility;  rickets;  nephritis. 

Treatment. — Open  the  bowels  with  castor^ 
oil  or  powdered  calomel  followed  by  a saline 
(see  Part  11).  Keep  the  parts  cleansed  with 
hot  alkaline,  antiseptic  lotions,  as  given 
under  Pharyngitis  Acuta.  Spray  the  parts 
occasionally  with  ice  water,  or  an  aqueous 
solution  of  tannic  acid,  gr.  iii-v  ad  5i,  or 
of  copper  sul{Dhate,  gr.  i-iii  ad  5 i ; or  prescribe 
the  following  gargle: 


II  Tincturae  kino, 

Tr.  cateclni  compositae, 

Glyceriti  acidi  tannici,  aa gi 

M.  Sig. — Teaspoonful  in  a half  glass  of  cold  water 
as  a gargle. 

If  necessary,  the  engorged  tissues  may  be 
depleted  by  means  of  from  ten  to  twenty 
punctures  ( — Author — ?). 

Vincent’s  Angina.— See  Tonsillitis  Acuta. 

Vocal  Cords,  Paralysis  of  the. — L.  vocal'is, 
from  vox,  voice;  Gr.  xopSi,  cord; 
Trapd  beside  + \veiv  to  loosen.  See 
Aphonia. 

Spasm  of  the. — Gr.  cnraanos.  See 
Neuroses  of  the  Larynx,  and  Laryn- 
gismus Stridulus. 

Voice  Fatigue.- — See  Speech  Defects. 

Loss  of. — See  Aphonia. 

Weak. — See  Speech  Defects. 


APPENDIX 


For  Schema  for  the  Nose  and  Throat  His- 
tory and  Examination,  see  appendix  to  Part  8 
on  Nose  Diseases. 

The  Throat  Armamentarium. — i.  Office  and 
Operating  Room  Equipment. — Straight  back  re- 
volving chair  with  adjustable  back  and  head 
rest;  two  piano  stools;  table  cabinet;  swing- 
ing fountain  cuspidor;  cupboard  for  sterile 
goods;  Rochester  sterilizer  for  dressings; 
instrument  sterilizer  (fish  kettle);  kerosene, 
gas  (argand  burner),  or  50  candlepower 
electric  lamp;  Mackenzie  condenser;  folding 
portable  lamp  for  laryngoscopy,  etc.;  head- 
mirror  with  Gleason’s  black  leather  head- 
band;  sink  with  foot-lever  spigots;  Kirstein 
head  lamp;  Champion  or  Little  Wonder 
pmnp  for  furnishing  compressed  air  for 
atomizers;  Pynchon  and  Hubbard  regulating 
ah  tanks;  light  concentrator  with  reflector; 
suspension  laiyngoscopy  apparatus;  X-ray 
machine  ; electricity ; galvanic,  faradic, 
static. 

Bristle  probang;  cold  whe  snare;  post- 
nasal forceps;  Moe’s  gum-elastic  forceps; 
Gottstein’s  adenoid  curettes,  various  sizes 
and  curves;  Heath’s  modification  of  Mac- 
kenzie’s guillotine,  various  sizes;  Roe’s 
lingual  tonsillotome;  Roe’s  laryngeal  dila- 
tor; Mackenzie’s  lateral  forceps;  post-nasal 
syringe;  fountain  sjTinge,  glass  or  metal  ; 
catheter  attached  to  rubber  bulb;  mouth- 
gag;  combined  mouth-gag  and  tongue  de- 
pressor ; pharyngeal  scissors  ; Escat  epi- 
glottis lifter;  tonsil  forceps;  tonsil  hsemostat; 
Robertson’s  tonsil  scissors,  two  pahs;  laryn- 
geal lancet;  Sajous’s  laryngeal  forceps  appli- 
cator; Krause-Heryng  laryngeal  forceps; 
Schroetter’s  laryngeal  dilator;  tracheo- 
bronchoscopes  and  accessories;  direct  laryn- 
goscopes and  accessories,  Killian-Briining; 
cesophagoscopes  and  accessories ; Jarvis 
needle;  Paquelin  cautery;  galvanocautery 
wdth  various  knives;  indirect  laryngoscopes, 
full  set;  rhinoscopic  and  laryngoscopic  mir- 
rors, various  sizes;  laryngeal  sound;  eustach- 
ian  catheter;  tongue  depressor;  Kirstein’s 
instruments  for  autoscopic  operations ; tonsil 
knives,  compressor,  and  punches;  Kirkpat- 
rick’s lingual  tonsil  scissors;  laryngeal  curette; 
laryngeal  electrode;  O’ Dwyer’s  intubation 
set;  tracheotomy  instruments:  blunt  retrac- 
tor, sharp  tenaculum,  sharp  and  probe- 
pointed  scalpels,  tracheal  dilator,  tracheot- 
omy tube  with  pilot;  Braun’s  artificial  larynx; 


dilating  intubation  tubes  or  T-shaped  trache- 
otomy tubes  for  laryngeal  stenosis;  Koenig’s 
long  tracheotomy  cannula;  intratracheal 
syringe;  palate  retractor,  self-retaining; 
Whistler’s  cutting  laryngeal  curette;  um- 
brella probang;  coin  catcher;  oesophageal 
bougie;  intralaryngeal  punch;  antitoxin 
syringes;  perforated  zinc  inhaler;  Mac- 
kenzie’s laryngeal  tube-forceps;  Laborde’s 
dilator;  Roe’s  tracheal  forceps;  Golding- 
Bird’s  double  retractor;  scalpels;  Fauvel’s 
forceps,  lateral  grasp  and  antero-posterior 
grasp  ; acid  applicator  ; laryngeal  serrated 
forceps,  Mackenzie’s  Dundas,  Grant’s,  etc.; 
E.  Mayer’s  ciuette;  camel’s-hah  brushes; 
sterile  cotton ; post-nasal  syringe;  laryngeal 
knife;  Hartmanns  ear  forceps;  forceps  for 
temporarily  clamping  the  two  pillars  of  the 
fauces  together;  haemostatic  forceps  with 
one  blade  against  the  tonsillar  bed  and  the 
other  outside ; artery  forceps ; Michel’s  hooks 
with  special  instruments ; long  curved  needles ; 
Elphick’s  modification  of  Ballenger’s  ton- 
sillotome; cm’ved,  blunt-pointed  scissors; 
curved  tonsil  scissors;  wire  snare;  tonsil 
cutting  hook;  laryngeal  brush;  ice-bag; 
hot  water  bag;  laryngeal  spray;  stomach 
tube. 

2.  Internal  Drugs  Mentioned  in  the  Text. — (a) 
Alteratives,  Stomachics,  and  Tonics. — L. 
at' ter 0,  I change;  to'nus,  tone.  Arsenious 
acid;  Fowler’s  solution;  tr.  ferri  chloridi; 
elixir  ferri,  quininse,  et  strychninse  phosphati ; 
Blaud’s  pills;  syr.  ferri  iodidi;  Basham’s 
mixture  ; strychnine  ; potassiimi  iodide  ; 
protoiodide  of  mercury ; elix.  hypophos- 
phites;  quinine  bromide;  dilute  hydrochloric 
acid;  pepsin  or  papain;  inf.  quassia;  phos- 
phorus; bromine;  codliver  oil;  maltine; 
dilute  nitric  acid. 

(b)  Neuromuscular  Sedatives. — L.  sedo, 
I allay.  Morphine;  codeine;  heroin;  Dover’s 
powder;  atropine;  tr.  belladonna;  chloretone; 
chloral;  potassium  or  sodium  bromide; 
brandy;  spt.  setheris;  spt.  chloroformi;  chlo- 
roform; ether;  phenacetin;  salophen;  anti- 
pyrine;  paregoric;  aspirin;  ammonium  bro- 
mide; ammonium  or  zinc  valerianate;  liq. 
ext.  of  grindelia;  pearls  of  amyl  nitrite. 

(c)  Diaphoretics. — Gr.  8lol  through  + 
4>opetv  to  carry.  Pilocarpine,  hypo,  tablets, 
gr.  ; pilocarpine,  granular  effervescent 
tablets,  gr.  Koo!  sodium  salicylate;  salol; 
aspirin;  tr.  aconiti;  aconitin. 


APPENDIX 


(d)  Purgatives. — L.  purga're,  to  cleanse. 
Ca.stor-oil;  calomel;  piilv.  rhei;  sodium  sul- 
phate; sodium  phosphate;  Rochelle  salt. 

(e)  Hemostatics. — Gr.  al/xa  blood  -|- 
araTLKos  stamhng.  FI.  ext.  hydrastis;  cal- 
cium chloride. 

(f)  Expectorants  and  Respiratory  An- 
tiseptics.— L.  ex.  out  -f  pec'tus,  breast. 
Ammonium  chloride;  ammonium  carbonate; 
ol.  eucalypti;  tr.  eucalypti;  tr.  and  comp.  tr. 
benzoin;  ext.  pini  canadensis;  guaiacol; 
guaiacol  carbonate;  ammoniated  tincture  of 
guaiacum;  guaiaci  resina;  ol.  pini  sylvestris; 
ol.  santali;  creosote;  oil  of  tar;  comp,  elixir 
of  terpene  hydrate  (Llewellyn’s);  wine  or 
syrup  of  ipecac;  syr.  tolutani;  terebene; 
cubebs;  syr.  of  squills;  apomorphine;  sodium 
benzoate;  potassium  chlorate;  smelling 
salts. 

(g)  Antilithics. — Gr.  avri  against  -|- 
Xidos  stone.  Lithium  carbonate;  colchicum; 
granular  effervescent  citrate  of  lithium; 
Vichy  tablets. 

(h)  Antitoxines  and  Ser a — Gr. 
avri  against  + to^lkov  jioison,  L.  se'runi, 
whey.  Diphtheria  antitoxin;  antistrep- 
tococcus serum. 

(i)  Menstrua  and  Flavors. — C’omp.  tr. 
lavender;  ol.  month,  jiip. ; aq.  cinnamomi; 
spt.  nienth.  pip.;  sherry  wine;  spt.  vini 
rectificati;  liq.  ext.  licorice. 

3.  Local  Preparations  Mentioned  in  the  Text. — 
(a)  Antiseptics  AND  Astringents. — Gr.  avA 
against  -b  <Tr]\l/Ls  putrefaction;  L.  ad,  to  -j- 
strin'gere,  to  bind.  Hydrogen  peroxide, 
potassium  chlorate;  ext.  hydrastis  (color- 
less); sodium  chloride;  borax;  sodium  bicar- 
bonate; sacchari  albi;  carbolic  acid;  comp. 


tr.  catechu;  iodoform;  aristol;  europhen;  tr. 
krameria;  tr.  myrrh;  tr.  kino;  borogly ceride ; 
formalin;  lozenges  of  formalin,  gr.  /8,  of 
carbolic  acid,  gr.  ]/i,  of  guaiacum,  of  menthol, 
gr-  I’ig,  of  potassium  chlorate,  of  camphor 
and  menthol,  of  krameria,  of  catechu,  and  of 
red  gum,  made  with  “ gly co-gelatine  ” or 
“fruit  paste”;  alcohol;  resorcin;  argyrol; 
comp.  tr.  benzoin;  silver  nitrate;  iodine; 
potassium  permanganate;  zinc  sulphocarbo- 
late;  aq.  ext.  hamamelidis;  salicylic  acid;  tr. 
iodi;  tannic  acid;  ichthyol;  glycerite  of 
tannic  acid;  carbolized  vaseline;  zinc  sul- 
phate; alumnol;  Dobell’s  solution. 

(b)  Styptics. — Gr.  o-ru^etp  to  contract. 
Adrenalin,  1 : 1000;  liq.  ferri  persulphatis; 
alum;  cocaine;  antipyrine. 

(c)  Caustics. — Gr.  KaZew  to  burn.  Silver 
nitrate;  chromic  acid;  lactic  acid;  zinc 
chloride;  trichloracetic  acid;  copper  sulphate. 

(d)  Mucous  IMembrane  Stimulants. — 
Thymol;  ol.  eucalypti;  oil  of  mustard;  ol. 
gaultheria;  ol.  menth.  pip.;  ol.  cinnamomi; 
lozenges  of  ammonium  chloride;  lozenges  of 
guaiacum;  ol.  cassire;  camphor;  menthol;  ol. 
santali;  ol.  pini  sylvestris;  tr.  and  comp, 
tr.  benzoin. 

(e)  Emollients  and  Menstrua. — L. 
emollio,  I soften.  Glycerine;  liquid  albolene; 
benzoinol;  cosmoline;  liquid  vaseline;  paro- 
line;  olive  oil;  sweet  almond  oil;  lanolin; 
petrolatum  molle;  refined  or  crude  petroleum. 

(f)  Local  Anodynes. — Gr.  av  without  -|- 
6hi)vr]  pain.  Cocaine;  orthoform;  ansesthesin, 
ethyl  chloride. 

{g)  Counter  Irritants. — Mustard;  tur- 
pentine; ung.  capsici;  camphorated  oil; 
soap  liniment. 


PART  10 

ORTHOPEDICS 


Abduction  of  the  Great  Toe. — L.  ab,  from 
+ du'cere,  to  draw.  See  Hallux  Valgus. 

Abscess  of  the  Ankle. — L.  absces'sus,  a 
going  apart.  See  Ankle  Joint  and 
Tarsal  Tuberculosis. 

Brodie’s. — See  Osteomyelitis. 

Buttock. — See  Pott’s  Disease. 

Dorsal. — L.  dor'sum,  back.  See  under 
Pott’s  Disease. 

Elbow. — See  Elbow  Tuberculosis. 

Hip. — See  Hip  Disease. 

Knee. — See  Knee  Tuberculosis. 

Lumbar. — L.  lum'bus,  loin.  See  under 
Pott’s  Disease. 

Post=Mediastinal.  — L.  post,  behind; 
me'dia,  middle.  See  Pott’s  Disease. 

Pott’s  Disease. — See  Pott’s  Disease. 

Psoas. — Gr.  \p6a  loin.  See  Pott’s  Disease. 

Retropharyngeal. — L.  retro,  back  + 
Gr.  (j)apvy^.  See  Pott’s  Disease. 

Sacro=Iliac.— See  Sacro-Iliac  Disease. 

Shoulder. — See  Shoulder  Tuberculosis. 

Tarsal.  — See  under  Ankle  Joint  and 
Tarsal  Tuberculosis. 

Acetabulum,  Fractures  of  the. — L.  “ vine- 
gar-cruet,” from  ace'ium,  vinegar.  See  Frac- 
tures of  the  Femoral  Neck;  and  Disloca- 
tions of  the  Hip,  Central. 

Achillobursitis. — Gr.  ’AxtXXei-s  Achilles  -f 
/Scpsa  sac  H — irts  inflammation.  Synonyms. — 
Retro-calcaneal  bursitis;  achillodynia. 

An  inflammatory  affection  of  the  bursa 
situated  between  the  insertion  of  the  tendo 
Achillis  and  the  os  calcis,  or  sometimes  of 
the  bursa  between  the  tendo  Achillis  and  the 
skin,  characterized  by  local  pain,  tenderness, 
and  usually  swelling. 

Etiology. — Traumatism;  pressure  from  the 
back  of  the  shoe;  overuse  of  the  gastroc- 
nemius muscle;  gonorrhoea;  rheumatism; 
gout;  infectious  disease;  tuberculosis  of  the 
os  calcis*;  exostosis  beneath  the  bursa;  con- 
cretions within  the  bursa. 

The  X-ray  (q.v.  in  Part  1)  is  indispensable 
for  a correct  cliagnosis. 

Treatment.— In  acute  and  subacute  cases, 
employ  rest,  hot  applications,  hot  air,  alter- 
nate hot  and  cold  douches,  massage,  the  appli- 
cation of  tincture  of  iodine  or  the  cautery, 
and  compression  by  adhesive  plaster  strap- 
ping or  the  application  of  a plaster  bandage. 
After  all  sensitiveness  has  disappeared, 
the  patient  may  be  allowed  about  with  the 
back  of  the  shoe  cut  away  to  avoid  pressure, 


and  rubber  heels  worn.  A weak  or  flat  foot 
should  receive  attention  (see  Weak  Foot). 

In  chronic  cases,  the  bursa,  thickened 
tissue,  and  exostoses  should  be  removed 
through  an  incision  on  the  inner  side  of  the 
tendon.  The  latter  may  sometimes  be  advan- 
tageously divided.  After  the  operation,  the 
foot  and  leg  are  fixed  in  a plaster  bandage, 
which  is  not  permanently  removed  until  all 
pain  and  tenderness  have  disappeared. 

Achillodynia. — Gr.  ’AxtXXe'js  Achilles  -)- 
68w7]  pain.  See  Achillobursitis. 

Achondroplasia.  — See  Part  I,  General 
Medicine  and  Surgery. 

Acromegaly. — See  Part  I,  General  Medi- 
cine and  Surgery. 

Acromial  End  of  the  Clavicle,  Dislocations 
of  the. — Gr.  aKpov  point  + wpos  shoulder. 
See  Dislocations  of  the  Clavicle. 

Acromioclavicular  Dislocations. — See  Dis- 
locations of  the  Clavicle. 

Acromion,  Fractures  of  the. — See  Frac- 
tures of  the  Scapula. 

Acute  Anterior  Poliomyelitis. — See  Part 
1,  General  Medicine  and  Surgery. 

Infantile  Paralysis.— L.fbi/ans;  Gr.  wapa 
beside  -f  Xrttr  to  loosen.  See  Anterior 
Poliomyelitis,  Acute,  in  Part  1. 

Poliomyelitis.— See  Part  1. 

Adolescents’  Kyphosis. — L.  adolescefitia, 
youth.  See  under  Kyphosis. 

Round  Back. — See  umler  Kyphosis. 

Anatomical  Neck  of  the  Humerus,  Frac= 
tures  of  the. — Gr.  ava  apart  + rkpveiv  to  cut. 
See  Fractures  of  the  Humerus. 

Anchylosis. — See  Ankylosis. 

Ankle,  Dislocations  of  the. — See  Disloca- 
tions of  the  Ankle. 

Fractures  of  the. — See  Fractures  of 
the  Ankle. 

Ankle  Joint  and  Tarsal  Tuberculosis. — L. 

tuber' culum,  nodule;  Gr.  rapids  tarsus  or 
in.step.  * The  affection  is  usually  subacute  or 
chronic,  and  is  characterized  by  discomfort, 
stiffness  and  lameness,  later  swelling,  and 
eventually  deformity,  e.g.,  valgus  (eversion) 
and  equinovalgus. 

The  Prognosis  is  usually  good. 

Treatment.— First  correct  deformity,  either 
(1)  by  immobilizing  the  joint  for  two  weeks, 
in  a plaster  cast  (see  Plaster  Bandages  and 
Plaster  Casts),  extending  from  the  ends  of 
the  toes  (Whitman),  or  from  the  base  of 
the  toes  ( Goldthwait,  Painter,  and  Osgood), 


ANKLE  SPRAIN 


to  just  below  the  knee,  followed  by  gentle 
manipulations  before  removing  the  cast  ; 
or  (2)  by  immediate  reduction,  under 
anajsthesia,  followed  by  fixation  in  a plaster 
cast  with  the  foot  at  a little  less  than  a 
right  angle  with  the  leg  and  slightly  inverted 
or  supinated. 

After  deformity  has  been  corrected,  allow 
the  patient  about  with  crutches  or  a Thomas 
knee-splint,  (g.w.),  with  the  foot  immobilized 
in  plaster.  Do  not  allow  the  patient  to  discard 
the  crutches  or  knee-splint  for  at  least  six 
months  after  all  symptoms  have  disappeared; 
and  retain  the  plaster  support  for  some 
time  after  that. 

If  the  skiagram  reveals  foci  of  infection 
not  communicating  with  the  joint,  these  foci 
should  be  excised  or  the  affected  bone 
removed.  Operation  is  not  otherwise  indi- 
cated unless  the  disease  is  not  amenable  to 
conservative  treatment,  when  astragalec- 
tomy  is  usually  preferable  to  gouging. 
Amputation  is  resorted  to  only  as  a life- 
saving necessity. 

For  the  treatment  of  abscess  and  sinuses, 
see  under  Pott’s  Disease  and  under  Hip 
Disease. 

For  the  auxiliaiy  or  adjuvant  treatment, 
see  under  Knee  Tuberculosis.  In  employing 
Bier’s  passive  hyperaemia,  apply  the  constric- 
tion above  the  knee. 

“ Motion  in  an  ankylosed  joint  may 
be  restored  by  the  removal  of  the  astrag- 
alus.” (Whitman.) 

Ankle  Sprain. — Exclude  fracture  by  means 
of  the  X-ray  {q.v.  in  Part  1). 

I.  Qibney=Whitman  Treatment. — If  much  pain 
and  swelling  are  present,  apply  firm,  even 
compression  by  means  of  absorbent  cotton 
and  a cloth  or  light  plaster  bandage  {q.v.) 
extending  from  the  toes  to  the  knee.  The 
plaster  .should  be  split  down  the  front  so  that 
it  may  be  removed.  Massage,  hot  air  (see 
under  Arthritis),  alternate  hot  and  cold 
douches  and  static  electricity  are  useful 
adjuvant  measures  in  promoting  the  absorp- 
tion of  fluid. 

Later,  when  the  acute  symptoms  have 
somewhat  subsided  (or  iimnediately  in 
moderate  cases),  apply  Whitman’s  niodifica- 
tion  of  Gibney’s  adhesive  plaster  strapjiing. 
After  shaving  the  parts,  apply  one  end 
of  a two-inch  wide  strip  of  adhesive 
plaster  to  the  lateral  aspect  of  the  log  just 
below  the  knee  (to  the  outer  aspect  if  the 
inner  side  of  the  ankle  is  sprained,  to  the 
inner  aspect  if  the  outer  side  is  sj^rained); 
carry  the  strip  down  the  leg,  “ over  the  malle- 
olus, Ix'neath  the  heel  and  arch,  and  up  the 
other  side  to  a point  opposite  the  beginning. 


where  it  is  fixed  by  a circular  band  about 
the  calf.”  Tension  should  be  made  upon 
the  plaster  while  applying  it,  so  as  to  hold  the 
foot  slightly  toward  the  injured  side.  Rein- 
force the  first  band  “ by  one  or  more  so  that 
the  lateral  aspect  of  the  ankle  is  completely 
covered.”  Then  enclose  the  entire  ankle 
with  snug,  overlapping  figure-of-eight  turns, 
leaving  exposed  the  heel,  ball  of  the  foot, 
and  toes.  ■ Then  apply  a snug  bandage  from 
the  toes  to  below  the  knee;  and  allow  the 
patient  to  walk. 

Change  the  adhesive  plaster  once 
every  week  or  two  for  five  or  six  weeks, 
and  massage  the  parts  vigorously  before 
each  reapplication. 

In  chronic  sprain  (exclude  tuberculosis 
and  arthritis  deformans),  first  overcorrect 
any  deformity  present,  under  anaesthesia  if 
necessary,  and  fix  thus  in  plaster  until  all 
pain  has  vanished,  at  the  same  time  allowing 
the  patient  to  walk.  Then  employ  massage, 
linmients,  hot  air,  etc.,  and  if  necessary, 
some  form  of  light  support.  Apply  a foot 
brace  if  flat-foot  is  present  (see  Weak  Foot). 

2.  Bristow  Treatment. — With  the  patient  ly- 
ing upon  a couch,  the  knee  is  semifiexed 
over  a sandbag,  and  one  electrode  of  an 
induction  coil  (a  4 by  3 inch  metal  plate 
covered  with  moistened  lint)  is  placed  be- 
neath the  knee.  The  other  electrode,  con- 
•sisting  of  a small  metallic  chsc,  is  held  in  the 
operator’s  left  hand,  while  the  right  hand 
fully  withdraws  the  soft  iron  core  of  the 
prunary  coil.  The  electrode  is  then  pressed 
firmly  over  the  peronei  muscles,  the  patient 
being  told  to  relax  all  his  muscles,  and  the 
iron  core  is  gradually  inserted  and  gradually 
withdrawn,  the  insertion  causing  a slow 
muscular  contraction  and  the  withdrawal 
a slow  relaxation.  After  exercising  the 
peronei  for  two  or  three  minutes,  the  anterior 
tibial  muscles  are  next  treated  in  the  same 
manner.  The  patient  is  then  allowed  to 
stand  and  to  walk. 

The  treatment  is  repeated  daffy,  together 
with  massage,  at  first  light.  “ The  patient 
should  be  walking  well  in  four  or  five  daj’S, 
and  leave  off  treatment  in  a fortnight.”  No 
bandaging  or  strapping  is  used. 

Chronic  sj^rain  is  treated  in  the  same  way. 
If  the  adhesions,  however,  “ fail  to  give  wa}^ 
after  a short  course  of  treatment,  they  should 
be  broken  down  under  an  antesthetic,  and 
treatment  begun  again  at  once.” 

For  pain,  one  may  employ  antiphlogistine 
or  cataplasma  kaolini,  or  ionization  {q.v.  in 
Part  1)  using  a 2 per  cent,  solution  of  sodium 
salicylate,  with  as  large  a milliamperage  as 
can  be  borne,  for  not  less  than  forty  minutes, 


ARTHRITIS;  SYNOVITIS;  JOINT  AFFECTIONS 


every  other  day,  unless  the  skin  becomes 
affected. 

Ankles,  Swollen. — Reduce  the  weight  if 
this  is  causative  (consult  Obesity,  in  Part  1). 
Support  weakened  arches  (see  Weak  Foot). 
Employ  local  massage,  and  compress  the 
parts  by  strapping  and  bandaging.  In 
obstinate  cases  the  swollen  tissues  may  be 
removed. 

Ankle  Tuberculosis.  — See  Ankle  Joint 
and  Tarsal  Tuberculosis. 

Weak. — See  Weak  Foot. 

Ankylosis. — Gr.  ayKvXr]  noose;  ayKvXusis. 
Active  and  passive  motion,  massage,  the 
application  of  antiphlogistine  or  cataplasma 
kaolini,  and  ionization  {q.v.  in  Part  1)  with 
sodium  chloride  or  sodimn  salicylate,  with  a 
milliamperage  of  60  to  80  to  100,  for  thirty 
minutes,  at  first  thrice  weekly,  and  later 
twice  and  once  weekly,  are  all  of  service. 

In  cases  not  amenable  to  the  above  treat- 
ment, one  may  resort  to  forcible  manipula- 
tions under  amesthesia,  followed,  if  deemed 
advisable,  by  the  injection  of  sterile  olive 
oil  or  vaseline  into  the  joint.  If  necessary, 
the  joint  may  be  opened,  adhesions  separated, 
oil  injected,  and  the  joint  closed.  In  intract- 
able cases,  one  may  transplant  into  the 
joint  a flap  of  fat  and  fascia  (Murphy);  or 
the  chromicized  submucosa  of  the  pig’s  blad- 
der (Barr) ; or  silver  unpregnated  fascia  lata 
(Allison  and  Brooke);  or  the  joint  may  be 
excised.  Where  there  is  firm  ankylosis, 
osteotomy  is  sometimes  required  to  correct 
deformity.  Artificial  supports  may  be  useful. 
See  also  under  Wounds,  in  Part  1,  General 
Medicine  and  Surgery. 

Anterior  Metatarsalgia.— L.  anter'ior,  fore- 
part; Gr.  nera  after  -|-  Taper 6s  tarsus  -f  aXyos 
pain.  Synonym.— Morton’s  painful  affection 
of  the  foot. 

This  affection  is  characterized  by  attacks 
of  cramp-like  pain  in  the  region  of  the  heads 
of  the  third  and  fourth  metatarsal  bones, 
due  to  weakness  or  depression  of  the  anterior 
metatarsal  arch  with  resulting  pressure  iipon 
the  plantar  nerves. 

Treatment.— The  shoes  should  be  sufficiently 
broad.  A bevelled  felt  or  leather  pad,  about 
three-eighths  of  an  inch  thick  and  an  inch 
across,  may  be  worn  behind  the  heads  of  the 
metatarsals,  i.e.,  just  behind  the  middle  of 
the  ball  of  the  foot,  and  fastened  to  the  foot 
by  a broad  band  of  adhesive  plaster;  or, 
better,  a metal  plate,  made  from  a plaster 
model  of  the  sole  of  the  foot  (see  under  Weak 
Foot),  from  which  sufficient  plaster  is  scraped 
away  beneath  the  depressed  area,  may  be 
worn.  The  plate  should  also  support  the 
longitudinal  arch.  Massage  and  forcible 
50 


plantar  flexion  of  the  toes  should  at  the  same 
time  be  practiced  systematically  for  the 
purpose  of  strengthening  the  foot.  Wlien  the 
latter  has  been  accomplished  (after  a few 
months),  the  brace  may  be  discarded. 

In  occasional  rigid  cases,  forcible  manipu- 
lation under  anaesthesia  may  be  required 
before  a brace  can  be  worn. 

In  rare,  intractable  cases,  the  head  and 
neck  of  the  involved  metatarsal  bone  may 
be  resected  through  a dorsal  incision. 

Anterior  Poliomyelitis,  Acute. — See  Part 
1,  General  Medicine  and  Surgery. 

Arm,  Obstetrical  Paralysis  of  the. — L.  oh, 
in  front  of  -F  sto,  I stand.  See  Brachial 
Plexus  Paralysis,  in  Part  1. 

Arthritis;  Synovitis;  Joint  Affections.— 
Gr.  apdpov  joint  -|-  -ltls  inflammation;  avv 
with  <I)6v  egg;  synovia  = the  mucinous, 
viscid  fluid  of  a joint-cavity,  bursa,  or 
tendon-sheath.  Etiological  Classification. — 1. 
Infection. — Rheumatic  fever,  gonorrhoea, 
tuberculosis,  syphilis,  scarlet  fever,  measles, 
mumps,  smallpox,  typhoid  fever,  malta 
fever,  influenza,  epidemic  cerebro-spinal 
meningitis,  pneumonia,  diphtheria,  dysen- 
tery, malaria,  dengue,  septico-pysemia,  puer-. 
peral  infection,  infectious  epiphysitis,  osteo- 
myelitis, tonsillitis,  pharyngitis,  pyorrhoea 
alveolaris,  dental  caries,  sinusitis,  otitis 
media,  bronchitis,  pelvic  inflammatory  dis- 
ease, posterior  urethritis,  prostatitis,  seminal 
vesiculitis,  infected  umbilical  cord,  appendi- 
citis, etc.  The  organisms  met  with  are  the 
gonococcus,  pneumococcus,  influenza  bacil- 
lus, streptococci,  and  staphylococci. 

2.  Toxemia  (?). — Diphtheria  antitoxin, 
exophthalmic  goitre,  Raynaud’s  disease, 
angioneurotic  oedema,  scleroderma,  gout, 
arthritis  deformans,  withdrawal  of  morphine 
in  morphinism,  intestinal  putrefaction,  men- 
strual irregularities,  chronic  suppuration, 
chronic  pulmonaiy,  cardiac,  and  renal  dis- 
ease, chronic  jaundice,  chronic  diarrhoea. 

3.  Hemorrhagic  Diathesis. — Hsemo- 

phila,  purpura,  scurvy. 

4.  Neuropathy. — Locomotor  ataxia,  sy- 
ringomyelia, dementia  paralytica,  acute 
myelitis,  hemiplegia,  hysteria. 

5.  Trauma. — External  violence,  pinching 
of  an  hypertrophied  synovial  villus,  impac- 
tion of  a floating  or  loose  body  within  the 
joint,  dislocation  or  fracture  of  a semilunar 
cartilage  of  the  knee-joint,  overweight, 
strains  induced  by  genu  valgum,  slipping 
patella,  weak  foot,  hyperplasia  of  fatty 
tissue  within  the  knee-joint,  epilepsy. 

6.  Miscellaneous  — Passive  congestion, 
sarcoma  of  the  joint  capsule  (blood-stained 
fluid  is  obtained  on  aspiration). 


ARTHRITIS;  SYNOVITIS;  JOINT  AFFECTIONS 


A.  Treatment  of  Acute  Infectious  Arthritis. — 
The  symptoms  are  pain,  swelling,  heat,  red- 
ness, and  disability. 

(a)  Early  Painful  Stage. — Put  the 
patient  to  bed  on  a light  diet,  open  the 
bowels  with  calomel,  followed  by  a saline 
(see  Part  11),  apply  a 25  to  40  per  cent, 
ichthyol  ointment,  together  with  compres- 
sion, and  immobilize  the  joint,  using  splints, 
if  need  be.  A hght  posterior  wire  splint 
may  be  employed;  for  the  hip,  a light 
Thomas  hip  brace  {q-v.).  Apply  heat  or 
cold,  as  preferred.  See  that  the  limbs  are 
kept  straight,  employing  traction  {q.v.  under 
Fracture)  if  necessary,  especially  in  inflam- 
mation of  the  hip-joint,  in  which  flexion 
and  adduction  of  the  thigh  favors  spon- 
taneous dislocation  when  the  joint  is  sud- 
denly distended  with  fluid  (should  this  occur, 
replace  the  parts  as  soon  as  possible,  before 
adhesions  and  contraction  have  occurred, 
employ  traction  in  bed,  and  later  apply  a 
short  spica  plaster  bandage  with  the  hip 
abducted  and  extended). 

Should  the  joint  become  acutely  dis- 
tended, and  constitutional  symptoms  super- 
vene, aspirate  the  joint.  If  the  fluid  with- 
drawn is  seropurulent,  the  joint  should  be 
opened.  If  it  is  the  knee-joint,  make  two 
lateral  longitudinal  incisions,  or  else  a 
U-shaped  incision,  beginning  on  the  side, 
well  above  the  patella  and  extending  down 
and  across  the  patellar  tendon,  dividing  the 
latter,  and  then  up  on  the  opposite  side  to 
well  above  the  patella  again;  turn  up  the 
patella  and  flex  the  knee.  Irrigate  the  joint 
with  hot  normal  salt  solution  (3i  ad  Oi), 
and  close  the  incision,  or  insert  a silk  seton, 
down  to  but  not  into  the  joint,  for  temporary 
drainage.  (Consult  also  Wounds,  in  Part  1). 
Discontinue  drainage  as  soon  as  the  acute 
symptoms  have  subsided,  and  begin  gentle 
active  and  passive  movements,  massage, 
and  hydrotherapy.  Good  functional  results 
may  be  expected,  if  early  and  free  drainage 
is  established;  but  loss  of  growth  may 
result  in  chikh-en.  In  suppurative  hip 
disease,  following  recovery  the  thigh  should 
be  supported  by  a splint  in  extension  and 
abduction  in  order  to  prevent  displacement. 

The  prmiary  cause  of  the  arthritis  (gonor- 
rhoeal urethritis,  etc.,  etc.)  should,  of  course, 
receive  due  attention. 

(b)  After  the  Subsidence  of  Acute 
Symptoms. — For  the  purpose  of  promoting 
the  absorption  of  exudate,  employ  active 
hypera'inia  for  thu’ty  to  sixty  minutes  daily, 
by  means  of  hot  air,  at  a temperature  of 
about  250°  or  300°  F.  (see  Fig.  114;  cover 
the  part  to  be  treated  with  three  thicknesses 


of  loose-meshed  Turkish  towelling;  allow 
the  oven  to  cool  before  removing  the  joint); 
or  sand  and  mud  baths,  the  Paquelin  caut- 
ery, electric  light  baths,  high  frequency  cur- 


rents, static  electricity  (see  Medical  Elec- 
tricity in  Part  1),  alternate  hot  and  cold 
douches,  passive  hyperaemia  (see  under  Knee 
Tuberculosis),  and  most  important  of  all, 
functional  use. 

In  cases  in  which  persistent  distention  of 
the  joint  with  sero-fibrinous  fluid  continues, 
open  the  joint,  irrigate  with  hot  normal 
saline  solution,  and  close  the  wound  or 
insert  a silk  seton  for  temporary  drain- 
age. Resort  to  active  and  passive  manipula- 
tions, massage  and  hydrotherapy  as  soon 
as  permissible. 

For  ankylosis,  due  to  adhesions  and  thick- 
ening of  tissues,  consult  Ankylosis;  and 
also  Wounds,  in  Part  1 — Sir  Robert  Jones’s 
recommen  dations . 

Old  dislocations  of  the  hip  following  sup- 
puration should  be  treated  by  Lorenz’s 
method  employed  in  congenital  dislocation 
of  the  hip. 

B.  Treatment  of  Hasmarthrosis. — Employ  ab- 
solute quiet,  immobilization,  and  gentle  com- 
pression with  the  limb  elevated,  followed 
after  a few'  days  by  gentle  massage  proximal 
to  the  joint,  but  not  to  the  joint  itself.  If 
contracture  occurs,  bring  about  gradual 
extension  by  means  of  an  adjustable  splint, 
or  a plaster  splint  frequently  reapplied. 
For  the  treatment  of  the  constitutional 
cause,  consult  Part  1 on  General  Medicine 
and  Surgery. 

C.  Treatment  of  Neuropathic  Arthritis. — In 
the  early  stages,  w'ith  much  effusion  into  the 
joint,  employ  w'eight  extension  and  fixation 
(see  Buck’s  extension.)  Aspirate  the  joint, 
if  need  be.  Later  employ  immobilization 
and  relief  from  the  body  w'eight  by  means 
of  ambulatoiy  splints.  In  trophic  ulcera- 
tion, sequestra  may  have  to  be  removed, 
or  even  amputation  performed.  To  prevent 


ARTHRITIS  DEFORMANS 


ulceration,  etc.,  all  traumatism,  due  to  ill- 
fitting  shoes,  etc.,  should  be  avoided. 

(See  Gangrene  of  the  Skin,  Part  5,  on 
Skin  Diseases,  for  other  causes  of  apparently 
spontaneous  necrosis.) 

In  hysteric  or  neurotic  joints,  support  of 
the  jomt  (spine,  see  Neurotic  Spme,  sacro- 
iliac joints,  see  Sacro-iliac  Affections,  feet  and 
knees),  when  relaxed,  by  means  of  adhesive 
plaster  strapping,  plaster-of-Paris  or  light 
braces,  is  often  very  beneficial.  Weak  foot 
{q.v.)  should  be  appropriately  treated.  Good 
hygiene,  rest,  exercise,  tonics,  stomachics, 
and  psychotherapy  are  important  (consult 
Hysteria,  in  Part  1). 

D.  Treatment  of  Traumatic  Synovitis. — Trau- 
matic synovitis  is  manifested  by  the  effusion 
of  fluid  within  the  jomt,  which,  when  in  suf- 
ficient amoimt,  causes  floating  of  the  patella. 

Elevate  and  splint  the  joint,  and  apply 
ice-bags  or  wet  compresses.  After  the  pain 
has  subsided,  place  a pad  of  cotton-wool  in 
the  popliteal  space,  draw  a close-fitting 
stocking  leg  over  the  knee,  strap  the  joint 
with  circular  bands  of  adhesive  plaster  as 
tightly  as  comfort  will  permit,  and  allow 
the  patient  up.  Renew  the  strapping  as  the 
swelling  diminishes,  until  cured  (Whitman). 
“A  simple  synovitis  should  recover  in  three 
to  six  weeks,”  says  H.  L.  Taylor. 

In  persistent,  intractable  synovitis,  open 
the  joint,  as  directed  above,  irrigate  it  with 
hot  normal  saline  solution,  5i  ad  Oi,  apply 
tincture  of  iodine  or  carbolic  acid,  and  close. 
As  soon  thereafter  as  pennissible,  employ 
active  and  passive  movements,  massage,  hot 
air,  (see  above),  etc.  For  troublesome  cases, 
use  a supporting  brace  which  limits  antero- 
posterior motion  and  prevents  lateral  motion. 

For  the  treatment  of  hypertrophy  of  the 
synovial  membrane  and  villi,  consult  Villous 
Arthritis ; for  loose  boches  within  the  joint,  for 
dislocation  of  a semilunar  cartilage,  and  for 
slipping  patella,  consult  the  appropriate  cap- 
tion; and  for  hyperplasia  of  fatty  tissue 
within  the  joint,  see  Lipoma  of  Joints  and 
Tendon  Sheaths. 

Arthritis,  Atrophic  of  Children. — Gr.  a neg. 
+ Tpo(f)T)  nourishment.  See  Still’s  Disease. 

Arthritis  Deformans. — Gr.  apdpov  joint  -|- 
-LTLs  inflaimnation ; L.  defor'mans,  deforming. 
Under  this  caption  are  included  several 
varieties  of  joint  affection  which  are  possibly 
separate  and  chstinct  diseases. 

The  onset  may  be  acute,  but  is  much  more 
commonly  gradual.  The  acute  cases  re- 
semble rheumatic  fever,  with  the  difference 
that  in  arthritis  deformans  some  permanent 
change  in  the  joint  is  left  after  the  acute 
disturbance  has  subsided.  (T.  McCrae.) 


Two  types  of  the  affection  are  distin- 
guished, an  atrophic  type  (rheumatoid 
arthritis),  and  a hypertrophic  type  (osteo- 
arthritis, rheumatic  gout,  spondylitis  defor- 
mans (q.v.,),  morbus  coxae  senihs,  villous 
arthritis  {q.v.),  Heberden’s  nodes  or  enlarge- 
ment of  the  articular  ends  of  the  terminal 
phalanxes  of  the  fingers). 

In  the  atrophic  type,  which  is  practically 
always  polyarticular,  of  insidious  onset,  and 
without  fever,  the  important  changes  are  as 
follows,  viz.,  capsular  infiltration,  atrophy 
and  erosion  of  the  articular  cartilage  and 
bone,  with  pain  and  crepitation  on  motion, 
tendency  to  flexion  and  subluxation  deform- 
ity, muscular  atrophy  especially  marked  in 
the  interossei  of  the  hand,  and  stiffness  of  the 
joints  due  to  muscle  sjjasm,  more  rarely  to 
ankylosis.  The  similar  affection  which 
occurs  before  the  fifteenth  or  twentieth 
year  of  life  is  probably  Still’s  disease  {q.v.). 

In  the  hypertrophic  type,  which  is  mon- 
articular or  polyarticular,  of  gradual  onset, 
and  usually  without  constitutional  sjonp- 
toms,  the  unportant  changes  are  as  follows, 
viz  , hypertrophy  of  the  articular  bone  ancl 
cartilage  with  resulting  pain  on  motion, 
often  creaking  in  the  joint,  impairment  of 
mobility,  muscular  atrophy,  a wearing  away 
of  the  weight-bearing  parts  with  the  forma- 
tion of  osteophytes  around  the  periphery, 
and  sometimes  the  occurrence  in  the  hip  and 
knee  joints  of  loose  bodies  consisting  of 
detached  pieces  of  hypertrophied  cartilage. 
Flatulence  and  constipation  are  often  com- 
plained of.  Senile  coxitis  may  be  marked 
by  sciatic  pain. 

The  diagnosis  is  much  aided  by  the  X-ray 
{q.v.  in  Part  1). 

Etiology.— Depressing  physical  and  mental 
influences,  grief,  fear,  shock,  physical  or 
mental  strain,  nervous  debility,  the  climac- 
terium, etc.,  are  cited  as  possible  causes  of 
the  atrophic  form,  and  occupational  or  other 
form  of  traumatism  and  exposure  as  causes 
of  the  hypertrophic  form. 

Since  it  is  possible  that  infection  or  tox- 
aemia may  be  a factor,  a careful  search  should 
be  made  for  foci  of  disease,  e.g.,  carious 
teeth,  abscess  at  the  root  of  a tooth,  pyorrhoea 
alveolaris,  tonsillar  infection,  nasal  suppur- 
ation, sinusitis,  otitis  media,  bronchitis, 
cholecystitis,  appendicitis,  ulcer  of  the  diges- 
tive tract,  rectal  ulceration,  dysentery,  indi- 
gestion, mtestinal  putrefaction,  genito-urinary 
infection,  prostatitis,  spermatocystitis,  pel- 
vic inflammatory  disease,  tuberculosis,  etc. 
Defective  metabolism  may  be  causative. 

Treatment. — A.  The  Atrophic  Type. — En- 
join an  out-of-door  life,  preferably  in  a dry, 


ARTHRITIS  DEFORMANS 


equable  climate,  such  as  that  of  southern 
California,  upper  Egj'pt,  or  Algiers,  frequent 
loathing,  warm  clothing  frequently  changed, 
woolen  socks  at  night,  a dry,  well-ventilated 
house,  fresh  air  at  night,  avoiding  draughts, 
regular  hours  of  eating  and  sleeping,  rest 
before  and  after  meals,  free  bowel  activity, 
systematic  exercise  of  the  joints  stopping 
short  of  fatigue  (knitting  and  piano-playing 
for  the  fingers,  the  use  of  weights  and  pulleys 
for  the  shoulders,  supination  and  pronation 
of  the  forearm,  bicycling  for  the  knees,  use 
of  the  Zander  machine,  the  army  setting-up 
exercises),  and  finally,  an  abundant,  mixed 
diet,  viz.,  milk,  buttermilk,  kifolac,  cream, 
olive  or  cottonseed  or  codliver  oil,  cocoa, 
eggs,  suet  puddings,  bacon,  meats,  cereals, 
fresh  green  vegetables,  plenty  of  water,  etc., 
but  excluding  alcohol,  sweets,  acids,  oat- 
meal, rhubarb,  tomatoes,  asjiaragus,  and 
acid  fruits.  General  gentle  massage,  vibras- 
age,  and  oil  inunctions,  practiced  two  or 
three  times  a week,  are  veiy  beneficial. 
Tonics  of  iron,  arsenic,  mix  vomica,  quinine 
and  glycerophosphates  may  be  useful  (see 
Drugs,  Part  11).  Guaiacol  carbonate  for  a 
prolongetl  period  is  strongly  recommended 
as  an  intestinal  antisejitic,  hych’ochloric  acid 
for  impaired  digestion.  Guaiacum  and  sul- 
phur are  highty  praised.  “Potassium  iodide, 
alkalies,  salicylates,  strenuous  bathing,  and 
low  cUet  should  be  avoided.”  (-Author-.?-). 

Curtailment  of  carbohydrates  is  said  to 
relieve  symptoms  (Pemberton). 

Locally  one  should  employ  stumilatiye 
measures,  e.g.,  hot  saline  compresses,  hot 
mud  or  sand-baths,  vapor  baths,  sun  or 
electric  light  baths,  hot-air  baking  (350°  F. 
for  twenty  to  thirty  minutes,  about  once  a 
day  in  severe  cases,  otherwise  two  or  three 
times  a week,  see  under  Arthritis),  alternate 
hot  and  cold  douches,  the  Paquelin  cautery, 
high-frequency  currents.  Bier’s  hyperaemia 
(for  one  hour  at  a time  at  fii-st,  then  rapidly 
increased  to  eight,  to  twelve,  to  twenty 
hours;  see  Knee  Tuberculosis),  rubber  tissue 
wrapped  about  the  joint,  deep  massage  above 
the  joint,  passive  movements,  and  resistance 
exercises. 

Ionization  (see  Part  1),  is  recommended. 
Large  pads  closely  adapted  to  the  joint  and 
attached  to  the  negative  pole  are  used.  The 
electrolytes  employed  are  sodium  salicydate, 
chloride,  and  iodide,  2 per  cent.  The  cur- 
rent is  gradually  raised  to  30  to  40  to  70, 
even  to  200  milliamperes,  and  is  allowed  to 
act  for  twenty  to  thirty  minutes.  The 
stronger  currents  should  not  be  repeated 
oftener  than  twice  weekly,  for  fear  of  the 
production  of  burns.  Chlorine  and  iodine 


ions  are  said  to  be  particularly  useful  in 
clearing  up  ankylosis. 

Deformity  should  be  corrected,  either  at 
once,  under  ana;.sthesia  if  necessary,  using 
only  moderate  force,  or  gradually,  by  a 
series  of  plaster  splints  as  in  the  correction  of 
congenital  club-foot  (q.v.).  Tenotomy  and  the 
genuclast  are  somethnes  required.  After  the 
deformity  has  been  corrected,  the  joint  should 
be  fixed  in  plaster  of  Paris  (q-v.)  according  to 
Goldthwait,  Painter,  and  Osgood,  for  a week 
or  longer,  but  T.  McCrae  says  that  passive 
movements  should  be  resorted  to  within 
twenty-four  hours.  A caliper  splint  or  a split 
plaster  splint  should  be  worn  during  the  day, 
with  crutches,  if  necessaiy,  and  a split  plaster 
splint  at  night,  until  the  deformity  no  longer 
tends  to  recur.  The  stimulative  measures 
enimierated  above  should  not  be  neglected. 

To  aid  in  the  painless  mobilization  of  stiff 
joints,  one  may  inject  sterile  oil.  If  all  other 
measures  fail,  one  may  introduce  into  the 
joint  a flap  of  fat  and  fascia  (Murphy),  etc. 
(see  Ankylosis),  or  excise  the  joint.  Hyper- 
trophied villi  sometimes  require  removal. 

All  active  treatment  should  be  witlilield 
in  the  presence  of  local  heat  and  swelling. 
In  these  acute  phases,  the  patient  should  be 
jiut  to  bed  and  the  joints  supported  with 
cotton  and  s{ilints.  Relief  may  be  afforded 
by  the  application  of  cold  or  hot  wet  com- 
presses, mustard  poultices,  tincture  of  iocUne, 
guaiacol,  one  part,  and  tincture  of  iodine,  six 
parts;  oil  of  wintergreen;  oil  of  wintergrecn. 
ten  parts,  spirits  of  menthol,  five  parts,  and 
elastic  collodion,  five  parts;  alcohol,  iodine- 
vasogen,  or  unguentum  iodi,  unguentum  cap- 
sid (see  Part  11);  a 20  per  cent,  alcoholic 
solution  of  salicylic  acid  containing  a few 
drops  of  chloroform,  chloroform  liniment,  the 
Paquelin  cautery,  or  repeated  small  blisters 
(see  Part  11).  Internal  analgesics  include 
aspirin,  pyramidon,  phenacetin,  antip3Tine, 
guaiacol  carbonate,  codeine,  and  ether  bj’ 
inhalation  for  fifteen  minutes. 

Faithful  treatment,  piu'sued  over  a long 
period  of  time,  can  be  expected  to  produce 
material  unprovement  and  sometimes  a 
cure  results. 

B.  The  Hypertrophic  Type. — The  treat- 
ment is  in  everv  respect  the  same  as  that  of 
the  atrojihic  t>'pe,  with  the  important  excej> 
tion  that  the  joints  should  be  adequatel}' 
protected  against  friction,  pressure,  strain, 
and  other  forms  of  trauma,  including  passive 
movements,  ly  fixation  in  plaster  or  leather 
splints,  with  the  object  of  promoting  the 
absorption  of  hypertrophied  bone  and  carti- 
lage. For  the  hands,  one  may  employ  “stout 
and  loosely  fitting  kid  gloves  reinforced  on 


VELPEAU’S  BANDAGE 


their  palmar  surface  by  light  steels  ’ ’ (Gold- 
thwait,  Painter,  and  Osgood) ; for  the  hip- 
joint,  a Thomas  walking  caliper  splint;  for 
the  spine,  a plaster  jacket  or  brace  (see  Spon- 
dylitis Deformans).  Flat-foot,  if  present, 
should  be  corrected  (see  Weak  Foot).  In 
senile  coxitis,  after  preluninary  traction  in 
bed,  (see  Buck’s  Extension),  to  reduce 
deformity,  a short  spica  is  applied  and  the 
patient  gotten  up  on  crutches,  or  else  a hip- 
splint,  jointed  at  the  knee,  employed.  In 
extreme  cases,  Albee’s  operation  to  produce 
ankylosis  is  justifiable,  for  the  relief  of  pain. 
Osteotomy  is  sometimes  required  to  correct 
deformity  where  there  is  firm  ankylosis. 

The  disease  shows  a tendency  to  self- 
limitation which  is  favored  by  protective 
treatment.  The  latter  serves  to  prevent  the 
occurrence  of  acute  symptoms  and  con- 
serves mobility. 

Arthritis  Deformans  of  the  Spine,  Hy= 
pertrophic.  — See  Spondylitis  De- 
formans. 

Gonorrhoeal  — Gr.  yovri  semen  peiv  to 

flow.  See  Arthritis. 

Haemophiliac. — ^Gr.  aipa  blood  + <t>L\€iv 
to  love.  See  Arthritis. 

Infectious,  Acute. — L.  infec'tio.  See 
Arthritis. 

Chronic. — See  Arthritis  Deformans. 
Still’s. — See  Still’s  Disease. 

Neuropathic. — Gr.  vevpov  nerve  + -irados 
disease.  See  Arthritis. 

Pneumococcus. — Gr.  Trrevp.<j:v  lung  -|- 
KOKKos  berry.  See  Arthritis. 

Purulent. — L.  pus,  pair'is,  pus.  See 
Arthritis. 

Rheumatoid. — Gr.  pevpa  flux  -|-  eidos 
form.  See  Aidhiitis  Deformans. 

Still’s. — See  Still’s  Disease. 

Suppurative. — L.  sub,  under  pus, 
pur'is,  pus.  See  Arthritis. 

Toxic. — Gr.  ro^ucoi' poison.  See  Arthritis. 

Traumatic. — Gr.  rpadpa  wound.  See 
Under  Arthritis. 

Villous. — See  Villous  Arthritis. 

Astragalus,  Fractures  of  the. — L. ; Gr. 
acTTpayoXos  die.  See  Fractures  of  the  Tarsal 
Bones. 

Atrophic  Arthritis  of  Children. — Gr.  a neg. 

Tpo(^i5  nourishment.  See  Still’s 
Disease. 

Type  of  Arthritis  Deformans. — See 

Arthritis  Deformans. 

Backache.  See  Part  1,  General  Medicine 
and  Surgery. 

Back,  Hump. — See  Kyphosis. 

Knee. — See  Genu  Recurvatum. 

Round. — See  Kyphosis. 

Stiff. — See  Stiff  Back. 


Bandages,  Plaster,  How  to  Prepare. — See 

Plaster  Bandages,  How  to  Prepare. 

Bandaging. 

Barton’s  Bandage. — Figure-of-8  of  the 
jaw  and  occiput.  Start  the  bandage  behind 
the  right  ear,  carry  it  obliquely  forward 
across  the  top  of  the  head,  down  the  left 
side  of  the  face  in  front  of  the  ear,  under 
the  chin,  up  the  right  side  of  the  face  in 
front  of  the  ear,  obliquely  backward  across 
the  top  of  the  head  over  the  left  parietal 
bone,  under  the  occiput  around  to  and 


across  the  front  of  the  chin,  horizontally 
around  the  neck  and  to  the  starting  point  be- 
hind theiright  ear.  Repeat  these  turns  and  In- 
sert pinsatthejunctionpoints.  (See Fig.  115). 

Four=Tailed  Bandage  to  the  Chin. — Place 


Fio.  111). — Four-tailed  bandage  to  the  chin. 


the  centre  of  the  bandage  (Fig.  116)  to  the 
chin;  bring  the  two  under  tails  up  over  the 
top  of  the  head  well  forward  and  tie  them 
there  tightly;  then  bring  the  two  upper  tails 
back  and  tie  them  tightly  over  the  lambda; 
then  tie  these  two  knots  together. 

Velpeau’s  Bandage. — Place  the  palm  of 
the  hand  upon  the  opposite  shoulder,  with 
cotton  interposed  between  opposing  skin 


BOW-LEG;  GENU  VARUM 


surfaces.  Start  the  bandage  posteriorly  at 
the  axilla  of  the  sound  side,  carry  it  obliquely 
upward  across  the  back  to  and  over  the 
shoulder  of  the  injured  side,  down  the  front, 
around  the  elbow,  up  the  back  to  and  over 
the  shoulder  of  the  injured  side,  across  the 
front  of  the  chest,  around  the  sound  side 
internal  to  the  arm,  straight  around  the 
back  to  and  around  (including)  the  arm  of 


ease;  mteomyelitis;  osteitis  deformans;  osteo- 
malacia. Anterior  bow-leg  may  be  due  to 
hereditary  syphilis  as  well  as  to  rickets. 

Treatment.— In  slight  cases  in  children 
under  three  years  of  age,  attempt  to  correct 
the  fleformity  by  pre.ssing  the  legs  gently 
together,  with  the  ankles  together,  for  ten 
minutes  or  longer  twice  daily.  In  more 
advanced  cases,  employ  a short  brace  for 


Fig.  117. — Velpeau  modifier.  (Dulbs.) 


Fig.  118. — The  short  (Knight)  and  the  long  (Napier) 
bow-leg  braces. 


the  injured  side  low  down  straight  across 
the  front  of  the  chest  around  to  the  back 
again,  then  obliquely  across  the  back  to  the 
shoulder,  and  repeat  from  the  beginning, 
each  vertical  turn  overlapping  the  preceding 
and  approaching  the  neck,  and  each  hori- 
zontal turn  ascending.  Pin  the  turns  where 
they  cross  each  other.  (See  Fig.  117). 

Beck’s  Paste. — See  Part  11. 

Bed=Sore;  Decubitus.  See  Part  1,  Gen- 
eral Medicine  and  Surgery. 

Bennet’s  Fracture. — See  Fractures  of  the 
Metacarpal  Bones. 

Bier’s  Passive  Hypersemia. — Gr.  vwep 
over  + aLpa  blood.  See  Part  1. 

Bone  Diseases.  See  Part  1- 

Bowed  or  Flexed  Scapula. — See  under 
Bound  Shoulders. 

Bow=Leg;  Genu  Varum. — L.  gen'u,  knee; 
var'um,  bent.  Outward  bending  of  the  knee, 
or  rather,  of  the  k‘g  below  the  knee. 

Causes.— Pickets;  ejuphyseal  injuiy  or  dis- 


deformity  below  the  knee,  and  a long  brace 
for  deformity  at  the  knee  (see  Fig.  118). 

In  children  over  four  years  of  age,  one 


Fig.  1 19. — Manual  of  Osteoclasis  of  bow-leg  over 
wooden  wedge. 

must  resort  to  osteoclasis  (see  Figs.  119  and 
120,  or  linear  osteotomy  (at  the  concavity  of 
the  curve).  The  deformity  should  be  over- 


BURSITIS 


corrected,  and  the  limb  then  fixed  in  plaster 
{q.v.)  extending  from  the  toes  to  the  tro- 
chanter. At  the  end  of  three  weeks,  the 
plaster  may  be  removed  in  order  to  see  if 
the  position  of  the  limb  is  correct.  If  it  is 


Fiq.  120. — Grattan  osteoclast. 

not,  it  should  be  corrected.  Fixation  should 
be  continued  for  eight  weeks. 

Anterior  bow-leg  calls  for  osteoclasis  or 
posterior  osteotomy,  with  division  of  the 
tendo  Achillis,  if  necessary. 

Brachial  Plexus  Paralysis.  See  Part  1, 
General  Medicine  and  Surgery. 

Breast,  Chicken. — See  Pigeon-Breast. 

Funnel. — See  Funnel-Chest. 

Pigeon. — See  Pigeon-Breast. 

Brodie’s  Abscess. — L.  absces'sus,  a going 
apart.  See  Osteomyehtis,  in  Part  1. 

Bryant’s  Line. — See  Fractures  of  the  Hip. 

Buck’s  Extension. — See  Fractures  of  the 
Femur. 

Bunion. — See  Hallux  Valgus. 

Bursitis. — L. ; Gr.  ^bpaa  a sac  or  pouch  -f- 
-LTLs  inflammation.  Inflammation  of  a bursa, 
due  to  trauma  or  sepsis. 

More  than  a thousand  bursae  are  present 
throughout  the  body,  but  the  following 
are  the  most  important  from  a patho- 
logical standpoint: 

Prepatellar  bursa,  involvement  of  which 
is  commonly  known  as  housemaid’s  knee. 

Pretibial  bunsa,  situated  beneath  the 
ligamentmn  patellae.  Enlargement  on  either 
side  of  the  ligamentum  patellae  may  be  due 
to  pretibial  bursitis  or  to  hypertrophied 
synovial  fringes. 

Superficial  pretibial  or  pretubercular 
bursa.  Fracture  of  the  tubercle  should  be 


excluded  by  means  of  the  X-ray  (q.v.  in 
Part  1). 

Popliteal  bursa,  situated  in  the  popliteal 
space  beneath  the  tendon  of  the  semi- 
membranosus and  that  of  the  inner  head  of 
the  gastrocnemius. 

Gluteal  bursa,  any  one  of  the  three  bursae 
beneath  the  gluteus  maximum  muscle. 

Iliopsoas  bursa. 

Calcaneal  bursa  (see  Painful  Heel.) 

Achillar  or  retro-calcaneal  bursa  (see 
Achillobursitis). 

Subdeltoid  or  subacromial  bursa,  inflam- 
mation of  which  causes  local  pain  and  limi- 
tation of  rotation  and  abduction  of  the 
arm.  Droop  shoulder  (q.v.)  may  be  a cause, 
from  the  rubbing  and  pressure  against  the 
tuberosity  of  the  humerus  which  it  is  apt 
to  produce. 

Subcoracoid  or  coracobrachialis  bursa, 
inflammation  of  which  causes  limitation  of 
rotation.  Droop-shoulder  (q.v.)  may  also  be 
a cause  here. 

Subscapular  bursa. 

Bursa  above  the  elbow. 

The  X-ray  may  give  valuable  informa- 
tion, as  in  cases  complicated  by  the  deposi- 
tion of  lime  salts. 

Treatment.— In  early  or  acute  cases,  with 
effusion,  employ  rest,  hot  water  bags,  baking 
(see  under  Arthritis),  or  the  cautery,  or  the 
application  of  tincture  of  iodine  or  blisters,  or 
strapping,  or  aspiration.  P.  G.  Skillern,  Jr., 
praises  the  use  of  a blister  in  the  early 
stages.  “A  square  inch  of  fabric  buttered 
with  ceratum  cantharides,  U.S.P.,  or  an 
equal  area  of  a ‘ ready-to-use  ’ plaster,  is 
moistened  with  olive  oil  and  applied  over 
the  inflamed  part.  It  is  covered  with  a 
dossil  of  gauze,  which  is  secured  by  adhesive. 
The  books  say  to  remove  the  plaster  in 
four  to  six  hours,  but  practically  it  works 
out  that  as  soon  as  the  blister  has  formed, 
the  cushion  of  serum  mterposed  between 
medicament  and  dermis  automatically  inhibits 
its  vesication.  For  this  reason  the  blister  is 
removed  the  next  day  and  a dressing  of  boric 
ointment  on  sirngical  lint  applied.  Inunobil- 
ization  is  now  secured.” 

The  occurrence  of  suppuration  demands 
free  incision  and  drainage. 

In  subdeltoid  and  subcoracoid  bursitis, 
active  and  passive  movements  (the  latter 
under  anaesthesia,  if  necessary)  and  massage 
may  be  requirecl  to  overcome  subsequent 
stiffness  due  to  adhesions.  When  free  mobil- 
ity has  been  accomplished,  the  scapulae 
should  be  strapped  together  with  adhesive 
plaster  for  several  days,  and  then  active  and 
passive  movements  resumed  until  normal 


CLAVICLE,  FRACTURES  OF  THE 


mobility  is  assured.  Droop- .slioulder  {q:v.) 
should  be  cori-eeted.  In  inveterate  subcora- 
coid cases,  it  may  be  necessary  to  remove 
the  tip  of  the  coracoid  process. 

In  chronic,  intractable  bursitis  the  sac 
should  be  removed. 

Buttock  Abscess. — L.  absces'sus,  a going 
apart.  See  Pott’s  Disease. 

Calcaneobursitis. — L.  calcan'eum,  heel- 
bone;  bur'sa,  sac.  See  Painful  Heel. 

Calcaneus. — See  Talipes  Calcaneus. 

Carpal  Bones,  Dislocations  of  the. — L. 
car' pus;  Gr.  Kapirbs  wrist.  See  Dis- 
locations of  the  Wri.st. 

Fractures  of  the. — See  Fractures  of 
the  Carpal  Bones. 

Tuberculosis. — See  Tuberculosis  of  the 
Wrist. 

Carpometacarpal  Joints,  Dislocations  of 

the. — Gr.  utra.  beyond.  See  Dislocations  of 
the  Wrist. 

Cartilage,  Semilunar,  Displacement  of  a. 

■ — See  Semilunar  Cartilage,  Displacement  of  a. 

Casts,  Plaster,  How  to  Prepare. — See 
Plaster  Casts,  How  to  Prepare. 

Cavus. — (See  Hollow  or  Contracted  Foot. 

Central  Dislocation  of  the  Hip. — L.  cen'- 
trum,  centre.  See  Dislocations  of  the  Hip. 

Cerebral  Paralysis  of  Children. — L.  cer'e- 
brum,  brain;  Gr.  irapii  beside  \vtiv  to 
loosen.  The  paralysis  is  of  the  spastic  type. 
It  may  involve  only  one  side  of  the  body 
(hemiplegia,  from  Gr.  — half  -f  ir\iyyr] 
stroke),  like  parts  on  both  sides  (diplegia, 
from  Gr.  bis  twice),  or  the  lower  extremities 
alone  (paraplegia,  from  Gr.  irapa  across). 
Mental  deficiency  and  epilepsy  are  com- 
mon accompaniments. 

Etiology  —Birth  traumatism  or  asph5rxia- 
tion;  hydrocephalus;  maternal  disease  dur- 
ing pregnancy;  marantic  conditions;  “ defec- 
tive development  of  the  motor  tract,  often 
associated  with  premature  birth  ”;  syphilis; 
chronic  meningitis  ; infectious  diseases ; 
fright. 

The  underlying  lesion  may  be  embolism, 
thrombosis,  hemorrhage,  or  encephalitis,  fol- 
lowed by  atrophy,  softening,  cyst  formation, 
or  sclerosis. 

Treatment.— In  mild  cases,  taken  early, 
practice  systematic  massage  and  manipula- 
tion to  the  normal  limits  in  all  chrections, 
and  train  the  muscles  by  jnirposive  move- 
ments. A jointed  leg  brace  attached  to  a 
pelvic  band  may  be  used  for  a time  to  hold 
the  limb  in  a symmetrical  position. 

Perform  tenotomies  for  the  correction  of 
contracture — subcutaneous  tlivision  of  the 
tendo  Achillis  at  the  ankle;  division  of  the 
Iiamstrings  at  the  knee  by  an  open  incision; 


division  of  the  adductor  tendons  at  the  hip 
by  an  open  incision  or  subcutaneously; 
detachment  of  the  tensor  vaginae  femoris 
from  the  crest  of  the  iliiun;  division  of  the 
plantar  fascia. 

The  tibialis  anticus  tendon  may  be 
split  and  its  outer  half  attached  to  the 
outer  border  of  the  foot.  The  flexor  wrist 
or  knee  tendons  may  be  transplanted  to 
the  extensors. 

After  performing  tenotomy,  apply  a plas- 
ter spica  bandage  with  the  hips 

extended  and  abducted,  the  limb  rotated 
outward,  the  knees  extended,  and  the  ankles 
flexed  at  a right  angle.  Retain  the  cast  for 
at  least  six  weeks.  The  patient  may  walk 
about  in  it  if  it  is  not  too  heavy. 

Employ  massage  and  active  and  passive 
exercises  in  the  after  treatment. 

“ Relapse  to  some  extent  may  occur,  but 
very  great  permanent  improvement  is  the 
rule,  not  only  in  walking,  but  in  general  and 
intellectual  improvement,”  particularly  in 
hemiplegics,  who  are  not  apt  to  show  the 
congenital  mental  deficiency  characteristic 
of  the  diplegic  and  paraplegic.  (After 
R.  W.  Lovett.) 

(For  the  immediate  treatment  of  intra- 
cranial hemorrhage  of  the  new-born,  con- 
sult Part  1.) 

Cervical  Vertebrae,  Dislocations  of  the. — 

L.  cer'vix,  neck;  ver'tebra,  vertebra.  See 
Dislocations  of  the  Spine. 

Charcot’s  Disease. — See  under  Arthritis. 

Chest,  Chicken. — See  Chicken  Breast. 

Flat. — The  treatment  is  that  of  Round 
Shoulders  (q.v.) 

Funnel. — See  Funnel- Chest. 

Pigeon. — See  Chicken-Breast. 

Chicken=Breast ; Pigeon=Breast. — Causes. 
—Adenoids,  enlarged  tonsils,  and  other  causes 
of  respiratory  obstruction;  rickets;  dorsal 
Pott’s  disease;  paralysis  of  the  muscles  of 
the  trunk. 

Treatment. — Attend  to  the  cause.  To  cor- 
rect the  deformity,  employ  deep-breathing 
exercises  and  exercises  involving  hanging  by 
the  arms.  In  extreme  cases  one  may  exert 
pressure  by  means  of  a pad  in  front  attached 
to  a back  brace. 

The  tendency  in  simple  pigeon-chest  is 
toward  spontaneous  cure;  it  is  rarely  seen 
in  adult  life. 

Chondrodystrophia. — Gr.  cartilage 

-f-  bvs-  ill  -f  Tpoct>ij  nutrition.  See  Achondro- 
plasia, in  Part  1. 

Clavicle,  Dislocations  of  the. — See  Dis- 
locations of  the  Clavicle. 

Fractures  of  the. — See  Fractmes  of  the 
Clavicle. 


CLUB-FOOT;  TALIPES  EQUINOVARUS 


Claw=Foot. — See  Hollow  or  Contracted 
Foot. 

Clicking  Knee  in  Babies. — See  Snapping 
or  Clicking  Knee  in  Babies. 

Club=Foot;  Talipes  Equinovarus. — L.  taV- 
ipes,  club-foot;  eq'uus,  horse;  var'us,  bent 
inward.  In  the  equinovarus  posture,  the 
heel  is  elevated,  the  sole  inverted,  and  the 
front  part  of  the  foot  adducted. 

Club  foot  is  either  congenital  (rarely 
paralytic,  due  to  spina  bifida),  or  acquired. 

The  causes  of  acquired  club  foot  are  as 
follows:  paralysis  of  the  anterior  leg  muscles, 
due  to  acute  anterior  poliomyelitis,  spastic 
paralysis,  neuritis,  hereditary  ataxia,  pro- 
gressive muscular  atrophy  of  the  peroneal 
type,  pseudo-hypertrophic  paralysis,  tabes 
dorsalis,  or  traumatism;  fracture;  cicatricial 
contraction  on  the  inner  side  of  the  foot  and 
leg;  ankle-joint  disease  (tuberculosis,  arthri- 
tis deformans,  etc.);  shortening  of  the 
leg  following  injury  or  disease;  spasm  of 
the  tibial  muscles;  long  confinement  in 
bed;  hysteria. 

The  prognosis  is  good  under  carefuJ 
treatment. 

A.  Treatment  of  Congenital  CIub=Foot. — Com- 
mence treatment  when  the  infant  is  two  or 
three  weeks  old.  Very  slight  cases  may 
possibly  be  cured  by  gentle  manipulation, 
practiced  two  or  three  times  a day,  first  cor- 
recting inversion  and  adduction,  then  plan- 
tar flexion,  in  an  attempt  to  overcorrect  the 
deformity.  When  this  can  be  accomplished 
easily,  and  the  patient  has  reached  the  age 
of  two  months  (H.  L.  Taylor),  apply 
plaster-of-Paris  over  cotton  (see  Plaster 
Casts) . Remove  the  plaster  at  the  end  of  two 
or  three  weeks,  and  reapply  it,  if  necessary. 

In  most  cases,  however,  manipulation 
does  not  wholly  correct  the  deformity.  Then 
the  foot  must  be  gradually  unfolded  by  suc- 
cessive plaster  splints,  renewed  once  a week, 
correcting  first  the  varus,  later  the  equinus. 
The  plaster  splint  is  applied  as  follows:  The 
foot,  leg,  and  lower  thigh  are  bathed  with 
soap  and  water,  thoroughly  dried  and  pow- 
dered, or  else  painted  with  Heusner’s  glue 
(alcohol,  50  C.C.,  benzine,  25  c.c.,  resin, 
50  gm.,  Venice  turpentine,  5 gm.  Fiske), 
pledgets  of  cotton  are  inserted  between  the 
toes,  a band  of  cotton  is  placed  about  the 
toes,  and  a long,  smooth-fitting  stocking  is 
(hawn  over  the  foot,  leg,  and  thigh.  Over 
the  sole  is  placed  a foot-board  held  by 
adhesive  (Ridlon).  The  knee  is  then  flexed 
at  a right  angle,  and  the  foot  gently  drawn 
outward  until  resistance  is  encountered.  A 
light  plaster  bandage  extending  above  the 
knee  is  now  smoothly  applied,  and  rubbed 


until  it  is  firm.  This  is  removed  each  week, 
the  leg  cleansed,  massaged,  and  powdered, 
and  a new  bandage  applied,  with  the  foot 
each  time  further  corrected,  until  an  atti- 
tude of  e.xaggerated  abduction  is  obtained. 
Four  to  six  treatments  should  ordinarily 
correct  adduction  and  inversion;  and,  in 
three  or  four  months  from  the  beginning 
of  treatment,  complete  dorsal  flexion  should 
be  attained.  “ See  that  the  heel  descends 
as  the  forefoot  is  pushed  up.”  (Whitman). 


Fig.  121. — C.  F.  Taylor's  long  club-foot 
splint,  with  Pelvic  Band  for  outward  rotation 
of  the  foot. 

In  some  cases  the  tendo  Achillis  and  even 
the  posterior  ligament  of  the  ankle  may 
have  to  be  divided.  Fixation  in  plaster  for 
three  or  more  weeks  is  then  required. 

The  foot  should  be  supported  in  the  over- 
corrected position,  until  the  child  begins  to 
walk,  by  means  of  a strip  of  adhesive 
plaster  passed  under  the  sole  and  up  the 
outer  border  of  the  leg,  or  by  means 
of  a cast  stopping  below  the  knee,  or  a 
brace.  The  Taylor  club  foot  brace  is  used 


CONGENITAL  DISLOCATION  OF  THE  HIP 


when  the  child  walks;  and  if  the  foot 
turns  in  in  walking,  its  upright  is  extended 
and  attached  to  a pelvic  band  (see  Fig. 
119).  The  outer  bonier  of  the  sole  of  the 
shoe  should  l)e  a little  thicker  than  the  inner. 
Several  times  daily  the  foot  should  be  mas- 
saged and  moved  to  its  normal  limits  in  all 
(Urections,  and  any  inward  rotation  of  the 
leg  on  the  thigh  or  the  thigh  on  the  hip  that 
may  be  present  should  be  corrected  by 
massage  and  stretching. 

Daily  massage  and  manipulation,  and,  if 
necessary,  a brace,  may  have  to  be  con- 
tinued for  a long  time,  and  the  patient  should 
be  kept  under  observation  indefinitely. 

Some  use  metal  splints  instead  of  plaster 
in  the  correction  of  club  foot. 

In  cases  not  treated  or  not  corrected  until 
the  child  has  learned  to  walk,  it  is  probably 
best  to  correct  the  deformity  at  once  by 
modelling  over  Koenig’s  wedge-block  with 
the  subcutaneous  division  of  the  Achilles 
and  posterior  tibial  tendons,  and  if  necessary, 
the  internal  lateral  ligament  and  plantar 
fascia.  A plaster  cast  is  then  applied,  with 
the  deformity  overcorrected  and  the  knee 
flexed,  and  after  about  ten  days  or  more,  the 
patient  is  allowed  to  walk  in  plaster  boots, 
and  he  need  not  be  seen  again,  says  Ridlon, 
until  the  boots  are  worn  through,  which  may 
not  be  for  four  months.  “Some  children  are 
cured  with  one  set  of  boots;  some  must 
have  them  changed  from  time  to  time  and 
wear  them  for  eighteen  months,  and  some 
ca.ses  must  have  the  plaster  casts  carried 
above  the  bent  knees  until  on  removal  the 
feet  do  not  spring  back  into  varus  ” (Rid- 
lon). In  infants  who  can  not  be  seen  often 
enough  to  carry  out  the  gradual  treatment, 
for  instance  with  those  who  live  at  a dis- 
tance, Ridlon  delays  treatment  until  the 
child  has  learned  to  walk,  and  then  employs 
the  operative  treatment  above  described. 

In  some  cases  the  astragalus  must  be  re- 
moved to  prevent  relapse. 

In  any  case  to  prevent  relapse,  it  is  neces- 
sary to  hold  the  foot  straight  by  means  of 
the  plaster  boot  until  it  remains  straight 
(Ridlon). 

B.  Treatment  of  Acquired  Equino= Varus. -Over- 
correct  the  deformity  under  anaesthesia  by 
forcible  manipulation  and  modelling  over 
Koenig’s  wedge-block,  dividing  contracted 
parts,  if  necessary,  and  retain  in  the  over- 
corrected position  for  three  weeks,  or  if  the 
tendo  Achillis  has  been  divided,  two  months 
or  longer.  Then  employ  a Taylor  or  similar 
club-foot  brace. 

Astragalectomy,  cuneiform  osteotomy, 
tendon  transplantation  (in  cases  of  over  two 


years  duration),  and  arthrodesis  (in  those 
over  eight  years  of  age)  are  sometimes 
required  (consult  the  standard  textbooks). 

Club=Hand. — A congenital  deformity, 

sometimes  due  to  absence  or  deficient  forma- 
tion of  the  radius  or  ulna. 

Treatment. — Correct  the  deformity  by  ma- 
nipulation, with  the  division  or  transplanta- 
tion of  tendons,  if  necessary;  then  retain  in 
an  overcorrected  position  by  a plaster  cast 
for  three  weeks  or  longer,  followed  by  mas- 
sage and  muscle  training.  Bony  defects  call 
for  special  operative  measures.  (Consult 
the  standard  textbooks.) 

Colles’s  Fracture. — See  Fractures  of  the 
Radius,  the  Lower  End. 

Compound  Fractures. — See  General  Con- 
siderations, under  Fractures. 

Condyle,  External,  Fractures  of  the. — L. 
con'dylus;  Gr.  k6v8v\os  knuckle.  See 
Fractures  of  the  Elbow. 

Internal,  Fractures  of  the. — See  Frac- 
tures of  the  Elbow. 

Congenital  Contraction  of  the  Fingers. — L. 

con,  together  -f-  gm'itxis,  born;  contrac'tio, 
shortening.  Correct  the  deformity  by 
manipulation  and  splinting,  or  by  a plastic 
operation  on  the  skin  and  fascia. 

Congenital  Dislocation  of  the  Hip. — The 
dislocation  is  usually  posterior,  or  according 
to  Ridlon,  directly  upward.  Unilateral  dis- 
location is  manife.sted  by  a limp,  in  w'hich 
the  body  lunges  toward  the  affected  or  short 
side,  prominence  and  elevation  of  the 
trochanter  (above  Nelaton’s  line,  see  Hip 
Disease),  flattening  of  the  buttock,  abnormal 
mobility,  and  shortening. 

Bilateral  dislocation  is  manifested  by  a 
waddling  gait,  lordosis,  flattening  of  the 
buttocks,  separation  of  the  thighs  and 
apparent  widening  of  the  pelvis. 

In  the  rare  anterior  dislocation,  the  symp- 
toms are  much  less  marked  in  degree. 

Treatment. — Ridlon  does  not  attempt  reduc- 
tion before  the  shortening  amounts  to  an 
inch.  To  do  so,  he  says,  is  to  court  dis- 
aster. His  bloodless  method  of  replacement, 
modified  from  Lorenz,  is  as  follows:  Under 
complete  anjesthesia,  with  the  pelvis  ele- 
vated about  three  inches  upon  folded  sheets 
or  a sandbag,  and  an  assistant  holding  the 
abducted  opposite  thigh  down  upon  the 
table,  the  operator  flexes  the  dislocated 
thigh,  with  the  knee  flexed,  until,  with  the 
fingers  of  the  other  hand  on  the  head,  neck 
and  greater  trochanter  of  the  opposite  femur, 
and  the  thumb  in  front  of  the  empty 
acetabulum,  he  can  feel  the  femoral  head  at 
the  lower  part  of  the  acetabulum.  He  then 
n)tates  the  thigh  inward  and  abducts,  w'hen 


COXA  VARA 


the  head  rises  upward  (forward)  and  slips 
into  the  acetabular  socket.  When  reduction 
is  accomplished  the  thigh  lies  flexed,  abduc- 
ted, and  rotated  outward,  each  at  an  angle 
of  90  degrees,  so  that  the  outer  side  of  the 
thigh  lies  on  the  table.  Then  the  operator 
proceeds  to  ascertain  in  what  position  of  the 
thigh  the  replacement  is  the  most  secure, 
and  the  limb  is  fixed  by  means  of  a plaster- 
cast  (q.v.)  in  this  position. 

The  cast  should  be  one-half  inch  thitk 
around  the  hip  and  body  and  one-quarter 
inch  thick  on  the  limb. 

If  the  thigh  is  outwardly  rotated  the  cast 
need  not  go  below  the  knee;  but  if  the  thigh 
is  not  rotated,  the  knee  should  be  flexed  to  90 
degrees  and  the  cast  caiTied  below  the  knee. 

If  but  one  side  is  involved  and  the  cast 
extends  only  to  the  knee,  the  child  should 
walk  in  two  weeks;  if  both  hips  have  been 
replaced,  in  two  months;  and  the  child  should 
continue  to  walk  in  the  same  cast  for  eight 
months. 

If  the  cast  extends  below  the  knee,  it 
should  be  cut  off  at  the  end  of  two  or  three 
months,  so  that  the  child  can  walk,  which 
is  essential. 

Ridlon  believes  that"all  cutting  operations 
(arthrotomy,  osteotomy  of  the  femur,  exca- 
vation of  the  acetabulum,  etc.)  except  to 
ankylose  the  hip,  are  “ not  only  unnecessary 
but  harmful.”  He  also  says  that  “it  is 
not  necessary  to  use  weight-and-pulling 
traction  ” before  the  bloodless  method 
of  reduction. 

Congenital  Dislocation  of  the  Shoulder. 

-Consult  Whitman’s  Orthsepedic 
Surgery. 

Congenital  Elevation  of  the  Scapula. — 

( 'orrect  the  deformity  in  childhood.  Through 
an  open  incision  divide  the  muscles  which  are 
holding  the  scapula  elevated,  e.g.,  all  the 
muscles  attached  to  the  vertebral  border  and 
spine  of  thescapula.  Insome  cases  the  scapula 
is  joined  to  the  spine  by  a bony  bridge,  which 
should  be  resected.  Draw  down  the  scapula 
as  far  as  possible.  No  subsequent  fixation  is 
necessary.  After  three  or  four  weeks  employ 
active  and  passive  exercises  and  massage. 

Congenital  Flexion  of  the  Knee. — In 
mild  cases,  employ  daily  stretching.  Severe 
cases  may  require  tenotomy  of  the  ham- 
strings and  forcible  stretching,  with  fixation 
in  a plaster  splint  (q.v.)  for  three  weeks 
or  longer. 

Contracted  Foot. — See  Hollow  or  Con- 
tracted Foot. 

Contraction  of  the  Fingers,  Congenital. — 

See  Congenital  Contraction  of  the  Fingers. 


Contraction  of  the  Fingers,  Dupuytren’s. — 

See  Dupuytren’s  Contraction  of  the  Fingers. 

Coracobrachial  Bursitis. — Gr.  KopaKos 
crow;  ^pax'uiov  arm.  See  Bursitis. 

Coxalgia. — L.  cox'a,  hip  + Gr.  aXyos  pain. 
See  Hip  Tuberculosis. 

Coxa  Vara. — L.  cox'a,  hip;  var'a,  bent 
inward.  Depression  of  the  neck  of  the  femur 
with  resulting  elevation  of  the  trochanter 
above  Nelaton’s  line  (q.v.,  under  Hip  Tuber- 
culosis). The  deformity  is  manifested  by 
limping,  discomfort,  adduction  and  outwartl 
rotation  of  the  thigh,  limitation  of  flexion, 
of  internal  rotation  and  of  abduction,  and 
apparent  and  actual  (see  under  Hip  Tuberc.) 


Fig.  122. — Long  Taylor  hip  splint  with 
perineal  straps  and  foot  plate  attachable  by 
buckles  to  adhesive  plaster  strips  applied 
to  leg. 

shortening,  due  to  elevation  of  the  trochanter. 

Etiology.— The  condition  is  rarely  congeni- 
tal. Rickets  is  the  commonest  cause  of 
bilateral  cases;  fracture  or  epiphyseal  sepa- 
ration is  the  commonest  cause  of  uni- 
lateral cases. 

Trauma,  long  standing,  overweight,  and 
strain  are  exciting  causes. 

Treatment.— Prescribe  a tonic  regimen,  e.g., 
fresh  air  day  and  night,  general  massage,  a 
daily  tepid  bath  followed  by  a cool  spinal 
douche,  a nonrachitic,  nutritious  diet  at 
regular  intervals,  and  care  of  the  bowels,  et(t. 
(See  Rickets,  in  Part  1.) 

In  progressive  bilateral  cases  in  young 
children,  the  patient  should  be  kept  in  a 


DISLOCATIONS  OF  THE  ANKLE;  TIBIOTARSAL  DISLOCATIONS 


reclining  posture,  and  not  allowed  to  sit, 
stand,  or  walk  for  two  or  three  months.  An 
attempt  should  be  made  to  bend  the  neck 
of  the  femur  into  the  proper  angle  with  the 
shaft  by  forcible  abduction  and  inward 
rotation  under  anajsthesia.  When  this  has 
been  accomplished,  a plaster  spica  (q.v.) 
is  applied  with  the  limb  in  extreme  abduction 
and  rotation  inward.  After  two  months  the 
plaster  is  removed,  massage  and  exercises 
are  employed,  and  a Taylor  hip-splint  is 
worn  for  two  or  three  months  longer. 

Recent  traumatic  cases  are  treated  in  the 
same  way. 

In  very  early  unilateral  cases,  one  may 
employ  a Taylor  convalescent  hip-splint 
(Fig.  122)  or  a Judson  perineal  crutch  (Fig. 
122),  to  take  the  weight  off  the  Ihnb, 
crutches  and  a high  shoe  being  worn  on 
the  sound  side,  and  practice  massage  and 
forcible  abduction,  outward  rotation  and 
extension,  continued  at  least  a year. 

In  old  cases  (not  before  the  fifth  year  of 
age),  .subtrochanteric  osteotomy,  linear  or 
cuneiform,  is  required.  A long  j)laster  spica, 
including  the  foot,  is  then  ajjplied,  with  the 
limb  in  extreme  abduction.  Thi.«  is  removed 
after  two  months  and  replaced  by  a 
l^rotective  splint  for  three  months  longer, 
followed  by  massage,  exercises,  horseback 
and  bicycle  riding,  and  manipulation 
(Whitman). 

Coxitis,  Senile. — L.  cox'a  hip  -|-  Gr.  -ltls 
inflammation;  L.  seniVis,  senile.  See 
Arthritis  Deformans. 

Tuberculous. — L.  cox'a,  hip  + Gr.  -trts 
inflammation.  See  Hip  Tubercu- 
losis. 

Crucial  Ligaments  of  the  Knee,  Rupture 
of  the. — L.  crux,  cross.  See  under  Displace- 
ment of  a Semilunar  Cartilage, 

Curvature,  Anterior,  of  the  Spine. — See 

Lordosis. 

Dorsal,  of  the  Spine. — See  Kyphosis. 

Lateral,  of  the  Spine. — See  Scoliosis. 

Dactylitis  Syphilitica. — Gr.  8clktv\os  finger 
-f-  -tris  inflammation.  Syphilitic  infection  of 
the  phalangeal  bones  is  characterized  by  a 
fusiform  or  spindle-shaped  swelling,  pain, 
and  tenderness,  and  must  be  distinguished 
from  tuberculosis,  which  presents  the  same 
local  symiAoms. 

Treatment.— Secure  absolute  rest  by  means 
of  sj)lints,  which  should  be  kept  on  for 
months.  Resort  to  surgical  measures  should 
suppuration  or  necrosis  occur.  Specific  con- 
stitutional treatment  should,  of  course,  be 
employed  (see  Syphilis,  in  Part  1). 

Dactylitis  Tuberculosa. — (See  Tubercu- 
losis of  the  Long  Bones  of  the  Hand  and  Foot. 


Decubitus. — See  Bed-Sore,  in  Part  1. 

Delayed  Union  in  Bone  Fracture. — See 
General  Considerations,  under  Fractures. 
_ Deltoid  Bursitis. — Gr.  6eXra  letter  A -|- 
el8os  form.  See  Bursitis. 

Derangement  of  the  Knee  Joint,  Internal. 

■ — See  Displacement  of  a Semilunar  Cartil- 
age, Loo.se  Bodies,  Lipoma,  and  Villous 
Arthritis. 

Dislocation,  Congenital,  of  the  Hip. — L. 

dis-  apart  -f-  loca're,  to  place.  See 
Congenital  Dislocation  of  the  Hip. 
Shoulder. — C o n s u 1 1 W h it  m a n’ s 
“ Orthopaedic  Surgery.” 

Paralytic. — See  Dislocations,  Paralytic. 

Pathologic. — See  Dislocations,  Patha- 
logical  or  Spontaneous. 

Dislocation,  Recurrent,  of  the  Shoulder; 
Loose  Shoulder. — Fit  a canvas  shoulder-cap 
to  the  shoulder  and  upper  arm,  and  hold  it 
in  place  by  means  of  bands  buckled  beneath 
the  other  arm  and  to  the  trousers. 

Resection  of  the  la.x  capsule  may  be  per- 
formed in  intractable  cases  (consult  Whit- 
man’s “ Ortliopsedic  Surgeiy  ”) 

Dislocation,  Sacro=Iliac.  — See  under 
Sacro-IIiac  Strain. 

Semilunar  Cartilage  of  the  Knee  Joint. 

— See  Displacement  of  a Semilunar 
Cartilage. 

Dislocations  of  the  Acromial  End  of  the 
Clavicle. — L.  dis-  apart  fl-  loca're,  to 
place;  Gr.  aKpov  point;  L.  clavic'ula, 
little  key.  See  Dislocations  of  the 
Clavicle. 

Acromioclavicular. — Gr.  aspov  point  -f- 
L.  clavic'ula,  little  key.  See  Disloca- 
tions of  the  Clavicle. 

Dislocations  of  the  Ankle;  Tibiotarsal 
Dislocations. — L.  tih'ia,  shin-bone;  tar'sus, 
tarsus.  Note  that  the  malleoli  are  intact. 

A.  Backward  Dislocations. — Under  anaesthesia, 
flex  the  foot  plantarward  and  pull  it  forward, 
while  an  assistant  pushes  the  lower  end  of  the 
tibia  backward;  then  flex  the  foot  dorsalward. 

In  a case  of  my  own,  in  which  manual 
traction  and  manipulation  under  anaesthesia 
were  unsuccessful,  I employed  traction  upon 
the  instep  and  heel  by  means  of  heavy 
weights,  and  morphine  and  chloral  (Part 
11)  as  sedatives,  and  reduction  occurred 
overnight  while  the  patient  slept.  If  reduc- 
tion has  not  been  effected  within  ten  to 
fourteen  days,  arthrotomy  may  be  required. 

After  reduction,  immobilize  the  ankle  for 
three  weeks  in  a posterior  plaster-of-Paris 
cast  (q.v.);  then  commence  massage  and 
passive  movements,  and  at  the  end  of  the 
fourth  week,  active  movements. 

B.  Forward  Dislocations. — Under  anaesthesia 


DISLOCATIONS  OF  THE  ELBOW 


flex  the  foot  strongly  clorsalward,  and  while 
an  assistant  presses  the  lower  end  of  the 
tibia  forward,  press  the  foot  backward  and 
then  flex  it  plantarward.  In  cases  of  ten  to 
fourteen  days  standing,  arthrotomy  may 
be  required. 

After  reduction,  immobilize  the  ankle  for 
three  weeks  in  a posterior  plaster-of-Paris 
cast;  then  commence  massage  and  passive 
movements,  and  at  the  end  of  the  fourth 
week,  active  movements. 

C.  Lateral  Dislocations.— One  or  both  malle- 
oli are  always  fractured.  The  treatment, 
after  reduction,  is  that  of  Pott’s  fracture  (q.v.). 

Dislocations  of  the  Carpal  Bones. — L. 
car'pus,  wrist.  See  Dislocations  of 
the  Wrist. 

Carpometacarpal  Joints. — Gr.  fiera  after 
■i-Kapwos  wrist.  See  Dislocations  of 
the  Wrist. 

Central,  of  the  Hip. — L.  cen'trum.  See 
Dislocations  of  the  Hip. 

Cervical  Vertebrae. — L.  cer'vix,  neck; 
ver'tebra,  vertebra.  See  Disloca- 
tions of  the  Spine. 

Dislocations  of  the  Clavicle. — L.  dim.  of 
clav'is,  key.  A.  Forward  Dislocation  of  the  Ster= 
nal  End.— With  the  knee  between  the  scapulae, 
draw  the  shoulders  backward,  while  an 
assistant  presses  the  dislocated  bone  back 
in  place.  Then,  after  cleansing  and  drying 
the  parts,  place  a pad  over  the  end  of  the 
bone,  and  hold  it  in  place  with  adhesive 
straps  or  a figure-of-eight  bandage. 

B.  Upward  Dislocation  of  the  Sternal  End. — 
Draw  the  shoulder  outward,  while  an  assist- 
ant presses  down  upon  the  displaced  end. 
Then,  after  cleansing  and  drying  the  parts, 
and  powdering  the  axilla,  apply  adhesive 
straps  and  a Velpeau  bandage  (q.v.),  with 
a pad  in  the  axilla. 

C.  Backward  Dislocation  of  the  Sternal  End. — 
Pull  the  shoulder  backward  and  outward. 
Arthrotomy  may  be  required. 

Recurrent  dislocations  at  the  sternal  end 
of  the  clavicle  call  for  the  use  of  silver  or 
bronze  aluminimi  sutures,  or  excision  of  the 
articular  surfaces. 

D.  Upward  Dislocation  of  the  Acromial  End 
(Supra=acromial). — Lift  the  arm  and  shoulder 
upward,  while  an  assistant  presses  the  clavi- 
cle downward.  Then,  after  cleansing  and 
drying  the  parts  and  powdering  the  axilla, 
apply  a strip  of  adhesive  plaster  from  before 
backward  over  the  acromial  end  of  the 
clavicle,  down  around  the  flexed  elbow,  and 
up  in  front  over  the  clavicle  again.  Then 
apply  a Velpeau  bandage  (q.v.),  with  a 
pad  in  the  axilla. 

Some  cases  require  suture  with  kangaroo 


tendon,  passed  through  the  clavicle  and 
coraco-acromial  ligament,  or  if  necessary, 
the  acromion  process. 

E.  Downward  and  Backward  Dislocation  at  the 
Acromial  End  (Subacromial). — With  the  elbow 
flexed,  pull  the  shoulder  outward,  while  an 
assistant  pushes  the  clavicle  upward.  Then 
cleanse,  dry,  and  powder  the  skin,  place  a 
pad  in  the  axilla,  and  apply  a Velpeau 
bandage  (q.v.). 

Dislocations,  Congenital,  of  the  Hip. — L. 

con,  together  + gen'itus,  born.  See 
Congenital  Dislocation  of  the  Hip. 

Shoulder  s. — Consult  Wliitman’s 
“ Orthopgechc  Surgery.” 

Dorsal,  of  the  Hip. — L.  dor' sum,  back. 

See  Dislocations  of  the  Hip. 

Dislocations  of  the  Elbow. — A.  Backward 
Dislocation  of  both  Ulna  and  Radius  or  of  the  Ulna 
Alone.— The  olecranon  lies  above  the  trans- 
verse line  joining  the  condyles. 

Under  anaesthesia,  supinate  and  hyper- 
extend  the  forearm,  and  exert  traction  until 
the  forearm  can  be  normally  flexed;  or  with 
the  knee  pressing  backward  the  lower  end  of 
the  humerus,  slowly  flex  the  forearm  until 
reduction  is  effected  (Cooper’s  method) . 

After  reduction,  cleanse,  dry,  and  powder 
the  skin,  pad  the  flexure  of  the  elbow,  and 
immobilize  the  latter  in  a position  of  acute 
flexion.  At  the  end  of  two  weeks,  com- 
mence massage  and  passive  movements  for 
ten  or  fifteen  minutes  twice  daily.  At  the 
end  of  four  weeks,  discard  the  splint,  and 
allow  active  motion. 

B.  Lateral  Dislocations  of  both  Ulna  and 
Radius. — Under  anaesthesia,  exert  traction 
upon  the  hyperextended  forearm,  at  the  same 
time  pressing  inward  or  outwartl,  as  the  case 
may  be,  upon  the  displaced, bones;  then  flex 
the  forearm.  Aidhrotomy  is  cometimes 
required. 

After  reduction,  treat  as  before  described 
for  backward  dislocation. 

C.  Forward  Dislocation  of  both  Ulna  and 
Radius.— Draw  the  upper  end  of  the  forearm 
downward  and  backward. 

After  reduction,  treat  as  directed  for 
backward  cUslocation. 

D.  Divergent  Dislocation  of  the  Ulna  and 
Radius. — Reduce  each  bone  separately,  the 
ulna  by  hyperextension  and  traction,  and 
the  radius  by  pressure. 

After  reduction,  treat  as  directed  for 
backward  dislocation. 

E.  Dislocation  of  the  Radius  Alone. — Exert 
traction,  and  press  the  head  of  the  radius 
back  into  place.  Then  immobilize  the 
elbow  as  directed  for  backward  dislocation 
of  both  ulna  and  radius. 


DISLOCATIONS  OF  THE  HIP,  TRAUMATIC 


Arthrotomy  is  sometimes  required,  and 
occasionally  resection  of  the  head. 

In  subluxation  of  the  radius  in  young 
children,  due  to  pulling  upon  the  forearm, 
supinate  the  forearm  until  a click  indicates 
that  the  bone  is  reduced. 

Old  dislocations  of  the  elbow  require 
arthrotomy. 

Dislocations  of  the  Fibula,  the  Upper  End. 

— Employ  chrect  pressure. 

Dislocations  of  the  Fingers  at  the  Inter= 
phalangeal  Joints. — L.  inier,  between  + Gr. 
4>a\ay^  phalanx.  Exert  traction  and  pres- 
sure upon  the  base  of  the  dislocated  phalanx. 
Perform  arthrotomy  as  a last  resort. 

Dislocations  of  the  Fingers  at  the  Meta= 
carpophalangeal  Joints. — See  Dislo- 
cations of  the  Metacarpophalangeal 
Joints. 

Foot. — See  Dislocations  of  the  Ankle. 

Hip,  Congenital. — L.  con,  together  + 
gen'ims,  born.  See  Congenital  Dis- 
location of  the  Hip. 

Dislocations  of  the  Hip,  Traumatic. — Gr. 

Tpavfj.0.  wound.  A.  Backward  or  Dorsal  Dislo= 
cations. ^Diagnosis. — The  limb  is  adducted, 
flexed,  rotated  inward  (the  toes  resting  upon 
the  instep  of  the  other  foot),  and  shortened, 
the  trochanter  lies  above  Nelaton’s  line,  and 
the  head  of  the  femur  may  be  jialpated,  dur- 
ing rotation,  through  the  gluteal  muscles. 
Nelaton’s  line  is  an  imaginary  line  extending 
from  the  anterior  superior  sj^ine  of  the  ilium 
to  the  ischial  tuberosity.  The  top  of  the 
great  trochanter  normally  lies  at  or  just 
below  this  line.  Measure  the  length  of  the 
limbs  from  the  anterior  superior  spine  to  the 
lower  border  of  the  malleolus,  with  the  trans- 
verse line  between  the  anterior  superior 
spines  of  the  ilium  at  right  angles  with  the 
long  axis  of  the  body,  and  the  two  limbs  in 
the  same  relative  position  to  the  midline  of 
the  body.  The  head  and  neck  of  the  femur 
have  the  same  general  direction  as  the 
internal  condyle  at  the  knee. 

Exclude  the  rare  impacted  fracture  of  the 
anterior  portion  of  the  neck  of  the  femur, 
with  inversion  of  the  Ihnb. 

In  very  rare  instances,  in  wliicli  the  Y 
ligament  is  torn,  the  limb  is  everted. 

Treatment. — With  the  patient  on  the 
floor,  anaesthetized,  and  an  assistant  steady- 
ing the  pelvis  by  exerting  pressure  upon  the 
two  anterior  superior  spines,  flex  the  thigh, 
in  the  adducted  and  inverted  j50sture,  to  a 
right  angle,  exert  traction  upward,  and  then 
circumduct  the  limb  outward,  and  gradually 
extend  it  (Bigelow);  or,  with  the  patient 
lying  face  downward  upon  a table,  with  the 
injured  limb  hanging  straight  downward. 


and  an  assistant  holding  the  sound  limb 
horizontal,  grasp  the  ankle  of  the  injured 
limb,  flex  the  knee  to  a right  angle,  and  rock 
and  rotate  the  limb  until  it  slips  into 
place.  (Stimson). 

Keep  the  patient  in  bed  for  three 
weeks;  then  coimnence  massage  and  passive 
movements  for  ten  to  fifteen  minutes  twice 
daily,  and  at  the  end  of  four  weeks,  begin 
active  movements. 

If  the  acetabuhmi  is  fractured.  Buck’s 
extension  (q-v.)  should  be  employed  for 
four  weeks. 

B.  Downward  and  Inward  or  Thyroid  Disloca= 
tions.— Diagnosis. — The  limb  is  abducted, 
flexed,  and  rotated  outward,  there  is  a 
depression  over  the  trochanter,  and  the 
head  of  the  femur  may  be  palpated  in  its 
inferior  or  internal  position. 

Exclude  impacted  fracture  of  the  neck  of 
the  femur. 

Treatment. — With  the  patient  on  the 
floor,  anaesthetized,  and  an  assistant  steady- 
ing the  pelvis,  by  exerting  pressure  upon 
the  two  anterior  superior  sjjines,  flex  the 
thigh,  in  its  abducted  and  everted  posture, 
to  a right  angle,  exert  traction  upward,  and 
then  circumduct  the  limb  inward,  and 
gradually  extend  it.  (Bigelow.) 

Keep  the  patient  in  bed  for  three 
weeks;  then  commence  massage  and  passive 
movements  for  ten  to  fifteen  minutes 
twice  daily,  and  at  the  end  of  four  weeks, 
active  movements. 

C.  Upward  and  Forward  or  Suprapubic  Disloca- 
tions.—The  head  of  the  femur  maybe  palpated 
in  the  groin. 

Treatment. — With  the  patient  on  the 
floor,  anaesthetized,  and  an  assistant  steady- 
ing the  pelvis  by  exerting  pressure  upon  the 
two  anterior  superior  spines,  while  another 
assistant  presses  upon  the  head  of  the 
femur,  exeid  traction  in  the  axis  of  the  limb 
as  it  lies,  or  abduct  it  if  the  head  is  near  the 
symphysis;  then  flex  the  limb,  but  not  to  a 
right  angle,  and  rotate  it  inward. 

Keep  the  patient  in  bed  for  three 
weeks ; then  commence  massage  and  passive 
movements  for  ten  to  fifteen  minutes  twice 
daily,  and  active  movements  at  the  end  of 
four  weeks. 

I).  Upward  or  Supracotvioid  Dislocations. — 
The  head  lies  near  the  anterior  superior  spine 
of  the  ilium,  and  the  limb  is  extended, 
adducted,  and  rotated  inward. 

Tre.^tment. — With  the  patient  on  the 
floor,  anaesthetized,  and  an  assistant  steady- 
ing the  pehds  by  exerting  pressure  upon  the 
two  anterior  superior  spines,  flex  the  limb 
moderately,  and  exert  traction,  while  an 


DISLOCATIONS,  PARALYTIC 


assistant  presses  the  head  of  the  femur 
downward  and  backward. 

Keep  the  patient  in  bed  for  three  weeks; 
then  commence  massage  and  passive  move- 
ments, and  active  movements  at  the  end  of 
four  weeks. 

E.  Downward  or  Infracotyloid  Dislocations. — 
The  head  lies  just  below  the  acetabulum, 
and  can  not  be  palpated;  the  limb  is  mark- 
edly flexed  and  adducted. 

Treatment. — With  the  patient  on  the 
floor,  anaesthetized,  and  an  assistant  steady- 
ing the  pelvis  by  exerting  pressm’e  upon  the 
two  anterior  superior  spines,  rotate  the 
limb,  exert  traction,  and  extend. 

Keep  the  patient  in  bed  three  weeks; 
then  commence  massage  and  passive  move- 
ments, and  active  movements  at  the  end  of 
four  weeks. 

F.  Central  Dislocations  through  the  Acetabulum. 
— The  limb  is  rotated  outward,  the  tro- 
chanter approaches  the  anterior  superior 
spine  of  the  ilium,  and  the  head  of  the  femm' 
can  be  felt  per  rectum. 

Treatment. — ^With  the  patient  on  the 
floor  anaesthetized,  and  an  assistant  steady- 
ing the  pelvis  by  exerting  pressure  upon  the 
two  anterior  superior  spines,  pull  the  head 
of  the  femur  out  of  the  pelvis.  Employ 
Buck’s  extension  {q.v.)  for  six  weeks. 

Arthrotomy  is  indicated  if  the  head  has 
penetrated  deeply  into  the  pelvis. 

Old  dislocations  of  the  hip  require  arthrot- 
omy. 

Dislocations  of  the  Humerus. — L.  hu'me- 
rus.  See  Dislocations  of  the  Shoulder. 

Inferior  Maxilla. — L.  lower  jaw.  See 
Dislocations  of  the  Lower  Jaw. 

Infracotyloid,  of  the  Hip. — L.  infra- 
beneath  -f  Gr.  kotv\6s  cup  -f-  eTSos 
form.  See  Dislocations  of  the  Hip. 

Interphalangeal  Joints  of  the  Fingers. — 
See  Dislocations  of  the  Fingers  at 
the  Interphalangeal  Joints. 

Jaw,  Lower. — See  Dislocations  of  the 
Lower  Jaw. 

Dislocations  of  the  Knee. — The  tibia  may 
be  dislocated  forward,  backward,  or  to 
either  side. 

Under  anaesthesia,  flex  the  thigh,  and 
exert  traction  upon  the  leg. 

Immobilize  the  knee  upon  a posterior 
splint  for  three  weeks;  then  commence  mas- 
sage and  passive  movements  for  ten  to  fifteen 
minutes  twice  daily,  and  active  movements 
at  the  end  of  four  weeks. 

Dislocations  of  the  Lower  Jaw. — The  jaw 
is  practically  always  dislocated  forward, 
usually  bilaterally. 

With  the  thumbs  (covered  with  cloth) 


over  the  molar  teeth,  and  the  fingers  grasp- 
ing the  jaw  from  the  outside,  exert  backward 
and  downward  pressure  with  the  thumbs, 
and  lift  up  the  chin  with  the  fingers;  or 
depress  the  cliin,  under  an  anaesthetic,  in 
order  to  relax  the  lateral  ligament,  and  then 
press  directly  backward.  (Scudder.) 

After  reduction,  immobilize  the  jaw  with  a 
four-tailed  or  a Barton  bandage  (see  Bandag- 
ing) for  two  weeks,  and  feed  only  with  liquids. 

Long-standing  and  recurrent  cases  some- 
times demand  arthrotomy,  with  suture  of 
the  meniscus  to  the  periosteum,  or  some- 
times, resection  of  the  condyle. 

Dislocations  of  the  Lower  Radio=Ulnar 
Joint. — L.  rad'ius,  spoke;  ul'na,  ulna. 
See  Dislocations  of  the  Wrist. 

Maxilla,  Lower. — L.  maxil'la,  jaw.  See 
Dislocations  of  the  Lower  Jaw. 

Dislocations  of  the  Metacarpophalangeal 
Joints. — Gr.  ^lerd  after  -|-  Kapiros  wrist 
<(>a\ay^  phalanx.  A.  Backward  Dislocation  of 
the  Thumb. — Exert  traction  upon  the  hyper- 
extended  thumb.  Then,  while  maintaining 
traction,  press,  or  have  an  assistant  press, 
the  base  of  the  first  phalanx  forward,  and 
quickly  flex  the  thumb. 

If  reduction  can  not  be  thus  effected,  per- 
form a palmar  arthrotomy. 

In  old  cases,  the  head  of  the  metacarpal 
bone  may  have  to  be  resected. 

B.  Forward  Dislocation  of  the  Thumb. — Exert 
traction,  flexion,  and  pressure  over  the  base 
of  the  first  phalanx. 

C.  Dislocations  of  the  Fingers  at  the  Metacarpo= 
phalangeal  Joint. — Exert  traction  and  flexion 
and  press  upon  the  base  of  the  first  phalanx. 

Dislocations  of  the  Neck. — See  Disloca- 
tions of  the  Spine. 

Dislocations  of  the  Patella. — L.  patella, 
pan.  Flex  the  thigh  on  the  abdomen,  and 
extend  the  knee,  in  order  to  relax  the 
quadriceps  femoris  muscle,  then  press  the 
bone  back  into  place. 

Operative  reduction  is  sometimes  required. 

Habitual  dislocation  requires  operative 
treatment. 

Dislocations,  Paralytic. — Such  dislocations 
are  rare. 

I.  Paralytic  Dislocation  of  the  Hip. — Inter- 
ference may  not  be  advisable,  except,  per- 
haps, a supporting  apparatus  for  the  leg  and 
compensation  of  the  shortening. 

If  deemed  of  advantage,  however,  the 
head  of  the  femur  may  be  replaced,  under 
ether,  and  a plaster  spica  applied  hokling  the 
limb  in  abduction,  as  described  under  Con- 
genital Dislocation  of  the  Hip;  or  the  con- 
tracted muscles  may  be  divided  through  an 
open  incision,  the  capsule  folded  and  stitched, 


DISLOCATIONS  OF  THE  SPINE 


or  a portion  excised,  and  the  head  replaced; 
or  artificial  ankylosis  may  be  secured. 

II.  Paralytic  Dislocation  of  the  Shoulder. — Incise 
the  joint,  shorten  the  capsule,  and  employ 
a slip  of  a sound  muscle  (pectoralis  major, 
trapezius,  etc.)  as  a support  to  the  humerus; 
or  secure  ankylosis. 

Dislocations,  Pathological  or  Spontaneous. 

— Gr.  TV  ados  disease  + Xoyos  discourse;  L. 
aponta'neus,  voluntary.  Causes.— Joint  dis- 
tention, occurring  in  typhoid  fever,  pyaemia, 
gonorrhoea,  pneumonia,  diphtheria,  small- 
pox, influenza,  scarlet  fever,  measles;  joint 
destruction,  occurring  in  tuberculous  arthri- 
tis, acute  osteomyelitis,  carcinoma,  sarcoma; 
joint  deformity,  occurring  in  locomotor 
ataxia,  syringomyelia,  arthritis  deformans; 
paralysis,  occurring  in  anterior  poliomyelitis 
(see  above). 

Dislocations  of  the  Peronaei  Tendons. — 

See  Whitman’s  Orthopaedic  Surgery. 

Radio=Carpal  Joint. — L.  rad'ius,  spoke 
+ car'pus,  wrist.  See  Dislocations 
of  the  Wrist. 

Radio=Ulnar  Joint. — L.  rad'ius,  spoke 
ul'na.  See  Dislocations  of  the 
Wrist. 

Radius  at  the  Elbow. — L.  rad'ius,  spoke. 
See  Dislocations  of  the  Elbow. 

Dislocations  of  the  Ribs. — Reduce  the 
dislocation  by  pressure.  Then,  after  cleans- 
ing, shaving,  and  drying  the  skin,  apply 
from  below  upward,  while  the  patient  is 
exhaling  deeply,  several  broad  overlapping 
adhesive  plaster  swathes,  extending  from 
beyond  the  spine  in  back  to  beyond  the 
sternum  in  front.  Overlap  each  swathe 
two-thirds.  C’over  the  nipple  with  gauze, 
or  cut  the  adhesive  away  over  the  nijiple. 
C’leanse  and  powder  the  axilla.  An  adhesive 
strap  may  be  passed  over  the  shoulder 
with  advantage. 

Change  the  adhesive  swathes  at 
least  every  seven  days  for  about  three  or 
four  weeks. 

Dislocations,  Sacro=Iliac. — See  under 
Sacro-Iliac  Strain. 

Semilunar  Cartilage  of  the  Knee=Joint. 

— See  Dis{)lacement  of  a Semilunar 
C’artilage. 

Dislocations  of  the  Shoulder. — The  cap- 
sule is  torn  at  its  inner  and  lower  portions. 

The  signs  of  shoulder  dislocations  are  as 
follows;  flattening  of  the  shoulder  below 
the  acromion,  which  is  unduly  prominent; 
hollow  tension  of  the  deltoid;  abduction  of 
the  elbow;  changed  direction  of  the  long  axis 
of  the  humerus;  inability  to  bring  the  hand 
to  the  opposite  shoulder,  unless  the  capsule 
is  very  much  torn;  detection  of  the  head  of 


the  humerus  ju.st  below  the  coracoid  process 
in  the  common  subcoracoid  dislocation,  just 
below  the  outer  end  of  the  clavicle  in  sub- 
clavicular  dislocation,  and  in  the  axilla  in 
subglenoid  dislocation.  In  the  latter  two 
varieties  of  dislocation  the  arm  is  sometimes 
fixed  in  a position  of  horizontal  abduction. 

In  the  very  rare  subacromial  and  subspinal 
dislocations,  the  posterior  wall  of  the  caj> 
sule  is  ruptured,  the  arm  is  adducted,  and 
the  head  of  the  humerus  can  be  palpated 
behind  and  below  the  acromion  or  the  spine 
of  the  scapula. 

Treatment.— Under  anaesthesia,  with  the 
patient  supine,  grasp  the  limb  above  the 
condyles  of  the  hmnerus  and  at  the  wrist. 
With  the  forearm  flexed  at  a right  angle, 
press  the  lunb  again.st  the  side  of  the  chest. 
Now  slowly  rotate  the  arm  firmly  outward 
the  arm  being  still  close  to  the  chest,  and, 
with  the  arm  still  rotated  outward,  adduct 
it  across  the  middle  line  of  the  chest,  at  the 
same  tune  raising  the  elbow  as  high 
as  possible.  Then  rotate  the  arm  inward 
until  the  hand  touches  the  opposite 
shoulder.  (Kocher.) 

If  Kocher’s  method  is  unsuccessful,  em- 
ploy traction  downward  and  outward  until 
the  arm  is  abducted  horizontally  from  the 
body  (counter-traction  being  made  by 
means  of  a folded  sheet  around  the  chest); 
then  exert  upward  pressure  upon  the  head 
in  the  axilla,  and  gradually  adduct  the 
limb. 

Gradual  traction  by  means  of  heavy 
weights  may  be  employed.  The  patient  is 
suspended,  lying  horizontally  on  his  side, 
in  a canvas  stretcher,  with  his  arm  hanging 
vertically  through  a slit  in  the  canvas,  and 
a weight  attached  to  the  wrist.  (Stimson.) 

Arthrotomy  is  a measure  of  last  resort.. 
It  is  best  deferred  for  ten  to  fourteen  days. 

After  having  reduced  the  dislocation, 
cleanse,  dry,  and  powder  the  skin,  pad  the 
axilla  and  elbow,  and  apply  a Velpeau 
bandage  {q.v.). 

At  the  end  of  a week  employ  a sling,  and 
begin  massage  and  passive  movements  for 
ten  to  fifteen  minutes  twdce  daily.  At  the 
end  of  four  weeks  discard  the  sling  and  per- 
mit active  movements. 

Old  and  recurrent  dislocations  are  best 
treated  by  arthrotomy. 

Dislocations  of  the  Spine. — It  is  practi- 
cally always  the  cervical  vertebrie  that  are 
dislocated.  The  dislocation  is  usually  uni- 
lateral, the  articular  process  of  the  affected 
A'ertebra  slipping  forward  or  backward  over 
the  one  below.  In  a unilateral  complete  dis- 
location, in  which  the  articular  process 


DISLOCATIONS  OF  THE  VEKTEBILE 


above  lies  in  the  hollow  (intervertebral 
notch)  in  front  of  the  articular  process 
below,  the  head  is  rotated  to  the  opposite 
side  and  bent  over  to  the  dislocated  side, 
and  the  sterno-mastoid  muscle  is  lax  on  the 
dislocated  side  and  stretched  and  tense  on 
the  opposite  side.  In  an  incomplete  uni- 
lateral dislocation,  in  which  the  articular 
process  becomes  caught  on  top  of  the  one 
below,  the  head  is  both  rotated  and  bent  over 
to  the  opposite  side. 

Treatment.— Under  deep  anaesthesia,  with 
an  assistant  exerting  countertraction  upon 
the  shoulders,  employ,  in  unilateral  forward 
dislocations,  traction,  lateral  flexion  toward 
the  nondislocated  side,  and  rotation  back- 
ward on  the  dislocated  side.  The  dislocation 
may  sometimes  be  sneezed  back  into  place. 

In  bilateral  forward  dislocations,  employ 
slight  extension,  and  backward  pressure  on 
the  dislocated  vertebra,  or  forward  pressure 
on  the  vertebra  below;  or  free  one  articular 
process  at  a time  as  in  unilateral  dislocation. 

Avoid  increasing  flexion  or  forward  dis- 
placement. Remember  that  sudden  death 
has  occurred  during  attempts  at  reduction, 
and  so  warn  the  family. 

If  manual  manipulation  is  unsuccessful, 
try  immobilization  with  plaster-of-Paris  and 
extension;  or  operate. 

After  reduction,  immobilize  the  neck,  by 
means  of  a plaster-of-Paris  or  other  form  of 
stiff  collar,  for  two  weeks;  then  practice 
massage  for  fifteen  minutes  twice  daily,  and 
continue  the  use  of  the  splint  for  another 
two  weeks. 

Dislocations,  Spontaneous. — See  Dislo- 
cations, Pathological. 

Sternal  End  of  the  Clavicle. — L.;  Gr. 
crepvos  breast-bone.  See  Disloca- 
tions of  the  Clavicle. 

Subacromial,  of  the  Clavicle. — L.  mb- 
under;  Gr.  clkpov  point  -f  d)p.os 
shoulcler.  See  Dislocations  of  the 
Clavicle. 

Shoulder. — See  Dislocations  of  the 
Shoulder. 

Dislocations,  Subastragaloid.— L.  suh- 
under  -)-  Gr.  dorpayaXos  die  + eibos  form. 
A.  Inward  Dislocation.— Under  anaesthesia, 
increase  the  existing  adduction,  then  press 
upon  the  side  of  the  astragalus,  and  upon  the 
inner  side  of  the  foot  below  the  astragalus, 
and  abduct  the  foot. 

After  reduction,  immobilize  the  foot  upon 
a po.sterior  pla.ster-of-Paris  cast  for  three 
weeks;  then  begin  massage  and  passive 
movements,  and  at  the  end  of  the  fourth 
week,  active  movements. 

If  reduction  has  not  been  effected  within 
51 


ten  to  fourteen  days,  excision  of  the  astrag- 
alus may  be  required. 

B.  Outward  Dislocation.— Under  anaesthesia, 
increase  the  existing  abduction,  then  press 
upon  the  inner  side  of  the  astragalus,  and 
upon  the  outer  side  of  the  foot  below  the 
astragalus,  and  adduct  the  foot. 

Excision  of  the  astragalus  is  some- 
tunes  required  in  cases  of  ten  to  fourteen 
days  duration. 

After  reduction,  treat  as  directed  for 
inward  dislocation. 

C.  Backward  Dislocation. — Under  anaesthesia, 
increase  the  existing  plantar  flexion,  then 
flex  the  foot  strongly  dorsalward,  while 
counter  pressure  is  made  upon  the  astragalus. 

Excision  of  the  astragalus  is  sometimes 
required  in  cases  of  ten  to  fourteen  days 
duration. 

After  reduction,  treat  as  directed  for 
inward  dislocation. 

D.  Forward  Dislocation. — Under  anaesthesia, 
flex  the  foot  dorsalward.  Excision  of  the 
astragalus  may  be  required  in  cases  of  ten 
to  fourteen  days  duration.  After  reduction, 
treat  as  directed  for  inward  dislocation. 

Dislocations,  Subclavicular,  of  the  Shoul= 
der. — L.  sub-  under  -|-  clavicula,  little 
key.  See  Dislocations  of  the  Shoulder. 

Subcoracoid,  of  the  Shoulder. — L.  sub, 
under  -j-  Gr.  KopaKoeLbi]s  crow-like. 
See  Dislocations  of  the  Shoulder. 

Subglenoid,  of  the  Shoulder.— L.  sub- 
under  + Gr.  y\r]vri  cavity  + eiSosform. 
See  Dislocations  of  the  Shoulder. 

Subspinous,  of  the  Shoulder. — h.  sub- 
under  spin'a,  spine.  See  Disloca- 
tions of  the  Shoulder. 

Supra=acromial,  of  the  Clavicle.— L. 
sup'ra,  above  -j-  Gr.  aKpov  point  -\- 
wp-os  shoulder.  See  Dislocations  of 
the  Clavicle. 

Dislocations,  Supracotyloid,  of  the  Hip. — 

L.  sup'ra,  above  -j-Gr.  KOTvXb^bris  cup- 
shaped. See  Dislocations  of  the  Hip. 

Suprapubic,  of  the  Hip. — L.  sup'ra, 
above  fl-  pub'es,  pubic  bone.  See 
Dislocations  of  the  Hip. 

Thumb. — See  Dislocations  of  the  Meta- 
carpophalangeal Joints. 

Tibiotarsal. — L.  tib'ia,  shin  bone-ftor’',sits, 
tarsus.  See  Dislocations  of  the  Ankle. 

Ulna  at  the  Elbow. — L.  ul'na.  See  Dis- 
locations of  the  Elbow. 

Ulno=radial  Joint,  Lower. — See  Dislo- 
cations of  the  Wrist. 

Upper  End  of  the  Fibula. — Employ  di- 
rect pressure. 

Vertebrae. — L.  ver'tebra,  spine-bone. 

See  Dislocations  of  the  Spine. 


DISPLACEMENT  OF  A SEMILUNAR  CARTILAGE 


Dislocations  of  the  Wrist. — A.  Dislocations 
of  the  Lower  Radio=ulnar  Joint. — Reduce  the 
dislocation  by  pressure  upon  the  dislocated 
bone  (radius  or  ulna),  and  counter  pressure 
upon  the  other  bone. 

B.  Dislocations  of  the  Radiocarpal  Joint  (Back= 
ward  or  Forward). — Exert  traction  upon  the 
hand  and  counter  traction  upon  the  forearm, 
and  press  the  displaced  carpus  into  place. 

C.  Dislocations  of  the  Carpal  Bones. — In  dislo- 
cations between  the  two  rows  of  carpal 
bones,  exert  traction  upon  the  hand,  and 
pressure  upon  the  distal  row,  and  flex  or 
extend  the  hand  as  the  case  may  be. 

In  anterior  dislocation  of  the  semilunar 
bone,  with  or  without  fracture  of  the  sca- 
phoid, have  an  assistant  press  firmly  upon 
the  ptilmar  surface  of  the  bone  with 
his  thumbs,  while  the  hand  is  hyper- 
extended  and  then  hyperflexed  over  the 
assi.stant’s  thumbs. 

If  the  dislocation  is  irreducible,  the  bone, 
together  with  part  or  whole  of  a fractured 
scaphoid,  if  necessary',  should  be  excised. 

D.  Dislocations  of  the  Carpometacarpal  Joints. — 
Exert  traction  upon  the  hand  and  press  upon 
the  base  of  the  dislocated  metacarpal  bone. 

Displacement  of  the  Peronei  Tendons.^ — 
Consult  Whitman’s  “Orthopaedic  Surgery.” 

Displacement  of  a Semilunar  Cartilage. — 
L.  sm't-half  -f-  luna, moon;  cartila'go,  gristle. 
The  knee  is  fixed  in  slight  flexion. 

The  dislocation  is  caused  by  a sudden 
rotation  of  the  tibia  outward  on  the  femur 
while  the  leg  is  slightly  flexed,  as  in  throw- 
ing a ball. 

Treatment. — With  the  patient  upon  his 
back,  and  thigh  flexed,  flex  the  leg  as  far  as 
possible,  abduct  it  on  the  femur,  rotate  it 
inward,  and  then  suddenly  exTencl  it,  at  the 
same  time  pressing  upon  the  displaced  car- 
tilage (the  inner  one).  An  anaesthetic  may 
be  used,  if  necessary  Reduction  is  indi- 
cated by  the  ability  freely  to  extend  the  knee. 

Sir  Robert  Jones  prefers  the  following 
method  of  reiluction:  The  patient  lies  upon 
his  back  with  the  thigh  flexed  on  the  body 
and  the  leg  on  the  thigh,  and  the  physician 
holding  the  leg.  At  the  command,  “(  )ne,  two, 
three,  kick!”  the  jiaticnt  exdends  the  limb  as 
suddenly  as  possible.  At  the  same  time  the 
physician  “ rotates  the  foot  inward  and 
pulls  while  pressure  is  placed  on  the  thigh.” 
After  reduction  has  been  accomplished, 
the  knee  is  surrounded  by  cotton-wool,  and 
then  firmly  bandaged  and  fixed  on  a poster- 
ior Icnee  splint,  or  immobilized  in  plaster, 
from  aid-de  to  pci'ineum. 

At  the  end  of  about  ten  days,  he  may  be 
allowed  to  walk  in  the  splint,  or  with  the 


knee  bandaged,  but  should  be  very  careful 
not  to  bend  the  knee  suddenly.  The  inner 
side  of  the  sole  and  heel  should  be  raised  to 
help  prevent  recurrence.  Daily  massage 
and  gentle  exercise  of  the  quadriceps  muscle 
should  be  employed,  and  active  flexion  of 
the  joint  shoukl  be  practiced  very  gradu- 
ally. Should  effusion  occur,  strap  the  knee 
as  described  under  Traumatic  Synovitis  (see 
under  Arthritis) . 

Forward  mobility  of  the  tibia  while 
extended,  and  backward  mobility  while  fully 
flexed,  indicates  elongation  or  rupture  of 
the  anterior  and  posterior  crucial  ligaments 
respectively.  The  treatment  in  such  cases 
is  prolonged  fixation  of  the  knee  in  extension 
(Sir  Robert  Jones),  say  for  four  weeks  or 
longer,  or  until  the  torn  ligaments  have  had 
time  to  heal. 

Fracture  of  the  spine  of  the  tibia  is  diag- 
nosed by  means  of  the  X-ray.  The  treatment 
is  fixation  in  extension  for  four  weeks  or 
longer.  If  extension,  however,  is  impossible, 
the  detached  spine  shoifld  be  removed  by 
an  incision  at  the  side  of  the  patella  or  by 
splitting  the  patella  longitudinally,  and  the 
knee  then  fixed  in  extension. 

For  recurrent  displacements  of  the  semi- 
lunar cartilage,  removal  of  the  cartilage  is 
mdicated.  The  skin  is  shaved,  scrubbed 
with  hot  water  and  soap,  rinsed,  and  pro- 
tected with  sterile  gauze  the  day  before  the 
operation.  At  operation,  an  Esmarch  band- 
age is  applied  in  order  to  avoid  swabbing, 
the  patient  is  cffawn  down  to  the  edge  of  the 
table,  so  that  the  leg,  flexed  to  a right  angle 
at  the  knee,  hangs  dependent  (Jones).  The 
gauze  is  then  removed,  the  skin  prepared 
with  iodine,  and  sterile  sheets  arranged. 
Jones  wraps  the  knee  in  sterile  gauze  soaked 
in  biniodide  solution,  makes  his  incision 
through  the  gauze,  and  clips  the  edges  of 
the  gauze  over  the  skin  edges  to  the  super- 
ficial fascia.  He  then  uses  a second  clean 
knife  for  the  deeper  dissections.  The  inci- 
sion is  made  over  the  anterior  end  of  the 
inner  semilunar  cartilage,  curving  slightly 
downwards  and  inwards — that  is,  nearly,  but 
not  quite,  parallel  to  the  upper  edge  of  the 
tibia  (Fig.  123),  for  about  an  inch  and  a 
half,  taking  great  care  not  to  extend  it  so 
far  as  to  cut  any  fibres  of  the  internal  lateral 
ligament  (Jones).  The  joint  being  opened, 
the  cartilage  is  divided  with  the  knife  into 
anterior  and  posterior  halves,  the  anterior 
half  is  easily  pulled  awaj'  with  forceps,  and 
the  posterior  half  is  separated  from  the  cap- 
sule and  the  tibia  with  scissors  and  then 
removed  (Whitman).  Twist,  do  not  tie, 
vessels.  The  synovial  membrane  is  then 


EPICONDYLES  OF  THE  HUMERUS,  FRACTURES  OF  THE 


closed  with  fine  catgut,  Lembert  or  mattress 
fashion,  and  the  capsule  and  other  tissues 
in  layers  with  stronger  sutures.  The  knee  is 
then  padded  and  fixed  in  extension  or 
slight  flexion  with  a light  plaster  splint  or  a 
simple  posterior  knee  splint.  The  splint  is 
retained  for  about  two  weeks,  and  then 
replaced  by  strapping,  “ to  guard  against 
strain.”  Massage  is  now  commenced,  and 
the  patient  is  allowed  each  day  to  practice 


gradually  bending  and  extending  the  knee, 
“ until  in  about  three  weeks  he  should  reach 
the  full  range  of  movement  and  walk  with 
freedom.”  (Jones.) 

A brace  which  limits  antero-posterior 
motion  and  prevents  lateral  motion,  or  the 
Griffiths  brace  may  be  employed  in  chronic,  re- 
current cases,  but  only  if  operation  is  refused. 

Dorsal  Abscess. — L.  dor' sum,  back;  ah- 
sces'sus,  a going  apart.  See  Pott’s 
Disease. 

Curvature  of  the  Spine. — See  Kyphosis. 

Dislocation  of  the  Hip. — See  Disloca- 
tions of  the  Hip. 

Flexion  of  the  Foot. — See  Talipes  Cal- 
caneus. 

Droop=Shoulders. — See  Round-Shoulders. 

Drop=Finger. — See  Mallet-Finger. 

Dupuytren’s  Contraction  of  the  Fingers. — 
A gradual,  painless  flexion  of  the  little  finger, 
and  perhaps  the  ring  finger,  rarely  others, 
occurring  commonly  in  arlult  males,  and 
associated  with  gout,  diabetes,  tabes,  or 
occupational  traumatism. 

A tense  band  is  felt  in  the  palm. 

Treatment.— Ionization  (q.v.  in  Part  1)  with 
sodium  chloride  or  salicylate,  with  a milli- 
amperage  of  60  to  80  to  100,  for  thirty  min- 


utes, at  first  thrice  weekly,  and  later  twice 
and  once  weekly,  is  recommended.  One 
may  remove  all  the  contracted  palmar 
fascia,  if  possible,  and  then  fix  the  fingers  in 
extension  for  two  or  three  weeks,  followed  by 
massage  and  active  and  passive  movements. 

Dupuytren  Splint. — See  Fractures  of  the 
Leg,  the  Lower  End. 

Elbow,  Dislocations  of  the. — See  Dislo- 
cations of  the  Elbow. 

Fractures  of  the. — See  Fractures  of  the 
Elbow. 

Elbow  Tuberculosis. — Tuberculosis  of  the 
elbow  joint  is  characterized  by  swelling, 
deformity,  pain  and  tenderness,  restriction 
of  motion  due  to  muscle  spasm,  and  muscu- 
lar atrophy. 

The  Prognosis  is  usually  good,  but  two 
years  or  more  of  treatment  may  be  required. 

Treatment.— If  the  X-ray  (q.v.  in  Part  1) 
reveals  localized  foci  of  infection  which  do 
not  communicate  with  the  joint,  these  foci 
may  be  removed  if  deemed  advisable. 

If  the  limb,  when  first  seen,  is  in  a faulty 
attitude,  one  should  attempt  to  draw  it 
gradually  into  a position  of  flexion  of  slightly 
less  than  a right  angle,  with  the  forearm 
midway  between  pronation  and  supination, 
so  that  if  ankylosis  occurs,  the  forearm  is  in 
the  best  position  for  use. 

To  this  end,  a series  of  plaster  splints  may 
be  applied  about  every  two  weeks,  or  else 
the  deformity  may  be  reduced  at  once 
under  ansesthesia. 

With  the  limb  in  the  position  above 
described,  apply  a plaster  bandage  (q.v.) 
from  the  wrist  to  the  axilla,  and  sling  the 
wrist  to  the  neck  beneath  the  clothing. 
Remove  the  cast  after  six  months  or  longer, 
and  have  the  patient  carry  the  arm  in  a 
sling  for  several  months  more,  employing  at 
the  same  time  massage  and  gentle  passive 
movements.  Bier’s  passive  hyperiemia  may 
be  tried  (see  under  Knee  Tuberculosis). 
For  the  constitutional  treatment  of  tu- 
berculosis, see  Tuberculosis,  Pulmonaiy,  in 
Part  1. 

If  the  disease  continues  to  progress  in 
spite  of  conservative  treatment,  perform 
erasion  of  the  joint  in  children,  excision  in 
the  adult. 

Treat  abscess  as  described  under  Hip 
Tuberculosis  and  Pott’s  Disease. 

Amputation  is  indicated  only  as  a life- 
saving measure  in  destructive  cases. 

Elevation  of  the  Scapula,  Congenital. — 

See  Congenital  Elevation  of  tfie  Scapula. 

Epicondyles  of  the  Humerus,  Fractures 
of  the. — Gr.  twi  upon  + k6v8v\os  knuckle. 
See  Fractures  of  the  Elbow. 


FRACTURES 


Epiphysis  of  the  Femur,  Lower,  Separa= 
tion  of  the. — Gr.  ewi  on  -)-  4>veLv  to 
grow.  See  Fractures  of  the  Fe- 
mur, the  Shaft. 

Upper,  Separation  of  the. — See  Frac- 
tm-es  of  the  Femur,  the  Neck. 

Humerus,  Lower,  Separation  of  the. — 
See  Fractures  of  the  Elbow. 

Upper,  Separation  of  the. — See  Frac- 
tures of  the  Humerus. 

Radius,  Lower,  Separation  of  the. — See 
Fractures  of  the  Radius,  the  Lower 
End. 

Equino  Valgus. — See  Talipes  Valgus. 

Varus. — See  Club-Foot. 

Equinus. — See  Talipes  Equinus. 

Extension,  Over,  of  the  Knee.  — See 
Genu  Recurvatum. 

External  Condyle,  Fractures  of  the. — See 

Fractures  of  the  Elbow. 

Femur,  Dislocations  of  the. — L.  fe'mur, 
thigh.  See  Dislocations  of  the  Hip. 

Fractures  of  the. — See  Fractures  of  the 
Femoral  Neck,  and  Fractures  of  the 
Femoral  Shaft. 

Separation  of  the  Lower  Epiphysis  of 

the. — See  Fractures  of  the  Femoral 
Shaft. 

Upper  Epiphysis  of  the. — See  Frac- 
tures of  the  Femoral  Neck, 

Fetal  Osteogenesis  Imperfecta. — L.foe'tus; 
Gr.  oareov  bone  -f-  yevvaoj  to  beget.  See 
Fragilitas  Ossimn,  in  Part  1,  General  Medi- 
cine and  Surgery. 

Fibula,  Dislocations  of  the  Upper  End  of 

the. — L.  fib'ula,  buckle.  See  Dislo- 
cations of  the  Fibula,  the  Upper  End. 

Fractures  of  the  Lower  End  of  the. — 
See  Fractures  of  the  Leg,  the  Lower 
End. 

Upper  End  of  the. — See  Fractures  of 
the  Leg,  the  Shaft. 

Finger  Contraction,  Congenital.  — See 

Congenital  Contraction  of  the  Fin- 
gers. 

Dupuytren’s.  — See  Dupuytren’s 
Contraction  of  the  Fingers. 

Dislocations  at  the  Interphalangeal 
Joints. — See  Dislocations  of  the 
Fingers  at  the  Interphalangeal 
Joints. 

Metacarpophalangeal  Joints.  — See 
Dislocations  of  the  IMetacarpo- 
phalangcal  Joints. 

Finger,  Drop. — See  Mallet-Finger. 

Dupuytren’s  Contraction  of  the. — See 
Dupu\dren’s  Contraction  of  the  Fin- 

Jerk. — See  Trigger-Finger. 

Joints,  Stiff. — See  Stiff  Finger  Joints. 


Finger,  Lock. — See  Trigger-Finger. 

Mallet. — See  Mallet-Finger. 

Snapping. — See  Trigger-Finger. 

Stiff. — See  Stiff  Finger  Joints. 

Syphilis. — See  Dactylitis  Syphilitica. 

Trigger  . — See  Trigger-Finger. 

Tuberculosis. — See  Tuberculosis  of  the 
Long  Bones  of  the  Hand  and  Foot. 

Flat=Chest. — The  treatment  is  that  of 
round  shoulders  {q-v.). 

Foot. — See  Weak  Foot. 

Flexed  Scapula.  — See  under  Round 

Shoulders. 

Flexion  of  the  Foot,  Dorsal. — L.  Hex'io, 
bending;  dor' sum,  back.  See  Tal- 
ipes Calcaneus. 

Plantar. — L.  plan'ia,  sole  of  the  foot. 
See  Talipes  Equinus. 

Knee,  Congenital. — L.  con,  together  -|- 
gen'itus,  born.  See  Congenital  Flex- 
ion of  the  Knee. 

Foot,  Claw. — See  Hollow  or  Contracted 
Foot. 

Club. — See  Club-Foot. 

Contracted. — Se6  Hollow  or  Contracted 
Foot. 

Dislocations  of  the. — See  Dislocations 
of  the  Ankle. 

Dorsal  Flexion  of  the. — L.  dor'sum, 
back;  flex'io,  bending.  See  Talipes 
Calcaneus. 

Flat. — See  Weak  Foot. 

Flexion,  Dorsal. — L.  flex'io,  bending; 
dor'sum,  back.  See  Talipes  Cal- 
caneus. 

Plantar. — L.  plan'm,  sole  of  the  foot. 
See  Talipes  Equinus. 

Hollow  or  Contracted. — See  Hollow  or 
Contracted  Foot. 

Inversion  of  the. — L.  in,  in  vert'ere, 
to  turn.  See  Talipes  Varus. 

Morton’s  Painful  Affection  of  the. — 
See  Anterior  IMetatarsalgia. 

Plantar  Flexion  of  the. — L.  plan'ta,  sole; 
flex'io,  bending.  See  Talipes  Equi- 
nus. 

Splay  . — See  Weak  Foot. 

Tuberculosis. — See  Tuberculosis  of  the 
Long  Bones  of  the  Hand  and  Foot. 

Weak. — See  Weak  Foot. 

Forearm,  Fractures  of  the. — See  Frac- 
tures of  the  Forearm,  the  Shaft;  Fractures  of 
the  Elbow;  Fractures  of  the  Radius,  the 
Lower  End. 

Fractures,  introduction.— General  Con- 
siDER.\TiONS. — The  symptoms  of  bone  frac- 
ture are  variable,  embracing  local  pain  and 
tenderness,  loss  of  function,  crepitus,  deform- 
ity, abnormal  mobility,  and  echymosis.  One 
should  compare  the  appearance  and  measure- 


FRACTURES 


ments  of  the  injured  side  with  those  of  the 
sound  side,  and  should  take  an  X-ray  pic- 
ture, (see  Part  1)  if  practicable.  In  using  the 
fluoroscope,  it  is  aclvised  that  the  limb  be 
held  eight  to  twelve  inches  from  the  tube, 
and  exposed  no  longer  than  five  minutes,  in 
order  to  avoid  a burn.  One  should  bear  in 
mind  that  the  X-ray  may  falsely  exaggerate 
the  degree  of  displacement. 

Before  applying  retentive  apparatus,  bathe 
the  skin  with  soap  and  warm  water,  shave, 
if  adhesive  plaster  is  to  be  applied,  rinse  and 
dry  thoroughly,  sponge  with  alcohol,  dry, 
and  dust  with  a bland  powder,  such  as  oxide 
of  zinc  and  starch,  equal  parts.  Paint  blebs 
with  alcohol  or  tincture  of  iodine,  open  with 
a sterile  needle,  and  cover  with  sterile  boric 
acid  and  sterile  gauze.  A little  morphine 
may  be  given  the  first  night,  if  much  pain 
is  complained  of.  For  in.structions  how  to 
prepare  plaster  bandages  and  casts,  see 
these  headings.  In  recumbent  cases,  one  may 
employ  the  Bradford  frame,  with  ropes  and 
pulleys,  for  elevating  the  patient  when  using 
the  bed-pan. 

Nerve  injury  is  due  to  contusion  or  lacera- 
tion, or  to  compression  by  callus.  A lacer- 
ated nerve  should  be  sutured  at  once.  Com- 
pressing callus  should  be  removed.  The, 
affected  muscles  should  be,  ^massaged  and 
stimulated  electrically  until  the  nerve  func- 
tion is  restored  (see  Anterior  Poliomyelitis, 
in  Part  1). 

Threatened  gangrene  calls  for  immediate 
amputation  well  above  the  fracture. 

For  the  treatment  of  gas  infection,  see 
Infection,  in  Part  1. 

For  the  treatment  of  gunshot  fractures, 
etc.,  see  Wounds,  in  Part  1. 

Open  fractures  should  be  treated  as  fol- 
lows: Wash  the  skin  with  soap,  brush,  and 
hot  water,  shave,  and  rinse  thoroughly,  and 
wash  the  wound  with  hot  water  with  extreme 
thoroughness,  using  the  gloved  fingers  and 
small  gauze  swabs  held  in  forceps.  Then,  if 
deemed  important,  irrigate  with  bichloride 
solution,  1 : 5000.  Do  not  remove  bone 
fragments  unless  they  are  completely  de- 
tached. Suture  the  bones  with  silver  or 
bronze  alummmn  wire,  or  use  boiled  beef- 
bone  screws  and  plate  (better  than  metal), 
or  an  intramedullary  beef-bone  peg.  Douche 
the  wound  again  thoroughly  with  hot  water, 
and  close,  leaving  in,  perhaps,  a small  drain 
for  twenty-four  hours.  Immobilize  the  parts. 

For  greater  comfort  and  convenience  in 
the  treatment  of  open  fractures,  the  window 
of  the  cast  may  be  sealed  to  the  skin  at  its 
circumference  by  means  of  dental  rubber. 
No.  2,  dissolved  in  chloroform  to  make  a 


semigelatinous  paste,  and  then  mixed  with 
absorbent  wool.  The  cast  is  then  covered 
with  shellac.  Fig.  124  shows  the  use  of  a 
U-shaped  piece  of  iron  in  the  treatment  of 
open  fractures. 

In  non-union  due  to  too  great  loss  of  sub- 
stance, Albee’s  method  of  autogenous  bone 
transplantation  is  indicated. 

In  the  operative  treatment  of  closed 
fractures,  it  is  perhaps 
best  to  wait  for  seven 
to  ten  days,  or  until 
the  tissues  have  re- 
covered somewhat. 

Operation  for  non- 
union should  not  be 
performed  until  all 
traces  of  inflammation 
are  absent.  Test  for 
latent  inflammation  by 
active  and  passive  move- 
ments, brisk  massage, 
and  the  elastic  tourni- 
quet. 

Union  of  a fracture 
occurs  usually  in  from 
three  to  four  weeks,  but 
it  is  not  solid  for  six 
to  eight  weeks  or  more. 

After  gunshot  frac- 
tures the  bones  remain 
soft  for  several  months 
after  union  hasoccurred, 
so  that  a calliper  splint 
or  other  support  should 
be  worn  during  this 
period,  in  these  cases. 

One  may  commence  massage  at  about  the  end 
of  two  weeks  (at  first  of  five  to  ten  minutes 
duration,  gradually  lengthened  to  thirty 
minutes) ; passive  motion  at  the  end  of  about 
four  weeks;  active  motion  at  about  the  end 
of  the  sixth  to  eighth  week.  Hot  air  (see 
under  Arthritis)  and  hot  or  cold  douches  are 
sei’viceable  stimulating  measures. 

Delayed  union  means  absence  of  rigid 
union  after  the  lapse  of  eight  to  twelve 
weeks.  The  causes  are  (1)  imperfect  immo- 
bilization, (2)  wide  separation  of  the  bone 
fragments,  (3)  the  interposition  of  soft 
tissue  between  the  bone  fragments,  (4)  over- 
extension  or  too  prolonged  extension,  espe- 
cially in  fractures  of  the  humerus,  and  (5) 
certain  constitutional  affections,  e.g.,  gout, 
rheumatism,  rickets,  scurvy,  diabetes,  chronic 
nephritis,  syphilis,  and  the  causes  of  fragil- 
itas  ossium  (q.v.,).  The  treatment  depends 
upon  the  cause.  Wide  separation  of  the  frag- 
ments and  the  interposition  of  soft  tissue 
call  for  operative  interference,  and  if  neces- 


FRACTURES  OF  THE  CLAVICLE 


sary,  resection  of  the  ends  of  the  fi-aginents. 
Autogenous  bone  transplantation,  intramed- 
ullary beef-bone  pegs,  or  boiled  beef-bone 
plates,  and  screws  may  be  employed.  Metal 
retards  bone  osteogenesis  and  destroys  bone 
cells.  Constitutional  disorders  call  for  appro- 
priate treatment.  Thyroid  extract,  pituitary 
extract,  and  potassium  iodide  (see  Drugs, 
Part  11)  are  well  recommended  for  their 
stimulating  effect  upon  bone  formation. 
Tonics  may  be  required:  strychnine,  nux 
vomica,  arsenic,  iron,  quinine,  phosphorus. 
Rubbing  the  fractured  ends  of  the  bone 
together  may  stimulate  bone  regeneration. 

In  vicious  union,  do  a transverse  or  cunei- 
form osteotomy  with  chisel  and  mallet,  and 
correct  the  deformity. 

Special  fractures  are  considered  in  their 
alphabetical  order. 

Fractures  of  the  Acetabulum. — L.,  “ vine- 
gar cruet,”  from  ace'tuni,  vinegar. 
See  Fractures  of  the  Femoral  Neck; 
and  Dislocations  of  the  Hip,Central. 

Acromion. — Gr.  ixKpov  point  + cu/xos 
shoulder.  See  Fractures  of  the 
Scapula. 

Anatomical  Neck  of  the  Humerus. — Gr. 

ava  apart  + Tetiveiv  to  cut.  See 
Fractures  of  the  Hiunerus. 

Fractures  of  the  Ankle. — Consider,  in 
injuries  at  the  ankle,  the  following  possibili- 
ties: Pott’s  fracture  of  the  lower  end  of  the 
tibia  and  fibula;  dislocation;  fracture  of  the 
tarsal  bones;  sprain;  rupture  of  the  tendo 
Achillis  {q.v.  in  their  alphabetical  order). 

Fractures  of  the  Astragalus. — L. ; Gr. 
aarpayaXos  die.  See  Fractures  of  the  Tarsal 
Bones. 

Fracture,  Bennet’s. — See  Fractures  of  the 
Metacarpal  Bones. 

Fractures  of  the  Carpal  Bones. — L.  car- 
pus; Gr.  Kapiros  wrist.  Fracture  of  the 
scaphoid  bone  (marked  particularly  by 
acute  tenderness  on  pressure  in  the  anatomi- 
cal snuff-box  when  the  hand  is  adducted, 
and  muscle-spasm  upon  forced  extension  of 
the  wrist,  is  perhaps  best  treated  by  excision 
of  the  smaller  fragment,  or  even  of  the  whole 
bone,  followed  by  immobilization  for  two 
weeks,  and  then  massage  and  passive  and 
active  movements.  The  fingers  are  to  be 
used  at  the  end  of  a week. 

If  conservative  treatment  is  tried,  immo- 
bilize the  parts  for  four  weeks,  followed  by 
massage  and  passive  and  active  movements 
for  four  weeks  longer.  If  then  there  is  no 
improvement,  operate. 

The  operation  of  Codman  and  Chase  is  as 
follows:  Make  a half-inch  long  incision  on 
the  dorsum  of  the  wrist,  just  internal  and 


parallel  to  the  tendon  of  the  extensor  carpi 
radialis  longior.  After  retracting  the  tissues, 
carry  this  incision  through  the  angular  liga- 
ment in  the  fibrous  septum  between  the  long 
extensors  of  the  fingers  and  the  long  exten- 
sors of  the  wrist. 

Fractures  of  the  Clavicle. — L.  clavic'ula, 
little  key,  from  clav'is,  key.  If  displacement 
exists,  the  inner  fragment  is  drawn  upward 
by  the  sterno-cleidomastoid  mascle,  while 
the  outer  fragment  lies  below  and  behind 
the  inner  fragment,  due  to  the  weight  of  the 
arm,  which  carries  the  shoulder  forward  and 
inward ; or  else  there  is  an  angular  deformity 
with  the  apex  directed  backward. 

After  carefully  cleansing  the  skin  with 
soap  and  water,  shaving,  drying,  sponging 
with  alcohol,  drying,  and  dusting  the 
axilla  and  flexure  of  the  elbow  with  talcum 
powder  or  equal  parts  of  starch  and  zinc 
oxide,  place  soft  pads  in  the  axilla,  flexure 
of  the  elbow,  and  on  the  forearm  where 
it  will  come  in  contact  with  the  chest.  En- 
circle the  upper  arm,  as  high  as  possible, 
with  a small  folded  towel  held  together  by 
adhesive  plaster.  Encircle  this  cloth  armlet 
and  fasten  with  a safety  pin  one  end  of  a 
long  zinc-oxide  adhe.sive  strap,  and  while 
seeing  that  the  shoulder  is  held  well  back 
and  elevated,  .so  as  to  bring  the  fragments 
in  apposition,  cany  the  adhesive  strap  back 
and  completely  around  the  chest  to  the 
axilla  of  the  injured  side.  Start  another  long 
adhesive  strap  at  the  back  of  the  injured 
shoulder,  and  carry  it  under  the  elbow 
(make  a hole  in  the  strap  to  receive  the 
point  of  the  elbow),  and  up  and  across  in 
front  to  the  well  shoulder,  the  forearm  being 
flexed  and  resting  upon  the  chest.  The  aim 
of  this  dressing  is  to  raise  and  cany  the 
shoulder  backward,  and  the  elbow  forward. 
Place  another  strap  horizontally  around  the 
whole  chest  and  arm  for  seciu’ity;  and  over 
all  apply  a Velpeau  bandage  (q.v.).  (Sayre.) 

If  a pad  over  the  fractured  ends  is  deemed 
advisable,  take  care  to  avoid  undue  pressure. 
Such  a pad  is  held  in  place  by  a long  adhesive 
strap  passed  beneath  the  flexed  elbow.  It  is 
seklom  required. 

Inspect  the  parts  frequently,  and  remove 
and  reapply  the  dressings  at  least  every 
twelve  days;  cleansing,  drying,  and  powder- 
ing the  skin  at  each  change  of  dressing.  In 
children,  the  skin  may  have  to  be  cleansed 
about  eveiy  third  day  to  avoid  chafing. 

Omit  the  Sayre  dressing  at  the  end  of 
three  or  four  weeks,  and  support  the  arm  in 
a sling  for  about  a week  longer.  After  the 
fourth  week,  begin  to  employ  massage  and 
passive  and  active  movements. 


FRACTURES  OF  THE  ELBOW 


Suture  of  the  fragments  with  kangaroo 
tendon  is  sometimes  the  best  treatment. 
The  parts  are  then  supported  by  means  of  a 
Velpeau  bandage  reinforced  with  adhes- 
ive straps. 

In  green-stick  fracture,  after  the  deform- 
ity has  been  corrected  under  anaesthesia,  it 
is  necessary  merely  to  bind  the  upper  arm 
to  the  chest  by  means  of  a towel  swathe  held 
in  place  by  shoulder  straps,  and  to  support 
the  forearm  in  a sling,  all  retentive  dressings 
being  dispensed  with  after  two  to  four  weeks. 

Fracture,  Colles’s. — See  Fractures  of  the 
Radius,  the  Lower  End. 

Compound. — See  under  Introduction: 
General  Considerations,  at  the  begin- 
ning of  Fractures 

Condyle,  External. — L.  con'dylus,  knuc- 
kle; exter'nus,  outside.  See  Frac- 
tures of  the  Elbow. 

Internal. — L.  inter'nus,  inside.  See 
Fractures  of  the  Elbow. 

Fractures  of  the  Elbow. — Consider,  in 
injuries  to  the  elbow,  the  following  possi- 
bilities: sprain;  supracondyloid  fracture  of 
the  humerus;  T or  Y-shaped  fractures  of  the 
humerus  into  the  joint;  fracture  of  the  inter- 
nal condyle;  fracture  of  the  external  con- 
dyle; fracture  of  the  internal  epicondyle  in 
children;  separation  of  the  lower  epiphysis 
of  the  humerus  (occurring  before  the  seven- 
teenth year) ; subluxation  of  the  head  of  the 
radius  (occurring  in  children  under  five 
years,  q.v.);  forward  dislocation  of  the  upper 
end  of  the  radius  (q-v.) ; fracture  of  the  upper 
end  of  the  ulna;  backward  dislocation  of  the 
radius  and  ulna  {q.v.),  with  or  without  frac- 
ture of  the  coronoid  process  of  the  ulna; 
fractine  of  the  olecranon  ; fracture  of  the 
neck  or  head  of  the  radius. 

Measure  the  distance  between  the  two 
condyles  of  the  hmnerus,  and  the  distance 
between  the  acromion  and  the  external  con- 
dyle, and  compare  these  measurements  with 
those  of  the  other  side.  Palpate  the  head 
of  the  radius  just  beneath  the  external  con- 
dyle, and  note  if  it  moves  with  the  shaft  of 
the  radius  during  pronation  and  supination. 
Compare  the  carrying  angle  of  the  injured 
arm  with  that  of  the  normal  arm. 

With  the  forearm  extended,  no  lateral 
motion  of  the  forearm  on  the  humerus  is 
normally  possible.  With  the  forearm  ex- 
tended, the  tip  of  the  olecranon  lies  on  or 
just  slightly  above  a transverse  line  drawn 
through  the  internal  and  external  condyles. 
With  the  forearm  flexed  to  a right  angle,  the 
tip  of  the  olecranon  and  the  two  condyles 
form  an  equilateral  triangle  with  the  ole- 
cranon at  the  lower  angle. 


Make  the  manipulative  examination  un- 
der anaesthesia  and  at  the  same  time  correct 
deformity,  by  flexing  the  elbow  to  a right 
angle,  exerting  traction  with  one  hand,  and 
pressing  the  fragments  into  position  with 
the  other.  An  X-ray  picture  should  be 
taken,  if  possible. 

Treat  any  of  the  varieties  of  fracture 
enumerated  above,  excepting  fracture  of  the 
olecranon,  as  follows: 

After  cleansing  and  drying  the  skin,  and 
reducing  displacements,  supinate  the  fore- 
arm fully  and  flex  it  acutely  as  far  as  possi- 
ble, with  a piece  of  protective  gauze  and 
talcum  powder  in  the  flexure  of  the  elbow. 
Hold  the  forearm  in  this  position  by  means 
of  a band  of  adhesive  plaster  around  the 
forearm  and  upper  arm,  with  pieces  of 
gauze  under  the  adhesive  plaster  at  points 
of  pressure  to  prevent  chafing,  or  else  by 
means  of  figure-of-eight  turns  of  a flannel 
bandage.  Piotect  apposed  skin  surfaces 
(hand,  forearm,  chest,  and  axilla)  with 
powder  and  thin,  soft  pads;  and  bind  the 
arm  to  the  chest  by  means  of  a Velpeau  band- 
age (q.v.)  reinforced  with  adhesive  plaster. 

Renew  the  dressing  as  the  swelling  sub- 
sides. At  the  end  of  the  fourth  week,  begin 
daily  massage  of  five  to  ten  minutes  dura- 
tion; and  passive  and  active  movements,  if 
not  painful,  at  the  end  of  the  fifth  or  sixth 
week.  In  performing  passive  movements, 
grasp  the  elbow  with  one  hand,  and  flex 
extend,  pronate,  and  supinate  the  forearm 
to  its  full  extent.  Gradually  diminish  the 
acuteness  of  flexion  at  the  end  of  the  fourth 
week  by  leng-thening  the  sling. 

If,  in  fractm’e  of  the  neck  or  head  of  the 
radius,  the  fragments  can  not  be  approxi- 
mated, resect  the  head  of  the  bone  after  the 
swelling  has  subsided. 

Gun.shot  fractures  tlnough  the  elbow  joint, 
in  view  of  the  danger  of  ankylosis,  should  be 
treated  at  right  angles,  with  the  forearm 
about  three-fourths  supinated.  (Col.  Sir 
Robert  Jones). 

Treatment  of  Fractures  of  the  Olecranon. — After 
cleansing,  drying,  and  powdering  the  skin, 
apply  with  adhesive  straps  a padded,  inter- 
nal, right-angled,  perforated  metal  splint  for 
about  six  days,  or  until  the  swelling  has  sub- 
sided. If  no  separation  of  the  fragments  is 
then  evident,  continue  this  position.  If 
separation  of  the  fragments  is  observed, 
however,  extend  the  arm,  and  apply  a long 
padded  internal  splint,  extending  from  the 
axilla  to  the  tips  of  the  fingers,  held  in  place 
by  straps  of  adhesive  plaster,  placed  above 
and  below  the  elbow  and  at  both  ends  of  the 
splint.  Hold  the  upper  fragment  of  the 


FRACTURES  OF  THE  FEMORAL  NECK 


olecranon  against  the  lower  fragment  by 
means  of  a strip  of  adhesive  plaster  fastcnetl 
to  the  splint.  Apply  over  all  a bandage 
extending  from  the  fingers  to  the  axilla. 

Renew  the  dressings  and  massage  the 
parts  once  a week.  Change  the  angle  of  the 
splint  after  the  third  week.  Employ  daily 
massage  and  passive  motion  at  the  end  of 
the  fourth  week.  Omit  splints  after  five 
weeks  and  support  the  arm  in  a sling. 

Operation  and  suture  of  the  fragments  is 
sometimes  required.  It  is  sufficient  to 
sutm-e  the  ajwneurosis  with  kangaroo  tendon. 

Fractures  of  the  Epicondyles  of  the 
Humerus.— Gr.  ewi  upon  + k6v8v\os 
knuckle.  See  Fractures  of  the  Elbow. 

External  Condyle  of  the  Humerus.— L. 
exter'nus,  outside;  con'dylus,  knuckle. 
See  Fractures  of  the  Elbow. 

Femoral  Head. — L.  fe'mur,  thigh.  See 
Fractures  of  the  Femoral  Neck. 

Femoral  Lower  End. — See  Fractures  of 
the  Femoral  Shaft. 

Fractures  of  the  Femoral  Neck. — With 
the  transverse  line  between  the  anterior 
superior  spines  of  the  ilium  at  right  angles 
with  the  long  axis  of  the  body,  and  the 
limbs  in  the  same  relative  position  to  the 
midline  of  the  body,  measure  and  compare 


the  lengths  of  the  two  limbs  between  the 
anterior  superior  spines  and  the  lower  border 
of  the  internal  malleoli;  bearing  in  mind 
that  in  some  individuals  a normal  difference 
of  one-half  to  one  inch  exists. 

The  top  of  the  great  trochanter  normally 
lies  on  or  ju.st  below  a line  drawn  from  the 
anterior  superior  spine  of  the  ilium  to  the 


tuberosity  of  the  ischimn  (Nelaton’s  line). 
Compare  the  two  sides. 

Biyant’s  line  is  a line  drawn  from  the 
top  of  the  trochanter  to  a perpendicular  line 
dropped  from  the  anterior  superior  spine  to 
the  horizontal  bed  or  table.  It  measures 
in  the  adult  normally  two  and  one-half 
inches.  Compare  the  two  sides. 

The  head  and  neck  of  the  femur  have  the 
same  geueral  direction  as  the  internal  condyle. 

In  fracture  of  the  neck  of  the  femur,  the 
limb  lies  helpless  and  everted  (inverted  in 
rare  instances  of  impaction  of  the  anterior 
portion  of  the  neck),  and  there  is  a slight 
fulness  just  below  the  fold  of  the  groin.  The 
limb  is  shortened,  and  the  top  of  the  great 
trochanter  is  above  Nelaton’s  line.  Exclude 
dislocation,  etc.  (see  Fractures  of  the  Hip). 
Avoid  breaking  up  an  impaction. 

In  fractures  at  the  junction  of  the  head 
and  neck,  bony  union  is  rare.  In  feeble 
patients  over  sixty,  no  matter  where  the 
fracture  is  located,  union  seldom  occurs. 

Treatment.  — Treat  young  patients  and 
healthy  adults  by  the  Whitman  method: 
First  cleanse,  dry,  and  powder  the  skin. 
Under  anaesthesia,  with  the  pelvis  elevated 
and  the  well  limb  strongly  abducted  and 
used  to  steady  the  pelvis,  flex  the  injured 
limb  somewhat,  rotate  it  in- 
ward to  disengage  any  soft 
tissues  from  between  the  frag- 
ments, lift  the  trochanter  for- 
ward, correctabnormal  eversion 
(or  inversion)  of  the  foot,  exert 
strong  traction  until  both  limbs 
are  of  equal  length,  and  then 
abduct  the  lunb  to  as  near  the 
normal  hmit  of  45°  as  possible. 
Now  apply  a plaster-of-Paris 
spica  to  the  pelvis,  thigh,  and 
leg,  down  to  the  middle  of  the 
leg  in  adults,  and  including  the 
foot  in  children  (see  Plaster 
Bandages  and  Plaster  Casts). 
Strengthen  the  cast  posterior 
to  the  joint  by  means  of  a 
strip  of  metal  bent  to  corre- 
spond with  the  curve  of  the 
buttock.  A strip  of  metal  may 
also  be  placed  at  the  knee.  At- 
tach a perineal  band  to  the 
pelvic  portion  of  the  spica  (see  Fig.  125). 
Employ,  besides,  traction  (see  below),  if  the 
shortening  is  greater  than  three-fourths  of  an 
inch,  and  the  fragments  are  not  impacted. 

Remove  the  jdaster  spica  after  about 
eight  weeks,  and  allow  the  patient  about  on 
crutches  for  several  weeks  longer  before 
allowing  the  foot  on  the  ground.  Raise  the 


FRACTURES  OF  THE  FEMORAL  NECK 


sole  of  the  shoe  on  the  sound  side  three  or 
four  inches  while  using  crutches. 

Another  but  less  accurate  method  of 
treatment,  by  which,  if  deemed  necessary, 
the  patient  may  be  allowed  out  of  bed  on 
crutches,  is  that  with  the  Thomas  hipsplint 
(see  Fig  126) : First  correct  displacement, 
under  anaesthesia,  by  traction,  forward  pres- 
sure upon  the  trochanter,  and  the  correction 
of  eversion  (or  inversion).  Then  apply  a 
Thomas  hip-splint,  which  consists  of  a pos- 
terior strip  of  soft  iron  extending  from  the 
axilla  to  the  calf  of  the  leg,  1}4  inches  wide 
and  }/i  inch  thick,  with  a chest  band  nearly 
encircling  the  chest,  13^4  inches  wide  and 
inch  thick,  with  holes  forged  in  the  ends, 
34  inch  in  chameter,  a thigh  band  midway 
between  the  two  extremities,  just  below  the 
perineum,  34  inch  wide  and  3-fe  inch  thick, 
two  inches  less  than  the  circmnference  of 
the  thigh,  and  a calf  band,  3s  inch  wide  and 
inch  thick,  two  inches  less  than  the  cir- 
cmnference of  the  calf  of  the  leg.  At  the 
buttock,  the  long  posterior  strip  is  bent  to 
conform  with  the  natural  curve  here.  The 
splint  may  be  made  by  a blacksmith.  The 
body  surface  of  the  splint  is  padded  with 
one-quarter  inch  felt,  and  covered  tightly 
with  basil  leather  put  on  wet.  The  splint 
is  bandaged,  or  strapped  and  buckled  to  the 
leg  anti  thigh,  and  then  the  shoulder  straps 
are  applied,  using  the  anterior  ends  of  the 
straps  to  fasten  the  ends  of  the  chest  band 
together.  If  traction  is  employed,  long  ad- 
hesive straps  may  be  fastened  to  each  sitle 
of  the  shaved  thigh  high  up  and  brought 
around  the  wings  of  the  calf  band,  the 
shoulder  straps  being  then  omitted. 

In  lifting  the  patient  to  adjust  the  bed- 
pan,  place  the  arms  below  the  knees.  Guard 
against  pressure  sores  by  turning  the  patient 
daily  on  the  sound  side  and  pulling  the  .skin 
first  to  one  side  of  the  splmt  and  then  to  the 
other.  Additional  padding  may  be  required. 

If  the  patient  is  gotten  up  on  crutches,  the 
sole  of  the  shoe  on  the  sound  side  should  be 
raised  about  three  or  four  inches. 

After  six  to  eight  weeks  omit  the  splint, 
and  after  four  more  weeks  in  bed,  in  cases 
in  which  recumbency  is  to  be  preferred, 
gradually  get  the  patient  up  on  crutches. 

In  old  and  feeble  patients  employ  the 
following  method:  Avoid  breaking  up  an 
impaction.  Place  boards  crosswise  under 
the  mattress  to  prevent  sagging.  Place  the 
leg  in  a comfortable  position  with  a pillow 
beneath  the  knee;  and  after  shaving  the 
skin,  cover  the  foot  with  a flannel  bandage 
from  the  toes  to  just  above  the  malleoli,  and 
apply  on  each  side  of  the  limb  from  the 


pubes  and  trochanter  to  the  malleoli,  and 
extending  six  inches  beyond  the  sole  of  the 
foot,  a long  strip  of  zinc  oxide,  or  better, 
moleskin  (yellow)  adhesive  plaster  (less 
irritating  than  rubber  plaster) , wide  above 
and  narrow  below  the  knee  (or  about  two 
inches  wide),  with  the  sticky  side  opposite 
the  ankle  and  foot  covered  with  muslin  or 
another  adhesive  strip,  to  prevent  adhesion 
to  the  ankle  and  foot  bandage.  Hold  these 
long  side  strips  in  place  by  means  of  two 
long  spiral  adhesive  strips  extending  from 
the  ankle  to  the  upper  part  of  the  thigh,  and 
other  circular  strips  around  the  ankle,  just 
above  the  knee,  and  around  the  upper  thigh 
(only  partly  encircling  the  limb  to  avoid 


Fig.  126.  Thomas'  single  hip-splint  in  position  (Hidlon). 
“The  Treatment  of  Fractures.” — Scudder.  (Courtesy  W.  B. 
Saunders  Co. 

constriction).  Fasten  the  ends  of  the  long 
side  strips  to  a wooden  spreader  a little 
broader  than  the  width  of  the  ankle,  and 
through  a hole  in  the  center  of  the  spreader 
pass  a clothes-line,  and  tie  the  proximal  end 
in  a knot  for  the  purpose  of  traction  upon 
the  spreader.  Pass  the  line  over  a pulley 
fastened  to  the  end  of  the  bed,  and  attach 
to  it  a weight  of  about  five  pounds.  Cover 
the  adhesive  strapping  with  a stocking 
or  with  an  evenly  applied  bandage 
extending  from  the  toes  to  the  groin,  with  its 
margins  stitched  to  keep  it  in  place. 
(Buck’s  extension.) 

Now  apply,  from  the  axilla  to  below  the 
foot,  a long,  padded,  wooden  T-splint  (four 
feet  long,  four  inches  wide,  one  inch  thick, 
with  a cross-piece  at  the  lower  end  fastened 
with  nails  or  an  iron  brace,  the  inner  limb 
of  this  foot-piece  containing  a hole  for  the 
passage  of  the  traction  cord),  and  bind  it 
to  the  trunk  with  a towel  or  with  broad 


FRACTURES  OF  THE  FEMORAL  SHAFT 


muslin  bandages,  and  to  the  leg  with  straps 
or  bandages,  and  place  a well-padded  per- 
ineal band  in  position  with  its  ends  passed 
through  holes  in  the  upper  part  of  the 
T-splint. 

Place  long  sandbags  on  each  side  of  the 
leg  and  thigh.  Protect  the  heel  from  pres- 
sure with  a padded  ring  or  a cushion  ring 
pessary;  and  keep  the  foot  at  right  angles 
with  the  leg.  Elevate  the  foot  of  the  bed 
six  inches  with  blocks  of  wood,  the  upper 
ones  being  cupped  out  to  receive  the  legs  of 
the  bed.  Protect  the  limb  from  the  weight 
of  the  bed-clothing  by  means  of  a cradle. 
Guard  against  bed-sores  {q.v.,  in  Part  1),  and 
against  hypostatic  pneumonia  by  deep 
breathing,  changing  the  position  of  the 
patient  frequently,  by  daily  general  massage, 
and  passive  and  active  movements  of  the 
sound  limbs. 

In  the  second  week,  prop  the  patient  up 
in  bed  with  pillows.  In  the  third  week  omit 
traction.  After  six  to  eight  weeks  get  the 
patient  up  in  a wheel  chair.  After  ten 
weeks,  allow  him  about  with  a crutch,  but 
permit  no  pressure  upon  the  foot  for  three 
or  four  months  from  the  reception  of  the 
injury.  At  the  end  of  a year  the  patient 
may  walk  with  a cane.  (Scudder.) 

Eisendrath  regards  as  the  best  method  of 
treatment  of  impacted  fractures  complete 
immobilization  in  the  impacted  position, 
“ without  attempting  to  correct  the  deform- 
ity,” accomplished  by  means  of  a plaster-of- 
Paris  spica  extending  from  the  umbilicus  to 
the  toes.  The  patient  is  allowed  about  on 
crutches,  if  not  too  feeble,  the  sole  of  the 
shoe  on  the  sound  side  being  raised  three  or 
four  inches.  No  weight  should  be  borne 
upon  the  foot  for  three  months.  Feeble 
patients  are  kept  upon  a firm  bed,  or  better, 
upon  a suspended  Verity  gas-pipe  frame, 
which  may  be  raised  or  lowered  at  will. 

Pegging  of  the  fracture  with  beef-bone  or 
ivory  screws,  or  pegs,  driven  through  the 
trochanter  into  the  head,  is  sometimes  con- 
sidered the  preferable  mode  of  treatment, 
especially  in  fractures  at  the  narrow  portion 
of  the  neck.  The  incision  is  made  to  the 
outer  side  of  the  tensor  vagin*  femoris 
muscle.  It  is  be.st  to  wait  eight  days  before 
operating.  After  the  operation,  immobilize 
the  hip,  in  an  abducted  position,  with 
j)laster-of-Paris,  as  in  the  Whitman  method, 
described  above. 

Fractures  of  the  Femoral  Shaft. — With 
the  transverse  line  between  the  anterior 
superior  spines  of  the  ilium  at  right  angles 
with  the  long  axis  of  the  body,  and  the  two 
limbs  in  symmetrical  positions  with  reference 


to  the  midline,  compare  the  lengths  of  the 
two  limbs  measured  from  the  anterior 
superior  spine  to  the  lower  border  of  the 
internal  malleolus. 

Treatment. — Under  anaesthesia,  with  an 
assistant  steadying  the  pelvis  and  upper 
fragment,  reduce  the  fracture  by  traction 
and  manipulation. 

A.  The  following  is  the  conventional 
method  of  fixation : Cleanse,  shave,  and  dry 
the  skin,  and  cover  the  foot  with  a flannel 
bandage  from  the  toes  to  ju.st  above  the 
malleoli.  Now  apply  on  each  side  of  the 
limb,  from  the  site  of  the  fracture  to  the 
malleoli,  and  extending  six  inches  beyond 
the  sole  of  the  foot,  a long,  two-inch-wide 
strip  of  zinc  oxide  aclhesive  plaster,  with  the 
sticky  side  opposite  the  ankle  and  foot  cov- 
ered with  another  adhesive  strip  or  with 
muslin,  to  prevent  adhesion  to  the  ankle  and 
foot  bandage.  Hold  these  long  side  strips 
in  place  by  means  of  two  long  spiral  adhesive 
strips  extending  from  the  ankle  to  the  seat 
of  fracture,  and  other  circular  strips  around 
the  ankle,  just  above  the  knee,  and  just 
below  the  fracture  (only  partly  encircling 
the  limb  to  avoid  constriction).  Fasten  the 
ends  of  the  long  side  strips  to  a wooden 
spreader  a little  broader  than  the  width  of 
the  ankle,  and  through  a hole  in  the  centre 
of  the  spreader  pass  a clothes  line,  and  tie 
the  proximal  end  in  a knot  for  the  purpose 
of  traction  upon  the  spreader.  Pass  the 
line  over  a pulley  fastened  to  the  end  of  the 
bed,  and  attach  to  it,  in  adults,  from  fifteen 
to  twenty-five  pounds,  or  sufficient  to  pre- 
vent shortening  (Buck’s  extension).  Cover 
the  adhesive  strapping  with  a stocking  or 
with  an  evenly  applied  bandage  extending 
from  the  toes  to  the  groin,  with  its  margins 
stitched  to  keep  it  in  place. 

Place  beneath  the  limb  a padded,  wooden 
posterior  or  ham  splint,  extending  from  the 
buttock  to  the  middle  of  the  leg,  with  an 
additional  pad  beneath  the  knee.  Fasten 
the  splint  to  the  limb  with  adhesive  plaster, 
one  strap  at  each  end  and  one  below  the 
knee.  Then  place  three  padded  coaptation 
splints,  one  anteriorly  from  the  groin  to  the 
patella,  one  external  1}^  from  the  trochanter 
to  the  external  condyle,  and  one  internally 
from  the  perineum  to  just  above  the  adduc- 
tor tubercle.  Hold  these  splints  in  place 
with  straps  and  buckles. 

Now  apply,  from  the  axilla  to  below  the 
foot,  a long,  padded,  wooden  T-splint  (four 
feet  long,  four  inches  wide,  one  inch  thick, 
with  a cross-piece  at  the  lower  end  fastened 
with  nails  and  an  iron  brace,  the  inner  por- 
tion of  the  foot-piece  containing  a hole  for 


FRACTURES  OF  THE  FEMORAL  SHAFT 


the  traction  line),  and  bind  it  to  the  trunk 
with  a broad  swathe,  and  to  the  thigh  and 
leg  with  straps,  and  place  a well- padded 
perineal  band  in  position  whth  its  ends 
passed  through  holes  in  the  upper  part  of 
the  T-splint.  The  Ihnb  should  be  some- 
what abducted. 

Place  long  sandbags  on  each  side  of  the 
thigh  and  leg.  Protect  the  heel  from  pres- 
sure with  a padded  ring  or  a cushion  ring 
pessar>'.  Keep  the  foot  at  right  angles  with 
the  leg,  and  guard  against  eversion  by  means 
of  a bandage  attached  to  the  ham  splint 
below  the  calf  of  the  leg  and  brought  up  on 
the  outer  side  of  the  leg  and  fastened  to  the 
top  edge  of  the  long  T-splint.  Raise  the 
foot  of  the  bed  about  six  inches  with  blocks 
of  wood,  the  upper  ones  being  cupped  out  to 
receive  the  legs  of  the  bed.  Place  a cradle 
over  the  foot  and  leg  to  protect  them  against 
the  weight  of  the  bed  clothing.  Guard 
against  outward  bowing  of  the  limb  with 


pressed  upon  with  danger  of  gangrene; 
therefore  always  examine  for  pulsation 
below  the  j)oint  of  fracture),  flex  the  leg, 
and  place  the  limb  upon  a double-inclinecl 
plane  (Fig.  127),  with  pads  beneath  the 
lower  fragment  to  raise  it  and  bring  it  in 
apposition  with  the  upper  fragment.  Trac- 
tion may  not  be  required. 

Remove  and  reapply  the  splints  and  dress- 
ings at  the  end  of  four  weeks,  and  see  that 
everything  is  correct.  Remove  all  retentive 
apparatus  at  the  end  of  the  eighth  week,  and 
begin  passive  and  active  movements  and 
massage.  Get  the  patient  up  on  crutches 
at  the  ninth  week,  with  the  shoe  raised  two 
inches  on  the  sound  side,  and  with  perhaps 
a light  plaster-of-Paris  spica  (q.v.)  from  the 
toes  to  the  waist,  or  a Taylor  hip-splint.  Dis- 
card all  support  at  the  end  of  twelve  weeks. 
The  bearing  of  weight  upon  the  foot  should 
be  gradual. 

D.  In  children  under  ten  years  of  age 


resulting  shortening,  and  against  inward  or 
outward  rotation.  Where  it  is  deemed  im- 
portant to  get  the  patient  up,  use  the 
Thomas  hip-splint  described  under  Fractures 
of  the  Femoral  Neck. 

B.  If  the  fracture  is  subtrochanteric,  the 
lower  fragment  and  leg  should  be  elevated 
upon  a single  inclined  plane,  and  abducted, 
so  as  to  bring  the  lower  fragment  on  a line 
with  the  upper  fragment.  Wiring  the  frag- 
ments with  silver  or  bronze  aluminum  is, 
however,  perhaps  best  in  fractures  in 
this  location. 

C.  If  the  fracture  is  supracondyloid 
(exclude  separation  of  the  lower  epiphysis 
of  the  femur,  q.v.,  and  dislocation  of  the 
knee,  q.v.;  in  supracondyloid  fracture  the 
lower  fragment  is  pulled  downward  and 
backward  by  the  gastrocnemius  muscle, 
whereas,  in  epiphyseal  separation,  the  upper 
fragment  is  pulled  downward  and  backward 
and  the  lower  fragment  is  displaced  forward; 
in  either  case  the  popliteal  vessels  may  be 


Scudder  recommends  the  Cabot  posterior 
wire  frame,  with  co-aptation  splints  and 
Buck’s  extension. 

At  the  end  of  four  weeks,  get  the  patient 
up  in  his  Cabot  splint,  with  shoulder  straps 
to  hold  it  up  (or  apply,  instead,  a light 
plaster-of-Paris  spica,  q.v.),  and  allow  him 
about  on  crutches  with  a high  shoe  on  the 
sound  foot. 

E.  In  very  young  children  one  may  strap 
the  patient’s  shoulders  and  hips  to  a Bradford 
frame  (or  gas  piping,  one  inch  wider  than 
the  width  of  the  hips  and  six  inches  longer 
than  the  child,  and  covered  with  canvas 
except  beneath  the  buttocks),  and  suspend 
the  limb  at  right  angles  to  the  trunk  by 
means  of  traction  straps,  cord,  pulleys,  and 
weights,  applied  as  before  described,  with 
coaptationsplintsapplied  as  before  described, 
the  only  difference  being  the  upright  posi- 
tion of  the  limb  (see  Fig.  128). 

F.  Probably  the  best  method,  however,  of 
immobilizing  a fracture  is  by  means  of 


FRACTURES  OF  THE  FEMORAL  SHAFT 


muslin  bandages,  and  to  the  leg  with  straps 
or  bandages,  and  place  a well-padded  per- 
ineal band  in  position  with  its  ends  passed 
through  holes  in  the  upper  part  of  the 
T-splint. 

Place  long  sandbags  on  each  side  of  the 
leg  and  thigh.  Protect  the  heel  from  pres- 
sure with  a padded  ring  or  a cushion  ring 
pessary;  and  keep  the  foot  at  right  angles 
with  the  leg.  Elevate  the  foot  of  the  bed 
six  inches  with  blocks  of  wood,  the  upper 
ones  being  cupped  out  to  receive  the  legs  of 
the  bed.  Protect  the  limb  from  the  weight 
of  the  bed-clothing  by  means  of  a cradle. 
Guard  against  bed-sores  (g.y.,in  Part  1),  and 
against  hypostatic  pneumonia  by  deep 
breathing,  changing  the  position  of  the 
patient  frequently,  by  daily  general  massage, 
and  passive  and  active  movements  of  the 
.sound  limbs. 

In  the  second  week,  prop  the  patient  up 
in  bed  with  pillows.  In  the  third  week  omit 
traction.  After  six  to  eight  weeks  get  the 
patient  up  in  a wheel  chair.  After  ten 
weeks,  allow  him  about  with  a crutch,  but 
permit  no  pressure  upon  the  foot  for  three 
or  four  months  from  the  reception  of  the 
injury.  At  the  end  of  a year  the  patient 
may  walk  with  a cane.  (Scudder.) 

Eisemlrath  regards  as  the  best  method  of 
treatment  of  impacted  fractures  complete 
immobilization  in  the  impacted  position, 
“ without  attempting  to  correct  the  deform- 
ity,” accomplished  by  means  of  a plaster-of- 
Paris  spica  extending  from  the  umbilicus  to 
the  toes.  The  patient  is  allowed  about  on 
crutches,  if  not  too  feeble,  the  sole  of  the 
shoe  on  the  sound  siile  being  raised  three  or 
four  inches.  No  weight  should  be  borne 
upon  the  foot  for  three  months.  Feeble 
patients  are  kept  upon  a firm  bed,  or  better, 
upon  a suspended  Verity  gas-pipe  frame, 
which  may  be  raised  or  lowered  at  will. 

Pegging  of  the  fracture  with  beef-bone  or 
ivory  screws,  or  pegs,  driven  through  the 
trochanter  into  the  head,  is  sometimes  con- 
sidered the  preferable  mode  of  treatment, 
especially  in  fractures  at  the  narrow  portion 
of  the  neck.  The  incision  is  made  to  the 
outer  side  of  the  tensor  vaginae  femoris 
muscle.  It  is  best  to  wait  eight  days  before 
operating.  After  the  operation,  immobilize 
the  hip,  in  an  abducted  position,  with 
plaster-of-Paris,  as  in  the  Whitman  method, 
described  above. 

Fractures  of  the  Femoral  Shaft. — With 
the  transverse  line  between  the  anterior 
superior  spines  of  the  ilium  at  right  angles 
with  the  long  axis  of  the  body,  and  the  two 
limbs  ill  .symmetrical  positions  with  reference 


to  the  midline,  compare  the  lengths  of  the 
two  limbs  measured  from  the  anterior 
superior  spine  to  the  lower  border  of  the 
internal  malleolus. 

Treatment. — Under  anajsthesia,  with  an 
assistant  steadying  the  pelvis  and  upper 
fragment,  reduce  the  fracture  by  traction 
and  manipulation. 

A.  The  following  is  the  conventional 
method  of  fixation : Cleanse,  shave,  and  dry 
the  skin,  and  cover  the  foot  with  a flannel 
bandage  from  the  toes  to  just  above  the 
malleoli.  Now  apply  on  each  side  of  the 
limb,  from  the  site  of  the  fracture  to  the 
malleoli,  and  extending  six  inches  beyond 
the  sole  of  the  foot,  a long,  two-inch-wide 
strip  of  zinc  oxide  adhesive  plaster,  with  the 
sticky  side  opposite  the  ankle  and  foot  cov- 
ered with  another  adhesive  strip  or  with 
muslin,  to  prevent  adhesion  to  the  ankle  and 
foot  bandage.  Hold  these  long  side  strips 
in  place  by  means  of  two  long  spiral  adhesive 
strips  extending  from  the  ankle  to  the  seat 
of  fracture,  and  other  circular  strips  around 
the  ankle,  just  above  the  knee,  and  just 
below  the  fracture  (only  partly  encircling 
the  limb  to  avoid  constriction).  Fasten  the 
ends  of  the  long  side  strips  to  a wooden 
spreader  a little  broader  than  the  width  of 
the  ankle,  and  through  a hole  in  the  centre 
of  the  spreader  pass  a clothes  line,  and  tie 
the  proximal  end  in  a knot  for  the  purpose 
of  traction  upon  the  spreader.  Pass  the 
line  over  a pulley  fastened  to  the  end  of  the 
bed,  and  attach  to  it,  in  adults,  from  fifteen 
to  twenty-five  pounds,  or  sufficient  to  pre- 
vent shortening  (Buck’s  extension).  Cover 
the  adhesive  strapping  with  a stocking  or 
with  an  evenly  applied  bandage  extending 
from  the  toes  to  the  groin,  with  its  margins 
stitched  to  keep  it  in  place. 

Place  beneath  the  limb  a padded,  wooden 
posterior  or  ham  splint,  extending  from  the 
buttock  to  the  middle  of  the  leg,  with  an 
atlditional  pad  beneath  the  knee.  Fasten 
the  splint  to  the  limb  with  adhesive  plaster, 
one  strap  at  each  end  and  one  below  the 
knee.  Then  place  three  padded  coaptation 
splints,  one  anteriorh^  from  the  groin  to  the 
patella,  one  externally  from  the  trochanter 
to  the  external  condjde,  and  one  internally 
from  the  perineum  to  just  above  the  adduc- 
tor tubercle.  Hold  these  splints  in  place 
with  straps  and  buckles. 

Now  apply,  from  the  axilla  to  below  the 
foot,  a long,  padded,  wooden  T-splint  (four 
feet  long,  four  inches  wide,  one  inch  thick, 
with  a cross-piece  at  the  lower  end  fastened 
with  nails  and  an  iron  brace,  the  inner  por- 
tion of  the  foot-piece  containing  a hole  for 


FRACTURES  OF  THE  FEMORAL  SHAFT 


the  traction  line),  and  bind  it  to  the  trunk 
with  a broad  swathe,  and  to  the  thigh  and 
leg  with  straps,  and  place  a well-padded 
perineal  band  in  position  with  its  ends 
passed  through  holes  in  the  upper  part  of 
the  T-splint.  The  Ihnb  should  be  some- 
what abducted. 

Place  long  sandbags  on  each  side  of  the 
thigh  and  leg.  Protect  the  heel  from  pres- 
sure with  a padded  ring  or  a cushion  ring 
pessarj'.  Keep  the  foot  at  right  angles  with 
the  leg,  and  guard  against  eversion  by  means 
of  a bandage  attached  to  the  ham  splint 
below  the  calf  of  the  leg  and  brought  up  on 
the  outer  side  of  the  leg  and  fastened  to  the 
top  edge  of  the  long  T-splint.  Raise  the 
foot  of  the  bed  about  six  inches  with  blocks 
of  wood,  the  upper  ones  being  cupped  out  to 
receive  the  legs  of  the  bed.  Place  a cradle 
over  the  foot  and  leg  to  protect  them  against 
the  weight  of  the  bed  clothing.  Guard 
against  outward  bowing  of  the  limb  with 


pressed  upon  with  danger  of  gangrene; 
therefore  always  examine  for  pulsation 
below  the  point  of  fracture),  flex  the  leg, 
and  place  the  limb  upon  a double-inclined 
plane  (Fig.  127),  with  pads  beneath  the 
lower  fragment  to  raise  it  and  bring  it  in 
apposition  with  the  upper  fragment.  Trac- 
tion may  not  be  required. 

Remove  and  reapply  the  splints  and  dress- 
ings at  the  entl  of  four  weeks,  and  see  that 
everything  is  correct.  Remove  all  retentive 
api^aratus  at  the  end  of  the  eighth  week,  and 
begin  passive  and  active  movements  and 
massage.  Get  the  patient  up  on  crutches 
at  the  ninth  week,  with  the  shoe  rai.sed  two 
inches  on  the  sound  side,  and  with  perhaps 
a light  plaster-of-Paris  spica  {q-v.)  from  the 
toes  to  the  waist,  or  a Taylor  hip-splint.  Dis- 
card all  support  at  the  end  of  twelve  weeks. 
The  bearing  of  weight  upon  the  foot  should 
be  gradual. 

D.  In  children  under  ten  years  of  age 


resulting  shortening,  and  against  inward  or 
outward  rotation.  Where  it  is  deemed  im- 
portant to  get  the  patient  up,  use  the 
Thomas  hip-splint  described  under  Fractures 
of  the  Femoral  Neck. 

B.  If  the  fracture  is  subtrochanteric,  the 
lower  fragment  and  leg  should  be  elevated 
upon  a single  inclined  plane,  and  abducted, 
so  as  to  bring  the  lower  fragment  on  a line 
with  the  upper  fragment.  Wiring  the  frag- 
ments with  silver  or  bronze  aluminum  is, 
however,  perhaps  best  in  fractures  in 
this  location. 

C.  If  the  fracture  is  supracondyloid 
(exclude  separation  of  the  lower  epiphysis 
of  the  femur,  q.v.,  and  dislocation  of  the 
knee,  q.v.-,  in  supracondyloid  fracture  the 
lower  fragment  is  pulled  downward  and 
backward  by  the  gastrocnemius  muscle, 
whereas,  in  epiphyseal  separation,  the  upper 
fragment  is  pulled  downward  and  backward 
and  the  lower  fragment  is  displaced  forward ; 
in  either  case  the  popliteal  vessels  may  be 


Scudder  recommends  the  Cabot  posterior 
wire  frame,  with  co-aptation  splints  and 
Buck’s  extension. 

At  the  end  of  four  weeks,  get  the  patient 
up  in  his  Cabot  splint,  with  shoulder  straps 
to  hold  it  up  (or  apply,  instead,  a light 
plaster-of-Paris  spica,  q.v.),  and  allow  him 
about  on  crutches  with  a high  shoe  on  the 
sound  foot. 

E.  In  very  young  children  one  may  strap 
the  patient’s  shoulders  and  hips  to  a Bradford 
frame  (or  gas  piping,  one  inch  wider  than 
the  width  of  the  hips  and  six  inches  longer 
than  the  child,  and  covered  with  canvas 
except  beneath  the  buttocks),  and  suspend 
the  limb  at  right  angles  to  the  trunk  by 
means  of  traction  straps,  cord,  pulleys,  and 
weights,  applied  as  before  described,  with 
coaptationsplintsapplied  as  before  described, 
the  only  difference  being  the  upright  posi- 
tion of  the  limb  (see  Fig.  128). 

F.  Probably  the  best  method,  however,  of 
immobilizing  a fracture  is  by  means  of 


FRACTURES  OF  THE  FOREARM,  THE  SHAFT 


plaster  {q.v.,)  which  should  extend  beyond 
the  joints  next  above  and  below  the  site 
of  fracture.  If  the  fractured  ends,  how- 
ever, are  oblique,  so  that  they  will  not 
remain  in  apposition,  or  if  soft  parts  are 


Fig.  128. — Suspension  method  of  treatment  of  fracture. 

interposed,  the  fracture  must  be  cut  down 
upon  and  the  ends  of  the  bone  united  by 
wire  or  plate,  the  latter  preferably  of  beef- 
bone  or  ivory  with  screws  of  a like  material. 

G.  The  Thomas  knee  splint  (see  under 
Fractures  of  the  Leg,  the 

Shaft)  may  be  used  for  frac- 
ture of  the  femoral  shaft. 

H.  Separation  of  the 
lower  femoral  epiphysis  oc- 
curs under  twenty-one  years 
of  age.  It  is  treated  as  fol- 
lows (Scudder) : If  the  frac- 
ture is  an  open  one,  resect 
any  of  the  cUaphysis  that 
happens  to  be  stripped  of 
its  periosteum,  reduce  the 
displacement,  and  if  neces- 
sary, suture  the  fragments. 

Immobilize  the  knee,  flexed 
at  a right  angle,  with  plas- 
ter-of-Paris  {q-v.),  applied 
from  the  toes  to  the  groin. 

If  the  fracture  is  closed, 
trjq  if  possible,  to  reduce  it 
by  traction  upon  the  lower 
end  of  the  thigh  upward, 
and  upon  the  leg  below  the  flexetl  knee  for- 
ward, as  shown  in  Fig.  129.  The  disaj)- 
pearance  of  shortening  shows  that  the 
displacement  has  been  corrected.  If  unsuc- 
cessful, operate. 

At  the  end  of  three  or  four  weeks,  grad- 


ually extend  the  leg.  At  the  end  of  about 
five  weeks,  allow  the  patient  to  commence 
bearing  .slight  weight  upon  the  leg.  After 
about  six  weeks,  remove  the  plaster-of- 
Paris  splint,  and  begin  massage  and  passive 
and  active  motion.  After  about  ten  weeks 
the  whole  weight  may  be  borne  upon  the  leg. 

I.  For  traction  purposes  one  may  use 
screws  introduced  into  the  uppermost  por- 
tion of  the  condyles  close  to  the  diaphysis 
to  a depth  of  two  to  three  centimetres. 

Fractures  of  the  Femur,  Subtrochanteric. 
— L.  sub-  under;  L.,  Gr.  Tpoxo-VTijp 
runner.  See  under  Fractures  of  the 
Femoral  Shaft. 

Supracondyloid. — L.  su'-pra-  above; 
con'dylus,  knuckle.  See  under 
Fractures  of  the  Femoral  Shaft. 

Fibula,  the  Lower  End. — L.  fib'ula, 
buckle.  See  Fracdures  of  the  Leg, 
the  Lower  End. 

Upper  End. — See  Fractures  of  the 
Leg,  the  Shaft. 

Fingers,  the  Phalanges. — See  Fractures 
of  the  Phalanges  of  the  Fingers. 

Fractures  of  the  Forearm,  the  Shaft. — 
After  cleansing,  dr>dng,  and  powdering 
the  skin,  reduce  the  fracture  under  anaes- 
thesia, and  see  that  the  forearm  can  be 
supinated  strongly. 

With  the  forearm  flexed  to  a right  angle 
and  semisupinated  so  that  the  thumb  points 


129. — Proper  way  to  reduce  fracture. 


upward,  cover  the  limb  with  a layer  of 
sheet  wadding,  and  apply  a plaster-of-Paris 
bandage  (q-v.)  from  the  metacarpophalangeal 
joints  to  the  axilla.  Split  the  splint 
before  it  has  hardened,  and  protect  the  cut 
edges  against  crumbling  with  a strip  of 


FRACTURES  OF  THE  HUMERUS 


adhesive  plaster.  Apply  a snug  bandage 
over  the  splint  to  hold  it  in  place.  Support 
the  arm  in  a sling. 

Readjust  the  splint  once  a week.  Discard 
it  at  the  end  of  four  weeks,  and  begin  daily 
massage  and  passive  and  active  movements. 

If,  because  of  swelling  and  bruising  of  the 
soft  parts,  it  is  deemed  best  to  employ 
wooden  splints  (made  of  thin  splint  wood, 
padded),  apply  one  posteriorly  from  the 
metacarpophalangeal  joints  to  the  elbow, 
and  another  anteriorly  from  the  middle  of 
the  palm  nearly  to  the  elbow,  cutting  out  a 
portion  of  the  latter  to  accormnodate  the  ball 
of  the  thumb.  The  splints  should  be  about 
a quarter  of  an  inch  wider  than  the  fore- 
arm. Hold  them  in  place  with  straps  of 
adhesive  plaster,  one  at  the  upper  end,  one 
at  the  wrist,  and  one  around  the  posterior 
splint  and  palm.  With  the  forearm  flexed 
at  a right  angle,  and  semi.supinated  so  that 
the  thumb  points  upward,  immobilize  the 
elbow  joint  by  means  of  an  internal,  right- 
angled,  perforated  metal  splint.  Apply  over 
all  a bandage  from  the  hand  to  the  axilla, 
and  place  the  arm  in  a sling  which  supports 
the  whole  foreg,rm  from  the  hand  to 
the  elbow. 

Remove  and  readjust  the  splints  twice  a 
week.  Discard  them  at  the  end  of  the 
fourth  or  fifth  week  and  commence  massage 
and  passive  and  active  movements. 

Fractures,  Glenoid. — Gr.  yXrjvri  cavity  + 
eL8os  form.  See  Fractures  of  the 
Scapula. 

Gunshot. — See  under  Introduction,  at 
the  beginning  of  the  subject  of 
Fractures. 

Head  of  the  Humerus. — See  Fractures 
of  the  Humerus. 

Head  of  the  Radius. — See  Fractures  of 
the  Elbow. 

Head  of  the  Femur. — See  Fractures  of 
the  Femqral  Neck. 

Fractures  of  the  Hip. — Consider,  in  in- 
juries to  the  hip,  the  following  possibilities; 
sprain,  fractures  of  the  head  and  neck  of 
the  femur,  epiphyseal  separation,  frac  tures 
of  the  acetabulum,  fractures  of  the  greater 
or  lesser  trochanter,  and  dislocations. 

With  the  transverse  line  between  the 
anterior  superior  spines  of  the  ilium  at 
right  angles  with  the  long  axis  of  the  body, 
and  the  limbs  in  the  same  relative  position 
to  the  midline  of  the  body,  measure  and 
compare  the  lengths  of  the  two  limbs  be- 
tween the  anterior  superior  spines  and  the 
lower  border  of  the  internal  malleoli.  Re- 
member that  in  .some  individuals  a normal 
difference  of  one  half  to  one  inch  obtains. 


The  top  of  the  greater  trochanter  normally 
lies  on  or  ju.st  below  a line  drawn  from  the 
anterior  superior  spine  of  the  ilium  to  the 
tuberosity  of  the  ischimn  (Nelaton’s  line). 
Compare  the  two  sides. 

Bryant’s  line  is  a line  drawn  from  the  top 
of  the  trochanter  to  a perpendicular  line 
dropped  from  the  anterior  superior  spine  to 
the  horizontal  bed  or  table.  It  measures  in 
the  adult  normally  two  and  a half  inches. 
Compare  the  two  sides. 

Note  whether  internal  or  external  rota- 
tion of  the  limb  is  present. 

The  head  and  neck  of  the  femur  have 
the  same  general  direction  as  the 
internal  condyle. 

In  manipulating  the  injured  limb,  take 
care  not  to  break  up  a possible  impaction. 

Fractures  of  the  Humerus. — L.  hu'merus, 
upper  arm  bone.  Compare  the  lengths  of 
the  two  upper  arms,  measured  from  the 
acromion  process  to  the  external  condyle. 
The  head  of  the  hmnerus  normally  points 
in  the  same  direction  as  the  internal  condyle 
at  the  elbow.  In  the  consideration  of  in- 
juries in  the  neighborhood  of  the  upper  end 
of  the  humerus,  consult  Fractures  of  the 
Shoulder. 

A.  Fracture  of  the  Anatomical  Neck. — This  is  a 
rare,  coimnonly  impacted  fracture,  which 
occurs  in  old  people,  and  which  requires 
simple  support  by  means  of  a sling,  and 
early  use  of  the  joint  as  soon  as  the  absence 
of  pain  permits.  An  axillary  pad  and  Vel- 
peau bandage  (q-v.)  may  be  employed.  Re- 
covery is  slow. 

B.  Fracture  of  the  Tuberosities. — The  treat- 
ment is  the  same  as  that  of  fracture  of  the 
anatomical  neck,  considered  above. 

C.  Separation  of  the  Upper  Epiphysis. — This 
occurs  between  the  sixth  and  twentieth  (to 
twenty-fifth)  year  of  age.  The  lower  frag- 
ment or  diaphysis  is  displaced  forward 
and  inward. 

Correct  displacement  by  traction  and 
pressure  against  the  upper  end  of  the  dia- 
physis backward  and  outward.  An  opera- 
tion is  sometimes  required  and  suture  of  the 
fragments  with  kangaroo  tendon. 

After  reduction,  immobihze  the  joint  as 
described  below  for  fracture  of  the  surgi- 
cal neck. 

[).  Fracture  of  the  Surgical  Neck. — Reduce  the 
fracture,  under  anaesthesia  if  necessary,  by 
traction  in  the  abducted  position. 

After  cleansing,  drying,  and  powdering 
the  whole  arm,  shoulder,  and  axilla,  apply  a 
firm,  even  flannel  bandage  from  the  middle 
of  the  hand  to  the  shoulder,  with  the  fore- 
arm flexed  at  a right  angle.  Then  place  in 


FRACTURES  OF  THE  HUMERUS 


the  axilla,  with  the  apex  upward,  a padded 
triangular  splint,  made  of  cardboard  or 
thin  wood,  one-eighth  of  an  inch  thick, 
and  a little  wider  than  the  arm,  the  triangle 
measuring  about  three  inches  at  its  base, 
and  extending  from  the  apex  of  the  axilla  to 
just  above  the  internal  condyle.  Hold  the 
triangle  in  position  by  means  of  a strap 
which  passes  around  the  trunk  or  around 
the  opposite  shoulder  and  axilla  in  the 
form  of  a figure-of-eight. 

Now  pad  the  entire  shoulder,  the  upper 
arm  down  to  the  elbow,  and  the  adjoining 
chest,  anteriorly  and  posteriorly,  with 
sheet  wadding,  and  apply  a shoulder  cap 
of  pla.ster-of-Paris  iq-v-)  covering  all 
these  parts. 

Then  place  a thin  towel  upon  the  sound 
of  the  thorax,  and  apply  a circular  bandage 
around  the  chest  and  affected  arm,  and 
another  bandage  under  the  triangular  splint 
and  over  the  shoulder,  to  hold  the  cap  in 
place.  Like  retaining  bandages  or  straps 
may  be  incorporated  in  the  shoulder  caji 
before  the  latter  is  completed.  Then  sup- 
port the  forearm,  not  including  the  elbow, 
in  a sling,  so  that  traction  may  be  exerted 
by  the  weight  of  the  arm. 

Eisendrath  says  that  a Velpeau  bandage 
{q-v.)  reinforced  by  adhesive  plaster  or  a 
few  turns  of  plaster-of-Paris  will  often  yield 
equally  as  good  re.sults  as  the  plaster-of- 
Paris  shoulder  cap. 

Instruct  the  patient  to  move  the  fingers 
frequently.  Remove  the  dressings,  and 
examine  the  arm  about  every  seven  days, 
and  apply  a fresh  shoulder  cap  when  the 
latter  becomes  loose. 

At  about  the  end  of  the  fourth  week,  when 
union  has  become  firm,  omit  all  dressings 
except  a sling  supporting  the  wrist,  and 
commence  massage  and  passive  movements. 

If  a position  of  stability  cannot  be  secured 
by  any  other  means,  owing  to  obliquity 
of  the  fracture  or  the  interposition  of  soft 
parts,  the  fragments  must  be  wired  with 
silver  or  bronze  aluminum.  (See  also  G, 
below). 

E.  Fractures  of  the  Shaft. — Reduce  the  frac- 
ture, under  ether  if  necessary",  and  see  that 
the  acromion  process  and  the  external  con- 
dyle are  in  the  same  line. 

After  cleansing,  drying,  and  powdering 
the  whole  arm,  shoulder,  and  axilla,  apply 
a firm,  even  flannel  bandage  from  the  middle 
of  the  hand  to  the  shoulder,  with  the  fore- 
arm flexed  at  a right  angle.  Then  place  in 
the  axilla  with  the  apex  upward,  a padded 
triangular  splint  made  of  cardboard  or  thin 
wood,  one-eighth  of  an  inch  thick,  and  a 


little  wider  than  the  arm,  the  triangle  meas- 
uring about  three  inches  at  its  base,  and 
extending  from  the  apex  of  the  axilla  to 
just  above  the  internal  condyle.  Hold  the 
triangle  in  position  by  means  of  a strap  which 
passes  around  the  trunk  or  around  the 
opposite  shoulder  and  axilla  in  the  form  of 
a figure  of  eight. 

Surround  the  upper  arm  with  coaptation 
splints,  made  by  laying  thin  splint  wood 
upon  the  sticky  side  of  adhesive  plaster  and 
then  splitting  the  wood,  but  not  the  plaster, 
into  strips  with  a knife.  Hold  the  splint  in 
place  with  three  straps  of  adhesive  plaster. 

Now  ajjply  a wide  adhesive  plaster  swathe 
around  the  chest  and  upper  arm,  extending 
from  the  acromion  above  to  the  external 
condyle  below.  Then  support  the  wTist  in 
a sling,  leaving  the  elbow  unsupported,  so 
that  traction  may  be  exerted  by  the  weight 
of  the  arm.  Rarely  is  additional  traction 
(by  means  of  strips  of  adhesive  plaster 
applied  to  the  inner  and  outer  aspects  of 
the  upper  arm,  a wooden  spreader  to  keep 
the  plaster  clear  of  the  elbow,  and  a weight 
of  three  pounds)  required. 

If  desired,  one  may  apply  a split  plaster- 
of-Paris  splint  iq-v.)  to  the  forearm,  arm,  and 
shoulder,  over  the  wooden  coaptation  splints. 

Reapply  the  dressings  once  a week, 
cleansing,  dr>dng,  and  powdering  the  skin 
each  time.  At  about  the  end  of  the  fourth 
week,  if  union  has  occurred,  commence 
massage  and  passive  movements;  and  about 
two  weeks  later  omit  all  support  e.xcept  a 
sling  to  the  w'rist. 

If  a po.sition  of  stability  of  the  two  frag- 
ments can  not  be  secured  by  the  above 
treatment,  owing  to  the  obliquity  of  the 
fracture  or  the  interposition  of  soft  parts, 
the  fragments  must  be  wired  w"ith  silver  or 
bronze  aluminum. 

Remember  that  the  musculospiral  nerve 
may  be  injured,  wdth  resulting  wristdrop. 
In  the  presence  of  such  a complication, 
operate,  to  free  or  suture  the  nerve,  only  if 
the  paralysis  persists  for  four  or  five  weeks. 
Resect  the  humerus  if  the  ends  of  the  nerve 
can  not  be  brought  together.  Employ 
massage,  electricity,  and  passive  motion 
until  power  is  restored,  that  is,  for  from 
five  to  eight  months.  (See  also  G,  below). 

F.  Fractures  of  the  Lower  End.  — See  Frac- 
tures of  the  Elbow. 

Q.  The  arm-abduction  splint  showm  in 
Fig.  130  is  a useful  appliance  for  upper  arm 
fractures.  Its  construction  is  described  by 
E.  W.  Cleary,  in  the  J.  A.  M.  A.  of  Nov. 
15,  1919,  as  follows:  A soft  iron  rod, 
inch  in  diameter  and  12  feet  long,  is  bent 


FRACTURES  OF  THE  HYOID  BONE 


into  the  shape  of  a double-pointed  carpet 
tack  (viz.,  ri)  with  legs  of  equal  length  and 
a middle  segment  one  foot  long.  The  middle 
segment  is  curved  to  fit  the  waist  on  the 
uninjured  side  at  the  level  of  the  iliac  crest, 
the  two  legs  of  the  bent  rod  pointed  upward. 
At  a point  2 inches  above  the  middle  seg- 
ment each  leg  is  bent  laterally  through  a 
right  angle;  and  at  another  point,  3^  inch 
further,  another  right  angle  bend  in  the 
reverse  direction  is  made.  These  bends 
prevent  the  attached  waist  belt  from  slip- 
ping upward.  One  inch  above  the  level  of 
the  axilla  the  two  legs  of  the  rod  arc  bent 
horizontally  across  the  body,  each  with  a 
slight  convex  cuiwature  toward  the  body. 
The  injured  arm  is  brought  to  a position  of 
90°  abduction,  with  the  elbow  in  right- 
angled  flexion  in  the  horizontal  plane.  The 
rear  rod  lies  behind  the  arm  and  projects 


able  diagonal  brace  may  be  applied,  as 
shown  in  Fig.  131. 

The  axillary  saddle  has  a thick  roll  of  felt 
under  leather  at  the  top  edge,  and  its  upper 
borders  are  sewed  firmly  to  the  acromial 
borders  of  the  shoulder  saddle. 

If  the  splint  is  to  be  worn  night  and  day, 
a strip  of  thick  leather,  3 inches  wide  and 
14  inches  long,  padded  with  felt,  is  sewed 
on  between  the  rear  rod  and  the  body. 

Fractures  of  the  Humerus,  the  Anatomi= 
cal  Neck. — Gr.  til'd  apart  -j-  rkfiveiv  to 
cut.  See  Fractures  of  the  Humerus. 
Condyle  s. — L.  con'dyLus,  knuckle. 

See  Fractures  of  the  Elbow. 
Epicondyle. — Gr.  kn-L  upon  k6v8v\os 

knuckle.  See  Fractures  of  the 
Elbow. 

Lower  End. — See  Fractures  of  the 
Elbow. 


beyond  the  elbow.  It  is  now  bent  forward 
through  a right  angle,  26 3^  inches  from  the 
last  bend,  so  that  it  lies  along  the  forearm. 
In  the  same  way  the  front  rod  is  bent  at  a 
point  213^^  inches  from  its  last  bend,  so 
that  it  extends  forward  inside  the  forearm. 
Eleven  inches  from  the  bend  at  the  elbow 
this  inside  rod  is  now  bent  through  a right 
angle  across  the  hand.  The  outside  rod  is 
bent  inward  through  a right  angle  where 
the  inside  rod  crosses  it,  and  the  surplus 
ends  of  the  two  rods  are  cut  off  so  that 
when  the  ends  of  the  frame  are  brazed  to- 
gether the  space  between  the  inside  and  the 
outside  forearm  rods  is  53^  inches.  A piece 
of  rod  13  inches  long  is  bent  into  an  arch 
and  ‘brazed  to  the  front  and  rear  rods  in 
such  a mannei  as  to  arch  over  the  injured 
shoulder.  Its  purpose  is  to  increase  the 
rigidity  of  the  frame.  It  should  not  rest  on 
the  shoulder.  In  heavy  individuals  a detach- 


Shaft. — See  Fractures  of  the  Humerus. 

Supracondyloid. — L.  su'pra,  above; 
Gr.  kovSv'Kos  knuckle  -f  eidos  form. 
See  Fractures  of  tne  Elbow. 

Surgical  Neck. — L.  chirur'gia,  from 
Gr.  xetp  hand  -f  ipyov  work.  See 
Fractures  of  the  Humerus 

T=Shaped,  in  the  Elbow  Joint. — See 
Fractures  of  the  Elbow. 

Tuberosities. — L.  luberos'itas,  emi- 
nence. See  Fractures  of  the 
Humerus. 

Y=Shaped,  into  the  Elbow  Joint.— 

See  Fractures  of  the  Elbow. 

Fractures  of  the  Hyoid  Bone. — Gr.  coet5r;s 
U-shaped.  The  resulting  symptoms  are  local 
swelling  and  ecchymosis,  dyspnoea,  cough, 
dysphonia,  dysphagia,  and  local  pain  on 
opening  the  mouth  or  protruding  the  tongue. 

Reduce  the  fracture  by  means  of  a finger 
in  the  mouth  and  the  other  hand  upon  the 


FRACTURES  (JF  THE  LEG,  THE  SHAFT 


outside.  Keep  an  ice-bag  over  the  bone. 
J'eed  the  patient  per  rectum  (see  Rectal  Feed- 
ing in  Part  1)  for  a time,  and  warn  him  not 
to  speak  or  whisper  for  a week.  A Thomas 
collar  (see  under  Torticollis)  may  be  em- 
ployed as  a splint. 

Fractures,  Idiopathic. — Gr.  Uios  ow7i  -f- 
irados  disease.  See  Fragilitas  Ossium, 
in  Part  1. 

Fractures  of  the  Inferior  Maxilla. — L., 

lower  jaw.  See  Fractures  of  the 
Lower  Jaw. 

Internal  Condyle  of  the  Humerus. — L. 

con'dylus,  knuckle.  See  Fractures  of 
the  Elbow. 

Epicondyle  of  the  Humerus. — Gr.  ext 

upon  + k6v5v\os  knuckle.  See 
Fractures  of  the  Elbow. 

Jaw,  Lower.  — See  Fractures  of  the 
Lower  Jaw. 

Upper.  — See  Fractures  of  the  Upper 
Jaw. 

Fractures  of  the  Knee. — Consider,  in 
injuries  at  the  knee,  the  following  possi- 
bilities: sprain,  fracture  of  the  lower  end  of 
the  femur,  separation  of  the  lower  femoral 
epiphysis,  fracture  of  the  patella,  dislocation 
of  the  patella,  dislocation  of  the  tibia,  frac- 
ture of  the  upper  end  of  the  tibia,  fracture 
of  the  upper  end  of  the  fibula,  dislocation 
of  a semilunar  cartilage,  rupture  of  the  liga- 
mentum  patellae. 

Fractures  of  the  Larynx. — Gr.  \apvy^ 
larynx.  The  symptoms  are  like  those  of 
fracture  of  the  hyoid  bone  (q.v.). 

Perform  tracheotomy  (q.v.  in  Part  1),  at 
once,  even  though  the  s>nnptoms  are  not 
urgent.  Displacement  may  be  corrected 
later.  Warn  the  patient  not  to  speak  or 
whisper  for  a week  or  longer.  Rectal  feed- 
ing (q.v.  in  Part  1)  may  be  required  for  a 
time. 

Fractures  of  the  Leg,  the  Lower  End; 
Pott’s  Fracture. — Fractures  of  the  lower 
end  of  the  tibia  and  fibula  are  all  called 
Pott’s  fracture. 

Pott’s  fracture  is  due  u.sually  to  forcible 
eversion  and  abduction  of  the  foot  upon  the 
leg;  rarely  to  inversion  and  adduction. 
The  deformity  is  one  of  eversion  and  back- 
ward displacement. 

Treatment.— If  the  swelling  is  very  great, 
support  the  elevated  leg  upon  a pillow  folded 
and  strapped  over  the  sides  of  the  leg,  with 
a jwsterior  and  two  lateral  wooden  splints 
between  the  pillow  and  straps,  and  defer  the 
rt'duction  of  the  fracture  until  later. 

After  about  seven  to  ten  days,  when  the 
swelling  has  sidtsided,  reduce  the  fracture 
untler  anaesthesia.  ( 'leanse,  dry,  and  powder 


the  skin.  With  the  foot  strongly  inverted 
and  adducted,  and  properly  lifted  forward 
so  as  to  overcome  posterior  displacement, 
apply,  over  roller-bandage  sheet-wadding, 
plaster-of-Paris  bandages  (q.v.)  from  the 
toes  to  the  middle  of  the  thigh.  Before  the 
plaster  has  hardened,  cut  out  a longitudinal 
strip  over  the  anterolateral  aspect  of  the 
limb,  for  inspection  of  the  ankle,  and  hold 
the  splint  in  place  with  buckled  straps  and 
bandages.  Massage  the  exposed  parts 
daily.  AVlien  the  swelling  has  disappeared, 
the  patient  may  be  allowed  up  on  crutches. 
At  the  end  of  five  or  six  weeks,  the  splint 
may  be  removed  and  a bandage  applied, 
and  passive  movements  begun.  At  the  end 
of  two  months,  gradual  weight  bearing  may 
be  begun.  For  at  least  six  months  there- 
after, the  longitudinal  arch  of  the  foot  under 
the  instep  should  be  supported  with  a pari. 

While  waiting  for  the  swelling  to  subside, 
and  until  plaster-of-Paris  can  be  secured, 
one  may  employ  the  Dupuytren  splint  (see 
Fig.  132).  The  inner  padding  of  folded 


Fig.  132. 

sheets  extends  from  the  middle  of  the 
thigh  to  just  above  the  internal  malleolus, 
and  is  thickest  below.  The  woodep  splint, 
the  lower  end  of  which  is  serrated,  extends 
from  the  middle  of  the  thigh  to  six  inches 
below  the  sole  of  the  foot.  The  splint  and 
padding  are  straiiped  and  buckled  to  the 
limb,  above  the  ankle,  above  the  knee,  and 
at  the  mitldle  of  the  thigh.  The  splint  is 
now  bound  to  the  ankle  by  circular  turns 
of  a bandage,  passed  from  the  splint  to  the 
leg,  which  is  then  passed  around  the  foot 
and  the  upper  serration,  while  the  foot  is 
held  adducted,  inverted,  and  lifted  forward. 
The  bandage  then  passes  around  the  ankle, 
and  back  over  the  instep,  and  around  the 
next  serration,  and  so  on,  making  successive 
figures-of-cight,  taking  care  also  to  lift  and 
hold  the  foot  forward  with  circular  turns  of 
the  bandage.  The  whole  limb  is  then  placed 
upon  pillows. 

As  soon  as  practicable,  apply  a plaster-of- 
Paris  bandage  as  before  described. 

Old  healed  Pott’s  fractures,  with  lateral 
or  backward  displacement,  are  corrected  by 
means  of  osteotomy  of  the  tibia  and  fibula. 

Fractures  of  the  Leg,  the  Shaft. — Com- 


FRACTURES  OF  THE  LEG,  THE  SHAFT 


pare  the  lengths  of  the  two  tibise,  measured 
from  the  upper  border  of  the  inner  tuber- 
osity of  the  tibia  to  the  lower  border  of  the 
inner  malleolus. 

Bathe  the  whole  limb  with  soap  and  warm 
water,  dry,  bathe  with  alcohol,  dry  thor- 
oughly, an(l  dust  with  talciun  powder.  Open 
blebs  aseptically,  and  cover  them  with 
sterile  boric  acid  and  sterile  gauze.  If  there 
is  much  swelling  and  displacement,  wait  a 
week  or  ten  days,  until  the  swelling  has  sub- 
sided, before  applying  the  permanent 
dressing.  In  the  meantime,  support  the 
elevated  leg  upon  a pillow  folded  and 
strapped  over  the  sides  of  the  leg,  with  a 
posterior  and  two  lateral  wooden  splints 
between  the  pillow  and  straps. 

After  the  swelling  has  subsided,  reduce  the 
fracture  under  anaesthesia.  See  that  the 
inner  side  of  the  great  toe,  the  middle  of 
the  patella,  and  the  anterior  superior  spine 
of  the  ilium  are  in  the  same  straight  line, 
and  that  the  foot  is  at  right  angles  with 
the  leg  and  a little  adducted;  and  guard 
against  backward  bowing. 

Now  apply,  over  an  abundance  of  sheet- 
wadding (applied  like  a bandage)  or  a 
flannel  bandage,  a light  plaster-of-Paris 
bandage  (g.y.),  reinforced  with  strips  of 
tin  or  wet  cypress  wood,  from  the  toes  to 
the  middle  of  the  thigh.  Split  the  plaster 
anteriorly  before  it  has  hardened.  If,  when 
the  case  is  first  seen,  there  is  little  or  no 
swelling  or  displacement,  this  splint  may 
be  applied  at  once.  Keep  the  limb  elevated 
and  watch  the  circulation. 

After  about  two  weeks,  when  the  splint 
has  become  loose,  either  apply  a new  one, 
or  cut  off  a strip  from  the  old  one,  and  draw 
it  together  tighter.  Cover  the  cut  edges 
with  adhesive  plaster  to  prevent  crumbling. 

At  the  end  of  four  or  five  weeks,  or  when 
union  has  occurred,  get  the  patient  up  on 
crutches  and  begin  daily  massage  and 
passive  and  active  movements. 

At  about  the  eighth  week,  omit  the 
splint,  bandage  the  leg  from  the  toes  to  the 
knee,  and  allow  a little  weight  bearing. 

At  about  the  tenth  to  twelfth  week, 
allow  walking  with  a cane. 

Another  method  of  immobilization  is  by 
means  of  Cabot’s  po.sterior  wire-splint.  The 
splint,  made  of  wh-e  about  a quarter  of  an 
inch  thick,  extends  from  the  sole  of  the  foot 
to  above  the  middle  of  the  thigh.  It  is 
narrow  below  and  broad  above,  and  has  a 
foot-piece  at  right  angles  with  the  leg.  The 
ends  of  the  wire  are  wound  together  with 
thin  copper  wire  or  solder.  The  wire  itself 
is  wound  with  sheet-wadding  and  a bandage, 
52 


and  then  the  bandage  is  carried  around  the 
frame  as  a whole.  The  splint  is  carefully 
padded  to  conform  with  the  posterior  con- 
tour of  the  Innb.  Lateral  padded  wooden 
splints,  extending  from  end  to  end  of  the 
posterior  wire-splint,  are  attached  with  straps 
and  buckles.  A ring  is  placed  beneath  the 
heel,  or  the  latter  is  slmig  from  its  sides  to 
the  foot-piece  with  adhesive  plaster.  The 
foot  is  strapped  to  the  foot-piece  with  ad- 
hesive plaster. 

If  displacement  tends  to  recur,  one  may 
employ  traction  by  means  of  Buck’s 
extension  (q-v.);  but  in  such  cases  (due  to 
obliquity  of  the  fracture  or  the  interposition 
of  soft  parts),  it  is  probably  best  to  suture 
the  bone  fragments  with  silver  or  bronze 
almninum  wire.  One  should  wait  about  ten 
days  for  the  traumatized  tissues  to  recover 
somewhat,  before  operating.  Union  is 
slower  in  cases  operated  upon.  Great 
swelling,  which  threatens  gangrene,  is  best 
treated  by  exposure  of  the  fracture  and 
suturing  of  the  fragments. 

Some  employ,  for  traction  purposes, 
screws  introduced  into  the  lower  fragment 
above  the  malleoli  to  a depth  of  2 to  3 cm. 

The  Thomas  splint,  (see  Fig.  140),  bent  at 
the  knee  to  30°  to  45°,  is  very  useful.  The 
leather  portion  should  be  kept  soft  with  sad- 
dle soap  and  the  iron  bars  smeared  with  vase- 
line. The  splint  is  applied  as  follows:  After 
applying  adhesive  strips  for  traction,  as  de- 
scribed for  Buck’s  extension  (q-v.),  an  assis- 
tant, grasping  the  heel  of  the  inj  ured  limb  with 
his  right  hand  and  the  forefoot  with  his  left, 
exerts  steady  traction,  while  another  assist- 
ant supports  the  fracture  above  and  below. 
The  physician  now  threads  on  the  splint, 
the  assistant  who  holds  the  foot  removing 
and  reapplying  the  upper  and  lower  hands 
alternately  to  allow  the  ring  to  be  passed 
over  the  foot.  The  ring  is  pushed  up  se- 
curely against  the  buttock,  care  being  taken 
to  keep  the  notched  transverse  bar  horizon- 
tal. The  second  assistant  continues  to  sup- 
port the  fracture.  The  traction  adhesive 
strips  with  interposed  spreader  are  fastened 
to  the  notched  transverse  bar.  Supporting 
flannel  slings  are  fastened  beneath  the  knee, 
ankle  and  calf,  and  to  prevent  the  leg  rising 
off  the  splint,  the  centre  of  a bandage  is 
placed  across  the  leg,  just  below  the  Imee, 
and  its  ends  carried  down  between  the  leg 
and  splint  and  up  outside  the  bars  and  tied 
above  the  leg.  Coaptation  splints  may  now 
be  applied  above  and  below  the  limb  and 
held  in  place  by  bandages  carried  around 
the  limb  outside  the  bars  of  the  splint. 
Sinclair’s  reversible  stu’rup  is  sprung  into 


FRACTURES  OF  THE  METACARPAL  BOXES 


the  splint  above  the  ankle,  with  its  foot 
toward  the  bed,  and  a bandage  is  applied  in 
the  form  of  a figure-of-eight,  to  prevent 
lateral  movement  of  the  foot.  A pad  should 
be  inserted  between  the  ring  and  the  outer 
side  of  the  thigh  to  serve  as  a wedge  and 
prevent  undue  movement. 

Open  fractures  should  be  treated  as  fol- 
lows: Wash  the  skin  with  soap,  brush,  and 
hot  water,  shave,  and  rinse  thoroughly,  and 
wash  the  wound  with  hot  water  with  extreme 
thoroughness,  using  the  gloved  fingers  and 
small  gauze  swabs  held  in  forceps.  Then, 
if  deemed  important,  irrigate  with  bichlor- 
ide solution,  1 : 5000.  Do  not  remove  bone 
fragments  unless  they  are  altogether  loose. 
Suture  the  bones  with  silver  or  bronze 
aluminum  wire.  Exsect  devitalized  tissue 
(see  Wounds,  in  Part  1).  Douche  the  wound 
thoroughly  again  with  hot  water,  and  close, 
leaving  in,  perhaps,  a small  drain  for 
twenty-four  hours.  Iimnobilize  the  limb. 

Fractures  of  the  Lower  End  of  the 
Femur. — See  Fractures  of  the 
Femur,  the  Shaft. 

Fibula. — L.  fib'ula,  buckle.  See 
Fractures  of  the  Leg,  the  Lower 
End. 

Humerus. — L.  hu'merus,  upper  arm 
bone.  See  Fractures  of  the  Elbow. 

Leg. — See  Fractures  of  the  Leg, 
the  Lower  End. 

Radius. — See  Fractures  of  the 
Radius,  the  Lower  End. 

Tibia. — See  Fractures  of  the  Leg, 
the  Lower  End. 

Fractures  of  the  Lower  Jaw. — Reduce  the 
fractiu-e  carefully,  and  hold  it  in  place 
temporarily  by  means  of  the  four-tailed 
bandage  to  the  chin  (see  Bamlaging). 

If  wiring  of  the  teeth  on  each  side  of  the 
fracture  with  silver  wire  (No.  26  gauge  Ger- 
man silver  wire)  is  deemed  sufficient,  include 
as  many  teeth  as  possible  and  not  only  the 
two  teeth  adjoining  the  fracture  But  this 
method  of  treatment  is  usually  inefficient, 
the  following  method  being  the  best: 

Dental  composition  is  softened  in  hot 
water,  and  then  placed  into  metal  modelling 
or  impression  cups,  one  for  the  upper  jaw 
and  one  for  the  lower  jaw.  The  surface 
of  the  composition  is  then  warmed  again, 
and  an  impression  of  the  teeth  and  alveolar 
border  of  both  jaws  made.  From  these  two 
molds  are  made  plaster-of  Paris  casts.  The 
cast  of  the  lower  jaw  is  cut  along  the  line  of 
fracture  with  a fine  saw,  and  the  fracture 
thus  reproduced  is  reduced  so  that  the  casts 
of  the  two  jaws  will  appose  properly.  The 
sawed  portions  are  held  together  with 


plaster  cream.  Both  casts  are  then  put  upon 
an  articulator,  and  a vulcanite  or  aluminum 
splint  made  from  the  lower  jaw  cast.  This 
work  is  done  by  a dentist. 

If  the  fracture  is  near  the  angle  of  the  jaw, 
the  interdental  splint  must  be  reinforced  by 
meansof  external  metal  contrivances  for  hold- 
ing the  fragments  more  efficiently  in  place. 

If  the  fracture  is  behind  the  molar  teeth, 
a dental  splint  is,  of  course,  impracticable. 
For  such  a fracture  one  may  employ  an 
external  pad  and  a metal  chin-piece,  held  in 
place  by  straps  and  buckles.  Such  an 
appliance  must  be  repeatedly  adjusted  so  as 
to  keep  the  fragments  in  place. 

Wiring  the  bone  fragments  with  fine  silver 
or  bronze  aluminum  wire  is  sometimes  the 
best  method  of  treatment.  The  skin  incision 
should  be  made  a little  below  and  parallel 
with  the  lower  border  of  the  lower  jaw. 

Open  abscesses  through  the  mouth, 
if  possible. 

Fractures  of  the  Malar  Bone. — L.  ma'la, 
cheek.  Under  general  anaesthesia,  attempt 
to  raise  the  depressed  fragment  from  inside 
the  cheek  with  a blunt  instrument.  If  this 
is  impossible,  elevate  the  fragment  through 
an  external  incision  by  means  of  a blunt 
hook,  steel  elevator,  or  gimlet.  Lothrop 
recommends  that  the  antrum  be  opened  by 
way  of  the  canine  fossa,  the  fragments 
raised  by  means  of  a curved  steel  m-ethral 
sound,  and  the  antrum  packed  with  narrow 
strips  of  gauze,  which  is  not  to  be  removed 
for  four  or  five  days,  the  mouth  and  nose 
being  kept  scrupulously  clean  with  alkaline 
antiseptic  solution,  such  as  Dobell’s  solu- 
tion {q.v.  in  Part  11). 

Fractures  of  the  Maxilla,  Inferior. — L., 

lower  jaw.  See  Fractures  of  the 
Lower  Jaw. 

Superior. — L.,  upper  jaw.  See  Frac- 
tures of  the  Upper  Jaw. 

Fractures  of  the  Metacarpal  Bones  — Gr. 
Aiera  after  -f-  Kapiros  wrist.  After  reduction 
of  the  fracture  by  traction  and  pressure,  and 
careful  cleansing,  drying,  and  powdering  of 
the  skin,  place  a rubber  tube  on  each  side 
of  the  fractured  bone  posteriorly,  and  hold 
the  rubber  tubes  in  place  by  straps  of  adhes- 
ive plaster,  one  around  the  middle  of  the 
hand  and  another  around  the  wrist.  Then 
pad  the  palm  and  dorsum  of  the  hand,  or 
employ  as  a palmar  splint,  a roller  bandage 
grasped  by  the  fingers  and  thumb;  hold  the 
pads  in  jjlace  with  adhesive  straps,  and 
cover  the  whole  with  a bandage. 

If  displacement  tends  to  recur,  employ 
traction  upon  the  corresponding  finger  by 
means  of  side  strips  of  adhesive  plaster. 


FRACTURES  OF  THE  PATELLA 


fastened  to  the  finger  by  circular  and  oblique 
straps,  and  attached  to  a long  padded 
palmar  splint  which  extends  beyond  the 
finger  and  is  attached  to  the  wrist  with 
adhesive  plaster. 

Rennet’s  fracture  through  the  base  of  the 
metacarpal  bone  of  the  thumb  is  best 
strapped  and  bandaged,  in  an  abducted  and 
extended  position,  to  a palmar  splint  w'hich 
extends  from  the  tip  of  the  thumb  to  the 
ulnar  side  of  the  wrist. 

Fractures  of  the  Metatarsal  Bones. — Gr. 
//era  after  + Taper  6%  tar.sus.  Remember,  in 
interpreting  a skiagram,  the  possible  pres- 
ence of  a separate  os  intermetatarseum  at 
the  base  of  the  first  or  second  metatarsal 
bone,  or  of  a separate  tuberosity  of  the  fifth 
metatarsal  bone. 

After  cleansing,  drying,  and  powdering  the 
skin,  immobilize  the  foot  for  four  weeks 
with  a plaster-of-Paris  bandage,  {q-v.),  from 
the  toes  to  the  middle  of  the  leg,  applied 
over  sheet-wadding.  Pad  the  instep  on 
allowing  the  patient  to  walk. 

Fractures  of  the  Nasal  Bones. — L.  nas'us, 
nose.  See  Fractures  of  the  Nose. 

Neck  of  the  Femur. — See  Fractures  of 
the  Femoral  Neck. 

Humerus,  the  Anatomical  Neck. — 
Gr.  ava  apart  -}-  TepveLV  to  cut. 
See  Fractures  of  the  Humerus. 
Surgical  Neck. — L.  chirur'gia,  from 
Gr.  yelp  hand  + epyov  work.  See 
Fractures  of  the  Humerus. 

Neck  of  the  Radius. — See  Fractures  of 
the  Elbow. 

Nerve  Injuries  Complicating. — See  Intro- 
duction at  the  beginning  of  Fractures. 

Fractures  of  the  Nose. — Examine  the 
nasal  septum  under  cocaine  anaesthesia 
(4  per  cent.),  for  deviation  and  hsematoma. 
A small  haematoma  may  be  left  alone,  but  a 
large  one  should  be  freely  incised,  by  means 
of  a unilateral,  horizontal  incision,  made  as 
low  down  as  possible.  A haematoma  is 
liable  to  infection. 

Replace,  under  general  anaesthesia,  a 
deviated  septum  ancl  displaced  nasal  bone 
fragments,  by  means  of  external  manipula- 
tion and  the  internal  use  of  Roe’s  elevator 
or  a similar  instrument,  such  as  a pair  of 
narrow-bladed  haemostatic  forceps  well  pro- 
tected by  gauze. 

To  retain  the  fragments  in  place,  employ 
tight,  high,  gauze  packing  for  fractures  high 
up,  changed  daily  for  about  four  days,  and 
Asch’s  tubes  for  low  fractures.  Keep  the 
nasal  cavity  cleansed  with  a warm  alkaline 
solution  such  as  that  of  Seiler  or  Dobell 
(see  Part  11),  employed  twice  daily. 


Efficient  external  nasal  splints  are  those  of 
Cobb  and  of  Coolidge. 

Fractures  of  the  Olecranon. — Gr.  o:\eKpavov 
See  Fractures  of  the  Elbow. 

Open. — See  Introduction,  at  the  begin- 
ning of  Fractures. 

Os  Calcis. — L.  See  Fractures  of  the 
Tarsal  Bones. 

Fractures  of  the  Patella. — L.  patel'la,  pan. 
To  hasten  the  absorption  of  the  blood  in  the 
joint,  elevate  the  limb  upon  pillows,  and 
apply  firm  even  compression  by  means  of 
an  elastic  rubber  bandage  kept  on  for  forty- 
eight  hours;  or  moisten  two  sea  sponges, 
dry  them  unfler  pressure,  so  as  to  flatten 
them,  and  bandage  them  to  the  sides  ami 
over  the  knee,  and  then  pour  on  cold  water; 
the  resulting  swelling  of  the  sponges  pro- 
vides even  and  firm  compression.  Change 
the  sponges  after  twelve  to  twenty-four 
hours  (Scudder).  Massage  practiced  for 
fifteen  to  thirty  minutes  twice  daily  also 
promotes  absorption. 

After  the  joint  effusion  has  subsided, 
extend  the  leg  upon  a wooden  ham-splint,  a 
little  wider  than  the  limb,  extending  from 
the  buttock  to  just  above  the  ankle,  and 
padded  so  as  to  conform  with  the  posterior 
surface  of  the  thigh,  knee,  and  leg.  Strap 
the  limb  to  the  splint  at  both  ends  of  the 
latter  and  below  the  knee.  Bandage  the 
lower  half  of  the  splint  to  the  leg,  and 
keep  the  foot  at  right  angles  with  the  leg. 
Instead  of  the  wooden  splint,  one  may  use 
plaster-of-Paris  (q.v.). 

Fix  the  lower  fragment  by  means  of 
obliquely  placed  overlapping  strips  of  adhes- 
ive plaster,  fastened  to  the  ham-splint  above 
the  fragment.  Then  elevate  the  whole  limb 
upon  an  inclined  plane,  in  order  to  relax  the 
quadriceps  femoris  muscle,  draw  down  the 
upper  fragment  by  means  of  obliquely 
placed  overlapping  adhesive  strips,  fastened 
to  the  ham-splint  below  the  fragment,  and 
place  another  strip  transversely  over  the 
line  of  fracture,  in  order  to  prevent  tilting 
of  the  fragments.  Hold  the  quadriceps 
muscle  by  means  of  padded  coaption  splints, 
and  by  straps  encircling  the  ham-splint. 
Massage  the  quadriceps  muscle  daily  from 
the  beginning,  to  prevent  atrophy. 

At  the  end  of  six  weeks,  when  union  is 
secured,  remove  the  above  apparatus,  and 
apply  a plaster-of-Paris  bandage  (q.v.) 
from  the  ankle  to  the  groin.  Split  this  in 
the  median  line  before  hardening,  so  that  it 
can  be  removed  for  the  purpose  of  cleanli- 
ness and  massage,  and  cover  the  cut  edges 
with  adhesive  plaster  to  prevent  crumbling. 
The  splint  may  be  covered  with  stockinette, 


FRACTURES  OF  THE  RADIUS,  THE  LOWER  END, 


and  leather  strips  containing  lacing  hooks 
stitched  to  each  cut  edge. 

Allow  the  patient  up  in  the  splint  on 
cnitches,  and  permit  slight  weight-bearing. 
Begin  also  at  this  time  passive  and  active 
movements.  At  the  end  of  eight  weeks, 
allow  the  patient  about  with  a cane  and  a 
supporting  bandage  extending  from  the 
(^alf  to  the  middle  of  the  thigh.  Omit  the 
latter  after  six  months.  Do  not  allow  flexion 
of  the  knee  while  walking  for  six  months. 

If  the  fracture  is  open,  or  compound, 
thus  exposing  the  knee  joint  (the  synovial 
membrane  of  the  knee  joint  is  attached  to 
the  posterior  surface  of  the  patella),  scrub 
and  sterilize  the  skin  and  wound  thoroughly, 
lay  the  joint  open  by  a curved  transverse 
incision,  and  cleanse  and  irrigate  the  parts, 
including  the  joint,  thoroughly  with  hot 
sterile  water,  paying  particular  attention 
to  the  posterior  recesses  of  the  joint.  Re- 
move small  loose  bone  fragments.  Then 
suture  the  fragments  with  chromicized  cat- 
gut, or  better,  kangaroo  tendon,  repair 
lateral  tears  in  the  aponeurosis  with  the 
same  material,  and  close  the  skin  wound 
with  fine  catgut.  Immobilize  the  joint  with 
plaster-of-Paris  {q.v.)  from  the  toes  to 
the  hip. 

Scudder  begins  massage  and  passive 
movements  at  the  end  of  two  weeks,  allows 
the  patient  about  with  a light  plaster  splint 
and  a cane  at  the  end  of  three  weeks,  and 
replaces  the  jilaster  with  a bandage  after 
about  six  weeks.  Eisendrath  does  not 
remove  the  plaster  splint  or  begin  massage 
for  six  weeks.  Ridlon  does  not  advocate 
early  massage  and  motion  in  the  treatment 
of  any  fracdure. 

The  operative  treatment  of  closed  patellar 
fractures  is  very  effectual,  but  strict  asepsis 
is  imperative.  Some  wait  seven  days  for 
the  swelling  to  subside  before  operating, 
others  operate  immediately.  The  operation 
is  performed  as  described  above.  Eisen- 
drath says:  “ Operation  is  contraindicatefl 
in  elderly  patients,  or  where  the  contusion  of 
the  skin  is  such  as  to  endanger  the  possi- 
bility of  obtaining  j^rimaiy  union  of  the 
external  wound.” 

Fractures,  Pathologic. — Gr.  iraOos  disease 
+ X070S  discourse.  See  Fragilitas  Ossiuni, 
in  Part  1. 

Fractures  of  the  Pelvis. — Ti.  pcJv'is,  basin. 
Do  not  neglect  a vaginal  or  rectal  examina- 
tion. 

If  wiring  of  the  bone  fragments  is  not 
performed,  treat  the  case  as  follows:  Immo- 
bilize the  fracture  by  means  of  a wide  band 
of  adhesive  plaster  or  a wide  muslin  binder 


encircling  the  pelvis,  taking  care  not  to  pro- 
duce displacement  thereby,  and  place  the 
patient  on  a Bradford  frame,  to  which  the 
trunk  and  thighs  may  be  bound  with 
towels.  The  thighs  and  knees  should  be 
bound  together. 

A long  wooden  T-splint  (see  Fractures  of 
the  Femoral  Neck)  reaching  from  the  axilla 
to  the  sole  of  the  foot  may  be  employed 
for  immobilization  purposes,  and  if  neces- 
sary, traction  may  be  exerted  upon  the 
thighs,  as  described  under  Fractures  of  the 
Femoral  Neck. 

If  the  urethra  is  ruptured,  with  resulting 
difficulty  of  urination,  or  retention,  and 
urethral  hemorrhage,  and  if  an  attempt  at 
catheterization  is  unsucce-ssful,  make  a 
perineal  incision,  find  the  proximal  end  of 
the  urethra,  pass  a catheter  through  the 
entire  length  of  the  urethra,  and  drain  the 
perineal  wound.  Perform  suprapubic  aspira- 
tion if  the  proximal  end  of  the  urethra  can- 
not be  found  (see  Injuries  of  the  Urethra, 
Part  3). 

If  rupture  of  the  bladder  is  suspected,  do 
an  exploratory  laparotomy  (see  Bladder 
Injuries,  Part  3). 

Administer  morphine  for  pain.  Keep  the 
patient  in  bed  for  six  to  eight  weeks. 

Fractures  of  the  Phalanges  of  the  Fingers. 
— Gr.  (j)a\ay^  phalanx.  After  cleansing, 
drying,  and  powdering  the  skin,  and  reducing 
the  fracture,  apply  a padded  palmar  splint 
extending  from  the  tip  of  the  finger  to  the 
ball  of  tlie  hand,  and  hold  it  in  place  with 
adhesive  straps.  Then  cover  the  finger  with 
a finger-cot.  Use  the  other  fingers  as  side 
splints,  with  powder  and  pieces  of  cloth 
protecting  contiguous  surfaces.  Cover  the 
whole  with  a bandage.  Guard  against  rota- 
tion or  lateral  deviation  of  the  distal  fragment. 

Massage  and  passive  motion  should  be 
begun  at  the  end  of  the  third  week,  in  articu- 
lar fractures,  in  order  to  prevent  ankylosis. 

Fractures  of  the  Phalanges  of  the  Toes. — 
After  cleansing,  drying,  and  powdering  the 
skin,  and  reducing  the  fracture,  apply  a 
padtled  wooden  plantar  splint  covering  the 
entire  sole  of  the  foot  and  the  injured  toe, 
and  hold  it  in  place  with  adhesive  plaster 
straps.  It  is  sometimes  best  to  immobilize 
the  ankle-joint. 

Fracture,  Pott’s. — See  Fractures  of  the 
Leg,  the  Lower  End. 

Fractures  of  the  Radius,  the  Head. — L. 
ra'dius,  spoke.  See  Fractures  of  the  Elbow. 

Fractures  of  the  Radius,  the  Lower  End 
(Colies’s  Fracture);  and  Separation  of  the 
Lower  Radial  Epiphysis. — L.  ra'dius,  spoke 
Gr.  £7t1  upon  + to  grow.  Colies’s  frac- 


FRACTURES  OF  THE  SHOULDER 


ture  is  a fracture  of  the  lower  end  of  the 
radius,  with  displacement  of  the  lower  frag- 
ment backward,  and  the  end  of  the  upper 
fragment  fonvard,  resulting  in  the  so-called 
silver-fork  deformity.  The  tlisplacement  is 
often  an  angular  one  Sometimes  it  is  the 
reverse  of  that  described. 

Separation  of  the  lower  radial  epiphysis 
occurs  before  the  twentieth  year  (see  Frac- 
tures of  the  Wrist). 

Under  anjEsthesia,  reduce  the  fracture 
(after  forcibly  breaking  up  impaction)  by 
traction  upon  the  wrist  and  pressure  of  the 
two  thumbs  upon  the  dorsum  and  radial 
side  of  the  lower  fragment. 

Cleanse,  dry,  and  powder  the  skin,  and 
after  placing  a pad  over  the  dorsiun  of  the 
lower  fragment  to  hold  it  in  place,  apply, 
with  the  hand  and  forearm  semipronated,  a 
padded  posterior  splint  (of  thin  splint  wood), 
extending  from  below  the  elbow  to  the 
heads  of  the  metacarpal  bones,  with  a semi- 
circular piece  cut  out  to  accommodate  the 
lower  end  of  the  ulna.  Then  apply  a padded 
anterior  splint  extending  between  the  same 
points,  and  cut  out  at  its  lower  end  to  clear 
the  ball  of  the  thumb.  The  splints  should 
be  a little  wider  than  the  forearm.  Pad  the 
anterior  splint  accurately  to  conform  with 
the  contour  of  the  forearm  and  hand.  Hold 
the  splints  in  place  with  adhesive  plaster 
straps,  and  cover  the  whole  with  a bandage, 
leaving  the  fingers  free.  Support  the 
whole  length  of  the  forearm  and  hand  in 
a sling.  Instruct  the  patient  to  move  the 
fingers  frequently. 

At  the  end  of  the  fourth  week,  omit  the 
splints,  support  the  wrist  in  a sling  so  that 
the  hand  hangs  adducted,  and  begin  mas- 
sage, and  passive  and  active  movements. 
Some  begin  massage  in  the  second  week. 

Instead  of  the  padded  wooden  splint,  one 
may  employ  a split  plaster-of-Paris  splint 
iq-v.),  or  a volar  plaster  splint,  with  the  wrist 
in  extension  (“cock  up”  splint),  and  leaving 
the  fingers  free.  The  splint  may  be  removed 
daily  and  the  parts  massaged. 

Fractures  of  the  Radius,  the  Neck. — See 
Fractures  of  the  Elbow. 

Shaft. — See  Fractures  of  the  Fore- 
arm, the  Shaft. 

Fractures  of  the  Ribs. — Pain  on  breathing 
is  present.  Local  pain  and  sometimes  crepi- 
tus are  elicited  by  antero-posterior  and 
lateral  compression  of  the  chest. 

Reduce  the  fracture,  if  there  is  displace- 
ment; and  after  cleansing,  shaving,  and  dry- 
ing the  skin,  apply  from  below  upward, 
while  the  patient  is  exhaling  deeply,  several 
broad  overlapping  adhesive  plaster  swathes. 


extending  from  beyond  the  spine  in  back  to 
beyond  the  sternum  in  front.  Overlap  each 
strip  or  swathe  two-thirds.  Cover  the 
nipple  with  gauze.  Cleanse  and  powder  the 
axilla.  A strap  may  also  be  passed  over  the 
shoulder  to  advantage.  A dose  of  morphine 
may  be  of  service. 

The  occurrence  of  alarming  dyspnoea  indi- 
cates pneumothorax,  and  calls  for  morphine, 
etc.  (see  under  Tuberculosis,  Pulmonary,  in 
Part  1). 

Change  the  adhesive-plaster  swathes  at 
least  every  seven  days  for  about  three  or 
four  weeks. 

Fractures  of_  the  Scaphoid  Bone. — Gr. 

cTKa</)?7  skiff  -h  eiSos  form.  See  Fractures  of 
the  Carpal  Bones. 

Fractures  of  the  Scapula. — L.  scap'ula, 
shoulder-blade.  After  cleansing  the  skin 
with  soap  and  warm  water,  rinsing,  diying, 
sponging  with  alcohol,  drying  again,  and 
dusting  with  talcum  powder  and  protecting 
appo.sed  skin  surfaces  with  soft  pads,  apply 
a Velpeau  bandage  (q.v.)  reinforced  by 
adhesive  plaster. 

In  fracture  of  the  acromial  process,  place 
a pad  over  the  inner  fragment.  The  Velpeau 
bandage  raises  the  elbow  and  outer  fragment, 
and  at  the  same  time  exerts  counter-pressure 
upon  the  pad  over  the  inner  fragment. 

Fractures  of  the  Shaft  of  the  Femur. — 
See  Fractures  of  the  Femoral 
Shaft. 

Forearm.  — See  Fractures  of  the 
Forearm,  the  Shaft. 

Humerus.-^ee  Fractures  of  the 
Humerus. 

Leg. — See  Fractures  of  the  Leg,  the 
Shaft. 

Fractures  of  the  Shoulder. — Consider,  in 
injuries  to  the  shoulder,  the  following  possi- 
bilities: sprain,  fractures  of  the  clavicle, 
dislocations  of  the  clavicle,  fractures  of  the 
scapula  (acromial  process,  glenoid,  or  spine), 
fracture  of  the  surgical  neck  of  the  humerus, 
fracture  of  the  anatomical  neck  of  the 
humerus,  fracture  of  the  tuberosities  of  the 
humerus,  separation  of  the  upper  epiphysis 
of  the  humerus,  dislocation  of  the  head  of 
the  humerus,  usually  subcoracoid,  disloca- 
tion and  fracture  combined. 

Compare  the  lengths  of  both  upper 
arms,  measured  from  the  acromion  pro- 
cess to  the  external  condyle.  Locate  the 
coracoid  process,  for  the  head  of  the  hume- 
rus lies  directly  behind  it.  The  head  of 
the  humerus  points  in  the  same  direction 
as  the  internal  condyle.  Examine,  under 
ether,  if  necessary,  and  employ  the  X-ray, 
if  practicable. 


FRACTURES  OF  THE  TARSAL  BONES 


Fractures  of  the  Skull.  — See  Part  1, 
General  Medicine  and  Surgery. 

Fractures  of  the  Spinal  Column. — Handle 
the  patient  with  the  greatest  care,  to  avoid 
injury  to  the  cord,  with  resulting  motor  and 
sensory  paralysis.  If  paralysis  is  present, 
have  an  X-ray  pictui’e  taken,  and  if  it  shows 
compression  of  the  cord  by  displaced  bone, 
an  operation  should  be  performed,  other- 
wise not. 

The  spine  may  be  immobilized  by  means 
of  sandbags,  extension  apparatus,  plaster 
jacket,  or  braces  (see  Pott’s  Disease).  In 
applying  a plaster  jacket,  the  patient  is  sus- 
pended prone  in  a hammock,  or  between  two 
tables,  so  as  to  produce  extension  and  correct 
deformity.  An  anaesthetic  may  be  required. 

Enjoin  absolute  rest,  including  feeding 
with  a spoon  and  the  use  of  the  bed-pan 
and  urinal.  Guard  against  bed-sores  {q.v., 
in  Part  1) ; and  also  against  cystitis,  in  the 
presence  of  retention,  by  means  of  the 
administration  of  urotropin,  gr.  vii,  t.i.d., 
regular  aseptic  catheterization,  and  irriga- 
tion of  the  bladder  with  warm  sterile  boric 
acid  solution,  a heaping  teaspoonful  to  the 
pint.  Employ  aperients  and  enemata  for 
the  bowels,  if  required.  The  diet  should  be 
bland  and  nutritious. 

Keep  the  muscles  in  tone  by  means  of 
massage,  electricity,  and  passive  movements 
(see  also  Haematomyelia,  in.  Part  1). 

Fractures  of  the  Spine  of  the  Scapula. — L. 
sjyiiia,  spine.  See  Fractures  of  the 
Scapula. 

Tibia. — See  under  Displacement  of  a 
Semilunar  Cartilage. 

Fracture,  Spontaneous. — L.  spontaneus, 
voluntary.  See  Fragilitas  Ossimn,  in  Part  1. 

Fractures  of  the  Sternum. — L. ; Gr.  arkpvov 
breast-bone.  Reduce  the  fracture  in  the 
following  manner;  Place  the  patient  supine 
upon  a table,  with  the  head  hanging  extended 
over  the  edge  of  the  table.  Then  raise  the 
arms  above  the  head  and  rotate  them  out- 
ward, while  an  assistant  steadies  the  lower 
thorax  and  presses  upon  the  lower  fragment. 
Then  apply  broad  adhesive-plaster  swathes 
about  the  chest,  held  by  adhesive  straps 
across  the  shoulders.  Apply  an  ice-bag. 
Keep  the  patient  in  bed  for  three  weeks; 
then  allow  him  up  carefully,  wearing,  for 
two  months,  a brace  such  as  is  used  in  high 
dorsal  Pott’s  disease. 

Operative  treatment  is  sometimes  the 
best,  care  being  taken  not  to  injure  the  mem- 
brane on  the  posterior  surface  of  the  sternum, 
The  mere  presence  of  deformity,  however, 
does  not  demand  operation.  The  latter  is 
indicated  if  serious  symptoms  are  present. 


Fractures  of  the  Styloid  Process  of  jhe 
Ulna.  L.  sty  lus,  pen  -f-  Gr.  eLSos 
form.  See  Fractures  of  the  Elbow. 

Subtrochanteric,  of  the  Femur.— L.  sub- 
under  L.,  Gr.  rpoxo-vT-qp  runner. 
See  Fractures  of  the  Femoral  Shaft. 

Superior  Maxilla. — L.,  upper  jaw.  See 
Fractures  of  the  Upper  Jaw. 

Supracondyloid,  of  the  Femur. — L. 
sup'ra,  above  -f-  con'dylus,  knuckle. 
See  under  Fractures  of  the  Femoral 
Shaft. 

Fractures,  Supracondyloid,  of  the  Humer= 

us.  — L.  sup'ra-  above  -f  con'dylus, 
knuckle.  See  Fractures  of  the  Elbow. 

Surgical  Neck  of  the  Humerus. — L. 
chirur'gia,  from  Gr.  xdp  hand  -f- 
epyov  work.  See  Fractures  of  the 
Humerus. 

Fractures  of  the  Tarsal  Bones. — L.;  Gr. 

rapaos  instep.  The  os  calcis  and  astragalus 
are  usually  the  only  bones  ever  fractured. 
Remember,  in  interpreting  a skiagram,  that 
there  is  often  present,  normally,  posterior 
to  the  astragalus,  a little  bone  called  the 
os  trigonum. 

Thoroughly  cleanse  the  skin  with  soap 
and  hot  water,  dry,  sponge  with  alcohol, 
dry,  and  dust  with  talcum  powder.  Support 
the  elevated  leg  and  foot  upon  a pillow, 
folded  and  strapped  over  the  sides  of  the 
leg  and  foot,  with  a posterior  and  two  lateral 
wooden  splints  between  the  pillow  and 
straps,  or  place  the  foot  in  a well-padded 
fracture  box  (Fig.  133). 


Fig.  133. — Lateral  view  of  fracture  box. 

After  about  eight  to  ten  days,  when  the 
swelling  has  subsided,  apply  over  sheet 
wadding,  with  the  foot  flexed  at  right  angles 
with  the  leg,  or  in  fractiu-es  of  the  os  calcis 
usually  plantar  flexed,  a plaster-of-Paris 
bandage  (q.v.)  from  the  toes  to  just  below 
the  knee,  and  split  it  before  it  hardens. 
Begin  now  to  massage  the  parts  daily. 

At  the  end  of  eight  weeks,  omit  the  plaster 
cast,  begin  passive  and  active  movements, 
and  allow  gradual  weight  bearing.  Pad 
the  instep. 

Suture  of  the  fragments  with  kangaroo 
tendon,  or  the  removal  of  the  smaller  frag- 
ments, is  sometimes  the  treatment  of  choice. 


GENU  RECURVATUM 


Fractures  of  the  Thigh. — See  Fractures  of 
the  Femur. 

Tibia,  the  Lower  End. — L.  tibia.  See 
Fractures  of  the  Leg,  the  Lower 
End. 

Shaft. — ^See  Fractures  of  the  Leg, 
the  Shaft. 

Spine. — L.  spina,  spine.  See  under 
Displacements  of  a Semilunar  Car- 
tilage. 

Upper  End.  — See  Fractures  of  the 
Leg,  the  Shaft. 

Fractures  of  the  Trachea. — L. ; Gr.  rpaxeta 
rough.  The  symptoms  are  like  those  of 
fracture  of  the  larynx  (q.v.). 

Perform  tracheotomy  (q.v.  in  Part  1), 
and  aspirate  the  effused  blood  from 
the  trachea. 

Fractures  of  the  Trochanters. — L.;  Gr. 

TpoxavT^P  runner.  See  Fractures  of 
the  Femoral  Shaft. 

T«=Shaped,  of  the  Humerus  into  the 
Elbow  Joint. — See  Fractures  of  the 
Elbow. 

Tuberosities  of  the  Humerus.  — See 

Fractures  of  the  Hmnerus. 

Ulna. — L.  ul'na.  See  Fractures  of  the 
Elbow,  and  Fractures  of  the  Forearm, 
the  Shaft. 

Upper  End  of  the  Fibula.  — See  Frac- 
tures of  the  Leg,  the  Shaft. 
Humerus.  — See  Fractures  of  the 
Humerus. 

Tibia.  — See  Fractures  of  the  Leg, 
the  Shaft. 

Ulna.^ — See  Fractures  of  the  Elbow. 

Fractures  of  the  Upper  Jaw. — Under  gen- 
eral anae.sthesia,  approach  depressed  bone 
fragments  by  way  of  openings  in  the  gums, 
using  blunt  instruments  to  raise  the  frag- 
ments. If  unsuccessful,  enter  the  antrum 
by  way  of  the  upper  part  of  the  canine  fossa, 
elevate  the  fragments  with  a curved  steel 
urethral  sound,  and  pack  the  antrum  with 
narrow  strips  of  gauze,  which  is  not  to  be 
removed  for  four  or  five  days,  the  mouth 
and  nose  being  kept  scrupulously  clean  with 
alkaline  antiseptic  solutions,  such  as  that  of 
Seiler,  or  Dobell  (q.v.  in  Part  11).  Hold  the 
jaws  together  by  means  of  an  external 
bandage.  Loose  teeth  may  eventually 
become  firmly  attached. 

If  the  fragments  tend  to  become  dis- 
placed, have  a dentist  make  a mold  in  dental 
composition  of  the  teeth  and  alveolar  border 
of  the  lower  jaw,  from  which  to  make  a rub- 
ber splint.  \Vhen  applied,  this  splint,  with 
the  lower  jaw,  should  be  held  snugly  up 
against  the  teeth  of  the  upper  jaw  by  means 
of  an  external  bandage.  The  patient  is  fed 


through  the  nose  by  means  of  a rubber 
catheter  with  rubber  tubing  and  funnel 
attached.  The  mouth  and  nose  are  kept 
scrupulously  clean,  and  the  mouth  is  drained 
of  saliva  with  .strips  of  gauze. 

Fractures  of  the  Vertebrse. — L.  vert'ebra, 
vertebra.  See  Fractures  of  the  Spinal 
Column. 

Fractures  of  the  Wrist. — Consider,  in 
injuries  of  the  wrist,  the  following  possi- 
bilities: sprain,  Colles’s  fracture  of  the 

lower  end  of  the  radius,  fracture  of  both 
radius  and  ulna,  fracture  of  the  styloid  proc- 
ess of  the  ulna,  fractures  of  the  carpal  bones, 
dislocations  of  the  carpal  bones,  dislocations 
of  the  wrist  joint,  and  dislocations  of  the 
carpo-metacarpal  joints. 

Fractures,  Y=Shaped,  of  the  Humerus  into 
the  Elbow  Joint.  — See  Fractures  of  the 
Elbow. 

Fragilitas  Ossium. — See  Part  1,  General 
Mechcine  and  Surgery. 

FunneI=Chest. — -Causes.— Rickets ; possi- 
bly adenoids;  Pott’s  disease;  certain  occu- 
pations, such  as  that  of  the  cobbler;  con- 
genital anomaly  (“  practically  always  ” 
the  cause). 

Treatment. — Any  po.ssible  causal  influence 
should,  of  course,  be  corrected,  and  respira- 
tory gymnastics  may  be  prescribed;  but, 
says  H.  L.  Taylor,  “ Even  when  extreme  it 
does  not  interfere  with  health  or  strength, 
and  is  incurable.” 

Gangrene  Complicating  Fracture. — Gr. 

yayypaiva  mortification.  See  General  Con- 
siderations, in  the  beginning  of  the  subject 
of  Fractures. 

Gas  Bacillus  Infection  Complicating  Frac- 
ture.— See  Infection,  in  Part  1. 

Genu  Recurvatum. — L.  gen'u,  knee;  re- 
curva'tum,  backward  bending.  Habitual 
hyperextension  of  the  knee;  back -knee. 

Causes. — Congenital  anomaly;  anterior 
poliomyelitis;  rickets;  tabes;  traction  upon 
the  leg  in  the  treatment  of  hip  disease; 
traumatism;  inflammation  of  the  knee 
joint;  deforming  disease  of  the  femur  or 
tibia;  pes  equinus  and  equino- varus;  loose 
knee  from  whatever  cause. 

Treatment.— In  the  congenital  variety, 
knead  and  massage  the  contracted  muscles, 
and  employ  passive  exercise  and  forcible 
flexion  (under  anaesthesia,  if  necessary);  or 
flex  the  leg  gradually  by  strapping  it  to  a 
frame  bent  under  the  knee. 

When  the  child  walks,  have  it  wear 
for  some  years  a light  brace  permitting 
only  normal  or  a little  less  than  normal  exten- 
sion, and  no  lateral  movement. 

The  brace  may  be  used  in  cases  due  to 


HIP  TUBERCULOSIS;  HIP-DISEASE 


other  causes.  If  the  femur  or  tibia  is  de- 
formed, an  osteotomy  is  required. 

Genu  Valgum. — See  Knock-Knee. 

Varum. — See  Bow-Leg. 

Glenoid, _ Fractures  of  the. — Gr.  yXrjvr] 
socket  -f-  etSos  form.  See  PTactures  of  the 
Scapula. 

Gluteal  Bursitis. — Gr.  jXovtos  buttock. 
See  Bursitis. 

Gonorrhoeal  Arthritis. — Gr.  yovr]  semen  + 
f>eLv  to  flow.  See  uiuler  Arthritis. 

Gout,  Rheumatic. — See  Arthritis  De- 
formans. 

Great  Toe,  Abduction  of  the. — L.  ah, 

from  + due' ere,  to  draw.  See  Hallux 
Valgus. 

Great  Toe=Joint,  Painful. — Causes. — Hal- 
lux rigidus;  weak  foot;  pressure  of  the  shoe. 

The  treatment  is  the  same  as  for  Hallux 
Rigidus. 

Great  Toe,  Rigid  or  Stiff.  — See  Hallux 
Rigidus. 

Gunshot  Fractures. — See  General  Con- 
siderations, in  the  beginning  of  “Fractures.” 

H®marthrosis. — Gr.  al/xa  blood  -J-  apdpov 
joint.  See  under  Arthritis. 

Haematoma  of  the  Sternomastoid  Muscle. 
— Gr.  aipa  blood  -wga  tmnor.  See  under 
Torticollis. 

Haemophiliac  Arthritis. — Gr.  alga  blood  + 
(piXelp  to  love.  See  under  Arthritis. 

Hallux  Dolorosa.  — L.  hal'lux,  great 
toe;  do' lor,  pain.  See  Great  Toe-Joint, 
Painful. 

Hallux  Rigidus. — L.  hal'lux,  great  toe; 
ri'gidus,  stiff.  Stiffness  and  swelling  of  the 
great  toe-joint. 

Causes. — Trauma  (stubbing  the  toe,  etc.); 
weak  or  flat-foot. 

Treatment. — Attend  to  the  cause.  In  trau- 
matic cases,  the  toe  may  be  splinted  by 
means  of  a long,  steel  sole-plate,  extending 
the  length  of  the  shoe,  placed  in  the  shoe  or 
between  the  layers  of  the  sole. 

Excise  the  joint  in  intractable  cases. 

Hallus  Valgus. — L.  hal'lux,  great  toe;  vaV- 
gus,  bent  outward.  Abtluction  of  the  great 
toe,  i.e.,  away  from  the  mid-line  of  the  body, 
outward  toward  the  other  toes.  Bunion 
is  the  symptom. 

Causes.— Short  and  narrow  stockings  and 
shoes  are  the  immediate  cause.  Aggravating 
or  predisposing  causes  are  gout,  rheumatism, 
traumatism,  and  depression  of  the  anterior 
metatansal  arch  (see  Anterior  Metatarsalgia). 

Treatment. — Broad  shoes  should  be  worn, 
and  there  should  be  a separate  stocking 
stall  for  the  big  toe.  Frequent  manual 
adduction  should  be  practiced.  A Holden 
toe-j)ost  (a  thin,  padded  metal  upright)  may 


be  worn  between  the  toes.  A depressed 
anterior  or  longitudinal  arch  should  be 
braced  (see  Anterior  Metatarsalgia,  and 
Weak  Foot).  The  Thomas  heel  (Fig.  134) 
“replaces  to  a certain  extent  the  function  of 
the  great  toe.”  (H.  L.  Taylor). 


In  severe  cases,  an  operation,  by  which 
the  projecting  bone  (non-articulating  por- 
tion of  the  metatarsal  head)  is  removed,  is 
requu-ed  (consult  the  standard  textbooks). 

For  inflamed  bunion  (bursitis),  employ  rest 
and  hot  applications.  Later,  remove  callus, 
and  use  a bunion  plaster  for  protection. 

Hallux  Varus. — L.  hal'lux,  great  toe; 
var'us,  bent  inward,  i.e.,  away  from  the 
other  toes.  See  Pigeon-Toe. 

Hammer=Toe. — Causes. — Short  and  nar- 
row shoe;  congenital  anomaly. 

Treatment.— In  slight  cases,  strap  the  toe 
to  a plantar  splint,  or  employ  Foote’s 
device.  In  severe  or  recurrent  cases,  divide 
the  dorsal  and  ventral  tendons  and  the  con- 
tracted ventral  fascia,  and  apply  a splint ; or 
better,  resect  the  joint.  Do  not  amputate 
the  toe. 

Hand,  Club. — See  Club-Hand. 

Tuberculosis. — See  Tuberculosis  of  the 
Long  Bones  of  the  Hand. 

Heberden’s  Nodes. — See  Arthritis  De- 
formans, the  Hypertrophic  Type. 

Heel,  Painful. — See  Painful  Heel. 

Hemorrhage  into  Joints.— Gr.  aipa  blood -|- 
pgyvvvaL  to  burst  forth.  See  under  Arthritis. 

Hip,  Congenital  Dislocation  of  the, — See 
Congenital  Dislocation  of  the  Hip. 

Disease. — See  Hip  Tuberculosis. 

Dislocation,  Congenital. — See  Congeni- 
tal Dislocation  of  the  Hip. 

Dislocations,  Traumatic.— See  Dislo- 
cations of  the  Hip. 

Osteochondrosis  of  the. — Gr.  barkov 
bone  -f-  xorbpos  cartilage  -|-  -trts  in- 
flammation. See  Perthes’s  Disease. 

Hip  Tuberculosis;  Hip=Disease. — L.  tu- 
ber'culum,  nodule.  Synoynms. — ^Co.xalgia  ; 

coxitis  (L.  cox'a,  hip ; Gr.  aXyos  pain 
-trts  inflammation). 

The  diagnostic  features  are  chronicity;  a 
limp;  pain,  as  a rule,  which  is  usually  occas- 
ional, and  referred  to  the  knee  (persistent 
pain  suggests  abscess  formation);  night 


HIP  TUBERCULOSIS;  HIP-DISEASE 


cries ; restriction  of  the  normal  range  of 
motion  in  every  direction,  due  to  muscle 
spasm,  and  later  also  to  adhesions  and  con- 
tractions (psoas  contraction  due  to  Pott’s 
(hsease  limits  extension  only);  attitude  of 
flexion,  abduction,  and  outward  rotation  in 
the  early  stages,  with  apparent  lengthening, 
as  shown  by  measuring  between  the  umbili- 
cus and  internal  malleoli,  with  the  limbs 
parallel,  and  usually  real  shortening  as 
shown  by  measuring  between  the  anterior 
superior  iliac  spines  and  the  internal  malle- 
oli (in  very  acute  early  cases  and  late  destruc- 
tive cases  the  limb  is  adducted,  rotated  in  or 
out  and  flexed,  with  apparent  shortening); 
atrophy,  as  shown  by  comparative  circum- 
ferential measurements.  If  the  trochanter 
rises  above  Nelaton’s  line  (“  a line  drawn 
from  the  lowest  point  of  the  anterior  superior 
iliac  spine  to  the  most  prominent  point  on 


strip  of  zinc  oxide,  or  better,  moleskin  (yel- 
low) adhesive  plaster  (less  irritating  than 
rubber  plaster),  wide  above  and  narrow 
below  the  knee,  with  the  sticky  side  opposite 
the  ankle  and  foot  covered  with  muslin  or 
another  adhesive  strip,  to  jirevent  adhesion 
to  the  ankle  and  foot  bandage.  Hold  these 
long  side  strips  in  place  by  means  of  two 
long  spiral  adhesive  strips  extending  from 
the  ankle  to  the  upper  part  of  the  thigh,  and 
other  circular  strips  around  the  ankle,  just 
above  the  knee,  and  around  the  upper  thigh 
(only  partly  encircling  the  Ihnb  to  avoid 
constriction).  Fasten  the  ends  of  the  long 
side  strips  to  a wooden  spreader  a little 
broader  than  the  width  of  the  ankle,  and 
thi'ough  a hole  in  the  centre  of  the  spreader 
pass  a clothes  line,  and  tie  the  proximal  end 
in  a knot  for  the  purpose  of  traction  upon 
the  spreader.  Pass  the  line  over  a pulley 


Fig.  135. — Gas-pipe  frame. 

the  lower  and  posterior  surface  of  the 
tuberosity  of  the  ischium  ”),  the  shortening 
is  due  to  bone  absorption  or  pathological 
dislocation  (see  also  Perthes’s  disease). 

F>rognosis.— From  two  to  four  years  of 
active  treatment  are  usually  required,  fol- 
lowed by  two  years  of  protection  of  the  joint. 

Treatment. — A correct  hygienic  regimen  is 
of  first  importance  (consult  Tuberculosis, 
Pulmonary,  in  Part  1). 

Local  treatment  aims  to  secure  immobil- 
ization, separation  of  the  joint  surfaces  by 
means  of  traction,  the  correction  of  a faulty 
attitude,  and  protection  from  weight  bear- 
ing,when  the  latter  is  a cause  of  discomfort. 

In  acute  cases,  with  much  tenderness  and 
muscle  spasm,  and  when  abscess  threatens 
or  is  present,  employ  recumbency  with 
splinting  and  traction,  until  the  acute  symp- 
toms have  quite  disappeared,  all  muscle 
spasm  is  overcome,  and  the  limb  is  straight. 
Proceed  as  follows:  Fasten  the  patient  upon 
a Bradford-Lovett  frame  (Fig.  135)  by  means 
of  shoulder  straps,  an  abdominal  band,  and  if 
need  be,  a perineal  counter-traction  band,  and 
secure  the  frame  to  the  top  of  the  bed.  Now 
cover  the  foot  with  a flannel  bandage  from 
the  toes  to  ju.st  above  the  malleoli,  and  apply 
on  each  side  of  the  limb  from  the  pubes  and 
trochanter  to  the  malleoli,  and  extending 
six  inches  beyond  the  sole  of  the  foot,  a long 


(Bradford  and  Lovett.) 

fastened  to  the  end  of  the  bed,  and  attach 
to  it  a weight.  Cover  the  adhesive  strapping 
with  a stocking  or  with  an  evenly  applied 
bandage  extending  from  the  toes  to  the 
groin,  with  its  margins  stitched  to  keep  it  in 
place  (Buck’s  extension).  Traction  should 
be  made  in  the  line  of  the  deformity,  the 
pelvis  being  parallel  transversely  with  the 
width-line  of  the  bed  and  the  lumbar  spine 
touching  or  nearly  touching  the  frame. 
Begin  with  three  to  six  pounds,  and  in- 
crease the  pull  gradually,  say  by  a pound  a 
day,  up  to  ten  to  twelve  or  more  pounds, 
employing  an  “amount  of  pull  agreeable  to 
the  patient.”  About  three  to  six  pounds  is 
sufficient  for  a child.  The  patient  should  be 
turned  over  once  daily  and  bathed  with 
alcohol. 

After  about  a week,  let  the  limb  down 
about  half  an  inch  or  more,  until  “ the  lum- 
bar spine  just  commences  to  rise.”  Repeat 
this  every  few  days  until  all  the  deformity  is 
reduced,  two  or  three  weeks  being  required. 

If  some  deformity  persists  after  muscle 
spasm  has  been  overcome  (due  to  contrac- 
ture), and  no  symptoms  of  active  disease 
are  present,  anse.sthetize  the  patient,  and 
with  the  buttocks  on  the  end  of  a table,  and 
an  assistant  holding  the  sound  thigh  firmly 
flexed  upon  the  abdomen,  overcome  and 
overcorrect  flexion  by  traction  and  a gentle 


HIP  TUBERCULOSIS;  HIP-DISEASE 


“pump-handle  leverage  action,”  taking  care 
not  to  fracture  the  neck  of  the  femur,  which 
is  apt  to  be  weak  from  atrophy;  correct  also 
adduction  and  rotation.  Then,  after  apply- 
ing traction  adliesive  strips,  as  before  de- 
scribed, apply  a long  plaster  spica,  reaching 
from  the  ankle  to  the  mammary  line,  with 


the  limb  in  moderate  abduction  (15°),  full 
extension,  and  slight  rotation  outward.  The 
plaster  spica  is  applied  as  follows:  The  trunk 
and  limbs  are  first  enclosed  in  a close-fitting 
seamless  stockinette  or  shirting  and  one  or 
more  layers  of  cotton  flannel  bandage  applied 
to  the  limb.  Bony  prominences  such  as  the 
femoral  condyles,  sides  of  the  pelvis,  anterior 
superior  iliac  spines  and  tho- 
rax, are  further  protected  by 
cotton  wadding.  The  patient 
is  placed  horizontally  upon 
his  back,  with  the  arms  above 
the  head  to  expand  the  tho- 
rax, and  is  supported  only 
at  the  head,  shoulder,  and 
sacrum,  with  the  limbs  sup- 
{X)rted  by  assistants,  trac- 
tion being  made  upon  the 
affected  Ihnb,  wdth  moderate  abduction; 
good  hip  and  shoulder  rests  are  the  follow- 
ing, viz.,  Gallie’s  suitcase  hip  and  shoulder 
rest  (Fig.  136),  Sanderson’s  portable  hip 
and  shoulder  rest  and  extension  apparatus 
(Fig.  137),  and  Echols  hip-rest  and  trac- 
tion appliance  (Fig.  138.)  Then  the  plaster 
bandages  {q-v.)  are  apj^lied  from  the 


ankle  to  the  mammary  line,  covering  in 
the  buttock  completely,  and  fitting  the 
shape  of  the  body  perfectly.  The  plas- 
ter may  be  reinforced  behind  and  in  front 
of  the  hip,  and  behind  the  knee  with  long 
strips  of  basswood  or  malleable  steel  The 


plaster  may  be  covered  with  stockinette  and 
the  perineal  portion  varnished.  After  the 
spica  has  been  completed,  put  the  patient 
to  bed  with  a traction  weight  of  ten  pounds 
or  more. 

As  soon  as  muscle  spasm  and  pain  have 
disappeared  (after  several  weeks  or  months), 
weight  bearing  (in  the 
plaster  spica)  is  per- 
mitted, if  it  causes  no 
discomfort.  If  dis- 
comfort or  muscle 
spasm  is  induced,  use 
axillary  crutches,  with 
a high  shoe  (wdth  a 
2)/2  hich  thick  cork  or 
wooden  sole  or  metal  patten)  on  the  sound 
leg.  The  ambulatory  long  plaster  spica  is 
best  made  to  include  the  foot  and  toes,  to 
avoid  oedema.  The  toes,  heel,  and  malleoli 
should  then  be  protected  by  cotton  wadding. 

Later,  as  healing  occurs,  Lorenz’s  short 
spica  may  be  substituted  for  the  long  spica, 
the  sides  of  the  spica  bemg  made  to  overlap 


the  short  ribs  and  a perineal  band  fastened  to 
buckles  in  front  and  back  placed  on  the  sound 
side  to  keep  this  part  from  slipping  upward 
and  thus  adducting  the  affected  limb. 
Moderate  abduction  (15°)  should  be  main- 
tained. A broad  bandage  to  be  used  as  a 
“scratcher  ” should  be  w'orn  next  the  skin. 
“A  cork  sole  of  about  an  inch  in  thickness 
may  be  used  on  the  abducted 
side  to  prevent  tilting  of  the  pel- 
vis.” (Chiefly  from  Whitman.) 

If,  when  first  seen,  the  disease 
is  not  active,  nor  of  the  destruc- 
tive t}"pe,  no  infiltration  of  the 
tissues  and  no  sinuses  are  present, 
but  deformity  is  present,  yet  not 
of  long  standing.  Whitman  ad- 
vocates unmediate  reduction  of 
the  deformity  under  anaesthesia, 
followed  by  traction  in  bed  (with  a weight 
of  ten  or  more  ixmnds),  with  the  limb  and 
trunk  encased  in  a long  plaster  spica,  in  full 
exiension  and  15°  of  abduction,  until  all 
acute  s^'inptoms  have  subsided,  that  is,  for 
“several  weeks  or  months.”  Then  w^eight 


Fig.  13G. — Suit  case  hip  and  shoulder  rest. 


HOLLOW  OR  CONTRACTED  FOOT;  CLAW-FOOT;  TALIPES  CAVUS 


bearing  is  tested,  and  the  case  treated  as 
before  described. 

If  the  disease,  when  first  seen,  is  not 
acute,  and  no  deformity  is  j^resent  (the 
usual  case  nowadays),  recumbency  is  not 
called  for,  but  the  plaster  spica  should  be 
employed. 

In  the  convalescent  stage  (afternoon 
temperature  normal;  pain,  tenderness  and 
muscle  spasm  absent),  Lorenz’s  short  spica 
holding  the  limb  in  moderate  abduction, 
may  be  used,  as  before  described.  This 
should  be  worn  at  least  two  years,  and  then 
gradually  discontinued.  Should  muscle 
spasm  recur,  return  to  treatment  by  traction 
or  plaster-splint. 

After  a cure  is  established,  train  the 
patient  “ to  walk  with  equal  steps,”  and 
correct  any  tendency  toward  flexion  and 
adduction  by  “ persistent  stretching  in  the 
direction  of  abduction  and  extension,”  and, 
if  necessary,  by  a return  to  the  use  of 
splinting  apparatus. 

In  adults,  “ early  excision  or  arthrotomy 
to  induce  ankylosis  may  be  advisable  to 
hasten  the  cure  of  the  disease.”  (Whitman). 

K,  when  first  seen,  upward  cUsplacement 
is  present,  or  ankylosis  in  a deformed  atti- 
tude, first  endeavor  to  cure  the  disease,  then 
correct  or  lessen  the  deformity  by  operative 
measures,  viz.,  subtrochanteric  osteotomy, 
or  forcible  correction  with  or  without  tenot- 
omy; or  excision  of  the  joint. 

Treatment  of  Abscess  and  Sinuses.  — Treat 
abscess  cases  by  recumbency  and  traction. 
If,  however,  the  abscess  continues  to  enlarge, 
incise  it  freely  in  two  or  more  places,  under 
the  strictest  asepsis,  through  the  thickest 
portion  of  intervening  tissue  and  skin  (avoid 
incising  through  thin  skin),  and  “ opposite 
the  least  dependent  point,”  to  obviate 
drainage.  Then  dissect  or  curette  out  the 
walls  of  the  abscess  cavity  and  all  necrosed 
tissue  with  a flushing  curette,  wipe  dry 
with  iodoform  gauze  on  a clamp,  sew  the 
wound  up  tight  with  deep  absorbable 
sutures,  leaving  no  dead  spaces,  and  apply 
a firm,  dry  dressing.  The  injection  of 
iodoform  emulsion  (10  per  cent,  in  glycer- 
ine or  oil,  10  c.c.  every  two  weeks,  or 
less  often,  following  aspiration)  is  not  gener- 
ally recommended. 

If  infection  with  pus  organisms  has 
occurred,  provide  drainage  by  means  of 
rubber  tubes.  “ If  there  is  much  dead  bone 
in  the  cavity,  this  should  be  removed  by 
curettage  or  excision  of  the  joint  ” (Prim- 
rose). The  latter  is  indicated  in  the  presence 
of  progressive  failure  of  health,  extension  of 
the  infectious  process,  or  inability  to  provide 


adequate  drainage.  Amputation  is  the  very 
last  resort. 

Sinuses,  as  well  as  abscess  cavities,  unless 
serving  as  drains,  are  best  excised  or  thor- 
oughly curetted;  or  they  may  be  injected 
with  Beck’s  mixture  of  iodoform  and  vase- 
line, 1 : 3,  or  Beck’s  bismuth  paste  (see  Part 
11),  after  drying  with  gauze.  The  injections 
are  made  every  three  days  through  a dry, 
sterile,  glass  syringe.  The  paste  is  not  to  be 
used  when  the  X-rays  show  a sequestrum; 
and  it  should  be  used  with  caution  in  large 
pus  sacs  which  may  become  filled  with 
residuary  bismuth,  for  fear  of  poisoning.  It 
acts  best  in  old  sinuses  with  little  discharge. 

In  sinuses  which  serve  as  drains,  introduce 
a rubber  tube  or  catheter  with  side-windows. 
Bier’s  suction  cups  may  be  applied  for  three 
to  five  minutes  at  three  to  five  minute  inter- 
vals for  half  an  hour  each  day.  Balsam  of 
Peru,  10  per  cent,  in  castor- oil,  is  recom- 
mended for  ulcers.  The  X-rays  and  direct 
sunlight  may  be  beneficial.  Rollier’s  method 
of  heliotherapy  “consists  in  beginning  above 
at  the  neck,  with  the  head  shielded,  and  below 
at  the  feet,  exposing  from  two  to  four  inches  of 
the  body  surface  for  five  minutes  twice  daily, 
increasing  time  and  surface  at  this  rate  until 
the  entire  body  is  exposed.  Time  and  insola- 
tion are  then  increased  according  to  the 
tolerance  of  the  individual.  Some  do  better 
with  eight  to  ten  hours  under  the  direct 
rays,  others  can  stand  only  three  or  four 
hours.”  In  sinus  cases,  the  discharge  is 
markedly  increased  during  the  first  week  or 
more  of  insolation,  but  then  declines,  with 
ultimate  closure  of  the  sinus. 

Hollow  or  Contracted  Foot;  Claw=Foot; 
Talipes  Cavus. — L.  ta'lus,  ankle  -f  pes  foot; 
ca'vum,  a hollow.  Causes. — Congenital  anom- 
aly; high-heeled  shoes;  too  short  shoes; 
paralysis  (anterior  poliomyelitis;  neuritis); 
gout  or  rheumatism;  sprain  or  fracture  of 
the  ankle;  professional  dancing  (upon  the 
ball  of  the  toes);  habitual  posture  due  to 
shortening  of  the  limb. 

Treatment.— In  slight  cases,  stretch  the  con- 
tracted tissues  by  forcible  manipulation,  and 
have  the  patient  wear  a properly  fitting  foot- 
plate (see  under  Weak  Foot),  for  the  relief 
of  discomfort. 

In  more  severe  cases  it  is  necessary  to 
divide  the  contracted  tissues  in  the  sole  of 
the  foot,  and,  if  necessary,  the  toe  extensor 
tendons,  attaching  the  latter  to  the  distal 
ends  of  the  metatarsals.  If  resistance  to 
dorsal  flexion  persists,  the  tendo  Achillis 
should  also  be  divided.  Then  correct  the 
deformity,  using  a Thomas  wrench,  if  neces- 
sary, and  apply  a plaster  bandage  (q-v.), 


jorxT,  :^ricE 


with  a thin  board  upon  the  sole  of  the  foot. 
After  six  weeks  or  longer,  during  wdiich  time 
the  patient  should  walk  about,  remove  the 
cast,  and  have  the  patient  wear  in  the  shoe  a 
flat  steel  plate  with  strong  leather  straps  pass- 
ing over  the  dorsum  of  the  foot.  Massage  and 
active  and  passive  stretching  exercises  should 
also  be  employed.  Severe  cases  may  require 
excision  of  the  heads  of  all  of  the  metatarsals, 
a cuneiform  osteotomy  of  the  up-curved 
metatarsus,  or  excision  of  the  astragalus. 

Housemaid’s  Knee. — See  Bursitis. 

Humerus,  Dislocations  of  the. — L.  See 
Dislocations  of  the  Humerus. 

Fractures  of  the. — See  Fractures  of  the 
Humerus,  and  Fractures  of  the  Elbow. 

Humpback. — See  Kyphosis. 

Hydrarthrosis,  Intermittent.  — Gr.  v5wp 
water  4-  apdpov  joint.  See  Arthritis. 

Hydrops  Articulorum  Intermittens. — L.; 
Gr.  v8pw^  dropsy;  L.  artic'ulus,  little  joint; 
in'ter,  between  + mit'tere,  to  send.  See 
Arthritis. 

Hyoid  Bone,  Fractures  of  the. — Gr.  voeid'fjs 
U-shaped.  See  Fractures  of  the  Hyoid  Bone. 

Hyperextension  of  the  Knee. — Gr.  virep 
over  + L.  exten'sio.  See  Genu  Recurvation. 

Hypertrophic  Arthritis  Deformans  of  the 
Spine. — Gr.  virkp  over  -j-  Tpo<pr]  nutri- 
tion. See  Spondylitis  Deformans. 

Pulmonary  Arthropathy.  — L.  pul' mo, 
lung;  Gr.  apdpov  joint  -|-  irados  dis- 
ease. See  under  Arthritis. 

Type  of  Arthritis  Deformans. — See 
Arthritis  Deformans. 

Hysteric  Joints. — Gr.  varkpa  womb.  See 
under  Arthritis. 

Iliopsoas  Bursitis. — L.  il'ium,  haunch- 
bone;  Gr.  \p6a  loin.  See  Bursitis. 

Infantile  Paralysis. — L.  in' fans,  infant; 
Gr.  Trapa  beside  -|-  \veiv  to  loosen. 
See  Poliomyelitis  Acuta,  in  Part  1. 

Scurvy. — See  Part  1,  General  Medicine 
ami  Surgery. 

Infectious  Arthritis. — L.  infec'tio.  See 
Arthritis;  and  Still’s  Disease. 

Inferior  Maxilla,  Dislocations  of  the. — L., 

lower  jawbone.  See  Dislocations 
of  the  Lower  Jaw. 

Fractures  of  the. — See  Fractures  of 
the  Lower  Jaw. 

Infracotyloid  Dislocations  of  the  Hip. — L. 

in' fra,  beneath;  Gr.  KOTvXub-qs  cup-shaped. 
See  Dislocations  of  the  Hip. 

Intermittent  Hydrarthrosis. — L.  in'ter,  be- 
tween -|-  mit'tere,  to  send;  Gr.  vbwp 
water  -f-  apdpov  joint.  See  Arthritis. 

Hydrops  Articulorum. — L. ; Gr.  vhpor\f 
dropsy;  L.  artic'ulus,  little  joint.  See 
Artiiritis. 


Internal  Condyle  of  the  Humerus,  Frac= 
tures  of  the. — Gr.  k6v8v\os  knuckle. 
See  Fractures  of  the  Elbow. 
Derangement  of  the  Knee  Joint. — See 

Displacement  of  a Semilunar  Carti- 
lage; Loose  Bodies;  Lipoma;  and 
Villous  Arthritis. 

Interphalangeal  Joints  of  the  Fingers,  Dis= 
locations  of  the. — L.  in'ter,  between  -f-  Gr. 
<pd\ay^.  See  Dislocations  of  the  Fingers 
at  the  Interphalangeal  Joints. 

Inversion  of  the  Foot. — L.  in,  in  -f-  ver'sio, 
turning.  See  Talipes  Varus. 

Ionization. — See  Part  1,  General  Medicine 
and  Surgery. 

Jaw,  Dislocations  of  the  Lower. — See  Dis- 
locations of  the  Lower  Jaw. 
Fractures  of  the  Lower. — See  Fractures 
of  the  Lower  Jaw. 

Upper. — See  Fractures  of  the  Upper 
Jaw. 

Jerk=Finger. — See  Trigger- Finger. 

Joint  Affections.— See  Arthritis. 

Ankle,  Tuberculosis  of  the. — See  Ankle 
Joint  and  Tarsal  Tuberculosis. 

Elbow,  Tuberculosis  of  the. — See  El- 
bow Tuberculosis. 

Finger,  Stiff. — See  Stiff  Finger  Joints. 
Great  Toe,  Painful. — See  Great  Toe- 
Joint,  Painful. 

Haemophiliac. — Gr.  alpa  blood  + 4>L\elv 
to  love.  See  under  Arthritis. „ 
Hemorrhage  within  the. — Gr.  alpa  blood 
-f  prjyvvvai  to  burst  forth.  See  under 
Arthritis. 

Hip,  Tuberculosis  of  the. — See  Hip 

Tuberculosis. 

Hysteric. — Gr.  varkpa  womb.  See  un- 
der Arthritis. 

Inflammation. — L.  inflamma're,  to  set 
on  fire.  See  Arthritis. 

Joint,  Knee,  Derangement,  Internal,  of 
the.— See  Knee,  Internal  Derangement  of  the. 
Joint,  Knee,  Displacement  of  a Semilunar 
Cartilage  of  the. — See  Displace- 
ment of  a Semilunar  Cartilage. 
Fatty  Overgrowth  in  the. — See  Li- 
poma of  Joints  and  Tendon  Sheaths. 
Internal  Derangement  of  the. — See 
Knee,  Internal  Derangement  of  the. 
Lipoma  in  the. — See  Lipoma  of 
Joints  and  Tendon  Sheaths. 

Loose  Bodies  in  the. — See  Loose 
Bodies  in  the  Knee-Joint. 

Joint,  Knee,  Tuberculosis  of  the. — See 
Knee  Tuberculosis. 

Lipoma. — See  Lipoma  of  Joints  and 
Tendon  Sheaths. 

Mice. — See  Loose  Bodies  in  the  Knee- 
Joint. 


KNEE  TUBERCULOSIS 


Neurotic. — Gr.  vevpov  nerve.  See  under 
Arthritis. 

Shoulder,  Tuberculosis  of  the. — See 

Shoulder  Tuberculosis. 

Stiff=Finger.— See  Stiff  Finger  Joints. 
Wrist,  Tuberculosis  of  the. — See  Wrist 
Tuberculosis. 

Knee,  Back. — See  Genu  Recurvatum. 
Clicking,  in  Babies. — See  Snapping  or 
Clicking  Knee  in  Babies. 

Congenital  Flexion  of  the. — See  Con- 
genital Flexion  of  the  Knee. 

Crucial  Ligament,  Rupture. — L.  crux, 
cross.  See  under  Displacement  of  a 
Semilunar  Cartilage. 

Derangement,  Internal,  of  the. — See 
Knee,  Internal  Derangement  of  the. 
Dislocations  of  the. — See  Dislocations 
of  the  Knee. 


Knock. — See  Knock-Knee. 

Lipoma  in  the. — See  Lipoma  of  Joints 
and  Tendon  Sheaths. 

Loose  Bodies  in  the. — See  Loose  Bod- 
ies in  the  Knee-Joint. 

Overextension  of  the. — See  Genu  Re- 
curvatum. 

Snapping  or  Clicking,  in  Babies. — See 

Snapping  or  Clicking  Knee  in  Babies. 

Sprain. — See  under  Arthritis. 

Knee  Tuberculosis.— Synonyms.  — Tumor 
albus;  white  swelling. 

Diagnostic  Features.— A slow,  insidious  onset; 
chronicity;  pain;  tenderness  on  point  pres- 
sure; swelling;  lameness;  reflex  muscle  spasm, 
limiting  extension ; local  elevation  of  tempera- 
ture; atrophy  of  the  thigh  and  calf  muscles. 
In  the  early  stage  of  the  disease,  the  affected 
limb  is  commonly  longer  than  the  sound  one. 


Fig.  139. — Reduction  of  flexion  deformity  by  traction. 


Displacement  of  a Semilunar  Cartilage 
of  the. — See  Displacement  of  a Semi- 
lunar Cartilage. 

Extension  of  the. — L.  exten'sio.  See 
Genu  Recurvatum. 

Fatty  Overgrowth  in  the. — See  Lipoma 
of  Joints  and  Tendon  Sheaths. 

Flexion,  Congenital,  of  the. — See  Con- 
genital Flexion  of  the  Knee. 

Fractures  of  the. — See  Fractures  of  the 
Knee. 

Housemaid’s. — See  Bursitis. 

Hyperextension  of  the. — Gr.  virkp  over 
+ L.  exten'sio.  (See Genu  Recurvatum. 

Knee,  Inflammation  of  the. — L.  intlam- 
mdre,  to  set  on  fire.  See  Arthritis. 

Internal  Derangement  of  the. — See 
Displacement  of  a Semilunar  Car- 
tilage; Loo.se  Bodies;  Lipoma;  and 
Villous  Arthritis. 


Prognosis.— This  is  usually  good  under 
treatment.  It  is  better  than  in  Pott’s  or 
hip-disease.  From  two  to  four  years  of 
treatment  are  required. 

Treatment.— Good  hygiene  is  of  first  impor- 
tance (consult  Tuberculosis,  Pulmonary, 
in  Part  1). 

Flexion  deformity  should  first  be  over- 
come, if  pos.sible,  either  by  traction  and 
gentle  leverage  under  an  anaesthetic,  or  by 
traction  in  the  line  of  deformity,  in  bed,  as 
shown  in  Fig.  139,  (see  under  Hip  Tubercu- 
losis, for  the  manner  of  applying  traction), 
or  by  fixation  of  the  joint  with  plaster  band- 
ages (q.v.)  extending  from  the  ankle,  or  better, 
the  toes,  to  the  groin,  or  to  and  including  the 
pelvis,  the  patient  not  being  confined  to 
bed,  except  in  very  acute  cases,  when  recum- 
bency for  a few  weeks  is  required.  Apply 
the  plaster  bandage  closely  over  a long, 


KNEE  TUBERCULOSIS 


white,  seamless  stocking  or  flannelette  or 
cotton  flannel  bandage,  with  light  cotton 
pads  covering  the  bony  prominences  of  the 
knee  and  ankle.  Apply  the  plaster  especially 
thickly  just  above  and  just  below  the  knee, 
“ carefully  moulding  it  into  the  depressions 
about  the  patella.”  Strips  of  steel  or  bass- 
wood may  be  incorporated  in  the  cast  to 
strengthen  it.  Slipping  down  of  the  cast 
may  be  prevented  by  applying  adhesive 
strips  to  the  leg  and  incorporating  their 
upper  free  ends  in  the  cast.  On  removing 
the  plaster  at  the  end  of  one  or  two  weeks, 


side  for  the  purpose  of  traction.  Shoulder 
straps  are  unnecessary  if  traction  is  employed. 
A plaster  bandage  may  be  worn  beneath  the 
brace  if  traction  is  not  employed.  The 
brace  should  be  worn  day  and  night.  After 
several  months  it  is  replaced  by  the  caliper 
brace,  the  lower  ends  of  which  are  turned  in 
and  fastened  to  the  heel  of  the  shoe,  but  the 
brace  is  a half  to  three-quarters  of  an  inch 
too  long  for  the  patient,  so  that  the  latter’s 
heel  does  not  reach  the  bottom  of  the  shoe, 
the  most  of  the  weight  being  borne  by  the 
ring  at  the  groin. 


Fig.  140. — Thomas  walking  knee-splint. 


the  deformity  will  be  found  much  more 
reducible,  when  another  plaster  should  be 
applied.  Unless  the  symptoms  are  acute 
(e.g.,  pain,  tenderness,  muscle  spasm,  local 
heat,  and  evening  fever),  the  patient  should 
be  allowed  about  in  the  cast  on  crutches, 
with  a high  sole  on  the  sound  leg,  until 
joint  sensitiveness  has  passed,  when  weight 
bearing  is  tentatively  allowed. 

Some  replace  the  jilaster,  after  the  acute 
symptoms  have  subsided,  by  the  Thomas 
knee  brace  (Fig.  140).  It  is  two  and  one-half 
or  three  inches  longer  than  the  limb,  and 
straps  are  attached  to  the  foot-piece  on  each 


After  several  months,  if  no  symptoms  are 
present,  the  brace  may  gradually  be  dis- 
pensed with;  but  on  the  first  return  of 
muscle  spasm,  etc.,  fixation  by  means  of 
jjlaster  should  be  resumed.  Saj's  Primrose; 
“As  a rule,  from  one  to  two  3^ears  must 
elapse  after  the  acute  sjnnptoms  have  dis- 
appeared before  retentive  apparatus  can 
be  abandoned.” 

Should  the  above-described  measures  fail 
to  correct  deformity,  owing  to  the  presence 
of  adhesions  and  contractions,  ankylosis,  or 
subluxation  of  the  tibia,  anaesthetize  the 
patient  and  employ  Whitman’s  manoeu\Te. 


KNOCK-KNEE;  GENU  VALGUM 


With  the  patient  lying  prone  upon  a table, 
the  feet  projecting  over  its  end,  place  enough 
pillows  under  the  trunk  to  bring  the  anterior 
border  of  the  tibia  down  upon  the  table. 
Then  hold  the  head  of  the  tibia  firmly  upon 
the  table  while  an  assistant  presses  down- 
ward upon  the  thigh,  avoiding  further  sub- 
luxation. Remove  the  pillows  as  the  con- 
traction yields.  Following  reduction,  or  as 
much  as  is  attainable  without  undue  force, 
employ  traction  witliin  a plaster-cast  in  bed 
for  a time  and  then  employ  a brace.  In  long 
standing  cases  Whitman  advises  preliminary 
open  division  of  the  flexor  (hamstring)  ten- 
dons, followed  by  partial  correction.  Later 
when  repair  is  complete,  the  Bradford-Gold- 
thwait  genuclast  or  Peter’s  wrench  may  be 
used;  and  finally  osteotomy,  if  required. 
After  correction  of  deformity  see  that  the 
circulation  of  the  limb  is  not  unpaired,  since, 
in  the  young,  the  epiphysis  of  the  femur 
may  become  separated  and  press  upon  the 
popliteal  vessels.  In  the  reduction  of  ex- 
treme deformity  by  osteotomy,  employ 
two  or  three  sittings,  in  order  to  avoid 
rupturing  the  large  blood-vessels  by  too 
sudden  stretching.  After  reduction  by 
osteotomy,  put  the  limb  up  in  plaster-of- 
Paris,  and  after  two  months,  allow  the 
patient  to  walk  about,  still,  however,  retain- 
ing the  plaster  for  some  time. 

In  children  under  fifteen  years  of  age,  the 
conservative  treatment  described  should  be 
employed;  but  in  adults  it  may  often  be 
advisable,  in  order  to  effect  a quick  cure,  to 
resort  to  operative  measures.  If  an  extra- 
articular  focus  is  located  by  means  of  a 
skiagram,  and  the  joint  is  not  yet  infected, 
and  the  patient  is  over  fifteen  years  of  age, 
excise  the  diseased  tissue.  Pure  carbolic  acid 
or  the  cautery  may  then  be  applied  to  the 
walls  of  the  cavity,  or  it  may  be  filled  with  a 
mixture  of  iodoform,  sixty  parts,  spermaceti 
and  oil  of  sesame,  twenty  parts  each, 
rendered  fluid  at  50°  C.,  thoroughly  stirred 
before  using  (V.  Mosetig-Moorhof),  and  the 
wound  closed.  If  the  joint  is  involved, 
erasion  or  excision  may  be  performed. 
Erasion  is  preferable  to  excision  in  children 
because  it  does  not  interfere  with  epiphyseal 
growth;  but  excision  (resection  of  the  knee- 
joint  followed  by  bony  ankylosis)  is  better 
in  adults.  Gouvain  says  “ Erasion  and 
scraping  operations  should  not  be  practiced 
if  they  can  po.ssibly  be  avoided.”  ^Vhen 
there  is  much  synovial  effusion,  arthrotomy 
may  be  performed  and  the  synovial  fringes 
cut  out  without  scraping.  Pure  carbolic 
acid  or  a strong  solution  of  zinc  chloride 
may  then  be  applied,  the  wound  closed, 


and  a plaster  support  applied.  ” In  invet- 
erate cases  the  entire  hypertrophied  syno- 
vial membrane  may  be  removed  by  an 
arthrectomy  ” and  the  knee  splinted  for  a 
year  or  longer  ( Author  ? — ). 

Amputation  is  employed  only  as  a last  resort 
to  save  life. 

Adjuvant  measures  for  the  relief  of  pain 
and  infiltration,  etc.,  are  the  application  of 
the  cautery  every  few  days,  the  X-ray, 
insolation  (see  under  Hip  Tuberculosis), 
ichthyol  ointment,  40  per  cent.,  and  Bier’s 
passive  hypcra?mia.  In  employing  the  latter, 
constrict  the  limb  above  the  affected  joint 
by  several  broad  turns  of  a soft  rubber 
bandage  just  sufficient  to  restrict  the  venous 
return,  producing  a bluish-red,  warm  swell- 
ing (not  white,  or  cold,  or  painful).  Con- 
tinue the  congestion  for  from  one  to  four 
hours  or  longer,  once  or  twice  daily,  and 
gradually  lengthen  the  time  each  day  up 
to  twelve  or  more  hours.  If  pain  is  pro- 
duced, discontinue  the  treatment. 

For  the  treatment  of  abscess  and  sinuses, 
see  under-Hip  Tuberculosis. 

Knock=Knee;  Genu  Valgum. — L.  genu, 
knee;  val'gum,  shambling,  wry.  Causes. — 
Congenital  anomaly;  rickets;  adolescence; 
fracture;  epiphyseal  injury  or  disease;  tuber- 
culosis of  the  knee;  inactivity,  as  in  the 
treatment  of  hip  disease;  osteomyelitis; 
anterior  poliomyelitis. 

Treatment. — In  slight  cases  in  young  chil- 
dren and  in  adolescents,  press  out,  for  ten  or 
more  minutes,  several  times  daily,  the 
extended  knee  with  one  hand,  while  the  other 
hand  presses  the  leg  in;  and  massage  the 
limbs  vigorously  morning  and  night.  Have 
the  sole  on  the  inner  side  of  the  shoes  raised 
one-quarter  of  an  inch,  and  instruct  the 
patient  to  walk  with  the  feet  parallel. 
Exercises  in  which  the  body  is  raised  upon 
the  toes,  such  as  bicycle  and  horseback 
riding,  are  recommended. 

If  this  treatment  is  insufficient,  employ 
the  Thomas  knock-knee  brace,  not  jointed 
at  the  knee  (Fig.  141)  combined  with  mas- 
sage, manual  correction,  and  exercises 
morning  and  night.  From  six  months  to 
one  year  of  treatment  by  braces  is  usually 
required,  says  Whitman,  whereas  in  young 
children  the  deformity  may  be  “corrected 
at  once  by  manual  force  under  aniesthesia.” 

In  marked  cases  after  the  age  of  four  or 
five  years,  osteotomy  or  o.steoclasis  (consult 
the  standard  textbooks)  will  probably  be 
required,  followed  by  fixation  in  plaster  for 
four  to  eight  weeks,  and  this  by  massage 
and  exercises,  and  if  deemed  advisable,  the 
brace,  for  several  months. 


LORDOSIS 


Kyphosis;  Hump=Back. — Gr.  KhcjiUKus 
hump-back,  from  crookedness.  Causes.— 
Round,  or  stoop,  or  di’oop  shoulders  {q.v., 
for  causes  and  treatment);  adolescence; 
Pott’s  disease;  syphilis;  malignant  disease; 
fracture;  aneurysmal  erosion;  osteitis  de- 
formans; spondylitis  deformans;  secondary 
osteoarthropathy;  acromegaly;  scoliosis; 
osteomalacia:  rickets;  marasmus;  scurvy; 
cretinism;  old  age  (atroi:)hy  of  the  inter- 
vertebral discs);  traumatism;  tabes. 


Fig.  141. — Knock-knee  brace. 

(Bradford  and  Lovett). 

Treatment.— This  depends,  of  course,  upon 
the  cause.  The  prognosis  in  the  kyphosis  of 
adolescents  is  not  good.  Whitman  gives  the 
following  directions:  “ In  favorable  cases 
partial  rectification  of  the  deformity  by 
force  (the  Calot  operation)  is  indicated. 
Afterward  support,  forcible  movements,  and 
corrective  exercises  should  be  employed  ” 
(see  Round  Shoulders). 

Treat  traumatic  spondylitis  as  in  Pott’s 
Disease  {q.v.,)  by  recumbency  and  hyper- 
extension of  the  spine,  in  very  acute  ca.ses, 
followed  by  a plaster  jacket  or  brace  for  six 
months  or  much  longer.  Employ  massage 
and  graduated  exercises  during  convales- 
cence. It  is  usually  cured  in  a year  or  two. 

Larynx,  Fractures  of  the. — See  Fractures 
of  the  Larynx. 

Lateral  Curvature  of  the  Spine. — See 

Scoliosis. 

Leg,  Fractures  of  the. — See  Fractures  of 


the  Leg,  the  Lower  End;  and  Fractures  of 
the  Leg,  the  Shaft. 

Legg’s  Disease. — See  Perthes’  Di.sease. 

Lipoma  Arborescens. — Gr.  Xittos  fat  -)- 
-wAta  tumor;  L.  ar'hor,  tree.  See  Villous 
Arthi-itis. 

Lipoma  of  Joints  and  Tendon  Sheaths. — 

Gr.  XLttos  fat  -f-  -co^ta  tumor.  Of  the  joints, 
the  knee,  and  of  the  tendon  sheaths,  the 
peroneals  and  posterior  tibial  are  most  fre- 
quently involved.  The  condition  is  mani- 
fested by  pain,  swelling,  and  disability,  and 
sometimes  crepitation,  and,  in  the  knee,  a 
dense  swelling  on  either  side  of  the  patella 
and  its  tendon. 

Treatment.— For  general  obesity,  employ 
the  reduction  treatment  described  under 
Obesity  (in  Part  1).  Locally  employ 
daily  vigorous  massage  of  the  tissues  about 
the  joint,  strapping  and  compression  of 
the  joint,  and  enjoin  the  avoidance  of  stair 
climbing  and  walking. 

If  a faithful  trial  of  the  above  conserva- 
tive treatment  affords  no  material  relief, 
remove  the  hypertrophied  masses  through  a 
lateral  incision  close  to  the  inner  border  of 
the  patella,  or  through  bilateral  incisions, 
and  close  the  wound  layer  by  layer  with 
interrupted  catgut  sutures,  leaving  in  a 
silk  seton  for  twenty-four  hours  for  clramage 
purposes.  At  the  end  of  a week,  remove  the 
stitches  and  commence  gentle  passive  manip- 
ulation. “ Three  to  four  weeks  should  put 
the  joint  in  a practically  normal  condition.” 
(Goldthwait,  Painter  and  Osgood.) 

Lock=Finger. — See  Trigger- Finger. 

Long  Bones  of  the  Hand  and  Foot, 
Tuberculosis  of  the. — See  Tuberculosis  of 
the  Long  Bones  of  the  Hand  and  Foot. 

Loose  Bodies  in  the  Knee  Joint;  Joint 
Mice. — Cause:  Osteochondritis  dessicans  fol- 
lowing injury.  The  characteristic  symptom 
is  recurrent  locking  or  sudden  interference 
with  the  function  of  the  joint. 

Treatment.— If  the  loose  body  can  be  felt, 
it  may  possibly  be  transfixed  with  a needle, 
under  local  ansesthesia  (see  cocaine  or  novo- 
caine  in  Part  11),  cut  down  upon,  and  re- 
moved. Have  the  patient  find  the  body 
with  sterile  gloved  hands.  The  joint  must 
then  be  immobilized  for  two  or  three 
weeks,  followed  Iw  passive  manipulation. 
For  the  removal  of  inaccessible  loose  bodies, 
the  patella  must  be  split  longitudinally,  with 
the  knee  flexed,  as  described  under  Dis- 
placement of  a Semilunar  Cartilage. 

Loose  Shoulder. — See  Dislocation,  Re- 
current, of  the  Shoulder. 

Lordosis. — Gr.  XopSoOr  to  bend.  Abnormal 
hollowness  of  the  back. 


OSTEOMYELITIS 


Causes.— Congenital  anomaly;  spondylo- 
listhesis; congenital  dislocation  of  the  hip; 
muscular  dystrophy;  compensatory  to  dorsal 
kyphosis  {q.v.) ; flexion  contraction  of  the 
thighs;  wearing  of  high  heels;  straight  front 
corset;  drag  of  a large  abdomen,  as  in  preg- 
nancy, abdominal  tumor,  etc.;  professional 
contortionism. 

Lower  Jaw,  Dislocations  of  the.  — See 

Dislocations  of  the  Lower  Jaw. 
Fractures  of  the. — See  Fractures  of 
the  Lower  Jaw. 

Lumbar  Abscess. — L.  lum'hus,  loin;  ab- 
sces'sus,  a going  apart.  See  Pott’s  Disease. 

Malar  Bone,  Fractures  of  the. — L.  ma'la, 
cheek.  See  Fractures  of  the  Malar  Bone. 

Mallet=Finger;  Drop=Finger. — This  de- 
formity is  due  to  tearing  of  the  extensor 
tendon  from  its  insertion  into  the  terminal 
phalanx. 

Treatment. — Fix  the  Anger  in  extension  by 
means  of  a palmar  splint  including  the  wrist 
until  the  tendon  has  had  time  to  reattach 
itself;  or,  first  suture  the  torn  tendon  to  the 
periosteum  and  then  apply  a palmar  splint. 

Maxilla,  Inferior,  Dislocations  of  the. — L. 
maxil'la,  jaw-bone.  See  Disloca- 
tions of  the  Lower  Jaw. 

Fractures  of  the. — See  Fractures  of 
the  Lower  Jaw. 

Superior,  Fractures  of  the. — See  Frac- 
tures of  the  Upper  Jaw. 

Metacarpal  Bones,  Fractures  of  the. — Gr. 
nera  after  -|-  Kap-iros  wrist.  See 
Fractures  of  the  Metacarpal  Bones. 
Tuberculosis  of  the. — See  Tubercu- 
losis of  the  Long  Bones  of  the  Hand. 

Metacarpophalangeal  Joints,  Dislocations 
of  the. — See  Dislocations  of  the  Metacar- 
pophalangeal Joints. 

Metatarsal  Bones,  Fractures  of  the. — Gr. 

fjLeTa  after  -j-  rapabs  tarsus.  See 
Fractures  of  the  Metatarsal  Bones. 
Tuberculosis  of  the. — See  Tubercu- 
losis of  the  Long  Bones  of  the  Hand 
and  Foot. 

Metatarsalgia,  Anterior. — See  Anterior 
Metatarsalgia. 

Mice,  Joint. — See  Loose  Bodies  in  the 
Knee  Joint. 

Morbus  Coxae  Senilis. — L.,  senile  disease 
of  the  hip.  See  Arthritis  Deformans,  under 
the  Hypertrophic  Type. 

Morton’s  Painful  Affection  of  the  Foot. — 
See  Anterior  Metatarsalgia. 

Nasal  Bones,  Fractures  of  the. — L.  nas'us, 
nose.  See  Fractures  of  the  Nose. 

Neck,  Stiff. — See  under  Torticollis, 

Nekton’s  Line. — See  under  Fractures  of 
the  Hip. 

53 


Nerve  Injuries  in  Fractures. — See  Gen- 
eral Considerations,  under  Fractures. 

Neuralgia,  Morton’s. — Gr.  vevpov  nerve  -p 
aXyos  pain.  See  Anterior  Metatar- 
salgia. 

Plantar. — See  Plantar  Neuralgia. 

Neurasthenic  Spine. — See  Neurotic  or 
Neurasthenic  Spine. 

Neuropathic  Arthritis. — Gr.  vevpov  nerve 
-p  Trados  disease.  See  under  Arthritis. 

Neurotic  Joints. — See  under  Arthritis. 

Neurotic  or  Neurasthenic  Spine. — Gr. 
vevpov  nerve  -p  a priv.  -p  adevos  strength;  L. 
spin' a,  spine  or  thorn.  The  neurasthenic  back 
is  characterized  by  an  attitude  of  ligamen- 
tous and  muscular  weakness,  local  pain  and 
debility,  and  the  presence  of  sensitive  points. 

Causes. — Inherent  weakness;  traumatism 
(chronic  sprain) ; weak  foot;  contracted  foot; 
faulty  attitude;  inequality  in  the  length  of 
the  legs;  worry;  overwork. 

Treatment.— Any  possible  causal  influence 
should  be  corrected.  A light  supporting 
brace  or  corset  is  of  service.  For  sprain,  a 
plaster  jacket  (see  under  Pott’s  Disease) 
should  be  employed  for  about  six  weeks,  and 
then  gradually  dispensed  with.  Massage, 
douches,  gymnastic  exercises,  avoiding  fa- 
tigue, the  thermocautery  for  pain,  good 
hygiene,  nutritious  food,  and  tonics,  if  indi- 
cated, are  all  of  service  in  ajipropriate  cases 
(for  the  treatment  of  neurasthenia,  see 
Neurasthenia,  in  Part  1). 

Nose,  Fractures  of  the. — See  Fractures  of 
the  Nose. 

Obstetrical  Paralysis.  — L.  oh,  in  front 
of  -p  sto,  I stand.  See  Brachial  Plexus 
Paralysis. 

Olecranon,  Fracturesof  the. — Gr.mXeKpavov. 
See  Fractures  of  the  Elbow. 

Open  Fractures. — See  General  Consider- 
ations, under  Fractures,. 

Os  Calcis,  Fractures  of  the. — L.  See 
Fractures  of  the  Tarsal  Bones. 

Osteitis  Deformans. — See  Part  1,  General 
Medicine  & Surgery. 

Osteoarthritis. — Gr.  barkov  bone  -p  apdpov 
joint  -p  -iTLs  inflammation.  See  Arthritis 
Deformans. 

Osteoarthropathy,  Secondary  Hypertro- 
phic.— See  Part  1,  General  Medicine  & 
Surgery. 

Osteochondritis. — See  Perthes’s  Disease. 

Osteogenesis  Imperfecta  Foetalis. — Gr. 
bareov  bone  -p  yevvaw  to  beget.  See  Fragilitas 
Ossium. 

Osteomalacia. — See  Part  1,  General  Medi- 
cine and  Surgery. 

Osteomyelitis. — See  Part  1,  General  Medi- 
cine and  Surgery 


PLANTAR  NEURALGIA 


Osteopathies,  The  Hypertrophic. — See 

Part  1,  General  Medicine  and  Surgery. 

Osteoporosis  Senilis. — Gr.  barkov  bone  + 
irbpos  passage.  See  Fragilitas  Ossium,  in 
Part  1. 

Osteopsathyrosis. — Gr.  baTtov  bone  + 
\padvpbs  friable.  See  Fragilitas  Ossium, 
in  Part  1. 

Overextension  of  the  Knee. — See  Genu 
Recurvatum. 

Paget’s  Disease. — See  Osteitis  Defor- 
mans, in  Part  1. 

Painful  Affection  of  the  Foot,  Morton’s. — 

See  Anterior  Metatarsalgia. 

Painful  Great  Toe=Joint. — Causes. — Hallux 
rigidus;  weak  foot;  pressure  of  the  shoe. 

The  Treatment  is  the  same  as  for  Hallux 
Rigidus. 

Painful  Heel  . — Causes. — Long  standing; 
weak  or  flat  foot;  hollow  or  contracted  foot; 
achillobursitis;  calcaneobursitis;  rheumatoid 
arthritis;  gonorrhoea;  exostosis;  neuroma. 

Treatment.— Attend  to  the  cause.  A rubber 
heel  may  afford  relief  in  mild  cases.  A metal 
plate  with  a concavity  beneath  the  painful 
area  may  be  worn.  Rest,  by  means  of  a 
plaster  bandage,  is  indicated  if  the  condi- 
tion is  inflammatory.  A chronically  inflamed 
bursa  or  spurs  (revealed  by  radiography) 
should  be  removed;  but  spurs  should  not  be 
removed  in  arthritis  deformans. 

Paralysis,  Brachial  Plexus. — Gr.  trapb 
beside  + \vtiv  to  loosen.  See 
Brachial  Plexus  Paralysis. 

Cerebral,  of  Childhood. — See  Cerebral 
Paralysis  of  Children. 

Infantile. — See  Poliomyelitis  Acuta, 
in  Part  1. 

Obstetrical. — L.  oh,  in  front  of  -f-  sto, 
I stand.  See  Brachial  Plexus  Paraly- 
sis. 

Complicating  Pott’s  Disease. — See  un- 
der Pott’s  Disease. 

Spastic  Cerebral — Gr.  cnraapibs  spasm. 
See  Cerebral  Paralysis  of  Children. 

Spastic  Spinal. — The  orthopaedic  treat- 
ment is  that  of  Cerebral  Paralysis  of 
Children. 

Paralytic  Dislocations. — See  Dislocations, 
Paralytic. 

Patella,  Dislocations  of  the. — L.  patel'la, 
pan.  See  Dislocations  of  the  Patella. 

Patella,  Fractures  of  the. — See  Fractures 
of  the  Patella. 

Slipping. — See  Slipping  Patella. 

Pathological  Dislocations. — See  Disloca- 
tions, Pathological  or  Spontaneous. 

Fractures. — See  Fragilitas  Ossium,  in 
Part  1. 

Peliosis  Rheumatica. — Gr.  neXibs  livid; 


bevpariKos.  See  Purpura,  in  Part  5,  Skin 
Diseases.) 

Pelvis,  Fractures  of  the. — L.  pel'vis, 
basin.  See  Fractures  of  the  Pelvis. 

Perthes’s  Disease;  Osteochondritis  De= 
formans  Juvenilis.— Gr.  bareov  bone  -1- 
xbvbpos  cartilage  -T  -ms  inflammation.  A 
newly  discovered  disease,  affecting  prin- 
cipally the  upper  femoral  epiphysis,  usually 
in  boys  between  five  and  ten  years  of  age, 
characterized  anatomically  by  a gradual  flat  - 
tening  of  the  femoral  head,  which  sometimes 
appears  crushed,  and  clinically  by  a slight 
limp,  restriction  of  abduction  and  inward 
rotation,  and  slight  shortening,  but  no  pain. 

The  affection  is  scarcely  to  be  distin- 
guished from  tuberculous  hip  disease,  except 
that  it  is  benign  and  disappears  spontane- 
ously in  from  two  to  four  years. 

Protection  by  means  of  a long  plaster  of 
Paris  fixation  splint  (see  under  Hip  Tuber- 
culosis) is  advised. 

Pes  Planus. — L.,  flat-foot.  See  Weak 
Foot. 

Valgus. — See  Weak  Foot. 

Phalanges  of  the  Fingers,  Dislocations  of 

the. — Gr.  4>a\ay^  phalanx.  See 
Dislocations  of  the  Fingers  at  the 
Interphalangeal  Joints,  and  Dis- 
locations of  the  Fingers  at  the 
Metacarpophalangeal  Joints. 
Fractures  of  the.— See  Fractures  of 
the  Phalanges  of  the  Fingers. 

Toes,  Fractures  of  the. — See  Fractures 
of  the  Phalanges  of  the  Toes. 

Tuberculosis  of  the. — See  Tubercu- 
losis of  the  Long  Bones  of  the  Hand 
and  Foot. 

Pigeon=Breast. — See  Chicken  Breast. 

Pigeon=Toe;  Hallux  Varus. — L.  hal'lux, 
great  toe;  var'us,  bent  inward,  i.e.,  away 
from  the  other  toes.  Causes. — Congenital 
hallux  varus;  bow-legs;  congenital  talipes; 
coxa  vara  wdth  the  femoral  necks  turned  for- 
ward; weak  foot;  weak  knees  (genu  valgum). 

Treatment.— Correct  the  caiuse.  In  simple 
cases,  raise  the  outer  border  of  the  sole  of 
the  shoe,  and  train  the  patient  to  walk  with 
the  feet  parallel.  In  congenital  hallux  varus 
correct  the  deformity  with  adhesive  plaster. 

Plantar  Flexion  of  the  Foot. — L.  plafita, 
sole  of  the  foot ; flex' io,  bending.  See  Talipes 
Equinus. 

Plantar  Neuralgia. — L.  plaiita,  sole  of  the 
foot;  Gr.  vevpov  nerve  -f  akyos  pain.  Causes.— 
Hollow  or  contracted  foot ; weak  or  flat  foot ; 
influenza;  gout  or  rheumatism;  rupture  of 
the  plantar  fascia. 

Treatment.— Attend  to  the  cause.  In 
injury  or  disease  of  the  plantar  fascia,  secure 


POTT’S  DISEASE 


rest  by  means  of  a plaster  bandage  until  the 
pain  and  sensitiveness  have  disappeared. 

Plaster  Bandages,  How  to  Prepare. — 
Plaster  bandages  are  made  by  rolling  four- 
yard  strips  of  washed  crinoline,  stitched 
together,  in  dental,  or  better  moulders’, 
plaster-of-Paris.  They  should  be  kept  in  a 
tin  bread-box  in  a dry  place.  Before  using, 
if  damp,  they  may  be  dried  in  an  oven. 

Plaster=Casts,  How  to  Make.  — After 
cleansing,  drying,  and  powdering  the  skin, 
apply  one  thickness  of  sheet-wadding  in  the 
form  of  a roller  bandage.  Cover  bony 
prominences  thickly.  Immer.se  the  plaster 
bandage  (see  How  to  Prepare,  above)  com- 
pletely, on  end  in  plain  warm  water,  until 
all  bubbles  cease  to  rise,  then  wring  it  out, 
and  apply.  Never  reverse  the  bandage  dur- 
ing the  application.  Renew  the  water  after 
the  third  bandage.  Thin  cypress  wood  or 
tin  strips,  perforated  with  holes  to  catch 
and  hold  the  plaster,  may  be  incorporated 
in  the  plaster  to  reinforce  it.  If  the  plaster 
is  to  be  split,  it  should  be  done  as  soon  as 
the  cast  is  completed,  a strip  of  tin  having 
been  previously  jilaced  over  the  skin  under 
the  line  to  be  cut.  Use  a jack-knife  to  cut 
the  pla.ster.  The  cut  edges,  after  drying, 
may  be  covered  with  adhesive  plaster,  to 
prevent  crumbling. 

To  remove  plaster  from  the  hands,  wash 
them  in  sugar  water. 

Pneumococcus  Arthritis.— Gr.  wvevfjLcov  lung 

KOKKos  berry.  See  under  Arthritis. 

Poliomyelitis  Acuta. — See  Part  1,  General 
Mecheine  and  Surgery. 

Popliteal  Bursitis. — L.,  from  pop'les,  the 
ham.  See  Bursitis. 

Post=Mediastinal  Abscess. — L.  post- 

after;  mediastinum,  median  partition.  See 
Pott’s  Disease. 

Pott’s  Disease. — Synonyms. — Spondylitis 
tuberculosa;  tuberculosis  of  the  spine. 

Diagnostic  featimes  are  (1)  stiffness  of  the 
spine,  due  to  muscle  spasm,  made  manifest 
when  the  patient  sits  down,  rises,  picks  an 
object  from  the  floor,  and  walks  (psoas 
contraction  limits  extension  of  the  thigh; 
in  hip-disease  motion  is  limited  in  all  direc- 
tions, not  in  extension  merely);  (2)  a pos- 
terior angular  projection,  or  kyphosis  {q.v.) ; 
(3)  torticollis  in  cervical  disease;  (4)  ab- 
normally square  shoulders  in  mitldorsal 
disease;  (5)  lordosis  and  over-erectness 
in  Imnbar  cRsease  (see  also  Lordosis) ; (6) 
“ peculiar  intoeing  step  ” in  dorsal  and 
lumbar  di.sease;  (7)  weakness  and  disinclina- 
tion to  walk;  (8)  paroxj^smal  pain,  causing 
“ night-cry  ” in  children  (occipital  ancl 
auricular,  sometimes  earache,  in  cervical 


disease;  thoracic  and  abdominal,  stomach- 
ache, in  dorsal  and  dorso-lumbar  disease; 
inguinal  and  thigh  pains,  sciatica,  etc.,  in 
lumbar  disease;  painful  cramp  is  common); 
(9)  grunting  respiration,  cough,  and  dysp- 
noea, sometimes  resembling  asthmatic  at- 
tacks, in  cervical  and  upper  dorsal  disease. 

Abscess  (retropharyngeal,  post-medias- 
tinal, dorsal,  lumbar  psoas,  buttock)  or 
paraly.sis  may  occur. 

Prognosis.— This  is  good  under  treatment, 
three  or  four  years  of  which  are  usually 
required.  The  outlook  in  paralysis  is  also 
usually  favorable. 

Treatment. — A correct  hygienic  regimen  is  of 
first  importance  (consult  Tuberculo.sis,  Pul- 
monary, in  Part  1). 

Local  treatment  aims  at  spinal  immobil- 
ization and  lessening  of  the  superincumbent 
weight  at  the  seat  of  disease  by  splinting  the 
spine  in  an  extended  position. 

In  very  acute  cases,  in  the  presence  of 
abscess,  tlireatened  or  actual  paralysis, 
intractable  pain,  progressive  deformity, 
marked  scoliosis,  psoas  contraction,  in  the 
rare  atlo-axoid  cases,  in  young  children  up 
to  four  years  of  age,  and  in  cases  which  do 
not  progress  satisfactorily  under  ambulatory 
treatment  the  treatment  should  be  by  recum- 
bency or  horizontal  fixation. 

It  is  essential  to  have  a firm  mattress 
upon  a stiff  woven-wire  spring,  and  between 
the  mattress  and  the  spring  a foot-wide 
planed  board  or  table  leaf,  placed  length- 
wise. Upon  the  mattress  is  placed  a rec- 
tangular, gaspipe  frame,  covered  with  cloth 
(Whitman’s  convex  stretcher  frame).  The 
frame  should  be  from  four  to  twelve  inches 
longer  than  the  patient  and  about  four- 
fifths  as  wide,  the  long  side  bars  lying  oppo- 
site the  articular  surfaces  of  the  four 
extremities  with  the  trunk,  so  that  the 
shoulders  and  arms  rest  on  the  bed  outside 
the  frame.  Bandages  may  be  wound  tightly 
around  that  portion  of  the  frame  opposite 
the  trunk,  so  as  “ to  make  the  support  as 
unyielding  as  possible.”  The  frame  is  then 
covered  with  strong  canvas  or  heavy  cotton 
cloth,  laced  tightly  down  the  back  with 
corset  lacing,  leaving  a space  at  the  buttocks 
for  the  evacuation  of  the  bowels.  On  each 
side  of  the  kyphus  or  seat  of  disease  are 
sewed  folded  sheets  or  felt  pads,  about  six 
or  seven  inches  long,  three  or  four  inches 
wide,  and  one  inch  thick,  or  thick  enough 
to  press  the  deformity  slightly  upward. 
The  patient  is  fastened  to  the  frame 
by  means  of  straps  crossing  the  chest  like 
those  of  a knapsack,  or  a waist  pinned 
above  the  shoulders  and  at  the  sides  or 


POTT’S  DISEASE 


back,  and  by  a sheet  bound  around  the 
pelvis.  A rubber  cloth  should  be  placed 
under  the  buttocks.  Once  a day,  the  patient 
should  be  turned  on  his  side  and  the  back 
bathed  with  alcohol  and  dusted  with  powder. 
Diapers  should  be  slipped  under  the  pelvis 
instead  of  lifting  the  pelvis  by  raising  the 
feet.  The  patient  should  lie  constantly  upon 
the  frame,  never  even  partially  sitting  up, 
until  the  acute  symptoms  have  subsided, 
that  is,  until  there  is  no  longer  pain,  fever, 
night  starts,  or  stiffness.  This  takes  from 
four  to  six  months,  or  in  the  presence  of 
abscess  or  paralysis,  from  six  to  eighteen 
months.  In  young  children,  recumbency 
should  be  continued,  even  after  the  sub- 
sidence of  acute  symptoms,  imtil  the  age 
of  two  and  a half  to  four  years.  The  child’s 
clothing  should  be  made  to  include  the  frame. 

The  frame  is  bent  so  that  the  convexity 
is  opposite  the  kyphus,  in  order  to  hyper- 
extend  the  spine,  and  this  bowing  should  be 
gradually  increased.  In 
cervical  disease  it  should 
be  quite  marked,  and  in 
these  cases,  too,  head 
traction  of  one  or  more 
pounds  should  be  em- 
ployed by  means  of  a 
pulley  and  the  Glisson 
chin  and  occiput  sling, 
and  raising  of  the  top  of 
the  bed.  In  occipito 
axoid  involvement  the 
head  should  also  be  fixed 
by  means  of  lateral  sand- 
bags or  a metal  brace. 

In  paralysis  traction  may  also  be  exerted 
upon  the  legs.  In  psoas  contraction  employ 
traction  upon  the  leg  in  the  line  of  deformity, 
and  gradually  lower  the  leg  as  hritation  and 
muscle  spasm  subside  (seeBuck’s  Extension). 

Following  treatment  by  recumbency,  am- 
bulatory supports  (pla.ster- jacket,  or  steel 
brace,)  are  employed. 

In  acute  cases  other  than  those  mentioned 
as  requiring  bed  treatment,  employ  the 
pi aster-of- Paris  jacket.  It  may  be  applied 
with  the  patient  face  downward  on  the  Brad- 
ford and  Lovett  hammock  frame  (Fig.  142). 

Next  to  the  skin  is  worn  a close-fitting, 
seamless  stockinette  or  shirting  reaching  to 
the  knees,  beneath  which  are  placed  length- 
wise two  strips  of  bandage,  one  in  front  and 
one  in  back,  with  ends  tied  together,  to  be 
used  as  “ scratchers.”  They  may  be  wet 
with  alcohol  and  used  to  bathe  the  skin,  and 
may  be  renewed  when  soiled.  The  kyphus 
and  all  bony  prominences  should  be  padded, 
and  felt  pads,  at  least  an  inch  in  thickness. 


should  be  placed  at  the  sides  of  the  kyphus. 
A folded  towel  may  or  may  not  be  placed 
over  the  abdomen,  to  furnish  room,  when 
removed  from  beneath  the  cast,  for  the  dis- 
tention of  the  abdomen  after  meals  (dinner 
pad).  The  plaster  bandages  {q.v.)  are 
then  applied,  beginning  from  below.  The 
cast  should  reach  from  the  pubes  to  the 
sternal  notch  in  front,  and  from  the  cleft 
of  the  buttocks  to  the  midscapular  region 
behind,  leaving  no  part  of  the  abdomen 
exposed  below  the  cast,  in  order  to  avoid 
hernia  (C.  L.  Starr).  Remember  that  “ the 
pelvis  is  the  base  of  support  for  all  forms  of 
splints.”  First,  beginning  as  low  down  as 
practicable,  apply  the  bandages  up  to  the 
level  of  the  apex  of  the  kyphus.  Then  after 
the  plaster  has  hardened,  loosen  the  ham- 
mock and  produce  hvperextension  “ to  the 
point  of  slight  discomfort.”  Then  com- 
plete the  jacket.  The  latter  should  be  uni- 
formly Ke  fo  H iiich  tliick. 


If  the  disease  involves  the  upper  dorsal 
region,  the  jacket  is  best  applied  (C.  L. 
Starr)  with  the  patient  lying  on  his  back 
upon  the  Goklthwait,  Metzger-Goldthwait, 
or  R.  T.  Taylor  apparatus.  In  using  Gold- 
thwait’s  portable  frame,  place  the  patient 
on  the  two  steel  bars,  with  the  latter  reach- 
ing only  to  the  apex  of  the  kyphus.  Then 
apply  the  plaster  bandages  up  to  this  point. 
Then  allow  ‘ ‘ the  upper  portion  of  the  trunk 
to  sink  downward  to  the  point  of  toleration,” 
and  complete  the  jacket.  Then  withdraw  the 
steel  bars.  The  Metzger-Goldthwait  appa- 
ratus “ permits  longitudinal  traction  as 
well  as  direct  leverage.”  Starr’s  forked  sup- 
{)ort  may  be  used.  It  may  be  adjusted 
to  the  desired  height  for  proper  hyperex- 
tension, and  supports  two  small  steel 
plates  padded  with  piano  felt,  which 
are  incorporated  in  the  plaster,  the  small 
opening  left  over  them  being  filled  with 
plaster  cream. 

Include  the  shoulders  and  the  neck  (a 


This  Width 
not 

ad  v<^ic(e  a» 


Openihq  for 
the  face . 


Fig.  142. — Arm  abduction  splint  (left).  Frame  with  double  anterior  brace.  No  metal 

across  the  back. 


POTT’S  DISEASE 


band  of  felt  being  placed  about  the  neck 
over  a high-neck  shirt)  if  the  fourth,  fifth, 
or  sixth  dorsal  vertebra  is  involved.  In 
high  dorsal  and  in  cervical  disease,  the  head 
should  also  be  included,  the  plaster  sup- 
porting the  occiput  and  forehead,  and  leav- 
ing the  top  of  the  head,  the  ears,  and  face 
exposed  (Minerva  head-piece). 

Says  H.  L.  Taylor:  “ If  the  disease  is  above 
the  tenth  dorsal  the  leverage  should  be 
increased  by  a head  or  chin  support, 
whether  a jacket  or  brace  is  employed.” 

The  method  of  applying  plaster- jackets 
with  vertical  suspension  of  the  patient  by 
means  of  a Sayre  head-piece  is  not  as  effi- 
cient, says  R.  W.  Lovett,  as  the  above 
described  methods,  by  which  it  has  been 
largely  replaced;  but  Whitman  says:  “ For 
the  routine  application  of  the  plaster- jacket, 
vertical  suspension  is  to  be  preferred.”  In 
employing  suspension,  use  traction  “ only  to 
the  point  of  comfort.”  Extend  the  jacket 
as  high  and  as  low  as  po.ssible.  Keep  the 
patient  in  a recumbent  position  for  one-half 
hour  or  longer  after 
the  jacket  has  been 
applied. 

“Jackets  should  be 
renewed  as  infrequent- 
ly as  possible,  being 
left  on  six  months  or 
a year  when  they  are 
efficient  and  comfort- 
able.” (Lovett.) 

The  treatment  by 
braces,  some  claim,  is 
the  most  efficient 
of  all  methods,  but 
requires  expert  knowledge.  Whitman,  how- 
ever, says:  “ The  absolute  control  of  the 
treatment,  assured  by  the  use  of  the  plaster- 
jacket,  will  often  overbalance  the  claims  of 
the  brace.”  The  C.  F.  Taylor  and  the  Bol- 
linger braces  are  the  best  (Lovett),  with  head 
supports  in  disease  above  the  middle  dorsal 
region.  The  Thomas  collar  (Fig.  143)  may 
be  employed  in  disease  of  the  upper  cervical 
region.  It  is  made  of  mill-board  or  oakum 
shaped  from  a paper  pattern.  The  mill- 
board  is  wet  anrl  moulded,  then  dried  and 
covered  with  cotton  wound  tightly  with  a 
gauze  bandage.  The  brace  should  be 
worn  day  and  night.  Once  a day  it  should 
be  removed,  with  the  patient  lying  upon  his 
face  or  side,  and  the  back  bathed  and 
rubbed  with  alcohol,  dried,  and  dusted  with 
powder.  It  should  be  readjusted  at  intervals. 

During  convalescence,  employ  a brace;  or 
the  plaster- jacket  split  down  the  front  (before 
it  is  dry,  see  Plaster-Casts)  and  laced;  or  a 


Fig.  143. — Thomaa  collar. 


corset  of  leather  or  aluminum,  made  on  a 
cast  obtained  by  filling  the  greased  plaster 
jacket  with  plaster-of-Paris  and  removing 
the  jacket  after  the  cast  has  hardened.  The 
leather  corset  is  made  of  light  sole  leather 
previously  softened  by  soaking  in  water  for 
twenty-four  hours,  then  stretched  and 
tacked  to  the  mould,  allowed  to  dry, 
trimmed,  holes  punched  in  it  to  make  it 
porous,  and  hooks  fastened  along  the  front 
to  lace  it.  Its  stiffness  may  be  increased  by 
two  or  three  coats  of  shellac. 

A spinal  support  shordd  be  worn  for  at 
least  a year  (in  abscess  or  paraplegia  proba- 
bly three  years)  after  all  muscle  spasm  and 
pain  have  disappeared.  Test  for  muscle 
spasm  by  elevating  the  feet  so  as  to  hyper- 
extend  the  back,  the  patient  lying  prone. 
“ The  disease  is  rarely  cured  in  two  years  ” 
(H.  L.  Taylor).  Tlmea  or  four  or  more 
years  of  treatment,  are  usually  required. 
Discontinue  the  support  gradually,  at  first 
only  at  night,  then  for  gradually  increasing 
periods  during  the  day.  Always  reapply  the 
support  with  the  patient  in  the  hyper- 
extended  position.  The  kyphosis  may 
increase,  even  after  the  disease  is  cured, 
from  static  conchtions. 

The  Albee  treatment  of  doj-sal  and  lum- 
bar caries,  is  as  follows:  The  exact  site  of 
the  disease  having*  been  ascertained  by 
means  of  the  X-rays,  the  spinous  processes 
are  exposed,  by  a semicircular  incision 
extending  well  above  and  below  the  lesion. 
The  spinous  processes  extending  two  verte- 
brae above  and  two  below  the  lesion  are  then 
split,  and  a strip  of  the  patient’s  tibia 
(avoiding  the  crest ; beveling  clear  through 
to  the  marrow)  inserted  between  the  split 
processes,  and  held  in  place  with  kangaroo 
tendon.  The  strip  of  tibia  is  cut  out  with 
a specially  designed  motor  saw.  The  patient 
is  kept  recumbent  for  three  months  (children 
one  year),  and  then  allowed  up  with  a 
supporting  jacket  or  brace  until  all  signs 
of  active  disease  have  disappeared. 

This  method  of  treatment  is  attended  by 
many  dangers,  e.g.,  shock,  pneumonitis, 
meningitis,  paraplegia,  abscess,  miliary  tu- 
berculosis, etc.,  and  its  results  are  probably 
not  so  good,  as  a rule,  in  children,  as  those 
from  the  older  method  of  treatment.  The 
bone  graft  often  fractures.  Theoretically  the 
treatment  seems  ideal,  but  it  has  not,  as 
yet,  proven  so  in  practice,  excepting,  per- 
haps, in  adults.  Hibb’s  method  is  preferred 
by  some,  especially  for  children. 

Treatment  of  Abscess. — Abscess  cases  should 
be*  treated  by  recumbency,  in  the  hope  that 
the  abscess  may  become  absorbed.  If  it 


PULMONARY  ARTHROPATHY 


continues  to  enlarge,  however,  incise  it 
freely  in  two  or  more  places,  uiuler  the 
strictest  asepsis,  through  the  thickest  por- 
tion of  intervening  tissue  and  skin  (avoid 
incising  through  thin  skin),  and  “opposite 
the  least  dependent  point,”  to  obviate 
drainage.  Then  dissect  or  curette  out  the 
walls  of  the  abscess  cavity  and  all  diseased 
tissue  with  a flushing  curette,  wipe  dry  with 
iodoform  gauze  on  a clamp,  sew  the  wound 
up  tight  with  deep  absorbable  sutures,  leav- 
ing no  dead  spaces,  and  apply  a firm,  dry 
dressing.  The  injection  of  iodoform  emul- 
sion (10  per  cent,  in  glycerine  or  oil,  10  c.c. 
every  two  weeks,  or  less  often,  following 
aspiration)  is  not  generally  recommended. 
One  should  aim  to  prevent  pyogenic  infec- 
tion of  the  abscess. 

If  infection  with  i:)us  organisms  has  oc- 
curred, provide  drainage  by  means  of  rub- 
ber tubes. 

A retrojjharyngeal  abscess  should  be 
opened  as  soon  as  thscovered,  because  of  the 
dangerous  possibilities.  If  serious  dyspnoea 
is  pre.sent,  open  the  abscess  through  the 
mouth,  with  the  head  low  (without  anaes- 
thesia). Holt  opens  the  abscess  with  the 
finger  nail  sharpened  to  a point.  In  non- 
urgent cases  make  the  incision  along  the 
posterior  border  of  the  upper  third  of  the 
sternocleido-mastoid  muscle,  and  carry  the 
dissection  behind  the  large  vessels  of  the 
neck  and  in  front  of  the  prevertebral  muscles 
until  the  abscess  is  reached.  The  external 
incision  is  to  be  preferred  because  of  the 
resulting  sinus,  which  may  persist  for 
many  months. 

Severe  and  frequent  attacks  of  inspiratory 
dyspnoea  indicate  the  pressure  of  an  abscess 
in  the  upper  thoracic  region  upon  the  trachea 
or  broncLi.  Costotransversectomy  is  here 
imheated.  One  or  two  articulations  between 
rib  and  transverse  ]wocess  are  resected,  and 
the  finger  is  inserted  until  the  abscess  is 
reached,  which  is  usually  in  front  of  the  fifth 
dorsal  vertebra.  A drainage  tube  is  inserted. 
(Whitman). 

Treatment  of  Sinuses.— Sinuses,  as  well  as 
abscess  cavities,  unless  serving  as  drains, 
are  best  excised  or  thoroughly  curetted;  or 
they  may  be  injected  with  Morrison’s  jiaste 
{q.v.  m Part  11),  or  Beck’s  bismuth  paste 
(Part  11),  after  drying  with  gauze.  The 
paste  liquefied  by  heat,  is  injected  until  it 
escapes  from  one  or  more  sinuses;  these  are 
then  closed,  anti  the  injection  continued 
until  the  patient  complains  of  some  pressure. 
The  injections  are  made  every  five  or  six  days 
through  a dry,  sterile  glass  s\Tinge  until  the 
discharge  ceases  or  becomes  sterile.  The 


paste  is  not  to  be  used  when  the  X-rays 
show  a seciuestrum;  and  it  should  be  used 
with  caution  in  large  pus  sacs  which  may 
become  filled  with  residuary  bismuth,  for 
fear  of  poisoning.  It  acts  be.st  in  old  sinuses 
with  little  discharge. 

In  sinuses  that  serve  as  drains,  introduce 
a rubber  tube  or  catheter  with  side  windows. 
Bier’s  suction  cups  may  be  applied  for  three 
to  five  minutes  at  three  to  five  minute  inter- 
vals for  a half  hour  each  day.  Balsam  of 
Peru,  10  per  cent,  in  castor  oil,  is  recom- 
mended for  ulcers.  The  X-rays  and  chrect 
sunlight  may  be  beneficial.  Rollier’s  method 
of  heliotherapy  “ consists  in  beginning  above 
at  the  neck,  with  the  head  shielded,  and 
below  at  the  feet,  exposing  from  two  to  four 
inches  of  the  body  surface  for  five  minutes 
twice  daily,  increasing  time  and  surface  at 
this  rate  until  the  entire  body  is  exposed. 
Time  and  insolation  are  then  increased 
according  to  the  tolerance  of  the  individual. 
Some  do  better  with  eight  to  ten  hours  under 
the  direct  rays,  other  can  stand  only  three 
or  four  hours.”  In  sinus  cases,  the  discharge 
is  markedly  increased  during  the  first  week 
or  more  of  insolation,  but  then  declines  with 
ultimate  closure  of  the  sinus. 

Treatment  of  Paralysis. — For  threatened  or 
actual  paralysis,  employ  horizontal  fixation, 
as  described  in  the  begimiing,  combined 
with  traction  upon  both  lower  extremities 
(see  Buck’s  extension),  and  countertraction 
upon  the  head  by  means  of  a chin  and  occi- 
put slmg  attached  to  a weight  over  a pulley. 
A plaster  jacket  may  also  be  worn  for  several 
weeks.  If  an  abscess  is  demonstrable  by 
radiograj^hy,  perform  costotransversectomy, 
as  previously  described.  Laminectomy  may 
be  resorted  to  only  when  conservative  treat- 
ment is  obviously  inefficient. 

Operations  upon  the  diseased  vertebrae 
are  very  rarely  justifiable,  as  for  the  purpose 
of  opening  growing,  deep-seated  abscesses, 
removing  a sequestrum,  or  securing  neces- 
sary drainage  so  as  to  avert  sepsis;  and  then 
care  shoukl  be  taken  not  to  expose  sound 
bone.  (Whitman.) 

Pott’s  Fracture. — See  Fractures  of  the 
Leg,  the  Lower  End. 

Prepatellar  Bursitis. — L.  'prev-  before  + 
paid' la,  pan.  See  Bursitis. 

Pretibial  Bursitis. — See  Bursitis. 

Pretubercular  Bursitis. — L.  proe-  before  -|- 
tuher'culum,  nodule.  See  Bursitis. 

Psoas  Abscess. — Gr.  i/'oa  loin.  See  Pott’s 
Disease. 

Pulmonary  Arthropathy. — L.  pul'mo,  lung. 
See  Osteoarthropathy,  Secondary  Hyper- 
trophic, in  Part  1. 


SACRO-ILIAC  AFFECTIONS 


Purulent  Arthritis. — L.  -pus,  pu'ris,  pus. 
See  Arthritis. 

Rachitis. — See  Rickets,  in  Part  1. 

Radial  Bursitis. — L.  ra'dius,  spoke;  hur'sa, 
sac.  See  Tenosynovitis. 

Radio=carpal  Joint,  Dislocations  of  the. — 
L.  rad'ius,  spoke;  car' pus,  wrist.  See  Dislo- 
cations of  the  Wrist. 

Radio=ulnar  Joint,  Dislocations  of  the. — 

See  Dislocations  of  the  Wrist. 

Radius,  Dislocations  of  the,  at  the  Elbow. 
See  Dislocations  of  the  Elbow. 

Fractures  of  the. — See  Fractures  of  the 
Elbow;  Fractures  of  the  Forearm,  the 
Shaft;  and  Fractures  of  the  Radius, 
the  Lower  End. 

Separation  of  the  Lower  Epiphysis  of 

the. — See  Fractiu'es  of  the  Radius, 
the  Lower  End. 

Recurrent  Dislocation  of  the  Shoulder. — 

L.  recur' rens,  returning.  See  Dislocation, 

Recurrent,  of  the  Shoulder. 

Relaxation  of  the  Sacro=iliac  Joint. — See 
under  Sacro-iliac  Strain. 

Retrocalcaneal  Bursitis.— L.  re'tro-  behind 
-h  calcaneum,  heel-bone.  See  Achillobursitis. 

Retropharyngeal  Abscess. — L.  retro-  be- 
hind; Gr.  (j>apvy^  pharynx.  See  under  Pott’s 
Disease. 

Rheumatic  Gout. — Gr.  pevpa  flux.  See 
Arthritis  Deformans. 

Torticollis. — See  Torticollis. 

Rheumatism,  Chronic  Articular. — See 
Arthritis  Deformans. 

_ Rheumatoid  Arthritis. — Gr.  f>evpa  flux  -f- 
eidos  Jorm.  See  Ai’thritis  Deformans. 

Ribs,  Dislocations  of  the. — See  Disloca- 
tions of  the  Ribs. 

Fractures  of  the. — See  Fractures  of  the 
Ribs. 

Rickets. — See  Rickets,  in  Part  1. 

Rigid  Flat=Foot. — See  Weak  Foot. 

Great  Toe. — See  Hallux  Rigidus. 

Spine. — See  Spondylitis  Deformans. 

Weak  Foot. — See  Weak  Foot. 

Round  Back. — See  Kyphosis. 

Round,  or  Stoop,  or  Droop=Shoulders. — 

Causes. — Faulty  posture  and  certain  occu- 
pations, as  those  of  the  cobbler,  tailor,  black- 
smith, carpenter,  boxer,  g5nnnast;  improper 
school  furniture;  suspension  of  the  clothing 
from  the  tips  of  the  shoulders;  clothing 
which  prevents  free  expansion  of  the  chest 
and  free  movement  of  the  arms;  overwork; 
nearsightedness;  nasal  obstruction;  bron- 
chitis, emphysema,  and  heart  chsease;  weak 
foot;  bad  hygiene  cau-sing  muscular  weakness 
and  relaxation;  paralysis  of  the  mu.scles  of 
the  back,  as  in  acute  poliomyelitis  (see 
Scoliosis).  Consult  also  kyphosis. 


Brachial  neuralgia  and  even  writer’s 
cramp  may  result.  See  under  Bursitis. 

The  prognosis  under  treatment  is  good. 

Treatment.— Instruct  the  patient  in  the 
“ setting  up  drill  ” employed  in  the  Army, 
with  particular  attention  upon  bringing 
and  keeping  the  shoulder  blades  together. 
The  brace  may  be  of  temporary  service; 
but,  says  Lovett,  “ supporting  braces 
should  be  avoided,  if  possible.”  The 
clothing  should  not  be  suspended  from  the 
tips  of  the  shoulders,  but  from  the  upper 
part  of  the  shoulders  by  cutting  it  high  in 
the  neck.  The  observance  of  correct  hygiene 
is,  of  course,  essential,  e.g.,  adequate  rest 
and  exercise,  fresh  air  day  and  night,  a 
tlaily  morning  warm  bath  before  breakfast, 
in  a comfortable  room,  followed  by  a cold 
spinal  douche  and  brisk  rubdown  with  a 
coarse  towel,  regular  hours  of  eating  and 
sleeping,  simple,  nutritious  food,  rest  before 
and  after  meals,  regulation  of  the  bowels, 
and  the  avoidance  of  such  poisons  as  alco- 
hol, tea,  coffee,  and  tobacco. 

Sometimes  “ bowed  or  flexed  scapula,” 
manifested  by  pain  and  a rubbing  sensa- 
tion on  moving  the  scapula,  may  result,  and 
may  interfere  with  the  correction  of  the 
shoulder  droop.  In  such  cases,  exercises  and 
the  brace  should  be  employed  for  four  or  five 
months.  If  no  relief  is  thereby  obtained, 
perform  Goldthwaite’s  operation:  Through  a 
three-inch  incision  just  above  and  parallel 
with  the  spine  of  the  scapula  (curved  down- 
ward, however,  in  women),  the  attachment 
of  the  trapezius  to  the  inner  portion  of  the 
spine  of  the  scapula  is  exposed  by  dissection. 
This  is  incised  for  about  two  inches,  exposing 
the  supraspinatus  muscle,  which  is  scraped 
back  from  the  scajiula  until  the  bowed  por- 
tion to  be  removed  is  exposed.  Other  mus- 
cular attachments  (levator  anguli  scapulae 
and  rhomboid  minor)  are  separated  with 
the  periosteal  elevator  without  chviding 
them.  The  bowed  portion  of  the  bone  is 
then  removed  with  bone  forceps.  The 
tendon  of  the  trapezius  is  sutured,  and  the 
wound  closed.  The  patient  is  kept  in  bed 
for  three  or  four  days,  is  allowed  to  walk  in 
about  a week,  and  is  well  in  about  another 
week.  Exercises  are  then  resumed. 

Rupture  of  a Crucial  Ligament  of  the 
Knee. — See  under  Displacement  of  a Semi- 
lunar Cartilage. 

Sacro=iliacAffections. — L.  sac' rum,  sacred; 
il'ium,  haunch-bone.  Arthritis  Deformans  or 
Osteoarthritis. 

Arthritis,  Infectious. 

Displacement. 

Osteomyelitis. 


SCOLIOSIS;  LATERAL  CURVATURE  OF  THE  SPINE 


Relaxation. 

Strain. 

Tuberculosis. 

Tumors. 

Sacro=iliac  Arthritis  Deformans.  — See 

Arthritis  Deformans. 

Infectious. — See  Arthritis. 

Disease. — See  Sacro-iliac  Tuberculosis. 

Displacement.  — See  under  Sacro-iliac 
Strain. 

Osteoarthritis.  — See  Arthritis  Defor- 
mans. 

Osteomyelitis. — See  Osteomyelitis,  in 
Part  1. 

Relaxation. — See  Sacro-iliac  Strain. 

Sacro=iliac  Strain  and  Relaxation. — Sacro- 
iliac strain  and  relaxation  is  manifested  by 
local  (unilateral  or  bilateral)  and  referred 
pain  and  local  tenderness.  The  pain  may 
be  referred  to  the  legs  and  feet  (sciatica; 
growing  jjains)  as  a result  of  pressure  upon 
the  sacral  plexus.  It  is  almost  always 
worse  at  night. 

Etiology.— Fall,  blow;  twist;  heavy  lifting; 
long  stooping,  standing,  lying,  or  sitting;  a 
heavy,  pendulous  abdomen;  scoliosis;  hip 
disease  or  ankylosis;  high  heels;  weak  foot; 
hollow  back;  overstraight  back;  pregnancy; 
menstruation;  chronic  utero-ovarian  dis- 
ease; neurasthenia. 

Treatment. — In  moderate  cases,  without 
displacement  of  the  bones,  apply  (1)  a snug, 
broad  leather  belt  above  the  trochanters;  or 
(2)  a wide  band  of  adhesive  plaster  around 
the  pelvis,  including  the  lumbar  spine  and 
the  buttock,  and  extending  in  front  beyond 
the  anterior  spines,  with  a felt  pad  over  the 
sacrum;  or  (3)  a long  plaster  or  stiffened 
leather  jacket  (see  Pott’s  Disease),  well 
down  over  the  trochanters.  At  night  a firm 
hair  pillow  may  be  placed  under  the  hollow 
of  the  back  or  side  and  under  the  knees. 
If  adhesive  strapping  is  employed,  it  should 
be  renewed  every  six  or  seven  days  for  three 
or  four  weeks,  and  then  a corset  belt  used. 

If  subluxation  exists,  it  should  be  cor- 
rected before  immobilization  is  employed. 
This  may  be  accomplished  (1)  by  swinging 
the  patient  prone  by  the  shoulders  and 
thighs  between  two  tables;  or  (2)  by  manual 
manipulation,  under  anaesthesia  if  necessary, 
first  flexing  the  thigh  with  the  leg  extended, 
if  the  sacrum  is  displaced  backward,  or  if  dis- 
placed forward  extending  the  thigh.  After 
replacement  is  accomplished,  apply  a plaster 
jacket,  “ well  down  over  the  buttocks  and 
the  anterior  part  of  the  thigh,  and  well  up 
the  thorax,”  and  keep  the  patient  in  bed  for 
three  or  four  weeks.  Then  employ  a remov- 
able stiffened  leather  or  plaster  jacket,  or 


other  form  of  support,  for  two  or  three 
months,  with  mas.sage  and  exercises. 

Arthrodesis  (artificial  ankylosis)  may  be 
resorted  to  in  intractable  cases.  (Chiefly 
from  Goldthwait,  Painter,  and  Osgood.) 

Sacro=iliac  Subluxation. — L.  sub-  under 
-f-  luxa'tio,  dislocation.  (See  under  Sacro- 
iliac Strain,  above.) 

Sacro=iliac  Tuberculosis. — The  diagnostic 
features  are  pain,  swelling,  tenderness  on 
pressing  the  ilia  together,  a limping  gait, 
and  lateral  curvature  of  the  spine,  with  the 
inclination  away  from  the  diseased  joint. 
An  X-ray  examination  should  be  made. 

The  Prognosis  is  serious. 

Treatment.— In  very  acute  cases,  put  the 
patient  to  bed,  and  employ  traction  upon 
the  limb  of  the  affected  side,  as  described 
under  Hip  Tuberculosis,  or  employ  a double 
Thomas  hip  splint  (g.f.);  or  apply  a double 
plaster  spica  (q.v.)  from  the  middle  of  the 
calf  muscles  to  the  mammary  line. 

After  the  acute  symptoms  have  sub- 
sided, apply  a plaster  spica,  down  to  the 
knee,  with  compression  upon  the  sides  of 
the  ilia  below  the  spines,  and  get  the  patient 
out  of  bed.  A tight  belt  about  the  pelvis 
underneath  the  jacket  may  be  of  additional 
benefit.  In  place  of  the  plaster  jacket  one 
may  employ  a removable  leather  jacket 
(see  under  Pott’s  Disease). 

Good  hygiene  is,  of  course,  of  prime 
importance  (consult  Tuberculosis,  Pulmon- 
ary, in  Part  1). 

For  the  treatment  of  abscess,  consult 
Pott’s  Disease  or  Hip-Disease.  If  the  ab- 
scess becomes  infected  with  pus  organisms, 
expose  the  articulation,  and  remove,  if  possi- 
ble, all  diseased  bone. 

Scaphoid  Bone,  Fractures  of  the. — Gr. 
(7Kd(t>r]  skiff  -f-  tidos  form.  See  Fractures  of 
the  Carpal  Bones. 

Scapula,  Bowed  or  Flexed. — L.,  shoulder- 
blade.  See  under  Round  Shoulders. 

Congenital  Elevation  of  the. — See  Con- 
genital Elevation  of  the  Scapula. 

Elevation  of  the.  Congenital. — See  Con- 
genital Elevation  of  the  Scapula. 

Flexed  or  Bowed. — See  under  Round 
Shoulders. 

Fractures  of  the.— See  Fractures  of  the 
Scapula. 

Schonlein’s  Disease. — See  Purpura,  in 
Part  5. 

Scoliosis;  Lateral  Curvature  of  the  Spine. 

— Gr.  (TKoXUaais  curvation.  Lateral  curvature 
is  either  functional  (postural;  early  stage; 
susceptible  of  correction)  or  organic  (struc- 
tural; late  stage;  difficult  or  impossible 
to  cure). 


SHOULDER,  DISLOCATION,  CONGENITAL,  OF  THE 


Sometimes  pain,  usually  lumbar,  is  com- 
plained of.  In  extreme  cases,  dyspnoea, 
cyanosis,  and  rapid  heart  action,  etc., 
may  result. 

Etiology.— Congenital  anomaly;  rickets;  an 
habitual  one-sided  posture,  caused  by  impro- 
per seats,  occupations  and  recreations,  gen- 
eral muscular  debility,  tilting  of  the  pelvis, 
as  in  inequality  in  the  length  of  the  limbs, 
pelvic  as3uumetry  (pelvic  obliquity),  torti- 
collis, unequal  vision  or  hearing  on  the  two 
sides;  paralysis  of  the  muscles  of  the  back, 
as  in  anterior  poliomyelitis,  cerebral  par- 
alysis, neuritis,  syringomyelia,  Friedreich’s 
heredo-ataxia,  traumatic  paralysis,  and  hys- 
teria; osteomalacia;  osteomyelitis;  arthritis 
deformans;  spinal  tuberculosis;  acromegaly; 
osteitis  deformans;  chronic  sciatic  and  lum- 
bar neuritis;  injury  and  fracture  of  the 
spine;  sacro-iliac  disease;  nasal  and  respira- 
tory obstruction;  heart  disease  ; empytema 
followed  by  cicatricial  contraction. 

Treatment. — A.  The  FUNCTIONAL  Type. — 
An  invigorating  regimen  is  important,  em- 
bracing open  air  exercise,  an  abundance  of 
nutritious  food,  a daily  morning  tepid  bath, 
before  breakfast,  in  a comfortable  room, 
followed  by  a cold  spinal  douche  and  brisk 
rubdown  with  a coarse  towel,  regular  hours 
of  eating  and  sleeping,  rest  before  and  after 
meals,  the  avoidance  of  overwork,  support 
of  the  clothing  from  the  waist  instead  of 
from  the  shoulders,  proper  lighting,  ventila- 
tion, seats,  and  sufficient  recesses  in  school. 

Employ  twice  daily,  to  the  |)oint  of  fatigue 
(one  to  three  hours  daily  at  intervals)  the 
setting  up  exercises  employed  in  the  Army, 
particularly  forward  and  backward  and  side 
to  side  bending,  and  circumduction  or  lateral 
twisting  of  the  trunk,  for  the  purpo.se  of 
reversing  the  habitual  posture;  and  employ, 
also,  the  “ Hoffa  self-correction  ” by  side 
pressure.  In  exercising,  the  military  atti- 
tude should  be  assumed : head  erect,  chin 
, depressed,  shoulders  thrown  back,  chest  ex- 
' panded,  and  abdomen  retracted.  Exercise 
no  earlier  than  two  hours  after  meals;  and 
do  not  exercise  during  menstruation.  Light 
dumbbells  may  be  used,  if  desired. 

I These  exercises  should  be  continued  for 
I months.  Their  purpose  is  to  correct  the 

I deformity  by  the  cultivation  of  correct 
( postural  habits,  and  to  strengthen  the  back 
muscles  so  that  the  corrected  posture  may 
be  maintained. 

Braces  or  corsets  are  not  as  a rule  required. 

Round  shoulders  {q.v.)  should  be  treated. 
If  one  leg  is  shorter  than  the  other,  it  should 
be  raised  by  means  of  a high  sole. 

In  functional  cases  of  scoliosis,  marked 


improvement  or  cure  should  be  noted  in 
from  three  to  six  months. 

B.  The  Structural  Type. — First  correct 
the  deformity  as  far  as  possible  by  vigorous 
gymnastic  exercises  to  the  point  of  fatigue 
(one  to  three  hours  daily  at  intervals), 
including  the  raising  of  heavy  bars  or  dumb- 
bells over  the  head,  combined  with  such 
measures  as  lateral  suspension  and  side 
pressure.  The  exercises  should  be  adapted 
to  each  individual  case,  and  should  be  super- 
vised at  first  by  the  physician. 

To  keep  the  gain  made  by  the  exercises, 
etc.,  a supporting  corset  or  jacket  should  be 
worn.  It  is  made  from  a mould  obtained  by 
filling  a plaster-of-Paris  jacket,  the  latter 
having  been  applied  to  the  patient  sus- 
pended by  a Sayre  head-piece  (see  under 
Pott’s  Disease  for  the  technique).  The  mould 
is  shaved  on  the  prominent,  convex  side, 
and  built  up  with  plaster  on  the  concave  side 
until  it  is  symmetrical,  or  perhaps  over- 
corrected. From  this  mold  is  made  a remov- 
able plaster  or  leather  corset  (see  Pott’s 
Disease)  laced  in  front.  The  corset  may 
have  to  be  renewed  or  altered  every  few 
weeks  or  months,  the  gymnastics,  of  course, 
being  continued. 

Supporting  jackets  or  braces  are  of  value 
to  relieve  discomfort  in  incurable  cases. 

In  anterior  poliomyelitis,  employ  a corset, 
to  hold  the  spine  erect,  and  a cork  sole  under 
the  short  leg. 

Albee’s  or  Hibb’s  operation  is  recom- 
mended for  paralytic  scoliosis  following 
correction  of  the  deformity  as  far  as  possible. 

For  the  treatment  of  empyema  cases,  see 
Empyema,  under  Pleurisy,  in  Part  1. 

Scurvy,  Infantile. — See  Part  1. 

Semilunar  Cartilage,  Displacement  of  a. — 
See  Displacement  of  a Semilunar  Cartilage. 

Senile  Coxitis. — L.  senil'is,  senile;  cox'a, 
hip.  See  Arthritis  Deformans. 

Osteoporosis. — Gr.  dcrreou  bone  -f-vropos 
passage.  See  Fragilitas  Ossium,  in 
Part  1. 

Separation  of  the  Epiphysis  of  the  Femur, 
the  Lower  End.-^ee  Fractures  of 
the  Femoral  Shaft. 

Upper  End. — See  Fractures  of  the 
Femoral  Neck. 

Humerus,  the  Lower  End. — See 

Fractures  of  the  Elbow. 

Upper  End. — See  Fractures  of  the 
Humerus. 

Radius,  the  Lower  End. — See  Frac- 
tures of  the  Radius,  the  Lower  End. 

Shoulder  Bursitis. — See  Bursitis. 

Dislocation,  Congenital,  of  the.— Consult 
Whitman’s  Orthopcedic  Surgery. 


SPONDYLITIS  DEFORMANS 


Shoulder,  Dislocation,  Recurrent,  of  the. 

— See  Dislocation,  Recurrent,  of  the 
Shoulder. 

Traumatic,  of  the. — See  Disloca- 
tions of  the  Shoulder. 

Droop. — See  Round,  or  Stoop,  or 
Droo{>Shoulders. 

Fractures  of  the. — See  Fractures  of  the 
Shoulder. 

Loose. — See  Dislocation,  Recurrent,  of 
the  Shoulder. 

Round. — See  Round  Shoulders. 

Stoop. — See  Round,  or  Stoop,  or 
Droop-Shoulders. 

Shoulder  Tuberculosis. — The  diagnostic 
features  are  pain,  tenderness,  often  local  heat 
and  swelling,  stiffness  and  limitation  of 
motion  due  to  muscle  spasm,  muscular 
atrophy,  and  chronicity.  The  disease  is  rare. 

Treatment. — Apply  a plaster-of-Paris  spica, 
with  the  limb  slightly  abducted  by  means  of 
axillary  pads,  and  midway  between  extreme 
inward  and  extreme  outward  rotation  (see 
Fractures  of  the  Humerus),  and  attach  the 
wrist  by  a sling  to  the  neck  beneath  all  the 
clothing,  to  ensure  continuous  rest. 

After  three  or  four  months,  remove  the 
plaster  and  carry  the  arm  in  a sling  for 
three  or  four  months  longer. 

If  a skiagram  reveals  localized  disease  not 
involving  the  joint,  operative  eradication  of 
the  diseased  tissue  may  be  advisable,  fol- 
lowed by  swabbing  with  tincture  of  iodine, 
and  closure.  A subsequent  sinus  should  be 
treated  with  dry  gauze,  without  irrigation, 
until  it  closes. 

If  the  disease  continues  to  progress  in 
spite  of  fixation  (say,  for  sLx  months), 
excise  the  joint;  but  in  children  attempt  to 
save,  if  feasible,  the  epiphyseal  cartilage. 
Amputation  is  to  be  considered  only  in  very 
destructive  cases,  to  save  life. 

For  the  treatment  of  abscess,  see  under 
Hip-Disease,  or  Pott’s  Disease. 

If,  in  healing,  ankylosis  occurs,  the 
joint  may  be  later  excised  in  order  to 
restore  motion. 

Sinuses. — L.  sinus,  cavity.  See  under 
Hi{>Disease,  Pott’s  Disease,  and  Shoulder 
Tuberculosis. 

Skull,  Fractures  of  the.^ — See  Fractures 
of  the  Skull. 

Slipping  Patella. — L.  pntel'Ia,  pan.  Causes. 
— Knock-knee  ; hereditaiy  hypermobility  ; 
weakness  or  atonicity  of  the  quadriceps 
extensor  muscle  and  ligament  ; imper- 
fect development  of  the  patella;  imperfect 
development  of  the  external  cond3de; 
trauma.  (Whitman.) 

Treatment.— In  traumatic  cases,  immobilize 


the  knee-joint  for  about  six  weeks  by  means 
of  a plaster  bandage  {q.  v.)  extending  from 
the  groin  to  the  ankle;  and  later  strap  the 
joint  and  allow  the  patient  up,  or  employ 
a knee-cap. 

In  other  cases,  employ  massage  of  the 
quadriceps  extensor  muscle  and  a light 
brace  which  prevents  lateral  motion  aTid 
restricts  flexion.  Correct  knock-knee  {q.v.) 

Operate  in  intractable  cases.  (After 
Whitman.) 

Snapping  Finger. — See  Trigger- Finger. 

Snapping  or  Clicking  Knee  in  Babies. — 

This  may  be  due  to  congenital  laxity  of 
the  ligaments.  Bandaging,  strapping,  or 
splinting  usually  corrects  the  condition. 
(H.  L.  Taylor.) 

Spasmodic  Torticollis. — Gr.  aTraag-h 

spasm.  See  Torticollis. 

Spastic  Cerebral  Paralysis. — See  Cerebral 
Paralysis  of  Children. 

Spinal  Paralysis. — The  orthopaedic 

treatment  is  that  of  Cerebral  Paraly- 
sis of  Children  {q.v.). 

Spine,  Arthritis  Deformans  of  the. — L. 

spina,  spine.  See  Spondylitis  De- 
formans. 

Curvature,  Anterior,  of  the. — See  Lor- 
dosis. 

Dorsal,  of  the. — See  Kj^phosis. 
Lateral,  of  the. — See  Scoliosis. 

Dislocations  of  the. — See  Dislocations 
of  the  Spine. 

Fractures  of  the. — See  Fractures  of 
the  Sjiine. 

Neurasthenic  or  Neurotic. — See  Neur- 
otic or  Neurasthenic  Spine. 

Paralysis,  Spastic. — The  orthopaedic 
treatment  is  that  of  Cerebral  Paralj'- 
sis  of  Children  {q.v.). 

Rachitic. — See  Rickets  in  Part  1. 

Rigid  . — See  Spondylitis  Deformans. 

Tibia,  Fracture  of  the. — See  under  Dis- 
placement of  a Semilunar  Cartilage, 

Tuberculosis  of  the. — See  Pott’s  Disease. 

Typhoid. — See  Tvphoid  Spine. 

Splay  Foot. — See  \Wak  Foot. 

Spondylitis  Deformans. — Gr.  aTrbvhv\os 
vertebra  -|-  -trts  inflammation;  L.  defor'- 
mans,  deforming.  Synonyms. — Spinal  hj'per- 
trophic  arthritis  deformans ; rigid  spine. 

The  disease  is  ushered  in  by  soreness  and 
stiffness  of  the  back,  and  eventually'  a 
rounded,  rigid  Rvphosis  appears.  Referred 
pains  and  even  paralj'ses,  from  nerve  root 
pressure,  maj'  occur. 

The  causes  are  those  of  arthritis  defor- 
mans (q.v).  Traumatism  is  a possible  cause. 
Gonorrhoea  is  apparently  the  commonest 
cause. 


SUBCLAVICULAR  DISLOCATIONS  OF  THE  SHOULDER 


Arrestof  the  disease  is  possible  in  early  cases. 

Treatment.— In  the  progressive  stage  of  the 
disease,  fix  the  spine  with  a light  plaster-of- 
Paris  jacket  (see  Pott’s  Disease),  extending 
from  the  level  of  the  trochanters  to  the 
axillae,  applied  with  the  patient  standing.  It 
produces  marked  improvement  in  the  symp- 
toms in  a few  days.  It  should  be  worn  until 
all  pain  has  disappeared,  and  then  replaced 
by  a light  brace  or  corset  {q.v.  under  Pott’s 
Disease).  Rubber  heels  may  be  worn  to  lessen 
jar.  Massage  and  hot  baths  are  beneficial. 
The  Paquelin  cautery  is  useful  for  the  relief 
of  pain.  “ Self-suspension  at  intervals  may 
relieve  the  dragging  sensation  in  the 
muscles.”  (Whitman.) 

Employ  no  gymnastics  or  passive  move- 
ments of  the  spine,  and  warn  against  lifting 
or  any  exertion  that  may  strain  the  back. 
Flat  foot,  if  present,  should  be  corrected. 
Attend  to  the  general  health  as  directed  under 
Arthritis  Deformans. 

Spondylitis  Traumatica. — Gr.  Tpav/ia 
wound.  See  under  Kyphosis. 

Tuberculosa. — See  Pott’s  Disease. 

Spondylolisthesis. — -Gr.  <nr6i'Su\os  verte- 
bra -|-  oXiadaveLV  to  slip.  Forward  subluxa- 
tion of  the  body  of  a lumbar  vertebra,  usu- 
ally the  fifth,  causing  a peculiar  gait,  marked 
lumbar  lordosis,  shortening  of  the  trunk, 
and  lumbar  pain  and  weakness.  A promi- 
nence may  be  detected  by  vaginal  examina- 
tion. An  X-ray  examination  should  be 
made.  The  condition  is  rare. 

Causes. — Congenital  anomaly;  overstrain 
or  other  form  of  injury  ; disease  of  the  lumbo- 
sacral articulation. 

Treatment. — If  local  pain  is  complained  of, 
a plaster-of-Paris  corset  may  be  aj^plied 
with  the  patient  suspended  by  a Sayre  head- 
piece  (see  under  Pott’s  Disease).  Whitman 
recommends  a “ strong  corset  or  back  brace 
of  the  Knight  or  Taylor  type.”  An  Albee 
splint  from  the  third  lumbar  to  the  third 
sacral  vertebra  is  lately  recommended. 

Spontaneous  Dislocations. — L.  sponta- 
neus,  voluntary.  See  Dislocations, 
Pathological  or  Spontaneous. 

Fracture. — See  Fragilitas  Ossium,  in 
Part  1. 

Sprained  Ankle. — See  Ankle  Sprain. 

Knee. — See  Traumatic  S3movitis,  under 
Arthritis. 

Wrist. — See  Wrist  Sprain. 

Sternal  End  of  the  Clavicle,  Dislocations 
of  the. — L. ; Gr.  aTkpvov  breast-bone.  See 
Dislocations  of  the  Clavicle. 

Sternomastoid  Muscle;  Haematoma  of  the. 
-^^Gr.  arkpvov  breast-bone;  paaros  breast  -F 
eiSos  form.  See  under  Torticollis. 


Sternum,  Fractures  of  the. — See  Frac- 
tures of  the  Sternum. 

Stiff  Back. — Causes. — Lumbago;  Spondy- 
litis Deformans;  Pott’s  disease;  metastatic 
cancer  of  the  vertebrae. 

Stiff  Finger  Joints. — Employ  baking  (see 
under  Arthritis),  massage,  manual  and 
vibratory,  electricity,  active  and  passive 
movements,  and  splints  to  straighten 
flexions. 

Stiff  Great  Toe. — See  Hallux  Rigidus. 

Neck. — See  Torticollis. 

Toe. — See  Hallux  Rigidus. 

Still’s  Disease. — A chronic,  atrophic, 
probably  infectious,  polyarthritis  of  child- 
hood, resembling  somewhat  the  atrophic 
type  of  arthritis  deformans  (q.v.),  asso- 
ciated with  enlargement  of  the  liver, 
spleen,  and  glands,  and  pyrexia.  Ankylosis 
and  deformity  is  the  usual  outcome,  although 
spontaneous  recovery  with  intact  joints  is 
occasionally  noted. 

Treatment. — In  the  acute  stage  of  the  dis- 
ease, employ  rest  and  protection  of  the 
joints.  Flush  the  bowels  thoroughly,  and 
prescribe  sour  milk  (kifolac),  as  recom- 
mended by  Hoke,  on  the  assumption  that 
intestinal  putrefaction  may  be  causative. 
Thyinus  gland,  potassium  iodide  in  large 
doses,  and  Fowler’s  solution  in  gradually 
increasing  doses  may  be  tried  experimen- 
tally (see  Part  11,  Drugs).  Locally,  one 
may  employ  hot  air  (see  under  Arthritis), 
electric  light  baths,  the  cautery,  ichthyol, 
etc.,  and,  in  the  absence  of  acute  symp- 
toms, massage  and  active  and  passive 
motion.  To  overcome  contraction  de- 
formity, employ  forcible  manipulation, 
and  if  necessary,  tenotomy  (see  Arthritis 
Deformans).  Ankylosed  joints  may  be 
excised  in  order  to  “ reestablish  painless 
motion.” 

Stoop  Shoulders. — Bee  Round  or  Stoop 
or  Droop  Shoulders. 

Strain,  Sacro=Iliac. — See  Sacro-Iliac 
Strain  and  Relaxation. 

Styloid  Process  of  the  Ulna,  Fractures  of 
the. — L.  styl'us,  pen  Gr.  eiSos  form.  See 
Fractures  of  the  Elbow. 

Subacromial  Bursitis.— L.  mb-  under  + 
Gr.  aKpov  point  -f-  3/xos  shoulder.  See 
Bursitis. 

Dislocations  of  the  Clavicle  — See  Dis- 
locations of  the  Clavicle. 

Subastragaloid  Dislocations.— L.  ,mb- 
under;  L.  Gr.  aarpayaXos  die  -|-  eidos  form. 
See  Dislocations,  Subastragaloid. 

Subclavicular  Dislocations  of  the  Shoul= 
der. — L.  davicula,  dim.  of  clav'is,  key.  See 
Dislocations  of  the  Shoulder. 


TALIPES  EQUINOVARUS 


Subcoracoid  Bursitis. — Gr.  KopaKoeib^s 

crow-like.  See  Bursitis. 

Dislocations  of  the  Shoulder.— See 
Dislocations  of  the  Shoulder. 

^ Subdeltoid  Bursitis. — Gr.  SeXra  letter  A-|- 
ei5os  form.  See  Bursitis. 

Subglenoid  Dislocations  of  the  Shoulder. 
— Gr.  7X571/77  cavity  -|-  tibos  form.  See  Dis- 
locations of  the  Shoulder. 

Subscapular  Bursitis. — L.  scap'ula,  shoul- 
der-blade. See  Bursitis. 

Subspinous  Dislocations  of  the  Shoulder. 
— L.  spina,  spine.  See  Dislocations  of  the 
Shoulder. 

Subtrochanteric  Fractures  of  the  Femur. 

— L.,  Gr.  TpoxoLVTfjp  runner.  See  Fractures 
of  the  Femoral  Shaft. 

Superior  Maxilla,  Fractures  of  the. — L. 
super' ior,  higher;  maxU'la,  jaw-bone.  See 
Fractures  of  the  Upper  Jaw. 

Suppurative  Arthritis. — L.  sub-  under  4- 
pus,  pur'is,  pus.  See  Arthritis. 

Supra=acromial  Dislocations  of  the  Clav= 
icle. — L.  sup'ra,  above;  Gr.  &Kpov  point 
(upos  shoulder.  See  Dislocations  of  the 
Clavicle. 

Supracondyloid  Fractures  of  the  Femur. — 

Gr.  KovSvXos  knuckle  + eidos  form. 
See  Fractures  of  the  Femoral 
Shaft. 

Humerus. — See  Fractures  of  the 
Elbow. 

Supracotyloid  Dislocation  of  the  Hip. — 

Gr.  KOTvXwdris  cup-shaped.  See  Dislocations 
of  the  Hip. 

Suprapubic  Dislocation  of  the  Hip. — L. 

pub'es,  hip-bone.  See  Dislocations  of  the  Hip. 

Surgical  Neck  of  the  Humerus,  Fractures 
of  the. — li.  chirur'gia,  from  Gr.  x«ip  hand  J- 
ipyov  work.  See  Fractures  of  the  Humerus. 

Swollen  Ankles. — See  Ankles,  Swollen. 

Synovitis. — Gr.  avv  with  wov  egg  -| — tns 

inflammation.  See  Arthritis. 

Syphilitic  Dactylitis.  — See  Dactylitis 
Syphilitica. 

Talipes  Arcuatus. — L.  tal'us,  ankle  -f-  pes, 
foot: club  foot ;or'ais,  arch.  See  Hollow  or 
C’ontracted  Foot. 

Talipes  Calcaneus. — L.  taVipes,  club-foot; 
calcaneum,  heel-bone.  Dorsal  flexion  de- 
formity of  the  foot,  with  the  patient  Avalking 
solely  on  his  heel. 

Causes.— Congenital  anomaly;  acute  polio- 
myelitis involving  the  calf  muscles  (q.v.) ; 
chronic  disease  of  the  ankle  joint  or  lower 
end  of  the  tibia  ; anterior  cicatricial  con- 
traction ; traumatism ; division  of  the  tendo 
Achillis;  hysteria. 

I.  Treatment  of  Congenit.vl  Calca- 
neus.— Retain  in  the  overcorrected  position 


by  means  of  the  plaster  bandage,  as  described 
in  principle  under  Club-Foot,  the  congenital 
form  (q.v.). 

II.  Treatment  of  Acquired  Calcaneus. 
— To  correct  slight  cases,  massage  and 
stretch  the  contracted  muscles  and  employ 
Judson’s  brace  (Fig.  144). 

Where  moderate  deformity  has  already 
occurred,  overcorrect  it  as  far  as  possible 
and  apply  a plaster  bandage  (q.v.)  over  a 
thin  board  sole.  Then  place  a cork  wedge 
beneath  the  sole,  so  as  to  make  it  level,  and 


Fig.  144. — Brace  for  calcaneus  deformity. 


allow  the  patient  to  walk.  After  the  con- 
tracted muscles  have  been  sufficiently 
stretched,  apply  the  Judson  brace,  and  em- 
ploy massage  and  manipulation. 

Marked  deformity  is  best  corrected  im- 
mediately under  anssthesia.  Correct  cavus 
by  tenotomy  of  the  plantar  fascia  and  the 
Thomas  wrench,  push  up  the  heel,  shorten 
the  tendo  Achillis  if  deemed  advisable,  and 
fix  in  plantar  flexion  with  plaster.  Get  the 
patient  upon  his  feet  as  soon  as  possible: 
and  after  twm  months  or  longer  remove  the 
plaster,  and  employ  for  several  months  a 
brace  which  holds  the  foot  at  right  angles 
with  the  leg.  Employ  also  massage  and 
manipulation  until  cured. 

Extreme  cases  of  over  two  years  duration 
and  in  those  over  eight  years  of  age  are  cor- 
rected by  Whitman’s  operation,  e.g.,  “ astra- 
galectomy,  arthrodesis,  tendon  transplanta- 
tion and  backward  displacement  of  the 
foot.”  (Consult  Whitman’s  Orthopaedic 
Surgery.) 

Talipes  Cavus. — L.  cav'um,  a hollow.  See 
Hollow  or  Contracted  Foot. 

Equinovalgus. — L.  eq'uus,  horse;  val'gru^, 
turned  outward.  See  Talipes  Valgus. 

Equinovarus. — L.  var'us,  turned  in- 
ward. See  Club-Foot. 


TALIPES  VALGUS;  TALIPES  EQUINOVALGUS 


Talipes  Equinus. — L.  tal'ipes,  club-foot; 
equinus,  equine.  Plantar  flexion  deformity 
of  the  foot. 

Causes.— Congenital  anomaly;  paralysis  of 
the  anterior  leg  muscles,  due  to  acute 
poliomyelitis  (q.v.),  spastic  paralysis  (q.v.), 
neuritis,  hereditary  ataxia,  progressive  mus- 
cular atrophy  of  the  peroneal  type,  pseudo- 
hypertrophic  paralysis,  or  locomotor  ataxia; 
fracture;  posterior  cicatricial  contraction; 
ankle-joint  disease  (tuberculosis,  arthritis 
deformans,  etc.) ; shortening  of  the  leg  fol- 
lowing injury  or  disease;  spasm  of  the  tibial 
muscles;  long  confinement  to  bed ; injury  of 
the  anterior  nerves  or  muscles ; hysteria. 

I.  Treatment  of  Congenital  Equinus — See 
Treatment  of  Congenital  Club-Foot. 

II.  Treatment  of  Acquired  Equinus. — In  slight 
cases  of  contracture,  splint  the  foot  at 


For  the  flail  paralytic  drop-foot,  with  little 
or  no  resistance  to  dorsal  flexion,  one  may 
employ  the  two-bar  brace  (shown  in  Fig. 
145),  which  has  a stop  at  the  ankle  to 
prevent  plantar  flexion,  or  to  allow  limited 
dorsal  and  plantar  motion.  An  outer  ankle 
strap  for  varus  and  an  inner  strap  for 
valgus,  as  shown  in  the  figure,  may  be  worn 
if  required.  Operative  measures  include 
the  shortening  of  the  anterior  tendons, 
and  also  the  suspension  of  the  foot  “ by 
braided  silk  cords  from  the  anterior  sur- 
face of  the  lower  part  of  the  tibia,  woven 
into  the  periosteum  up,  across,  and  down 
for  a couple  of  inches;  tbe  free  ends  hanging 
down  are  drawn  under  the  skin  and  suturecl 
to  the  periosteum,  taking  in  a little  bone  at 
the  sides  of  the  scaphoid  and  cuboid  through 
separate  small  incisions.”  (H.  L.  Taylor.) 


Fig.  145. 


right  angles  with  the  leg  for  several 
weeks  at  a tune,  and  practice  forcible 
manual  dorsiflexion. 

In  more  marked  cases,  immediate  correc- 
tion under  anaesthesia  is  best.  If  necessary, 
divide  the  tendo  Achillis,  and  correct  cavus 
by  subcutaneous  tenotomy  of  the  plantar 
fascia  and  the  Thomas  wrench;  then  fix  the 
foot  in  plaster  (q.v.)  in  dorsiflexion,  with 
a wooden  foot-plate  for  a period  of  two 
months  or  longer;  but  get  the  patient  up  and 
walking  in  the  plaster  cast  as  soon  as  possi- 
ble. After  two  months  or  longer,  remove 
the  plaster,  and  employ,  for  .several  months 
(or  indefinitely  in  complete  paralysis),  a 
brace  which  holds  the  foot  at  right  angles 
with  the  leg.  At  night,  strap  the  foot  to 
the  leg  in  dorsiflexion.  Employ  massage 
and  passive  dorsiflexion  until  cured. 


Arthrodesis,  or  fixation  of  the  foot  at 
right  angles  with  the  leg  by  artificial  anky- 
losis, may  be  resorted  to  in  cases  of  complete 
incurable  paralysis  in  those  over  eight  years 
of  age. 

Astragalectomy  is  indicated  in  “ resist- 
ant deformity  following  fracture  at  the 
ankle.”  (Whitman.) 

In  fixed  equinus  due  to  a shortened  limb, 
employ  an  extension  shoe  in  which  the  entire 
sole  supports  the  weight. 

Talipes  Valgus;  Talipes  Equinovalgus. — 
L.  tal'ipes,  club  foot;  equinus,  equine;  val'gus, 
turned  outward.  In  talipes  valgus  the  foot 
is  abducted  and  everted;  in  equinovalgus 
there  is  also  slight  plantar  flexion. 

Causes. — Congenital  anomaly;  paralysis, 
e.g.,  acute  poliomyelitis  {q.v.),  and  spastic 
paralysis  {q.v.)]  joint  disease,  e.g.,  tuber- 


TENOSYis^OVmS 


culosis,  arthritis  deformans,  etc.;  Pott’s 
fracture;  hysteria. 

I.  Treatment  of  Congenital  Valgus. — Attempt 
to  correct  the  deformity  by  manipulation, 
with,  if  necessary,  retention  in  plaster  in  the 
equinovarus  posture,  as  described  in  princi- 
ple under  Club-Foot,  the  congenital  form. 
When  the  child  begins  to  walk,  treat  the 
condition  as  directed  under  Weak  Foot. 

II.  Treatment  of  Acquired  Equinovalgus. — 
Retain  the  foot  in  plaster  {q.  v.),  in  an 
attitude  of  varus,  and  allow  the  patient  to 
walk.  After  the  deformity  has  thus  been 
corre(;ted,  fit  the  j)atient  with  a metal  brace 
as  for  Weak  P’oot  (g.  v.),  and  raise  the 
inner  border  of  the  sole  of  the  shoe. 

Tendon  transplantation  in  cases  of  over 
two  years  duration,  and  arthrodesis  in  those 
over  eight  years  of  age  may  be  indicated. 

In  deformity  resulting  from  Pott’s  frac- 
ture, osteotomy  of  the  tibia  above  the  ankle 
may  be  performed. 

Talipes  V'arus. — L.  tal'ipes,  club-foot; 
var'us,  inversion.  See  Club-Foot. 

Tarsal  Bones,  Fractures  of  the. — L.,  Or. 
Taper  6s  instep.  See  PTactures  of  the 
Tarsal  Bones. 

Tuberculosis. — See  Ankle  Joint  and 
Tarsal  Tuberculosis. 

Tendon  Sheaths,  Inflammation  of. — L. 

tendo.  See  Tenosynovitis. 

Lipoma  of. — See  Lipoma  of  Joints 
and  Tendon  Sheaths. 

Tenosynovitis. — Gr.  Ttveov  tendon;  avv  with 
d)6v  egg;  -tTts  inflammation.  Inflammation 
of  a tendon  sheath  is  manifested  by  local 
pain,  tenderness,  and  disability,  sometimes 
swelling,  and  sometimes  a creaking  sensation 
on  motion.  Suppurative  inflammation  is 
characterized  by  extreme  tenderness,  lim- 
ited to  the  sheath,  rigid  flexion  of  the 
involved  Anger,  and  great  pain  along  the 
sheath  on  extending  the  Anger. 

The  palmar  tendon  sheaths  are  divisible 
into  three  groups;  (1)  the  short  sheaths  of 
the  index,  middle,  and  ring  Angers,  (2)  the 
long  sheath  of  the  thumb  with  its  j:)rolonga- 
tion  in  the  hand  called  the  radial  bursa, 
and  (3)  the  long  sheath  of  the  little  Anger, 
with  its  prolongation  in  the  palm  called  the 
ulnar  bursa.  The  various  sheaths  may  com- 
municate (see  Fig.  146.)  Pus  in  the  tendon 
sheaths  may  rupture  into  the  fascial  spaces 
{q.v.,  under  Hand  Infections,  in  Part  1), 
and  into  the  forearm,  where  it  is  always 
found  beneath  the  flexor  profundus  and  upon 
the  pronator  quadratus  and  interosseous 
septuTii,  and  following  the  ulnar  artery. 

Etiology. — Traumatism,  overuse,  strain, 
etc.;  gout;  rheumatism;  infectious  diseases; 


gonorrhoea;  staphylococcic  and  streptococcic 
infection;  tuberculosis;  syphilis. 

Treatment.— A.  NoN-SuppuRATIVE  TENO- 
SYNOVITIS.— Employ  rest  and  compression 
by  means  of  adhesive  straps,  an  ordinary 
bandage,  or  a plaster  bandage  (q.  v.);  and 
elevate  the  affected  member.  Heated  or  cold, 
the  cautery,  iodine  or  ichthyol  may  be 


Fig.  146. 

applied.  P.  G.  Skillern,  Jr.,  jiraises  the  use 
of  a blister  in  the  early  stages:  “A  square 
inch  of  fabric  ‘ buttered  ’ with  ceratum 
cantharidis,  U.S.P.,  or  an  equal  area  of  a 
‘ ready  to  use  ’ plaster  is  moistened  with 
olive  oil  and  applied  over  the  inflamed  part. 
It  is  covered  with  a dossil  of  gauze,  which 
is  secured  by  adhesive.  The  books  say  to 
remove  the  plaster  in  four  to'six  hours,  but 
practically  it  works  out  that  as  soon  as  the 
blister  has  formed,  the  cushion  of  serum 
interposed  between  medicament  and  dermis 
automatically  inhibits  vesication.  For  this 
reason  the  blister  is  removed  the  next  day 
and  the  wound  dressed  with  boric  ointment 
(see  Part  11.)  on  surgical  lint.  Immobili- 
zation is  now  secured.  It  is  astonishing 
how  crepitation-free  tendon-play  rapidly 
returns.” 

Make  multiple  small  incisions  if  great 
pain  and  swelling  are  present.  Resort  to 
moderate  active  and  passive  movements  as 
soon  as  all  acute  symptoms  have  subsided, 
in  order  to  prevent  adhesions. 

In  chronic  intractable  cases,  usually 
tuberculous,  remove  the  diseased  sheath. 

B.  Suppurative  Tenosynovitis. — Split 
the  sheath  wide  ojien  at  the  side  (not  in  the 
median  line),  but  leave  bridges  over  the 
articulations,  to  prevent  prolapse  of  the 
tendon.  Drain  with  gauze  saturated  with 


TORTICOLLIS;  WRYNECK 


sterile  vaseline  or  with  gutta-percha  strips. 
To  prevent  a too  rapid  entrance  of  toxines 
into  the  system,  Kanavel  applies  a broad 
bandage  to  the  arm,  tight  enough  to  com- 
press the  veins,  but  not  the  arteries.  It 
may  be  left  on  for  twelve  to  eighteen 
hours.  The  hand  may  be  soaked  in  hot 
boric  acid  or  bichloride  solution  for  an  hour 
after  the  operation.  The  hand  should  be 
kept  in  extension  by  means  of  splints;  and 
should  be  dressed  once  or  twice  a day. 
As  soon  as  the  inflammation  has  subsided 
(about  three  days),  begin  passive  and 
active  movements. 

In  involvement  of  the  forearm,  make  a 
three-inch-long  lateral  incision,  about  an 
inch  above  the  styloid  process  of  the  ulna, 
and  on  a level  with  the  volar  surface  of  the 
ulna.  Separate  the  bone  from  the  attached 
deep  fascia,  and  insert  the  finger  between 
the  pronator  quadratus  and  the  overlying 


tendons.  If  it  is  deemed  advisable  to  make 
a radial  counter-opening,  push  an  artery 
forceps  through  to  the  skin  of  the  radial 
side,  and  make  a free  incision  here  (see 
Fig.  147. 

Should  severe  hemorrhage  occur  in  a fore- 
arm infection,  cut  down  upon  the  ulnar 
artery  and  ligate  it. 

Involvement  of  the  wrist  joint  sometimes 
follows  radial  bursitis.  This  is  indicated  by 
crepitation,  tenderness,  swelling,  and  a 
fluctuating  fulness  on  the  dorsum  over  the 
radiocarpal  articulation.  It  calls  for  curet- 
tage of  necrosed  bone  or  resection  of  one 
or  all  of  the  carpal  bones.  For  ankylosis 
one  may  try  a transplant  of  fat  and  fascia 
into  the  joint  (see  also  Ankylosis). 

If  a chronic  sinus  follows  infection,  open 
the  sinus  and  search  for  a focus  of  necrosis. 
Remove  all  necrotic  tissue,  whether  tendon 
or  bone.  (After  Allen  N.  Kanavel). 

Thigh,  Fractures  of  the. — See  Fractures 
of  the  Femoral  Neck;  and  Fractures  of  the 
Femoral  Shaft. 

Thomas  Hip=Splint. — See  Fractures  of  the 
Femoral  Neck. 

Thomas  Knee=Splint. — See  Fractures  of 
the  Leg,  the  Shaft. 

Thumb,  Dislocations  of  the. — See  Dislo- 
cations of  the  Metacarpophalangeal  Joints. 


Tibia,  Dislocations  of  the. — L.  See  Dis- 
locations of  the  Knee;  and  Disloca- 
tions of  the  Ankle. 

Fractures  of  the. — See  Fractures  of  the 
Leg,  the  Shaft;  and  Fractures  of  the 
Leg,  the  Lower  End. 

Tibial  Spine,  Fracture  of  the. — See  under 
Displacement  of  a Semilunar  Cartilage. 

Tibiotarsal  Dislocations. — See  Disloca- 
tions of  the  Ankle. 

Toe,  Great,  Abduction  of  the. — L.  ab- 

from  + du'cere,  to  draw.  See 
Hallux  Valgus. 

Adduction  of  the. — L.  ad-  to  4- 
du'cere,  to  draw.  (See  Pigeon-Toe 
Painful.-^ee  Painful  Great-Toe 
Joint. 

Rigid  . — See  Hallux  Rigidus. 

Hammer. — See  Hammer-Toe. 

Painful  Great. — See  Painful  Great  Toe- 
Joint. 

Pigeon. — See  Pigeon-Toe. 

Rigid  Great. — See  Hallux  Rigidus. 

Torticollis;  Wryneck. — L.  tor'tus,  twisted 
-F  col'lum,  neck.  Etiology.— Congenital 
shortening  and  atrophy  of  the  sternomastoid 
muscle,  nearly  always  the  right,  rarely  the 
trapezius;  congenital  osseous  deformity  (very 
rare);  cervical  rib  (see  Part  1);  rupture  of 
the  sternomastoid  muscle  at  birth ; muscidar 
traumatism;  cicatricial  contraction  pro- 
duced by  burns  or  disease;  exposure  to  cold 
producing  myalgia  or  muscular  rheumatism 
(“stiff-neck”);  furunculus;  cellulitis;  lym- 
phadenitis; tonsillitis,  and  pharyngitis;  paro- 
titis; otitis;  mastoiditis;  dental  caries;  lesions 
of  the  mediastinal  glands;  suboccipital  ar- 
thritis, due  to  local  infection,  rheumatism  or 
infectious  disease;  occipital  neuralgia;  occu- 
pation neurosis,  observed  in  tailors,  cobblers, 
pavers,  seamstresses,  and  hat-makers;  vol- 
untary habit;  ocular  defects;  marked  scolio- 
sis; psychical  defect  (of  will);  unilateral  dis- 
location of  the  cervical  spine;  paralysis,  due 
to  acute  poliomyelitis,  diphtheria;  rheuma- 
tism, traumatism,  bone  caries,  progressive 
muscular  atrophy  and  bulbar  paralysis, 
nerve  compression  by  meningeal  exudates, 
apoplexy  (Part  1);  muscular  spasm,  due  to 
heredity,  overstudy,  anxiety,  shock,  an  ha- 
bitual constrained  position  of  the  head,  in- 
testinal intoxication  (Part  1);  spondylitis 
deformans;  cervical  Pott’s  disease;  rarely 
syphilis,  vaccinia,  malaria,  influenza,  chorea, 
debility,  rickets,  epilepsy,  meningitis,  hemi- 
plegia, hysteria. 

Treatment.' — This  depends,  of  course,  upon 
the  cause  (q.v.).  The  X-ray  is  of  diagnostic 
service  in  doubtful  cases. 

In  rupture  of  the  sternomastoid  muscle 


TUBERCULOSIS  OF  THE  HAND 


with  the  formation  of  a hematoma,  apply 
hot  fomentations,  to  promote  the  absorption 
of  the  extravasated  blood,  and  massage  the 
parts  gently  with  a bland  oil  (olive  or  cotton- 
seed oil  or  vaseline  or  lard),  at  the  same  time 
stretching  the  affected  muscle  by  tilting  the 
head.  Do  this  several  times  a day,  and  in 
the  meantime  see  that  the  head  is  kept  in  a 
proper  posture.  If  necessary,  a Thomas  col- 
lar, made  high  on  the  side  toward  which  the 
head  inclines,  may  be  worn ; it  may  be  made 
of  thick  cotton  covered  with  a bandage 
and  two-inch  adliesive  plaster  (see  also 
Fig,  148). 

In  okl  cases,  after  the  third  year  of  age, 
where  there  is  shortening  of  an  inch  or  more, 
the  contracted  parts  require  division  by 
subcutaneous  tenotomy  or  an  open  incision 
(consult  the  standard  textbooks).  Then  the 
head  is  fixed  in  a plaster  support,  in  the 

overcorrected 
position,  for  four 
to  eight  weeks, 
followed  by  mas- 
sage, manipula- 
tion, stretching 
exercises,  and 
sus])ension  by 
means  of  the 
Sayre  h e a d - 
piece. 

In  rheiunatic 
torticollis  (“stiff 
neck  ”),  employ 

Fig.  148.— Thomas  collar.  fomen- 

tations or  liniments  (see  Part  11,  Drugs), 
oil  of  wintergreen  or  ung.  capsici,  locally,  and 
the  salicylates  (sod.  salicylate,  aspirin,  salol), 
with  or  without  antipyrine  or  phenacetin 
internally.  To  keep  the  head  at  rest  and 
relieve  pain,  apply  a thick  collar  of  cotton, 
made  high  on  the  side  toward  which  the 
head  tilts,  and  covered  with  a bandage  and 
wide  adhesive  plaster  to  make  it  stiff;  or 
apply  splints  of  moulded  felt. 

In  spasmodic  torticollis,  sedative  drugs  are 
recommended,  e.g.,  belladonna  or  atropine, 
hyoscyamus  or  hyoscine,  cannabis  indica, 
bromides,  gelseiniuni.  In  the  experience  of 
Sachs,  however,  the  foregoing  drugs  are  “not 
worthy  of  trial,”  excepting  fluid  extract  of 
gelsemium,  one  or  two  drops  every  four  hours, 
very  gradually  increased,  up  to  five,  ten,  or 
fifteen  drops,  never  more  than  twenty  drops, 
to  be  discontinued  if  double  vision  occurs. 
Morphine  is  more  effectual  but  should  not 
be  used.  Sachs  also  recommends  the  full 
rest  treatment  (see  Neurasthenia,  in  Part 
1);  but  declares  that  “electricity  is  practi- 
cally useless.”  Massage  may  be  beneficial. 


Employ  antiluetic  treatment  and  eliminate 
inte.stinal  intoxication,  if  either  lues  or 
the  latter  is  suspected.  Systematic  coordi- 
native  gjminastic  movements  of  the  head 
are  advisable. 

An  operation,  however,  will  probably  be 
eventually  required,  viz.,  resection  of  the 
spinal  accessoiy  and  posterior  branches  of 
the  upper  cervical  nerves,  and  muscle  sec- 
tion (comsult  the  standard  textbooks). 

In  paralytic  torticollis,  employ  massage 
and  electricity  to  improve  the  nutrition  and 
tone  of  the  affected  muscles. 

Toxic  Arthritis. — Gr.  to^lkov  poison.  See 
Arthritis. 

Trachea,  Fractures  of  the. — L. ; Gr.  rpaxeta 
rough.  See  Fractures  of  the  Trachea. 

Traumatic  Dislocations. — Gr.  rpadpa 
woimd.  See  Dislocations. 

Fractures. — See  Fractures. 

Spondylitis. — Gr.  a-n-6p8v\os  vertebra  -f- 
-LTLs  inflammation.  See  under  Ky- 
phosis. 

Synovitis. — Gr.  aw  with  w6v  egg  -F 
-iTLs  inflanunation.  See  Arthritis, 

Trigger=Finger. — Synonyms.  — Lock- finger ; 
snapping  finger;  jerk-finger. 

Etiology. — Interference  with  the  motion 
of  the  tendon  in  its  sheath,  due  to  con- 
genital defects,  tramna,  overuse,  gout, 
arthritis  deformans. 

Treatment. — “ It  may  in  mild  cases  dis- 
appear spontaneously  ” (H.  L.  Taylor). 
Rest,  massage,  manual  or  vibratory,  and 
soothing  applications/'  will  effect  a cure  in 
many  cases  ” (R.  W.  Lovett).  Otherwise, 
slit  open  the  tendon  sheath,  and  remove  the 
obstacle  to  free  motion,  which  may  be  a 
ganglion,  loose  cartilage,  tendon  nodule, 
or  sesamoitl  bone. 

Trochanters,  Fractures  of  the. — L.;  Gr. 

Tpoxo-vTTip  runner.  See  Fractures  of  the 
Femoral  Shaft. 

T=shaped  Fractures  of  the  Humerus  into 
the  Elbow  Joint. — See  Fractures  of  the 
Elbow. 

Tuberculosis  of  the  Ankle. — ^L.  tuber'eu- 
lum,  nodule.  See  Ankle  Joint  and 
Tarsal  Tuberculosis. 

Carpus. — L.  car’pus,  wrist.  See  Tuber- 
culosis of  the  Wrist. 

Elbow. — See  Elbow  Tuberculosis. 

Fingers. — See  Tuberculosis  of  the  Long 
Bones  of  the  Hand  and  Foot. 

Tuberculosis  of  the  Foot,  the  Long  Bones. 
— See  Tuberculosis  of  the  Long  Bones 
of  the  Hand  and  Foot. 

Hand,  the  Long  Bones. — See  Tubercu- 
losis of  the  Long  Bones  of  the  Hand 
and  Foot. 


VILLOUS  ARTHRITIS 


Tuberculosis  of  the  Hip. — See  Ilip. 

Knee. — See  Knee  Tuberculosis. 

Tuberculosis  of  the  Long  Bones  of  the 
Hand  and  Foot. — The  characteristic  symp- 
toms are  pain,  tenderness,  and  a fusiform 
swelling.  It  must  be  distinguished  from 
syphilitic  dactylitis. 

Treatment.— Secure  absolute  rest  by  means 
of  splints,  which  should  be  kept  on  for 
months,  and  employ  compression  with 
adhesive  plaster.  If  the  joint  is  involved, 
amputation  of  the  affected  finger  or  toe  may 
be  advisable.  If  a single  carpal  or  metacarpal 
bone  is  affected,  excise  the  diseased  parts. 

Tuberculosis  of  the  Metacarpal  Bones. — 
Gr.  nerk  beyond  Kapwos  w’rist.  See 
Tuberculosis  of  the  Long  Bones  of  the 
Hand  and  Foot. 

Metatarsal  Bones. — Gr.  per  a beyond  -f 
Tapa- 6s  tarsus.  See  Tuberculosis  of 
the  Long  Bones  of  the  Hand  and 
Foot. 

Phalanges. — Gr.  cj)a\ay^  phalanx.  See 
Tuberculosis  of  the  Long  Bones  of 
the  Hand  and  Foot. 

Sacro=lliac  Joint. — See  Sacro-Iliac  Tu- 
berculosis. 

Shoulder. — See  Shoulder  Tuberculosis. 

Spine. — L.  spina,  spine.  See  Pott’s 
Disease. 

Tarsus. — See  Ankle  Joint  and  Tarsal 
Tuberculosis. 

Tuberculosis  of  the  Wrist. — The  charac- 
teristic symptoms  are  local  pain,  tenderness, 
heat,  and  swelling,  limitation  of  motion  due 
to  muscle  spasm,  and  muscular  atrophy. 

Treatment.— Splint  the  wrist,  in  an  attitude 
of  moderate  dorsal  flexion,  by  means  of  a 
plaster  bandage  applied  from  the  ends  of 
the  fingers  to  the  elbow.  If,  however,  flex- 
ion deformity  is  present,  overcome  it  grad- 
ually by  a series  of  plaster  splints  applied 
about  every  two  weeks.  Bier’s  passive  hy- 
persemia  {q.v.)  may  be  tried. 

When  the  disease  has  become  quiescent, 
shorten  the  lower  end  of  the  splint  up  to  the 
heads  of  the  metacarpal  bones,  and  enjoin 
daily  movement  of  the  fingers. 

Excise  the  affected  parts  if  conservative 
treatment  fails. 

Early  excision  is  usually  to  be  advised  in 
adults.  Amputation  is  indicated  in  cases  of 
extensive  destruction. 

Tuberosities  of  the  Humerus,  Fracture 
of  the. — L.  tuberositas,  broad  eminence. 
See  Fractures  of  the  Humerus. 

Tumor  Albus. — L.,  white  swelling.  See 
Knee  Tuberculosis. 

Typhoid  Spine. — The  occurrence  of  very 
acute  and  painful  spinal  symptoms  late  in 
54 


the  course  of  typhoid  fever,  sometimes  asso- 
ciated with  disturbances  of  the  reflexes, 
cramps  in  the  legs,  and  paralysis,  with 
involvement  of  the  bladder  and  rectum. 

The  condition  is  usually  cured  in  six 
months. 

Treatment.— Fix  the  patient  upon  a Brad-, 
ford  bed  frame,  as  in  acute  Pott’s  disease, 
until  the  very  acute  symptoms  have  sub- 
sided; then  employ  a pla.ster  jacket  or  Taylor 
brace,  as  described  under  Pott’s  Disease 
(q.v.).  The  Paquelin  cautery  may  be  of 
service  for  the  relief  of  pain.  The  condition 
may  be  hysterical  (Osier). 

Ulna,  Dislocations  of  the. — L.  See  Dis- 
locations of  the  Elbow,  and  Disloca- 
tions of  the  Wrist. 

Fractures  of  the. — See  Fractures  of  the 
Elbow;  and  Fractures  of  the  Forearm, 
the  Shaft. 

Ulno=Radial  Dislocation. — See  Disloca- 
tions of  the  Wrist. 

Union,  Delayed. — See  General  Considera- 
tions, under  Fractures. 

Vicious. — See  General  Considerations, 
under  Fractures. 

Upper  Jaw,  Fractures  of  the. — See  Frac- 
tures of  the  Upper  Jaw. 

Valgus. — L.,  timned  outward.  See  Tali- 
pes Valgus. 

Varus. — L.,  turned  inward.  See  Club- 
Foot. 

Velpeau  Bandage. — See  Bandaging. 

Vertebrse,  Dislocations  of  the. — L.  See 
Dislocations  of  the  Spine. 

Fractures  of  the. — See  Fractures  of  the 
Spine. 

Vicious  Union. — See  General  Considera- 
tions, under  Fractures. 

Villous  Arthritis. — L.  villosus,  covered 
with  villi;  Gr.  apdpov  joint  fl-  -ltis  inflammar 
tion.  Hypertrophy  of  the  synovial  mem- 
brane and  villi,  secondary  to  trauma,  flat- 
foot,  arthritis  deformans,  tuberciflosis,  syph- 
ilis, or  other  joint  affection.  Fatty  degenera- 
tion (lipoma  arborescens)  may  occur  (see 
Lipoma  of  Joints  and  Tendon  Sheaths. 

Crepitation,  creaking,  snapping,  and  inter- 
ference with  motion  may  occur  on  w'alking, 
and  also  occasional  attacks  of  pain  and 
swelling  due  to  injury  to  the  hypertrophied 
masses.  The  diagnosis,  however,  is  usually 
made  only  on  exploratory  incision. 

When  pain  and  swelling  occur,  strap  the 
joint,  or  splint  it  with  pasteboard  strips 
held  in  place  by  a bandage,  or  apply  a 
snugly  fitting  kneecap.  Light  manual  or 
vibratory  mas.sage,  electricity,  and  heat  are 
of  service.  ' Any  possible  causal  influence 
should  be  corrected. 


WEAK  FOOT 


In  intractable  cases,  it  is  necessary  to 
excise  the  hypertrophied  masses. 

Weak  Ankle. — See  Weak  Foot,  below. 

Weak  Foot. — Synonym.s. — Flat-foot;  splay- 
foot; pes  planus;  pes  valgus;  talipes  valgus. 

“ The  deformity  (pronation  or  abduction 
of  the  foot)  is  essentially  a displacement  of 
the  astragalus  on  the  bones  of  the  tarsus.” 
(R.  W.  Lovett.) 

Etiology. — Congenital  anomaly;  improper 
attitude,  particularly  turning  the  feet  out- 
ward in  walking;  improper  shoes  (cramping 
the  toes  and  heel;  and  high  heels);  weak 
muscles  and  ligaments  due  to  poor  health, 
old  age,  exhausting  illness,  childbirth,  labor- 
ious occupation,  rapid  growth,  overweight, 
prolonged  stancling  on  hard  floors,  rickets, 
poliomyelitis,  spa.stic  paralysis;  sprain;  frac- 
ture, especially  Pott’s  fracture;  shortened 
gastrocnemius  muscle;  ankle  joint  disease 
(tuberculosis,  gonorrhoea,  arthritis  defor- 
mans, etc.) ; corns  and  bunions. 

Treatment.— Moderate  cases  may  be  cor- 
rected by  the  following  means,  viz.,  (1)  com- 
fortably fitting  shoes  with  ample  toe  space, 
low,  broad  heels,  and  the  inner  border  of  the 
heel  and  sole  about  one-quarter  inch  thicker 
than  the  outer;  (2)  frequent  throwing  of  the 
weight  on  the  outer  border  of  the  feet  while 
standing;  (3)  tip-toe  exercises  practiced 
twice  daily  to  the  point  of  fatigue:  standing 
with  the  toes  directed  inward,  the  patient 
raises  and  lowers  himself  upon  the  toes,  and 
while  de.scending  rolls  the  feet  into  the 
attitude  of  adduction;  (4)  walking  with  the 
feet  held  parallel  and  pointing  forward  and 
with  the  weight  thrown  upon  the  outer  side; 
(5)  the  Barron  ladder. 

If  the  above  measures  prove  insufficient, 
a brace  must  be  resorted  to,  following  the 
correction  of  bone  displacement  by  means 
of  active  and  passive  manipulation  to  the 
limit  in  all  directions,  particularly  adduction 
and  supination,  aided  by  massage  and 
the  application  of  heat.  The  brace  is 
made  from  a plaster  cast,  as  described  by 
Whitman  thus:  “ Seat  the  patient  in  a 
chair;  in  front  of  him  place  another,  some- 
what less  in  height;  on  it  lay  a thick  pad  of 
cotton-batting  and  cover  it  with  a square  of 
cotton  cloth.  Put  about  a quart  of  cold 
water  into  a basin  and  sprinkle  plaster-of- 
Paris  on  the  surface  until  it  does  not  readily 
sink  to  the  bottom;  then  stir.  When  the 
mixture  is  of  the  consistency  of  very  thick 
cream,  pour  it  upon  the  cloth.  The  patient’s 
knee  is  then  flexed,  and  the  outer  side  of  the 
foot,  previouskv  rubbed  with  talcum  jwwder, 
is  allowed  to  sink  into  the  plaster,  and  the 
border  of  the  cloth  being  raised,  the  plaster 


is  pressed  against  the  foot  until  rather  more 
than  half  is  covered.  The  foot  should  be 
slightly  adducted,  slightly  plantar  flexed, 
and  the  sole  shoukl  be  in  the  plane  perpendic- 
ular to  the  seat  of  the  chair.  As  soon  as  the 
plaster  is  hard  its  upper  surface  is  coated 
with  vaseline  or  talcum  powder,  and  the 
remainder  of  the  foot  is  covered  with  plaster; 
the  two  halves  are  then  removed,  dusted 
with  talcum  powder,  bound  together,  and 
filled  with  plaster  cream.  In  a few  moments 
the  outer  shell  may  be  removed,  and  one 
has  a reproduction  of  the  foot,  which  when 
properly  made  should  stand  upright  without 
inclination  to  one  side  or  the  other.  In  most 
instances  it  will  be  of  advantage  to  deepen  in 


Fig.  149. — a,  about  half  an  inch  below  the  malleolus,  well 
above  all,  the  prominent  bones;  6,  enclosing  the  calcaneo- 
cuboid junction;  c,  the  great  toe  joint;  d,  the  center  of  the 
heel;  e,  a point  just  behind  the  base  of  the  fifth  metatarsal 
bone.  The  extension  represented  by  the  dotted  line  is  for 
“very  heavy  subj  ects’  ’ and  for  depression  of  the  anterior  meta- 
tarsal arch  (see  Anterior  Metatarsalgia).  After  Whitman. 

the  plaster  model  the  inner  and  outer  seg- 
ments of  the  arch,  in  order  that  the  arch  of 
the  brace  may  be  slightly  exaggerated, 
especially  at  the  heel,  so  that  the  depression 
of  the  anterior  extremity  of  the  os  calcis 
may  be  prevented.  If  the  outer  border  of 
the  cast  is  flattened  by  pressure,  a little 
plaster  should  be  added  to  approximate  the 
normal  rounded  contour  of  the  foot.  Upon 
the  model  the  outline  of  the  brace  is  drawn 
as  illustrated  in  the  diagrams.  The  best 
sheet  steel,  18  to  20  gauge,  cut  after  the 
pattern,  is  moulded  upon  it  and  tempered. 
The  brace  may  be  nickel-plated,  galvanized, 
or  tin-plated.  Fig.  149. 

The  inner  border  of  the  sole  and  heel  of 
the  shoe  should  be  thickened,  the  exercises 
before  described  should  be  followed,  and 
massage  and  passive  movements  in  all 
directions,  particularly  dorsal  flexion  and 
adduction  to  the  full  limit,  should  be  prac- 
ticed twice  daily.  After  several  months,  it 
may  be  advisable  to  make  a second  cast, 
“ to  conform  to  the  improved  contour  ” of 
the  foot.  After  about  six  months,  if  the 


Y-SHAPED  FRACTURES  OF  THE  HUMERUS  INTO  THE  ELBOW  JOINT 


faulty  attitude  has  been  corrected,  the 
brace  may  be  gradually  discarded;  but  in 
chronic  cases  it  may  have  to  be  continued 
indefinitely.  Emphasis,  however,  is  to  be 
laid  upon  the  importance  of  correct  attitude 
and  appropriate  exercises,  and  the  elimina- 
r,ion  of  braces,  if  possible. 

In  painful,  swollen  cases,  employ  rest, 
massage,  soaking  in  hot  water,  alternate  hot 
and  cold  douches,  or  hot  air,  until  the  acute 
symptoms  have  subsided,  before  resorting 
to  the  brace. 

"Where  there  is  resistance  to  the  correction 
of  deformity,  due  chiefly  to  muscle  spasm, 
the  latter  may  be  overcome  gradually  by 
adducting  the  foot  as  far  as  possible,  and 
holding  it  thus  by  a wide  band  of  adhesive 
plaster,  passing  from  just  below  the  exter- 
nal malleolus  beneath  the  arch  and  up  the 
inner  side  of  the  leg  to  the  knee,  and  sup- 
ported by  straps  about  the  instep,  ankle, 
and  calf,  and  covered  by  a bandage.  The 
adhesive  strapping  is  to  be  renewed  at  inter- 


Fio.  150. 


vals  until  normal  adduction  is  possible.  If  de- 
sired, however,  the  deformity  may  be  reduced 
at  once,  under  anaesthesia,  as  described  below. 

In  rigid  flat  foot,  due  chiefly  to  adhesions 
and  contractions,  correct  the  deformity 
forcibly,  under  anaesthesia,  as  follows: 
Forcibly  extend,  flex,  abduct,  and  adduct 
the  foot  repeatedly  to  the  normal  limits, 
using  the  block  (Fig.  150)  and  Thomas 
wrench  (Fig.  151),  if  necessary,  until  perfect 
flexibility  is  obtained.  In  some  cases  the 
tendo  Achillis  may  have  to  be  divided,  and 
occasionally  also  the  peronei  (hook  them  up 
through  an  incision  behind  the  lower  part  of 
the  fibula  and  excise  one  or  two  inches).  H. 
A.  Wilson’s  flat-foot  correction  screw  may  be 
u.sed,  it  is  stated,  without  an  anaisthetic. 

After  the  rigidity  has  been  overcome,  put 
the  foot  up  in  an  overcorrected  position 
(extreme  adduction  and  supination)  in 
plaster  {q.v.),  over  thick  cotton,  extending 
to  the  knee. 

After  three  or  four  weeks,  during  which 
the  patient  should  walk  about  upon  the 
cast,  remove  the  latter,  and  prepare  a plaster 


model  of  the  foot  for  a Whitman  brace. 
Then  reapply  the  plaster  bandage,  and 
retain  until  the  brace  is  ready. 

On  finally  removing  the  plaster  splint,  if 
the  foot  is  swollen  and  painful,  employ  hot 
air  (see  under  Arthritis),  prolonged  soaking 
in  hot  water,  and  massage  for  several  days. 
Thereafter,  once  or  twice  daily,  forcibly 
adduct  and  flex  the  foot  dorsalward  and 
plantarward,  to  the  normal  limits,  the 
patient  assisting  by  active  efforts,  and  con- 
tinue this  “from  day  to  day  until  there  is 
no  longer  a sensation  of  pain  or  tension.” 
About  three  to  six  weeks  from  the  begin- 
ning of  treatment  are  required  for  a cure; 
but  the  brace  should  be  worn  indefinitely. 
The  shoes  should  be  raised  on  the  inner 
border,  and  the  exercises  and  postures 
already  described  should  be  followed. 
(Chiefly  from  Whitman.) 


In  congenital  flat  foot,  manipulate  the 
foot  into  the  correct  position,  and  fix  it  thus 
with  a plaster  bandage,  renewed  at  intervals. 
Tenotomy  may  be  required.  Support  the  arch 
with  a brace  when  the  child  begins  to  walk. 

White  Swelling. — See  Knee  Tuberculosis. 

Wrist,  Dislocations  of  the. — See  Disloca- 
tions of  the  Wrist. 

Fractures  of  the.— See  Fractures  of  the 
Wrist. 

Wrist=Sprain. — Exclude  fracture  by  means 
of  the  X-ray. 

In  acute  sprain,  strap  the  hand,  wrist,  and 
lower  forearm  with  adhesive  plaster,  after 
shaving  the  skin. 

In  chronic  sprain,  employ  massage,  hot 
air  (see  under  Arthritis),  the  thermocautery, 
electricity,  ionization  {q.v.),  Bier’s  passive 
hypersemia,  and  plaster  strapping  when  the 
joint  is  in  use. 

Wrist  Tuberculosis. — See  Tuberculosis  of 
the  Wrist. 

Wryneck. — See  Torticollis. 

Y=shaped  Fractures  of  the  Humerus  into 
the  Elbow  Joint. — See  Fractures  of  the  Elbow. 


APPENDIX 


The  Orthopaedic  Armamentarium.  — i. 

Orthopaedic  Apparatus. — Plaster-of-Paris ; felt; 
straps;  pulleys;  clothesline;  fifteen  one- 
pf)und  weights;  Glisson  chin  and  occiput 
sling;  sandbags;  corset  lacings;  Bradford 
and  Lovett  hammock  frame;  muslin,  gauze, 
cotton  flannel  and  flannelette  bandages; 
jDlaster  bandages ; Goldthwait,  Metzger- 
Goldthwait,  or  R.  L.  Taylor  apparatus; 
Starr’s  forked  support;  Sayre  headpiece,  for 
applying  plaster  jackets  with  the  patient 
suspended;  mill-board  or  oakum;  Volkmann 
spoon;  iodoform  gauze;  needle-holder  and 
needles;  sterile  gauze  and  cotton;  aspirating 
needle  and  syringe;  knives;  bone  and  rib 
instruments;  rubber  catheter;  Bier’s  suction 
cups;  glass  syringe  for  injecting  bismuth 
paste;  X-ray  machine;  adhesive  plaster; 
ionization  outfit  (see  Part  1);  dumbbells; 
Bradford-Lovett  frame;  moleskin  (yellow) 
plaster;  ether  mask;  wheeled  couch;  crutches; 
cotton  wadding ; basswood  strips  or  malleable 
steel;  cloth  straps  and  buckles;  Gallie’s  suit- 
case hip  and  shoulder  rest;  Schultze’s  hip 
rest;  Sanderson’s  portable  hip  and  shoulder 
rest  and  extension  apparatus;  Echols  hip 
rest  and  traction  appliance;  flushing  curette; 
Bradford  - Goldthwait  genuclast ; Peter’s 
wrench;  soft  rubber  bandage;  hot  air  appa- 
ratus; jurymast;  block;  Thomas  wrench; 
H.  A.  Wilson’s  flat-foot  correction  screw; 
bunion  plaster;  vibrasage  machine;  bone 
forceps;  periosteal  elevator;  Paquelin 
cautery;  half-inch  trephine;  chisel  and 
gouge;  knee-cap;  Zander  machine;  elec- 
tric light  bath;  vapor  bath;  rubber  tis- 
sue; high  frequency  current;  genuclast; 
static  electricity;  joint  aspirating  needle; 
alcohol  lamp;  water  glass  solution;  ice-bags; 
sinusoidal  current;  dry  cups;  cotton-wool; 
specially  designed  motor  saw  for  cutting  out 
piece  of  tibia  for  Albee’s  bone  grafting  in 
spinal  caries. 

2.  Internal  Drugs  Mentioned  in  the  Text. — (a) 
Antirheumatics. — Sodium  salicylate;  aspi- 
rin, oil  of  wintergreen;  salicylic  acid. 

(b)  Alteratives  and  Tonics  (L.  altern're 
to  change;  tonus,  tone). — Potassium  iodide; 
comp.  tr.  gentian;  tr.  nucis  vomicae;  cod- 
liver  oil;  hypophosphites;  s>t.  iodide  of 
iron;  Fowler’s  solution;  mercury,  arsenious 
acid;  Bland’s  pills;  giiaiacol  carbonate; 
thyroid  gland  extract;  quinine;  dilute 
hydrochloric  acid;  sulphur;  guaiacum; 


guaiacol;  phosphorus;  pituitary  extract; 
urotropine;  strychnine. 

(c)  Neuromuscular  Sedatives  (L.  sedo, 
I allay). — Ether;  chloroform;  Dover’s  pow- 
der; tr.  belladonna;  bromides;  hyoscyamine; 
cannabis  indica;  fl.  ext.  gelsemii;  morphine; 
hyoscine;  aspirin;  pyramidon;  phenacetin; 
antip3^ine;  codeine. 

(d)  Hemostatics  (Gr.  aifxa  blood  -|- 
aroLTiKos  standing). — Calcium  chloride,  lac- 
tate, and  citrate;  thymus  gland  extract; 
suprarenal  gland;  fresh  human,  horse  or 
rabbit  sermn;  antidiphtheritic  serum. 

(e)  Purgatives  (L.  purgar'e,  to  cleanse). 
— Castor- oil;  sulphur;  sodium  phosphate. 

(f)  Vaccines  and  Sera.- — Antigonoccoc- 
cus  serum  and  vaccine. 

(g)  Diuretics  (Gr.  Sia  through  -f  ovpov 
urine). — Potassium  citrate;  spt.  aeth.  ni- 
trosi;  potassium  bitartrate. 

(h)  Diaphoretics  (Gr.  5td  through  -|- 
4>opeiv  to  carry). — Aspirin;  Dover’s  powder; 
liq.  amnion,  acet. 

(i)  Vehicles  and  Flavors. — Syr.  sim- 
plex; aq.  camphorse;  spt.  menthol. 

3.  Local  Medicinal  Agents  Mentioned  in  the  Text, 
(a)  Antiseptics. — Alcohol;  iodoform;  bis- 
muth subnitrate  free  from  ar.senic;  formaline; 
carbolic  acid;  sodium  chloride;  tr.  iodi;  zinc 
chloride;  balsam  of  Peru;  ichthyol;  oil  of 
wintergreen;  ung.  capsici;  iodine-vasogen; 
beta-naphthol ; sodium  carbonate;  chloro- 
form liniment;  spt.  menthol;  sodium  bicar- 
bonate; menthol. 

(b)  Vehicles  and  Protectives. — Tal- 
cum; glycerine;  petrolatimi  molle;  white  wax; 
soft  paraffin;  spermaceti;  oil  of  sesame;  gela- 
tine; olive-oil. 

(c)  Miscellaneous. — IMustard;  flaxseed; 
lead  and  opium  wash. 

Fracture  and  Dislocation  Equipment. — (a) 
Working  Material.- — Fracture  box  (see 
Fig.  Ill);  Volkmann’s  sliding  splint,  for 
use  with  Buck’s  extension  in  fractures  of  the 
femur;  double  inclined  plane  for  fractures 
of  the  lower  end  of  the  femur;  Thomas  hip- 
splint;  Thomas  knee-splint;  long  wooden 
external  T-splint;  thin  splint  wood  or  bass- 
wood, inch  in  thickne.ss;  iron  wire,  34 
inch  in  diameter;  Cabot  posterior  wire  splint 
for  adult  leg;  Smith  anterior  wire  splint  for 
adult  leg;  Hodgen’s  modification  of  Smith’s 
anterior  splint;  buckles  and  straps;  muslin 
and  flannel  roller  bandages;  muslin  slings; 


THE  ORTHOPAEDIC  ARMAMENTARIUM 


heavy  cardboard;  wooden  Mitteldorpf  tri- 
angle; steel  tape-measure;  heavy  scissors; 
jack-knife;  zinc  oxide  adhesive  plaster,  three 
inches  wide;  tin  strips  and  cypress  wooa 
strips;  dental  rubber  No.  2;  crinoline  strips, 
four  yards  long,  stitched  together,  two,  three, 
or  four  inches  wide,  washed  free  of  glue  in 
warm  water  and  thoroughly  rinsed  and 
dried;  plaster-of-Paris  bandages  in  sealed 
metal  cans;  dental  plaster-of-Paris,  sold  in 
five-pound  cans,  or  better,  moulder’s  plaster- 
of-Paris;  sheet  wadding,  purchasable  in 
dry-goods  stores;  cotton  batting;  cheese 
cloth;  Levis  perforated  metal  splints,  two 
sizes,  for  children  and  adults;  bronze  alumi- 
num or  silver  wire;  bed-pan;  Bradford 
frame;  rope  and  pulleys;  measuring  tape; 
X-ray  machine;  razor;  sterile  gauze;  needles, 
needle-holder,  and  silk,  catgut,  silkworm-gut, 
and  chromicisedcat  gut ; galvanic  and  Faradic 
currents:  amputation  instruments;  Zander’s 
apparatus;  hot-air  apparatus;  absorbent 
wool;  shellac;  U-shaped  piece  of  iron  used 
in  the  treatment  of  open  fractures;  scalpels; 
Roe’s  elevator  of  nasal  bones ; narrow-bladed 
haemostatic  forceps;  Asch’s  tubes;  Seiler’s 
tablets  for  making  Seiler’s  solution;  Cobb’s 
external  nasal  splint;  Coolidge’s  external 
nasal  splint;  ether  mask;  curved  steel 
urethral  sound;  rubber  catheter  with  rub- 
ber tubing  and  funnel  attached  for  nasal 
feeding;  No.  26  gauge  German  silver  wire; 
external  metal  contrivances  for  holding  the 
fragments  in  fractures  of  the  lower  jaw  in 


place;  metal  chin  piece,  with  straps  and 
buckles;  ice-bags. 

Tracheotomy  In.struments ; blunt  retrac- 
tor, sharp  tenaculum,  sharp-  and  probe- 
pointed  scalpels;  tracheal  dilator;  tracheot- 
omy tube  with  pilot. 

Dieulafoy  or  Potain  thorax  aspirator; 
small  plain  towels;  safety-pins;  straight 
pins;  kangaroo  tendon;  cardboard  or  thin 
wood  3^  inch  thick;  internal,  right  angle, 
perforated  metal  splint  for  upper  extremity; 
finger-cots;  rubber  tubing;  strips  of  metal 
for  reinforcing  plaster-of-Paris;  material  for 
perineal  bands;  long  sandbags;  sheet  wad- 
ding; cradle  to  protect  legs  from  weight  of 
bed  clothing:  wheel  chair;  Verity  gas-pipe 
frame;  clothesline;  straps  and  buckles; 
34-inch  thick  wire  for  making  the  Cabot  pos- 
terior wire  frame;  elastic  rubber  bandage; 
sea-sponges;  tin  or  cypress  wood  strips;  thin 
copper  wire  for  binding  together  the  ends  of 
Cabot’s  posterior  wire  splint;  air  cushions; 
cotton  wool;  rubber  rings. 

(b)  Local  Medicaments. — Talcum  pow- 
der; zinc  oxide;  starch;  dermatol;  alcohol; 
tr.  iodi;  boric  acid;  aristol;  cocaine;  Dobell’s 
solution;  tr.  benzoin;  bismuth;  iodol;  per- 
oxide of  hydrogen;  balsam  of  Peru ; castor-oil. 

(c)  Anaesthetics  (Gr.  av  not  -f-  aiadriais 
sensation). — Morphine;  chloroform;  ether. 

(d)  Alteratives  and  Tonics  (L.  altera're, 
to  change;  ton' us,  tone). — Thyroid  extract; 
potassium  iodide;  strychnine;  arsenic;  iron; 
quinine;  phosphorus. 


PART  11 

ALPHABETICAL  LIST  OF  DRUGS,  WITH  THEIR  DOSAGE,  METHOD  OF 
ADMINISTRATION,  PHYSIOLOGIC  AND  TOXIC  ACTION,  AND  USES 

(The  dosage  for  children  is  chiefly  from  Kerley,  partly  from  Holt,  partly 
from  other  sources) 


Acacia  (Gum  Arabic,  soluble  in  2 of  water;  prac- 
tically insoluble  in  alcohol). 

Acacise,  Mucilago  (acacia  35,  distilled  water  to 

100). 

Advlt  Dosage. — Min.,  3iij  av.,  iv;  max.,  vi. 

Physiologic  Action  and  Uses. — Demulcent.  Used 
to  suspend  insoluble  powders  in  mixtures. 

Acaciae,  Syrupus  (10  per  cent.;  should  be  freshly 
made). 

Physiologic  Action  and  Uses. — Demulcent.  Used 
to  suspend  insoluble  powders  in  mixtures. 

Acetanilidi,  Pulvis  Compositus  (acetanilid  70, 
caffeine  10,  sodium  bicarbonate  20). 

AdvlUDosage. — Min.,  gr.  v;  av.,  viiss;  max.,  x. 

Method  of  Administration. — Pulveris  acetani- 
lidi compositi,  gr.  viiss. 

Mitte  talis  pulveres  no.  8. 

Sig. — Une  powder  three  or  four  times  a day,  as 
required. 

Acetanilidum;  antifebrm  (soluble  in  190  of  water; 
3.4  of  alcohol). 

H 

C 

/\ 

HC  I I CH 

HC  I CH 

\/  H 

C-N<^ 

COCHs 

Adult  Dosage. — Min.,  gr.  i;  av.,  iii;  max.,  y. 

Method  of  Administration. — Acetanilidi,  gr. 
iss-ii. 

Mitte  talis  pulveres  sive  tabellse  vel  capsulae,  no.  8. 

Sig. — One  every  hour  or  two,  until  effectual;  or 
three  or  four  times  a day,  as  required.  Tablets 
should  be  crushed  before  swallowing. 

Physiologic  Action  ami  Uses. — Analgesic;  nervous 
sedative ; antipyretic  acting  upon  the  heat-regiflating 
centre.  An  unsafe  drug,  now  largely  replaced  by 
phenacetin.  Local  antiseptic  and  analgesic. 

Toxic  Action. — -Cardiovascular  and  respiratory 
depression;  sweating,  vomiting,  cyanosis,  methsemo- 
globinEemia  and  methajmoglobinuria,  collapse;  a 
dangerous  drug. 

Aceticum,  Acidum  (CH3COOH,  36  per  cent,  in 
water). 

Use. — Local  escharotic. 

Toxic  Action. — -Gastro-enteritis. 

Aceticum,  Acidum,  Dilutum  (acetic  acid  10,  dis- 
tilled water  50;  contains  6 per  cent,  of  absolute 
acetic  acid). 

Adult  Dosage. — Min.,  iiyxv;  av.,  xxx;  max.,  5iii. 

Uses. — Refrigerant;  diuretic;  urinary  acidifier 
(oxidized  into  carbonic  acid);  antiseptic;  haemo- 
static; anthelmintic. 

Aceticum,  Acidum,  Qlaciale,  CH2COOII. 

Use. — Local  escharotic. 

Toxic  Action. — Gastro-enteritis. 

Acetonum;  Dimethyl-ketone: 

(miscible  with  water,  alcohol,  ether,  and  chloroform). 


f/se.— Pharmaceutic  solvent. 
Acetphenetidinum;  Phenacetin: 
O-C2H6 
C 


HC  I I CH  (soluble  in  1310  of  water;  15  of 
HC  I I CH  alcohol.) 


^\CO.CH., 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 years 
gr.  iss;  5 years,  gr.  ii.  Adult  min.,  gr.  v;  av.,  x; 
max.,  XV. 

Method  of  Administration. — Acetphenetidini, 
gr.  V. 

Mitte  tabs  pulveres  sive  tabelhe  vel  capsulae  no.  22. 

Sig. — One  powder  or  tablet  as  required,  or  about 
every  three  hours.  Allow  no  more  than  20  to  60 
grs.  in  twenty-four  hours  to  an  adult. 

Physiologic  Action  and  Uses. — Analgesic;  nervous 
sedative;  hypnotic;  antipyretic,  lessening  heat  pro- 
duction (comparatively  safe).  Local  antiseptic. 

Toxic  Action. — Cardiovascular  and  respiratory 
depression,  dyspnoea,  sweating,  cyanosis,  vomiting, 
methaemoglobinaemia  and  methaemiglobinuria,  col- 
lapse. 

Acetum  Cantharidis. 

Uses. — Rubefacient  and  vesicant. 

Toxic  Action. — Gastro-enteritis,  strangury,  pria- 
pism, h®maturia,  abortion,  convulsions,  coma. 

Acetum  Scillse  (10  per  cent,  in  dilute  acetic  acid, 
biologically  assayed). 

Adult  Dosage. — Min.,  tjjv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Aceti  Scillaj 
(biologically  assayed),  gss. 

Sig. — 15  drops  in  water,  three  or  four  times  daily. 

Physiologic  Action  and  Uses. — Expectorant;  diu- 
retic; slows  and  strengthens  the  heart,  and  raises 
the  arterial  pressure. 

Toxic  Action. — Vomiting,  purging,  strangury, 
hsematuria,  convidsions,  paralysis. 

Acetylsalicylicum,  Acidum;  Aspirin:  CsHiO 

(CHaCObCOOH.  1 : 2 (soluble  in  100  of  water, 
freely  in  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  min., 
gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — -R  Acidi  acetylsali- 
cylici,  gr.  v-xv. 

Mitte  talis  capsuke  sive  pulveres  in  charta  cerata 
no.  12. 

Sig. — -One,  four  or  five  times  a day,  or  every  three 
hours,  until  sahcylism  (ringing  in  the  ear,  etc.) 
is  noted. 

Physiologic  Action  ami  Uses. — Antirheumatic; 
antipyretic;  analgesic;  diaphoretic;  disinfectant  of 
the  pancreatic  ducts,  through  which  it  is  excreted. 

Toxic  Action. — Symptoms  of  salicylate  poisoning. 
{q.v.) 

Acidi  Arsenosi,  Liquor  (arsenic  trioxide  1 per  cent.^ 
in  dilute  hydrochloric  acid  5 per  cent.,  and  water). 


ACIDUM  BORICUM 


Method  of  Administration. — Liquoris  acidi 
arsenosi. 

Sig. — TTtfiii,  well  diluted,  t.i.d.p.c. 

Acidi  Borici.Unguentum  (boric  acid  10,  paraffin  10, 
white  petrolatum  80). 

Uses. — Antiseptic,  emollient  and  protective. 

Acidi  Carbolici,  Qlyceritum  (liquid  phenol  20; 
glycerine  80). 

Adult  Dosage. — Min.,  T^iii;  av.,  v;  max.,  x. 

Method  of  Administration. — Glyceriti  acidi 
carbolici,  51- 

Sig. — 15  minim.s  in  two  tablespoonfuls  of  warm 
water,  as  a mouth-wash. 

Physiologic  Action  and  Uses. — Anti.septic.  Fats, 
vegetable  oils,  and  glycerine,  however  (excepting 
lanoline  and  liquid  petrolatum),  almost  prevent  the 
germicidal  action  of  phenol. 

Acidi  Carbolici,  Trochisci  (gr.  }4)  et  mentholis 
(grl^o). 

Uses. — Throat  antiseptic  and  anodyne. 

Acidi  Carbolici,  Unguentum  (Phenol  3,  white 
petrolatum  97). 

Uses. — Antiseptic  emollient. 

Acidi  Citrici,  Syrupus  (citric  acid  1,  distilled  water 
1,  tr.  of  lemon  peel  50  per  cent.  1,  syrup  to  100). 

Adult  Dosage. — Indefinite. 

Uses. — Flavor  and  vehicle  for  salty  substances, 
such  as  bromides. 

Acidi  Hydriodici,  Syrupus  (1  per  cent,  of  HI). 

Dosage. — 5 years,  irjv-x.  Adult,  min.,  5ss;  av., 
i;  max.,  ii. 

Method  of  Administration. — 1^  Syrupi  acidi 
hydriodici,  gii. 

Sig. — One  dram,  well  diluted,  t.i.d. 

Uses. — Alterative;  used  also  for  coughs. 

Acidi  Pyrogallici,  Unguentum  (Pyrogallic  acid  or 
pyrogallol,  tri-hydroxy-benzene,  CeH3(OH) 3,  1 part, 
lard  8 parts). 

Method  of  Administration. — -It  should  not  be 
applied  to  a large  surface,  for  fear  of  absorption. 

Uses. — ^Antiseptic  emollient. 

Toxic  Action. — Vomiting,  diarrhoea,  rigo's,  fever, 
nephritis. 

Acidi  Salicylici,  Collodium  (10  to  20  per  cent.). 

Uses. — Keratolytic  for  corns  and  calluses. 

Acidi  Salicylici,  Unguentum. 

Method  of  Administration. — I^  Acidi  salicylici, 
gr.  v-x-xxx-xlviii;  Petrolati  et  Adipis  lame  hydrosi, 
aa,  5ss. 

Uses. — Antiseptic,  parasiticide,  keratolytic. 

Acidi  Tannici,  Qlyceritum  (Tannic  acid  1,  gR- 
cerine  4). 

Adult  Dosage. — n^xx-x. 

Method  of  Administration. — Throat  paint.  As  a 
gargle  or  spray:  5i  ad  aquam  Oi. 

Uses. — Astringent;  hardening  agent  for  sore 
nipples. 

Acidi  Tannici,  Trochisci  (gr.  i). 

Uses. — Throat  astringent. 

Acidi  Tannici,  Unguentum  (20  per  cent,  in  glycer- 
ine and  petrolatum). 

Uses. — Astringent  emollient;  useful  in  the  treat- 
ment of  hemorrhoids. 

Acidum  Aceticum  (36  per  cent,  of  CII3COOII  in 
water). 

Uses. — Local  caustic;  rubefacient;  parasiticide. 

T oxic  Action. — Gastro-enteritis. 

Acidum  Aceticum  Dilutum  (acetic  acid  10,  dis- 
tilled water  50;  contains  6 per  cent,  of  absolute 
acetic  acid) . 

Adult  Dosage. — Min.,  injxv;  av.,  xxx;  max.,  piii- 

Physiologic  Action  ami  Uses. — Refrigerant;  diu- 
retic; diaphoretic;  urinary  acidifier  (oxidized  into 
carbonic  acid);  hoemostatic;  anthelmintic;  anti- 
septic. 


Acidum  Aceticum  Glaciate,  CH3COOH. 

Uses. — -Local  escharotic. 

Toxic  Action. — Ga.stro-enteritis. 

Acidum  Acetylsalicylicum;  Aspirin:  (C6H4)0. 

(CH3CO).  COOH.  1:2  (soluble  in  100  of  water, 
freely  in  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 

3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  min., 
gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — Acidi  acetylsah- 
cylici,  gr.  v-xv. 

Mitte  talis  capsulae  sive  pulveres  in  charta  cerata, 
no.  12. 

Sig. — One,  four  or  five  times  a day,  or  every  three 
hours,  until  salicylism  (ringing  in  the  ear,  etc.) 
is  noted. 

Physiologic  Action  and  Uses. — Antirheumatic; 
antipyretic;  analgesic;  diaphoretic;  disinfectant  of 
the  pancreatic  ducts,  through  which  it  is  excreted. 

Toxic  Action.— Symptoms  of  salicylate  poisoning. 
(g.v.) 

Acidum  Agaricum.CigHseOH  (COOH)s-f  IJ^  HjO. 

Adult  Dosage. — Min.,  gr.  max., 

Method  of  Administration. — Acidi  agarici 
tabella?,  gr. 

Sig. — One  tablet  by  mouth  at  bedtime.  Give  no 
more  than  gr.  iss  in  one  day.  ( )w'ing  to  its  irritant 
action  it  cannot  be  given  hypodermically. 

Physiologic  Action  and  Uses. — Anhidrotic,  paralys- 
ing the  peripheral  nerves  of  the  sweat  glands.  The 
action  appears  in  a few  hours,  and  is  not  lasting. 

Toxic  Action. — Purgation  and  vomiting. 

Acidum  Arsenosum;  Arseni  trioxidum:  AS2O3 

(soluble  in  about  100  of  water;  readily  soluble  in 
solutions  of  acids  or  alkalies). 

Dosage. — 18  months,  gr.  >^00;  3 years,  gr.  ’{so;  5 
years,  gr.  ’foo.  Adult,  min.,  gr.  lUi  av.,  ’{ol  max.,  Mo- 

Method  of  Administration. — R Acidi  arsenosi,  gr.  ’^o- 

Mitte  talis  tabellaj  no.  24. 

Sig. — Two  tablets,  t.i.d.p.c.,  gradually  increased  by 
gr.  Mo,  t.i.d. 

Uses. — ^Stomachic;  tonic;  alterative;  haematinic; 
antiseptic.  Local  escharotic. 

Toxic  Action. — (Edema  and  itching  or  burning  of 
the  eyelids,  salivation,  nausea,  and  vomiting,  epi- 
gastric pain  and  soreness,  diarrhoea,  thirst,  anore.xia, 
burning  in  the  mouth,  belching,  skin  eruptions, 
albuminuria,  odor  of  garlic  on  the  breath,  brownish 
pigmentation,  hyperkeratoses  of  the  skin,  nndtiple 
neuritis,  feeble  and  irritable  heart,  fatty  degeneration 
of  the  viscera. 

Acidum  Benzoicum:  CsHs.  COOH  (soluble  in 

275  of  water,  2.3  of  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii;  3 
years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  viii;  max.,  xv. 

Method  of  Administration. — 1^  Acidi  benzoici, 
gr.  viii. 

Mitte  talis  pulveres  sive  trochisci  no.  12. 

Sig. — One  powder  or  wafer  dissolved  in  water 
every  two  to  four  hours. 

Physiologic  Action  and  Uses. — Urinary  acidifier 
(excreted  partly  as  hippuric  acid);  diuretic;  dia- 
phoretic; antiseptic. 

Acidum  Boricum,  H3BO3  (soluble  in  18  of  water, 
18  of  alcohol,  4 of  glycerine). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  ppr. 

Method  of  Administration. — I^  Acidi  borici,  gr.  x. 

Mitte  talis  pulveres  no.  12. 

Sig. — One  powder  dissolved  in  water,  three  or 
four  times  daily.  Give  no  more  than  3i  a day. 

For  local  use:  One  to  four  drams  to  the  pint; 

4 per  cent,  is  a saturated  solution. 

Uses. — Urinary  acidifier  and  antiseptic;  local 
antiseptic.  Glycerine  used  as  a solvent  of  boric 


ACIDUM  NITROHYDROCHLORICUM  DILUTUM 


acid  in  aqueous  solution  more  or  less  destroys  its 
antiseptic  value  (Goodrich). 

Toxic  Action. — Vomiting,  purging,  albuminuria, 
headache,  insomnia,  subnormal  temperature,  feeble 
pulse,  depression,  erythematous  eruption  with 
swelling,  followed  by  exfoliation,  muscular  weakness, 
collapse. 

Acidum  Camphoricum. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Acidi  camphorici, 
gr.  XV. 

Mitte  talis  pulveres  no.  12. 

Sig. — -One  powder,  dry  on  the  tongue,  t.i.d.,  or 
about  two  hours  before  the  expected  sweat. 

Physiologic  Action  and  Uses. — Anhidrotic;  intes- 
tinal disinfectant;  sedative  action  on  the  respiratory 
centre. 

Acidum  Carbolicum  (Phenol),  CeHsOH. 

Adult  Dosage. — -Min.,  gr.  i;  max.,  iii. 

Method  of  Administration. — R Acidi  carbolici 
liquefacti,  3i- 

Sig. — One  drop  in  one  tablespoonful  of  water 
every  fifteen  minutes  for  three  or  four  hours. 

Physiologic  Action  and  Uses. — Gastric  sedative 
and  antiseptic;  local  antiseptic  in  strength  of  gr.  v 
ad  5i;  disinfectant  in  5 per  cent,  strength,  or  1 : 20, 
local  anresthetic  and  caustic;  antipruritic. 

Toxic  Action. — ^Gastritis,  fall  of  temperature,  fall 
of  blood-pressure,  slowing  of  the  heart  and  respira- 
tion, smoky  urine,  collapse,  stupor,  coma,  convul- 
sions, paralysis. 

Acidum  Chromicum;  Chromii  Trioxidum:  CrOa 
(soluble  in  0.6  of  water). 

Method  of  Administration. — To  fuse  the  acid  on  the 
end  of  a probe,  first  warm  the  probe,  dip  it  in  the 
chromic  acid  crystals,  and  then  warm  the  part  of  the 
probe  next  beyond  the  crystals  until  the  latter  melt. 

Uses. — Caustic. 

Acidum  Citricum:  H3C6H5O7+H2O  (soluble  in 

0.5  of  water  and  1.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xv. 

Method  of  Administration. — Acidi  citrici,  gr.  xvii, 
ad  aquam  5ss  is  equivalent  to  fresh  lemon  juice,  5ss. 

U ses. — Ref  rigerant . 

Acidum  Disethylbarbituricum;  Veronalum: 

CzHa.  /CO— NH 

\q/ 

CaHs/"  \C0— NH 

(soluble  in  about  150  of  cold  water,  about  12  of 
boiling  water;  and  soluble  in  8 of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — R Veronali,  gr.  v, 
pulveres,  tabellae,  vel  capsula*  no.  6. 

Sig. — One,  one  and  one-half  to  two  hours  before  bed- 
time, followed  by  a cupful  of  hot  water,  tea,  or  milk. 

Keep  the  bowels  active  with  salines,  and  give 
alkalies,  on  prolonged  use  of  the  drug. 

Physiologic  Action  and  Uses. — Hypnotic;  gr.  viii 
have  been  fatal;  relatively  safe  in  small  doses;  begins 
to  act  in  about  half  an  hour. 

Toxic  Action. — Abdominal  pain,  sweating,  pyrexia 
erythema,  neuralgia,  nausea,  vomiting,  oliguria, 
glycosuria,  ataxia,  somnolence  deepening  to  coma, 
trembling  and  restlessness  during  the  sleep,  fall 
of  temperature. 

Acidum  Gallicum  (soluble  in  87  of  water,  4.0  of 
alcohol,  10  of  glycerine). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Acidi  gallici,  gr.  xv. 

Mitte  talis  pulveres,  capsulae,  sive  tabellce  no.  12. 

Sig. — One,  three  or  four  times  daily. 

Uses. — Astringent;  hsemostatic. 

Acidum  Hydriodicum  Dilutum  (10  per  cent,  of  HI 
by  weight). 


Adult  Dosage. — Min.,  igjv;  av.,  x;  max.,  lx. 

Method  of  Administration. — R Acidi  hydriodici 
diluti,  5i. 

Sig. — Ten  drops  in  a tablespoonful  of  water, 
t.i.d. 

Uses. — Alterative;  used  also  for  coughs. 

Acidum  Hydrobromicum  Dilutum  (10  per  cent, 
of  HBr). 

Adult  Dosage. — Min.,  tijjxx;  av.  5i;  nnax.  5ii. 

Method  of  Administration. — R Acidi  hydrobro- 
mici  diluti,  Bii. 

Sig. — One  dram,  well  diluted,  every  three  or 
four  hours. 

Uses. — Nervous  sedative. 

Acidum  Hydrochloricum  Dilutum  (10  per  cent,  of 
HCl  by  weight). 

Dosage. — 6 months,  gt.  to  18  months,  gt.  i; 

3 years,  gtt.  ii;  5 years,  gtt.  iii-v.  Adult,  min.,  ngv; 
av.,  XV ; max.,  x.xx. 

Method  of  Administration. — R Acidi  hydrochlo- 
rici  diluti,  5ii- 

Sig. — 20  drops  in  half  a tumbler  of  sweetened 
albumen  water,  taken  through  a straw  or  glass  tube, 
during  and  one-half  to  one  hour  after  meals.  Rinse 
the  mouth  afterward  with  soda  water. 

Uses. — Digestant;  antiseptic  and  antifermenta- 
tive;  astringent.  Astringent  gargle. 

Acidum  Hydrocyanicum  Dilutum  (2  per  cent,  of 
HCN  by  weight;  keep  tightly  stoppered  in  a cool, 
dark  place;  it  will  decompose  within  a year). 

Adult  Dosage. — Min.,  tiji;  av.,  iss;  max.,  iii  (not 
drops). 

Method  of  Administration. — R Acidi  hydro- 
cyanici  diluti,  iijiv;  aquam,  ad,  oiv. 

M.  Sig. — One  dram,  repeated  if  necessary. 

Uses. — Gastric  analgesic  and  sedative. 

Toxic  Action. — Palpitation,  cardiac  depression, 
dizziness,  tinnitus,  vomiting,  muscular  weakness, 
dyspnoea,  salivation,  headache,  numbness;  often 
insensibility,  convulsions  or  rigidity  and  death. 

Acidum  Hypophosphorosum  Dilutum  (10  per  cent, 
of  H3PO2  in  water). 

Adult  Dosage. — Min.,  t^v;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Acidi  hypophos- 
phorosi  diluti,  5ii- 

Sig. — 20  drops  in  water,  t.i.d. 

U ses. — Aphrodisiac. 

Acidum  Lacticum  (75  per  cent,  by  weight). 

Dosage. — 18  months,  gt.  i;  3 years,  gtt.  ii;  5 years, 
gtt.  iii-v.  Adult,  min.,  njjxx;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — R Acidi  lactici  et 
syrupi  simplicis,  aa,  5i- 

M.  Sig.-— One  dram  in  water  eveiy  two  hours. 

Uses. — Intestinal  antifermentative;  local  anti- 
septic. Caustic  in  pure  form  : dissolves  protein  and 
keratin. 

Acidum  Monochloraceticum. 

Uses. — Caustic. 

Acidum  Nitricum,  HNO3. 

Method  of  Administration. — Apply  by  means  of  a 
glass  rod  or  matchstick,  with  the  surrounding 
healthy  tissue  protected  by  vaseline. 

Uses. — Caustic. 

Acidum  Nitricum  Dilutum  (10  per  cent,  of  HNO3 
by  weight). 

Adult  Dosage. — Min.,  t^x;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — R Acidi  nitrici  diluti, 

Sig. — 30  drops  in  a wineglassful  of  water,  t.i.d., 
taken  through  a glass  tube.  Rinse  the  mouth  after- 
ward with  soda  water. 

Uses. — Cholagogue;  acid. 

Acidum  Nitrohydrochloricum  Dilutum  (nitric  acid 
4,  hydrochloric  acid  18,  water  78  vols. ; should  be 
freshly  prepared). 


ACIDUM  TARTARICUM 


Adult  Dosage. — Min.,  ttjv;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Acidi  nitrohydro- 
'chlorici  diluti,  3i. 

Sig. — Fifteen  drop.s  in  a wineglassfid  of  water, 
t.i.d.,  taken  through  a glass  tube.  Rinse  the  mouth 
afterward  with  soda  water. 

Uses. — Cholagogue;  acid. 

Acidum  Oleicum  (practically  insoluble  in  water; 
partially  soluble  in  60  per  cent,  alcohol). 

Uses. — Emollient;  solvent  for  making  oleates. 

Acidum  Oxalicum:  COOH 

ioOH 

(soluble  in  10  of  water). 

Adult  Dosage. — Min.,  gr.  Ko)  av.,  max., 

Method  of  Administration. — Acidi  oxalici, 
gr.  iv.  Syrupi  limonis,  5h- 

M.  Sig. — One  dram,  t.i.d. 

Uses. — Emmenagogue. 

Toxic  Action. — Burning  pain  in  the  throat  and 
abdomen,  vomiting,  small,  irregular  pulse,  collapse, 
stupor,  sometimes  convulsions,  respiratory  paralysis. 

Acidum  Phenylcinchoninicum;  Atophan: 
C6H6C9H6N.(C00II)  (insoluble  in  water;  only 
slightly  soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  viii;  max.,  xv. 

Method  of  Administration. — R Acidi  phenylcin- 
choninici,  gr.  xv,  pulveres  12. 

Sig. — One  powder,  suspended  in  a glassfid  o’f 
water,  two  or  three  times  a day,  (or  eight  grains 
four  times  a day),  together  with  sodium  or  potas- 
sium bicarbonate,  5iss-iii  -f-;  daily,  to  prevent  the 
deposition  of  free  uric  acid  m the  urinary  tract. 

Physiologic  Action  and  Uses. — Diuretic;  causes  a 
markedly  increased  excretion  of  uric  acid  by  the 
kidneys. 

Acidum  Phosphoricum  Dilutum  (10  per  cent,  of 
orthophosphoric  acid,  H3PO4). 

Dosage. — 6 months,  gtt.  i-ii;  18  months,  gtt.  ii-iii; 
3 years,  gtt.  v;  5 years,  gtt.  x.  Adult,  min.,  ttijx;  av., 
XXX ; max.,  xlv. 

Method  of  Administration. — Acidi  phosphorici 
diluti,  5ii. 

Sig. — Twenty  drops  in  a wineglassful  of  water, 
t.i.d. 

U ses. — Stomachic ; alterative ; refrigerant  beverage. 

Acidum  Picricum  (Trinitrophenol,  C6H20H(N02)3; 
soluble  in  78  of  water  and  12  of  alcohol). 

A one  per  cent,  solution  (gr.  Ixxvii  ad  Oi)  was  once 
extensively  used  for  burns.  It  should  not  be  applied 
to  a large  surface,  for  fear  of  absorption. 

Uses. — Local  antiseptic,  analgesic,  and  coagulant. 

Toxic  Action. — Nausea,  vomiting,  diarrhoea, 
strangury,  anuria,  yellow  staining  of  the  skin  and 
mucous  membranes. 

Acidum  Pyroligneum. 

Method  of  Administration. — 5ui-v  ad  aquam  Oii, 
as  a vaginal  douche  in  senile  vaginitis.  (Bandler.) 

Acidum  Salicylicum:  CelLiOIDCOOH  (soluble 

in  460  of  water,  but  readily  soluble  in  10  per  cent, 
sodium  phosphate  solution;  soluble  in  2.7  of  alcohol). 

Adult  Dotsage. — Min.,  gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Acidi  salicylic!, 
oiss;  sodii  phosphatis,  ohi;  aqiue,  q.s.  ad,  3iv. 

M.  Sig.— ^ne  tablespoonful,  well  diluted,  every 
four  hours. 

For  gastric  lavage,  gr.  xv  ad  Oi. 

As  a dusting  powder,  2 to  .5  per  cent.,  with  boric 
acid,  talcum,  starch,  or  zinc  oxide. 

Uses. — Antirheumatic  and  antipyretic;  local  anti- 
septic, parasiticide,  and  keratolylic. 

Toxic  Action. — Nausea,  vomiting,  tinnitus,  sense 
of  fulness  in  the  head,  disturbances  of  sight  and 
hearing,  sweating,  mydriasis,  delirium,  dyspnoea, 
slow  pulse,  nephritis. 


Acidum  Sodiophosphatum;  Sodii  Biphosphas: 
NaH2P04-(-H20.  (Very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  xv;  av.,  xxx;  max.,  3h 

Method  of  Administration. — R Sodii  biphos- 
phatis,  qiv;  syrui)i  simplicis,  o'v,  aquaj  destUlatse, 
q.s.  ad,  3iv. 

M.  Sig. — One  tablespoonful  in  water  every  three 
hours. 

It  may  be  given  up  to  one  ounce  a day  in  100 
ounces  of  distilled  water. 

Physiologic  Action  and  Uses. — Urinary  acidifier. 
Do  not  administer  hexamethylenamine  until  after 
the  acid  phosphate  has  left  the  stomach. 

Acidum  Sulphuricum  Aromaticum  (an  ether,  con- 
sisting of  sulphuric  acid,  H2SO4,  11  per  cent,  by 
volume  in  alcohol,  flavored  with  cinnamon  and 
ginger). 

Adult  Dosage. — Min.,  i^v;  av.,  xv;  max.  xx. 

Method  of  Administration. — R Acidi  sulphurici 
aromatici.  Si- 

Sig. — Fifteen  drops  in  a wineglassful  of  sweeten3d 
water,  every  three  or  four  hours,  taken  through  a 
glass  tube.  Rinse  the  mouth  afterward  with 
soda  water. 

Uses. — Astringent;  haemostatic;  urinary  acidifier. 

Acidum  Sulphuricum  Dilutum  (10  per  cent,  of 
II2SO4  by  weight). 

Adult  Dosage. — Min.,  ngv;  av.,  xxx;  max.,  xl. 

Method  of  Administration. — R Acidi  sulphurici 
diluti.  Si. 

Sig. — Thirty  drops  in  half  a glass  of  sweetened 
water,  every  three  or  four  hours,  taken  through  a 
glass  tube.  Rinse  the  mouth  afterward  with  soda 
water. 

Uses. — Astringent;  haemostatic;  urinary  acidifier. 

Acidum  Sulphurosum,  H2SO3. 

Adult  Dosage. — Min.,  i^v;  av.,  xxx;  max.,  be. 

Method  of  Administration. — -Antiseptic  spray  or 
application  to  mucous  membranes  and  skin. 

As  an  astringent  gargle  or  spray:  gr.  v-x  ad  Si- 

Uses. — Local  antiseptic;  gastric  antifermentative. 

Acidum  Tannicum;  Tannin  (soluble  in  1 of  water; 
very  soluble  in  alcohol  and  glycerine.) 

Adult  Dosage. — Min.,  gr.  ii;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Acidi  tannici, 
gr.  X. 

Mitte  talis  trochisci  sive  pihila?  sive  capsulaj  no.  12. 

Sig.— One  t.i.d. 

As  a gargle,  oi  ad  Oi. 

As  an  astringent  enema,  1 to  2 per  cent,  solution. 

Suppository  for  hemorrhoids,  gr.  viii. 

Physiologic  Action  and  Uses. — Astringent;  haemo- 
static. It  coagulates  protein  in  or  on  the  tissues, 
and  thus  hardens  them. 

Toxic  Action. — ^Vomiting  due  to  gastric  irritation. 

Acidum  Tannicum  Diacetylicum;  Tannigen  (CH3, 

C0)2ChH309- 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-ii, 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  Min. 
gr.  viii;  Max.,  .xv. 

Method  of  Administration. — R Tannigen,  gr.  x, 
pulveres  no.  12. 

Sig. — One,  four  times  a day,  dry  on  the  tongue, 
followed  by  a swallow  of  water;  or  it  may  be 
sprinkled  on  food 

It  may  be  given  up  to  oii  daily. 

Physiologic  Action  and  Uses. — Astringent;  insol- 
uble in  the  gastric  juice,  but  splits  off  tannic  acid  in 
the  alkaline  fluids  of  the  intestjne. 

Acidum  Tartaricum  (soluble  in  0.75  of  water,  and 
in  3.3  of  alcohol). 

Adult  Dosage. — Min.,  p.  v;  av.,  x;  max.,  xx. 

Method  of  Administratiori. — TSventy  grains  exactly 
neutralize  22  grains  of  sodium  bicarbonate,  with  the 
effervescence  of  carbon  dioxide  gas. 


^THER 


Physiologic  Action  and  Uses. — Mild  acid;  used  in 
the  manufacture  of  effervescent  salts. 

Toxic  Action. — ^Vomiting. 

Acidum  Trichloraceticum:  CCI3COOH. 

Uses. — Caustic;  styptic. 

Acoi n ( Alkyloxypheny Iguanidin) . 

Method  of  Administration. — 0.1  to  0.3  per  cent, 
solution  by  instillation. 

Uses. — Local  amesthetic  and  bactericide. 

Aconitina:  C34H47NO11  (Aconitine  crystalis6e  of 

Dequesnel;  alkaloid). 

Adult  Dosage. — -Min.,  gr.  ’(00  av.,  Kooi  max.,  ]4oo- 

Method  of  Administration. — Aconitirue,  gr. 
Koo,  pillulae  no.  10. 

Sig. — One  pill  every  four  to  two  hours. 

Physiologic  Action  and  Uses. — Circulatory  seda- 
tive, analgesic,  diaphoretic,  and  antipyretic,  indi- 
cated in  beginning  fevers  with  high  temperature, 
rapid,  strong  pulse,  and  dry,  hot  skin.  It  slows  and 
steadies  the  heart  by  stimulating  the  vagus  roots, 
lowers  the  blood-pressure,  slows  the  respiration,  and 
depresses  the  peripheral  nerve  terminations,  especi- 
ally the  sensory.  It  should  be  used  temporarily  only 
in  sthenic  subjects  with  vascular  excitement.  Local 
counter-irritant  and  anesthetic. 

Toxic  Acifon.— Cardiac  and  respiratory  depres- 
sion, weak,  irregular  pulse,  dyspnoea,  fall  of  blood- 
pressure  and  temperature,  feeling  of  chilliness  and 
general  weakness,  general  tingling  sensations,  sense 
of  faucial  constriction,  salivation,  perhaps  nausea 
and  vomiting,  dilatation  of  the  pupils,  collapse. 

Aconiti  Tine tura  ( 10  per  cent,  assayed  biologically) . 

Dosage. — 6 months,  gt.  18  months,  gt. 

3 years,  gt.  i;  5 years,  gtt.  i-ii.  Adult,  min.,  irgi; 
av.,  iii;  max.,  ix. 

Method  of  Administration. — I^  Tincturae  aconiti 
(assayed  biologically),  3i- 

Sig. — One  drop  in  water  every  fifteen  minutes 
until  effectual,  or  1 to  5 drops  every  one  to  two  hours, 
as  required;  no  more  than  njxxxv  in  one  day.  (See 
Aconitina,  above.) 

Acriflavine;  Trypaflavine;  3-6  diamino-lO-methyl- 
acridinium  chloride : 


H 

C 


H2N\/\/\/NHj 

/N\ 

CHs  Cl 

Uses. — Antiseptic,  1 : 4,000 — 1,000  in  normal 
saline  solution  (0.85  per  cent. 

Addison’s  Pill. — R Pulveris  digitalis,  gr.  i;  pulveris 
scillai,  gr.  i;  hydrargyri  chloridi  mitis,  gr.  %. 

Misce  et  fiat  pilula. 

Sig. — One  pill  twice  daily. 

Uses. — Cardiovascular  tonic,  diuretic,  laxative. 

Adeps  Benzoinatus  (1  to  2 per  cent,  of  powdered 
benzoin  in  hog  lard). 

f/ses.— Ointment  basis,  used  particularly  when 
absorption  is  desired. 

Adeps  Lanae  Hydrosus;  Hydrous  Wool-fat  of  the 
sheep;  Lanolin  (miscible  with  about  twice  its  weight 
of  water). 

[/ses.— Ointment  basis,  employed  when  it  is 
desired  that  the  medicament  be  absorbed  by  the  skin. 

Adhesive  Plaster;  Emplastrum  Adha?sivurn  (rub- 
ber 2,  petrolatum  2,  lead  plaster  9(i). 

Adnesive  plaster  may  be  removed  by  means  of  a 
small  quantity  of  oil  of  wintergreen.  (Potter.) 

Adonidinum  (a  glucoside:  C24II40O9). 

Adult  Dosage. — Min.,  gr.  U;  max., 

Method  of  Administration. — R Adonidini,  gr.  }{. 

Mitte  talis  tabellai  no.  18. 


Sig. — One  tablet  four  to  six  times  daily. 

Physiologic  Action  and  Uses. — Cardiovascular 
tonic;  diuretic;  slows  and  strengthens  the  heart., 
and  raises  the  arterial  tension;  slows  and  strengthens 
the  respiration. 

Toxic  Actum. — Nausea,  vomiting,  diarrlima,  rapid 
heart  action. 

Adonis  Vernalis,  Fluidextractum. 

Adult  Dosage. — Min.,  ajss;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Fluidextracti 

adonidis  vernalis,  3i- 

Sig. — Three  drops  in  water,  four  to  six  times  daily. 

Physiologic  Action  and  Uses. — Cardiovascular 
tonic;  diuretic;  slows  and  strengthens  the  heart,  and 
raises  the  arterial  tension;  slows  and  strengthens 
the  respiration. 

Toxic  Action. — See  under  Adonidinum. 

Adonis  Vernalis,  Infusum. 

Adult  Dosage. — Min.,  3i;  max.,  iv. 

Method  of  Administration. — R Infusi  adonidis 
vernalis  recentis,  §iv. 

Sig. — -Four  drams  every  two  to  four  hours. 

Physiologic  Action  and  Uses. — Cardiovascular 
tonic;  diuretic;  slows  and  strengthens  the  heart, 
and  raises  the  arterial  tension;  slows  and  strengthens 
the  respiration. 

Toxic  Action. — See  under  Adonidinum. 

Adrenal  Gland  (fresh  sheep’s  gland,  kept  on  ice; 
1 gland  = about  2 mg.  of  adrenalin). 

Method  of  Administration. — Grind  up  with  gly- 
cerine and  normal  saline  solution,  1 teaspoonful  to 
the  ounce,  allow  to  stand  for  half  an  hour,  filter 
through  muslin,  and  take  at  once — one  or  two  or 
more  a day. 

Uses. — Used  in  Addison’s  Disease  and  in  hsema- 
temesis. 

Adrenal  Gland,  Powdered  (about  0.5  per  cent,  of 
epinephrin). 

Adult  Dosage. — Min.,  gr.  iii;  av.,  v;  max.,  xx. 

Method  of  Administration. — R Glandulae  supra- 
renalis  siccaj,  gr.  v-xx. 

Mitte  talis  pulveres  no.  21. 

Sig. — One  powder,  by  mouth,  t.i.d. 

Gr.  ii  -j-  every  half  hour,  to  a one-year  old,  for 
hsematemesis.  (Holt.) 

Uses. — Used  in  Addison’s  Disease  and  in  haima- 
temesis. 

Adrenalinum  Chloridum,  1 : 1000  solution  (iiRx  = 
gr.  Koo  of  the  chloride).  See  also  Epinephrin. 

Dosage. — 18  months,  Trjii;  3 years,  t^v;  5 years, 
iTjv.  Adult,  min.,  irjv;  av.,  x;  max.,  xxx. 

Method  of  Administration. — ^ Adrenalini  chlo- 
ridi, 1 : 1000,  Bi. 

Sig. — Ten  to  thirty  drops  in  a teaspoonful  of 
water,  by  mouth,  every  one  to  four  hours,  for  two 
or  three  doses. 

If  given  hypodermically,  it  should  be  administered 
in  one  pint  of  normal  saline  solution,  very  slowly. 

Physiologic  Action  and  Uses. — Hasmostatic;  stim- 
ulates the  vaso-constrictor  nerve  endings,  tliereby 
also  raising  the  blood-pressure.  Its  effects  last  only 
a few  minutes.  See  also  Epinephrin. 

Toxic  Action. — Facial  pallor,  rise  in  blood-pressure, 
tachycardia,  general  trembling,  glycosuria,  due  to 
stimulation  of  glycogen  transformation  in  the  liver, 
albuminuria,  necrosis  of  liver  and  kidney  cells,  ather- 
oma of  vessels.  Unless  well  diluted  with  normal  sal- 
ine solution,  the  h}q3odermic  administration  of 
adrenalin  may  produce  fibrillation  of  the  ventricles. 

/Ether  (C2H6)20  (soluble  in  12  of  water). 

Adult  Dosage. — Min.,  njx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R /Etheris,  Bss. 

Sig. — Fifteen  to  thirty  drops,  in  sweetened  water, 
every  hour,  or  as  required.  Hypodermically,  for 
heart-failure,  njx-xx-lx. 


AGARICUM  ACIDUM 


Physiologic  Action  and  Uses. — Cardiovascular 
stimulant;  stimulant  of  the  vaso-constrictor  and 
respiratory  centres;  anodyne;  carminative;  anti- 
spasmodic;  sedative;  general  anaesthetic  (contra- 
indicated in  bronchial  and  renal  disease.) 

Toxic  Action. — -Undue  slowing  of  the  respiration, 
and  rapid  heart  action.  Treatment. — Lower  the 

patient’s  head,  draw  the  tongue  forward,  but  not 
too  far,  perform  artificial  respiration,  apply  heat  to 
the  trunk  and  limbs,  slap  the  face  and  chest  with  a 
cold,  wet  towel,  administer  strychnine  and  atropine 
hypodermically. 

Ether  pneumonia  is  possibly  due  to  the  aspiration 
of  mucus  and  sahva,  the  secretion  of  which  is  in- 
creased by  ether.  This  may  be  lessened  or  pre- 
vented by  a hjrpodermic  of  atropine  or  scopolamine 
just  before  the  administration  of  the  ether. 

Conditions  in  which  anaisthesia  is  dangerous; 
cardiac  degeneration  or  dilatation,  renal  disease, 
pulmonary  disease,  asthma,  diabetes  mellitus, 
arteriosclerosis,  chronic  alcoholism,  cerebral  tumor, 
fainting  spells,  enlarged  tonsils. 

/Etheris  Spiritus  (Ether,  alcohol  %). 

Adult  Dosage. — Min.,  njx;  av.,  5i;  max.,  ii. 

Method  of  Administration. — 1^  Spiritus  setheris,  § i. 

Sig. — Teaspoonful  in  a wineglass  of  sweetened 
water,  as  required,  or  every  one  to  three  hours. 

Uses. — Diffusible  stimulant;  anodyne;  carmina- 
tive ; aids  digestion  of  fats. 

/Etheris  Spiritus  Compositus  (Hoffmann’s  ano- 
dyne: ether  323/2>  alcohol  65,  ethereal  oil  2}/2). 

Dosage. — 6 months,  gtt.  ii;  18  months,  gtt.  iii-v; 
3 years,  gtt.  v;  5 years,  gtt.  v-x.  Adult,  min.,  5ss; 
av.,  i;  max.,  ii. 

Method  of  Administration. — R Spiritus  setheris 
compositi,  5i- 

Sig. — One  teaspoonful  in  a wineglass  of  water,  as 
required,  or  every  one  to  three  hours. 

Physiologic  Action  and  Uses. — Diffusible  stimu- 
lant; anodyne;  carminative;  aids  digestion  of 
fats. 

Etheris  Spiritus  Nitrosi  (Sweet  Spirits  of  Nitre; 
ethyl  nitrite,  C2H5NO2,  4 per  cent,  in  alcohol; 
miscible  with  alcohol  or  water;  should  not  be  kept 
long,  as  it  turns  acid). 

Dosage. — 6 months,  gtt.  ii-iii;  18  months,  gtt.  iii-v 
3 years,  gtt.  y;  5 years,  gtt.  v-x.  Adult,  min.,  3ss; 
av.,  i;  max.,  ii. 

Method  of  Administration. — R Spiritus  setheris 
nitrosi,  §i. 

Sig. — One  teaspoonful  well  diluted  in  sweetened 
water,  every  one  to  three  hours. 

Uses. — Diaphoretic;  diuretic;  carminative. 

Ethylis  Carbamas;  Urethane:  NH2.  CO.  0(C2ll6) 
(soluble  in  0.45  of  water,  and  in  0.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — In  powder,  cachets, 
or  solution,  best  gr.  v,  frequently  repeated,  as  a 
full  dose  may  cause  vomiting.  (Potter.) 

Uses. — Very  mild  hypnotic,  diuretic. 

Ethylis  Chloridum,  C2II5CI. 

Physiologic  Action  and  Uses. — Transient  general 
anajsthetic;  local  ana'sthetic  in  the  form  of  a spray, 
producing  intense  cold. 

Ethylis  Hydrocupreinae  Hydrochloridum;  Opto- 
chin  (a  quinine  alkaloid)  Hydrochloride;  Ci>iH22N2. 
OH.  O.  C2II5.  HCl. 

Adult  Dosage. — Av.,  gr.  viiss  t.i.d. 

Method  of  Administration. — One  to  2 per  cent, 
aqueous  solution,  freshly  prepared,  or  1 to  2 per 
cent,  solution  in  oil  or  ointment;  specific  in  serpent 
ulcer  of  the  cornea  due  to  the  pneumococcus;  1 to  2 
per  cent,  solution  as  a gonococcocide. 

For  pneumonia,  0.024  gram  per  kilogram  of  body 
weight  every  twenty-four  hours  is  required  to  pro- 


duce a bactericidal  action  in  the  blood  serum.  Thus, 
for  the  average  sized  individual,  the  amount  for 
twenty-four  hours  is  1.5  grams,  administered  as 
follows:  initial  dose,  0.45  gram,  followed  every 

three  hours  by  0.15  gram;  second  twenty-four  hours, 
ten  doses  of  0.15  gram;  best  given  in  capsule.  (Allan 
M.  Chesney.) 

Uses. — Antiseptic ; antipneumococcic. 

Toxic  Action. — Tinnitus,  deafness,  amblyopia, 
amaurosis;  retinitis. 

Ethylis  lodidum,  C2H5I. 

Adult  Dosage. — Av.,  i^xv. 

Method  of  Administration. — On  lint,  inhaled,  in 
asthma. 

Uses. — Antispasmodic;  general  stimulant;  anaes- 
thetic. 

Ethylmorphinae  Hydrochloridum;  Dionin  (solu- 
ble in  8 of  water;  22  of  alcohol.) 

Dosage. — 6 months,  gr.  tfooi  18  months,  gr.  ’loo; 
3 years,  gr.  5 years,  gr.  ]ia.  Adult,  min,  gr. 
av.,  max.,  Yi. 

Method  of  Administration. — R Ethylmorphinae 
hydrochloridi,  gr.  Y,  tabellae  no.  6. 

Sig. — Tablet  two  or  three  times  a day,  as  required. 

As  a local  ophthalmic  analgesic  and  lymphagogue, 
a 4 to  10  per  cent,  aqueous  solution,  1 drop  three  or 
four  times  a day;  or  1.5  to  10  per  cent,  ointment. 
Chemosis,  redness,  and  burning  should  continue  for 
from  one  to  two  minutes  after  its  application,  in 
order  to  secure  the  desired  therapeutic  effect. 

Physiologic  Action  and  Uses. — Nervous  sedative 
and  analgesic;  action  upon  the  respiratory  and  cough 
centres  the  same  as  that  of  codeine;  ophthalmic 
analgesic  and  lymphagogue,  causing  local  hyperiemia 
and  acute  conjunctival  oedema. 

Agaricinas  Sodii. 

Acbdt  Dosage. — Min.,  gr.  ii;  max.,  iv. 

Method  of  Administration. — R Sodii  agaricinatis, 
gr.  ii,  capsuliE  no.  6. 

Sig. — One  or  two  capsules,  at  bedtime. 

Uses. — Anhidrotic. 

Agar=Agar  (a  gelatinous  carbohydrate  obtained 
from  certain  varieties  of  Asiatic  seaweed). 

Dosage. — 3 to  5 years,  pi.  Adult,  Min.,  pi;  av., 
piiss;  max.,  gi. 

Method  of  Administration. — -To  be  taken,  t.i.d.,  in 
apple  sauce  or  mashed  potatoes,  with  no  water 
immediately  afterward,  continued  for  six  to  eight 
weeks,  gradually  reducing  the  dose.  Contraindi- 
cated in  marked  atony'.  (Ortner.) 

Physiologic  Action  and  Uses. — Laxative,  by  virtue 
of  the  fact  that  it  is  not  digested  or  absorbed,  and 
has  an  affinity  for  fluids. 

Agarici  AIbi,  Extractum  Alcoholicum. 

Adult  Dosage. — Av.,  gi-.  iii. 

Method  of  Administration. — R Extracti  alco- 
holici  agarici  albi,  gr.  iii. 

Mitte  tabs  pulveres  sive  pilulae  no.  6. 

Sig. — One  at  bedtime. 

Physiologic  Action  and  Uses. — Anhidrotic,  paraly- 
zing the  secretory'  nerve-endings  like  atropine. 

Toxic  Action. — Vomiting  and  purging. 

Agarici  Albi  Pulvis. 

Adult  Dosage. — Min.,  gr.  x;  max.,  xv. 

Method  of  Administration. — R Pulveris  agarici 
albi,  gr.  x-xv. 

Mitte  tabs  pulveres  no.  6. 

Sig. — <^ne  powder  at  bedtime. 

Physiologic  Action  and  Uses. — Anhidrotic,  paraly- 
zing the  secretory  nerv'e-endings  bke  atropine. 

Toxic  Action. — Vomiting  and  purging. 

Agaricum,  Acidum,  Ci9H360H(COOH)3-l-l}4H20. 

Adult  Dosage. — Gr.  Ka  to 

Method  of  Administration. — R Acidi  agarici, 
tabellae,  gr.  ’i 


AMMONIA  LINIMENTUM 


Sig. — One  tablet,  by  mouth,  at  bedtime. 

Give  no  more  than  gr.  iss  in  one  day.  Owing  to  its 
irritant  action  it  cannot  be  given  liypodermically. 

Physiologic  Action  and  Uses. — Anhidrotic,  paraly- 
zing the  peripheral  nerves  of  the  sweat  glands.  Xhe 
action  appears  in  a few  hours  and  is  not  lasting. 

Toxic  Action. — Vomiting  and  purging. 

Agurin  (TheobrominoeSodio-acetas) : NaC7H7N402 
-|-NaC2H302  (soluble  in  water). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xv-f-. 

Method  of  Administration. — 1^  Theobrominie 

sodio-acetatis,  gr.  xv. 

Mitte  talis  trochisci  sive  capsula;  sive  pulveres 
no.  12. 

Sig. — One,  t.i.d.,  in  water. 

Physiologic  Action  and  Uses. — Diuretic  (non-irri- 
tating) ; does  not  irritate  the  stomach. 

Albolenum  Liquidum  (petroleum  product). 

Method  of  Administration. — Instilled  with  a medi- 
cine dropper,  or  sprayed  with  an  oil  atomizer. 

Uses. — ^Emollient;  lubricant. 

Alcohol:  C2H6OII  (Ethyl  Alcohol). 

Dosage. — See  Whiskey  or  Brandy. 

Method  of  Administration. — See  Whiskey  or 
Brandy. 

Uses. — Local  antiseptic;  astringent;  rubefacient; 
and  refrigerant.  See  Alcohol  Dilutuni. 

Toxic  Action. — Chronic  alcoholism:  ga.stritis, 

dilatation  of  the  stomach,  renal  and  hepatic  disease, 
delirium  tremens,  peripheral  neuritis,  insanity. 

Alcohol  Dilutum  (alcohol  and  distilled  water, 
equal  parts). 

Uses. — Local  antiseptic;  astringent;  rubefacient; 
and  refrigerant.  Diluted  alcohol  is  more  antiseptic 
than  pure  alcohol  because  the  latter  causes  coagu- 
lation. Fifty  per  cent,  is  the  optimum  strength. 

Alkaline  Bath.  See  Baths,  Medicated. 

Allii,  Infusum  (Garlic  Infusion)  (2  or  3 bulbs, 
chopped  up,  and  boiled  in  1 quart  of  water  or  milk, 
and  strained). 

Method  of  Administration. — Inject  one-third  high 
into  the  colon  on  successive  days. 

Uses.  — Anthelmintic. 

Allii,  Oleum. 

Adult  Dosage. — Gtt.  ii,  t.i.d. 

Allii  Sativi  Succus  (fresh). — pi  every  4 to  6 
hours,  3ss  for  a child  under  12  years,  best  in  syrup. 
(Minchin).  Recommended  by  Minchin  as  an  anti- 
septic and  antitubercular.  The  fresh  bulb  may  be 
held  in  the  mouth  and  scored  occasionally  with  the 
teeth.  The  fresh  juice  with  equal  parts  of  water 
may  be  used  for  the  nose  and  throat. 

Allii  Syrupus  (Garlic  20  per  cent,  in  sweetened 
dilute  acetic  acid;  active  principle,  allyl  sulphide 

(C3H5)2S). 

Dosage. — -5  years,  3i-  Adult  Min.,  pi;  max., 
5iv. 

Method  of  Administration. — I^  Syrupi  alii,  gii. 

Sig. — One  to  four  teaspoonfuls,  according  to  age, 
t.i.d. 

Uses. — -Irritant  expectorant;  anthelmintic;  nerv- 
ous sedative. 

Toxic  Action. — Gastric  irritation,  flatulence,  hem- 
orrhoids, headache  and  fever. 

Almond  Oil.  See  Oleum  Amygdala:. 

Aloes  Extractum. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  viiss. 

Method  of  Administration. — R Extracti  aloes, 
pilulaj,  gr.  iii,  no.  24. 

Sig. — A pill  at  bedtime. 

Physiologic  Action  and  Uses. — Purgative;  acts  in 
eight  to  ten  hours,  chiefly  on  the  lower  bowel,  pro- 
ducing pelvic  congestion;  emmenagogue. 

Aloes  et  Ferri  Pilulae. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 


Method  of  Administration. — R Pilulae  aloes  ct 
ferri,  no.  24. 

Sig. — One  pill  t.i.d. p.c. 

Uses. — Purgative;  haematic;  emmenagogue. 

Aloes  et  Myrrhae  Pilulae. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 

Method  of  Administration. — R Pilulae  aloes  et 
myrrhae,  no.  24. 

Sig. — Gne  pill,  t.i.d. 

Uses. — Purgative ; emmenagogue. 

Aloes  Pilulae. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 

Method  of  Administration. — 1 to  2 to  5 pills  at 
bedtime. 

Uses. — Purgative. 

Aloinum. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Aloini,  gr.  i, 
pilulae  no.  24. 

Sig. — One  pill  at  bedtime,  with  plenty  of  water 
and  a cracker  or  other  food. 

Uses. — Purgative. 

Toxic  Action. — Renal  irritation. 

Alumen,  A1K(S04)2  + 12H20  (soluble  in  7.2  of 
water;  practically  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  x; 
pi  as  an  emetic. 

Method  of  Administration. — Gr.  v-xv-xxiv  ad  pi 
as  an  astringent  lotion  for  mucous  membranes. 

For  urethral  injection  : 0.5  to  1 per  cent, 

solution. 

Uses. — Astringent;  haemostatic;  styptic;  emetic. 

Toxic  Action. — Gastro-intestinal  irritation. 

Alumini  Acetas:  A1(C2H302)3. 

Method  of  Administration. — Alumini  acetatis, 
pi-iii  ad  Oi,  for  local  use. 

Uses. — Astringent;  antiseptic. 

Alumini  Acetatis,  Liquor. 

Method  of  Administration. — 1.  R Aluminii  sul- 
phatis,  giiiss;  Acidi  acetici,  5ivss;  aquae,  5x. 

2.  R Calcii  carbonatis,  5 iss;  aquae,  giiss. 

Add  1 to  2,  stirring.  (Kerley.) 

Uses. — Astringent  and  antiseptic  lotion. 

Alumini  Subacetatis,  Liquor  (A1(C2H302)20H, 
about  8 per  cent.). 

Method  of  Administration. — Dilute  usually  with 
about  four  to  nine  parts  of  water. 

Uses. — ^ Astringent  and  antiseptic  lotion. 

Alumnol;  Alumini  Naphtholsulphonas,  ALiCioHs. 
OH.  (803)2)  3. 

Method  of  Administration. — 0.5  to  5 per  cent,  solu- 
tion, for  local  use. 

Uses. — Antiseptic;  astringent. 

Alypin  (Hydrochloride  of  2-benzoxy-2-dimethyl- 
amino-methyl-l-dimethyl-amino-butane : CH3.CH2. 
C(C6H5C00)  [CH2N(CH3)2].CH2N:  (CH3)2.HC1. 

Method  of  Administration. — 10  per  cent,  solution 
externally;  1 to  4 per  cent,  hypodermically;  1 to  2 
per  cent,  solution  in  the  eye;  5 to  6 drops  of  a 5 
per  cent,  solution  for  vomiting. 

Uses. — Local  anajsthetic;  about  half  as  toxic  as 
cocaine. 

Ammoniae  Aqua  (10  per  cent,  by  weight  of 

NH3). 

Adult  Do.sage. — Min.,  i^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Aquae  ammoniae,  Ji 

Sig. — Five  to  thirty  drops,  well  diluted. 

Uses. — Fugacious,  indirect,  cardio-respiratory 
stimulant;  local  irritant  and  antacid. 

Ammoniae  Aqua,  Fortior  (28  per  cent,  by  weight 
of  NH3). 

Adult  Dosage. — Min.,  njii;  av.,  v;  max.,  x. 

Ammoniae  Linimentiim  (Aqua  ammonia:  35, 
cottonseed  oil  57,  alcohol  5,  oleic  acid  3). 

U ses. — Rubefacient ; counter-irritant. 


AMYLENUM  HYDRATUM 


Ammoni®  Spiritus  Aromaticus  (contains  ainmon. 
carbonate,  aq.  ammoniac,  oils  of  lemon,  lavender  and 
nutmeg,  alcohol  and  water). 

Dosage. — 6 months,  gtt.  hi;  18  months,  gtt.  ih-v; 
3 years,  gtt.  v;  5 years,  gtt.  v-x.x.  Adult,  min.,  irjxv; 
av.,  XXX ; max.,  lx. 

Method  of  Administrat  ion. — Spiritus  ammonia) 
aromatici,  5i- 

Sig. — One-half  to  one  teaspoonful  in  half  a tum- 
bler of  water,  every  one  to  two  hours.  A moderate 
dose  may  be  repeated  in  fifteen  to  thirty  minutes. 

Uses. — Transient  cardio-respiratory  stimulant; 
stimulating  expectorant ; carminative. 

Ammoniated  Mercury  Ointment  (Unguentum 
Hydrargyri  Ammoniati,  HgNH2Cl,  1 to  10  per  cent.) 

Uses. — Antiseptic  emollient. 

Ammonii  Acetatis  Liquor  (prepare  fresh  by  neu- 
tralizing dilute  acetic  acid  with  ammonium  carbon- 
ate, forming  a solution  of  (CH3COO)NH4,  about 
7 per  cent.). 

Dosage. — 18  months,  oss-i;  3 years,  3i;  5 years, 
5ii.  Adult,  min.,  oiij  nv.,  iv;  max.,  §i. 

Method  of  Administration. — R Liquoris  ammonii 
acetatis,  § iv. 

Sig.; — -A  tablespoonful  in  half  a glass  of  efferves- 
cent water,  every  two  to  three  to  four  hours. 

Physiologic  Action  and  Uses. — Diaphoretic;  diu- 
retic; stimulating  expectorant. 

Ammonii  Benzoas,  CeHsCOONIR  (soluble  in  10 
of  water;  35  of  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  5 years,  gr.  ui-v.  Adult,  min.,  gr.  v; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — R Ammonu  benzo- 
atis,  3ii  3ii;  aqum,  5ii- 

M.  Sig. — 3i“ii  in  water,  three  or  four  times  daily. 

Uses. — -Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antiseptic. 

Ammonii  Bromidum,  NIRBr  (soluble  in  1.5 
of  water). 

Dosage. — 6 months,  gr.  i-ih;  18  months,  gr.  ii-iv; 
3 years,  gr.  ui-v;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  ,xv;  max.,  ,xxx. 

Method  of  Administration. — R Ammonii  bro- 
midi,  3ii  3h;  aqua),  gii. 

M.  Sig. — 3 i-ii,  in  a wineglass  of  water,  two  to 
four  times  daily. 

Uses. — Nervous  sedative;  cerebral  depressant; 
anaphrodisiac ; diminishes  central  reflex  hyperexcit- 
ability. 

Toxic  Action. — Bromism  is  manifested  by  palatal 
and  pharymgeal  ansesthesia,  with  the  absence  of 
gagging  on  mechanical  irritation,  by  sexual  impo- 
tence, diminished  reflexes,  nervous  and  muscular 
depression,  apathy,  weakening  of  memory,  pallor, 
lowered  arterial  tension  and  temperature,  muddy 
complexion,  acne,  coated  tongue,  fetor  oris,  indi- 
gestion, emaciation,  drowsiness,  respiratory  catarrh, 
rapid  feeble  heart. 

Ammonii  Carbonas  (soluble  in  4 of  water). 

Dosage. — 6 months,  gr.  H-Hi  18  months,  gr.  ss-i; 
3 years,  gr.  i;  5 years,  gr.  i-ii.  Adult,  min.,  gr.  iii; 
av.,  v;  max.,  x. 

Method  of  Administration. — R Annnonii  car- 
bonatis,  3i  3i;  syrupi  acacia),  3ii- 

M.  Sig. — -One  dram  in  effervescing  water  or 
milk  every  two  to  four  hours. 

Physiologic  Action  and  Uses. — Stimulating  expec- 
torant; diffu.sible  stimulant.  It  is  probably  excreted 
in  part  in  the  bronchial  mucous  membrane,  where  it 
li(piefies  mucus  by  its  alkalinity,  and  stimulates 
ciliary  movements. 

Ammonii  Chloridum:  NH4CI  (soluble  in  2.6  of 

water). 

Dosage. — 6 months,  gr.  18  months,  gr. 


3 years,  gr.  i;  5 years,  gr.  i-ii.  Adult,  min.,  gr.  v; 
av.,  viiss;  max.,  xx. 

Method  of  Administration. — R Ammonii  chloridi, 
3ii  3ii  (gr.  v per  dram);  syrupi  acidi  citrici,  gii; 
aquae,  q.s.  ad.  oiv. 

M.  Sig. — One  or  two  drams  in  water,  t.i.d.  It 
m:iy  be  given  up  to  75  grains  a day.  The  citric 
acid  is  added  to  modify  the  taste.  It  should  be 
diminished  for  children,  and  followed  by  a pepper- 
mint or  wintergreen  lozenge  {“Useful  Drugs"  of  the 
A.  M.  A.). 

Uses. — Stimulating,  liquefying  ex-pectorant; 
cholagogue. 

Ammonii  Chloridi,  Trochisci  (gr.  iss). 

Adult  Dosage. — Min.,  1;  max.,  10. 

Method  of  Administration. — One  to  ten  troches, 
t.i.d.,  or  every  two  or  three  hours. 

Uses. — Stimulating,  liquefying  e.xpectorant; 

cholagogue. 

Ammonii  Hippuras. 

Adult  Dosage. — Min.,  gr.  iv;  max.,  xv. 

Method  of  Administration. — R Ammonii  hippu- 
ratis,  gr.  x,  capsulae  24. 

Sig. — One,  t.i.d. 

Phy.siologic  Action  and  Uses. — Solvent  of  urates. 

Ammonii  lodidum:  NH4I  (soluble  in  0.6  of  water). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  x. 

Method  of  Administration. — R Ammonii  iodidi, 
3ii;  aquae,  3h- 

M.  Sig. — Drops  two,  well  diluted,  t.i.d. p.c., 
gradually  increased. 

Uses. — Ex-pectorant;  alterative;  discutient. 

Ammonii  Sulphodchthyolas:  C2sH36S306(NH4)2 

(Ichthyol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  v;  max.,  x. 

Method  of  Administration. — R Ichthyoli,  gr.  x, 
capsulae  24. 

Sig. — One  t.i.d.,  up  to  3 iss  daily. 

Uses. — Antiseptic;  antiphlogistic;  analgesic; 

alterative. 

Ammonii  Tartras  (neutral). 

Method  of  Administration. — Ten  per  cent,  solution 
used  to  bathe  the  eye  for  the  purpose  of  clearing  the 
cornea  of  opacities  due  to  the  deposition  of  calcium 
carbonate  following  lime  bums.  (Zur  Nedden.) 

Ammonii  Valeras,  NH4C6H9O2  (soluble  in  0.3  of 
water,  and  0.6  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  viiss;  max.,  x. 

Method  of  Administratiori. — R Ammonii  valera- 
tis,  3ii  3ii;  aquae,  5ii- 

M.  Sig.— One  dram,  t.i.d.,  or  every  two  to 
four  hours. 

Uses. — Nervous  sedative. 

Amygdalae  Amarae,  Aqua  (oil  of  bitter  almonds  in 
water,  1 : 1000). 

Adult  Dosage. — Min.,  3ij  av.,  ii;  max.,  iv. 

Uses. — Flavoring  agent. 

Amygdalae  Amarae,  Oleum;  Oil  of  Bitter  Almond 
(yields  benzaldchyde,  about  85  per  cent.,  and  hydro- 
cyanic acid,  about  3 per  cent.). 

Adult  Dosage. — Min.,  av.,  max.,  i. 

Uses. — Flavoring  agent  ; sedative. 

Amygdalae  Expressum  vel  Dulcis,  Oleum;  Oil 
of  Sweet  Almond. 

Adult  Dosage. — Min.,  qi;  av..  Si;  max.,  5iss. 

Uses. — Emollient;  nutritive;  laxative. 

Amylenum  Hydratum  (dimcthyl-ethyl-carbinol) 

CH, 

OH,  -C-OTT 

C2II6 

(soluble  in  8 of  water). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  i.ss. 

Method  of  Administration. — R Amyleni  hy- 
drati, 


ANTITHYROIDINE 


Sig. — One  teaspoonful  dissolved  in  three  table- 
spoonfuls of  warm  water  or  milk  at  bedtime. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
hypnotic;  acts  in  fifteen  to  twenty  minutes. 

Amyli  Qlyceritum  (starch  10,  water  10,  glycerine 
80,  triturated  and  heated  to  a jelly). 

Uses. — Emollient;  vehicle. 

Amylis  Nitris,  C5H11NO2. 

Adidt  Dosage. — Min.,  irpii;  av.,  iii;  max.,  v. 

Method  of  Administration. — Amylis  nitritis, 

TTgiii-v. 

Dispense  in  perles,  no.  12. 

Sig. — Break  a perle  in  the  handkerchief  and  inhale 
as  required. 

Physiologic  Action  and  Uses. — Vasodilator,  acting 
both  centrally  and  peripherally,  depressing  the  tonus 
of  the  vasomotor  centre  and  the  vessels.  The  action 
lasts  but  a few  minutes. 

Toxic  Action. — Nausea,  vomiting,  unconscious- 
ness, occasionally  convulsions;  methaemoglobinaemia, 
collapse,  respiratory  paralysis. 

Amylum;  Starch;  Cornstarch:  CeHioOs. 

Uses. — Vehicle;  protective. 

Ansesthesin  (^Ethylis  Amino-Benzoas). 

NH2 

I 

C 

HC  i^'^i  CH 

Hc  c*;h 

c 

COOC2H6 

Adult  Dosage. — Min.,  gr.  v;  max.,  viii. 

Method  of  Administration. — AUthylis  amino- 
benzoatis,  gr.  viii. 

Mitte  tabs  pidveres  sive  trochisci,  no.  12. 

Sig. — One  powder  or  lozenge  as  required,  for 
gastralgia,  or  about  two  to  six  a day. 

It  may  be  applied  as  a dusting  powder,  in  oint- 
ment, or  in  suppositories. 

Uses. — Local  ansesthetic. 

Anisi  Aqua. 

Adult  Dosage. — Av.,  3iv. 

Uses. — Flavoring  agent. 

Anisi  Oleum. 

Adult  Dosage. — Min.,  T^i;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  anisi,  3i. 

Sig. — Three  drops  in  a teaspoonful  of  warm  water, 
as  required  for  colic  and  flatulence. 

Uses. — Carminative;  expectorant;  flavor. 

Anisi  Pulvis. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  x. 

Uses. — Carminative;  expectorant;  flavor. 

Antidiphthericum,  Serum  (keep  sealed  in  a cool, 
dark  place);  Diphtheria  Antitoxin  (not  less  than 
250  antitoxic  units  per  c.c.). 

Dosage. — 6 months,  1500  units;  18  months,  2000 
units;  3 years,  4000  units;  5 years,  5000  units. 
Adult,  min.,  5000  units;  av.,  15,000  units;  max., 
40,000  units. 

Immunizing  do.se,  500  units  for  infants,  1500  to 
2000  units  for  children  over  two  years;  Kerley 
says,  at  least  1000  units,  regardless  of  the  age  of 
the  child.  Immunity  lasts  about  three  weeks. 
Adults  need  not  bo  immunized,  and  children  only 
where  there  is  overcrowding,  as  in  institutions. 
See  Diphtheria,  Part  1. 

Antifebrin.  See  Acetanilidum. 

Antimonii  et  Potassii  Tartras;  Tartar  Emetic 
(soluble  in  12  of  water). 

Dosage. — 6 months,  gr.  18  months,  gr.  Kso! 
3 years,  gr.  Kooi  5 years,  gr.  Koo-  Adult,  min.,  gr. 
av.,  Ho;  max.,  H- 


Method  of  Administration. — ^ Antimonii  et 
potassii  tartratis,  gi-.  Hi  syrupi  rubi  idsei,  ^i. 

M.  Sig. — One  dram  every  hour. 

I^  Antimonii  et  potassii  tartratis,  gr.  Ho- 

Mitte  talis  tabelke,  no.  8. 

Sig. — Tablet  in  water  every  three  or  four  hours. 

U ses. — S t i m u 1 a t i n g , nauseant  expectorant ; 
diaphoretic. 

Toxic  Action. — Nausea  and  vomiting,  prostration, 
fall  of  temperature,  cardio-vascidar  depression; 
sweating,  salivation,  cramps  in  the  limbs,  cyanosis, 
dehrium,  exfoliative  enteritis,  suppression  of  urine, 
paralyses,  convidsions,  collapse. 

Antimonii  Vinum  (about  2 grains  of  tartar  emetic 
to  the  ounce). 

Adult  Dosage. — Min.,  irgv;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Employ  doses  of  three 
minims  as  an  expectorant. 

Antiphlogistine.  See  Cataplasma  Kaolini. 

Antipyrina ; Phenyl-dimethyl-pyrazolon : 

(CHa)2C CH  (soluble  in  1 of  water,  and  1.3  of 

I II  alcohol). 

0=C  N 


I 

Cells 


Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i-iss; 
3 years,  gr.  ii;  5 years,  gr.  ii-iii.  Adult,  min.,  gr.  v; 
av.,  x;  max.,  xv;  no  more  than  gr.  iv  under  15  years. 

Method  of  Administration. — I^  Antipyrina;,  gr. 
xl;  sodii  bicarbonatis,  gr.  xx;  aqua;,  5i- 

M.  Sig. — One  dram  three  or  four  times  a day. 

I^  Antipyrina;,  gr.  v,  pulveres  4. 

Sig. — One  powder,  repeated  every  hour  or  two 
until  effectual. 

According  to  Useful  Drugs  of  the  A.  M.  A.,  it 
should  be  given  with  even  greater  caution  tnan 
acetanilid  and  acetphenetidin. 

Physiologic  Action  and  Uses. — Analgesic;  nervous 
sedative;  antipyretic;  local  ha;mostatic  in  15  per 
cent,  solution;  local  ansesthetic  in  50  per  cent,  solu- 
tion. It  narcotizes  the  heat  regulating  and  sensory 
centres  of  the  brain,  and  produces  cerebral  and 
cutaneous  vasodilatation. 

Toxic  Action. — Vertigo,  faintness,  tinnitus,  nau- 
sea, vomiting,  an  exanthem,  methmmoglobinsemia 
and  methaemoglobinuria. 

Antipyrinae  Salicylas;  Salipyrin:  C11H12N2O. 

C6H4OH.COOH  (soluble  in  200  of  water;  readUy 
soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Antipyrina;  sali- 
cylatis,  gr.v-x,  capsula;  vel  tabeUse  vel  pulveres  no.  24. 

Sig. — One,  three  or  four  times  daily;  or  every 
one  to  two  hours  until  3h  have  been  taken.  (Potter.) 

Uses. — Analgesic;  antirheumatic;  antipyretic. 

Antisepticus,  Liquor  (boric  acid  2,  benzoic  acid  0.1, 
thymol  0.1,  eucalyptol  0.025,  oil  of  peppermint  0.05, 
oil  of  gaultheria  0.025,  oil  of  thyme  0.01,  alcohol  25, 
purified  talc  2,  water  to  100). 

Adult  Dosage. — Min.  gss;  av.  i;  max.  ii. 

Method  of  Administration. — IJ  Liquoris  antisep- 
tica^  ^ii. 

Sig. — One  teaspoonful  t.i.d. 

Uses. — Local  and  intestinal  antiseptic;  aromatic 
mouth-wash. 

Antithyroidin  (serum  of  thyroidectomized  sheep). 
(Merck.) 

Adult  Dosage. — Min.,  i^x;  max.,  Ixxx. 

Method  of  Administration. — I^  Seri  antithyroidei 
(Merck),  gii. 

Sig. — TTjx,  by  mouth,  gradually  increased  to  a 
maximum  of  80  nj,  t.i.d. 

Uses. — Used  in  hyperthyroidism. 


ARGENTI  NITRAS 


Antitoxin.  See  Sera. 

Antivenene  (Polyvalent  or  specific).  Rattlesnake 
and  moccasin  antivenenes  are  obtainable  from 
the  Rockefeller  Institute  in  New  York;  cobra  and 
daboia  antivenenes  in  India,  notechis  antivenene 
in  Australia,  and  lachesis  antivenene  in  Brazil  and 
Japan.  (Blumer.) 

Adult  Dosage. — Min.,  50  c.c.;  max.,  100  c.c. 

Method  of  Administration. — In  serious  cases,  intra- 
venously, if  possible,  otherwise  intramuscularly. 
Use  a polyvalent  serum  if  a specific  serum  is  not 
obtainable. 

Uses. — Used  in  snake  poisoning,  g.v.  in  Part  1. 

Apiolum  Crystallisatum  (Parsley  Camphor:  2.5- 
dime  t ho  xy-3 . 4- methendioxy- 12  propenylbenzene, 
CHa  : CH.CIl2.C6H(OCH3)2  : O2  : CH2CH. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  x. 

Method  of  Administration. — R Apioli,  gr.  v; 
capsuUe  no.  30. 

Sig. — ■Cap.sule,  two  or  three  times  a day,  p.c., 
for  one  week  before  and  also  during  the  period. 

Uses. — Emmenagogue. 

Toxic  Action. — Headache,  tinnitus,  giddiness, 
cerebral  excitation,  narcosis. 

Apocyni,  Fluidextractum. 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  x.xx. 

Method  of  Administration. — R Fluidextracti 

apocyni,  ^i. 

Sig. — ^Fifteen  drops  in  water,  three  or  four  times 
a day. 

Uses. — Laxative;  diuretic;  diaphoretic;  expector- 
ant; cardiac  tonic. 

Toxic  Action. — Vomiting  and  purging,  drowsiness. 

Apocyni  Tinctura. 

Apomorphinae  Hydrochloridum,  C17H17NO2HCI, 
morphine  minus  a molecule  of  water  (soluble  in  50 
of  water  and  in  50  of  alcohol). 

Adult  Dosage. — Min.,  gr.  av.,  ]io]  max.,  '4o,  as 
an  expectorant;  min.,  gr.  Ks;  av.,  }io;  max.,  %;  as  an 
emetic. 

Method  of  Administration. — R Apomorphinaj, 
gr.  tabella;  no.  10. 

Sig. — One  tablet,  by  mouth,  every  two  to  four 
hours,  as  an  expectorant.  Hypodermically  as  an 
emetic;  not  over  gr.  %o  to  young  children. 

Physiologic  Action  and  Uses. — Stimulating,  nau- 
seant  expectorant;  emetic.  It  acts  upon  the 
vomiting  centre  in  the  medulla. 

Toxic  Action. — Cardiac  and  respiratory  depres- 
sion, delirium,  collapse,  convidsions. 

Aqua  Ammoniae  (10  per  cent,  by  weight  of  NH3). 

Adult  Dosage. — Min.,  irgv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Aquai  am- 

monia}, 5i. 

F’ive  to  thirty  drops,  well  diluted. 

Uses. — Fugacious,  indirect,  cardio-respiratory 
stimulant;  local  irritant  and  antacid. 

Aqua  Ammonia;,  Fortior  (28  per  cent,  by  weight 
of  NII3). 

Adult  Dosage. — Min.,  i^ii;  av.,  v;  max.,  x. 

Aqua  Amygdala;  Amarae  (oil  of  bitter  ahnonds  in 
water,  1 : 1000). 

Adult  Dosage. — Min.,  oij  av.,  ii;  max.,  iv. 

Uses. — -Flavoring  agent. 

Aqua  Anisi. 

Adult  Dosage. — Av.,  5iv. 

Uses. — Flavoring  agent. 

Aqua  Camphora;  (camphor  8,  alcohol  8,  talc  15, 
distilled  water  to  1000). 

Adult  Dosage. — Min.,  oii;  av.,  iv;  max.,  5ii- 

Uses. — Vehicle. 

Aqua  Chloroform!  (saturated  solution). 

Dosage.- — 0 months,  5ss;  18  months,  5ss-ii; 
3 years,  qii-iii;  5 years,  3iv.  Adult,  min.,  5ss;  av., 
i;  max.,  ii. 


Method  of  Administration. — R Aquae  chloro- 
formi,  oiv. 

Sig. — A dose  as  required  for  colic  and  flatulence. 

Use.s. — ^Vehicle;  carminative. 

Aqua  Cinnamomi  (oil  of  cinnamon  2,  talc  15, 
distilled  water  to  1000). 

Adult  Dosage. — Av.,  3iv-t-- 

Uses. — Vehicle. 

Aqua  Cologniensis  (alcohol  800,  water  158,  acetic 
ether  2,  oil  of  bergamot  16,  oil  of  lemon  8,  oil  of 
rosemary  8,  oil  of  lavender  flowers  4,  and  oil  of 
orange  flowers  4 parts). 

Uses. — ^Perfume. 

Aqua  Foeniculi;  Fennel  Water  (oil  2,  distilled  water 

1000). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  gi. 

Uses. — Carminative. 

Aqua  Hamamelidis;  Extractum  Hamamelidis 
Destillatum. 

Adult  Dosage. — Min.,  3i;  av.,  ii;  max.,  iii. 

Uses. — Astringent;  haemostatic. 

Toxic  Action. — Throbbing  pain  in  the  head. 

Aqua  Laurocerasi,  B.  P.  (Cherry  Laurel  Water, 
standardized  to  contain  0.1  per  cent,  of  pure 
HCN). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Aqua;  laurocerasi, 
B.P.,  Si. 

Sig. — One  teaspoonful  in  water,  for  the  relief 
of  vomiting. 

Uses. — Gastric  sedative;  local  antipruritic. 

Aqua  Menthse  Piperitae  (Saturated  Peppermint 
Water,  containing  0.2  per  cent,  oil  of  peppermint). 

Dosage. — 6 months,  3i;  18  months,  3i~ii;  3 years, 
3iii;  5 years,  3iv.  Adult,  min.,  3iv;  max.,  vi. 

Method  of  Administration. — -R  Aquae  menthae 
piperitae,  gviii. 

Sig. — Tablespoonful  every  two  hours,  for  colic  and 
flatulence,  up  to  5 to  6 ounces  a day  for  an  adult. 

Uses. — ^Carminative;  stimulant;  vehicle. 

Aqua  Menthae  Viridis  (Spearmint  Water,  contain- 
ing 0.2  per  cent,  oil  of  spearmint). 

Dosage. — 6 months,  3i;  18  months,  3ii;  3 years, 
3iii;  5 years,  3iv.  Adult,  min.,  3iv;  max.,  vi. 

Method  of  Administration. — R Aquae  menthae 
viridis,  gii- 

Sig. — A dose,  as  required,  for  colic  and  flatulence. 

Uses. — Carminative;  vehicle. 

Aqua  Pimentae  (Allspice  Water).  Caiminative 
vehicle. 

Aqua  Rosae  (Rose  Water). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  gi- 

Uses. — Perfumed  vehicle. 

Argenti  Colloidali,  Unguentum;  Ung.  Credo  (15 
per  cent,  collargol). 

Adult  Dosage. — Min.,  gr.  xxx;  av.,  gi;  max.,  iv. 

Method  of  Administration. — Rub  very  thoroughly 
into  the  skin,  gi  once  to  thrice  dtuly  for  infants;  as 
much  as  giv  twice  daily'  for  older  children;  cover 
with  rubber  tissue. 

The  ointment  is  good  as  long  as  it  colors  the 
skin  black. 

Uses. — .Vntiseptic;  promotes  leucocytosis  and 
phagocytosis. 

Argenti  Nitras,  AgNOs  (soluble  in  0.4  of  water; 
in  30  of  alcohol). 

Adult  Dosage. — Min.,  gr.  av.,  max., 

Method  of  Administration. — R .-Vrgenti  nitratis, 
gr.  %;  kaolini  et  petrolati,  q.s. 

Mitte  talis  pilula;  no.  24. 

Sig. — A pill,  t.i.d.,  on  an  empty  stomach. 

For  colonic  injection,  1 : 5000,  increased  to  1 : 500, 
1 litre,  washed  out  with  normal  saline  solution. 

For  conjunctival  instillation:  1 to  2 p)er  cent., 
washed  out  with  normal  saline  solution. 


ASAFCETID.E  EMULSUM 


For  urethral  injection,  1 ; 10,000  to  2000.  For 
vesical  injection,  1 : 10,000  to  5000. 

For  local  caustic  effect,  0.01  to  10  per  cent.,  in 
distilled  water. 

Uses. — Gastric  astringent;  nerve  tonic;  antisep- 
tic; caustic. 

Toxic  Action. — Cardiac  and  respiratory  depression; 
lowered  temperatiu'e ; tetanic  convulsions  or  paralysis. 

Argyria  results  from  prolonged  use.  It  is  a slate- 
colored  pigmentation  of  the  skin  and  tissues  of  the 
body  due  to  the  deposition  of  silver. 

Argent!  Nitras  Fusus  (Moulded  Lunar  Caustic). 

Method  of  Administration. — Should  be  moistened 
before  use,  and  held  with  forceps  or  a holder. 

Uses. — Caustic  and  astringent. 

Argent!  N!tras  M!t!gatus  (Mitigated  Caustic: 
silver  nitrate  melted  with  twice  its  weight  of  potas- 
sium nitrate). 

Use. — Caustic  and  astringent. 

Argent!  Prote!nas;  Protargol  (slowly  soluble  in  2 
of  water;  dissolve  in  cold  water). 

Method  of  Administration. — For  instillations  or 
injections;  0.25  to  1 per  cent,  solutions;  5 to  10  per 
cent,  in  chronic  urethritis  or  cystitis. 

For  irrigations;  1 : 2000  to  1000. 

Uses. — Antiseptic. 

Argentum  CoIIoidale;  Argentum  Crede;  Collarg- 
olum  (colloidal  suspension  of  metallic  silver). 

Adult  Dosage. — Min.,  gr.  iss;  av.,  iii;  max.,  x. 

Method  of  Administration. — For  intravenous  in- 
jections, 10  to  20  c.c.  of  a 2 per  cent,  .suspension  in 
sterile  water. 

For  parenchymatous  injections,  20  to  40  c.c.  of  a 
0.5  to  1 per  cent,  glycerine  solution. 

For  washes,  0.02  to  1 per  cent,  suspension. 

Internally,  1 : 500  to  100,  teaspoonful  doses, 
freely  with  the  food. 

Uses. — -Antiseptic;  promotes  leucocytosis  and 
phagocytosis. 

Argyrol  (Silver  Vitellin). 

Method  of  Administration. — Five  to  fifty  per  cent, 
solution  or  ointment.  Do  not  keep  the  solution 
over  two  weeks;  it  is  best  renewed  daily. 

Uses. — Astringent,  antiseptic;  less  irritating  than 
protargol. 

Aristol;  Thymolis  lodidum;  Dithymol-di-iodid : 
(C6H2.CH3.C3HtOI)2. 

Uses. — -Antiseptic  powder;  less  efficient  than 
iodoform. 

Ar!stoqu!n;  Quininae  Carbonas:  (C2oH23N20).0. 
CO.O(C2oH23N20).  (tasteless  because  insoluble  in 
water). 

Adult  Dosage. — ^Min.,  gr.  vii;  max.,  xv. 

Method  of  Administration. — I^  Aristochin.,  gr.  vii 
sacchari  lactis,  q.s.;  pulveres  18.  ■ 

Sig. — One  powder,  t.i.d.,  dry  on  the  tongue. 

Gr.  i-v  for  children,  according  to  age. 

Uses. — Antimalarial. 

Aromaticum,  Elixir  (Simple  Elixir:  comp.  spt.  of 
orange,  1.2,  purified  talc  3,  syrup  37J^;  alcohol  and 
distilled  water  to  100). 

Adult  Dosage. — -Min.,  5i;  max.,  5i  + - 

Uses. — -Flavoring  vehicle  and  ailuent. 

Arsanilas  Sod!!;  Atoxyl,  see  Atoxyl. 

Arsenas,  Sod!!:  Na2HAs  04-f-7Il20  (soluble  in  1.5 
of  water;  slightly  in  alcohol). 

Adult  Dosage. — Min.,  gr.  '{g;  av.,  ’<2;  max.,  %. 

Method  of  Administration. — IJ  Sodii  arsenatis, 
gr.  vii  (gr.  Ki  per  dose  of  3 minims);  aqua;,  3iv. 

M.  Sig. — Three  minims,  in  water,  t.i.d.p.c. 

It  may  be  given  in  pill  form. 

Physiologic  Action  and  Uses. — Alterative;  tonic; 
stomachic;  inhibits  oxidation  and  stimulates  ana- 
bolism ; stimulates  the  ha;matopoietic  organs. 

Arsenas  Sod!!,  Exs!ccatus:  Na2HAs04 
55 


(soluble  in  3.1  of  water). 

Adult  Dosage. — Min.,  gr.  av.,  max.  , Vn. 

Method  of  Administration. — I^  Sodii  arsenatis 
exsiccati,  gr.  iv  (gr.  per  dose  of  3 minims) ; aqua;, 
3iv. 

M.  Sig. — Three  minims,  in  water,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Alterative;  tonic; 
stomachic;  inhibits’ oxidation  and  stimulates  ana- 
bolism; stimulates  the  ha;matopoietic  organs. 

Arsen!  Chlor!d!  Liquor;  Liquor  Acidi  Arsenosi 
(arsenic  trioxide  1 per  cent,  in  dilute  hydrochloric 
acid,  5 per  cent,  and  water). 

Method  of  Administration. — IJ  Liquoris  acidi 
arsenosi. 

Sig. — -iTjiii,  well  dihited,  t.i.d. 

Arsen!  et  Hydrargyr!  lodid!.  Liquor;  Donovan’s 
solution. 

Adult  Dosage. — Min.,  inii;  av.,  iss;  max.,  v. 

Method  of  Administration. — I^  Liquoris  arseni  et 
hydrargyri  iodidi,  3ii- 

Sig. — Two  drops  in  water,  t.i.d.p.c. 

Uses. — Alterative. 

Arsen!  lodidum:  AsL  (soluble  in  7 of  water).. 

Adult  Dosage. — Gr.  Ho-Ko-)^. 

Arsen!  Trioxidum;  Aeidum  Arsenosum:  AS2O3. 

(soluble  in  about  100  of  water;  readily  soluble  in 
solutions  of  acids  or  alkalies). 

Dosage. — 18  months,  gr.  Haa',  3 years,  gr.  Xso!  5 
years,  gr.  ’{oo-  Adult,  Min.,  gr.  '^4;  ay.,  %o;  max.,  Ko- 

Method  of  Administration. — 1^  Acidi  arsenosi,  gr. 

Mitte  talis  tabella;  no.  24. 

Sig. — Two  tablets,  t.i.d.,  p.c.  gradually  increased 
by  gr.  t.i.d. 

I/ses.— Stomachic;  tonic;  alterative;  ha;matinic; 
antiseptic.  Local  escharotic. 

Toxic  Action. — CEdema  and  itching  or  burning  of 
the  eyelids,  salivation,  naiusea,  and  vomiting,  epi- 
gastric pain  and  soreness,  diarrhera,  thirst,  anore.xia, 
burning  in  the  mouth,  belching,  skin  eruptions, 
albuminuria,  odor  of  garlic  on  the  breath,  brownish 
pigmentation,  hyperkeratoses  of  the  skin,  multiple 
neuritis,  feeble  and  irritable  heart,  fatty  degenera- 
tion of  the  viscera. 

Arsen!t!s  Potass!!,  L!quor  (Fowler’s  solution). 

Dosage. — 6 months,  gt.  ss;  18  months,  gt.  i;  3 years 
gtt.  ii;  5 years,  gtt.  ii-v.  Adult,  njiii-vi  -f-. 

Method  of  Administration. — I^  Liquoris  potassii 
arsenitis,  5ss. 

Sig. — Two  or  three  drops,  well  diluted  in  water, 
t.i.d.,  p.c.,  gradually  increased  by  one  drop  every 
one,  two  or  three  days,  up  to  ten  or  fifteen,  or  even 
25  drops  t.i.d.,  even  to  a child  of  six  years.  Should 
toxic  symptoms  occur,  stop  the  -drug  for  three  or 
four  days,  and  begin  again  with  smaller  doses.  The 
maximum  dose  may  be  taken  for  weeks  or  months 
in  the  absence  of  toxic  symptoms. 

Physiologic  Action  arm  Uses. — Stomaclnc,  tonic, 
alterative;  inhibits  oxidation  and  stimulates  ana- 
bolism; stimulates  the  haematopoietic  organs. 

. Toxic  Action. — CEdema  and  itching  or  burning  of 
the  eyelids,  conjunctival  congestion,  salivation, 
burning  in  the  mouth,  belching,  odor  of  garlic  on 
the  breath,  coated  tongue,  anorexia,  epigastric  pain 
and  soreness,  nausea,  vomiting,  diarrhoea,  thirst, 
albuminuria,  skin  eruptions,  cutaneous  hyperkera- 
toses, brownish  pigmentation  of  the  eyes,  multiple 
neuritis,  weak  heart;  sometimes  collapse  and 
convulsions. 

Arsenobenzol.  See  Salvarsan. 

Arsenophenylglydn. 

Uses. — U.sed  in  sleeping  sickness. 

Arsenosum  Addum.  See  Arseni  Trioxidum. 

Arsphenamlna.  See  Salvarsan. 

Asafoetidae  Emulsum  (4  per  cent,  in  water). 

Adult  Dosage.  3ii-iv-.5i. 


AURANTII,  SPIRITUS  COMPOSITUS 


Method  of  Administration. — Emulsi  asa- 
fcetida?,  giv. 

Sig. — Tvvo  teaspoonfuls  four  times  a day;  or  two 
tablespoonfuls  in  one  dose. 

Uses. — Antispasmodic,  nerve  stimulant;  carmin- 
ative; stimulating  expectorant;  tonic;  laxative; 
diuretic;  diaphoretic;  emmenagogue;  aphrodisiac; 
anthelmintic.  Psed  as  an  enema  in  tympanites. 

Toxic  Action. — Nausea,  vomiting,  purging. 

Asafcetida;  Pilulae  (asafoetida,  gr.  iii,  soap,  gr.  i). 

Method  of  Administration. — Pilulce  asatetidae, 
no.  24. 

Sig. — One  or  two  pills,  four  tunes  a day;  or  six 
pills  in  one  dose. 

Asafoetidae  Tinctura  (20  per  cent.). 

Adult  Dosage. — Min.,  i^x;  av.,  .xxx;  max.,  Lx. 

Method  of  Administration. — Tinctura;  asa- 
foetida',  gi. 

Sig. — Fifteen  drops  in  water,  four  tinles  a day; 
or  3 i in  one  dose. 

Aspidii  Oleoresina. 

Dosage. — 3 years,  gr.  x-xv;  5 years,  gr.  xx-xxx. 
Adult,  min.,  gr.  xv;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — E Oleoresinae  aspi- 
dii, gi- 

Shake  well  and  div.  in  capsula  8. 

Sig. — Four  capsules  (uncapped),  with  half  a glass 
of  hot  water  at  9 a.  m.,  and  four  capsules  (uncapped), 
with  hot  water  at  10  a.  m.,  preceded  by  thorough 
emptying  of  the  bowels,  and  followed  at  12  m.  by  a 
non-oily  purge,  as  described  under  Tapeworm,  Part  1. 

Uses. — Anthehnintic ; tenicide. 

Toxic  Action. — Vomiting,  purging,  acute  abdom- 
inal pain,  great  weakness,  .spasms  in  the  extremities, 
sometimes  convulsions;  stupor,  coma,  collapse ; some- 
times deafness  and  blindness^  temporary  or  perma- 
nent (due  to  optic  atrophy),  jaundice,  rarely  tetany. 

Aspirin;  Acidum  Acetylsalicylicum : CeH4.0, 

(CH3C0)C00H.  1 : 2 (soluble  in  100  of  water 
freely  in  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v 
av.,  x;  max.,  xx. 

Method  of  Administration. — Acidi  acetylsah- 
cylici,  gr.  v-xv. 

Mitte  talis  capsulse,  sive  jjulveres  in  charta  cerata 
no.  12. 

Sig. — One,  four  or  five  times  a day,  or  every  three 
hours,  until  salicylism  (ringing  in  the  ear,  etc.) 
is  noted. 

Uses. — Antirhemnatic;  antipyretic;  analgesic; 
diaphoretic;  disinfectant  of  the  pancreatic  ducts, 
through  which  it  is  excreted. 

Toxic  Action.- — Symptoms  of  sahcylate  poison- 
ing (q.v.). 

Atophan;  Acidum  Phenylcinchoninicum : CeH^. 

CsHsN.iCOOH).  (Insoluble  in  water;  only  slightly 
soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  viii;  max.,  xw. 

Method  of  Administration. — Acidi  phenylcin- 
choninici,  gr.  ,xv,  pulveres  12. 

Sig. — One  powder  suspended  in  a glassful  of  water, 
two  or  three  times  a day  (or  8 grains  4 times  a day), 
together  with  sodium  or  potassium  bicarbonate, 
3iss-Lii  -f  daily,  to  prevent  the  deposition  of  free  mic 
acid  in  the  urinary  tract. 

Physiologic  Action  and  f/ses.— Diuretic;  causes 
a markedly  increased  excretion  of  uric  acid  by  the 
kidneys. 

Atoxyl;  Sodii  Arsanilas;  Sodium  Arsanilate: 

C6H4NH2 

0=AsT^=~0H 

^^ONa 

(soluble  in  6 of  water). 


Adult  Dosage. — Min.,  gr.  max.,  iii. 

Method  of  Administration. — Administer  gr.  }^-iii, 
hypodermically,  every  other  day,  gradually  increas- 
ing the  dose,  if  necessary,  up  to  gr.  x,  and  until 
a total  of  100  grains  has  been  given.  Do  not  give 
the  drug  by  mouth,  as  it  is  decomposed  by  the 
acid  contents  of  the  stomach,  and  toxic  symptoms 
may  result. 

Uses. — Antiprotozoal. 

Toxic  Action. — Digestive  disturbances,  nephritis, 
shock,  optic  atrophy,  and  the  usual  arsenic  effects. 

Atropina  (Alkaloid,  C17H23NO3;  soluble  in  455  of 
water;  in  2 of  alcohol) 

H Hj  CH2OH 

H2C— C — C I 

I ^NCHa^CHO— CO-9^^ 

H2C— C — C I 

H H2  CeHs 

Tropine  Tropic  acid 

Dosage. — 6 months,  gr.  3^00;  18  months,  gr.  %ao] 
3 years,  gr.  Mm;  5 years,  gr.  Moo-  Adults,  min.,  gr.  Moo; 
av.,  M20;  max..  Mo- 

Method  of  Administration. — Administer  by  mouth 
or  hypodermically.  Gradually  increase  the  dose 
every  two  hours  until  the  skin  flushes,  the  throat 
becomes  dry,  and  the  pupils  dilate,  even  up  to  gr. 
Mo,  t.i.d.,  in  adults.  As  a mydriatic,  gr.  i-ii-iv  ad  5i, 
according  to  the  degree  of  photophobia,  lacbrjana- 
tion,  and  blepharospasm,  one  or  two  drops  instilled 
into  the  conjunctival  sac. 

Physiologic  Action  and  Uses. — Atropine  paralyzes 
the  nerve  endings  of  the  autonomic  or  parasjTnpa- 
thetic  system,  e.g.,  the  sphincter  iridis  and  cihary 
muscle  nerves,  producing  mydriasis  and  paralysis  of 
accommodation;  the  chorda  tympani,  producing 
dryness  of  the  mouth;  the  vagus  and  sacral  or  pelvic 
nerves,  removing  cardiac  inhibition,  relaxing  the 
bronchial,  gastric,  intestinal,  gall-bladder,  uterine, 
and  vesical  musculature,  and  inhibiting  the  secre- 
tion of  the  skin,  bronchial  mucosa,  and  glands.  It 
stimulates  the  central  nervous  system  (respiratory, 
vasomotor,  and  cerebral  centres).  In  small  doses 
it  stimulates  the  automatic  Auerbach’s  plexuses  in 
the  stomach  and  intestines,  which  act  independently 
of  the  vagus  and  sjanpathetic,  and  so  accelerates 
and  strengthens  the  contractions  of  the  bowel. 
It  increases  intraocular  tension  by  causing  mydria- 
sis, which  closes  the  spaces  of  Fontana  and  so  pre- 
vents the  exit  of  fluid  from  the  chamber  of  the 
eye. 

Toxic  Action. — Rapid  pulse,  flushing  of  the  skin, 
talkative  delirium,  dilatation  of  the  pupils,  some 
elevation  of  temperature,  dryness  of  the  throat  and 
skin,  imconsciousness,  prostration,  paralysis  of  the 
voluntary  muscles,  vasomotor  paralj-sis.  Atropine 
in  the  eye  sometimes  sets  up  a marked  conjunctivitis, 
with  perhaps  oedema  of  the  lids. 

Atropinae  Sulphas  (soluble  in  0.4  of  water  and  in 
5 of  alcohol). 

Dosage. — 6 months,  gr.  MooJ  18  months,  gr.  Mooi 
3 years,  gr.  Mm!  5 years,  gr.  Adult,  min.,  gr. 
av.,  M20;  max..  Mo-  See  Atropina,  above. 

Aurantii  Amari,  Tinctura  (Tincture  of  Bitter 
Orange  Peel,  20  per  cent.). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Uses. — Flavor. 

Aurantii  Dulcis  Tinctura;  Tincture  of  Sweet 
Orange  Peel,  50  per  cent,  in  alcohol. 

Adult  Dosage. — Av.,  3i- 

Uses. — Flavor. 

Aurantii,  Spiritus  Compositus  (oil  of  orange  peel  20, 
oil  of  lemon  5,  oil  of  coriander  2,  oil  of  anise 
alcohol  to  100). 


BECK’S  BISMUTH  PASTE 


Adult  Dosage. — Min.,  5i;  max.,  ii. 

Uses. — Flavor. 

Aurantii,  Syrupus  (tincture  of  sweet  orange  peel 
20  per  cent.,  5,  magnesium  carbonate  1,  citric  acid  5, 
sugar  82,  water  to  100). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Uses. — Flavor. 

Auri  Chloridum  (AuCb;  very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  max.,  y^o. 

Method  of  Administration. — Auri  chloridi, 
gr.  Yi]  aquaj  destillatae,  §ii. 

M.  Sig. — One  dram  in  water,  t.i.d. 

Uses. — Alterative. 

Toxic  Action. — Gastro-enteritis,  tremors,  cramps, 
priapism,  insomnia,  salivation,  headache,  insen- 
sibility. 

Auri  et  Sodii  Chloridum  (AuCl3NaCl-l-2H20;  very 
soluble  in  water). 

Adult  Dosage. — Min.,  gr.  av.,  '{o!  max., 

Method  of  Administration. — Auri  et  sodii 
chloridi,  gr.  ss;  aquaj  destillatae,  5ii. 

M.  Sig. — One  dram  in  water,  t.i.d. 

It  may  also  be  prescribed  in  pill  form. 

Uses. — Alterative. 

Bacillus  Bulgaricus.  Preparations  are  obtainable 
from  the  B.  B.  Culture  Laboratories,  Yonkers,  N.  Y. ; 
Fairchild  Bros.  & Foster,  New  York;  Hynson,  West- 
cott,  and  Dunning,  Baltimore;  Schieffelin  & Co., 
New  York;  H.  K.  Mulford  Co.,  Philadelphia; 
Abbott  Laboratories,  Chicago;  Swan-Myers  Com- 
pany, Indianapolis,  Ind.;  Vitalait  Laboratory,  Inc., 
Newton  Centre,  Mass. 

Uses. — ^Lactic  acid  effects:  inte.stinal  antifennen- 
tation;  local  antiseptic. 

Bacterins,  see  Vaccines. 

Balsamum  Qurjunfe  (sive  Dipterocarpi). 

Adult  Dosage. — Min.,  njx;  max.,  oh- 

Method  of  Administration. — I^  Balsami  gurjunaq 
5i  (i5fxv-x  per  dram);  liquoris  calcis  vel  muci- 
laginis  acaciaj,  5iii~v. 

Misce  et  fiat  emulsum. 

Sig. — One-half  to  two  to  four  drams  two  or 
three  times  daily;  together  with  daily  inunctions  of 
25  to  50  per  cent,  of  the  oil  in  olive  oil,  for  one  to 
two  hours  at  a time,  into  the  lesions. 

Uses. — Used  in  leprosy. 

Balsamum  Peruvianum  (Benzyl  cinnamate, 
C16H14O21,  60  per  cent.,  cinnamic  acid  6 per  cent., 
resins  30  per  cent.,  benzoic  acid,  etc.,  soluble  in 
alcohol,  practically  insoluble  in  water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxv. 

Method  of  Administration. — One  part  to  one  to 
six  parts  of  castor-oil,  as  a local  antiseptic  and 
stimulant. 

Uses. — ^Local  antiseptic  and  protective;  para- 
siticide. 

Toxic  Action. — ^Gastralgia,  nausea,  vomiting, 
cohcky  diarrhoea,  albuminuria. 

Balsamum  Tolutanum  (contains  benzoin  or  its 
derivatives;  soluble  in  alcohol ; nearly  insoluble  in 
water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — I^  Balsami  tolutani, 
3iv  (gr.  XV  per  dram);  mucilagmis  acaciaj,  5ii- 

M.  Sig. — One  dram  two  or  three  times  a day. 

Uses. -Stimulating  and  disinfecting  expectorant. 

Barbital. — See  Veronal. 

Barii  Sulphas:  BaS04  (freed  from  soluble  barium 
and  other  salts,  for  Rontgen-ray  work). 

Method  of  Administration. — For  the  X-ray  e.xami- 
nation  of  the  stomach:  administer,  the  evening 

before,  one  ounce  of  castor-oil.  In  the  morning 
administer  an  ordinary  portion  of  wheat-meal  por- 
ridge containing  two  ounces  of  barium  sulphate, 
with  a little  sugar  and  cream.  No  further  food 


should  be  taken  until  after  the  examination,  six 
hours  later. 

For  the  X-ray  examination  of  the  colon:  inject 
into  the  rectum,  from  a height  of  from  three  to  six 
feet,  an  enema  consisting  of  16  ounces  of  mucilage 
of  acacia,  3 pounds  of  condensed  milk,  and  8 ounces 
of  barium  sulphate,  warmed  to  body  temperature. 
Make  a fluoroscopic  examination  while  the  enema 
is  passing  into  the  rectum.  From  N.  N.  R. 

Barii  Sulphidum,  BaS. 

Method  of  Administration. — R Barii  sulphidi, 
3iii;  zinci  o.xidi;  pulveris  amyh,  aa,  3iiss. 

M.  Sig. — Add  sufficient  water  to  make  a paste, 
and  apply  for  about  ten  minutes,  or  until  a burning 
sensation  is  felt.  Then  wash  off. 

Uses. — Depilatory. 

Toxic  Action. — Gastro-enteritis,  salivation,  thirst, 
dyspnoea,  slow  pulse,  central  nervous  and  cardiac 
paralysis. 

Basham’s  Mixture:  Liquor  Ferri  et  Ammonii 

Acetatis  (Tr.  ferric  chloride  4,  dilute  acetic  acid  6, 
solution  of  ammonium  acetate  50,  aromatic  elixir  12, 
glycerine  12,  water  to  100.) 

Dosage. — 3 years,  3ss;  5 years,  3i-  Adult,  min., 
3ii;  av.,  iv;  max.,  vi. 

Method  of  Administration. — R Liquoris  ferri  et 
ammonii  acetatis,  3vi. 

Sig. — One  tablespoonful,  well  diluted  in  water, 
three  or  four  times  daily. 

Uses. — Diuretic;  diaphoretic;  haematic. 

Basic  Orexin  (Phenyl-dihydro-chinazolin). 

Adult  Dosage. — Min.,  gr.  iss;  max.,  v. 

Method  of  Administration. — R Orexini,  gr.  v, 
tabellae  vel  capsulae  no.  12. 

Sig. — A tablet,  t.i.d.,  or  b.i.d.,  a.c.,  followed  by  a 
draught  of  warm  water,  milk,  or  beef-tea. 

Uses. — Stomachic,  appetizer. 

Basilicon  Ointment;  Ceratum  Resinaj  (rosin  35, 
yellow  wax  15,  lard  50). 

Uses. — Protective  emollient. 

Baths,  Medicated: 

1.  The  Alkaline  Br.an  Bath:  Sod.,  bicarb.,  ^ii-x, 
bran,  1 gallon  to  30  gallons  of  water. 

2.  The  Carbon  Dioxide  or  Nauheim  Bath:  Sod. 
Chloride,  8 lbs.,  calc,  or  mag.  chloride,  2 lbs.,  sod. 
bicarb.,  l^lbs.,  sod.  bisjilphate  (yielding  CO2),  2)^ 
lbs.,  bath  water  at  90°-95°  F.,  40  to  45  gallons.  Pro- 
tect the  tub  against  the  bisulphate  by  means  of  a 
large  rubber  cloth.  Add  the  salts  to  the  bath  in 
the  order  above  given.  (See  under  Cardiac  Insuf- 
ficiency in  Part  1.) 

3.  The  Electric  Bath : Use  either  the  alternating 
or  sinusoidal  current  and  large  copper  or  zinc  elec- 
trode, and  a current  strong  enough  to  produce 
prickly  sensations  but  no  discomfort. 

4.  The  Sulphur  Bath:  Pot.  sulphide,  ,Ui-iv,  to 
30  gallons  of  tepid  water;  or  lime,  ^ss,  sublimed 
sulphur,  i,  distilled  water,  .5  x,  boiled  down  to  vi 
and  filtered, — .^ii-iv  to  30  gallons  of  water. 

Bay  Rum;  Spiritus  Myrcise  Compositus:  (oil  of 
myrcia  16,  oil  of  orange  peel  1,  oil  of  pimenta  1, 
alcohol  1220,  water  to  2000). 

Uses. — Perfume;  cutaneous  stimulant. 

Beck’s  Bismuth  Paste: 

Firm  Bismuth  Pa.ste: 

Bismuth  subnitrate  (pure,  free  from  arsenic) 
30  grams. 

White  wax,  5 grams. 

Soft  paraffin  (melting  point  120°  F.),  5 grams. 

Vaseline  (yellow  or  white),  60  grams. 

Softer  Bismuth  Paste : 

Bismuth  subnitrate,  1 part. 

Vaseline  (yellow  or  white),  2 parts. 

One-half  to  one  per  cent,  formaliu  may  be  added 
if  desired. 


BENZOAS,  SODII 


The  bismuth  is  added  to  the  other  ingredients 
while  boiling. 

Allow  no  water  to  drop  into  the  boiling  paste. 

Method  of  Administration. — The  injecting  .syringe 
(usually  a glass  syringe  with  rounded  end)  should  be 
dry  sterilized;  and  if  the  plunger  needs  lubrication 
it  should  be  dipped  in  sterile  vaseline  instead  of 
water.  No  preliminary  irrigation  of  the  cavity  to  be 
injected  is  permissible.  The  paste,  liquefied  over  a 
water  bath,  is  drawn  into  the  warmed  syringe. 
Whether  for  diagnostic  or  therapeutic  purposes,  the 
paste  must  penetrate  into  and  entirely  fill  all  pockets 
and  reces.ses  of  the  cavity  injected.  The  cavity  may 
have  to  be  injected  only  once,  or  possibly  every 
three  to  seven  days,  so  as  to  keep  it  filled  until  it  is 
healed.  In  injecting  cold  abscesses  through  a short 
incision,  without  drainage  or  closure  of  the  wound, 
use  no  more  than  100  grams  of  10  per  cent,  bismuth 
in  vaseline.  If  a large  cavity,  such  as  the  pleural 
cavity  in  chronic  empyema,  is  injected,  remove  the 
amount  of  paste  in  excess  of  100  grams  within 
twenty-four  hours  with  olive-oil. 

Uses. — -Used  in  the  treatment  of  chronic  suppura- 
tive sinuses,  fistulae  or  abscess-cavities,  excepting 
gall-bladder  and  pancreatic  fistulae  and  those  com- 
municating with  the  cranial  cavity.  (Beck.) 

Toxic  Action. — Acute  nitrite  poi.soning:  methae- 
moglobinaemia,  cyanosis,  dyspnoea,  abdominal 
cramps,  diarrheea. 

Chronic  bismuth  poisoning:  pallor,  small  blue 

ulcerations  of  the  gums,  black  discoloration  beneath 
the  tongue,  nausea,  headache,  often  diarrhoea. 

Remove  the  paste  by  means  of  oil. 

Beef  Extract,  see  Meat  Extracts. 

Beef  Juice,  see  Meat  Juice. 

Beef  or  Dry  Peptonoids  (a  powder  consisting  of 
partially  peptonized  beef,  milk,  and  wheat  gluten, 
and  containing  40  per  cent,  of  proteins  and  52  per 
cent,  of  carbohydrates.  Liquid  peptonoids  is  the 
same  in  liquid  form. 

Adult  Dosage. — -on  to  iv. 

Method  of  Administration. — In  water,  milk,  wine, 
broths,  soups,  etc.,  or  in  gruels,  first  dissolved  in 
water.  One-half  ounce  represents  about  65  calories. 

Uses. — ^Nutrient,  500  gm.  furmishes  2045  calories, 
960  due  to  protein,  and  1085  to  carbohydrate  and 
fat. 

Belladonnae  Emplastrum  (30  per  cent,  of  ext. 
bclladonnaj  mi.xed  with  adhesive  plaster. 

Physiologic  Action  and  Uses. — Local  anodyne, 
jjaralyzing  sensory  nerve  terminations. 

Toxic  Action. — ^Dryness  of  the  mouth,  throat,  and 
skin,  a red  flush  on  the  face  and  neck  (in  the  “blush- 
ing area”),  dilatation  of  the  pupils,  rapid  pulse, 
nausea,  husky  phonation,  difficulty  in  swallowing, 
mental  excitement,  tremor  and  marked  motor 
activity,  perhaps  convtdsions;  acceleration  followed 
by  .slowing  of  the  respiration,  low  blood-pressure, 
eventual  slowing  of  the  heart,  stupor,  coma. 

Belladonnae  Folia. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iss; 
gradually  increased  (see  Atropina). 

Uses. — Local  anodyne,  etc.,  see  Atropina. 

Belladonnae  Foliorum  Extractum  (gr.  corre- 
sponds approximately  to  gr.  )^oo  of  mydriatic 
alkaloids). 

Adult  Dosage. — Min.,  gr.  ’L;  av.,  Ki  max.,  %. 

Method  of  Administration. — I^  Extracti  bella- 
donna', gr.  }4,  pilule  no.  12. 

Sig. — <)nc  pill,  t.i.d.,  see  Atropina. 

Uses. — Local  anodyne,  etc.,  see  Atropina. 

Belladonnae  Foliorum,  Tinctura  (10  per  cent.) 
(iT^xii  represents  aiiproximately  gr.  '^oo  of  mydriatic 
alkaloids). 

Dosage. — 6 months,  gt.  ]4~V2]  18  months,  gt.  i; 


3 years,  gtt.  i-ii;  5 years,  gtt.  iii-v.  Adult,  min.,  tijv; 
av.,  x;  max.,  xxx. 

Method  of  Administration. — I^  Tincturae  bella- 
donme,  51 

Sig. — Ten  drops  in  an  ounce  of  water,  every  three 
or  four  hours. 

Give  belladonna  in  sufficient  dosage  to  produce 
flushing  of  the  .skin,  dryness  of  the  throat,  and  dila- 
tation of  the  pupils. 

Uses. — ^Local  anodyne,  etc.,  see  Atropina. 

Belladonnae  Linimentum  (camphor  5,  dissolved  in 
fl.  ext.  belladonna  root  to  100). 

Uses. — Local  anodyne,  etc.,  see  Atropina. 

Belladonnae  Radicis  Fluidextractum. 

Dosage. — 3 years,  TrjM;  5 years,  Adult, 

min.,  iTEss;  av.,  i;  max.,  ii. 

Method  of  Administration. — 1^  Fluidextracti  bel- 
ladonna;, 3i. 

M.  Sig. — One  drop  in  water,  every  four  hours. 

Uses. — -Local  anodyne,  etc.,  see  Atropina. 

Belladonnae  Unguentum  (ext.  belladonmc  10, 
diluted  alcohol  5,  benzoated  lard  65,  lanolin  20). 

Uses. — Local  anodyne,  etc.,  see  Atropina. 

Benzenum  Medicinale,  Celle. 

Adult  Dosage. — Alin.,  irjviii;  max.,  xv. 

Method  of  Administration. — I^  Benzeni  medicin- 
alls,  TTjviii-xv,  capsulae  no.  20. 

Sig. — One  capsule,  four  times  a day.  Stop  the 
drug  when  the  leucocytes  fall  to  12,000,  as  a further 
drop  tends  to  occur.  Keep  close  tab  on  the  blood 
and  urine. 

Uses. — Leucocyte  and  erythrocyte  destruction. 

Toxic  Action. — Albuminuria,  hcematuria,  giddi- 
ness, headache,  abdominal  pain,  vomiting,  purpura, 
amemia,  leucopenia,  delirium,  tonic  convulsions, 
followed  by  narcosis. 

Benzinum  Purificatum. 

Adult  Dosage. — Min.,  gtt.  v;  max.,  x. 

Method  of  Administration. — I^  Benzini  purifi- 
cati,  ^t.  XX,  in  one  pint  of  warm  water,  injected 
high  into  the  colon.  By  mouth  it  is  given  on  sugar 
or  in  mucilage. 

(7ses.— Anthelmintic. 

Benzoas  Ammonii:  C6H5COONH4  (soluble  in 

10  of  water;  in  35  of  alcohol). 

Dosage. — 43  months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  xv;  max.,  xxx. 

Method  of  Administration. — B Ammonii,  sodii, 
vel  lithii  benzoatis,  3iv,  gr.  vii  per  dram;  aquae, 
5iv. 

M.  Sig. — Two  drams  in  half  a tumbler  or  more 
of  water,  every  two  to  four  hours. 

Uses. — Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antiseptic. 

Benzoas  Lithii:  CelLCOOLi  (soluble  in  4 of  water. 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii); 
3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Ammonii,  sodii, 
vel  lithii  benzoatis,  3iv,  gr.  vii  p>er  dram;  aqua',  5iv. 

AI.  Sig. — -Two  drams  in  half  a tumbler  or  more 
of  water,  every  two  to  four  hours. 

Uses. — Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antiseptic. 

Benzoas,  Sodii:  Na(C6H5COO)  (soluble  in  1.8 

of  water). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — I^  Ammonii,  sodii, 
vel  lithii  benzoatis,  3iv,  gr.  vii  per  dram; 
aqu;e,  5iv. 

AI.  Sig. — Two  drams  in  half  a tumbler  or  more 
of  water,  every  two  to  four  hours. 


BISMUTHI  SUBIODIDUM 


Uses. — Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antisej)tic. 

Benzoicum  Acidum:  CeHaCOOH  (soluble  in  100 
of  water). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  viiss;  max.,  xx. 

Method  of  Administration. — Acidi  benzoici, 
gr.  viiss,  pulveres  12. 

Sig.— ^ne  powder  dissolved  in  half  a tumbler  of 
water,  every  two  to  four  hours. 

Uses. — Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antiseptic. 

Benzoinatus  Adeps  (2  per  cent,  powdered  benzoin) 

Uses. — Ointment  basis. 

Benzoin!  Tinctura  (20  per  cent,  benzoin). 

Adult  Dosage. — Min.,  i^x;  av.,  xv;  max.,  xx. 

Method  of  Administration. — 3ii-iv  to  the  pint  of 
steaming  water,  as  an  inhalant. 

Physiologic  Action  and  Uses. — Bronchial  sedative 
and  stimulating  e.xpectorant ,'  local  stimulant  and 
protective  to  ulcers  and  fissures. 

Benzoin!  Tinctura  Composita;  Friar’s  Balsam 
(benzoin  10,  aloes  2,  storax  8,  balsam  of  tolu  4, 
alcohol  to  100). 

Adult  Dosage. — Min.,  rn^x;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — 3i~3i  to  the  pint  of 
steaming  water,  as  an  inhalant. 

Physiologic  Action  and  Uses. — Bronchial  sedative 
and  stimulating  ex-pectorant;  local  stimulant  and 
protective  to  ulcers  and  fissures. 

Benzol,  see  Benzenum  Medicinale. 

Benzosalin;  Methylis  Benzoyl-Salicylas : CeH^O 
(CH3).C0.0.(C6H6C0,  1 : 2. 

Adult  Dosage. — Min.,  gr.  viiss;  max.,  xv. 

Method  of  Administration. — Benzo-salin.,  gr. 
viiss-xv,  pulveres  vel  tabellae  no.  24. 

Sig. — t)ne  powder  or  tablet,  four  times  a day 
(gr.  45  to  60  a day). 

Physiologic  Action  and  Uses. — Decomposes  in  the 
intestine  into  benzoic  and  salicylic  acids. 

Benzosulphinidum;  Saccharin;  Glusidum: 
C6H4SO2.CONH  (soluble  in  290  of  water,  and  31 
of  alcohol;  but  much  more  soluble  in  water  mixed 
with  an  equal  amount  of  sodium  bicarbonate.  It  is 
about  500  times  as  sweet  as  sugar,  weight  for 
weight) . 

Adult  Dosage. — Gr.  ss-iii-v,  up  to  gr.  xxx  per 
diem,  if  required. 

Ordinarily  gr.  ss-i  is  used  to  sweeten  eight  fluid 
ounces  of  food. 

B Benzosulphinidi ; sodii  bicarbonatis,  aa,  gr.  ss. 

Misce.  Mitte  tabs  tabella?  no.  30. 

Sig. — One  tablet  dissolved  in  each  eight  fluid 
ounces  of  food,  as  a sweetener. 

Uses. — Substitute  for  sugar  as  a flavoring  agent. 

Bergamottoe  Oleum. 

Uses. — Flavoring  agent;  perfume. 

Betainae  Hydrochloridum  (acidol:  C6II11NO2.HCI; 
freely  soluble  in  water). 

Adult  Dosage. — Av.,  gr.  viii. 

Method  of  Administration. — B Betaina?  hydro- 
chloridi,  gr.  viii,  tabellae  no.  21. 

Sig.— One  tablet,  freshly  dissolved  in  water, 
after  meals. 

Physiologic  Action  and  Uses. — Nascent  HCl  is 
slowly  liberated  in  the  aqueous  solution;  gr.  viii 
corresponds  to  about  18  minims  of  dilute  hydro- 
chloric acid. 

Betanaphthol,  a monohydroxyphenol : C10N7OH 
(soluble  in  1000  of  water,  0.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  iii;  av.,  v;  max.,  x. 

Method  of ^ Administration. — B .Betanaphthol, 
gr.  y,  pilulae  (intestinal  coated),  no.  *21. 

Sig. — One  pill,  t.i.d.a.c. 


Externally  as  a 3 to  5 per  cent,  ointment  (danger 
of  ab.sorption). 

Uses. — Inte.stinal  and  urinary  antiseptic;  anthel- 
mintic; local  antiseptic  and  parasiticide. 

Toxic  Action. — Nephritis,  anaemia  from  destruc- 
tion of  the  red  blood-cells,  sometimes  retinal  and 
lenticular  changes. 

Betulac,  Oleum  Empyreumaticum  Rectificatum; 
Oleum  Ilusci  Rectificatum. 

Adult  Dosage. — Min.,  i^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — -Used  in  a 2 to  10  per 
cent,  ointment. 

Uses. — Local  stimulant  and  antiseptic. 

Bichloridum  Hydrargyri,  HgCL  (soluble  in  13.5  of 
water,  and  3.8  of  alcohol). 

Dosage. — -6  months,  gr.  18  months,  gr.  }{oo', 
3 years,  gr.  Koo;  5 years,  gr.  Adult,  min.,  gr.  Yu] 
av.,  Mo:  max.,  %. 

Method  of  Administration. — R Hydrargyri  bi- 
chloridi,  gr.  M2,  tabella;  no.  60. 

Sig. — One  tablet,  t.i.d.,  well  diluted. 

Uses. — -Antiluetic;  antiseptic  in  solution,  1 : 20,- 
000-4000-1000.  Tonic  in  small  doses,  increasing 
growth  and  weight  and  the  formation  of  red  blood- 
cells. 

Toxic  Action. — Vomiting,  diarrhoea,  foul  smelling 
and  bloody  stools,  nervous  symptoms,  weakness, 
nephritis,  anuria,  salivation,  gingivitis. 

Bile  Salts,  see  Sodii  Glycocholas. 

Biniodidum  Hydrargyri,  HgR. 

Adult  Dosage. — Min.,  gr.  Mol  av.,  Mo;  max., 

Method  of  Administration. — R Hydrargyri  bini- 
odidi,  gr.  Mo  tabellae  no.  60. 

Sig. — One  tablet,  t.i.d. 

Uses. — -Antiluetic;  alterative. 

B.  I.  1.  P. ; Morrison’s  Paste  (Iodoform,  2 ounces, 
bismuth  subnitrate,  c.  p.,  1 ounce,  liquid  paraffin, 
q.  s.  to  make  a soft  paste  or  about  one  ounce). — 
The  bismuth  and  liquid  paraffin  are  sterilized  by 
dry  heat  at  248°  F.  for  thirty  minutes.  The  ingredi- 
ents are  mixed  in  a sterile  mortar. 

Uses. — For  infected  wounds.  After  filling  the 
wound  or  infected  cavity  with  the  paste,  and  cover- 
ing with  a pad,  it  may  be  left  for  days  or  weeks 
unless  pain  or  constitutional  disturbance  occurs. 

Bismuth!  Subcarbonas  (insoluble  in  water  or 
alcohol). 

Dosage. — 6 months,  gr.  x;  18  months,  gr.  x-xv; 
3 years,  gr.  x-xv;  5 years,  gr.  xx.  Adult,  min.,  3ss; 
max.,  i. 

Method  of  Administration. — R Bismuthi  sub- 
carbonatis,  3iv,  (3ss-l  per  dose);  syrupi  acacise, 
5ii;  aquae  cinnamomi,  q.s.  ad,  giv. 

M.  Sig. — Shake  well,  and  take  one  or  two  table- 
spoonfuls every  one  to  four  hours. 

Physiologic  Action  and  Uses. — Intestinal  astrin- 
gent and  antiseptic;  gastric  sedative  (neutralizes  the 
acid  of  the  gastric  juice  with  the  formation  of  the 
insoluble  oxychloride  of  bismuth  which  coats  the 
stomach);  local  protective;  used  in  X-ray  work. 

Toxic  Action. — See  Bismuthi  Subnitras. 

Bismuthi  Subgallas;  Dermatol  (insoluble  in 
water  or  alcohol). 

Dosage. — ^6  months,  gr.  iii-v;  18  months,  gr.  v; 
3 years,  gr.  v-x;  5 years,  gr.  x.  Adult,  min.,  gr.  x; 
max.,  XX. 

Method  of  Administration. — May  be  prescribed  like 
the  subcarbonate  above.  Also  used  locally  as  a pro- 
tective powder  and  in  ointment  form,  10  to  20  percent. 

Uses. — Intestinal  astringent  and  antiseptic;  gas- 
tric sedative. 

Local  antiseptic  and  protective. 

Bismuthi  Subiodidum. 

Adult  Dosage. — Min.,  gr.  iss;  max.,  iii. 

Uses. — Antiseptic  dusting  powder. 


BROMIDUM  AMMONII 


Bismuth!  Subnitras  (almost  insoluble  in  water; 
insoluble  in  alcohol). 

Dosage. — G months,  gr.  v-x;  18  months,  gr.  x; 
3 years,  gr.  x-xv;  5 years,  gr.  xx.  Adult,  min.,  5ss; 
max.,  i. 

Method  of  Administration.- — Bismuthi  sub- 
nitratis,  3iv  (3ss-i  per  dose);  sulphuris  prajcipitati, 
gr.  viii  (gr.  i-ii  per  dose);  mucilaginis  acaciac,  gh; 
aqua?,  q.s.  ad,  giv. 

M.  Sig. — Shake  well,  and  take  one  or  two  table- 
spoonfuls every  one  to  four  hours  or  until  the  stools 
are  blackened. 

Uses. — -Intestinal  astringent  and  antiseptic  (lib- 
erating nitrite);  gastric  sedative,  not  materially 
antacid;  local  protective,  astringent,  and  antiseptic. 

Toxic  Action. — Blue  line  on  the  gums;  headache; 
nausea;  vomiting;  stomatitis;  intestinal  ulceration 
and  diarrhma,  fever,  rapid  pulse,  nephritis,  mdema 
of  the  legs. 

Nitrite  poisoning  is  manifested  by  vasomotor 
paralysis,  tachycardia,  and  asphyxia,  due  to  the 
occurrence  of  raethsemoglobintcmia. 

Bismuthi  Subsalicylas  (almost  insoluble  in  water 
or  alcohol). 

Dosage. — G months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  .5  years,  gr.  iii-v.  Adult,  min.,  gr.  x; 
max.,  XX. 

Method  of  Administration. — R Bismuthi  sub- 
salicylatis,  giss  (gr.  xi  per  dose);  syrupi  acacia,',  gii. 
Aqum  cinnamomi,  q.s.  ad,  giv. 

M.  Sig. — Shake  well,  and  take  one  tablespoonful 
every  two  to  four  hours. 

Uses. — Intestinal  astringent  and  antiseptic. 

Bismuth  Paste,  see  Beck’s. 

Black  Wash;  Lotio  Ilydrargyri  Nigra  (calomel 
gr.  XXX,  in  lime-water,  gx,  producing  the  black 
oxide,  HgaO). 

A n f iQOT^'f  ir* 

Blaud’s  Pills  (Piliilai  Ferri  Carbonatis,  FeCOs). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  ii;  5 years,  gr.  ii.  Adult,  min.,  gr.  v; 
max.,  vii. 

Method  of  Administration. — R Pilula)  ferri  car- 
bonatis (Blaudii),  pulveris  recentis  pra'parati,  gr.  v. 

Dispense  in  gelatine  capsules  hardened  with  for- 
malin (Sahli’s  glutoid  capsules,  grade  ii  of  hardness), 
capsules  no.  .50. 

Sig. — One  pill,  t.i.d.p.c.,  increased  by  one  pill  each 
week  until  four  or  five  pills  are  taken  t.i.d. 

U ses.  — Hajmatic. 

Bleaching  Powder,  see  Calx  Chlorinata. 

Blister,  see  Cantharides. 

Blue  Mass;  Blue-Pill;  Mas.sa  Hydrargyri  (mer- 
cury 33,  licorice  10,  althaea  15,  glycerine  9,  honey 
of  rose  33). 

Dosage. — 3 years,  gr.  i;  5 years,  gr.  i-ii.  Adult, 
min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — I^  Massae  hydrar- 
gyri, gr.  v-x,  piluhe  no.  60. 

Sig. — One  pill  a day. 

Uses. — Cathartic;  antiluetic. 

Blue  Ointment;  I'nguentum  Hydrargyri  Dilutum 
(unguentum  hydrargyri  G7,  petrolatum  33). 

Dosage. — 6 months,  gr.  xw;  18  months,  gr.  xv; 
3 years,  gr.  xxx;  5 years,  3ss-i.  Adult,  min.,  3iss; 
av.,  iii;  max.,  vi. 

Method  of  Administration. — R Unguenti  hydrar- 
gyri diliiti,  3i. 

Mitte  talis  capsulae  no.  14. 

Rub  into  a non-hairy  region  of  the  skin,  each  night, 
to  the  point  of  dryness,  at  least  thirty  minutes  for 
one  dram,  rubbing  a different  part  each  night.  On 
the  seventh  day  take  a hot  sweat  bath.  (See  Part  1 ; 
Syphilis.) 

Uses. — Antiluetic;  antiseptic. 


Bolus  Alba;  Kaohnum  (purified  native  aluminum 
silicate). 

Adult  Dosage. — Av.,  5ss. 

Method  of  Administration. — Kaohn  may  be  given 
ad  libitum  in  an  equal  amount  of  water. 

R Kaolini;  carbonis  ligni,  aa. 

M.  Sig. — Two  tablespoonfuls,  once  to  thrice  a day. 

Physiologic  Action  and  Uses. — Absorbent  in  diar- 
rhcea  or  dy.sentery.  It  probably  acts  by  absorbing 
toxines  and  mechanically  carrying  bacteria  away 
with  it. 

Borax;  Sodii  Boras:  Na2B407-f  10  HjO  (soluble 
in  15  of  water;  insoluble  in  alcohol). 

Adidt  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xxx. 

Method  of  Administration. — As  an  eye-wash,  1 to 

2 per  cent,  solution.  As  a mouth-wash  and  gargle, 
3ii  ad  Oi. 

Uses. — Antiseptic;  astringent;  detergent;  alka- 
line; antipruritic. 

Toxic  Action. — Gastro-enteritis,  nephritis,  skin 
eruptions,  visual  disturbances,  fall  of  temperature, 
collapse,  and  a widespread  fatty  degeneration,  dry 
skin,  red  mucous  membranes. 

Borici  Acidi  Unguentum  (boric  acid  10,  paraffin  10, 
white  petrolatum  80). 

Uses. — Antiseptic  emollient  and  protective. 

Boricum  Acidum,  H3BO3  (soluble  in  18  of  water, 
18  of  alcohol,  4 of  glycerine). 

Adult  Dosage. — Mm.,  gr.  v;  av.,  x;  max.,  .xxv. 

Method  of  Administration. — I^  Acidi  borici,  gr.  x. 

Mitte  talis  pulveres  no.  12. 

Sig. — One  powder  dissolved  in  water,  three  or  four 
times  daily. 

Give  no  more  than  3i  a day. 

For  local  use,  one  to  four  drams  to  the  pint; 
4 per  cent,  is  a saturated  solution. 

Uses. — Urinary  acidifier  and  antiseptic;  local 
antiseptic.  Glycerine  used  as  a solvent  of  boric  acid 
in  aqueous  solution  more  or  less  destroys  its  anti- 
septic value.  (Goodrich). 

Boroglycerini  Qlyceritum  (boric  acid  310,  and 
glycerine  460,  evaporated  by  heat  down  to  500 
grams,  and  an  equal  weight  of  glycerine  added). 

Uses. — -Antiseptic. 

Bougard's  Paste,  see  Part  5,  Skin  Diseases,  imder 
Carcinoma  Cutis. 

Bovinine;  Bovril  (partially  digested  meat  juice). 

Uses. — Nutrient. 

Bran  Bath,  see  Baths,  Medicated. 

Brandy;  Spiritus  V'ini  Gallic!  (alcohohc  content  39 
to  47  per  cent,  by  weight.) 

Dosage. — 6 months,  gtt.  v-x;  18  months,  gtt.  x-xx; 

3 years,  gtt.  xx-xxx;  5 jnars,  gtt.  xxx-xl.  Adult, 
min.,  3ii;  max.,  5h- 

Method  of  Administration. — I^  Spiritus  vini 
gallici,  5 viii. 

Sig. — .A  dose,  diluted  six  to  ten  times  in  water, 
every  one  to  four  hours;  no  more  than  one-half 
to  one  ounce  in  twenty-four  hours  to  an  infant  of 
one  year  or  less,  three  to  four  ounces  to  a child  of 
five  years,  no  more  than  ten  ounces  to  an  adult. 

Physiologic  Action  and  Uses. — General  stimulant 
in  its  initial  effect,  followed  by  sedation  and  even- 
tually narcosis;  dilates  the  cutaneous  vessels;  anti- 
pyretic; diuretic;  removes  inhibition;  produces 
euphoria  by  blunting  the  feehngs  of  discomfort; 
stomachic;  antiseptic;  local  rubefacient. 

Bromidum  Ammonii,  NH^Br  (soluble  in  1.5  of 
water). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-;-iv, 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min.; 
gr.  x;  av.,  xv;  max.,  xl. 

Method  of  Administration. — I^  Ammonii  bro- 
midi,  3v  3i  (gr.  x per  dram);  aquae,  giv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler 


BUROW’S  SOLUTION 


of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant j anaphrodisiac : diminishes  cen- 
tral reflex  hyperexcitability. 

Toxic  Action. — Bromism  is  manifested  by  palatal 
and  pharyngeal  anaesthesia,  with  the  absence  of 
gagging  on  mechanical  irritation,  by  sexual  impo- 
tence, diminished  reflexes,  nervous  and  muscular 
depression,  apathy,  weakening  of  memory,  pallor, 
lowered  arterial  tension  and  temperature,  muddy 
complexion,  acne,  coated  tongue,  fetor  oris,  indi- 
gestion, emaciation,  drowsiness,  respiratory  catarrh, 
rapid  feeble  heart. 

Bromidum  Calcii,  CaBr2  (soluble  in  0.7  of  water 
and  1.3  of  alcohol). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  xv;  max.,  lx. 

Method  of  Administration. — Calcii  Bromidi, 
3v  3i  (gr.  x per  dram);  aqum,  giv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler 
of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac:  diminishes  cen- 
tral reflex  hyperexcitability. 

Bromidum  Potassii,  KBr  (soluble  in  1.6  of  water). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-iv;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  xv;  max..  Lx. 

Method  of  Administration. — Potassii  bromidi, 
3v  3i  (gr.  X per  dram);  aqua?,  5iv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler 
of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac:  diminishes  cen- 
tral reflex  hyperexcitability. 

Bromidum  Sodii,  NaBr  (soluble  in  1 of  water). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  xv;  max.,  lx. 

Method  of  Administration. — Sodii  bromidi, 
3v  9i  (gr.  x per  dram);  aqua?,  5iv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler 
of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

At  three  months,  gr.  iii  every  two  hours,  for 
convulsions.  (Holt.) 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac;  diminishes  cen- 
tral reflex  hyperexcitability. 

Bromidum  Strontii,  SrBr2(H20)e  (soluble  in  0.35 
of  water). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Strontii  bromidi, 
3v  3i  (gr.  X per  dram);  aqua?,  giv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler 
of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac:  diminishes  cen- 
tral reflex  hyperexcitability. 

Bromipin  (Brominized  Sesame  Oil,  10  per  cent.). 

Adult  Dosage. — Min.,  3i;  av.,  ii;  max.,  gi. 

Method  of  Administration. — Bromipin,  gii; 
syrupi  simplicis;  aqua?  mentha?  piperita?,  aa,  gi. 

Fiat  emulsum. 

Sig. — Two  teaspoonfuls  every  four  hours. 

R Bromipin,  gii. 

Sig. — One  teaspoonful  in  warm  milk  every  four 
hours. 


Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac;  diminishes  cen- 
tral reflex  hyperexcitability. 

Bromocoll  Unguentum,  20  per  cent.  (Bromocoll  = 
bromine  compound  with  gelatine,  containing  about 
20  per  cent,  of  bromine). 

Uses. — Antipruritic.  (Ortner.) 

Bromoformum;  Tri-brom-methane:  CHBrs; 

(.slightly  soluble  in  water;  miscible  with  alcohol; 
reject  if  colored). 

Dosage. — 6 months,  gt.  i;  18  months,  gt.  iss; 
3 years,  gtt.  iii;  5 years,  gtt.  v.  Adult,  i^iii-v. 

Method  of  Administration. — 1^  Bromoformi,  gss. 

Sig. — Five  drops,  in  milk,  or  on  sugar,  or  dissolved 
in  almond  oil,  every  four  hours.  Five  to  twenty 
minims  a day,  in  whooping-cough. 

Physiologic  Action  and  Uses. — Nervous  Sedative; 
anaphrodisiac;  diminishes  reflexes. 

Toxic  Action. — Narcosis. 

Bromum:  Br  (.soluble  in  90  of  water,  freely  soluble 
in  alcohol  or  ether). 

Uses. — Irritant. 

Toxic  Action. — Gastritis,  depression,  collapse. 

Bromural  (2-monobrom-isovaleryl-urea:  CII3.CH 
(CH3)CHBr.CO)HN.CO.NH2.  easily  soluble  in 
hot  water). 

Adult  Dosage. — Min.,  gr.  v;  max.,  x. 

Method  of  Administration. — I^  Bromural,  gr.  v, 
tabella?  no.  12. 

Sig. — One  tablet  t.i.d.;  or  two  tablets  in  hot  water 
or  spirits,  at  bedtime,  repeated  if  necessary  during 
the  night,  after  the  action  of  the  first  dose  has  ceased. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
hypnotic,  acts  in  twenty  to  thirty  minutes,  its  effects 
continuing  three  to  five  hours.  It  is  considered 
safe  and  reliable,  but  not  active  in  insomnia  due  to 
pain,  cough,  or  delirium. 

Brown  Mixture;  Mistura  Glycyrrhiza?  Composita 
(pure  extract  glycyrrhiza?  3,  syrup  5,  acacia  3,  tr. 
opii  camph.  12,  vinum  antimonii  6,  spiritus  a?theris 
nitrosi  3,  and  water  to  100). 

Dosage. — 6 months,  gtt.  xv;  18  months,  gtt.  xx; 
3 years,  gtt.  xxx-xl;  5 years,  gtt.  xl-Lx.  Adult  min., 
gi;  av.,  ii;  max.,  gi. 

Method  of  Administration. — Mistura?  glycyr- 
chiza?  composita?,  giv. 

Sig. — Two  to  four  teaspoonfuls,  every  two  hours, 
until  the  cough  is  relieved. 

Uses. — Sedative  e.xpectorant. 

Buchu  Fluidextractum. 

Adult  Dosage. — Min.,  ajxv;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — I^  Fluidextractl 

buchu,  gii. 

Sig. — ^Thirty  drops  in  a glassful  of  water,  three  or 
four  times  a day,  with  plenty  of  water  in  the  intervals. 

Uses. — Diuretic.  The  best  of  the  vegetable 

diuretics,  says  Casper. 

Toxic  Action. — Burning  sensation  in  the  stomach, 
vomiting,  purging,  strangury. 

Buchu  Infusum  (gi  of  the  dried  leaves  to  the  pint). 

Adult  Dosage. — Min.,  gss;  av.,  i;  max.,  ii. 

Method  of  Administration. — I^  Infusi  buchu,  g viii. 

Sig. — Two  tablespoonfuls  in  a glassful  of  water, 
three  or  four  times  a day,  with  plenty  of  water  in 
the  intervals. 

Uses. — Diuretic.  The  best  of  the  vegetable  diu- 
retics, says  Casper. 

Bulgaricus  Bacillus,  see  Bacillus  Bulgaricus. 

Burgundy  Pitch  ; Fix  Burgundica. 

Uses. — Rubefacient;  basis  for  plasters.  It  softens 
and  becomes  adhesive  at  the  body  temperature. 

Burow’s  Solution: 

R LiquorLs  alumini  acetatis,  giii;  plumbi  ace- 
tatis,  gr.  Ixxv;  aqua?  destillatae,  giii  3 i. 

M.  Sig. — For  local  use. 


CALCII  CHLORIDUM 


Uses.- — ^ Astringent;  antiseptic. 

Butyl=chloral  Hydras,  CIl3CHCl.CCl2CII(OII)2 
(soluble  in  50  of  water). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xx. 

Method  of  Administration. — Butyl-chloral 
liydratis,  gr.  v,  pilula3  no.  4. 

Sig. — One  pill  every  half  hour  until  effectual,  or 
until  four  have  been  taken. 

Uses. — Nervous  sedative;  hyjjnotic;  analgesic. 

Cacao=B utter;  Theobromatis  Oleum  (melts  at 
body  temperature). 

Uses.- — Emollient;  suppository' basis. 

Cacodylas  Sodii;  Sodium  Dimethylarsenate: 

— ^CHs  (soluble  in  0.5  of 

0=As^^ — — CH3  water,  and  in 
^\ONa  2.5  of  alcohol). 


Adult  Dosage. — Min.,  gr.  ’(q!  av.,  max.,  i. 

Method  of  Administration. — Sodii  cacodylatis, 
gr.  xlviii;  aqua*  dcstillata',  Sh 

M.  Sig. — Inject  npviiss  (^.  ^),  hj-jradermically, 
and  increase  the  dose  daily  up  to  even  gr.  xw, 
unless  poisonous  effects  occur. 

Physiologic  Action  and  Uses. — Much  less  toxic 
thiin  the  ordinary  arsenic  preparations,  due  to  the 
slow  liberation  of  the  arsenous  acid  in  the  body.  It  is 
best  given  hypodermically,  because  it  is  sometimes 
decomposed  in  the  stomach. 

Toxic  Action. — Permanent  optic  atrophy. 

Cadinum  Oleum  (Empyreumatic  Oil  of  Juniper). 

Uses. — Local  cutaneous  stimulant. 

Caffeina;  Trimethyl-xanthine  (alkaloid): 


/CHs 


CH3N— CO 

I I 

CO  C— N< 

I II  ^CH 

CH3N  — C— N/- 


(soluble  in  46  of  water, 
and  66  of  alcohol;  sol- 
ubility in  water  greatly 
increased  by  the  addi- 
tion of  sodium  benzoate 
or  salicylate). 


Adult  Dosage.- — Min.,  gr.  ss;  av.,  i;  max.,  v. 

Method  of  Administration. — Caffeina",  gr.  i, 
pulveres,  capsula",  vel  tabellse  no.  12. 

Sig. — One  powder  every  half  to  one  hour  until 
relieved;  may  be  given  h>q)odermically. 

A cup  of  coffee  made  from  a tablespoonful  of 
ground  coffee  contains  from  1)^  to  3 grains  of 
caffeine. 

Physiologic  Action  and  Uses. — Stimulates  the 
cerebral,  medullary,  and  spinal  centres,  increases 
the  general  reflex  excitability,  stimulates  the  vaso- 
inotor,  respiratory,  and  vagus  centres  in  the  medulla, 
but  also  acts  periplierally  (in  the  brain,  kidneys,  and 
coronary  vessels)  as  a vasodilator,  and  stimulates 
the  cardiac  accelerator  mechanism.  It  also  increases 
the  tendency  to  premature  contractions  of  extra- 
systoles by  action  on  the  intracardiac  motor  mech- 
anism. It  stimulates  directly  cardiac  and  volun- 
tary muscles,  increasing  their  irritability  and  power 
of  contraction,  and  lessening  fatigue.  It  is  a gen- 
eral neuromuscular  stimulant,  antineuralgic,  and 
diuretic. 

Toxic  Action. — Insomnia,  nervousness,  sense  of 
heaviness  in  the  head,  headache,  palpitation  due  to 
exdra-systoles,  nausea  or  vomiting,  lessened  capacity 
for  mental  or  muscular  work;  flashes  of  light  before 
the  eyes,  tinnitus,  muscular  tremors,  flatulent  indi- 
gestion, vertigo,  frequent  urination,  elevation  of 
temperature,  mental  confusion,  exaggerated  reflexes, 
tetanic  convulsions,  cardiac  dilatation. 

Caffeina  Citrata  (50  per  cent,  caffeine;  soluble  in 
about  25  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  ss-i; 
3 years,  gr.  i;  5 years,  gr.  i-ii.  Adult,  min.,  gr.  i; 
av.,  v;  max.,  x. 


Method  of  Administration. — Caffeinse  citratae, 
gr.  iii,  pulveres  no.  12. 

Sig.-^)ne  powder  every  three  hours. 

Not  adapted  for  hypodermic  use. 

Caffeinae  Sodio=benzoas  (caffeine  and  sodium  ben- 
zoate, aa’ soluble  in  1.1  of  water  and  30  of  alcohol). 

Adult  Dosage. — Gr.  v by  mouth,  gr.  i-iii  hypo- 
dermically, dissolved  in  1 c.c.  of  distilled  water. 

Method  of  Administration. — I^  Caffeina."  sodio- 
benzoatis,  vel  sodio-salicylatis,  gr.  v,  pulveres  no.  12. 

Sig. — One  powder  by  mouth  every  four  to  six  hours. 

Caffeinae  Sodio=saIicylas  (caffeine  and  sodium 
salicylate,  aa;  soluble  in  2 of  water). 

Adult  Dosage. — Gr.  v by  mouth,  gr.  i-iii  hypo- 
dermically, dissolved  in  1 c.c.  of  distilled  water. 

Method  of  Administration. — See  above. 

Cajaputi  Oleum. 

Adult  Dosage. — Min.,  ttjv;  av.,  viii;  max.,  x. 

Method  of  Administration. — Olei  cajaputi,  3i- 

Sig. — TTgi-iii  in  hot  water  every  two  hours. 

Uses. — Carminative  in  flatulent  colic. 

Calamina  (Native  Zinc  Carbonate;  insoluble 
in  water). 

Uses. — A flesh-colored,  protective  powder. 

Calamine  Liniment. 

Method  of  Administration. — 1^  Calamina",  5iv; 
zinci  oxidi,  3iv;  acidi  carbolici,  rjxx-.xl;  olei  olivae, 
5iv;  liquoris  calcis,  5iv. 

M.  Sig. — Shake  well.  For  local  use. 

Uses. — Antiseptic;  antipruritic;  protective. 

Calamine  Lotion. 

Method  of  Administration. — Calamina",  3iss; 
zinci  oxidi,  3ui;  acidi  borici,  3ii;  glycerini,  tijjv-xv; 
acidi  carbolici,  Ti!jxv-3i;  liquoris  calcis,  5ii;  aquae, 
q.s.  ad.,  5 viii. 

M.  Sig. — Shake  well.  For  local  use. 

Uses. — Antiseptic;  antipruritic;  protective. 

Calcii  Bromidum:  CaBr2  (soluble  in  0.7  of  water 
and  1.3  of  alcohol). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min., 
gr.  x;  av.,  xv;  max.,  lx. 

Method  of  Administration. — Calcii  bromidi, 
3v  9i  (gr.  X per  dram);  aquae,  giv. 

M.  Sig. — One  to  three  drams,  in  half  a tumbler 
of  water,  milk,  or  an  alkaline  effervescent  water, 
two  to  four  times  a day. 

Physiologic  Action  and  Uses. — Nervmus  sedative; 
cerebral  depressant;  anaphrodisiac;  diminishes  reflex 
hyperexcit  ability. 

Toxic  Action. — For  symptoms  of  Bromism,  see 
Bromidum  .Ammonii. 

Calcii  Carbonas  Prscipitatus;  Precipitated  Chalk: 
CaCOs  (nearly  insoluble  in  water  and  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  .xlv. 

Method  of  Administration. — I^  Calcii  carbonatis 
pra"cipiti,  gr.  xv-lx,  pulveres  no.  12. 

Sig. — A powder  two  or  three  times  daily. 

Physiologic  Action  and  Uses. — Antacid;  intestinal 
astringent;  neutralizes  acids  (fatty  acids,  sulphuric 
and  phosphoric  acids)  in  the  intestine,  and  so 
deprives  the  urine  of  a portion  of  its  acid  constitu- 
ents, rendering  it  less  acid,  or  even  alkaline,  and 
therefore  favoring  the  solution  of  uratic  deposits  in 
the  urinary  tract. 

Calcii  Chloridum,  CaCU  (soluble  in  1.2  of  water 
and  10  of  alcohol). 

Dosage.- — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  i-ii;  5 years,  gr.  ii.  Adult,  min.,  gr.  v; 
av.,  viii;  max.,  xv-|-. 

Method  of  Administration. — ^ Calcii  chloridi,  gi 
(gr.  xw  ad  gss);  aqua;  et  syrupi,  q.s.  ad  gii. 

M.  Sig. — (4ne  half  to  one  dram,  well  diluted  in 
w'ater,  four  times  a day  (one  to  two  drams  of 
calcium  chloride  daily). 


CALUMB^  FLUIDEXTRACTUM 


During  the  administration  of  calcium  salts,  avoid 
all  acids,  acid  fruits,  shell-fish,  and  egg  albumen 
(decalcifying  agents),  and  secure  moderate  catharsis. 

Physiologic  Action  and  Uses. — Hiemostatic,  alter- 
ative, increases  the  viscosity  of  the  blood.  If  con- 
tinued longer  than  three  days,  it  is  said  to  diminish 
the  coagulability  of  the  blood.  It  is  best  given  for  a 
day  or  two  every  week. 

Toxic  Action. — Lowered  temperature,  slow  pulse, 
tendency  to  cardiac  paralysis. 

Calcii  Qlycerophosphas:  CaCsHrOeP  (soluble  in 
50  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  v. 

Method  of  Administration. — I^  Calcii  glycero- 
phosphati,  gr.  v,  pulveres,  tabellae,  vel  capsute 
no.  36. 

Sig. — One,  t.i.d. 

Physiologic  Action  and  Uses. — Alterative,  tonic. 
Calcium  salts  are  muscular  and  nervous  sedatives. 
U.sed  against  urticaria  and  serum  rashes. 

Calcii  Hypochloris;  Bleaching  Powder,  see  Calx 
Chlorinata. 

Calcii  Hypopliosphis:  Ca(PIl202)2  (soluble  in  0.8 
of  water;  insoluble  in  alcohol). 

Adidt  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xv. 

Method  of  Administration. — R Calcii  hypophos- 
phitis,  3ii  3fi  (gr.  vad  3i)j  syrupisimplicisetaquiB, 
aa,  5ii- 

M.  Sig. — Two  drams,  t.i.d. 

Uses. — Alterative,  tonic. 

Calcii  lodidum:  CaL. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xx. 

Uses. — Alterative;  praised  as  a cough  remedy. 

Calcii  Lactas:  Ca(C3H503)2  5H2O  (soluble  in  20 
of  water;  almost  imsoluble  in  alcohol). 

Dosage.^-Q  months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  i-ii;  5 years,  gr.  ii.  Adult,  min.,  gr.  v;  av., 
xv;  max.,  3i- 

Method  of  Administration. — -I^  Calcii  lactatis, 
gr.  icf,  pulveres,  in  charta  cerata,  no.  12. 

Sig. — One  or  two  powders  in  water,  four  to  six 
times  a day. 

Physiologic  Action  and  Uses. — Haemostatic;  alter- 
ative; increases  the  viscosity  of  the  blood.  If  con- 
tinued longer  than  three  days,  it  is  said  to  diminish 
the  coagulability  of  the  blood.  It  is  best  given  for 
a day  or  two  every  week.  It  is  less  irritating  than 
the  chloride,  and  therefore  more  suitable  for  hypo- 
dermic use.  See  also  Calcii  Chloridum. 

Toxic  Action. — Lowered  temperature,  slow  pulse, 
tendency  to  cardiac  paralysis. 

Calcii  Lactophosphatis  Syrupus. 

Dosage. — 6 months,  Ttjxxx;  18  months,  njxlv;  3 
years,  3i;  5 years,  3 i-ii-  Adult,  min.,  3ij  av.,  iiss; 
max.,  iv. 

Method  of  Administration. — R Syrupi  calcii  lac- 
tophosphatis, oiv. 

Sig. — Two  tea.spoonfuls,  t.i.d. 

Uses. — -Alterative;  tonic. 

Calcii  Permanganas. 

Adult  Dosage. — Min.,  gr.  ii;  max.,  vi. 

Method  of  Administration. — ^Gr.  ii-vi  ad  aquam, 
Oi,  freely,  for  cholera,  q.v.  in  Part  1. 

Uses. — Antiseptic. 

Calcii  et  Sodii  Qlycerophosphati  Elixir. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — I^  Elixiris  calcii  et 
sodii  glycerophosphati,  giv. 

Sig.— Two  teaspoonfuls,  t.i.d. 

Uses. — Alterative;  tonic. 

Calcii  Sulphiduin  Crudum;  Calx  Sulphurata:  CaS 
(very  slightly  soluble  in  water;  insoluble  in  alcohol). 

Dosage. — 6 months,  gr.  %q;  18  months,  gr.  Ko)  3 
years,  gr.  5 years,  gr.  Adult,  rnin.,  gr.  av., 

max.,  i-ii. 


Method  of  Administration. — R Calcii  sulphidi, 
gr.  ss. 

Make  into  a pill  with  glucose  and  milk  sugar,  and 
varnish.  Dispense  pills  no.  18. 

Sig. — One  pill,  twice  daily,  p.c.,  increased,  if 
desired,  to  three  to  four  jfills,  twice  a day. 

Uses. — Antipustulant ; local  depilatory  (see  Barii 
Sulphiduin). 

Calcined  Magnesia;  Magnesii  O.xidum:  MgO; 

Lidit  Magnesia. 

Dosage. — <5  months,  gr.  v-x;  18  months,  gr.  x-xx; 
3 years,  gr.  xx-.x.xx;  5 years,  gr.  x.xx-xl.  Adult,  min., 
3ss;  max.,  i. 

Method  of  Administration. — R Magnesii  oxidi, 
3iv  (gr.  XV  to  the  tablespoonful) ; syrupi  acacise,  5iv; 
aquaj,  q.s.  ad,  5viii. 

M.  Sig. — Shake  well  and  take  one  to  two  table- 
spoonfuLs  as  required,  for  acidity,  or  about  one  to 
two  hours  after  meals. 

Uses. — Antacid;  laxative. 

Calcis  Linimentum;  Carron  Oil  (lime-water  and 
linseed  or  cottonseed  oil,  aa). 

Uses. — -Bland,  protective  emollient. 

Calcis  Liquor;  Lime-Water  (Ca(OII)2,  not  less 
than  0.14  per  cent.). 

Adult  Dosage. — -Min.,  gss;  max.,  i. 

Method  of  Administration. — -An  excess  of  lime 
should  be  kept  in  the  bottom  of  the  container  in 
order  to  preserve  the  strength  of  the  solution,  for 
lime  water  absorbs  CO2  from  the  air,  with  the  result- 
ing precipitation  of  calcium  carbonate  and  a weak- 
ening of  the  solution. 

Uses. — Gastric  sedative;  antacid;  intestinal 
astringent. 

Calcis  Sulphuratas  Liquor;  Vleminckx’s  Solution: 

Method  of  Administration. — R Calcis,  Sss;  sul- 
phuris  praecipitatae,  gi;  aquae  destillataj,  Sx. 

M.  Boil  down  to  six  ounces  and  filter. 

Sig. — Dilute  at  first  with  about  ten  parts  of  water, 
and  bathe  the  parts  for  five  to  ten  minutes.  Increase 
the  strength  gradually  every  few  nights,  with  the 
object  of  producing  some  irritation. 

Uses. — Stimulating  lotion;  depilatory. 

Calomel;  Hydrargyri  Chloridum  Mite;  HgCl. 

Dosage.-AS  months,  gr.  '{oi  18  months,  gr.  Ao', 
3 years,  gr.  )(;  5 years,  gr.  Adult,  min.,  gr.  ii; 
av.,  v;  max.,  viii. 

Method  of  Administration.—Pf  Hydrargyri  chlo- 
ridi  mitis,  gr.  i (for  infants) ; sacchari  albi,  q.s. 

Misce  et  divide  in  pulveres  no.  10. 

Sig. — One  powder  every  half  to  one  hour  until 
effectual  or  until  the  stools  turn  green;  usually  no 
inore  than  one  grain  for  infants.  Follow  after  about 
six  hours  or  the  next  morning  by  a saline. 

R Hydrargyri  chloridi  mitis,  gr.  W,  tabelke  no.  1 2 
(for  adults). 

Sig. — -One  tablet  every  fifteen  minutes,  or  four 
tablets  every  hour  (or  gr.  ii-viii  in  a single  dose  at 
bedtime,  followed  by  a saline  one  hour  before 
breakfast. 

Physiologic  Action  and  Uses. — Antiluetic;  hydra- 
gogue  purgative,  acting  (in  one  to  twenty  hours)  on 
both  the  large  and  small  bowel,  by  interfering  with 
the  absorption  of  fluids;  the  green  color  of  the  stools 
is  due  partly  to  sulphide  of  mercury,  and  not  alto- 
gether to  biliverdin;  diuretic,  acting  the  same  as 
potassium  citrate,  q.v.-,  intestinal  antiseptic;  gastric 
sedative  in  small  doses. 

Toxic  Action. — ^Abdominal  pain;  loose  stools; 
salivation;  gingivitis;  malaise. 

Calumbae  Fluidextractum. 

Adult  Dosage. — Min.,  irgxv;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti  cal- 
umbcD,  5ii- 

Sig. — One-half  dram  in  water,  t.i.d.a.c. 


CANNABIS  INDICiE  FLUIDEXTRACTUM 


Physiologic  Action  and  Uses. — Simple  stomachic 
bitter;  stimulates  appetite  and  digestion  through 
reflex  stimulation  of  the  nerves  of  taste;  contains 
no  tannin,  and  can  therefore  be  prescribed  with 
iron,  but  not  ferric  salts. 

Calumbae  Infusum  (made  with  cold  water). 

Adult  Dosage. — Min.,  5ss;  max.,  i. 

Method  of  Administration. — Infusi  calumbffi,  Oss. 

Sig. — Tablespoonful,  t.i.d.a.c. 

Calumbae  Tinctura. 

Adult  Dosage.-~M.in.,  5i;  av.,  ii;  max.,  iv. 

Method  of  Administration. — 1^  Tincturse  cal- 
umbae, 5iv. 

Sig. — -One  or  two  teaspoonfuls  in  water,  t.i.d.a.c. 

Calx  Chlorinata;  “Chloride  of  Lime”;  Bleaching 
Powder  (a  compound  of  calcium  chloride  and  hypo- 
chlorite containing  not  less  than  30  per  cent,  of 
available  chlorine;  partially  soluble  in  water  and 
in  alcohol). 

Uses. — Disinfectant,  especially  for  excreta,  used 
liberally  and  left  in  contact  at  least  one  hour. 

Calx  Sulphurata;  Calcii  Sulphidum  Crudum:  CaS 
(very  slightly  soluble  in  water;  insoluble  in  alcohol). 

Dosage. — 6 months,  gr.  18  months,  gr.  l4o; 
3 years,  gr.  )4o;  5 years,  gr.  Ko-  Adult,  min.,  gr. 
av.,  max.,  i-ii. 

Method  of  Administration. — Calcii  sulphidi, 
gr.  ss. 

Make  into  a pill  with  glucose  and  milk  sugar,  and 
varnish.  Dispense  pills  no.  18. 

Sig. — -One  pill,  twice  daily,  p.c.,  increased,  if 
desired,  to  three  or  four  pills  twice  a day. 

Uses. — Antipustulant;  local  depilatory  (see  Barii 
Sulphidum). 

Camphora. — See  Camphorse,  Pulvis,  below. 

Camphorse  Aqua  (camphor  8,  alcohol  8,  talc  15, 
distilled  water  to  1000). 

Adult  Dosage. — Min.,  3i;  av.,  ii;  max.,  iv. 

Uses. — Vehicle;  mildly  carminative  and  expec- 
torant. 

Camphorae  Linimentum;  Camphorated  Oil  (cam- 
phor 20,  cottonseed  oil  80). 

Method  of  Administration. — ^Tliis  preparation,  as 
found  in  drug  stores,  should  not  be  used  hypodermi- 
cally. (See  Oleum  Camphorata.) 

Uses. — Local  rubefacient. 

Camphorae  et  Mentholis  Trochisci. 

Method  of  Administration. — ^A  lozenge  every 
two  hours. 

C/ses.— Expectorant;  diaphoretic;  refrigerant;  ano- 
dyne. 

Camphorae  Pulvis:  CgHieCO  (a  ketone)  (very 

slightly  soluble  in  water,  freely  soluble  in  alcohol, 
ether,  chloroform,  and  in  fi.xed  and  volatile  oils). 

Dosage. — 6 months,  gr.  Koi  18  months,  gr. 

3 years,  gr.  5 years,  gr.  )^.  Adult,  min.,  gr.  iss; 
av.,  ii;  max.,  v. 

Method  of  Administration. — For  collapse,  gr.  i-ii- 
iii  in  igjxv-xxx  of  olive-oil  or  ether,  hj’podermically 
or  deep  into  the  muscle,  every  half  to  one  to  two 
hours,  up  to  10  to  20  grains  of  camphor  in  twenty- 
four  hours.  The  oily  solution  may  be  sterilized 
by  heat. 

For  coryza:  Camphorae  pulveris,  gr.  Lxxx 

(gr.  V per  dram);  syrupi  acaciae;  aquas,  aa  Si- 

M.  et  fiat  emulsum. 

Sig. — -One  dram  every  two  hours. 

Physiologic  Action  and  Uses. — Stimulates  the 
cerebral  and  medullary  centres,  vasoconstrictor  and 
respiratory,  and  the  heart  directly;  diaphoretic; 
expectorant;  anodyne;  antiseptic. 

Toxic  Action. — Delirium,  languor,  dizziness,  men- 
tal confusion,  dimness  of  vision,  drowsiness,  head- 
ache, cardiovascular  depression,  cold  skin,-gastro- 
enteritis,  unconsciousness,  convulsions. 


Camphorse  Spiritus  (10  per  cent,  in  alcohol). 

Dosage. — 6 months,  gtt.  iii;  18  months,  gtt.  v; 
3 years,  gtt.  v-x;  5 years,  gtt.  x.  Adult,  min.,  n)jx; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — Spiritus  cam- 
phorae, 5ii. 

Sig. — Fifteen  drops  on  sugar  or  well  diluted  in 
water,  every  four  to  sLx  hours.  For  collapse,  it 
may  be  injected  deep  into  the  muscle  every  hour 
or  two. 

Uses. — Anodyne;  carminative;  diaphoretic;  anti- 
catarrhal;  general  stimulant. 

Camphorae  Unguentum  (5  to  15  per  cent.). 

U ses. — antipruritic. 

Camphora  Monobromata:  CioHisBrO  (almost 

insoluble  in  water;  soluble  in  6.5  of  alcohol). 

Adult  Dosage.— Gr.  i-ii-v. 

Method  of  Administration. — -I^  Camphorae  mono- 
bromatae,  gr.  l.xxx  (gr.  v per  dram);  syrupi  acaciae; 
aquae,  aa  §i. 

M.  et  fiat  emulsum. 

Sig. — ^One-half  to  one  dram,  t.i.d.  It  may  be 
prescribed  in  pill  or  capsule. 

Uses. — Nervous  sedative ; hypnotic ; anaphrodisiac. 

Camphorata  Oleum  (camphorated  oil,  10  per 
cent.,  not  the  liniment). 

Dosage. — 6 months,  gtt.  iii;  18  months,  gtt.  v; 
3 years,  gtt.  v-x;  5 years,  gtt.  x.  Adult,  mm.,  irjjxv; 
av.,  xxx;  max.,  pi- 

Method  of  Administration. — For  collapse:  sterilize 
by  heat,  and  inject  deep  into  a muscle  every  hour  or 
two,  or  inject  0.5  c.c.  every  fifteen  minutes  for  four 
doses,  if  necessary. 

This  is  not  the  camphorated  oil  of  the  shops. 
The  latter  is  Linimentum  Camphorse,  which  should 
not  be  used  hypodermically. 

Uses. — General  stimulant;  mild  local  rubefacient. 

Camphor=Chloral  (a  fluid  obtained  by  triturating 
together  equal  parts  of  camphor  and  chloral  hydrate) 

Uses. — Local  anodyne. 

Camphoricum  Acidum. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Acidi  camphorici, 
gr.  xv;  mitte  talis  pulveres  no.  12. 

Sig. — One  powder,  dry  on  the  tongue,  t.i.d.,  or 
about  two  hours  before  the  expected  sweat. 

Physiologic  Action  and  Uses. — Anhidrotic;  intes- 
tinal disinfectant;  sedative  action  on  the  respirator}' 
centre. 

Cannabinum  Tannas. 

Adult  Dosage. — Min.,  gr.  v;  max.,  x. 

Method  of  Administration.— Cannabini  tan- 
natis,  gr.  v,  pulveres  no.  4. 

Sig.— One  powder,  repeated  if  necessary. 

U ses. — Hypnotic. 

Cannabis  Indicae  Extractum  (biologically  assayed). 

Advlt  Dosage. — Min.,  gr.  }g;  av.,  i^;  max.,  ii. 

Method  of  Administration. — Extracti  cannabis 
indicae  (biologically  assayed)  gr.  1^,  pilulae  no.  15. 

Sig.— One  pill,  repeated  ever}'  half  to  one  hour, 
until  effectual. 

Uses. — Analgesic;  h}’pnotic;  aphrodisiac. 

Toxic  Action. — Sensation  of  enormous  dimensions, 
dilatation  of  the  jjupils,  anaesthesia,  diminished 
reflexes,  somnolence,  catalepsy,  coma,  cardiac  failure. 

Cannabis  Indicae  Fluidextractum  (biologically 
assayed.  When  added  to  water  the  precipitate 
shouldbeofa"  decided  olive-green  color  ” ; if  a “ dirty 
yellow-bro^\'n,”  the  preparation  is  inert.  (Potter.) 

Adidt  Dosage.— M'm.,  nji;  av.,  ii;  max.,  v. 

Method  of  Administration. — Fluidextracti  can- 
nabis indiem  (biologically  assayed),  gss. 

Sig. — One  drop  in  water,  every  half  to  one  hour, 
cautiously  increased  until  effectual,  even  up  to  one 
dram,  if  necessary.  (Potter.) 


CAllYOPHYLLI  OLEUM 


Uses. — Analgesic;  hypnotic;  aphrodisiac. 

Cannabis  Indicee  Tinctura  (biologically  assayed, 
see  above  rule). 

Adult  Dosage. — Min.,  iiev;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Tincturae  can- 
nabis indicae  (biologically  assayed),  5i- 

Sig. — Five  drops  in  water,  every  half  to  one  hour, 
cautiously  increased  until  effectual.  (Potter.) 

The  dosage  of  cannabis  indica  is  uncertain,  because 
specimens  of  the  plant  vary  greatly  in  activity. 

Uses. — Analgesic;  hypnotic;  aphrodisiac. 

Cantharidatum  Collodium;  Blistering  Collodion 
(Cantharides  60,  flexible  collodion  85,  chloroform 
to  100). 

Method  of  Administration. — See  below. 

Uses. — Vesicant. 

Toxic  Action. — Nephritis  (from  local  absorption). 

Cantharidatum  Emplastrum  Picis  (cerate  of  can- 
tharides 8,  Burgundy  pitch  to  100). 

Method  of  Administration. — Moisten  a square  inch 
with  olive  oil  and  apply.  Cover  with  a dossil  of 
gauze  secured  by  adhesive  plaster.  Remove  in  six 
to  eight  hours,  or  the  next  day,  and  dress  with  boric 
ointment  on  surgical  lint. 

Uses. — -Vesicant. 

Cantharidis  Acetum. 

Uses. — Rubefacient  and  vesicant. 

Cantharidis  Ceratum;  Blistering  Cerate  (Can- 
tharides 32,  yellow  wax  18,  rosin  18,  lard  17,  liquid 
petrolatum  15). 

Method  of  Administration. — Butter  a square  inch 
of  fabric  with  the  cerate,  and  apply.  Cover  with  a 
dossil  of  gauze  secured  by  adhesive  plaster.  Remove 
in  six  to  eight  hours,  or  the  next  day,  and  dress  with 
boric  ointment  on  surgical  lint. 

Uses. — Rubefacient  and  vesicant. 

Cantharidis  Tinctura. 

Dosage. — 3 years,  gt.  5 years,  gt.  H.  Adult, 
min.,  Tigi;  av.,  v;  max.,  x. 

Method  of  Administration. — Tincturae  can- 
tharidis, 3ii- 

Sig.— ngi-ii  in  water,  every  two  to  three  hours, 
or  t.i.d. 

Uses. — ^Diuretic;  local  genito-urinary  irritant; 
aphrodisiac;  corrective  of  albuminuria. 

Toxic  Action. — Gastro-enteritis,  salivation,  swell- 
ing of  the  submaxillary  glands,  strangury,  nephritis, 
cystitis,  haematuria,  albuminuria,  anuria,  swollen 
genitals,  priapism,  abortion,  convulsions,  collapse, 
coma.  Give  alkahes  until  the  urine  is  rendered 
alkaline. 

Capsid  Emplastrum. 

Uses. — Counter-irritant. 

Capsici  Tinctura  (cayenne  pepper  10  per  cent.). 

Dosage. — 18  months,  gt.  i;  3 years,  gtt.  ii-iii; 
5 years,  gtt.  iii-v.  Adult,  min.,  i^jv;  av.,  x;  max.,  xx. 

Method  of  Administration. — Tincturae  cap- 
sici, 5ss. 

Sig. — -Ten  drops,  well  diluted  in  water,  t.i.d.,  or 
as  required. 

Uses. — Stomachic;  carminative;  aphrodisiac;  diu- 
retic; diaphoretic. 

Toxic  Action. — Gastritis;  narcosis. 

Capsici  Unguentum. 

Uses. — Counter-irritant. 

Capsicum;  Cayenne  Pepper. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  ii. 

Uses. — Stomachic. 

Caraway  Seed ; Carum. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xx. 

Uses. — Flavoring  agent;  carminative. 

Carbo  Ligni;  Wood  Charcoal. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xx;  max.,  pd. 

Method  of  Administration. — Carbonis  Ligni, 
gr.  X,  capsulae  vel  trochisci  no.  30. 


Sig. — -Two  capsules,  t.i.d.  May  be  prescribed 
in  suspension. 

Uses. — Absorbent;  deodorant;  used  in  flatulent 
dyspepsia. 

Carbolated  Iodine  (usually  iodine  1,  to  phenol  4). 

Uses. — Local  antiseptic. 

Carbolici  Acidi  Qlyceritum  (liquid  phenol  20, 
glycerite  80). 

Adult  Dosage. — -Min.,  Trgiii;  av.,  v;  max.,  x. 

Method  of  Administration. — R Glyceriti  acidi 
carbolici,  5i- 

Sig. — Fifteen  minims  in  two  tablespoonfuls  of 
warm  water,  as  a mouth-wash. 

Physiologic  Action  and  Uses.' — Antiseptic.  How- 
ever, fats,  vegetable  oils,  and  glycerine  (excepting 
lanoline  and  liquid  pet  olatum),  almost  prevent  the 
germicidal  action  of  phenol. 

Carbolici  Acidi  Trochisci  (gr.  34)  et  Mentholis 
(gr.  '4o). 

t/ses.— Throat  antiseptic  and  anodyne. 

Carbolici  Acidi  Unguentum  (phenol  3,  white 
petrolatum  97). 

Uses. — ^Antiseptic  emollient.  Phenol  in  liquid 
petrolatum  is  more  than  twice  as  active  an  anti- 
septic as  phenol  in  water. 

Carbolicum  Acidum;  Phenol:  CeHsOH. 

Adult  Dosage. — Min.,  gr.  i;  max.,  iii. 

Method  of  Administration. — R Acidi  carbohci 
liquefacti,  Ji. 

Sig. — One  drop  in  one  tablespoonful  of  water, 
every  fifteen  minutes  for  three  to  four  hours. 

Uses. — -Gastric  sedative  and  antiseptic;  local 
antiseptic  in  strength  of  gr.  v ad  5i;  disinfectant  in 
5 per  cent,  strength,  or  1 : 20;  local  anaesthetic  and 
caustic;  antipruritic. 

Toxic  Action.— Gastritis,  fall  of  temperature,  fall 
of  blood-pressure,  slowing  of  the  heart  and  respira- 
tion, smoky  urine,  collapse,  stupor,  coma,  convul- 
sions, paralysis. 

Carbon  Dioxide  Bath,  see  Medicated  Baths. 

Cardamomi  Tinctura  (20  per  cent.). 

Dosage. — 6 months,  gtt.  v;  18  months,  gtt.  x; 
3 years,  gtt.  xv;  5 years,  gtt.  xx.  Adult,  Min.,  3ss; 
av.,  i;  max.,  iss. 

Method  of  Administration. — R Tincturae  carda- 
momi compositae,  5ii- 

Sig. — One  teaspoonful  in  water,  t.i.d. 

Uses. — Stomachic;  carminative. 

Cardamomi  Tinctura  Composita  (cardamom  25, 
cinnamon  25,  caraway  12,  cochineal  5,  glycerine  50, 
diluted  alcohol  to  1000). 

Dosage. — 6 months,  gtt.  v;  18  months,  gtt.  x; 
3 years,  gtt.  xv;  5 years,  gtt.  xx.  Adult,  min.,  3ss; 
av.,  i;  max.,  iss. 

Method  of  Administration. — R Tincturae  carda- 
momi compositae,  3ii. 

Sig. — One  teaspoonful  in  water,  t.i.d. 

Uses. — Stomachic;  carminative. 

Carlsbad  Salts  (sodium  sulphate  50,  sodium  bi- 
carbonate 6,  sodium  chloride  3 parts). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — One  teaspoonful  in 
solution,  one  hour  before  breakfast. 

Uses. — Laxative. 

CarreUDakin  Solution,  see  Dakin’s  solution. 

Carron  Oil;  Linimentum  Calcis  (lime-water  and 
• linseed  or  cottonseed  oil,  aa). 

Uses. — -Bland,  protective  emollient. 

Caryophylli  Oleum;  Oil  of  Cloves. 

Adult  Dosage. — Min.,  igjss;  av.,  iii;  max.,  iv. 

Method  of  Administration. — R Olei  Caryophylli, 3 i- 

Sig. — One  to  three  drops  in  hot  water  or  on  sugar, 
every  two  hours. 

[/ses.-;-Carminative;  local  anaesthetic  and 
antiseptic. 


CHALK  POWDER  COMPOUND;  PULVIS  CRET.E  COMPOSITES 


Cascarae  Sagrada;  Extractum. 

Dosage. — 18  months,  gr.  ss;  3 years,  gr.  i-ii;  5 
years,  gr.  iii-v.  Adult,  min.,  gr.  v;  av.,  viii;  max.,  x. 

Method  of  Administration. — Extract!  cascaraj 
sagradae,  gr.  v,  pilulaj  no.  24. 

Sig. — A pill  twice  daily,  or  two  pills  at  bedtime. 

Physiologic  Action  and  Uses. — Laxative;  acts 
chiefly  on  the  lower  bowel;  the  dose  can  be  gradually 
reduced  without  secondary  constipation  following. 

Cascarae  Sagradae,  Fluidextractum. 

Adult  Dosage. — Min.,  t^x;  av.,  xxx;  max.,  be. 

Method  of  Administration. — Fluidextracti  cas- 
carae sagradae,  5iv. 

Sig. — Ten  to  sixty  drops  in  water  at  bedtime;  or 
5 to  30  drops  t.i.d.a.c.,  gradually  decreased  by  one 
drop  per  dose. 

Physiologic  Action  and  Uses. — Laxative;  acts 
chiefly  on  the  lower  bowel;  the  dose  can  be  gradually 
reduced  without  secondary  constipation  following. 

Cascarae  Sagradae,  Fluidextractum,  Aromaticum. 

Dosage. — 0 months,  gtt.  xv;  18  months,  gtt.  xxx- 
xlv;  3 years,  3i;  5 years,  3i~ii-  Adult,  3i~ii- 

Method  of  Administration. — Fluidextracti  cas- 
carae sagradae  aromatici,  5iv. 

Sig.— One-half  dram,  t.i.d.a.c.,  gradually  de- 
creased by  one  drop  per  dose ; or  one  to  two  drams 
at  bedtime. 

Uses. — ^Laxative,  pleasant  tasting. 

Cassiae  Oleum;  Oleum  Cinnamomi. 

Adult  Dosage. — -Min.,  T^i;  av.,  hi;  max.,  v. 

Method  of  Administration. — Olei  cinna- 
momi, 3i- 

Sig. — -Three  to  five  drops  in  hot  water  every  two 
hours. 

Uses. — Carminative;  stimulant;  uterine  haemo- 
static. 

Toxic  Action. — Local  irritation;  narcosis. 

Castor=Oil;  Oleum  Ricini. 

Dosage. — 6 months,  3i;  18  months,  3ii;  3 yeans, 
3iii;  5 years,  3iv.  Adult,  min.,  5ss;  max.,  i. 

Method  of  Administration. — A dose  at  bedtime, 
administered  in  capsules,  or  as  follows:  float  the 

oil  on  wine,  gruel,  orange  juice,  soda  water,  or  coffee, 
without  touching  the  oil  to  the  sides  of  the  glass, 
then  bolt  the  dose  at  one  gulp,  throwing  it  back  into 
the  throat.  The  mouth  is  first  best  lubricated  with 
cream. 

Physiologic  Action  and  Uses. — Laxative;  its  soap 
acts  on  both  the  small  and  large  intestine  as  a local 
irritant;  it  is  effectual  in  two  to  four  hours; 
demulcent. 

Cataplasma  Kaolin!  (glycerine  371^  parts  by 
weight,  boric  acid  4b^,  tlijanol  J-io,  methyl  salicylate 
K,  oil  of  peppermint  Me  kaolin  57%,  heated  and 
mixed  together.) 

Uses. — Antiphlogistic  poultice;  similar  to  anti- 
phlogistine. 

Catechu  (or  Gambir)  Pulvis. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Pulveris  catechu, 
gr.  XX,  pulveres  no.  12. 

Sig.— One  powder,  three  or  four  times  a day. 

Uses. — Intestinal  astringent  (containing  tannic 
acid). 

Catechu  (or  Gambir)  Tinctura  Composita  (gambir 
5,  cinnamon  2%,  diluted  alcohol  to  100). 

Adult  Dosage.-— Min.,  3ss;  av.,  i;  max.,  iii. 

Method  of  Administration. — Tinctura;  catechu 
composite,  5ii- 

Sig. — Teaspoonful,  three  or  four  times  daily. 

As  a gargle,  5ss  ad  aquam  Oi. 

Uses. — Astringent  (containing  tannic  acid). 

CatechU'  (or  Gambir)  Trochisci  (nearly  1 gr. 
Gambir). 

Uses. — Astringent  (eontaining  tannic  acid). 


Cera  Alba;  White  Wax  (yellow  beeswax  bleached; 
soluble  in  oils). 

Uses. — Gives  consistence  to  cerates  and  ointments. 
Cera  Flava;  Yellow  Wax  (beeswax;  soluble  in  oils). 
Uses. — Gives  consistence  to  cerates  and  ointments. 
Ceratum  Cantharidis;  Blistering  Cerate  (Can- 
tharides  32,  yellow  wax  18,  resin  18,  lard  17,  liquid 
petrolatum  15). 

Method  of  Administration. — Butter  a square  inch 
of  fabric  with  the  cerate,  and  apply.  Cover  with  a 
dossil  of  gauze  secured  by  adhesive.  Remove  in  six 
to  eight  hours,  or  the  next  day,  and  dress  with  boric 
ointment  on  surgical  lint. 

Uses. — Rubefacient  and  vesicant. 

Ceratum  Plumbi  Subacetatis  (liquor  plumbi 
subacetatis  20,  camphor  2,  wool  fat  20,  paraffin  20, 
white  petrolatum  38). 

Uses. — Astringent  application. 

Ceratum  Resinje;  Basilicon  Ointment  (rosin  35. 
yellow  wax  15,  lard  50.) 

Uses. — ^Prote<;tive  emollient. 

Ceratum  simplex  (white  wax  30,  white  petrolatum 
20,  benzoinated  lard  50). 

Uses. — Protective  application. 

Cereal  Waters:  Boil  one  even  tablespoonful  of 
the  cereal  flour  in  twelve  ounces  of  water  for  twenty 
minutes,  or  two  tablespoonfuls  of  the  grains,  with 
a pinch  of  salt,  in  one  quart  of  water,  for  six  hours, 
the  amount  being  kept  up  to  one  quart  by  the  addi- 
tion of  boiling  water.  After  boihng,  strain  through 
coarse  muslin. 

Cereo  (an  amylolytic  ferment,  manufactured  by 
the  Cereo  Co.,  Tappan,  N.  Y.). 

Method  of  Administration. — To  dextrinize  gruels, 
i.e.,  change  their  starch  to  dextrine  and  maltose, 
add  one  teaspoonful  of  cereo  to  the  pint  of  gruel  after 
it  has  been  cooked  and  cooled  to  a temperature  a 
little  above  bloodheat,  or  about. 

Uses. — Am^-lolytic  or  starch-splitting  ferment. 
Ceridin;  Cerolin  (yeast  fats). 

Dosage. — 3 years,  gr.  %-i;  5 years,  gr.  iss.  Adult, 
min.,  gr.  iss;  max.,  v. 

Method  of  Administration. — Cerolin,  gr.  iss, 
pilulse  no.  24. 

Sig. — One  to  three  pills,  t.i.d. 

U ses. — .(Anti-pustular ; laxative. 

Cerevisiaj  Fermentum  Compressum;  Compressed 
Yeast. 

Method  of  Administration. — One-half  teaspoonful 
daily  to  a child  of  two  to  three  years.  (Holt.) 

Uses. — For  furunculosis;  see  also  Ceridin.  L'^sed 
also  to  ferment  milk. 

Cerii  Oxalas  (insoluble  in  water,  alcohol,  or  ether). 
Dosage. — 6 months,  gr.  ii;  18  months,  gr.  ii-iii; 
3 years,  gr.  iii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
max.,  X. 

Method  of  Administration. — Cerii  oxalatis,  gr. 
v-x;  sacchari  albi,  q.s. 

Mitte  tabs  pulveres  no.  12. 

Sig. — One  powder  every  two  to  three  hours;  or 
t.i.d.  for  several  days. 

Uses. — Gastric  sedative. 

Cereii  O.xalas  Effervescens. 

Cetaceum;  Spermaceti  (a  solid  fat  from  the  sperm 
whale). 

Uses. — Ointment  basis. 

Chalk  Powder  Compound ; Pulvis  Crete  Composi- 
tus  (prepared  chalk  30,  acacia  20,  sugar  50). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xxx;  max.,  lx. 
Method  of  Administration. — I^  Pulveris  Crete 
compositi,  3v  (gr.  xii  per  dram);  aqua;  cinnamomi, 
3x;  aqiue,  q.s.  ad,  5 hi  3i- 
of  M.  et  fiat  emulsum  (=mistura  Crete). 

Sig. — 3i-iv-viii  every  four  hours. 

Uses. — .Antacid;  astringent. 


CHLOROFORMI,  AQUA 


Chalk,  Precipitated;  Calcii  CarbonasPraecipitatus: 
CaCOs  (nearly  insoluble  in  water  and  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xlv. 

Method  of  Administration. — Calcii  carbonatis 
prajcipitati,  gr.  xv-lx,  pulveres  no.  12. 

Sig. — -A  powder  two  or  three  times  daily. 

Physiologic  Action  and  U.ses. — Antacid;  intestinal 
astringent;  neutralizes  acids  (fatty  acids,  sulphuric 
and  phosphoric  acids)  in  the  intestine,  and  so  de- 
prives the  urine  of  a portion  of  its  acid  constituents, 
rendering  it  le.ss  acid  or  even  alkaline,  and  therefore 
favoring  the  solution  of  uratic  deposits  in  the 
urinary  tract. 

Chalk,  Prepared;  Greta  Prmparata,  CaCOs  (puri- 
fied native  calcium  carbonate). 

Dosage. — 6 months,  gr.  ii;  18  months^  gr.  iii; 
3 years,  gr.  v;  5 years,  gr.  v-viii.  Adult,  mm.,  gr.  x; 
av.,  xv;  max..  Ixxv. 

Method  of  Administration. — Greta;  praeparata', 
5iv  (gr.  X to  the  dose) ; syrupi  acacia;,  §ii;  aqua;  cin- 
namomi,  q.s.  ad,  giv. 

Misce  et  fiat  emulsum. 

Sig. — One  teaspoonful  every  three  to  four  hours. 

Uses. — ^Antacid,  astringent. 

Charcoal,  Wood;  Garbo  Ligni. 

Adult  Dosage. — -Min.,  gr.  x;  av.,  xx;  max.,  3h. 

Method  of  Administration. — Carbonis  ligni, 
gr.  X,  capsuliE  vel  trochischi,  no.  30. 

Sig. — Two,  t.i.d. 

May  be  prescribed  in  suspension. 

Uses. — Absorbent;  deodorant;  used  in  flatulent 
dyspepsia. 

Charta  Potassii  Nitratis  (paper  impregnated  with 
potassium  nitrate). 

Method  of  Administration. — Burn  the  paper  and 
inhale  the  smoke. 

[7ses.— Used  in  asthma. 

Chaulmoograe  Oleum;  Oleum  Gynocardia;. 

Adult  Dosage. — Min.,  i^v;  max.,  x.  , 

Method  of  Administration. — Olci  gynocardia;, 
5ii. 

Sig. — -Three  to  five  drops  in  milk  (or  in  capsule) 
t.i.d.a.c.,  increased  by  one  or  two  drops  every  three 
to  five  days,  up  to  even  1.50  or  more  drops,  t.i.d., 
together  with  daily  inunction  of  the  oil,  25  to  50 
per  cent,  in  oil  or  lard,  lasting  one  to  two  hours. 

Uses. — For  leprosy  (q.v..  Part  5,  Skin  Diseases). 

Chelsea  Pensioner;  Gonfectio  Guaiaci  Gomposita. 

Adult  Dosage. — ^Min.,  3i;  max.,  ii. 

Method  of  Preparation. — Guaiaci,  5ss;  sul- 
phuris  sublimati,  3ih  gr.  xv;  magnesii  carbonatis, 
3ss;  pulveris  zingiberis,  gr.  xv;  theriaca;  (treacle) 
vel  mellis  depurati,  3iii- 

Uses. — Laxative  in  chronic  rheumatism. 

Chenopodii  Oleum;  American  Wormseed  Oil 
(should  be  kept  in  well-stoppered,  amber  colored 
bottles,  in  a cool,  dark  place). 

Dosage. — -18  months  gt.  iss;  3 years,  gtt.  iii;  5 
years,  gtt.  v.  Adult,  min.,  gtt.  x'  max.,  xv. 

Meth^  of  Administration.— -Cleanse  the  bowels 
the  evening  before,  then  give  one  drop  of  the  oil  for 
every  year  of  age  up  to  fifteen  in  a teaspoonful 
of  granulated  sugar,  every  two  hours,  for  three  doses, 
followed  two  hours  later  by  a good  dose  of  castor 
oil. 

“Subminimal  doses  repeated  at  intervals  of  sev- 
eral days  become  toxic”  {Epitome  of  the  U.  S.  P. 
and  N.  F).  Each  minim  equals  about  2t^  drops. 

Uses. — Anthelmintic  against  the  round-worm  and 
hookworm. 

Toxic  Action. — Gardiovascular  and  respiratory  de- 
pression, bradycardia,  fall  of  blood-pressure,  album- 
inuria, somnolence,  coma,  paralysis. 

Chiratae  Fluidextractum  (contains  no  tannin). 

Adult  Dosage. — Min.,  rr^x;  av.,  xv;  max.,  xx. 


Method  of  Administration. — R Fluidextracti  chi- 
rata;,  5i- 

Sig. — Fifteen  drops  in  water,  t.i.d.a.c. 

Uses. — Stomachic  bitter  and  laxative;  may  be 
administered  with  iron. 

Chiratae  Infusum. 

Adult  Dosage. — Min.,  5ss;  max.,  i. 

Method  of  Administration.— ^ Infusi  chirata;, 
Sviii. 

Sig. — ^Tablespoonful,  t.i.d.a.c. 

Uses. — Stomachic  bitter  and  laxative;  may  be 
administered  with  iron. 

Chloral  Camphoratum;  Gamphorated  Ghloral, 
N.  F.  (equal  parts  of  hydrated  chloral  and  camphor). 

Uses. — Local  rubefacient  and  analgesic. 

Chloralum  Hydratum;  GGI3GHO-I-H2O  Trichlor- 
acetaldehyde-|-H20  (soluble  in  0.25  of  water  and 
in  1.3  of  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i;  3 years, 
gi-.  iss;  5 years,  gr.  ii.  Adult,  min.,  gr.  viii;  av.,  xx; 
max.,  XXX. 

Method  of  Administration. — R Ghlorali  hydrati, 
gr.  Ixxx  (gr.  XX  per  dose) ; aquae  menthae  piperitae,  5ii- 

M.  Sig’. — Tablespoonful,  well  diluted  in  water. 

R Ghlorali  hydrati,  gr.  .xvi  (gr.  ii  ad  3ss) ; syrupi 
tolutani,  §ss. 

M.  Sig. — An  appropriate  dose,  as  required  (about 
every  four  hours). 

The  dose  per  rectum  is  double  that  by  mouth. 
For  convulsions  larger  doses  than  usual  are  given 
(see  Part  1). 

U ses. — N ervous  sedative ; hypnotic ; antispasmodic. 

Toxfc  Action. — -Goma;  loss  of  I’eflexes,  slow  respira- 
tion, fall  of  blood-pressure  and  temperature  due  to 
cardiovascular  depression,  dilated  pupils,  perhaps 
nausea  and  vomiting,  perhaps  an  exanthem,  anaunia 
and  insanity. 

Chloralformamidum;  Ghloralamide : GGI3GII 

(OH)N(GHO)H  (.soluble  in  about  18.7  of  water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — R Ghloralformamidi, 
gr.  XV,  pulveres  in  charta  cerata,  no.  2. 

Sig. — -One  or  two  powders  in  warm  water,  or  in 
one  oimce  of  whiskey,  diluted,  one  hour  before 
bedtime. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
mild  hypnotic;  acts  in  sbety  to  ninety  minutes. 

Toxic  Action. — Nausea,  vomiting,  dryness  of  the 
mouth,  thirst,  vertigo,  restlessness,  weak,  rapid 
pulse. 

Chloretone  or  Chlorbutanol ; Acetone  Ghloroform; 
Trichlortertiary-butylalcohol:CGl3G(OH)GH3.CH3. 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Ghloretone,  gr. 
XV.  tabella;  vel  capsul®  no.  2. 

Sig. — One  tablet,  repeated  if  nece.ssary. 

Uses. — Mild  hyijnotic;  local  ana;sthetic  (saturated 
solution  hypodermically);  gastric  sedative;  anti- 
septic 

Toxic  Action. — Depression;  peripheral  neuritis. 

Chlorine  Water;  Liquor  Ghlori  Gompositus  (pre- 
pared by  adding  potassium  chlorate  5,  hydrochloric 
acid  18,  and  distilled  water  20,  heating  on  a water 
bath  for  two  or  three  minutes,  adding  distilled  water 
to  1000,  and  agitating). 

Adult  Dosage. — Min.,»iTjxx;  av.,  3i;  max.,  ii;  (in 
water,  freshly  prepared). 

Method  of  Administration. — The  official  chlorine 
water,  freshly  made  and  mLxed  with  an  equal  amount 
of  water,  is  used  as  a collyrium  for  the  eyes. 

Uses. — Antiseptic. 

Chloroform!  Aqua  (saturated  solution). 

Dosage. — 6 months,  3ss;  18  months,  3ss-ii;  3 
years,  3ii-iii;  5 years,  3iv.  Adult,  min.,  gss; 
max.,  ii. 


CINNAMOMI  TINCTURA 


Method  of  Administration. — Aquaj  chloroformi 
Siv. 

Sig. — A dose  three  or  four  times  a day.  For 
vomiting,  a teaspoonful,  ice-cold,  every  hour. 

Uses. — ^Carminative;  anodyne;  antiseptic;  vehicle. 

Chloroformi  Linimentum  (chloroform  30,  soap 
liniment  70). 

Uses. — Rubefacient;  anodyne. 

Chloroformi  Linimentum  Compositum  (Chloro- 
form 5i,  oil  of  turpentine  3i,  tr.  opii  gss,  tr.  aconite 
5ii,  soap  liniment  5h). 

Uses. — Rubefacient;  anodyne. 

Chloroformi  Spiritus  (chloroform  6,  alcohol 
94). 

Dosage. — 0 months,  gtt.  ii-iii;  18  months,  gtt.  iii-v; 
3 yeans,  gtt.  v-xv;  5 years,  gtt.  xv-xx.  Adult,  min., 
i^x;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — Spiritus  chloro- 
foimi,  5i. 

Sig. — A close,  well  diluted  in  water,  as  required. 

Uses. — Carminative;  nervous  sedative. 

Chloroformum;  Trichlormethane,  CHCb  (soluble 
in  210  of  water;  miscible  with  alcohol,  ether,  and 
oily  substances). 

Adult  Dosage. — Min.,  ijji;  av.,  v;  max.,  x. 

Method  of  Administration. — Chloroformi,  3i- 

Sig. — Five  to  ten  drops  on  sugar  or  cracked  ice, 
every  hour,  for  vomiting. 

Uses. — General  ana5sthetic;  local  sedative,  car- 
minative, and  anodyne;  antiseptic. 

Toxic  Action. — Chloroform  poisoning:  respiration 
stertorous  or  shallow,  heart  slow  and  weak,  extreme 
pallor,  pupils  dilated,  subsequent  fatty  degeneration 
of  the  liver,  heart,  kidneys,  etc. 

Chromii  Trioxidum;  Chromicum  Acidum:  Crl^s 
(soluble  in  0.6  of  water). 

Method  of  Administration. — ^To  fuse  the  acid  on 
the  end  of  a probe,  first  warm  the  probe,  dip  it  in  the 
chromic  acid  crystals  and  then  warm  the  part  of 
the  probe  next  beyond  the  crystals  until  the  latter 
melt. 

Uses. — Caustic. 

Toxic  Atiton. — Gastro-enteritis. 

Chrysarobini  Unguentum  (chrysarobin  5,  ben- 
zoinated  lard  95). 

Method  of  Administration. — Dilute  the  official 
ointment  one  to  three  times  for  average  use.  It 
stains  the  skin  and  clothing,  sometimes  causes  an 
itching  erythema,  and  should  not  be  used  on  the 
face  or  scalp,  for  fear  of  being  conveyed  to  the  eyes 
and  setting  up  a conjunctivitis.  The  skin  stain  may 
be  removed  with  a weak  solution  of  chlorinated  lime. 
The  clothing  stain  may  be  removed  with  a dilute 
solution  of  caustic  soda  or  a solution  of  chlorinated 
soda. 

Uses. — Antiseptic ; antiparasitic. 

Chrysarobinum,  C30H26O7  (soluble  in  385  of  water; 
rather  more  soluble  in  alcohol;  soluble  in  12.5  of 
chloroform). 

Adult  Dosage. — Min.,  gr.  av.,  K;  max.,  i. 

Method  of  Administration. — -As  an  ointment:  2 to 
10  to  20  per  cent. 

Toxic  Action. — Vomiting,  diarrhoea,  general  ery- 
thema, nephiitis. 

Cimicifugae  Fluidextractum. 

Adult  Dosage. — Min.,  aExv;  av.,  xx;  max.,  5i- 

Method  of  Administration. — Fluidextracti 
cimicifugo',  gi. 

Sig. — Twenty  drops  in  water  every  two  to  four 
hours. 

Uses. — Stomachic;  aphrodisiac;  expectorant;  ano- 
d\me;  uterine  stimulant;  cardiovascular  tonic;  dia- 
phoretic; diuretic. 

Toxic  Action. — Mydriasis,  vertigo,  headache, 
nausea,  and  vomiting. 


Cimicifugae  Tinctura. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — Tincturae  cimi- 
cifugse,  5ii. 

Sig. — ^Teaspoonful  in  water  every  two  to  four 
hours. 

Uses. — Stomachic;  aphrodisiac;  expectorant;  ano- 
dyne; uterine  stimulant;  cardiovascular  tonic;  dia- 
phoretic; diuretic. 

Toxic  Action. — Mydriasis,  vertigo,  headache, 
nausea,  and  vomiting. 

Cinchonae  Fluidextractum. 

Adult  Dosage. — Min.,  njx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti  cin- 
chona;, 5i. 

Sig. — Fifteen  drops  in  water,  t.i.d.a.c. 

Uses. — Stomachic  or  bitter  tonic. 

Cinchonae  Tinctura  (cinchona,  20  per  cent.). 

Dosage. — 18  months,  gtt.  v-x;  3 years,  gtt.  xv; 
5 years,  gtt.  xx-xxx.  Adult,  min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — I^  Tinctura;  cin- 
chonae, §ii. 

Sig. — -Teaspoonful,  t.i.d.a.c. 

Uses. — Stomachic  or  bitter  tonic. 

Cinchonae,  Tinctura  Composita  (red  cinchona  10, 
bitter  orange  peel  8,  serpentaria  2,  alcohol  85,  water 
glycerine  7}4. 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Tincturae  cin- 
chona; compositae,  5iv. 

Sig. — One  or  two  teaspoonfuls  in  water,  t.i.d.a.c. 

Uses. — Stomachic  or  bitter  tonic. 

Cinchophen. — See  Atophan. 

Cinereum  Oleum;  Gray  Oil. 

Adult  Dosage. — Min.,  igjii;  max.,  vi. 

Method  of  Administration. — I^  Hydrargyri  bide- 
stillati,  3uss;  alboleni,  3 in;  adipis  lanae  hydrosi,  5iss. 

Prepare  from  sterile  materials  imder  aseptic  con- 
ditions, and  triturate  the  mercury  with  the  lanolin 
for  at  least  two  hours.  Dose,  two  to  six  minims, 
injected  intramuscularly  every  two  weeks  (see 
Syphili^  in  Part  1). 

The  Gray  Oil  or  Mercurial  Oil  described  by  the 
N.  N.  R.  is  a 40  to  50  per  cent,  preparation.  It  is 
directed  to  be  administered  once  or  twice  a week, 
one  minim  being  the  initial  dose,  and  two  minims 
the  maxim mn.  “The  ‘course’  should  not  be  con- 
tinued beyond  five  or  six  weeks,  without  an  inter- 
mission of  equal  duration.”  (N.  N.  R.) 

Uses. — Antiluetic. 

Cinnamomi  Aqua  (01.  cin.  2,  talc  15,  distilled 
water  to  1000). 

Adult  Dosage. — Av.,  3iv. 

Method  of  Administration. — I^  Aquae  cinnamomi, 
§iv. 

Sig. — Tablespoonful  every  two  hours. 

Uses. — Carminative;  vehicle;  aseptic. 

Cinnamomi  Oleum;  Oleum  Cassiae. 

Adult  Dosage. — -Min.,  T^i;  av.,  hi;  max.,  v. 

Method  of  Administration. — ^I^Olei  cinnamomi,  3i- 

Sig. — Three  to  five  drops  in  hot  water  every  two 
hours. 

Rscs.— Carminative;  stimulant;  uterine  haemo- 
static. 

Toxic  Action. — Local  irritation;  narcosis. 

Cinnamomi  Syrupus. 

Uses. — Flavoring  vehicle. 

Cinnamomi  Tinctura  (cinnamon  20,  glycerine  ~]/2, 
alcohol  and  water  to  100). 

Adult  Dosage. — Min.,  n^xx;  av.,  tox]  max.,  pi- 

Method  of  Administration. — I^  Tincturae  cinna- 
momi, 5ii- 

Sig. — Half  a teaspoonful  in  hot  water  every  two 
hours. 

Uses. — Carminative;  stimulant. 


CODLIVER  OIL;  OLEUM  MORRHU.E 


Citarin ; Sodium  anhydro-methylene  citrate  (freely 
soluble  in  water). 

AduU  Dosage. — Min.,  gr.  xv;  ma.x.,  xxx. 

Method  of  Administration. — R Citarin,  gr.  xv- 
XXX,  pulveres,  in  charta  cerata,  no.  16. 

Sig. — A powder,  dissolved  in  a glassful  of  water, 
three  to  four  times  daily. 

Physiologic  Action  and  Uses. — Antilithic:  “It 

liberates  formaldehyde  in  the  blood  and  thereby 
forms  soluble  combinations  with  uric  acid.”  (Potter.) 

Citric!  Acidi  Syrupus  (citric  acid  1,  distilled  water 
1,  tincture  of  lemon  peel  (50  per  cent.)  1,  syrup  to 
100). 

Adult  Dosage. — Indefinite. 

Uses. — Flavor  and  vehicle  for  salty  substances, 
such  as  bromides. 

Citricum  Acidum:  H3C6H5O7  + H2O  (soluble  in 

0.5  of  water  and  1.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xv. 

Method  of  Administration. — Acidi  citrici,  gr.  xvii, 
ad  aquam  gss  is  equivalent  to  fresh  lemon-juice,  5ss. 

Uses. — Refrigerant. 

Citrine  Ointment;  Un^ientum  Hydrargyri  Nitra- 
tis  (mercury  7,  dissolved  in  nitric  acid  17)A,  lard  76). 

Uses. — -Antiseptic. 

Cloves,  Oil  of;  Oleum  Caryophylli. 

Adult  Dosage. — Min.,  iiKss;  av.,  iii;  max.,  iv. 

Method  of  Administration. — R Olei  caryophylli,  3i- 

Sig. — One  to  three  drops  in  hot  water  or  on  sugar 
every  two  hours. 

Uses. — Carminative;  local  anaesthetic  and  anti- 
septic. 

Coagulen  Ciba;  Coagulen  Kocher=Fonio  (consists 
of  blood  platelets  and  glucose  or  lactose). 

Method  of  Administration. — Make  a 5 to  10  per 
cent,  solution  in  water  or  normal  saline  solution, 
and  boil  for  three  to  five  minutes.  Use  as  a spray 
or  on  compresses  or  internally,  subcutaneously  or 
intravenously  (see  Hemorrhage,  in  Part  1).  It  must 
be  used  on  the  same  day  it  is  prepared.  Get  a small 
package  (1.25  gm.)  because,  when  once  opened,  it 
should  be  used  within  three  months. 

Physiologic  Action  and  Uses. — Haemostatic.  “ The 
subcutaneous  or  intravenous  injection  is  contrain- 
dicated in  cases  in  which  there  is  a tendency  to 
thrombosis  or  embolism,  as  in  arteriosclerosis, 
aneurysm,  heart  weakness,  phlebitis,  certain  stages 
of  lues,  and  in  varicose  veins.”  (N.  N.  R.) 

Cocaina  (alkaloid,  C17H21NO4:  soluble  in  600  of 
water,  6.5  of  alcohol,  0.7  of  chloroform — Benzoylec- 
gonine  methyl  ester; 


COOCH3 


H2C— CH  — CH2 


Dosage. — 18  months,  gr.  Kooi  3 years,  gr.  Ho',  5 
years,  gr.  Ks-  Adult,  min.,  gr.  H;  av.,  H;  max.,  i. 

Method  of  Administradon. — In  suppository  gr.  i. 

Physiologic  Action  and  Uses.- — Local  anaesthetic, 
causing  paralysis  of  the  sensory  nerve  terminations 
and  the  smaller  fibrils;  gastric  sedative;  local  vaso- 
constrictor; stimulant  (followed  by  depression)  of 
the  cerebral,  spinal,  and  medullary  centres;  stimu- 
lant of  the  sympathetic  nerve  endings  of  the  eye, 
causing  mydriasis  and  vaso-constriction  of  the  con- 
junctiva and  iris. 

Toxic  Action. — Acute  poisoning;  Extreme  pallor, 
cardio-vascular  and  respiratory  depression,  tremors, 
sonmolence,  stupor,  coma,  convulsions,  respiratory 
paralysis,  cardiac  and  vasomotor  paralysis,  some- 
times sudden  death. 

Cocainism:  Indigestion,  anorexia,  insomnia,  ema- 


ciation, mental  enfeeblement,  fetid  breath,  tremors, 
amblyopia,  visual  hallucinations,  delirium,  mental 
degeneration. 

Cocainse  Hydrochloridum;  C17H21NO4.HCI  (sol- 
uble in  0.4  of  water,  3.2  of  alcohol,  12.5  of  chloroform. 

Dosage. — 18  months,  gr.  )(oo;  3 years,  gr.  Ho',  5 
years,  gr.  !4-  Adult,  min.,  gr.  H',  av.,  H;  max.,  i. 

Method  of  Administration. — ^As  a surface  anaes- 
thetic, 1 to  4 to  10  per  cent,  solution. 

Subcutaneously,  0.01  to  0.2  to  1 per  cent,  solution. 

In  suppository,  gr.  i. 

To  keep  cocaine  solution  indefinitely  dissolve 
cocaine  hydrochloride  (the  alkaloid  is  insoluble)  in 
glycerine  of  starch  in  any  strength  (J.  T.  Hall). 

Physiologic  Action  and  Uses. — Local  anaesthetic, 
causing  paralysis  of  the  sensory  nerve  terminations 
and  the  smaller  fibrils;  gastric  sedative;  local  vaso- 
constrictor; stimulant  (followed  by  depression)  of 
the  cerebral,  spinal,  and  medullary  centres;  stimu- 
lant of  the  sympathetic  nerve-endings  of  the  eye, 
causing  mydriasis  and  vaso-constriction  of  the  con- 
junctiva and  iris. 

Toxic  Action. — Acute  poisoning:  Extreme  pallor, 
cardio-vascular  and  respiratory  depression,  tremors, 
somnolence,  stupor,  coma,  convulsions,  respiratory 
paralysis,  cardiac  and  vasomotor  paralysis,  some- 
times sudden  death. 

Cocainism:  Indigestion,  anorexia,  insomnia,  ema- 
ciation, mental  enfeeblement,  fetid  breath,  tremors, 
amblyopia,  visual  hallucinations,  dehrium,  mental 
degeneration. 

Coca=Nucis  Oleum. 

Cocculi  Indici  Tinctura  (10  per  cent,  in  diluted 
alcohol). 

Method  of  Administration. — For  destroying  pedi- 
culi^  dilute  with  1,  2,  or  3 parts  of  water. 

Uses. — Parasiticide;  source  of  picrotoxin. 

Codeina  (alkaloid:  Methyhnorphine,  Ci8H2:N03 
-1-H20;  soluble  in  120  of  water). 

Dosage. — 18  months,  gr.  Ho',  3 years,  gr.  Ym;  5 
years,  gr.  H.  Adult,  min.,  gr.  H;  av.,  H;  max.,  i. 

Method -of  Administration. — R Codeinae,  gr.  to 
Yio,  tabellae  no.  9. 

Sig. — -A  tablet  several  times  daily,  or  every  three 
to  four  hours,  as  required.  According  to  Frankel, 
smaller  doses  than  this,  even  when  frequently  re- 
peated, are  of  slight  efficiency  and  are  not  to  be 
recommended.  Give  no  more  than  three  doses  in 
twenty-four  hours  to  children  (Kerley). 

Physiologic  Action  and  Uses. — Nervous  sedative; 
analgesic;  hypnotic;  bronchial,  gastric,  and  intes- 
tinal sedative.  Its  action  on  the  respiratory  and 
cough  centres  predominates  over  its  narcotic  action. 

Codeinae  Phosphas  (soluble  in  2.3  of  water). 

Dosage. — 18  months,  gr.  Ho',  3 years,  gr.  Ho',  5 
years,  gr.  H-  Adult,  min.,  gr.  H;  av..  Hi  max.,  i. 

Method  of  Administration.— Codeina. 

Uses. — See  Codeina. 

Codeinae  Sulphas;  soluble  in  30  of  water. 

Dosage. — 18  months^  gr.  Ho',  3 years,  gr.  Ho',  5 
years,  gr.  Yg.  Adult,  mm.,  gr.  %;  av.,  H',  max.,  i. 

Method  of  Administration.— See  Codeina. 

Uses. — See  Codeina. 

Codliver  Oil;  Oleum  Morrhuae. 

Dosage. — 6 months,  gtt.  x-xv;  18  months,  gtt. 
xv-xx;  3 years,  gtt.  xx-xxx;  5 years,  3ss-i.  Adult, 
min.,  3i;  av.,  iv;  max.,  vi. 

Method  of  Administration. — R Olei  morrhuae,  5 viii. 

Sig. — Teaspoonful  to  tablespoonful,  t.i.d.,  one- 
half  to  one  hour  p.c.  Begin  with  small  doses. 

It  may  be  prescribed  in  half  dram  (2  c.c.)  cap- 
sules. Its  digestibility  is  increased  by  the  admixture 
of  ether,  i^iv  to  each  dram.  See  Codliver  Oil 
Emulsions. 

Uses.— Nutrient,  contraindicated  in  warm  weather, 


CONFECTIO  GUAIACI  COMPOSITA 


liigh  fever,  gastric  irritation,  coated  tongue,  and 
poor  digestion. 

Codliver  Oil  ■Emulsions: 

EmULSUM  OlEI  MoRRHU^  cum  HyI’OPHOSPHI- 
TIBUS,  U.  S.  P. 

Dosage. — 3 years,  pss;  5 years,  3ss-i.  Adult, 
min.,  3i;  av.,  ii;  max.,  vi. 

Method  of  Administration. — Olei  morrhuae,  Sviii; 
acaciae,  5ii  3ss;  calcii  hypophospliitis,  gr.  Ixx'v ; potas- 
sii  hypophosphitis  gr.  xl;  syrupi  simplicis,  5i  3v; 
olei  gaultherup,  3ss;  aqua',  q.s.  ad,  Oi. 

Misce  et  fiat  emulsum. 

Sig. — Tablespoonful  (3ii  of  the  oil)  t.i.d.p.c. 

Emulsum  Olei  Morrhu.®  cum  Malto,  N.  F. 

Dosage. — 3 years,  3ss;  5 years,  3ss-i. 

Method  of  Administration. — Olei  morrhuae, 
5xvi;  mucilaginis  dextrini,  §iv  3ij  e.xtracti  malti, 
5 xiiss. 

Misce  ct  fiat  emulsum. 

Sig. — Tablespoonful  (3ii  of  the  oil)  t.i.d.p.c. 

Emulsum  Olei  Morrhuae  cum  Vitello. 

Method  of  Administration. — Olei  morrhuae, 
§ii;  vini  albi,  5iss;  acidi  phosphorici  diluti,  3iii; 
syrupi  simplicis,  3v;  vitelhim,  i;  aquae  amygdalae 
amarae,  q.s.  ad,  Sviii. 

Misce  et  fiat  emulsum. 

Sig. — Tablespoonful  (3i  of  the  oil),  t.i.d.p.c. 
(Potter.) 

Colchicina  (alkidoid:  C22H26NO6;  soluble  in  22 

of  water). 

Adult  Dosage. — Min.,  gr.  ({so;  av.,  Yno',  max.,  14- 

Method  of  Administration. — Colchicinae,  gr. 
tabellie  no.  12. 

Sig. — Tablet  every  four  hours. 

It  may  be  injected  hyjiodcrmically.  It  is  the 
best  pre])aration  of  colchicum. 

Uses. — Antilithic;  diuretic;  diaphoretic;  purga- 
tive; emetic;  analgesic. 

Toxic  Action. — Nausea,  vomiting,  abdominal  pain 
purging,  enteritis,  cardiovascular  depression,  neph- 
ritis, prostration,  convulsions,  collapse,  ascending 
paralysis. 

Colchici  Seminis  Fluidextractum. 

Adult  Dosage. — Min.,  i^ii;  av.,  v;  max.,  viii. 

Method  of  Administration. — Fhiide.'rtracti  col- 
chici seminis,  gss. 

Sig. — Five  drops  in  water  every  four  hours  until 
purging,  nausea,  or  vomiting  occurs. 

Colchici  Seminis  Tinctura. 

Adult  Dosage. — Min.,  iriixv;  av.,  x-xx;  max.,  3i- 

Method,  of  Administration. — Tinctura;  colchici 
seminis,  5u- 

Sig. — -Ten  to  thirty  drops  in  water  every  two  to 
four  hours  for  eight  to  ten  doses,  then  every  four 
hours  for  three  or  four  days  until  pain  is  relieved  or 
toxic  symptoms  occur,  (q.v.  under  Colchicina). 

Colchici  Seminis  Vinum. 

Adult  Dosage. — Min.,  ijjx;  av.,  .xxx;  max.,  3h 

Method  of  Administration. — Vini  colchici 
seminis,  ,3ii. 

Sig. — Ten  to  thirty  drops  in  water,  every  two  to 
four  hours  for  eight  to  ten  doses,  then  every 
four  hours  for  three  or  four  days,  until  pain  is 
relieved  or  toxic  symptoms  occur  {q.v.  under 
Colchicina). 

Cold  Cream;  Unguentum  aqua;  rosa;  (aqua  rosa; 
fortior  19,  expres.sed  oil  of  almond  56,  spermaceti 
1214,  white  wax  12,  sodium  borate  J4)- 

Uses. — Emollient. 

Coley’s  Mixed  Toxines  of  Erysipelas  and  Bacil= 
lus  Prodigiosus. 

Method  of  Administration. — One  to  eight  minims 
hypodermically,  for  the  treatment  of  malignant 
disease.  A reaction  follows  the  injections  until  toler- 
ance becomes  established. 


Collargolum;  Argentum  Colloidale;  Argentum 
Crede  (colloidal  suspension  of  metahe  silver). 

Adult  Dosage. — ^Min.,  gr.  iss;  av.,  iii;  max.,  x. 

Method  of  Administration. — For  intravenous  injec- 
tion, 10  to  20  c.c.  of  a 2 per  cent,  suspension  in 
sterile  water. 

For  parenchymatous  injection,  20  to  40  c.c.  of  a 
0.5  to  1 per  cent,  glycerine  solution. 

For  washes,  0.02  to  1 per  cent,  suspension. 

Internally,  1 ; 500  to  100,  teaspoonful  doses, 
freely  with  the  food. 

Physiologic  Action  and  Uses. — Antiseptic;  pro- 
motes leucocytosis  and  phagocytosis. 

Collodium  (pyroxylin  4,  ether  75,  alcohol  25). 

U ses. — Protective. 

Collodium  Acidi  Salicylici  (10  per  cent.). 

Uses. — ^Keratolytic. 

Collodium  Cantharidatum  (cantharides  60,  flex- 
ible collodion  85,  chloroform  to  100). 

Uses. — Vesicant. 

Collodium  Flexile  (collodion  92,  Canada  turpem 
tine  5,  castor  oil  3). 

Uses. — Protective. 

Collodium  Stypticum  (ether  25,  alcohol  5,  tannic 
acid  20,  collodion  to  100). 

Uses. — Styptic  or  local  hemostatic. 

Collyrium  Astringens  Luteum  or  Horst’s  Eye- 
Water: 

Method  of  Preparation. — Take  of  ammonium 
chloride  50  centigrammes  and  zinc  sulphate  125 
centigrammes,  dissolve  in  200  grammes  of  distilled 
water  and  add  a solution  of  40  centigrammes  of 
camphor  in  20  grammes  of  dilute  alcohol  and  10 
centigrammes  of  saffron.  Digest  for  twenty-four 
hours  with  frequent  agitation,  and  filter. 

Colocynthidis  Extractum. 

• Adult  Dosage. — Min.,  gr.  Yd,  av.,  }4',  max.,  i. 

Method  of  Administration. — ^ Extracti  colo- 
cynthidis,  gr.  K,  pulveres  no.  6. 

Sig. — ()ne  powder  at  bedtime. 

Uses. — Hydragogue  cathartic. 

Toxic  Action. — Gastroenteritis. 

Colocynthidis  Extractum  Compositum  (ext.  colo- 
cynth  16,  aloes  50,  cardamom  6,  resin  of  scammony 
14,  soap  14,  alcohol  10). 

Adult  Dosage. — Min.,  gr.  v;  av.,  vii.ss;  max.,  xx. 

Method  of  Administration. — Extracti  colo- 
cymthidis  compositi,  gr.  v,  pilulie  no.  6. 

Sig. — One  or  two  pills  at  bedtime. 

Uses. — Hydragogue  cathartic. 

Toxic  Action. — Gastroenteritis. 

Cologniensis  Aqua  (alcohol  800,  water  158,  acetic 
ether  2,  oil  of  bergamot  16,  oil  of  lemon  8,  oil  of 
rosemaiy  8,  oil  of  lavender  flowers  4,  and  oil  of 
orange  flowers  4 parts). 

U ses. — Perf  ume . 

Condurango  Fluidextractum. 

Adult  Dosage. — Min.,  5ss;  max.,  i. 

Method  of  Administration. — I^  Fluidextracti  con- 
durango, oiv. 

Sig. — Teaspoonful  in  water,  t.i.d.a.c. 

Uses. — Bitter  tonic;  gastric  sedative. 

Condurango  Pulvis. 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — I^  Pulveris  condu- 
rango, oss;  aqua',  Oi. 

Boil  down  to  half  a pint. 

Sig. — Tablespoonful,  three  or  four  times  a day, 
before  meals. 

Uses. — Bitter  tonic;  gastric  sedative. 

Confectio  Guaiaci  Composita:  Chelsea  Pen- 

sioner. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Composition. — I^  Guaiaci,  3ss;  sulphuris  subli- 
mati,  3ih,  sr.  xxq  magnesii  carbonatis,  3ss;  pulveris 


CREDE  UNGUENTUM 


zingiberis,  gr.  xv;  theriacse  (treacle)  vel  mellis 
depurati,  3 iii. 

Uses. — ^Laxative  in  chronic  rheumatism. 

Confectio  Sennse  (senna  10,  cassia  fistula  16, 
tamarind  10,  prune  7,  fig.  12,  sugar  55  oil  of 
coriander  water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Confectionis  sen- 
nac,  5ii. 

Sig. — One  or  two  teaspoonfuls  at  bedtime. 

Uses. — Pleasant  laxative. 

Conii  Fluidextractum. 

Adult  Dosage. — Min.,  Ti^i;  av.,  iii;  max.,  x. 

Method  of  Administration. — ^1^  Fluidextracti  conii, 

3i-  . 

Sig. — -Three  drops  in  water  repeated  as  required 
to  produce  the  desired  effect. 

Uses. — Motor  depressant. 

Toxic  Action. — Nausea,  vomiting,  muscular  weak- 
ness, vertigo,  impaired  speech,  labored  breathing, 
motor  paralysis  without  anaesthesia  or  unconscious- 
ness, loss  of  speech  and  vision,  death  from  paralysis 
of  the  respiratory  muscles. 

Convallariae  Fluidextractum. 

Adult  Dosage. — Min.,  cjii;  av.,  viii;  max.,  xx. 

Method  of  Administration. — Fluidextracti  con- 
vallariae  3ii- 

Sig. — Eight  drops  in  water,  four  times  a day. 

Uses. — Cardiovascular  stimulant;  diuretic. 

Toxic  Action. — Irregular,  rapid  heart,  spasm 
of  the  respiratory  muscles,  slow,  deep  respira- 
tions. 

Copaibae  Oleum;  Oleoresina  Copaibse:  CioHie 

Adult  Dosage. — Min.,  irgv;  av.,  viii;  max.,  xv. 

Method  of  Administration. — Olei  copaib®, 
TiEX-xv,  capsulse  no.  24. 

Sig. — Capsule,  four  or  five  times  a day. 

Uses. — Stimulant  diuretic;  urinary  sedative;  ex- 
pectorant; diaphoretic;  broncho-pulmonary  anti- 
septic and  deodorizer. 

Toxic  Action. — Gastro-intestinal  catarrh,  nausea 
and  vomiting,  nephritis,  erythema. 

Copper,  see  Cuprum. 

Corpus  Luteum  Dessiccatum;  Lutein. 

Adidt  Dosage. — Min.,  gr.  v;  max.,  x. 

Method  of  Administration. — Corporis  lutei, 
gr.  v-x,  pulveres,  tabella;,  vel  capsulje  no.  36. 

Sig. — ^Tablet,  capsule,  or  powder,  t.i.d.p.c. 

Uses. — Alterative  in  amenorrhcea  and  the  meno- 
pause, or  “ovarian  insufficiency.” 

Corrosive  Sublimate;  Hydrargyri  Chloridum 
Corrosivum,  HgCL.  (Soluble  in  13.5  of  water,  and 
3.8  of  alcohol.) 

Dosage. — 6 months,  gr.  18  months,  gr.  }{oo', 
3 years,  gr.  Koo,'  5 years,  gr.  Adult,  min.,  gr. 
av.,  54o;  max.,  3^- 

Method  of  Administration. — Hydrargyri  bi- 
chloridi,  gr.  Kz  tabella;  no.  60. 

Sig.— One  tablet,  t.i.d.,  well  diluted. 

Physiologic  Action  and  Uses. — Antiluetic;  anti- 
septic in  solution  1 : 20,000  to  1 : 4000  to  1 : 1000. 
Tonic  in  small  do.ses,  increasing  growth  and  weight 
and  the  formation  of  red  blood-cells. 

Toxic  Action. — ^Vomiting,  diarrhoea,  frequent 
foul-smelling  and  bloody  stools,  nervous  symptoms, 
weakness,  nephritis,  anuria,  salivation,  gingivitis. 

Cosmoline,  see  Petrolatum. 

Cotarninae  Hydrochloridum;  Stypticin  (freely 
soluble  in  water);  Cotamine  is  methyloxy  hydras- 
tinine:  CuHi2N03(0.CH3). 

Adult  Dosage. — Min.,  gr.  i;  max„  v. 

Method  of  Administration. — Cotarninae  hydro- 
chlqridi,  gr.  i-iss,  tabellae,  pilulae,  vel  capsulae  no.  15. 

Sig. — Tablet  four  to  five  times  daily. 

Hypodermically,  gr.  % to  M to  %. 

56 


Uses. — Haimostatic  and  local  styptic;  uterine 
haemostatic  and  sedative. 

Cotarninae  Phthalas;  Styptol:  (Ci2Hi303N)2C6H4 
(C00H)2;  freely  soluble  in  water. 

Adult  Dosage. — Min.,  gr.  max.,  v. 

Method  of  Administration. — Cotarninae  phtha- 
latis,  gr.  tabelkc  no.  30. 

Sig. — Tablet  three  to  five  to  nine  times  daily. 

Hypodermically,  gr.  iii  in  t^^xxx  of  water. 

Uses. — Haemostatic  and  local  styptic;  uterine 
haemostatic  and  sedative. 

Coto  Bark  Fluidextract. 

Adult  Dosage. — Av.,  irgv. 

Uses. — ^Anti-diarrha'al. 

Toxic  Action. — Irritant  to  the  skin  and  mucous 
membranes. 

Cotton  Root  Bark ; Gossypii  Cortex. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max., 

3i- 

Method  of  Administration. — Gossypii  corticis, 
5iv;  aquae,  Oii. 

Boil  down  to  a pint. 

Sig. — A wineglassful  every  few  hours,  or  t.i.d. 

Uses. — Supposed  emmenagogue  and  oxytocic. 

Cotton  Root  Bark,  FI.  Ext.;  Fluide.xtractum  Gos- 
sypii Corticis,  N.  F. 

Adult  Dosage. — Av.,  njxxx. 

Method  of  Administration. — ^I^  Fluidextracti  gos- 
sypii corticis,  N.  F.,  3ii- 

Sig. — Tijxxx,  in  water,  t.i.d. 

Cottonseed  Oil;  Oleum  Gossypii  Semini.s. 

Dosage. — 6 months,  gtt.  xv;  18  months,  gtt.  xv- 
XXX ; 3 years,  3ss-i;  5 years,  3i-  Adult,  min.,  3i; 
av.,  iv;  max.,  5i- 

Method  of  Administration. — I^  Olei  gossypii 
seminis,  Sviii. 

Sig. — A teaspoonful  to  two  tablespoonfuls, 
t.i.d.p.c. 

As  a laxative,  5ii~vi  twice  daily. 

As  an  enema,  five  to  sLxteen  ounces  high  into  the 
colon. 

Uses. — ^Nutrient;  lubricant;  emoUient;  laxative. 

Couch  Grass,  see  Triticum. 

Coumarinum. 

Uses. — Perfume  and  flavor;  used  to  disguise  the 
odor  of  iodoform. 

Cream  of  Tartar;  Potassii  Bitartras,  KHC4H4O6 
(soluble  in  1.55  of  water). 

Adult  Dosage. — Min.,  gr.  xx;  av.,  xxx;  max.,  3i- 

Method  of  Admmfstmtiow.— Dissolve,  for  infants 
pi-ii,  and  for  children  of  five  years  and  adults  5ii-iv, 
in  one  or  two  pints  of  boiling  water;  allow  to  cool, 
flavor  with  sugar  and  lemon  juice,  and  administer 
freely  during  the  twenty-four  hours. 

Uses. — Diuretic;  aperient;  refrigerant. 

Crede  Argentum;  Argentum  Colloidale;  Collargo- 
lum:  colloidal  suspension  of  metallic  silver. 

Adult  Dosage. — Min.,  gr.  iss;  av.,  iii;  max.,  x. 

Method  of  Administration. — For  intravenous  in- 
jections, 10  to  20  c.c.  of  a 2 per  cent,  suspension  in 
sterile  water. 

For  parenchymatous  injections,  20  to  40  c.c.  of  a 
0.5  to  1 per  cent,  glycerine  solution. 

For  washes,  0.02  to  1 per  cent,  suspension. 

Internally,  1 : 500  to  100,  toaspoonful  doses, 
freely  with  the  food. 

Uses. — Antiseptic;  promotes  leucocytosis  and 
phagocytosis. 

Crede  Unguentum;  Unguentum  Argenti  Colloidah 
(15  per  cent,  collargol). 

Adult  Dosage. — Min.,  gr.  xxx;  av.,  3i;  max.,  iv. 

Method  of  Administration. — Rub  very  thoroughly 
into  the  skin,  3i,  once  to  thrice  daily,  for  infants;  as 
much  as  5iv,  twice  daily,  for  older  children;  cover 
with  rubber  tissue. 


CUPRI  SULPHAS 


Tlie  ointment  is  good  as  long  as  it  colors  the 
skin  black. 

Physiologic  Action  and  Uses. — Antiseptic;  promotes 
leucocytosis  and  phagocytosis. 

Creolin  (an  emulsion  of  cresols  and  hydrocarbons 
of  uncertain  and  varying  composition). 

Method  of  Administration. — For  colonic  or  gastric 
irrigation,  0.5  to  1.0  per  cent,  solution. 

For  vaginal  irrigation,  2 per  cent,  solution. 

For  nasal,  aural,  conjunctival  and  vesical  irri- 
gation, 1 : 1000. 

Uses. — Antiseptic. 

Creosoti  Carbonas;  Creosotal  (insoluble  in  water; 
freely  soluble  in  alcohol). 

Dosage. — 6 months,  gt.  ss;  18  months,  gtt.  ii; 

3 years,  gtt.  ii-iii;  5 years,  gtt.  iii-iv.  Adult,  min., 
njv;  av.,  xx;  max.,  xsx. 

Method  of  Administration. — Creosoti  car- 
bonatis,  ovi;  tincturse  gentiana;  compositaj,  q.s. 
ad,  §iii. 

M.  Sig. — One  dram,  in  water,  t.i.d.p.c.  The  dose 
may  be  gradually  increased  to  no  more  than  3iss 
of  the  carbonate  per  diem. 

It  may  also  be  administered  in  milk,  wine,  brandy, 
codliver  oil,  or  capsules. 

Physiologic  Action  and  Uses. — Pulmonary  seda- 
tive expectorant  and  antiseptic;  intestinal  anti- 
septic; tonic.  It  passes  the  stomach  unchanged,  and 
is  decomposed  in  the  intestines;  is  not  a gastric 
irritant. 

Toxic  Action. — Resembles  phenol  poisoning. 

Creosoti  Valeras;  Eo.sote. 

Adult  Dosage. — Gr.  iii  + . 

Method  of  Administration. — R Creosoti  valeratis; 
gr.  iii,  capsulae  no.  24. 

Sig. — Capsule  t.i.d.p.c.,  gradually  increased  in 
dosage. 

Physiologic  Action  and  Uses. — Pulmonary  seda- 
tive expectorant  and  antiseptic;  intestinal  antiseptic, 
tonic.  It  passes  the  stomach  unchanged,  and  is 
decomposed  in  the  intestines;  is  not  a gastric  irritant. 

Toxic  Action. — Resembles  phenol  poisoning. 

Creosotum  (chiefly  guaiacol  and  creosol;  soluble  in 
about  150  of  water;  freely  soluble  in  alcohol). 

Dosage. — 6 months,  gt.  ss;  18  months,  gtt.  ii; 
3 years,  gtt.  ii-iii;  5 years,  gtt.  iii-v.  Adult,  min., 
igjv;  max.,  x. 

Method  of  Administration. — R Creosoti  (beech- 
wood),  3i;  tinctura?  gentiana;  compositae,  oii;  vini 
xerici,  q.s.  ad,  Sviii. 

M.  Sig. — One  teaspoonful  to  three  tablespoonfuls, 
in  water,  after  meals. 

Creosote  may  also  be  administered  in  capsules, 
milk,  brandy,  or  codliver  oil. 

It  may  be  gradually  increased  by  one  minim  daily 
up  to  15  to  30  minims  daily. 

For  inhalation  purposes:  10  drops  in  a pint  of 

steaming  water. 

Physiologic  Action  and  Uses.  Pulmonary  sedative 
expectorant  and  antiseptic;  intestinal  antiseptic; 
tonic;  gastric  irritant. 

Toxic  Aefion.— Resembles  phenol  poisoning. 

Cresol  (a  mixture  of  three  isomeric  cresols: 
C6H4(CH3)0H;  soluble  in  50  of  water).  Methyl 
Phenol. 

Adult  Dosage. — ttlss;  i,  ii. 

Method  of  Administration. — One-fourth  to  one  per 
cent,  solution  as  a local  antiseptic  and  disinfectant. 

Uses. — -Antiseptic  and  disinfectant;  more  actively 
germicidal  than  phenol. 

Toxic  Action. -Symptoms  and  treatment  those  of 
carbolic  acid  poisoning. 

Cresolis  Liquor  Compositus  (cresol  50,  linseed  oil 
35,  potassium  hydro.xide  8,  water  to  100;  similar 
to  lysol). 


For  mucous  membranes,  1 to  2 per  cent,  solution. 

For  the  skin,  1 to  5 per  cent. 

Uses. — Antiseptic  and  disinfectant.  More  ac- 
tively germicidal  than  phenol. 

Toxic  Action. — Symptoms  and  treatment  those  of 
carbolic  acid  poisoning. 

Cretae  Pulvis  Compositus  (prepared  chalk  30, 
acacia  20,  sugar  50). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xxx;  max.,  be. 

Method  of  Administration. — R Pulveris  creta; 
compositi,  3v  (gr.  xii  per  dram);  aquae  cinnamomi, 
3x;  aquae,  q.s.  ad,  §iii  5i-  ( = Mistura  Cretae). 

M.  Sig. — 3i~iv-viii  every  four  hours. 

Uses. — -Antacid;  astringent. 

Creta  Praeparata;  Prepared  Chalk  (purified  native 
CaCOs). 

Dosage. — 6 months,  gr.  ii;  18  months,  gr.  iii;  3 
years,  gr.  v;  5 years,  gr.  v-viii.  Adult,  min.,  gr.  x 
av.,  xv;  max.,  Ixxv. 

Method  of  Administration. — R Cretae  praeparata-, 
3iv  (gr.  x to  the  dose);  syrupi  acaciae,  gii;  aqua; 
cinnamomi,  q.s.  ad,  giv. 

M.  Sig.— A)ne  teaspoonful  every  three  to  four 
hours. 

Uses. — Antacid;  astringent. 

Croton=chloral  Hydras;  Butyl-chloral  Hydras 
CHsCHCl.CCb.CHfOHlz;  (soluble  in  50  of  water). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xx. 

Method  of  Administration. — R Butyl-chloral 
hydratis,  gr.  v,  pilulae  no.  4. 

Sig. — One  pill  every  half  hour  until  effectual,  or 
until  four  have  been  taken. 

Uses. — Nervous  sedative;  hjrpnotic;  analgesic. 

Croton  Oil;  Oleum  Tiglii. 

Adult  Dosage. — Min.,  i^ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Adrninister  in  four  or 
five  drops  of  olive  oil  or  glycerine,  or  on  sugar,  or 
butter,  or  in  a bread  pill. 

Physiologic  Action  and  Uses. — Purgative,  acting 
as  a local  irritant  (in  two  to  four  hours),  chiefly  on 
the  small  bowel;  local  rubefacient  and  vesicant. 

Cubebae  Oleoresina;  Oleum  Cubebae. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  xx. 

Method  of  Administration. — R Oleoresinae  cu- 
bebae, gr.  viii,  capsulae  no.  24. 

Sig.--^apsule,  t.i.d.p.c. 

Uses. — Broncho-pulmonary  antiseptic  and  de- 
odorizer; stimulating  diuretic;  expectorant;  urinary 
astringent,  feeble  antiseptic,  and  sedative. 

Toxic  Action. — Nausea;  headache;  haematuria; 
irritability  of  the  neck  of  the  bladder. 

Cupri  Citras  (but  shghtly  soluble  in  cold  water). 

Adult  Dosage. — Min.,  gr.  K;  av.,  max.,  i. 

Method  of  Administration. — R Cupri  citratis, 
gr.  pilulae  no.  30. 

Sig. — One  pill,  t.i.d.,  (increased,  if  desired  to 
gr.  i,  t.i.d.). 

Uses. — Antiseptic;  antimycotic;  astringent. 

Toxic  Action. — Nausea,  vomiting,  gastro-enteritis, 
heart  depression,  quickened  respiration,  fever,  head- 
ache, bronchial  catarrh,  sahvation,  ana-mia, 
emaciation. 

Cupri  Sulphas:  CUSO4-I-5H2O  (soluble  in  2.5 

of  water). 

Adult  Dosage. — Gr.  in  solution  or  in  pill 

as  an  astringent;  gr.  v-x-xv,  in  solution  as 
an  emetic,  or  gr.  v every  fifteen  minutes  until 
effectual. 

R . Cupri  sulphatis,  gr.  M-M,  pilulae  no.  30. 

Sig. — One  pill  t.i.d.  (increased  if  necessary  to  gr.  i 
t.i.d!)  As  a local  antiseptic  or  asan astringent  throat 
gargle  use  a one  per  cent,  solution,  or  gr.  v ad  Si. 

Physiologic  Action  and  Uses. — Antiseptic;  .astrin- 
gent; antimycotic;  emetic  (acting  reflexly).  Copper 
is  only  very  slightly  poisonous. 


DI^THYLBARBITURICUM  ACIDUM 


Curare. 

Adult  Dosage. — Gr.  K2  hypodermically  every  six 
hours. 

Uses. — To  allay  spasms  in  tetanus. 

Cystogen,  see  Hexamethylenamina. 

Dakin’s  Solution. — A neutral  solution  of  sodium 
hypochlorite,  NaClO,  of  0.45  to  0.5  per  cent, 
strength.  Less  than  0.4  per  cent,  strength  is  too 
inert;  greater  than  0.5  per  cent,  is  too  irritating. 

Method  of  Preparation. — Dissolve  140  grams  of 
dry  sodium  carbonate  or  400  grams  of  the  crystals 
(washing  soda)  in  10  litres  of  top  water,  and  add 
200  grams  of  bleaching  powder  containing  24  to  28 
per  cent,  of  “ available  chlorine  ” (see  below).  After 
shaking  very  thoroughly,  allow  to  stand  for  half  an 
hour,  then  siphon  off  the  clear  supernatant  liquid 
and  filter.  To  the  filtrate  add  40  grams  of  boric 
acid.  The  resulting  so-called  Dakin’s  solution  is 
good  for  only  one  week;  it  should  be  kept  in  a cool 
place  in  the  dark,  and  should  be  tested  daily  for 
strength  and  neutrality. 

To  test  for  neutrality,  add  a little  of  the  solution 
to  a trace  of  solid  phenolplithalein  suspended  in 
water.  If  a red  color,  indicating  free  alkali,  devel- 
ops, more  boric  acid  should  be  padded  to  the 
Dakin’s  solution. 

To  test  for  strength,  proceed  as  follows:  To  10  c.c. 
of  the  solution  add  5 c.c.  each  of  10  per  cent,  sodium 
or  potassium  iodide  and  10  per  cent,  pure  or  glacial 
acetic  acid  in  water.  Iodine  is  thereby  liberated  in 
amount  equivalent  to  the  amount  of  active  chlorine 
in  the  solution  under  test.  Now  determine  the 
amount  of  iodine  liberated  by  adding  from  a burette 
a decinormal  sodiiun  thiosulphate  solution  (24.8 
grams  of  pure  crystallized  .sodium  thiosulphate  in 
1000  c.c.  of  water)  until  almost  all  the  iodine  has 
disappeared.  Now  add  a few  drops  of  starch  paste 
(about  0.1  gram  of  starch  boiled  with  100  c.c.  of 
water,  and  allowed  to  cool  and  sediment) , and  con- 
tinue the  addition  of  the  tliiosulphate  until  the  blue 
color  just  disappears.  Each  cubic  centimetre  of 
thiosulphate  used,  represents  0.00372  gram  of  so- 
dium hypochlorite.  Multiply  the  latter  figure  by 
the  number  of  cubic  centimetres  used,  and  this 
by  10,  and  the  result  is  the  percentage  of  so- 
dium hypochlorite  in  the  solution  tested.  (Dakin 
and  Dunham). 

To  determine  the  “ available  chlorine  ” content  of 
bleaching  powder,  proceed  as  follows:  Triturate  10 
grams  of  the  powder  in  a mortar  with  successive 
small  quantities  of  water,  transfer  completely  to  a 
litre  flask,  and  add  water  to  1000  c.c.  Shake  well, 
and  allow  to  stand  for  an  hour  or  two.  Then  test  1() 
c.c.  of  the  clear  supernatant  liquid  precisely  as  de- 
scribed for  the  sodium  hypochlorite  test.  Each  cubic 
centimetre  of  sodium  thiosulphate  used  represents 
0.00354  gram  of  available  chlorine.  The  number  of 
cubic  centimetres  used  multiplied  by  0.00354  multi- 
plied by  1000  equals  the  percentage  of  available 
chlorine  in  the  bleaching  powder  tested.  In  using 
200  grams  of  bleaching  powder  for  10  litres  of  solu- 
tion, the  resulting  sodium  hypochlorite  solution  will 
contain,  roughly,  as  much  hypochlorite  as  is  repre- 
sented by  the  available  chlorine  of  the  bleaching 
powder  divided  by  50.  Thus  a bleaching  powder 
containing  25  per  cent,  available  chlorine  will  give 
0.5  per  cent,  sodium  hypochlorite  solution.  A less 
than  23  per  cent,  bleaching  powder  should  not  be 
used.  When  using  higher  than  28  per  cent,  bleaching 
powder,  its  amoimt  should  be  correspondingly  re- 
duced. (Dakin  and  Dunham). 

Uses. — Dakin’s  solution  has  two  effects.  (1)  It 
dissolves  dead  tis.sue  and  (2)  forms  therewith  highly 
germicidal  chlorinated  proteins  (chloramines).  Italso 
dissolves  catgut  (in  two  to  three  hours),  chromicized 


catgut  (in  a day),  and  even  silk  and  linen,  the  latter 
least.  It  therefore  promotes  secondary  hemorrhage. 
It  is  irritating  to  the  skin  but  not  to  woimds.  It 
parts  with  its  chlorine  rapidly  in  the  presence  of 
proteins  (within  one  to  two  hours).  In  using  Dakin’s 
solution,  the  correct  technique  should  be  fol- 
lowed strictly,  otherwise  it  had  better  not  be  em- 
ployed. 

The  H.  K.  Mulford  Co.  of  Philadelphia,  furnish  a 
“Concentrated  Solution  Sodium  Hypochlorite”  one 
volume  of  which  is  diluted  with  nine  volumes  of 
water  and  the  amount  of  boric  acid  required  (stated 
on  the  label  of  each  bottle)  to  render  the  solution 
neutral  is  added.  It  should  not  be  used  if  it  is 
pink. 

Daturina  (a  mixture  of  the  alkaloids,  atropine, 
hyoscyamine,  and  hyoscine). 

Adult  Dosage. — Min.,  gr.  %oo',  max.,  ’^o- 

Toxic  Action.- — Dryness  and  redness  of  the  throat 
and  skin,  delirium,  incoordination  of  movement, 
inability  to  walk,  etc. 

Decoctum  Qranati. 

Adult  Dosage. — Min.,  giv;  max.,  vi. 

Method  of  Administration. — I^  Granati  recentis, 
oxvii;  aqua;,  5xvii. 

Boil  down  to  ounces  xii,  and  strain. 

Sig. — Four  to  six  ounces  every  hour  for  two  or 
three  doses,  preceded  and  followed  in  a few  hours 
by  a brisk  cathartic. 

Uses. — Anthelmintic. 

Dermatol ; Bismuthi  Subgallas  (insoluble  in  water 
or  alcohol). 

Dosage. — 6 months,  gr.  iii-v;  18  months,  gr.  v; 
3 years,  gr.  v-x;  5 years,  gr.  x.  Adult,  min.,  gr.  x; 
max.,  XX. 

Method  of  Administration. — May  be  prescribed 
like  Bismuthi  Subcarbonas.  Also  used  locally  as  a 
protective  powder  and  in  ointment  form,  10  to  20 
per  cent. 

Uses. — Intestinal  astringent  and  antiseptic;  gas- 
tric sedative;  local  antiseptic  and  protective. 

Toxic  Action. — Blue  line  on  the  gums,  headache, 
nausea,  vomiting,  stomatitis,  intestinal  ulceration 
and  diarrhoea,  fever,  rapid  pulse,  nephritis,  oedema 
of  the  legs. 

Dextri=MaItose  Mead’s  (maltose  52  per  cent., 
dextrin  41.7  per  cent.,  sodium  chloride  2 per  cent, 
moisture  4.3  per  cent.,  prepared  by  the  action  of, 
diastase  on  starch);  500  grams  correspond  approx- 
imately to  1920  calories. 

Uses . — N utritive. 

Dextrinum  (an  intermediate  product  in  the  con- 
version of  starch  into  maltose  or  glucose;  a trans- 
parent, brittle  sohd,  soluble  in  water  and  dilute 
alcohol). 

Uses. — Substitute  for  acacia  and  other  gums. 

Diachylon  Unguentum  (lead  plaster  50,  ohve 
oil  or  white  petrolatum  49,  oil  of  lavender  flow- 
ers 1). 

Uses. — Local  antiseptic  and  astringent  emollient. 

Diaethylbarbituricum  Acidum;  Veronal;  Diethyl 
Malonyl  Urea: 


NHs^ 

caa/  ^CO— NH-^ 


CO 


(soluble  in  about  150  of  cold  water,  about  12  of 
boiling  water;  soluble  in  8 of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — R Veronali,  gr.  v, 
pulveres,  tabella;,  vel  capsula;  no.  6. 

Sig.— One,  one  and  a half  to  two  hours  before  bed- 
time, foOowed  by  a cupful  of  hot  water,  tea,  or  milk. 

Keep  the  bowels  active  with  salines,  and  give 
alkalines,  on  prolonged  use  of  the  drug. 


DIGITOXINUM 


Physiologic  Action  and  Uses. — Hypnotic;  gr.  viii 
have  been  fatal;  relatively  safe  in  small  doses;  begins 
to  act  in  about  half  an  hour. 

Toxic  Action. — Abdominal  pain,  sweating,  pyrexia 
erythema,  neuralgia,  nau.sea,  vomiting,  oliguria, 
glycosuria,  ataxia,  .somnolence  deepening  to  coma, 
trembling  and  restlessness  during  the  sleep,  fall 
of  temp(^rature. 

Diastasum  (a  mixture  containing  amylolytic 
enzymes  from  malt;  soluble  in  water). 

Adidt  Dosage. — Av.,  gr.  viii. 

Method  of  Administration. — Diastasi,  gr.  viii, 
capsuhc  no.  30. 

Sig. — Capsule,  t.i.d.p.c. 

Uses. — Amylolytic  ferment,  converting  starch 
into  sugar. 

Dichloramine  =T;  Paratoluenesulphodichlora- 
mme:  CII3.C6H4.SO2NCI2. 

ITsed  as  a local  antiseptic  dissolved  in  chlorinated 
paraffin  wax  (“chlorcosane”),  one-fourth  to  one  per 
cent,  in  the  nose  and  throat;  one-fourth  to  two  per 
cent,  for  burns;  five  per  cent,  for  wounds. 

To  make,  say,  a five  per  cent,  solution,  warm 
about  a quarter  of  the  oil,  say  25  grams,  to  75°  or 
80°  C.  (not  above  80°),  in  a glass  receptacle  that 
has  been  cleansed  with  ether,  then  with  chloroform, 
and  dried;  then  add  the  5 grams  o^  dichloramine-T, 
work  into  a smooth  paste,  and  then  stir  in  the  re- 
maining 70  grams  of  cold  oil.  Shake  the  suspension 
frequently  during  the  next  twenty-four  hours  when 
it  will  dissolve.  Filter  and  keep  in  a well-stoppered, 
dark  amber  bottle,  protected  from  light,  heat  and 
moisture.  It  should  keep  perhaps  about  three 
months.  Should  a crystalline  deposit  occur,  or 
shoidd  it  smell  of  chlorine,  or  taste  sour  (due  to 
HCl),  the  preparation  should  be  rejected. 

It  is  applied  by  means  of  a dry  glass  syringe  or 
pipette,  or  cotton  swab,  or  rubber  tube.s,  or  glass 
atomizer.  No  metal  should  be  used;  no  alcohol.  It 
gives  off  chlorine  slowly  for  twenty -four  hours; 
therefore  it  should  be  renewed  once  every  twenty- 
four  hours.  Dakin’s  Solution  parts  with  its  chlorine 
in  from  one  to  two  hours. 

Dichloramine-T  is  much  more  actively  germi- 
cidal than  sodium  hypochlorite,  exerts  a more  pro- 
longed antiseptic  action,  and  is  less  irritating,  but 
it  has  little  solvent  action  on  necrosed  ti.ssues. 

Digipuratum  (contains  the  cardiac  stinudants, 
digitoxin  and  digitalin,  but  not  the  depressant, 
digitonin). 

Adidl  Dosage.- — Av.,  gr.  iss. 

Method  of  Administration. — Digipurati,  gr. 
iss,  tabellae  no.  30. 

Sig. — One  tablet,  three  or  four  times  a day,  grad- 
ually reduced  after  the  object  of  the  drug  has  been 
accomplished. 

Physiologic  Action  and  Uses. — Digitalis  slows  and 
strengthens  the  heart.,  increases  the  judse  volume, 
and  raises  the  arterial  tension  by  stimidation  of  the 
vagus  inhibitory  and  vaso-constrictor  centres  and 
the  heart-muscle.  It  diminishes  the  conductivity 
of  the  bundle  of  His,  and  may  even  produce  complete 
heart-block.  It  is  thus  of  value  in  auricular  fibrilla- 
tion by  protecting  the  ventricle  against  a constant 
shower  of  stiimdi  from  the  fibrillating  auricle. 
(Halsey.)  It  increases  the  tendency  to  premature 
contractions  or  extra -systoles  by  increasing  the 
irritability  of  the  motor  ganglia  or  centres  in  the 
heart.  It  acts  directly  on  the  vessel  walls,  causing 
vaso-constriction.  Small  doses,  however,  dilate  the 
renal  vessels,  large  doses  constrict.  The  vessels  of 
the  portal  system  are  constricted.  Digitalis  regu- 
lates the  heart’s  action  excejit  in  poisonous  doses, 
which  produce  irregidarity.  Digitalis  is  diuretic  in 
moderate  doses.  No  appreciable  effect  is  to  be 


e.xpected  within  twenty-four  hours  after  oral 
administration. 

Toxic  Action. — Slowing  of  the  pulse,  occurrence  of 
occasional  extra-systoles,  coupling  of  the  beats,  di- 
minished excretion  of  urine,  headache,  nausea,  vom- 
iting, colic,  diarrhoea,  bad  dreams,  cardiac  irregu- 
la'ity,  heart-block,  lowered  temperature,  faintness, 
vertigo,  hallucinations,  delirium,  restlessness,  delir- 
ium cordis,  falling  blood-i)ressure. 

When  these  symptoms  occur,  discontinue  the 
drug  until  the  pulse  rate  begins  to  increase  again 
(usually  several  days). 

Contraindications  to  the  administration  of  digi- 
talis: acute  infectious  disease,  fatty  and  other 

forms  of  degeneration  of  the  heart-muscle,  aortic 
disease,  slow  pulse,  forcible  apex  beat  and  bounding 
arteries. 

Digitalinum,  French  or  Homolle’s  (consisting 
mainly  of  digitalinum  verum). 

Adult  Dosage. — Min.,  gr.  ,'^40;  av.,  ’(o,'  max.,  ’^o- 

Method  of  Administration. — H Digitalini 

(French),  gr.  tabella;  no.  30. 

Sig. — One  tablet,  increased,  if  necessary,  everj' 
two  to  four  hours. 

Maximum  daily  dose,  gr.  Ko- 

Digitalinum  Qermanicum  (Merck;  consisting 
largely  of  digitonin,  with  digitalinum  verum  and 
other  glucosides). 

Dosage. — 6 months,  gr.  18  months,  gr.  Hoo', 
3 years,  gr.’fso;  5 years,  gr.  Koo-  Adult,  min.,  gr.  %(,; 
av.,  Ko;  max.,  ]4. 

Method  of  Administration. — I^  Digitahni  Ger- 
manici  (Merck),  gr.  Ko,  tabellae  no.  12. 

Sig. — Tablet  by  mouth  or  subcutaneously,  t.i.d. 

Digitalinum  (Nativelle’s),  see  Digitoxinum. 

Digitalinum  Verum  (a  glucoside,  CssHseOn). 

Adult  Dosage. — Min.,  gr.  %o',  max.,  %p- 

Method  of  Ad^ninistration.- — I^  Digitalini  veri, 
gr.  1^0,  pilulae  no.  12. 

Sig. — A pill  every  three  to  four  hours.  It  may  be 
given  hypodermically. 

Digitalis  Fluidextractum. 

Adult  Dosage. — Min.,  i^i;  max.,  iv. 

Method  of  Administration. — I^  Fluidextracti  digi- 
talis, 3i- 

Sig. — One  to  four  minims,  well  diluted  in  water, 
three  or  four  times  a day. 

Digitalis  Infusum  Recens. 

Dosage. — 3 years,  5ss-i;  5 years,  qi-iii-  Adult, 
min.,  3ii;  max.,  iv. 

Method  of  Administration. — I^  Infusi  digitalis 
recentis,  §iv. 

Sig. — A do.se,  well  diluted  in  water,  three  or  four 
times  a day.  (See  under  Digipuratum  for  physio- 
logic and  toxic  action,  etc.) 

Digitalis  Pulvis. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  ii. 

Digitalis  Tinctura  (will  keep  only  about  twelve 
months;  as  good  a preparation  as  any  when  stand- 
ardized) . 

Dosage. — 6 months,  gt.  ss;  18  months,  gt.  i;  3 
years,  gtt.  i-ii;  5 j'ears,  gtt.  ii-iii.;5  to  10  years, 
ir^iii-v.  Adult,  min.,  t^v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — I^  Tincturaj  digi- 
talis, oss. 

Sig. — Eight  to  ten  minims,  well  diluted  in  water, 
every  four  hours,  or  three  or  four  times  a day. 

The  patient  should  be  kept  in  bed  while  giving 
digitalis  in  full  doses.  (See  under  Digipuratum  for 
physiologic  and  toxic  action,  etc.) 

Digitoxinum:  C34H54O11,  a glucoside,  the  Digi- 

taline  Nativelle  of  the  French. 

Adidt  Dosage. — Min.,  gr.  1(40:  max.,  'W 

Method  of  Administration. — R Digito.xini,  gr.  Jlso, 
tabellae  no.  12. 


ELIXIR  GLYCEROPHOSPHATI  COMPOSITUM 


SiK- — One  tablet,  no  of  toner  than  twice  a clay. 
Reduce  or  stop  the  dose  immediately  when  the 
therapeutic  effect  or  toxic  symptoms  aj)pear,  for 
the  drufc,  when  continued,  has  a cumulative  action. 

Dionin;  ^diithylmorphina}  Ilydrochloridum  (sol- 
uble in  8 of  water;  22  of  alcohol). 

Dosag  ■. — 0 month  , gr.  Hoo',  18  months,  gr.  ’{ooi 
3 years,  gr.  Ko',  5 years,  gr.  ]io-  Adult,  min.,  gr.  le) 
av.,  V,  max.,  M. 

Method  of  Administration. — iEthylmorphiniE 
hydrochloridi,  gr.  K,  tabellsc  no.  6. 

Sig. — One  tablet  two  or  three  times  a day,  as 
required. 

As  a local  ophthalmic  analgesic  and  lymphagogue : 
a 4 to  10  per  cent,  aqueous  solution,  one  drop  three 
or  four  times  a day,  or  a 1.5  to  10  per  cent,  ointment. 
Chemosis,  redness,  and  burning  should  continue  for 
one  to  two  minutes  after  its  application,  in  order  to 
secure  the  desired  therapeutic  effect. 

Physiologic  Action  and  Uses. — Nervous  sedative 
and  analgesic;  action  upon  the  respiratory  and  cough 
centres  the  same  as  codeine;  ophthalmic  analgesic 
and  l3onphagogue,  causing  local  hyperaemia  and 
acute  conjunctival  oedema. 

Diphtheria  Antitoxin,  see  Serum  Antidiphthericum. 

Diuretin;  Theobrominae  Sodio-Salicylas  (soluble 
in  1 part  of  water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xx. 

Method  of  Administration. — R Theobrominae  sodio 
salicylatis,  gr.  xv,  pulveres  in  charta  cerata  no.  12. 
Dispense  in  a well-sealed  bottle  (for  it  rapidly 
absorbs  carbonic  acid  from  the  air  and  decompo.ses). 

Sig. — One  powder,  dissolved  in  hot  water,  two  to 
four  times  a day,  up  to  3ss-3iss  in  twenty-four 
hours,  avoiding  acids  and  acid  vegetable  juices, 
which  precipitate  the  alkaloid. 

Uses. — Diuretic.  It  should  be  used  for  only  one 
or  two  days  at  a time,  preferably  one  day. 

Dobell’s  Solution. 

Method  of  Administration. — R Phenolis  cryst., 
gr.  xxiv;  sodii  boratis,  3h;  sodii  bicarbonatis,  3ii; 
glycerin!,  §ss;  aquae  destillatae,  q.s.  ad,  Oi. 

M.  Sig. — Use  as  a nasal  or  throat  spray  or  mouth- 
wash, twice  daily. 

Uses. — Alkaline  antiseptic. 

Donovan’s  Solution:  Liquor  Arseni  et  Hydrargyri 
lodidi. 

Adult  Dosage. — Min.,  i^ji;  av.,  iss;  max.,  v. 

Method  of  Administration. — R Liquoris  arseni  et 
hydrargjui  iodidi,  3h- 

Sig. — Two  drops  in  water,  t.i.d.p.c. 

U ses. — Alterative. 

Dover’s  Powder;  Pulvis  Ipecacuanha3  et  Opii 
(ipecac  10,  powdered  opium  10,  sugar  of  milk  80). 

Dosage.—^  months,  gr.  18  months,  gr. 

3 years,  gr.  i-iss;  5 years,  gr.  ii-iii.  Adult,  min.,  gr.  v; 
av.,  viiss;  max.,  xv. 

Method  of  Administration. — R Pulveris  ipecacu- 
anhae  et  opii,  gr.  v,  pulveres  no.  6. 

Sig. — One  powder  as  required  (about  every  three 
to  four  hours,  if  neces.sary). 

Uses. — Nervous  sedative;  sedative  expectorant; 
diaphoretic. 

Duboisinse  Sulphas. 

Adult  Dosage. — Min.,  gr.  Kooi  av.,  Yeo]  max.,  Ko. 

Method  of  Administration. — Gr.  Vm-Yi  may  be 
administered  hypodermically,  twice  daily. 

Used  as  a mydriatic,  gr.  ii  ad  3i,  ia  the  place  of 
atropine,  when  the  lattcu  gives  ri.se  to  conjunctivitis. 

Physiologic  Actum  ami  Uses. — Nervous  sedative; 
anhidrotie;  mydriatic;  action  similar  to  that  of 
atropine. 

Toxic  Action. — ^Vertigo,  nausea,  syncope,  dryness 
and  redness  of  the  throat  and  skin,  delirium,  inco- 
ordination of  movement. 


Duldn;  Sucrol  (Para-phenetol-carbamide ; sol- 
uble in  800  of  water). 

Adult  Dosage. — Gr.  s-ii,  up  to  a daily  ma.ximum 
of  30  grs. 

Uses. — Sugar  substittite,  about  200  times  sweeter 
than  sugar. 

Duotal;  Guaiacolis  Carbonas:  C6ll4(OCH3)2C03 
(insoluble  in  water;  soluble  in  alcohol  1 : 60). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — R Guaiacolis  car- 
bonatis,  gr.  xv,  pulveres,  capsulae,  vel  trochisci  no.  12. 

Sig. — One,  t.i.d.p.c.  The  dose  may  be  gradually 
increased  to  a maximum  of  3 iss  per  diem.  The 
drug  may  be  administered,  if  desired,  in  codliver  oil, 
a bitter  tincture,  or  mucilage  of  tragacanth. 

Uses. — Intestinal  antiseptic;  bronchial  stimulant. 

Eisenzucker;  Ferri  0.xidum  Saccharatum. 

Adult  Dosage. — Av.,  gr.  iii. 

Method  of  Administration. — R Ferri  o.xidi  sac- 
charati,  gr.  iii,  tabellae  no.  30. 

Sig. — Tablet,  t.i.d.p.c.,  crushed  with  the  teeth 
before  swallowing. 

Elaterinum,  C20H28O6  (not  to  be  confounded  with 
Elaterium). 

Adult  Dosage. — Min.,  gr.  Yo',  max.,  Ko. 

Method  of  Administration. — R Elaterini,  gr.  Yo, 
tabella;  no.  6. 

Sig. — ^Tablet  two  or  three  times  a day. 

Physiologic  Action  and  Uses. — Hydragogue  ca- 
thartic, acting  upon  both  the  large  and  small 
intestine. 

Toxic  Action. — Nausea,  vomiting,  prostration. 

Elaterini  Trituratio  (Elaterin  10,  sugar  of  milk  90). 

Adult  Dosage. — Min.,  gr.  av.,  14;  max.,  i. 

Method  of  Administration. — R Triturationis  ela- 
terini, gr.  tf,  tabellsD  no.  6. 

Sig. — Tablet  two  or  three  times  a day. 

Physiologic  Action  and  Uses. — Hydragogue  ca- 
thartic, acting  upon  both  the  large  and  small 
intestine. 

Toxic  Action. — Nausea,  vomiting,  jirostration. 

Elder  Flowers;  Sambucus. 

Adult  Dosage. — Min.,  3ss;  max.,  i. 

Method  of  Administration. — In  hot  infusion,  as 
a tea. 

Uses. — Diaphoretic. 

Electrargol  (a  colloidal  suspension  of  silver,  0.04 
per  cent.,  containing  a small  percentage  of  sodium 
arabate). 

Adult  Dosage. — Min.,  5 c.c.;  max.,  25  c.c. 

Method  of  Administration. — Injected  subcutane- 
ously, intramuscularly,  or  intravenously  after  being 
made  isotonic  by  the  addition  of  sodium  chloride 
solution. 

Uses. — Antiseptic  and  germicide. 

Electric  Bath,  see  Baths,  Medicated. 

Elixir  Aromaticum  vel  Simplex  (comp.  spt.  of 
orange  1.2,  purified  talc  3,  syrup  3714;  alcohol  and 
distilled  water  to  100). 

Adult  Dosage. — Min.,  3i;  max.,  oi  + - 

Uses. — Flavoring  vehicle  and  diluent. 

Elixir  Calcii  et  Sodii  Glycerophosphati. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — R Elixiris  calcii  et 
sodii  glycerophosphati,  5iv. 

Sig. — Two  teaspoonfuls,  t.i.d. 

Uses. — Alterative ; tonic. 

Elixir  Ferri  Quinina;  et  Stryclminae  Phosphatiim. 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Elixiris  ferri, 
quininac,  et  strychnina^  phosphati,  5iv. 

Sig. — Teaspoonful  in  half  a tumbler  of  water, 
t.i.d.p.c. 

Uses. — Tonic. 

Elixir  Glycerophosphati  Compositum,  N.  F.  (Sod. 


EPINEPHRINA 


glycerophos.  4,  calc,  glycerophos.  1.6,  ferric  glycero- 
phos.  0.3,  soluble  manganese  glycerophos.  0.2, 
quinine  glycerophos.  0.1,  strychnine  glycerophos. 
0.015,  lactic  acid  1,  in  compt.  spt.  cardamom,  alco- 
hol, glycerine  and  water  to  100). 

Adult  Dosage. — Av.,  oh- 

Method  of  Administration. Elixiris  glycero- 
phosphati  compositi,  N.  F.,  5viii. 

Sig. — Two  teaspoonfuls,  t.i.d. 

Uses. — Tonic. 

Elixir  Quaranae  (contains  caffeine  and  theobro- 
mine). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — Elixiris  guarame 

Sii- 

Sig. — One  or  two  teaspoonfuls  every  four  hours 
until  relieved. 

Uses. — Analgc.sic;  stimulant. 

Elixir  Quaranae  et  Celerinae  (supposed  to  contain 
caffeine,  coca,  celery,  kola,  and  viburnum,  with 
aromatics). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — R Potassii  bromi^, 
3ii  (gr.  x"v  per  dose) ; elixiris  guaranse  et  celerinae,  5 iv. 

M.  Sig. — A dessertspoonful  in  hot  water,  every 
four  hours  (Kelly’s  Dysmenorrhoea  mixture). 

Elixir  Phosphori,  N.  E.  (phosphorus  0.025  per 
cent.,  in  chloroform,  alcohol,  glycerine,  and  water, 
flavored  with  comp.  spt.  of  orange  and  oil  of  anise; 
one  dram  contains  gr.  Ya  of  phosphorus;  deteriorates 
rapidly). 

Adult  Dosage. — Min.,  tg;xv;  max.,  3i- 

Method  of  Administration. — R Elixir  phos- 

phori, 3ii. 

Sig. — One  dram,  t.i.d. 

Uses. — Alterative. 

Elixir  Simplex,  see  Elixir  Aromaticum,  above. 

Elixir  Terpini  Hydratis,  N.  F.  (terpin  hydrate, 
1.75  per  cent.,  tr.  of  sweet  orange  peel,  spirit  of  bitter 
almond,  alcohol  about  42  per  cent.,  glycerine,  syrup, 
and  water). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — R Elixiris  terpini 
hydratis,  N.  F.,  gii. 

Sig. — Teaspoonful  every  three  to  four  hours,  with 
plenty  of  water. 

Uses. — Broncho-pulmonary  antiseptic;  stimulat- 
ing expectorant;  diaphoretic;  diuretic;  used  in  pro- 
fuse bronchorrha’a. 

Emetinae  Hydrochloridum:  C30H44N2O4.2HCI. 

(Alkaloid;  freely  soluble  in  water  or  alcohol). 

Dosage. — Under  1 year,  gr.  Ys  for  two  or  three 
doses;  2 years,  gr.  K,  every  twelve  hours  for  three 
doses  (Martin);  Adults,  gr.  ss-iss-ii. 

It  may  be  administered  by  mouth  in  keratin- 
coated  capsules,  with  a bowl  of  milk  or  gruel  on  an 
empty  stomach ; or  it  maybe  administered  hypo- 
dermically. Give  gr.  iss  to  ii  on  alternate  days  for 
five  doses,  followed  by  three  or  four  weeks  rest,  and 
a repetition  of  the  course  if  necessary. 

U ses. — Amcebi  cide. 

Toxic  Action. — Vertigo,  malaise,  nausea,  vomiting, 
diarrhoea,  facial  flushing, — dyspnoea,  shock. 

Emplastrum  Adhaesivum  (rubber  2,  petrolatum  2, 
lead  j)laster  96). 

Adhesive  plaster  may  be  removed  by  means  of  a 
small  quantity  of  oil  of  wintergreen.  (Potter.) 

Emplastrum  Belladonnse  (ext.  belladonna  30  per 
cent.,  with  adhesive  plaster). 

Uses. — Anodyne  plaster. 

Emplastrum  Capsici  (oleoresin  of  capsicum  with 
adhesive  plaster). 

Uses. — Warming  plaster. 

Emplastrum  Hydrargyri  (mercury  30,  oleate  of 
mercury  1,  hydrous  wool  fat  10,  lead  plaster  59). 


Uses. — Antiseptic. 

Emplastrum  Picis  Cantharidatum  (cerate  of  can- 
tharides  8,  Burgundy  pitch  to  100). 

Method  of  Administration. — Moisten  a square  inch 
with  olive-oil  and  apply.  Cover  with  a dossil  of 
gauze  secured  with  adhesive.  Remove  in  six  to 
eight  hours,  or  the  next  day,  and  dress  with  boric 
ointment  on  surgical  hnt. 

Uses. — Vesicant. 

Emplastrum  Plumb!  (lead  acetate  60,  soap  100). 

Emplastrum  Saponis  (soap  10,  lead  plaster  90, 
water,  q.s.). 

Emulsum  Asafoetidae  (4  per  cent.)  in  water  . 

Adult  Dosage. — Min.,  3h;  av.,  iv;  max.,  5i- 

Method  of  Administration. — R Emulsi  asafee- 
tidae,  giv. 

Sig. — Two  teaspoonfuls,  four  times  a day;  or  two 
tablespoonfuls  in  one  dose. 

Used  as  an  enema  in  tympanites. 

Uses. — Antispasmodic;  nerve  stimulant;  carmina- 
tive; stimulating  expectorant;  tonic;  laxative;  diu- 
retic; diaphoretic;  emmenagogue;  aphrodisiac; 
anthelmintic. 

Toxic  Action. — Nausea,  vomiting,  purging. 

Emulsum  Olei  Morrhuae,  see  Codliver  Oil 
Emulsions. 

Emulsum  Olei  Terebinthinse  (rectified  oil  15, 
expressed  oil  of  almond  5,  syrup  25,  acacia  15, 
water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Emulsi  olei  tere- 
binthinae,  gi. 

Sig. — Teaspoonful,  three  to  six  times  daily. 

Enzymol  (contains  pepsin  and  HCl). 

Method  of  Administration. — Used  locally  as  a 
digestant  of  necrosed  tissue,  diluted  with  one-half 
to  one  to  two  volumes  of  water,  or  better,  0.2  per 
cent,  hydrochloric  acid  solution. 

Uses. — Proteolytic. 

Eosote;  Creosoti  Valeras. 

Adult  Dosage. — Av.,  gr.  ui-1-. 

Method  of  Administration. — R Creosoti  valera- 
tis,  gr.  iii,  capsulae  no.  24. 

Sig. — Capsule  t.i.d.p.c.,  gradually  increased  in 
dosage. 

Physiologic  Action  and  Uses. — Pulminary  seda- 
tive expectorant  and  antiseptic;  intestinal  anti- 
septic; tonic.  It  passes  the  stomach  unchanged,  and 
is  decomposed  in  the  intestines;  is  not  a gastric 
irritant. 

Toxic  Action. — Resembles  phenol  poisoning. 

Epicarin  Unguentum  (Epicarin;  oxynaphthyl- 
ortho-oxydoluic  acid  or  betanaphtholhydroxytoluic 
acid,  CeHsiOH)  (COOH)  (CH^CioHeOH)  2 : 3 : 1,  5 
to  20  per  cent,  ointment,  with  lanolin  or  petrolatum 
as  a base,  or  in  the  form  of  oily  or  alcoholic  solu- 
tions, 10  per  cent.). 

Uses. — Antiseptic  emollient. 

Epinephrina;  Adrenalin:  1,  2-dihydroxy-R- 

methyl-amino-ethyl-4'-o'-benzene,  a brenzcatechin 
derivative : 

H 

C 

HO— C^ (^HOHCHsNHCHa 

I I 

HO— C CH 


H 

Of  a 1 : 1000  solution  of  the  chloride  n]^x=gr.  Moo 
of  the  chloride). 

Dosage. — 18  months,  irsii;  3 years,  nijv;  5 years,  tiRV. 
Adult,  min.,  nev;  av.,  x;  max.,  xxx. 


ESSENTIA  PEPSINI 


Method  of  Administration. — Adrenalini 

chloridi,  1 : 1000, 

Sig. — Ten  to  thirty  drops  in  a teaspoonful  of 
water,  by  mouth,  every  one  to  four  hours  for  two 
or  three  doses. 

If  given  hypodermically,  it  should  be  administered 
in  one  pint  of  normal  saline  solution,  very  slowly. 

Physiologic  Action  and  Uses. — A specific  excitant 
of  sympathetic  nerve-endings;  strengthens  and 
accelerates  the  heart  beat  through  stimulation  of 
the  accelerans  and  direct  action  on  the  heart;  dilates 
the  pupil  through  stimulation  of  the  cervical  sym- 
pathetic; increases  the  salivary  secretion  through 
stimulation  of  the  sympathetic  nerves;  relaxes  the 
bronchial  musculature  through  stimulation  of  the 
pulmonary  sympathetics;  acts  upon  the  inhibitory 
sympathetic  fibres  of  the  stomach,  intestines,  and 
bladder;  stimulates  the  uterus;  stimulates  vaso- 
constrictor nerve-endings,  thereby  raising  the  blood- 
pressure;  does  not  affect  autonomic  or  parasympa- 
thetic nerves  (vagus,  chorda  tympani,  oculo-motor 
(autonymic  fibres), sacral  nerves  to  the  colon, bladder, 
rectum,  and  genital  organs).  It  is  synergistic  with 
cocaine. 

If  epinephrine  is  old  it  may  cause  vasodilatation 
and  fall  of  pressure  instead  of  vasoconstriction. 

Epsom  Salt;  Magnesii  Sulphas:  MgSo4-t-7H20; 
soluble  in  1 of  water. 

Dosage. — 6 months,  gr.  x-xv;  18  months,  gr.  xx; 
3 years,  gr.  xx-xxx;  5 years,  3ss-i.  Adult,  min., 
3ii;  av.,  iv;  max.,  5i- 

Method  of  Administration. — I^  Magnesii  sul- 
phatis,  3 XV  (gr.  Ixxv  per  teaspoonful);  aquae,  3u- 

M.  Sig. — Teaspoonful,  well  diluted  in  coffee,  every 
hour,  until  effectual. 

Physiologic  Action  and  Uses. — Sahne  cathartic, 
causing  purgation  by  osmosis  and  interference  with 
the  absorption  of  fluids  from  the  bowel;  acts  in  one 
to  twenty  hours. 

Ergotae  Extractum. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  x. 

Method  of  Administration. — I^  Extracti  ergotse, 
gr.  iv,  pilulse  no.  12. 

Sig. — A pill,  t.i.d. 

Physiologic  Action  and  Uses. — Uterine  stimulant 
(acting  peripherally) ; haemostatic  (stimulating  the 
vaso- constrictor  nerve  endings);  slows  the  pulse  by 
stimulating  the  vagus  centres. 

Toxic  Action. — Cardiac  depression,  slow  heart, 
high  followed  by  low  tension,  nausea,  vomiting, 
purging,  vertigo,  headache,  retention  of  urine  due 
to  contraction  of  the  vesical  sphincter;  fall  of  tem- 
perature, convulsions. 

Chronic  ergotism  presents  a convulsive  form  and 
a gangrenous  form. 

Ergotae  Fluidextractum. 

Dosage. — 6 months,  gtt.  ii-iii;  18  months,  gtt.  v; 
3 years,  gtt.  v-viii;  5 years,  gtt.  x-xv.  Adult,  min. 
3ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — I^  Fluidextracti  ergotae. 

Sig. — A teaspoonful  in  water,  by  mouth,  t^xx 
hypodermically. 

Physiology  Action  and  Uses. — Uterine  stimulant 
(acting  peripherally);  haemostatic  (stimulating  the 
vaso-constrictor  nerve  endings);  slows  the  pulse  by 
stimulating  the  vagus  centres. 

Toxic  Action. — Cardiac  depression,  slow  heart, 
high  followed  by  low  tension,  nausea,  vomiting, 
purging,  vertigo,  headache,  retention  of  urine  due 
to  contraction  of  the  vesical  sphincter,  fall  of  tem- 
perature, convulsions. 

Chronic  ergotism  presents  a convulsive  form  and 
a gangrenous  form. 

Ergotin. 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 


Method  of  Administration. — I^  Ergotinae,  gr.  i, 
pilulae  no.  12. 

Sig.^ — A pill,  t.i.d. 

Physiologic  Action  and  Uses. — Uterine  stimulant 
(acting  peripherally);  haemostatic  (stimulating  the 
vaso-constrictor  nerve  endings);  slows  the  pulse  by 
stimulating  the  vagus  centres. 

Toxic  Action. — Cardiac  depression,  slow  heart, 
high  followed  by  low  tension,  nausea,  vomiting, 
purging,  vertigo,  headache,  retention  of  urine  due 
to  contraction  of  the  vesical  sphincter,  fall  of  tem- 
perature, convulsions. 

Chronic  ergotism  presents  a convulsive  form  and 
a gangrenous  form. 

Ergotol  (Sharp  and  Dohme). 

Adult  Dosage. — Min.,  t^xv;  max.,  lx. 

Method  of  Administration. — I^  Ergotol  (Sharp 
and  Dohme),  Si. 

Sig. — TTjxv,  in  water,  three  to  six  times  daily. 

Forty  to  sixty  minims  may  be  injected  intramus- 
cularly and  the  injection  repeated,  if  nece.ssary. 

Erythrol  Tetranitras;  Tetranitrin:  C4H6(N03)4. 

Adult  Dosage. — Min.,  gr.  K2;  av.,  max.,  i. 

Method  of  Administration. — Erthyrol  tetra- 
nitratis,  gr.  }i2,  tabellaj  no.  100. 

Sig. — One  tablet  every  three  to  six  hours,  gradu- 
ally increased  to  gr.  or  imtil  the  occurrence 

of  flushing,  throbbing,  or  slight  transient  faintness, 
indicates  that  the  physiological  dose  has  been 
reached. 

Physiologic  Action  and  Uses. — Vaso-dilator,  acting 
directly  upon  the  vascular  muscle;  action  begins  in 
fifteen  minutes  and  persists  for  three  or  four  to 
six  hours. 

Eserinae  (Physostigminac;  alkaloid:  C16H21N3O2) 
Salicylas  (soluble  in  75  of  water). 

Adult  Dosage. — ^Min.,  gr.  Hoo',  av.,  J4o;  max.,  Ko. 

Method  of  Administration. — I^  Physostigmime 
salicylatis,  vel  sulphatis,  gr.  %o,  tabellae  no.  6. 

Sig. — One  tablet,  by  mouth,  or  hypodermically 
once  or  twice  a day. 

For  the  eye:  gr.  ii-iv  ad  5i  of  water  or  oil,  or 
from  0.1  to  1 per  cent. 

Physiologic  Action  and  Uses. — Physostigmine  or 
eserine  is  the  antagonist  of  atropine.  It  increases 
the  excitability  of  autonomic  or  parasympathetic 
nerve  endings;  causes  myosis  and  contraction  of 
the  ciliary  muscle  (spasm  of  accommodation),  with 
resulting  relaxation  of  the  capsule  of  the  lens, 
and  increased  sphericity  of  the  latter  and  diminu- 
tion of  intraocular  tension;  increases  the  secretion 
of  tears,  saliva,  sweat,  and  the  bronchial  secretions; 
contracts  the  bronchial,  gastro-intestinal,  and  vesical 
muscles;  increases  the  excitability  of  the  nerve  end- 
ings supplying  striped  or  voluntary  muscles;  also 
renders  more  excitable  the  motor  cortical  centres, 
tending  to  convulsions;  slows  the  heart,  deepens 
respirations;  depresses  the  vagus  and  the  action  of 
the  spinal  cord. 

Toxic  Action. — Muscular  weakness  and  tremor, 
loss  of  reflex  action,  nausea,  salivation,  vomiting, 
severe  intestinal  cohc,  purging,  sweating,  myosis, 
bradycardia,  dyspnoea,  motor  paralysis.  Eserine  in 
the  eye  may  produce  a feeling  of  great  tension  in  the 
, eye,  headache,  and  nausea. 

Eserinae  (Physo-stigminae)  Sulphas  (very  soluble 
in  water). 

Adult  Dosage. — Min.,  Kool  av.,  l^oimax..  Ho. 

Method  of  Administration. — See  above. 

Essentia  Pepsini  (Fairchild;  18.5  per  cent,  of 
alcohol). 

Dosage. — 6 months,  gtt.  xx;  18  months,  gtt. 
xxx-xl;  3 years,  gtt.  xl-3i;  5 years,  3i-  Adult,  av., 
3i+- 

Method  of  Administration. — I^Essentiae  pepsini,  5 iv. 


EUCALYPTI  FLUIDEXTRACTUM 


Sig. — Teaspoonful,  in  water,  t.i.d.p.c. 

Uses. — Proteolytic  and  milk-curdling. 

Ether:  (C2H6)20  (soluble  in  12  of  water). 

Adult  Dosage. — Min.,  ngx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — ^Etheris,  5ss. 

Sig. — Fifteen  to  thirty  drops  in  sweetened  water, 
every  hour,  or  as  required. 

Hypodermically,  for  heart-failure,  ngx-xx-lx. 

Ether  pneumonia  is  possibly  due  to  the  aspiration 
of  mucous  and  saliva,  the  secretion  of  which  is 
increased  by  ether.  This  may  be  les.sened  or  pre- 
vented by  a hypodermic  of  atropine  or  scopolamine 
just  before  the  achninistration  of  the  ether. 

Uses. — Cardiovascular  stimulant;  stimulant  of  the 
vaso-constrictor  and  respiratory  centres;  anodyne; 
carminative;  antispasmodie;  sedative;  general  anaes- 
thetic (contraindicated  in  bronchial  and  renal 
disease). 

Conditions  in  which  anaesthesia  is  dangerous  are 
cardiac  degeneration  or  dilatation,  renal  disease, 
pulmonary  disease,  asthma,  diabetes  mellitus,  arterio- 
sclerosis, chronic  alcoholism,  cerebral  tumor,  faint- 
ing spells,  enlarged  tonsils. 

Toxic  Action. — Undue  slowing  of  the  respiration 
and  rapid  heart  action. 

Treatment:  Lower  the  patient’s  head,  draw  the 
tongue  foi-ward,  but  not  too  far,  perform  artificial 
respiration,  apply  heat  to  the  trunk  and  limbs,  slap 
the  face  and  chest  with  a cold  wet  towel,  administer 
strychnine  and  atropine  hypodermically. 

Etheris  Spiritus  (ether  alcohol  yf). 

Adult  Dosage. — -Min.,  t^x;  av.,  5ij  max.,  ii. 

R Spiritus  aitheris,  gi. 

Sig. — Teaspoonful  in  a wineglass  of  sweetened 
water,  as  required ; or  every  one  to  three  hours. 

Uses. — Diffusible  stimulant;  anodyne;  carmina- 
tive ; aids  digestion  of  fats. 

Etheris  Spiritus  Compositus  (Hoffmann’s  Ano- 
d5me:  Ether,  32  alcohol  6.5,  etherial  oil  2)^). 

Dosage. — 6 months,  gtt.  ii;  18  months,  gtt.  iii-v; 
3 years,  gtt.  v;  5 years,  gtt.  v-x.  Adult,  min.,  gss; 
av.,  i;  max.,  ii. 

Method  of  Administration. — R Spiritus  setheris 
compositi,  gi. 

Sig.— -Teaspoonful  in  a w'ineglass  of  water,  as 
required,  or  every  one  to  three  hours. 

Uses. — -Anodyne,  carminative,  stimulant. 

Etheris  Spiritus  Nitrosi  (Sweet  Spirits  of  Nitre: 
Ethyl  nitrite,  C2H6NO2,  4 per  cent,  in  alcohol;  mis- 
cible with  alcohol  or  water;  should  not  be  kept  long, 
as  it  turns  acid). 

Dosage. — 6 months,  gtt.  ii-iii;  18  months,  gtt.  iii- 
v;  3 years,  gtt.  v;  5 years,  gtt.  v-x.  Adult,  min., 
5ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Spiritus  setheris 
nitrosi,  gi. 

Sig. — One  teaspoonful,  well  diluted  in  sweetened 
water,  every  one  to  three  hours. 

Uses. — Diaphoretic,  diuretic,  carminative. 

Ethylis  Carbamas;  Urethane:  NH2.CO.()(C2H6) 
(soluble  in  0.45  of  water  and  0.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — In  powder,  cachets,  or 
solution,  best  gr.  v,  frequently  repeated,  as  a full 
dose  may  cause  vomiting.  (Potter.) 

Uses. — Very  mild  hypnotic;  diuretic. 

Ethylis  Chloridum,  C2H6CI. 

Uses. — Transient  general  ana'sthetic;  local  ana?s- 
thetic  in  the  form  of  a spray,  producing  intense  cold. 

Ethylis  Hydrocupreinae  Hydrochloridum;  Opto- 
chin  (a  quinine  alkaloid)  Hydrochloride;  C19II22N2 
OH.O.C2H6.HCI. 

Adult  Dosage. — Av.,  gr.  viiss,  t.i.d. 

Method  of  Administration. — One  to  two  per  cent, 
aqueous  solution,  freshly  prepared,  or  1 to  2 per  cent. 


solution  in  oil  or  ointment;  specific  in  serpent  ulcer 
of  the  cornea  due  to  the  pneumococcus.  One  to 
two  per  cent,  solution  as  a gonococcocide. 

For  pneumonia,  0.024  gram  per  kilogram  of  body 
weight  every  twenty-four  hours  is  required  to  pro- 
duce a bactericidal  action  in  the  blood  serum.  Thus, 
for  the  average  sized  individual,  the  amoimt  for 
twenty-four  hours  is  1.5  grams,  administered  as 
follows:  initial  dose  0.45  gram,  followed  every  three 
hours  by  0.15  gram;  second  twenty-four  hours,  ten 
doses  of  0.15  gram;  best  given  in  capsule.  (Allan 
M.  Chesney.) 

Uses. — Antiseptic ; antipneiunococcic. 

Toxic  Acff(w.-— Tinnitus,  deafness,  amblyopia, 
amaurosis,  retinitis. 

Ethylis  lodidum,  C2H6I. 

Adult  Dosage. — Av.,  tijxv. 

Method  of  Administration. — On  lint,  inhaled 
in  asthma. 

Uses. — Antispasmodie;  general  stimulant;  anaes- 
thetic. 

Ethylmorphinae  Hydrochloridum;  Dionin  (solu- 
ble in  8 of  water;  22  of  alcohol). 

Dosage. — 6 months,  gr.  Koo;  18  months,  gr.  Kooi 

3 years,  gr.  Koi  5 years,  gr.  )4o.  Adult,  min.,  gr. 
av.,  Vi,  max.,  ]{. 

Method  of  Administration. — R jEthyhnorphinae 
hydrochloridi,  gr.  ]4,  tabellae  no.  6. 

Sig. — Tablet  two  or  three  times  a day,  as  required. 

As  a local  ophthalmic  analgesic  and  lymphagogue, 
a 4 to  10  per  cent,  aqueous  solution,  one  drop  3 or 

4 times  a day;  or  1.5  to  10  per  cent,  ointment. 
Chemosis,  redness,  and  burning  should  continue  for 
from  one  to  two  minutes  after  its  appheation,  in 
order  to  secure  the  desired  therapeutic  effect. 

Physiologic  Action  and  Uses. — Nervous  sedative 
and  analgesic;  action  upon  the  respiratory  and  cough 
centres  the  same  as  that  of  codeine;  ophthalmic 
analgesic  and  lymphagogue,  causing  local  hyperaemia 
and  acute  conjunctival  oedema. 

Eucaince  (p)  Hydrochloridum;  Beta-eucainae 
Hydrochloridum : Trimethylbenzoyl-oxypiperidine 

(soluble  in  30  of  water,  35  of  alcohol). 


COO.C 


p/CHs 

NH 


CH2  CH.CHa 

Adult  Dosage. — Min.,  gr.  %;  max.  i. 

Method  of  Administration. — For  the  eye,  2 to  3 
per  cent,  solutions. 

For  the  nose  and  throat,  5 to  10  per  cent,  solutions. 

For  hypodermic  use,  0.2  per  cent.  It  may  be 
sterilized  by  boiling. 

Physiologic  Action  and  Uses.- — Loeal  ana'sthetic: 
action  like  that  of  cocaine,  but  less  toxic. 

Eucalypti  Fluidextractum. 

Adidt  Dosage. — Min.,  thix;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — R Fluide.xtracti  eu- 
calypti, Si. 

Sig. — Thirty  drops  in  water,  every'  two  to  four 
hours. 

Uses. — Naso-pharyngeal,  gastro-intestinal,  bron- 
chopulmonary’, and  genito-urinary  stimulant  and 
antiseptic;  diaphoretic. 

Toxic  Action.- — Indigestion,  nausea,  vomiting, 
diarrha'a,  lowered  temperature,  muscular  weakness, 
narcosis. 


EXTRACTUM  C'OLOCYNTHIDIS  COMPOSITUM 


Eucalypti  Oleum. 

Adult  DoKfKje. — Min.,  irpv;  av.,  viii;  max.,  xx. 

Method  of  Administration. — (^lei  eucalypti, 
T^fx,  capsuUe  no.  12. 

Sig. — Capsule  every  two  to  four  hours. 

For  local  use,  5 per  cent,  in  liquid  petrolatum. 

Uses. — Naso-pharyngeal,  gastro-intestinal,  bron- 
chopulmonary, and  genito-urinary  stimulant  and 
antiseptic;  diaphoretic. 

Toxic  Action. — Indigestion,  nausea,  vomiting, 
diarrhcea,  lowered  temperature,  muscular  weakness, 
narcosis. 

Eucalyptol;  Cineol:  CioHuO  (an  organic  oxide 

obtained  from  oil  of  eucalyptus). 

Adult  Dosage. — Min.,  T^iii;  av.,  v;  max.,  x. 

Method  of  Administration. — Eucalyptol,  rtijv, 
capsulaj  no.  12. 

Sig. — Capsule  every  two  to  four  hours.  It  may 
be  dispensed  in  emulsion  or  in  dilute  alcohol. 

For  local  use,  5 per  cent,  in  liquid  petrolatum. 

Uses. — ^Naso-pharyngeal,  gastro-intestinal,  bron- 
chopulmonary, and  genito-urinary  stimulant  and 
antiseptic;  diaphoretic. 

Toxic  Action. — Indigestion,  nausea,  vomiting, 
diarrhcea,  lowered  temperature,  muscular  weakness, 
narcosis. 

Eumydrin;  Methylatropinse  Nitras:  CeHsfHO. 

CIl2).CH.C02.C7lIiiN(CH3)oN03. 

Adult  Dosage. — Min.,  gr.  '^o;  max.,  1^. 

Method  of  Administration. — As  a mydriatic,  gr.  v 
ad  5i)  one  to  two  drops  in  the  eye. 

Uses. — Mydriatic;  anhidrotic;  used  for  the  same 
purposes  as  atropine;  much  less  toxic  than  atropine. 

Euonymi  Extractum. 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Extracti  euonymi, 
gr.  ii,  pilula;  no.  3. 

Sig. — One  pill  at  bedtime. 

Uses. — Cholagogue  cathartic;  diuretic.  “The 
uncertain  absorption  of  this  drug  makes  its  use 
inadvisable.”  (Epitome  of  the  U.  S.  P.  and  N.  F.) 

Toxic  Action. — Toxic  digitalis  effects. 

Euonymi  Fluidextractum. 

Adidt  Dosage. — Min.,  irgv;  av.,  viii;  max.,  xv. 

Method  of  Administration. — I^  Fluidextracti  euo- 
nymi, 5i- 

Sig. — Eight  drops  in  water  at  bedtime.  (See 
above.) 

Euphthalminae  Hydrochloridum;  Phenylglycolyl- 
Methyl-Vinyl  Diacetonalkamine  Ilydrochloricle : 
C5ll6N(CH2)4  (CeHs.CHOH.COOf.HCl. 

Method  of  Administration. — Two  or  three  drops  of 
a 5 to  10  per  cent,  solution  in  the  eye. 

Uses. — -Transient  mydriatic. 

Euporphina. 

Adult  Dosage. — Min.,  gr.  Hoi  max.,  X2. 

Method  of  Administration. — R Euporphinae,  gr. 
Ko,  pulveres  no.  20. 

Sig. — One  powder  every  two  hours  (up  to  gr.  % to 
Ya  a day). 

Uses. — Stimidating  expectorant;  emetic. 

Euquinina;  Quinina}  Aithylcarbonas : C2H5O.CO. 
O.C20H23N2O  (sparingly  .soluble  in  water,  soluble  in 
alcohol  and  ether). 

Dosage. — G months,  gr.  ii-iii;  18  months,  gr.  iii-iv; 
3 years,  gr.  iii-v;  .5  years,  gr.  v.  Achdt,  gr.  v;  max., 

XXX. 

Method  of  Administration. — I^  Euciuinina>,  gr. 
v-x,  pulveres,  tabella',  vel  capsula>  no.  G. 

Sig. — One,  once  or  twice  a day. 

Physiologic  Action  ami  Uses. — Antimalarial;  taste- 
le.ss  in  substance,  but  bitter  in  solution. 

Europhen;  Di-Isobutyl-Cresol-Iodide:  Cells 

(C4H2).(CH3)(0I).CeH2(CH3)(:0)(.C4H9). 

Adult  Dosage. — Min.,  gr.  iii;  max.,  v. 


Method  of  Administration. — In  pill  form.  As  an 
ointment,  with  lanolin,  10  per  cent. 

Uses. — Antiseptic  powder;  substitute  for  iodoform. 

Exalgin;  Methylis  Acetanelidum  (sparingly  sol- 
uble in  water;  readily  soluble  in  dilute  alcohol). 

Adidt  Dosage. — Min.,  gr.  i;  av.,  iii;  max.,  vi. 

Method  of  Administration. — I^  Methylis  acetane- 
lidi,  gr.  iii,  pcdveres  no.  4. 

Sig. — A powder  in  wine,  twice  daily,  as  required. 
No  more  than  gr.  xii  per  diem. 

Uses. — Analgesic;  nervous  sedative. 

Extractum  Agarici  Alcoholicum. 

Adult  Dosage. — Av.,  gr.  iii. 

Method  of  Administration.' — 1^  Extracti  alco- 
holici  agarici  albi,  gr.  iii. 

Mitte  talis  pulveres  sive  pilula;  no.  6. 

Sig. — One  at  bedtime. 

Physiologic  Action  ami  Uses. — Anhidrotic,  para- 
lyzing the  secretory  nerve  endings  like  atropine. 

Toxic  Action. — Vomiting  and  purging. 

Extractum  Aloes. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  viiss. 

Method  of  Administration. — I^  E.xtracti  aloes, 
pilula',  gr.  iii,  no.  24. 

Sig. — A pill  at  bedtime. 

Physiologic  Action  and  Uses. — Purgative;  acts  in 
eight  to  ten  hours,  chiefly  on  the  lower  bowel,  pro- 
ducing pelvic  congestion;  emmenagogue. 

Extractum  Belladonnae  Foliorum  (gr.  corre- 
sponds apiJroxLmately  to  gr.  }ioo  of  mydriatic  alka- 
loids). 

Adult  Dosage. — Min.,  gr.  ho,'  av.,  H;  max.,  %. 

Method  of  Administration. — I^  Extracti  bella- 
donna?,  gr.  pilula;  no.  12. 

Sig. — One  pill  t.i.d.  See  Atropina. 

Uses. — Local  anodyne,  etc.  See  Atropina. 

Toxic  Action. — Dryness  of  the  mouth,  throat,  and 
skin,  a red  flush  on  the  face  and  neck  (in  the  “blush- 
ing area”),  dilatation  of  the  pupils,  rapid  pulse, 
nausea,  husky  phonation,  difficulty  in  swallowing, 
mental  excitement,  tremor,  and  marked  motor  activ- 
ity, perhaps  convulsions;  acceleration  followed  by 
slowing  of  the  respiration,  low  blood-pressure, 
eventual  slowing  of  the  heart,  stupor,  coma. 

Extractum  Cannabis  Indicae  (Biologically  assayed) 

Adult  Dosage. — Min.,  gr.  'A;  av.,  A;  max.,  ii. 

Method  of  Administration. — I^  Extracti  canna- 
bis indicae  (biologically  assayed),  gr. pilula*  no.  15. 

Sig. — One  pill,  repeated  every  half  to  one  hour, 
until  effectual 

Uses. — Analgesic;  hypnotic;  aphrodi.siac. 

Toxic  Action. — Sensation  of  enormous  dimensions, 
dilatation  of  the  pupils,  ana'.sthesia,  diminished 
reflexes,  somnolence,  catalepsy,  coma,  cardiac 
failure. 

Extractum  Cascarae  Sagradae. 

Dosage. — 18  months,  gr.  ss;  3 years,  gr.  i-ii;  5 
years,  gr.  iii-v.  Adult,  min.,  gr.  v;  av.,  viii;  max.,  x. 

Method  of  Administration. — I^  Extracti  cascara* 
sagrada;,  gr.  v,  pilula;  no.  24. 

Sig. — A pill  twice  daily,  or  two  pills  at  bedtime. 

Physiologic  Action  ami  Uses. — Laxative;  acts 
chiefly  on  the  lower  bowel.  The  dose  can  be  gradu- 
ally reduced  without  secondary  constipation 
following. 

Extractum  Colocyntliidis. 

Adult  Dosage. — Min.,  gr.  av.,  Hi  max.,  i. 

Method  of  Administration. — Extracti  colo- 

cynthidis,  gr.  pulveres  no.  G. 

Sig. — (3ne  powder  at  bedtime. 

Uses. — Hydragogue  cathartic. 

T oxic  Action. — Gastro-enteritis. 

Extractum  Colocynthidis  Compositum  (ext.  colo- 
cynth.  IG,  aloes  50,  cardamom  6,  resin  of  scammony 
14,  soap  14,  alcohol  10). 


EXTRACTUM  RHAMNI  PURSHLVNiE 


Adidt  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xx. 

Method  of  Administration. — Extracti  colocyn- 
thiclis  compositi,  gr.  v,  pilula5  no.  6. 

Sig. — One  or  two  pills  at  bedtime. 

Uses. — Hydragogue  cathartic. 

Toxic  A ction. — Gastro-enteritis. 

Extractum  Ergotae. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  x. 

Method  of  Administration. — Extracti  ergotaj, 
gr.  iv,  pilul®  no.  12. 

Sig. — A pill  t.i.d. 

Physiologic  Action  and  Uses. — Uterine  stimulant, 
acting  peripherally;  hiemostatic  (stimulating  the 
vaso-constrictor  nerve  endings);  slows  the  pulse  by 
stimulating  the  vagus  centres. 

Toxic  Action. — Cardiac  depression,  slow  heart, 
high  followed  by  low  tension,  nausea,  vomiting, 
purging,  vertigo,  headache,  retention  of  urine  due 
to  contraction  of  the  vesical  sphiucter,  fall  of  tem- 
perature, convulsions. 

Chronic  ergotism  presents  a convulsive  form  and 
a gangrenous  form. 

Extractum  Euonymi. 

Adult  Dosage.- — -Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — Eirtracti  euonymi, 
gr.  ii,  pilulm  no.  3. 

Sig. — One  pill  at  bedtime. 

Physiologic  Action  and  Uses. — Cholagogue  cathar- 
tic; diuretic.  “The  uncertain  absorption  of  this  drug 
makes  its  use  inadvisable”  (Epitome  of  the  U.  S.  P. 
and  N.  F.). 

Toxic  Action. — ^Toxic  digitalis  effects. 

Extractum  Fellis  Bovis  (Oxgall  Extract). 

Adult  Dosage. — Av.,  gr.  iss. 

Method  of  Administration. — R Extracti  fellis 
bovis,  gr.  iss,  pilulse  vel  capsulae  (hardened  with 
formalin),  no.  12. 

Sig. — One  pill,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Cholagogue;  laxa- 
tive; intestinal  antiseptic;  aids  in  the  absorption 
of  fats. 

Extractum  Qentianae. 

Dosage. — 3 years,  gr.  5 years,  gr.  ss-i. 

Adult,  min.,  gr.  i;  av.,  iv;  max.,  x. 

Method  of  Administration. — R Extracti  gen- 
tianae,  gr.  iv,  piluise  no.  30. 

Sig. — Pill,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Stomachic;  bitter 
tonic;  contains  tannin  in  small  amount. 

Extractum  Hamamelidis  Destillatum;  Aqua 
Ilamamelidis. 

Adult  Dosage. — -Min.,  3ij  av.,  ii;  max.,  iii. 

Uses. — -Astringent;  haemostatic. 

Toxic  Action. — Throbbing  pain  in  the  head. 

Extractum  Hydrastis. 

Adult  Dosage. — Av.,  gr.  viii. 

_ Method  of  Administration. — Extracti  hydras- 
tis.  gr.  viii,  capsulae  no.  24. 

Sig. — Capsule,  three  or  four  times  daily. 

Physiologic  Action  and  Uses. — Uterine  stimulant; 
haemostatic;  stomachic;  exerts  a peripheral  exciting 
action  upon  the  uterus,  and  upon  the  blood-vessels, 
and  also  stimulates  the  vasomotor  centres. 

Toxic  Action. — ^Indigestion,  comstipation,  tetanic 
convulsions,  motor  depression,  medullarjq  spinal, 
and  cardiac  depression. 

Extractum  Hyoscyami. 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  viii. 

Method  of  Administration. — Extracti  hyo- 
scyami, gr.  i-ii,  pilulse  no.  12. 

Sig. — Pill  t.i.d. 

Uses. — Cerebral  sedative;  anodyne;  hypnotic; 
mydriatic. 

Toxic  Action. — Central  respiratory  depression,  fall 
of  blood-pressure,  dryness  in  the  mouth  and  throat. 


inydriasis  and  paralysis  of  accommodation,  hypno- 
sis, delirium,  collapse. 

Extractum  Kramerise  (Rhatany). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — Extracti  kra- 
merise,  gr.  viii,  pilula;  no.  12. 

Sig. — Pill  every  three  or  four  hours. 

Uses. — Intestinal  astringent. 

Extractum  Malti  (chiefly  diastase,  maltose,  and 
extractives). 

Dosage. — 6 months,  3i-u;  18  months,  5ii-iv; 
3 years,  5iv;  5 years,  5i-  Adult,  min.,  3i;  av.,  iv; 
max.,  3i. 

Method  of  Administration. — R Extracti  malti, 
5iv. 

Sig. — Tablespoonful,  t.i.d.p.c. 

Uses. — Starch  digestant  and  nutrient. 

Extractum  Nucis  Vomicse. 

Adult  Dosage. — Min.,  gr.  ]i;  av.,  max., 

Method  of  Administration. — R Extracti  nucis 
vomicae,  gr.  pilulae  no.  30. 

Sig. — Pill,  t.i.d.  Maximum  in  24  hours,  gr.  ii. 

Uses. — Bitter  stomachic  and  tonic;  general  stim- 
ulant. 

Extractum  Opii  (20  per  cent,  morphine). 

Adult  Dosage. — Min.,  gr.  av.,  3^;  max.,  ii. 

Method  of  Administration. — R Extracti  opii, 
gr.  ss,  pilulae  no.  6. 

Sig.-A!)ne  pill  (morphine  gr.  ]{o)  every  three  to 
four  hours. 

Uses. — Nervous  sedative  and  analgesic.  See 
Morphine. 

Extractum  Parathyroideae. 

Adult  Dosage. — ^Av.,  gr.  ]i. 

Method  of  Administration. — R Extracti  para- 
thyroideae, gr.  ]i,  pulveres  no.  21. 

Sig. — Powder  t.i.d. 

Uses. — Alterative. 

Toxic  Action. — Muscular  tremor. 

Extractum  Physostigmatis  (about  2 per  cent, 
of  alkaloids). 

Adult  Dosage. — Min.,  gr.  Ksi  av.,  H;  max.,  }4- 

Method  of  Administration. — R Extracti  physo- 
stigmatis, gr.  }i,  pilulae  no.  6. 

Sig. — A pill  once  or  twice  daily.  “Gr.  i-iv  are 
used  in  tetanus”  (Potter). 

Physiologic  Action  and  Uses. — Physostigmine  or 
eserine  is  the  antagonist  of  atropine.  It  increases 
the  excitability  of  autonomic  or  parasympathetic 
nerve  endings;  causes  myosis  and  contraction  of 
the  ciliary  muscle  (spasm  of  accommodation)  vith 
resulting  relaxation  of  the  capsule  of  the  lens  and 
increased  sphericity  of  the  latter  and  diminution  of 
intraocular  tension;  increases  the  secretion  of  tears, 
saliva,  sweat,  and  the  bronchial  secretion;  contracts 
the  bronchial,  gastro-intestinal  and  vesical  muscles: 
increases  the  excitability  of  the  nerve  endings  sup- 
plying striped  or  voluntary  muscles;  also  renders 
more  excitable  the  motor  cortical  centres,  tending 
to  convulsions;  slows  the  heart;  deepens  respirations; 
depresses  the  vagus  and  the  action  of  the  spinal  cord. 

Toxic  Action. — Muscular  weakness  and  tremor, 
loss  of  reflex  action,  nausea,  salivation,  vomiting, 
severe  intestinal  colic,  purging,  sweating,  myosis, 
bradycardia,  dyspnoea,  motor  paralysis. 

Eserine  in  the  eye  may'  produce  a feeling  of  great 
tension  in  the  eye,  headache,  and  nausea. 

Extractum  Pini  Canadensis  (Hemlock  Spruce). 

Extractum  Rhamni  Purshianae  (Extractum  Cas- 
cara;  Sagrada;). 

Dosage. — 18  months,  gr.  ss;  3 years,  gr-  i~ii;  5 
years,  gr.  iii-v.  Adult,  min.,  gr.  v;  av.,  viii;  max.,  x. 

Method  of  Administration. — R Extracti  cascarae 
sagradae,  gr.  v,  pilula;  no.  24. 

Sig. — A pill  twice  daily,  or  two  pills  at  bedtime. 


FERRI  LACTAS 


Physiologic  Action  and  Uses. — Laxative;  acts 
chiefly  on  the  lower  bowel;  the  dose  can  be  gradually 
reduced  without  secondary  constipation  following. 

Extractum  Rhei  (1  gram  represents  2 grams  of 
rhubarb). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  x. 

Physiologic  Action  and  Uses. — Cathartic;  bitter 
stomachic  tonic;  somewhat  astringent  in  its  after- 
effects; acts  chiefly  on  the  lower  bowel. 

Extractum  Viburni  Prunifolii. 

Adult  Dosage. — Av.,  gr.  viii. 

Uses. — Uterine  sedative. 

Fellis  Bovis  Extractum  (Oxgall  Extract). 

Adult  Dosage. — Av.,  gr.  iss. 

Method  of  Administration. — Ex-tracti  fellis 
bovis,  gr.  iss,  pilulae  vel  capsulte  (hardened  with 
formaline),  no.  12. 

Sig. — One  pill,  t.i.d.p.c. 

Uses. — Cholagogue;  laxative;  intestinal  antisep- 
tic; aids  in  the  absorption  of  fats. 

Fennel  Oil;  Oleum  Foeniculi  (nearly  insoluble  in 
water;  soluble  in  alcohol). 

Adult  Dosage. — Min.,  i^ii;  av.,  iii;  max.,  v. 

Uses. — Carminative . 

Fennel  Water;  Aqua  Foeniculi  (oil  2,  distilled 
w’ater  1000). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  5i- 

U ses.  — Carminative. 

Ferratin;  Sodii  Ferrialbuminas. 

Adult  Dosage. — Av.,  gr.  viiss. 

Method  of  Administration. — kSodii  ferrialbu- 
minatis,  gr.  viiss,  tabellae  vel  capsulae,  no.  60. 

Sig. — Tablet,  three  or  four  times  daily,  p.c. 

The  powder  may  be  flavored  with  chocolate 
and  saccharin. 

Uses. — Hsematic. 

Toxic  Action. — Indigestion,  nausea,  vomiting, 
constipation,  sense  of  tension  or  fulness  in  the  head. 
Iron  is  contraindicated  in  plethora,  hemorrhage, 
and  fever. 

Ferri  Albuminas. 

Dosage. — 6 months,  gr.  xx;  18  months,  gr.  xxx; 
3 years,  5ss;  5 years,  pi.  Adult,  min.,  5i;  max.,  ii. 

Method  of  Administration. — I^  Ferri  albumina- 
tis,  5ii  (3i  per  dose);  acidi  hydrochlorici  diluti,  3i 
(iTjiv  per  dose);  aquae,  q.s.  ad,  Sviii. 

M.  Sig. — One  tablespoonful,  t.i.d.p.c. 

U ses. — Hsematic. 

Ferri  et  Aloes  Pilulae. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 

Method  of  Administration. — I^  Pilulae  aloes  et 
ferri,  no.  24. 

Sig. — One  pill,  t.i.d.p.c. 

Uses. — Purgative;  haematic;  emmenagogue. 

Ferri  et  Ammonii  Acetatis  Liquor;  Mistura 
Bashami  (Tr.  ferric  chi.  4,  dil.  acetic  ac.  6,  sol.  of 
ammon.  acetate  50,  aromatic  ehxir  12,  glycerine  12, 
water  to  100). 

Dosage. — -3  years,  pss;  5 years,  5i-  Adult,  min., 
3ii;  av.,  iv;  max.,  §i. 

Method  of  Administration. — I^  Mistura;  Bashami 
recentis  praeparati,  5 iv. 

Sig. — One  or  two  tablespoonfuls  in  a tumbler  of 
water,  every  three  to  four  hours. 

Uses. — Diuretic;  diaphoretic;  haematic. 

Ferri  et  Ammonii  Citras  (very  soluble  in  water; 
insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  x. 

Method  of  Administration. — I^  Ferri  et  ammonii 
citratis,  3ii  9ii  (gr.  v per  dose);  syrupi  limonis,  5iv; 
vini  xerici,  q.s.  ad,  3 viii. 

M.  Sig. — Two  drams,  three  or  four  times  a day, 

P- 

For  hypodermic  injection  into  the  skin  of  the 
back  or  thighs,  1 c.c.  of  a 10  per  cent,  aqueous  neutral 


solution,  sterilized,  one  daily,  or  every  other  day, 
using  a platinum  hypodermic  needle.  (Forchheimer.j 

Uses. — Hffimatinic;  practically  non-astringent. 

Ferri  Carbonas  Saccharatus  (FeCOs,  preserved 
with  sugar). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xxx. 

Method  of  Administration. — I^  Ferri  carbonatis 
saccharati,  gr.  v,  pulveres,  in  charta  cerata,  no.  60. 

Sig. — A powder,  three  or  four  times  daily,  p.c. 
The  dose  may  be  gradually  increased  to  gr.  xxx. 

Uses. — Hiematinic. 

Ferri  Carbonatis  Pilulae  (Blaudii). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  ii;  5 years,  gr.  ii.  Adult,  min.,  gr.  v; 
max.,  vii. 

Method  of  Administration. — I^  Pilulae  ferri  car- 
bonatis (Blaudii),  pulveris,  recentis  praeparati,  gr.  v. 

Dispense  in  gelatine  capsules  hardened  with  for- 
malin (Sahli’s  glutoid  capsules,  grade  ii  of  hardness), 
capsulae  no.  50. 

Sig. — One  pill  t.i.d.p.c.,  increased  by  one  pill  each 
week  until  four  or  five  pills  are  taken  t.i.d. 

Uses.— Haematinic. 

Ferri  Chloridi  Liquor  (Feds,  about  10.5  per  cent, 
in  water). 

Adult  Dosage. — Min.,  nji;  av.,  iss;  max.,  iii;  well 
diluted. 

Uses. — Local  astringent. 

Ferri  Chloridi  Tinctura  (FeCL). 

Dosage. — 6 months,  gt.  i;  18  months,  gtt.  iii;  3 
years,  gtt.  v;  5 years,  gtt.  x-xv.  Adult,  min.,  rgjx; 
max.,  xxx. 

Method  of  Administration. — I^  Tincturac  ferri 
chloridi,  5i;  glycerini,  5 i;  syrupi  aurantii  vel  limonis, 
q.s.  ad,  §iv. 

M.  Sig. — One  or  two  drams  in  water,  t.i.d.p.c., 
sucked  through  a glass  tube,  followed  by  rinsing 
and  brushing  of  the  teeth. 

Uses. — Astringent;  haematic.  As  a throat  appli- 
cation: tr.  ferri  chloridi,  glycerine,  and  water, 

equal  parts. 

Ferri  Citratis  Vinum,  see  Ferri  et  Ammonii 
Citras,  above. 

Ferri  Hydroxidum,  Fe(OH)3  (sol.  ferric  sulphate 
36  per  cent.  100,  ammonia  water  138,  water  to 
300  C.C.). 

Adult  Dosage. — Min.,  3i;niax.,  3iv. 

Method  of  Administration. — Prepare  fresh,  and 
give  one  teaspoonful  in  water  frequently. 

Uses. — Arsenic  antidote. 

Ferri  Hydroxidum  cum  Magnesii  Oxido. 

Method  of  Administration. — Made  by  mixing,  when 
needed,  the  following  two  preparations. 

1.  Ferric  sulphate  solution  (36  per  cent.),  40  c.c. 
in  water,  125  c.c. 

2.  Magnesium  o.xide,  10  grams,  rubbed  up  with 
water,  750  c.c.  in  a bottle  of  1000  c.c.  capacity. 

Give  5iv,  frequently  repeated. 

Uses. — Arsenic  antidote  (the  best). 

Ferri  lodidi  Pilulse  (FeL). 

Adult  Dosage. — 1 to  2 pills. 

Method  of  Administration. — I^  Pilula;  ferri  iodidi, 
no.  60. 

Sig. — Two  pills,  t.i.d.p.c. 

Uses. — Haematic. 

Ferri  lodidi  Syrupus  (EeU). 

Dosage. — 6 “months,  gtt.  iii;  18  months,  gtt.  vi; 
3 years,  gtt.  x;  5 years,  gtt.  xx-xxx.  Adult,  min., 
3ss;  max.,  i. 

Method  of  Administration. — I^  Syrupi  ferri  iodidi, 
5ii. 

Sig. — Half  a dram,  in  half  a glass  of  water, 
t.i.d.p.c.,  fucked  through  a glass  tube. 

Uses. — Haematic;  alterative. 

Ferri  Lactas  (soluble  in  40  of  water;  freely  soluble 


FERRUM  ALBUMINATUM 


in  solutions  of  alkali  citrates;  almost  insoluhlc  in 
alcohol) ; re(C3lI;, 03)2+31120. 

Adult  Dosage. — gr.  i;  av.,  v;  max.,  x. 

MeUmd  of  Adyninislration. — Ferri  lactatis, 
oi  3i  (gr.  V per  dose) ; ))otassii  citratis,  oi  3i;  syrupi 
limonis,  3iii;  aqua>,  (ps.  ad,  Sviii. 

M.  Sig. — ^Tablespoonful,  t.i.d.p.c. 

Uses. — Haematic. 

Ferri  Laxans  Mistura. 

Method  of  Administration. — R Ferri  sulphatis, 
gr.  ii ; magne.su  sulphatis,  5i;  acidi  sulphurici  diluti, 
TTjiii;  spiritus  chloroformi,  trgxx;  aquae  menthse 
piperitae,  q.s.  ad,  5i. 

M.  Sig. — One  ounce,  t.i.d. 

Ferri  Malas,  see  Ferri  Pomatum,  Extractum. 

Uses. — ■Hmmatic. 

Ferri  Oxidum  Saccharatum  (Eisenzucker). 

Adult  Dosage. — Av.,  gr.  iii. 

Method  of  Administration. — Ferri  oxidi  sac- 
charati,  gr.  iii,  tabellae  no.  30. 

Sig. — Tablet,  t.i.d.p.c.,  crushed  with  the  teeth 
before  swallowing. 

Uses. — Hajmatic. 

Ferri  Peptonas. 

Adult  Dosage. — Min.,  gr.  v;  max.,  ,x. 

Method  of  Administration. — R Ferri  peptonatis, 
gr.  v-x,  capsulm  no.  60. 

Sig. — Capsule  t.i.d.p.c. 

Uses. — Ha'matic. 

Ferri  Peptonati  Liquor,  N.  F. 

Adult  Dosage. — Av.,  3u- 

Method  of  Administration. — R Liquoris  ferri 
peptonati  N.  F.,  gviii. 

Sig. — Two  teaspoonfuls,  t.i.d.p.c. 

Uses. — Hmmatic. 

Ferri  Peptonati  et  Mangani  Liquor,  N.  F. 

Adult  Dosage. — Av.,  3ii. 

Method  of  Administration. — R.  Liquoris  ferri 
peptonati  et  mangani,  N.  F.,  Sviii. 

Sig. — ^Tw'o  teaspoonfuls,  t.i.d.p.c. 

Uses. — -Haematic. 

Ferri  Perchloridi  Tinctura  (FeCls). 

Dosage. — 6 months,  gt.  i;  18  months,  gtt.  iii;  3 
years,  gtt.  v;  5 years,  gt,t.  x-.xv.  Adult,  min.,  tjix; 
max.,  XXX. 

Method  of  Administration. — R Tincturae  ferri 
chloridi,  3 i ; glycerini,  3 i ; syrupi  aurantii  vcl  limonis, 
q.s.  ad,  3iv. 

M.  Sig. — One  or  two  dramS;  in  water,  t.i.d.p.c., 
sucked  tlirough  a glass  tube,  followed  by  rinsing 
and  brushing  of  the  teeth. 

Uses. — -Astringent;  haematinic.  As  a throat  appli- 
cation, tr.  ferri  chloricb,  glycerine,  and  waiter, 
equal  parts. 

Ferri  Phosphas  Solubilis. 

Adult  Dosage.- — -Min.,  gr.  i;  av.,  iv;  max.,  vi. 

Method  of  Administration. — R Ferri  phosphatis 
solubilis,  oii,  gr.  viii  (gr.  iv  ad  3i);  syrupi  aurantii, 
3ii;  aquae,  q.s.  ad,  3iv. 

M.  Sig. — One  dram,  t.i.d.p.c. 

Uses. — -Hauna  tic. 

Ferri  Pomata  Tinctura,  N.  F. 

Adidt  Dosage. — Av.,  3i. 

Method  of  Administration. — R Tincturaj  ferri 
pomatie,  N.  F.,  3iv. 

Sig. — <)ne  teaspoonful,  t.i.d.p.c. 

Uses. — Hiematic. 

Ferri  Pomatum  Fxtractiim,  N.  F. 

Adidt  Dosage. — Av.,  gr.  x. 

Method  of  Administration. — R ExTracti  ferri 
pomati,  gr.  x,  piluhe  vel  capsukc  no.  60. 

Sig.— One,  t.i.d.ji.c. 

Uses.- — -Ha'matic. 

Ferri  et  Potassii  Tartras  (very  soluble  in  water; 
insoluble  in  alcohol). 


Adult  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  x. 

Method  of  Administration. — R Ferri  et  potassii 
tartratis,  3ii  3ii  (gr-  v per  dose);  syrupi  limonis, 
3iv;  villi  xerici,  q.s.  ad,  3 viii. 

M.  Sig. — Two  drams,  three  or  four  times  a day,p.c. 

U ses. — Haimatic. 

Ferri  Pyrophosplias  Solubilis. 

Dosage. — 3 years,  gr.  i-ii;  5 years,  gr.  ii-iii.  Adult, 
av.,  gr.  V. 

Method  of  Administration. — R Ferri  pyrophos- 
phatis  solubilis,  3ii,  9ii  (gr.  v per  dose),  syrupi 
limonis,  3ii;  aquae,  q.s.  ad,  5iv. 

M.  Sig. — One  dram  t.i.d.p.c. 

Uses. — Ha'matic. 

Ferri,  Oriininae  et  StrychnincC  Phosphatum,  Elixir. 

Dosage. — Adult,  min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Elixiris  ferri,  qui- 
ninae,  et  strychninai  phosphati,  3iv. 

Sig. — Teaspoonful,  in  half  a timibler  of  water, 
t.i.d.p.c. 

Uses. — Tonic,  ha'matic. 

Ferri,  Quininae  et  Strychinin®  Phosphatum, 
Syrupus. 

Dosage. — Adult,  min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Syrujii  ferri,  qui- 
nina',  et  strychninae  phosphati,  3iv. 

Sig. — Teaspoonful  in  half  a tumbler  of  water, 
t.i.d.p.c. 

Uses. — Tonic;  haematic. 

Ferri  Sesquichloridi  Liquor  (FeCls,  about  10.5 
per  cent,  in  water). 

Adult  Dosage. — Min.,  irgi;  av.,  iss;  max.,  iii;  well 
diluted. 

Uses. — Local  astringent. 

Ferri  Subsulphatis  Liquor  (Monsel’s  Solution). 

Adult  Dosage. — Min.,  iiji;  av.,  iii;  max.,  v;  well 
diluted. 

Uses. — Local  styptic  and  astringent. 

Ferri  Sulphas:  FeS04+7Il20  (soluble  in  1.4  of 
water;  insoluble  in  alcohol). 

Ad-idt  Dosage. — Min.,  gr.  i;  av.,  iii;  max.,  v. 

Method  of  Administration. — R Ferri  sulphatis, 
3ii,  Bii  (gr.  v per  dram);  glycerini,  3i;  aquae, 
q.s.  ad  piv. 

M.  Sig. — One  dram,  t.i.d.p.c. 

Uses. — Haematic. 

Ferri  Sulphas  Exsiccatus. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  ii;  max.,  iii. 

Method  of  Administration.- — R Ferri  sulphatis 
exsiccati,  gr.  ii,  pilulae  no.  30. 

Sig. — Pill,  t.i.d.p.c. 

Uses. — Haematic. 

Ferri  Vinum  Amarum;  Bitter  Wine  of  Iron  (solu- 
ble iron  and  quinine  citrate  5,  tr.  am-antii  dulcis  6, 
sjTup  30,  w'hite  wine  to  100). 

Dosage. — 6 months,  3ss;  18  months,  3ss;  3 years, 
3i;  5 years,  3i-  Adult,  min.,  3i;  av.j  ii;  max.,  iv. 

Method  of  Administration. — R Vmi  ferri  amari, 
5 viii. 

Sig. — ^Tw'O  drams,  t.i.d.p.c. 

Uses. — Hiematic. 

Ferri  Vinum  Citratis  (iron  and  ammoniiun  citrate 
4 per  cent.,  in  tr.  sweet  orange  peel,  sjunp,  and  white 
wine). 

Dosage. — 6 months,  3ss;  18  months,  3ss;  3 yeai"s, 
3i;  .6  yearn,  3i-  Adult,  min.,  3i;  av.j  ii;  ma.x.,  iv.  _ 

Method  of  Admini.drntion. — R \’mi  ferri,  3''’iii- 

Sig. — Two  drams,  t.i.d.p.c. 

f/sfis. — Ihematic. 

Ferri  Vitellinum  Syntheticum;  Ovoferrin. 

Adidt  Dosage. — Min.,  3ii;  max.,  iv. 

Method  of  Administration. — R Ovoferrin,  Svih. 

Sig. — Tablespoonful  in  water,  t.i.d.p.c. 

Uses. — Ha'inatinic. 

Ferrum  Albuminatum  (Ferri  Albuminas). 


FLUIDEXTRACTUM  GRINDELIvE 


Dosage. — 6 months,  gr.  xx;  18  months,  gr.  xxx; 
3 years,  oss;  5 years,  5i-  Adult,  min.,  5i;  max.,  ii. 

Method  of  Administration. — ^ Ferri  albuminatis, 
gii;  acidi  hydrochloric!  diluti,  5i;  aqua;,  q.s.  ad, 
gviii. 

M.  Sig. — One  tablespoonful,  t.i.d.p.c. 

Uses. — Ila^matic. 

Ferrum  Peptonatum  (Ferri  Peptonas). 

Adult  Dosage. — Min.,  gr.  v;  max.,  x. 

Method  of  Administration. — Ferri  peptonatis, 
gr.  v-x,  capsulae  no.  60. 

Sig. — -Capsule  t.i.d.p.c. 

Uses. — -Ha;matic. 

Ferrum  Reductum,  Fe  (Metallic  iron  in  fine 
powder). 

Dosage. — 6 months,  gr.  18  months,  gr.  3^;  3 
years,  gr.  5 years,  gr.  i.  Adult,  min.,  gr.  i;  av., 
ii;  max.,  vi. 

Method  of  Administration. — R Ferri  reducti,  gr. 
ii,  pulveres,  capsulae,  vel  pilulae,  no.  60. 

Sig. — One,  t.i.d.a.c.,  gradually  increased  to  three, 
t.i.d. 

Physiologic  Action  and  Uses. — Iron  is  essential  to 
metabolism  and  growth.  It  stimulates  the  ha;ma- 
topoietic  organs  and  increases  the  production  of 
haemoglobin.  The  inorganic  preparations  are  more 
efficient  than  the  organic,  because  of  the  difficulty 
with  which  the  latter  are  decomposed.  To  demon- 
strate the  presence  of  available  or  ionizable  iron, 
add  haematoxylin,  when  a dark  violet  color  will  re- 
sult.— Macallum 

Fibrolysin;  Liquor  Thiosinaminae  Sodio-Salicylatis 
(15  per  cent,  or  gr.  2)4  per  c.c.):  (NH2.CS.NHCH2. 
CH  :CH2)C6H4(0H)  (COONa). 

Adult  Dosage. — Av.,  2.3  cc. 

Method  of  Administration. — Subcutaneously,  in- 
tramuscularly, or  intravenously,  every  one,  two,  or 
three  days.  The  dose  may  gradually  be  increased 
to  gr.  xl  of  fibrolysin. 

Physiologic  Action  and  Uses. — To  promote  the  ab- 
sorption of  scar  tissue ; contraindicated  in  tuberculosis. 

Toxic  Action. — Digestive  disturbance,  lassitude, 
fever. 

Filix=Mas  (Oleoresina  Aspidii). 

Dosage. — 3 years,  gr.  x-xv;  5 years,  gr.  xx-xxx. 
Adult,  min.,  gr.  xv;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — R Oleoresina?  aspi- 
dii, 3i. 

Shake  well  and  div.  in  caps.  8. 

Sig. — Four  capsules  (uncapped),  with  half  a glass 
of  hot  water,  at  9 A.M.,and  four  capsules  (uncapped), 
with  hot  water  at  10  A.M.,  preceded  by  a thorough 
emptying  of  the  bowels,  and  followed,  at  12  M.,  by 
a non-oily  purge,  as  described  under  Tapeworm, 
Part.  1. 

Uses. — Anthelmintic;  tenicide. 

Toxic  Action. — Vomiting,  purging,  acute  abdomi- 
nal pain;  great  weakness,  spasms  in  the  extremities; 
sometimes  convrdsions,  stupor,  coma,  collapse,  some- 
times deafness  and  blindness,  temporary  or  perma- 
nent (due  to  optic  atrophy),  jaundice,  rarely  tetany. 

Flaxseed  (Linseed)  Tea;  Infusum  Lini. 

Method  of  Administration. — Linseed,  3hi;  licorice- 
root,  3i;  boiling  water,  gx. 

Infused  for  four  hours  and  strained.  Dose  in- 
definite. 

Uses. — Demulcent;  expectorant;  diuretic. 

Fluidextractum  Adonis  Vernalis. — See  Adonis 
Vemalis,  Fluidextractum. 

Fluidextractum  Apocyni. — See  Apocyni,  Fluidex- 
tractum. 

Fluidextractum  Belladonnae  Radicis. — See  Bella- 
donna? Kadicis,  Fluidextractum. 

Fluidextractum  Buchu. — See  Buchu,  Fluidex- 
tractum. 


Fluidextractum  Calumbae. — See  Calumba?,  Fluid- 
extractum. 

Fluidextractum  Cannabis  Indicae. — See  Cannabis 
Indica?,  Fluidextractum. 

Fluidextractum  Cascarse  Sagradae. — See  Cascara? 
Sagrada?,  Fluidextractum. 

Fluidextractum  Cascarae  Sagradae  Aromaticum. — 
See  Cascara?  Sagrada?, Fluidextractum  Aromaticum. 

Fluidextractum  Chiratce. — See  Chirata?,  Fluid- 
extractum. 

Fluidextractum  Cimicifugae. — See  Cimicifuga?, 
Fluidextractum. 

Fluidextractum  Cinchonas.  — See  Cinchona', 
Fluide  Atractum . 

Fluidextractum  Colchici  Seminis. — See  Colchici 
Seminis,  Fluidextractum. 

Fluidextractum  Condurango. — See  Condurango, 
Fluidextractum. 

Fluidextractum  Conii. — See  Conii^  Fluidextractum. 

Fluidextractum  Convallariae. — Sec  Convallaria-, 
Fluidextractum . 

Fluidextractum  Coto  Bark. — See  Coto  Bark  Fluid- 
extractum. 

Fluidextractum  Digitalis. — See  Digitalis  Fluid- 
extractum. 

Fluidextractum  Eriodictyi  (Yerba  Santa). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xw;  max.,  xxx. 

Uses.- — Expectorant;  combined  with  glycyrrhiza 
to  disguise  the  taste  of  quinine. 

Fluidextractum  Ergotae. — See  Ergota?  Fluidex- 
tractum. 

Fluidextractum  Eucalypti. — See  Eucalyjjti  Fluid- 
extractum. 

Fluidextractum  Euonymi. — See  Euonymi,  Fluid- 
extractum. 

Fluidextractum  Qelsemii. 

Adult  Dosage. — Min.,  njss;  av.,  i;  max.,  iii. 

Method  of  Administration. — B Fluidextracti  gel- 
semii,  3i- 

Sig. — One  or  two  drops  in  water,  every  four  hours, 
very  gradually  increased  up  to  five,  ten,  or  fifteen 
drops,  never  more  than  twenty  drops.  Discontinue 
if  double  vision  occurs. — Sachs. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
antineuralgic  (contramdicated  if  the  heart  is  weak). 

Fluidextractum  Gentianse. 

Adult  Dosage. — Min.,  t^ix;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti  gen- 
tiana?,  Ji. 

Sig. — Fifteen  drops  in  water,  t.i.d.a.c. 

Uses. — Simple  bitter  stomachic. 

Fluidextractum  Qlycyrrhizse. 

Adult  Dosage. — Min.,  itjx;  av.,  xxx;  max.,  3h 

Uses. — Flavor;  demulcent;  expectorant. 

Fluidextractum  Qossypii  Corticis  (Cotton  Root 
Bark). 

Adult  Dosage. — Av.,  i^xxx. 

Method  of  Administration. — R Fluidextracti  gos- 
sypii  corticis,  N.F.,  Bii- 

water,  t.i.d. 

Uses. — Supposed  emmenagogue  and  oxytocic. 

Fluidextractum  Granati. 

Adult  Dosage. — Min.,  n^x;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — R Fluidextracti  gra- 
nati^5ss. 

Sig. — 3ss-i  in  water,  preceded  and  followed  in  a 
few  hours  by  a brisk  cathartic. 

Uses. — Anthelmintic. 

Fluidextractum  Grindeliae. 

Adidt  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  be. 

Method  of  Administration. — R Fluidextracti  grin- 
delia',  gii. 

Sig.--^ne-half  to  one  teaspoonful,  stirred  in 
sweetened  water  or  milk,  every  three  or  four  hours. 


FLUIDEXTRACTUM  SENEG.E 


Used  locally  for  ivy  poisoning  in  the  strength  of 
1 :9  of  water. 

Uses. — Broncho-pulmonary  sedative;  diuretic. 

Fluidextractum  Quaranae  (contains  caffeine  and 
theobromine). 

Adult  Dosage. — Min.,  t^jxv;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti 
guaran®,  5i. 

Sig. — Twenty  to  thirty  minims  in  water,  every 
two  to  three  hours,  as  required. 

Uses. — Antineuralgic  (used  in  migraine). 

Fluidextractum  Hamamelidis  Foliorum  (Witch 
Hazel). 

Adult  Dosage. — Min.,  t^jxv;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti 
hamamelidis  foliorum,  5 i- 

Sig. — Thirty  to  sixty  drops  in  water,  five  times  a 
day. 

Uses. — Astrmgent;  hsemostatic. 

Toxic  Action. — Throbbing  pain  in  the  head. 

Fluidextractum  Hoang-Nan. 

Adult  Dosage. — Min.,  iTgv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti 

hoang-nan. 

Sig. — Five  to  thirty  drops  in  water,  t.i.d. 

Uses. — ^LTsed  in  leprosy,  q.v.,  Part  1. 

Fluidextractum  Humuli  (Hops). 

Adult  Dosage. — Min.,  ngv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti  hu- 
muli, Sii. 

Sig. — Fifteen  to  thirty  drops  in  water,  t.i.d. 

Uses. — Bitter  stomachic;  feeble  hypnotic. 

Fluidextractum  Hydrastis. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti  hy- 
drastis,  §i. 

Sig. — Thirty  drops,  well  diluted  in  water  or  milk, 
two,  three,  or  four  times  a day. 

In  menorrhagia,  it  may  be  given  for  one  week 
before,  and  also  during  the  flow. 

For  systemic  hemorrhage  it  may  be  given  every 
hour  for  four  or  five  doses. 

Physiologic  Action  and  Uses. — Systemic  haemo- 
static; stomachic;  uterine  stimulant  and  vaso-con- 
strictor;  exerts  a peripheral  stimulating  action  on 
the  uterus;  cau.ses  vaso-constriction  and  rise  of 
blood-pressure  by  stimulation  of  the  vasomotor 
centres  and  peripheral  action  on  the  blood-vessels. 

Fluidextractum  Ipecacuanhae. 

Dosage. — As  an  expectorant,  rjss-i-ii,  every  two 
to  four  hours,  in  water.  As  an  emetic,  tijx— xx-xxx, 
in  water. 

Physiologic  Action  and  Uses. — Stimulating  expec- 
torant; emetic  (acts  reflexly);  diaphoretic;  stimu- 
lates the  stomach  and  liver. 

Fluidextractum  Jaborandi  (Pilocarpi). 

Adult  Dosage. — Min.,  ttjx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — I^  Fluidextracti  pilo- 
carpi, 5ss. 

Sig. — TTjxxx  in  water,  at  night.  (Contraindicated 
if  the  heart  is  weak). 

Physiologic  Action  and  Uses. — ^Diaphoretic;  siala- 
gogue;  promotes  the  absorption  of  inflammatory 
exudate. 

Fluidextractum  Krameriae  (contains  tannin). 

Adtdt  Dosage. — Min.,  irjv;  av.,  xv;  max.,  xx. 

M ethod  of  Administration.- — R I'luidextracti  kra- 
meriae,  5i. 

Sig. — Fifteen  to  twenty  drops  in  water,  three  or 
four  times  daily. 

Uses. — Astringent  (contains  tannin). 

Fluidextractum  Lobeliae  (Indian  Tobacco). 

Adult  Dosage. — Min.,  npi;  av.,  iiss;  max.,  xv.  (?). 

Physiologic  Action  and  U.ses.— Sedative  expector- 
ant; diaphoretic;  diuretic;  nervous  sedative;  relieves 


bronchial  spasm  by  depressing  the  vagus  nerve 
terminals  in  the  lungs;  stimulates  the  respiratory 
centre.  A dangerous  drug,  resembling  nicotine. 

Toxic  Action. — Vomiting,  collapse. 

Fluidextractum  Pareirse. 

Adult  Dosage. — Min.,  t^x;  av.,  xxx;  max.,  3i- 

Method  of  Administration.—^  Fluidextracti  pa- 
reira*,  §ii. 

Sig. — Half  to  one  teaspoonful  in  plenty  of  water, 
three  or  four  times  a day. 

Uses. — Bitter  tonic;  diuretic;  laxative. 

Fluidextractum  Pilocarpi. 

Adult  Dosage. — Min.,  npx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti  pilo- 
carpi, gss. 

Sig. — i^xxx  in  water,  at  night.  (Contraindicated 
if  the  heart  is  weak.) 

Physiologic  Action  and  Uses. — Diaphoretic;  siala- 
gogue;  promotes  the  absorption  of  inflammatory 
exudate. 

Fluidextractum  Pruni  Virginianse. 

Adult  Dosage. — Min.,  t^xx;  av.,  xxx;  max.,  xl. 

Uses. — Bronchial  sedative;  flavor  and  vehicle. 

Toxic  Action. — Cardiac  depression. 

Fluidextractum  Quassias. 

Adult  Dosage. — Min.,  t^jv;  av.,  x;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti 

quassias,  §i. 

Sig. — Ten  drops  in  water,  t.i.d.  a.c. 

Physiologic  Action  and  Uses. — Simple  bitter  sto- 
machic; contains  no  tannin;  may  therefore  be 
prescribed  with  iron. 

Fluidextractum  Rhamni  Purshianae. — See  Cascarae 
Sagradae,  Fluidextractum. 

Fluidextractum  Rhamni  Purshianae  Aromaticum. — 
See  Cascarae  Sagradae,  Fluidextractum  Aromaticum. 

Fluidextractum  Rhei. 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti 

rhei,  5i- 

Sig. — Fifteen  to  thirty  drops,  in  water,  at  bedtime. 

Physiologic  Action  and  Uses. — Stomachic;  laxa- 
tive, acting  chiefly  on  the  lower  bowel. 

Fluidextractum  Rhois  Aromaticae  (Sweet  Sumach). 

Dosage. — 18  months,  ttev;  3 years,  t^x;  5 years,  ngx. 

Adult,  min.,  ngx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti  rhois 
aromaticae,  §i.  * 

Sig. — Fifteen  drops  in  sweetened  water,  three  or 
four  times  daily  (for  children  over  six  j'ears  of  age). 

Physiologic  Action  and  Uses. — ^Urinary  astringent; 
recommended  for  enuresis. 

Fluidextractum  Sabali  (Saw  Palmetto). 

Adult  Dosage. — Min.,  ttbxv;  max.,  lx. 

Method  of  Administration. — R Fluidextracti 

sabali. 

Sig. — Fifteen  to  sixty  drops  in  water,  three  or  four 
times  a day. 

Uses. — Diuretic. 

Fluidextractum  Salviae  (Sage). 

Adult  Dosage. — Min.,  nj^xv;  max.,  be. 

Method  of  Administration. — R Fluidextracti  sal- 
viae,  gi. 

Sig. — Fifteen  to  sixty  drops  in  water,  t.i.d. 

Uses. — Anhidrotic. 

Fluidextractum  Senecionis,  N.F. 

Adult  Dosage. — Min.,  gss;  max.,  i. 

Method  of  Administration. — R Fluidextracti  se- 
necionis, gi. 

Sig. — Dne-half  to  one  dram  in  water,  t.i.d. 

Uses. — Ha?mostatic. 

Fluidextractum  Senegae  (contains  saponin). 

Adult  Dosage. — Min.,  irijv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R FluidexTracti 
senega.',  gii- 


GALBANUM 


Sig. — Five  to  ten  drops  in  water,  every  two  to 
three  hours. 

Uses. — Stimulating  expectorant;  diuretic;  dia- 
phoretic. 

Fluidextractum  Sennae. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  5i- 

Method  of  Administration. — Fluidextracti 
seimae,  5i- 

Sig. — Thirty  drops  in  water,  at  bedtime. 

Physiologic  Action  and  Uses. — Cathartic;  acts  in 
five  to  eight  hours,  chiefly  on  the  lower  bowel. 

Fluidextractum  Spigeliae. 

Dosage. — 3 years,  t^x-xx;  5 years,  npxxx.  Adult, 
min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — B Fluidextracti  spi- 
gelia;;  fluidextracti  sennae,  aa,  gss. 

M.  Sig. — One  teaspoonful  in  water,  for  a child; 
two  teaspoonfuls  for  an  adult,  every  two  hours,  for 
three  doses. 

Uses. — Anthelmintic  for  ascarides. 

Toxic  Action. — Vertigo,  amblyopia,  mydriasis, 
convulsions. 

Fluidextractum  Sumbul. 

Adult  Dosage. — Min.,  irjx;  av.,  xxx;  max.,  pi- 

Method  of  Administration. — B Fluidextracti  sum- 
bul, 3i. 

Sig. — Thirty  drops,  in  water,  t.i.d. 

Uses. — Antispasmodic;  nerve  tonic. 

Fluidextractum  Thujae. 

Adult  Dosage. — Av.,  i^xxx. 

Method  of  Administration. — Fluidextracti 
thujae.  Si- 

Sig. — tiEv,  in  water,  t.i.d.,  for  the  removal  of  warts, 
together  with  local  application. 

Fluidextractum  Tritici  (Couch  Grass). 

Adult  Dosage. — Min.,  3i;  av.,  iiss;  max..  Si- 

Method  of  Administration. — Fluidextracti  tri- 
tici, Siv. 

Sig. — Two  or  three  teaspoonfuls,  with  plenty  of 
water,  every  three  or  four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Fluidextractum  Uvae  Ursi. 

Adult  Dosage. — Min.,  t^x;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — Fluidextracti 
uvae  ursi.  Si- 

Sig. — Half  a teaspoonful,  with  plenty  of  water, 
three  or  four  times  a day. 

Physiologic  Action  arid  Uses. — Slightly  antiseptic 
diuretic;  contains  the  glucoside,  arbutin,  which  is 
split  up  in  the  kidney  into  sugar  and  the  antiseptic 
hydrochinone. 

Fluidextractum  Valerianae. 

Adult  Dosage. — Min.,  ngx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti  Va- 
lerianae, Si- 

Sig. — Thirty  drops  in  water  every  two  to  four  hours. 

Uses. — Antispasmodic;  central  nervous  depressant. 

Fluidextractum  Veratri. 

Adult  Dosage. — Min.,  Ttji;  av.,  iss;  max.,  iv. 

Method  of  Administration. — Fluidextracti  ver- 
atri, 3i- 

Sig. — One  or  two  drops  in  water,  as  required. 

Physiologic  Action  and  Uses. — Cardiac  and  nervous 
sedative  in  fevers;  increases  excitability  of  voluntary 
muscle  with  the  occurrence  of  contracture  or  slow 
relaxation  following  stimulation;  exerts  same  action 
on  heart- muscle,  causing  slowing;  may  also  stimulate 
vagus  centre;  antipyretic  by  action  on  heat-regu- 
lating centre;  lowers  blood-pressure. 

Fluidextractum  Viburni  Prunifolii. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti  vi- 
burni prunifolii,  Si- 

Sig. — Thirty  drops  in  water,  three  or  four  times 
a day. 


Uses. — ^Uterine  sedative. 

Fluidextractum  Zeae  (Corn  Silk). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Fluidextracti 
zeaj,  Sii- 

Sig. — One-half  to  one  teaspoonful,  with  plenty  of 
water,  every  three  or  four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Fluidextractum  Zingiberis  (Ginger). 

Adult  Dosage. — Min.,  njx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Fluidextracti  zin- 
giberis, Sss. 

Sig. — Fifteen  drops  in  hot  water  every  two  hours. 

Uses. — Carminative;  stimulant;  flavor. 

Foeniculi  Aqua;  Fennel  Water  (oil  2,  distilled 
water  1000). 

Adult  Dosage. — Min.,  3i,‘  av.,  iv;  max.,  Si- 

U ses . — Car  mina  tive . 

Foeniculi  Oleum;  Fennel  Oil  (nearly  insoluble  in 
water;  soluble  in  alcohol). 

Adult  Dosage. — Min.,  nEii;  av.,  iii;  max.,  v. 

Uses. — Carminative. 

Formaldehydi  Liquor;  Formalin  (HCHO  about 
40  per  cent,  in  methyl  alcohol  and  water). 

Method  of  Using. — To  disinfect  rooms,  unfold 
and  suspend  heavy  clothing,  etc.,  make  the  room 
air-tight,  and  use  20-32  ounces  of  formalin, 
poured  upon  8 to  10  ounces  of  potassium  permanga- 
nate in  a large  wash-bowl  on  the  floor,  for  every 
1000  cubic  feet  of  air  space.  No  fire  should  be  in  the 
room,  as  the  gas  is  slightly  inflammable.  The  tem- 
perature of  the  room,  however,  shoidd  not  be  below 
60°  F.,  or  the  relative  humidity  below  65  per  cent. 
Keep  the  room  sealed  for  twelve  to  twenty-four 
hours. 

As  a local  anhidrotic:  1 to  10  per  cent,  solution  in 
alcohol. 

Physiologic  Action  and  Uses. — Astringent;  disin- 
fectant; local  anhidrotic.  Ten  parts  of  glycerine 
may  be  added  to  formalin  to  prevent  polymerization. 

Toxic  Action. — Nausea,  vomiting,  quick  respira- 
tion, narcosis,  coma. 

Formalin,  see  above. 

Formalin!  Trochisci  (gr.  }Q,  made  with  “glyco- 
gelatine”  or  “fruit  paste.” 

Uses. — Throat  antiseptic. 

Formin.  See  Hexamethylenamina. 

Fowler’s  Solution;  Liquor  Potassii  Arsenitis. 

Dosage.— 6 months,  ss;  18  months,  gt.  i;  3 

years,  gtt.  ii;  5 years,  gtt.  ii-v.  Adult,  min.,  nEii; 
av.,  iii;  max.,  vi-|-. 

Method  of  Administration.- — B Liquoris  potassii 
arsenitis,  Sss. 

Sig. — Two  to  three  drops,  well  diluted  in  water, 
t.i.d.p.c.,  gradually  increased  by  one  drop  every  one, 
two,  or  three  days,  up  to  ten  to  fifteen,  or  even 
25  drops,  t.i.d.,  even  to  a child  of  six  years.  Should 
toxic  symptoms  occur,  stop  the  drug  for  three  or 
four  days,  and  begin  again  with  smaller  doses.  The 
maximum  dose  may  be  taken  for  weeks  or  months, 
in  the  absence  of  toxic  symptoms. 

Physiologic  Action  and  Uses. — Alterative;  tonic; 
stomachic;  inhibits  oxidation  and  stimulates  ana- 
bolism; stimulates  the  hscmatopoietic  organs. 

Toxic  Action. — See  under  Arseni  Trioxidum. 

Fuller’s  Lotion. 

Method  of  Preparation. — Sodii  carbonatis, 
3vi;  tincturae  opii.  Si;  glycerini,  Sii;  aquae,  Six- 

M.  Sig. — Apply  warm. 

Uses. — Local  analgesic. 

Furunculin  (Yeast  Powder). 

Uses. — Anti-furuncular. 

Qalbanum. 

Adult  Dosage. — Min.,  gr.  x;  max.,  xx. 

Method  of  Administration. — B Galbani,  3ii  9ii 


GENTIAN.E  TINCTURA  COMPOSITA 


({jr.  X per  dose);  mucilaginLs  acaci®.  5ii;  aqu®,  q.s. 
ad,  5iv. 

Miscc  et  fiat  emulsum. 

Sig. — Dessertspoonful  every  two  to  four  hours. 
(It  may  be  prescribed  in  pill  form.) 

Uses. — Stimulant;  expectorant;  antispasmodic. 

Qallae  et  Opii,  IJnguentum. 

Method  of  Preparation. — I^  Pulveris  gall®,  5iss; 
pulveris  opii,  gr.  xlviii;  petrolati  mollis,  gi. 

Uses. — Astringent;  anodyne. 

Gall®  Unguentum  (Nutgall,  20  per  cent.). 

Uses. — A.stringent. 

Gallicum  Acidum  (soluble  in  87  of  water,  4.6  of 
alcohol,  or  10  of  glycerine). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — R Acidi  gallici,  gr.  xv. 

Mitte  tabs  pulveres,  capsular,  sive  tabeU®,  no  12. 

Sig. — One,  three  or  four  times  daily. 

Uses. — Astringent ; hamostatic. 

Gambir  Pulvis  (Catechu). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Pidveris  catechu, 
gr.  XX,  pulveres  no.  12. 

Sig. — One  powder,  three  or  four  times  daily. 

Uses. — Intestinal  astringent  (containing  tannic 
acid). 

Gambir  Tinctura  Composita  (Gambir  5,  cinnamon 
2]/2,  diluted  alcohol  to  100). 

Adult  Dosage. — Min.,  5ss;  av.,  i;  max.,  iii. 

Method  of  Administration. — R Tinctur®  catechu 
composit®  3u. 

Sig. — Teaspoonful,  three  or  four  times  daily. 

As  a gargle,  gss  ad  aquam  Oi. 

Uses. — Astringent  (containing  tannic  acid). 

Gambir  Trochisci  (nearly  gr.  i of  gambir). 

Uses. — Astringent  (containing  tannic  acid). 

Garlic  Infusion;  Infusum  Alii  (two  or  three  bulbs, 
chopped  up,  and  boiled  in  one  quart  of  water  or 
milk,  and  strained). 

Method  of  Administration. — Inject  one-third  high 
into  the  colon  on  successive  days. 

Uses. — Anthelmintic. 

Garlic  Syrup;  Syrupus  Alii  (Garlic  20  per  cent.,  in 
sweetened  dilute  acetic  acid;  active  principle  allyl 
sulphide,  (C3H5)2S. 

Dosage. — 5 years,  5i-  Adult,  min.,  5i;  max.,  3iv. 

Method  of  Administration. — R Sjrupi  alii,  5ii. 

Sig. — One  to  four  teaspoonfuls,  according  to 
age,  t.i.d. 

Uses. — Irritant  expectorant;  anthelmintic;  ner- 
vous sedative. 

Toxic  Action. — Gastric  irritation,  flatulence,  hem- 
orrhoids, headache  and  fever. 

Gaultlieri®  Oleum;  Oil  of  Wintergreen  (Methylis 
Salicylas). 

Dosage. — 6 months,  gt.  i;  18  months,  gtt.  ii-iii; 
3 years,  gtt.  iii;  5 years,  gtt.  iii-v.  Adult,  min.,  ngv; 
av.,  xw;  max.,  xxx. 

Method  of  Administration. — I^  Olei  gaultheri®,  5i- 

Sig. — Twelve  to  twenty  drops,  well  diluted,  in 
sweetened  water  or  milk,  every  two  to  four  hours. 

It  may  be  prescribed  in  formalin  hardened  capsules. 

For  external  airiilication  and  absorjjtion:  either 

pure,  or  diluted  with  lanolin  (10  per  cent,  img.), 
or  an  oil. 

Physiologic  Action  and  Uses.- — ,\ntirlieumatic; 
antipyretic;  local  anodyne;  flavor;  very  irritating 
to  the  stomach;  readily  absorbed  through  the  skin. 

Geintinum  (Merck’s  Sterilized). 

Method  of  Administration. — Two  ounces  of  a 
10  per  cent,  flavored  solution  or  jelly,  by  mouth,  t.i.d. 

Hypodermically,  2 ]>er  cent.,  in  normal  saline 
solution,  200  to  250  c.c.,  or  per  rectum,  every  day  or 
every  other  day. 

The  following  is  a method  of  preparing  and  steril- 


izing gelatine:  “Take  5 gm.  of  common  salt,  one 
litre  of  distilled  water,  100  gm.  of  gelatine.  Bring 
the  water  to  80°  C.,  and  slowly  stir  in  the  gelatine 
until  it  is  all  in  solution.  Remove  the  solution  from 
the  stove,  cool  it  to  40°  C.,  and  add  to  it  the  white 
of  an  egg.  Stir  for  several  minutes,  and  then  put 
the  flask  on  the  stove  and  boil  the  fluid.  The  white 
of  egg  coagulates  and  clears  the  fluid.  Filter  through 
gauze  and  then  through  paper.  Place  the  fluid  in 
test-tubes,  each  of  which  will  contain  10  c.c.,  and 
insert  a cotton  plug  in  the  mouth  of  each  tube. 
Sterilize  by  putting  the  tubes  in  a steam  sterilizer 
fifteen  minutes  on  two  successive  days.  When  you 
wish  to  use  a tube,  place  it  in  a cup  of  hot  water 
until  the  gelatine  liquefies.  Pour  the  gelatine  in  a 
sterilized  glass,  and  draw  it  up  into  a sterilized 
syringe.  When  kept  several  weeks,  the  tubes  dry 
out.”  Sailer’s  modification  of  Carnot’s  solution. 
(Da  Costa.) 

Physiologic  Action  and  Uses. — Nutrient;  h®mo- 
static;  increases  the  coagulability  of  the  blood. 

Gelsemii  Fluidextractum. 

Adult  Dosage. — Min.,  nsss;  av.,  i;  max.,  iii. 

Method  of  Administration. — R Fluidextracti  gel- 
semii, oi- 

Sig. — One  or  two  drops  in  water  every  four  hours, 
very  gradually  increased  up  to  5,  10,  or  15  drops, 
never  more  than  20  drops.  Discontinue  if  double 
vision  occurs.  (Sachs.) 

Physiologic  Action  and  Uses. — Nervous  sedative; 
antineuralgic  (contraindicated  if  the  heart  is  weak). 

Toxic  Action. — Vertigo,  diplopia,  heaviness  and 
drooping  of  the  eyelids,  dilated  pupils,  muscular 
wealmess,  slow,  feeble  heart,  slow  respiration, 
sweating,  anaesthesia,  dropped  jaw. 

Gelsemii  Tinctura. 

Adult  Dosage. — Min.,  trgiv;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Tinctur®  gel- 
semii, 5ss. 

Sig. — Four  drops  in  water  every  three  to  four 
hours.  Starr  gives,  for  neuralgia,  ten  drops  every 
three  hours,  increased  by  one  drop  at  each  dose 
until  the  patient  perceives  a “heaviness  of  the  upper 
eyelids  and  a difficulty  in  opening  the  eyes.”  Tins 
dose,  he  says,  may  be  continued  for  several  days. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
antineuralgic  (contraindicated  if  the  heart  is  weak.) 

Gentian®  Extractum. 

Dosage. — 3 years,  gr.  5 years,  gr.  ss-i. 

Adult,  min.,  gr.  i;  av.,  iv;  max.,  x. 

Method  of  Administration. — R Extracti  gen- 
tian®, gr.  iv,  jiilul®  no.  30. 

Sig. — Pill,  t.i.d. p.c. 

Uses. — Stomachic;  bitter  tonic;  contains  tannin 
in  small  amount. 

Gentian®  Fluidextractum. 

Adult  Dosage. — Min.,  ngx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti  gen- 
tian®, oi- 

Sig. — Fifteen  drops  in  water,  t.i.d.a.c. 

Uses. — Simple  bitter  stomachic. 

Gentian®  Infusum  compositum  (gentian  10, 
bitter  orange  peel  2J^,  coriander  2J4,  alcohol  40, 
water  to  320). 

Adult  Dosage.- — Min.,  5ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Infusi  gentian® 
compositi,  oviii. 

Sig. — One  or  two  tablespoonfuls,  t.i.d.a.c. 

Uses. — Simple  stomachic  bitter;  contains  tannin 
in  small  amount. 

Gentian®  Tinctura  Composita  (gentian  10,  bitter 
orange  peel  4,  cardamom  1,  alcohol  and  water 
to  100). 

Adult  Dosage. — Min.,  5ss;  av.,  i;  max.,  ii. 


GLYCERITUM  ACIDI  CARBOLICI 


Method  of  Administration. — Tincturae  gen- 
tianae  compositi,  oiv. 

Sig. — Teaspoonful,  t.i.d.a.c. 

Uses. — Simple  stomachic  bitter;  contains  tannin 
in  small  amount. 

Glandulae  Mammae  Dessicatae  (Dessicated  Mam- 
mary Gland). 

Adult  Dosage. — Min.,  gr.  ii;  max.,  vi. 

Method  of  Administration. — Glandulaj  mam- 
maj  dessicatae,  gr.  ii,  tabellae  no.  30. 

Sig.— One  to  three  tablets,  t.i.d. 

Uses. — Uterine  haemostatic. 

Glandulae  Ovariae  Dessicatae;  Ovarin. 

Adult  Dosage. — Min.,  gr.  iii;  max.,  v. 

Method  of  Administration. — Glandulae  ovariae 
siccae,  gr.  v,  tabellae  no.  60. 

Sig. — Tablet,  three  or  four  times  a day. 

Uses. — Used  in  the  menopause,  or  ovarian  insuf- 
ficiency. 

Glandulae  Pituitariae  Dessicatae  (Anterior  Lobe). 

Adult  Dosage. — 'Min.,  gr.  i;  max.,  iv. 

Method  of  Administration. — Hypophysis  des- 
sicatae  (anterior  lobe),  gr.  i-iv,  pulveres  vel  tabellae 
no.  30. 

Sig. — One,  t.i.d. 

Physiologic  Action  and  Uses. — The  anterior  lobe 
of  the  hypophysis  cerebri  or  pituitary  body  is 
related  to  the  general  growth  of  the  body,  and  especi- 
ally of  the  skeleton.  It  may  possibly  be  of  service 
in  infantilism,  obesity  associated  with  impotence, 
and  the  later  stages  of  acromegaly. 

Glandulae  Pituitariae  Dessicatae  (Posterior  Lobe); 
Hypophysis  Sicca. 

Adult  Dosage. — 'Min.,  gr.  ss;  max.,  iii. 

Method  of  Administration. — Hypophysis  siccae, 
gr.  ss,  capsulae  no.  60. 

Sig. — Capsule  four  times  daily.  Eight  to  ten 
grains  per  diem  may  probably  be  given  by  mouth. 
Oral  administration,  however,  is  said  to  be  ineffec- 
tive. 

Physiologic  Action  and  Uses. — Uterine,  intestinal, 
and  cardio-vascular  stimulant;  promotes  the  con- 
tractility and  increases  the  tone  of  involuntary  and 
cardiac  muscle;  excites  the  activity  of  the  kidneys 
and  mammary  glands;  useful  in  collapse,  intestinal 
paresis,  and  uterine  atony. 

Glandulse  Suprarenales  Siccae  (about  0.5  per  cent, 
epinephrine). 

Adult  Dosage. — Min.,  gr.  hi;  av.,  v;  max.,  xx. 

Method  of  Administration. — I^  Glanduke  supra- 
renahs  siccae,  gr.  v-xx. 

Mitte  talis  pulveres  no.  21. 

Sig. — One  powder,  by  mouth,  t.i.d. 

Gr.  ii-b,  every  half  hour,  to  a one-year  old,  for 
haematemesis.  (Holt.) 

Uses. — Used  in  Addison’s  Disease,  and  in 
hajmatemesis. 

Glandulae  Thymae  Dessicatae. 

Adult  Dosage. — Min.,  gr.  h;  av.,  iv;  max.,  Lxxv. 

Method  of  Administration. — Glandulae  thymae 
dessicatae,  gr.  iv,  tabellae  no.  30. 

Sig. — Tablet,  t.i.d. 

Uses. — Used  empirically  in  infantile  maras- 
mus, rickets,  haemophilia,  hyperthyroidism,  tuber- 
culosis. 

Glandulae  Thyroideae  Siccae;  Thyriodeum  Siccum. 

Dosage. — 6 months,  gr.  %;  18  months,  gr.  ss; 
3 years,  gr.  ss;  5 years,  gr.  ss-i.  Adult,  min.,  gr.  iss; 
av.,  v;  max.,  x. 

Method  of  Administration. — R Thyroidei  sicci, 
gr.  ss-i,  tabellae,  capsulae,  vel  pulveres,  no.  30. 

Sig.— A)ne  tablet,  once  to  thrice  daily,  gradually 
and  cautiously  increased  to  three  or  five  tablets, 
t.i.d.,  or  until  the  patient  is  normal  or  toxic  symp- 
toms appear.  Then  reduce  the  dose  until  the  proper 
57 


amount  required  to  maintain  the  mental  and  bodily 
integrity  is  found.  See  Cretinism,  Myxoedema,  and 
H3T50thyroidism,  in  Part  1. 

Physiologic  Action  and  Uses. — Used  in  hypo- 
thyroidism (see  Cretinism  and  Myxoedema,  in 
Part  1);  stimulates  metabohsm,  causes  an  in- 
crease in  the  nitrogen  of  the  urine  and  a decrease  in 
weight. 

Toxic  Action. — Rapid  heart  action,  palpitation, 
nervousness,  insomnia,  tremors,  headache,  flushing, 
sweating,  loss  of  weight,  sometimes  coryza,  anorexia, 
faintness,  dyspnoea,  elevation  of  temperature, 
pallor,  perhaps  nausea  and  vomiting,  diarrhoea, 
neuralgic  pains,  vertigo,  sometimes  delirium,  some- 
times albuminuria  or  glycosuria. 

Glauber’s  Salt;  Sodii  Sulphas:  Na2SO4-|-10H2O 
(soluble  in  one  of  water). 

Dosage. — 6 months,  gr.  xw-xxx;  18  months,  gr. 
xxx-xlv;  3 years,  gr.  jd-3i;  5 years,  3i-  Adult, 
min.,  3ii;  av.,  iv;  max.,  3i- 

Method  of  Adyninistration. — A tablespoonful  dis- 
solved in  water  one  hour  before  breakfast;  or  a tea- 
spoonful in  hot  water,  two  to  four  times  a day,  on 
an  empty  stomach. 

As  an  enema,  two  tablespoonfuls  ad  Oi. 

Physiologic  Action  and  Uses. — Saline  cathartic; 
causing  purgation  by  osmosis  and  interference  with 
the  absorption  of  fliuds  from  the  bowel;  acts  in  one 
to  twenty  hours. 

Glonoini  Spiritus  (1  per  cent,  alcoholic  solution  of 
nitroglycerin). 

Dosage. — 6 months,  gt.  )4]  18  months,  gt.  3 
years,  5 years,  gt.  i.  Adult,  min.,  t^jss;  av.,  i; 

max.,  u. 

Method  of  Administration. — Spiritus  glonoini, 
5ss. 

Sig. — One-half  to  one  drop  in  water,  or  dropped  on 
or  under  the  tongue,  every  half  to  two  to  four 
hours;  or  one  drop  three  to  four  times  a day,  in- 
creased by  one  drop  every  four  or  five  days,  until 
flushing,  headache,  palpitation,  or  buzzing  in  the 
ears  occurs;  then  reduce  the  dose  several  drops 
and  occasionally  increase  it  tentatively;  nEviii-x  may 
have  to  be  given  before  the  desired  physiological 
effect  is  produced.  Intermit  the  drug  every  ten 
days  for  five  days. 

Physiologic  Action  and  Uses. — Vasodilator:  peri- 
pheral relaxant  action  upon  the  muscles  of  the 
arterioles;  also  relaxes  spasm  of  the  bronchi,  intes- 
tines, renal  and  bihary  tracts.  The  effect  lasts 
about  twenty  to  forty  minutes. 

Glusidum.  See  Saccharin. 

Glycerin!  Suppositoria  (Sod.  carb.  gr.  stearic 
ac.,  gr.  iii,  glycerine,  gr.  xlvi). 

Uses. — Intestinal  evacuant. 

Glycerinum  C3H5(OH).^. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — One  or  two  teaspoon- 
fuls in  lemonade  (in  place  of  sugar),  up  to  two  to 
four  ounces  daily,  for  renal  colic  and  pressure  pains 
in  nephrolithiasis.  As  an  enema,  two  tablespoonfuls 
to  the  quart. 

Uses. — Solvent,  sweetening  agent,  demulcent, 
emollient,  rectal  evacuant. 

Glyceritum  Acidi  Carbolici  (liquid  phenol  20, 
glycerine  80). 

Adnlt  Dosage. — Min.,  miii;  av.,  v;  max.,  x. 

Method  of  Adyninistration. — R Glyceriti  acidi 
carbolici,  5i- 

Sig. — Fifteen  minims  in  two  tablespoonfuls  of 
warm  water,  as  a mouth-wash. 

Uses. — Antiseptic.  (?)  Glycerine  used  as  a solvent 
more  or  less  destroys  the  antiseptic  power  of  such 
antiseptics  in  aqueous  solution  as  phenol,  boric  acid, 
thymol,  bichloride,  etc.  (Goodrich). 


GOULARD’S  EXTRACT 


Glyceritum  Acidi  Tannici  (tannic  acid  1,  glycerine 
4). 

Adult  Dosage. — Av.,  nijxxx. 

Method  of  Administration. — Throat  paint.  As  a 
gargle  or  spray:  5i  ad  aquam  Oi. 

(/ses.— Astringent;  hardening  agent  for  sore 
nipples. 

Glyceritum  Amyli  (starch  10,  water  10,  glycerine 
80,  triturated  and  heated  to  a jelly). 

Uses. — Emollient;  vehicle. 

Glyceritum  Boroglycerini  (boric  acid  .310,  and 
glycerine  460,  evaporated  by  heat  down  to  .500 
grams,  and  an  equal  weight  of  glycerine  added). 

Uses. — Antiseptic. 

Glyceritum  Guaiaci  (equal  parts  of  glycerine  and 
guaiac;. 

Adult  Dosage. — Min.,  njx;  max..  Lx;  for  local  ap- 
plication to  inflamed  joints,  etc. 

Glyceritum  Phenolis. — See  Glyceritum  Acidi  Car- 
bolici. 

Glycerophosphas  Calcii:  CaCJIyOeP  (soluble  in 
50  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  ii;  max.,  v. 

Method  of  Administration. — Calcii  glycero- 
pho.sphatis,  gr.  iv,  tabellaj  no.  GO. 

Sig. — Tablet,  t.i.d. 

Uses. — Tonic;  alterative. 

Glycerophosphas  Sodii  (very  soluble  in  water; 
nearly  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  v. 

Method  of  Administration. — Sodii  glycero- 
phosphatis,  3ii  (gr.  ss  ad  irpi);  aquae,  q.s.  ad,  5ss. 

M.  Sig.-^ix  minims  t.i.d. 

It  may  be  prescribed  in  tablet  form. 

Uses. — Tonic. 

Qlycerophosphati  Elixir  Compositum  (sod.  gly- 
cerophos.  4,  calc,  glycerophos.  1.6,  ferric  glycerophos. 
0.3,  soluble  manganese  glycerophos.  0.2,  quinine 
glycerophos.  0.1,  strych.  glycerophos.  0.015,  lactic 
acid  1,  in  comp.  spt.  cardamom,  alcohol,  glycerine 
and  water  to  100). 

Adult  Dosage. — Av.,  3u. 

Method  of  Administration. — 1^  ElLxiris  glycero- 
phosphati  compositi,  N.  F.,  5viii. 

Sig. — Two  teaspoonfuls,  t.i.d. 

Uses. — Tonic. 

Glycerylis  Nitras;  Nitroglycerin:  C,3H5(N03)3. 

Dosage. — 6 months,  gr.  Koo,"  18  months,  gr.  }4oo', 
3 years,  gr.  '^ooi  5 years,  gr.  Koo-  Adult,  min.,  gr.  Kooi 
max.,  gr.  %o. 

Method  of  Administration. — Tabellarum  trini- 
trini,  gr.  Ym,  no.  20. 

Sig. — One  tablet  in  water  or,  best,  dissolved  on  or 
under  the  tongue,  every  two  to  four  hours;  or  three 
or  four  times  a day,  gradually  increased  by  one  tab- 
let every  four  or  five  days,  until  flushing,  headache, 
palpitation,  or  buzzing  in  the  ears  occurs;  then  re- 
duce the  dose  several  tablets,  and  occasionally  in- 
crease it  tentatively;  gr.  J4o  or  even  Ko  may  have  to 
be  given  before  the  desired  physiological  effect  is 
produced.  Intermit  the  drug  every  ten  days  for 
five  days. 

Phrjsiologic  Action  and  Uses. — ^Vasodilator;  periph- 
eral relaxant  action  upon  the  musculature  of  the 
arterioles;  also  relaxes  spasm  of  the  bronchi,  intes- 
tines, renal  and  biliary  tracts.  The  effect  of  a single 
dose  lasts  about  twenty  to  forty  minutes. 

Glycerylis  Nitratis  Spiritus  (1  per  cent,  alcoholic 
solution  of  nitroglycerin).  See  Glonoini,  Spiritus. 

Glycocholas  Sodii. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  xx. 

Method  of  Administration. — I^  Sodii  glycocho- 
latis,  gr.  V,  tabellae  no.  24. 

Sig. — Tablet  t.i.d.p.c.,  dissolved  in  water. 

Uses. — Cholagogue;  stimulates  digestion  of  fats. 


Glycyrrhizae  Fluidextractum. 

Adidt  Dosage. — Min.,  iijx;  av.,  xxx;  max.,  3i- 

Uses. — Flavor;  demulcent  expectorant. 

Glycyrrhiz«  Mistura  Composita;  Brown  mixture 
(Ext.  glycyr.  3,  syrup  5,  acacia  3,  paregoric  12, 
vin.  antim.  6,  spt.  seth.  nit.  3,  water  to  100). 

Dosage. — 6 months,  gtt.  xv;  18  months,  gtt.  xx; 
3 years,  gtt.  xxx-xl;  5 years,  gtt.  xl-3i-  Adult,  min., 
oi;  av.,  iiss;  max.,  gi. 

Method  of  Administration. — I^  Misturaj  glycer- 
rhiza;  compositse. 

Sig. — Two  or  four  teaspoonfuls,  every  two  hours, 
or  as  required  for  cough. 

Uses. — Sedative  e.xpectorant. 

Glycyrrhizac  Pulvis  Compositus;  Compound  lic- 
orice powder  (Senna  18,  glycyr.  23}4,  oil  of  fennel 
0.4,  wa.shed  sulphur  8,  sugar  50). 

Dosage. — 6 months,  gr.  x;  18  months,  gr.  x-xx; 
3 years,  gr.  xxx;  5 years,  gr.  xl-3i.  Adult,  min.,  3i; 
max.,  ii. 

Method  of  Administration. — Pulveris  glycyr- 
rhiza;  compositi,  3i,  no.  12. 

Sig. — A powder  at  bedtime. 

Uses. — Laxative. 

Glycyrrhizse  Syrupus,  N.  F.  (Fluidglycerate  of 
gly'cyrrhiza,  25  per  cent.,  in  syrup). 

Adult  Dosage. — Av.,  3u- 

Uses. — Flavor. 

Gold  Chloride;  Auri  Chloridum,  AuCL  (very  solu- 
ble in  water). 

Adult  Dosage.— Min.,  gr.  Yo‘,  max.,  %o- 

Method  of  Administration. — I^  Auri  chloridi, 
gr.  ]4i  aqu»  destillatse,  gii. 

M.  Sig. — 3i  in  water,  t.i.d. 

Uses. — Alterative. 

Gold  and  Sodium  Chloride  (.AuCl3NaCH-H20; 
very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  }io‘,  av.,  Yo',  max.,  Y. 

Method  of  Administration. — R Auri  et  sodii 
chloridi,  gr.  ss;  aquae  destillatae,  5u- 

M.  Sig. — 3i  in  water,  t.i.d. 

It  may  also  be  prescribed  in  pill  form. 

Uses. — Alterative. 

Gomenol  Oil. 

Uses. — Used  locally  in  tuberculous  cystitis. 

Goose=Oil. 

Uses. — Nutritive  inunction. 

Gossypii  Cortex;  Cotton-Root  Bark. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — ^I^  Gossypii  corticis 
oiv;  aquae,  Oii. 

Boil  down  to  a pint. 

Sig. — A winegla-ssful  every  few  hours,  or  t.i.d. 

Uses. — Supposed  emmenagogue  and  oxytocic. 

Gossypii  Corticis  Fluidextractum,  N.  F. 

Adxdt  Dosage. — Av.,  njxxx. 

Method  of  Administration. — I^  Fluidextracti  gos- 
sypii corticis.  N.  F.,  5u- 

Sig. — i^xxx  in  water,  t.i.d. 

Gossypii  Seminis  Oleum;  Cottonseed  OU. 

Dosage. — 6 months,  gtt.  xv;  18  months,  ^t.  xv- 
XXX ; 3 years,  3ss-i;  5 years,  3i-  Adult,  min.,  3i; 
av.,  iv;  max.,  §i. 

Method  of  Administration. — I^  Olei  gossypii 
seminis,  oviii. 

Sig.— A teaspoonful  to  two  tablespoonfuls, 
t.i.d.p.c. 

As  a laxative,  oii~vi,  twice  daily. 

As  an  enema,  5 to  16  oz.  high  into  the  colon. 

Uses. — Nutrient;  lubricant;  emollient;  laxative. 

Goulard’s  Extract;  Liquor  Plumbi  Subacetatis 
(Lead  acetate  18,  lead  oxide  11,  distilled  water 
to  100). 

Method  of  Administration. — Diluted  15  to  30 
times  with  water. 


GUARANI  ET  CELERIN.E  ELIXIR 


Uses. — Astringent  and  cooling  lotion;  should  not 
be  applied  to  denuded  surfaces. 

Granati  Decoctum. 

Adult  Dosage. — Min.,  5iv;  max.,  vi. 

Method  of  Administration. — Granati  recentis, 
oxvii;  aquae,  5xvii. 

Boil  down  to  twelve  ounces,  and  strain. 

Sig. — ^5*v-vi  every  hour,  for  two  or  three  doses, 
preceded  and  followed  in  a few  hours  by  a brisk 
cathartic. 

U ses. — Anthelmintic. 

Toxic  Action. — Weakness  of  the  limbs,  giddiness, 
confusion,  nausea,  vomiting,  purging. 

Granati  Fluidextractum. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — Fluidextracti  gra- 
nati, 5ss. 

Sig. — 3ss-i,  in  water,  preceded  and  followed  in  a 
few  hours  by  a brisk  cathartic. 

U ses.  — Anthelmintic . 

Toxic  Action. — Weakness  of  the  limbs,  giddiness, 
confusion,  nausea,  vomiting,  purging. 

Gray  Oil;  Oleum  Cinereum. 

Method  of  Administration. — Hydrargyri  bides- 
tillati,  3iiss;  alboleni,  oiii;  adipis  lana;  hydrosi,  Jiss. 

Prepare  from  sterile  materials  under  aseptic  con- 
ditions, and  triturate  the  mercury  with  the  lanolin 
for  at  least  two  hours. 

Dose. — ^Two  to  six  minims  injected  intramuscu- 
larly every  two  weeks  (see  Part  1,  under  Syphilis). 

The  Gray  Oil  or  Mercurial  Oil  described  by 
N.  N.  R.  is  a 40  to  50  per  cent,  preparation.  It  is 
directed  to  be  administered  once  or  twice  a week, 
1 minim  being  the  initial  dose,  and  2 minims  the 
maximum.  “The  ‘course’  should  not  be  continued 
beyond  five  or  six  weeks  without  an  intermission  of 
equal  duration.”  (N.  N.  R.) 

Uses. — Antiluetic. 

Gray  Powder;  Hydrargyrum  cum  Greta. 

Dosage. — 6 months,  gr.  34;  18  months,  gr.  34; 
3 years,  gr.  34;  5 years,  gr.  34.  Adult,  min.,  gr.  iss; 
av.,  iv;  max.,  viiss. 

Method  of  Administration. — Hydrargyri  cum 
Greta,  gr.  34~34»  pulveres  in  charta  cerata  no.  4. 

Sig.— A)ne  powder  every  hour  for  four  doses  (for 
children). 

Uses. — Cathartic;  antiluetic. 

Grindeliae  Fluidextractum. 

Adult  Dosage. — Min.,  njx;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — Fluidextracti 
grindeliae,  5u- 

Sig. — One-half  to  one  teaspoonful,  stirred  in 
sweetened  water  or  milk,  every  three  or  four  hours. 

Uses. — Broncho-pulmonary  sedative  ; diuretic. 
Used  locally  for  ivy  poisoning  in  the  strength  of  1 :9 
of  water. 

Gruels.  See  Cereal  Waters. 

Guaiacamphol  (Camphoric  acid  ester  of  guaiacol). 

Adult  Dosage. — Min.,  gr.  iii;  av.,  v;  max.,  xv. 

Method  of  Administration. — Guaiacamphol, 
gr.  V,  pulveres  no.  6. 

Sig. — Powder  at  bedtime  for  three  to  six  nights. 

Uses. — Anhidrotic. 

Guaiaci  Confectio  Composita  (Chelsea  Pensioner). 

Adult  Dosage. — -Min.,  3i;  max.,  u. 

Method  of  Preparation.  — R Guaiaci,  3ss; 

sulphuris  subUmati,  3 hi,  gr.  xv;  magnesii  carbon- 
atis,  3ss;  pulveris  zingiberis,  gr.  xv;  theriacae  (tre- 
acle) vel  mellis  depurati,  3 hi. 

Uses. — Laxative  in  chronic  rheumatism. 

Guaiaci  Glyceritum  (equal  parts). 

A.dult  Dosage. — Min.,  i^x;  max.,  lx,  for  local  appli- 
cation to  inflamed  joints,  etc. 

Guaiaci  Tinctura  (20  per  cent.). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  iss. 


Method  of  Administration. — Tincturae  guaiaci; 
syrupi  acacia?,  aa,  5h. 

M.  Sig. — One  to  two  teaspoonfuls  in  milk,  t.i.d. 

Uses. — E.xpectorant;  diaphoretic;  alterative;  pur- 
gative. 

Toxic  Aeffon.— Indigestion,  vomiting,  purging, 
headache. 

Guaiaci  Tinctura  Ammoniata  (Guaiac,  20,  arom. 
spt.  ammon.  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Tinctura?  guaiaci 
ammoniata?,  Ji. 

Sig. — Thirty  minims,  well  diluted  in  milk,  t.i.d. 

Uses. — Expectorant;  diaphoretic;  alterative; 

purgative. 

Guaiaci  Trochisci. 

Adult  Dosage. — Av.,  gr.  hi. 

Method  of  Administration. — Trochisci  guaiaci, 
no.  12. 

Sig. — Lozenge  every  two  to  four  hours. 

Uses. — For  sore  throat. 

Guaiacol  (metho.i^-hydroxy-bonzene : CeH4(OH), 
(OCHa),  ) soluble  in  53  of  water;  freely  soluble  in 
alcohol. 

Adult  Dosage. — Min.,  itjv;  av.,  viii;  max.,  xv. 

Method  of  Administration. — I^  Guaiacolis  5ss. 

Sig. — Two  or  three  drops,  in  whiskey,  well  diluted, 
t.i.d.p.c.,  increased  by  one  drop  daily,  up  to  fifteen 
to  eighteen  drops,  t.i.d. 

It  may  be  dispensed  in  capsules  or  pills. 

Tg^xx-l,  painted  on  the  .skin,  causes  a prompt  fall 
of  temperature,  but  collapse  may  occur. 

Uses. — Bronchial  stimulant  and  expectorant; 
antipyretic;  local  ana?sthetic  and  antiseptic;  tonic; 
intestinal  and  urinary  antiseptic. 

Toxic  Action. — Resembles  phenol  poisoning. 

Guaiacolis  Carbonas;  Duotal:  (C6H4(0CH3))2C03 
(insoluble  in  water;  soluble  in  alcohol,  1:G0). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — I^  Guaiacolis  car- 
bonatis,  gr.  xv,  pulveres  vel  capsula?  vel  trochisci 
no.  12. 

Sig. — One,  t.i.d.p.c.  The  dose  may  be  gradually 
increased  to  a maximum  of  3iss  per  diem.  The  drug 
may  be  administered,  if  desired,  in  codliver  oil,  a 
bitter  tincture,  or  mucilage  of  tragacanth. 

Uses. — Intestinal  antiseptic;  bronchial  stimulant. 

Guaiacum. 

Adult  Dosage. — -Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Guaiaci,  gr.  xv, 
trochisci  no.  12. 

Sig. — A wafer  every  two  to  four  hours. 

Uses. — ^Alterative;  laxative;  diuretic. 

Guarana  (contains  caffeine  and  theobromine). 

Adult  Dosage. — Min.,  gr.  xv;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — I^  Guaranae,  gr.  xxx, 
pulveres  no.  6. 

Sig. — -A  powder  once  or  twice  daily,  as  required. 

Uses. — Analgesic;  stimulant. 

Guaranae  Elixir  (contains  caffeine  and  theobro- 
mine). 

Adult  Dosage.— Min.,  3i;  max.,  ii. 

Method  of  Administration. — I^  Elixiris  guaranae 

5ii- 

Sig. — One  or  two  teaspoonfuls  every  four  hours, 
until  relieved. 

Uses. — Analgesic;  stimulant. 

Guaranae  et  Celerinae  Elixir  (supposed  to  contain 
caffeine,  coca,  celery,  kola,  and  viburnum,  with 
aromatics). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — R Potassu  bromidi, 
3ii  (gr.  XV  per  dose) ; elixiris  guaranae  et  celerinae,  5 iv. 

M.  Sig. — A dessertspoonful  in  hot  water  every 
four  hours  (Kelly’s  Dysmenorrhoea  Mixture). 


HIPPURAS  AMMONII 


Quaranae  Fluidextractum  (contains  caffeine  and 
theobromine). 

Adult  Dosage. — Min.,  tExv;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti  gua- 
ranEC,  5i- 

Sig. — Twenty  to  thirty  minims,  in  water,  every 
two  to  three  hours,  as  required. 

Uses. — Antineuralgic,  used  in  migraine. 

Qum  Salt  Solution;  Seven  percent,  of  gmn  acacia 
in  normal  salt  solution  (0.85  per  cent.).  It  is  of  the 
same  viscosity  as  the  blood  and  is  used  as  an  infu- 
sion in  preference  to  normal  saline,  as  being  less  apt 
to  produce  pulmonary  oedema. 

Qurjuni  Balsamum. 

Adult  Dosage. — Min.,  tijx;  max.,  3h- 

Method  of  Administration. — Balsami  gurjuni 
vel  dipterocarpi,  t®x,  capsula?  no.  30. 

Sig. — Capsule,  t.i.d.,  gradually  increased.  It  may 
also  be  administered  m the  form  of  an  emulsion, 
and  also  used  locally. 

Uses. — Used  in  Leprosy,  q.v.,  Part  1. 

Qutta=perchae  Liquor  (10  per  cent.  sol.  in  chloro- 
form; Traumaticin). 

Uses. — Protective  application  to  shght  wounds. 

Guy’s  Pill. 

Method  of  Administration. — I^  Pulveris  digitalis, 
gr.  i;  pulveris  scill®,  gr.  i;  hydrargyri  chloridi  mitis, 
gr.  i;  confectionis  rosae,  q.s. 

MLsce  et  fiat  pilula.  Mitte  talis  no.  12. 

Sig. — One  pill  every  eight  hours. 

Physiologic  Action  and  Uses. — Digitalis  and 
squills  are  cardiac  stimulants;  calomel  is  laxative 
and  diuretic. 

Qynocardas  Sodii. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  xlv. 

Method  of  Administration. — R Sodii  gynocar- 
datis,  gr.  ss,  capsulae  no.  12. 

Sig. — One  capsule  t.i.d.p.c.  Gradually  increase 
the  dose  to  gr.  iii-xlv,  t.i.d.,  or  gr.  iii-v,  in  capsule, 
ten  to  twenty  times  daily. 

Uses. — ^Axiti-lej^rosy. 

Qynocardiae  Oleum;  Oleum  Chaulmoogrse. 

Adult  Dosage. — Min.,  ngv;  max.,  x. 

Method  of  Administration. — R Olei  gynocardiae, 
Sii. 

Sig. — Three  to  five  drops  in  milk  (or  in  capsule), 
t.i.d.a.c.,  increased  by  one  or  two  drops  every  three 
to  five  days,  up  to  even  150  or  more  drops  t.i.d.; 
together  with  daily  inunctions  of  the  oil,  25  to  50 
per  cent,  in  oil  or  lard,  lasting  one  to  two  hours. 

Physiologic  Action  and  Uses. — For  leprosy,  q.v., 
Part  1. 

Haemogallolum  (reduced  or  deoxidized  Haemo- 
globin). 

Adult  Dosage. — Min.,  gr.  iv;  max.,  x. 

Method  of  Administration. — -I^  Haemogalloli,  gr. 
iv;  sacchari  albi,  q.s. 

Mitte  taUs  pulveres  no.  60. 

Sig. — Powder,  t.i.d.,  one-half  hour  a.c. 

It  may  also  be  dispensed  in  tablet  form. 

Uses. — Ha’matinic. 

Hsemolum  (reduced  or  deoxidized  Hajmoglobin). 

Adult  Dosage. — Min.,  gr.  ii;  max.,  x. 

Method  of  Administration. — Hiemoli,  gr.  vi; 
sacchari  albi,  q.s. 

Mitte  talis  pulveres  no.  60. 

Sig. — Powder,  t.i.d.,  one-half  hour  a.c. 

Uses. — Haematinic. 

Hamamelidis  Aqua;  Extractum  Hamamelidis 
Destillatum. 

Adult  Dosage. — Min.,  3ij  av.,  ii;  max.,  iii. 

Uses. — Astringent;  haemostatic. 

Toxic  Action. — Throbbing  pain  in  the  head. 

Hamamelidis  Foliorum  Fluidextractum. 

Adult  Dosage. — Min.,  nExw;  av.,  xxx;  max.,  xlv. 


Method  of  Administration. — I^  Fluidextracti  ha- 
mamehdis  foliorum,  gi. 

Sig. — Thirty  to  sixty  drops  in  water,  five  times 
a day. 

Uses. — Astringent;  haemostatic. 

Hedeomae  Oleum;  Oil  of  Pennyroyal. 

Adult  Dosage. — Min.,  ajji;  av.,  iii;  max.,  v. 

Method  of  Administration. — I^  Olei  hedeomae, 
rnjiii,  capsulae  no.  12. 

Sig.— A)ne  capsule,  t.i.d.p.c. 

It  may  be  prescribed  on  sugar. 

Uses. — Stimulant;  carminative;  emmenagogue. 

Toxic  Action. — Narcosis. 

Hedonal;  Methylpropylcarbinol  Urethane:  CHa 
CIl2CH2CH(CH3)O.CO.NH2. 

Adult  Dosage. — Min.,  gr.  xv;  max.,  xxx. 

Method  of  Administration. — I^  Hedonal,  gr.  xv, 
pulveres,  capsulae,  vel  tabellae  no.  4. 

Sig. — One  at  bedtime,  repeated  if  necessary. 

Uses. — Nervous  sedative;  hypnotic. 

Helmitol;  Hexamethylenaminae  Methylencitras: 
C7ll808(CH2)6N4;  soluble  in  about  10  of  water. 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xxx. 

Method  of  Administration. — I^  Helmitol,  gr.  v-x, 
pulveres  vel  tabellae  no.  24. 

Sig. — One,  t.i.d.  It  may  be  given  up  to  3i-ii 
daily. 

Physiologic  Action  and  Uses. — Urina^  antiseptic; 
fiberates  fomialdehyde  in  both  alkaline  and  acid 
media,  e.g.,  the  urinary  tract,  biliary  passages,  pan- 
creatic ducts,  meninges  and  sahva. 

Heroin  Hydrochloride;  Diacetylmorphinae  Hydro- 
chloridum  (soluble  in  2 of  water). 

Dosage. — 18  months,  gr.  Koo,'  3 years,  gr.  Ko;  5 
years,  gr.  Ko-  Adult,  min.,  gr.  iio',  av.,  jio',  max.,  %. 

Method  of  Administration. — I^  Diacetylmorphinae 
hydrochloridi,  gr.  lao,  tabellae  no.  5. 

Sig. — One  tablet,  as  required  for  the  relief  of  an 
irritable  cough  (three  or  four  times  a day,  if  need  be). 

Physiologic  Action  and  Uses. — Respiratory  seda- 
tive; said  to  be  more  depressant  on  the  respiratory 
centre  than  morphine  or  codeine  and  not  more 
efficacious. 

Hexamethylenamina;  Urotropin:  (CH2)6N4  (solu- 
ble in  1.5  of  water  and  in  12.5  of  alcohol). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  i-ii;  5 years,  gr.  ii-v.  Adult,  min.,  gr.  v; 
av.,  x;  max.,  xv. 

Method  of  Administration. — I^  Hexamethyleni- 
minae,  gr.  v-x,  pulveres,  vel  tabellae,  vel  capsulae  no.  24. 

Sig. — A powder,  in  solution,  in  water,  t.i.d.  It 
may  be  given  up  to  pi  daily,  for  adults.  If  sodium 
acid  phosphate  is  given  to  render  the  urine  acid, 
hexamethylenamine  should  not  be  taken  for  several 
hours  later. 

Physiologic  Action  and  Uses. — Urinary  antiseptic; 
fiberates  formaldehyde  only  in  an  acid  medium  (not 
otherwise). 

Toxic  Action. — Indigestion,  abdominal  pain,  diar- 
rhoea, strangury',  albuminuria,  haematuria;  haemo- 
globinuria;  headache,  tinnitus,  measly  rash. 

Hexamethylenaminae  Methylencitras;  Helmitol. 
See  Helmitol. 

Hexamethylenaminae  Salicylas;  Saliformin: 
(CH2)6N4C6H40H.C00H  (readily  soluble  in  water 
or  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xxx. 

Method  of  Administration. — Hexamethylena- 
minae  saficy'latis,  gr.  Ixxx  (gr.  v ad  3i);  efixiris 
simplicis,  oii- 

M.  Sig.— A)ne  or  tw'o  teaspoonfuls  every  four  hours. 

It  may  be  prescribed  in  tablet  form. 

Uses  — Urinary'  antiseptic. 

Hippuras  Ammonii. 

Adult  Dosage. — Min.,  gr.  iv;  max.,  xv. 


HYDRARGYRI  lODIDUM  RUBRUM 


Method  of  Administration. — Ammonii  hippu- 
ratis,  gr.  x,  capsulse  24. 

Sig. — One,  t.i.d. 

Uses. — Solvent  of  urates. 

Hoang=Nan  Fluidextractum. 

Adult  Dosage. — Min.,  rg;v;  max.,  xxx. 

Method  of  Administration. — Fluidextracti 
Hoang-Nan. 

Sig. — Five  to  thirty  drops  in  water,  t.i.d. 

Uses. — Used  in  Leprosy,  q.v.,  Part  1. 

Hoang=Nan  Pulvis. 

Adult  Dosage. — Min.,  gr.  iii;  max.,  v. 

Method  of  Administration. — Pulveris  hoang- 
nan,  gr.  hi,  pilulse  no.  60. 

Sig. — One  pill,  t.i.d. 

Uses. — Used  in  Leprosy,  q.v.,  Part  1. 

Hoffman’s  Anodyne;  Spiritus  Ailtheris  Compositus 
(ether  323^,  alcohol  65,  etherial  oil  2J^). 

Dosage. — 6 months,  gtt.  ii;  18  months,  gtt.  iii-v; 
3 years,  gtt.  v;  5 years,  gtt.  v-x.  Adult,  min.,  3ss; 
av.,  i;  max.,  ii. 

Method  of  Administration. — Spiritus  aetheris 
compositi.  Si- 

Sig. — One  teaspoonful  in  a wineglass  of  water,  as 
required,  or  every  one  to  three  hours. 

Uses. — Anodyne;  carminative;  stimulant. 

Holocainae  Hydrochloridum  (the  hydrochloride  of 
phenetidyl-acetphenetidin:  CH3C:  (NC6H4OC2H5) 
(NH.C6H40C2H5).HC1.  Soluble  in  50  parts  of 
water. 

Method  of  Administration. — One  per  cent,  solution 
as  an  anaesthetic  collyrium.  The  solution  should  be 
prepared  in  a porcelain  vessel  instead  of  glass. 

Homatropinae  Hydrobromidum:  Ci6H2i03NHBr; 
soluble  in  6 of  water.  Homatropin  is  an  ester  of 
tropine  with  mandelic  acid. 

Adult  Dosage. — Min.,  gr.  Xso,’  av.,  K20;  max.,  Koo- 

Method  of  Administration.— One  or  two  drops  of  a 
1 to  2 per  cent,  solution  in  the  eye,  as  a mydriatic 
and  cycloplegic. 

Uses. — Transient  mydriatic  and  cycloplegic. 

Honey;  Mel  (about  40  per  cent,  levulose,  35  per 
cent,  dextrose,  and  3 per  cent,  saccharose.) 

Hops.  See  Hmnulus,  below. 

Horst’s  Eye  Water ; Collyrium  Astringens  Luteum. 
— See  Collyrium  Astringens  Luteum. 

Humuli  Fluidextractum. 

Adult  Dosage. — Min.,  tijv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Fluidextracti 
humuli,  5ii- 

Sig. — Fifteen  to  thirty  drops  in  water,  t.i.d. 

Uses. — Bitter  stomachic;  feeble  hypnotic. 

Humuli  Infusum  (5ss  of  hops  ad  aquam  Oi). 

Adult  Dosage. — Min.,  Si;  max.,  iv. 

Method  of  Administration. — Infusi  humuli,  Oi. 

Sig. — One  to  four  ounces,  t.i.d. 

Uses. — Bitter  stomachic;  feeble  hypnotic. 

Humuli  Tinctura. 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — In  aquam,  ad  5i“ii)as 
a vehicle  for  other  hypnotics. 

Uses. — Bitter  stomachic;  feeble  hypnotic. 

Hydrargyri  Ammoniati  Unguentum  (HgNHaCl, 
1 to  12  per  cent.). 

Method  of  Administration. — R Hydrargyri  am- 
moniati, gr.  xlviii;  adipis  lanaj  hydrosi;  petrolati 
mollis,  aa,  Sss. 

Sig. — For  local  application,  as  directed. 

Uses. — Antiseptic  emollient  and  local  stimulant. 

Hydrargyri  Chloridum  Corrosivum;  HgCL. 

Dosage.-^  months,  gr.  l^oo;  18  months,  Koo;  3 
years,  gr.  Koc;  5 years,  gr.  Ks.  Adult,  min.,  gr.  Ym, 
av.,  Mo;  max., 

Method  of  Administration. — R Hydrargyri  bi- 
chloridi,  gr.  K2,  tabellm  no.  60. 


Sig.^ — One  tablet,  t.i.d.,  well  diluted. 

Physiologic  Action  and  Uses. — Tonic  in  small 
doses,  increasing  growth  and  weight  and  the  forma- 
tion of  red  blood-cells;  antiluetic;  antiseptic  in  solu- 
tion 1 ; 20,000-4000-1000. 

Toxic  Action. — Vomiting,  diarrhoea,  frequent 
foul-smelling  and  bloody  stools,  nervous  symptoms, 
weakness,  nephritis,  anuria,  salivation,  gingivitis. 
(See  under  Hydrargyri  Cyandium.) 

Hydrargyri  Chloridum  Mite;  Calomel:  HgCl. 

Dosage.-^  months,  gr.  Mo;  18  months,  gr.  Mol 
3 years,  gr.  34i  5 years,  gr.  Adult,  min.,  gr.  ii; 
av.,  v;  max.,  viii. 

Method  of  Administration. — I^  Hydrargyri  chlo- 
ridi  mitis,  gr.  i (for  infants) ; sacchari  albi,  q.s. 

Misce  et  divide  in  pulveres  no.  x. 

Sig. — One  powder  every  half  to  one  hom"  until 
effectual,  or  imtil  the  stools  turn  green;  usually  no 
more  than  one  grain  for  infants.  Follow  after  about 
six  hours  or  the  next  mornmg  by  a saline. 

Hydrarg}Ti  chloridi  mitis,  gr.  Yi,  tabellse 
no.  12  (for  adults). 

Sig.— One  tablet  every  fifteen  minutes,  or  four 
tablets  every  hour  (or  gr.  ii-viii  in  a single  dose  at 
bedtime,  followed  by  a saline,  one  hour  before 
breakfast. 

Physiologic  Action  and  Uses. — Antiluetic;  hydra- 
gogue  purgative,  acting  (in  one  to  twenty  hours)  on 
both  the  large  and  small  bowel,  by  interfering  with 
the  absorption  of  fluids.  The  green  color  of  the 
stools  is  due  partly  to  sulphide  of  mercury  and  not 
altogether  to  biliverdin;  diuretic,  acting  the  same 
as  potassium  citrate,  q.v.]  intestinal  antiseptic;  gas- 
tric sedative  in  small  doses. 

Toxic  Action. — Abdominal  pain,  loose  stools,  sali- 
vation, gingivitis,  malaise.  (See  under  Hydrargyri 
Cyanidum.) 

Hydrargyri  Cyanidum,  Hg(CN)2,'  soluble  in  12.8 
of  water. 

Adult  Dosage. — Min.,  gr.  Me;  max.,  M. 

Method  of  Administration. — R Hydrargyri  cya- 
nidi,  gr.  K2,  tabelhe  no.  60. 

Sig. — One  tablet,  well  diluted,  t.i.d. 

Physiologic  Action  and  Uses. — Antiluetic;  local 
antiseptic : 1-4000-2000,  may  be  applied  to  the  eye 
or  mucous  membranes. 

Toxic  Action. — Acute  poisoning:  nausea,  vomit- 
ing, gastralgia,  purging,  nephritis,  suppression  of 
urine,  bloody  diarrhoea,  collapse. 

Chronic  poisoning:  (hydrargyrism)  colicky  diar- 
rhoea, soreness  of  the  gums,  salivation,  fetid  breath, 
gingivitis,  stomatitis,  metallic  taste  m the  mouth, 
anorexia,  indigestion,  fever,  emaciation,  erythema, 
headache,  neuralgia,  insomnia,  muscular  tremor, 
coryza,  diarrhoea,  bloody  stools,  anaemia,  albumin- 
uria, polyneuritis,  convulsions,  coma. 

Hydrargyri  Emplastrum  (mercury  30,  oleate  of 
mercury  1,  hydrous  wool-fat  10,  lead  plaster  59). 

Uses. — Antiseptic. 

Hydrargyri  lodidum  Flavum;  Protiodide:  Hgl 
(almost  insoluble  in  water). 

Adult  Dosage. — Min.,  gr.  Mo;  av.,  Y%]  max.,  M-ii- 

Method  of  Administration.- — Hydrargyri  iodidi 
flavi,  gr.  %,  pilulae  no.  30. 

Sig. — Pill  t.i.d.p.c.,  increased  by  gr.  % daily  to  the 
limit  of  tolerance. 

In  the  treatment  of  syphilis  (q.v.,  Part  1)  Keyes 
prefers  the  Gamier  and  Lamoureux  granules  of 
green  protiodide,  gr.  M,  to  the  yellow  protiodide, 
gr-  M-H,  because  the  latter  is  too  irritating  to  the 
bowel. 

Uses. — Antiluetic;  alterative. 

Toxic  Action. — See  under  Hydrargyri  Cyanidum. 

Hydrargyri  lodidum  Rubrum;  Bmiodide,  HgL, 
(almost  insoluble  in  water). 


HYDRASTIS  TINCTURA 


Dosage. — fi  months,  gr.  Kso)  18  months,  gr.  Ym', 
3 years,  gr.  MoJ  5 years,  gr.  Ms-Ko.  Adult,  min.,  gr.  MoJ 
max..  Ye- 

Method  of  Administration. — Hydrargyri  iodidi 
rubri,  gr.  pilulse  no.  30. 

Sig. — Pill,  t.i.d.p.c. 

Uses. — Antiluetic;  alterative;  antiseptic. 

Toxic  Action. — See  under  Hydrargyri  Cyanidum. 

Hydrargyri  Linimentum. 

Uses. — Used  locally  for  tuberculous  peritonitis. 

Hydrargyri  Massa;  Blue  Mass;  Blue  Pill  (mer- 
cury 33,  licorice  10,  althaja  15,  glycerine  9,  honey  of 
rose  33). 

Dosage. — -3  years,  gr.  i;  5 years,  gr.  i-ii.  Adult, 
min.,  gr.  ii;  av.,  v;  max.,  xv. 

Method  of  Administration. — Massae  hydrar- 
gyri, gr.  V,  pilulse  no.  G. 

Sig. — -Pill  once  a day,  at  bedtime. 

Uses. — Antiluetic;  cathartic. 

Hydrargyri  Nitratis  Liquor:  IIg(NO3)2,G0percent. 

Uses. — Caustic. 

Hydrargyri  Nitratis  Unguentum;  Citrine  Oint- 
ment (mercury  7,  dissolved  in  nitric  acid  173^, 
lard  76). 

Uses. — -Antiseptic. 

Hydrargyri  Oleatum  (yellow  oxide,  HgO  25,  dis- 
tilled water  25,  oleic  acid  to  100). 

Adidt  Dosage. — Min.,  gr.  Y2',  max.,  K- 

Uses. — Antiluetic;  alterative. 

Hydrargyri  Oxidi  Flavi  Unguentum  (yellow  mer- 
curic oxide,  HgO,  2 per  cent,  for  the  eye;  5 to  10 
per  cent,  for  the  skin,  with  equal  parts  of  lanolin 
and  vaseline). 

Method  of  Administration. — Hydrargyri  oxidi 
flavi,  gr.  i;  adipis  lana;  hydrosi;  petrolati  albi,  aa,  Sss. 

M.  Sig. — Apply  wdth  a wooden  toothpick  or 
camel’s-hair  brush  (in  conjunctival  or  corneal 
ulceration). 

Uses. — Antiseptic;  local  stimulant. 

Hydrargyri  Oxycyanidum,  Hg(CN)2HgO  (solu- 
ble in  about  80  of  water). 

Adult  Dosage. — Min.,  gr.  Ym',  av.,  Yo',  max.,  %. 

Method  of  Administration. — May  be  given  hypo- 
dermically in  the  same  doses  as  mercuric  chloride; 
said  to  be  less  irritating  than  the  latter  and  more 
antiseptic. 

Physiologic  Action  and  Uses. — Antiluetic;  anti- 
septic in  solution  of  1 : 5000  or  slightly'  stronger; 
does  not  corrode  steel  instruments. 

Hydrargyri  Perchloridum.  See  Hydrargyri 
Chloridum  Corrosivum. 

Hydrargyri  Salicylas  (nearly  insoluble  in  water). 

Advit  Dosage. — Min.,  gr.  Y',  av.,  Ks;  max.,  ii. 

Method  of  Administration. — Hydrargyri  sali- 
cylatis,  gr.  Y\&,  pihda;  no.  60. 

Sig.— One  pill,  t.i.d. 

For  intramuscular  injection : ttjx  of  a well-shaken 
10  per  cent,  suspension  in  liquid  petrolatum,  deep 
into  the  gluteal  muscle  every  fourth  day,  increased 
to  every  second  day',  if  necessary.  Clean  needle 
and  syringe  thoroughly  after  each  injection. 

Uses. — Antiluetic;  antiseptic. 

Hydrargyri  Succinimidum,  Hg  ((CH2.CO)2N)2 
(freely  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  av.  Ml  max.,  M- 

Method  of  Administration. — Hydrargyri  suc- 
cinimidi,  gr.  M>  tabellae  no.  30. 

Sig. — A tablet,  dissolved  in  water,  and  injected 
hypodermically,  once  daily. 

Uses. — Antiluetic ; antitubercular. 

Hydrargyri  Sulphidum  Rubrum. 

Hydrargyri  Tannas. 

Adult  Dosage. — Min.,  gr.  iv;  max.,  v. 

Method  of  Administration. — R Hydrargyri  tan- 
natis,  gr.  v,  pilul®  no.  30. 


Sig. — Pill,  t.i.d. 

Uses. — Antiluetic,  alterative. 

Hydrargyri  Unguentum;  Mercurial  Ointment 
(mercury  50,  lard  25,  suet  23,  oleate  of  mer- 
cury 2). 

Dosage. — 6 to  18  months,  gr.  x-xv-xxx.  Adult, 
Min.,  5ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — R Unguenti  hy- 
drargyri, 5ss-i,  capsula?  no.  12. 

Sig. — One  capsule  daily,  for  inunction  (see  Syphilis 
in  Part  1). 

Uses. — Antiluetic;  antiseptic;  parasiticide. 

Hydrargyri  Unguentum  Dilutum;  Blue  Ointment 
(mercurial  ointment  67,  petrolatum  33). 

Uses. — Antiluetic;  antiseptic;  parasiticide. 

Hydrargyrum  Bidestillatum  (Dentists’  Mercury). 
See  Gray  Oil. 

Hydrargyrum  Bisulphuretum. 

Hydrargyrum  cum  Creta;  mercury  with  chalk; 
Gray  Powder. 

Dosage. — 6 months,  gr.  Ml  18  months,  gr.  Ml  3 
years,  gr.  Ml  5 years,  gr.  M.  Adult,  min.,  gr.  iss; 
av.,  iv;  max.,  viiss. 

Method  of  Adininistration. — R Hydrargyri  cum 
creta,  gr.  M“M>  pulveres  in  charta  cerata  no.  4. 

Sig. — One  powder  every  hour  for  four  doses 
(for  children). 

Uses. — Cathartic;  antiluetic. 

Hydrargyrum  Sozoiodolatum. 

Hydrastininae  Hydrochloridum  (alkaloid;  very 
soluble  in  water). 

Adult  Dosage. — Min.,  gr.  Ml  av.,  ss;  max.,  iss. 

Alethod  of  Administration. — R Hydrastininae  hy- 
drochloridi,  gr.  ss,  capsulae  no.  24. 

Sig. — Capside  three  to  four  times  daily. 

It  may  be  administered  hypodermically. 

Physiologic  Action  and  Uses. — Uterine  stimulant; 
haemostatic;  stomachic;  exerts  a peripheral  exciting 
action  upon  the  uterus  and  upon  the  blood-vessels, 
and  also  stimulates  the  vasomotor  centre. 

Toxic  Action. — Indigestion,  constipation,  tetanic 
convidsions,  motor  depression,  medullary,  spinal, 
and  cardiac  depression. 

Hydrastis  Extractum. 

Adult  Dosage. — -Av.,  gr.  viii. 

Method  of  Administration. — R Extract!  hydras- 
tis,  gr.  viii,  capsulae  no.  24. 

Sig. — Capsule  three  to  four  times  daily. 

Physiologic  Action  and  Uses. — Uterine  stimulant; 
haemostatic;  stomachic;  exerts  a peripheral  exciting 
action  upon  the  uterus  and  upon  the  blood-vessels, 
and  also  stimulates  the  vasomotor  centre. 

Toxic  Action. — Indigestion,  constipation,  tetanic 
convulsions,  motor  depression,  medullary,  spinal, 
and  cardiaic  depression. 

Hydrastis  Fluidextractum. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti  hy- 
drastis,  5i. 

Sig. — Thirty  drops,  well  diluted  in  water  or  milk, 
two,  three,  or  four  times  a day. 

In  menorrhagia  it  may  be  given  for  one  week 
before  and  also  during  the  flow.  For  systemic  hem- 
orrhage it  may  be  given  every  hour  for  four  or  five 
doses. 

Physiologic  Action  and  Uses. — Uterine  stimulant; 
haemostatic;  stomachic;  exerts  a peripheral  exciting 
action  upon  the  uterus  and  upon  the  blood-vessels, 
and  also  stimulates  the  vasomotor  centre. 

Toxic  Action. — Indigestion,  constipation,  tetanic 
conx'ulsions,  motor  depression,  medullary,  spinal, 
and  cardiac  depression. 

Hydrastis  Tinctura. 

Adult  Dosage. — Min.,  qss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Tincturae  hydrastis. 


HYPOPHOSPHOROSUM  ACIDUM  DILUTUM 


Sig. — One  dram  in  water,  prescribed  in  the  same 
way  as  the  fluid  extract. 

Physiologic  Action  and  Uses. — Uterine  stimulant; 
hasmostatic;  stomachic;  exerts  a peripheral  exciting 
action  upon  the  utenis  and  upon  the  blood-vessels, 
and  also  stimulates  the  vasomotor  centre. 

Toxic  Action. — Indigestion,  constipation,  tetanic 
convulsions,  motor  depression,  medullary,  spinal, 
and  cardiac  depression. 

Hydriodici  Acidi  Syrupus  (1  per  cent,  of  HI). 

Dosage. — 5 years,  i^v-x.  Adult,  min.,  3ss;  av.,i; 
max.,  ii. 

Method  of  Administration. — I^  Syrupi  acidi 
hydriodici,  gii. 

Sig. — ^3i,  well  diluted,  t.i.d. 

Uses. — Alterative;  used  in  coughs. 

Hydriodicum  Acidum  Dilutum  (10  per  cent,  of 
HI  by  weight). 

Adult  Dosage. — Min.,  i^v;  av.,  x;  max.,  lx. 

Method  of  Administration. — I^  Acidi  hydriodici 
diluti,  5i. 

Sig. — Ten  drops  in  a tablespoonful  of  water,  t.i.d. 

U ses. — Alterative . 

Hydrobromicum  Acidum  Dilutum  (10  per  cent, 
of  HBr). 

Adult  Dosage. — Min.,  TTgxx;  av.,  3i;  max.,  ii. 

Method  of  Administration. — I^  Acidi  hydrobro- 
mici  diluti,  3 ii. 

Sig. — 3i,  well  diluted,  every  three  to  four  hours. 

Uses. — Nervous  sedative. 

Hydrochloricum  Acidum  Dilutum  (10  per  cent,  of 
HCl  by  weight). 

Dosage. — 6 months,  gt.  18  months,  gt.  i; 

3 years,  gtt.  ii;  5 years,  gtt.  iii-v.  Adult,  min.,  njv; 
av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Acidi  hydrochlo- 
rici  diluti,  5ii- 

Sig. — Twenty  drops  in  half  a tumbler  of  sweetened 
albumen  water,  taken  through  a straw  or  glass  tube, 
during  and  one-half  to  one  hour  after  meals.  Rinse 
the  mouth  afterwards  with  soda  water. 

Uses. — Digestant;  antiseptic  and  antifermenta- 
tive;  astringent;  astringent  gargle. 

Hydrocyanicum  Acidum  Dilutum  (2  per  cent,  of 
HCN  by  weight;  keep  tightly  stoppered  in  a cool, 
dark  place;  it  will  decompose  within  a year). 

Adult  Dosage. — Min.,  i^i;  av.,  iss;  max.,  iii,  not 
drops. 

Method  of  Administration. — Acidi  hydrocy- 
anici  diluti,  irjiv;  aquam  ad,  3iv. 

M.  Sig.— One  dram,  repeated  if  necessary. 

Uses. — Gastric  analgesic  and  sedative. 

Toxic  Action. — Palpitation,  cardiac  depression, 
dizziness,  tinnitus,  vomiting,  muscular  weakness, 
dyspnoea,  salivation,  headache;  numbness;  often 
insensibility,  convulsions  or  rigidity,  and  death. 

Hydrogenii  Dioxidi  Liquor  (H2O2  about  3 per 
cent.;  with  a small  amount  of  phosphoric  acid  to 
prevent  deterioration). 

Adult  Dosage. — Min.,  5ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — I^  Liquoris  hydro- 
genii dioxidi,  5 h- 

Sig. — Teaspoonful,  diluted  with  four  parts  of 
water,  t.i.d. 

For  woimds,  dilute  one  part  with  four  of  water. 

For  mucous  membranes,  dilute  1 : 7 as  a spray. 

Uses. — Local  antiseptic  (very  feeble)  and  hajmo- 
static;  intestinal  antiseptic.  The  frothing  is  due  to 
the  liberation  of  gaseous  oxygen  brought  about  by 
the  action  of  an  enzjroe,  ‘xatalase,”  present  in 
blood,  pus  and  muscle  juice. 

Hyoscinae  (Scopolaminae)  Hydrobromidum  (solu- 
ble in  1.5  of  water  and  20  of  alcohol.  The  alkaloid, 
hyoscin,  C17H21NO4,  is  the  tropic  acid  ester  of 
scopolamine). 


Adult  Dosage. — Min.,  gr.  Koo)  av.,  %o‘,  max., 

Method  of  Administration. — 1^  Hyoscinse  hydro- 
bromidi,  gr.  }ioo-%o,  tabellse  no.  6. 

Sig. — A tablet  by  mouth  or  hypodermically,  sev- 
eral tunes  daily. 

Uses. — Cerebral  sedative;  anodyne;  hypnotic; 
mydriatic. 

Toxic  Action. — Central  respiratory  depression, 
fall  of  blood-pressure,  dryness  in  the  mouth  and 
throat,  mydriasis  and  paralysis  of  accommodation, 
hypnosis,  delirium,  collapse. 

Hyoscyami  Extractum. 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  viii. 

Method  of  Administration. — I^  Extracti  hyo- 
scyami, gr.  i-ii,  pilula;  no.  12. 

Sig.— Pill,  t.i.d. 

Uses. — Cerebral  sedative;  anodyne;  hypnotic. 

Hyoscyaminse  Hydrobromidum  (very  soluble  in 
water). 

Adult  Dosage. — Min.,  gr.  Koo;  av.,  K28;  max.,  Koo- 

Method  of  Administration. — In  tablet  form;  larger 
doses  for  the  insane,  several  times  daily,  by  mouth 
or  hypodermically. 

t/ses.— Cerebral  sedative;  anodvme;  hvpnotic; 
mydriatic. 

Hyoscyami  Tinctura. 

Dosage. — 6 months,  gt.  ss-i;  18  months,  gtt.  i-ii; 
3 years,  gtt.  iii;  5 years,  gtt.  iii-v.  Adult,  min.,  rrgv; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — I^  Tinctura)  hyo- 
scyami, gi. 

Sig. — Fifteen  drops,  in  water,  t.i.d. 

Uses. — Cerebral  sedative;  anodyne;  hypnotic. 

Hydronaphthol  (said  to  be  an  impure  beta- 
naphthol). 

Adult  Dosage. — Min.,  gr.  i;  max.,  iii  +. 

Method  of  Administration. — I^  Hydronaphthol, 
gr.  iii,  pilula)  (keratin  or  salol  coated)  no.  21. 

Sig.-^ne  pill,  t.i.d.a.c. 

C/ses.— Intestinal  antiseptic. 

Hypnal  (combination  of  chloral  and  antipyrine; 
soluble  in  6 of  water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Hypnal,  gr.  xv, 
pulveres  no.  4. 

Sig. — A powder  in  solution,  well  diluted,  best  per 
rectum,  every  four  hours. 

Uses. — Analge.sic;  hypnotic. 

Hypophosphis  Calcii,  Ca(PH202)  (soluble  in  6.5  of 
water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  xv. 

Method  of  Administration. — ^ Calcii,  potassii, 
vel  sodii  h}q)ophosphitis,  3ii  Bu  (gr.  x per  dose); 
syrupi  simplicis,  gh;  aqua),  q.s.  ad,  giv. 

Sig. — Dessertspoonful,  t.i.d. 

U ses. — Alterative. 

Hypophosphis  Potassii,  KH2PO2  (soluble  in  0.6  of 
water). 

Adidt  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  x. 

Method  of  Administration. — (See  above). 

Uses. — -Alterative. 

Hypophosphis  Sodii,  NaH2P02-|-H20  (soluble  in 
one  of  water;  soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xw;  max.,  xxx. 

Method  of  Administration. — (See  above). 

U ses. — Alterative. 

Hypophosphitum  Syrupus  (Ca.,  Sod.,  and  Pot.). 

Dosage. — 6 months,  3ss;  18  months,  3 Mi  3 years, 
3i;  5 yeans,  3i-ii-  Adult,  min.,  3ii;  av.,  iiss;  max.,  iv. 

Method  of  Administration. — I^  Syrupi  hypophos- 
phitum, 5 viii. 

Sig. — Dessertspoonful,  t.i.d. 

Uses. — Alterative. 

Hypophosphorosum  Acidum  Dilutum  (10  per 
cent,  of  II3PO2  in  water). 


lODEX 


Adult  Dosage. — Min.,  i^v;  av.,  x;  max.,  xx. 

Method  of  Administration. — Acidi  hypophos- 
phoro.si  djluti,  5ii- 

Sig. — Twenty  drops  in  water,  t.i.d. 

Uses. — Aphrodisiac. 

Hypophysis  Liquor  (Posterior  Lobe). 

Adult  Dosage. — Min.,  njv;  max.,  xv. 

Method  of  Administration. — Used  hypodermically. 
Says  H.  H.  Dale:  “When  a ma.ximal  dose  has  been 
given,  further  doses  have  practically  no  effect  for  a 
few  hours. 

Physiologic  Action  and  Uses. — Uterine,  intestinal, 
and  cardio- vascular  stimulant;  promotes  the  con- 
tractility and  increases  the  tone  of  involuntary  and 
cardiac  muscle;  excites  the  activity  of  the  kidneys 
and  mammary  glands;  useful  in  collapse,  intestinal 
paresis,  and  uterine  atony. 

Hypophysis  Sicca  (Posterior  Lobe). 

Adult  Dosage. — Min.,  gr.  ss;  max.,  hi. 

Method  of  Administration. — Hypophysis  siccae, 
gr.  ss,  capsulai  no.  60. 

Sig. — Capsule  four  times  daily. 

Eight  to  ten  grains  per  diem  may  probably  be 
given  by  mouth. 

Oral  administration,  however,  is  said  to  be 
ineffective. 

Hyposulphis  Sodii;  Sodii  Thiosulphas:  Na2S«03 
-I-5H2O  (soluble  in  0.5  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Sodii  hyposul- 
phitis,  pv  ^i  (gr.  xx  per  dram);  aquse,  q.s.  ad,  gii. 

M.  Sig.— ^ne  dram  3 to  4 times  a day. 

External  antiseptic  and  parasiticide:  10  per  cent, 
lotion  or  ointment. 

Physiologic  Action  and  Uses. — Partly  decomposed 
by  the  acid  of  the  stomach  into  sulphurous  acid, 
with  the  eventual  formation  of  sulphate,  which 
acts  as  a purgative.  Gastric  and  external  antiseptic 
and  parasiticide. 

Ichthalbin;  Ichthyoli  Albuminas. 

Dosage. — 6 to  18  months,  gr.  ii-v;  3 to  5 years, 
gr.  x-xv.  Adult,  min.,  gr.  xv;  av.,  xx;  max.,  xxx. 

Method  of  Administration. — Ichthalbin,  gr. 
XX,  tabellse  (chocolate)  no.  30. 

Sig. — One  tablet,  t.i.d. 

For  infants  it  may  be  given  in  gruel.  For  older 
children,  mixed  with  scraped  chocolate. 

Uses. — Intestinal  antiseptic;  alterative. 

Ichthyoli  Unguentum  (5  to  50  per  cent.). 

Uses. — Antiphlogistic ; antiseptic. 

Ichthyolum  (Ammonium  Sulpho-ichthyolate, 
C28H36S30e(NH4)2;  contains  about  10  per  cent,  of 
sulphur). 

Adult  Dosage. — Min.,  TTgih;  av.,  x;  max.,  xxx. 

Method  of  Administration. — I^  Ichthyoli,  igjx, 
capsulae  no.  30  (hardened  with  formalin). 

Sig. — Capsule,  t.i.d. 

It  may  be  prescribed  in  solution  in  water  or  pep- 
ptermint  water. 

It  may  be  given  up  to  piss  daily. 

3i  to  the  quart  as  a colonic  enema. 

Uses. — Intestinal  antiseptic;  alterative. 

Infusum  Adonis  Vernalis.— See  Adonis  Vernalis, 
Infusum. 

Infusum  Alii. — See  Alii,  Infusum. 

Infusum  Buchu. — See  Buchu,  Infusum. 

Infusum  Calumbse. — See  Calumba;,  Infusum. 

Infusum  Chiratsc. — See  Chirata^  Infusum. 

Infusum  Digitalis  Recens.— See  Digitalis,  Infusum. 

Infusum  Qentianae  Compositum.--^e  Gentianae, 
Infusum  Compositum. 

Infusum  Humuli. — See  Humuli,  Infusum. 

Infusum  Juniperi  (Juniper  berries.  5i,  in  boiling 
water  Oi^^for  one  hour,  then  strained). 

Adult  Dosage. — §i-ii. 


Method  of  Administration. — I^  Infusi  juniperi,  Oi. 

Sig. — Two  ounces  every  two  hours,  with  plenty  of 
water,  up  to  one  pint  in  twenty-four  hours. 

Physiologic  Action  and  Uses. — Irritant  diuretic; 
diaphoretic;  contraindicated  in  acute  nephritis. 

^ Infusum  Lini;  Flaxseed  or  Linseed  Tea  (Linseed 
3iii,  licorice  root  3i,  boiling  water  gx,  infused  for 
four  hours  and  strained). 

Dosage. — Indefinite. 

Uses. — Demulcent;  expectorant;  diuretic. 

Infusum  Pareirae  (gi  ad  Oi). 

Adult  Dosage. — Min.,  gi;  max.,  ii. 

Method  of  Administration. — I^  Infusi  pareira?,  Oi. 

Sig. — One  to  two  oimces,  three  or  four  times  daily, 
with  plenty  of  water. 

Uses. — Bitter  tonic;  diuretic;  laxative. 

Infusum  Picis  Liquidae;  Liquor  Picis  Alkalinus, 
N.  F.  (Tar  25,  pot.  hydrox.  12.5,  water  to  100). 

Uses. — Local  antiseptic  and  stimulant. 

Infusum  Quassise  (Quassia  chips  gi,  cold  water 
gx,  macerated  for  half  an  hour  and  strained). 

Adult  Dosage. — Min.,  gi;  max.,  hi. 

Method  of  Administration. — I^  Infusi  quassise, 
gviii. 

Sig. — ;Two  tablespoonfuls  to  a wineglassful,  t.i.d. 

For  pin  worms,  gi-ii  of  the  chips  are  macerated  in 
Oi  of  boiling  water  and  the  resulting  solution  injected 
high  into  the  bowel. 

Uses. — Simple  stomachic  bitter;  anthelmintic. 

Infusum  Salvise  (Sage  infusion). 

Adidt  Dosage. — Min.,  gi;  max.,  ii. 

Method  of  Administration. — I^  Infusi  salvise,  Oi. 

Sig. — Two  table.spooufuls  to  a wineglassful,  t.i.d. 

Uses. — Anhidrotic. 

Infusum  Scoparii  (Broom  Tops  gss  in  water  Oiss, 
boiled  down  to  a pint). 

Adult  Dosage. — Av.,  gh. 

Method  of  Administration. — I^  Scoparii,  giv; 
aquse,  Oiss. 

Boil  down  to  a pint  and  filter. 

Sig. — '^o  ounces  or  a wineglassful,  frequently, 
until  a pint  is  taken  in  twenty-four  hours. 

Uses. — Diuretic;  laxative. 

Infusum  Senegae  (B.  P.). 

Adult  fiosage. — Min.,  gss;  max.,  i. 

Uses. — Stimulating  or  nauseant  expectorant  (due 
to  saponin) ; diuretic;  diaphoretic. 

Toxic  Action. — Cardio-vascular  depression,  weak- 
ness. 

Infusum  Tritici;  Couch  Grass  Infusion. 

Adult  Dosage. — Av.,  gh. 

Method  of  Administration. — Tritici,  gi;  aquae, 
Oiss. 

Boh  down  to  a pint,  and  filter. 

Sig. — Two  ounces  or  a wineglassful,  frequently, 
until  a pint  is  taken  in  twenty-four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Infusum  Uvae  Ursi  (gi  in  Oi). 

Adult  Dosage. — Min.,  gi;  max.,  h. 

Method  of  Administration. — I^  Infusi  uv£e  ursi, 
gviii. 

Sig. — ^Two  tablespoonfuls  three  to  four  times  daih'. 

Physiologic  Action  and  Uses. — Diuretic;  urinary 
antiseptic  and  sedative;  contains  the  glucoside 
arbutin,  which  is  split  up  in  the  kidney  into  sugar 
and  the  antiseptic  hydrochinone. 

Ingluvinum  (a  bitter  obtained  from  the  gizzard  of 
the  fowl;  not  a digestive  ferment). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xx;  max.,  xxx.. 

Method  of  Administration. — I^  Ingluvuu,  gr.  xx, 
pulveres  no.  12. 

Sig. — Powder,  half  an  hour  before  meals. 

Uses. — Gastric  sedative. 

lodex;  Pigm.  lodi,  M.  and  J. 

Method  of  Administration. — I^sed  for  gentle 


lODOTHYRIN 


inunction  upon  inflamed  glands  or  wounds,  about 
every  two  hours.  It  is  highly  praised. 

Uses. — Local  antiseptic  and  stimulant. 

lodidum  Ammonii,  NH4I  (soluble  in  0.6  of  water). 

Adidt  Dosage. — Min.,  gr.  ii;  av.,  v;  max.,  x. 

Method  of  Administration. — Ammonii  iodidi, 
3iv;  aquae  destillatae,  3iv. 

M.  Sig. — ^Two  to  five  drops,  well  diluted  in  water 
or  milk,  t.i.d.p.c.  gradually  increased,  if  required. 

Physiologic  Action  and  Uses. — Expectorant;  diu- 
retic; discutient;  alterative,  antiluetic;  relieves  bron- 
chial spasm,  possibly,  as  suggested  by  Halsey,  by 
stimulating  the  thyroid  function,  which  stimulates 
the  chromaffin  organs  with  resulting  increase  of 
epinephrin,  the  latter  producing  relaxation  of  the 
bronchial  muscles  by  stimulation  of  the  sympathetic 
nerve-endings  in  the  lungs;  increases  the  amount  of 
thyroidin  in  the  thyroid  gland. 

Toxic  Action. — lodism:  coryza,  lacrimation,  con- 
junctival injection,  sneezing,  respiratory  catarrh, 
cough,  salivation,  sore  throat,  conjunctivitis,  head- 
ache, tinnitus,  swelling  of  the  salivary  glands, 
localized  oedema  (of  the  eyelids,  larynx),  indigestion, 
nausea,  vomiting,  diarrhoea,  saline  or  metallic  taste 
in  the  mouth,  neuralgic  pains,  anaemia,  emaciation, 
acne,  erythema,  purpura,  etc.,  mental  depression. 

lodidum  Calcii:  CaL. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xx. 
Praised  as  a cough  remedy. 

lodidum  Potassii,  KI  (soluble  in  0.7  of  water) 
M i (more  than  one  drop)  of  a saturated  solution, 
contains  about  gr.  i of  KI. 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v; 
av.,  viii;  max.,  xx. 

Method  of  Administration. — Potassii  iodidi, 
5iv;  aquae  destillatae,  3iv. 

Sig. — Five  to  eight  drops,  well  diluted  in  water 
or  milk,  t.i.d.p.c.,  gradually  increased  even  to  20 
or  60  drops,  t.i.d. 

Every  week,  intermit  the  drug  for  four  to  five  days. 

Physiologic  Action  and  Uses.—See  above. 

Toxic  Action. — See  above. 

lodidum  Sodii,  Nal  (soluble  in  0.55  of  water,  and 
in  3 of  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v; 
av.,  viii;  max.,  xx. 

Method  of  Administration. — I^  Sodii  iodidi,  3iv; 
aquae  destillata;,  3iv. 

Sig. — Five  to  six  drops^  well  diluted  in  water  or 
milk,  t.i.d.p.c.,  gradually  increased  even  to  20  to  60 
drops  t.i.d. 

Every  week,  intermit  the  drug  for  four  to  five  days. 

Physiologic  Action  and  Uses. — See  above. 

Toxic  Action. — See  above. 

lodidum  Thymolis;  Aristol;  Dithymol-di-iodid ; 
(C6H2.CH3.C3H7OD2. 

Physiologic  Action  and  Uses. — Antiseptic  powder, 
less  efficient  than  iodoform. 

lodidum  Zinci:  Znl2  (very  soluble  in  water  and  in 
alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — In  syrup. 

lodi  Linimentum. 

lodi  Liquor  Compositus;  Lugol's  Solution  (iodine: 
5,  pot.  iodi  10,  distilled  water  to  100). 

Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  x. 

Method  of  Administration. — Liquoris  iodi  com- 
positi,  5ss- 

Sig. — 'Three  drops,  in  a wineglassful  of  water, 
t.i.d.p.c. 

Uses. — Alterative. 

Iodi  Tinctura  (I  about  7,  KI  about  5,  alcohol  to 

100). 


Adult  Dosage. — Min.,  npi;  av.,  iii;  max.,  v. 

Method  of  Administration. — I^  Tincturse  iodi, 
gss. 

Sig. — Three  drops,  well  diluted  in  water, 
t.i.d.p.c. 

For  vomiting,  one  drop  in  a teaspoonful  of  water, 
every  ten  to  thirty  minutes,  usually  with  one  drop 
of  carbolic  acid. 

Uses. — Alterative;  gastric  sedative;  local  anti- 
•septic  and  counter-irritant. 

Iodi  Tinctura  Churchillii. 

Composition. — Iodi,  gr.  Ixxv;  potassii  iodidi, 
3iss;  alcoholis,  gi. 

Uses. — Local  antiseptic  and  counter-irritant. 

Iodi  Trichloridum. 

Method  of  Administration. — I^  Iodi  trichloridi, 
gr.  v;  aquae,  gi.  (1  per  cent,  of  solution.) 

M.  Sig. — For  local  use. 

Uses. — Local  antiseptic. 

lodi  Unguentum  (Iodine  4,  pot.  iodide  4,  glycerine 
12,  benzoinated  lard  80). 

Method  of  Preparation. — Pulverize  the  iodine, 
then  add  a little  alcohol,  and  finally  the  excipient  by 
degrees.  Should  be  prepared  as  required. 

Uses. — Antiseptic  and  counter-irritant. 

Iodine=Petrogen,  5 per  cent. 

Uses. — ^Local  antiseptic  and  counter-irritant. 

Iodine=Vasogen,  4 to  8 per  cent. 

lodipin  (Iodized  Sesame  Oil). 

Adult  Dosage. — Min.,  gss;  max.,  ii. 

Method  of  Administration. — Of  10  per  cent,  iodi- 
pin,  by  mouth,  in  capsules  or  emulsion,  three  or  four 
times  a day,  3 i-ii-  Of  25  per  cent,  iodipin,  hypo- 
dermically, once  daily,  gss  to  iss. 

U ses.  — Alt  e rative . 

Iodized  Phenol;  lodum  Phenolatum  (usually, 
iodine  1,  to  crystalhzed  phenol  4). 

Uses. — Antiseptic  and  counter-irritant. 

lodoformi  Unguentum  (Iodoform  10,  lard  90). 

Uses. — Antiseptic. 

lodoformum;  Triiodomethane : CHI3. 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  vi. 

Method  of  Administration. — I^  lodoformi,  gr.  iv, 
pilulse  vel  capsulse  no.  30. 

Sig. — One,  t.i.d. 

It  may  also  be  dissolved  in  codliver  oil. 

Uses. — Alterative;  local  antiseptic,  stimulant  and 
anaesthetic. 

Toxic  Action. — Restlessness,  headache,  insomnia, 
nausea  and  vomiting,  anassthesia,  sometimes  uncon- 
sciousness, occasionally  convulsions,  hallucinations, 
and  delusions  of  persecution,  rapid  pulse,  fever, 
perhaps  collapse,  coma,  death. 

lodoglycerinum. 

lodolum:  Tetraiodopyrrol:  C4I4NH. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  x. 

Method  of  Administration. — Q lodoli,  gr.  iv 
pilulae  no.  30. 

Sig. — One,  t.i.d.p.c. 

Uses. — Alterative ; antiseptic. 

lodophen;  Nosophen;  Tetra-iodo-phenolphtha- 
lein). 

Adult  Dosage. — Min.,  gr.  v;  max.,  viii. 

Uses. — Antiseptic  powder. 

lodothyrin;  Thyroidin  (Thyroglobulin : split  off 
from  thyroid  protein  by  acid  hydrolysis). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iss;  max.,  v-x. 

Method  of  Administration. — 1^  lodothyrin,  gr.  ss, 
tabella;  no.  30. 

Sig. — Tablet,  t.i.d.,  gradually  and  cautiously 
increased. 

See  Cretinism,  and  Myxcedema,  Part  1. 

Physiologic  Action  and  Uses. — Alterative;  not  as 
reliable  as  thryoid  substance  (see  Thyroideum 
siccum). 


JUNIPERI  SPIRITUS 


lodovasogen  (4  to  8 per  cent.)- 

Uses. — Antiseptic  and  counter-irritant. 

loduni:]  (soluble  in  2950  of  water,  12.5  of  alcohol; 
freely  soluble  in  solutions  of  alkali  iodides). 

Adult  Dosage. — Min.,  gr.  )4o;  av.,  Ko;  max., 

Method  of  Administration. — Well  diluted. 

Uses. — Antiseptic. 

lodum  Phenolatum  (usually,  iodine  1,  to  phenol  4). 

Uses. — Antiseptic  and  counter-irritant. 

Ipecacuanhas  Fluidextractum. 

Adult  Dosage. — As  an  expectorant,  Min.,  irgss;  av., 
i;  max.,  ii,  in  water,  every  two  to  four  hours.  As  an 
emetic  Min.,  i^x;  av.,  xx;  max.,  xxx,  (diluted). 

Physiologic  Action  and  Uses. — Stimulative  expec- 
torant; emetic  (acts  reflexly);  diaphoretic;  gastric 
and  hepatic  stimulant. 

Ipecacuanhas  et  Opii  Pulvis;  Dover’s  Powder 
(Ipecac  10,  powdered  opium  10,  sugar  of  milk  80). 

Dosage.-^  months,  gr.  ; 18  months,  gr.  ; 
3 years,  gr.  i-iss;  5 years,  gr.  ii-iii.  Adult,  min., 
gr.  v;  av.,  viiss;  max.,  xv. 

Method  of  Administration. — R Pulveris  ipeca- 
cuanhae  et  opii,  gr.  v,  pulveres  no.  6. 

Sig. — One  powder  as  required  (about  every  three 
to  four  hours,  if  necessary). 

Uses. — Nervous  sedative;  sedative  expectorant; 
diaphoretic. 

Ipecacuanhae  et  Opii  Tinctura  (Tr.  opii  deod.  100 
evaporated  to  80,  fl.  ext.  ipecac  10,  diluted  alcohol  to 
100;  Dover’s  powder  in  hquid  form). 

Adult  Dosage. — Min.,  t^v;  av.,  viii;  max.,  xv. 

Method  of  Administration. — R Tincturae  ipe- 
cacuanha; et  opii. 

Sig. — Five  to  eight  drops,  in  water,  as  required 
(about  every  three  to  four  hours  if  necessary). 

Uses. — Nervous  sedative;  sedative  expectorant; 
diaphoretic. 

Ipecacuanhae  Pulvis  (The  powdered  Brazilian 
root  is  richest  in  the  alkaloid,  emetine). 

Adult  Dosage. — ^As  an  e.xpectorant,  Min.,  gr.  ss; 
av.,  i;  max.,  ii,  every  two  hours.  As  an  emetic,  Min., 
gr.  x;  av.,  xv;  max.,  xx. 

In  amoebic  dysentery  it  is  given  in  salol-coated 
piUs,  each  0.3  to  4 grams.  See  Dysentery,  Amcebic, 
Part  1. 

Uses. — ^Expectorant;  emetic;  amoebicide. 

Toxic  Action. — ^Vomiting,  purging,  haemoptysis 
and  other  hemorrhages. 

Ipecacuanhae  Syrupus. 

Adult  Dosage. — As  an  expectorant,  Min.,  njx; 
av.,  XV ; max.,  xx,  every  one  to  three  hours.  As  an 
emetic,  Min.,  3ii;  av.,  iv;  max.,  vi.  To  a child,  3i 
every  ten  to  fifteen  minutes,  until  vomiting  occurs. 

Uses. — Expectorant;  emetic. 

Ipecacuanhae  Vinum. 

Adult  Dosage. — As  an  expectorant,  Min.,  t^ix;  av., 
XV ; max.,  xx,  every  one  to  two  hours.  As  an  emetic, 
Min.,  3ss;  av.,  iv;  max.,  vi.  To  a child,  3i  every 
ten  to  fifteen  minutes,  until  vomiting  occuis. 

Uses. — Expectorant;  emetic. 

Iron;  Ferrum. — See  Ferri. 

Iron  Somatose  (Somatose  which  is  said  to  contain 
nearly  90  per  cent,  of  albumose,  plus  iron).  Gr.  Ixxx 
correspond  to  about  1 ounces  of  fresh  beef. 

Uses. — Nutrient  tonic. 

Irontropon. 

Isopral  (Trichlor-isopropyl-alcohol;  soluble  in 
water  and  alcohol). 

Adult  Dosage. — Min.,  gr.  viii;  av.,  x;  max.,  xii. 

Method  of  Administration. — R Isopral,  gr.  x, 
pulveres  no.  4. 

Sig. — Powder  at  bedtime. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
hypnotic;  acting  in  fifteen  to  thirty  minutes. 

Toxic  Action. — Lowering  of  blood-pressure. 


Jaborandi  Fluidextractum  (Pilocarpi). 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Fluidextracti  pilo- 
carpi, 5ss. 

Sig. — njxxx  in  water,  at  night  (contraindicated  if 
the  heart  is  weak). 

Physiologic  Action  and  Uses. — Diaphoretic;  sia- 
logogue:  promotes  absorption  of  inflammatory  ex- 
udate. 

Jalapae  Pulvis  Compositus  (Jalap  35,  pot.  bitart- 
rate 6.5). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Philveris  jalapse 
compositi,  gr.  xxx,  no.  6. 

Sig. — ^A  powder,  in  a little  water,  once  or  twice 
a day. 

Physiologic  Action  and  Uses. — Hydragogue  ca- 
thartic; (local  irritant;  acts  on  both  large  and  small 
bowel);  diuretic. 

Jalapae  Resina. 

Dosage. — 3 years,  gr.  ii;  5 years,  gr.  iii.  Adult, 
min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Resinae  jalapae, 
gr.  ii-iii,  pilulae  no.  6. 

Sig. — Pill  at  bedtime. 

Physiologic  Action  and  Uses. — Hydragogue  ca- 
thartic; (local  irritant;  acts  on  both  large  and  small 
bowel);  diuretic. 

Jambul. 

Adult  Dosage. — Min.,  gr.  v;  max.,  xxx. 

Method  of  Administration. — R Jambul,  gr.  v- 
XXX,  tabellae  no.  30. 

Sig. — One  tablet,  with  or  after  meals,  t.i.d. 

Physiologic  Action  and  Uses. — Diminishes  glyco- 
suria; prolonged  use  produces  gastric  irritation. 

Jequiritol  (Romer)  and  Jequiritol  Serum  (Merck). 

Method  of  Administration. — For  the  jequirity 
treatment  of  old  pannus,  see  Part  6,  Eye  Diseases. 

Physiologic  Action  and  Uses. — Irritant  diuretic; 
diaphoretic;  contraindicated  in  acute  nephritis. 

Toxic  Action. — Gastro-enteritis ; strangury;  pri- 
apism; hsematuria;  nephritis;  p>elvic  congestion 
(abortion),  suppression  of  urine,  uraemia. 

Juniper!  Infusum  (Juniper  Berries  gi  in  boihng 
water  Oi  for  one  hour,  then  strain). 

Adult  Dosage. — Min.,  5i;  max.,  ii. 

M ethod  of  Administration. — R Infusi  juniperi,  Oi. 

Sig. — ^Two  ounces,  every  two  hours,  with  plenty 
of  water,  up  to  one  pint  in  twenty-four  hours. 

Physiologic  Action  and  Uses. — Irritant  diuretic; 
diaphoretic;  contraindicated  in  acute  nephritis,  as 
it  may  cause  urinary  suppression. 

Toxic  Action. — Gastro-enteritis;  strangury;  pria- 
pism; haematuria;  nephritis;  p>elvic  congestion  (abor- 
tion), suppression  of  urine,  uraemia. 

Juniperi  Oleum. 

Adult  Dosage. — -Min.,  T^i;  av.,  v;  max.,  xv. 

Method  of  Administration.— Olei  juniperi, 
ngiii-v,  capsulae  no.  6. 

Sig.— One  capsule,  t.i.d.,  with  plenty  of  water. 

Physiologic  Action  and  Uses. — Irritant  diuretic; 
diaphoretic;  contraindicated  in  acute  nephritis 

Toxic  Action. — Giistro-enteritis;  strangury;  pria- 
pism; haematiuia;  nephritis;  pelvic  congestion  (abor- 
tion), suppression  of  urine,  uraemia. 

Juniperi  Spiritus  (5  per  cent,  of  the  oil). 

Adidt  Dosage. — Min.,  3ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — R Spiritus  juniperi, 

5i. 

Sig. — 3ss-i,  with  plenty  of  water,  t.i.d. 

Physiologic  Action  and  Uses. — ^Irritant  diuretic; 
diaphoretic;  contraindicated  in  acute  nephritis. 

Toxic  Adron.— Giistro-enteritis;  strangury;  pria- 
pism; haematuria;  nephritis;  pelvic  congestion  (abor- 
tion), suppression  of  urine,  uraemia. 


LANOLIN 


Juniper!  Spiritus  Compositus  (Juniper  oil  8, 
caraway  oil  1,  fennel  oil  1,  alcohol  1400,  water  to 
2000;  practically  gin.) 

Adult  Dosage. — Min.,  3i;  av.,  ii;  max.,  iv. 

Method  of  Administration. — Spiritus  juniperi 
compositi. 

Sig. — ^Two  teaspoonfuls,  well  diluted,  t.i.d. 

Junket:  Curds  and  Whey. 

Preparation. — Add  a junket  tablet  or  two  tea- 
spoonfuls of  essence  of  pepsin  or  liquid  rennet  to  a 
pint  of  fresh  lukewarm  milk,  and  allow  to  stand  at 
room  temperature  until  firmly  coagulated. 

Kaolinum;  Bolus  Alba  (purified  native  aluminum 
sihcate). 

Adult  Dosage. — -Av.,  5ss. 

Method  of  Administration. — Kaolin  may  be  given 
ad  libitum  in  an  equal  amount  of  water. 

K Kaolini;  Carbonis  ligni,  aa. 

M.  Sig. — Two  tablespoonfuls,  once  to  thrice  a day. 

Physiologic  Action  and  Uses. — Absorbent  in  diar- 
rhoea or  dysentery.  It  probably  acts  by  absorbing 
toxines  and  mechanically  carrying  bacteria  away 
with  it. 

Kaolini  Cataplasma  (glycerine  37}^  parts  by 
weight,  boric  acid  43^  ,thymol  Ko,  methyl  salicylate 
%,  oil  of  peppermint  ]4o,  kaohn  57^,  heated  and 
mixed  together). 

Uses. — Antiphlogistic  poultice,  similar  to  anti- 
phlogistine. 

Kephalin;  a brain  phosphatid. 

Uses. — Local  ha;mostatic. 

Kephir  (lactic  acid  and  alcohohc  fermentation  of 
cow’s  or  mare’s  milk,  caused  by  a mixture  of  bacteria 
and  yeasts). 

Method  of  Preparation. — ^Add  one  kefir  pastille 
to  one  quart  of  cow’s  milk;  keep  at  a temperature 
of  21°  to  27°  C.  until  the  kefir  grains  rise  to  the 
surface;  then  strain  the  grains  off,  and  place  the 
milk  in  well-corked  bottles,  to  continue  fermenting. 

Kino. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  x. 

Method  of  Administration. — Kino  gr.  viii,  pul- 
veres  no.  12. 

Sig. — Powder  three  or  four  times  daily. 

Uses. — ^Astringent. 

Kino  Pulvis  Compositus  (Kino  15,  opium  1, 
cinnamon  4). 

Adidt  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — K Pulveris  kino 
compositi,  gr.  xv,  pulveres  no.  12. 

Sig. — One  powder,  once  or  twice  a day. 

Uses. — A.stringent. 

Kino  Tinctura  (10  per  cent.). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Tincturae  kino. 

Sig. — Teaspoonful  in  water  three  or  four  times 
daily. 

U ses. — Astringent. 

Koumiss;  Lac  Fermentatum  (Fermented  mare’s 
or  cow’s  milk). 

Method  of  Preparation. — To  five  quarts  of  clean, 
fresh  milk,  at  a temperature  of  70°  F.,  add  and 
mix  one  cake  of  Fleischmann’s  yeast  and  five 
heaping  teaspoonfuls  of  ^anulated  sugar.  After 
standing  one-half  hour,  stir  thoroughly,  and  place 
in  beer  bottles  with  lever  corks.  Leave  in  a tempera- 
ture of  70°  for  three  hours,  shaking  twice,  then  in  a 
temperature  of  60°  to  64°  for  a week,  shaking  twice 
a day;  then  on  ice,  shaking  once  a day  until  used. 
In  opening  a bottle,  reverse  it  in  a pitcher,  and  raise 
the  lever  slowly.  (S.  W.  Dana.) 

Wolff’s  method  is  as  follows:  “Dissolve  a table- 
spoonful of  grape  sugar  in  four  ounces  of  water, 
and  a teaspoonful  of  Fleischmann’s  compressed 
yeast  or  brewer’s  yeast  (well  washed  and  pressed 


out)  in  two  ounces  of  cow’s  milk.  Mix  the  two  solu- 
tions in  a quart  champagne  bottle,  and  fill  the  latter 
to  within  two  inches  of  the  top  with  cow’s  milk. 
Cork  well,  secure  the  cork  with  wire,  keep  in  a cold 
cellar,  or  ice-chest,  at  a temperature  of  50°  F.,  or 
less,  and  agitate  twice  daily.”  Use  in  three  to  four 
days;  and  do  not  keep  longer  than  four  to  five  days. 
“Draw  it  with  a champagne  tap.”  If  the  tempera- 
ture be  higher  than  50°  F.,  the  fermentation  will 
be  of  the  objectionable  acetous  variety.  (Potter.) 

Koumiss  may  also  be  made  with  Kumysgen,  with 
which  is  supplied  by  the  manufacturers  a special 
bottle  and  tap.  (Potter.) 

Physiologic  Action  and  Uses. — Koumi.ss  is  nu- 
trient, diuretic,  diaphoretic,  somnolent,  and  anti- 
fermentative. 

Krameriae  Extractum. 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — I^  Extracti  kra- 
meriae, gr.  x,  pilulae  vel  capsula;  (intestinal  coated), 
no.  18. 

Sig. — One,  three  to  four  times  daily. 

Uses. — Astringent  (contains  tannin). 

Krameriae  Fluidextractum. 

Adidt  Dosage. — Min.,  Trgv;  av.,  xv;  max.,  xx. 

Method  of  Administration. — I^  Fluidextracti  kra- 
meriae, 3ss. 

Sig. — Fifteen  drops  in  water,  three  to  four  times 
daily. 

Uses. — ^Astringent  (contains  tannin). 

Krameriae  Tinctura. 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Tincturae  kra- 
meriae, 5ii. 

Sig. — ^Teaspoonful  in  water,  three  to  four  times 
daily. 

Uses. — Astringent  (contains  tannin). 

Krameriae  Trochisci  (Ext.,  gr.  i). 

Uses. — Astringent  (contains  tannin). 

Kreolin.  See  Creolin. 

Lac  Fermentatum.  See  Koumiss. 

Lacticum  Acidum  (75  per  cent,  by  weight). 

Dosage. — 18  months,  gtt.  i;  3 years,  gtt.  ii;  5 years, 
gtt.  iii-v.  Adult,  min.,  iiJ!xx;  av.,  xxx;  max.,  lx. 

Method  of  Administration. — K Acidi  lactici, 
(3ss  per  dose) ; syrupi  simplicis,  aa  5i- 

M.  Sig. — 3i  in  water  every  two  hours. 

Uses. — Intestinal  antifermentative ; local  anti- 
septic; caustic  in  pure  form  (dissolves  protein  and 
keratin) . 

Lactobacilline;  Lactone  (BaciUi  Bulgaricus  et 
Paralacticus). 

Method  of  Administration. — I^  Lactobacilline 
tablets,  no.  60. 

Sig. — Two  to  four  tablets  p.c.,  followed  by  a 
little  sweetened  food  or  water. 

Physiologic  Action  and  Uses. — Intestinal  anti- 
fermentative and  antiseptic;  used  also  to  sterihze 
typhoid  carriers. 

Lactophenin  (Lactylparaphenetidin;  phenacetin  in 
which  the  acetyl  radicle  has  been  replaced  by  the 
lactic  acid  radicle: — C6H4.0C2H5.NH.(CH3CHOH. 
CO). 

Advil  Dosage. — Min.,  gr.  viii;  max.,  xx. 

Method  of  Administration. — K Lactophenii,  gr. 
viii,  tabellas  vel  pulveres  no.  4. 

Sig. — One  as  required  (about  three  times  daily, 
if  necessary) ; no  more  than  gr.  xlv-lxxv  per  diem. 

Uses. — Analgesic;  hypnotic;  antipyretic. 

Lanolin;  Adeps  Lanoe  Hydrosus;  Hydrous  Wool- 
fat  of  the  sheep;  (miscible  with  about  twice  its 
■weight  of  water). 

Physiologic  Action  and  Uses. — Ointment  basis 
employed  when  it  is  desired  that  the  medicament  be 
absorbed  by  the  skin. 


LINSEED  OR  FLAXSEED  TEA 


Lapacticae  Pilulae  (aloin  gr.  strychnine  gr.  Xo, 
ext.  belladonna,  gr.  Vs,  ipecac  gr.  Ke). 

Adult  Dosage. — Min.,  1 pill;  max.,  2 pills. 

Method  of  Administration. — R Pilulae  lapacticae 
no.  60. 

Sig.— One  or  two  pMs  at  bedtime. 

U ses. — Laxative. 

Lassar’s  Peeling  Paste;  R Betanaphthol,  3ss-ii; 
sulphuris  praecipitati,  ^iv;  saponis  viridis,  ^ii; 
petrolati  mollis,  5 ii. 

Method  of  Administration. — Apply  the  paste  at 
night,  and  leave  on  for  ten  to  thirty  minutes,  or 
until  burning  begins,  then  wipe  it  off  with  a cloth 
moistened  with  olive-oil;  wash  with  soap  and  warm 
water,  and  apply  cold  cream.  Repeat  every  night, 
or  two  or  three  times  daily,  until  desquamation 
occurs.  The  patient  should  remain  indoors  during 
the  treatment. 

Laudanum;  Tinctura  Opii. 

Dosage.— Q months,  18  months, 

3 years,  i^i;  5 years,  njii-iii.  Adult,  ngv;  av.,  x; 
max.,  XXX.  (njx  contains  of  opium  gr.  i,  or  mor- 
phine gr.J^). 

Uses. — Nervous  sedative;  analgesic. 

Laurocerasi  Aqua,  B.  P.  (Cherry-laurel  water, 
standardized  to  contain  0.1  per  cent,  of  pure  HCN). 
Adult  Dosage. — Min.,  5ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — -R  Aquas  lauro- 
cerasi, B.  P.,  5i- 

Sig. — One  teaspoonful  in  water,  for  the  relief 
of  vomiting. 

Uses. — Gastric  sedative;  local  antipruritic. 
Lavandulae  Oleum;  Oil  of  Lavender. 

Dosage. — Min.,  iwi;  av.,  iii;  max.,  v. 

Uses. — ^Flavoring  and  perfume. 

Lavandulae  Spiritus  (Oil  5,  in  alcohol  9.5). 

Adult  Dosage. — Min.,  njx;  av.,  x,xx;  max.,  xlv. 
Uses. — Flavoring  agent. 

Lavandulae  Tinctura  Composita  (oil  of  lavender  8, 
oil  of  rosemary  2,  Saigon  cinnamon  20,  cloves  5, 
nutmeg  10,  red  saunders  10,  alcohol  750,  water  to 
1000). 

Adult  Dosage. — Min.,  3ss;  max.,  ii. 

Uses. — Flavor;  stimulant;  carminative. 

Lead  Acetate;  Sugar  of  Lead;  Plumbi  Acetas: 
Pb(CH3COO)2-f-3H'>0  (soluble  in  1.4  of  water  and 
38  of  alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  v. 
Method  of  Administration. — R Plumbi  acetatis, 
gr.  i,  pilulas  no.  12. 

Sig. — One  pill,  t.i.d. 

Physiologic  Action  and  Uses. — Bronchial  and 
intestinal  astringent  and  haemostatic.  A concen- 
trated alcoholic  solution  is  useful  in  ivy  poisoning. 
Lead  and  Opium  Wash;  Lotio  Plumbi  et  Opii: 

R Plumbi  acetatis,  gr.  xxvii;  tincturae  opii, 
3i;  aquarn  ad,  3 hi. 

M.  Sig. — For  external  use. 

R Liquoris  plumbi  subacetatis,  3h-iv;  tinc- 
turac  opii,  5ss-iv;  aquam  ad,  5>v. 

M.  Sig. — -For  external  use. 

Uses. — Astringent,  anodyne  lotion. 

Lead  Subacetate  Solution;  Goulard’s  Extract; 
Liquor  Plumbi  Subacetatis  (Lead  acetate  18,  lead 
oxide  11,  distilled  water  to  100). 

Method  of  Administration. — Diluted  fifteen  to 
thirty  times  vdth  water. 

Physiologic  Action  arvl  Uses. — Astringent  and 
cooling  lotion;  should  not  be  applied  to  denuded 
surfaces. 

Leprolin  (Toxin  produced  by  lepra  bacilli). 

Adult  Dosage. — Av.,  lOc.c. 

Method  of  Administration. — Injected  deep  into 
the  muscles,  every  ten  to  fourteen  daj'S. 

Uses. — For  leprosy  {q.v.,  Part  1.) 


Levulosum;  Fruit  Sugar:  CeH^Os  or  CH2OH. 
CHOH.CHOH.CHOH.CO2CH2OH. 

Adult  Dosage. — Av.,  3v. 

Method  of  Administration. — T.i.d.,  by  mouth  or 
rectum,  in  acidosis  {q.v.,  Part  1). 

In  administering  levidose  per  rectum,  dissolve 
Siss,  together  with  sodium  chloride  3h,  in  a quart 
of  warm  water,  and  introduce  slowly. 

Uses. — Used  in  diabetic  acidosis. 

Limonis  Corticis  Tinctura  (50  per  cent.). 

Adult  Dosage. — Min.,  3ss;  max.,  iv. 

U ses. — Flavor. 

Limonis  Oleum. 

Adult  Dosage. — Min.,  rroi;  av.,  iii;  max.,  v. 

Uses. — Flavor. 

Limonis  Syrupus.  See  Syrupus  Acidi  Citrici. 

Linden  Flowers. 

Method  of  Administration. — Tea,  hot. 

U ses. — -Diaphoretic. 

Lini  Infusum;  Linseed  or  Flaxseed  Tea  (Linseed 
3 hi.  Licorice  root  3i,  boihng  water  3x,  infused  for 
four  hours  and  strained). 

Dosage. — Indefinite. 

Uses. — -Demulcent;  expectorant;  diuretic. 

Linimentum  Ammonise  (Aqua  ammonia;  35,  cot- 
tonseed oil  57,  alcohol  5,  oleic  acid  3). 

U ses. — Rubefacient;  counter-irritant. 

Linimentum  Belladonnae  (camphor  5,  dissolved 
in  fl.  ext.  belladonna  root  to  100). 

Uses. — Local  anodyne,  etc.  See  Atropine. 

Linimentum  Calaminae: 

R Calaimnse  3iv;  zinci  oxidi  3iv;  acidi  carbolic! 
Tijxx-xl;  olei  ohvae  5iv;  hquoris  calcis  5iv. 

M.  Sig. — SRake  well.  For  local  use. 

Uses. — Antiseptic;  antipruritic;  protective. 

Linimentum  Calcis;  Carron  Oil  (lime  water  and 
linseed  or  cottonseed  oil,  aa). 

Uses. — Bland,  protective  emollient. 

Linimentum  Camphorae;  Camphorated  Oil  (cam- 
phor 20,  cottonseed  oil  80). 

Method  of  Administration. — This  preparation,  as 
found  in  drug  stores,  should  not  be  used  hypodermi- 
cally. See  Oleum  Camphorata. 

Uses. — Local  Rubefacient. 

Linimentum  Chloroformi  (chloroform  30,  soap 
hniment  70). 

Uses. — Rubefacient;  anodyne. 

Linimentum  Chloroformi  Compositum  (chloro- 
form 5i,  oil  of  turpentine  5i,  tr.  oph  Sss,  tr.  aconiti 
3h,  soap  hniment  3h). 

Uses. — ^Rubcfacient;  anodyne. 

Linimentum  Hydrargyri. 

Uses. — Used  locally  for  tuberculous  peritonitis. 

Linimentum  lodi. 


Linimentum  Saponis  (white  castile  soap  6,  camphor 
43^,  oil  of  rosemary  1,  alcohol  72)^,  water  to  100). 

Uses. — Mild  rubefacient,  detergent,  and  vehicle. 

Linimentum  Saponis  Mollis;  Tincture  of  Green 
Soap  (soft  soap  65,  oil  of  lavender  2,  alcohol  to  100). 

U ses. — Detergent. 

Linimentum  Terebinthinae  (oil  of  turpentine  35, 
rosin  cerate  65). 

Uses. — Rubefacient  and  counter-irritant. 

Linimentum  Terebinthinae  Aceticum  (oil  of  tur- 
pentine 4,  glacial  acetic  acid  1,  camphor  hniment  4). 

Uses. — Rubefacient  and  counter-irritant. 

Lini  Oleum;  Linseed  Oil,  Raw  (not  boiled  oil). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Glei  lini,  5iv. 

Sig. — Two  tablespoonfuls  twice  or  thrice  daily. 

Uses. — Laxative;  diuretic;  e.xpectorant;  demul- 
cent ; emolhent . 

Linseed  or  Flaxseed  Tea;  Infusum  Lini  (Linseed 
3 iii,  licorice  root  3i,  boihng  water  5-x,  infused  for 
four  hours  and  strained). 


LIQUOR  POTASSII  VEL  SODII  SILICATIS 


Dosage. — Indefinite. 

Uses. — Demulcent;  expectorant;  diuretic. 

Lipanin. 

Adult  Dosage. — Min.,  3i;  ma.x.,  iv;  t.i.d. 

Liquid  Albolene;  Albolenum  Liquidum  (Petroleum 
product). 

Method  of  Administration. — Instilled  with  a medi- 
cine dropper  or  sprayed  with  an  oil  atomizer. 

Uses. — Emollient;  lubricant. 

Liquid  Paraffin.  See  Petroleum  Liquidum. 

Liquid  Peptonoids  (liquid  form  of  Beef  Peptonoids, 
q.v.). 

Adult  Dosage. — Min.,  5ss;  max.,  i.  Three  to  six 
times  daily. 

Uses. — Nutrient;  500  gm.  furnish  410  calories,  of 
which  125  are  due  to  protein  and  285  to  carbohy- 
drates. 

Liquid  Petrolatum;  Liquid  Paraffin;  Mineral  Oil. 

Adult  Dosage. — Min.,  5ss;  max.,  iii. 

Method  of  Administration. — Paraffini  liquidi 
purificati,  §viii. 

Sig. — One-half  to  three  ounces  a day,  in  a single 
dose  on  retiring,  or  in  divided  doses;  or  two  tea- 
spoonfuls to  two  tablespoonfuls  one-half  hour  before 
meals.  Do  not  give  it  with  meals,  to  avoid  indiges- 
tion. Remove  the  taste  with  warm  water,  milk  or  a 
bite  of  dry  bread. 

Uses. — -Laxative;  emollient;  vehicle. 

Liquor  Alumini  Acetatis. — See  Alumini  Acetatis, 
Liquor. 

Liquor  Alumini  Subacetatis.— See  Alumini  Sub- 
acetatis,  Liquor. 

Liquor  Ammonii  Acetatis. — See  Ammonii  Acetatis, 
Liquor. 

Liquor  Antisepticus  (boric  acid  2,  benzoic  acid 
0.1,  thymol  0.1,  eucalyptol  0.025,  oil  of  peppermint 
0.05,  oil  of  gaultheria  0.025,  oil  of  thyme  0.01, 
alcohol  25,  purified  talc  2,  water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Liquoris  anti- 
septici,  5ii- 

Sig.  One  teaspoonful,  t.i.d. 

Uses. — Local  and  intestinal  antiseptic;  aromatic 
mouth- wash. 

Liquor  Antisepticus  Alkalinus  N.  F.  (pot.  bicarb. 
3.2  per  cent.,  sod.  borate  3.2  per  cent.,  and  sod. 
benzoate  0.8  per  cent.,  with  thymol,  eucalyptol,  oil 
of  peppermint,  methyl  salicylate  and  cudbear  in 
alcohol,  glycerine  and  water). 

Uses. — Mild  antiseptic  gargle. 

Liquor  Arseni  et  Hydrargyri  lodidi. — See  Dono- 
van’s solution. 

Liquor  Calcis;  Lime  Water. — See  Calcis,  Liquor. 

Liquor  Calcis  Sulphurate. — See  Calcis  Sulphur- 
atsB,  Liquor. 

Liquor  Carbonis  Detergens  (a  proprietary  article 
imitated  by  the  Liquor  Picis  Carbonis  of  the  B.  P., 
—a  20  per  cent,  solution  of  tar  with  tincture  of 
quillaia). 

Uses. — Local  antiseptic  stimulant. 

Liquor  Chlori  Compositus. — Bee  Chlorine  Water. 

Liquor  Cocci  N.  F.;  Cochineal  color. 

Uses. — Coloring  agent. 

Liquor  Cresolis  Compositus. — See  Cresolis,  Liquor 
Compositus. 

Liquor  Ferri  et  Ammonii  Acetatis. — See  Basham’s 
Mixture. 

Liquor  Ferri  Chloridi  (FeCL,  about  10.5  per  cent.). 

Adult  Dosage. — Min.,  njji;  av.,  iss;  max.,  iii. 

Method  of  Administration. — Well  diluted.  / 

Uses. — ^Astringent;  styptic  (coagulant). 

Liquor  Ferri  Peptonati. — See  Ferri  Peptonati, 
Liquor. 

Liquor  Ferri  Peptonati  et  Mangani. — See  Ferri 
Peptonati  et  Mangani. 


Liquor  Ferri  Subsulphatis. — See  Ferri  Subsulphatis, 
Liquor. 

Liquor  Formaldehydi;  Formalin. — See  Formalde- 
hydi.  Liquor. 

Liquor  Qutta=perchae  (10  per  cent,  solution  in 
chloroform;  Traumaticin). 

Uses. — Protective  application  to  slight  wounds. 

Liquor  Hydrargyri  Nitratis:  Hg(NOa)2,  60  per 
cent. 

Uses. — Caustic. 

Liquor  Hydrogenii  Dioxidi. — See  Hydrogenii  Di- 
o.xidi  Liquor. 

Liquor  Hypophysis  (Posterior  Lobe). — See  Hypo- 
physis, Liquor. 

Liquor  lodi  Compositus;  Lugol’s  Solution. — See 
lodi.  Liquor  Compositus. 

Liquor  Magnesii  Citratis  (mag.  carb.  15,  citric 
acid  33,  syrup  of  citric  acid  60,  pot.  bicarb.  21^, 
water  to  360). 

Dosage. — 3 years,  Sii;  5 years,  Sii-iv.  Adult, 
min.,  5vi;  av.,  xii;  max.,  xx. 

Method  of  Administration. — ^Take  in  one  dose, 
12  oimces  in  a bottle. 

Uses. — Saline  laxative. 

Liquor  Magnesii  Sulphatis  Effervescens  N.  F. 
(mg.  sulph.  about  7 per  cent.,  with  syrup  of  citric 
acid,  pot.  citrate  and  water). 

Adult  Dosage.— Av.,  3 xii,  or  the  contents  of  a bottle. 

Uses. — Saline  hydragogue  cathartic. 

Liquor  Pancreatini  (Pancreatin  1.75  per  cent., 
sod.  bicarb.  5 per  cent.,  with  comp.  spt.  cardamom, 
sod.  chloride  and  chloroform  in  alcohol,  glycerine 
and  water). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — Liquoris  pan- 
creatini, §iv. 

Sig. — Teaspoonfid  t.i.d.p.c.,  in  achlorhydria.  It 
is  destroyed  by  the  acid  of  normal  gastric  juice. 

To  peptonize  milk,  add  one-third  water  to  fresh 
cow’s  milk,  boil,  cool,  add  liquor  pancreatini,  3i-ii 
to  each  pint,  and  keep  in  a warm  place  (about  40°  C.) 
for  one  hour. 

Uses. — Proteolytic,  amylc^tic,  and  lipolytic. 

Liquor  Picis  Alkalinus  N.  F.  (Wood  tar  25,  pot. 
hydrox.  12.5,  water  to  100). 

Uses. — Local  antiseptic  stimulant. 

Liquor  Picis  Carbonis  N.  F.  (coal  tar  20  per  cent., 
quillaia  and  alcohol). 

Uses. — Local  antiseptic  stimulant. 

Liquor  Plumbi  Subacetatis. — See  Goulard’s 

Extract. 

Liquor  Piumbi  Subacetatis  Dilutus;  Lead  Water 
(4  per  cent.) 

Uses. — Astringent  and  cooling  lotion. 

Liquor  Potassae  (KOH,  4.5  to  5 per  cent.). 

Adult  Dosage. — Min.,  njv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Liquoris  potass®, 
5ss. 

Sig. — Fifteen  drops,  well  diluted,  three  or  four 
times  daily. 

Uses. — Antacid;  caustic;  dissolves  proteid  and 
keratin. 

Liquor  Potassii  Arsenitis. — See  Fowler’s  Solu- 
tion. 

Liquor  Potassii  Citratis  (8  per  cent.). 

Adult  Dosage. — Min.,  3iv;  max.,  5i-+. 

Method  of  Administration. — R Liquoris  potassii 
citratis  5vi. 

Sig. — Tablespoonful  with  plenty  of  water,  three  or 
four  times  a day. 

Uses. — Alkaline  diuretic;  laxative. 

Liquor  Potassii  vel  Sodii  Silicatis;  Soluble  Glass 
Solution. 

Method  of  Use. — Painted  on  in  order  to  stiffen 
bandages  after  they  have  been  applied. 


LUPULINUM 


Liquor  Sod$  Chlorinatas;  Labarraque’s  Solu- 
tion. 

Adult  Dosage. — Min.,  i^x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — In  15  to  20  parts  of 
water,  as  a spray,  gargle,  or  wash. 

As  a vaginal  douche,  one  teaspoonful  to  the  pint. 

Uses.- — Antiseptic;  disinfectant. 

Liquor  Sodse  et  Menthae;  Soda-Mint  N.  F.  (Sod. 
bicarb.  5,  arom.  spt.  ammon.  1,  spearmint  water 
to  100). 

Adult  Dosage. — Av.,  3ii- 

Method  of  Administration. — Misturai  sodse  et 
mentha?,  giv. 

Sig. — Two  teaspoonfuls,  as  required. 

Uses. — Antacid  and  carminative. 

Liquor  Sodii  Hydroxidi  (Soda  56,  distilled  water 
to  100). 

Adult  Dosage. — Min.,  irjv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Well  diluted  in  water. 

Uses. — Antacid. 

Liquor  Thiosinaminae  Sodio=Salicylatis. — See  Fi- 
brolysin. 

Liquorice.  See  Glycyrrhiza. 

Lithii  Benzoas  (soluble  in  4 of  water). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 
3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  xv;  max.,  xxx. 

Method  of  Administration. — Lithii  benzoatis, 
3iv  (gr.  viiss  per  dram);  aqua,  giv. 

M.  Sig. — Two  drams  in  half  a tiunbler  or  more  of 
water,  every  two  to  four  hours. 

Uses. — Urinary  acidifier  and  antiseptic;  diuretic; 
intestinal  antiseptic. 

Toxic  Action. — Nausea,  vomiting,  diarrhoea,  acute 
gastro-cnteritis;  circulatory  depression,  malaise, 
muscular  weakness. 

Lithii  Bicarbonas. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  x;  max.,  xv. 

Method  of  Administration. — Lithii  bicarbon- 
atis  vel  carbonatis,  gr.  v-x,  tabella?  no.  24. 

Sig. — Tablet,  three  or  four  times  daily. 

Uses. — Antacid. 

Lithii  Carbonas  Li2COs  (soluble  in  78  of  water). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  viii;  max.,  xv. 

Method  of  Administration. — Lithii  bicarbon- 
atis  vel  carbonatis,  gr.  v-x,  tabellse  no.  24. 

Sig. — Tablet,  three  or  four  times  daily. 

Uses. — Antacid. 

Lithii  Citras  LisCsHsO?  (soluble  in  1.4  of  water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  xx. 

Method  of  Administration. — Lithii  citratis, 
gr.  v-x,  tabellae  no.  24. 

Sig. — Tablet  three  or  four  times  daily. 

Uses. — Systemic  alkali  and  diuretic. 

Lithii  Citras  Effervescens  (citrate  5,  sod.  bicarb. 
57,  tartaric  acid  30,  citric  acid  193^). 

Adult  Dosage. — Min.,  3i;  av.,  ii;  max.,  iii. 

Method  of  Administration. — I^  Lithii  citratis 
effervescentis,  5vi. 

Sig. — Two  drams  in  a glass  of  water,  three  or 
four  times  a day. 

Uses. — Systemic  alkali  and  diuretic. 

Lithii  Salicylas  (very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Physiologic  Action  and  Uses. — Inferior  to  sodium 
salicylate  because  of  the  toxic  action  of  the  lithium 
with  adequate  doses. 

LobelitE  Fluidextractum  (Indian  Tobacco). 

Adult  Dosage. — Min.,  irji;  av.,  iiss;  max.,  xv  (?). 

Physiologic  Action  and  Uses. — Sedative  expector- 
ant; ^aphoretic;  diuretic;  nervous  sedative;  reheves 
bronchial  spasm  by  depressing  the  vagus  nerve 
terminals  in  the  lungs;  stimulates  respiratory  centre. 
A dangerous  drug,  resembling  nicotine. 

Toxic  Action.  — Vomiting,  purging,  depression. 


feeble  heart  action,  muscular  weakness,  fall  of  tem- 
perature, coma. 

Lobelise  Pulvis. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  viiss;  max.,  xv. 

Lobeliae  Tinctura. 

Adidt  Dosage. — Min.,  Trpv;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Tincturae  lobeliap, 
3ii. 

Sig. — Ten  minims  in  water,  every  fifteen  minutes 
until  nausea  or  relief  is  experienced. 

Uses. — For  bronchial  asthma. 

Loeffler’s  Solution: 

Method  of  Preparation. — Toluol,  36.0;  alco- 
holis  absoluti,  60.0;  liquoris  ferri  sesquichloridi,  4.0. 

M.  Sig. — ^Apply  once  to  thrice  daily. 

Uses. — Antiseptic  astringent.  See  Part  1. 

Lotio  Alba. 

Method  of  Administration. — I^  Zinci  sulphatis, 
3ss-iv;  potassii  sulphureti,  3ss-iv;  glycerini,  rrgiv- 
viii;  aqua;,  Siv. 

M.  Sig. — Apply  two  or  three  times  daily,  begin- 
ning with  a diluted  solution  and  gradually  increasing 
the  strength  until  some  irritation  and  desquamation 
is  produced. 

Uses. — Local  stimulating  lotion. 

Lotio  Calaminac. 

Method  of  Administration. — Calaminse,  3iss: 
zinci  oxidi,  5iii;  acidi  borici,  3ii;  glycerini,  i^v-xv; 
acidi  carbolici,  irjxv-3i;  liquoris  calcis,  5ii;  aquae, 
q.s.  ad,  3 viii. 

M.  Sig. — Shake  well.  For  local  use. 

Uses. — Antiseptic;  antipruritic;  protective. 

Lotio  Fulleri;  Fuller’s  Lotion. 

Method  of  Administration. — Sodii  carbonatis, 
3vi;  tincturae  opii,  gi;  glycerini,  5ii;  aquae,  gix. 

M.  Sig. — Apply  warm. 

Uses. — Local  analgesic. 

Lotio  Nigra;  Black  Wash  (calomel  gr.  xxx,  in 
hme-water  3x,  producing  the  black  oxide,  Hg20b 

Uses. — Antiseptic. 

Lotio  Plumbi  et  Opii. 

Method  of  Administration. — I^  Plumbi  acetatis, 
gr.  xxvii;  tinctura;  opii,  3ij  aquam  ad,  5ih. 

M.  Sig. — For  external  use. 

^ Liquoris  plumbi  subacetatis,  3ii-iv;  tincturae 
opii,  3ss-iv;  aquam  ad,  5iv. 

M.  Sig. — For  external  use. 

Uses. — Astringent,  anodyne  lotion. 

Lozenges.  See  Trochisci. 

Lubraseptic  (chondrus,  boric  acid,  and  formalde- 
hyde). 

Uses. — Lubricant  for  instnunents. 

Lubrichondrin  (chondrus  crispus,  oil  of  eucalyptus, 
and  formaldehyde). 

Uses. — Lubricant  for  instruments. 

Lugol’s  Solution;  Liquor  lodi  Compositus  (iodine 
5,  pot.  iodide  10,  distilled  water  to  100). 

Adult  Dosage. — Min.,  T^i;  av.,  iii;  max.,  x. 

Method  of  Administration. — Liquoris  iodi 
compositi,  5ss. 

Sig. — Three  drops  in  a wineglassful  of  water, 
t.i.d.p.c. 

U ses. — Alterative. 

Luminal;  Luminal-Sodium. 

Adult  Dosage.— Gr.  iss-ii-iii,  by  mouth  or  hypo- 
dermically. 

Uses. — Nervous  sedative;  employed  in  epilepsy, 
chorea  insaniens,  and  nervous  excitation. 

Lupulinum  (glandular  powder  obtained  from 
hops). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  xv.  __ 

Method  of  Administration. — Lupulini,  gr.  viii, 
pulveres  no.  12. 

Sig. — One,  t.i.d. 

Uses. — Bitter  tonic. 


MANNA 


Lutein;  Corpus  Luteum  Dessiccatum. 

Advil  Dosage. — Gr.  v-x. 

Method  of  Administration. — Corporis  lutei, 
gr.  v-x,  pulveres,  tabellae,  vel  capsulae  no.  36. 

Sig. — Tablet,  capsule,  or  powder,  t.i.d.p.c. 

Physiologic  A ction  and  U ses. — Alterative  in  amen- 
orrhoeaand  the  menopause,  or  “ ovarian  insufficiency.” 

Lycopodium  (Spores  of  the  Club-moss). 

Uses. — Protective  powder;  diluent. 

Lysol  (a  strongly  alkaline  solution  of  cresols  50 
per  cent.,  and  higher  homologues,  similar  to  liquor 
cresolLs  compo.situs) , g.v.;  “prepared  by  treating  the 
fraction  of  tar  oils  chiefly  composed  of  cresols  with 
fat  and  then  saponifying  with  alcoholic  soda” 
(Dakin  and  Dunham). 

Method  of  Administration. — One  teaspoonful  to 
the  quart  of  water,  as  an  antiseptic  wash. 

Uses. — Antiseptic. 

Magnesise  Magma;  Milk  of  Magnesia;  Fluid 
Magnesia  (suspension  of  mag.  hydroxide,  Mg(OH)2, 
about  7 per  cent,  in  water). 

Adult  Dosage. — -Av.,  Siiss. 

Method  of  Administration. — Magmse  magnesise. 

Sig. — Shake  well,  and  take  a tablespoonful,  with 
a teaspoonful  of  lemon  juice,  as  a laxative;  without 
the  lemon  juice  as  an  antacid  (about  one  to  two 
hours  after  meals). 

Uses. — Antacid;  laxative;  tooth-wash. 

Magnesii  Borodtras. 

Adult  Dosage. — Av.,  gr.  xv,  t.i.d. 

Method  of  Administration. — 1^  Magnesii  car- 
bonatis,  3i;  acidi  citrici,  3ii;  sodii  bibora tis,  3ii; 
aquae  bullientis,  Sviii. 

M.  Sig. — Tablespoonful,  two  or  three  times  daily 

Uses. — Uric  acid  solvent. 

Magnesii  Carbonas  (MgC03)4Mg(0H)2-|-5H20. 

Dosage. — 6 months,  gr.  v-x;  18  months,  gr.  xx; 
3 years,  gr.  xxx-xl;  5 years,  gr.  xl-3i-  Adult,  min., 
gr.  xxx;  av.,  xlv;  max.,  31- 

Method  of  Administration. — Magnesii  car- 
bonatis,  gr.  xxx;  sacchari  lactis,  q.s. 

Misce  et  mitte  talis  pulveres  no.  12. 

Sig. — -Powder  one  to  two  hours  after  meals. 

Physiologic  Action  and  Uses. — Mild  laxative; 
antacid;  neutralizes  acid  in  the  intestine  and  so 
deprives  the  urine  of  a portion  of  its  acid  constituents. 

Magnesii  Citratis  Liquor  (mag.  carb.  15,  citric 
acid  33,  syrup  of  citric  acid  60,  pot.  bicarb.  2)^, 
water  to  360). 

Dosage. — 3 years,  Sh;  5 years,  gii-iv.  Adult, 
min.,  5vi;  av.,  xii;  max.,  xx. 

Method  of  Administration. — Take  in  one  dose, 
twelve  ounces  in  a bottle. 

Uses. — Saline  laxative. 

Magnesii  Qynocardas. 

Adult  Dosage. — ^Min.,  gr.  ss;  av.,  iii;  max.,  xlv. 

Method  of  Administration. — Magnesii  gyno- 
cardatis,  gr.  ss,  capsulaj  no.  12. 

Sig.^— One  capsule,  t.i.d.p.c.,  the  dose  to  be  grad- 
ually increased  to  gr.  iii-xlv,  t.i.d.,  or  3 to  5 grain 
capsules  ten  to  twenty  times  daily. 

Uses. — Used  in  leprosy. 

Magnesii  Oxidum,  MgO  (Light  or  Calcined 
Magnesia;  gelatinizes  with  15  of  water,  after  stand- 
ing one-half  hour,  having  become  hydrated). 

Dosage. — 6 months,  gr.  v-x;  18  months,  gr.  x-xx; 
3 years,  gr.  xx-xxx;  5 years,  gr.  xxx-xl.  Adult,  min., 
3ss;  max.,  i. 

Method  of  Administration. — Magnesii  oxidi, 
3iy  (gr.  XV  to  the  tablespoonful);  syrupi  acaciae, 
Sii;  aq^,  q.s.  ad,  Sviii. 

M.  Sig.— ^hake  well,  and  take  one  to  two  table- 
spoonfuls, as  required,  for  acidity,  or  about  one  or 
two  hours  after  meals. 

Uses. — Antacid;  laxative. 


Magnesii  Oxidum  Ponderosum,  MgO  (Heavy 
Magnesia;  does  not  gelatinize  with  water). 

Dosage. — 6 months,  gr.  v-x;  18  months,  gr.  x-xx; 
3 years,  gr.  xx-xxx;  5 years,  gr.  xx.x-xl.  Adult,  min., 
3ss;  max.,  i. 

Method  of  Administration. — Magnesii  oxidi 
ponderosi,  3iv  (gr.  xv  to  the  tablespoonful);  syrupi 
acacia?,  5iv;  aquae,  q.s.  ad,  5viii. 

M.  Sig.— ^hake  well,  and  take  one  to  two  table- 
spoonfuls, as  required,  for  acidity. 

Uses. — Antacid;  laxative. 

Magnesii  Sulphas;  Epsom  Salt;  MgS04+7H20 
(soluble  in  1 of  water). 

Dosage. — 6 months,  gr.  x-xv;  18  months,  gr.  xx; 
3 years,  gr.  xx-xxx;  5 years,  3ss-i.  Adult,  min.,  3i; 
av.,  iv;  max.,  gi. 

Method  of  Administration. — 1^  Magnesii  sulpha- 
tis,  5i  (pii  per  dose);  aquae,  q.s.  ad,  3h- 

M.  Sig. — Tablespoonful  in  half  a cup  of  coffee, 
every  two  hours  until  effectual. 

Two  tablespoonfuls  of  the  salt  to  the  pint  as  an 
enema. 

Uses. — Saline,  hydragogue  cathartic. 

Magnesii  Sulphatis,  Liquor  Effervescens,  N.  F., 
(Mg.  sulph.  about  7 per  cent,  with  syrup  of  citric 
acid,  pot.  citrate,  and  water). 

Adult  Dosage. — Av.,  3 xii,  or  the  contents  of  a 
bottle. 

Uses. — Saline,  hydragogue  cathartic. 

Male  Fern. — See  Aspidii  Oleoresina. 

Mallein  (Toxin  produced  by  the  bacillus  mallei  of 
glanders). 

Method  of  Administration  ■ — Begin  with  1 milli- 
gram, hypodermically,  and  increase  the  dose  in  the 
course  of  sixteen  days  to  thirty  milligrams  or 
more. 

Uses — Used  in  the  diagnosis  and  treatment  of 
glanders.  For  diagnostic  purposes  it  is  used  the 
same  as  tuberculin. 

Malti  Extractum  (chiefly  diastase,  maltose,  and 
extractives). 

Dosage — 6 months,  3i~ii;  18  months,  3h-iv; 
3 years,  3iv;  5 years,  gi.  Adult,  min.,  5i;  av.,  iv; 
max.,  5i- 

Method  of  Administration. — Extracti  malti, 
Sviii. 

Sig — One  to  four  teaspoonfuls,  alone  or  in  milk 
or  bouillon,  once  to  four  times  daily,  p.c. 

Uses. — Amylolytic  enzyme;  nutrient. 

Maltine.  See  E.xtractum  Malti. 

Mammary  Gland  Dessicated;  Glandulse  Mammae 
Dessicatae. 

Adult  Dosage. — Min.,  gr.  ii;  max.,  vi. 

Method  of  Administration. — Glandulae  mam- 
mae dessicatae,  gr.  ii,  tabellae  no.  30. 

Sig. — One  to  three  tablets,  t.i.d. 

Uses. — Uterine  haemostatic. 

Mandl’s  Solution. 

Method  of  Preparation. — lodi  puri,  gr.  vi; 
potassii  iodidi,  gr.  xx;  olei  menthae  piperitae,  i^v; 
glycerini,  gi. 

Uses. — Local  stimulating  application  to  mucous 
membranes. 

Mangani  Dioxidum  Praecipitatum,  Mn02. 

Adult  Dosage. — Min.,  gr.  ii;  av.,  iv;  max.,  x. 

Method  of  Administration.— Mangani  dioxidi 
praecipitati,  gr.  iv,  tabellae  no.  30. 

Sig. — Pill,  three  or  four  times  a day,  before  or 
after  meals. 

Uses. — Emmenagogue;  intestinal  antiseptic. 

Toxic  Action. — Gastro-intestinal  irritation;  cardio- 
vascular depression;  emaciation;  paraplegia;  acute 
fatty  degeneration  of  the  liver. 

Manna  (a  dried  sap  containing  mannite,  CeHuOe, 
glucose,  mucilage,  etc.). 


MERCURY 


Advil  Dosage. — Min.,  3i;  av.,  iv;  max.,  5i- 

Method  of  Administration. — Manna)  optima;,  5i- 

Sig. — Teaspoonful  to  tablespoonful,  dissolved 
in  mUk. 

Uses. — Mild  laxative. 

Mannae  Syrupus  N.  F.  (Manna  12.5  per  cent., 
alcohol  and  syrup). 

Advlt  Dosage. — Av.,  3ii- 

Mannitol  Hexanitras. 

Adult  Dosage. — Av.,  gr.  i. 

Method  of  Administration. — R Mannitol  hexa- 
nitratis,  gr.  i,  tabella;  no.  20. 

Sig. — Tablet,  t.i.d.,  increased  gradually  until 
flushing,  throbbing,  or  slight  transient  faintness 
are  felt. 

Physiologic  Action  and  Uses. — Vasodilator;  begins 
to  act  after  about  two  hours,  and  the  action  persists 
for  several  hours. 

Marsden’s  Paste. — See  Part  5,  Skin  Diseases, 
under  Carcinoma  Cutis. 

Uses. — Caustic. 

Massa  Hydrargyri;  Blue  Mass;  Blue  Pill,  (q.v.) 

Dosage. — 3 years,  gr.  i;  5 years,  gr.  i-ii.  Adult, 
min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Adininislration. — Massae  hydrar- 
gyri, gr.  v-x,  pilula;  no.  60. 

Sig. — One  pill  a day. 

Uses. — Cathartic;  antiluetic. 

Matzoon;  Zoolak. 

Method  of  Preparation. — Boil  thoroughly  eleven 
and  a quarter  quarts  of  milk,  and  remove  all  the 
cream  from  the  top.  While  the  milk  is  still  quite 
warm,  add  and  mix  thoroughly  a bottle  of  prepared 
bottled  zoolak;  place  quickly  in  pmt  bottles,  not 
entirely  fidl;  cork  tightly  at  once,  and  keep  in  a 
warm  place  until  the  liquid  appears  creamy  through 
the  bottles.  Then  keep  in  a cold  place. 

Meat  Extracts. 

Method  of  Preparation. — Thoroughly  mix  one 
pound  of  finely  minced  beef  with  one  pint  of  cold 
water.  Set  aside  for  ten  minutes.  Place  in  a pot 
surrounded  by  water,  and  gradually'  heat  the  water 
to  the  boiling  point.  Decant  off  the  liquid,  and, 
after  cooling,  skim  off  the  fat. 

Physiologic  Action  and  Uses. — Digestive  stimu- 
lant; neces.sary  to  normal  metabolism. 

Meat  Juice. 

Method  of  Preparation. — 1.  Stir  four  parts  of 
finely  chopped  or  ground  fresh  raw  steak  with  one 
part  of  cold  water,  allow  to  stand  for  half  an  hour 
in  the  cold,  and  then  exjjress  the  juice  through  a 
cloth  or  meat  press;  or  place  one  pound  in  a pint  of 
sterile  water  on  ice  over  night;  strain  in  the  morning 
through  a sterile  cheesecloth  bag,  season,  and 
slightly  warm. 

2.  Cut  round  or  sirloin  steak  into  small  cubes; 
broil  quickly  both  sides  so  as  to  prevent  the  escape 
of  the  contained  juices.  Squeeze  out  the  juice  by- 
means  of  a hot  lemon-squeezer,  into  a hot  wine- 
glass, season  with  salt  and  cayenne  pepper,  and 
serve  hot. 

Medinal.  See  Veronal-Sodium. 

Mel;  Honey  (about  40  per  cent,  levulose,  35  per 
cent,  dextrose,  and  3 per  cent,  saccharose). 

Menthae  Piperitae  Aqua  (Saturated  Peppermint 
Water,  containing  0.2  per  cent,  oil  of  peppermint). 

Dosage. — 6 months,  5i|  18  months,  oi-ii;  3 years, 
oiii;  5 years,  piv.  Adult,  min.,  piv;  max.,  vi. 

Method  of  Administration. — Aquae  menthae 
piperitae,  Sviii. 

Sig. — ^Tablespoonful  every  two  hours,  for  colic 
and  flatulence,  up  to  five  to  six  ounces  a day  for 
an  adult. 

Uses. — Carminative;  stimulant;  vehicle. 

Menthae  Piperitae  Oleum;  Oil  of  Peppermint. 


Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  menthae 
piperitae,  3i- 

Sig. — Three  drops  in  hot  water,  every  two  hours. 

Uses. — Carminative  and  flavoring  agent;  local 
anodyne. 

Menthae  Piperitae  Spiritus;  Essence  of  Pepper- 
mint (oil  of  peppermint  10,  bruised  herb  1,  alcohol 
to  100). 

Adult  Dosage. — Min.,  ngx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Spiritus  menthae 
piperitae,  gss. 

Sig. — Thirty  drops  in  hot  water,  every  two  hours. 

Uses. — -CaiTninative;  stimulant. 

Menthae  Viridis  Aqua  (spearmint  water,  contain- 
ing 0.2  per  cent,  of  oil  of  spearmint). 

Dosage. — 6 months,  pi;  18  months,  pii;  3 years, 
oiii;  5 years,  piv.  Adult,  min.,  3iv;  max.,  vi. 

Method  of  Administration. — Aquae  menthae 
viridis,  gii. 

Sig. — A dose,  as  required,  for  colic  and  flatulence. 

Uses. — Carminative;  vehicle. 

Menthae  Viridis  Oleum;  Spearmint  Oil. 

Adult  Dosage. — Min.,  irjii;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  menthae 
viridis,  3i- 

Sig. — Three  to  five  drops,  in  hot  water,  every 
two  hours. 

Uses. — Carminative;  flavoring  vehicle. 

Menthae  Viridis  Spiritus;  Essence  of  Spearmint 
(oil  of  spearmint  10,  bruised  herb  1,  alcohol  to 
100). 

Adult  Dosage. — Min.,  igjx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Spiritus  menthae 
viridis. 

Sig.— Thirty  drops  in  hot  water  every  two  hours. 

Uses. — Carminative;  flavoring  vehicle. 

Menthol:  CioHigOH  (obtained  from  mint  oils; 
shghtly  soluble  in  water,  very  soluble  in  alcohol, 
chloroform,  ether,  and  oils). 

Advlt  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  v. 

Method  of  Administration. — R Mentholis,  gr. 
xxiv  (gr.  0.2  ad  i^i);  olei  olivae  vel  aetheris,  3h- 

Misce  et  fiat  solutio. 

Sig. — ^Ten  drops,  on  sugar,  as  a gastric  sedative. 

R Mentholis,  gr.  i-iii,  olei  olivae,  q.s. 

M.  Fiat  solutio  et  pone  in  capsula  (hardened  with 
formalin). 

Mitte  tabs  capsulae  no.  30. 

Sig. — One  capsule  three  to  five  times  a day,  p.c.,  as 
an  intestinal  antiseptic. 

Mentholis,  gr.  ii-x-xx.  Petrolati  hquidi,  pi. 

M.  Sig. — Nasal  or  throat  spray.  (For  the  nose, 
do  not  as  a rule  exceed  gr.  v to  the  ounce). 

Uses. — Gastric  sedative;  local  analgesic;  anti- 
pruritic; refrigerant;  counter-irritant;  intestinal 
antiseptic. 

Mentholis  Unguentum  (5  to  15  per  cent.). 

Uses. — Antipruritic;  refrigerant. 

Mentholis  Valeras;  Validol:  CH3.CH2.CH2COO. 

CioH  19. 

Adidt  Dosage. — Min.,  t^jx;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Menthohs  valer- 
atis,  3ii- 

Sig. — Ten  to  twenty'  drops  on  sugar,  or  in  a little 
sweet' wine  or  coffee  every'  four  hours,  or  once  to 
thrice  daily. 

Uses. — Gastric  sedative. 

Mercurochrome=220;  sodium  salt  of  dibrom-oxy- 
mercury-fluorescein  (readily  soluble  in  water) . 

Uses. — Local  urinary  antiseptic  in  1 per  cent, 
solution.  Remove  skin  stains  by  rubbing  first  with 
pot.  permang.,  2 per  cent.,  then  with  oxahe  acid,  2 
per  cent. 

Mercury.  See  Hydrargyrum. 


MORPHINA 


Mercury=Vasogen  (comes  in  33  per  cent.,  50  per 
cent.,  and  75  per  cent,  strengths). 

Method  of  Administration. — Mercury-Vasogen 
50  TCr  cent.,  5ss-i,  capsulae  no.  12. 

Sig.— One  capsule  daily  for  inunction.  See  Part  1, 
under  Syphilis. 

Uses. — AntUuetic;  antiseptic;  parasiticide. 

Methylene  Blue;  Methyltluoninae  Chloridum 
(freely  soluble  in  water  and  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  vi. 

Method  of  Administration. — Methylthioninae 
chloridi;  myristicae,  aa,  gr.  iv. 

M.  Mitte  talis  capsulae  no.  30.  (The  nutmeg  is 
added  to  prevent  strangury). 

Sig. — One  capsule  three  to  five  times  daily. 

Physiologic  Action  and  Uses. — Urinary  antiseptic; 
inhibits  the  growth  of  staphylococci  in  the  kidneys 
and  bladder;  antimalarial. 

Methylis  Chloridum  CH3CI  (a  gas). 

Uses. — Local  refrigerant. 

Methylis  Salicylas;  Oil  of  Wintergreen,  Oleum 
Gaultheriae. 

Dosage. — 6 months,  gt.  i;  18  months,  gtt.  ii-iii; 
3 years,  gtt.  iii;  5 years,  gtt.  iii-v.  Adult,  min.,  njv; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — Olei  gaultheriae,  §i. 

Sig. — Twelve  to  twenty  drops,  well  diluted  in 
sweetened  water  or  milk,  every  two  to  four  hours. 
It  may  be  prescribed  in  formalin-hardened  cap- 
sules. 

For  external  application  and  absorption:  either 
pure  or  diluted  with  lanolin  (ten  per  cent,  ung.) 
or  an  oil. 

Physiologic  Action  and  Uses. — ^ Antirheumatic; 
antip3Tetic;  local  anodyne;  flavor;  very  irritating 
to  the  stomach;  readily  absorbed  through  the  skin. 

Mineral  Oil.  See  Petrolatum  Liquidum. 

Mineral  Waters: 

Carbonated — West  Virginia:  Old  Sweet  Spring; 
Virginia:  Sweet  Chalybeate  Spring.  Germany: 
Sellers  (Seltzer),  Apolhnaris. 

Alkaline — ^America : Bladon  Spring,  Ala. ; Con- 
gress Spring,  Cal.;  Seltzer  Spring,  Cal.;  St.  Louis 
Spring,  Mich. ; Buffalo  Lithia  Spring,  Congress, 
Hathorn,  Kissingen  and  Vichy  Springs,  in  Va.; 
Saratoga,  N.  Y.;  Hot  Spring,  Va. ; Warm  Spring, 
Va.;  Berkeley  Spring,  Va.;  Bethesda  Spring,  Wis.; 
Gettysburg  Spring,  Pa.  France  : Vichy,  Vais, 
Royat,  La  Bourboule.  Austria:  Gleickenberg,  Luh- 
ctschowitz.  Germany:  Ems,  Salzbrunn,  Sellers, 
Wiesbaden. 

Saline — ^America:  Saratoga  Springs,  N.  Y. ; 
Ballston,  N.  Y. ; Hot  Springs,  Ark. ; St.  Catherine’s, 
Ontario,  Canada.  Spain:  Rubinat.  Bohemia:  Carls- 
bad, Ptillna,  Seidlitz,  Marienbad,  Franzenbad. 
England:  Cheltenham.  Hungary:  Apenta,  Hunyadi 
Janos.  Germany:  Friedrichshall,  Baden-Baden, 

Wiesbaden,  Kissingen,  Reichenhall,  Adelheidsquelle, 
Kreutznach. 

Sulphurous— America:  Blue  Lick  Spring,  Ky.; 
Sharon  Spring,  N.  Y.;  Yellow  Sulphur  Spring,  Va.; 
White  Sulphur  Spring,  W. Va.  France:  Bareges, 
Eaux  Bonnes.  Britain:  Llandrindod,  Wales;  Har- 
rowgate,  England.  Germany:  Aix-la-Chapelle. 

SiLicious — America:  Geysers  of  Yellowstone 

Park.  Iceland : Hot  Springs. 

Ferruginous — America:  Saratoga  and  Sweet 
Chalybeate,  Va.  Switzerland:  St.  Moritz,  Levico, 
Roncegno.  Belgium : Spa.  Germany  and  Austria : 
Pyrmont,  Franzenbad,  Kissingen,  Langenschwal- 
bach. 

Mistura  Bashami;  Liquor  Ferri  et  Ammonii 
Acetatis  (tr.  ferri  chi.  4,  dilute  acetic  acid  6,  sol.  of 
ammon,  acetate  50,  aromatic  elixir  12,  glycerine  12, 
water  to  100). 

58 


Dosage. — 3 years,  3ss;  5 years,  3i-  Adult,  min., 
3ii;  av.,  iv;  max..  Si- 

Method  of  Administration. — I^  Misturae  Bashami, 
recentis  prseparati,  Siv. 

Sig. — One  or  two  tablespoonfuls  in  a tumbler  of 
water,  every  three  to  four  hours. 

Uses. — Diaphoretic;  diuretic;  haematic. 

Mistura  Ferri  Acida;  Mistura  Ferri  Laxans. 

Method  of  Administration. — I^  Magnesii  sulpha- 
tis,  Sb  ferri  sulphatis,  gr.  iv-viii;  acidi  sulphurici 
diluti,  5i-ii;  aquae  menthae  piperitae,  q.s.  ad,  5iv. 

M.  Sig. — Tablespoonful  in  a full  glass  of  water, 
one  hour  before  breakfast. 

Uses. — ^Acid,  chalybeate,  saline  aperient. 

Mistura  Qlycyrrhizae  Composita;  Brown  Mixture 
(ext.  glycyr.  3,  syrup  5,  acacia  3,  paregoric  12,  vin. 
antim.  6,  spt.  aeth.  nit.  3,  water  to  100). 

Dosage.-^  months,  gtt.  xv;  18  months,  gtt.  xx; 
3 years,  ^t.  x.xx-xl;  5 years,  gtt.  xl-3i.  Adult,  min., 
3i;  av.,  iiss;  max..  Si- 

Method  of  Administration. — I^  Misturae  glycyr- 
rhizae  compositae,  5iv. 

Sig. — ^Two  or  three  or  four  teaspoonfuls  every 
two  hours,  or  as  required,  for  cough. 

Uses. — Sedative  expectorant. 

Mistura  Helonin  Composita. 

Method  of  Administration. — I^  Misturae  helonin 
compositae,  5iv. 

Sig. — Teaspoonful  in  half  a teacupful  of  hot 
water  every  fifteen  minutes  during  a paroxysm  of 
menstrual  pain;  or  t.i.d.  during  the  intermenstrual 
period  for  a week  before  the  flow  is  expected. 

Uses. — Uterine  sedative. 

Mistura  Rhei  et  Sodae  (sod.  bicarb.  33^,  fl.  ext. 
rhei  1}^,  fl.ext.  ipecac,  K,  glycerine  35,  spt.  menth. 
pip.  334,  water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — I^  Misturae  rhei  et 
sodae,  gii. 

Sig. — Teaspoonful  once  to  thrice  daily,  p.c 

Uses. — Antacid;  laxative. 

Mistura  Rhei  et  Sodas  (Kerley). 

Dosage. — 6 months,  3ss;  18  months,  3ii;  3 years, 
3 iii;  5 years,  3iv.  Adult,  av.,  3iv. 

Method  of  Administration. — R Pulveris  rhei, 
gr.  xlviii;  sodii  bicarbonatis,  gr.  xlviii;  syrupi  rhei 
aromatici,  5i;  aqiue,  q.s.  ad,  5ii- 

M.  Sig. — A dose  once  to  thrice  daily.  (Kerley.) 

Uses. — Antacid;  laxative. 

Mistura  vel  Liquor  Sodae  et  Menthae;  Soda-Mint, 
N.  F.  (sod.  bicarb.  5,  arom.  spt.  ammon  1,  spear- 
mint water  to  100). 

Adult  Dosage. — Av.,  3ii- 

Method  of  Administration. — I^  Misturae  sodae  et 
menthae,  5iv. 

Sig. — Two  teaspoonfuls,  as  required. 

Uses. — Antacid  and  carminative. 

Monobromated  Camphor;  Camphora  Monobro- 
mata:  CioHisBrO  (almost  insoluble  in  water;  solu- 
ble in  6.5  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Camphorae  mono- 
bromatae,  gr.  Lxxx  (gr.  v per  dram);  syrupi  acaciae; 
aquae,  aa,  gi. 

M.  et  ft.  emulsum. 

Sig. — 3ss-i,  t.i.d.  It  may  be  prescribed  in  pill 
or  capsule. 

Uses. — Nervous  sedative;  hypnotic;  anaph'odisiac. 

Monochloraceticum  Acidum. 

Uses. — Caustic. 

Morphina  (an  alkaloid:  C17H19NO3;  soluble  in 
3340  of  water,  210  of  alcohol). 

Dosage. — 6 months,  gr.  Ym]  18  months,  gr.  Koo; 
3 years,  gr.  Y,^]  5 years,  gr.  Hq-Hq.  Adult,  mm.,  gr. 
av.,  3^ ; max.,  34- 


NEOSALVARSAN 


Method  of  Administration. — The  preceding  are 
Kerley’s  doses  for  cliildren.  Holt’s  doses  are  gr.  Kooo 
at  one  month,  Koo  at  three  months,  34oo  at  one  year. 
Says  Potter;  Avoid  giving  morphine  to  children 
under  ten  years,  and  never  give  it  hypodermically 
to  those  below  fifteen  years.  The  dose  may  be 
repeated  every  three  to  four  hours,  if  required. 
Ordinarily  it  should  not  be  repeated  oftener  than 
every  two  hours. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
analgesic;  hypnotic;  diaphoretic;  depresses  the  per- 
ception of  pain  and  discomfort  in  the  sensorium; 
depresses  the  refle.x  excitabihty  of  the  cough  centre; 
renders  respiration  quieter,  deeper,  and  slower; 
relieves  cough  and  cardiac  dyspnoea;  quiets  peristal- 
sis. Contraindicated  where  expectoration  is  marked. 
Morphine  causes  constipation  by  persistent  closure 
of  the  i)ylorus,  which  retards  the  passage  of  chyme 
into  the  intestine ; by  lessening  the  gastric,  pancreatic, 
and  intestinal  secretion,  by  diminishing  the  excita- 
bility of  the  vagus  and  sensory  nerve-endings  in 
the  walls  of  the  intestine,  and  probably  by  contract- 
ing the  ileocolic  sphincter. 

Toxic  Action. — Stupor,  marked  miosis,  slow  respir- 
ations, slow,  weak  heart,  coma,  death  from  respira- 
tory failure.  Less  than  one  grain  is  seldom  fatal 
to  an  adult. 

Morphin®  Hydrochloridum:  C17H19NO3.HCI-I- 
3H2O  (soluble  in  17.5  of  water,  52  of  alcohol). 

Dosage,  etc. — See  Morphina,  above. 

Morphinae  Sulphas:  (Ci7Hi9N03)2.H2S04-l-5H20. 
(soluble  in  15.2  of  water,  565  of  alcohol). 

Dosage,  etc. — See  Morphina,  above. 

Morrhuse  Oleum;  Codhver  Oil.  See  Codliver  Oil. 

Morrison’s  Paste. — See  B.  I.  I.  P. 

Mucilago  Acaciae  (Acacia  35,  distilled  water  to 
100). 

Adult  Dosage.- — Min.,  3ii;  av.,  iv;  max.,  vi. 

Uses. — Demulcent;  used  to  suspend  insoluble 
powders  in  mixtures. 

Mucilago  Cydonii;  Mucilago  Seminum  Cydonio- 
rum  (Quince-seed). 

Dosage. — Indefinite. 

Uses. — Demulcent;  emollient. 

Mucilago  Sassafras  Medullae. 

Adult  Dosage. — Av.,  qiv. 

Uses. — Demulcent;  flavor;  for  the  suspension  of 
insoluble  powders. 

Mucilago  Tragacanthae  (Tragacanth  6,  glycerine 
18,  water  to  100). 

Adult  Dosage. — Min.,  5ii;  av.,  iv;  max.,  vi. 

Uses. — Demulcent;  used  to  suspend  insoluble 
powders  in  mixtures. 

Muscarinae  Nitras  (Muscarine  is  an  alkaloid, 
C6H13NO2;  readily  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  Ho;  max.,  Ke  (Merck). 
Min.,  gr.  H;  max.,  ^ (Ringer). 

Metlwd  of  Administration. — Hypodermically,  five 
minims  of  a one  per  cent,  solution  (gr.  }io)  is  recom- 
mended as  an  anhidrotic  (why?). 

Physiologic  Action  and  Uses. — -Antagonist  of 
atropine  (q.v.) : stimulates  autonomic  nerve  endings, 
producing  miosis,  slowing  of  the  heart,  contraction 
of  the  bronchial  muscles,  contraction  of  the  gastric 
and  intestinal  muscles,  increased  glandular  secretion. 

Toxic  Action. — Resjiiratory  and  cardiac  depres- 
sion, lowered  arterial  tension,  salivation,  lachryuna- 
tion,  sweating,  dyspnoea,  oliguria,  colic,  vomiting, 
jHirging,  lowered  temperature,  miosis  and  spasm 
of  accommodation. 

Mustard;  Sinapis;  Sinapis  Nigra. 

Adult  Dosage. — Min.,  5i;  av.,  iiss;  max.,  iv. 

Method  of  Administration. — In  half  a glass  of 
lukewarm  water,  as  an  emetic.  ‘ 

Mustard  paste  or  poultice:  1 part  black  mustard 


with  2 to  6 of  flour,  made  up  into  a paste  with  water, 
and  applied,  between  layers  of  cheesecloth,  until  a 
red  flush  is  produced  (usually  about  20  minutes). 
It  may  be  repeated  three  to  six  times  daily. 

Mustard  Bath  or  Pack:  One  to  two  tablespoon- 

fuls to  four  to  six  gallons  of  water. 

Foot-Bath:  One  tablespoonful  to  the  gallon. 

Uses. — Emetic;  rubefacient  and  counter-irritant; 
vesicant. 

Toxic  Action. — Gastro-enteritis. 

Mustard  Plaster;  Emplastrum  Sinapis. 

U ses. — Counter-irritant. 

Myristica;  Nutmeg. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xv. 

Uses. — Stomachic;  carminative;  astringent;  re- 
lieves strangury. 

Toxic  Action. — Stupor,  delirium. 

Myrrhse  et  Aloes;  Pilulae. 

Adult  Dosage. — Min.,  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — Pilulae  aloes  et 
myrrhae,  no.  24. 

Sig.-A)ne  pill,  t.i.d. 

Uses. — Purgative;  emmenagogue. 

Myrrhae  Tinctura. 

Adult  Dosage. — Min.,  ngx;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Tincturae  myr- 
rhae, §i. 

Sig. — Fifteen  drops,  in  water,  t.i.d. 

Mouth-wash  and  gargle: — §i  ad  aquam  5i-Oi. 

Uses. — ^Astringent;  carminative;  emmenagogue; 
local  stimulant  and  disinfectant. 

Toxic  Action. — Vomiting;  purging. 

Myrtol;  Oleum  Myrti;  Oil  of  Myrtle. 

Adult  Dosage. — Mm.,  gtt.  i;  av.,  ii;  max.,  iii. 

Method  of  Administration. — R Olei  myrti,  gtt.  ii, 
capsula3  no.  30. 

Sig. — One  capsule  three  to  five  times  a day,  or 
every  two  hours. 

Uses. — Gastric  tonic;  bronchial  and  urinary  anti- 
septic; anthelmintic. 

Naphthaleni  Tetrachloridum. 

Adult  Dosage. — Min.,  gr.  v;  max.,  x. 

Method  of  Administration. — R Naphthaleni  tet- 
rachloridi,  gr.  v-x,  capsulse  no.  30. 

Sig. — Capsule,  three  or  four  times  daily. 

For  children,  gr.  ii-vi,  according  to  age. 

Physiologic  Action  and  Uses. — Intestinal  antisep- 
tic; insoluble,  therefore  not  absorbed,  and  so  not 
to.xic. 

Naphthol,  Beta;amonohydroxyphenol:  C10H7OH 
(soluble  in  1000  of  w'ater,  0.8  of  alcohol). 

Adidt  Dosage. — Min.,  gr.  iii;  av.,  v;  max.,  x. 

Alethod  of  Administration. — R Betanaphthol, 
gr.  V,  pilul®  (intestinal  coated)  no.  21. 

Sig. — One  pill,  t.i.d.a.c. 

Externally  as  a 3-5  per  cent,  ointment  (danger  of 
absorption). 

Physiologic  Action  and  Uses. — Intestinal  and  uri- 
nary antiseptic;  anthelmintic;  local  antiseptic  and 
parasiticide. 

Toxic  Action. — Nephritis;  an®mia  from  destruc- 
tion of  the  red  blood-cells;  sometimes  retinal  and 
lenticular  changes. 

Naphthol  Camphoratum  (Beta-naphthol  1,  heated 
carefully  with  camphor  2 parts). 

Adult  Dosage. — Min.,  irfii;  max.,  v. 

Method  of  Administration. — Injected,  undiluted, 
or  in  olive  oil,  into  cavities  and  tissues. 

Uses. — Antiseptic. 

Nauheim  Bath.  See  Baths,  Medicated. 

Neosalvarsan;  Neo-arsphenamine;  Sodium  3-di- 

amino-4-dihvdroxi-l-arsenobenzene-methanal-sul- 

phoxylate:  NH2.OH.C6H3.  .VS  : As.CeHj.OH.NH. 
(CIROlOSNa.  (A  soluble  compound  of  salvarsan). 

Adult  Dosage. — Min.,  0.6;  av.,  0.75;  max.,  0.9,  gm. 


NOVOCAINA 


for  males.  Min.,  0.45;  av.,  0.6;  max.,  0.75,  gm.,  for 
females.  For  children — Min.,  0.15;  max.,  0.3  gm. 

Method  of  Administration. — For  intravenous  injec- 
tion one  may  employ  25  cc.  of  sterile,  freshly  dis- 
tilled, cold  water,  or  well-boiled  and  cooled  tap 
water  (not  over  22°  C.,  or  71°  F.),  for  every  0.15 
gm.  of  neosalvarsan;  for  intramuscular  injection, 
employ  3 cc.  of  water  for  each  0. 15  gm. ; an  approxi- 
mately isotonic  solution ; but  a concentrated  solution 
may  be  employed  intravenously,  using  10  cc.  sterile 
distilled  water  for  0. 45-0.6  gm.,  and  15  cc.  for  0.75-0.9 
gm.  neosalvarsan.  See  Part  1,  under  Syphilis. 

Nitre,  Sweet  Spirits  of;  Spiritus  jEtheris  Nitrosi: 
Ethyl  Nitrite  C2H6NO2,  4 per  cent,  in  alcohol 
(should  not  be  kept  long,  as  it  turns  acid) . 

Dosage. — 6 months,  gtt.  ii-iii;  18  months,  gtt.  iii- 
v;  3 years,  gtt.  v;  5 years,  gtt.  v-x.  Adult,  min., 
3ss;  av.,  i;  max.,  ii. 

Method  of  Administration.—^.  Spiritus  aetheris 
nitrosi,  5i- 

Sig. — One  teaspoonful,  well  diluted,  in  sweetened 
water,  every  one  to  three  hours. 

Uses.- — Diaphoretic,  diuretic,  carminative. 

Nitricum  Acidum  HNO3. 

Method  of  Administration. — Apply  by  means  of  a 
glass  rod  or  matchstick,  with  the  surrounding 
healthy  tissue  protected  by  vaseline. 

Uses. — Caustic. 

Nitricum  Acidum  Dilutum  (10  per  cent,  of  HNO3 
by  weight). 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  xl. 

Method  of  Administration. — ^ Acidi  nitrici  di- 
luti,  5i- 

Sig. — Thirty  drops,  in  a wineglassful  of  water, 
t.i.d.,  taken  through  a glass  tube;  rinse  the  mouth 
afterward  with  soda-water. 

Uses. — Cholagogue;  acid. 

Nitris  Amylis:  C5H11NO2. 

Adidt  Dosage. — ^ngii;  av.,  iii;  max.,  v. 

Method  of  Administration. — Amylis  nitritis, 
Miii-v. 

Dispense  in  perles,  no.  12. 

Sig. — Break  a perle  in  the  handkerchief,  and  in- 
hale, as  required. 

Physiologic  Action  and  Uses. — Vasodilator,  acting 
both  centrally  and  peripherally,  depressing  the  tonus 
of  the  vasomotor  centre  and  the  vessels.  The  action 
lasts  but  a few  minutes. 

Toxic  Action. — Nausea,  vomiting,  unconscious- 
ness, occasionally  convulsions,  methaemoglobinajmia, 
collapse,  'respiratory  paralysis. 

Nitris  Sodii  NaN02  (soluble  in  1.5  of  water). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iii. 

Method  of  Administration. — Sodii  nitritis,  gr. 
xvi  (gr.  i per  dram).  Aquae  destillatae,  5ii- 

Sig. — One  dram,  threeor  fourtimesdaily,  gradually 
increase^,  until  flushing,  palpitations,  buzzing  in  the 
ears,  or  headache  occurs,  then  reducing  the  dose 
somewhat,  and  occasionally  increasing  it  tentatively. 
Intenmt  the  drug  every  ten  days  for  five  days. 

Physiologic  Action  arid  Uses. — Vasodilator  (periph- 
eral action) ; relaxant  of  bronchial  tubes,  intestines, 
renal  and  biliary  tracts.  The  effect  of  a single  dose 
lasts  from  one-half  to  two  hours. 

Toxic  Action. — Flushing,  palpitation,  tinnitus, 
severe  headache,  methaemoglobinaimia,  with  result- 
ing asphyxia. 

Nitrogenii  Monoxidum  N2O;  Nitrous  Oxide; 
Laughing  Gas. 

Uses. — Inhalation  anaesthetic. 

Nitroglycerin,  Spirit  of;  Spiritus  Glycerylis  Nitratis 
(1  per  cent.). 

Dosage.— 6 months,  gt.  18  months,  gt.  K;  3 
years,  gt.  5 years,  gt.  i.  Adult,  min.,  tijss;  av.,  i; 
max.,  ii. 


Method  of  Administration. — Spiritus  glonoini, 
5ss. 

Sig. — One-half  to  one  drop,  hi  water,  or  dropped  on 
or  under  the  tongue,  every  half  to  two  to  four  hours, 
or  one  drop  three  or  four  times  a day,  increased 
by  one  drop  every  four  or  five  days,  until  flushing, 
headache,  palpitation,  or  buzzing  in  the  ears  occurs; 
then  reduce  the  dose  several  drops,  and  occasionally 
increase  it  tentatively,  rijviii-x  may  have  to  be 
given  before  the  desired  physiological  effect  is  pro- 
duced. Intermit  the  drug  every  ten  days  for  five 
days. 

Physiologic  Action  and  Uses. — Va.sodilator;  periph- 
eral relaxant  action  upon  the  muscles  of  the  arterioles ; 
also  relieves  spasm  of  the  bronchi,  intestines,  renal 
and  biliary  tracts.  The  effect  lasts  about  twenty 
to  forty  minutes. 

Nitroglycerin  Tablets;  Tabellae  Trinitrini:  C3H5 

(N03)3. 

Dosage. — 6 months,  gr.  Kooi  18  months,  gr.  3^;  3 
years,  gr.  Koo;  5 years,  gr.  Koo-  Adult,  min,.  Koo; 
max.,  Vso. 

Method  of  Administration. — I^  Tabellarum  trini- 
trini, gr.  Koo,  no.  20. 

Sig. — One  tablet,  in  water,  or  best  di.ssolved  on 
or  under  the  tongue,  every  two  to  four  hours; 
or  three  to  four  times  a day,  gradually  increased 
by  one  tablet  every  four  or  five  days,  until  flushing, 
headache,  palpitation,  or  buzzing  in  the  ears  occurs; 
then  reduce  the  dose  several  tablets  and  occasion- 
ally increase  it  tentatively.  Gr.  Ko  or  even  Ko  may 
have  to  be  given  before  the  desired  physiological 
effect  is  produced.  Intermit  the  drug  every  ten  days 
for  five  days. 

Physiologic  Action  and  Uses. — Vasodilator;  periph- 
eral relaxant  action  upon  the  muscles  of  the  arterioles; 
also  relieves  spasm  of  the  bronchi,  intestines,  renal 
and  biliary  tracts.  The  effect  of  a single  dose  lasts 
about  twenty  to  forty  minutes. 

Nitrohydrochloricum  Acidum  Dilutum  (nitric  acid 
4,  hydrochloric  acid  18,  water  78  vols.;  should  be 
freshly  prepared). 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  x.x. 

Method  of  Administration. — I^  Acidi  nitrohydro- 
chlorici  diluti,  5i- 

Sig. — Fifteen  drops  in  a wineglassful  of  water, 
t.i.d.,  taken  through  a glass  tube;  rinse  the  mouth 
afterward  with  soda  water. 

Uses. — Cholagogue;  acid. 

Normal  Salt  Solution.  See  Sodii  Chloridum. 

Nosophen;  lodophen;  Tetraiodo-phenolphthalein. 

Adult  Dosage. — Min.,  gr.  v;  max.,  viii. 

Uses. — ^Antiseptic  powder. 

Novaspirin;  Methylene-Citrylsalicylic  Acid: 


CH2.COO(C6H4.COOH) 
I yO.CH2v 

CHa.COOfCsH^.COOH) 


Adult  Dosage. — Gr.  x-xv-xx. 

Method  of  Administration. — I^  Novaspirin.,  gr. 
XV,  pulvcres,  tabellae,  vel  capsulae  no.  6. 

Sig. — One,  twice  daily. 

Uses. — Analgesic;  antirheumatic. 

Novocaina;  Monohydrochloride  of  Para-amino- 
benzoyl-dieth  j4-amino-ethanol ; 


NH2 

HC/  \cH  (soluble  in  one  of  water  and  30  of 
HC\  yen  alcohol). 

C00(CH2CH2N(C2H3)2)HC1. 

Method  of  Administration. — For  infiltration  anaea- 


OLEUM  FCENICULI 


thesia:  novocaine,  gr.  iv,  with  epinephrine  solution 
(1:1000),  gtt.  v-x,  in  physiologic  salt  solution, 
(0.8  per  cent.)  1.6-3. 2 ounces. 

For  conjunctival  instillation:  1,  5 and  10  per 
cent,  solution. 

For  nasopharyngo-laryngeal  application:  five  to 
twenty  per  cent.,  with  six  to  eight  drops  of  adrenalin 
(1:1000)  to  each  10  cc.,  appUed  on  a pledget  of 
cotton  for  five  minutes. 

Physiologic  Action  and  Uses. — Local  antesthetic 
(safe).  It  may  be  boiled  repeatedly. 

Nucis  Vomicae  Extractum. 

Adult  Dosage. — Min.,  gr.  X;  av.,  Mi  max., 

Method  of  Administration. — Extracti  nucis 
vomicae,  gr.  34,  pillulaj  no.  30. 

Sig. — Pill,  t.i.d.  Maximum  in  twenty-four  hours, 
gr.  ii. 

Uses. — Bitter  stomachic  and  tonic;  general  stimu- 
lant. 

Toxic  Action. — Muscular  twitching,  stiffness  of 
the  neck,  slight  vertigo,  indigestion,  muscular  stiff- 
ness, increased  reflex  excitability,  spasm  of  the  neck 
of  the  bladder,  slight  disturbance  of  vision,  dilata- 
tion of  the  pupils,  restlessness,  trembling,  tetanic 
convulsions,  paralysis.  Diagnostic  features  are  the 
rapid  onset  of  the  attack,  affection  of  the  jaw  after 
the  limbs  and  trunk,  risus  sardonicus,  opisthotonus, 
relaxation  between  convrdsions,  retention  of  con- 
sciousness. 

Nucis  Vomicae  Tinctura. 

Dosage. — 6 months,  gt.  ss;  18  months,  gt.  i;  3 
years,  gtt.  i-ii;  5 years,  gtt.  ii-iv.  Adult,  min.,  njv; 
av.,  x;  max.,  xv. 

Method  of  Administration. — Tincturaj  nucis 
vomicae,  5ss. 

Sig. — Ten  drops  in  water,  t.i.d.,  gradually  in- 
creased to  twenty  to  twenty-five  drops,  t.i.d.,  if 
desired. 

Mx  contain  approximately  gr.  Koo  of  strychnine. 

Uses. — Bitter  stomachic  tonic;  general  stimulant. 

Toxic  Action. — See  above. 

Nucleinum. 

Adult  Dosage. — ^Min.,  gr.  viii;  max.,  xv,  t.i.d. 

Method  of  Administration. — Ten  to  sixty  minims 
of  a 5 per  cent,  solution  are  injected  hj-podermically, 
once  a day,  in  cases  of  septicaemia  in  which  there 
is  little  or  no  leucocytosis. 

Physiologic  Action  and  Uses. — Said  to  increase  the 
number  of  leucocytes. 

Nutmeg;  Myristica. 

Adult  Dosage. — Min.,  gr.  v;  av.,  viiss;  max.,  xv. 

Uses. — Stomachic;  carminative;  astringent;  re- 
lieves strangury. 

Toxic  Action. — Stupor;  delirium. 

Nutrose;  Sodii  Caseinas  (a  sodium  salt  of  milk 
casein,  containing  65  per  cent,  of  proteins). 

U ses. — N utrient . 

Oleatum  Hydrargyri  (yellow  oxide  HgO  25,  dis- 
tilled water  25,  oleic  acid  to  100). 

Adult  Dosage. — ^Min.,  gr.  Yn',  max.,  Y^. 

Uses. — Antiluetic;  alterative. 

Oleatum  Stanni;  Oleate  of  Tin. 

Oleatum  Zinci. 

Oleicum  Acidum  (practically  insoluble  in  water; 
jiartially  soluble  in  60  per  cent,  alcohol). 

Uses. — Emollient;  solvent  for  making  oleates. 

Oleoresina  Aspidii. — See  Aspidii  Oleoresina. 

Oleoresina  Copaiba. — See  Copaibac,  Oleum. 

Oleoresina  Cubebec;  Oleum  Cubebse. — See  Cu- 
bcbac. 

Oleum  Amygdal®  Amarae;  Oil  of  Bitter  Almond 
(yields  bcnzaldehyde  about  85  per  cent,  and  hydro- 
cyanic acid  about  3 per  cent.). 

Adult  Dosage. — Min.,  av.,  3^;  max.,  i. 

Uses. — Flavoring  agent;  sedative. 


Oleum  Amygdalae  Expressum  vel  Dulcis;  Oil  of 

Sweet  Almond. 

Adult  Dosage.— Min.,  5i;  av.,  gi;  max.,  iss. 

Uses. — Emolhent;  nutritive;  laxative. 

Oleum  Anisi. — See  Anisi,  Oleum. 

Oleum  Bergamottae. 

Uses. — Flavoring  agent;  perfume. 

Oleum  Betulae  Empyreumaticum  Rectificatum; 
Oleum  Rusci  Rectificatum. 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Used  in  a 2 to  10  per 
cent,  ointment. 

Uses. — ^Local  stimulant  and  antiseptic. 

Oleum  Cadinum;  Oil  of  Juniper  Tar. 

Method  of  Administration. — Used  in  a 1 to  10  per 
cent,  ointment. 

Uses. — Local  stimulant  and  antiseptic. 

Oleum  Cajuputi. 

Adxdt  Dosage. — Min.,  tjjv;  av.,  viii;  max.,  x. 

Alethod  of  Administration. — I^  Olei  cajuputi,  3i- 

Sig. — TTgi-iii  in  hot  water  every  two  hours. 

Uses. — Carminative  in  flatulent  colic. 

Oleum  Camphorata  (10  per  cent.);  Camphorated 
Oil,  not  the  liniment. 

Dosage. — 6 months,  gtt.  iii;  18  months,  gtt.  v;  3 
years,  gjt.  v-x;  5 years,  gtt.  x.  Adult,  min.,  nijxv; 
av.,  xxx;  max.,  3i- 

Method  of  Administration. — For  collapse:  Sterilize 
by  heat,  and  inject  deep  into  the  muscle  every  hour 
or  two;  or  inject  0.5  cc.  every  fifteen  minutes  for  four 
doses  if  necessary.  This  is  not  the  camphorated  oil 
of  the  shops.  The  latter  is  Linimentum  Camphorse, 
which  should  not  be  used  hj^iodermically. 

Physiologic  Action  and  Uses. — General  stimulant; 
mild  local  rubefacient. 

Oleum  Caryophylli;  Oil  of  Clove. 

Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  iv. 

Uses. — Local  anresthetic;  antiseptic,  counter- 
irritant;  carminative. 

Oleum  Cassise;  Oleum  Cinnamomi. — See  Cinna- 
momi.  Oleum. 

Oleum  Chaulmoograe;  Oleum  Gynocardiae.  See 
Chaulmoogrce. 

Oleum  Chenopodii;  Oil  of  American  Wormseed 
(should  be  kept  in  well-stoppered  amber-colored 
bottles  in  a cool,  dark  place). 

Dosage. — 18  months,  gt.  iss;  3 months,  gtt.  iii; 
5 years,  gtt.  v.  Adult,  min.,  ttjv;  av.,  x;  max.,  xv. 
Each  minim  equals  about  2)4  drops. 

Method  of  Adtninistration. — For  hookworm  disease 
the  following  treatment  is  recommended:  Cleanse 
the  bowels  the  evening  before,  then  give  one  drop 
of  the  oil  for  every  year  of  age  up  to  fifteen,  in  a 
teaspoonful  of  granulated  sugar,  every  two  hours 
for  three  doses,  followed  two  hours  later  by  a good 
dose  of  castor-oil. 

“Subminimal  doses,  rep>eated  at  intervals  of 
several  days,  become  toxic”  (Epitome  of  the  L^.  S. 
P.  and  N.  F.) 

Physiologic  Action  and  Uses. — Anthelmintic,  espe- 
cially for  round-worms  and  hook-worms. 

Toxic  Action. — Cardiovascular  and  respiratory 
depression;  bradycardia,  fall  of  blood-pressure, 
albuminuria,  somnolence,  coma,  paralysis. 

Oleum  Cinereum.  See  Gray  Oil. 

Oleum  Cinnamomi;  Oleum  Cassise.  See  Cinna- 
momi, Oleum. 

Oleum  Coca-nucis. 

Oleum  Copaibae;  Oleoresina  Copaibse.  See  Copai- 
bae.  Oleum. 

Oleum  Cubebae;  Oleoresina  Cubebse.  See  Cube- 
ba*. 

Oleum  Eucalypti.  See  Eucalypti,  Oleum. 

Oleum  Foeniculi  (nearly  insoluble  in  w^ater;  solu- 
ble in  alcohol). 


OLEUM  TANACETI 


Advlt  Dosage. — Min.,  iijjii;  av.,  iii;  max.,  v. 

Uses. — Carminative. 

Oleum  Qaultheriae;  Oil  of  Wintergreen;  Methyl 
Sahcylas.  See  Gaultheriae,  Oleum. 

Oleum  Qossypii  Seminis.  See  Cottonseed  Oil. 

Oleum  Qurjunse.  See  Gurjunse,  Balsamum. 

Oleum  Qynocardise.  See  Chaulmoograe,  Oleum. 

Oleum  Hedeomae;  Oil  of  Pennj^oyal. 

Advlt  Dosage. — Min.,  nji;  av.,  lii;  max.,  x. 

Method  of  Administration. — Olei  hedeomae, 
i^iii,  capsulse  no.  12. 

Sig.— A)ne  capsule,  t.i.d.p.c. 

It  may  be  prescribed  on  sugar. 

Uses. — Stimulant;  carminative;  emmenagogue. 

Toxic  Action. — -Narcosis. 

Oleum  Juniper!.  See  Juniperi,  Oleum. 

Oleum  Lavandulae;  Oil  of  Lavender. 

Adult  Dosage. — Min.,  tTjji;  av.,  iii;  max.,  v. 

Uses. — ^Flavoring  and  perfume. 

Oleum  Limonis;  Oil  of  Lemon. 

Adult  Dosage. — Min.,  aji;  av.,  iii;  max.,  v. 

Uses. — Flavoring  agent. 

Oleum  Lini;  Linseed  or  Flaxseed  Oil. 

Adult  Dosage. — Min.,  gss;  av.,  i;  max.,  ii. 

Uses. — Laxative ; emollient. 

Oleum  Menthae  Piperitae;  Oil  of  Peppermint. 

Adult  Dosage. — Min.,  aji;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  menthae 
piperitae,  5i- 

Sig. — Three  drops  in  hot  water,  every  two  hours. 

Uses. — Carminative  and  flavoring  agent;  local 
anodyne. 

Oleum  Menthae  Viridis;  Spearmint  Oil. 

Adult  Dosage. — Min.,  rrjii;  av.,  iii;  max.,  v. 

. Method  of  Administration. — Olei  menthae  viri- 
d’is,  3i. 

Sig. — Three  to  five  drops  in  hot  water,  every  two 
hours. 

Uses. — Carminative;  flavoring  vehicle. 

Oleum  Morrhuae. — See  Codliver  Oil. 

Olei  Morrhuae  Emulsum,  U.  S.  P. — See  Codliver 
Oil  Emulsions. 

Olei  Morrhuae  cum  Hypophosphitibus  Emulsum, 
U.  S.  P. — See  Codhver  Oil  Emulsions. 

Olei  Morrhuae  cum  Malto  Emulsum  N.  F. — See 
Codliver  Oil  Emulsions. 

Olei  Morrhuae  cum  Vitello  Emulsum. — See  Cod- 
liver Oil  Emulsions. 

Oleum  Myrti ; Myrtol;  Oil  of  Myrtle.— See  Myrtol. 

Oleum  Olivae;  Sweet  Oil. 

Dosage. — 6 months,  gtt.  xv;  18  months,  gtt.  xv- 
xxx;  3 years,  3ss-i;  5 years,  3i-  Adult,  min.,  3i; 
av.,  iv;  max.,  vi. 

Method  of  Administration. — I^  Olei  olivae,  Sviii. 

Sig.— Tablespoonful,  t.i.d.p.c. 

As  a laxative,  5ii“vi,  twice  daily. 

As  an  enema,  five  to  sixteen  ounces,  high  into 
the  colon. 

Uses. — Emollient;  laxative;  nutrient. 

Oleum  Origani. 

Adult  Dosage. — -Av.,  njv. 

Method  of  Administration. — Olei  origani,  3i- 

Sig. — Five  drops  in  hot  water,  three  or  four  times 
a day. 

Uses. — Stimulant;  carminative. 

Oleum  Phosphoratum  N.  F.  (1  per  cent,  dissolved 
in  ether  and  added  to  expressed  oil  of  almond; 
should  be  recently  made;  gr.  Km  of  phosphorus  to 
each  minim). 

Dosage. — ^ months,  gt.  ss;  18  months,  gt.  i;  3 
years,  gtt.  iss;  5 years,  gtt.  ii-iv.  Adult,  min., 
iTRi;  max.,  iii. 

Method  of  Administration. — 01eiphosphorati,3i- 

Sig.— One  minim,  on  the  tongue,  gradually  in- 
creased to  three  or  four  minims,  t.i.u.p.c. 


Physiologic  Action  and  Uses. — Alterative;  aphro- 
disiac; stimulates  metabolism,  causing  increased 
growth  and  new  formation  of  tissues  (red  blood- 
cells,  bone,  etc.);  inhibits  oxidation;  used  principally 
in  rickets. 

Toxic  Action. — Acute  poisoning  is  manifested  by 
nausea,  garlic  eructations,  pain  and  burning  in  the 
stomach,  vomiting,  sometimes  diarrhcea;  after 
several  days,  fatty  degeneration  of  the  organs  with 
vomiting  of  blood,  drowsiness,  enlarged  painful 
liver  and  scanty  urine;  later  perhaps  delirium, 
somnolence,  coma,  and  occasionally  convulsions. 

Chronic  poisoning  is  manifested  by  necrosis  of 
the  lower  jaw,  and  fatty  degeneration  of  the  various 
organs,  followed  by  a proliferation  of  the  con- 
nective tissue: — ^anaemia,  general  debility,  slight 
jaundice,  indigestion,  diarrhoea. 

Oleum  Picis  Liquidae  Rectificatum;  Rectified  Oil 
of  Tar  (nearly  insoluble  in  water;  soluble  in 
alcohol). 

Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  picis  hquidse 
rectificati,  irgiii,  capsulae  no.  12. 

Sig. — ^A  capsule  every  three  hours. 

Uses. — Antiseptic;  irritant;  parasiticide;  irritant 
expectorant. 

Oleum  Pini  Pumilionis;  Dwarf  Pine  Needle  Oil 
(nearly  insoluble  in  water;  soluble  in  alcohol). 

Method  of  Administration. — 3ss  to  Oi  of  steaming 
water,  as  an  inhalation. 

Uses. — Bronchial  sedative. 

Oleum  Pini  Sylvestris;  Scotch  Fir  Oil. 

Method  of  Administration. — 3ss  to  Oi  of  steaming 
water,  as  an  inhalation. 

Uses. — Bronchial  sedative. 

Oleum  Ricini;  Castor-Oil. — See  Castor-Oil. 

Oleum  Rosae;  Attar  of  Rose. 

Uses. — ^Perfume. 

Oleum  Rosae  Qeranii. 

U ses. — Perfume. 

Oleum  Rusci  Rectificatum.  See  Oleum  Betulae. 

Oleum  Rutae;  Oil  of  Rue. 

Adult  Dosage. — Min.,  Tjji;  av.,  ii;  max.,  v. 

Uses. — Emmenagogue;  aphrodisiac. 

Toxic  Action. — (jastro-enteritis;  prostration;  con- 
vulsions; strangury;  anuria;  narcosis. 

Oleum  Sabinae;  (jil  of  Savin:  CioHie. 

Adult  Dosage. — Min.,  irjji;  av.,  ii;  max.,  iv. 

Uses. — Emmenagogue. 

Toxic  Action. — Gastro-enteritis;  haematuria;  dysu- 
ria;  narcosis. 

Oleum  Santali;  Oil  of  Sandalwood. 

Adult  Dosage. — Min.,  ngv;  av.,  x;  max.,  xx. 

Method  of  Administration. — Olei  santaU,  tiijx, 
capsulse  no.  12. 

Sig. — One,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Urinary  astringent 
and  antiseptic;  useful  in  subacute  gonorrhoea  and 
ammoniacal  cystitis  due  to  pyogenic  cocci;  broncho- 
pulmonary antiseptic  and  deodorizer. 

Toxic  Action. — Gastric  and  intestinal  irritation, 
lumbar  pain. 

Oleum  Sassafras. 

Adult  Dosage. — Min.,  tpji;  av.,  iii;  max.,  iv. 

Method  of  Administration. — It  may  be  prescribed 
in  emulsion,  but  better  in  capsule. 

C/ses.— Flavor;  rubefacient. 

Oleum  Sesami;  Teel  Oil;  Benne  Oil. 

Uses. — Emollient;  substitute  for  olive-oil. 

Oleum  Sinapis  Volatile;  Mustard  Oil;  Allyl 
Sulpho-cyanide;  C4H5NS. 

Adult  Dosage. — Min.,  max.,  14- 

Uses. — Vesicant. 

Oleum  Tanaceti;  Oil  of  Tansy. 

Adult  Dosage. — Min.,  i^ii;  max.,  x. 


ORTHOFORMUM 


Method  of  Administration. — R Olei  tanaceti, 
Tijiii,  pilulaj  vel  capsul®  no.  24. 

Sig. — One,  t.i.d.  It  may  also  be  administered 
on  sugar. 

Uses. — Emmenagogue;  diuretic;  anthelmintic. 

Toxic  Action. — Abdominal  pain,  vomiting,  un-  . 
consciousness,  convulsions. 

Oleum  Terebinthinae  Rectificatum  CioHie;  Recti- 
fied Oil  or  Spirits  of  Turpentine  (a  mixture  of  pinene, 
CioHie,  with  small  amounts  of  other  terpenes  and 
traces  of  organic  acids;  insoluble  in  water;  soluble  in 
3 of  alcohol;  soluble  in  oil). 

Adidt  Dosage. — Min.,  rnjv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — -Pf  Olei  terebinthinai 
rectificati,  5ss. 

Sig. — -Five  to  fifteen  drops  on  sugar,  bread,  or  in 
milk,  three  to  six  times  daily,  together  with  plenty 
of  water.  It  may  also  be  jirescribed  in  capsule. 

As  an  enema:  5ss-i-iv  to  the  quart  of  soapsuds. 
As  a hot  stupe : ten  to  twenty  drops  to  the  pmt. 

Physiologic  Action  and  Uses. — Counter-irritant; 
external  and  intestinal  antiseptic;  anthelmintic; 
carminative;  irritating  diuretic;  haemostatic;  bron- 
cho-pulmonary antiseptic  and  deodorizer;  stimulant. 

Olei  Terebinthinae  Emulsum  (rectified  oil  15,  ex- 
pressed oil  of  almond  5,  syrup  25,  acacia  15,  water 
to  100). 

Adidt  Dosage. — Min.,  oss;  av.,  i;  max.,  ii+. 

Method  of  Administration. — R Emulsi  olei  tere- 
binthinae, §iv  (trjiii  per  dram). 

Sig. — Teaspoonful,  three  to  six  times  daily,  to- 
gether with  lots  of  water.  The  taste  may  be  dis- 
guised with  oil  of  gaultheria,  nji  to  the  dose. 

R Olei  terebinthinae  rectificati,  3i,  9i  (tU!x 
per  dose);  olei  gaultheriae,  ngviii;  glycerini,  5i; 
mucilaginLs  acaciae,  5i;  aquae,  q.s.  ad  5iv. 

Misce  et  fiat  emulsum. 

Sig. — Tablespoonful,  three  to  six  times  daily,  with 
lots  of  water. 

Oleum  Theobromatis;  Cacao  Butter  (melts  at 
body  temperature). 

Uses. — Emollient;  lubricant  in  massage;  supposi- 
tory basis. 

Oleum  Thymi;  Oil  of  Thyme. 

Adult  Dosage. — Tiji;  av.,  iii;  max.,  v. 

Oleum  Tigiii;  Croton  Oil. — See  Croton  Oil. 

Olive-Oil;  Sweet  Oil;  Oleum  Olivae. — See  Oleum 
Olivm. 

Opii  Extractum  (1  gm.  represents  about  2 gms. 
opium). 

Adult  Dosage. — Min.,  gr.  fi]  av.,  3^;  max.,  ii. 

Method  of  Administration. — Prescribe  in  pill  form; 
gr.  ss  contains  about  gr.  Ko  of  morphine. 

Uses. — See  Morj)hino. 

Toxic  Action. — Myosis,  sometimes  nausea  and 
vomiting,  slowing  of  the  respiration  and  pulse,  the 
latter  later  becommg  rapid,  diminished  reflexes, 
deepening  stupor,  coma. 

Opii  Pilulae  (pulveris  opii,  gr.  i;  morifliinae  gr.  ){). 

Adult  Dosage. — Min.,  1;  max.,  3. 

Opii  Pulvis  (gr.  i contains  of  morphine  gr.  )s). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iii. 

Opii,  Pulvis  Ipccacuanhae  et;  Dover’s  powder. — 
See  Dover’s  Powder. 

Opii  Tinctura;  Laudanum.  See  Laudanum. 

Opii  Tinctura  Campliorata;  Paregoric  (pulv.  opii 
4,  benzoic  acid  4,  camphor  4,  oil  of  anise  4,  glycerine 
40,  diluted  alcohol  to  1000). 

Dosage. — 6 months,  gtt.  iii-v;  18  months,  gtt.  x; 

3 years,  gtt.  xw-xx;  5 years,  gtt.  x.x-xxx.  Adult, 
min.,  5i;  av.,  ii;  max.,  iv. 

Method  of  Administration. — Wachenheim  gives 
one  minim  for  each  two  pounds  of  the  infant’s 
weight,  oiv  contains  nearly  one  grain  of  irowdcred 
opium,  or  gr.  % of  morphine. 


Opii  Tinctura  Deodorati. 

Dosage. — 6 months,  18  months,  3 

years,  ngi;  5 years,  i^ii-iii;  adults,  i^v-x-xxx;  ajx  is 
equivalent  to  powdered  opium  gr.  i,  or  morphine 
g >8. 

Opii,  Tinctura  Ipecacuanha  et. — See  Ipecacuanhse 
et  Opii,  Tinctura. 

Opii,  Syrupus  Ipecacuanhae  et;  Syrup  of  Dover’s 
Powder,  N.  F.  (tr.  of  ipecac  and  opium,  8.5  per  cent., 
flavored  with  .spirit  of  cinnamon  and  cinnamon 
water  in  syrup). 

Adult  Dosage. — Min.,  oss;  av.,  i;  max.,  ii. 

Optochin;  Ethyhs  Hydrocuprein  Hydrochloridum 
(a  quinine  alkaloid)  C19H22N2.OH.O.C2H5.HCI. 

Adult  Dosage. — Gr.  viiss,  t.i.d. 

Method  of  Administration. — One  to  two  per  cent, 
aqueous  solution,  freshly  prepared,  or  1 to  2 per 
cent,  solution  in  oil  or  ointment:  specific  in  serpent 
ulcer  of  the  cornea  due  to  the  pneumococcus;  1 to  2 
per  cent,  solution  as  a gonococcocide. 

For  pneumonia,  0.024  gram  per  kilogram  of  body 
weight  every  twenty-four  hours  is  required  to  pro- 
duce a bactericidal  action  in  the  blood  serum.  Thus 
for  the  average  sized  individual,  the  amount  for 
twenty-four  hours  is  1.5  grams,  administered  as 
follows:  initial  dose  0.45  grams,  follow’ed  every 
three  hours  by  0.15  gram;  second  twenty-four  hours, 
ten  doses  of  0.15  gram;  best  given  in  capsule  (Allan 
M.  Chesney.) 

U ses. — Antiseptic ; antipneumococcic. 

Toxic  Action. — Tinnitus,  deafness,  amblyopia, 
amaurosis,  retinitis. 

Orange.  See  Aurantium. 

Orexinum  Basicum;  Phenyl-dihydrochinazohn. 

Adult  Dosage. — Min.,  gr.  iss;  max.,  v. 

Method  of  Administration. — R Orexini;  gr.  5, 
tabellaj  vel  capsiilse  no.  12. 

Sig. — A tablet,  t.i.d.,  or  b.i.d.a.c.,  followed  by  a 
draught  of  warm  water,  milk,  or  beef  tea. 

Uses. — Stomachic;  appetizer. 

Orexinum  Tannicum. 

Adult  Dosage. — Min.,  gr.  iv;  av.,  vLii;  max.,  xii. 

Method  of  Administration. — R Orexini  tannici, 
gr.  viii,  capsulae  no.  12. 

Sig. — A capsule  t.i.d.,  or  b.i.d.a.c.,  followed  by  a 
draught  of  warm  water,  milk,  or  beef  tea. 

Uses. — Stomaclric;  appetizer. 

Origani  Oleum. 

Adult  Dosage. — Av.,  ttjv. 

Method  of  Administration. — R Olei  origani,  3i- 

Sig. — Five  drops  in  hot  water,  three  or  four  times 
a day. 

Uses. — Stimulant;  carminative. 

Orthoformum;  Meta-Amino-Para  Oxybenzoate  of 
Methyl : 

C6H3.NH2.0H.C0.0.(CH3),  3:4:1, 
or  NH2  (scarcely  soluble  in  water) 

CK.O/  NcH 

60OCH3 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — R Orthoformi,  gr. 
Lxxx;  mucilaginis  acaciaj,  Sii;  aquae,  q.s.  ad  oiv. 

Misce  et  fiat  emulsum. 

Sig.— Tablespoonful  (gr.  x)  three  to  eight  times 
daily  as  required.  It  is  used  m the  form  of  a lozenge, 
for  painful  mouth;  as  a powder,  for  wounds;  mixed 
with  milk  sugar  for  insufflation;  dissolved  in  ether 
and  mixed  in  oil  for  pencihngs;  mixed  with  lanolin 
as  a salve. 

Physiologic  Action  and  Uses. — Local  anaesthetic 


PAREGORIC 


to  abraded  surfaces,  e.g.,  gastric  ulcer  and  cancer, 
etc.  Since  it  acts  only  on  abraded  or  ulcerated  sur- 
faces, the  relief  of  pain  probably  indicates  the  pres- 
ence of  ulceration. 

Toxic  Action. — Used  as  a dusting  powder  on  ulcers, 
it  may  cause  oedema,  eczema,  and  gangrene. 

Oubain. — See  Strophanthin. 

Ovariae  Glandulae  Dessicatse;  Ovarin. 

Adult  Dosage. — Min.,  gr.  iii;  max.,v. 

Method  of  Administration. — Ovariae  glandulae 
siccae,  gr.  v,  tabellae  no.  60. 

Sig. — Tablet  three  or  four  times  a day 

Physiologic  Action  and  Uses. — Used  in  the  meno- 
pause or  ovarian  insufficiency. 

Ovoferrin;  Ferri  Vitellinum  Syntheticum. 

Adult  Dosage. — Min.,  3iii  max.,  iv. 

Method  of  Administration. — Ovoferrin,  §viii. 

Sig. — Tablespoonful  in  water,  t.i.d.a.c. 

Uses. — Haematinic. 

Oxalicum  Acidum:  COOH 
COOH 

(soluble  in  10  of  water). 

Adult  Dosage. — Min.,  gr.  Ko,‘  av.,  max., 

Method  of  Administration. — Acidi  oxalici,  gr. 
iv;  syrupi  limonis,  §ii. 

M.  Sig. — One  dram,  t.i.d. 

Uses. — ^Enunenagogue. 

Toxic  Action. — Burning  pain  in  the  throat  and 
abdomen,  vomiting;  small,  irregular  pulse,  collapse, 
stupor,  sometimes  convulsions,  respiratory  paralysis. 

Oxgall  Extract;  Extractum  Felhs  Bovis. 

Adult  Dosage. — Av.,  gr.  iss. 

Method  of  Administration. — Extract!  fellis 
bovis,  gr.  iss,  pilulae  vel  capsulae  (hardened  with 
formalin)  no.  12. 

Sig. — One  pill,  t.i.d.p.c. 

Uses. — Cholagogue;  laxative;  intestinal  antiseptic; 
aids  in  the  absorption  of  fats. 

Oxygenium;  Oxygen:  O2. 

Method  of  Administration. — Oxygen  should  be  ad- 
ministered very  slowly  through  a funnel  draped  with 
a curtain  and  held  over  the  mouth  and  nose.  Pure 
oxygen,  says  L.  E.  Hill,  may  be  breathed  for  two  to 
four  hours  continuously,  without  harm;  and  an  at- 
mosphere of  50  per  cent,  oxygen  can  be  breathed 
indefinitely.  “The  cylinder  valve  must  be  opened 
wide  enough  to  give  a pleasant  cool  current  (as 
tested  upon  the  lips),  and  drive  the  exhaled  CO2  out 
of  the  mask”  (L.  E.  HiU). 

Physiologic  Action  and  Uses. — Used  in  asphyxia, 
carbon-monoxide  poisoning,  etc. 

Pancreatini  Liquor  N.  F.  (pancreatin  1.75  per 
cent.,  sod.  bicarb.  5 per  cent.,  with  comp.  spt.  of 
cardamom,  sod.  chloride  and  chloroform  in  alcohol, 
glycerine,  and  water). 

Adult  Dosage. — ^Av.,  3i- 

Method  of  Administration. — Liquoris  pancre- 
atini, §iv. 

Sig. — Teaspoonful  t.i.d.p.c.,  in  achlorhydria.  It 
is  destroyed  by  the  acid  of  normal  gastric  juice. 

To  peptonize  milk,  add  one-third  water  to  fresh 
cow’s  milk,  bod,  cool,  add  h'quor  pancreatini,  3i-ii, 
to  each  pint,  and  keep  in  a warm  place  (about  40°  C) 
for  one  hour. 

' Uses. — Proteolytic,  amylolytic,  and  lipolytic. 

Pancreatinum  (contains  trypsin,  amylopsin,  and 
steapsin). 

Adult  Dosage. — Min.,  gr.  iii;  av.,  viii;  max.,  xv. 

Method  of  Administration. — 1|  Pancreatini,  gr. 
viiss,  pdulae  (salol-coated)  vel  capsuke  (hardened 
with  formalin)  no.  .30. 

Sig. — One  pill  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Proteolytic,  amylo- 
^ic,  and  lipolytic;  used  in  pancreatic  insufficiency. 
It  is  destroyed  by  acids. 


Pancreon  (Pankreon)  (pancreatin  with  about  8 per 
cent,  of  tannin). 

Dosage. — 5 years,  gr.  i-v.  Adult,  min.,  gr.  iv; 
max.,  XV. 

Method  of  Administration. — Pancreon.,  gr. 
vi-x,  pilulse  (salol-coated)  no.  30. 

Sig. — One  pill,  t.i.d. 

Physiologic  Action  and  Uses. — Astringent;  di- 
gestant;  used  in  pancreatic  insufficiency. 

Panopepton  (predigested  beef  and  wheat  with 
sheny  wine;  500  gm.  furnishes  495  calories,  of  which 
155  are  due  to  protein  and  340  to  carbohydrates). 

Adult  Dosage. — 3i-u.  Several  tunes  a day  and  at 
bedtime.  For  infants,  from  a few  drops  to  thirty 
minims. 

Uses. — Concentrated  liquid  food. 

Papayotin;  Papain;  Papoid;  Papaiva  (a  pro- 
teolytic ferment  obtained  from , the  carica  papaya 
tree  of  South  America) ; soluble  in  water  but  not  in 
alcohol. 

Adidt  Dosage. — ^Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — Papayotin,  gr.  ii, 
pilulaj  no.  30. 

Sig. — One  pill,  t.i.d.  It  may  be  dispensed  in 
aqueous  solution. 

U ses. — Proteolytic. 

Paraffinum  (solid). 

A preparation  melting  at  41°  to  45°  C.  (105.8° 
to  113°  F.)  is  used  for  prosthetic  purposes  in 
surgery. 

Paraffinum  Liquidum  Purificatum;  Petrolatum 
Liquidum;  Mineral  Oil. 

Adult  Dosage. — Min.,  §ss;  max.,  iii. 

Method  of  Administration. — I^  Paraffini  liquid! 
purificati,  3 viii. 

Sig. — One-half  to  three  ounces  a day,  in  a single 
dose  on  retiring,  or  in  divided  doses;  or  two  tea- 
spoonfuls to  two  tablespoonfuls,  one-half  hour  be- 
fore meals,  two  to  three  times  a day.  Do  not  give 
it  with  or  after  meals  to  avoid  indigestion.  Remove 
the  taste  with  warm  water,  milk,  or  a bite  of  dry 
bread. 

Uses. — Laxative,  emollient,  vehicle. 

Paraffinum  Molle;  Petrolatum  Molle;  Vasehne 
(white  vaselin  is  soft  paraffine  which  has  been  filtered 
through  animal  charcoal). 

Uses. — Base  for  ointments;  protective  emollient. 

Paraldehydum:  (CHsCOHls  (soluble  in  8 of 
water,  and  in  all  proportions  with  alcohol). 

Adult  Dosage. — Min.,  tujxx;  av.,  xxx;  max.,  3ii- 

Method  of  Administration. — I^  Paraldehydi,  5i- 

Sig. — One-half  to  one  teaspoonful,  in  water  or 
diluted  brandy,  or  better  with  cracked  ice  or  ice- 
cold  liquids,  at  bedtime. 

I^  Paraldehydi,  3ii  (3 ss  per  dose);  ehxiris  aro- 
matic!, q.s.  ad  3ii. 

M.  Sig. — Tablespoonful  at  bedtime. 

Physiologic  Action  and  Uses. — Rapid  and  reason- 
ably safe  hypnotic,  acting  in  ten  to  fifteen  minutes; 
promotes  sleep  by  impairing  the  perception  of  ex- 
ternal stimuli. 

Toxic  Action. — Headache,  excitement,  salivation, 
vasomotor  and  respiratory  and  cardio-vascular  de- 
pression. From  habitual  use,  dyspepsia,  ana3mia, 
cardiovascular  depression,  emaciation,  insanity. 

Parathyroideae  Extractum. 

Adult  Dosage. — -Av.,  gr.  %. 

I^  Extract!  parath3Toideae,  gr.  )i,  pulveres  no.  21. 

Sig. — Powder,  t.i.d. 

Uses. — ^Alterative. 

Toxic  Action. — Muscular  tremor. 

Paregoric;  Tinctura  Opii  Camphorata  (pulv. 
opii  4,  benzoic  ac.  4,  camphor  4,  oil  of  anise  4, 
glycerine  40,  diluted  alcohol  to  1000). 

Dosage. — 6 months,  gtt.  iii-v;  18  months,  gtt.  x; 


PHENOCOLL  HYDROCHLORIDUM 


3 years,  gtt.  xv-xx;  5 years,  gtt.  xx-xxx.  Adult, 
min.,  3i;  av.^  ii;  max.,  iv. 

Wachenheim  gives  one  minim  for  each  two 
pounds  of  the  infant’s  weight.  3iv  contains  nearly 
one  grain  of  powdered  opium,  or  gr.  3^  of  mor- 
phine. 

Uses. — See  Morphine. 

Pareirse  Fluidextractum, 

Adult  Dosage. — Min.,  ttjx;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — Fluidextracti  pa- 
reirse,  gii. 

Sig. — Half  to  one  teaspoonful,  in  plenty  of  water, 
three  to  four  times  a day. 

Uses. — Bitter  tonic;  diuretic;  laxative. 

Pareirae  Infusum  (5ad  Oi). 

Adult  Dosage. — Min.,  5i;  max.,  ii. 

Method  of  Adyninistration. — Infusi  pareirae,  Oi. 

Sig. — One  to  two  ounces,  three  to  four  times  a day, 
with  plenty  of  water. 

Uses. — Bitter  tonic;  diuretic;  laxative. 

Parolein;  Paroline.  See  Petrolatum  Liquidum. 

PelletierincB  Tannas  (a  mi.xture  of  four  active 
alkaloids  from  pomegranate). 

Adxdt  Dosage. — Min.,  gr.  iii;  av.,  iv;  max.,  v. 

Method  of  Adyninistration. — Pelletierinae  tan- 
natis,  gr.  iv,  capsulae  no.  1. 

Sig. — Take  in  the  morning,  fasting,  and  follow  in 
one  to  two  hours  by  a brisk  castor-oil  purge.  The 
powder  may  also  bo  administered  suspended  in 
water.  It  should  be  preceded  by  a day  of  mdd 
purging  and  light  diet. 

Physiologic  Action  and  Uses. — Anthelmintic  and 
teniafuge;  no  more  than  five  grains  shoidd  be  given, 
for  fear  of  paralysis. 

Toxio  Action. — Dizziness,  confusion,  faintness, 
weakness,  occasionally  serious  disturbances  of  vision. 

Pennyroyal  Oil  of;  Oleum  Hedeomse.  See  Olemn 
Hedeom®. 

Pepo;  Pumpkin  Seed. 

Dosage. — 3 years,  pi  + ;5years,  3H~-  Adult, min., 
5ss-i;  av.,  ii;  max.,  iv. 

M ethod  of  Administration. — Beat  up  into  an  emul- 
sion with  sugar  and  water,  take  on  an  empty  stom- 
ach, and  follow  in  two  hours  by  a brisk  cathartic. 

Uses. — Anthelmintic;  teniafuge. 

Peppermint.  See  Mentha  Piperita. 

Pepsini  Essentia. 

Dosage. — b months,  gtt.  xx;  18  months,  gtt.  xxx- 
xl;  3 years,  gtt.  xl-pi;  5 years,  3i-  Adult,  av.,  3|- 

Method  of  Administration. — R Essentia;  pepsini, 

. , . 

Sig. — A dose,  t.i.d.p.c.  Pepsin  acts  only  m an 
acid  mechum.  One  cc.  will  curdle  250  cc.  of  milk  at 
38°  C.  in  a few  minutes. 

Physiologic  Action  and  Uses. — Proteolytic;  milk- 
curdling;  vehicle;  used  to  prepare  whey  and  junket 
(q.v.). 

Pepsinum  (soluble  in  50  of  water,  nearly  insolu- 
ble in  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii;  3 
years,  gr.  ii-iii;  5 years,  gr.  ui.  Adult,  min.,  gr.  v; 
av.,  viii;  max.,  xv. 

Method  of  Administration. — R Pepsini,  3R 
(gr.  X per  dram);  acidi  hydrochlorici  diluti,  5i 
(tojxx  per  dram);  aqua;,  q.s.  ad  5iii- 

M.  Sig. — One  dram,  in  half  a tumbler  of  sweetened 
albumen  water,  taken  through  a straw  or  glass  tube, 
during  or  after  meals.  Rinse  the  mouth  afterward 
with  soda-water. 

Phyjsiologic  Action  and  Uses. — Proteolytic,  acting 
only  in  an  acid  medium. 

Peptogenic  Milk  Powder. 

Method  of  Use. — To  peptonize  milk  add  one- 
third  water  to  fresh  cow’s  milk,  boil,  cool,  and  add 
peptogenic  milk  powder,  to  the  pint,  and  allow  to 


stand  in  a warm  place  (about  40°  C.)  for  one  hour. 

Uses. — Used  to  peptonize  milk. 

Peptonized  Milk.  See  Liquor  Pancreatini,  and 
Peptogenic  Milk  Powder,  above. 

Peptonoids,  Beef  or  Dry  (a  powder  consisting  of 
partially  peptonized  beef,  milk,  and  wheat  gluten, 
and  containing  40  per  cent,  of  proteins  and  52  per 
cent,  of  carbohydrates.  Liquid  peptonoids  is  the 
same  in  hquid  form). 

Adult  Dosage. — 3ii-iv  in  water,  milk,  wine, 
broths,  soups,  etc.,  or  in  gruels,  first  dissolved  in 
water.  One-half  ounce  represents  about  sixty-five 
calories. 

Uses. — Concentrated  food. 

Peptonoids,  Liquid;  Liquid  form  of  Beef  Pepto- 
noids. See  above. 

Adult  Dosage. — 5ss-iv  three  to  six  times  daily. 

Uses. — Concentrated  liquid  food.  500  gm.  fur- 
nishes 4 10  calories,  of  which  125  are  due  to  protein, 
and  285  to  carbohydrates. 

Perhydrol  (H2O2,  30  per  cent.,  free  from  acid). 

Method  of  Administration. — Used  locally  in  full 
strength,  or  diluted  one-half  to  two-thirds  with 
water. 

Uses. — Antiseptic. 

Peruvianum  Balsamum.  See  Balsamum  Peru- 
vianum. 

Petrolatum;  Petroleinn  .Jelly. 

Uses. — Base  for  ointments;  protective  emolhent. 

Petrolatum  Liquidum;  Liquid  Paraffin;  Mineral 
Oil. 

Adult  Dosage. — Min.,  5ss;  max.,  iii. 

Method  of  Administration. — R Paraffini  liquidi 
purificati,  5 viii. 

Sig. — One-half  to  three  ounces  a day,  in  a single 
dose  on  retiring,  or  in  divided  doses;  or  two  tea- 
spoonfuls to  two  tablespoonfuls,  one-half-hour  be- 
fore meals,  two  or  three  times  a day.  Do  not  give 
it  with  or  after  meals  for  fear  of  disturbing  diges- 
tion. Remove  the  taste  with  xvarm  water,  milk,  or 
a bite  of  dry  bread. 

Uses. — -Laxative  emollient;  vehicle. 

Phenacetin;  Acetphenetidinum : 


lie 

HC 


O-C2H5 
/°\CH 


CH 

H 

O.CH3 


(soluble  in  1310  of  water, 
15  of  alcohol). 


Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  iss;  5 years,  gr.  ii.  Adult,  min.,  gr.  v;  av., 
x;  max.,  xv. 

Method  of  Administration. — R Acetphenetidmi, 
gr.  V.  Mitte  talis  pulveres  sive  tabellae  vel  capsulae, 
no.  22. 

Sig. — One  powder  or  tablet  as  required,  or  about 
every  three  hours.  Allow-  no  more  than  gr.  xx-Lx  in 
twenty-four  homs,  to  an  adult. 

Physiologic  Action  and  Uses. — Anal^sic;  nervous 
sedative;  hj-pnotic;  antipyretic,  lessening  heat  pro- 
duction (comparatively  safe).  Local  antiseptic. 

Toxic  Adion.— Cardiovascular  and  respiratory 
depression,  dyspnoea,  sweating,  cyanosis,  voniiting, 
methaemoglobinemia  and  methsemoglobinuria,  col- 
lapse. 

Phenocoll  Hydrochloridum;  Aminoacetpheneti- 
dini  Hydrochloridum:  C6H4.0C2H5NH(CHjNHs. 
CO)HCl;  soluble  in  16  of  water). 

Adult  Dosage. — Min.,  p-.  v;  max.,  xx. 

Method  of  Administration. — R Phenocoll  hydro- 
chloridi,  gr.  v,  pulveres  no.  12. 


PHYSOSTIGMATIS  EXTRACTUM 


Sig. — A powder,  dissolved  in  water,  three  to  four 
times  a day,  as  required. 

Uses. — Analgesic;  antineuralgic;  antipyretic. 

Phenol.  See  Acidum  Carbolicum. 

Phenolatum  lodum;  Iodized  Phenol  (usually, 
iodine  1,  to  phenol  4). 

Uses. — Antiseptic  and  counter-irritant. 

Phenolis  Qlyceritum.  See  Acidi  Carbolici  Gly- 
ceritum. 

Phenolis  Unguentum  (phenol  3,  white  petrolatum 
97). 

Uses. — Antiseptic  emollient. 

Phenolphthaleinum;  Dihydroxyphthalophenone 
C6H4(0H)2C0.C6H4C0. 

Dosage. — ^For  children,  gr.  i-ii.  Adult,  min.,  gr.  i; 
av.,  iv;  max.,  viii. 

Met)wd  of  Administration. — I^  Phenolthalcini, 
gr.  i,  trochisci  no.  x. 

Sig. — One  or  more  at  bedtime. 

Uses. — Laxative. 

Toxic  Action. — Prolonged  use  irritates  the  kidneys. 

Phenolsulphonas  Sodii;  Sodii  Sulphocarbolas 
(soluble  in  4.2  of  water). 

Adult  Dosage.— Min.,  gr.  ii;  av.,  iv;  max.,  x. 

Method  of  Administration. — Sochi  phenolsul- 
phonatis,  gr.  Ixxx  (gr.  v per  dram);  aquaj,  Jii. 

M.  Sig.— One  dram  in  water,  three  to  four  times 
daily. 

Uses. — Local  and  internal  antiseptic  (?) 

Phenolsulphonas  Zinci;  Zinci  Sulphocarbolas 
(soluble  in  1.6  of  water,  and  in  1.8  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Zinci  phenoLsul- 
phonatis,  gr.  xlviii  (gr.  iii  per  dram);  aqua;,  Bii. 

M.  Sig. — One  dram  in  water,  three  to  four  times 
daily. 

Uses. — Local  and  internal  antiseptic  and  astrin- 
gent. 

Phenolsulphonephthalein : 

/CeHiv  /C6H4OH 

SO2C  >c< 

\C6H4OH 

Used  for  determining  the  functional  activity  of 
the  kidneys.  See  Urinalysis,  Part  1. 

Phenyldnchoninicum  Acidum;  Atophan.  — See 
Atophan. 

Phenylis  Salicylas;  Salol:  C6H4(OH)COOC6H6l  : 
2 (soluble  in  6670  parts  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i-ii;  3 
years,  gr.  ii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v;  av., 
vLiss;  max.,  xv. 

Method  of  Administration. — R Phenylis  salicy- 
latis,  gr.  V,  capsulae,  tabelke,  vel  pulveres  no.  12. 

Sig. — One,  every  two  to  four  hours. 

Physiologic  Action  and  Uses. — -Intestinal  and  uri- 
naiy  antiseptic  by  the  hberation  of  phenol  and 
sahcylic  acid ; antirheumatic ; antipyretic ; diaphoretic. 

Toxic  Action. — Symptoms  of  salicyhc  acid  poison- 
ing, together  with  lumbar  heaviness,  smoky  urine, 
and  other  phenol  effects. 

Phloridzin:  C2iH240io-f-2H20  (Glucoside). 

Adult  Dosage. — Min.,  gr.  v;  max.,  x (by  mouth). 

Uses. — Used  for  testing  the  functional  activity  of 
the  kidneys.  See  Urinalysis,  Part  1. 

Phosphidum  Zinci. 

Adult  Dosage. — Min.,  gr.  max.,  Kj- 

Method  of  Administration. — I^  Zinci  phosphidi, 
gr.  %,  piluke  no.  30. 

Sig. — One  pill,  t.i.d. 

Phosphoratum  Oleum  (1  per  cent,  dissolved  in 
ether  and  added  to  expressed  oil  of  almond ; should 
be  recently  made;  gr.  Koo  of  phosphorus  to  each 
minim). 

Dosage. — 6 months,  gt.  ss;  18  months,  gt.  i;  3 


years,  iss;  5 years,  gtt.  ii-iv.  Adult,  min.,  T^j; 
max.,  iii. 

Method  of  Administration. — R Olei  phosphorati, 

3>- 

Sig. — One  minim  on  the  tongue,  gradually  in- 
creased to  three  to  four  minims,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Alterative;  aphro- 
disiac; stimulates  metabolism,  causing  increased 
growth  and  new  formation  of  tissues  (red  blood-cells 
bone,  etc.);  inhibits  oxidation;  used  principally  in 
rickets. 

Toxic  Action. — Acute  poisoning  is  manifested  bv 
garlic  eructations,  pain  and  burning  in  the  stomach, 
nausea  and  vomiting,  sometimes  diarrhoea,  after 
several  days  fatty  degeneration  of  the  organs,  with 
vomiting  of  blood,  drowsiness,  enlarged  painful  live'-, 
and  scanty  urine;  later  perhaps  delirium,  somno- 
lence, coma,  and  occasionally  convidsions. 

Chronic  poisoning  is  manifested  by  necrosis  of 
the  lower  jaw  and  fatty  degeneration  of  the  various 
organs  followed  by  a prohferation  of  the  connective 
tissue;  anemia,  general  debility,  slight  jaundice, 
indigestion,  diarrhma. 

Phosphoricum  Acidum  Dilutum  (10  per  cent,  of 
orthophosphoric  acid,  H3P94). 

Dosage. — 6 months,  gtt.  i-ii;  18  months,  gtt.  ii-iii; 
3 years,  gtt.  v;  5 years,  gtt.  x.  Adult,  min.,  tqjx; 
av.,  XXX ; max.,  xlv. 

Method  of  Administration. — I^  Acidi  phosphorici 
diluti,  Sii- 

Sig. — ^Twenty  drops  in  a wineglassfid  of  water, 
t.i.d. 

Physiologic  Action  and  Uses. — Stomachic;  alter- 
ative; refrigerant  beverage. 

Phosphor!  Elixir  N.  F.  (Phos.  0.025  per  cent.,  in 
chloroform,  alcohol,  glycerine,  and  water,  flavored 
with  comp.  spt.  of  orange  and  oil  of  anise : 3 i contains 
of  phosphorus  gr.  K?;  deteriorates  rapidly). 

Adult  Dosage. — Av.  3i- 

Method  of  Administration. — I^  ElLxiris  phos- 
phor!, N.  F.,  5ii- 

Sig. — One  dram,  once  a day,  gradually  increased 
to  t.i.d. 

Physiologic  Action  and  Uses. — See  above. 

Toxic  Action. — See  above. 

Phosphor!  Pilulae  (P.  gr.  Koo  per  pill;  should  be 
recently  made). 

Adult  Dosage. — Min.,  1;  max.,  4. 

Alethod  of  Administration. — I^  Pdulte  phosphor!, 
no.  60. 

Sig. — One  pill,  gradually  increased  to  four  pills, 
t.i.d. 

Physiologic  Action  and  Uses. — See  above. 

Toxic  Action. — See  above. 

Phosphorus  (soluble  in  17  of  chloroform,  in  400  of 
dehydrated  alcohol). 

Dosage. — 6 months,  gr.  Koo;  18  months,  gr.  }4oo', 
t.i.d.  Adult,  min.,  gr.  Ksoi  av.,  K20;  max.,  Ko,  t.i.d. 
Administered  in  the  form  of  pills  or  as  phosphor- 
ated oil. 

Physiologic  Action  and  Uses.- — See  above. 

Toxic  Action. — See  above. 

Physiologic  Salt  Solution  (0.85  per  cent.,  or  8.5 
gm.  to  1000  c.c.  of  water;  or  about  one  dram  to  the 
pint). 

Physostigmatis  Extractum  (about  2 per  cent,  of 
alkaloids). 

Adult  Dosage. — Min.,  gr.  Ke;  av.,  K;  max., 

Method  of  Administration. — I^  Extract!  physos- 
tigmatis, gr.  K,  pilula;  no.  6. 

Sig. — A pill  once  or  twice  daily.  “Gr.  i-iv  are 
used  in  tetanus.” — Potter. 

Physiologic  Action  and  Uses. — Physostigmine  or 
eserine  is  the  antagonist  of  atropine.  It  increases 
the  excitability  of  autonomic  or  parasympath  ;tic 


PILULiE  BLAUDII 


nerve  endings;  causes  myosis  and  contraction  of  the 
ciliary  muscle  (spasm  of  accommodation  with  result- 
ing relaxation  of  the  capsule  of  the  lens  and  increased 
spheroidity  of  the  latter,  and  diminution  of  intra- 
ocular tension);  increases  the  secretion  of  tears, 
saliva,  sweat,  and  the  bronchial  secretions;  contracts 
the  bronchial,  gastro-intestinal  and  vesical  muscles; 
increases  the  excitability  of  the  nerve  endings  supply- 
ing striped  or  voluntary  muscles;  also  renders  more 
excitable  the  motor  cortical  centres,  tending  to  con- 
vidsions;  slows  the  heart ; deepens  respirations;  de- 
presses the  vagus' and  the  action  of  the  spinal  cord. 

Toxic  Action. — Muscular  weakness  and  tremor, 
loss  of  reflex  action,  nausea,  salivation,  vomiting, 
severe  intestinal  colic,  purging,  sweating,  myosis, 
headache,  giddiness,  fever,  bradycardia,  dyspncea, 
motor  paralysis. 

Eserine  in  the  eye  may  produce  a feehng  of  great 
tension  in  the  eye,  headache,  and  nausea. 

Physostigmatis  Tinctura  (about  0.015  per  cent,  of 
alkaloids). 

Adult  Dosage. — Min.,  irgv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Tincturse  physos- 
tigmatis 3ii- 

Sig. — -Fifteen  drops  in  water,  once  or  twice  daily. 

Physostigminae  (Eserina;;  alkaloid:  C15H21N3O2) 
Salicylas  (soluble  in  75  of  water). 

Adult  Dosage. — -Min.,  gr.  Koo)  av.,  Yeo',  max.,  Y^o. 

Method  of  Administration. — Physostigmin® 
salicylatis  (vel  sulphatis)  gr.  %o,  tabella;  no.  6. 

Sig. — One  tablet,  by  mouth  or  hj-podermically, 
once  or  twice  a day.  For  the  eye:  gr.  ii-iv  ad  §i  of 
water  or  oil,  or  from  0. 1 to  1 per  cent. 

Physostigminae  Sulphas  (very  soluble  in  water). 

Adult  Dosage. — ^Min.,  gr.  Moo;  av.,  Mo;  max..  Mo- 

Method  of  Administration. — See  above. 

Picis  Carbonis  Liquor  N.  F.  (coal  tar  20.  per 
cent.,  quillaja  and  alcohol) 

Uses. — Local  antiseptic;  stimulant. 

Picis  Liquidae  Infusum;  Liquor  Picis  Alkalinus, 

N.  IL  (tar  25,  pot.  hydrox.  12.5,  water  to  100). 

Uses. — Local  antiseptic  and  stimulant. 

Picis  Liquidae,  Oleum  Rectificatum;  Rectified  Oil 
of  Tar  (nearly  insoluble  in  water;  soluble  in  alcohol). 

Adult  Dosage. — Min.,  t^i;  av.,  iii;  max.,  v. 

Method  of  Administration. — Olei  picis  liquidae 
rectificati,  iiKiii,  capsulae  no.  12. 

Sig. — -A  capsule  every  three  hours. 

Uses. — Antiseptic;  irritant;  parasiticide;  irritant 
e.xpectorant. 

Picis  Liquidae  Syrupus;  Syrup  of  Tar  (pine  tar 

O. 5  per  cent,  in  alcohol  and  syrup). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

M ethod  of  Administration. — Syrupi  picis  liqui- 
dae, Si. 

Sig. — Teaspoonful  every  three  hours. 

Uses. — -Irritant  expectorant. 

Picis  Liquidae  Unguentum  (pine  tar  50,  yellow 
wax  15,  lard  35). 

Method  of  Administration. — At  first,  strengths  of 
2 to  4 per  cent,  may  be  used,  and  gradually  in- 
creased. 

Uses. — Sthnulating  antiseptic;  antipruritic. 

Picricum  Acidum  (Trinitrophenol,  CeHoOH 
(N()2)3;  soluble  in  78  of  water  and  12  of  alcohol). 

Uses. — Local  antiseptic ; analgesic,  and  coagulant. 

A 1 per  cent,  solution  (gr.  Ixxvii  ad  Oi)  was  once 
extensively  used  for  burns.  It  should  not  be  applied 
to  a large  surface  for  fear  of  absorption. 

T'oxic  Action. — Nausea,  vomiting,  diarrhoea, 
strangury,  anuria,  yellow  staining  of  the  skin  and 
mucous  membranes. 

Picrotoxinum,  C30H34O13  (soluble  in  240  of  water; 
in  9 of  alcohol). 

Adult  Dosage. — Min.,  gr.  Moo;  av..  Mo;  max.,  Ym- 


Method  of  Administration. — Picrotoxini,  gr. 
Moo-Mo,  tabelke  no.  6. 

Sig. — One,  t.i.d. 

Physiologic  Action  and  Uses. — Anhidrotic;  stimu- 
lates centrally  all  the  cranial  and  sacral  autonomic 
nerves. 

Toxic  ■ Action. — Nausea,  salivation,  dizziness, 
drowsiness,  perhaps  stupor  and  convulsions. 

Pilocarpi  Fluidextractum  (Jaborandi). 

Adult  Dosage. — Min.,  ii^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti  pilo- 
carpi, 5ss. 

Sig. — TTjfxxx,  in  water,  at  night.  Contraindicated 
if  the  heart  is  weak. 

Physiologic  Action  and  Uses. — Pilocarpme  is  the 
antagonist  of  atropine.  It  stimulates  autonomic  or 
parasyunpathetic  nerve  terminals  and  also  the 
nerves  of  the  sweat  glands  in  the  skin,  but  it  does 
not  affect  the  renal  or  lacteal  secretions,  but  in- 
creases all  others;  stimulates  involuntary  nerve 
terminals  (gastro-intestinal,  uterine,  etc.);  pro- 
motes absorption  of  inflammatory  exudate;  myotic 
and  cihary  stimulant;  diaphoretic;  sialogogue. 

Toxic  Action. — Cardio-vascular  depression,  re- 
spiratory depression,  salivation,  even  pulmonary 
oedema,  sweating,  drowsiness,  chilhness,  pallor, 
weakness,  giddiness,  myosis,  colicky  pains  in  the 
intestines,  muscular  tremors. 

Pilocarpinae  Hydrochloridum,  alkaloid  hj'drochlo- 
ride,  C11H16N2O2.HCI  (soluble  in  0.3  of  water,  and 

3 of  alcohol). 

Dosage. — -3  to  5 years,  gr.Ko-  Adult  Min.,  gr.  M^; 
av.,  M;  max., 

Method  of  Administration. — I^  Pilocarpinae  hy- 
drochloridi,  gr.  iii  (2.5  percent,  sol.;  5 drops  =gr.  Is-) 
Aquae  destillatae,  3ii- 

M.  Sig. — Five  drops  in  water,  twice  or  thrice  daily, 
increased  rapidly  by  one  drop  at  a time,  until  slight 
sweating  and  sahvation  are  produced,  and  then  con- 
tinued for  two  or  more  months,  if  necessary.  Gr. 
M2  to  % may  be  administered  hypodermically.  As  a 
myotic,  1 to  2 per  cent,  solution,  instilled  into 
the  eye. 

Pilocarpinae  Nitras  C11H16N2O2.HNO3  (soluble  in 

4 of  water,  and  75  of  alcohol). 

For  dosage,  action,  and  uses,  etc.,  see  above. 

Pilulae  Aloes. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5 pills  at 
bedtime. 

Uses. — Purgative. 

Pilulae  Aloes  et  Ferri. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 

Method  of  Administration. — I^  Piluhe  aloes  et 
ferri,  no.  24. 

Sig. — One  pill,  t.i.d. p.c. 

Uses. — ^Purgative;  haematic;  emmenagogue. 

Pilulae  Aloes  et  Myrrhae. 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5. 

Method  of  Administration. — I^  Pilulae  aloes  et 
myrrhae,  no.  24. 

Sig.— One  pill,  t.i.d. 

Uses. — Purgative;  emmenagogue. 

Pilulae  Asafoetida  (asafeetida  gr.  iii,  soap  gr.  i). 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  6. 

Method  of  Administration. — I^  Pilulae  asafeetidae, 
no.  24. 

Sig. — One  to  two  pills,  four  times  a day;  or  six 
pills  in  one  dose. 

Uses. — Antispasmodic;  nerve  stimulant;  car- 
minative; stimulating  expectorant;  tonic;  laxative; 
diuretic;  diaphoretic;  emmenagogue;  aphrodisiac; 
anthelmintic. 

Toxic  Action. — Nausea,  vomiting,  purging. 

Pilulas  Blaudii;  Pilulae  Ferri  Carbonatis,  (FeCOs). 

Dosage. — 0 months,  gr.  ss;  18  months,  gr.  i;  3 


PODOPHYLLI  RESINA 


years, gr. ii; 5years, gr.  ii.  Adult, min., gr. v;max.,vii. 

Method  of  Administration. — Pilulse  ferri  car- 
bonatis  (Blaudii),  pulveris,  recentis  prseparati,  gr.  v. 

Dispense  in  gelatine  capsules  hardened  with  for- 
malin (Sahli’s  glutoid  capsules,  grade  ii  of  hardness), 
capsules  no.  50. 

Sig. — One  pill,  t.i.d.p.c.,  increased  by  one  pill 
each  week,  until  four  to  five  pills  are  taken  t.i.d. 

U ses — Haematic. 

Pilulse  Ferri  lodidi  (Fel2). 

Adult  Dosage. — Min.,  1 pill;  max.,  2 pills. 

Method  of  Administration. — Pilulae  ferri  iodidi, 
no.  60. 

Sig. — Two  pills,  t.i.d.p.c. 

Uses. — Haematic. 

Pilulae  Lapacticae  (aloin  gr.  strychnine  gr.  %o, 
ext.  belladonna  gr.  %,  ipecac  gr.  Ks). 

Adult  Dosage. — Min.,  1 pill;  max.,  2 pills. 

Method  of  Administration. — 1^  Pilulae  lapacticae, 
no.  60. 

Sig. — One  to  two  pills  at  bedtime. 

Uses. — Laxative. 

Pilulae  Laxativae  Compositae  (aloin  gr.  strych- 
nine gr.  Ym,  ext.  belladonna  gr.  M ipecac  gr.  Ye). 

Adult  Dosage. — Av.,  2 pfils  at  oedtime. 

Uses. — Laxative. 

Pilulae  Opii  (pulveris  opii  gr.  i);  (morphine  gr.  %). 

Adult  Dosage. — Min.,  1;  max.,  3. 

Physiologic  Action  arid  Uses. — See  Morphine. 

Pilulae  Phosphor!  (P  gr.  Koo  per  pill;  should  be 
recently  made). 

Adult  Dosage. — Min.,  1;  max.,  4. 

Method  of  Administration. — Pilulae  phosphori, 
no.  60. 

Sig. — One  pill,  gradually  increased  to  four  pills, 
t.i.d. 

Physiologic  Action  and  Uses. — See  Phosphorus. 

Pilulae  Rhei  Compositae  (rhubarb  gr.  ii,  aloes  IY2, 
myrrh  1,  oil  of  peppermint  gr.  Yo). 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5.  Pills  at 
bedtime. 

Uses. — ^Laxative. 

Pimentae  Aqua  (allspice  water). 

Uses. — Carminative  vehicle. 

Pini  Canadensis  Extractum  (Hemlock  Spruce). 

Pini  Pumilionis  Oleum;  Dwarf  Pine-Needle  Oil 
(nearly  insoluble  in  water;  soluble  in  alcohol). 

Method  of  Administration. — 3ss  to  Oi  of  steaming 
water,  as  an  inhalation. 

Uses. — Bronchial  .sedative. 

Pini  Sylvestris  Oleum;  Scotch  Fir  Oil. 

Method  of  Administration. — 3ss  to  Oi  of  steaming 
water,  as  an  inhalation. 

Uses. — Bronchial  sedative. 

Piperazinum;  Diethylene-diamine: 

/CH^.CHj. 

NH<  >NH-f-6H20. 

^CHa  CHj/ 

(soluble  in  water;  liquefies  when  exposed  to  the  air). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — Dissolve  fifteen  to 
thirty  grains  in  half  a pint  of  water  and  add  this  to 
a pint  of  carbonated  water.  Administer  this  in 
divided  doses  throughout  the  day.  A fresh  solution 
should  be  made  each  day.  The  drug  cannot  be 
dispensed  in  powders,  but  in  solution. 

Uses. — Uric  acid  solvent. 

Pituitary  Extract;  Pituitrin;  Liquor  Hypophysis 
(Posterior  Lobe). 

Adult  Dosage. — Min.,  njv;  max.,  xv. 

Method  of  Administration. — Used  hypodermically. 
Says  H.  H.  Dale:  “When  a maximal  dose  has  been 
given,  further  doses  have  practically  no  effect  for  a 
few  hours.” 


Physiologic  Action  and  Uses. — Uterine,  intestinal, 
and  cardio-vascular  stimulant;  promotes  the  con- 
tractility and  increases  the  tone  of  involuntary  and 
cardiac  muscle;  excites  the  activity  of  the  kidneys 
and  mammary  glands;  useful  in  collapse,  intestinal 
paresis  and  uterine  atony. 

Pituitary  Gland,  Dessicated  (Anterior  Lobe). 

Adult  Dosage. — Min.,  gr.  i;  max.,  iv. 

Method  of  Administration. — Hypophysis  des- 
sicatse  (anterior  lobe),  gr.  i-iv,  pulveres  vel  tabellie 
no.  30. 

Sig. — One,  t.i.d. 

Physiologic  Action  and  Uses. — The  anterior  lobe 
of  the  h)q3ophysis  cerebri  or  pituitary  body  is  re- 
lated to  the  general  growth  of  the  body  and  espe- 
cially of  the  skeleton.  It  may  possibly  be  of  service 
in  infantilism,  obesity  associated  with  impotence, 
and  the  later  stages  of  acromegaly. 

Pituitary  Gland,  Dessicated  (Posterior  Lobe); 
Hypophysis  Sicca. 

Adult  Dosage. — Min.,  gr.  ss;  max.,  iii. 

Method  of  Administration. — -I^  Hypophysis  sic- 
cse,  gr.  ss,  capsulae  no.  60. 

Sig. — Capsule,  four  times  daily.  Eight  to  ten 
gr.  per  diem  may  probably  be  given  by  mouth. 
Oral  administration,  however,  is  said  to  be  in- 
effective. 

Physiologic-  Action  and  Uses. — See  above  (Pitu- 
itary Extract). 

Pix  Burgundica;  Burgundy  Pitch.  Softens  and 
becomes  adhesive  at  the  body  temperature. 

Uses. — Rubefacient;  basis  for  plasters. 

Plumbi  Acetas;  Sugar  of  Lead:  Pb(CH3COO)2  + 
3H2O  (soluble  in  1.4  of  water  and  38  of  alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  v. 

Method  of  Administration. — I^  Plumbi  acetatis, 
gr.  i,  pilulse  no.  12. 

Sig. — One  pill,  t.i.d. 

Physiologic  Action  and  Uses. — Bronchial  and  in- 
testinal astringent  and  hsemostatic;  a concentrated 
alcoholic  solution  is  useful  externally  in  ivy  poison- 
ing. 

Toxic  Action. — Acute  poisoning:  vomiting,  purg- 
ing or  constipation,  paralysis;  collapse;  coma. 
Chronic  poisoning  (plumbism):  anorexia,  pallor, 
emaciation,  colic,  constipation,  wrist-drop,  albu- 
minuria, slow  heart,  arthritis,  blue  line  along  the 
margins  of  the  gums,  nemalgia,  insanity. 

Plumbi  Emplastrum  (lead  acetate  60,  soap  100). 

Plumbi  et  Opii,  Lotio;  Lead  and  Opium  wash. 

Method  of  Preparation. — 1^  Plumbi  acetatis,  gr. 
xx'vii;  tincturse  opii,  3i,‘  aquam  ad  5 hi. 

M.  Sig. — For  external  use. 

Uses. — ^Astringent;  anodyne  lotion. 

Plumbi  Subacetatis  Ceratum  (liq.  plumbi  sub- 
acetatis  20,  camphor  2,  wool-fat  20,  paraffin  20, 
white  petrolatum  38). 

Uses. — Astringent  application. 

Plumbi  Subacetatis  Liquor;  Goulard’s  Extract 
(lead  acetate  18,  lead  oxide  11,  dLstilled  water  to  100). 

Method  of  Administration. — Diluted  fifteen  to 
thirty  times  with  water. 

Physiologic  Action  and  Uses. — Astringent  and 
coohng  lotion;  should  not  be  applied  to  denuded 
surfaces. 

Plumbi  Subacetatis  Dilutus  Liquor;  Lead  Water 
(Goulard’s  Extract  4 per  cent.,  with  water). 

Uses. — Astringent  and  cooling  lotion. 

Podophylli  Resina. 

Adult  Dosage. — Min.,  gr.  Ko,‘  av.,  Yo]  max.,  ]/2. 

Method  of  Administration. — I^  Resinae  Podoph- 
ylli, gr.  Y2,  pilulse  no.  12. 

Sig. — One  pill,  once  or  twice  daily,  as  a laxative, 
two  to  six  pills  as  a hydragogue  cathartic. 

Uses. — Slow,  irritant  cathartic. 


POTASSII  CITRAS 


Polantinum  Liquidum  (“Sterile  immunized  or 
antitoxic  horse-serum  with  the  addition  of  0.25  per 
cent,  carbolic  acid”). 

Method  of  Administration. — Instil  one  drop  in 
each  conjunctival  sac  and  in  the  nose,  in  the  morning 
before  arising,  and  repeat  the  treatment  during  the 
day  “only  when  signs  of  irritation  appear.” — Dun- 
bar. See  Hay-Fever,  Part  1. 

Uses. — -Pollen  antitoxin  in  liquid  form. 

Polantinum  Siccum  (“Dried,  sterile,  pulverized 
antitoxic  horse-serum  with  the  addition  of  sterile 
powdered  mUk  sugar  ”). 

Method  of  Administration. — Insufflate  about  a 
pinhead-sized  amount  of  the  powder  in  each  con- 
junctival sac  and  in  the  nose  in  the  morning  before 
arising,  and  repeat  the  treatment  during  the  day 
“only  when  signs  of  irritation  appear.” — Dunbar. 
See  Hay -Fever,  Part  1. 

Uses. — Pollen  antitoxin  in  powder  form. 

Pollen  Extract;  Pollen  Vaccine  (a  solution  of 
pollen  protein). 

Method  of  Administration. — To  test  the  patient’s 
susceptibihty,  one  may  rub  a small  quantity  of  vac- 
cine into  a scratch  of  the  skin.  Sensitiveness  to 
that  particular  pollen  is  manifested  by  the  appear- 
ance of  an  urticarial  wheal.  To  determine  the 
proper  dosage  in  each  individual  case,  make  a series 
of  scratches  at  a distance  from  the  first  test  scratch, 
and  apply  to  these  25  per  cent.,  10  per  cent.,  1 per 
cent.,  or  even  weaker  dilutions  of  the  vaccine. 
From  five  to  ten  minims  of  thatdilution  which  fails  to 
produce  a reaction  is  injected  hypodermically  as  the 
first  dose.  Every  few  days  or  a week  gradually  in- 
creasing doses  are  given  until  unmunity  is  estab- 
lished. 

Pomegranate.  See  Granatum. 

Potassse  Liquor  (KOH,  4.5  to  5.0  per  cent). 

Adult  Dosage. — Min.,  iijv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Liquoris  potassm, 
gss. 

Sig. — Fifteen  drops,  well  diluted,  three  to  four 
times  daily. 

Physiologic  Action  and  Uses. — Antacid;  caustic: 
dissolves  proteid  and  keratin. 

Toxic  Action. — Potassium  salts  in  overdose  are 
cardiac  depressants. 

Potassa  Sulphurata  (chiefly  pot.  polysulphides 
and  pot.  thiosulphate,  very  soluble  in  water). 

Uses. — Parasiticide;  cutaneous  stimulant. 

Potassii  Acetas  KCH3COO  (soluble  in  0.5  of 
water  and  2.9  of  alcohol). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  ii-iii; 
3 years,  gr.  iii;  5 years,  gr.  v.  Adult,  min.,  gr.  v; 
av.,  xv;  max.,  xxx-gi. 

Method  of  Administration. — I^  Potassii  acetatis, 
giv  (gr.  xw  per  dram);  aquaj,  gii. 

M.  Sig. — One  dram,  with  plenty  of  water,  three  to 
four  times  daily. 

Not  more  than  one  ounce  of  the  salt  in  one  day. 

Uses. — Systemic  alkah  and  diuretic;  refrigerant. 

Potassii  et  Antimonii  Tartras  (Tartar  Emetic) 
soluble  in  12  of  water. 

Dosage. — 6 months,  gr.  )4oo;  18  months,  gr.  Kso,"  3 
years,  gr.  Moo,'  5 years,  gr.  Moo  Adult,  min.,  gr.  Ke; 
av.,  gr.  Ko;  max.,  gr.  }4. 

Method  of  Administration. — I^  Antimonii  et 
potassii  tartratis,  gr.  M;  syrupi  rubi  idmi,  gi- 

M.  Sig. — gi  every  hour. 

I^  Antimonii  et  potassii  tartratis,  gr.  Mo. 

Mitte  talis  tabellae  no.  8. 

Sig. — Tablet  in  water  every  three  to  foim  hours. 

Uses. — Stimulating,  nauseant  expectorant;  dia- 
phoretic. 

Toxic  Action. — Nausea  and  vomiting,  prostration, 
fall  of  temperature,  cardio-vascular  depression. 


sweating,  salivation,  cramps  in  the  limbs,  cyanosis, 
delirium,  exfohative  enteritis,  suppression  of  urine, 
paralyses,  convulsions,  collapse. 

Potassii  Bicarbonas,  KHCO3  (soluble  in  2.8  of 
water;  almost  insoluble  in  alcohol.) 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xlv. 

Method  of  Administration. — I^  Potassii  bicarbo- 
natis,  giv  (gr.  xv  per  dram);  aquae,  gii. 

M.  Sig.— One  dram,  in  a glass  of  water,  every  four 
hours. 

Uses. — Systemic  alkali  and  diuretic;  refrigerant. 

Potassii  Bitartras;  Cream  of  Tartar,  KHC4H4O6. 

Adult  Dosage. — Min.,  xx;  av.,  xxx;  max.,  gi. 

Method  of  Administration. — Dissolve,  for  infants, 
gi-ii,  and  for  children  of  five  years  and  adults  gii- 
iv,  in  one  or  two  pints  of  boiling  water;  allow  to 
cool,  flavor  with  sugar  and  lemon  juice,  and  ad- 
minister freely  during  the  twenty-four  hours. 

Uses. — Diuretic;  aperient;  refrigerant. 

Potassii  Bromidum,  KBr  (soluble  in  1.6  of  water). 

Dosage. — 6 months,  gr.  i-iii;  18  months,  gr.  ii-iv; 
3 years,  gr.  iii-v;  5 years,  gr.  v-viii.  Adult,  min., 
x;  av.,  xv;  max.,  be. 

Method  of  Administration. — I^  Potassii  bromidi, 
gv  9i  (gr.  X per  dram);  aquae,  giv. 

M.  Sig. — One  to  three  drams  in  half  a tumbler  of 
water  or  milk  or  an  alkaline  effervescent  water, 
two  to  four  times  a day,  p.c. 

Physiologic  Action  and  Uses. — Nervous  sedative; 
cerebral  depressant;  anaphrodisiac;  diminishes  cen- 
tral reflex  hyperexcitabihty. 

Toxic  Action. — Bromism  is  manifested  by  palatal 
and  pharyngeal  anaesthesia^  with  the  absence  of 
gagging  on  mechanical  irntation,  by  sexual  im- 
potence, diminished  reflexes,  nervous  and  muscular 
depression,  apathy,  weakening  of  memory,  paOor, 
lowered  arterial  tension  and  temperature,  muddy 
comple.xion,  acne,  coated  tongue,  fetor  oris,  indi- 
gestion, emaciation,  drowsiness,  respiratory  catarrh, 
rapid  feeble  heart. 

Potassii  Carbonas,  K2CO3  (soluble  in  0.9  of  water, 
insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  xv;  max.,  xx,  well 
diluted,  as  an  antacid. 

Uses. — Alkaline  caustic. 

Potassii  Chloras,  KCIO3  (soluble  in  11.5  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  ii-iii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v; 
av.,  x;  max.,  .xv. 

Method  of  Administration. — I^  Potassii  chloratis, 
gr.  Lxxx  (gr.  v per  dram);  aquae  destillatae,  gii. 

M.  Sig. — One  dram,  every  two  to  three  hours,  or 
three  to  four  times  a day.  Not  more  than  10  grains 
in  twenty-four  hours  to  infants,  or  fifteen  grains  in 
twenty-four  hours  to  children  of  three  years. 

For  local  use,  gr.  x-xx  to  the  ounce. 

Method  of  Administration. — I^  Potassii  chloratis, 
gi;  glycerini,  giv;  aquae,  q.s.  ad  gvi. 

M.  Sig. — Throat  gargle. 

Uses. — Astringent;  antisialagogue. 

Toxic  Action. — Albuminnria,  nephritis,  cardiac 
depression,  cyanosis,  drowsiness,  suppression  of  mine. 

Potassii  Chloratis  Trochisci  (pot.  chlorate,  gr.  iiss, 
with  sugar  and  tragacanth). 

Adult  Dosage. — Min.,  1;  max.,  3. 

Lozenges,  slowly  dissolved  in  the  mouth,  t.i.d. 

Potassii  Citras,  K3C6H5O7+H2O  (soluble  in  0.8 
of  water;  very  slightly  soluble  in  alcohol). 

Dosage. — 6 months,  gr.  ss-i;  18  months,  gr.  i-ii; 
3 years,  gr.  iii;  5 years,  gr.  iv.  Adult,  min.,  gr.  x; 
av.,  XV ; max.,  xxx. 

Method  of  Administration. — I^  Potassii  citratis, 
giv  (gr.  XV  per  dram);  syrupi  simplicis,  et  aqua;, 
aa  gi. 

M.  Sig. — One  dram,  in  a glass  of  water,  three  to 


PROTARGOL 


four  times  daily.  Not  more  than  one  ounce  of  the 
salt  in  one  day. 

Physiologic  Action  and  Uses. — Systemic  alkah  and 
diuretic;  refrigerant.  Diuresis  is  produced  as  fol- 
lows: absorbed  into  the  blood,  the  potassium  salts 
by  osmotic  tension  cause  hydraemia  or  abstraction 
of  fluid  from  the  tissues;  filtrated  into  the  kidney 
tubules,  the  salt,  by  osmotic  tension,  causes  a “renal 
diarrhoea.” 

Potassii  Citras  Effervescens  (pot.  cit.  20,  sod. 
bicarb.  47.7,  tartaric  acid  25.2,  citric  acid  16.2). 

Adult  Dosage. — Min.,  3i;  max.,  ii. 

Method  of  Administration. — Potassii  citratis 
effervescentis,  §ii. 

Sig. — Teaspoonful  in  a glass  of  water,  three  to 
four  times  a day. 

Potassii  Citratis  Liquor  (8  per  cent.). 

Adult  Dosage. — Min.,  3iv;  max.,  §i-t-. 

Method  of  Administration. — Liquoris  potassii 
citratis,  §iv. 

Sig. — Tablespoonful,  with  plenty  of  water,  three 
to  four  times  a day. 

Uses. — Alkahne  diuretic;  laxative. 

Potassii  Hydroxidum;  Caustic  Potash:  KOH 
(soluble  in  0.9  of  water  and  3 of  alcohol). 

Uses. — ^Antacid;  caustic;  solvent. 

Toxic  Action. — Local  corrosion,  pain,  diarrhoea, 
convulsions,  dehrium. 

Potassii  Hydroxidi  Liquor  (KOH  4.5  to  5.0  per 
cent.). 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Liquoris  potassaj, 
5ss. 

Sig. — Fifteen  drops,  well  diluted,  three  to  four 
times  daily. 

Physiologic  Action  and  Uses. — Antacid;  caustic; 
dissolves  proteid  and  keratin. 

Potassii  Hypophosphis:  KHaPOa  (soluble  in  0.6 
of  water  and  9 of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  x. 

U ses. — Alterative. 

Potassii  lodidum:  KI  (soluble  in  0.7  of  water). 
M i (more  than  1 drop)  of  a saturated  solution  con- 
tains about  gr.  i of  KI. 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii;  3 
years,  gr.  ii-iii;  5 years,  gr.  hi.  Adult,  min.,  gr.  v; 
av.,  vih;  max.,  xx. 

Method  of  Administration. — Potassh  iodidi, 
3iv;  aquae  destUlatae,  3iv. 

M.  Sig. — Five  to  eight  drops,  well  diluted  in 
water  or  milk,  t.i.d.p.c.,  gradually  increased  even 
to  twenty  to  sixty  drops  t.i.d.  Every  week,  inter- 
mit the  drug  for  four  to  five  days. 

Physiologic  Action  and  Uses. — E^ectorant;  diu- 
retic, discutient;  alterative;  antiluetic;  reheves  bron- 
chial spasm,  possibly,  as  suggested  by  Halsey,  by 
stimulating  the  thyroid  function,  which  stimulates 
the  chromaffia  organs  with  resulting  increase  of  epi- 
nephrin,  the  latter  producing  relaxation  of  the  bron- 
chial muscles  by  stimulation  of  the  sympathetic 
nerve-endings  in  the  hmgs;  increases  the  amount  of 
thyroidin  in  the  thyroid  gland. 

Toxic  Action. — lodism:  coryza,  lacrimation,  con- 
junctival injection,  sneezing,  respiratory  catarrh, 
cough,  sahvation,  sore  throat,  conjunctivitis,  head- 
ache, tinnitus,  sweUing  of  the  sahvary  glands,  local- 
ized cedema  (of  the  eye-hds,  larynx),  indigestion, 
nausea,  vomiting,  diarrhoea,  saline  or  metalhc  taste 
in  the  mouth,  neuralgic  pains,  anaemia,  emaciation, 
acne,  erythema,  purpura,  etc.,  mental  depression. 

Potassii  Nitras;  Saltpetre:  KNO3  (soluble  in  2.8 
of  water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  viii;  max.,  xx, 
well  diluted. 

Uses. — Refrigerant;  irritant  diuretic;  diaphoretic. 


Potassii  Nitratis  Charta  (paper  impregnated  with 
potassium  nitrate). 

Method  of  Administration. — Burn  the  paper  and 
inhale  the  smoke.  Used  in  asthma. 

Potassii  Perraanganas:  KMn04  (soluble  in  13.5 
of  water). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iii. 

Method  of  Administration. — 1^  Potassii  perman- 
ganatis,  gr.  i,  pilulse,  no.  20. 

Sig. — One  pfil,  three  to  four  times  a day,  p.c. 

For  irrigation:  1:4000-2000. 

For  ulcers:  1:1000-500. 

Mouth  and  throat  wash:  gr.  ^-i  ad  Si- 

Uses. — External  and  intestinal  antiseptic  and 
astringent  (see  Cholera  Asiatica,  Part  1);  deodor- 
ant; emmenagogue. 

Toxic  Action. — Gastro-enteritis. 

Potassii  vel  Sodii  Silicatis,  Liquor;  Soluble  Glass 
Solution.  Painted  on,  in  order  to  stiffen  bandages, 
after  the  latter  have  been  apphed. 

Potassii  et  Sodii  Tartras;  Rochelle  Salt:  KNaC4 
H40e+4H20  (soluble  in  0.9  of  water). 

Dosage.— & months,  gr.  xv;  18  months,  gr.  xxx; 
3 years,  3i-h;  5 years,  3ih-iv.  Adult,  min.,  3i; 
av.,  iiss;  max.,  iv. 

Method  of  Administration. — Dissolved  in  half  a 
glass  of  water,  one  hour  before  breakfast.  One-half 
to  one  teaspoonful  may  be  given  every  one  to  two 
hours  until  purgation  occurs. 

Physiologic  Action  and  Uses. — Saline  cathartic; 
causing  purgation  by  osmosis  and  interference  with 
the  absorption  of  fluids  from  the  bowel;  acts  in  one 
to  twenty  hours. 

Potassii  Tartra=boras  (boric  acid  1,  pot.  bitartrate 
4,  water  10  parts,  heated  together;  soluble  in  2 of 
water). 

Adult  Dosage. — ^Av.,  gr.  xx. 

Method  of  Administration. — Potassii  tartra- 
boratis,  3x  Bu  (gr.  xx  per  dram);  aquaj,  q.s.  ad  giv. 

M.  Sig. — One  dram  in  a glass  of  water,  three  to 
four  times  a day. 

Uses. — Uric  acid  solvent. 

Potassii  Telluras:  K2Te04. 

Adult  Dosage. — Min.,  gr.  max.,  iss. 

Uses. — ^Anhidrotic. 

Precipitated  Chalk;  Calcii  Carbonas  Precipitatis : 
CaCOs  (nearly  insoluble  in  water  and  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xlv. 

Method  of  Administration. — I^  Calcii  carbonatis 
prsecipitati,  gr.  xv-lx,  pulveres  no.  12. 

Sig. — A powder  two  to  three  times  daily. 

Physiologic  Action  and  Uses. — Antacid;  intestinal 
astringent;  neutrahzes  acids  (fatty  acids,  sulphuric 
and  phosphoric  acids)  in  the  intestine,  and  so  de- 
prives the  urine  of  a portion  of  its  acid  constituents, 
rendering  it  less  acid  and  even  alkahne,  and  there- 
fore favoring  the  solution  of  uratic  deposits  in  the 
urinary  tract. 

Prepared  Chalk; Creta  Praeparata  (Purified Native 

CaCOs). 

Dosage. — 6 months,  gr.  ii;  18  months  gr.  iii;  3 
years,  gr.  v;  5 years,  v-viii.  Adult,  min.,  gr.  x; 
av.,  xv;  max.,  Ixxv. 

Method  of  Administration. — R Creta;  pra;para- 
tae,  3iv  (gr.  x to  the  dose);  syrupi  acaciae,  gii;  aquae 
cinnamomi,  q.s.  ad  giv. 

Misce  et  fiat  emulsum. 

Sig. — One  teaspoonful  every  three  to  four  hours. 

Uses. — ^Antacid;  astringent. 

Procaine. — See  Novocaine. 

Protargol ; Argenti  Proteinas  (slowly  soluble  in  2 
of  water). 

Method  of  Administration. — For  instillations  or 
injections:  0.25  to  1 per  cent,  solutions;  5 to  10  per 
cent,  solutions  in  chronic  urethritis  or  cystitis. 


PYROGALLOL 


For  irrigation : 1 :2000  to  1000.  Dissolve  it  in  cold 
water. 

Uses. — Antiseptic. 

Pruni  Virginianse  Fluidextractum. 

Adult  Dosage. — Min.,  tijxx;  av.,  xxx;  max.,  xl. 

Uses. — Bronchial  sedative;  flavor  and  vehicle. 

Toxic  Action. — Cardiac  depression. 

Pruni  Virginianse  Syrupus  (Syrup  of  Wild  Cherry; 
contains  HCN). 

Dosage. — 3 years,  5ss;  5 years,  3i-  Adults, 
3 ss-i-iss. 

Uses. — Bronchial  sedative;  flavor  and  vehicle. 

Toxic  Action. — Cardiac  depression. 

Pulsatillse  Tinctura  (10  per  cent.),  N.  F. 

Adult  Dosage. — Av.,  njxxx. 

Method  of  Administration. — R Tincturae  pulsa- 
tilla',  10  per  cent.,  N.  F.,  gii. 

Sig. — Thirty  drops,  in  water,  t.i.d.,  for  one  week 
before  the  menstrual  flow. 

Uses. — Sedative;  antispasmodic. 

Toxic  Action. — Gastro-intestinal  irritation,  nau- 
sea, vomiting,  diarrhoea,  hsematuria,  sweating, 
coryza,  cough,  vesiculo-pustular  eruptions,  ocular 
pain,  amblyopia,  stupor,  coma,  convulsions. 

Pulvis  Acetanilidi  Compositus. — See  Acetanilidi; 
Pulvis  Compositus. 

Pulvis  Agarici  Albi. — Se§  Agarici  Albi  Pulvis. 

Pulvis  Anisi. — See  Anisi  Pulvis. 

Pulvis  Camphorae. — See  Camphor®  Pulvis. 

Pulvis  Catechu  vel  Qambir. — ^ee  Catechu  Pulvis. 

Pulvis  Condurango. — See  Condurango  Pulvis. 

Pulvis  Cretae  Compositus. — See  Chalk  Powder 
Compound. 

Pulvis  Digitalis. — See  Digitalis  Pulvis. 

Pulvis  Effervescens  Compositus;  Seidlitz  Powder: 
Blue  Paper;  Rochelle  salt  120  gr.,  sod.  bicarb.  40  gr. 
White  Paper:  Tartaric  acid,  35  gr. 

Adult  Dosage. — Min.,  1 pair;  max.,  2 pairs. 

Method  of  Administration. — Dissolve  the  contents 
of  each  paper  separately  in  water,  and  pour  the  two 
solutions  together. 

Uses. — Sahne  aperient. 

Pulvis  Qambir  (Catechu). — See  Catechu  Pulvis. 

Pulvis  Qlycyrrhizse  Compositus;  Compound  Lico- 
rice Powder. — See  Glycyrrhiz®  Pulvis  Compositus. 

Pulvis  Hoang=Nan.— ^ee  Hoang-Nan,  Pulvis. 

Pulvis  Ipecacuanhse. — See  Ipecacuanh®,  Pulvis. 

Pulvis  Ipecacuanh®  et  Opii. — See  Dover’s 
Powder. 

Pulvis  Jalap®  Compositus. — See  Jalap®  Pulvis 
Compositus. 

Pulvis  Kino  Compositus. — See  Kino  Pulvis  Com- 
positus. 

Pulvis  Lobeli®. — See  Lobeli®  Pulvis. 

Pulvis  Opii. — See  Opii  Pulvis. 

Pulvis  Pepsini. — See  Pepsinum. 

Pulvis  Pyrethri. — See  Pyrethrum. 

Pulvis  Rhei. 

Adult  Dosage. — As  a stomachic,  Min.,  gr.  i;  max., 
V.  As  a laxative,  Min.,  gi-.  x;  av.,  xv;  max.,  xxx. 

Physiologic  Action  and  Uses. — Stomachic;  laxative 
(also  somewhat  astringent);  acts  chiefly  on  the 
colon. 

Pulvis  Rhei  Compositus;  Gregory’s  Powder  (rhu- 
barb 25,  magnesia  65,  ginger  10). 

Adult  Dosage. — Min.,  gr.  xv;  av.,  xxx;  max., 

Method  of  Administration. — R Pulveris  rhei 
compositi,  5ii- 

Sig. — -One-half  teaspoonful  in  water,  two  to  three 
times  a day. 

Physiologic  Action  and  Uses. — Stomachic;  laxative 
(also  somewhat  astringent);  acts  chiefly  on  the 
colon. 

Pulvis  Sanguinari®. 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 


Method  of  Administration. — R Pulveris  sangui- 
nari®, gr.  ii,  pilul®  no.  12. 

Sig. — One  pill  every  two  hours. 

Uses.- — Nauseant  expectorant. 

Pulvis  Scammoni®. 

• Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  x. 

U ses. — Cathartic. 

Pulvis  Scill®  (biologically  assayed). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iss;  max.,  v. 

Physiologic  Action  and  Uses. — Expectorant;  diu- 
retic; slows  and  strengthens  the  heart,  and  raises 
the  arterial  pressure. 

Toxic  Action. — Vomiting,  purging,  strangury, 
h®maturia,  convulsions,  paralysis. 

Pulvis  Stramonii. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iii. 

Uses. — Used  in  “asthma  powders.” 

Pulvis  Valerian®. 

Adult  Dosage. — ^Min.,  gr.  x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — R Pulveris  valeri- 
an®, gr.  5,  capsul®  no.  6. 

Sig. — One,  t.i.d.,  the  dose  to  be  gradually  in- 
creased to  gr.  xl,  t.i.d.,  in  diabetes  insipidus. 

Physiologic  Action  and  Uses. — Nerve  sedative; 
central  nervous  depressant.  (?) 

Pumpkin  Seed;  Pepo. 

Dosage.—^  years,  3i  +;  5 years,  3i  +.  Adult, 
min.,  ,5ss-i;  av.,  ii;  max.,  iv. 

Method  of  Administration. — -Beat  up  into  an  emul- 
sion with  sugar  and  water,  take  on  an  empty 
stomach,  and  follow  in  two  hours  by  a brisk 
cathartic. 

Uses. — Anthelmintic,  teniafuge. 

Pyoktanin;  Methyl-Violet  (soluble  in  75  of  water 
and  in  12  of  alcohol). 

Method  of  Administration. — 1 : 1000  solution,  as 
a local  antiseptic. 

U ses. — Antiseptic. 

Pyramidon ; Dimethylaminoantipyrina : 


CO  C.N(CH3) 
// 

n 

// 

N(CH3).C(CH3). 


2 


(soluble  in  11  of  water). 

Adult  Dosage. — Min.,  gr.  iv;  av.,  vi;  max.,  viii. 

Method  of  Administration. — R Pyramidon,  gr. 
vi,  tabell®  vel  capsul®  no.  10. 

Sig. — One  tablet  as  required.  “Usually  a single 
dose  suffices  for  twenty-four  hours”  (N.  and  N.  O.  R.) ; 
but  it  may  be  repeated  thrice  daily.  Give  no  more 
than  gr.  ?d  in  twenty-four  hours. 

Physiologic  Action  and  Uses. — Safe  and  efficient 
analgesic;  antip3Tetic;  hy'pnotic. 

Pyrethrum;  Pelhtory  Root. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  .xlv. 

To  destroy  mosquitoes,  saturate  the  rooms  with 
fumes  of  burning  pyrethrum  powder. 

Uses. — Masticatory  sialogogue;  local  irritant; 
insecticide. 

Pyredina:  CsHjN  (alkaloidal  base). 

Adidt  Dosage. — Min.,  tr^v;  max.,  xv;  internally. 
By  inhalation:  “3h  allowed  to  -evaporate  in  an 
open  dish  in  a small  room,  in  which  the  patient  is 
exposed  for  twenty  to  thirty  minutes  thrice  daily, 
for  the  rehef  of  asthma.”  (Potter.) 

Pyrogallol;  PjTogallic  Acid;  "Trihydroxy’benzene: 
C6H3(0H)3  (soluble  in  1.7  of  watei^  1.3  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;-max.,  ii. 

Method  of  Administration. — -Used  only  locally  as 
a 5 per  cent,  ointment. 

Uses. — Irritant  antiseptic. 

Toxic  Action. — Meth®moglobinuria,  jaundice,  cy- 
anosis, nephritis,  ur®mia. 


QUININiE  ET  URE^  HYDROCHLORIDUM 


Pyroligneum  Acidum. 

Method  of  Administration. — 3iii-v  ad  aquam  Oii, 
as  a vaginal  douche  in  senile  vaginitis  (Handler). 

Quassiae  Fluidextractum. 

Adult  Dosage. — Min.,  n\,v;  av.,  x;  max.,  xxx. 

Method  of  Administration.  — R Fluidextracti 
quassise,  5 i. 

Sig. — Ten  drops  in  water,  t.i.d.a.c. 

Physiologic  Action  and  Uses. — Simple  bitter 
stomachic;  contains  no  tannin,  so  that  it  may  be 
prescribed  with  iron. 

Toxic  Action. — Narcosis. 

Quassiae  Infusum  (Quassia  chips  3i)  cold  water 
§x,  macerated  for  half  an  hour  and  strained). 

Adult  Dosage. — Min.,  §i;  max.,  iii. 

Method  of  Administration. — R Infusi  quassiae, 
I viii. 

Sig. — Two  table^oonfuls  to  a wineglassful,  t.i.d. 

For  pin-worms,  51-u  of  the  chips  are  macerated 
in  Oi  of  boihng  water,  and  the  resulting  solution 
injected  high  into  the  bowel. 

Physiologic  Action  and  Uses. — Simple  bitter 
stomachic;  anthelmintic. 

Quassiae  Tinctura. 

Adult  Dosage. — Min.,  tiiv;  av^  xxx;  max.,  gi. 

Method  of  Administration. — R Tincturae  quas- 
siae, §ii. 

Sig. — Half  a dram  in  water,  t.i.d. 

Physiological  Action  and  Uses. — Simple  stomachic 
bitter;  contains  no  taimin  and  may  therefore  be 
prescribed  with  iron. 

Quinina:  C20H24N2O2+3H2O 


CH3OO 

HG 


H 

/""Nc 


C CioHuOHN 

CH 


C CH 

\q/  Nn/' 

H 


(soluble  in  1560  of  water  and  0.8  of  alcohol;  very 
soluble  in  dilute  acids). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-iv.  Adult,  gr. 
v-x-xl. 

Method  of  Administration. — For  infants,  no  more 
than  four  doses  of  gr.  i-ii  in  twenty-four  hours. 

For  older  children,  fifteen  to  thirty  gr.  daily. 

Quinine  is  best  administered  to  infants  in  pow- 
dered form,  dry  on  the  tongue;  to  older  children  in 
syrup  of  glycerrhiza  or  syrup  of  yerba  santa,  which 
masks  its  bitter  taste. 

R Quininae,  gr.  v — tabellae  vel  capsulae  no.  25. 

Sig.— ^ne,  three  to  four  times  daily,  or  every 
four,  six  or  eight  hours. 

R Quininae  vel  quininae  tannatis,  xxxii  (gr. 
ii  ad  TT\,xv);  syrupi  glycerrhizae  vel  eriodictyi,  q.s. 
ad  3ss. 

M.  Sig. — Fifteen  to  thirty  minims,  four  times  a 
day. 

Physiologic  Action  and  Uses. — Bitter  tonic;  anal- 
gesic; antipyretic;  antiseptic;  antimalarial ; oxytocic; 
retards  metabohc  processes  (both  anabolic  and 
catabolic)  and  thus  lessens  heat  formation  and 
spares  the  tissues  of  the  body;  acts  peripherally  on 
the  uterine  nerves. 

Toxic  Action. — Cinchonism:  sense  of  fulness  in 
the  head,  tinnitus,  vertigo,  deafness,  amblyopia, 
headache,  mydriasis;  transient  rashes,  delirium, 
coma. 

Quininae  /^thylcarbonas;  Euquinina:  C2H5O.CO. 
O.C20H23N2O  (sparingly  soluble  in  water,  soluble  in 
alcohol  and  ether). 

Dosage. — 6 months,  gr.  ii-iii;  18  months,  gr.  iii-iv; 


3 years,  gr.  iii-v;  5 years,  gr.  v.  Adult,  min.,  gr.  v; 
max.,  xxx. 

Method  of  Administration. — R Eiiquininae,  gr. 
v-x,  pulveres,  tabella;,  vel  capsulse  no.  6. 

Sig. — One,  once  or  twice  a day. 

Uses. — Antimalarial ; tasteless  in  substance,  but 
bitter  in  solution. 

Quininae  Bisulphas  (soluble  in  9 of  water,  and  23  of 
alcohol). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  ui-iv.  Adult,  min., 
gr.  v;  av.,  vh;  max.,  xv. 

Quininae  Carbonas;  Aristoquin:  (C2oH23N20).0. 
CO.O(C2oH23N20).  (tasteless  because  insoluble  in 
water) . 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-m;  5 years,  gr.  ui-v.  Adult,  min., 
gr.  v;  av.,  vii;  max.,  xv. 

Method  of  Administration. — R Aristochin,  gr. 
vii,  sacchari  lactis,  q.s.,  pulveres  18. 

Sig. — One  powder,  dry  on  the  tongue,  t.i.d.  Gr. 
i-v  for  children,  according  to  age. 

Uses. — Antimalarial. 

Quininae  Dihydrochloridum  (soluble  in  0.6  of 
water,  and  12  of  alcohol). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl.  Because  of  its  solubility  may  be  used 
hypodermically. 

Quininae  Hydrobromidum  (soluble  in  40  of  water 
and  0.9  of  alcohol). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl. 

Quininae  Hydrochloridum  (soluble  in  18  of  water 
and  0.8  of  alcohol). 

Dosage. — b months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl. 

Quininae  Sulphas  (soluble  in  725  of  water  and  107 
of  alcohol,  but  soluble  in  water  containing  1 drop 
of  dilute  sulphuric  or  hydrochloric  acid  to  each  grain 
of  the  sulphate  of  quinine). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl. 

Method  of  Administration. — R Quininae  sul- 
phatis,  ,^i  (gr.  xv  per  dram);  acidi  sulphurici  diluti, 
gi;  tincturae  capsici,  gi;  spiritus  frumenti,  q.s.  ad 
5ss. 

Misce  et  fiat  solutio. 

Sig. — Fifteen  to  thirty  drops,  in  a wineglassful  of 
water,  every  four,  six  or  eight  hours. 

Quininae  Tannas  (very  slightly  soluble  in  water, 
more  so  in  alcohol;  almost  tasteless). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl. 

Method  of  Administration. — R Quinina?  tannatis, 
gr.  i-ii;  sacchari  albi,  q.s. 

M.  Mitte  tabs  pulveres  no.  20. 

Sig. — -One  powder,  no  oftener  than  four  times  in 
twenty-four  hours,  for  infants. 

Quininae  et  Ureae  Hydrochloridum  (soluble  in  0.9 
of  water,  and  2.4  of  alcohol). 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-iii; 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  gr. 
v-x-xl. 

Method  of  Administration. — Suitable  for  hypo- 
dermic injection,  because  of  its  solubility  and  .slight 
irritability:  one  dose  of  fifteen  grs.  daily,  in  malaria. 

For  local  anaesthesia,  0.25  to  1 per  cent,  by  in- 
filtration, 10  to  20  per  cent,  by  surface  application 
to  mucous  membranes.  It  should  be  boiled  before 
using. 


RHOIS  TOXICODENDRI  TINCTURA 


Uses. — Antimalarial,  etc.;  safe  local  anaesthetic. 
— Anaesthesia  begins  in  about  ten  minutes  and  lasts 
several  hours  or  longer  (seven  to  ten  days?).  It  is 
said  to  delay  skin  union,  except,  perhaps,  in  one- 
quarter  per  cent,  strength. 

Radium;  Radii  Bromidum  (RaBr2),  Chloridum 
(RaCb),  Sulphas  (RaS04),  vel  Carbonas  (RaCOa). 

Radium  salts  may  be  obtained  from  the  W.  L. 
Cummings  Chemical  Co.,  Lansdowne,  Pa.;  the 
Radium  Co.  of  America,  Sellersville,  Pa. : the 
Schlesinger  Radium  Co.,  Denver,  Colo.,  and  the 
Standard  Chemical  Co.,  Pittsburgh,  Pa. 

Apparatus  for  the  production  of  radioactive  drink- 
ing water  may  be  obtained  from  Schieffehn  and  Co., 
New  York,  and  from  Radium  Limited,  New  York 
Radium  compresses,  radium  earth,  radium  solution 
for  bathing,  and  radium  solution  for  drinking  may  be 
obtained  from  the  Standard  Chemical  Co.,  Pitts- 
burgh, Pa. 

Method  of  Administration. — For  surgical  use, 
radium  salts  are  enclosed  preferably  in  glass  con- 
tainers. “Radium  may  be  administered  as  baths, 
by  subcutaneous  injection  in  the  neighborhood  of 
an  involved  joint  (0.25  to  0.5  microgram  in  one  or 
two  cc.  distilled  water),  by  local  application  as 
compresses  (from  five  to  ten  micrograms),  by 
mouth  as  a drink  cure  (in  increasing  doses  of  from 
one  to  ten  micrograms  three  or  more  times  a day), 
by  drinking  radioactive  water,  containing  only 
radium  emanation  (from  two  to  twenty  microcuries 
of  emanation,  or  more  in  twenty-four  hours),  by 
inhalation  of  the  emanation,  the  patient  for  two 
hours  daily  remaining  in  the  emanatorium  which 
contains  0.0025  to  0.25  (average  0.1)  microcurie  of 
emanation  per  htre  of  air.”  N.  and  N.  O.  R.  (See 
Radium,  in  Part  1.) 

Raspberry  Syrup:  Syrupus  Rubi  Idaci  (rasp- 
berries, sugar  and  water,  boiled  and  strained.  Do 
not  use  tin  vessels). 

Uses. — Flavoring  agent. 

Regulin  (Agag-agar  containing  25  per  cent.  ext. 
cascarse  sagrada?). 

Uses. — Laxative. 

Resinae  Ceratum;  Basilicon  Ointment:  Ro.sin  35, 
yellow  wax  15,  lard  50. 

Uses. — Protective  emolhent. 

Resina  Jalapas. 

Dosage. — 3 years,  gr.  ii;  5 years,  gr.  iii.  Adult, 
min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — Resina;  jalapa;, 
gr.  ii-iii,  pilulae  no.  6. 

Sig. — Pill  at  bedtime. 

Physiologic  Action  and  Uses. — Hydragogue  ca- 
thartic (local  irritant);  diuretic;  acts  on  both  large 
and  small  bowel. 

Resina  Podophylli. 

Adult  Dosage. — Min.,  gr.  Mol  av..  Mo;  max.,  1'2- 

Method  of  Administration. — I^  Resin®  podoph- 
ylli, gr.  m,  pilul®  no.  12. 

Sig. — -One  pill,  once  or  twice  daily,  as  a laxative; 
two  to  six  pills  as  a hydrogogue  cathartic. 

Uses. — Slow,  irritant  cathartic. 

Resorcinol;  Meta-dihydroxi-benzene : C6H4(OII)2 
1 : 3 (soluble  in  0.9  of  water,  and  0.9  of 
alcohol). 

Adidt  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  x. 

Method  of  Administration. — -Gr.  v every  two  hours 
as  an  antipyretic;  no  more  than  gr.  xlv  in  twenty- 
four  hours. 

External  astringent  in  1 to  3 per  cent,  solutions; 
Keratolytic  in  10  to  20 per  cent,  strength;  ointment, 
5 to  10  per  cent. 

I^  Resorcinol,  gr.  xx.xii.  (gr.  ii  ad  5i);  aquam 
ad  5ii. 

M.  Sig. — One  dram,  three  to  four  times  a day. 


Uses. — Antiseptic;  astringent;  keratolytic;  anti- 
fermentative;  antipyretic. 

Toxic  Action. — Cardiac  and  respiratory  depres- 
sion, sweating,  narcosis,  collapse. 

Rhamnus  Purshiana.  See  Cascara  Sagrada. 

Rhatania.  See  Krameria. 

Rhei  et  Sod®  Mlstura  (Soda  bicarb.  33^,  fl.  ext. 
rhei  1 3^,  fl.  ext.  ipecac  M,  glyc.  35,  spt.  menth.  pip. 
334)  water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — Mistur®  rhei  et 
sod®,  5ii- 

Sig. — Teaspoonful  once  to  thrice  daily,  p.  c. 

Uses. — Antacid;  laxative. 

Rhei  et  Sod®  Mistura  (Kerley). 

Dosage. — 6 months,  3ss;  18  months,  3ii;  3 years, 
3 iii;  5 years,  3iv.  Adult,  av.,  3iv. 

Method  of  Administration. — Pulveris  rhei, 
gr.  xlviii;  sodii  bicarbonatis,  gr.  xlviii;  syrupi  rhei 
aromatici,  SM  aqu®,  q.s.  ad  5ii- 

M.  Sig. — A dose  once  to  thrice  daily. — Kerley. 

Uses. — Antacid;  laxative. 

Rhei  Extractum  (1^.  represents  2 gm.  rhubarb). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  x. 

Physiologic  Action  arid  Uses. — Cathartic;  bitter 
stomachic  tonic;  somewhat  astringent  in  its  after- 
effects; acts  chiefly  in  the  lower  bowel. 

Rhei  Fluidextractum. 

Adult  Dosage. — Min.,  t®v;  av.,  xv;  max.,  xxx. 

Fluidextract;  rhei.  Si- 

Sig. — 15  to  30  drops  in  water  at  bedtime. 

Rhei  Pilul®  Composit®  (rhubarb  gr.  ii,  aloes  gr. 
iss,  myrrh  gr.  i,  oil  of  peppermint  gr.  Mo.) 

Adult  Dosage. — Min.,  1;  av.,  2;  max.,  5.  Pills  at 
bedtime. 

Rhei  Pulvis. 

Adult  Dosage. — As  a stomachic.  Min.,  gr.,  i;  max.j 
V.  As  a laxative.  Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Rhei  Pulvis  Compositus. — See  Pulvis  Rhei  Com- 
positus. 

Rhei  Syrupus  Aromaticus  (arom.  tr.  rhei  15, 
syrup  85). 

Dosage. — 6 months,  Sb  18  months,  3ii;  3 years, 
5iii;  Syears,  3iy.  Adult, min. , 3ii;av.,iiss;max.,iv. 

Method  of  Administration. — Syrupi  rhei  aro- 
matici, 5ii- 

Sig. — One  tofourteaspoonfuls,once  to  thrice  daily. 

Uses. — Pleasant  laxative;  stomachic. 

Rhei  Tinctura  Aromatica  (rhubarb  20,  cinnamon 
4,  cloves  4,  nutmeg  2,  glyc.  10,  alcohol  and  water  to 
100). 

Adult  Dosage. — Min.,  itEx;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — Tinctur®  rhei 
aromatic®,  §i. 

Sig. — Thirty  drops  in  water,  once  to  thrice  daily. 

Rhois  Aromatic®  Fluidextractum  (Sweet  Sumach). 

Dosage. — ^18  months,  tt^v;  3 years,  i^x;  5 years, 
iTEx.  Adult,  min.,  ttex;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Fluidextracti  rhois 
aromatic®,  o'- 

Sig. — Fifteen  drops  in  sweetened  water,  three  to 
four  times  daily  (for  children  over  six  years  of  age). 

Physiologic  Action  and  Uses. — LYinary  astringent; 
recommended  for  enuresis. 

Rhois  Toxicodendri  Tinctura  (Poison  Ivy). 

Adult  Dosage. — hlin.,  115M0;  max.,  ii. 

Method  of  Administration. — E Tinctur®  rhois 
toxicodendri,  3ss  (iieMo  ad  iriji);  aqu®,  3ivss. 

M.  Sig. — One  minim,  in  water,  three  to  four  times 
daily,  gradually  increased. 

Physiologic  Action  and  Uses. — Possibly  prophy- 
lactic and  curative  in  ivy  poisoning. 

Toxic  Action. — Nausea,  vomiting,  vertigo,  stupe- 
faction, colic,  diarrhoea,  h®maturia,  anuria,  fever, 
dehrium,  general  pains. 


SALICYLAS  SODII 


Ricini  Oleum;  Castor-Oil. — See  Castor-Oil. 
Ringer’s  Solution  (Sodium  chlor.  9 gms.,  calc, 
chi.  0.24  gms.,  pot.  chi.  0.42  gm.,  sod.  bicarb.  0.2  gm., 
water  1000  c.c.). 

Rochelle  Salt;  Potassii  et  Sodii  Tartras:  KNa 
C4H4O6+4H2O  (soluble  in  0.9  of  water). 

Dosage. — 6 months,  gr.  xv;  18  months,  gr.  xxx; 
3 years,  5i-ii;  5 years,  3hi-iv.  Adult,  min.,  3i; 
av.,  iiss;  max.,  iv. 

Method  of  Administration. — Dissolved  in  half  a 
glass  of  water,  one  hour  before  breakfast.  One-half 
to  one  teaspoonful  may  be  given  every  one  to  two 
hours,  until  purgation  occurs. 

Physiologic  Action  and  Uses. — Saline  cathartic; 
causing  purgation  by  osmosis  and  interference  with 
the  absorption  of  fluids  from  the  bowel;  acts  in  one 
to  twenty  hours. 

Rosae  Aqua;  Rose-Water. 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  gi. 

Uses. — Perfumed  vehicle. 

Rosae  Qeranii  Oleum. 

U ses. — ^Perfume. 

Rosae  Oleum;  Attar  of  Rose. 

U ses. — Perfume. 

Rosmarini,  Spiritus. 

Uses. — Cutaneous  stimulant. 

Rubi  Idaei  Syrupus  ; Raspberry  Syrup  (raspberries, 
sugar,  and  water,  boiled  and  strained.  Do  not  use 
tin  vessels). 

Dosage. — Ad  libitum. 

Uses. — Flavoring  agent. 

Rubrum  Scarlatinum;  Scarlet  Red;  Toluyl-Azo- 
Betanaphthol ; CH3C6H4N  : NCsHs.iCHslN  ; N. 
C10H5.OH. 

* Method  of  Administration. — R Unguenti  rubri 
scarlatini,  4 to  8 per  cent.,  §i. 

Sig. — For  local  application. 

Physiologic  Action  and  Uses. — Said  to  stimulate 
epithehal  proliferation. 

Toxic  Action. — Giddiness,  headache,  vomiting, 
abdominal  pains,  albuminuria,  cyanosis,  increased 
pulse-rate. 

Rusci  Oleum  Rectihcatum.  See  Oleum  Betulsc. 
Rutae  Oleum;  Oil  of  Rue. 

Adult  Dosage. — -Min.,  tgji;  av.,  ii;  max.,  v. 

C/ses.— Emmenagogue;  aphrodisiac. 

Toxic  Action. — Gastro-enteritis,  prostration,  con- 
vulsions, strangury,  anuria,  narcosis. 

Sabinae  Oleum;  Oil  of  Savin:  CmHie. 

Adult  Dosage.— Min.,  rgji;  av.,  ii;  max.,  iv. 

U ses.— Emmenagogue. 

Toxic  Action. — Gastro-enteritis,  haematuria,  dys- 
uria,  narcosis. 

Saccharin;  Benzosulphinidum : C6H4SO2.CONH 
(soluble  in  290  of  water  and  31  of  alcohol;  but 
much  more  soluble  in  water  mixed  with  an  equal 
amount  of  sod.  bicarb.  It  is  about  500  times  as 
sweet  as  sugar,  weight  for  weight). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  v.  Up 
to  gr.  xxx  per  diem,  if  required.  Ordinarily  gr.  ss-i 
is  used  to  sweeten  eight  fluid  ounces  of  food. 

R _ Benzosulphinidi ; sodii  bicarbonatis,  aa  gr.  ss. 
Misce.  Mitte  tahs  tabellae  no.  30. 

Sig. — One  tablet  dissolved  in  each  eight  fluid 
oimces  of  food,  as  a sweetener. 

Uses. — Substitute  for  sugar  as  a flavoring  agent. 
Saccharin  Soluble;  Sodii  Benzo.sulphinidum; 
Sodium  Saccharin  (soluble  in  1.2  of  water  and  50  of 
alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  v.  Up 
to  gr.  xxx  per  diem,  if  required.  Ordinarily  gr.  ss-i 
is  used  to  sweeten  eight  fluid  ounces  of  food,  i 
R Sodii  benzosulphinidi,  gr.  ss,  tabellae  no.  100. 
Sig. — One  or  two  tablets  dissolved  in  each  eight 
fluid  ounces  of  food,  as  a sweetener. 

59 


Uses. — Substitute  for  sugar  as  a sweetening  agent. 
Saccharum  Album;  Cane  Sugar;  Saccharose: 
Ci2H220u  (soluble  in  0.5  of  water  and  170  of 
alcohol). 

Uses. — Flavoring  agent;  diluent;  food. 

Saccharum  Lactis;  Milk  Sugar;  Lactose:  C12H22 
Oii-f-H20  (soluble  in  4.9  of  water,  but  practically 
insoluble  in  alcohol). 

Physiologic  Action  and  Uses. — Flavoring  agent; 
diluent;  food;  .shghtly  laxative  and  diuretic. 

Sajodin;  Calcium  Monoiodobehenate : (C21H42 
ICOO)2Ca.  (Insoluble  in  water). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv.  Gr. 
xv-xlv  daily  in  powder,  tablet,  or  capsule,  one-half 
hour  p.c. 

R Sajodin,  gr.  v-xv,  pulveres,  tabell®,  vel  cap- 
sul®,  no.  30. 

Sig. — -One,  t.i.d.,  one-half  hour  after  meals. 
Physiologic  Action  and  Uses. — Sajodin  contains 
26  per  cent,  of  iodin  and  4.1  per  cent,  of  calcium, 
and  is  indicated  wherever  iodine  or  iodide  is  indi- 
cated. It  is  said  to  be  less  hable  to  injure  the  stom- 
ach or  produce  rashes. 

Salicinum:  CisHisO?  (glucoside;  soluble  in  28  of 
water  and  in  30  of  alcohol). 

Adult  Dosage. — -Min.,  gr.  x;  av.,  xv;  max.,  xxx. 
Method  of  Administration. — R Sahcini,  gr.  xv, 
capsulae  no.  30. 

Sig. — One  or  two  capsules  every  two  to  four  hours. 
Physiologic  Action  and  Uses. — -Antirheumatic; 
oxidized  in  the  body  into  saUcylic  acid. 

Toxic  Action. — Nausea,  vomiting,  sweating,  sense 
of  fulness  in  the  head,  tinnitus,  dizziness,  headache, 
deafness,  dimness  of  vision,  dyspnoea,  mydriasis, 
delirium,  cardiac  and  respiratory  depression,  low 
blood  tension,  epistaxis  and  other  hiEemorrhages, 
erythematous  and  other  rashes,  irritation  of  the 
kidneys,  central  nervous  depression,  slowing  and 
depression  of  the  respiration,  collapse  (abortion), 
rarely  convulsions. 

Give  sod.  bicarb,  in  large  doses. 

Salicylas  Methylis;  Artificial  Oil  of  Wintergreen; 
Oleum  Gaultheriae. 

Dosage. — 6 months,  gt.  i;  18  months,  gtt.  ii-iii; 

3 years,  gtt.  iii;  5 years,  gtt.  iii-v.  Adult,  min., 
rr^v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Olei  gaultheriae,  gi. 
Sig. — Twelve  to  twenty  drops,  well  diluted  in 
sweetened  water  or  milk,  every  two  to  four  hours. 
It  may  be  prescribed  in  formalin-hardened  capsules. 

For  external  application  and  absorption:  either 
pure  or  diluted  vnth  lanolin  (10  per  cent,  ung.)  or 
an  oil. 

Physiologic  Action  and  Uses. — Antirheumatic; 
antipyretic;  local  anodyne;  flavor;  very  irritating 
to  the  stomach;  readily  absorbed  through  the  skin. 
Toxic  Action. — See  under  Salicinum. 

Salicylas  Phenylis;  Salol:  C6H4(OH)COOC6H6 
1 : 2 (soluble  in  6670  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i-ii; 

3 years,  gr.  ii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v; 
av.,  viiss;  max.,  xv. 

Method  of  Administration. — R Phenylis  salicy- 
latis,  gr.  V,  capsulae,  tabellae,  vel  pulveres  no.  12. 

Sig. — One  every  two  to  four  hours. 

Physiologic  Action  and  Uses. — Intestinal  and  uri- 
nary antiseptic  by  the  liberation  of  phenol  and 
salicylic  acid;  antirheumatic;  antipyretic;  diapho- 
retic. 

Toxic  Action. — Symptoms  of  .salicylic  acid  poison- 
ing, together  with  lumbar  heaviness,  smoky  urine, 
and  other  phenol  effects. 

Salicylas  Sodii:  C6H4(OH)(COONa)  (soluble  in 
0.9  of  water  and  9.2  of  alcohol). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii;  3 


SANTALI  OLEUM 


years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Under  3 years, 
12  to  15  grains  daily;  5 years,  20  grains  daily;  8 to 
10  years,  30  grains  daily;  10  years,  40  grains  daily. 
— Kerley.  Adult,  min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — Sodii  salicylatis, 
3ss  (gr.  XV  per  dose);  sodii  bicarbonatis,  5ss-i  (gr. 
xv-xxx  per  dose);  aquae,  q.s.  ad  5xii. 

M.  Sig. — Six  drams,  in  half  a tumbler  of  water, 
every  one,  two,  three  to  four  hours,  until  pain  is  re- 
lieved, then  every  four  to  five  hours  until  the  tem- 
perature begins  to  fall.  Should  toxic  symptoms 
appear,  stop  the  drug,  and  resume  later  in  smaller 
doses.  The  alkah  is  added  to  prevent  sahcyhc 
acidosis. 

Physiologic  Action  and  Uses. — -Antirheumatic; 
analgesic;  antipyretic;  diaphoretic;  cholagogue; 
bihary  antiseptic;  increases  nitrogenous  metabolism 
and  the  excretion  of  uric  acid.  The  salicylates  are 
contra-indicated  in  meningeal  inflammation  or  con- 
gestion, otitis  media,  renal  insufficiency. 

Toxic  Action. — See  under  Salicinum. 

Salicylic!  Acidi  Collodium  (10  per  cent.). 

Uses. — -Keratolytic  for  corns  and  callouses. 

Salicylic!  Acidi  Unguentum. 

Acidi  sahcyhci,  gr.  v-x-xxx-xlviii ; petrolati 
et  adipis  lance  hydros!,  aa  gss.  M.  et  fiat  ung. 

Uses. — Antiseptic;  parasiticide;  keratolytic. 

Salicylicum  Acidum:  CeH4(OH)COOH  (soluble  in 
460  of  water,  but  readily  soluble  in  10  per  cent.  sod. 
phosphate  solution;  soluble  in  2.7  of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xx. 

Method  of  Administration. — Acidi  salicylici, 
3iss;  sodii  phosphatis,  piu;  aquae,  q.s.  ad  $iv. 

M.  Sig. — One  tablespoonful,  well  diluted,  every 
four  hours.  For  gastric  lavage,  gr.  xv  ad  Oi. 

As  a dusting  powder:  2 to  5 per  cent.,  with  boric 
acid,  talcum,  starch,  or  zinc  oxide. 

Physiologic  Action  and  Uses. — ^Antirheumatic  and 
antipyretic;  local  antiseptic,  parasiticide,  and 
keratolytic. 

Toxic  Action. — ^Nausea,  vomiting,  tinnitus,  sense 
of  fulness  in  the  head,  disturbances  of  sight  and 
hearing,  sweating,  mydriasis,  dehrium,  dyspnoea, 
.slow  pulse,  nephritis.  • 

Saliformin;  Hexamethylenaminae  Salicylas:  (CH2) 
6N4C6H4.OH.COOH  (readily  soluble  in  water  or 
alcohol). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xxx. 

Method  of  Administration. — Hexamethyena- 
minse  salicylatis,  gr.  Lxxx  (gr.  v ad  3i)i  ehxiris  sim- 
phcis,  5u. 

M.  Sig. — One  or  two  teaspoonfuls  every  four 
hours.  It  may  be  prescribed  in  tablet  form. 

Uses. — Urinary  antiseptic. 

Saline  Cathartics:  Rochelle  Salt,  Glauber’s  Salt, 
Sodium  Phosphate,  Seidhtz  Powder,  Magnesii 
Sulphas,  Magnesii  Citratis,  Liquor,  Magnesii  Car- 
bonas,  Magnesii  O.xidum,  Potassii  Bitartras,  Potassii 
Citras. 

Saline  Solution,  Normal  or  Physiologic:  a 0.85 
per  cent,  solution  of  sodium  chloride  in  water,  or 
about  one  dram  to  the  pint. 

Physiologic  Action  and  Uses. — Isotonic  with  the 
red  blood-cells. 

Salipyrin;  Antipyrinae  Salicylas:  CUH12N2O.C6 
H4OH.COOH  (soluble  in  200  of  water;  readily  solu- 
ble in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — -I^  Antipyrinae  sa- 
licylatis, gr.  v-x,  capsulae,  tabellae,  vel  pulveres 
no.  24. 

Sig. — One,  three  to  four  times  daily;  or  every 
one  to  two  hours  until  3ii  have  been  taken 
(Potter). 

Uses. — Analgesic;  antirheumatic;  antipyretic. 


Salol;  Phenylis Salicylas:  C6H4(OH)COOC6H6l  : 2 
(soluble  in  6670  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i-ii;  3 
years,  gr.  ii;  5 years,  gr.  iii.  Adult,  min.,  gr.  v; 
av.,  viiss;  max.,  xv. 

Method  of  Administration. — I^  Phenylis  salicy- 
latis, gr.  V,  capsulae,  tabeUae,  vel  pulveres  no.  12. 

Sig. — One,  every  two  to  four  hours. 

Physiologic  Action  and  Uses. — Intestinal  and  uri- 
nary antiseptic,  by  the  hberation  of  phenol  and 
sahcyhc  acid;  antirheumatic;  antipyretic;  diapho- 
retic. 

Toxic  Action. — Symptoms  of  sahcyhc  acid  poison- 
ing, together  with  lumbar  heaviness,  smoky  urine, 
and  other  phenol  effects. 

Salophen;  Acetylparaminophenyl  Salicylate: 
C6H4.0H.C0.0.(C6H4.NH(CH3C0).  (almost  insolu- 
ble in  water;  freely  soluble  in  alcohol). 

Adult  Dosage. — -Min.,  gr.  v;  av.,  x;  max.,  xv. 

Method  of  Administration. — I^  Salophen,  gr. 
v-x,  pulveres,  tabellae,  vel  capsulae  no.  24. 

Sig. — One,  three  to  four  times  daily,  if  necessary, 
up  to  3i-iss  in  twenty-four  hours  (Potter). 

Physiologic  Action  and  Uses. — Antirheumatic; 
antipjuetic;  analgesic;  antiseptic;  urinary  and  in- 
testinal antiseptic. 

Salvarsan;  Arsenobenzol;  Arsphenamina ; “606”; 
3-diamino-4-dihydroxyl-l-arsenobenzene  hydro- 
chlorid:  HCl.NH2.0H.C6H3.As:As.C6H30H.NH2 

HCI-I-2H2O. 

Dosage. — 18  months,  .02  grn.;  3 years,  0.1  gm.; 
5 years,  0. 1-0.2  gm.  Adult,  min.,  0.3;  max.,  0.6  gm. 

Method  of  Administration. — See  Part  1,  Syphilis. 

Physiologic  Action  and  Uses. — Anthuetic;  altera- 
tive; useful  in  all  spiriUum  affections. 

Toxic  Action. — Headache,  perhaps  feeble  and 
rapid  action  of  the  heart,  cutaneous  eruption,  renal 
irritation,  gastro-enteritis,  hemorrhage. 

Salvije  Fluidextractum;  Sage,  fl.  e^rt. 

Adult  Dosage. — Min.,  tijxv;  max.,  xl. 

Method  of  Administration.  — I^  Fluidextracti 
salvia?,  gi. 

Sig. — Fifteen  to  sixty  drops,  in  water,  t.i.d. 

Uses. — Anhidrotic. 

Salvias  Infusum;  Sage  Infusion. 

Adult  Dosage. — Min.,  §i;  max.,  u. 

Method  of  Administration. — I^  Infusum  salviae. 

Sig. — Two  tablespoonfuls  to  a wineglassful,  t.i.d. 

Uses. — ^ Anhidrotic. 

Sambucus;  Elder  Flowers. 

Adult  Dosage. — Min.,  3ss;  max.,  i. 

Method  of  Administration. — In  hot  infusion,  as  a 
tea. 

U ses. — Diaphoretic. 

Sanguinarias,  Pulvis. 

Adult  Dosage. — Min.,  i;  av.,  ii;  max.,  v. 

R Pulveris  sanguinariae,  gr.  u;  pilulae  No.  12. 

Sig. — One  pill  every  two  horns. 

Uses. — Nauseant  expectorant. 

Sanitas  Oil  or  Disinfecting  Fluid  (an  aqueous  solu- 
tion of  turpentine  which  has  been  oxidized  by 
exposure  to  the  air,  containing  hydrogen  dioxide, 
thymol,  camphor,  and  camphoric  acid). 

Uses. — Antiseptic. 

Sanose  (80  per  cent,  casein,  20  per  cent,  albumose). 

Uses. — Concentrated  albuminous  food. 

Santali  Oleum;  Oil  of  Sandalwood. 

AdvU  Dosage. — Min.,  i^v;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Olei  santah,  iiex, 
capsulae  no.  12. 

Sig. — One,  t.i.d. p.c. 

It  may  be  prescribed  in  emulsion,  but  better  in 
capsule. 

Physiologic  Action  and  Uses. — Urinary  astringent 
and  antiseptic;  useful  in  sub-acute  gonorrhoea  and 


SENEGA  INFUSUM 


ammoniacal  cystitis  due  to  pyogenic  cocci;  broncho- 
pulmonary antiseptic  and  deodorizer. 

Toxic  Action. — Gastric  and  intestinal  irritation; 
lumbar  pain. 

Santoninum  (soluble  in  5300  of  water,  and  43  of 
alcohol). 

Dosage.— % months,  gr.  %;  18  months,  gr.  3 
years,  gr.  3^;  5 years,  gr.  Adult,  min,,  gr.  ss; 
av.,  i;  ma.x.,  iii. 

Method  of  Administration. — Santonini,  gr.  Ys; 
sacchari  lactis,  q.s. 

Misce.  Mitte  talis  pulveres  no.  9. 

Sig. — One  powder,  every  four  hours,  for  three 
doses,  soon  followed  by  calomel,  or  castor  oil;  a 
purge  should  have  been  given  the  evening  before. 
Repeat  for  two  or  three  successive  days.  See  Ascari- 
asis.  Part  1,  for  important  information. 

Physiologic  Action  and  Uses. — Anthelmintic,  espe- 
cially toward  the  round-worm,  in  less  degree  toward 
the  thread- worm.  Contra-indications:  fever,  con- 
stipation. 

Toxic  Action. — Xanthopsia  or  yellow  vision, 
vertigo,  mental  confusion,  tremors,  grinding  of  the 
teeth,  weakness,  slow  pulse,  feeble  respiration, 
nausea,  vomiting,  purging,  stupor,  mydriasis, 
sweating,  convulsions,  paralysis,  temporary  blind- 
ness lasting  a week  or  longer. 

Sapo;  Soap;  White  Castile  Soap  (prepared  from 
olive-oil  and  sodium  hydrate). 

U ses. — Detergent. 

Sapo  Mollis;  Soft  or  Green  Soap  (prepared  from 
cottonseed  oil  and  pot.  hydrate). 

U ses. — -Detergent. 

Saponis  Emplastrum  (soap  10,  lead  plaster  90, 
water  q.s.). 

Saponis  Linimentum  (white  castile  soap  6,  cam- 
phor 43^,  oil  of  rosemary  1,  alcohol  72}/^,  water  to 
100). 

Uses. — Mild  rubefacient,  detergent,  and  vehicle. 

Saponis  Mollis  Linimentum;  Tincture  of  Green 
Soap  (soft  soap  65,  oil  of  lavender  2,  alcohol 
to  100). 

Uses. — Detergent. 

Sarsaparillae  Syrupus  Compositus  (fl.  ext.  sarsap. 
20,  fl.  ext.  glycyrrhiza  1}^,  fl.  ext.  senna  13^,  sugar 
65,  oils  of  sassafras,  anise,  and  gaultheria,  each  0.02, 
water  to  100). 

Adult  Dosage. — Min.,  pi;  av.,  iv;  max.,  5i- 

Uses. — Vehicle. 

Sassafras  Medullae  Mucilago. 

Adult  Dosage. — Av.,  piv. 

Uses. — Demulcent;  flavor;  for  the  suspension  of 
insoluble  powders. 

Sassafras  Oleum. 

Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  iv. 

Uses. — Flavor;  rubefacient. 

Saw  Palmetto  Fluid=extract;  Fluidextractum 
Sabah. 

Adult  Dosage. — Min.,  itexv;  max.,  lx. 

Method  of  Administration. — Fluidextracti  sa- 
bah.  Si- 

Sig. — Fifteen  to  sixty  drops,  in  water,  three  to  four 
times  a day. 

Uses. — Diuretic. 

Saxin  (600  times  sweeter  than  sugar). 

f/ses.— Substitute  for  sugar,  as  a flavor. 

Scammoni®  Pulvis. 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  x. 

Uses. — Cathartic. 

Scarlet  Red — See  Rubrum  Scarlatinum. 

Schlesinger’s  Analgesic  Solution: 

R Scopolaminae  hydrobromidi  0.0025  or  gr. 

(gr.  Kiq  ad  itjv) ; dionin®,  0.4  or  gr.  vi  (gr.  Y,  ad  itev)  ; 
morphin®  hydrobromidi,  0.2  or  gr.  iii  (gr.  Ko  ad  itev)  ; 
aqu®  destillat®,  q.s.  ad  10.0  or  3hss. 


M.  Sig. — iTEv-vu,  hypodermically. 

Physiologic  Action  and  Uses. — A greatly  superior 
substitute  for  morphine  for  the  relief  of  pain  and 
suffering. 

Scill®  Acetum  (10  per  cent,  in  dilute  acetic  acid; 
biologically  assayed). 

Adult  Dosage. — Min.,  t^jv;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Aceti  scill®  (bio- 
logically assayed),  Sss. 

Sig. — -Fifteen  drops  in  water,  3 to  4 times 
daily. 

Physiologic  Action  and  Uses. — Expectorant;  diure- 
tic; slows  and  strengthens  the  heart  and  raises  the 
arterial  pressure. 

Toxic  Action. — Vomiting,  purging,  strangury, 
h®maturia,  con-vulsions,  paralysis. 

Scill®  Pulvis  (biologically  assayed). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iss;  max.,  v. 

Scill®  Syrupus  (biologically  assayed). 

Adult  Dosage. — Min.,  ttex;  av.,  xxx;  max.,  3i- 

Method  of  Administration. — R Syrupi  scill® 
(biologically  assayed),  3i. 

Sig. — ^Thirty  drops,  3 to  4 times  a day. 

Scill®  Tinctura  (biologically  assayed). 

Adult  Dosage. — Min.,  ttex;  av.,  xv;  max.,  xxx. 

Scoparii  Infusum  (broom  tops,  5ss,  in  water  Oiss, 
boiled  down  to  a pint). 

Adult  Dosage. — Av.,  Ju. 

Method  of  Adjninistration.—Pi,  Scoparii,  3iv; 
aqu®,  Oiss.  Boil  down  to  a pint  and  filter. 

Sig. — Two  ounces,  or  a wineglassful,  frequently, 
until  a pint  is  taken  in  twenty-four  hours. 

Uses. — -Diuretic;  laxative. 

Scopolamin®  (Hyoscin®)  Hydrobromidum: 
Ci7H2iN04HBr-|-3H20.  (alkaloid;  the  tropic  acid 
ester  of  scopoline;  soluble  in  1.5  of  water,  and  20  of 
alcohol). 

Adult  Dosage. — Min.,  gr.  )^oo;  av.,  %o',  max.,  Yo- 

Method  of  Administration. — R Hyoscin®  hydro- 
bromidi, gr.  Yoo-%0,  tabell®  no.  6. 

Sig. — A tablet,  by  mouth  or  hyqrodermically, 
several  times  daily.  As  a mydriatic,  in  place  of 
atropine,  when  the  latter  causes  conjunctivitis: 
34  to  3^  per  cent.,  or  about  2 grains  to  the 
ounce. 

Uses. — Cerebral  sedative;  mydriatic. 

Toxic  Action. — Respiratory  depression,  fall  of 
blood-pressure,  collapse. 

Seidlitz  Powder;  Pulvis  Effervescens  Compositus. 
Blue  paper:  Rochelle  salt  120  grs.,  sod.  bicarb.  40 
grs.  White  paper:  Tartaric  acid  35  grs. 

Adult  Dosage. — Av.,  1 to  2 pairs. 

Method  of  Administration. — Dissolve  the  contents 
of  each  paper  -separately  in  water,  and  pour  the  two 
solutions  together. 

Uses. — Saline  aperient. 

Senecionis  Fluidextractum  N.  F. 

Adult  Dosage. — Min.,  3ss;  max.,  i. 

Method  of  Administration. — R Fluidextracti 
senecionis,  5i- 

Sig. — 3ss-i,  in  water,  t.i.d. 

Uses. — H®mostatic. 

Seneg®  Fluidextractum. 

Adult  Dosage. — Min.,  tiev;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — R Fluidextracti 
seneg®,  3ih  3i  (ttexuss  per  dram);  syrupi  simpUcis, 
Si;  aqu®,  q.s.  ad,  Sh- 

M.  Sig.— A)ne  dram,  every  2 to  3 hours. 

Physiologic  Action  and  Uses. — Stimulating  or 
nauseant  expectorant  (due  to  saponin);  diuretic; 
diaphoretic. 

Toxic  Action. — Cardiovascular  depression,  weak- 
ness. 

Seneg®  Infusum  (B.  P.). 

■ Adult  Dosage. — Min.,  Sss;  max.,  i. 


SERUM,  NORMAL  HORSE 


Senna. 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Physiologic  Action  and  Uses. — Cathartic;  acts  in 
five  to  eight  hours,  chiefly  on  the  lower  bowel. 

Sennae  Confectio  (Senna  10,  cassia  fistula  16, 
tanaarind  10,  prune  7,  fig  12,  sugar  55 oil  of 
coriander  water  to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Confectionis 

sennae,  5u- 

Sig.— One  teaspoonful  at  bedtime. 

Uses. — A pleasant  laxative. 

Sennae  Fluidextractum. 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  oi- 

Method  of  Administration. — R Fliiidextracti 
sennae,  piv;  syrupi  glycyrrhizaj,  q.s.  ad  5ii- 

M.  Sig. — ^Two  teaspoonfuls  at  bedtime. 

Sennae  Syrupus  (FI.  ext.  sennae  25,  oil  of  coriander 
Hi  syrup  to  100). 

Adult  Dosage. — Min.,  pss;  av.,  i;  max.,  ii. 

Method  of  Administration. — R Syrupi  sennae,  5ii- 

Sig. — One  teaspoonfifl  at  bedtime. 

Serobacterins.  See  Vaccina. 

Serum  Antianthracum  (an  antibacteriaf  serum). 

Adult  Dosage. — Min.,  30  c.c.;  max.,  100  c.c. 

Method  of  Administration. — An  initial  dose  of  80 
to  100  c.c.,  divided  in  three  or  four  portions,  may  be 
injected  under  the  sldn  at  different  points,  or  admin- 
istered intravenously,  and  repeated  in  twenty-four 
hours  if  no  improvement  is  noted.  Daily  injections 
may  have  to  be  administered.  It  is  said  to  be  harm- 
less but  for  the  ether  it  contains  (see  Anaphylactic 
Shock,  Part  1).  In  severe  cases  100  c.c.  may  be 
injected  several  times  a day. 

Toxic  Action. — Serum  disease  is  manifested  by  an 
urticarial  or  exanthematous  rash,  cndematous  swell- 
ing of  the  mucous  membranes,  swelling  of  the  lymph 
glands,  perhaps  vomiting,  dyspncea,  rapid  pulse, 
cyanosis,  joint  pains  and  swelling,  general  malaise, 
subnormal  temperature  or  fever,  perhaps  convid- 
sions,  collapse,  and  prolonged  prostration,  very 
rarely  death.  These  symptoms  may  appear  xvithin 
a few  days  to  one  or  two  weeks  after  the  injection  of 
the  serum. 

Serum  Antibotulinum. 

Serum  Anticholerum. 

Serum  Anticolonicum. 

Serum  Antidiphthericum;  Diphtheria  Antitoxin 
(Not  less  than  250  antitoxic  units  per  c.c.).  Keep 
sealed  in  a cool,  dark  place. 

Dosage. — 6 months,  1500  units;  18  months,  2000 
units;  3 years,  4000  units;  5 years,  5000  units.  Adult, 
min.,  5000 units;  av.,  15,000  imits;  max.,  40,000  units. 

Method  of  Administration. — Immunizing  dose, 
500  units  for  infants,  1500  to  2000  units  for  children 
over  two  years;  Kerley  says,  at  least  1000  units, 
regardless  of  the  age  of  the  child.  Immunity  lasts 
about  three  weeks.  Adults  need  not  be  immunized, 
and  children  only  where  there  is  overcrowding,  as  in 
institutions.  See  Diphtheria,  Part  1. 

Serum  Antidiphthericum  Purificatum  (Diphtheria 
antitoxin  globuhns;  Refined  and  Concentrated 
Diphtheria  Antitoxin  in  Physiologic  Sodium  Chlo- 
ride Solution).  Lessens  the  danger  of  serum  disease. 
The  dosage  is  the  same  as  that  of  Serum  Anti- 
diphthericum. 

Serum  Antidiphthericum  Siccum;  Dried  Diph- 
theria Antitoxin  (Evaporated  Serum).  The  dosage 
is  the  same  as  that  of  Serum  Antidiphthericum. 

Serum  Antidysentericum  (antitoxic  and  anti- 
bacterial against  the  Shiga,  Flexner,  and  Y strains  of 
the  dysentery  bacillus). 

Adult  Dosage. — Min.,  20  c.c.;  max.,  100  c.c.,  sub- 
cutaneously, to  be  followed  at  eight-hour  intervals 
by  doses  of  50  c.c.  until  400  c.c.  are  given. 


Serum  Anti=Qlanders. 

Serum  Antigonococcum  (antibacterial). 

Adult  Dosage. — Min.,  2 c.c.;  av.,  4 c.c.;  max. 

6 c.c.,  injected  deeply,  but  not  necessarily  into  the 
muscle,  every  day,  or  every  second  or  third  day, 
gradually  increased  to  6 to  8 c.c.  every  fifth  day. 

Serum  Antileprum. 

Serum  Antimeningococcum  (antibacterial). 

Dosage.— 3 to  5 years,  5 c.c.  Adult,  30  c.c. 
“Ma.ximum  safe  doses”  {Useful  Drugs,  A.  M.A.). 
Introduce  the  serum,  intraspinaUy,  slowly  bv 
gravity,  after  the  removal  of  an  equal  amount  of 
cerebrospinal  fluid,  the  administration  being 
controlled  by  blood-pressure  readings,  a drop  of 
10  mm.  of  mercury  during  administration  being 
the  signal  for  withdrawal  of  the  needle.  Repeat 
the  dose,  as  indicated,  and  continue  the  treatment 
as  long  as  active  symptoms  remain  (see  Cerebro- 
spinal Fever,  Part  1). 

Serum  Anti=Plague. 

Adult  Dosage. — Min.,  20  c.c. ; max.,  320  c.c.,  Hj-po- 
dermically  or  intravenously,  every  day. 

Serum  Antipneumococcum  (antibacterial). 

Adult  Dosage. — Min.,  50  c.c.;  max.,  100  c.c. 

Method  of  Administration. — Hypodermically  or 
intravenously  every  eight  hours.  There  are  four 
types  of  pneumococci,  and  the  serum  used  should  be 
obtained  from  the  type  of  organism  present  in  the 
case  under  treatment  (see  Pneumonia  in  Part  1). 
Type  I immune  serum  is  the  most  valuable  one. 

Serum  Antirabicum. 

Adult  Dosage. — 10  c.c.,  five  c.c.,  and  5 c.c.,  on  three 
successive  days. 

Serum  Antistaphylococcum  (antibacterial). 

Adult  Dosage. — Min.,  20  c.c.;  max.,  100  c.c.,  re- 
peated as  indicated  by  the  symptoms. 

Serum  Antistreptococcum  (antibacterial). 

Adult  Dosage. — Min.,  20  c.c.;  max.,  100 c.c., hj-po- 
dermicaUy,  every  four  to  six  hours,  according  to 
the  severity  of  the  case  and  the  age  of  the  patient. 

Serum  Antitetanicum;  Tetanus  Antitoxin. 

Adult  Dosage. — ^Min.,  3000  units;  max.,  10,000 
units.  Immunizing  dose,  1500  units,  to  be  given 
hypodermically  on  the  day  of  the  wound,  and 
repeated  weekly  until  healed. 

Curative  dose,  3000  to  5000  units,  intraspinally, 
diluted  with  an  equal  volume  of  physiologic  saline 
solution,  and  10,000  units  intravenously  as  soon  as 
possible,  the  intraspinal  dose  to  be  repeated  daily 
until  the  patient  is  cured,  and  10,000  units  to  be 
given  hypodermically  on  the  fourth  day. 

Serum  Antitetanicum  Purificatum  (Antitetanic 
Globuhns;  Refined  and  Concentrated  Tetanus 
Antito.xin  in  Physiological  Sodium  Chloride  solu- 
tion). 

Method  of  Administration. — The  dosage  Ls  the 
same  as  that  of  Serum  Antitetanicum. 

Serum  Antitetanicum  Siccum;  Dried  Tetanus 
Antitoxin  (Evaporated  Serum). 

Method  of  Administration. — The  dosage  is  the 
same  as  that  of  serum  antitetanicum.  It  may  be 
dusted  into  a suspicious  woimd. 

Serum  Antityphosum. 

Adult  Dosage. — -10  to  12  c.c.,  hj-podermically,  to 
vigorous  adults;  6 to  8 c.c.  if  treatment  is  com- 
menced on  the  fifth  day  of  the  disease;  4 to  10  c.c. 
after  a week,  if  the  fever  is  high. — Chantemesse. 

Serum,  Normal  Horse. 

Method  of  Administration. — .According  to  Weil, 
the  dose  intravenously  is  10  to  20  c.c.  for  adults,  half 
this  amount  for  children;  subcutaneously,  20  to 
30  c.c.  for  adults  and  half  this  for  children.  Accord- 
ing to  Moss,  “as  much  as  100  or  even  200  c.c.  in 
four  or  five  days”  may  be  given.  Ortner  mentions 
doses  of  2 to  4 ounces. 


SODII  CHLORIDUM 


Physiologic  Action  and  Uses. — Haemostatic;  in- 
creases the  coagulability  of  the  blood. 

Sesami  Oleum;  Teel  Oil;  Benne  Oil. 

Uses. — Emolhent:  substitute  for  olive  oil. 

Sevum  Praeparatum;  Prepared  Mutton  Suet. 

Uses. — Ointment  basis;  do  not  use  if  rancid. 

Sherry  Wine;  Vinum  Xericum  (20  to  35  per  cent, 
alcohol). 

Dosage. — 18  months,  gtt.  xxx;  3 years,  gtt.  xlv-oi; 
5 years,  5i-h.  Adult,  min.,  5i;  max.,  ii. 

Method  of  Administration. — Every  one  to  four 
hours;  no  more  than  1 to  2 oz.  in  twenty-four  hours 
to  a child  of  one  year  or  less,  6 to  8 oz.  to  a child  of 
five  years,  20  oz.  to  an  adult. 

Uses. — Alcoholic  stimulant  and  sedative. 

Silver.  See  Argentum. 

Sinapis;  Sinapis  Nigra;  Mustard. — See  Mustard. 

Sinapis  Emplastrum;  Mustard  Plaster. 

Uses. — Counter-irritant. 

Sinapis  Oleum  Volatile;  Mustard  Oil;  Allyl 
Sulpho-Cyanide : C 4HsNS8. 

Adult  Dosage. — Min.,  max., 

Uses. — Vesicant. 

Smelling  Salts  (ammonium  carbonate  with  ethe- 
real salts,  such  as  the  oil  of  lavender). 

U.ses. — Stimulant. 

Sodas  Chlorinatse  Liquor;  Labarraque’s  Solution. 

Adult  Dosage. — Min.,  i^ix;  av.,  .xv;  max.,  xxx. 

Method  of  Administration. — In  15  to  20  parts 
water,  as  a spray,  gargle,  or  wash.  As  a vaginal 
douche,  one  teaspoonful  to  the  pint. 

Uses. — Antiseptic;  disinfectant. 

Soda=Mint;  Mistura  vel  Liquor  Sodae  et  Mentha', 
N.  F.  (sod.  bicarb.  5,  arom.  spt.  ammon,  1,  spear- 
mint water  to  100). 

Adult  Dosage. — -Av.,  Sh- 

Method  of  Administration. — R Mistura?  soda?  et 
menthae,  $iv. 

Sig. — Two  teaspoonfuls,  as  required. 

Uses. — Antacid  and  carminative. 

Sodii  Agaracinas. 

Adult  Dosage. — Min.,  gr.  ii;  max.,  iv. 

M ethod  of  Administration. — R Sodii  agaracinatis, 
gr.  ii,  capsulse  no.  6. 

Sig. — One  or  two  capsules,  at  bedtime. 

U ses. — Anhidrotic. 

Sodii  Arsenas:  Na2HAs  04-b7H20  (soluble  in 
1.5  of  water;  slightly  soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  Ke;  av.,  Vn]  max.,  H. 

Method  of  Administration. — Sodii  arsenatis, 
gr.  vii  (gr.  Ki  per  dose  of  3 minims);  aquae,  5iv. 

M.  Sig. — Three  minims  in  water,  t.i.d.p.c.  It 
may  be  given  in  pill  form. 

Uses. — Alterative;  tonic;  stomachic;  inhibits 
o.xidation  and  stimulates  anabolism;  stimulates  the 
haematopoietic  organs. 

Sodii  Arsenas  Exsiccatus:  Na2HAs04  (soluble  in 
3.1  of  water). 

Adult  Dosage. — Min.,  gr.  Ko;  av.,  Mo;  max.,  Ms- 

Method  of  Administration. — R Sodii  arsenatis 
exsiccati,  gr.  iv  (gr.  Mo  per  dose  of  3 minims) ; aquae, 
3iv. 

M.  Si^. — Three  minims  in  water,  t.i.d.p.c. 

Sodii  Arsenilas;  Atoxyl. — Bee  Atoxyl. 

Sodii  et  Auri  Chloridum:  AuClsNaCl 4-21120 
(very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  Mo,’  av..  Mo,"  max.,.  %. 

Method  of  Administration. — -R  Auri  et  sodii 
chloridi,  gr.  ss;  aquae  destillatae,  5ii. 

M.  Sig. — 5i  in  water,  t.i.d.  It  may  also  be  pre- 
scribed in  pill  form. 

U ses. — Alterative. 

Sodii  Benzoas:  Na(C6H5COO)  (soluble  in  1.8  of 
water). 

Dosage. — 6 months,  gr.  i;  18  months,  gr.  i-ii; 


3 years,  gr.  ii;  5 years,  gr.  iii-v.  Adult,  min.,  gr.  v; 
av.,  xv;  max.,  x.xx. 

Method  of  Administration. — I^  Sodii  benzoatis, 
3iv  (gr.  viLss  per  dram);  aqua?,  jiv. 

M.  Sig. — Two  drams  in  half  a tumbler  or  more  of 
water,  every  two  to  four  hours. 

Uses. — -Urinary  acidifier  and  antiseptic;  diuretic* 
intestinal  antiseptic. 

Sodii  Benzosulphinidum;  Sodium-Saccharin ; Solu- 
ble Saccharin  (soluble  in  1.2  of  water,  and  in  50  of 
alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  v;  up 
to  gr.  xxx  per  diem,  if  required.  Ordinarily,  gr. 
ss-i  is  used  to  sweeten  eight  fluid  ounces  of  food. 

R Sodii  benzosulphinidi,  gr.  ss,  tabellee  no.  100. 

Sig. — One  or  two  tablets  dissolved  in  each  8 fluid- 
ounces  of  food,  as  a sweetener. 

Uses. — Substitute  for  sugar  as  a sweetening  agent. 

Sodii  Bicarbonatis;  BaWngSoda:  NaHCOs  (solu- 
ble in  10  of  water;  insoluble  in  alcohol;  converted  by 
boiling  into  the  normal  carbonate). 

Dosage. — 6 months,  gr.  i-ii ; 18  months,  gr.  ii ; 3 
years,  gr.  iii;  5 years,  gr.  v.  Adult,  min.,  gr.  v;  av., 
xv;  max.,  xxx;  up  to  two  ounces  daily,  in  acidosis. 

For  intravenous  injection:  6 per  cent,  solution, 
sterilized  by  boihng  and  thus  partly  converted  into 
the  normal  carbonate,  which  is  caustic, — -1000  c.c. 
injected  with  great  care  that  none  of  the  hquid  gets 
outside  the  veins  lest  necrosis  occur. 

For  subcutaneous  or  intramuscular  injection:  3 
per  cent,  solution,  boiled,  cooled,  and  treated  with 
carbon  dioxide  until  colorless  to  phenolphthalein. 

For  rectal  administration:  4 per  cent,  solution  by 
the  drop  method.  See  Acidosis,  Part  1. 

Uses. — Antacid;  analgesic;  antipruritic;  non- 
caustic. 

Sodii  Biphosphas;  Sodium  Acid  Phosphate: 
NaH2P04-|-H20  (very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  xv;  av.,  xx;  max.,  3i- 

Method  of  Administration. — IJ  Sodii  biphospha- 
tis,  3iv  (gr.  xx  per  dose);  syrupi  simphcis,  5 iii; 
aqua?  destillatse,  q.s.  ad  5vi. 

M.  Sig — Tablespoonful  in  water,  every  two  to 
three  hours,  for  from  5 to  10  doses,  or  until  the 
urine  is  rendered  acid. 

Physiologic  Action  and  Uses. — Urinary  acidifier. 
Do  not  administer  hexamethylenamine  until  after 
the  acid  phosphate  has  left  the  stomach. 

Sodii  Boras;  Borax. — See  Borax. 

Sodii  Bromidum. — See  Bromidum  Sodii. 

Sodii  Cacodylas. — See  Cacodylas  Sodii. 

Sodii  et  Calcii  Qlycerophosphati  Elixir. 

Adult  Dosage. — -Min.,  3i;  max.,  ii. 

Method  of  Administration. — Eli.xiris  calcii  et 
sodii  glycerophosphati,  §iv. 

Sig. — Two  teaspoonfuls,  t.i.d. 

Uses. — -Alterative;  tonic. 

Sodii  Carbonas  Monohydratus:  Na2C03-t-Il20 
(soluble  in  3 of  w'ater;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  vii. 

Alkaline  Bath : 2 to  6 ounces  to  30  gallons  of  water. 

Uses. — Antacid;  detergent. 

Sodii  Chloras:  NaClOs  (soluble  in  1.1  of  water 
and  about  100  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  iv;  max.,  x. 

Method  of  Administration. — See  Potassii  Chloras. 

Sodii  Chloridum;  Common  Salt:  NaCl  (soluble  in 
2.8  of  water;  nearly  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  3i;  max.,  iv. 

Method  of  Administration. — As  a laxative:  3i  in 
aquam  Oss-i,  one  hour  before  breakfast. 

As  an  emetic:  5iv  in  concentrated  solution,  or 
about  1 Yi  oz.  of  water. 

Physiologic  Salt  Solution:  0.85  per  cent.,  or  8.5 
gm.  to, 1000  c.c.  water,  or  about  one  dram  to  the  pint. 


SPIRITUS  AMMONIA  AROMATICUS 


I7ses.— Laxative;  emetic;  used  to  prepare  isotonic 
or  physiologic  salt  solution. 

Sodii  Qlycerophosphas. — See  Glycerophosphas 
Sodii. 

Sodii  Qlycocholas. — See  Glycocholas  Sodii. 

Sodii  Qynocardas. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  iii;  max.,  xlv. 

Method  of  Administration. — Sodii  gynocarda- 
tis,  gr.  ss,  capsula;  no.  12. 

Sig. — One  capsule,  t.i.d.p.c.  Gradually  increase 
the  dose  to  gr.  iii-xlv,  t.i.d.,  or  gr.  iii-v,  in  capsule, 
ten  to  twenty  times  daily. 

Uses. — Anti-leprosy. 

Sodii  Hydroxidi  Liquor  (soda  56,  distilled  water  to 

100). 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  xxx;  weU 
diluted  in  water. 

Uses. — Antacid. 

Sodii  Hydroxidum;  Caustic  Soda:  NaOH  (solu- 
ble in  0.9  of  water,  very  soluble  in  alcohol). 

Uses. — Alkaline;  caustic. 

Sodii  Hypophosphis:  NaH-2P02-l-H20  (soluble  in 
1 of  water;  soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — II  Sodii  hypophos- 
phitis,  3ii  3 h (gr.  -x  per  dose);  syrupi  simpUcis, 
5 Li;  aqua?,  q.s.  ad  giv. 

M.  Sig. — Dessertspoonful  t.i.d. 

Uses. — Alterative. 

Sodii  Hyposulphis;  Sodii  Thiosulphas:  Na2S203-f- 
5H2O  (soluble  in  0.5  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Sochi  hyposul- 
phitis,  3v  9i  (gr.  xx  per  dram);  aquae,  q.s.  ad,  gii. 

M.  Sig. — One  dram  three  to  four  times  a day. 

External  antiseptic  and  parasiticide:  10  per  cent, 
lotion  or  ointment. 

Physiologic  Action  and  Uses. — Partly  decomposed 
by  the  acid  of  the  stomach  into  sulphurous  acid, 
with  the  eventual  formation  of  sulphate,  which  acts 
as  a purgative;  gastric  and  external  antiseptic  and 
parasiticide. 

Sodii  lodidum. — -See  lodidiun  Sodii. 

Sodii  Nitris. — See  Nitris  Sodu. 

Sodii  Phosphas:  Na2HP04-|-12  H2O  (soluble  in 
2.7  of  water;  insoluble  in  alcohol). 

Dosage. — 6 months,  gr.  v-x;  18  months,  gr.  x-xv; 
3 years,  gr.  .xv-xx;  5 years,  gr.  xx-xxx.  Adult,  min., 
3ss;  av.,  i;  max.,  iv. 

Method  of  Administration. — I^  Sochi  phosphatis, 
gii. 

Sig. — Teaspoonful,  dissolved  in  hot  water,  t.i.d., 
one  hour  a.c. 

Physiologic  Action  and  Uses. — Saline  cathartic: 
causing  purgation  by  osmosis  and  interfering  with 
the  absorption  of  fluids  from  the  bowel;  acts  in  one 
to  twenty  hours. 

Sodii  Phosphas  Effervescens  (exsiccated  sod. 
phos.  20,  sod.  bicarb.  47%,  tartaric  acid  25%, 
citric  acid  16%). 

Adult  Dosage. — Min.,  3i;  av.,  uss;  max.,  hi. 

Method  of  Administration. — Sochi  phosphatis 
effervescentis,  giv. 

Sig. — Two  or  three  teaspoonfuls  in  water,  t.i.d., 
one  hour  a.c. 

Sodii  Phosphas  Exsiccatus:  Na2HP04  (soluble  in 
8.1  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Gr.  xv-xxx. 

1^  Sodii  phosphatis  exsiccati,  gii. 

Sig. — Half  a teaspoonful,  in  hot  water,  t.i.d.,  one 
hour  a.c. 

Sodii  Pyrophosphas:  Na4P2O7-|-10  H2O  (soluble 
in  12  of  water;  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx:  max.,  xlv. 

Method  of  Administration. — Sodii  pyrophos- 


phatis,  gu  3h  (gr.  xx  per  gss);  aquae,  q.s. 
ad,  giv. 

M.  Sig.— Tablespoonful,  every  two  to  three  hours. 

For  children:  gr.  x-xv  every  two  hours,  or  2 to  3 
teaspoonfuls  of  the  above  .solution. 

Physiologic  Action  and  Uses. — For  acute  inflam- 
matory conditions  threatening  suppuration. 

Sodii  Salicylas. — See  Sahcylas  Soclii. 

Sodii  Sulphas;  Glauber's  Salt.— See  Glauber’s  Salt. 

Sodii  Sulphidum:  Na2S. 

Method  of  Administration. — Sulphur  Bath:  Sod. 
.sulplude  2 oz.,  sod.  chloride  2 oz.,  sod.  bicarb.  1 oz., 
to  50  to  60  gallons  of  hot  water. 

Uses. — Used  in  lead  poisoning. 

Sodii  Sulphis  Exsiccatus:  Na2SOs  (soluble  in  3.2 
of  water;  in  alcohol,  sparingly). 

Adult  Dosage. — Av.,  gr.  xv. 

Uses. — Antiseptic. 

Sodii  Sulphocarbolas  vel  Phenolsulphonas. — See 
Phenol  Sulphonas  Sodii. 

Sodii  vel  Potassii  Telluras. 

Adult  Dosage. — Min.,  gr.  %;  max.,  iss. 

Method  of  Administration. — Sochi  telJuratis, 
gr.  ss,  tabehae  no.  10. 

Sig. — One  or  more  tablets,  t.i.d. 

Uses. — Anhidrotic. 

Sodii  Thiosulphas;  Sodu  Hyposulphis. — See  Hy- 
posulphis Sodu. 

Sodiophosphatum  Acidum;  Sodii  Biphosphas: 
NaH2P04-t-H20  (very  soluble  in  water). 

Adult  Dosage. — Min.,  gr.  xv;  av.,  xxx;  max.,  gi- 

Method  of  Administration. — Sodii  biphospha- 
tis,  giv;  syrupi  simpheis,  gi;  aquae  destihatae,  q.s.  ad 
giv. 

M.  Sig. — One  tablespoonful  in  water  every  three 
hours. 

It  may  be  given  up  to  one  ounce  a day  in  100  oz. 
distilled  water. 

Physiologic  Action  and  Uses. — Urinary  acidifier. 
Do  not  administer  hexamethylenamine  until  after 
the  acid  phosphate  has  left  the  stomach. 

Somatose  (meat  albumoses,  nearly  90  per  cent., 
with  peptones). 

Method  of  Adyninistralion. — Three  to  4 teaspoon- 
fuls a day,  cooked  in  soup,  nulk,  or  cocoa. 

Uses. — Concentrated  albuminous  food. 

Spearmint.  See  Mentha  Viridis. 

Spermaceti ; Cetaceum  (a  sohd  fat  from  the  sperm 
whale). 

Uses. — Ointment  basis. 

Spigeliae  Fluidextractum. 

Dosage. — 3 years,  ttrx-xx;  5 years,  njxxx.  Adult, 
min.,  gss;  av.,  i;  max.,  ii. 

Method  of  Administration. — I^  Fluidextracti 
spigelia?;  fluidextracti  sennse,  aa  gss. 

M.  Sig. — One  teaspoonful  in  water  for  a child,  two 
teaspoonfuls  for  an  adult,  eveiy  two  hours  for  three 
doses. 

Uses. — Anthelmintic  for  Uscarides. 

Toxic  Action. — Vertigo,  amblympia,  mydriasis, 
spasms,  convulsions. 

Spiritus  /Etheris  (ether  alcohol  %). 

Adult  Dosage. — Min.,  x;  av.,  gi;  max.,  u. 

Method  of  Administration. — I^  Spiritus  setheris. 

gi. 

Sig. — Teaspoonful  in  a wineglass  of  sweetened 
water,  as  reqiured,  or  every  one  to  three  hours. 

Uses. — Diffusible  stimulant;  anodyne;  carmina- 
tive; aids  digestion  of  fats. 

Spiritus  /Etheris  Compositus. — See  iEtheris  Spiri- 
tus Compositus. 

Spiritus  /Etheris  Nitros. — See  .Etheris  Spiritus 
Nitrosi. 

Spiritus  Ammoniee  Aromaticus. — See  Ammoniae 
Spiritus  Aromaticus. 


SULPHONAL 


Spiritus  Aurantii  Compositus. — See  Aurantii  Spir- 
itus  Compositus. 

Spiritus  Camphorae. — See  Camphorse  Spiritus. 

Spiritus  Chloroformi. — See  Chloroformi  Spiritus. 

Spiritus  Frumenti;  Whiskey  (37  to  47.5  per  cent, 
of  alcohol,  by  weight). 

Dosage. — 6 months,  gtt.  v-x;  18  months,  gtt.  x-xx; 
3 years,  gtt.  xx-xxx;  5 years,  gtt.  xxx-xl.  Adult, 
min.,  3ii;  av.,  5ii;  max.,  iv. 

Method  of  Administration. — Every  one  to  four 
hours,  diluted  six  to  ten  times  with  water.  No  more 
than  to  1 oz.  in  twenty-four  hours  to  a child  of 
one  year  or  less,  3 to  4 oz.  to  a child  of  five  years, 
10  oz.  to  an  adult. 

Physiologic  Action  and  Uses. — General  stimulant 
in  its  initial  effects;  followed  by  sedation  and  event- 
ually narcosis;  diaphoretic,  dilating  the  cutaneous 
vessels;  antipyretic;  diuretic;  removes  inhibition; 
produces  euphoria  by  blunting  the  feelings  of  discom- 
fort; stomachic;  antiseptic;  local  rubefacient. 

Spiritus  Glonoini  vel  Qlycerylis  Nitratis. — See 
Glonoini  Spiritus. 

Spiritus  Juniperi. — See  Juniperi  Spiritus. 

Spiritus  Juniperi  Compositus. — See  Juniperi  Spiri- 
tus Compositus. 

Spiritus  Lavandulae  (oil  5,  in  alcohol  95). 

Adult  Dosage. — n\^x;  av.,  xxx;  max.,  xlv. 

Uses. — Flavoring  agent. 

Spiritus  Menthae  Piperitae. — See  Menthae  Piperitse 
Spiritus. 

Spiritus  Menthas  Viridis. — See  Menthae  Viridis 
Spiritus. 

Spiritus  Mindereri;  Liquor  Ammonii  Acetatis. — 
See  Ammonii  Acetatis  Liquor. 

Spiritus  Myrciae  Compositus;  Bay  Rum  (oil  of 
myrcia  16,  oil  of  orange  peel  1,  oil  of  pimenta  1,  alco- 
hol 1220,  water  to  2000). 

f/ses.— Perfume;  cutaneous  stimulant. 

Spiritus  Rectificatus  (90  per  cent,  alcohol). 

Spiritus  Rosmarini. 

Uses. — Cutaneous  stimulant. 

Spiritus  Terebinthinae.  See  Oleum  Terebinthinae 
Rectificatum. 

Spiritus  Vini  Qallici;  Brandy. — See  Brandy. 

Spiritus  Vini  Rectificatus  (90  per  cent,  alcohol). 

Squibb’s  Surgical  Powder;  Squibb’s  Compound 
Alum  Powder. 

A heaping  teaspoonful  suspended  in  500  c.c.  hot 
water,  as  a local  styptic. 

Stagnin  (an  extract  derived  from  the  spleen  of 
the  horse  by  autolysis). 

Uses. — Haemostatic  and  styptic. 

Starch;  Amylum;  Corn  Starch;  CeHioO,. 

Uses. — Vehicle;  protective. 

Stramonii  Unguentum  (ext.  stramonii  10,  diluted 
alcohol  5,  benzoinated  lard  65,  lanohn  20). 

U ses. — Anodyne. 

Stramonium. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iii. 

Physiologic  Action  and  Uses. — Component  of 
“asthma  powders”;  action  similar  to  that  of  bella- 
donna. 

Strontii  Bromidum:  see  Bromidum  Strontii. 

Strophanthinum  (glucoside  or  mixture  of  glu- 
cosides;  very  soluble  in  water  and  in  diluted  alcohol). 

Dosage.— Adult,  min.,  gr.  Hco;  av.,Moo:  max.,  %a. 

Method  of  Administration. — Intramuscularly  or 
intravenously,  once  daily  for  two  to  three  days.  The 
effects  last  several  days.  It  is  not  readily  absorbed 
from  the  gastro- intestinal  tract,  hence  its  use  by 
mouth  is  not  advised.  It  should  be  borne  in  mind 
that  the  drug  in  overdose  is  highly  poisonous. 

Physiologic  Action  and  Uses. — Cardiac  tonic; 
diuretic;  slows  and  strengthens  the  heart,  and  raises 
the  arterial  tension,  but  not  by  vaso-constriction. 


Caution : do  not  use  strophanthin  for  at  least  two 
days  after  digitahs  has  been  adnoinistered.  It  is 
best  given  intravenously  {q.v.  in  Part  1)  at  the  same 
time  that  digitalis  is  administered  by  mouth,  forthe 
latter  does  not  act  for  twenty-four  hours.  Do  not 
repeat  oftener  than  every  twenty-four  hours. 

Toxic  Action. — Paralysis  of  voluntary  and  invol- 
untary and  cardiac  muscle  by  direct  action. 

Strophanthi  Tinctura  (10  per  cent.;  should  be 
standardized  or  biologically  assayed  by  producing 
death  in  frogs). 

Dosage. — ^6  months,  gt.  i;  18  months,  gtt.  i-ii; 
3 years,  gtt.  ii;  5 years,  gtt.  ii-iii;  5 to  10  years,  gtt. 
iii-v.  Adult,  min.,  iijv;  av.,  viii;  max.,  x. 

Method  of  Administration. — -I^  Tincturar  stro- 
phanthi, oSS. 

Sig. — drops  in  water  or  cocoa,  every  two, 

three  to  four  hours;  no  more  thansix  doses  in  twenty- 
four  hours.  (Kerley.)  Action  by  mouth  uncertain. 

For  intramuscular  or  intravenous  injection:  “Not 
more  than  2 minims  as  a rule.”  Useful  Drugs  of 
A.M.A. 

Strychnina:  Alkaloid,  C21H22N2O2  (soluble  in 
6420  of  water  and  136  of  alcohol). 

Dosage. — 6 months,  gr.  %oo-'Aw',  18  months,  gr.  ’{50, 
3 years,  gr.Kooi  5 years,  gr.  Ym.  Adult,  min.,  gr.  }io; 
av.,  Ao]  max.,  Yu. 

Method  of  Administration. — As  a heart  stimulant, 
gr.  Yso,  every  six  hours,  is  perhaps  frequent  enough. 

Gr.  Ao  may  be  adrninistered  every  two  to  four 
hours  until  facial  twitching  occurs. 

Gr.  Yo  may  be  prescribed  t.i.d.,  and  gradually 
increased  to  gr.  Ao-'/u~Ao,  t.i.d.,  if  desired. 

Physiologic  Action  and  Uses. — Stomachic  bitter 
and  general  stunulant  and  tonic;  sensitizes  the  sen- 
sory or  perceptive  portion  of  the  reflex  arcs  in  the 
central  nervous  system,  causing  increased  reflex 
irritability,  and  intensification  of  the  five  senses; 
increases  the  excitability  of  the  respiratory,  vagus, 
and  vaso-constrictor  centres;  increases  the  extent 
and  duration  of  muscular  contraction;  increases 
intestinal  peristalsis  by  stimulation  of  Auerbach's 
plexuses. 

Strychninae  Nitras:  C21H22N2O2.HNO3  (solu- 

ble in  42  of  water  and  150  of  alcohol). 

Dosage. — 6 months,  gr.  Yoc-Aoo',  18  months,  gr.  Ym', 
3 years,  gr.  Ym',  5 years,  gr.  Yiou-  Adult,  min.,  gr.  %o', 
av.,  Ao',  max.,  Y12. 

Strychninae  Sulphas:  (C2iH22N202)2H2S0i-f- 

2H2O. 

Dosage. — 6 months,  gr.  Ym-Y2oo',  18  months,  gr.  Ym', 
3 years,  gr.  Kooi  5 years,  gr.  Yioo-  Adult,  min.,  gr.  Ao', 
av.,  Ao',  max.,  K2. 

Stypticin;  see  Cotarninae  Hydrochloridum. 

Styptol;  see  Cotarninae  Phthalas. 

Suet ; Sevum  Praeparatum ; prepared  mutton  suet. 

Uses. — Ointment  basis.  Do  not  use  if  rancid. 

Sugar.  See  Saccharum. 

Sulphocarbolas  Sodii;  see  Phenolsulphonas  Sodii. 

Sulphocarbolas  Zinci;  see  Phenolsulphonas  Zinci. 

Sulphonal;  Sulphonmethanum ; Diethylsulphone- 
dimethylmethane:  (CHa)2  =C  = (S02C2H5)2  (solu- 
ble in  365  of  water  and  60  of  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xii;  max.,  xxx. 

Method  of  Administration. — I^  Sulphonmethani, 
gr.  xii,  pulveres  no.  iii. 

Sig.— Dne  powder,  in  hot  milk  or  water,  one  to 
two  hours  before  bedtime. 

Physiologic  Action  and  Uses. — Hypnotic;  acts  in 
one  to  two  hours;  promotes  sleep  by  impairing  the 
perception  of  sensory  impressions;  dangerous. 

Toxic  Action. — Vomiting,  diarrhoea  or  constipa- 
tion, confusion,  headache,  vertigo,  abdominal  pain, 
ataxia,  a.scending  paralysis,  ptosis,  oliguria,  al- 
buminuria, ha;matoporphyrinuria,  tinnitus,  (edema. 


SYEUPUS  EUBI  ID^I 


Sulphonethylmethanum;  Trional;  Diethylsul- 
phoneraethylethylmethane : (CH3HC2Ho)C(S02C2 

Hs)2  (soluble  in  200  of  water;  freely  soluble  in 
alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xii;  max.,  xxx. 

Method  of  Administration. — Sulphonethyl- 
methani,  gr.  xii,  pulveres  no.  iii. 

Sig. — One  powder,  in  a hot  liquid,  one-half  to  one 
hour  before  retiring. 

Give  alkalies  freely  while  administering  trional. 
Do  not  use  for  more  than  two  or  three  clays  con- 
secutively. 

Physiologic  Action  and  Uses. — Hypnotic;  acts  in 
one-half  to  one  hour,  sometimes  not  until  the  next 
day;  action  is  transient;  promotes  sleep  by  impairing 
the  perception  of  external  stimuli. 

Toxic  Action. — Hsematoporphyrinuria  (indicated 
by  a pinkish  or  red  color),  lassitude,  weakness, 
nausea,  diarrhoea  or  constipation,  followed  by  ab- 
dominal tenderness,  vomiting,  ataxia,  paresis  of  vari- 
ous muscles,  loss  of  reflexes,  nephritis,  finally  collapse 
and  usually  death.  It  is  often  too  late  to  save  the 
patient  when  hsematoporphyrinuria  occurs. 

Sulphur  Bath.  See  Baths,  Medicated. 

Sulphuricum  Acidum  Aromaticum  (an  ether  con- 
sisting of  sulphuric  acid,  H2SO4,  11  per  cent,  by 
volume  in  alcohol,  flavored  with  cinnamon  and 
ginger). 

Adult  Dosage. — Min.,  iiev;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Acidi  sulphurici 
aromatici,  5i- 

Sig. — Fifteen  drops  in  a winegla.ssful  of  sweetened 
water,  every  three  to  four  hours,  taken  through  a 
glass  tube.  Rinse  the  mouth  afterward  with  soda 
water. 

Uses. — Astringent;  hcemostatic;  urinary  acidifier. 

Sulphuricum  Acidum  Dilutum  (10  per  cent,  of 
H2SO4  by  weight). 

Adult  Dosage. — Min.,  i^v;  av.,  xxx;  max.,  xl. 

Method  of  Administration. — I^  Acidi  sulphurici 
diluti,  §i. 

Sig. — ^Thirty  drops  in  half  a glass  of  sweetened 
water,  fevery  three  to  four  hours,  taken  through  a 
gla.ss  tube.  Rinse  the  mouth  afterward  with  soda 
water. 

Uses. — Astringent;  hcemostatic;  urinary  acidifier. 

Sulphuris  Unguentum  (washed  sulphur  15,  ben- 
zoinated  lard  85). 

Uses. — Antiseptic;  parasiticide;  keratolytic. 

Sulphur  Lotum;  Washed  Sulphur. 

Dosage. — 6 months,  gr.  v;  18  months,  gr.  v-x; 
3 years,  gr.  xv-xxx;  5 years,  3i-  Adult,  min.,  3ss; 
av.,  ii;  max.,  iv. 

Method  of  Administration. — I^  Sulphuris  loti  vel 
praecipitati,  gi  (3i  per  dose);  syrupi  acaciae,  5ii; 
aquae,  q.s.  ad,  5iv. 

M.  Sig. — Tablespoonful,  t.i.d. 

Physiologic  Action  and  Uses. — Laxative;  altera- 
tive; parasiticide;  as  a purgative,  acts  chiefly  on  the 
large  bowel  after  conversion  into  hydrogen  sulphide 
or  other  sulphides,  which  are  antiseptic  and  irritant; 
converted  also  into  sulphides  on  the  skin. 

Toxic  Action. — Vomiting,  purging,  anaemia,  ema- 
ciation, debility. 

Sulphurosum  Acidum  II2SO3. 

Adult  Dosage. — ^Min.,  i^v;  av.,  xxx;  max..  Lx. 

Method  of  Administration. — Antiseptic  spray  or 
application  to  mucous  membranes  and  skin. 

Uses. — Local  antiseptic;  gastric  antifermentative. 

Sulphur  Praecipitatum;  Lac  Sulphuris. 

Dosage. — 6 months,  gr.  v;  18  months,  gr.  v-x; 
3 years,  gr.  xv-xxx;  5 years,  3i-  Adult,  min.,  3ss; 
av.,  ii ; max.,  iv. 

Method  of  Administration. — See  under  Sulphur 
Lotum. 


Sulphur  Sublimatum;  Sublimed  Sulphur. 

Adult  Dosage. — Min.,  3ss;  av.,  ii;  max.,  iv.  For 
room  disinfection  burn  3 pounds  sulphur  to  each 
1000  cubic  feet  of  air  space.  All  surfaces  and 
articles  should  be  wet. 

Sumbul  Fluidextractum. 

Adult  Dosage. — Min.,  ttjx;  av.,  xxx;  max.,  3i. 

Method  of  Administration. — Fluidextracti 
sumbul,  5i. 

Sig. — Thirty  drops  in  water,  t.i.d. 

Uses. — Antispasmodic;  nerve  tonic. 

Suppositoria  Glycerin!  (sod.  carb.  gr.  stearic 
acid  gr.  iii,  glyc.  gr.  xlvi). 

Uses. — Laxative,  by  reflex  action. 

Suprarenalis  Extractum;  Powdered  Adrenal  Gland 
(about  0.5  per  cent,  of  epinephrin). 

Adult  Dosage. — Min.,  gr.  iii;  av.,  v;  max.,  xx. 

Method  of  Administration. — I^  Glandulae  sup- 
rarenaUs  siccae,  gr.  v-xx. 

Mitte  talis  pulveres  no.  21. 

Sig. — -One  powder,  by  mouth,  t.i.d. 

Gr.  ii-f-  every  half  hour  to  a one-year  old,  for 
haematemesis.  (Holt.) 

Uses. — Used  in  Addison’s  Disease  and  in  haemat- 
emesis. 

Synol  Soap. 

Uses. — In.stmment  lubricant. 

Syrupus;  Syrupus  Simplex  (sugar  85,  distilled 
water  to  100). 

Uses. — Flavor  and  vehicle. 

Syrupus  Acaciae.  See  Acaciae,  Syrupus. 

Syrupus  Acidi  Citrici.  See  Acidi  Citrici,  Syrupus. 

Syrupus  Acidi  Hydriodici.  See  Acidi,  Hydriodici, 
Syripus. 

Syrupus  Alii.  See  Alii,  Syrupus. 

Syrupus  Aurantii.  See  Aurantii  Syrupus. 

Syrupus  Calcii  Lactophosphatis.  See  Calcii  Lac- 
tophosphatis,  Syrupus. 

Syrupus  Cinnamomi. 

Uses. — Flavoring  vehicle. 

Syrupus  Ferri  lodidi  (FeL).  See  Ferri  lodidi 
Syrupus. 

Syrupus  Ferri  Quininae  et  Strychninae  Phos- 
phatum. 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Syrupi  ferri, 
quininae,  et  strychninae  phosphati,  5iv. 

Sig. — Teaspoonful,  in  half  a tumbler  of  water, 
t.i.d.p.c. 

Uses. — Haematic;  tonic. 

Syrupus  Qlycyrrhizae  N.  F.  (Fluidglycerate  of 
GlycyTrhiza,  25  per  cent.j  in  syrup). 

Adult  Dosage. — Av.,  3ii- 

Uses. — Flavor. 

Syrupus  Hypophosphitum.  See  Hypophosphitum 
Syrupus. 

Syrupus  Ipecacuanhae.  See  Ipecacuanhae  Syrupus. 

Syrupus  Ipecacuanhae  et  Opii;  Sy-rup  of  Dover’s 
Powder,  N.  F.  (tr.  of  ipecac  and  opium,  8.5  per  cent., 
flavored  with  spirit  of  cinnamon  and  cinnamon 
water  in  sjTup).  , 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Uses. — Nervous  sedative;  sedative  e.xpectorant; 
diaphoretic. 

Syrupus  Limonis.  See  Acidi  Citrici,  Syrupus. 

Syrupus  Mannae  N.  F.  (Manna  12.5  per  cent., 
alcohol,  and  syrup). 

Adult  Dosage. — Av.,  3ii- 

Uses. — Mild  laxative. 

Syrupus  Picis  Liquidae.  See  Picis  Liquidae  Syrupus. 

Syrupus  Pruni  Virginianae.  See  Pruni  Virginianae, 
Syrupus. 

Syrupus  Rhei  Aromaticus.  See  Rhei,  Syumpus 
Aromaticus. 

Syrupus  Rubi  Idaei;  see  Raspberry  Syrup. 


TEREBINTHINiE  LINIMENTUM 


Syrupus  Sarsaparillae  Compositus  see  Sarsaparillse, 
Syrupus  Compositus. 

Syrupus  Sciiias;  see  Scillae  Syrupus. 

Syrupus  Sennse;  see  Sennse  Syrupus. 

Syrupus  Simplex  (sugar  85,  distilled  water  to 
100). 

Uses. — Flavor  and  vehicle. 

Syrupus  Tolutanus;  Syrup  of  Tolu  (tr.  of  tolu  5, 
syrup  to  100). 

Adult  Dosage. — Min.,  oi;  av.,  iv;  max.,  vi. 

Uses. — Stimulating  expectorant;  flavored  vehicle 
in  cough  mixtures. 

Syrupus  Zingiberis;  Syrup  of  Ginger  (fl.  ext. 
ginger  3,  alcohol  2,  syrup  to  100). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  gi. 

Uses. — Flavor;  carminative. 

Taka=Diastasum  (Starch-digesting  enzyme  ob- 
tained from  the  mould,  Eurotium  oryzce,  of  the 
Aspergillus  family,  which  grows  upon  hydrolized 
wheat  bran). 

Adult  Dosage. — Min.,  i;  max.,  v. 

Method  of  Administration. — 1^  Taka-diastasi,  gr. 
iii,  tabellae  no.  30. 

Sig. — Tablet,  before,  with,  or  after  meals. 

Physiologic  Action  and  Uses. — Amylolytic  enzyme, 
three  times  more  active  than  malt  diastase;  acts  in 
neutral,  acid,  or  alkaline  media. 

Talcum  Purificatum  (Purified  native  hydrous 
magnesium  silicate). 

Uses. — Dusting  powder;  clarifying  agent. 

Tanaceti  Oleum;  see  Oleum  Tanaceti. 

Tannalbin;  Albuminis  Tannas. 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr*  i-ii; 
3 years  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  min.,  gr. 
X,  av.,  xxx;  max.,  3i- 

Method  of  Administration. — R Albuminis  tanna- 
tis,  gr.  xxx,  pulveres,  tabellae,  vel  capsulaj  no.  12. 

Sig. — One,  t.i.d.,  followed  by  water. 

Albuminis  tannatis,  gr.  xl  (gr.  v per  dram); 
syrupi  acaciae,  3iv;  aquae,  q.s.,  ad,  5i 

M.  Sig. — Shake  well,  and  give  one  dram  three  to 
four  times  daily. 

Physiology  Action  and  Uses. — Astringent;  insolu- 
ble in  gastric  juice,  but  slowly  splits  off  tannic  acid 
in  the  intestine. 

Tannici  Acidi  Qlyceritum  (tannic  acid  1,  glycerine 

4). 

Adult  Dosage. — Av.,  nijxxx. 

Uses. — Astringent;  hardening  agent  for  sore 
nipples;  throat  paint.  As  a gargle  or  spray : 3i  ad 
aquam  Oi. 

Tannici  Acidi  Unguentum  (20  per  cent,  in  glyc. 
and  petrolatum). 

Uses. — Astringent  emoUient;  useful  in  the  treat- 
ment of  hemorrhoids. 

Tannicum  Acidum;  Tannin  (soluble  in  1 of  water; 
very  soluble  in  alcohol  and  glycerine). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  x;  max.,  xx. 

Method  of  Administration. — R Acidi  tannici,  gr.x. 

Mitte  talis  trochisci  sive  pilulae  sive  capsulrc  no.  12. 

Sig. — One,  t.i.d. 

As  a gargle,  3i  ad  Oi.  As  an  astringent  enema,  1 
to  2 per  cent,  solution. 

Physiologic  Action  and  Uses. — Astringent;  haemo- 
static. It  coagulates  protein  in  or  on  the  tissues, 
and  thus  hardens  them. 

Toxic  Action. — Vomiting  due  to  gastric  irritation. 

Tannigen;  Acidum  Tannicum  Diacetylicum : 
(CHj.COlzCuHsOg. 

Dosage. — 6 months,  gr.  i-ii;  18  months,  gr.  i-ii, 
3 years,  gr.  ii-iii;  5 years,  gr.  iii-v.  Adult,  min.; 
gr.  viii;  max.,  xv. 

Method  of  Administration. — Tannigen,  gy.  x, 
pulveres  no.  12. 

Sig. — One,  four  times  a day,  dry  on  the  tongue. 


followed  by  a swallow  of  water;  or  it  may  be 
sprinkled  on  food.  It  may  be  given  up  to  3ii  daily. 

Physiologic  Action  and  Uses. — ^ Astringent;  insoluble 
in  the  gastric  juice,  but  sphts  off  tannic  acid  in  the 
alkaline  fluid  of  the  intestine. 

Tannin;  Acidum  Tannicum  (soluble  in  1 of  water; 
very  soluble  in  alcohol  and  glycerine). 

Adult  Dosage. — Min.,  gr.  ii;  av.,  x;  max.,  xx. 

Method  of  Administration. — I^  Acidi  tannici,  gr.  x. 

Mitte  talis  trochisci,  sive  piluke  sive  capsulae 
no  12. 

Sig. — One,  t.i.d. 

As  a gargle,  3i  ad  Oi.  As  an  astringent  enema, 
1 to  2 per  cent,  solution. 

Physiologic  Action  and  Uses. — Astringent;  hemo- 
static. It  coagidates  protein  in  or  on  the  tissues,  and 
thus  hardens  them. 

Toxic  Action. — Vomiting,  due  to  gastric  irritation. 

Tannocol  (Tannic  acid  and  gelatin,  aa). 

Adult  Dosage. — Min.,  gr.  vii;  max.,  xv. 

Method  of  Administration. — R Tannocol,  gr.  x, 
pulveres  no.  12. 

Sig. — Powder,  dry  on  the  tongue,  followed  by  a 
swallow  of  water,  and  repeated  3 to  5 times  daily. 

Uses. — Intestinal  astringent. 

Tannoform;  Tanninformaldehydum:  CH2(Ci4H9 
09)2. 

Adult  Dosage. — Min.,  gr.  iv;  av.,  viii;  max.,  xv. 

Method  of  Administration. — R Tanninformalde- 
hydi,  gr.  viii,  capsule  no  12  (glutoid  caps.,  no.  2 or  3 
of  hardness). 

Sig. — One  capsule,  three  to  four  times  daily. 

As  a local  antiseptic  and  anliidrotic : 20  to  50  per 
cent,  mixture  with  starch  or  talcum;  or  10  per  cent, 
ointment. 

Uses. — Astringent;  local  antiseptic  and  anhidrotic. 

Tannopin,  Hexamefhylene  = Tetramine  = Tannin  : 

(Ci4Hio09)3.(CH2)6N4. 

Dosage. — 18  months,  gr.  v;  3 years,  gr.  v;  5 years, 
gr.  viii.  Adult,  av.,  gr.  xv. 

Method  of  Administration. — R Tannopin,  gr.  xv, 
pulveres  no.  12. 

Sig. — A powder,  four  times  a day,  dry  on  the 
tongue,  followed  by  a swallow  of  water,  or  it  may  be 
sprinkled  on  food. 

Physiologic  Action  and  Uses. — Intestinal  astrin- 
gent and  antiseptic;  insoluble  in  the  gastric  juice, 
but  breaks  up  into  tannic  acid  in  the  alkaline  fluids 
of  the  intestine. 

Tar.  See  Pix  Liquida  and  Pix  Carbonis. 

Tartar  Emetic;  see  Antimonii  et  Potassii  Tartras. 

Tartaricum  Acidum. — See  Acidum  Tartaricum. 

Telluras  Sodii  vel  Potassii. 

Adult  Dosage. — Min.,  gr.  max.,  iss. 

Method  of  Administration. — R Sodii  vel  potassii 
telluratis,  gr.  ss,  tabellae  no.  10. 

Sig. — One  or  more  tablets  t.i.d. 

Uses. — Anhidrotic. 

Terebenum  (mixture  of  terpenes  formed  by  the 
action  of  sulphuric  acid  on  oil  of  turpentine;  only 
slightly  soluble  in  water;  soluble  in  3 of  alcohol). 

Dosage. — 18  months,  gt.  i;  3 years,  gtt.  i-ii;  5 
years,  gtt.  ii.  Adult,  min.,  iijv;  av.,  viii;  max.,  xv. 

Method  of  Administration. — R Terebini,  3ii- 

Sig. — -Five  drops  on  sugar,  t.i.d.  It  may  also  be 
administered  in  capsule. 

For  inhalation:  3iss  diiring  the  twenty-four  hours. 

Uses. — Stimulating  expectorant;  broncho-pulmo- 
nary antiseptic. 

Terebinthinae  Aceticum  Linimentum  (oil  of  turpen- 
tine 4,  glacial  acetic  acid  1,  liniment  of  camphor  4). 

Uses. — Rubefacient  and  counter  irritant. 

Terebinthinae  Linimentum  (oil  of  turpentine  35, 
rosin  cerate  65). 

Uses. — Rubefacient  and  counter-irritant. 


THIGENOL 


Terebinthinae  Olei  Emulsum  (rectified  oil  15,  ex- 
pressed oil  of  almond  5,  syrup  25,  acacia  15,  water 
to  100). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii-f-. 

Method  of  Administration. — Emulsi  olei  tere- 
binthinse,  giv.  (i^iii  per  dram.) 

Sig. — Teaspoonful,  three  to  six  times  daily 
together  with  plenty  of  water.  The  taste  may  be 
disguised  with  oil  of  gaultheria,  irji  to  the  dose. 

Action  and  Uses. — See  under  Oleum  Terebinthinae. 

Toxic  Action. — Vomiting,  diarrhoea,  lumbar  pain, 
dysuria,  strangury,  haematuria,  anuria,  muscular 
weakness,  incoordination,  narcosis. 

Terebinthinae  Oleum  Rectificatum. — See  Oleum 
Terebinthinae  Rectificatum. 

Terpini  Hydras:  CioHi8(OH)2-|-H20  (soluble  in 
200  of  water  and  13  of  alcohol). 

Dosage. — 3 years,  gr.  34i  5 years,  gr.  ss.  Adult, 
min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — R Terpini  hydratis, 
gr.  ii,  pulveres,  tabellae,  vel  capsulae  no.  12. 

Sig.— One,  every  three  to  four  hours,  with  plenty 
of  water. 

Uses. — Broncho-pulmonary  antiseptic;  stimulat- 
ing expectorant;  diaphoretic;  diuretic;  used  in  pro- 
fuse bronchorrhea. 

Terpini  Hydratis  Elixir  N.  F.  (Terpin  hydrate 
1.75  per  cent.,  tr.  of  sweet  orange  peel,  spirit  of 
bitter  almond,  alcohol  about  42  per  cent.,  glycerine, 
syrup,  and  water). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — R Elixiris  terpini 
hydratis,  N.  F.,  gii. 

Sig. — Teaspoonful  every  three  to  four  hours,  with 
plenty  of  water. 

Uses. — Counter  irritant;  external  and  intestinal 
antiseptic;  anthelmintic;  carminative;  irritating 
diuretic;  haemostatic;  broncho-pulmonary  antiseptic 
and  deodorizer;  stimulant. 

Terra  Silicea  Purificata;  Silica:  Si02. 

Uses. — Clarifying  agent. 

Tetranitrin;  Erythrol  Tetranitras:  C4H6(N03)4. 

Adult  Dosage. — Min.,  gr.  Yu,  av.,  max.,  i. 

Method  of  Administration. — R Erythrol  tetrani- 
tratis,  gr.  Ka,  tabellae  no.  100. 

R One  tablet  every  three  to  six  hours,  grad- 
ually increased  to  gr.  ^-M-i,  or  until  the  occur- 
rence of  flushing,  throbbing,  or  slight  transient  faint- 
ness indicate  that  the  physiological  dose  has  been 
reached. 

Physiologic  Action  and  Uses. — Vasodilator,  acting 
directly  upon  the  vascular  muscle;  action  begins  in 
fifteen  minutes  and  persists  for  three  or  four  to  six 
hours. 

T etronal ; Diethylsulphon-diethyl-methane 


C2Hs.^^02C2H5 
C2H/.  \sO2C2H5 


Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Uses. — Hypnotic. 

Thallini  Sulphas;  Sulphate  of  Tetra-hydro-para- 
methyloxy-quinoline  (soluble  in  water). 

Adult  Dosage. — -Min.,  gr.  ii;  av.,  v;  max.,  xv. 

Method  of  Administration. — R Thallini  sulphatis, 
gr.  V,  tabell®  no.  3. 

Sig. — One  tablet. 

Uses. — Antipyretic. 

Toxric  Action. — Profuse  sweating  and  depression. 

Theobromatis  Oleum;  Cacao  Butter  (melts  at 
body  temperature). 

Uses. — Emollient;  lubricant  in  massage;  supposi- 
tory basis. 

Theobromina;  3,  7-dimethyl-xanthin;  (very  slight- 
ly soluble  in  water,  but  soluble  in  100  of  alcohol). 


NH — 
1 

-CO 

1 

/CH3 

n/ 

CO 

c - 

1 

CH3N 

1- 

;cH 

Method  of  Administration. — R Theobrominse, 
gr.  v-viiss,  pulveres  no.  6. 

Sig. — A powder  every  three  hours  for  six  doses. 

Physiologic  Action  and  Uses. — Diuretic  (non- 
irritating  to  kidneys);  irritant  to  the  stomach. 
Dilates  the  renal  ve.ssels  by  a direct  relaxant  action; 
also  dilates  the  coronary  vessels  by  peripheral  action ; 
better  than  caffeine  because  of  the  very  shght  action 
on  the  vasocon-strictor  centre  in  the  medulla.  All 
diuretics  should  be  administered  for  only  one  or  two 
days  at  a time,  preferably  one  day. 

Theobrominae  Sodio=Acetas;  Agurin;  NaC?H7N4 
02+NaC2Hs02  (soluble  in  water). 

Adult  Dosage. — Min.,  gr.  v;  max.,  xv. 

Method  of  Administration. — R Theobromine 
sodio-acetatis,  gr.  xv. 

Mitte  talis  trochisci  sive  capsule  sive  pulveres 
no.  12. 

Sig.— One,  t.i.d.  in  water. 

Physiologic  Action  and  Uses. — Diuretic  (non- 
irritating) ; does  not  irritate  the  stomach.  See  under 
Theobromina. 

Theobromine  Sodio=Salicylas;  Diuretin  (soluble 
in  1 part  of  water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xx. 

Method  of  Administration. — R Theobromine 
sodio-saUcylatis,  gr.  xw,  pulveres  in  charta  cerata 
no.  12.  Dispense  in  a weU-sealed  bottle,  for  it 
rapidly  absorbs  carbonic  acid  from  the  air  and  de- 
composes. 

Sig.— One  powder,  dissolved  in  hot  water,  two  to 
four  times  a day,  up  to  3ss-iss  in  twenty-four  hours, 
avoiding  acids  and  acid  vegetable  juices,  which 
precipitate  the  alkaloid. 

Physiologic  Action  and  Uses. — Diuretic;  non- 
irritating to  the  stomach.  See  under  Theobromina. 

Theophyllina:  Theocin;  1,  3-dimethyl-xanthin 

(soluble  in  100  of  water;  and  in  80  of  alcohol). 


CH3N- 


CO 

I 

CH3N- 


00 


C— NH 


\CH 


Adxdt  Dosage. — Min.,  gr.  iii;  av.,  iv;  max.,  viiss. 

Method  of  Administration. — R Theophyllinae,  gr. 
iv,  pulveres  in  charta  cerata  no.  12. 

Sig. — A powder  in  a hot  drink,  well  diluted,  two, 
three  to  four  times  daily  for  two  to  three  days,  fol- 
lowed by  a theobromine  salt. 

Physiologic  Action  and  Uses. — Diuretic,  more 
powerful  than  theobromine,  but  its  action  not  so 
lasting.  Diuresis  may  not  follow  for  forty-eight 
hours.  After  three  to  four  days  the  drug  ceases  to 
act  as  a diuretic.  It  dilates  the  renal  vessels  by  a 
direct  relaxant  action;  also  dilates  the  coronary 
vessels  by  peripheral  action;  better  than  caffeine 
because  of  the  very  slight  action  on  the  vaso- 
constrictor centre. 

Toxic  Action. — Vomiting,  diarrhoea. 

Thigenol  (solution  of  Sodium  Sulpho-Oleate;  con- 
taining 2.85  per  cent,  sulphur;  very  soluble  in  dis- 
tilled water,  dilute  alcohol,  glycerine,  chloroforni, 
and  oily  or  fatty  bases;  hara  water  causes  a precipi- 
tate). 

Adult  Dosage. — Min.,  gr.  iii;  max.,  x. 

Method  of  Administration. — R Thigenol,  3i  (gf- 
viiss  per  dose);  sjTupi  simpheis,  5ii;  aquae  destillatae, 
q.s.  ad  5iv. 


TINCTURA  LAVANDULAE  COMPOSITA 


M.  Sig. — Tablespoonful,  t.i.d. 

Locally  it  may  be  used  pure,  or  mixed  in  any 
proportion  with  ointment  bases  or  glycerine. 

Physiologic  Action  and  Uses. — Said  to  stimulate 
granulation,  restrict  secretion,  and  to  be  anti- 
pruritic; used  in  skin  and  uterine  diseases. 

Thiocol;  Potassium  Guaiacol  Sulphonate  (readily 
soluble  in  water). 

Adult  Dosage. — Min.,  gr.  vii;  max.,  xxx;  up  to 
5iss-iv  daily,  by  mouth  or  hypodermically. 

Method  of  Administration. — Thiocol  gr.  x, 
pilulaj  no.  30. 

Sig. — One  pill,  t.i.d.p.c.  It  may  also  be  prescribed 
in  solution. 

Uses. — Bronchial  stimulant  and  antiseptic; 
tonic. 

Thiosinamina;  Allyl  Sulphocarbamide : (NHj). 
CS.NHCHj.CH  ; CH,. 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  iss. 

Method  of  Administration. — I^  Thiosinamina;,  gr. 
i-iss,  capsulte  vel  tabeUse  no.  60. 

Sig.— One,  t.i.d. 

Hypodermically,  gr.  i-v  in  15  per  cent,  alcoholic 
or  10  per  cent,  glycerinated  water  solution,  every 
third  day,  beginning  with  the  smaller  doses. 

Thiosinamina;,  gr.  viii  (about  gr.  iss  ad  igjxx) ; 
glycerini,  itexx;  aqu®,  q.s.  ad  i^cx. 

Dissolve  with  gentle  heat.  Sig. — Inject,  every 
third  day,  about  20  minims,  beginning  with  smaller 
doses. 

Physiologic  Action  and  Uses. — Promotes  the  ab- 
sorption of  scar  tissue;  contraindicated  in  tubercu- 
losis. “ Thiosinamine  cannot  be  dissolved  in  water, 
and  the  alcoholic  and  glycerine  solutions  produce 
local  irritation”;  but  fibrolysin  solutions  are  free 
from  this  fault. — N.  and  N.O.R. 

Toxic  Action. — Digestive  disturbance,  lassitude, 
fever. 

Thiosinaminae  Sodio=Salicylatis,  Liquor. — See 
Fibrolysin. 

Thorium=X. — Used  in  pernicious  anajmia. 

Thujae  Fluidextractum. 

Adult  Dosage. — Av.,  njxxx. 

Method  of  Administration. — H Fluidextracti 
thujae,  5i- 

Sig. — ngv,  in  water,  t.i.d.,  for  the  removal  of  warts, 
together  with  its  local  application. 

Thymae  Glandulae  Dessicatae. 

Adult  Dosage. — Min.,  gr.  ii-iv;  av.,  xxv;  max., 
boev. 

Method  of  Administration. — Glandulae  thymae 
dessicati,  gr.  iv,  tabeUae  no.  30. 

Sig. — Tablet,  t.i.d. 

Uses. — Used  empirically  in  infantile  marasmus, 
rickets,  haemophdia,  h3qDerthyroidism,  tuberculosis. 

Thy  mi  Oleum;  Oil  of  Thyme. 

Adult  Dosage. — Min.,  nji;  av.,  iii;  max.,  v. 

Thymol;  Methyhsopropylphenol : CfilLfCHa) 

(OHjfCsH?)  —1:3:4  (soluble  in  1010  of  water;  in 
1 of  alcohol). 

Dosage. — 3 years,  gr.  v;  5 years,  gr.  v-xv.  Adult, 
min.,  gr.  xv";  av.,  xxx;  max.,  3i- 

Method  of  Administration. — For  the  administra- 
tion of  thymol  in  hookworm  disea.se,  see  Part  1. 

For  flatulence:  gr.  i in  pill,  three  to  four  times  a 
day. 

For  gastric  lavage:  a solution  of  1 : 2000. 

As  an  antiseptic  spray:  1 : 1010,  or  a saturated 
solution. 

As  an  ointment:  gr.  v-xxx  ad  Si- 

Uses. — Antiseptic;  anthelmintic. 

Toxic  Action. — Weakness,  collapse,  albuminuria, 
diminished  reflexes,  slow  respiration,  low  tempera- 
ture and  arterial  tension,  coma.  Give  saline  cathar- 
tics and  water  copiously;  no  alcohol. 


Thymolis  lodidum;  Aristol;  Dithymol-di-iodid: 
(CeH^.CHj.CsHTODs. 

Uses. — Antiseptic  powder;  less  efficient  than 
iodoform. 

Thyroideum  Siccum. — See  Glandula;  Thyroidese 
Sicca;. 

Thyroidin. — See  lodothyrin. 

Tiglii  Oleum. — See  Croton  Oil. 

Tinctura  Aconiti. — See  Aconiti  Tinctura. 

Tinctura  Apocyni. — See  Apocyni. 

Tinctura  Asafoetid®. — See  Asafeetida;  Tinctura. 

Tinctura  Aurantii  Amari;  Tincture  of  Bitter 
Orange  Peel. 

Adult  Dosage. — Min.,  3ij  max.,  ii. 

Uses. — Flavoring  agent. 

Tinctura  Aurantii  Dulcis;  Tincture  of  Sweet 
Orange  Peel. 

Adult  Dosage. — Min.,  3L  max.,  ii. 

Uses. — Flavoring  agent. 

Tinctura  Belladonn®  Foliorum. — See  Belladonn® 
Foliorum  Tinctura. 

Tinctura  Benzoini. — See  Benzoini  Tinctura. 

Tinctura  Benzoini  Composita. — See  Benzoini  Tinc- 
tura Composita. 

Tinctura  Calumb®. — -See  Calumb®  T inctura. 

Tinctura  Cannabis  Indie®. — See  Cannabis  Indie® 
Tinctura. 

Tinctura  Cantharidis. — See  Can tharidis  Tinctura. 

Tinctura  Capsici. — See  Capsici  Tinctura. 

Tinctura  Cardamomi. — See  Cardamomi  Tinctura. 

Tinctura  Cardamomi  Composita. — See  Carda- 
momi Tinctura  Composita. 

Tinctura  Catechu  (Gambir)  Composita.  — See 
Catechu. 

Tinctura  Cimicifug®. — See  Cimicifug®  Tinctura. 

Tinctura  Cinchon® — -See  Cinchon®  Tinctura. 

Tinctura  Cinchon®  Composita. — -See  Cinchon® 
Tinctura  Composita. 

Tinctura  Cinnamomi — See  Cinnamomi  Tinctura. 

Tinctura  Cocculi  Indici  (10  per  cent,  in  diluted 
alcohol). 

Method  of  Administration. — For  destroying  pedi- 
culi,  dilute  with  1,  2,  or  3 parts  of  water. 

Uses.— Parasiticide;  source  of  picrotoxin. 

Tinctura  Cocculi  Orientalis. 

Method  of  Administration. — Ten  to  fifteen  drops 
daily,  for  giddiness  (?). 

Tinctura  Colchici  Seminis. — See  Colchici  Seminis 
Tinctura. 

Tinctura  Digitalis. — See  Digitalis  Tinctura. 

Tinctura  Ferri  Chloridi. — See  Ferri  Perchloridi 
Tinctura. 

Tinctura  Ferri  Pomata. — See  Ferri  Pomata  Tinc- 
tura. 

Tinctura  Gambir. — See  Catechu  Tinctura  Com- 
posita. 

Tinctura  Qelsemii. — See  Gelsemii  Tinctura. 

Tinctura  Gentian®  Composita. — See  Gentian® 
Tinctura  Composita. 

Tinctura  Guaiaci. — See  Guaiaci  Tinctura. 

Tinctura  Guaiaci  Ammoniata.— See  Guaiaci  Tinc- 
tura Ammoniata. 

Tinctura  Humuli. — See  Ilumuli  Tinctura. 

Tinctura  Hydrastis. — See  Hydrastis  Tinctura. 

Tinctura  Hyoscyami. — See  Hyoscyami  Tinctura. 

Tinctura  lodi.— See  lodi  Tinctura. 

Tinctura  lodi  Churchillii:  I^  lodi,  gr.  Ixxv;  po- 
tassii  iodidi,  3 iss;  alcoholis,  5i.  Local  antiseptic  and 
counter-irritant. 

Tinctura  Ipecacuanh®  et  Opii. — See  Ipecacuanh® 
et  Opii  Tinctura. 

Tinctura  Kino. — See  Kino  Tinctura. 

Tinctura  Krameri®. — See  Krameri®  Tinctura. 

Tinctura  Lavandul®  Composita. — See  Lavandul® 
Tinctura  Composita. 


TROCHISCI  CAMPHORiE  ET  MENTHOLIS 


Tinctura  Limonis  Corticis  (50  per  cent.). 

Adult  Dosage. — Min.,  3ss;  max.,  iv. 

Uses. — Flavor. 

Tinctura  Lobeliae. — See  Lobeliae  Tinctura. 

Tinctura  Myrrhae. — See  Myrrhse  Tinctura. 

Tinctura  Nucis  Vomicas. — See  Nucis  Vomicae  Tinc- 
tura. 

Tinctura  Opii. — See  Laudanum. 

Tinctura  Opii  Camphorata.  See  Opii  Tinctura 
Camphorata. 

Tinctura  Opii  Deodorati.  See  Opii  Tinctura 
Dcodorati. 

Tinctura  Physostigmatis.  See  Physostigmatis 
Tinctura. 

Tinctura  Picis  Carbonis  Composita;  Compound 
Tincture  of  Coal  Tar. 

Tinctura  Picis  Liquidas  Composita;  Compound 
Tincture  of  Pine  Tar. 

, Tinctura  Pulsatillae.  See  Pulsatillae  Tinctura. 

Tinctura  Quassiae.  See  Quassiae  Tinctura. 

Tinctura  Rhataniae.  See  Krameriae  Tinctura. 

Tinctura  Rhei  Aromatica.  See  Rhei  Tinctura 
Aromatica. 

Tinctura  Rhois  Toxicodendri.  See  Rhois  Toxico- 
dendri  Tinctura. 

Tinctura  Scillae.  See  Scillae  Tinctura. 

Tinctura  Strophanthi.  See  Strophanthi  Tinctura. 

Tinctura  Valerianae  (20  per  cent.). 

Adult  Dosage. — Min.,  5ss-i;  av.,  ii;  max.,  iv. 

Method  of  Administration. — -R  Tincturae  Val- 
erianae, 5ii. 

Sig. — -Tea.spoonful  in  water,  every  two  hours. 

Uses. — -Antispasmodic;  nerve  sedative. 

Tinctura  Valerianae  Ammoniata  (valerian  20, 
arom.  spt.  ammonia  to  100). 

Adult  Dosage. — Min.,  t^v;  av.,  xxx;  max.,  5ii. 

Method  of  Administration. — R Tincturae  Val- 
erianae ammoniatae,  5ii- 

Sig. — Half  to  one  teaspoonfid,  well  diluted  in 
water,  every  two  to  three  hours. 

Uses. — Antispasmodic;  gentle  stimulant. 

Tinctura  Veratri  Viridis  (10  per  cent.). 

Adult  Dosage. — -Min.,  i^viii;  av.,  xv;  max.,  x.xx. 

Method  of  Ad7Jiinistration. — ^Foreclampsia  (Edgar): 
10  to  20  minims  subcutaneously,  then  10  minims 
every  half  hour,  “till  the  pulse  continues  below 
sixty  to  the  minute.” 

Physiologic  Action  and  [fses.— Increases  the  excita- 
bility of  voluntary  muscle,  with  the  occurrence  of 
contracture  or  slow  relaxation  following  stimulation; 
exerts  the  same  action  on  the  heart  muscle,  causing 
slowing  and  a fall  of  blood-pressure;  may  also  stimu- 
late the  vagus  centre;  antipyretic  by  action  on  the 
heat  regidating  centre. 

Tinctura  Zingiberis;  Tincture  of  Jamaica  Ginger 
(20  per  cent.). 

Adult  Dosage. — Min.,  i^x;  av.,  xxx;  max.,  pi. 

Uses. — Flavor;  carminative;  stimulant. 

Tolutanum  Balsamum  (contains  benzoin  or  its 
derivatives;  soluble  in  alcohol,  nearly  insoluble  in 
water). 

Adult  Dosage. — Alin.,  gr.  v;  av.,  xx’^;  max.,  xx. 

Method  of  Administration. — R Balsami  tolutani, 
3iv  (gr.  XV  per  dram);  mucilaginis  acacia',  q.s. 
ad  gii. 

M.  Sig. — One  dram  two  or  tliree  times  a day. 

t/ses.— Stimulating  and  disinfecting  expectorant. 

Tolutanus  Syrupus;  Syrup  of  Tolu  (tr.  of  Tolu  5, 
syrup  to  100). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  vi. 

Uses. — Stimulating  expectorant;  flavored  vehicle 
in  cough  mixtures. 

Tragacantha;  Mucilago  (Tragacanth  6,  glycerine 
18,  water  to  100). 

Adult  Dosage. — Av.,  5iv-f. 


C/ses.— Demulcent;  used  to  suspend  insoluble 
powders  in  mixtures. 

Traumaticin  (10  per  cent,  solution  of  gutta-percha 
in  chloroform).  For  application  to  shght  wounds 
as  a protectiye  covering.  The  chloroform  evaporates, 
leaving  a thin,  adherent  pellicle. 

Trichloraceticum  Acidum:  CCLCOOH. 

Uses. — Caustic;  antiseptic;  styptic. 

Trinitrophenol;  Picric  Acid;  See  Acidum  Picricum. 

Trional;  Sulphonethyhnethanum;  Diethylsul- 
phone-diethylmethane:  (CH3)(C2H5)C(S02C2H5)2 

(soluble  in  200  of  water;  freely  soluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xii;  max.,  xxx. 

Method  of  Administration. — R Sulphonethyl- 
methani,  gr.  xii,  pulveres  no.  iii. 

Sig. — One  powder,  in  a hot  liquid,  one-half  to  one 
hour  before  retiring.  Give  alkalies  freely  while 
administering  trional.  Do  not  use  for  more  than 
two  to  three  days  consecutively. 

Physiologic  Action  and  Uses. — Hjq>notic,  acts  in 
one-half  to  one  hour,  sometimes  not  until  the  next 
day;  action  is  transient;  promotes  sleep  by  impairing 
the  perception  of  external  stimuli. 

Toxic  Action. — Haematoporphyrinuria  (indicated 
by  a pinkish  or  red  color),  lassitude,  weakness, 
nausea,  diarrhoea  or  constipation,  followed  by 
abdominal  tenderness,  vomiting,  ataxia,  paresis  of 
various  muscles,  loss  of  reflexes,  nephritis,  finally 
collapse  and  usually  death.  It  is  often  too  late  to 
save  the  patient  when  hajmatoporphyrinuria  appears. 

Triphenin;  Propionyl  Phenetidin:  CeH^fOCoHs) 
NH.(CH3CH2C0).  (Soluble  in  2000  of  water;  sol- 
uble in  alcohol  and  ether). 

Adult  Dosage. — As  an  antipyretic,  gr.  iv-x.  As  an 
antineuralgic,  gr.  xv-xx. 

R Triphenin,  gr.  v,  tabell®  vel  capsulae  no.  5. 

Sig. — One  every  two  hours  for  five  doses. 

Uses. — Analgesic;  hypnotic;  antipyretic;  milder 
than  phenacetin. 

Tritici  Fluidextractum;  FI.  ext.  of  Couch  Grass. 

Adidt  Dosage. — Min.,  5i;  av.,  iiss;  max.,  §i. 

Method  of  Administration. — R Fluidextracti  tri- 
tici, o'i. 

Sig. — Teaspoonful  in  a glassful  of  water,  every 
three  to  four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Tritici  Infusum;  Couch  Grass  Infusion. 

Adidt  Dosage. — Av.,  5d. 

Method  of  Administration. — R Tritici,  gi;  aquae, 
Oiss. 

Boil  down  to  a pint  and  filter. 

Sig. — Two  ounces,  or  a wineglassful,  frequently 
until  the  whole  pint  is  taken  in  twenty-four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Trituratio  Elaterini  (Elaterin  10,  sugar  of  milk  90). 

Adidt  Dosage. — Min.,  gr.  av.,  ss;  max.,  i. 

Method  of  Administration. — R Triturationis  elat- 
erini, gr.  tabelke  no.  6. 

Sig. — Tablet  two  to  three  times  a day. 

Physiologic  Action  and  Uses. — Ilydragogue  cathar- 
tic; acting  upon  both  the  large  and  small  intestine. 

Toxic  Aciion. — Nausea,  vomiting,  prostration. 

Trochisci  Acidi  Carbolici  (gr.  et  menthoHs  (gr. 

Mo). 

Uses. — Throat  antiseptic  and  anodjme. 

Trochisci  Acidi  Tannici  (gr.  i). 

Uses. — Throat  astringent. 

Trochisci  .Ammonii  Chloridi  (gr.  iss). 

Adult  Dosage. — One  to  ten  troches,  t.i.d. 

Uses. — Stimulating  e.xpectorant ; cholagogue. 

Trochisci  CamphorJB  et  Mentholis. 

Method  of  Administration. — A lozenge  every  two 
hours. 

Uses. — Expectorant;  diaphoretic;  refrigerant  ano- 
dyne. 


UNGUEXTUM  PHENOLIS 


Trochisci  Catechu  vel  Qambir  (nearly  gr.  i). 

Uses. — Throat  astringent,  by  virtue  of  the  con- 
tained tannic  acid. 

Trochisci  Formalini  (gr.  made  with  “glyco- 
gelatin”  or  “fruit  paste.” 

Uses. — Throat  antiseptic. 

Trochisci  Qambir  vel  Catechu  (nearly  gr.  i). 

Uses. — Throat  astringent  (containing  tannic 
acid). 

Trochisci  Quaiaci  (gr.  hi). 

Method  of  Administration. — Troclusci  guaiaci 
(gr.  iii),  no.  12. 

Sig.— One,  every  two  to  fovir  hours. 

Uses. — Expectorant;  diaphoretic;  alterative. 

Trochisci  Krameriae  (Ext.  gr.  i). 

Uses. — Astringent. 

Trochisci  Potassii  Chloratis  (gr.  iiss). 

Adult  Dosage. — One  to  three  troches.  Slowly  dis- 
solved in  the  mouth,  t.i.d. 

Uses. — Astringent ; antisialogogue. 

Tropon  (vegetable  and  animal  albumins). 

Uses. — Concentrated  albuminous  food. 

Trypanroth  (a  dye,  formed  by  introducing  H2SO4 
radicles  in  the  benzol  ring  of  benzopurpurin;  soluble 
in  water). 

Method  of  Administration. — Used  by  injection. 

Uses. — Specific  protozoal  poison  used  in  try- 
panosomiasis. 

Trypsinum. 

Adult  Dosage. — Av.,  gr.  h+. 

Method  of  Administration. — Trypsini,  gr.  ii, 
capsidic  (hardened  with  formalin,  grade  ii)  no.  30. 

Sig. — One  capside,  t.i.d.p.c. 

Physiologic  Action  and  Uses. — Proteolytic  enzyme, 
acting  best  in  a feebly  alkahne  medium,  not  exceed- 
ing one  per  cent.  sod.  bicarb.,  and  at  a temperature 
of  40°  C.  It  is  destroyed  in  the  stomach. 

Tuberculinum  (Bozillenemulsion;  B.  E.;  Human 
or  Bovine;  an  emulsion  of  dead,  powdered  tubercle 
bacilli). 

Adult  Dosage. — Mg.  Koo,ooo,  initial  dose,  mixed  with 
physiologic  salt  solution.  See  Tuberculosis,  Pulmon- 
ary, Part  1. 

Tuberculin  may  be  obtained  already  serially 
diluted,  from  many  pharmaceutical  firms. 

Tuberculinum  (Denys;  Bouillon  Filtr6:  B.  F.; 
Human  or  Bovine:  simply  a glycerin-broth  culture 
of  the  tubercle  bacillus,  passed  through  a porcelain 
filter,  and  containing  the  soluble  tubercle  toxines; 
prepared  like  old  tuberculin,  without  the  prolonged 
heating  and  concentration). 

Adult  Dosage. — Mg.  Ko,ooo,  initial  dose,  diluted  with 
distilled  water.  See  Part  1,  Tuberculosis,  Pulmon- 
ary. 

Tuberculinum  (Dixon;  a suspension  in  physio- 
logic salt  solution  of  dead  tubercle  bacilli,  from 
which  the  fat  has  been  removed  by  prolonged  treat- 
ment with  alcohol  and  ether). 

Adult  Dosage. — Mg.  Kooo,  standard  therapeutic 
dose. 

Tuberculinum  (Old  or  Original,  of  Koch;  O.  T.; 
prepared  froni  glycerine  bouillon  cultures  of  the 
tubercle  bacillus  by  evaporation  to  one-tenth  the 
original  volume,  sterilizing  at  100  C.  for  an  hour, 
and  filtering  through  a Berkefeld  filter;  it  is  filtrate 
of  soluble  tubercle  toxines). 

Adult  Dosage. — Mg.  )io,noo,  initial  dose,  diluted  with 
distilled  water.  See  Part  1,  Tuberculosis,  Pulmon- 
ary. 

Tuberculinum  (Riickstand;  Rest;  Residue;  T.  R. : 
an  emulsion  of  dead  bacilli  freed  from  soluble 
toxines). 

Adult  Dosage. — Mg.  Ko,ooo,  initial  dose,  diluted 
with  distilled  water.  See  Part  1,  Tuberculosis,  Pul- 
monary. 


Turpentine.  See  Terebinthina. 

Unguentum  Acidi  Borici  (boric  acid  10,  paraffin  10, 
white  petrolatum  80). 

Uses. — Antiseptic  emollient  and  protective. 

Unguentum  Acidi  Carbolici  (phenol  3,  white 
petrolatum  97). 

Physiologic  Action  and  Uses. — Antiseptic  emollient. 

Unguentum  Acidi  Salicylici. 

Method  of  Administration. — K Acidi  salicylici, 
gi-.  v-x-xxx-xlviii;  petrolati  et  adipis  lana;  hydrosi, 
aa  §ss. 

Uses. — Antiseptic;  parasiticide;  keratolytic. 

Unguentum  Acidi  Tannici  (20  per  cent,  in  glycerine 
and  petrolatum). 

Physiologic  Action  and  Uses. — Astringent  emol- 
lient; u.seful  in  the  treatment  of  hemorrhoids. 

Unguentum  Aquae  Rosae;  Cold  Cream  (aqua 
ro.sac  fortior  19,  expressed  oil  of  almond  56,  sper- 
maceti 12J-2,  white  wax  12,  sodium  borate  3^). 

Uses. — Emollient. 

Unguentum  Belladonna;  (ext.  belladonna;  10, 
diluted  alcohol  5,  benzoated  lard  65,  lanolin  20). 

Uses. — ^Local  anodyne,  etc.  See  Atropina. 

Unguentum  Bromocoll  (20  per  cent.;  BromocoU  is 
a bromine  compound  with  gelatin,  containing  about 
20  per  cent  of  bromine). 

Uses. — Antipruritic.  (Ortner.) 

Unguentum  Camphorae  (5  to  15  per  cent.). 

Uses. — Antipruritic. 

Unguentum  Capsid  (made  with  spermaceti  and 
olive-oil). 

Uses. — Counter-irritant. 

Unguentum  Chrysarobini;  see  Chry.sarobini 
Unguentum, 

Unguentum  Crede;  see  Argenti  Colloidah  Inguen- 
tum. 

Unguentum  Diachylon  (lead  plaster  50,  olive  oil  or 
white  petrolatum  49,  oil  of  lavender  flowers  1). 

Uses. — Local  antiseptic  and  astringent  emoUient. 

Unguentum  Epicarin;  see  Epicarin  Unguentmn. 

Unguentum  Qallae  (nut  gall  20  per  cent.). 

Uses. — ^ Astringent. 

Unguentum  Qallae  et  Opii: 

Pulveris  galla;  3iss;  pulveris  opii  gr.  .xlviii; 
petrolati  molhs  §i. 

Uses. — Astringent;  anodjme. 

Unguentum  Hydrargyri;  see  Hydrargyri  Lffiguen- 
tum. 

Unguentum  Hydrargyri  Ammoniata;  see  Hydrar- 
gyri Ammoniati  Unguentum. 

Unguentum  Hydrargyri  Dilutum;  Blue  ointment 
(mercurial  ointment  67,  petrolatum  33). 

Uses. — Antiluetic;  antiseptic;  para.siticide. 

Unguentum  Hydrargyri  Nitratis. — See  Citrine 
Ointment. 

Unguentum  Hydrargyri  Nitratis  Dilutum. 

Unguentum  Hydrargyri  Oxidi  Flavi;  see  Hydrar- 
gyri Oxidi  Flavi,  Imguentum. 

Unguentum  Ichthyoli  (5  to  50  per  cent.). 

Uses. — Antiphlogistic ; antiseptic. 

Unguentum  lodi  (iodin  4,  pot.  iodid  4,  glycerine  12, 
benzoinated  lard  80.  Piflverize  the  iodine,  then  add 
a little  alcohol,  and  finally  the  excipient  by  degrees). 
It  should  be  prepared  as  required. 

Uses. — Antiseptic  and  counter-irritant. 

Unguentum  lodoformi  (iodoform  10,  lard  90). 

Uses. — .Antiseptic. 

Unguentum  Mentholis  (5  to  15  per  cent.). 

Uses. — ^^.A.ntipruritic ; refrigerant. 

Unguentum  Opii. 

I^  Pulveris  opii,  gr.  xlviii;  Petrolati  mollis,  5i- 

Uses. — Anodyne. 

Unguentum  Phenolis;  Unguentum  Acidi  Car- 
bolici (phenol  3,  white  petrolatum  97). 

Uses. — ^Antiseptic  emollient. 


VACCINUM  ANTIRABICUM 


Unguentum  Picis  Liquidse;  pine  tar  50,  yeUow  wax 
15,  lard  35). 

Method  of  Administration. — At  first,  strengths  of 
2 to  4 per  cent,  may  be  used  and  gradually  increased. 

Uses. — Stimulating  antiseptic;  antipruritic. 

Llnguentum  Stramonii  (e.xt.  stramonii  10,  diluted 
alcohol  5,  benzoinated  lard  65,  lanolin  20). 

Uses. — Anodyne. 

Unguentum  Sulphuris  (washed  sulphur  15,  ben- 
zoinated lard  85). 

Uses. — Antiseptic;  parasiticide;  keratolytic. 

Unguentum  Veratrinae  (veratrine  4,  e.xpressed  oil 
of  almond  6,  benzoinated  lard  90). 

Physiologic  Action  and  Uses. — Local  antineuralgic 
application;  dangerous  if  absorbed  through  an 
abrasion. 

Unguentum  Zinci  Oxidi  (zinc  oxide  20,  benzoinated 
lard  80). 

Uses. — Antiseptic  and  protective  emollient. 

Unguentum  Zinci  Stearatis  (zinc  stearate  50, 
white  petrolatum  to  100). 

Uses. — Antiseptic  and  protective  emollient. 

Urea  Carbamide:  CO(NH2)2  (soluble  in  1 of 
water). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  lx. 

R Urese,  5iv  ( 3ss  per  dram);  aqu®,  q.s.  ad  5i- 

M.  Sig. — One  teaspoonful  t.i.d.  with  lots  of  water. 
It  may  be  prescribed  in  cachets. 

Uses. — Diuretic. 

Ureae  Quinas;  Urol. 

Adult  Dosage. — Min.,  gr.  xxx;  max.,  xl. 

Method  of  Administration. — R Ure®  quinatis, 
gr.  xxx,  tabelhe  no.  10. 

Sig.— One,  twice  daily, with  large  amounts  of  water. 

Uses. — Diuretic. 

Urethane;  ^Ethylis  Carbamas:  NH2.CO.O(C2ll5) 
(.soluble  in  0.45  of  water,  and  in  0.8  of  alcohol). 

Adult  Dosage. — min.,  gr.  x;  av.,  xw;  max.,  xxx. 

Method  of  Administration. — In  powder,  cachets,  or 
solution, — best  gr.  v,  frequently  repeated,  as  a full 
dose  may  cause  vomiting.  (Potter.) 

Uses. — Very  mild  hypnotic;  diuretic. 

Urotropin;  Hexamethylenamina : (CH2)6N4  (solu- 
ble in  1.5  of  water). 

Dosage. — 6 months,  gr.  ss;  18  months,  gr.  i;  3 
years,  gr.  i-ii;  5 years,  gr.  ii-v.  Adult,  min.,  gr.  v; 
av.,  x;  max.,  xv. 

Method  of  Administration. — R Hexamethylena- 
min®,  gr.  v-x,  pulveres,  tabell®,  vel  capsula*,  no.  24. 

Sig. — A powder  in  solution  in  water,  t.i.d.  It  may 
be  given  up  to  qi  daily,  for  adults.  If  sodium  acid 
phosphate  is  given  to  render  the  urine  acid,  hex- 
amethylenamine  should  not  be  taken  for  several 
hours  later. 

Physiologic  Action  and  Uses. — Urinary  antiseptic; 
liberates  formaldehyde  only  in  an  acid  medium  (not 
otherwise). 

Toxic  Action. — Indigestion,  abdominal  pain,  diar- 
rhoea, strangury,  albuminuria,  h®maturia,  h®mo- 
globinuria,  headache,  tinnitus,  measly  rash. 

Uvas  Ursi  Fluidextractum. 

Adult  Dosage. — Min.,  njx;  av.,  xxx;  max.,  qi- 

Method  of  Administration. — R Fluidextracti  uv® 
ursi,  5i. 

Sig. — Half  a teaspoonful  with  plenty  of  water, 
three  to  four  times  daily. 

Physiologic  Action  and  Uses. — Diuretic:  urinary 
antiseptic  and  sedative;  contains  the  glucoside  arbu- 
tin,  wnich  is  split  up  in  the  kidney  into  sugar  and 
the  antiseptic  hydrochinone. 

Toxnc  Action. — Vomiting,  purging. 

Uvse  Ursi  Infusum  (gi  in  Oi). 

Adult  Dosage. — Min.,  5i;  max.,  ii. 

Method  of  Administration. — R Infusi  uv®  ursi, 
Sviii. 


Sig. — Two  tablespoonfuls,  three  to  four  times  daily. 

Physiologic  Action  and  Uses. — Slightly  antiseptic 
diuretic;  contains  the  glucoside  arbutin,  which  is 
split  up  in  the  kidney  into  sugar  and  the  antiseptic 
hydrochinone. 

Vaccinum,  Acne. 

Adult  Dosage. — Five  to  ten-f  millions,  hypo- 
dernucally  every  ten  days,  when  the  comedo  pre- 
dominates; staphylococcus  vaccine,  beginning  with 
about  200  millions  when  there  is  much  pustulation. 

Vaccines  or  bacterins  are  suspensions  of  killed 
bacteria  in  physiological  salt  solution,  usually  with 
the  addition  of  cresol  or  trikresol,  0.4  per  cent.,  or 
phenol  0.5  per  cent.,  as  a preservative.  They  are 
used  for  the  purpose  of  producing  active  immunity. 
Autogenous  vaccines  are  prepared  from  cultures  ob- 
tained from  the  patient  to  be  treated;  whereas  stock 
vaccines  are  obtained  from  other  sources,  and  are 
therefore  probably  less  effective.  The  severer  the 
disease,  the  smaller  the  dose,  and  the  shorter  the 
intervals.  In  mdd  affections  a systemic  reaction 
may  be  desirable.  The  use  of  vaccines  is  obviously 
contraindicated  in  bacter®mia.  A sensitized  vaccine 
(serobacterin)  is  one  in  which  the  organism  has  been 
brought  in  contact  with  its  specific  anti-body  by 
treatment  with  the  serum  of  an  animal  which  has 
been  immunized  to  some  extent  against  the  organ- 
ism, the  anti-body  combining  with  the  organism. 
A forty-eight  hour  culture  of  the  organism  is  sus- 
pended in  physiologic  salt  solution  (0.85  per  cent.) 
and  the  resulting  emulsion  superimposed  in  a tube 
upon  the  immune  serum.  The  two  layers  of  fluid 
do  not  unite,  but  after  a short  incubation  at  37°C., 
the  organisms  become  agglutinated  and  fall  to  the 
bottom  of  the  tube.  The  supernatant  liquid  is  de- 
canted, the  microbial  sediment  washed  several  times 
by  careful  centrifugation  in  phj'siologic  salt  solution, 
and  the  sensitized  bacteria  are  then  suspended  in  a 
sufficient  amount  of  salt  solution  to  give  the 
mixture  the  appearance  of  a twenty-four-hour 
typhoid  culture  (60  to  80  millions  of  bacteria  per 
millilitre).  The  preparation  is  then  heated  to 
56°  C.  three  times  during  one  hour.  The  first  dose 
is  one  millilitre  hypodermically,  followed  after  five 
days  by  two  millilitres,  which  may  be  repeated,  if 
desired,  three,  four,  or  five  times.  (Bazy  and 
Cuvillier.)  “This  treatment,  it  is  claimed,  sensitizes 
the  bacteria  so  that  they  are  more  easily  attacked 
by  the  protective  forces  of  the  patient,  cause  less 
reaction  (they  are  one-fourth  to  one-fifth  as  toxic), 
and  produce  a quicker  immunity.”  “It  is  held  that 
a time-consuming  portion  of  the  process  of  immunity, 
namely,  the  formation  of  specific  amboceptors  neces- 
sarj'  for  the  breaking  up  of  the  bacteria,  is  dis- 
pensed with.”  “These  amboceptors,  procured  from 
the  immimizcd  goat  or  horse  and  combined  with  the 
bacteria,  it  is  believed,  prepare  the  bacteria  in  the 
same  manner  as  amboceptors  formed  in  the  body  of 
the  patient;  their  action,  therefore,  is  much  more 
rapid  than  that  of  the  ordinarj-  bacterial  vaccine.” 
(From  New  and  Non-Official  Remedies.)  I do  not 
see  how  such  an  emasculated  bacterin  can  bring 
about  active  immunity.  On  administration,  a sensi- 
tized vaccine  does  not  produce  the  so-called  “nega- 
tive phase”  so  that  larger  doses  may  be  used  than 
with  non-sensitized  vaccines. 

\'accines  have  not  proven  of  great  curative  value 
in  most  cases,  and  they  may  do  harm . Their  pro- 
phylactic value  in  certain  cases  is  established. 

Vaccinum  .Antirabicum  (the  virus  of  rabies,  the 
virulence  of  which  is  greatlj'  attenuated  by  passage 
through  a long  series  of  rabbits,  drying — i.e.  the 
spinal  cords  of  the  infected  rabbits — and  preserva- 
tion in  glycerine). 

Method  of  Administration. — For  use,  the  spinal 


VALIDOL;  MENTHOLIS  VALERAS 


cord  is  emulsified  in  physiological  saline  solution, 
and  injected,  subcutaneously,  into  the  anterior 
abdominal  wall, — one  injection  daily  for  twenty-one 
to  twenty-five  days.  Immunity  may  thus  be  estab- 
hshed  before  the  incubation  period  of  the  disease 
has  terminated.  A dose  may  be  procured  each 
day  by  mail  from  the  following  manufacturers: 
H.  M.  Alexander  and  Co.,  Marietta,  Pa.;  W.  T. 
McDougall,  Kansas  City,  Kans.;  Schieffelin  and 
Co.,  New  York;  H.  K.  Mulford  Co.,  Phila.;  E.  R. 
Squibb  and  Sons,  New  York;  Pasteur  Institute  of 
St.  Louis;  and  Eli  Lilly  and  Co.,  N.  Y.,  Chicago, 
St.  Louis,  Kansas  City,  New  Orleans,  or  Indianapolis. 

Vaccinum,  Cholera. 

Adult  Dosage. — 500  million,  first  injection;  sec- 
ond, five  to  six  days  later,  1000  miUion,  and  later 
another  injection  of  1000  milhon : for  prophylactic 
purposes. 

Vaccinum,  Colon  Bacillus. 

Adult  Dosage. — 10  to  100-|-milhon ; one  may 
begin  with  five  miUion,  and  increase  by  five  miUion 
every  three  days,  up  to  50  to  100  million,  if  necessary. 

Vaccinum  Diphthericum. 

Adult  Dosage. — 100  to  800  miUion;  used  to 
eliminate  the  bacilU  in  carriers. 

Vaccinum  Erysipelatum  et  Prodigiosum;  Erysipe- 
las and  Prodigiosus  Toxins  (Coley). 

Adult  Dosage. — Min.,  nji;  max.,  viii;  hypodermically 
partly  in  or  near  the  tumor,  and  partly  at  a distance. 
“A  reaction  consisting  of  chill  and  rise  of  tempera- 
ture is  expected  to  follow  the  injections  until  toler- 
ance becomes  estabUshed.”  Used  in  inoperable 
sarcoma,  in  which  10  per  cent,  of  cures  is  reported. 
New  and^  Non-Official  Remedies. 

Vaccinum,  Friedlander  Bacillus  Pneumoniae. 

Adult  Dosage. — 50  to  400  miUion,  in  serial  doses. 

Vaccinum  Qonococcum. 

Adult  Dosage. — 10  to  50  to  500  miUion;  every 
four  to  five  days,  beginning  with  small  doses. 

Vaccinum,  Malta  Fever. 

Adult  Dosage. — 1000  miUion,  repeated  in  a week. 

Vaccinum  Meningococcum. 

Adult  Dosage. — 500  miUion;  foUowed  in  ten  days 
by  1000  miUion,  and,  after  another  interval  of  ten 
days,  by  1000  iruUion;  as  a protective. 

Vaccinum  Paratyphosum  A et  B. 

Adult  Dosage — -125  mUlion  of  each,  followed  by 
the  same  or  double  the  dose  a week  later. 

Vaccinum,  Pertussis  Bacillus. 

Adult  Dosage. — 25  to  800  miUion;  in  serial  doses. 

Vaccinum  Plague  Bacillus. 

Adult  Dosage. — 250  to  1000  to  5000  miUion;  in 
two  doses,  five  to  six  days  apart,  for  prophylactic 
purposes.  A relative  immunity  is  produced,  lasting 
about  four  months. 

Vaccinum  Pneumococcum. 

Adult  Dosage. — 10  to  100  to  500  miUion;  in  serial 
doses. 

Vaccinum  Pollen  or  Multipollen.  See  Hay-Fever. 

Vaccinum  Pyocyaneum. 

Adult  Dosage. — 25  to  1000  miUion;  in  serial  doses. 

Vaccinum  Staphylococcum  (made  from  the 
staphylococcus  pyogenes  aureus,  albus,  or  citreous, 
or  all  three). 

AduU  Dosage. — 50  to  400  to  1000  miUon;  in  serial 
doses,  every  three  to  four  days. 

Vaccinum  Streptococcum  (made  from  different 
strains  of  streptococcus  pyogenes). 

Dosage. — 5 to  100  to  500  to  lOCIO  million;  in  serial 
doses,  every  four  days. 

Vaccinum  Typhosum  (made  from  BaciUus  ty- 
phosus, to  which  is  sometimes  added  BaciUus 
para  typhosus,  A and  B). 

Adult  Dosage. — 500  milhon;  foUowed,  in  seven  to 
ten  days,  by  1000  miUion,  and  the  latter  dose 


repeated  after  another  seven  to  ten  days;  as  a 
prophylactic.  Immunity  probably  lasts  about  two 
to  four  years  or  longer.  Vaccine  may  also  be  useful 
in  eUminating  bacilU  in  carriers.  (See  also  Typhoid 
Fever  in  Part  1.) 

Virus  Vaccinicum;  Vaccine  Virus  (obtained  from 
the  vesicles  of  calves  with  vaccinia). 

For  instructions  and  other  information,  see 
Smallpox,  Part  1. 

Uses. — Prophylactic  against  smaUpox. 

Valeras  Ammonii:  NH4C6H9O2  (soluble  in  0.3  of 
water  and  0.6  of  alcohol). 

Adult  Dosage. — Min.,  gr.  i;  av.,  viiss;  max.,  x. 

Method  of  Administration. — I^  Ammonii  valera- 
tis,  3ii  3ii;  aqua;,  5ii- 

M.  Sig. — 3i,  t.i.d.,  or  every  two  to  four  hours. 

Uses. — Nerve  sedative. 

Valeras  Mentholis;  Validol:  CH3.CH2.CH2.COO. 

C10H19. 

Adult  Dosage. — Min.,  njjx;  av.,  xv;  max.,  xx. 

Method  of  Administration. — B Mentholis  valera- 
tis,  3ii- 

Sig. — Ten  to  twenty  drops  on  sugar,  or  in  a little 
sweet  wine  or  coffee,  every  four  hours,  or  once  to 
thrice  daUy. 

Uses. — Gastric  sedative. 

Valeras  Zinci  (soluble  in  70  of  water  and  22  of 
alcohol). 

Adult  Dosage. — Min.,  gr.  av.,  ii;  max.,  iv. 

Method  of  Administration. — B Zinci  valeratis, 
gr.  ii,  capsula;  no.  30. 

Sig. — One,  t.i.d..  It  may  be  given  up  to  gr.  .xxx, 
t.i.d.,  in  dialaetes  insipidus. 

Uses. — Nerve  sedative;  central  nervous  depressant 

(?). 

Valerianae  Fluidextractum. 

Adult  Dosage. — Min.,  Tijfx;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — B Fluidextracti  val- 
erianse,  gi. 

Sig. — Thirty  drops  in  water,  every  two  to  four 
hours. 

Uses. — Nerve  sedative ; central  nervous  depressant 

(?). 

Toxic  Action. — Hiccough,  nausea,  vomiting,  diar- 
rhoea, frequent  urination,  mental  disturbance, 
diminished  reflexes,  lowered  blood-pressure,  slow 
heart,  melanchoUa  after  prolonged  use. 

Valerianae  Pulvis. 

Adult  Dosage. — Min.,  gr.  x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — B Pulveris  val- 
erian®, gr.  5,  capsul®  no.  6. 

Sig. — One,  t.i.d.,  the  dose  to  be  graduaUy  increased 
to  gr.  xl,  t.i.d.,  in  diabetes  insipidus. 

Uses. — Nerve  sedative;  central  nervous  depressant 

(?). 

Valerianae  Tinctura  (20  per  cent.). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — B Tinctur®  val- 
erian®, 5ii- 

Sig. — Teaspoonful  in  water,  t.i.d.,  increased,  in 
diabetes  insipidus,  even  up  to  gss,  or  a tablespoonful 
four  times  a day. 

Uses. — Nerve  sedative;  central  nervous  depressant 

(?). 

Valerian®  Tinctura  Ammoniata  (Valerian  20, 
arom.  spt.  ammonia  to  100). 

Adult  Dosage. — Min.,  njv;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — B Tinctur®  val- 
erian® ammoniat®,  5u- 

Sig. — Half  to  one  teaspoonful,  well  dUuted  in 
water,  every  two  to  three  hours. 

Uses. — Amtispasmodic;  gentle  stimulant. 

Validol;  Mentholis  Valeras:  CH3.CH2.CH2.COO. 
CioH,9. 

Adult  Dosage. — Min.,  njx;  av.,  xv;  max.,  xx. 


VLEMINCKX’S  SOLUTION 


Method  of  Administration. — Mentholis  val- 
eratis,  3ii- 

Sig. — Ten  to  twenty  drops  on  sugar,  or  in  a little 
sweet  wine  or  coffee,  every  four  hours,  or  once  to 
thrice  daily. 

Uses. — Gastric  sedative. 

Vaseline;  Paraffinum  vel  Petrolatum  Molle  (white 
vaseline  is  soft  paraffin  which  has  been  filtered 
through  animal  charcoal). 

Uses. — Base  for  ointments;  protective  emolHent. 

Vaselin  Liquid ; Petrolatum  Liquidum;  Paraffinum 
Liquidum  Purificatum;  Mineral  Oil. 

Adult  Dosage. — Min.,  gss;  max.,  iii. 

Method  of  Administration. — 1^  Paraffin!  liquid! 
purificati,  Sviii. 

Sig. — Half  to  three  ounces  a day,  in  a single  dose 
at  bed  time,  or  in  divided  doses;  or  two  teaspoonfuls 
to  two  tablespoonfuls,  one-half  hour  before  meals, 
two  to  three  times  a day. 

Uses. — Laxative  emollient;  vehicle. 

Vasotonin;  Yohimbin  Urethane  (Urethane  is 
.Uthylis  Carbamas:  NIl2.CO.O(C2H5)). 

Method  of  Administration. — Subcutaneously,  every 
day,  or  every  other  day. 

Physiologic  Action  and  Uses. — Used  in  arterial 
hyjjcrtension  because  of  its  peripheral  vaso-dilator 
action. 

Veratri  Fluidextractum. 

Adult  Dosage. — Min.,  nji;  av.,  iss;  max.,  iv. 

Method  of  Administration. — Jluidextracti  vera- 
tri,  3i. 

Sig. — One  to  two  drops  in  water,  as  required. 

Physiologic  Action  and  Uses. — Cardiac  and  ner- 
vous sedative  in  fevers;  increases  excitability  of  vol- 
untary muscle  with  the  occurrence  of  contracture  or 
slow  relaxation  following  stimulation;  exerts  same 
action  on  heart  muscle,  causing  slowing;  may  also 
stimulate  vagus  centre;  antipjuetlc  by  action  on 
heat-regulating  centre;  lowers  blood-pressure. 

Toxic  Action. — Small,  rapid  pulse,  dyspnoea,  giddi- 
ness, impaired  vision,  vomiting,  purging,  great 
weakness,  stupor,  collapse,  convulsions. 

Veratri na  (mixture  of  alkaloids;  shghtly  soluble  in 
water,  soluble  in  3 of  alcohol,  96  of  glycerine,  56  of 
olive  oil). 

Adult  Dosage. — Min.,  gr.  }io',  av.^o,  max.,  Ko. 

Physiologic  Action  and  Uses. — Cardiac  sedative 
in  fevers,  but  a dangerous  poison. 

Veratrins  Unguentum  (veratrine  4,  expressed  oil 
of  almond  6,  benzoinated  lard  90). 

Physiologic  Action  and  Uses. — Local  antineuralgic 
application;  dangerous  if  absorbed  through  an 
abrasion. 

Veratri  Tinctura  (10  per  cent.). 

Adult  Dosage. — Min.,  irgviii;  av.,  xw;  max.,  xxx. 

Method  of  Administration. — For  eclampsia 

(Edgar):  10  to  20  minims,  subcutaneously,  then 
10  minims  every  half  hour,  “tiU  the  pulse  continues 
below  60  to  the  minute.” 

Physiologic  Action  and  Uses.— See  Veratri,  Fluid- 
extractum (above). 

Veronal  Sodium;  Sodii  Dia?thyl-Barbituras;  Medi- 
nal  (soluble  in  5 of  water).  See  Veronalum. 

Adult  Dosage. — Min.,  gr.  v;  max.,  x. 

Veronalum;  Diethyl  Malonyl  Urea;  Acidum 
Disthyl-Barbituricum : 


CiIL^  ^CO-NH^ 

Ciu/  ^co-nr/^ 


CO 


(soluble  in  about  150  of  cold  water,  about  12  of 
boiling  water;  soluble  in  8 of  alcohol). 

Adult  Dosage. — Min.,  gr.  v;  av.,  x;  max.,  xv. 
Method  of  Administration. — Veronali,  gr.  v, 
pulveres,  tabeUsc,  vcl  capsulaj,  no.  6. 


Sig. — One,  one  and  a half  to  two  hours  before  bed- 
time, followed  by  a cupful  of  hot  water,  tea,  or 
milk.  Keep  the  bowels  active  with  saUnes,  and 
give  alkalies,  on  prolonged  use  of  the  drug. 

Physiologic  Action  and  Uses. — Hypnotic:  gr.  viii 
have  been  fatal;  relatively  safe  in  small  doses; 
begins  to  act  in  about  half  an  hour. 

Toxic  Action. — Abdominal  pain,  sweating,  pyrexia, 
erythema,  neuralgia,  nausea,  vomiting,  ouguria, 
glycosuria,  ataxia,  somnolence  deepening  to  coma, 
trembling  and  restlessness  during  the  sleep,  faU  of 
temperature. 

Viburni  Prunifolii  Extractum. 

Adult  Dosage. — Av.,  gr.  viii. 

Uses. — Uterine  sedative. 

Viburni  Prunifolii  Fluidextractum. 

Adult  Dosage. — Min.,  n^x;  av.,  xxx;  max.,  xlv. 

Method  of  Administration. — Fluidextracti  vi- 
burni prunifolii,  gi. 

Sig. — -Thirty  drops  in  water,  three  to  four  times  a 
day. 

Uses. — Uterine  sedative. 

Vichy  Salt,  Artificial;  Sal  Vichyanum  Factitium, 
N.  F.  (pot.  carb.  3.85,  mag.  sulphate  8,  sod.  chloride 
7.7,  sod.  bicarb.  84.6). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — In  a tumblerful  of 
water,  one  hour  before  meals. 

Uses. — Alkahne  saline  cathartic. 

Vichy  Salt  Effervescent,  Artificial;  Sal  Vichyanum 
Factitium  Effervescens  N.  F.  (Artificial  Vichy  salt 
25,  sod.  bicarb,  48.5,  tartaric  acid  16.45,  citric  acid 
to  100). 

Adult  Dosage. — Av.,  3i- 

Method  of  Administration. — In  a tumblerful  of 
water,  one  hour  before  meals. 

Uses. — Alkaline  sahne  cathartic. 

V'insip. 

Vinum  Album;  white  wine  (alcohol  7 to  12  per 
cent,  by  weight). 

Adult  Dosage. — Min.,  gi;  max.,  iv. 

Includes  California  Riesling,  Ohio  Catawba,  etc., 
made  by  fermenting  grape  juice,  freed  from  seeds, 
stems,  and  skins. 

Uses. — Alcoholic  stimulant  and  sedative. 

Vinum  Antimonii  (about  2 grs.  of  tartar  emetic  to 
the  ounce;  soluble  in  12  of  water). 

Adult  Dosage. — Min.,  i|ev;  av.,  xv;  max.,  xx. 

Method  of  Administration. — Employ  doses  of  three 
minims  as  an  expectorant. 

Vinum  Colchici  Seminis. — See  Colchici  Seminis, 
Vinum. 

Vinum  Ferri  Amarum.— See  Ferri  Vinum  Amarum. 

Vinum  Ferri  Citratis. — See  under  Ferri  et  Am- 
monii  Citras. 

Mnum  Ipecacuanhse.  See  Ipecacuanhae,  Vinum. 

Vinum  Rubrum;  Red  Wine  (alcohol  7 to  12  per 
cent,  by  weight). 

Adult  Dosage. — Min.,  gi;  max.,  iv.  Includes  native 
claret,  burgundy,  etc.,  made  by  fermenting  the 
juice  of  colored  grapes  with  their  skins. 

Uses. — Alcoholic  stimulant,  sedative,  and  astrin- 
gent. 

V'inum  Xericum;  Sherry  Wine  (alcohol  20  to  35 
per  cent.). 

Dosage. — 18  months,  gtt.  'xxx;  3 years,  gtt.  xlv- 
gi;  5 years  gi-u.  Adult,  min.,  gi;  max.  ii. 

Method  of  Administration. — Every  one  to  four 
hours,  diluted  with  water;  no  more  than  1 to  2 
ounces  in  twenty-four  hours  to  a child  of  one  year  or 
less,  6 to  8 ounces  to  a child  of  five  years,  20  ounces 
to  an  adult. 

Uses. — Alcoholic  stimulant  and  sedative. 

Vleminckx’s  Solution;  Liquor  Calcis  Sulphur- 
atae. 


ZINCI  PHENOLSULPHONAS 


Method  of  Administration. — Calcis,  5ss;  sul- 
phuris  prjBcipitati,  Bi;  aqu®  destillat®,  5x. 

M.  Boil  down  to  six  ounces,  and  filter. 

Sig. — Dilute  at  first  with  about  ten  parts  of 
water,  and  bathe  the  parts  for  five  to  ten  minutes. 
Increase  the  strength  gradually  every  few  nights, 
with  the  object  of  producing  some  irritation. 

Uses. — Stimulating  lotion;  depilatory. 

Waters,  Cereal.  See  Cereal  Waters. 

Waters,  Mineral.  See  Mineral  Waters. 

Wax,  White;  Cera  Alba  (yellow  beeswax  bleached; 
soluble  in  oUs). 

Wax,  Yellow;  Cera  Flava  (beeswax;  soluble  in  oils). 

Uses. — Gives  consistence  to  cerates  and  ointments. 

Whiskey;  Spiritus  Prumenti  (37  to  47.5  per  cent, 
of  alcohol  by  weight). 

Dosage. — 6 months,  gtt.  v-x;  18  months,  gtt.  x-xx; 
3 years,  gtt.  xx-xxx;  5 years,  gtt.  xxx-jd.  Adult, 
min.,  3ii;  av.,  §ii;  max.,  iv. 

Method  of  Administration. — Every  one  to  four 
hours,  diluted  six  to  ten  times  -with  water;  no  more 
than  to  1 ounce  in  twenty-four  hours  to  a child 
of  one  year  or  less;  3 to  4 ounces  to  a child  of  five 
years,  10  ounces  to  an  adult. 

Physiologic  Action  and  Uses. — General  stimulant 
in  its  initial  effect;  followed  by  sedation  and  event- 
ually narcosis;  diaphoretic,  dilating  the  cutaneous 
vessels;  antipyretic;  diuretic;  removes  inhibition; 
produces  euphoria  by  blunting  the  feehngs  of  dis- 
comfort; stomachic;  antiseptic;  local  rubefacient. 

Wild  Cherry  Syrup;  Syrupus  Pruni  Virginian® 
(contains  HCN). 

Dosage. — 3 years,  3ss;  5 years,  3i-  Adult,  min., 
3ss;  av.,  i;  max.,  iss. 

Uses. — Bronchial  sedative;  flavor  and  vehicle. 

Toxic  Action. — Cardiac  depression. 

Wine.  See  Vinum. 

Wintergreen,  Oil  of.  See  Gaultheri®,  Oleum. 

Witch-Hazel.  See  Hamamehs. 

Wright’s  Hypertonic  Solution  (sodium  chloride  5, 
sod.  citrate  0.5  to  1,  water  to  100).  The  citrate  is 
added  to  prevent  coagulation  of  lymph. 

Uses. — Purpose:  to  produce  a “lymph  lavage’’  of 
infected  wounds  by  osmosis. 

Yeast;  Brewers’  Yeast,  Fresh. 

Method  of  Administration. — Four  to  five  wineglass- 
fuls a day,  or  a teaspoonful  to  a tablespoonful, 
t.i.d.a.c. 

Uses. — For  furunculosis;  used  also  to  ferment 
milk. 

Yeast  Cake;  Compressed  Yeast;  Cerexdsi®  Fer- 
mentum  Compressum. 

Method  of  Administration. — One-half  teaspoonful 
daily  to  a child  of  two  to  three  years.  (Holt.) 

Uses. — For  furunculosis;  used  also  to  ferment 
milk. 

Yerba  Santa;  Eriodictyon. 

Adult  Dosage. — Min.,  gr.  v;  av.,  xv;  max.,  xxx. 

Physiologic  Action  and  Uses. — Expectorant;  com- 
bined with  glycyrrhiza  to  disguise  the  taste  of 
quinine. 

Yerba  Santa,  Fluid  extract;  Fluidextractum  Erio- 
dictyi. 

Adult  Dosage. — Min.,  t^v;  av.,  xv;  max.,  xxx. 

Physiologic  Action  and  Uses. — Expectorant;  com- 
bined with  glycyrrhiza  to  disguise  the  taste  of 
quinine. 

Yerbazine  (preparation  of  Yerba  Santa,  made  by 
Lilly  and  Co.). 

Uses. — Menstruum  for  quinine. 

Yohimbina  (alkaloid;  keep  in  an  amber-colored 
bottle  in  a dark  place). 

Adult  Dosage. — Min.,  gr.  Ko,’  max.,  Yt. 

Method  of  Administration. — Yohimbin®  solu- 
tionis, 2 per  cent.,  gss. 

60 


Sig. — iiEV-viii,  gradually  increased  to  n^^xvi. 
(Potter.) 

Physiologic  Action  and  Uses. — Aphrodisiac;  pro- 
duces vasodilatation  in  the  external  genitalia  by 
direct  action  on  the  vessel  walls,  and  also  augments 
the  reflex  excitabihty  of  the  centres  of  erection  in 
the  cord;  local  anssthetic. 

Yohimbin-Urethane;  Vasotonin  (Urethane  is 
.(Ethyhs  Carbamas:  NH2.CO.O(C2H5). 

Method  of  Administration. — Subcutaneously,  every 
day  or  every  other  day. 

Physiologic  Action  and  Uses. — Used  in  arterial 
hypertension  because  of  its  peripheral  vasodilator 
action. 

Ze®  Fluidextractum  (Corn  Silk). 

Adult  Dosage. — Min.,  3ss;  av.,  i;  max.,  ii. 

Method  of  Administration. — Fluidextracti  ze®, 
5ii. 

Sig. — One-half  to  one  teaspoonful,  with  lots  of 
water,  every  three  to  four  hours. 

Uses. — Diuretic;  urinary  sedative. 

Zinci  Acetas:  CHsCOOv 

yZn  -1-2H20 
CHsCOO^ 

(soluble  in  2.3  of  water  and  in  30  of  alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  ii;  max.,  hi. 

Method  of  Administration. — Collyrium:  gr.  ss-u, 
ad  5i. 

Uses. — Astringent;  antiseptic. 

T oxic  Action. — Gastro-enteritis. 

Zinci  Bromo=Valeras. 

Adult  Dosage. — Min.,  gr.  i;  max.,  hi. 

Uses. — Nerve  sedative. 

Zinci  Carbonas  Pr®cipitatus:  ZnCOs  (soluble  in 
water  or  alcohol). 

Uses. — Local  protective. 

Zinci  Chloridum:  ZnCL  (.soluble  in  0.25  of  water 
and  in  1.3  of  alcohol). 

Method  of  Administration. — CoUyrium:  gr.  i-ii, 
ad  5i. 

Throat  astringent  lotion:  gr.  x-xx  ad  3i- 

Uses. — Antiseptic;  astringent;  caustic. 

Toxic  Action. — Gastro-enteritis. 

Zinci  lodidum:  ZnU  (very  soluble  in  water  and 
in  alcohol). 

Adult  Dosage. — Min.,  gr.  ss;  av.,  i;  max.,  ii;  in 
syrup. 

Zinci  Oxidi  Unguentum  (Zn.  ox.  20,  benzoinated 
lard  80). 

Uses. — Protective,  sedative  emolhent. 

Zinci  Oxidum:  ZnO  (in.soluble  in  water  or  alcohol). 

Dosage. — 5 years,  gr.  i-ii-v.  Adult,  min.,  gr.  v; 
max.,  X. 

Method  of  Administration. — In  pill,  t.i.d.,  in 
ephepsy,  to  obviate  impairment  of  memory. 

As  a dusting  powder;  5 to  10  per  cent.,  with 
starch  or  talcum. 

Uses. — Protective,  antiseptic,  astringent,  and 
anhidrotic  dusting  powder. 

Toxic  Action. — Vomiting. 

Zinci  Peroxidum  (Zn02,  at  least  45  per  cent,  with 
ZnO;  practically  insoluble  in  water,  but  gradually 
decomposed  by  it  into  hydrogen  peroxide  and  zinc 
hydroxide,  the  latter  further  decomposing  the  former 
with  the  liberation  of  oxygen).  It  may  be  sterilized 
by  heat,  being  .stable  at  150°  C. 

Method  of  Use. — As  a dusting  powder,  either 
alone  or  mixed  with  tannin. 

As  an  ointment, — 10  per  cent.. 

Uses. — Antiseptic;  astringent. 

Zinci  Phenolsulphonas;  Zinci  Sulphocarbolas 
(soluble  in  1.6  of  water  and  in  1.8  of  alcohol^ 

Adult  Dosage. — Min.,  gr.  i;  av.,  ii;  max.,  v. 

Method  of  Administration. — B Zinci  phenolsul- 
phonatis,  gr.  xlviii  (gr.  hi  per  dram);  aqu®,  gh. 


ZOOLAK 


M.  Sig. — One  dram  in  water,  three  to  four  times 
daily. 

Uses. — Local  and  internal  antiseptic  and  astringent. 

Zinci  Phosphidum. 

Adult  Dosage. — Min.,  gr.  Mol  max.,  Hz. 

Method  of  Administration. — PJ  Zinci  phospliidi, 
gr.  H,  pilulaj  no.  30. 

Sig. — One  pill,  t.i.d. 

Physiologic  Action  and  Uses. — Alterative.  See 

Phosphorus. 

Zinci  Stearas  (practically  insoluble  in  water  and 
alcohol). 

Uses. — Astringent  dressing  powder  and  vehicle. 

Zinci  Stearatis  Unguentum  (zn.  stearate  50,  white 
petrolatum  to  100). 

Uses. — Protective  emollient. 

Zinci  Sulphas:  ZnS04+7H20  (soluble  in  0.6  of 
water;  practically  insoluble  in  alcohol). 

Adult  Dosage. — Min.,  gr.  x;  av.,  xv;  max.,  xxx. 

Method  of  Administration. — In  aqueous  solution, 
as  an  emetic,  repeated  in  fifteen  minutes,  if  neces- 
sary. 

As  an  astringent  solution  for  the  eye:  gr.  i-iii-v, 
ad  5i. 

As  an  astringent  throat  lotion:  gr.  x-xx,  ad  §i. 

As  a urethral  astringent:  gr.  iiss-xix,  ad  5i- 

Physiologic  Action  and  Uses. — Astringent;  styptic; 
caustic;  emetic;  acting  refiexly  upon  the  gastric 
mucous  membrane;  not  very  poisonous. 

Toxic  Action. — -Gastro-enteritis. 

Zinci  Sulphocarbolas. — -See  Zinci  Phenolsul- 

phonas,  above. 


Zinci  Valeras  (soluble  in  70  of  water  and  in  22  of 
alcohol). 

Adult  Dosage. — Min.,  gr.  av.,  ii;  max.,  iv. 

Method  of  Administration. — Zinci  valeratis, 
gr.  ii,  capsulae  no.  30. 

Sig. — One,  t.i.d.  It  may  be  given  up  to  gr.  xxx 
t.i.d.,  in  diabetes  insipidus. 

Uses. — Nerve  sedative;  central  nervous  depres- 
sant (?). 

Zingiberis  Fluidextractum;  FI.  ext.  of  Ginger. 

Adult  Dosage. — Min.,  t^x;  av .,  xv;  max.,  xxx. 

Method  of  Administration. — I^  Fluidextracti  zin- 
giberis, 5ss. 

Sig. — Fifteen  drops  in  hot  water,  every  two  hours. 

Uses. — Carminative;  stimulant;  flavor. 

Toxic  Aciion.— Gastro-intestinal  irritation. 

Zingiberis  Syrupus;  Syrup  of  Ginger  (fl.  ext.  ginger 
2,  alcohol  2,  syrup  to  100). 

Adult  Dosage. — Min.,  3i;  av.,  iv;  max.,  5i- 

Uses. — Flavor;  carminative. 

Zingiberis  Tinctura;  Tincture  of  Jamaica  Ginger 
(20  per  cent.). 

Adult  DoscLge. — Min.,  njx;  av.,  xxx;  max.,  3i. 

Uses. — -Flavor;  carminative;  stimulant. 

Zoolak;  Matzoon:  Boil  thoroughly  llj^  quarts 
of  milk  and  remove  all  the  cream  from  the  top. 
While  the  milk  is  still  quite  warm,  add  and  mix 
thoroughly  a bottle  of  prepared  bottled  Zoolak; 
place  quickly  in  pint  bottles,  not  entirely  full;  cork 
tightly  at  once,  and  keep  in  a warm  place  until  the 
liquid  appears  creamy  through  the  bottles.  Then 
keep  in  a cold  place. 


PHARMACOLOGIC  INDEX 


Absorbents  (L.  ah  from  + sor'bere  to  suck).— 
Wood  charcoal;  Kaolin 

Acidifiers,  Urinary. — See  Urinary  Acidifiers. 

Alkalinizers,  Blood. — See  Blood  Alkalinizers. 

Alteratives  (L.  altera' re  to  change). — Iodine,  e.g., 
tr.  iodi,  the  iodides,  Lugol’s  sol.,  sajodin,  dilute 
hydriodic  acid,  syrup  of  hydriodic  acid,  iodipin, 
iodoform,  iodol;  arsenic,  e.g. — Fowler’s  sol.,  salvar- 
san,  neo-salvarsan,  sod.  cacodylate,  Donovan  s sol.; 
mercury,  e.g. — the  protiodide,  biniodide,  oleate,  etc.; 
sulphur;  ichthyol,  ichthalbin;  phosphorus,  dilute 
phosphoric  acid,  hypophosphites,  glycerophosphates, 
lactophosphates;  gold  chloride,  gold  and  sodium 
chloride;  calcium,  e.g. — calc,  chloride,  calc,  lactate, 
calc,  glycerophosphate,  calc,  hypophosphite,  calc, 
sulphide,  syrup  of  calc,  lactophosphate,  ehxir  of 
calc,  and  sod.  glycerophosphate;  glandular  prepara- 
tions, e.g. — thyroid,  parathyroid,  adrenal,  ovarian, 
corpus  luteum  or  lutein,  pituitary,  thymus,  iodo- 
thyrin;  antithyroidin;  yeast  and  yeast  preparations, 
e.g. — furunculin  (yeast  powder),  ceredin  or  cerolin 
(yeast  fats) ; iron,  e.g. — syrup  of  the  iodide,  elixir  of 
iron,  quinine,  and  strychnine  phosphate,  etc.;  cod- 
liver  oil;  creosote;  guaiacum,  guaiacol;  thiosinamin, 
fibrolysin. 

Amoebicides  (Gr.  afioifSr/  change  -f-  L.  coe'dere  to 
kill). — Ipecac;  emetin  hydrochloride;  emetine  bis- 
muth iodide. 

Anaesthetics,  General  (Gr.  av  not  -f  aladtjcnq  sen- 
sation).— Ether;  chloroform;  nitrous  oxide;  ethyl 
chloride. 

Anaesthetics,  Local. — Cocaine,  novocaine,  eucaine, 
holocaine;  alypin;  acoin;  quinine  and  urea  hydro- 
chloride; anesthesin;  orthoform;  chloretone;  guaia- 
col; ethyl  chloride;  ethyl  iodide;  ether;  menthol;  oil 
of  clove ; carbolic  acid ; yohimbin ; aconite ; antipyrine. 

Analgesics,  General  (Gr.  av  neg.  + d?.yof  pain). — 
Opium,  laudanum,  paregoric,  Dover’s  powder,  mor- 
phine, codeine,  dionin,  Schlesinger’s  analgesic  solu- 
tion, cannabis  indica,  hyoscyamus,  hyoscin,  hyo- 
scyamine  hydrobromide,  gelsemium,  aconite,  chloral, 
butyl  chloral  hydrate,  hypnal,  acetanihd,  comp, 
acetanilid  powder,  exalgin,  antipyrin,  salipyrin, 
phenacetin,  salophen,  phenocoll^  triphenin,  lacto- 
phenin,  pyramidon,  salicylic  acid,  sod.  salicylate, 
methyl  salicylate,  aspirin,  novaspirin,  sod.  bicar- 
bonate, caffeine,  guarana,  elixir  guaranaj  et  celerina;, 
ether,  spt.  of  ether,  comp.  spt.  of  ether,  alcohol, 
quinine,  colchicum,  cimicifuga,  chloroform. 

Analgesics,  Local. — Sod.  bicarb.,  iodoform,  ace- 
tanilid, dionin,  menthol,  camphor,  camphor-chloral, 
spt.  of  camphor,  ichthyol,  oil  of  peppermint,  oil  of 
wintergreen,  chloroform,  chloroform  liniment,  comp, 
chloroform  liniment,  aconite,  ammonia  water.  Ful- 
ler’s lotion,  lead  and  opium  wash,  picric  acid,  bella- 
donna liniment,  plaster,  and  ointment,  ung.  stra- 
monii,  ung.  veratrina;,  ung.  gallse  et  opii,  and  the 
drugs  enumerated  under  Anesthetics,  Local,  and 
Antipruritics. 

Anaphrodisiacs  (Gr.  av  neg.  -|-  afpoSiaia  venery). 
— Bromides,  bromoform,  monobromated  camphor. 
(See  also  Priapism,  in  Part  3.) 

Anhidrotics  (Gr.  av  priv.  + iSp6^  sweat). — Atro- 
pine, belladonna,  duboisine,  eumydrin,  muscarine, 
picrotoxin,  agaricinic  acid,  sod.  agaracinate,  cam- 
phoric acid,  guaiacamphol,  sod.  or  potass,  tellurate, 
sage,  zinc  oxide.  Local  anhidrotics  are  formalin, 
tannoform.  (See  also  Hyperidrosis,  General  and 
Local,  in  Part  5.) 


Anodynes,  General  (Gr.  av  neg.  o&vvn  pain). — 
See  Analgesics,  General. 

Anodynes,  Local. — See  Analgesics,  Local. 

Antacids,  Gastro=Intestinal,  Etc.  (L.  an'ii  against 
-F  a'cidus  sour). — Sod.  bicarbonate,  sod.  carbonate, 
sod.  biborate,  sod.  hydroxide,  potass,  hydroxide,  liq. 
sod.  or  pot.  hydroxide,  soda-mint,  ammonia  water, 
mist,  rhei  et  soda;,  milk  of  magnesia,  mag.  carbonate, 
mag.  oxide,  lime-water,  precipitated  chalk,  prepared 
chalk,  comp,  chalk  powder,  lithium  bicarbonate, 
carbonate,  citrate,  and  effervescent  citrate.  (See 
also  Hyperacidity,  in  Part  1.) 

Antacids,  Urinary. — See  Urinary  Antacids. 

Anthelmintics  {Gr.avri  against  -f-  i^.pivg  worm). — ■ 
Aspidium,  chenopodium,  santonin,  pepo  or  pumpkin 
seed,  pomegranate,  thymol,  myrtol,  chloroform,  beta- 
naphthol,  salol,  calomel,  tansy,  .spigelia,  turpentine, 
pelletierine,  garlic,  asafoetida,  quassia,  benzine, 
acetic  acid. 

Antifermentatives  (L.  an'ii  against  -f-  fermen'tum 
leaven). — Resorcin,  hydrochloric  acid,  sulphurous 
acid,  sod.  hyposulphite,  bacillus  Bulgaricus  (intest, 
antiferment.),  koumiss  (intest,  antiferment.). 

Antileprosy.' — -Mag.  or  sod.  gynocardate;  bals. 
gurjunsc;  chaulmoogra  oil;  hoang-nan;  leprolin. 

Antilithics  (Gr.  avrc  against  -|-  A/(?of  stone).— Uric 
Acid  and  Urate  Solvents:  Mag.  borocitrate,  potass, 
tartraborate,  ammon.  hippurate,  precipitated  chalk, 
piperazin,  citarin.  Stimulators  of  Uric  Acid  Excre- 
tion: Colchicum,  atophan,  citarin,  sod.  salicylate. 
(See  also  Nephrolithiasis  and  Gout,  in  Part  1.) 

Antiluetics. — Mercury,  e.g.,  mercurial  ointment, 
blue  ointment,  mercury  vasogen,  oleate  of  mercury, 
gray  oil,  blue  mass,  gray  powder,  calomel,  mercury 
succinimid,  tannate,  bichloride,  protiodide,  binio- 
dide, cyanide,  oxycyanide,  salicylate;  arsenic,  e.g., 
salvarsan,  neosalvarsan ; iodides,  sajoclin. 

Antimalarial. — Quinine,  euquinine,  aristoquin, 
arsenic,  methylene  blue. 

Antineuralgics  (Gr.  avrt  against  + vevpov  nerve  -f 
aXyog  pain). — See  Analgesics. 

Antiparasitics.— See  Parasiticides. 

Antiphlogistics  (Gr.  avri  against  -F  <pX6yuaoc  in- 
flammation, from  <tiX6^  flame). — Antiphlogistin,  cata- 
plasma  kaohni,  ichthyol,  ichthyol  ointment. 

Antipruritics  (L.  an'ti  against  -F  pruri're  to  itch). 
— Carbolic  acid,  sod.  bicarbonate,  borax,  lime-water, 
ammonia  water,  cherry-laurel  water,  calamine  lotion, 
calamine  lininient,  menthol,  camphor,  camphor- 
chloral,  camphor  ointment,  menthol  ointment,  tar 
ointment,  bromocoll  ointment,  thigenol,  and  the 
drugs  enumerated  under  Analgesics,  Local.  (See 
also  Pruritus,  in  Part  5.) 

Antipyretics  (Gr.  dvrt  against  -F  fire). — Ace- 

tanelid,  antipyrin,  phenacetine,  salipyrin,  salophen, 
triphenin,  lactophenin,  phenocoll,  pyramidon,  sali- 
cylic acid,  sod.,  methyl  and  phenyl  salicylate, 
aspirin,  quinine,  resorcin,  phenol,  guaiacol,  alcohol, 
thallin  sulphate,  veratrum  viride,  aconite,  liq.  am- 
monii  acetatis,  citric  acid,  dilute  pho.sphoric  acid, 
dilute  acetic  acid,  potassium  acetate,  citrate,  bicar- 
bonate, bitartrate,  and  nitrate,  water.  (See  also 
Fever,  in  Part  1.) 

Antirheumatics. — Salicylic  acid,  sod.  salicylate, 
salol,  oil  of  wintergreen,  salicin,  salophen,  salipyrin, 
aspirin,  novaspirin. 

Antiseptics,  Biliary  (Gr.  avri  against  -F  ag-ipcf 
putrefaction). — Sodium  salicylate,  helmitol. 

Antiseptics,  Blood. — See  Blood  Antiseptics. 


PHARMACOLOGIC  INDEX 


Antiseptics,  Broncho- Pulmonary. — See  Broncho- 
pulmonary Antiseptics. 

Antiseptics,  Gastric. — See  Antifermentatiyes. 
Antiseptics,  Intestinal. — See  Intestinal  Antiseptics. 
Antiseptics,  Local. — (a)  Aqueous  Solutions;  Loef- 
fler’s  sol.,  calamine  lotion,  calamine  liniment,  black 
wash,  Mandl’s  sol.,  lysol,  hydrogen  peroxide,  per- 
hydrol,  sulphocarbolate  of  sod.  or  zinc,  potass,  per- 
nianganate,  argyrol,  protargol,  silver  nitrate,  acri- 
flavin,  mercurochi'oine,  pyoktanin,  resorcin,  zinc 
chloride,  zinc  sulphate,  zinc  acetate,  benzoic  acid, 
boric  acid,  carbohe  acid,  dilute  hydrochloric  acid, 
picric  acid,  acoin,  alcohol,  garlic,  liq.  alumin.  acet., 
alumnol,  ichthyol,  liq.  antisepticus,  liq.  antisepticus 
alkalinus,  mercury  bichloride,  borax,  Burow’s  sol., 
calcium  permanganate,  chloride  of  lime,  chloretone, 
chlorine  water,  chloroform  water,  cinnamon  water, 
creolin,  cresol,  h(j.  cresol.  comp.,  copper  salts, 
Dakin’s  solution,  Dobell's  sol.,  optochin,  guaiacol, 
mere,  cyanide,  oxycyanide  of  mercury,  mere,  sali- 
cylate, sod.  hyposulphite,  iodine  trichloride,  liq. 
carbonis  detergens,  liq.  picis  alkalinus,  liq.  picis 
carbonis,  infus.  picis  liquid®,  liq.  sod®  chlorinate. 

(b)  Fluids,  Pastes  and  Oils:  Lysol,  creolin,  cresol, 
liq.  cresol.  comp.,  naphthol-camphor,  oil  of  clove, 
oil  of  tar,  oil  of  turpentine,  sanitas  oil,  carbolic  acid, 
glyceritum  acidi  carbolici,  lactic  acid,  acetic  acid, 
alcohol,  ichthyol,  balsam  of  Peru,  boroglyceride, 
carbolated  iodine,  chloroform,  dichloramin-T,  euca- 
lyptus, gomenol  oil,  guaiacol,  iodol;  B.  I.  I.  P.  or 
Morrison’s  paste,  Beck’s  bismuth  paste,  tr.  of  myrrh, 
tr.  of  iodine,  the  volatile  oils  (oil  of  peppermint, 
anise,  etc.). 

(c)  Powders  and  Solids;  lodophen  or  nasophen, 
tannoform,  thymol,  aristol,  zinc  o.xide,  zinc  stearate, 
acetanilid,  phenacetine,  benzoic  acid,  borje  acid, 
salicylic  acid,  alumin.  acetate,  silver  nitrate,  argyrol, 
bismuth  salts,  borax,  camphor,  iodex,  iodoform, 
europhen,  emplast.  hydrargyri. 

(d)  Ointments:  Mercury,  beta-naphthol,  ol.  rusci, 
tar,  pyrogallol,  resorcin,  scarlet  red,  sulphur,  zinc 
oxide,  zinc  stearate,  benzoic  acid,  boric  acid,  carbolic 
acid,  saUcylic  acid,  ammoniated  mercury,  ichthyol, 
Crete,  bals.  of  Peru,  chrysarobin,  diachylon,  epicarin, 
citrine,  hydrarg.  ox.  flav.,  iodex,  iodine,  iodoform. 

Antiseptics.  Meningeal. — Helmitol;  salvarsan,  etc. 
Antiseptics.  Pancreatic. — Helmitol. 

Antiseptics.  Salivary. — Helmitol;  potass,  chlorate. 
Antiseptics,  Urinary. — See  Urinary  Antiseptics. 
Antisialics  (Gr.  avri  against  cia7Mv  saliva). — • 
Atropine,  belladonna,  duboisine,  potass,  or  sod. 
chlorate. 

Antispasmodics,  Biliary  (Gr.  avri  against  + 
aKaafioQ  spasm). — Atropine,  morphine,  nitroglycer- 
ine, sod.  nitrite.  (See  also  Cholelithiasis,  in  Part  1.) 

Antispasmodics,  Bronchial. — See  Bronchial  Anti- 
spasmodics. 

Antispasmodics,  Intestinal. — See  Intestinal  Anti- 
spasmodics. 

Antispasmodics,  Renal. — Atropine;  morphine; 
sod.  nitrite;  nitroglycerine.  (See  also  Nephrolithia- 
sis, in  Part  1.) 

Antispasmodics,  Uterine. — See  Uterine  Sedatives. 
Antisyphilitics. — See  Antiluetics. 

Aperients  (L.  ape'rien.'j  opening). — See  Purgatives. 
Aphrodisiacs  (Gr.  rlApofS;n-('a  venery).— Phosphorus, 
dilute hypophosphorous acid;  yohimbine ; asafoetida, 
cannabis  indica;  cimicifuga;  oil  of  rue;  oil  of  savin; 
tr.  cantharidis;  tr.  capsici.  (See  al»o  Impotence,  in 
Part  3.) 

Appetizers  (L.  appe'tcre  to  desire).  — See  Sto- 
machics. 

A.stringents,  Intestinal  (L.  ad  to  -)-  strin'gere  to 
bind).— See  Intestinal  Astringents. 


Astringents,  Local. — Copper  salts;  zinc  salts,  e.g. — 
acetate,  chloride,  sulphate,  oxide,  stearate,  peroxide, 
sulphocarbolate;  lead,  e.g. — lead  acetate,  lead  water, 
Goulard’s  extract,  lead  and  opium  wash,  ceratum 
plumbi  subacetatis;  alum,  alumnol,  liq.  alum,  ace- 
tatis;  Burow’s  solution;  iron  sulphate,  tr.  ferric 
chloride,  liq.  ferri  sesquichloridi,  IVIonsel’s  solution, 
Loeffier’s  solution;  silver  nitrate,  argyrol;  gallic  acid, 
tannic  acid,  glyceritmn  acidi  tannici,  ung.  acidi 
tannici,  ung.  gall®,  ung.  gall®  et  opii;  kino;  krameria; 
catechu  or  gambir;  precipitated  chalk,  prepared 
chalk,  compound  chalk  powder;  tr.  of  myrrh;  potass, 
chlorate;  resorcin;  dilute  hydrochloric  acid;  dilute 
and  aromatic  sulphuric  acid;  alcohol;  borax;  dia- 
chylon ointment;  witch-hazel;  formalin;  bismuth 
salts. 

Astringents,  Urinary. — See  Urinary  Astringents. 
Biliary  Antiseptics. — Sod.  salicylate;  helmitol. 
Biliary  Antispasmodics. — Atropine,  morphine,  ni- 
troglycerine, sod.  nitrite.  (See  also  Cholehthiasis,  in 
Part  1.) 

Bitters,  Stomachic. — See  Stomachic  Bitters. 
Blistering  Agents. — See  Vesicants. 

Blood  Alkalinizers  or  Antacids  (Arabic  al-qaliy 
potash). — Potassium  acetate,  citrate,  bicarbonate 
and  bitartrate;  sodium  carbonate  and  bicarbonate. 
(See  also  Acidosis,  in  Part  1.) 

Blood  Antiseptics. — Sod.  sulphide;  electrargol; 
collargol;  ung.  Crede;  nuclein;  mercury  preparations; 
salvansan;  neosalvarsan;  arsenous  acid;  sodium 
arsanilate;  tartar  emetic;  quinine;  optochin. 

Bronchial  Antispasmodics  (Gr.  avri  against  -f 
a~aap6^  spasm). — Atropine,  belladonna,  nitroglycer- 
ine, sod.  nitrite,  amyl  nitrite,  sod.  or  potass,  iodide, 
hydriodic  acid,  ethyl  iodide,  ether,  potass,  nitrate 
(paper),  stramonium,  pyredin,  tr.  and  comp.  tr.  of 
benzoin,  adrenalin,  grindelia,  calcium  salts,  lobelia, 
syrup  or  fl.  ext.  of  wdld  cherry,  codeine,  morphine. 
(See  also  Asthma,  in  Part  1.) 

Broncho=Pulmonary  Antiseptics. — Creosote,  creo- 
sote carbonate,  creosote  valerate,  oil  of  turpentine, 
terebene,  terpene  hydrate,  thiocol,  eucalj-ptus, 
myrtol,  balsam  of  tolu,  copaiba,  cubebs,  sandalwood. 

Broncho-Pulmonary  Deodorizers  (L.  de  from  -f 
o'dor  odor). — Turpentine,  copaiba,  cubebs,  sandal- 
wood, creosote. 

Cardiac  Sedatives  (L.  sedo  I allay). — Aconite, 
veratrum,  muscarine. 

Cardiac  Stimulants  (L.  stim'ulus  goad). — Digi- 
talis, digitahn,  digitoxin,  digipuratum;  strophanthus, 
strophanthin;  squills;  adonis  vernahs;  apocjmum; 
cimicifuga;  convallaria;  strv'chnine,  nux  vomica; 
atropine,  belladonna;  caffeine;  camphor;  spt.  cam- 
phor®; ether;  spt.  ®theris;  spt.  ®theris  comp.;  ethyl 
iodide;  alcohol;  spt.  of  peppermint;  Addison’s  or 
Guy’s  pill;  aqua  ammoni®,  arom.  spt.  of  ammonia; 
ammon.  carbonate;  adrenalin;  pituitrin;  morphine. 

Carminatives  (L.  car'men  charm). — Peppermint 
oil,  spirit  and  water;  spearmint  oil,  spirit  and  water; 
soda-mint;  oil  of  aniseed,  oil  of  clove;  oil  of  penny- 
royal; ol.  origani;  caraway;  cardamom;  cinnamon 
oil,  water,  tinct.  and  syrup;  fennel  oil  and  water; 
oil  of  cajaput;  nutmeg;  tr.  of  mjTrh;  oil  of  turpen- 
tine; ginger;  sinapis;  asafoetida;  tr.  capsici;  comp, 
tr.  lavandul®;  alcohol;  ether,  spt.  mtheris,  spt. 
®theris  comp.;  chloroform,  spt.  chloroformi,  chlo- 
roform water;  arom.  spt.  ammoni®;  spt.  camphor®, 
camphor  water. 

Cathartics  (Gr.  Kadapatc  a cleansing). — See 
Purgatives. 

Caustics  (Gr.  K)a;E(v  to  burn). — Acetic  acid;  mono- 
chloracetic  acid;  trichloracetic  acid;  nitric  acid;  car- 
bolic acid;  lactic  acid;  chromic  acid;  arsenous  acid; 
liq.  hydrargyri  nitratis;  silver  nitrate;  iodine; 
Marsden’s  paste;  ammoniated  mercury;  alumenex- 


PHARMACOLOGIC  INDEX 


siccatum;  potass,  carbonate;  potass,  hydroxide;  liq. 
potass®;  sod.  caj’bonate;  sod.  hydroxide;  zinc  chlo- 
ride; zinc  sulphate. 

Cerebral  Sedatives  (L.  sedo  I allay). — See  Ner- 
vous Sedatives. 

Cerebral  Stimulants  (L.  stim'ulus  goad). — Caf- 
feine; atropine;  strychnine;  camphor;  asafoetida. 

Cholagogues  (Gr.  bile  -b  ayeuv  to  lead). — Fel 
bovis;  sod.  glycocholate;  salicylic  acid;  sod.  salicy- 
late; ammon.  chloride;  dilute  nitric  acid;  dilute  nitro- 
hydrochloric  acid;  euonymus. 

Circulatory  Sedatives. — See  Cardiac  Sedatives. 

Corrosives  (L.  con  with  -f-  ro'dere  to  gnaw). — See 
Caustics. 

Cough  Sedatives  (L.  sedo  I allay). — Morphine, 
codeine,  heroin,  dionin,  opium,  brown  mixture, 
chloral  hydrate,  chloroform,  calcium  salts,  ol.  pini 
pumilionis,  ol.  pini  sylvestris. 

Counter-Irritants.-^ee  Cutaneous  Irritants. 

Cutaneous  Irritants  or  Stimulants. — Mustard,  tur- 
pentine, camphorated  oil,  camphor-chloral,  emplas- 
trum  capsici,  ung.  capsid,  tr.  iodi,  ung.  iodi  or  iodo- 
vasogen,  iodized  phenol,  menthol,  cantharides,  ol. 
rusci,  oil  of  cade,  oil  of  tar,  oil  of  clove,  oil  of  sassa- 
fras, ol.  tiglii.  Burgundy  pitch,  ung.  picis  liquid®, 
pyrogallol  ung.,  scarlet  red,  pyrethrum,  potassa  sul- 
phurata,  tr.  of  green  soap,  Lassar’s  peeling  paste, 
lotio  alba,  alcohol,  bay  rum,  spt.  rosmarini,  tr.  and 
comp.  tr.  of  benzoin,  acetic  acid,  ammonia,  liniment, 
ammoni®,  chloroform  liniment,  comp,  chloroform 
liniment,  soap  liniment,  turpentine  liniment,  acetic 
turpentine  liniment,  infus.  picis  liquid®,  liq.  carbonis 
detergens,  liq.  calcis  sulphurat®,  liq.  picis  alkalinus, 
liq.  picis  carbonis. 

Cycloplegics. — See  Mydriatics  and  Cycloplegics. 

Cyclotonics. — See  Myotics  and  Cyclotonics. 

Demulcents. — Mucilage  of  acacia,  tragacanth, 
cydonium  and  sassafras  medull®;  dextrin;  licorice; 
glycerine;  flaxseed  or  linseed  tea;  linseed  oil;  ammon. 
chloride;  potass,  chlorate. 

Deodorants. — Potass,  permanganate;  wood  char- 
coal. 

Deodorizers,  Broncho-Pulmonary. — See  Broncho- 
Pulmonary  Deodorizers. 

Depilatories  (L.  de  from  -f-  pi'lus  hair). — Barium 
sulphide;  calcium  sulphide;  liq.  calcis  sulphurat®; 
electrolysis;  X-ray.  (See  also  Hypertrichosis,  in 
Part  5.) 

Depressants  (L.  de  down  -f-  prem'ere  to  press). — 
See  Sedatives. 

Detergents  (L.  deterge're  to  cleanse). — Castile 
soap;  soft  soap;  tr.  of  green  soap;  soap  liniment; 
borax;  sod.  carbonate.  „ 

Diaphoretics  (Gr.  5ia  through  -f-  <j>opnv  to  carry). 
— Pilocarpine,  pilocarpus;  physostigmin,  physo- 
stigma;  aconite;  lobelia;  morphine,  opium;  Dover’s 
powder;  ipecac;  senega;  apocynum;  asafoetida; 
cimicifuga;  colchicum;  eucal3q)tus;  copaiba;  guaia- 
cum;  juniper;  ammon.  acetate,  liq.  ammon.  acetatis, 
liq.  ferri  et  ammonii  acetatis;  dilute  acetic  acid; 
benzoic  acid;  spt.  ®theris  nitrosi;  potass,  nitrate; 
sqd.  sahcylate,  salol,  aspirin;  tartar  emetic;  terpcno 
hydrate;  alcohol;  camphor,  spt.  camphor;  tr.  capsici; 
elder  flower;  linden  flower  tea;  koumiss;  water. 

Digestives  (L.  dis  apart  -(-  grr'ere  to  carry). — 
Dilute  hydrochloric  acid,  betain  hydrochloride  (lib- 
erates nascent  HCl) ; fel  bovis  and  sod.  glycocholate 
(aid  digestion  of  fats) ; spt.  ®theris  (aids  digestion  of 
fats);  proteolytic  enzymes  (Gr.  iv  in  -j-  cr/xn  leaven), 
e.g. — pepsin,  peptogenic  milk  powder,  trypsin,  enzy- 
mol,  papayotin,  pancreatin;  amylolytic  enzymes, 
e.g. — diastase,  taka-diastase,  malt  extract,  cereo, 
pancreatin;  combined  proteolytic,  amylolytic  and 
lipolytic,  e.g. — pancreatin,  pancreon,  and  liq.  pan- 
creatini. 


Digestive  Stimulants. — See  Stomachics. 

Discutients  (L.  discu'tere  to  di.ssipate). — ^lodides. 

Disinfectants  (L.  dis- apart  inA'cere  to  corrupt). 
— See  Antiseptics.  „ 

Diuretics  (Gr.  &loc  through  -|-  chpew  to  urinate). — • 
Potassium  salts,  e.g. — acetate,  citrate,  nitrate,  bicar- 
bonate, bitartrate;  .sod.  nitrite;  liq.  potassii  citratis; 
lith.  citrate,  and  effervescent  hth.  citrate;  ammon. 
acetate,  liq.  ammon.  acetatis,  liq.  ferri  et  ammon. 
acetatis;  dilute  acetic  acid;  spt.  ®theris  nitrosi; 
benzoic  acid  and  benzoates;  alcohol;  iodides;  linseed 
oil;  lobeUa;  copaiba;  cubebs;  sandalwood;  oil  of 
tansy;  oil  of  turpentine;  sparteine,  squills;  senega; 
strophanthus;  digitalis;  Addison’s  or  Guy’s  pill; 
calomel;  adonis  vernalis;  apocynum;  asafo?tida; 
cimicifuga;  colchicum;  atophan;  urethane;  conval- 
laria;  euonymus;  grindelia;  guaiacum;  terpene  hy- 
drate; jalap;  diuretin;  theobromine;  theophyllin  or 
theocin;  agurin;  caffeine;  urea,  urol;  pareira;  saw 
palmetto;  spoparium;  triticum;  buchu;  uva  ursi; 
zea;  juniper;  flaxseed  tea;  tr.  cantharidis;  tr.  capsici; 
pituitary  extract;  koumiss;  milk;  water. 

Emetics  (Gr.  kpcriKdc). — Mustard;  sod.  chloride; 
alum;  zinc  sulphate;  copper  sulphate;  ipecac;  emetin 
hydrochloride;  apomorphine;  euporphine;  colchi- 
cum ; tartar  emetic. 

Emmenagogues  (Gr.  ep/xriva  menses  -f-  aynv  to 
lead). — Aloes,  aloin,  and  other  purgatives;  tr.  of 
myrrh;  pilula  aloes  et  myrrh®;  pilula  aloes  et  ferri; 
apiol;  asafoetida;  cotton-root  bark;  oil  of  pennyroyal; 
oil  of  rue;  oil  of  savin;  oil  of  tansy;  oxalic  acid;  potass, 
permanganate;  manganese  dioxide.  (See  also  Amen- 
orrhoea,  in  Part  2.) 

Emollients  (L.  e out  -f-  mol'lis  soft). — Petrolatum; 
liquid  petrolatum;  benzoinated  lard;  suet;  lanolin; 
linseed  oil;  olive-oil;  cottonseed  oil;  oil  of  sweet 
almond;  oil  of  sesame;  cacao  butter;  oleic  acid; 
glycerine;  glyceritum  amyli;  cold  cream;  ceratum 
resin®;  ceratum  simplex;  ung.  boric  acid;  ung. 
carbolic  acid;  ung.  zinc  oxide;  ung.  zinc  stearate; 
mucilage  of  cydonium ; carron  oil. 

Enzymes. — See  Digestives. 

Escharotics  (Gr.  £(yx^pa-  scab). — See  Caustics. 

Expectorants  (L.  ex  out  -|-  pec'his  breast).  — 
Ammon,  chloride;  ammon.  carbonate;  liq.  ammon. 
acetatis;  arom.  spt.  ammoni®;  ammon.  iodide;  cal- 
cium iodide;  sod.  or  potass,  or  strontium  iodide; 
syrup  of  hydriodic  acid ; creosote ; creosote  carbonate; 
creosote  valerate;  guaiacum;  guaiacol;  guaiacol  car- 
bonate; tolu  balsam;  tolu  syrup;  terebene;  terebene 
hydrate;  copaiba;  cubebs;  oil  of  tar;  syrup  of  tar; 
senega;  squills;  sanguinaria;  apocynum;  asafoetida; 
garlic;  cimicifuga;  lobeha;  galbanum;  hcorice;  yerba 
Santa;  ol.  anisi;  flaxseed  or  linseed  oil;  flaxseed  tea; 
ipecac;  tartar  emetic;  Brown  mixture;  physostigma; 
apomorphine;  euporpliin;  tr.  and  comp.  tr.  of  ben- 
zoin; camphor;  spt.  of  camphor;  Dover’s  powder. 

Ferments,  Digestive. — See  Digestives. 

Flavoring  Agents. — Peppermint  oil,  water  and 
essence;  spearmint  oil,  water  and  essence;  oil  of 
wintergreen ; oil  and  water  of  bitter  almond ; oil  and 
water  of  aniseed;  oil  of  bergamot;  oil  of  sassafras; 
mucilago  sassafras  medull®;  lemon  oil,  syrup  and 
tinct.;  orange  syrup,  comp,  spt.,  tinct.  of  sweet 
orange  peel,  tr.  of  bitter  orange  peel;  syrup  of  citric 
acid;  lavender  oil,  spt.,  and  comp,  tinct.;  syrup  of 
wild  cherry:  syrup  of  raspberry;  syrup  of  tolu;  cin- 
namon oil',  tinct.,  and  syrup;  licorice;  sarsaparilla; 
ginger;  caraway  seed;  simple  syrup;  aromatic  or 
simple  elixir;  coumarin;  glycerine;  cane  sugar;  milk 
sugar;  saccharin;  saxin;  dulcin  or  sucrol. 

Qalactogogues  (Gr.  ya?.a  milk  -|-  ayuySc  leading). 
— Pituitary  extract.  (See  also  under  Infant  Feeding, 
in  Part  1.) 


PHARMACOLOGIC  INDEX 


Qalactophyga  (Gr.  yala  milk  + flight). — 

Atropine,  belladonna.  (See  also  under  Management 
of  the  Puerperium,  in  Part  4.) 

Gastric  Antifermentatives. — See  Antifermenta- 
tives. 

Gastric  Antiseptics. — See  Antifermentatives. 

Gastric  Sedatives  (L.  se'do  I allay).  — Menthol; 
menthol  valerate  or  validol;  cocaine;  chloretone; 
chloral  hydrate;  chloroform;  codeine;  morphine; 
opium;  dilute  hydrocyanic  acid;  aqua  laurocerasi; 
lime-water;  tr.  iodi;  cerium  o.xalate;  ingluvin;  car- 
bohc  acid;  silver  nitrate;  bismuth  salts;  calomel  in 
small  doses;  condurango.  (See  also  under  Vomiting, 
in  Part  1.) 

Gastric  Stimulants. — See  Stomachics. 

Haematics  (Gr.  aiya  blood). — Iron  preparations, 
including  ovoferrin,  haemol,  haemogallol,  Basham’s 
mixture,  Bland’s  pill,  iron  and  aloes  pill,  elix.  ferri, 
quin,  et  strych.  phosphat.,  etc.;  arsenic  prepara- 
tions, including  Fowler’s  sol.,  sod.  cacodylate,  sod. 
arsanilate,  etc. 

Haemostatics  (Gr.  ciya  blood  -h  arariKd^  stand- 
still).— ^Epinephrin;  calcium  chloride,  calc,  lactate; 
normal  horse  serum;  stagnin;  coagulen;  mammary 
gland;  hydrastis,  hydrastinin;  ergot;  cotarnin  (styp- 
tol  and  stypticin);  gelatin;  cinnamon;  witch-hazel; 
oil  of  turpentine;  fl.  ext.  senecionis;  gallic  acid;  tan- 
nic acid;  alum;  lead  acetate;  acetic  acid;  sulphuric 
acid.  (See  also  Hemorrhage,  Hemoptysis,  and  He- 
matemesis,  in  Part  1.) 

Hypnotics  (Gr.  virvuTUidg) . — Opium;  morphine; 
Dover’s  powder;  codeine;  chloral  hydrate;  butyl 
chloral  hydrate;  chloralamide;  chloretone;  urethane; 
amylene  hydrate;  paraldehyde;  trional;  tetronal; 
veronal;  medinal  (veronal  sodium);  sulphonal; 
hedonal;  hypnal;  isopral;  bromural;  bromides;  bro- 
moform;  monobromated  camphor;  hyoscyamus; 
hyoscin;  hyoscyamine  hydrobromide;  pyramidon; 
phenacetine;  triphenin;  lactophenin;  cannabis  indica; 
cannabin;  hops;  alcohol;  koumiss. 

Intestinal  Antiseptics. — Menthol;  camphoric  acid; 
benzoic  acid  and  benzoates;  benzosalin;  eucalyptus; 
creosote;  guaiacol,  guaiacol  carbonate;  ichthalbin; 
beta-naphthol;  hydronaphthol;  naphthalene  tetra- 
chloride; tannopin;  potass,  or  calc,  permanganate; 
salol;  salophen;  oil  of  turpentine;  calomel;  bismuth 
salts;  liq.  antisepticus;  manganese  dioxide;  fel  bovis; 
lactic  acid;  lactobacilline  or  lactone;  bacillus  Bul- 
garicus;  hydrogen  peroxide;  bolus  alba. 

Intestinal  Antispasmodics. — Atropine;  belladonna; 
morphine;  opimn;  codeine;  nitroglycerine;  sod. 
nitrate. 

Intestinal  Astringents  and  Sedatives. — Opium; 
morphine;  codeine;  tannic  acid,  tannalbin,  tannigen, 
tannocol,  tannoform,  tannopin;  catechu  or  gambir; 
kino;  krameria;  coto-bark;  precipitated  chalk,  pre- 
pared chalk,  compound  chalk  powder,  lime-water; 
bismuth  salts;  .silver  nitrate;  lead  acetate;  potass, 
permanganate. 

Intestinal  Stimulants. — Strychnine;  atropine; 

pituitary  extract.  (See  also  Purgatives.) 

Keratolytics  (Gr.  Kspag  horn  + a loosening). 
— Salicylic  acid;  sulphur;  resorcin;  lactic  acid;  hq. 
potass®;  green  soap;  Lassar’s  peeling  paste. 

Laxatives  (L.  laxati'vus  relaxing).— ^ee  Purgatives. 

Lubricants. — Petrolatiun  molle;  petrolatum  liqui- 
dum;  cottonseed  oil;  glycerine;  boroglyceride;  cacao 
butter;  synol  soap;  lubraseptic;  lubricondrin. 

Meningeal  Antiseptics. — Helmitol;  salvarsan,  etc. 

Mydriatics  and  Cycloplegics  (Gr.  pvSpiaai^  dilata- 
tion of  the  pupil;  circle  + Trlr/y^  stroke). — 

Atropine,  homatropine,  euphthalmine,  eumydrin, 
duboisine,  hyoscin,  hyoscyamine,  hydrobromide, 
cocaine,  adrenalin. 


Myotics  and  Cyclotonics  (Gr.  fiduoLQ  pupillary  con- 
traction; vt/ckof  circle  -|-  r6vog  tone). — Physostigmin; 
pilocarpine;  muscarine. 

Narcotics  (Gr.  vapur/  stupor). — See  Hypnotics. 

Nervous  Sedatives. — Opium,  laudanum,  pare- 
goric, Dover’s  powder,  morphine,  codeine,  dionin 
heroin,  Schlesinger’s  analgesic  solution;  alumnol; 
hyoscyamus,  hyoscyamin,  hyoscin  or  scopolamine, 
hyoscyamine  hydrobromide;  duboisine;  alcohol; 
ether;  spt.  ®theris,  spt.  ®th.  comp.;  chloroform,  spt. 
chloroform;  ethyl  chloride;  nitrous  oxide;  cannabis 
indica;  gelsemium;  conium;  sumbul;  veratrum; 
lobeha;  valerian,  valerates;  asafoetida;  garlic;  aco- 
nite; bromides,  bromural,  bromoform,  hydrobromic 
acid,  monobromated  camphor;  chloral  hydrate, 
butyl  chloral  hydrate ; chloral  formamide ; chloretone ; 
urethane;  paraldehyde;  amylene  hydrate;  trional; 
tetronal;  sulphonal;  veronal;  medinal;  hedonal; 
hypnal;  isopral;  pyramidon;  phenacetin;  triphenin; 
lactophenin; acetanihd; exalgin;  antipyrin;  sahpyrin; 
salophen;  phenocoll;  aspirin;  calcium  salts.  (See 
also  Anesthetics,  General;  Anesthetics,  Local;  Anal- 
gesics, General;  Analgesics,  Local;  Antipruritics; 
Antispasmodics;  Hypnotics.) 

Nervous  Stimulants. — Strychnine;  atropine;  caf- 
feine; camphor;  asafoetida. 

Nutrients. — Meat  juice,  meat  extracts,  bovinine 
or  bovril,  Leube’s  beef  solution,  beef  or  dry  pepto- 
noids,  hquid  peptonoids,  panopepton,  tropon, 
sanose,  somatose,  iron  somatose,  nutrose  or  sod. 
caseinate,  gelatin,  matzoon  or  zoolak,  koumiss, 
kephir,  junket,  malt  extract,  dextri-maltose,  honey, 
levulose,  cereal  waters  and  gruels,  cod-liver  oil, 
olive  oil,  cottonseed  oil,  sweet  almond  oil,  goose  oil. 

Oxytocics  (Gr.  swift  4-  rd/cof  birth). — See 
Uterine  Stimulants. 

Pancreatic  Antiseptics. — Helmitol. 

Parasiticides  (L.  parasi'tus  parasite  -|-  cmde're  to 
kill). — Mercury;  chrysarobin;  resorcin;  thymol; 
salicylic  acid;  beta-naphthol;  benzoin;  camphor; 
tar;  balsam  of  Peru;  ichthyol;  sulphur;  sulphu- 
rated potash;  iodine;  pyre  thrum;  acetic  acid; 
trypanroth;  tr.  cocculeus  Indicus;  sod.  hyposul- 
phite. (See  also  Antiseptics,  Local.) 

Protectives. — (a)  Powders:  Zinc  carbonate,  cala- 
mine, zinc  oxide,  zinc  stearate,  boric  acid,  starch, 
talcum,  bismuth  salts,  aristol,  lycopodium. 

(b)  Solutions:  Calamine  lotion,  calamine  liniment, 
tr.  and  comp.  tr.  benzoin. 

(c)  Oils  and  Ointments. — See  Emollients. 

(d)  Others:  Traumaticin,  collodium,  collodium 
fle.xile,  bals.  of  Peru. 

Purgatives  (L.  purga're  to  cleanse). — (a)  Vegetable 
Purgatives:  Manna,  syrup  of  manna;  rhubarb; 

senna;  podophyllum;  elaterium,  elaterin;  aloes, 
aloin;  cascara  sagrada;  jalap;  castor-oil;  croton 
oil;  sweet-almond  oil;  olive-oil;  cottonseed  oil; 
linseed  oil;  pareira;  scammony;  scoparium;  agar- 
agar;  apocynum;  asafoetida;  yeast;  ceredin  or 
cerolin  (yeast  fats);  chirata;  colchicum,  colchicin; 
colocynth;  euonymus:  guaiacum. 

(b)  Saline  Purgatives:  Magnesium  sulphate; 

mag.  oxide;  mag.  carbonate;  milk  of  magnesia ; hq. 
magnesii  citratis;  liq.  mag.  sulphatis  effervescent; 
mist,  ferri  acida;  Rochelle  salt;  Seidlitz  powder; 
sod.  phosphate;  sod.  sulphate;  sod.  chloride;  effer- 
vescent sod.  phosphate;  Vichy  salt;  Carlsbad  salts; 
cream  of  tartar;  sod.  hyposulphite;  liq.  potassu 
citratis. 

(c)  Mercurial  Purgatives:  Calomel;  gray  powder; 
blue  mass. 

(d)  Miscellaneous:  Fel  bovis;  liquid  petrolatum 
or  mineral  oil;  phenolphthalein;  agar-agar;  reguhn; 
sulphur;  glj'cerine;  yeast;  ceredin  or  cerolin  (yeast 


PHARMACOLOGIC  INDEX 


fats);  mist,  rhei  et  sodae;  comp,  laxative  pill;  lapactic 
pill:  comp,  rhubarb  pill;  Addison’s  or  Guy’s  piU; 
Chelsea  pensioner;  comp,  hcorice  powder. 

Refrigerants  (L.  fri'gor  cold). — Local  refrigerants 
are  menthol,  menthol  ointment,  methyl  chloride, 
lead  water,  Goulard’s  extract,  dilute  acetic  acid  or 
vinegar,  alcohol.  Systemic  refrigerants  are  enume- 
rated under  Antipyretics. 

Renal  Antispasmodics. — Atropine;  morphine; 

nitroglycerine;  sod.  nitrite. 

Respiratory  Sedatives. — Opium,  morphine,  co- 
deine, dionin,  heroin,  chloroform,  chloral,  camphoric 
acid. 

Respiratory  Stimulants. — Strychnine,  atropine, 
caffeine,  camphor,  ether,  ammonia,  aqua  ammonia}, 
arom.  spt.  ammonia},  adonis  vernalis,  lobelia,  mor- 
phine, etc. 

Rubefacients  (L.  ru'ber  red  fa'cere  to  make). — 
See  Cutaneous  Irritants. 

Salivary  Antiseptics. — Helmitol,  potass,  chlorate. 

Sedatives,  Bronchial. — See  Bronchial  Antispas- 
modics. 

Sedatives,  Cardiac. — See  Cardiac  Sedatives. 

Sedatives,  Circulatory. — See  Cardiac  Sedatives. 

Sedatives,  Cough. — See  Cough  Sedatives. 

Sedatives,  Gastric. — See  Gastric  Sedatives. 

Sedatives,  Intestinal. — See  Intestinal  Astringents. 

Sedatives,  Nervous. — See  Nervous -Sedatives. 

Sedatives,  Respiratory. — See  Respiratory  Seda- 
tives. 

Sedatives,  Urinary. — See  Urinary  Sedatives. 

Sedatives,  Uterine. — See  Uterine  Sedatives. 

Sialagogues  (Gr.  iciaMv  spittle  -t-  yewau  to  pro- 
duce).— Pilocarpine;  physostigma,  physostigmin; 
adrenahn;  pyrethrum. 

Skin  Irritants. — See  Cutaneous  Irritants. 

Somnolents  (L.  som'nus  sleep;. — See  Hypnotics. 

Spinal  Stimulants. — Strychnine,  caffeine. 

Stimulants,  Cardiac. — See  Cardiac  Stimulants. 

Stimulants,  Cerebral. — See  Cerebral  Stimulants. 

Stimulants,  Cutaneous. — See  Cutaneous  Irritants. 

Stimulants,  Gastric. — See  Stomachics. 

Stimulants,  General. — See  Cardiac  Stimulants. 

Stimulants,  Nervous. — See  Nervous  Stimulants. 

Stimulants,  Respiratory. — See  Respiratory  Stimu- 
lants. 

Stimulants,  Spinal. — See  Spinal  Stimulants. 

Stimulants,  Uterine. — See  Uterine  Stimulants. 

Stomachics. — Basic  orexin,  tannic  orexin;  nux 
vomica,  strychnine;  alcohol;  quinine,  cinchona; 
gentian;  quassia;  calumba;  cardamom;  chirata; 
capsicum;  cimicifuga;  pareira;  condurango;  lupu- 
lin,  hops;  hydrastis;  cotarnin  (styptol  and  styp- 
ticin);  ipecac;  nutmeg;  myrtol;  rhubarb;  dilute 
phosphoric  acid;  acidum  arsenosum;  Fowler’s  solu- 
tion; meat  extracts. 


Styptics  (Gr.  crTvirriKdc  astringent). — Adrenalin; 
cocaine;  antipyrin;  hydrogen  peroxide;  alum; 
Squibb’s  surgical  powder;  ferric  chloride;  Monsel’s 
solution;  coagulen;  kephahn;  stagnin;  cotarnin; 
acetic  acid;  trichloracetic  acid;  static  collodion; 
witch-hazel;  normal  horse  serum.  (See  also  Astrin- 
gents; and  Hemorrhage  in  Part  1.) 

Sudorifics  (L.  su'dor  sweat  + fer're  to  bear). — 
See  Diaphoretics. 

Tonics  (Gr.  rdvog  tone). — See  Alteratives  and 
Stimulants. 

Urate  Solvents. — See  Antilithics. 

Uric  Acid  Excretion,  Stimulators. — See  Antilithics. 

Urinary  Acidifiers. — Mineral  acids,  e.g. — dilute 
acetic  acid,  dilute  and  aromatic  sulphuric  acid; 
boric  acid;  benzoic  acid  and  its  salts;  benzosalin; 
sod.  biphosphate. 

Urinary  Antacids. — Potassium  salts;  sod.  carb. 
and  bicarb. 

Urinary  Antiseptics. — Urotropin;  helmitol;  meth- 
ylene blue;  myrtol;  guaiacol;  eucalyptus;  beta- 
naphthol;  copaiba;  cubebs;  sandalwood;  salol; 
salophen;  saliformin;  benzosalin;  sahcyhc  acid; 
aspirin;  sod.  .sahcylate;  benzoic  acid  and  benzoates; 
boric  acid;  sod.  borate;  uva  ursi. 

Urinary  Astringents. — Copaiba;  cubebs;  sandal- 
wood; rhois  aromatica. 

Urinary  Sedatives. — Nutmeg;  copaiba;  cubebs; 
triticum;  zea;  uva  ursi. 

Uterine  Haemostatics. — Ergot;  pituitrin;  hydras- 
tis; cotarnin  (stypticin  and  styptol);  mammary 
gland;  oil  of  cinnamon. 

Uterine  Sedatives. — Veratrum;  pulsatilla;  vibur- 
num; cotarnin  (stypticin  and  styptol);  mist,  helonin 
comp. ; ehx.  guaransB  et  celerina}. 

Uterine  Stimulants. — Pituitary  extract;  ergot; 
hydrastis;  hydrastinin;  quinine;  cimicifuga;  adre- 
nahn. 

Vasoconstrictors  (L.  vas  vessel  -|-  con  together  -|- 
slrin'gere  to  draw). — Epinephrin  or  adrenahn;  co- 
caine; pituitary  extract;  atropine;  strychnine; 
digitahs;  squills;  adonis  vernalis;  convalaria; 
cimicifuga;  hydrastis;  hydrastinin;  camphor; 
ergot;  ether. 

Vasodilators. — Nitroglycerine;  amyl  nitrite;  sod. 
nitrite;  mannitol  hexanitrate;  erythrol  tetranitrate; 
vasotonin;  alcohol. 

Vehicles. — Waters  of  peppermint,  spearmint, 
camphor,  chloroform,  cinnamon,  allspice,  and  rose; 
syrups  of  wild  cherry,  tolu,  citric  acid,  and  cinna- 
mon; simple  syrup;  comp,  syrup  of  sarsaparilla; 
aromatic  or  simple  elixir;  essence  of  pep.sin;  honey; 
milk  sugar;  saccharum;  starch;  glyceritum  amyli; 
hquid  petrolatum;  soap  liniment. 

Vesicants  (L.  vesi'ca  bhster). — Mustard;  mustard 
oil;  cantharides;  iodine. 


WEIGHTS  AND  MEASURES 


Equivalents  of  Apothecaries’  Fluid  Measure 
Metric 


Minims 

1 =0.06161  mils. 

or  c.c. 

U 

2 = 0.123  “ 

u u 

a 

3 = 0.185 

( ( u 

ti 

4=0.246  “ 

u u 

u 

5 = 0.308  “ 

((  u 

u 

6 = 0.370  “ 

il  ll 

<( 

7=0.431  “ 

il  il 

(( 

8 = 0.493 

a ll 

(i 

9 = 0.555 

ll  ll 

a 

10  = 0.616  “ 

ll  ll 

11=0.678 

it  il 

(( 

12  = 0.739 

li  ll 

u 

13  = 0.801 

ll  ll 

u 

14  = 0.863 

il  ll 

u 

15  = 0.924 

a (( 

u 

20  = 1.232  “ 

U ll 

u 

25  = 1. .540  “ 

ll  ll 

u 

30  = 1.848 

il  ll 

Fluid-drachms  1 = 3.697  mils,  or  c.c 

il 

‘ 2=  7.393 

U ll  li 

it  i 

‘ 3=  11.090 

ll  il  ll 

U 

‘ 4=  14.787 

ll  ll  ll 

U 

‘ 5=  18.483 

ll  ll  ll 

u < 

‘ 6=  22.180 

ll  li  u 

“ “ 7=  25.877 

ll  ll  ll 

Fluid-ounces  1=  29  573 

ll  ll  ll 

U i 

2=  59.147 

ll  ll  ll 

u u 

3=  88.721 

ll  Cl  li 

u n 

4 = 118.295 

li  ll  ll 

u u 

5 = 147.869 

ll  ll  ll 

u u 

6 = 177.442 

ll  ll  ll 

(t  u 

7 = 207.016 

ll  ll  ll 

u u 

8 = 236.590 

ll  ll  ll 

U ll 

10  = 295.737 

li  ll  ll 

n u 

12  = 354.884 

il  ll  ll 

u u 

14=414.032 

ll  ll  ll 

“ 16  (Oi)  =473.179  mils,  or  c.c 

“ 32  = 946.35  mils,  or  c.c. 


Grain  125  = 0.0026  gram. 
^4  = 0.0027 
“ 1^  = 0.0032 

“ 118  = 0.0036 

“ 116  = 0.0040 

“ 115  = 0.0042 

“ 112  = 0.0054 

llo  = 0.0065 
“ 11  = 0.008 

“■  11  = 0.011 

“ 11  = 0.016 

“ 11  = 0.022 

“ 11  = 0.032 

“ %=  0.043 

“ H = 0.049 

“ 1=0.065  “ 

“ 2 = 0.130 

“ 3=0.194 

“ 4 = 0.259 

“ 5=0.324  “ 

“ 6 = 0.389 

“ 7 = 0.454 

“ 8 = 0.518 

“ 9 = 0.583 

“ 10  = 0.648  “ 

“ 12  = 0.778  “ 

“ 15  = 0.972 

“ 18  = 1.166 

“ 20  = 1.296 

“ 25  = 1.620 

“ 30=1.944 

“ 35  = 2.268  “ 

“ 40  = 2.592 

“ 45=2.916  “ 

“ 50  = 3.240 

“ 60  (3i)  =3.888  “ 

Drachms  2 = 7.776  “ 

“ 3 = 11.664 

“ 4 = 15.552 

“ 5 = 19.440 

“ 6=23.328  “ 

“ 7=27.216 

“ 8(3i)  =31.103  “ 


Equivalents  of  Apothecaries’  Weight  in  Metric 

(To  convert  grains  into  grams,  multiply  by 
0.0648;  to  convert  grams  into  grains,  multiply 
by  15,432.) 

Grain  }{ooo  = 0.000065  gram. 

“ =0.000129  ' “ 

“ Koo  = 0.00016 

“ 1^00  = 0.00022 

‘ ^40  = 0.00027 

“ Koo  = 0.00032 

“ )bo  = 0.000;i6 

“ M6o  = 0.00040 

“ Mso  = 0.00043 

“ ){2o  = 0.000.54 

“ Moo  = 0.00065 

“ Mo  = 0.00081 

“ M4  = 0.00101 

“ Mo  = 0.00108 

“ Mo  = 0.00129 

“ 1^48=0.00135 

“ Mo  = 0.0016 

“ Me  = 0.0018 

“ M.2  = 0.0020 

“ Mo  = 0.0022 


Metric  Measures  of  Weight 

(A  gramme  is  the  weight  of  1 milliliter  (c.c.)  of 
distilled  water  at  4°  C.) 

1 milligram  (mg.)  = .001  gram. 

1 centigram  (eg.)  = .01  “ 

1 decigram  (dg.)  = .1  “ 

1 Decagram  (Dg.)  = 10. 

1 Hectogram  (Hg.)  = 100. 

1 Kilogram  (Kg.)  = 1000. 


grams. 


1 Myriagram  (Mg.)  = 10000. 

Metric  Fluid  Measure 


1 milliliter  (ml.  or  mil.  or  c.c.)  = .001  liter. 

1 centiliter  (cl.)  = .01  “ 

1 deciliter  (dl.)  = .1  “ 

1 Decaliter  (Dl.)  = 10.  liters. 

1 Hectoliter  (HI.)  = 100. 

1 Kiloliter  (Kl.)  = 1000. 

1 Myrialiter  (Ml.)  =10000.  “ 

To  convert  Fahrenheit  degrees  into  those  of 
Centigrade,  subtract  32  and  divide  by  1.8. 

To  convert  Centigrade  degrees  into  those  of 
Fahrenheit,  multiply  by  1.8  and  add  32. 


( 


ll 


Ik  I 


